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Mental Health in the Age of COVID-19

It is 3:00am and I am awake. Again.

This is the third time this week. I reach for my phone and open up my social media app where I scroll through the latest COVID-19 updates in a group of doctors that is 13,000-strong. My eyes frantically try to keep up with numerous graphs, projections, news stories and the impacts of compromised mental health during COVID-19. Scattered in between these are personal stories of frustration, anger or even complete denial of the scale of the problem.

By the time I manage to get to work and see my first patient at 8:00, my mind has already spent 5 hours ruminating about COVID-19. My eyes are dry and my shoulders already feel heavy. Surely this behaviour is unsustainable? A chat in the tearoom with my colleagues, sitting 1.5m away from me, reveal this phenomenon to be common.

As we find ourselves in the midst of a one in 100-year event that has upheaved our daily schedules, it is normal to feel stressed, worried or anxious. With rapidly changing government policies regarding work and play, isolation and uncertainty prevails over consistency, routine and social interactions. Many of us in the healthcare and technology industries, who are still able to work and have a steady income, watch in fear as those in the hospitality, retail and tourism industries lose their jobs and livelihoods. We worry about the future and about the economy.

Is the government doing enough?
Why did they let all those people off the Ruby Princess?
Are we doing enough to look after mental health during COVID-19?
Will there be a global economic recession or a depression on the other side of this pandemic?

Stress occurs when there is a perceived threat that is beyond our ability to control. When we are are stressed, there are physiological changes within our body that cause us to be more alert and vigilant. This is commonly known as the ‘fight or flight’ response. If the threat is continuous or persistent, those physiological changes can affect our emotional health and well-being in the form of anxiety.

Anxiety, much like a chameleon, can manifest in many ways. It can be as subtle as mild irritability and a reduction in concentration, to a more noticeable insomnia, early morning rising or reduced appetite, to full blown panic attacks with physical symptoms. This can be compounded by our current situation of physical and social isolation, that has become an mandated part of life today.

How Can We Deal With the Constant Strain on Mental Health during COVID-19?

The first step to coping is to accept that there are many variables that are completely out of our control, such as the duration of this pandemic; how many people will be affected; how others are responding to the situation and if there is enough toilet paper at the shops.

The second step is focusing on the variables we do have control over – such as our daily routine, finding enjoyable things to do at home, connecting with and supporting our friends, families and colleagues. Practically this may involve simple things like going for daily exercise in the morning, getting ready everyday, going to ‘work’ in a dedicated room and clearing it away when work has finished, having breaks, doing activities with the family, debriefing with friends and colleagues and switching off the news and social media. Some workplaces have created virtual ‘tea rooms’ or ‘water coolers’ in their respective meeting applications where staff can drop in at random times, as they would if in an office, and catch up with other colleagues whom they may not interact with regularly.

Of the above, daily exercise is proven to be the most effective intervention for stress at a population level. This is likely because sunlight and the natural hormones that get released during exercise can elevate the mood. For me personally, limiting social media and the news has also helped significantly as my brain gets a break from the constant negative stimulus after 7pm every night. Re-discovering the myriad of enjoyable things to do at home such as gardening, board games and reading, to finally getting through the decade old to-do list of sorting travel photos and decluttering, these activities have provided a welcome sense of achievement.

The link below is a great resource that explains how our normal worries can become excessive, and it provides some methods on how we can stop ourselves from progressing through a negative chain of thoughts that can lead to heightened risk to our mental health during COVID-19. There are also some practical tools included, such as an Activity Menu to keep occupied and a Decision Tree about how to prevent ourselves from overthinking things which are out of our control.

Click here to download a helpful PDF on managing stress and anxiety during this difficult time.

If these simple measures do not help to improve how you are feeling, then it may be time to check-in with your GP.

Authored by:


