In March 2020, many West Australians were glued to their televisions, as Premier Mark McGowan announced he would be exercising the “Rottnest Option” – sending international cruise ship passengers and possible COVID-19 cases to quarantine on an island, 20 kilometres offshore.
It was clear that the government’s COVID-19 strategy would have significant implications for Australians’ mental health and well-being. We know the potential costs of mental health on our economy and community are enormous.
In response, UWA, with support from Minderoo Foundation, quickly launched a national survey to capture data from individuals experiencing Australia’s quarantining and social distancing measures.
From April to June 2020, the “COVID-19 CARE (Connected Activated Resilient & Engaged) Study”* collected data over a 14-day window from approximately 2500 Australians to improve understanding of the impact quarantine (n=132) and social distancing (n=2393) have on mental health.
Unsurprisingly, quarantining at home is less damaging than quarantining in a facility (such as a hotel), particularly for those with a current mental health condition. In fact, 100 per cent of participants experiencing mental health issues reported negative impacts when quarantining in a facility, compared to 42 per cent of those who isolated at home.
In our sample, 16 per cent of respondents who underwent quarantine had a current mental health condition diagnosis in the study sample. A further 20 per cent had been diagnosed with a mental health condition in the past.
Simply the prospect of quarantine substantially increases anxiety. Half of all people surveyed who had a current mental health condition diagnosis perceived their risk of becoming isolated or lonely during quarantine as “high” to “very high,” compared to just 23 per cent of people with no history.
Within the social distancing group, young people, students and the unemployed were most concerned about negative outcomes. As in the quarantine group, perceived risk of loneliness and becoming mentally unwell was much higher in those with a pre-existing mental health diagnosis.
But even people with no history of mental health issues expressed high rates of concern. In fact, almost 40 per cent of respondents with no previous mental health diagnosis perceived their risk of becoming isolated and lonely as “moderate” to “very high.”
According to figures released in October by the Department of Health, 130,000 travellers have been quarantined since March. Given an estimated one in five Australians have some sort of mental or behavioural condition, the number of people in this group with a prior or current mental health diagnosis is likely to number in the tens of thousands.
Modelling by the University of Sydney suggests Australia is likely to experience sharp spikes in rates of mental distress and suicide – costing lives and billions of dollars of lost productivity.
The key implication of the CARE Study’s findings was, wherever possible, people who are required to quarantine should be given the option of quarantining at home – particularly if they have a pre-existing mental health issue.
Of course, this must involve taking a cautious approach to the health risks of likely further transmission of COVID-19 – we know the rate of compliance with home quarantine is not 100 per cent, and the cost of COVID-19 transmission includes both illness and death. Enabling this option will likely require extra transport arrangements and/or additional home visits, raising the cost of quarantine arrangements. Arguably, these costs would be outweighed by the potential savings for the community in future health services.
Focused efforts also need to be made to bolster the mental health of young people, students, the unemployed and those who already have a mental health diagnosis. While front-line mental health services have been prioritised in the recent federal budget, we need to focus on early interventions that are both scalable and meet the unique needs of young people, who are less likely to seek help than other age groups. In particular, evidence-based, technology-enabled solutions that can offer complementary mental health support in an accessible and scalable manner will be crucial.
While the cost of responding to mental health risks may seem significant, the long-term cost of inaction – socially and economically – is too high for us to wait.
* The “COVID-19 CARE (Connected Activated Resilient & Engaged) Study” is being carried out by Dr Julie Ji, Dr Julian Basanovic, and Professor Colin MacLeod at the University of Western Australia’s School of Psychological Science, in collaboration with the Forrest Research Foundation and Minderoo Foundation.
Fiona was appointed as the inaugural Research Chair of Minderoo Foundation in 2018. In her previous role as Executive Director of Global Research for Minderoo Foundation’s Walk Free, Fiona led the team that created the Global Slavery Index, from its 1st to 4th edition. A lawyer and criminologist, Fiona has worked for more than twenty years at the intersection of crime, law reform and human rights.
Julie Ji is a Forrest Research Fellow in Psychological Science at UWA. She completed her PhD at the University of Cambridge, and was one of two fellows appointed in the 2017 inaugural fellowship round.