Rapid deployment of support for a mental health crisis: 10 priorities framing Australia’s COVID-19 pandemic response

Keywords: community, COVID-19, mental health, policy.

In response to the first cases of COVID-19 in Australia in January 2020, state and national governments implemented travel restrictions and border closures, followed by incremental restrictions on social gatherings, culminating in nationwide recommendations for people to stay at home where possible from 24 March 2020. These measures aimed to prevent disease transmission, protect vulnerable groups, and preserve health system capacity. Pandemics, and measures implemented to control them, can negatively impact mental health (Peng et al. 2010; National COVID-19 Health and Research Advisory Committee 2020). However, most people demonstrate resilience in the face of disaster and some find new strengths (Pfefferbaum and North 2020). Those at increased risk of mental illness during a public health emergency include people with previous mental illness and psychosocial and/or socioeconomic vulnerabilities, such as healthcare workers, people who have experienced abuse (Brooks et al. 2018), those having to self-isolate or quarantine (National COVID-19 Health and Research Advisory Committee 2020), and those suffering short or long-term economic consequences, including job insecurity (Burgard et al. 2012).

In Australia, COVID-19 unfolded alongside a mental health system that was already under pressure, accompanied by a sense of urgency to identify and address deficits in system capacity to support citizens’ mental health (National Mental Health Commission 2019). In November 2019, the Council of Australian Governments (COAG) agreed to address the critical issue of Australia’s mental health in light of three ongoing, parallel enquiries: the Australian National Mental Health Commission (NMHC) 2030 Vision for Mental Health and Suicide Prevention (National Mental Health Commission 2019), the 2019–2020 Royal Commission into Victoria’s Mental Health System (Royal Commission into Victoria’s Mental Health System 2020), and the Productivity Commission’s inquiry into the social and economic benefits of improving mental health (2018–2020) (Productivity Commission 2020). In addition to research examining the mental health impacts of isolation and quarantine (National COVID-19 Health and Research Advisory Committee 2020), these investigations provided important evidence to inform decision-making. They highlighted the groups most vulnerable to poor mental health outcomes during the pandemic, including young people, older people, and people with complex, chronic and severe mental illness (National Mental Health Commission 2020a).

On 29 March 2020, at the peak of Australia’s first tranche of restrictions, the Government announced a A$74 million funding package for mental health initiatives. Australia’s National Mental Health and Wellbeing Pandemic Response Plan was developed by the National Mental Health Commission (NMHC) in collaboration with the states and territories, represented by New South Wales and Victorian Governments, and mental health sector leaders with lived, clinical, and research experience. The aim was to monitor and model the mental health impact of COVID-19, strengthen outreach capability, and improve connectedness through clear pathways of care and coordinated service linkage to guide both short- and long-term mental health interventions. Utilising the 10 priority areas identified in the Plan (Box 1), we summarise Australia’s national mental health policy response to COVID-19 from January 2020 to December 2021. Australian Government mental health initiatives are outlined in Table 1, and some Victorian Government initiatives during the Victorian second wave during mid-2020 are in Table 2. Fig. 1 presents these chronologically in the context of the evolving epidemiological curve.

Table 1.  Australian Government COVID-19 mental health initiatives.

Table 2.  Victorian Government mental health initiatives during the COVID-19 second wave until September 2020.

Fig. 1.  Australian Government mental health initiatives during the first 8 months of the COVID-19 pandemic.

In March 2020, the NMHC launched a national online campaign, #InThis Together (National Mental Health Commission 2020b). Communicated through conventional and social media channels, the aim was to support social and emotional connections during the pandemic. Links were provided to the many community-based services that were already responding. Reframing the phrase ‘social distancing’ to ‘physical distancing with social connection’ was an important aspect of promoting active, problem-based coping mechanisms associated with resilience in the face of stress (Southwick et al. 2005). Australia’s past investment in reducing the stigma associated with mental illness (Beyondblue 2015) and existing networks of community mental health services provided a foundation for building community trust and engagement.

