Open Access
Psychological medicine

Improving mental health and reducing suicide risk: how GPs can help during the COVID-19 pandemic

WEI-MAY SU, LOUISE STONE, GRANT BLASHKI
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The economic impact of the pandemic may include job loss, financial loss and changes to support services and/or living circumstances including loss of stable accommodation. These impacts can compound to adversely affect people’s mental health. Even for those who have not previously considered themselves to be vulnerable to mental illness, economic downturns may pose a risk to their sense of identity, and sense of meaning and life direction. Suddenly, they may become acutely anxious or depressed, which profoundly affects their sense of self.

Effects of isolation

Changes to people’s daily work and home routines have proven to be a major challenge to maintaining their mental health. For some, isolation at home and endless video-chat meetings have taken a toll on their mental wellbeing and, as the months pass by, they become fatigued and have a sense of disconnection. For others, home life has become a pressure cooker with children at home and partners working from home. Notably, there has been a significant rise in the number of calls to domestic violence services.7

It has been said that a crisis can bring out the very best in people and also the very worst, and xenophobia and discrimination have been an unfortunate response from some parts of the community during this pandemic. Fearmongering about ‘the Chinese threat’ or scapegoating of the residents of North Melbourne’s public housing towers have reintroduced an unhelpful and stigmatising narrative for some of our patients from culturally and linguistically diverse backgrounds. The contribution of discrimination to poor mental health is well documented and GPs, as leaders in the community, can be vocal in countering unacceptable stereotypes.8

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The gradual loosening up of isolation restrictions brings its own challenges. Some people, having retreated to the ‘cocoon’ of home isolation have found it to be a haven away from other life stressors, allowing them time to recalibrate and reassess. For some, it has been a time for reflection and has been transformative. For others, for example those with anxiety conditions, it has specifically potentiated avoidant behaviours and re-emerging after lockdown can be stress inducing.

Patterns of usage have changed for patients with substance use disorders or other addictions such as gambling.9 For example, the lack of daily structure and nonrequirement to attend work have opened the door to unhealthy drinking habits.10

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It is worth remembering that particular groups of people who were more vulnerable to suicide before the pandemic remain at risk. This includes those from Aboriginal and Torres Strait Islander communities, rural men, those discharged from forensic mental health services, young people and people with pre-existing mental illness (Table).11-15

It is hard to say what impact isolation will have on the nursing home population in Australia, though it has been a difficult time for older Australians who are at higher risk of poor outcomes from the disease and find themselves unable to have the usual support from visitors during the isolation requirements. We do know a reduction in protective support may contribute to active or passive suicidal ideation.16

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Listening for the underlying stories behind these vulnerable groups is a crucial step towards a therapeutic relationship and working together to address emotional distress associated from the circumstances. Problem solving and prioritising during crisis can then be achieved more effectively.

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Dr Su is Academic Lead (GP) at the Health Education and Training Institute Higher Education, Sydney; and Adjunct Clinical Senior Lecturer in the School of Medicine, The University of Notre Dame Australia, Sydney, NSW. Associate Professor Stone is Clinical Associate Professor, Academic Unit of General Practice, ANU Medical School, Australian National University, Canberra, ACT. Associate Professor Blashki is Associate Professor at the Nossal Institute for Global Health, The University of Melbourne, Melbourne, Vic.