COVID-19 impact on mental health

The potential for COVID-19 to impact mental health and wellbeing was recognised early in the pandemic (WHO 2020). In addition to concerns around contracting the virus itself, some of the measures necessary to contain its spread were also likely to negatively impact mental health (NMHC 2020). Widespread restrictions of movement, social distancing measures and physical isolation, or ‘lockdowns’, were implemented from March 2020. The sudden loss of employment and social interaction, the added stressors of moving to remote work or schooling and, more recently, impacts of sudden, localised ‘lockdowns’ to prevent further outbreaks have impacted the mental health of many Australians. Stress, confusion and anger are commonplace as a result of the pandemic (Brooks et al. 2020) and, while many people may not experience any long-term concerns, COVID-19 has the potential to contribute to or exacerbate long-term mental illness.

Throughout 2020 and in the early months of 2021, many researchers gathered evidence revealing heightened psychological distress during the pandemic (Aknin et al. 2021). While there was a rise in the use of mental health services and an increase in psychological distress during 2020, COVID-19 has not been associated with a rise in suspected deaths by suicide. The heightened usage of mental health services continued in 2021 and at the time of writing (October 2021) was ongoing. More information on data on suspected deaths by suicide during 2020 and 2021 can be found on the AIHW’s Suicide & Self-harm monitoring website.

As outlined in other sections of Mental Health Services in Australia (MHSA), a range of mental health-related services provided by various levels of government are available to support Australians experiencing mental health issues. Since April 2020, the AIHW has been assisting the Australian Government Department of Health to curate, analyse and report on mental health-related service activity during the course of the COVID-19 pandemic. Data is reported via 2 dashboards and includes information from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), crisis and support organisations (Lifeline, Kids Helpline, Beyond Blue), and analysis of emerging research findings. In addition, the AIHW has facilitated the sharing of detailed data on the use of mental health services with the New South Wales, Victorian and Queensland governments. Importantly, this involves a two-way sharing of data with the  Australian Government.  

There is a national version of the mental health COVID-19 reporting dashboard and a jurisdictional version that focuses on service activity in New South Wales, Victoria, and Queensland.

Data downloads:

Mental Health Impact of COVID-19 (1.1MB PDF)

This Mental Health Services in Australia section will be updated quarterly during the pandemic and was last updated in December 2021. It presents information reported via the mental health COVID-19 dashboards issued on 29 September 2021. Reporting focuses on activity during the 4-week period from 23 August 2021 to 19 September 2021. During this 4-week period New South Wales was in a state-wide lockdown that began on 14 August 2021 (NSW Health 2021a) and Victoria was under lockdown restrictions that began mid July 2021. During the four-week period, Queensland had no pandemic-related restrictions in place.

 ‘The same period in 2020’ refers to the period 24 August to 20 September 2020 and ‘the same period in 2019’ refers to the period 26 August to 22 September 2019, except where otherwise noted in text. MBS statistics are based on claims for services processed within a particular reporting period. Mental health-related MBS items are listed in the Medicare-subsidised mental health-specific services section of MHSA. PBS scripts dispensed are subject to change due to late claims and adjustments; private scripts are not included. Population rates are calculated using Australian Bureau of Statistics (ABS) estimated resident populations at 31 December 2018 for 2019, 31 December 2019 for 2020, and 31 December 2020 for 2021.

Key points

  • Between 16 March 2020 and 19 September 2021, almost 21 million MBS-subsidised mental health-related services were processed.
  • MBS mental health services delivered via telephone or videoconference peaked during April 2020 when about half of MBS mental health services were delivered via telehealth. In the 4 weeks to 19 September 2021, 37.0% of MBS mental health services were delivered via telehealth.
  • The volume of mental health-related PBS prescriptions dispensed spiked in March 2020 when COVID-19 restrictions were first introduced, followed by a dip in April 2020. From mid-May 2020 to early-August 2021 weekly volume tracked above the same week one year prior. These patterns were observed across all jurisdictions.
  • In the 4 weeks to 19 September 2021:
    • Lifeline saw several historical record high daily call volumes, and 96,273 calls were offered in total, up 14.1% and 33.1% from the same periods in 2020 and 2019 respectively;
    • Kids Helpline received 32,572 answerable contact attempts, up 4.6% and 16.7% from the same periods in 2020 and 2019 respectively;
    • Beyond Blue received 27,099 contacts, down 2.7% and up 20.9% from the same periods in 2020 and 2019 respectively.

