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Monitoring mental health and suicide prevention reform: National Report 2020

Chapter 1: A season of natural disasters

Even before the COVID-19 pandemic reached Australia, the communities on the east coast of Australia and in South Australia were experiencing some of the largest bushfires (in scale and duration) in Australian history.

Many of these rural communities were still in the midst of an extended severe drought when the bushfires occurred. Following the fires, many were impacted by floods and hailstorms.

The effects of acute natural disasters on mental health are well documented, but chronic natural disasters—such as the prolonged drought experienced by communities across Australia—bring unique challenges. Unlike natural disasters that often pose a contained acute stress and crisis period, the nature of drought is such that it continues long term, resulting in sustained chronic stress and a prolonged impact on communities.


Drought significantly impairs the ability of many people in rural communities to live a contributing life, given the sustained impact on their homes, relationships and communities, and income and employment—all key social determinants of mental health.


The summer bushfires caused significant damage to life, homes, natural bushland and businesses across Australia. The financial impacts of the bushfires were estimated to exceed $10 billion; however, the mental health impacts on communities have not been quantified. This gap in the data needs to be addressed both to ensure that mental health need is being met and for better planning. As mentioned in Section 1, Chapter 1, the Royal Commission into National Natural Disasters Arrangements highlighted the need for consistent measurement of the impacts of natural disasters and better data sharing.

Research released by the Australian Institute of Health and Welfare on 25 November 2020 shows that, following the introduction of the Medicare Benefits Schedule (MBS) mental health items for bushfire-affected people, the number of services accessed each week rose throughout the year, peaking at around 650 in mid-June, and averaged 498 services accessed per week. However, it is difficult to know how many people may have accessed services through general MBS mental health items for problems related to the bushfires.

Evidence from previous fires in Australia indicates that a range of psychological factors result from the processing of trauma after bushfires, especially for those directly impacted, such as first responders and communities living in fire-ravaged areas. Common mental health impacts include anxiety, depression, substance abuse and post-traumatic stress disorder. Others may also experience increased suicide risk, acute stress or poor sleep quality. These past studies on previous significant bushfires in Australia are a useful reference to understand the impacts that are likely to be felt by affected communities.

The Beyond Bushfires Study was a six year study into the impacts of the 2009 Victorian bushfires by the University of Melbourne, which contributed to the evidence base on the short- and long-term impacts of disasters. Although most people recover over time, a sizeable group of people experience mental health problems for months or even years after the initial trauma. Five years after the 2009 bushfires, 22% of people in high-impact communities were reporting symptoms of mental health disorders at twice the rate of the general population.

The University of Wollongong has prioritised a number of research projects to understand the impacts of these fires and floods, and the pandemic on the communities in the Wollongong region. Researchers will consider the extent of the mental health impact of the fires, and the interaction and influence of community resilience, self-care of older Australians, disability inclusion and stories for healing. These projects, along with the research projects discussed below, undertaken through the Medical Research Future Fund, will be instrumental in informing our understanding and our response in the future.

Evidence indicates that the uptake of mental health services following emergencies is suboptimal and that we need to better understand why this is the case, to ensure that appropriate services are being provided to communities. The study into the 2009 bushfires showed that only 25% of those identified as severely distressed actually sought help.

For those who have disconnected from services, proactive outreach continues to be vital to re-engagement. In regions suffering the long-term impacts of droughts, floods and fires, it is clear that outreach in the form of regular mental health and wellbeing checks can play a number of roles, including undertaking nonmedical screening, helping people connect to services if and when they need to, supporting families and carers, and strengthening community connections.

Bushfire and drought response: what has been done?

 

Australian Government response

By early January 2020, it was evident to governments that a coordinated response to the bushfires needed to address mental health needs in both the short and longer terms. On 12 January 2020, the Australian Government announced a mental health package to support the provision of coordinated mental health services to meet the needs of the broader community, including first responders and communities directly affected by the fires. The government announced a further mental health package on 11 May 2020 to support locally led mental health supports in regions severely impacted by the 2019–20 bushfires. The flexibility, change and cooperation achieved during the year have shown how innovation and collaboration can work well—for example, in the development of digital services, the broader benefits of telehealth and innovative community models, including support by peer workers.

The lessons learned need to be harnessed to inform the ongoing response to the events of 2020 and to strengthen the system in the future. The National Bushfire Recovery Agency was established on 6 January 2020 to lead and coordinate a national response to rebuilding communities affected by bushfires across large parts of Australia. The agency administers the National Bushfire Recovery Fund ($2 billion over two years), which is supporting recovery efforts across Australia. Priorities for the fund include a mental health package for first responders and communities.

