Mental wellness in a time of crisis recovery
Article from: Counselling Australia Journal: Volume 23: Number 2 – Winter 2022
By Melissa Marino
Over the past 20 years in Australia, great gains have been made in public health outcomes; however, mental wellbeing is a notable exception. As the COVID-19 pandemic shines a spotlight on mental health, Black Dog Institute executive director Professor Sam Harvey shares his insights on how we can start to rectify this – and the critical role counsellors will play.
As the executive director of Black Dog Institute, Professor Sam Harvey leads research and on-the-ground programs to understand, treat and prevent mental illness. On a personal level, he keeps on top of his own mental health through a few simple activities. “Spending time with my kids, going out for a walk – they are really important to me so I make sure they’re prioritised,” he says.
His advice to others seeking to maintain their own wellbeing is to recognise the specific activities that matter to them – and to take the time out to do them. “As individuals, taking action is how we can help our own mental health,” he says.
For Professor Harvey, the COVID-19 pandemic and the lockdowns that came with it provided a better balance between work and home life and more time for the activities he enjoys.
But for many others, the experience was the opposite. Home schooling was much harder in smaller dwellings with fewer computers. And many people in the lowest-paid, least-secure jobs either lost employment or were unable to work from home.
The effect of changed working conditions under COVID-19 on people’s mental health was so significant, Black Dog Institute produced a white paper on the issue. “COVID disproportionately affected those who were least able to take another hit,” says Professor Harvey. “And it’s something we really need to keep an eye on because we know the mental health consequences of insecure work are very substantial.”
Increased reports of depression, anxiety and eating disorders are all symptoms of what has been coined a ‘shadow pandemic’ of mental ill-heath playing out in the wake of COVID-19.
By amplifying social disadvantage, the pandemic has propelled trends that have been a long time building, making mental ill-health one of the dominant health problems in society today.
In Australia, mental health symptoms are now the number one cause for people consulting with their GP, Professor Harvey says. And suicide has overtaken motor vehicle accidents as the leading cause of death among young people.
Unlike other major public health issues that have trended down over time, rates of mental health symptoms, particularly among young people, are increasing year on year, he says.
“This is particularly damning because since the industrial revolution, by and large, we have handed over better health outcomes to future generations – for example in cardiovascular disease and lung health,” he says. “The two areas in which we’ve failed are obesity and mental health. They’re the two that are getting worse in the next generation, and we don’t understand why.”
As the relatively new executive director of Black Dog Institute (since November 2021) this is an issue Professor Harvey wants to understand and reverse. “It’s a huge unanswered question,” he says.
What is known is that increased rates of mental ill-health have corresponded with increased awareness of the issue – with both peaking in the pandemic.
If there is any silver lining, this heightened awareness opens a window of opportunity to address mental health meaningfully, says Professor Harvey, who is also the Institute’s chief scientist.
“As a community and at policymaker level, there’s an understanding of just what a big issue mental health is, and my key concern is that we don’t miss that opportunity with small-scale, ineffective interventions,” he says. “We have to use this moment to do things properly.”
For Professor Harvey, the right approach starts with increased funding. “We’ve underinvested in the past. And given that mental health is one of the most pressing health issues for society, an inadequate proportion of the budget at all levels of government goes towards it.”
Secondly, the funding must back evidence-based, coordinated programs and services around prevention, early intervention and treatment, he says. And COVID-19 has provided a blueprint for how science can guide such a response to a widespread, urgent public health issue.
“We mobilised the scientific community to answer the big questions and the people making decisions were guided by that science,” he says. “We need exactly that to happen with mental health. And the solution doesn’t lie just within the health settings. We have to do the right things in schools, in workplaces and in communities.”
Schools and workplaces across Australia are full of good intentions to raise awareness around mental health, he says. But without adequate, science-backed resources to support them, they could be doing more harm than good.
“By just telling people about symptoms [of depression or anxiety] without giving them any practical skills to deal with them, without making sure there are services that can actually help, you risk at best wasting a lot of money and good intentions on something that’s not helpful,” he says. “And at worst, without offering any practical assistance, you may cause people to be more distressed than they would have been otherwise.”
Instead, he says, if programs such as those based around cognitive behavioural therapy, for example, were used in schools, initial distress could be prevented from developing into a more severe mental health problem.
