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| PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 100-102 |
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COVID-19 Pandemic and Australia: “The Lucky Country”
Kevin Kendrick1, Mohan Isaac2
1 Department of Psychiatry, Fremantle Hospital, Fremantle, Australia
2 Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| Date of Submission | 16-May-2020 |
| Date of Decision | 29-May-2020 |
| Date of Acceptance | 05-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Mohan Isaac
Level 6, W Block, Fremantle Hospital, 1 Alma Street, Fremantle 6160, Western Australia
Australia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_28_20
Australia has indeed come through the first-wave COVID lightly. The strain on Australian society is more from the secondary effects of adaptation to contain the outbreak than from the outbreak itself. On a societal level, Australia has several factors that have contributed to the comparative mildness of the impacts of the lockdown. Tertiary psychiatric service demands appear to have been well met, although there appears to have been an increase in required support in other areas. The mental health burden of COVID is unlikely to be spread proportionately across the population, with variations based on the rural location, ethnicity, age, and indigenous status. Beyond the acute phase of the pandemic significant challenges loom. One can expect severe economic repercussions, including a spike in unemployment and a concomitant rise in anxiety and depression as other social determinants worsen.
Keywords: Australia, Covid 19, pandemic
How to cite this article:
Kendrick K, Isaac M. COVID-19 Pandemic and Australia: “The Lucky Country”. World Soc Psychiatry 2020;2:100-2 |
| Introduction | |  |
Australia has long described itself as the lucky country and compared to much of the rest of the world, it has indeed come through the first-wave COVID lightly. Consequently, the strain on Australian society is more from the secondary effects of adaptation to contain the outbreak than from the outbreak itself, and even these secondary effects have been limited in comparison to other nations. Australia seems to be seeing instead impacts nestled less within psychopathology than the shaded edges of normality.
The core of early Australian governmental response to COVID was a closure of borders and implementing a policy of social distancing to limit transmission. This required that individuals in nonessential services remain home except for activities required for daily living such as exercise, food shopping, and specific types of work. International travel was limited, and even travel within cities scrutinized. Visiting the homes of others was permitted, but kept to a minimum.[1] Within the cities, this brief period of restriction was well tolerated, with trust in parliamentary institutions at a 5-year high.[2]
Given the recent onset of COVID, there is limited academic data available. Predictions have been largely based on common sense projections of what occurs through the reduction of access to mental health services. Anecdotally; however, psychiatric demands on tertiary care providers do not appear to have significantly increased beyond capacity. As an example, freely available Western Australian emergency department activity data support that demand or wait times have not significantly increased, and anecdotal reports are that acute statewide psychiatric demand may have decreased.[3] How much of this is due to fear of hospital-acquired infection is unclear. Similarly under captured is the extent anxiety has risen in the primary care sector.
On a societal level, Australia has several factors that have contributed to the comparative mildness of the impacts of the lockdown. Australia is an isolated country, bounded by oceans that limit viral transmission. Although its raw strategic reserves are low and its capability to rapidly produce medical supplies limited, its large landmass, natural resources, and small population predispose to self-sufficiency. Much of its population lives in large state capitals, with over 86% of the population living in urban environments.[4] It has a well-developed medical system encompassing both public and private sectors, good access to broadband Internet to reduce the impact of social isolation policies, a broadly supported, although often subsistence level, social welfare net for the unemployed, and a strong roster of nongovernmental agencies to provide support. These factors mitigate many stressors the pandemic has been burdened other countries with.
Australia is also not unfamiliar with pandemics. In 2009, it was affected by H1N1, with close to 40,000 confirmed cases.[5] Having managed this pandemic, the government had a small-scale blueprint to operate from. The population is thus also not naive to the types of messaging and coordination required. In addition, Australia itself had only in March 2020, emerged from the “black summer” of bushfires.[6] For much of Australia and particularly rural areas, this meant that COVID was merely a transition from a readiness for one respiratory crisis to another.
This is not to suggest we underestimate the extent of stress generated. While crisis can build resilience, it can also develop into exhaustion. Providers of online mental health support such as beyond blue, have reported an increase in demand of 40%.[7] Spending on alcohol and tobacco during the lockdown has increased markedly,[8] while government statements reported a 75% increase in searches on domestic violence.[9] In abusive homes, social distancing and service changes are likely to reduce the degree of support available to vulnerable individuals, while also confining them into extended close proximity with perpetrators. This is particularly true of individuals with a disability who will be reliant on abusive family members for care.
Much of the differentiation of stress levels will focus on adaptability to a more online-based social model. This may be a simpler transition that might be expected. While the stereotypical Australian might be a crocodile-hunter like a figure, over decades there has been an increase in daily screen time, decreased time outdoors, and a trend toward sedentary, single individual, and home-based lifestyles. It remains to be seen whether these changes have mentally prepared Australia for the realities of a lockdown, or have merely predisposed us to sensitivity to even greater isolation. However, certainly, youth appears better poised to adapt, through activities such as virtual meetups and surges in Esports viewership in lieu of conventional sports.[10]
It should also be emphasized advantages easing the burden do not apply equally to all areas of Australia. Rural areas are less supported in terms of both general and mental health care provision, with a higher base rate of depression, anxiety, and suicide. In the Indigenous Australians, Australia has a particularly underserviced group, who, along with profound levels of socioeconomic disadvantage, have increased rates of cardiac, respiratory, endocrine, and psychiatric diagnoses. Moreover, the interactions of that population with the Australian government over recent generations have done little to engender their trust, which may cause problems with encouraging guideline compliance.
A further complication is Australia's cultural heterogeneity. For decades after the Second World War, Australia attempted to increase its population by 1% per year, initially limited by the White Australia Policy, but later opening to an increased influx of Asian and Indian immigrants. By 2020, close to 30% of the Australia populace was born overseas.[11] Within these communities, psychiatric responses and presentations tend to differ. Overall; however, it is not that immigrant citizens tend to worse general health outcomes indeed, partially due to screening they tend to have better but that mental health problems at a primary level may be undertreated due to stigma and reduced ease of access to culturally fluent primary care providers. In ordinary circumstances, this leads to disproportionate levels of involuntary admissions and admissions to acute units. In times of crisis, with primary care providers overburdened, this may be attenuated. In addition, specific ethnicities, particularly Asians, have suffered a significant raise in racist incidents since the start of the pandemic.[12] This is, unfortunately, only part of a long history of racial targeting during times of crisis, with victims, including Islamic migrants, African migrants, and even Indigenous Australians. The increased stress, sense of exclusion, and anxiety caused should be self-evident.
Beyond the acute phase of the pandemic, significant challenges loom. We can expect severe economic repercussions, including a spike in unemployment and a concomitant rise in anxiety and depression as other social determinants worsen. On topics such as governmentally-mandated mobile phone tracking, there lays the Hobbesian question as to the extent to which liberties in a crisis may be sacrificed. While Australia has managed the early physical challenge of COVID-19 well, the primary psychiatric challenge still remains in future.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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