Mental Health Service Activity in Australia

Medicare-subsidised mental health-specific services

During the course of the COVID-19 pandemic, the Australian Government introduced a wide range of additions to the Medicare Benefits Schedule (MBS) to support provision of health care via telehealth (telephone and videoconference). This was intended to help reduce the risk of community transmission of COVID-19 and provide protection for both patients and health care providers. These MBS-subsidised items include mental health services provided by GPs, psychiatrists, psychologists and other allied health workers.

Services under the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative (Better Access) are available for people with a clinically diagnosed mental disorder to receive up to 10 individual and 10 group mental health services per calendar year (DoH 2021a). In August 2020, the Better Access initiative was expanded to provide 10 additional MBS individual psychology sessions for people in areas subject to lockdown restrictions due to the pandemic. As part of the 2020–21 Federal Budget in October 2020, the Australian Government expanded access to these 10 additional sessions to all Australians regardless of location.

MBS mental health service activity in Australia

Between 16 March 2020 and 19 September 2021, 21.0 million MBS mental health-related services were processed nationally ($2.3 billion in benefits paid). About 6.0 million (28.8%) of these services were delivered via telehealth (as opposed to face-to-face) with $714.3 million in benefits paid for telehealth services.

In the week beginning 16 March 2020 the total number of weekly MBS mental health services was 238,044. This increased to 297,631 in the week beginning 7 December 2020. The number of weekly services increased again from a low of 174,933 in the week beginning 4 January 2021 to peaks of 319,648 and 317,080 in the weeks beginning 16 August 2021 and 6 September 2021, respectively (Figure COVID.1). A decline in services occurred during the Christmas/New Year period, which is consistent with seasonal patterns observed in previous years. Variability can be due to the administrative arrangements associated with the processing of claims as well as practitioner/practice leave arrangements associated with public holidays.

In the 4 weeks to 19 September 2021, 1,215,475 MBS mental health-related services were processed, 7.1% and 21.8% higher than the same periods in 2020 and 2019, respectively. There was a drop in March and April of these years which is consistent with previous years and is likely due to the Easter holidays.

Figure COVID.1: Number of MBS mental health services, by week of processing, January 2019 – September 2021

Figure COVID.1: Line chart showing the total number of Medicare Benefits Schedule (MBS) mental health services processed each week nationally from January 2019 to September 2021. At the start of the COVID-19 pandemic, the total number of MBS mental health services increased from 238,044 in the week beginning 16 March 2020 to 297,631 in the week beginning 7 December 2020 with a low of 63,115 services in the week beginning 28 December. The number of services increased from another low of 174,933 in the week beginning 4 January 2021 to peaks of 299,330, 319,648 and 317,080 in the weeks beginning 22 March 2021, 16 August 2021 and 6 September 2021, respectively. The drops in March/April are consistent with previous years due to the Easter holidays, however the drops in 2020 and 2021 are not as pronounced as 2019 which may be due to the increased availability of telehealth services.
Figure COVID.1.1: Line chart showing the proportion (per cent) of processed Medicare Benefits Schedule (MBS) services delivered by telehealth each week nationally from January 2020 to September 2021. The proportion of services delivered via telehealth rapidly increased from 1.1% in the week beginning 9 March 2020 to a record high of 50.5% in the week beginning 13 April 2020 during the first wave of the pandemic. Following this, the proportion has gradually declined to 18.0% in the week beginning 14 June 2021 to peaks of 32.0%, 38.0% in the weeks beginning 19 July 2021 and 6 September 2021.

Notes:
Figure COVID.1:
1. The drop in service numbers in late December 2020 – early January 2021 is similar to that observed for the same time period in previous years.
2. Data points represent week commencing date.

Figure COVID.1.1:
1. Data points represent week commencing date.
Source: Medicare Benefits Schedule data.

The proportion of mental health services delivered via telehealth peaked during April 2020 (Figure COVID.1.1) when about half of the MBS mental health services were provided remotely. There was an uptrend in the use of telehealth services from late May 2021 to late September 2021 corresponding with lockdowns in response to COVID-19 outbreaks. The proportion of services delivered via telehealth reached a 2021-to-date high in the week commencing 6 September 2021, with 38.0% of MBS services delivered via telehealth (Figure COVID.1.1). In the 4 weeks to 19 September 2021, 37.0% of MBS mental health services were delivered via telehealth. More information can be found in the Mental Health Service Activity in New South Wales, Victoria and Queensland section of this report.

