A view of mental health from the very top 

15 October 2020

The mental health effects of the COVID-19 pandemic are likely to be with us for many years, says the Chief Psychiatrist of South Australia Dr John Brayley.

“Traditionally after a disaster occurs we would be planning for the mental health effects of the disaster for a two to four year period in terms of community recovery and seeking to prevent mental illness,’’ Dr Brayley says.

“The impacts on unemployment, underemployment and financial stress affect people’s mental health and what is being described nationally is a disproportionate impact on the mental health of younger people which we are seeing here in South Australia.’’

This week is Mental Health Week and the grim reality is people under the age of 25 account for about half of a recent 10 per cent increase in mental health and drug and alcohol ED presentations across Adelaide, with the RAH experiencing a 20 per cent rise in all mental health and drug and alcohol presentations in recent months.

The huge job losses in retail and the “uncertainty’’ COVID has created has our younger generation fearing for their future and unable to make plans.

Despite the increased numbers, Dr Brayley remains optimistic the mental health system will cope.

“In terms of the specific COVID pressure there have been a range of additional services that have been provided to respond to increased demand,’’ he says.

“Examples include helplines, local heath networks increasing staffing, specific support for vulnerable groups through increased services through the Child and Adolescent Mental Health Service, forensic mental health inreach into prisons and rapid access support into aged care services.

“In addition, there has been some expansion of drug and alcohol services and additional funding through the Commissioner for Public Sector Employment to boost peer support and access to employee assistance.

“All up there has been just over $5 million of extra funding for support services to address specific COVID-related demand and that has been delivered through non-government services and also our local health networks and Drug and Alcohol services.

“The broader picture about the pressures on our mental health system reflects the fact that prior to COVID there was already a need for significant change in our mental health services, across aged groups, to both improve and expand the services available,’’ Dr Brayley says.

“My confidence is that we do have a well-consulted Mental Health Services plan that describes how services should change, develop, be added to, and this is even more important given the demands we are currently facing.

“One aspect of that is improvements in our crisis response system, both mobile responses in the community … the mental health ambulance co-response service and also new alternatives to EDs such as the Urgent Mental Health Centre and future crisis centres.’’

As for the actual increase in demand for mental health services pre-COVID? “There is debate as to what extent that is due to a change in prevalence or simply a positive effect of destigmatisation,’’ Dr Brayley says.

“People (now) are prepared to seek help for mental illness in the same way they would seek help for a physical illness.

“So, across both primary care and tertiary specialist services there has been significant demand and unmet need’’.

As Chief Psychiatrist, an independent statutory officer, Dr Brayley has governance and oversight responsibility for monitoring and influencing mental health care for the community and can issue standards for the care or treatment of patients as well as visit and inspect public and private hospitals’ premises.

Back in June, he made headlines when, following an unannounced inspection, he issued a three-month intervention order on the RAH over the use of shackles, physical restraints and seclusion on mental health patients stuck in the ED.

“Our office was presented a detailed plan in response by CALHN that addressed three aspects of that (order),’’ Dr Brayley said.

These were the required development of a model of care, “linking up ED and mental health staff”, improved reporting of restrictive practices and also the provision of an interview room, which he expects to be completed this month.

Dr Brayley says there has been “significant work and engagement” on the model of care and “the reporting of restraints has significantly improved”.

One of the most important tools in the fight against mental health is “early intervention”.

“We can still take action to look after our own mental health and the mental health of family and friends,’’ Dr Brayley says.

“There is strong evidence about the benefits of early intervention as far as people speaking up, talking to people they know, seeking professional help.

“These actions are to be encouraged because we can take action to mitigate the mental health effects of the pandemic.

“This is important for everyone but it is particularly important for health professionals who are spending their days looking after other people and at times it can be easier to be helping other people than putting your hand up and seeking help yourself.

“For the community and for all of our health staff, identifying early symptoms and seeking help is critical.’’

Such symptoms include anxiety, fatigue, disturbed sleep, lethargy and headaches.

“There have been some initiatives such as a communities of practice that has been operated for mental health staff by Professor Nicholas Procter at UniSA, that has helped frontline mental health staff talk to each other about the practical challenges of delivering mental health care during the COVID period,’’ Dr Brayley said.

“People can also benefit from some personal mental health education and Professor Procter also assisted by providing some education about mental health and self-care to South Australian nurses who had responded to the call to assist in Victoria.’’

Professor Procter, Chair: Mental Health Nursing and leader of the Mental Health and Suicide Prevention Research Group, UniSA Clinical and Health Sciences, is a guest speaker at today’s ANMF (SA Branch) Annual Professional Conference.

“All of us should be taking care at this time because the impact of COVID on mental health could affect any person in the community, irrespective of age or circumstances,’’ Dr Brayley says.

“But, in addition, there are particular vulnerable groups (such as health professionals) who can be more at risk at this time.’’

He says people might recognise mental health symptoms in others. “Speak to family and friends, peers at work can be very important because they know what it’s like in a particular workplace.
“Frontline workers need to seek help too.’’