PEOPLE: Providing mental health services in an overloaded industry during a pandemic

CONTENT WARNING: The following article mentions suicide and domestic violence. If this triggers something or you need to talk to someone, please called Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636. If you’re in immediate danger, call 000.

During the coronavirus pandemic, many are doing it tough, including the thousands of healthcare workers on the frontlines. Sarah Goulding is one of these frontline workers, taking on night shifts to deliver much-needed mental health services to patients, while homeschooling during the day. In this interview, she shares how she has seen the mental health industry evolve throughout her career, her experiences during the pandemic, and advice for others considering a career in this space.

  • Working in the mental health space, what are the major mental health challenges you’ve seen Australians struggle with and how has that changed over time, particularly now during COVID-19?

The major challenges we face in mental health are access to service issues and under resourcing. Access to community mental health services and inpatient beds remain an issue – long waitlists for community treatment teams, blockages in Emergency Departments for consumers awaiting and inpatient beds.

Staff are constantly under pressure to move people through the system as quickly as possible, to make more space for the high demand of patient flow. This has resulted in poor patient outcomes and high staff burn out rates. 

The majority of struggle during COVID-19 has been the sudden spike in mental health issues whether consumers have pre existing conditions or new presentations. When you have a system that is already overloaded and these unprecedented events occur, it can be quite catastrophic. Consumers have been struggling with a range of emotions, such as panic, hoarding, low mood, and anxiety. We also have to consider our consumers that have pre existing mental health conditions who have relapsed under the stressful conditions of social isolation. 

There have been reports of impulsive suicide in the community and for consumers in quarrantine. There has been a major spike in domestic and family violence cases. 

Over time we have learnt to adapt to staff shortages, bed shortages and lack of resources, however the rapid increase of mental health presentations and relapse in consumers with pre existing conditions has made it very difficult to manage. COVID-19 has required public services partnering with private services, cooperation and problem solving to try and attend to the needs of a community in crisis. My hope after COVID-19 is for more awareness on the fragility of our community especially post the bushfires, we need mental health services more than ever.

  • What are some of the signs people should recognize as indicators that someone needs professional mental health support? 

As a general guide, I would look for behavioral changes, mood shifts, food intake, sleep, levels of motivation and socialization, (even via Facetime during COVID-19) irritability, hopeless or helpless themes in conversation.

Risk issues can be a difficult conversation to have with another person, however if they express suicidal ideas or thoughts of suicide it is really important that they speak with a professional immediately to get advice. Options include your local G.P, telehealth services such as Beyond Blue, Life Line and Suicide Call Back Service. If there are imminent risk issues it is best practice outside of business hours to contact 000 and attend your local Emergency Department. Another challenge we are facing is that consumers that are acutely suicidal are very reluctant to attend hospital or be admitted to an inpatient unit for fear of contracting COVID-19, so there is a huge amount of pressure on community services right now. 

If there are changes in mental state with low risk, for more than 7 days and the symptoms are unchanged or worsening, the first place to start is with your local G.P who can link you to the appropriate support, and if there are ongoing issues, then there are alternative options for pharmacotherapy and more intensive specific therapies.

Secondly, pre existing mental health conditions and managing relapse are very much dependent on the diagnosis. As a community we are predominantly educated on  Depression and Anxiety, Diagnoses such as Bipolar Disorder, Schizophrenia, Personality Disorders and Eating Disorders are far more prevalent than most of the community are aware. In many cases most people would not know what to look for. For example, Eating Disorders have the highest mortality rate of all psychiatric conditions. I think as a community we are very uncomfortable about discussing suicide, self harm and challenging or difficult behaviours. We need to be more transparent and direct more attention to capture a better view and understanding of mental health outside Depression and Anxiety.

  • Particularly now, as many are struggling with increased stress, anxiety and loneliness, how can we help others in our life who may be struggling with these things, but who we can’t physically be close to at the moment?

Maintaining emotional contact with the people in your life is very important. Even though we may not be physically present, when we have presence, albeit, technology based, it does give us the sense of company and emotional contact. Using Facetime, Zoom and other social platforms are helpful in maintaining a sense of familiarity, connectedness and staying in touch with laughter, thought and conversational skills.        

Encouraging and assisting people in using technology online is also important – Online G.P reviews, telehealth appointments with Psychologists and Mental Health Social Workers.

Similarly, for the elderly setting up an ipad or sending videos if they have tech – or if not lending them simple tech and showing them how to use a device to maintain contact – is really helpful. For the elderly that don’t have these options, family, friends or carers, slip a card into their letterbox, phone them, check in with them. It makes a difference.

  • You believe diversity is important so we get a better understanding and appreciation of where people are coming from and their experiences. What are some of the best and worst things you’ve experienced in your work, where that understanding or appreciation did or didn’t exist?

The best experiences I’ve encountered in my work are seeing recoveries, and those consumers living their best life, having the opportunity to specialize in Eating Disorders and learning so much from clinical information to service design and implementation. Being invited to speak at a consultation group during the Royal Commission into mental health (Victoria) was a humbling experience to meet people you would rarely have an opportunity to speak with. CEO’s of NGO’s, Board of Health and Hospital Directors, the Commissioners – it was great to speak about a variety of my experiences in real time with people of influence and that have the ability to make social change. 

The worst experiences are obviously suicides of consumers we work closely with, and working with severely mentally ill consumers requiring physical or chemical constraint can also be very confronting. Involuntary detention is always an unpleasant way in which to work, however in some cases it is necessary for the safety of the consumer, their carers and the public. 

Mental health is a very difficult and complex profession. We often work in high pressure environments, making serious decisions in short time frames, working with severely distressed consumers and families. It requires a certain skill and knowledge level. We often work alone or in very small teams, and in the long term, on a sub conscious level, the cumulative effect of trauma is manifest through our interpersonal relationships, and workplace culture. I think at times this has led to very negative workplace dynamics which is hard to navigate if you are early on in your career and have not had time or experience to re frame and reflect.

  • Would you recommend a career in mental health to others? Why or why not?

I would recommend a career in mental health. If you are passionate about people, if you are passionate about social justice, and have a legitimate interest in psychiatry then it’s certainly a place where you will get to experience many different bio psychosocial scenarios, learn about different legislation, micro, meso, macro systems and public service structure and development. It is a multi-faceted career path and you do have the ability to specialize in different areas. 

However, in my experience, you will need a rigorous self-care and external professional supervision regime, be open to learning, adjusting and adapting to scenarios because unlike general medicine, Psychiatry is not linear, there are no direct cures only treatments. At times I’ve found this frustrating, but I do have hope that mental health will slowly get the full recognition that it deserves and consumers get the highest quality of service.

About the expert

Sarah Goulding is an Accredited Mental Social Worker and Family Therapist. She has spent the past 19 years working in public mental health services. She has worked on Inpatient units, Community Care Teams, Crisis Assessment and Treatment Teams, Emergency Department Triage, Eating Disorder Treatment and Recovery, mental health service design and development, private practice, telehealth and community consultation groups in Victoria and NSW. Her passion, commitment to quality, education, awareness and advocacy for mental health continues to guide her practice and she is always inspired and motivated by consumers’ strength and resilience, with the hope of continually improving the space in which we work.