Pharmaceutical Benefits Scheme (PBS) prescriptions

In March 2020, the Australian Government implemented temporary changes to medicines regulation to support Australians’ continued access to PBS medicines in response to the COVID-19 pandemic (Services Australia 2021). These temporary changes allowed pharmacists to dispense up to a one-month supply of most mental health-related PBS medicines without a prescription if the medical need was deemed urgent and the medicine had been previously prescribed. Other temporary changes to support people in isolation included a home delivery service of PBS medicines and digital prescriptions sent from telehealth appointments directly to pharmacists to dispense (Services Australia 2021).

A spike in PBS-subsidised and under co-payment prescriptions, including all mental health-related prescriptions, was observed in March 2020 during the first wave of the pandemic and the nationwide lockdown in 2020. This represented an 18.6% increase in the number of mental health-related prescriptions dispensed in the 4 weeks to 29 March 2020 compared to the 4 weeks to 31 March 2019. In the 4 weeks to 8 August 2021, there was a 3.9% increase in mental health-related prescriptions dispensed under the PBS compared to the 4 weeks to 9 August 2020. Prescriptions for antidepressants increased by 5.0% between these periods (Figure COVID.2). PBS data reported in fortnightly dashboards lag other sources by 6 weeks to reduce the effect of administrative arrangements including late claims, updates to claims and cancellations.

Figure COVID.2: Number of PBS mental health-related prescriptions dispensed, by week, January 2019 – August 2021

Figure COVID.2: Line chart showing the number of Pharmaceutical Benefits Scheme (PBS) mental health-related prescriptions dispensed by week from January 2019 to August 2021. The number of prescriptions dispensed increased from 749,191 in the week beginning 6 January 2020 to a sharp peak of 1,013,903 in the week beginning 16 March 2020. A low occurred in the week beginning 6 April 2020 with 661,428 prescriptions dispensed, gradually increasing to a second peak of 903,405 in the week beginning 14 December 2020. The number of prescriptions dispensed throughout 2020 remained slightly higher than in 2019. The number of prescriptions dispensed in the first few months of 2021 follows a similar pattern to 2020 and 2019, but remains slightly higher from January 2021 to August 2021, with no observed peaks. In the week beginning 2 August 2021 there were 848,082 prescriptions dispensed.

Notes:
1) Mental health-related prescriptions include medications labelled as antidepressants (N06A); antipsychotics (N05A); anxiolytics (N05B); hypnotics and sedatives (N05C); and psychostimulants, agents used for ADHD and nootropics (N06B).
2) Data points represent week commencing date.

Source: Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data maintained by the Department of Health and sourced from Services Australia.

National use of crisis and support organisations and online mental health information services

There are a range of crisis, support and information services available to support Australians experiencing mental health issues, such as Lifeline, Kids Helpline, Beyond Blue, and ReachOut. Head to Health is a website created by the Australian Government that brings together apps, online programs, online forums, phone services, and digital information resources to help people find the digital mental health services most suited to their needs. The Australian Government also funded Beyond Blue to create a dedicated Coronavirus Mental Wellbeing Support Service to provide free 24/7 mental health support, particularly for people not already connected to the mental health system. Other support organisations have incorporated COVID-19 support into their day-to-day services.

These crisis support services reported an increased demand for their services in March 2020 and have recorded fluctuations in activity during the course of the pandemic. Total demand for crisis and support organisations has trended upward since June 2021, with Lifeline reaching record call demand in September 2021 (Figure COVID.3). Direct comparisons between organisations are not meaningful due to differences in populations being serviced, service models, funding envelopes, workforce availability and information systems.

Figure COVID.3: Crisis and support organisation contacts, by week, January 2019 – September 2021