Dr. Fabrina Hossain
Clinical Advisor at Best Practice Software

Do You Know What Mental Health Is? View from a Doctor’s Desk – Dr Lisa Surman

World Mental Health Day is today (October 10th) – a chance to look at how we can support our patients’ mental health. The Do You See What I See? campaign aims to challenge perceptions about mental illness, encouraging everyone to look at mental illness with a more positive light to reduce stigma and make it easier to seek support and help for the one in five Australians affected by mental illness every year. The campaign has enrolled over 700 organisations asking everyone to make a #MentalHealthPromise and to take a more positive view . The promises that have been made by individuals are at 1010.org.au The website has some suggestions for promises you may like to make and a page to post your own promise and associated image. Stigma around mental illness remains an issue for Australians, delaying or preventing people from seeking help. The misconceptions and misrepresentations about those who experience mental illness can be damaging, including references about those suffering from mental illness as being incompetent, weak or scary and appear in the media, the arts and conversations at school, work and in the home. The majority of people affected by mental illness are able to lead contributing and independent lives in the community with treatment and support. The website encourages a different light to look at mental illness, colour and life, resilience, bravery, recovery, hopefulness, courage, contribution and more. To learn more about mental illness, and provide valuable resources for your patients, there are several organisations with easily accessible online information: SANE Australia at https://www.sane.org/mental-health-and-illness Beyondblue at https://www.beyondblue.org.au/the-facts/what-is-mental-health Headspace at https://www.headspace.org.au/young-people/what-is-mental-health/ World health Organisation at http://www.who.int/features/factfiles/mental_health/en/ To find help: see Mental Health Australia https://1010.org.au/need-help or mindhealthconnect Guided Search Tool: https://www.mindhealthconnect.org.au/   Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

Mental Health Remains the Most Common Reason for a GP Visit. View from a Doctor’s Desk – Dr Lisa Surman

With this month being Mental Health Month, the focus is on the importance of the mental health of our patients and the resources we can provide, which was highlighted in the Australian Health of the Nation Report. The recently released annual Royal Australian College of General Practitioners (RACGP) Health of the Nation Report identified the current health trends and issues for General Practice . Patients see GPs more than any other health professional and 84% visit their GP multiple times a year. Three in every four patents report that their GP always listens carefully, shows respect and spends enough time with them. Mental health issues such as depression, mood disorders and anxiety remain the most common health issue managed by GPs and was also identified as the health issue causing GPs the most concern for the future, followed by obesity. Mental health and obesity were the key areas the federal government should prioritise for action. One in four Australians will face a major mental health problem in their life, mental health being the ability to think, feel and behave in a way that allows us to perform at our best – in our personal lives with family and friends, at university at work and in the community. The most common issues are anxiety and depression. Learning to manage anxiety and/or depression can make a difference to how your patients react to stresses in life and feel calmer. There are many levels and different techniques and tips on how to achieve this :
  • Exercise regularly
  • Eat well
  • Get enough sleep
  • Practice relaxation exercises
  • Reduce alcohol and drug use
  • Spend time with friends
  • Ensure work/study/life balance
  • Use cognitive strategies to deal with stressful thoughts
  • Practice mindfulness to let go of worries
  • Engage in enjoyable and fun activities
Take the opportunity during Mental Health Month to encourage patients to reach out for further assessment, support and referral if required. There are also a host of great resources you can refer them to on the Australian Government’s Head To Health website. Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

How Successful is Australian IVF? View from a Doctor’s Desk – Dr Lisa Surman

As health professionals, it’s important to have the latest information and resources on IVF. A recent report published by the University of New South Wales announced that 18% of IVF cycles in Australia and New Zealand result in a live birth Of the just over 81 000 initiated IVF cycles in 2016-2017, 82.2% resulted in either a successful embryo transfer or all oocytes/embryos being preserved at subzero temperatures for use in IVF ( cryopreservation) In 2016-2017 the highest annual number of births in Australia and New Zealand IVF’s history were recorded, 15,198 babies. The proportion of IVF cycles resulting in twins and triplets is now one of the lowest rates in the world, 3.8%. The average age of women being treated with IVF is 36 years. The report was produced after the Victorian Government announced a review into the state’s IVF laws to ensure women were getting accurate information from IVF and fertility doctors about success rates and treatment options. Each cycle is expensive, with IVF Australia figures showing patients are out of pocket as average of $ 4,707 for their first IVF cycle and $4,151 for subsequent cycles. The IVF success rates published for Australian Fertility Clinics can be misleading The rates are given as live birth per pregnancy or per embryo transfer and do not take into account all those whose cycles did not result in an embryo transfer or those pregnancies that do not go to term. Different countries have differing laws regarding public access to fertility treatment outcomes. Australia’s IVF success rates are assumed to be similar to those of the UK. According to the UK’s National Health Service, between 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was 29% for women under 35, 23% for women aged 35 to 37, 3% for women aged 43 to 44. The Human Fertilisation & Embryology Authority is the UK Government’s independent regulator overseeing fertility treatment and research. This site provides clear outlines about the different treatments available and the associated options, including risks and results.  The HFEA is a very useful reference for Australian women as the fine details are not easily available and not mandated by laws. The IVF success rates published for US Clinics are higher than Australian rates possible because there was a much higher rate of multiple births from the US Clinics. For your patients planning or currently trying to start a family, a valuable resource could be The Fertility Coalition, formed by four organisations in Australia – the Victorian Assisted Reproduction Treatment Authority, Andrology Australia, Jean Hailes Research Unit and The Robinson Research Institute; and funded by the Australian Government Department of Health and the Victorian Government Department of Health and Human Services. The site provides facts about fertility for men, women, trans and gender diverse people to make the best possible decisions about having children for your circumstances, the most up to date scientific information to improve fertility. See yourfertility.org.au For your patients choosing an IVF Clinic and about to attend the first appointment a useful guide is available here. Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