To investigate the impact of adequate support structures, Black Dog Institute is embarking on research with a group of workers identified at increased risk of mental ill-health. It is screening emergency service workers to identify those who are at risk or unwell, and test whether their outcomes can be improved by having a range of health professionals, including counsellors, on hand.
“The reality is we’ve never been able to show the benefit of that support before, so this is a big step for us,” he says.
Professor Harvey says a larger, better-funded and more coordinated mental health workforce is critical to ensure people get assistance when they need it. “There’s a lot of promotion encouraging people to get help when they have symptoms – which is fantastic – but let’s make sure when they see a doctor or counsellor or psychiatrist, they’re not left on a 12-month waiting list,” he says.
Wait times of this length are ludicrous, he says, and ultimately Australia needs to train a bigger workforce to meet demand. In the interim, in a lesson learnt through the rise in telehealth consultations over lockdowns, the existing workforce could be used more efficiently by blending online and face-to-face care.
Technology could also help address the fragmentation of mental health care that Professor Harvey says has become more pronounced over the past decade. If people could access their information, for example, they could share it between counsellors and other health professionals and “move more seamlessly between services to receive the support they need depending on how their symptoms are progressing”.
Counsellors, he says, will play a critical role in a better coordinated pool of mental health professionals supporting people’s changing needs.
“We need more counsellors, but we also need them to be properly integrated into the other parts of the health service, such as general practice,” he says. “There needs to be more of a focus funding collaborative care that brings everybody together rather than individuals operating in isolation.”
Evidence from Europe and the US shows that when you do collaborative care well, clients have improved outcomes and, overall, the costs are less. In Australia, coordination is challenging because of its mix of state and federal government and public and private sector providers. But it’s a challenge that must be tackled, he says. “Given the size of the problem, I just don’t think it’s optional anymore.”
Not a week goes by at Black Dog Institute without a parent or individual seeking help to navigate the system, he says. And there has also been a surge in schools and workplaces asking for advice around how to manage the distress and mental health challenges presenting in students and staff.
Leading Australia’s mental health response through schools, workplaces and communities is one of four key priorities in Black Dog Institute’s new five-year strategy. Another is developing new models of blended care to get optimal, tailored treatment to individuals.
“We want to make sure that mental health and wellbeing is front and centre when we think about what a post-COVID recovery looks like, making sure that as we return to some form of normality, we prioritise mental health in the way we set up our workplaces, schools and clinical settings.”
In workplaces, training for managers to spot when someone may be struggling is showing a way forward. “We’ve done large, controlled studies demonstrating that this type of intervention has a return on investment of A$10 saved for every dollar spent on the training because of the reduction in sickness absence among workers,” he says.
The wellbeing of those working in the sector is also a focus, with the Institute researching why health professionals have elevated rates of mental health symptoms and an increased risk of suicide.
The Institute also provides a national clinical service for health professionals, as well as training programs, resources and networks to manage burnout and promote mental health and wellbeing.
In schools, Institute research is underway with primary-aged children on how to reliably identify those who may be struggling and help alter their trajectory. “We now know you can see clear signs of anxiety when children are in primary school. And that’s important because it’s much easier to treat the problems when their minds are more flexible,” Professor Harvey says. “If you leave it until they’re older, it becomes harder to shift.”
There are also promising developments in early intervention for adults, he says. Institute research from 2021 shows that the number of stressed workers who went on to develop depression was reduced through the use of a smartphone app featuring activities to develop mental fitness and resilience.
“There’s a range of exciting opportunities around prevention that we’re now trying to demonstrate can work broadly,” he says.
Prevention is a long-term goal, but – like most public health research – a focus on the cure usually comes first.
“If we look at other areas of health like cardiovascular disease, the first wave of progress was in having effective treatments. The next wave was working out how you can prevent people becoming unwell through changing diets, increasing exercise and stopping smoking,” he says.
“We now have good treatments for mental health, so one of the next frontiers is prevention – and there’s early signs we can do that at scale.”
And while an increased attention on mental health in light of COVID-19 is welcome, there now needs to be action, he says. “I think the next year or so will really determine whether improved mental health and wellbeing is a lasting legacy of what’s happened as a result of COVID or whether it’s just another false dawn.”