The potential for COVID-19 to increase suicide rates (Reger et al. 2020) led to calls for urgent preventive action, acknowledging that increased risk need not translate into fact (Morgan 2020). Critical needs such as improving remote access points and staff training to support new ways of working were addressed, together with the introduction of economic safety nets, including the JobSeeker and JobKeeper initiatives (Prime Minister of Australia 2020c). Additional funding through the MRFF to investigate the mental health impacts of COVID-19 aimed to provide rapid and actionable scientific evidence within 12–18 months of commencement in 2020 (Table 3; Minister for Health and Aged Care 2020a).

Table 3.  Medical Research Future Fund 2020 COVID-19 Mental Health Research-funded projects.

A dedicated COVID-19 mental health support website, Head to Health (Australian Government Department of Health 2020b), was established to provide educational resources and services, with particular attention to populations identified as vulnerable. Specific funding was directed to expand existing online, telephone and digital support services. This included fast-tracked access to headspace for young people aged 12–25 years and training additional counsellors to meet potential increases in demand for services provided through Kids Helpline and Lifeline. Specialised services were also bolstered, such as the Butterfly Foundation, Eating Disorders Family Australia, the Older Persons Advocacy Network, Perinatal Anxiety and Depression Australia, and support for families, schools and employers through the Raising Children Network (Raising Children Network Australia 2020). This facilitated responsiveness to the 25–56% increases in service demand reported by Beyond Blue, Lifeline and Kids Helpline in May 2020 (Prime Minister of Australia 2020b).

Loneliness became a parallel epidemic with the potential to negatively impact physical and mental health (Nobel 2020). For some, including older people, migrants and refugees, social distancing compounded existing isolation and loneliness (Armitage and Nellums 2020; Lima et al. 2020; National Academies of Sciences, Engineering and Medicine 2020; National COVID-19 Health and Research Advisory Committee 2020). For many residents of aged care facilities, loneliness was amplified by visitor restrictions. In March 2020, further funding enabled the expansion of a community visitor scheme to help older people stay connected by telephone or online. This bolstered the Commonwealth Home Support Programme for older Australians, allowing the provision of emergency food supply boxes to people’s homes during the pandemic.

Social isolation measures may result in reduced access to drugs of dependence and substitution with other drugs, or use of alcohol or drugs as a coping mechanism. Reduced access to support services can lead to relapse for some in recovery (Alcohol and Drug Foundation 2020). Anticipatory government funding enabled the scale-up and expansion of services such as the Alcohol and Drug Foundation, Turning Point, and SMART recovery.

People with existing mental health challenges experienced both physical and mental health impacts. Emerging evidence indicated that some people with complex, chronic, and severe mental illness had disconnected from services early in the pandemic (National Mental Health Commission 2020a). Peer support services were expanded for those with urgent, severe, and complex mental health conditions. Existing psychosocial support services for community mental health clients were extended to prevent delayed presentations and increased acuity and severity of subsequent presentations (Prime Minister of Australia 2020a).

Dedicated funding enabled Beyond Blue, a prominent national mental health support organisation, to develop resources for people experiencing COVID-19-related stress or anxiety, including an information hub, digital resources and a 24-h telephone counselling service (Beyondblue 2020). Gayaa Dhuwi (Proud Spirit) Australia was funded to develop culturally relevant resources for Aboriginal and Torres Strait Islander peoples.

New telehealth measures were rapidly implemented in March 2020, to facilitate safe access to regular healthcare while reducing the risk of COVID-19 transmission (Desborough et al. 2020; Hall Dykgraaf et al. 2021). Both first contact and continued engagement with mental health services were supported by introducing specified telehealth items for mental health care services under the MBS. An increase from 10 to 20 annual Medicare-subsidised psychological therapy sessions offered under the Better Access Initiative were made available for people subjected to further restrictions (Minister for Health and Aged Care 2020b). This was subsequently expanded to aged care residents in response to the Royal Commission into Aged Care Quality and Safety COVID-19 Special Report (Australian Government Department of Health 2020a).