R U OK? Day. View from a Doctor’s Desk – Dr Lisa Surman

For the medical community, the annual R U OK? Day reminds us to stay connected, have meaningful conversations and encourage more people to ask R U OK? at work, school and in the community. The website includes suggestions for simple steps that could save a life :
  1. Ask
  2. Listen
  3. Encourage action
  4. Check in
There are conversations tips, videos of how to ask and resources including how to find professional help if needed if the conversation becomes too big for family and friends. Lifeline provides a directory of free or low cost health and community services available in Australia for areas such as domestic violence, family and children’s services, financial assistance and mental health services at lifeline.serviceseeker.com.au The BeyondNow suicide safety plan app helps create a safety plan in crisis and distress for those in need, ideally with support us, as health professionals, or someone they trust, to work through when they are experiencing suicidal thoughts, feelings, distress or crisis. The app is available to download and to read further about the app, see beyondblue.org.au The Headgear app provides workers with a simple and anonymous way to assess and monitor their mental health. The app was developed by researchers at the University of Sydney and the Black Dog Institute. The app guides the user through a 30 day mental health challenge aiming to increase wellbeing and reduce risk of future mental health problems. moodGYM is an online self-help program that has been available since 2001, using cognitive behaviour training to develop skills to manage depression and anxiety symptoms. The program allows real-time self monitoring of problem moods, thoughts and behaviours via mobile phone or computer. Those using the programme monitor three symptoms of their choice or three recommended to them by myCompass through answering the profiling questionnaire ( eg stress, depression, confidence, worry, irritability, motivation, diet and medication use) See moodgym.com.au myCompass is a self-help tool for mental health, providing proven techniques to help manage stress, anxiety and depression. Here are some of the agencies that offer good support to those in need:
  • Lifeline, 1311 14 for 24/7 crisis support, the Suicide Call Back at 1300 659 467
  • kidshelpline at 1800 55 1800 for counselling to young people under 25 years
  • Griefline on 1300 845 745
Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.  

View from a Doctor’s Desk. Women’s Health Week – by Dr Lisa Surman

For everyone working in health, Women’s Health Week is a chance for us to take stock, look at trends and find new resources to help female patients. The Women’s Health Survey of more than 15,000 Australian women is a valuable “snapshot” of women’s health in Australia. It reveals that while they are juggling children, the digital world, career and ageing parents,  more women are exercising ( 70.3% are doing more than 2 hours of moderate exercise weekly)  and less are smoking ( 90.5%). However, there are concerning statistics regarding their wellbeing that, as health professionals, we need to be aware of:
  • 50.8% of surveyed women describe themselves as overweight or obese
  • 9.5% of women drink daily
  • 46.1% of surveyed women have been diagnosed with depression or anxiety by a doctor or psychologist
  • 34.5% of women reported not getting enough time to themselves on a weekly basis
  • 66.9% of women reported feeling nervous, anxious or on edge nearly every day or on more than seven days in the past few weeks
Jean Hailes for Women’s Health conducted the survey and Director, Janet Michelmore says the data demonstrates the complex demands on modern women who are either trying, or think they are expected, to do so much. She says that time is the biggest barrier for women who are trying to make health a priority, but finding that a challenge. Social media also plays a part in the expectations of women to always appear as perfect. You can read the whole report here. The Jean Hailes Women’s Health Week runs all this week (3rd to 7th September) and for more information visit www.womenshealthweek.com.au. The organisation provides free daily videos, podcasts, stories, recipes and more throughout the week. The Jean Hailes Organisation provides practical, accessible evidence-based and reliable  information on the website and in 2016 was recognised officially as the Federal Government’s national digital gateway for women’s health. A valuable resource, indeed, for giving the best possible care to Australian female patients. Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

