The impact of Covid-19 and lockdowns – Considerations for Suicide Prevention

Covid-19 is far from over – but what do we understand as the main challenges in our national recovery?

The following summarises what we currently know about the impact of Covid-19 from the available evidence. Of course, in the middle of yet another lockdown in Sydney, we see the ongoing pressures associated with the national management of the virus, together with political tension as we ‘map a pathway out’. This can create uncertainty, discomfort, and ambiguity, especially because in a time of crisis we often look to our leaders for resolution.

Covid-19 has really put a magnifying glass to the existing inequities in our society. While we highlight who experiences the greatest impacts of this pandemic, we also focus on opportunities for engagement and intervention.

Where are the greatest impacts?

The elderly have felt the most significant impacts from the virus, not only due to morbidity and mortality. Measures to avoid infection have increased social and emotional isolation, contributing to loneliness, poorer health, & mental health generally. Further, those in residential care are likely still affected by factors identified in the Royal Commission into Aged Care Quality & Safety.. With 148 recommendations, there are too many cites, however, the most pressing seems to be ensuring high quality, compassionate care is implemented by skilled and diligent workers. This is only possible when they are supported by the system which is complicated by changing Covid-19 management measures.

Financial insecurity has impacted several sub-populations, including itinerant and casual workforces and occupational groups, such as hospitality and entertainment. The circumstances also compound existing financial pressures associated with unemployment and underemployment. History indicates that economic recession and financial insecurity are associated with the most adverse mental health and suicide-related outcomes.

Covid-19 has had significant implications with respect to job insecurity and labour market participation notably for women in their 20s, but certainly young people generally. Although young men have typically had higher rates of unemployment, young women have experienced greater rates of un- and under-employment in 2020 specifically due to Covid-19 and the associated lockdowns. Women tend to fill more retail, hospitality, and accommodation roles, which do not easily transition to work from home. Further, women tended to lose their job when they concurrently hold family/caring responsibilities, more so than their male counterparts.

Covid-19 is noted to increase the potential for domestic and family violence. It has been described as a ‘perfect storm’ for gender-based violence, but more so for people identifying as LGBTIQ+, with a disability, of CALD background, and/or elderly. Those groups that had marginal access to support services prior to Covid-19, likely find those barriers amplified in the current circumstances.

Lockdowns and restrictions amplify conditions for parental burnout, child abuse, and neglect. Parental burnout is defined as the ‘prolonged response to chronic and overwhelming parental stress’ is associated with emotional and physical exhaustion, resulting in parents emotionally detaching from their children. As such, Covid-19 is likely to exacerbate the psychosocial conditions that underpin child abuse and neglect, as parents attempt to juggle ongoing, competing responsibilities.

Stress and distress experienced during the early stages of the pandemic have been described as ‘transient’ for the majority of people. For those with pre-existing mental health conditions, social, work/education, and financial stress is likely to exacerbate and maintain mental illness – in part due to pressures and in part due to the likely reduced access to services, caused by lockdowns, social distancing, and increased demand.

Natural disasters including bushfires, drought, and floods experienced by Australians immediately before and during Covid-19 have compounded the impacts of Covid-19 and the severity of distress experienced. With evidence that one in three Australians were impacted by the severe bushfires in 2019, not to mention drought and flood, it is projected that one in five Australians are likely to report ongoing mental health symptoms due to the compounding effects of natural disasters while concurrently managing effects of Covid-19.

Substance misuse has been flagged as a concern during the Covid-19 pandemic, where sales in alcohol have risen markedly across the world, and at least in the USA, there has been up to a 40% increase in overdose death in some regions. Concerns are many, including increased stigma and discrimination associated with substance misuse, increased health complications associated with substance misuse generally and specifically when fighting Covid-19 infection, and psychosocial hazards of increased prevalence of violence, mental health, and substance use disorder, and difficulties in following community orders, such as social distancing when intoxicated.

