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EVEN in a “best-case scenario”, Australia is forecast to see an increase in suicide deaths of “at least” 13.7% over the next 5 years, according to a new report released by the University of Sydney’s Brain and Mind Centre.
Maintaining employment programs such as JobKeeper, investing in education programs, and doubling the capacity of mental health services could help Australia navigate the “perfect storm” of mental health risk factors and prevent more than 1500 suicide deaths in the next 5 years, say the authors.
The Road to recovery: restoring Australia’s mental wealth report, released late last week, highlighted the importance of coordinated economic, education, social and mental health measures in safeguarding the mental health of Australians in the wake of the coronavirus disease 2019 (COVID-19) pandemic. The report cautioned that more awareness may not be the answer, forecasting that mental health awareness programs may increase mental health-related emergency department (ED) presentations by 5.2% in the 2020–2025 period.
The authors developed a prototypic national system dynamics model (to complement previously published place-based models) as a decision support tool to forecast the impacts of proposed economic, education, health and social measures.
The authors modelled three scenarios:
- a best-case scenario, which assumes unemployment reaches 11.7% and youth unemployment rises to 19%;
- an extended-duration scenario, which retains the peak unemployment rates of the best-case scenario but extends the duration of high unemployment (ie, unemployment stays above 8.5% and youth unemployment above 15% until August 2022); and
- A worst-case scenario which assumes unemployment reaches 17% and youth unemployment rises to 26.1%.
Each of these scenarios also assumes a 10% reduction in community connectedness resulting from social dislocation unrelated to job loss (eg, working from home, not participating in sports, reduced social gatherings), which will persist for a period of 12 months.
According to the model, under the best-case scenario, Australia was likely to see 19 878 suicide deaths over the period 2020–2025, an increase of at least 13.7%.
The best-case scenario also forecast that there would be 173 123 hospitalisations for self-harm and 1.6 million mental health-related ED presentations.
The authors also modelled the effects of broad strategies and directions for which there is national support or commitment, namely employment programs (eg, JobKeeper), mental health awareness programs, and potential expansion of the Better Access scheme (lifting the cap on the number of sessions with psychiatrists, psychologists and allied professionals that can be claimed on the Medicare Benefits Schedule). They further modelled the impact of education support programs to increase enrolment to post-secondary education and vocational training, and initiatives to increase capacity of mental health services.
The report authors found that the most effective strategy modelled to “bend the mental health curve” was a combination of employment programs extended to March 2022; youth education programs; a doubling of current growth rate in community-based specialist mental health services; coordinating multidisciplinary, measurement-based care enabled through technology; and post-suicide attempt assertive aftercare.
“This combination is projected to prevent 97 030 mental health-related ED presentations, 13 842 self-harm presentations, and 1590 suicide deaths over the period 2020–2025,” the report said.
Report co-author Professor Ian Hickie, Co-Director, Health and Policy, at the Brain and Mind Centre, told InSight+ that the most important intervention in reducing the adverse mental health impacts of COVID-19 was the duration and scale of the JobKeeper program.
He said JobKeeper was all about keeping people connected with jobs, and this was crucial.
“JobSeeker isn’t the same – that’s about paying people welfare once they are out of a job. We want to keep people in jobs,” Professor Hickie said, noting that fear of unemployment was a key driver of psychological distress.
“During lockdown, people have used their resources, they have used their savings, they have kept their businesses afloat, they have borrowed from their superannuation, they have been distressed about the social dislocation. We already know that rates of psychological distress are markedly increased, particularly in young people and in women and rates of suicidal ideation have gone up and we are already seeing this in presentations to EDs.
“We have the perfect storm of factors that put people’s psychological health at risk.”
Lifeline has reported a 22% spike in calls from Victoria, compared with the same time the previous year, in the days after Melbourne and the Mitchell Shire went into lockdown for the second time.
Professor Hickie said this additional demand for mental health care came at a time when Australia’s mental health system was already “broken”, pointing to the Royal Commission into Victoria’s Mental Health System and the recently released Productivity Commission report.
“In my view, unless there is a massive expansion in public mental health, we will not be able to cope. And the only way to do that is for the public sector to purchase capacity from the private sector,” he said. “Just as [federal Health Minister] Greg Hunt bought all the ventilators to ensure access to ventilators in the early days of the pandemic, that’s exactly what we need for mental health.”
Professor Hickie said complex modelling was critical in guiding the response to the potential mental health impacts because some approaches could make matters worse.
For instance, he said, expanding the Better Access scheme by lifting the cap on the number of sessions with psychiatrists, psychologists and allied professionals that could be claimed on the Medicare Benefits Schedule, would increase demand for services but not capacity.
“The [mental health] workforce is gradually growing, but in the short term, demand will rapidly increase and you could make the situation worse, because some people will miss out on care,” he said.
