31 January 2022

Now for the mental health echo-demic

Comment COVID-19 Mental Health

We’re looking at a wave of anxiety disorders and depression. As a GP, this is where I could really use help.

Welcome back. Welcome to 2022.  

How are you feeling? Refreshed and rejuvenated and ready to take on whatever challenges the new year presents? 

Not quite? Hmmm – I thought so. Even if you did manage to get away over the holiday period it is unlikely there was any clear delineation between hurdles needed to be overcome in 2021 and what we are facing when we front up to practice in 2022.  

I’d say it’s a bit like Groundhog Day, except that rather than every day being the same, we seem to have a situation where each week brings yet another challenge.  

Just doing an n=1 study of our practice – when the word went out for everybody to get a booster our vaccine supplies were delayed. Fully booked vaccination clinics had to be rescheduled. And then two of our GPs and one of our reception staff contracted covid, which meant a lot of phone calls and patient juggling.  

And then we had to start managing often highly anxious covid patients at home via telehealth. And then we started vaccinating the five to 12-year-olds as well the adult boosters (nothing like the screams of a hysterical eight-year-old to add to the ambience of the waiting room) and now it seems we’re going to add Novavax to our vaccination menu – great!  

It’s more than a little crazy isn’t it? I know the current challenges are being recognised by the powers that be, both within the profession and in government.  

I have heard, seen and read the cries for help – more manpower, more resources, more information  – and yes, of course we need all those things. But the reality is, the sort of help we need cannot be conjured up overnight. Look how long it has taken to get adequate supplies of RATs in Australia, and that’s just a product. It takes time to address issues around trained personnel and tailored services, and even information resources and protocols. 

I may be being unduly pessimistic, but I suspect by the time we start seeing any of this “help” materialise we will be well and truly through this current crisis. And on a much more positive note, I honestly believe, in a few months, we will be out the other side, things will improve.   

Given the experience from overseas, what we currently know about Omicron, our new options for treatment and our high vaccination coverage, it is not unreasonable to suggest that if we can just hang in there – get all the boosters done, get all the kids jabbed, stay well ourselves and stay on top of the chaos for just a few more months, life will improve.  

So what will become of that energy and effort that is currently being directed to develop resources to help general practice and GPs cope in covid crises?  

It’s tricky. History has shown we don’t always get it right in preparedness, despite our best efforts. People are often very wise with hindsight: “We should have known we’d need more RATs”; “We should have ordered more Pfizer vaccines”; “We should have lockdowned earlier”; but you can’t always predict these things.  

We need to plan, of course, and Australia has done pretty well overall, nonetheless, planning for future covid crises in general practice is fraught. 

But there are things we do know. Almost every week now there is some new research on the detrimental effect of covid, or the measures taken to prevent it, or the effect it has had on mental health, especially on young people. From “covid babies” who have only known a world of masked strangers and have rarely socialised, to home-schooled teenagers whose view of the world is now totally dominated by social media without the reality check of face-to-face personal interaction, we are staring down the barrel of an epidemic of anxiety disorders and depression.  

And from my perspective, help is hard to find.  

Most recently I had a young teenage boy come and see me – with his mother. He had become increasingly isolated and started self-harming. He said he felt like life was not worth living. His distress was obvious. This wasn’t just a red flag – it was a great big bloody flashing emergency alarm.  

Off to hospital – he needed professional help – now. He was home  a few hours later! His poor mother was beside herself. Admittedly the mental health services were going to contact him, but the first instruction was follow-up with GP.  

I know this is just one case. But I am finding first presentation mental illness is becoming increasingly common. And my experience is not unique if the research is to be believed.   

In all the current chaos, among the mayhem of covid vaccinations, infections, testing and certification, if I were to nominate one area of general practice that I would most appreciate help with it would be this.  

Please help me to get effective and timely help for this young boy, my 10-year-old girl who is so anxious about going back to school she can’t sleep, my 27-year-old young woman who lost her job in covid and is now a fully-fledged alcoholic, and so many more.  

Mental illness was always a common presentation in general practice but it has become so much worse over the last couple of years. And to be honest, I fear I have less and energy to manage it, courtesy of covid.  

Yes, my New Year editorial lacks a certain joie de vivre, and I’m sorry.  

I really should be grateful for so many things, including being able to have such a worthwhile job in general practice as well as the very real prospect of covid soon becoming an endemic nuisance rather than a pandemic peril.  

At least, coming from such a low bar it is likely that, in 2022, things are likely to improve in GP land.  

Hopefully, before too long we will be meeting at conferences (preferably on a Greek island somewhere) and reminiscing about how we survived the covid crisis years and our patients (and quite possibly ourselves) will no longer be experiencing the psychological fallout from a pandemic that has generated widespread fear, social phobia and depression in so many people, especially young people.