With ongoing coronavirus lockdowns – amid national confusion re vaccine rollout instructions, crowded vaccine centres, frustration at lengthy testing queues, anger at regular quarantine lapses, worrying announcements of dangerous new COVID-19 variants and ongoing massive international failures in global containment – experts are highlighting the danger signs for a nationwide mental health crisis.

When the Victorian Government announced an extension to that state’s fourth COVID-triggered ‘lockdown’ on Wednesday 2 June, ANZ Bank chief executive Shayne Elliott grabbed headlines by revealing how he battles to keep his 7,000+ Melbourne staff motivated during a lockdown that mental health experts “warn is harder than Victoria’s previous three”.

Elliott told The Australian Financial Review: “A lot of staff have told me this lockdown is a major psychological blow and is worse than last time – with that loss of optimism and hope.”

Even from his privileged position as CEO, he noted: “There is a sense of déjà vu. It’s hard to sit here on my own in a room and stay motivated.”

Mental health expert Cate Page, who was “being wheeled out to frontline health, aged care and quarantine workers, department officials and businesses across Melbourne this week to help people manage the lockdown” explained the impact of this latest lockdown was “cumulative, with many people feeling a lack of motivation and focus” in what psychologists have termed “languishing”.

She explained: “This term ‘languishing’ is resonating with people’s emotional state at the moment. Apathy, disengagement, feeling stagnated: it’s normal to be feeling like that, but you can’t stay like that without having a mental health consequence.

“Even those people who have a long history of rigid self-discipline, who have gotten to where they are through self-discipline, are being challenged; they are exhausted. They thought they could have a break, but are struggling to get back into those patterns.”

Impairment To Emotional Functioning

Amid COVID-19’s initial 2020 rampage, a report into the work environment for the Finance Sector Union (which analysed submissions from 353 bank employees) found “the most often revealed work harm for FSU members was impairment of their psychological and emotional functioning”.

In a significant industry update on that same Wednesday 2 June Victorian lockdown extension, the AFR reported “large banks forced to close offshore processing centres due to coronavirus outbreaks are struggling to clear backlogs as the paperwork from a buoyant property market piles up.

“Bottlenecks and delays in bank processes are adding to the pressure felt by white-collar workers and raising fears they will contribute to poor mental health outcomes.”

Richard Wensley, managing director of C&S Legal (responsible for 20% of all property settlements in Western Australia) said “as many as two-in-five” settlements were not occurring on time, and warned: “I have had major concerns for the mental wellbeing and health of my staff and other employees in the banks for some time now.

“I can’t allow my staff to go into this horrible mental health spiral. I had someone resign yesterday and someone resign two weeks ago. They are spending too much time trying to achieve the unachievable.”

He emphasised it was “not fair to blame the banks”, which had been “hit with a perfect storm following the disruption caused by the coronavirus and the unexpectedly sharp economic recovery”.

During the same week, on a panel discussion of lenders held for mortgage brokers, the AFR noted representatives from Australia’s Big Four banks “pleaded for understanding”, with one calling for “a little bit of compassion, human decency and respect”.

Resilience Sorely Tested

On the same day as Shayne Elliott’s revelations, the AFR reported law firms in Victoria had “doubled down on their mental health programs” as the latest pandemic lockdown was extended for another week, with one chief executive declaring staff were “pretty raw”.

The newspaper added Melbourne-based bosses of national law firms said that with no lockdown release date in sight, the “resilience of all those in the state most affected by the pandemic was being sorely tested”.

Lander & Rogers CEO Genevieve Collins said the lockdown extension had “prompted real concerns about how staff were coping”, triggering the firm to (a) send a wellness survey to staff “as a temperature check” on the day the extension was announced and then (b) repeat the survey two days later to identify further “people of concern, trends and deterioration”.

In addition, she said: “We have also asked all team leaders to arrange that every team member be contacted personally within the next 24 hours (following the second survey) to see if they’re ok.”

She said the “prevailing feeling is one of frustration that this has happened again. As a community, we’ve definitely built resilience from multiple previous lockdowns. However, this is now being tested coming into winter and compounded by uncertainty . . . We’re very conscious of the financial, business and personal hardships many within our community are facing, including clients and family members.”

Richard Spurio, managing partner at fellow leading national law firm Allens, emphasised the latest lockdown extension was “tough news for everyone in Victoria” because of the “ongoing uncertainty”.

He said his firm had “been in regular communication with our teams about what we can do to support them . . . and will continue to offer support and assistance.”

Hall & Wilcox managing partner Tony Macvean said his firm had “worked hard to destigmatise mental health in our organisation. We are staying close to staff and offering whatever support we can.”