This latest report comes after InSight+ last week published a View from experts at the Black Dog Institute questioning the validity of the Brain and Mind Centre’s previous place-based modelling. That modelling, released in May, had projected that increased unemployment, social disconnection and health services at capacity would result in an extra 750–1500 suicides per year over 5 years, with an increase rate of 25–50% per year.
The Black Dog Institute authors wrote that there was a wide variance in the forecasts made in the Brain and Mind Centre modelling and that of the Epworth Centre for Innovation in Mental Health at Monash University, which predicted relatively lower increases in the suicide rate over the coming decade.
They cautioned against the reliance of modelling studies in designing suicide prevention interventions, saying that empirical data were “a more useful resource than modelling studies in informing response planning as they are free of the assumptions which inform modelling studies”.
Professor Hickie stood by the findings of the complex modelling and simulation, saying that such dynamic modelling played a crucial role in informing suicide prevention measures because they accounted for the interaction between factors.
“Our models do not just look at employment on its own, as simple regression models do,” he said. “Dynamic models tell you potentially which sorts of programs – JobKeeper, education support, mental health programs – will achieve the biggest effects and how to best frame this support.”
Professor Hickie said that while complex modelling and simulation had not been extensively used in psychiatry, its use was well established in other professions such as economics and engineering, and such modelling had also been crucial in guiding the infectious disease response to the COVID-19 pandemic.
“In psychiatry, we have tended to fall back on very traditional epidemiology, which is excellent in predicting the past and uses simple regression models against simple outcomes.”
Responding to criticism that the Brain Mind Institute’s modelling lacked transparency, Professor Hickie and co-researcher Associate Professor Jo-An Atkinson said:
“Much rigorous modelling is done by reputable agencies that produce real-time reports for government, and other substantive agencies and sources. Most is not directed simply at producing academic reports. While we support the call for greater transparency in modelling, transparency does not in itself represent a reliable indicator of the utility or robustness of predictive modelling.”
Professor Hickie also said that relying on data collection to inform a mental health response was “a complete nonsense”.
“This is like waiting until we have all the COVID-19-attributed deaths in 5 years’ time to work out what we should do with COVID-19 next week in Melbourne,” he said.
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It’s scary to see the statistics for the year in Australia, alone. And the one topic never touched by the media is suicide. We all know one or more, I’m sure. And the numbers go up every year. With new influences like social media impacting people’s emotional state.
It’s like the quiet killer. Taking lives daily. Yet I’m sure inside the heads of those who have taken their life, was a torturous screaming mess of despair. Inside themselves.
More needs to be done as a community. Not everyone who needs help will ring a number or sit in an office and “talk” so what can be done to make self esteem build as people grow. Are Indigenous people being helped? Or abandoned. I hear another Dan Murphy’s may open in a remote are. Seriously??? $$$ Are the schools taking in teaching inclusion, that all sexuality’s are acceptable? Is bullying really addressed? Are rape victims or returning soldiers looked after, after-the-fact? My point is – emotionally and mentally is enough being done??? For everyone. Are people allowed to grieve? Do people know how to grieve? Or do we drink or take drugs? So many dots not being joined. Many suffer, alone. Yet we are a sociable society. Something is amiss then. Pressures, disappointments, esteem, worth. Validation. We can all do more to support those around us.
As the mother of a teen who died from suicide last year, I can say that all this talk about services is rubbish. We could get no consistent adequate youth-targeted help. Now suffering in the aftermath, it’s interesting that even with a mental health plan, a psychologist’s gap is at LEAST $60. Unaffordable for more than a few sessions. Someone’s getting rich but the impoverished aren’t able to access this help. Regarding statistics. The true figures are unknown as suicide is often recorded as accidental or otherwise, drug overdose or vehicle “accident”. Then we have the ripple effect. My life is destroyed. We battled for four years to get help. My son is now merely a forgotten statistic from last year. The code of silence leads to lack of education around the signs and my experience is that suicide remains a taboo topic.
Learning more about why people are so vulnerable and providing therapy from a much earlier age. There are always symptoms before the decision is made and most of us can’t see them
Want to start fixing the suicide problem??
Protect our aged & vulnerable from all health threats!!
Open up the borders & lift all the restrictions all over Australia!!
Sadly this topic is often far more complicated than it might appear to be.
As someone who has suffered the loss of a mother to suicide before I was a teenager, I can say that unemployment and loneliness is only a small aspect of the problem. It is always because the distress exceeds coping resources. For some, losing financial security can be a trigger. For others it can be something else entirely.
The solution is to get to the bottom of what is causing someone to feel as though their life isn’t worth living. And, sadly, even then, sometimes that is not enough.
Projections and reality is always different… suicides are silent… there will be much more than the projected scenarios.
Having experienced the chronic apathy towards mental health both personally, and through trying to get serious help for a relation, every avenue was blocked, or filled with amateur psychologists who had more problems than any potential patient. Most people suffering from mental health problems do not have the extortionate prices to see a psychiatrist, and if they do they are treated with a variety of useless drugs that do nothing for the underlying problem, regardless of the absolute honesty of the patient.
