Bushfires, drought and a pandemic have together taken a severe toll on the mental health of rural communities – but our support services need to move away from being reactionary and crisis-triggered, and more consistent and holistic.

Tessa Cummins is the Program Manager of the Rural Adversity Mental Health Program (RAMHP), an initiative of the Centre for Rural and Remote Mental Health, and has worked closely with communities bearing the brunt of a devastating year.

“COVID-19 was the straw that broke the camel’s back and really showed what compounding adversity can do to people”, she told HealthTimes.

“All of this adversity – bushfires, drought and COVID-19 – doesn’t happen in isolation, though. People don’t disaggregate their trauma and stress depending on a particular event.”

“Our response needs to recognise this, and not be polarising where a person can only access a service if they’ve been affected by bushfires, but not if they’ve been impacted by drought.”

“We need a longer term, holistic approach to adversity in rural areas and get services that align to that – as opposed to having one-off, intense support reactions and then moving on to the next one.”

Ms Cummins was commenting on the release of new recommendations from the Royal Commission into National Natural Disaster Arrangements on reducing the health and human cost of future bushfire seasons, and other natural disasters.

Among the Commission’s 80 recommendations was a call to prioritise mental health support during and after natural disasters.

CEO of the National Rural Health Alliance (NRHA), Dr Gabrielle O’Kane, told HealthTimes that rural communities have been profoundly impacted by the cumulative effects of drought, bushfires and the pandemic.

“Many lives have been lost and people have suffered acute and ongoing health issues such as respiratory and cardiovascular problems.”

“Frontline organisations are also seeing an increase in the prevalence of psychological conditions such as disaster-related trauma, depression and financial stress.”

“Although resilience is a hallmark of rural people, these disasters have significantly impacted the health and wellbeing of communities, which are already disadvantaged by barriers to accessing services and shortages of health professionals”, Dr
O’Kane said.

CRRMH recently released a paper highlighting how rural adversity overlays normal hardships, and extends beyond natural disasters. The authors recommend that rural adversity be understood as a combination of experiences rather than as discrete events - this in turn has implications for preparedness, response and recovery planning.

Ms Cummins said that the major impact on people’s mental health has been the result of the exhaustion and prolonged stress that comes with relentless drought conditions.

“You’re just not sure when the drought is going to break. This affects people’s decision making, and things can deteriorate quickly from there.”

And then, COVID-19 happened. Ms Cummins said that at the start, rural communities believed they would be largely protected from the effects of the pandemic, but the implications started to quickly roll in.

“Agricultural business thought they were getting the season they needed, then they were lumped with a whole heap of extra restrictions and guidelines, and that ability to process all these decisions after years of stress was very difficult.”

Ms Cummins said that with the introduction of social distancing measures, communities that had relied on coming together to support each other through tough times were dealt another blow.

‘Luckily, it started to rain at that point, so from a hope perspective, there was a little more left in the tank.”

Dr O’Kane commented that the NRHA welcomed the Australian Government’s $76 million mental health package for communities affected by COVID-19.

“We need to ensure that affordable health services are in place well beyond this latest health emergency response.”

“The current focus on mental health is targeted and welcome, but to be sustainable we also need a commitment to improving the recruitment and retention of a highly skilled rural health workforce.”

Ms Cummins explained the RAMHP initiative, currently comprised of 20 coordinators across rural NSW, continues to play a key role in connecting people to mental health support and services.

“We provide tailored advice on what services they can access, be it online or in the community. It’s very hard to navigate the system in rural areas, so our coordinators provide one-on-one advice on how to best access help.”

“We also do a lot of education, and upskilling of community members and organisations to support someone and identify when they may be struggling.”

She said this made a real difference over the summer period, where local members of the community had the skills to be able to support their friends in need.

“Because our coordinators live and work in those communities, they already know local services and stakeholders, so when disaster happens, they already have a relationship with the community.”

“We're often the only ones left when other services leave an area after a disaster. We are there trying to keep stakeholders in the same room, and figuring out how to get a community back on its feet.”

Ms Cummins said a current focus of RAMPH was to work alongside local councils and committees to develop individualised, tailored approaches that meets the needs of different communities going forward.

“This won't be the first bad bushfire season, or the last drought, so we’ve got to make sure service models are able to support people right throughout the journey.”