The Aftershock of the Pandemic — a Brief Essay
Mental health impact in a dysfunctional health system
The necessity to prioritise protection of life cannot be rationalised with. Preventing explosive viral spread resulting in the calamitous situation of the emergency health system getting overloaded — with potentially more sick people requiring ICU beds than we had capacity for — needed to be done before anything else.
But, when Scott Morrison and Chief Medical Officer Prof Brendan Murphy hesitated for too long from implementing further containment measures after they presciently, admirably, closed our borders to China earlier than the World Health Organisation were advising, the medical community nervously swelled into calls for more decisive action — especially after the Ruby Princess debacle in Sydney, which injected the biological equivalent of a ‘cluster bomb’ into NSW.
We managed to dodge that bullet…of mushrooming viral spread reaching a critical mass whereby we would have lost control over it, leading us to the kind of carnage we viewed with growing horror happening in Wuhan, Milan, Iran and NYC. We quashed the wave before it became a tsunami. We carried off a small miracle. We watched in quiet horror the growing numbers of infected all around us worldwide, whilst we studied and worked from home and applied for financial concessions and welfare payments. But there will be a "secondary health impact” of the pandemic — an aftershock that also needs to be reckoned with: the downstream adverse effects of job losses, financial stress and social isolation. And how will we cope with that wave? The Australian on 25 March wrote an article 'Coronavirus: Mental health strategy targets risk of suicide surge’ that quoted eminent youth psychiatrist Prof Pat McGorry: “It will be a challenge to meet the new demand, as it will be difficult to see people face-to-face.”
And “Unlike the physical health system, the mental health system is not fit for purpose.” That’s because the non-medical penny-pinching bureaucrats who took over its management in the 80s ‘reformed' it by plucking out all its feathers, ground it down, eroded it, and, quite frankly, decimated it over these many years to become a frugal, bare-bones, base 'crisis care’ minimalist version.
It is never too late to construct a superior quality, cutting-edge, world’s best health system. That would require a reconfiguration though — the medical specialists would need to be deployed to take control to re-design, re-build and take over operation of it based on modern healthcare principles. That would need to replace the dysfunctional despotic, populist, medieval principles and soul-less practices that have been allowed to flourish.
The key method would be putting the experts in charge and revising the administrative job descriptions such that bureaucrats would be working alongside the clinicians, following their leadership and guidance about healthcare matters. It would need to be enshrined in legislation to never again allow to creep into place such a sick, topsy-turvy, dysfunctional system model where the tail wags the dog — administrators telling the healthcare experts how to do their job should never be allowed to happen again. Lives are lost, disability rates soar much higher and huge amounts of healthcare dollars are wasted than need to be the case.
If only the administrators had listened to the doctors about how to manage what was primarily a healthcare emergency…we could have avoided the billions of dollars now needing to be spent on welfare, rebuilding the economy (when we were so close to a budget surplus that the pollies could smell it) and the coming likely aftershocks of the pandemic.
I’m not going to hold my breath waiting for anyone to learn anything from what happened and to change the entire administrative model and dysfunctional healthcare culture when administrators are more in control of it more than politicians are, and whilst politicians are more likely to ask those very bureaucrats for solutions (where the solution is that most of them should be sacked due to the excessive layers of bureaucracy present) than to ask healthcare clinicians in any meaningful way. The way the Government currently goes about asking for health system reform advice, when they do (which is mostly setting up expensive committees made up of non-experts), is meaningless and leads to no change at best and at worst to wasteful and meaningless reshuffling, musical chairs and more expensive bureaucratic layers being added onto an already fractured system due to the number of criss-crossing unnecessary layers and superficial populist models and solutions.
No, I’m just going to get on with treating, in the private sector, anyone needing care, all those with existing mental health problems and new onset. A fascinating clinical aspect is the different psychological responses I’ve seen to the pandemic and the subsequent measures and restrictions to deal with it. I’ve noticed 3 broad categories of response:
- Majority have had an amplification of their distress and propensity to symptoms due mainly to the restrictions especially those finding themselves stuck with dysfunctional and/or triggering families.
- Smaller but substantial group who feel surprisingly good — they are in fact relieved that they are no longer outliers as their distress levels are being felt by everyone else — they feel more ‘in sync’ with their social environment, which appears to be a healing experience for them. I’ve noticed they have a spring in their step.
- Very small group of very angry patients who experience a perverse pleasure and gratification that the human race is suffering what they perceive as a biblical punishment for society’s multiple crimes — against humanity, the environment, for failing to protect the more vulnerable...like they were. This group are hoping to come out on top — that this catastrophe, like the biblical flood, will be a great leveller, equaliser and give them some degree of psychological reparation. I ran this categorisation by 550 of my colleagues and their response was that their experiences matched mine.