By: Associate Professor Samuel Harvey, Chief Psychiatrist at the Black Dog Institute & Richard Bryant, Scientia Professor at UNSW Sydney
The bushfires that raged across Australia were unprecedented in their scale and duration. While the physical effects of these fires are readily captured in images of razed homes and injured wildlife, the mental health impacts are harder to measure. With the Morrison Government’s announcement of $76 million for mental health support, it’s timely to ask what the science tells us about how this funding can be most usefully spent.
Professor Samuel Harvey, Chief Psychiatrist at the Black Dog Institute
Richard Bryant, Scientia Professor at UNSW Sydney
Studies done after previous large-scale disasters tell us that most people are able to bounce back from these terrible situations. That is not to say that there will not be a significant amount of distress, worry, tears and sleepless nights along the way. We know that these reactions are very common and understandable. However, these are usually temporary, and most people will be able to adapt.
While this is an important message to be getting out, we must not forget the sizable proportion of individuals who will face long lasting mental health issues as a result of these fires. When residents impacted by the Black Saturday bushfires were followed up four years after the fires, around one in six of still had symptoms suggestive of posttraumatic stress disorder (PTSD), with similarly high rates of depression, anxiety and alcohol use problems.
The evidence from Australia and overseas tells us there are four key things that our leaders must do as they plan our recovery response in order to reduce the mental health impacts of the current crisis.
First, for many years the knee-jerk reaction has been to deploy well-meaning counsellors to disaster sites to offer psychological debriefing. This is not what these communities need. There is ample evidence that immediate debriefing after trauma is not helpful and probably harmful. What is critical in this early response stage is to ensure that people feel safe, can return to their routines, and are not exposed to additional sources of stress. This means the best thing that can happen right now to reduce the mental health impacts of these fires is to ensure that impacted communities have access to shelter, resources, communication, reliable information and hope for the future.
Second, there is overwhelming evidence that social support is a major factor in determining how people respond to trauma. A delay in being able to connect with loved ones was a major risk factor for mental health problems following the 2005 London Bombings. Over the coming weeks, affected communities must be given the resources and support to come together in the ways that best fit their existing context, their culture and history. This can be especially important for children, whose adaptations will be largely influenced by the support offered by parents; which is much more important than counselling provided by strangers.
Third, we know that a significant number of people in the impacted communities are going to need ongoing professional mental health support. A disturbing finding from the Black Saturday fires was that despite an influx of widely promoted support services, one-third of people with significant long-term mental health problems were not receiving any mental health care. Not only do we need to ensure that GPs and mental health services have the resources and skills to deal with mental health needs, any barriers to accessing these services must also be removed. After Hurricane Katrina, rates of mental health issues were still rising one year after the storm, so additional resources will need to be in place for many years.
Finally, special consideration needs to be given to the first responders who are risking their lives to protect communities. They will be exposed to a lot of trauma on top of being fatigued, displaced from their families and communities and, in some cases, suffering themselves from property loss. Although Australian first responder agencies have access to some of the world’s leading mental health initiatives, many volunteer firefighters will require additional focused support in the years ahead.
The current bushfire crisis is testing our society in myriad ways. Huge amounts of money and resources are now being promised to impacted communities, which shows our country at its best. But we know the mental health impacts of these fires will still be felt long after the final fire is extinguished. As we look towards a future of increasingly long fire seasons, we owe it to our impacted communities and first responders to make evidence-based recovery decisions now, or risk paying a significant psychological price in the long run.
Feb. 20, 2020
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