The well-being of the healthcare workforce, as the foundation of the health system, was considered crucial (Pfefferbaum and North 2020). Healthcare workers have suffered high levels of distress and anxiety in previous pandemics (Black Dog Institute 2020a), and funding initiatives aimed to support workforce capacity, including training additional counsellors for services such as Kids Helpline, Lifeline, and headspace. Head to Health’s healthcare worker portal provided links to Mindspot, where psychological tips for frontline staff were available (Australian Government Department of Health 2020b). TEN – The Essential Network for Health Professionals, a resource developed by the Black Dog Institute with nine collaborating organisations, was launched in May 2020 (Black Dog Institute 2020b).

Planning and decision-making were facilitated through data sharing across jurisdictions, with responses informed by local needs, services, and epidemiological context. During the second wave in mid-2020, a joint Commonwealth and Victorian Mental Health Pandemic Response Taskforce was established to support the implementation of 15 new mental health clinics in Victoria and ensure they complemented existing services while avoiding duplication and fragmentation. These clinics, initially established in Greater Melbourne (n = 9) and regional Victoria (n = 6) for 12 months, were welcomed by communities and mental health providers, resulting in calls for their continuation (Kinsella 2021). In August 2021, 10 additional clinics were established in NSW, with 12 Victorian clinics extended until June 2022. The recently developed National Safety and Quality Digital Mental Health Standards (Australian Commission on Safety and Quality in Health Care 2020), were available to support the uptake of digital mental health services.

The first tranche of social restrictions effectively limited the physical health impact of the pandemic and started to ease from early May 2020. The potential for ongoing and long-term mental health impacts of COVID-19 containment measures was acknowledged. Further investment was aligned to the National Mental Health and Wellbeing Pandemic Response Plan and announced when National Cabinet endorsed the plan on 25 May 2020. For many Australians, the initial reprieve was short-lived. In mid-June 2020, community transmission of COVID-19 began increasing in Victoria, culminating in stage 4 restrictions plus a nighttime curfew in metropolitan Melbourne and stage 3 restrictions in regional Victoria for several months. Intermittent lockdowns occurred across state jurisdictions during late 2020 and early 2021. In August 2021, following the easing of mask wearing and physical distancing restrictions and coinciding with the emergence of the Omicron variant, a resurgence of cases was seen in NSW, followed by Victoria and Queensland (Australian Government Department of Health 2022).

Preceding the pandemic, in November 2019, demand for mental health services in Victoria had reportedly overtaken capacity and was being ‘driven by crisis’ (Royal Commission into Victoria’s Mental Health System 2020). Re-imposing restrictions during the State’s second wave tested community resilience even further. The impact was felt on work, social and family life, by healthcare workers and their families, and those combining home schooling and home working. Older residents of aged care facilities were particularly affected, which was distressing for their loved ones, who were again unable to spend time with them due to isolation restrictions. In response to this second wave, the Victorian Government implemented several complementary initiatives, outlined in Table 2.

By 10 September 2020, 3360 Victorian healthcare workers had been diagnosed with COVID-19; 17% of Australia’s 19 668 total cases (Victorian Healthcare Association 2020). In the preceding month, national helplines reported both increased calls and severity of distress (Morgan 2020). Victorian emergency departments reported a 19% increase in presentations for emergency and urgent mental health services. Particular concern was expressed for young people, with a 33% increase in presentations for self-harm observed (Dunlevie 2020). In response, further Australian Government funding focused on supporting young people, including Year 11 and 12 students, tertiary students and young unemployed through outreach services connected with headspace. Beyond Blue’s capacity to provide 24/7 web chat support was expanded. Assistance was given for Lifeline and Kids Helpline to respond to additional service demands (Department of Health 2020). Additional funds were directed through PHNs to supplement support for people with severe mental illness affected by COVID-19 (Minister for Health and Aged Care 2020c).

