ZOE DANIEL:
And the Deputy Chief Medical Officer for Mental Health, Dr Ruth Vine joins me now. Welcome to RN Drive.
DR RUTH VINE:
Good afternoon.
ZOE DANIEL:
Can you give us a sense of the depth and breadth of the mental health impact of COVID-19 on Australians right now?
DR RUTH VINE:
Well, look, I think we'd have to say it's unfolding because I think there was an initial phase where people were anxious and uncertain about the immediate health impacts and of course felt the biggest brunt of the social isolation.
And now, we're emerging from social isolation but there is still a degree of uncertainty about the pace of that, and a degree of uncertainty about whether the viral infection will turn in clusters or other patterns. And of course, there's the longer term future and economic impacts. So, I think it's hard to sort of quantify that because the impact is significant.
Clearly, surveys demonstrate that a large proportion of those surveyed are concerned about this and are concerned about different aspects of it. But I also think it's very important to remember that it is affecting different people or different groups of people differently, which is why I think there's the breadth of response that we have.
ZOE DANIEL:
Yes. So, how do you in your role get the measure of how people are feeling and what sorts of feelings people are having, and then the severity of those feelings which must have many, many layers?
DR RUTH VINE:
Well, I guess we use whatever means we can. So, as I mentioned, there are population-based surveys that are asked particular questions, but we can also monitor how services are being used, so that includes helplines. And how clinical services are being used, which includes both the number of mental health plans being generated through general practice but also the take up of mental health items provided through psychology and psychiatry. And I think amazingly what we do see with that is I think almost 50 per cent of those are now through telehealth, and by my— I guess, my other informal source of information is from my psychiatry colleagues, how they're experiencing providing services in this environment and the responses they're getting from their clients or patients.
ZOE DANIEL:
Yes. And what are you gleaning from that? Has there been, for example, a rise in prescription-based treatments for things like depression or anxiety, or anecdotally, what are your colleagues saying?
DR RUTH VINE:
Look, I cannot answer the question about prescriptions, I'd have to take that one on notice. But mostly what colleagues are saying is that the take up of telehealth has been terrific, as we know, and for many people it's actually been better. So, for some, of course, that has to do with practical things like not having to go out for an appointment, not having to leave children or find alternative care arrangements for children, and for some it's to do with distance.
And so I was talking to a colleague recently who had been providing telehealth to a farmer, and in fact was able to gain a much richer experience of that person's current situation by talking directly to him in his natural environment. So, I think there is a mix. I think for some people this has been a challenge, because not everyone has access to the appropriate infrastructure — a smartphone or IT capability — and for those, I think there has been a— people who've missed that face-to-face contact, have missed the outreach services. But they are gradually going to come back now with due precaution. And in fact, some of the funding was to improve the outreach with mental health nurses, sort of funded through the PHN.
So, I don't want to make life complicated for you but I do think there are different responses to different people, and having a breadth of a range of options available actually makes sense in this sort of environment.
ZOE DANIEL:
There were some awful predictions around potential increases of up to 25 per cent in suicides. What are you seeing there?
DR RUTH VINE:
I agree that they were awful predictions, and we can all hope most sincerely that that was very much worst case and that there are things that have been put in place to make that far less likely. I think— so, right now I don't think there has been a discernible increase in suicide. I have to say, I don't think there's been a discernible decrease either, as far as I'm aware.
But I think we need to watch that very closely over the next 6 to 12 months. And some of the protective factors for suicide are, of course, social connectedness and people having a sense of hope and people being able to source support from those around them, and including structure. So, things like school and getting back to employment. And those are things that I think everyone will be keen to see increasing over the next month.
ZOE DANIEL:
Is it something that you have to consider that in part you're dealing with an entire population that has at least some level of anxiety? I mean, obviously some people have a level of anxiety all the time. But this has introduced that to many people who perhaps usually don't experience it and therefore how do you deal with it?
DR RUTH VINE:
Yeah, look, it's a very good point. Most of us, most of us deal with anxiety by seeking information to— so, that we're more knowledgeable by talking about it with our friends or our colleagues. And the next step up is maybe talking to a professional or seeking professional help, and first line treatment for anxiety is usually not to go down a medication path but to use psychological treatments more. I— of course, subsequently, use of medications is often very effective and in fact quite often anxiety and depression are mixed. I do think it's very important to stress the importance of those more informal measures, and particularly I think within families that's very important. The young children are more likely to feel anxious if they picked that up from their parents, if they're not talking about it within families and talking about it with their peers.
ZOE DANIEL:
In general, is it fair to say that those people who are usually capable of managing their own anxiety will start to feel better as the situation normalises?
DR RUTH VINE:
So, one would expect so, but again coming back to my first point I think the situation is that's normalising in relation to the immediate concerns about viral infections, but it may be a much longer time before the situation normalises in terms of our economic wellbeing. I think it's terrific that we're now allowed to have friends around and I've certainly gone off and visited my family. You know, having that greater degree of freedom to seek the normal supports and social connectedness and communications with that should continue.
ZOE DANIEL:
People are missing many things during this. But I do wonder about the impact of not being able to touch other people and whether for some people that is a real source of disconnection, especially people who live alone or have limited contact with others. When they do see them, they want to hug them.
DR RUTH VINE:
Yeah, I agree, and I think people have been very understanding that that shouldn't happen and that social distancing is sort of in our behaviour now, isn't it? It's sort of become something we just do. So, I agree that it is a normal part of human behaviour to have physical comfort and physical contact. What the relationship with that and more significant mental distress is, I don't know.
ZOE DANIEL:
Now, part of this funding is for genomic testing. What is that and why is that a priority now?
DR RUTH VINE:
Look, I think it's— so firstly, what is it? It's understanding that while we might have generic classes of drugs with an expected range of side effects and onset and so forth, that we all carry different — subtly different — ways of reacting to a particular drug through our genetic makeup.
And so, so-called personalised medicine or pharmacogenomics is getting a better understanding of what a particular person's fingerprint, if you like, is in relation to particular substances. It's particularly important now if we are seeing or we are likely to see increased use of psychotropics, particularly anti-depressants, then knowing which particular class of drug or even which particular type of drug is most likely to be most effective in an individual, it is more likely then to give us a faster onset of action with fewer side effects. So, that's the sort of ultimate aim to be able to say that if you require that sort of agent, then the one that is, without going through trials — and usually you have to trial a drug for days or weeks to work out whether it's going to be effective or not, and often you have to tolerate side effects at the beginning — to be able to know which is least likely to cause side effects and most likely to be effective, it's a progress. And any time's good for progress, but maybe now's a particularly good time to try and better understand how people respond to particular psychotropic medications.
ZOE DANIEL:
Yes. It makes sense that it's a time to continue to be cautious too. But I wonder at a base level of helping us all to be optimistic, should we be celebrating a little more about how we've handled this as a collective nation?
DR RUTH VINE:
Well, yes. I think Minister Hunt in his press conference today touched on just how different Australia is from a number of other nations at the moment. And while no one— he said we mustn't be complacent, but I think we can sort of be saying, wow, what a speed of response we had, how rapidly we have ramped up testing, how reassuring in a way that testing has been because of the very low positive rate that's been found. So, yes, I agree with you. We should— without being overly self-congratulatory, we should be thinking, maybe we're doing this pretty well.
ZOE DANIEL:
Ruth, thank you very much for your time.
DR RUTH VINE:
And thank you.
ZOE DANIEL:
Dr Ruth Vine is the Deputy Chief Medical Officer for Mental Health.
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