Gavin MacLaren at Corrs Chambers Westgarth declared it was “a challenging time for everyone in Victoria, given the experience (repeated lockdowns) of last year. We are very conscious of the impact on the health and wellbeing of our people and are encouraging our teams to stay close to one another.”

Teen suicide threats skyrocket

Alarming new figures from Kids Helpline reveal “emergency interventions” to protect young Victorians from suicide and child abuse have skyrocketed 184% over the past six months ‘as

the state grapples with mental health consequences of repeated COVID-19 lockdowns’.

Between 1 December 2020 and 31 May 2021, 75% of crisis interventions (dispatching police, ambulances or child protection officers) were to teenagers 13- 18 years of age – and 44% of total Victorian interventions were responding to a young person’s ‘immediate intent to suicide’.

Nationally, total emergency interventions rose 99% including kids as young as 5 and Kids Helpline’s Tracy Adams said lockdown-induced loneliness and uncertainty over what their lives would look like post-pandemic were triggers for these mental health emergencies – with the Victorian figures ‘very disturbing’.

She warned the trauma inflicted on young people by COVID-19 would be long-term and told the AFR: ‘When you look at these numbers you can’t help but bereally concerned and distressed, as what we’re continuing to see is young people really struggling to find a way through the pandemic.’

School Closures Erode Wellbeing

Meanwhile education experts have warned schoolchildren “are disproportionately bearing the brunt of COVID-19 lockdowns in Victoria” with their academic and psychological wellbeing eroded by school closures.

Professor Sharon Goldfield, a public health physician with the Murdoch Children’s Research Institute, said there needed to be “a national plan to give direction about a more nuanced approach” to school closures.

She said a survey during last year’s lockdowns on the impact of remote learning on children’s social and emotional wellbeing found Victorian children were worse affected than children in other states, because of the length of time they had spent in lockdown since the outbreak of the pandemic.

Jordana Hunter at the Grattan Institute tole the AFR the effects of school shutdowns on individual children were well documented, noting: “There is a risk of significant learning loss for many students, as well as negative social and emotional consequences due to the disruption of familiar routines and engagement with peers.”

Return To The Office

Amid Victoria’s lockdown extension, Prime Minister Scott Morrison called for workers nationwide to “return to the office” as a key strategy to combat COVID fatigue and reflect Australia’s overall flattening of the coronavirus curve.

Australian Industry Group chief executive Innes Willox welcomed government action to deal with what he called “a white-collar workforce issue”.

He told the AFR: “Many employers are reporting strong pockets of resistance from some workers to spending time in the office. The longer workers are away from the office, the less connection they have with their colleagues. Innovation, collaboration and productivity all suffer.”

Willox said Victoria’s latest lockdown “has meant efforts to get people back into the office have hit a roadblock. Any momentum in that direction has been snuffed out.”

Property Council chief executive Ken Morrison “applauded the Prime Minister’s message” on returning to workplaces, commenting: “We are proactively making the case for workers to return to their offices and re-engage with all the benefits of face-to-face working.”

Vaccine Hesitancy & Supply Challenges

Eighteen months into the COVID-19 pandemic – as Victorians grimly hunkered down for the second week of their fourth lockdown – Dr Roderick McRae, head of the Australian Medical Association’s Victorian chapter, warned bluntly: “This virus is probably going to stay with us as a species forever, and traditionally every mutation is bigger and stronger.

“So now we need to take this chance to look at how we’re going to manage this and accept that we’re going to have to adapt.”

That week at Carlton’s Royal Exhibition Building, vaccination queues regularly lasted three hours as demand surged.

But while Federal Health Minister Greg Hunt grabbed to opportunity to talk up the increasing pace of the vaccine rollout, many of those waiting on the queues reacted to media questions with blunt references to “missed targets”, widespread “vaccine hesitancy” and international “supply challenges’.

Victorian-based newspaper columnist James Thomson summed up: “While the city has been quick to slip back into old lockdown habits, this time there’s a much clearer sense of frustration and anger, even among those who supported last year’s long lockdown.”

Thomson noted the “increased confusion about what this extended lockdown is designed to achieve” and summed up: “After four lockdowns, this frustrated, exhausted and anxious city deserves a clear-eyed view of what it’s facing.”

Video Call Fatigue

video conference fatigueAmid ongoing COVID-19 lockdowns, combined with continued use of video conferencing technology and increasing work-from-home, “it seems we’re suffering the effects of over-indulging on Zoom, as researchers have now identified what video calls do to our brains” reported thebigsmoke.com.au.

The emerging condition ‘video call fatigue’ can make otherwise relaxed people apprehensive and “may increase anxiety levels in those already experiencing such feelings”; it can also cause people to feel overwhelmed when they would not usually, “leading to increased tiredness and even exhaustion”.