The National Mental Health Commission (the Commission) is leading the development of the National Disaster Mental Health and Wellbeing Framework to guide a national coordinated response. The framework is intended to improve coordination arrangements for mental health and wellbeing, and allow governments to foster and enable participative, localised responses following disasters; it is expected to be released in June 2021. The framework is being developed in consultation with people in areas affected by disasters, state and territory governments, people with lived experience of mental illness, local governments, nongovernment organisations involved in disaster support, and mental health and disaster management researchers.

Further research is being funded by the Medical Research Future Fund to better understand the physiological impacts of prolonged exposure to bushfire smoke and the mental health impacts of bushfires on affected communities. Grants awarded under the mental health stream in May 2020 included research into the mental health impacts on children, first responders and affected communities.

 

State and territory government responses

The states and territories are primarily responsible for mental health during a disaster, and have a number of programs and arrangements in place to assist communities and individuals. At a state and territory level, governments responded individually to the summer bushfires in their jurisdiction, either expanding existing local mental health services or introducing new programs. Some examples are provided below.


Box 9: Government responses

The Victorian Government provided case management support to people living in Gippsland and north-east Victoria via the Victorian Bushfires Case Support Program. The program provides a support coordinator as a single point of contact to link people directly with supports, such as information and advice, mental health support and financial counselling.

In New South Wales, the Rural Adversity Mental Health Program’s team of 20 coordinators provided assistance in affected communities by:

  • • attending evacuation centres to link distressed individuals to mental health services and provide resources
  • • participating in disaster recovery committees and activities
  • • deploying a media and social media communications strategy to promote normal emotional responses to disasters and advise when a person should seek professional support
  • • developing dedicated evidence-based bushfire resources, including webpages and hard-copy fact sheets for those without internet access.

The Queensland Government delivered a recovery package to support the mental health and resilience of communities impacted by the bushfires. This included:

  • • addressing risks to the mental health and wellbeing of impacted communities
  • • employing community development officers
  • • establishing a community mental health program to provide specialist mental health support and emotional wellbeing for individuals, families, volunteers and communities impacted by the bushfires.

The South Australian Government provided a mental health and recovery package for targeted supports to aid long-term recovery in the Adelaide Hills, Yorketown and Kangaroo Island communities.


Inquiries into Natural Disasters

The Royal Commission into National Natural Disasters Arrangements collected evidence from many communities affected by the fires, and the organisations and services that provided support to them. Many were critical of the level of support and leadership provided following the bushfires, stating that this had left people still living in tents with mental health issues increasing. Some called for mental health to be a key component of all disaster planning by governments.


There have also been calls to increase the training of local health and support services (such as GPs) in trauma and mental health so that communities are better prepared for natural disasters.


More robust and long-term investment in mental health supports for communities was also seen as key to community resilience, particularly for children.

State inquiries highlighted the longer-term impact on mental health, especially on first responders, following such a long and arduous fire season. The final report of the New South Wales Bushfire Inquiry recommended that the New South Wales and Australian governments work to provide firefighters access to mental health support through GPs, including free mental health screenings following bushfires.

The Inquiry into the 2019–20 Victorian Fire Season has released its Phase 1 report. Mental health does not feature significantly in the report, although an observation made in the report indicated that the emergency management sector had in place multiple mental health and wellbeing initiatives for staff that were available before, during and after emergencies. The Phase 2 report, expected by 30 June 2021, will consider the emergency relief and recovery response.

In November 2019, a Senate inquiry into the Australian Government’s response to the drought, and the adequacy and appropriateness of policies and measures to support farmers, regional communities and the Australian economy was referred to the Rural and Regional Affairs and Transport References Committee. In its submission to the inquiry, the Commission highlighted a number of mental health–related items for specific consideration in relation to the Australian Government’s response to the drought. These included:

  • • development of a long-term national program that promotes mental health, improves service access and coordination, and links farming communities to more effective local responses to emerging mental health needs
  • • a specific response to suicide prevention, including evidence-based community awareness training and resources such as community gatekeeper training (where connected community members are trained to recognise and respond to people who are at risk of suicide) and the involvement of peer workers; access to services (including aftercare); and postvention support
  • • a specific response for young people in drought-affected communities
  • • a specific response for Aboriginal and Torres Strait Islander people in drought-affected communities.

The committee’s final report is due in February 2021.