Mental health workers Dr Nikola Leka and Sarah Ellyard spoke to Green Left’s Tom Eccles and Rachel Evans about the mental health crisis exacerbated during the COVID-19 pandemic.
Were vulnerable people were adequately supported during the pandemic?
Leka: No, they were abandoned, consigned to the too-hard basket. There were many stories of the vulnerable being unable to obtain food and medicines.
Part of this is that the person-to-person transmission vectors in a pandemic will inevitably make personal care more difficult. From anecdotal accounts, the evidence across all sectors of health care is that we were generally unprepared.
Ellyard: The COVID-19 pandemic exposed and exacerbated the issues which already existed for vulnerable people in our society and within the mental health system.
The narrative within the mental health sector is for the focus to be on community care, which is the right approach. However, the funding and the resources are not there for this to be feasible.
There are insufficient mental health workers in the community and insufficient support available. In my experience, the systems and supports available are often difficult for people to navigate.
What are the main factors that cause mental health issues to emerge and develop?
Ellyard: The causes of mental health issues are multifaceted. I provide care for people experiencing acute phases of mental health conditions and am by no means an expert on all the causes of mental health conditions.
Mental health conditions may affect any one of us, however, there are known factors associated with higher rates and exacerbation of mental health conditions, including trauma, socio-economic disadvantage and social isolation.
What caused higher levels of mental distress during the pandemic? What impact did this have on frontline workers?
Leka: My work is with older people with serious behavioural difficulties related to dementia. For this cohort, the imperative to give hands-on care was stressful.
For others having their mental health care delivered entirely through electronic media is challenging. Accessing care over the internet can be stressful and difficult for many people suffering mental distress who do not have good internet access or secure housing.
What made things particularly difficult for patients [during lockdowns] was their greater dependence on social support from visitors and caregivers, who were not able to come in and see them.
Ellyard: Social isolation increased. Services were further stretched. People lost jobs and income. In the early stages of the pandemic and during the first lockdowns, people were reluctant to seek care for mental health conditions and we saw a drop in the number of people presenting to services.
As more people began to seek help, we saw people whose mental health had had been exacerbated by stressors such as job loss, working from home and social isolation.
People also presented to mental health services for the first time. For people receiving treatment in the mental health inpatient setting, restrictions on visitors and the cancellation of leave added an additional layer of stress.
What structural and economic changes could help people who suffer psychological distress?
Ellyard: We must have a fairer society to begin with, one which supports people to secure housing, education and work. We need a lot more funding for community mental health services and primary health care.
We need an increase in Medicare-funded sessions to see psychologists. Where people do require inpatient admissions, improving the staffing available is essential to provide support and therapeutic engagement.
While psychiatric medications will continue to be necessary, the current system is too reliant on medications as being the centre of treatment. It is essential this changes. I would like to see opportunities for nurses to increase their psychotherapy skills, but increased funding and staffing is essential for this.
Leka: We need secure housing and an adequate income, and much higher levels of non-pharmaceutical interventions. We must also take into account that most people are aware of the climate catastrophe enveloping us.
Psychiatric medications are of course necessary to ameliorate acute symptoms. But there is inadequate resourcing for health care workers using other modalities such as counselling and the arts.
Professionals working as psychologists or in allied health or nursing often have a rather unimaginative approach to treatment. But funding for imagination simply does not exist — nor is there any tolerance for the risks such approaches may entail.
Capitalism exploits the majority and disproportionately impacts on vulnerable communities. What are some caring strategies?
Leka: The best approach is to support what can be done through local community networks. Local councils can do a lot more. Small and local initiatives did spring up during the pandemic as people in neighbourhoods decided to look out for each other.
A conscious focus on encouraging acceptance and neighbourliness would benefit everyone — not just those who may be marked or diagnosed as “different”. Some of the approaches adopted for health and education during the time when Hugo Chavez was a leader in Venezuela are worth studying.
Ellyard: It’s clear that an inequitable society exacerbates health inequalities and leads to poorer mental health outcomes. This emphasises the need for a fairer society and universal access to services that are inclusive of minority and marginalised groups.
What can COVID-19 teach us about treating mental health in the future?
Leka: The main thing is to ensure we act locally, tackle the causes of the major problems that face us — in particular the trashing of human rights and the planet. We need to learn how to live in relation to each other, rather than existing as “consumers”.
Ellyard: COVID-19 has reinforced the need for funding and resourcing the mental health system. We need to continue to de-stigmatise mental health conditions and ensure universal access to mental health care.
We need to address social inequality which we know contributes to poorer mental health outcomes. The challenges will continue to test all aspects of our health system. Importantly, we need to prepare the health system for the impact of the climate crisis which will take a significant toll on mental health.
[Dr Nikola Leka has been enrolled as a mental health nurse since 1982 and has a PhD in Health Social Science. Sarah Ellyard is a registered nurse working in mental health.]