In the US, many workers are finding they are feeling more exhausted when working from home than they would when working in the office, and this exhaustion “is even the case after factoring in a long commute” (now absent) noted medicalnewstoday.com.

Stanford University Professor Jeremy Bailenson, who has been studying the impact of video call overload on people, told CNBC: “Currently the medium is designed to allow various forms of exhaustion and fatigue – socially, emotionally and physically.”

As a result, financial industry leaders HSBC and Citi have introduced ‘Zoom-free days’, setting aside one-day-per-week when employees aren’t expected to be on video calls.

US researchers suggest several “psychological occurrences” not present in typical daily work life “affect video call fatigue” explained medicalnewstoday.com, including:

  • Gaze awareness – in person, when two or more people converse, eye contact is made; on a video call, the camera is not located in the same place as the person they’re talking to, so people often appear to be looking elsewhere and the lack of eye contact “can lead to people feeling they are not being listened to, causing frustration with their peers.
  • Limited attention – it is easier to lose focus on a video call (and be seen to do so); in addition, the temptation to continue to send emails or complete other tasks (while on a video call) often trigger diminished attention, resulting in greater fatigue by working harder to refocus full attention.
  • Technical issues – many technical problems can occur during video calls (internet interruptions, frozen screens, transmission delays, etc) causing frustration and either making conversation impossible to continue or requiring speakers to repeat themselves, which can prove tiring.
  • Performance pressure – in video calls (more than face-to-face) people re very aware others are watching, and keeping up a high level of performance on screen can be tiring and trigger increased stress; in addition, participants can see themselves in a little box in the corner of the screen, making them self-conscious and distracting their attention away from the meeting (what else is going on in a person’s home while on a video call may also make them self-conscious, especially noisy children or uncontrolled pets).
  • Screen time – following significant work video calls, adding extra screen time into the mix for end-of-day necessary connection with family and friends can contribute to tiredness and irritability.

In summary, research suggests video call fatigue can “make otherwise content people anxious, may increase anxiety levels in those already experiencing such feelings and cause people to feel overwhelmed when they would not normally, leading to increased tiredness and even exhaustion”.

Suggested steps to “ensure people are not letting video calls have a negative impact on their mental health” include: limiting calls to only those necessary; building in breaks; limiting numbers on each call (allowing more time for individuals to speak); establishing rules (for example, microphones on ‘mute’ when not speaking).

Mental Impact On Healthcare Workers

Healthcare workers (HCWs) are a “vulnerable population” who’ve been “exposed to high work-related stress during the COVID-19 pandemic because of the high risk of infection and excessive workloads” reported the Australian Journal of General Practice.

Hence HCWs are at a greater risk of “mental illness, particularly sleep disturbances, post-trauma stress syndromes, depression and anxiety”.

The psychiatric impact of COVID-19 on frontline HCWs has highlighted the “need for screening and early diagnosis by GPs” and the appropriate psychosocial strategies and treatments.

HCWs generally report a higher risk of mental health problems (including greater risk of suicide, suicidal ideation and self-harm behaviours), but during a pandemic they are particularly vulnerable because of the high risk of personal infection (and mortality worries), increased work stress (including potential moral dilemmas) and fear of spreading the virus to their families, in addition to fears associated with ongoing uncertainty (direct and economic) and stigma (especially in the context of social isolation and being in quarantine), plus external factors such as shift work, excessive workloads and high-pressure environments amplifying risks of burn-out and depression, as well as usual methods of maintaining work-life balance (for sustaining wellbeing and mitigating burn-out risks) being impeded by high work demands, fear and various social restrictions on usual leisure activities.

The “entire experience can be traumatising, with several studies showing an increased risk of acquiring a trauma or stress-related disorder” summarised AJGP.

It noted various international studies finding:

  • more than 70% of a group of 1,200 HCWs reported “psychological distress with high rates of depression, anxiety and insomnia”;
  • anxiety shown to be “a significant factor affecting nurses and staff with direct contact with infected patients”;
  • two-thirds of HCWs on the frontline “reported moderate-to-high levels of stress”;
  • in one cohort of 4,000 HCWs mental health issues included 15% depression, 25% anxiety and 30% acute stress symptoms”;
  • the burden of “adhering to strict protective measures” highlighted as a “contributor to levels of distress”;
  • HCWs who viewed “protection as insufficient, rated higher levels of depression, anxiety and acute stress than those who perceived it to be adequate”.

Particularly worrying, AJGP highlighted that in Australia it’s been reported “40% of individuals use alcohol to cope with stress, and this is likely to increase during a pandemic”.

