THIS summer’s ongoing and unprecedented bushfires have caused tragic human fatalities, killed a billion animals, destroyed homes and burned millions of acres.
The impacts of the bushfires go beyond physical harms and will have lasting mental health impacts. The government recently announced a $76 million mental health support package for people affected the disaster.
But is this enough? The short answer is no.
Experience from the 2009 Black Saturday fires in Victoria tells us that the mental health impacts will likely be protracted. The Beyond Bushfires Study found that 5 years after the bushfires, 22% of people in high impact communities were still reporting symptoms of mental health disorders at approximately twice the rate evident in low impact communities and higher than what would be expected in the general population.
Analysis by Deloitte Access Economics of the Black Saturday fires found that the social costs of the fires, including mental health problems and unemployment and increases in suicide, substance misuse, relationship breakdowns and domestic violence, were worth $3.9 billion in 2015 dollars.
The recent fires have burnt 25 times more land than the 2009 Black Saturday fires and the current fire season is not over yet.
A national survey by the think tank the Australia Institute has found that most Australians have already been affected by the bushfires and related smoke pollution. Their research states that it’s probable that more than 5 million people have suffered adverse health impacts as a result of the fires.
The scale of the current bushfire crisis is immense and will require a longer term comprehensive response to prevent serious impacts on many Australians and Australia’s health system.
It is normal for people to feel angry, distressed and anxious after an overwhelming event. However, bushfire victims, firefighters and other support personnel are at risk of developing post-traumatic stress disorder, depression, anxiety and complicated grief. Unless adequately treated, these disorders carry the tragic risk of suicide. Some of the people afflicted will self-medicate with alcohol or drugs, fuelling the risk of addiction. Mental health problems may take years to manifest.
We urgently need to plan how to get mental health care to the people who need it now, and to those who will need it in the future.
What problems need to be addressed?
There are already significant barriers to obtaining mental health care in rural communities. The per capita number of mental health professionals is significantly lower in rural areas compared with the number in major Australian cities. Fly in/fly out (FIFO) services are often used, but have been criticised because they cannot provide appropriate 24-hour support. Their short visits make it difficult to build relationships with local communities and to develop the required cultural awareness.
The federal government’s establishment of a new body, the National Bushfire Recovery Agency is welcomed but this agency must not delegate its long term mental health care response to existing state mental health services, which are already overstretched. The mental health care response to the current crisis requires additional long term resources funded by the Commonwealth. The agency needs to facilitate education to service providers and to the public about the psychological impact of trauma and on the importance of providing skilled and empathic trauma care when needed.
Supporting social networks and community is also important in fostering recovery and in cultivating resilience. Examples include public education about the disaster’s mental health impacts and how people can rebuild their lives. All support systems, including the insurance industry, need to respond empathetically and avoid inflexible responses.
The mental health impacts of the bushfires go beyond those directly affected. Hazardous smoke has blanketed major metropolitan areas for prolonged periods and curtailed normal life. Children have been unable to play outside and sports events have been cancelled. It is likely that many people exposed to news of fatalities and witnessing graphic media images of the fires, desolate landscapes and injured and dead animals have experienced increased anxiety.
These experiences can have an impact on mental health in the population. As a psychiatrist, I have observed patients who present with chronic stress, anxiety or depression about climate change – “eco-anxiety” or a chronic fear of environmental doom is at large. This anxiety is fuelled by feelings of helplessness.
This unprecedented bushfire season is a reminder that climate change poses an existential threat unless we take action to limit global heating to 1.5°C.
Even with such action, Australia will have to adapt to a more flammable future. This will require more than new approaches to land, fire and emergency management. It will also require new approaches to building community and personal resilience.
As global heating worsens, the frequency of natural disasters will increase and there will be less time for survivors to recover. There are limits to resilience and recovery in the face of overwhelming threats, and no amount of adaptation will maintain Australia’s quality of life when faced with the catastrophic impacts of global heating of 2°C or 3°C.
This is why peak medical bodies around the globe have classified climate change as the biggest threat to human health in the 21st century. As medical professionals, we have a responsibility to our patients to urge our politicians to base their decisions on the predictions of climate science.
The government must adopt carbon emissions targets in line with the science which will require a reduction of 7.6% per annum over the next decade to avoid a human and environmental catastrophe.
To meet this challenge, we must move beyond hyperpartisan politics. As humans, we have an innate biological drive that fosters the bonds between us. We must find a way for the competing interests in the climate debate to cooperate in order to save ourselves, our children and the planet on which we all depend for our survival.
Robert Llewellyn-Jones is a psychiatrist with extensive experience helping people to heal from the impact of traumatic events. He is a member of Doctors for the Environment Australia.
If this article has raised issues for you, help is available at:
Doctors’ Health Advisory Service (http://dhas.org.au):
- NSW and ACT … 02 9437 6552
- NT and SA … 08 8366 0250
- Queensland … 07 3833 4352
- Tasmania and Victoria … 03 9280 8712 http://www.vdhp.org.au
- WA … 08 9321 3098
- New Zealand … 0800 471 2654
Medical Benevolent Society (https://www.mbansw.org.au/)
AMA lists of GPs willing to see junior doctors (https://www.doctorportal.com.au/doctorshealth/)
Lifeline on 13 11 14
beyondblue on 1300 224 636
beyondblue Doctors’ health website: https://www.beyondblue.org.au/about-us/our-work-in-improving-workplace-mental-health/health-services-program
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.,nh