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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© JPC-PROD/stock.adobe.com models used for illustrative purposes only
© JPC-PROD/stock.adobe.com models used for illustrative purposes only
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.

Impacts of COVID-19 on the medical workforce

The pandemic has highlighted the importance of proactive support of the mental wellbeing of the medical workforce.  COVID-19-related stresses include uncertainty about the scale of the pandemic, distressing news from overseas experiences, the challenge of physical distancing (initially called social distancing) and adjustments to new forms of operation such as telehealth. Unfortunately, entrenched cultural issues in the workforce, such as bullying, harassment, and unsustainable working hours and conditions, are likely to escalate during this time of prolonged stress.

Initial projections about populations affected with COVID-19 prompted drastic reforms in the health sector in preparation for a patient load predicted to overload the health system. Health professionals in Australia were particularly concerned by stories about their international colleagues and the traumatising ethical dilemmas they faced in resource allocation. Lack of personal protective equipment necessary to safely carry out face-to-face duties was a great source of stress. The high-profile reporting of the suicide of Dr Lorna Breen, an emergency doctor working in Manhattan in the US, reverberated through the health community.17

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Physical distancing has meant the loss of touch, of connection. For GPs on the front line, it has meant a complete restructure of their mode of practice. Telehealth has been widely embraced by Australian GPs and their patients, and it has afforded the opportunity to provide health care for chronic medical conditions in addition to mental health care using telephone or video-chat facilities. However, telehealth is not ideal for all patients. It presupposes access to a phone, computer or the internet, and the organisational and psychological foundations to be able to access telehealth. Many vulnerable patients have found the change of style of interaction has increased their isolation, often when they are already significantly isolated.18 Some patients report that this has stopped them from accessing care, even when care nominally may be available.19,20 For GPs, it has meant adapting their style of practice and the challenge of projecting empathy through a screen. Ensuring that there are reflective processes for individual and group practice can be an important mechanism to adapt to rapid changes.

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What can GPs do to mitigate suicide risk?

Suicide prevention strategies can be conceptualised as primary, secondary and tertiary prevention.21

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Primary prevention

Primary prevention includes public health initiatives from the government, including awareness campaigns, appropriate reporting in the media and reducing access to means.22 Government initiatives should be directed towards social determinants of health: financial support (both medium and longer term); a focus on rebuilding the economy; strategies towards reducing domestic violence, substance use and online gambling; and improved access to mental health education and support. The narrative that frames the disaster recovery is crucial; people need to hear that the burden of isolation was necessary.23 Examples of community messages that provided meaning or purpose include: ‘Staying home to save lives’; and ‘As a community, we support each other during a tough time’. As GPs, we can continue to stay up to date with and reinforce the community messages of COVID-19-specific health advice, as well as general public health advice. Government resources including federal, state and local council resources can be important to address the societal impacts of unemployment and financial or accommodation stress. GPs can assist and advocate to facilitate patients towards these resources. Primary Health Networks can help to improve the co-ordination between health professionals and the services available.