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Expert calls for frontline mental health preservation

Friday 15, May 2020

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Expert calls for frontline mental health preservationAssociate Professor David Lawrence, a mental health researcher at the University of Western Australia, has called for essential frontline health workers to be given time to process, rest and recover after each shift caring for coronavirus (COVID-19) patients. The call is based on Associate Professor Lawrence’s expertise drawn from cases of post-traumatic stress disorder (PTSD) he has researched among Australia’s emergency workers and bushfire fighters. Associate Professor Lawrence has also highlighted the importance of having a good level of social support in place for frontline workers, which is especially challenging due to current isolation requirements.

“I think that the COVID-19 pandemic and all the disruptions associated with it are a unique situation that we don’t really have ready experiences to draw from in forecasting what the longer term impacts might be,” Associate Professor Lawrence said. “What we have learnt from our work with emergency services workers is that the cumulative exposure to multiple traumatic events over a period of time can impact on wellbeing. Resilience also is not just a yes/no concept, where you either have it or you don’t. For anyone, even those with high levels of resilience, there are potentially things that can overwhelm their innate resilience.”

Associate Professor Lawrence’s advice is informed by his research project ‘Answering the call, national mental health and wellbeing study of police and emergency services’, and also on research he is currently involved in that explores the impact of the summer bushfire season on the mental health and wellbeing of first responders. This research focuses on organisational and team culture, and workplace factors that can affect mental wellbeing, including attitudes and experiences of stigma and discrimination. It considers the use of support services when needed — including those provided within and outside agencies — and the barriers that might stand in the way of someone seeking help when needed.

Respondents to his ‘Answering the call’ study included ambulance, police, fire and SES employees, volunteers and retired personnel. Respondents answered questions about their wellbeing and resilience, anxiety conditions, depression, PTSD and suicidal thoughts. “In terms of COVID frontline health workers, there are already reports emerging from New York, Italy and other places where there have been large numbers of cases and large numbers of deaths, of physicians and health workers becoming overwhelmed by the enormity of the challenge confronting them,” Associate Professor Lawrence said.

Almost half of employees and one in three volunteers in emergency services have been diagnosed with a mental health condition, and half the employees have experienced a traumatic event in their work that deeply affected them. Further, one in three emergency services and police employees experience high or very high psychological distress compared to one in eight Australian adults.

“If we were to apply lessons from emergency services workers to frontline health staff, optimally we would want to ensure that everyone working on the frontline in Australia has adequate time to rest and recover after every shift,” Associate Professor Lawrence said. “Of course that would not be possible if the caseload were swamping the available healthcare resources. We would also want to ensure that our healthcare workers have good levels of social support, which is also challenged somewhat by the isolation requirements of this highly infectious virus.”

Research to date has shown that a culture exists within emergency service organisations that may impact help-seeking — with an assumption being that as these people had helped others in emergency situations, they should be strong enough to deal with a range of challenges, without needing help. “This definitely impacts on help-seeking when it is needed,” Associate Professor Lawrence said.

“There is some evidence that some doctors feel similarly about mental health issues too. This sometimes results in people dealing with an accumulation of stress over an extended period of time in unhelpful ways such as the use of alcohol. When problems aren’t addressed, when they arise they can become more impactful and more difficult to treat. One thing we do know about PTSD is that early treatment is associated with much greater chance of full recovery with much less intensive treatment.”

Associate Professor Lawrence also said that little is known currently about the mental health impact of the public referring to bushfire fighters, emergency service workers and COVID-19 healthcare workers as their “superheroes”. “I think that some people appreciate the recognition and others really don’t,” Associate Professor Lawrence said. “Our research on the impacts of this summer’s bushfires is still very much in early stages, but people do seem to have responded to it in different ways — eg, some people thought the offers of payment for bushfire volunteers were tokenistic compared to the amount of work.”

If you are affected by any of the issues discussed in this article, Lifeline has a 24/7 crisis support service that can help, please call 13 11 14.

For the latest information on Australia’s whole-of-government response to COVID-19, visit

Image credit: © Kneschke