What do we know about Covid-19 and suicide so far?

Many of the challenging experiences that have been intensified by Covid-19 are also risk factors for suicide. While the above research demonstrates that psychological distress during the Covid-19

pandemic has been high, there is no evidence to date that there has been a corresponding rise in suicide deaths to date for Australians.

Is this because we have had sufficient and effective support? We are yet to see what has assisted in navigating the Covid-19 path through so far, and indeed, whether the impacts are simply delayed. With pressures of Covid-19 ongoing (including for those living in Sydney right now) and there is yet to be some certainty in how post-Covid-19 life will progress. However, as mental health professionals, we are seeing firsthand the impacts of the psychosocial pressures on those we work with, including clients, colleagues, family, and the greater community who may be struggling.

Support systemic interventions

Despite these challenges, there is a range of actions and interventions to prevent the ongoing impacts at a community and population level to prevent potential suicide-related outcomes.

Consider how you understand and engage with each of the above populations and circumstances impacted.

• Are you equipped to identify and respond to identified risks?
• What would you do to make a difference in those communities?
• Can you offer alternative behaviours and supports for those in need?
• Would you lobby for labour market programs to support employment and training options?
• Advocate for additional and ongoing funding to be specifically allocated to local services that meet the above impacts, including domestic and family violence, alcohol and substance misuse, and mental health to name a few.

There is of course the potential for significant changes in suicide risk for our communities as Covid-19 continues to impact. We need to be responsive and aware of who our most vulnerable people maybe – but we also need to think about our own wellbeing, after which time we can ensure our ongoing capability to make a local impact.

Actions to guide our way forward

Acknowledge the impacts – take it as an opportunity to share how you are feeling with others and invite them to talk with you about how they are going. Focus on coping skills that might help them get through tough times.  Talking about how it affects you can be the icebreaker to better understand how those around you are also going.

Collate a list of local resources together with national services, such as Lifeline, Beyond Blue, and Suicide Call Back Service so you have things at hand if you or someone you care about needing them. Local resources are particularly important if you are looking for activities or connections.

Harness the benefits of technology – for your social media contacts, make the decision to privately reach out to people to check in on how they are going. Think about what you want to share and ask – doing this through private messaging allows you to have more meaningful conversations as well as engage with someone for longer. Better still, talk with them by phone or video call.

Exercise – Exercise can really help to lift your mood, as well as offer those additional health benefits. Check out YouTube for ideas if you have existing health limitations or your living arrangements make movement limiting. There are also many exercise-at-home apps available now, which are excellent sources of motivation and fitness ideas for people who need extra motivation or are unable to visit the gym due to lockdown restrictions. Consider Peloton, 7 Minute Workout, or Daily Yoga.

Practice mindfulness and gratitude through a mindfulness meditation app such as Smiling Mind, Headspace, and Calm. Better still, think about initiating a self-care routine where you may have a range of practices to explore mindfulness and gratitude.

Set yourself a ‘Lockdown goal’. This could be to learn a new skill, get creative, return to an old passion, or simply read a book. It shouldn’t be a chore that makes you feel guilty if you don’t get to achieve it, but certainly, something that leaves you feeling inspired and excited if you can make a start.

Reach out to professional supports if you find there are impacts that are hard to adapt to or when the impacts are getting more significant. As professionals, we are likely to put our own mental health needs behind those of the people we work with – but we are such an important link in the recovery of others that we need to practice what you preach!

Focus on the future – when we are in the middle of an event or situation that is causing us to feel low, sad, or isolated, reminding ourselves that Covid-19 is not a permanent state can be useful in reframing the negativity. While we will likely have to deal with the risk of Covid-19 for years to come, vaccines are being delivered and other countries have found a road map out of Covid-19 where life has resumed some sense of normality. Having positive thoughts about change and improvements can help us focus on the future and reframe our perceptions of today.