Is Breast Best? View from a Doctor’s Desk – Dr Lisa Surman

Public health officials around the globe were stunned when the American delegation attending the World Health Assembly in Geneva sought to soften the resolution to encourage breast feeding, after decades of research has demonstrated that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes. It is believed that the US delegation was influenced by the interests of infant formula manufacturers, seeking to remove language that called for governments to ” protect, promote and support breastfeeding” and for policy makers to restrict the promotion of inappropriate food products to infants and children. When Equador tried to save the proposal, the US threatened trade sanctions and diminished military aid. In the end Russia introduced the measures which were introduced with most of the original wording Breast feeding is the optimal way to feed neonates and infants. Breast milk provides complete nutrition, is readily available, helps prevent infection and has long term benefits such as improved cognitive and neurological development and reduced likelihood of obesity. Benefits to mothers include weight loss, reduced risk of osteoporosis, ovarian cancer and breast cancer. A study published in the Lancet in 2016 announced that “breastmilk makes the world healthier, smarter and more equal” and predicted that 800 000 child deaths a year across the world could be prevented and $300 billion in savings from reduced health care costs and improved economic outcomes for those reared on breast milk. There is some nuance to the evidence for the benefits of breastfeeding as the benefits are not possible to disentangle from socioeconomic factors in observational studies. Scientists are not ethically able to conduct double-blind studies providing one group of infants with breast milk and the other breast milk substitute. A small number of women are unable to breastfeed their baby and breast feeding can be difficult for many reasons. Support for breast feeding is critical, including institutional provisions, emotional support, reassurance, practical help and information. Importantly parents need support, advice, practical assistance and no judgement from professionals, community and peers. Resources, an online forum and links to social media or a local group for breast feeding women are available at breastfeeding.asn.au More fact sheets are also available at https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-overview Reliable sources of information about medicine use in breastfeeding are LactMed http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT and Infant Risk Centre at www.infantrisk.com/categories/breastfeeding For those who are unable or who chose not to breastfeed the online group at  fearlessformulafeeder.com is dedicated to providing non-judgemental support for all new parents at #ISupportYou   Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites

View from a Doctor’s Desk – Dr Lisa Surman

Getting Health Screening Advice from your trusted health professional Recently, a TV show gave the impression that having a blood test for prostate specific antigen (PSA) and digital rectal examination by a Urologist for prostate cancer was potentially life-saving, and showed a popular presenter having the screening tests done. The specific benefits and harms were not broken down, nor quantified. There was no discussion about the very well documented pros and cons to weigh up before the test and although acknowledging the risk of impotency and incontinence as a consequence of prostate surgery, it was framed as though it was a thing of the past, “The treatments are so vast these days that it’s not as bad as all that, and you’ve got to get checked. You must get checked.”   For men aged 50-69 (without a family history of prostate cancer) the benefit/harm debate for prostate screening using the PSA test is unclear and open to individual interpretation. The decision to have the screening test is a personal one and needs to be done after weighing up the benefits, harms and uncertainties of prostate cancer screening. If you have a PSA test, you are much more likely to be over-diagnosed and over-treated for prostate cancer than have your life saved from early detection of a nasty form of the disease. This is why the Australian Government does not have a funded, organised prostate screening program and why the Royal Australian College of General Practitioners advises members not to recommend PSA screening to patients. A digital rectal examination is no longer recommended should a man request screening for prostate cancer after being informed about the risks and benefits of testing. The National Health and Medical Research Council (NHMRC) advises that a patient who asks a GP about the tests, should be informed of the following information calculated for men in their 60s with no first-degree relatives affected by prostate cancer who have yearly PSA tests. The stated potential benefits are reassurance if the PSA is normal or very low, early detection and early treatment, hopefully cure. The potential harms are false positive results, with unnecessary biopsy required, false negatives, over-diagnosis and overtreatment resulting in harmful effects without any health benefit. Potential Benefits:
  • For every 1000 men tested, 2 men will avoid death from prostate cancer before they reach 85 years. This benefit seems greater for men with a strong family history of the disease
  • For every 1000 men tested, 2 men will avoid metastatic prostate cancer before the age of 85 years
Potential Harms:
  • For every 1000 men tested, 28 men will have prostate cancer diagnosed, many of whom would have remained without symptoms for life
  • For every 1000 men treated, 25 men will have surgery or radiation because of uncertainty about which cancers need to be treated. Many would do well without treatment
  • 7 to 10 of these 25 men will develop persistent impotence and/or incontinence and some will develop persisting bowel problems from the treatment
  • For every 2000 men tested, one man will have a serious cardiovascular event, such as a heart attack because of the treatment
The advice delivered in the television series ” The medical checks you have to have” was not in line with current RACGP guidelines nor NHMRC guidelines, which do not recommend routine PSA measures without discussion, nor routine digital rectal examinations as part of screening. To read the fine detail of the NHMRC recommendations for PSA testing in asymptomatic men, click here. The RACGP also has a fact sheet to help men make the decision as to whether they will screen for prostate cancer at racgp.org.au and available from your GP. Information has been developed for men with a family history of prostate cancer that is available on the NSW Health Department’s Centre for Genetics Education website at www.genetics.edu.au/Genetic-conditions-support-groups/prostate-cancer-screening Andrology Australia ( andrologyaustralia.org) have very detailed, but easily understood fact sheets available with further detail about the statistics and risks of prostate cancer screening. Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.