Figure COVID.3: Line chart showing the number of contacts made to Lifeline (calls offered), Kids Helpline (answerable calls, webchats, and emails) and Beyond Blue (calls offered, webchats, and emails) by week from January 2019 to September 2021. The number of calls to Lifeline increased from a low of 16,553 in the week beginning 6 May 2019 to a peak of 21,399 in the week beginning 20 April 2020. The number of calls offered to Lifeline have fluctuated with a peak of 22,064 in the week beginning 28 December 2020 to 23,723 in the week beginning 13 September 2021. Kids Helpline contacts increased from a low of 5,082 in the week beginning 23 December 2019 to a steep peak of 9,435 in the week beginning 30 March 2020, with a gradual decline to 5,323 in the week beginning 21 December 2020 followed by a gradual increase to 7,863 contacts in the week beginning 13 September 2021. Contacts to Beyond Blue (including the Coronavirus Mental Wellbeing Support Service) gradually increased from a low of 3,735 in the week beginning 23 December 2019 to a peak of 7,709 in the week beginning 3 August 2020, with fluctuations to 6,372 contacts in the week beginning 13 September 2021.
Figure COVID.3.1: Table showing the total number of contacts and number of answered contacts for the four weeks from 23 August 2021 to 19 September 2021. In the 4 weeks to 19 September 2021 there were: 96,273 calls offered to Lifeline (a 14% increase and a 33% increase from the same periods in 2020 and 2019, respectively); 32,572 contacts to Kids Helpline (a 5% increase and a 17% increase); and 27,099 contacts to Beyond Blue (a 3% decrease and an 21% increase). Over the same 4-week period in 2021: 85,908 calls were answered by Lifeline (a 12% increase and a 48% increase from the same periods in 2020 and 2019, respectively); 12,265 contacts were answered by Kids Helpline (a 14% decrease and an 20% increase); and 22,404 contacts were answered by Beyond Blue (a 13% decrease and a 12% increase).

Notes:
Figure COVID.3:
1) Direct comparisons between organisations are not meaningful due to differences in populations being serviced, service models, funding envelopes, workforce availability and information systems.
2) Comparisons with previous years should be made with caution as historical trends may be impacted by a range of events, including planned awareness raising campaigns.
3) Kids Helpline contacts presented in this graph exclude phone contact attempts abandoned during the privacy message.
4) Data points represent week commencing date.

Figure COVID.3.1:
1) Direct comparisons between organisations are not meaningful due to differences in populations being serviced, service models, funding envelopes, workforce availability and information systems.
2) Comparisons with previous years should be made with caution as historical trends may be impacted by a range of events, including planned awareness raising campaigns.
3) Kids Helpline contacts exclude phone contact attempts abandoned during the privacy message.
4) The period in 2020 refers to dates 24 Aug – 20 Sep 2020, and the period in 2019 refers to 26 Aug – 22 Sep 2019.
Sources: Lifeline; Kids Helpline; Beyond Blue.

Recent activity 

In the 4 weeks to 19 September 2021, crisis organisation activity varied with different overall trends in demand by organisation in comparison to previous years. Lifeline saw demand that exceeded the same period in both 2019 and 2020 by a substantial margin, while Kids Helpline and Beyond Blue saw similar demand to the same period in 2020, but exceeded 2019. In the 4 weeks to 19 September 2021:

  • 96,273 calls were offered by Lifeline, which is a 14.1% and 33.1% increase from the same periods in 2020 and 2019, respectively. Note that calls offered represent the number of callers who stayed on the line after listening to the announcements in the online menu.
  • 85,908 calls were answered by Lifeline, which is an 11.7% and 47.8% increase from the same periods in 2020 and 2019, respectively.
  • Kids Helpline received 32,572 answerable contact attempts (call, webchats and email), which is a 4.6% and 16.7% increase from the same periods in 2020 and 2019, respectively. 
  • 12,265 contacts were answered by Kids Helpline. This is a 14.1% decrease and a 19.8% increase from the same periods in 2020 and 2019, respectively. Of note is the fact that Kids Helpline have experienced remote working and workforce issues due to the lockdowns, resulting in decreased answered contacts compared to the same period in 2020. They have also noted increased vigilance and responses to duty of care related contacts, which take longer to handle and can impact overall responses. It should be noted that answerable contact attempts exclude phone contact attempts abandoned during the privacy message, which cannot be skipped. This message was increased from 22 to 48 seconds in April 2020.
  • 15.1% of Kids Helpline answered and outbound contacts were related to COVID-19.
  • 27,099 contacts were made to Beyond Blue (calls offered, webchats and email), which is a 2.7% decrease and a 20.9% increase from the same periods in 2020 and 2019, respectively (Figure COVID.3).
  • 22,404 contacts contacts were answered by Beyond Blue which is a 13.0% decrease and an 11.8% increase from the same periods in 2020 and 2019, respectively (Figure COVID.3.1).
  • Contacts to the Coronavirus Mental Wellbeing Support Service accounted for 21.1% of all contacts to Beyond Blue. 

The ReachOut and Head to Health websites saw increased activity during the first wave of the pandemic, peaking in March 2020 amid nationwide lockdown restrictions, with subsequent fluctuations. Since early July 2021, there has been a gradual uptrend in Head to Health activity, and ReachOut has seen an increase in mid-July from a seasonal low in late June and early July, followed by a relatively steady period to mid-September. In the 4 weeks to 19 September 2021:

  • ReachOut reported an average of 7,581 website users per day, a decrease of 34.9% and 14.9% compared to the same periods in 2020 and 2019, respectively.
  • Head to Health received an average of 2,393 users per day, a decrease of 21.7% and an increase of 115.0% compared to the same periods in 2020 and 2019, respectively (Figure COVID.4).

