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COVID-19 and Psychogeriatrics: the View from Australia International Psychogeriatrics (2020), 32:10, 1135–1141 © International Psychogeriatric Association 2020. ThisisanOpenAccessarticle,distributedunderthetermsoftheCreativeCommons Attribution licence(http://creativecommons.org/licenses/by/4.0/),which permits unrestrictedre-use, distribution, andreproductioninanymedium,providedthe originalworkisproperlycited. COMMENTARY doi:10.1017/S1041610220000885 COVID-19 and psychogeriatrics: the view from Australia “Traveler, there are no paths. Paths are made by walking.” Australia has a universal national health care – from a poem by the Spanish poet Antonio Machado system, Medicare, which covers all citizens and permanent residents. Medicare pays for inpatient, ambulatory, and community care provided by pub- Introduction lic hospitals and subsidizes the cost of inpatient, ambulatory, and community care provided in the The continent of Australia is approximately the size private sector by general practitioners (primary care of the continental United States, with a population practitioners) and other specialists. It also subsidizes of 25.7 million people, 29% of whom were born the cost of ambulatory care provided by psycholo- overseas (Australian Bureau of Statistics, 2019a). gists, nurse practitioners, and some other health The three largest countries of origin for immigrants practitioners. are, in order, England, China, and India (Australian Bureau of Statistics, 2019b). The Indigenous popu- lation includes both Australian Aboriginal people and Torres Strait Islanders, who represent about National mental health access, concerns, and 3.3% of the population (Australian Bureau of resources Statistics, 2018a). These features, as well as The national “Health Sector Emergency Response ’ Australia s position as a major modern tourist Plan for Novel Coronavirus (COVID-19)” was pub- destination, all play a role in the current global lished by the Federal Government on the February pandemic of Coronavirus Disease 2019 (COVID- 18, 2020 (Australian Government Department of 19), the disease caused by the novel pathogen severe Health, 2020b). The strategic objectives in this plan acute respiratory syndrome coronavirus 2. include characterizing the clinical severity of the Australia recorded its first case of COVID-19 on disease in Australia, minimizing transmissibility of January 25, 2020 in the state of Victoria, when a man the virus, minimizing health care system burden, returning from Wuhan, China, tested positive for the and informing and empowering the public. virus. The total number of new cases grew exponen- Although initially access to mental health services tially, leveled out at about 360 new cases per day on fell under the post-crisis, “stand-down” phase of the March 22, 2020, and then fell to its current level of 26 national response plan, the federal government new cases on May 6, 2020, on which date there were (Australian Government Department of Health, 6,849 confirmed cases of COVID-19 in Australia 2020c), as well as peak healthcare organizations (Australian Government Department of Health, across the nation, soon realized the need for ongoing 2020a). Of confirmed cases of COVID-19 in and improved access to mental healthcare services. Australia, 96 have died from the virus (Australian For example, telehealth items have been greatly Government Department of Health, 2020a). Cur- expanded across all professions, for all Australians rently, Australia does not have widespread commu- irrespective of COVID-19 status, including psycho- nity transmission of COVID-19; over half a million therapy items for psychologists and psychiatrists, tests have been conducted nationally (Australian and both telephone and videoconferencing items Government Department of Health, 2020a). have been included (Australian Government From mid-March 2020, Australia has undertaken Department of Health (2020d). Access to flexible a series of increasingly stringent measures to limit ways to deliver “care at a distance” is important with transmission of the virus. Travel to and transit respect to the treatment of older adults, who may through Australia is limited to Australian nationals have difficulty connecting with mental healthcare and members of certain Pacific Island nations. Bor- providers over videoconferencing platforms and are ders between several of the five states and two at increased risk of hospitalization and death from territories in Australia have been closed. Non- COVID-19. This has not been the case in all coun- essential businesses (such as restaurants and many tries’ responses to COVID-19, for example, in the retail stores) have been closed, and people have been United States, the Centers for Medicare and urged to avoid unnecessary travel and maintain Medicaid Services had stated that services by psy- physical distancing when in public spaces. chologists count as telehealth only if they include Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.219, on 28 Sep 2021 at 03:34:35, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1041610220000885 1136 Commentary two-way audio and video components (American sometimes in pain or to the detriment of their health. Psychological Association, 2020a), and this has only Unanticipated risks, such as a greater risk of falls for very recently been modified to include telephone- those waiting for hip replacements, may also lead to only consultations (American Psychological Associ- premature nursing home admissions. Although ation, 2020b). elective surgery will be gradually opened back up The timing of the coronavirus reaching Australia nationwide in May 2020, because of concerns about in many ways could not have been worse. In late their increased vulnerability to the virus, both older 2019 and early 2020, Australia was ravaged by adults themselves as well as providers may still be intense bushfires which resulted in great human deterred from undergoing such procedures. and wildlife losses, and the devastation of (largely The shutdown due to COVID-19 has resulted in regional) businesses and important national park major unemployment and an economic crisis that areas. This national disaster affected all Australian have wreaked havoc globally. Australia has a strong states and territories and followed several years of welfare system which has now been boosted by severe drought that had adversely affected the health massive government spending in financial support and financial well-being particularly of regional and for businesses, the unemployed, rent assistance, and rural farming communities. Although the cumula- deferred or reduced tax payments. Families have tive fiscal effects of these events – drought, bushfires, been advised not to visit their older relatives, and COVID-19 – have been written about (The some face additional burden in how to provide Guardian, 2020b), less attention has been paid to financial support. Older adults themselves are con- the cumulative health and particularly mental health cerned about their superannuation given the state of effects of these sequential traumatic events on the world markets, which has also caused much worry Australian public and the difficulties accessing men- and distress for them. These stresses increase the tal health services. Older adults aged 60–69 lost their risk of anxiety and depression for older adults as well life in the greatest numbers in Australian bushfires as younger persons. over the last decade; many of these were older persons attempting to save their property, or not evacuating in time (PreventionWeb 2020). Loss of Unique Australian circumstances of COVID-19 homes, death of partners, lack of mental health transmission support, and (for some) the subsequent trauma of severe flooding following the fires exacted an enor- A significant proportion of confirmed cases of mous toll on older adults. Now with COVID-19 COVID-19 acquired the virus, while overseas restrictions, psychosocial support is for the most part (64%), persons returning from Europe and the obtained only at a physical distance, over the tele- Americas, as well as those returning from cruise phone or other electronic means, and for older ships, make up by far the three largest components persons doubly affected by these disasters and of these cases (Australian Government Department COVID-19, this is a huge strain. Both the recent of Health, 2020a). In 2018, Australia was the 5th natural disasters as well as the COVID-19 situation largest cruise market globally, with 1.43 million also have severely tested the disaster preparedness of Australians accounting for approximately 5.2% of Australia’s nursing home care industry. all global cruise passengers (from an estimated 30 Older people in the community, particularly million each year) (Cruise Lines International Asso- those living alone, who rely on community services ciation, 2019; Moriarty et al., 2020). Importantly, a such as meals on wheels, home help and community third of the world’s cruising passengers in 2018 were nurses, or access to day centers and communal over the age of 60, with 19% aged between 60 and 69 activities, now find that these are curtailed or ceased and 14% over 70 (Cruise Lines International Asso- with the lockdown conditions. Others decide not to ciation, 2018). allow services into their home for fear of being As the unprecedented COVID-19 pandemic infected, with potential deleterious effects on their unfolded, cruise ships found themselves denied entry well-being. Community announcements have
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