The World Health Organisation recommends “timely provision of psychological first aid” for frontline HCWs, including: encouraging lifestyle/wellbeing strategies (healthy food, exercise, sleep, rest and recreation, sunlight exposure for shift workers, ongoing connection with family and friends, maintaining leisure activity schedules, limiting social media use); providing advice/assistance to discourage unhealthy coping strategies (tobacco, alcohol, other drugs); and initiating/maintaining workplace interventions (providing adequate and timely COVID information, training and updates, plus encouraging sick and annual leave without feeling guilty or irresponsible).

Aust Hospital Front-line Distress

A survey conducted at a major tertiary hospital in Melbourne – to measure burnout and psychological distress among Australian HCWs in front-line departments (daily direct contact with COVID-19 patients) at the height of the initial pandemic crisis in April-May 2020 – concluded: “Despite low levels of COVID contact, moderate-to-high levels of psychological distress were reported.

Importantly, it emphasised: “Continued monitoring and support for HCWs’ mental wellbeing is warranted as the COVID-19 pandemic develops.”

The survey, reported in the journal Australasian Psychiatry, found:

  • 21% showed “significant symptoms of moderate-severe level depression”;
  • 20% suffered from “anxiety”;
  • 29% exhibited “post-traumatic stress disorder”;
  • 5% “screened positively for symptoms of burnout”
  • 1% reported “suicidal ideation” during the 2-week reporting period; and
  • 3% requested “follow-up” by a psychiatric clinician.

The 320 participants included 99 medical practitioners (31%: 58 senior medical staff, 41 junior medical staff), 84 nurses (26%), 105 allied health practitioners (33%) and 28 non-clinical or other (95).

The majority of participants were female (78%) and 241 (75% had at least five years of clinical experience.

The survey authors noted “psychological distress in HCWs may develop in response to a range of stressors: risk of personal infection, fear of spreading the illness to family and friends, inadequate access to personal protective equipment and moral distress.”

They also noted “Senior medical staff reported lower levels of psychological distress than other staff. This nis consistent with beyondblue survey data, showing senior doctors report less psychological distress that their less senior colleagues.”

The survey emphasised psychological resilience “mediates the stress response to trauma” and reported “high levels of psychological resilience are protective against the development of mental illness. Hence the authors noted: “Recent research has considered introducing resilience training as a preventative treatment for reducing mental health outcomes among first responders. Similar strategies could be developed for HCWs in anticipation of future public health emergencies.”

The study highlights “the importance of mental health support during and following the COVID-19 pandemic”.

Aust HCWs 58% Burnout

A later survey of more than 10,000 Australian HCWs found “more than half are feeling burnt out by the demands of the coronavirus pandemic” and many were “planning to leave the workforce due to concerns about their mental health”.

The survey – conducted by Associate Professor Natasha Smallwood from Royal Melbourne Hospital and reported by the ABC in October 2020 – found:

  • 61% reported “anxiety”;
  • 58% reported “being burnt out”; and
  • 28% reported “depression”.

Dr Smallwood said it was “difficult to know” whether authorities were listening to concerns about anxiety, depression and burnout among healthcare workers, commenting: “The concerns we’re seeing are quite categorical and people in very different health professional backgrounds, so nurses, doctors, allied health staff, all indicating that enough’s enough and they need to leave.

“They’re all feeling guilty they they’re having to give up a role they love, but they’re having to make that decision.”

She said that while HCWs reported they were doing their best to “look after themselves” – by exercising and using apps to track their mental health – there needed to be a “systemic response to the issues leading to mental health problems in the workforce” and these “need to be long-term, not just reactive solutions put in place during a pandemic,

“They want support, not just at an individualistic level checking in once-a-week, making the focus on having a resilient workforce rather than having to do it yourself.

“The focus should be on organisational leadership and good government response to care for HCWs.”

Dr Smallwood said one simple fix would be to have “consistent guidelines for personal protective equipment (PPE) across all healthcare settings”, noting “that variation is actually really stressful if people work at multiple organisations, where they have to remember to do something different every time they go to work.

“They’re worried they’ll make a mistake; they’re worried about what that means for their patients, but also if they make a mistake and bring it home.”

Keep Mentally Healthy

The Australian Department Of Health has set down guidelines to “mental health for the health workforce during COVID-19”.

The guidelines note: “Long and irregular hours and heavy workloads can increase stress and cause mental health issues, including burnout. Managers and supervisors should be sensitive to the issues that might affect their employees.”

A particular emphasis includes: “Looking after your mental health and psychosocial wellbeing is important to help you cope in the longer term. This is not a sprint; it’s a marathon.”

The key tips include:

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