Figure COVID.4: Average number of daily website users, by website, week, January 2019 – September 2021

Figure COVID.4: Line chart showing the average number of daily website users by week for ReachOut and Head to Health from January 2019 to September 2021. The average number of daily ReachOut users by week increased from a low of 4,320 in the week beginning 23 December 2019 to a peak of 13,380 in the week beginning 30 March 2020. The average number of daily ReachOut users has fluctuated and is similar to 2019 levels in recent months, with an average of 6,914 daily users in the week beginning 13 September 2021. The average number of daily Head to Health users per week increased from a low of 429 in the week beginning 23 December 2019 to a steep peak of 9,309 in the week beginning 23 March 2020. After a decline in subsequent months, the average number of daily Head to Health users further declined from another peak of 5,386 average daily users in the week beginning 15 February 2021 to 2,461 in the week beginning 13 September 2021, similar to 2019 levels.

 

Note:
1. Data points represent week commencing date.

Sources: Head to Health; ReachOut.

Mental Health Service Activity in New South Wales, Victoria, and Queensland

A key observation during the course of the pandemic has been the pattern of differential use of mental health-related services by state and territory residents. As at December 2020, New South Wales, Victoria and Queensland comprised 78.0% of Australia’s population. However, New South Wales, Victoria and Queensland combined reported 96.3% of Australia’s COVID-19 cases to 19 September 2021 (DOH 2021b). The jurisdictional version of the dashboard has focused on the mental health service use by residents of these 3 states. 

Chronology of COVID-19 Pandemic Restrictions – New South Wales, Victoria, and Queensland New South Wales

The New South Wales government imposed a number of general restrictions on gatherings and movement during the pandemic and are continuously assessing areas identified as ‘hotspots’. Hotspot areas may be subjected to more restrictive measures such as not being permitted to travel to certain other jurisdictions. These restrictions were tightened in December 2020 after an outbreak of COVID-19 in Greater Sydney (NSW Health 2020). There was an outbreak in mid-June 2021 in Sydney’s Eastern Suburbs, which spread from there to West and South Western Sydney (NSW Health 2021b).

Clusters developed in the Central Coast, Hunter New England, Western NSW, Far Western NSW, and Southern NSW regions. The NSW government reimposed strict lockdowns during this time across all regional NSW. This lockdown was extended throughout August 2021 and was partially lifted on 11 September 2021 (NSW Health 2021c, NSW Health 2021d).

Victoria

On 4 August 2020, lockdown restrictions began in Melbourne and surrounding Victorian regional areas in an attempt to reduce the number of COVID-19 cases following the start of Victoria’s second wave. Restrictions involved curfews, a limit of how far from home a person could travel, and on people gathering. Restrictions gradually lifted in Victoria as there were no newly diagnosed cases in the state for 6 weeks from 27 October 2020 to 10 December 2020 (Vic DHHS 2020). However, they were reintroduced over the New Year period following a cluster of community acquired cases. Over January and February there were locally acquired cases linked to hotel quarantine, sparking further lockdown restrictions (Vic DHHS 2021a). Lockdown restrictions were put in place across Victoria in mid July 2021 and continued into October 2021 for metropolitan Victoria, however restrictions have been eased in regional Victoria since early September (Vic DHHS 2021b, Vic Premier 2021).

Queensland

The first restrictions were introduced in Queensland on 23 March 2020 with some businesses being required to close; restrictions tightened further, with stay-at-home rules and excluding non-Queensland residents from entering the state commenced from 3 April 2020 (APH 2021). As the state’s first COVID-19 wave was controlled, restrictions began to ease from 26 April 2020 (APH 2021). However, many snap lockdowns were implemented in Greater Brisbane and South East Queensland throughout 2021, including from 8 to 11 January in Greater Brisbane, 29 March to 1 April in Greater Brisbane, 29 June to 2 July in South East Queensland, Townsville, and Palm Island, 29 June to 3 July in Brisbane and Moreton Bay, 31 July to 8 August in South East Queensland, and 8 to 11 August in Cairns (Qld Gov 2021).