In August 2020 the NMHC, in partnership with 20 mental health organisations, launched the #Getting Through This Together campaign (National Mental Health Commission 2020c). Key at-risk groups were prioritised, including women and children, people struggling with financial and unemployment stress, young people – especially year 12 and university students, women, and vulnerable people living alone or disconnected from support services and community. On 17 August, the Victorian Government announced additional funding for family violence services (Premier of Victoria 2020a). As Victorian COVID-19 cases decreased in September, the impact on secondary students and economic impact on businesses was acknowledged. To support recovery, early rollout of the secondary school mental health practitioners initiative (Premier of Victoria 2020b) and a $3 billion funding package for businesses were announced by the Victorian Government (Premier of Victoria 2020c).

In November 2020, a further $10 million was committed to a new NMHC ‘Hows’ your head today?’ campaign that urged people to prioritise their mental health and encouraged identification of problems and help-seeking behaviour (Minister for Health and Aged Care 2020d). In August 2021, 10 additional pop-up clinics were opened in the greater Sydney region in response to widespread outbreaks across NSW. The operation of 12 Victorian clinics was extended until 30 June 2022 (Vines 2021).

Building on pre-pandemic concerns about underfunding of the mental health system relative to the burden of disease and the social impact of mental ill-health, there is a growing need for mental health strategies targeting at-risk groups and those with the poorest mental health, including youth and those in regional areas (Enticott et al. 2021). The substantial mental health impact of the pandemic, unfolding against this background (Rosenberg et al. 2020), poses composite risks but may also offer opportunities to reshape responses to ongoing challenges for mental healthcare in Australia (Blecher et al. 2020). Guided by the National Mental Health and Wellbeing Pandemic Response Plan, national policy responses aimed for greater engagement with people with lived experience of mental health issues, more agile coordination between acute and primary care, and acknowledgement of essential social and basic needs such as housing for the homeless. However, limited data are currently available to assess outcomes.

Early reports indicated that expanded levels of service and technical integration between primary, community, and tertiary mental healthcare, and access to e-health, were key to organising an effective response in Australia (Rosenberg et al. 2020). Head to Health was a well utilised resource, with significantly increased traffic. Utilisation of the dedicated COVID-19 pages more than doubled the average daily sessions during October 2020, with over 380 000 unique views in the 7 months to 26 October (Minister for Health and Aged Care 2020d). Consistent with the marked switch towards telehealth delivery modes for many healthcare services, remote mental health consultations were also widely adopted. Over 2.4 million phone and video consultations were undertaken by general practitioners, psychiatrists, and other mental health service providers between March 2020 and September 2021 (Services Australia 2022). Further research is required to evaluate the effectiveness of these initiatives, and Government funding has been dedicated for this purpose. Funding was distributed rapidly to various providers – many more than described in our tables and figures. Despite efforts to the contrary, this might have resulted in duplication and fragmentation of mental health services.

Australia’s emergency mental health response to COVID-19 was supported through more than $500 million in Australian Government funding allocated in the first 6 months of the pandemic. This investment targeted expanded capacity for existing services and rapid development and implementation of new services. Collaborative planning, early recognition, and ongoing reflexive policy initiatives were instituted to progressively support community mental health and wellbeing as the COVID-19 pandemic evolved throughout 2020 and 2021.

The data supporting this study will be shared upon reasonable request to the corresponding author.

Michael Kidd, Ruth Vine and Mark Roddam were employed by the Australian Government Department of Health when this paper was written. Jane Desborough, Sally Hall and Ashvini Munindradasa were on secondment to the Australian Government Department of Health at this same time.

This research did not receive any specific funding.

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