My own problems are related to a debilitating disability, I have always complied with a physician’s request, or demand to see a psychologist. They are utterly useless, and so are the psychiatrists. I am lucky that up until now suicidal thoughts have never entered my head, other people are not so lucky. For so many the pathetic apathy of the medical profession to mental health has, and will continue to be much of the reason for the high rate in suicide, especially amongst our youth, and now with our pathetic response to nothing more than a bad flu, there will be a dramatic rise in youth suicide as they are left in Limbo. Those students in their VCE Year have no idea where they stand at present, their entire future’s in many cases will be shattered. There is a destructive entity within our societies and they don’t give a damn about who gets hurt. I fear whatever becomes of our communities, 13.7% maybe a low figure, a low percentage of suicides.
It seems the grim data of the 2020 Australian suicide rate spike is being closely guarded. The Australian government’s own modelling predicted 5000-14000 extra deaths if Sweden’s model had been adopted (see here https://www.aihw.gov.au/reports/australias-health/australias-health-2020-data-insights/contents/summary). I wonder if the suicide numbers have already eclipsed this. As the cancer surgeon commented above, add the secretive suicide numbers to all of the unnecessary cancer deaths, I’m sure history if it is allowed to be accurately written and data-led, will paint a very dim picture of the quarantine.
As recent history has shown how poor modelling is when it comes to predicting healthcare outcomes, it would be beneficial to have more empirical data than simply the rise in calls to Lifeline.
In particular, what is the incidence of suicide and/or attempted suicide so far during the pandemic compared to the same time period in recent years? This would be far more meaningful, and it might indicate whether the models have any hope of being useful.
Is anyone monitoring deaths in medical practitioners and nursing staff – surely the stress of working so close to a dangerous virus in PPE in hot weather in particular when it comes soon is going to push health care workers over the edge for a while and this increase the death rate? Does the Medical Board and their AHPRA drones monitor this sort of thing or is it all done after the event and we can say “so sad too bad”?
Interesting to note that ‘raising awareness’ may be counterproductive. I loathe the catchcry of ‘raising awareness’. In fundraising efforts. It just seems like an excuse to raise income for unproductive chicken littles. Raise money for research into treatments by all means but spare me the hand wringing.
Sobering and concerning statistics in this article about projected rising suicide rates . In the same MJA edition there’s an article by pall care specialist Odette Spruyt expressing her concerns about Victoria’s Voluntary Assisted Dying legislation and normalisation of the practice , calls to expand criteria here and in Canada and the push to train more doctors and to spend more money to provide this .
Those at risk of suicide( as in this article ) AND those considering VAD can ALL benefit from more community services , support and engagement to help alleviate and transform their suffering. We humans are all interconnected.
The irony of the authors in this article wanting to prevent suicides in Australians while the Victorian and WA governments provide VAD as a right to their citizens, while continuing to underfund adequate palliative care and support services is perfectly highlighted .
Suicide is a directly predicted mortality outcome – the associated morbidity in families and communities, combined with the also measurable health outcomes of intergenerational poverty makes for a cruel arithmetic. People will be dying from the secondary effects of this pandemic long after the infection has gone . Do the QALYs add up for the shutdown vs not?
Everyone can consider this a very conservative estimate. It will at least be double. And that’s not taking into account the morbidity of a debilitating psychosis. I’ve maintained right from the start that our so-called expert colleagues have been grossly negligent in ignoring this. They’ve had 102 years since the last pandemic to devise a plan for when the next one happened. And the best they can come up with is to hit the panic button. Simply lamentable. I’m a cancer surgeon so don’t even get me started on the excess cancer deaths as result of this ludicrous strategy.
On the usefulness of modelling, I wonder what Prof Hickie means when he is quoted as saying, “traditional psychiatry …. is excellent in predicting the past”. If he is referring to reliance on past information to devise a model for future possibilities, then my question would be, “how does this differ from all other modelling?” One can add more information according to the complexity of the scenarios, but doesn’t that still rely on past information? I strongly believe in scenarios for future planning. However, obviously they can be disastrously wrong. In fact a typical example of this is the experience of the COVID-19 epidemic, quoted here, strangely, in a positive sense. Improvement in modelling does not come from increasing the numbers of inputs but from increasing their relevance. That can only be based on opinion. Opinion is like scientific theory. It is essential to progress but it is only theory – until all the results are in.
If we tackle reducing suicide statistics via mental health treatment services we might be in trouble. Perhaps another way is to urgently be able to have services that can up-skill the person to live well in the world that they are in. Why don’t we have a federally funded website like this yet?
https://www.nowmattersnow.org/
And, the Better Stop suicide app is worth checking out. https://www.thebetterappcompany.com/better_stop_suicide