MBS mental health service activity in New South Wales, Victoria, and Queensland

In the 4 weeks to 19 September 2021 MBS service use increased in New South Wales (9.3%), Victoria (2.6%), and Queensland (7.9%), from the same 4-week period in 2020 (Figure COVID.5). Per capita, Victorians had the highest rate of MBS service use (5,525 services per 100,000 population), which is consistent with pre-pandemic service use trends. People in New South Wales (4,449 services per 100,000 population) and Queensland (4,778 services per 100,000) had higher rates of MBS service use compared to the rest of Australia (4,163 services per 100,000 population, excluding Victoria) (Figure COVID.5).

These states have seen differing demand for MBS services throughout the pandemic. The 4-week period with the highest mental health-related MBS service use during the pandemic to 19 September 2021 for each state was the 4 weeks to 12 September 2021 with 4,557 services per 100,000 population in New South Wales, 5,660 in Victoria, and 4,898 in Queensland.

Figure COVID.5: MBS mental health services per 100,000 population, by jurisdiction, week of processing, January 2019 – September 2021

Figure COVID.5: Line chart showing the rate per 100,000 population of Medicare Benefits Schedule (MBS) mental health services processed each week for New South Wales, Victoria, Queensland and the rest of the country (i.e. all states and territories excluding New South Wales, Victoria, and Queensland, and excluding missing and unknown jurisdiction) from January 2019 to September 2021. The rate of services processed in New South Wales increased from a low of 737 in the week beginning 6 April 2020 to a peak of 1,119 in the week beginning 14 December 2020 before a sharp dip to 241 two weeks later in the week beginning 28 December 2020, followed by a return to typical levels with 1,058 services per 100,000 population processed in the week beginning 13 September 2021. The rate of mental health MBS services processed in Victoria per 100,000 population gradually increased from 851 in the week beginning 6 April 2020 to peak at 1,385 in the week beginning 12 October 2020, with a sharp dip to 307 in the week beginning 28 December 2020 followed by a return to typical levels with 1,309 services per 100,000 population processed in the week beginning 13 September 2021. The rate of services per 100,000 population processed in Queensland follows a similar pattern to New South Wales and Victoria, increasing from 801 in the week beginning 6 April 2020 to a peak at 1,213 in the week beginning 23 November 2020 to a sharp dip of 226 in the week beginning 28 December 2020 followed by a slight increase to 1,153 in the week beginning 13 September 2021. The rate of services processed in the rest of the country also follows a similar pattern, increasing from 667. In the week beginning 6 April 2020 to peak at 1,018 in the week beginning 7 December 2020 to a sharp dip of 203 in the week beginning 28 December 2020 followed by a slight increase to 1,000 services per 100,000 population processed in the week beginning 13 September 2021.

Visualisation not available for printing

Notes:
1) Rest of country refers to MBS services identified as having been delivered for people usually residing in WA, SA, Tas, ACT and NT.
2) Rates are based on estimated resident populations as at 31 December 2018 for 2019, 31 December 2019 for 2020, and 31 December 2020 for 2021.
3) Data points represent week commencing date.

Source: Medicare Benefits Schedule data.

MBS mental health telehealth services in New South Wales, Victoria, and Queensland

In the 4 weeks to 19 September 2021, just over half (53.3%) of services in New South Wales were delivered via telehealth, compared to half (49.6%) in Victoria, 15.8% in Queensland, and 14.7% in the rest of Australia excluding missing and unknown jurisdiction (Figure COVID.6).

Early in the pandemic there was a steep increase nationally in the proportion of mental health-related MBS services delivered via telehealth between March and April 2020 (corresponding with the introduction of a range of temporary telehealth items to the MBS), followed by a gradual decline through May and June 2021 for all states and territories except Victoria. There was a small peak in the proportion of services delivered via telehealth in New South Wales for the week beginning 21 December 2020 which corresponds with the start of the 3 week lockdown following the outbreak of COVID-19 in Sydney’s Northern Beaches (NSW Health 2021e). There has also been a large increase since 16 June 2021 when strict lockdown restrictions were reintroduced following the outbreak in Sydney’s Bondi Beach (NSW Health 2021f). This increase grew to a record high in the proportion of services delivered via telehealth in New South Wales, with 54.0% in the weeks commencing 30 August 2021 and 6 September 2021.

Victoria experienced another increase in the proportion of telehealth mental health-related services in July and August 2020 when COVID-19 case numbers began to rise in the state. The proportion of telehealth service use in Victoria gradually declined after peaking during August–September 2020, but remained higher than New South Wales and the rest of Australia until mid 2021. Spikes occurred in February, May/June and July coinciding with brief restrictions. From August to September of 2021, the proportion of telehealth services rose in line with state wide lockdowns implemented across the state from early August 2021 (44.1% of MBS services were delivered via telehealth in the week beginning 16 August 2021 and 51.5% in the week beginning 6 September 2021) (Vic DHHS 2021b, Vic DHHS 2021c).

The small peak in the proportion of services delivered via telehealth in Queensland at the end of March 2021 corresponds to a lockdown in Greater Brisbane (Qld Gov. 2021). A year-to-date high was seen in the week beginning 2 August 2021 with 30.4% of MBS services delivered via telehealth following the implementation of an 8 day lockdown in South East Queensland (Qld Gov 2021c).

Figure COVID.6: Proportion (per cent) of MBS mental health services delivered via telehealth, by jurisdiction, week of processing, March 2019 – September 2021

COVID.6: Line chart showing the per cent of processed Medicare Benefits Schedule (MBS) mental health services delivered via telehealth each week for New South Wales, Victoria, Queensland, and the rest of the country (i.e. all states and territories excluding New South Wales, Victoria and Queensland, and excluding missing and unknown jurisdiction) from March 2020 to September 2021. The proportion of services delivered via telehealth in New South Wales increased from 3.1% in the week beginning 16 March 2020 to a peak of 48.8% in the week beginning 13 April 2020, with a decline to 16.0% in the week beginning 24 May 2021, then an increase to 52.7% in the week beginning 13 September 2021. The proportion of services delivered via telehealth in Victoria increased from 2.5% in the week beginning 16 March 2020 to a peak of 55.5% in the week beginning 27 April 2020, and following a dip in June, increased to the highest peak at 63.8% in the week beginning 31 August 2020 followed by a gradual decrease to 49.5% in the week beginning 13 September 2021. The proportion of services delivered via telehealth in Queensland increased from 3.6% in the week beginning 16 March 2020 to a peak of 48.0% in the week beginning 13 April, with a decline to 15.3% in the week beginning 13 September 2021. The proportion of services delivered via telehealth in the rest of the country follows a similar pattern to New South Wales and Queensland, increased from 2.4% in the week beginning 16 March 2020 to a peak at 49.4% in the week beginning 13 April 2020 and then gradually decreased to 14.4% in the week beginning 13 September 2021.

Visualisation not available for printing

Notes:
1) Rest of country refers to MBS services identified as having been delivered for people usually residing in WA, SA, Tas, ACT and NT.
2) Data points represent week commencing date.

Source: Medicare Benefits Schedule data.

New South Wales, Victoria, and Queensland use of crisis and support organisations and online mental health information services

For New South Wales and Victoria, since the early stages of the pandemic in Australia to March 2021, contacts per 100,000 population answered by Lifeline, Kids Helpline and Beyond Blue, have tended to be notably higher than the same period one-year prior until around April 2021. After that, the comparison period one-year prior is also during the pandemic, and the year-on-year comparison tends to differ between jurisdictions and organisations, and over time (Figure COVID.7).

Lifeline

In the 4 weeks to 19 September 2021:

  • Lifeline answered 30,705 calls from New South Wales. This represented increases of 22.8% and 69.7% from the same periods in 2020 and 2019, respectively.
  • Victoria (with 24,534 answered calls) saw increases of 8.5% and 54.8% from the same periods in 2020 and 2019, respectively.
  • Queensland (with 12,684 answered calls) saw a decrease of 15.9% and an increase of 2.9% from the same periods in 2020 and 2019, respectively.
  • The rest of Australia (with 17,985 answered calls) saw increases of 26.6% and 51.5% from the same periods in 2020 and 2019, respectively.

Kids Helpline

In the 4 weeks to 19 September 2021:

  • New South Wales accounted for 3,599 answered calls, webchats, emails, and outbound contacts with Kids Helpline, which is a decrease of 15.5% and an increase of 22.1% from the same periods in 2020 and 2019, respectively.
  • Victoria (with 2,989 answered and outbound contacts) saw a decrease of 18.4% and an increase of 28.9% from the same periods in 2020 and 2019, respectively.
  • Queensland (with 1,778 answered and outbound contacts) saw decreases of 24.3% and 14.1% from the same periods in 2020 and 2019, respectively.
  • The rest of Australia (excluding missing and unknown jurisdiction) accounted for 2,439 answered and outbound contacts, which is a decrease of 1.3% and an increase of 36.0% from the same periods in 2020 and 2019, respectively.
  • Of note is the fact that Kids Helpline have experienced remote working and workforce issues due to the lockdowns, resulting in decreased answered contacts compared to the same period in 2020. They have also noted increased vigilance and responses to duty of care related contacts, which take longer to handle and can impact overall responses.

Beyond Blue

In the 4 weeks to 19 September 2021:

  • Beyond Blue answered 5,393 calls, webchats, and emails from New South Wales (including the dedicated Beyond Blue COVID-19 Support Service). This represented increases of 8.7% and 36.7% from the same periods in 2020 and 2019, respectively.
  • Victoria (with 5,002 answered contacts) saw a decrease of 25.6% and an increase of 31.3% from the same periods in 2020 and 2019, respectively.
  • Queensland (with 2,201 answered contacts) saw decreases of 14.7% and 3.1% from the same periods in 2020 and 2019, respectively.
  • The rest of Australia excluding missing and unknown jurisdiction (with 2,765 answered contacts) saw a decrease of 7.5% and an increase of 0.7% from the same periods in 2020 and 2019, respectively (Figure COVID.7, Figure COVID.7.1).

Figure COVID.7: Crisis and support organisation answered contacts per 100,000 population, by jurisdiction, week, January 2019 – September 2021

Figure COVID.7: Grid of twelve line charts showing the rate per 100,000 population of crisis and support organisation answered contacts each week, for New South Wales, Victoria, Queensland and the rest of the country (i.e. all states excluding New South Wales, Victoria, and Queensland, and excluding missing and unknown jurisdiction) from January 2019 to September 2021. The rate of answered contacts from the early stages of the pandemic in Australia to March 2021 tended to be notably higher than the same period one year prior, across all charts, except for Beyond Blue from the rest of the country for which 2020 rates tended to track more similarly to 2019. In September 2021, rates were broadly similar to September 2020 rates.
Figure COVID.7.1: Table showing mental health support organisation answered contacts in the four weeks to 19 September 2021 and per cent changes from same periods in 2020 and 2019 for New South Wales, Victoria, Queensland, and the rest of the country (all states and territories not including New South Wales, Victoria, and Queensland, and excluding missing and unknown jurisdiction). In the 4 weeks to 19 September 2021, Lifeline answered 30,705 contacts from New South Wales (representing 23% and 70% increases from the same periods in 2020 and 2019, respectively), 24,534 contacts from Victoria (increase of 8% and increase of 55%), 12,684 contacts from Queensland (decrease of 16% and increase of 3%), and 17,985 contacts from the rest of the country (increases of 27% and 52%). In the 4 weeks to 19 September 2021, Kids Helpline answered 3,599 contacts from New South Wales, 2,989 contacts from Victoria, 1,778 contacts from Queensland, and 2,439 contacts from the rest of the country; and Beyond Blue answered 5,393 contacts from New South Wales, 5,002 contacts from Victoria, 2,201 contacts from Queensland, and 2,765 contacts from the rest of the country.

Visualisation not available for printing

Notes:
Figure COVID.7:
1) Lifeline numbers represent answered calls only. Kids Helpline numbers represent answered calls, webchats, emails, and outbound contacts. Beyond Blue numbers represent answered calls, webchats and emails.
2) The Beyond Blue COVID line changed their system for collecting information about the caller's state/territory from 6 June 2020. Comparisons to 2019 and 2020 should be made especially cautiously due to high and inconsistent proportions of contacts with unknown jurisdiction.
3) Rest of country includes WA, SA, Tas, ACT and NT.
4) Rates are based on estimated resident populations as at 31 December 2018 for 2019, 31 December 2019 for 2020, and 31 December 2020 for 2021.
5) Data points represent week commencing date.

Figure COVID.7.1:
1) Lifeline numbers represent answered calls only. Kids Helpline numbers represent answered calls, webchats, emails, and outbound contacts. Beyond Blue numbers represent answered calls, webchats and emails.
2) The Beyond Blue COVID line changed their system for collecting information about the caller's state/territory from 6 June 2020.
3) Rest of country includes WA, SA, Tas, ACT and NT.
4) The period in 2020 refers to dates 24 Aug – 20 Sep 2020, and the period in 2019 refers to 26 Aug – 22 Sep 2019.
Sources: Lifeline; Kids Helpline; Beyond Blue.

In the 4 weeks to 19 September 2021, 89,452 visits to the ReachOut website originated from New South Wales, a decrease of 24.0% from the same period in 2020. 57,338 visits originated from Victoria in the same period in 2021, a decrease of 38.0% from the same period in 2020. 29,084 visits originated from Queensland in the same period in 2021, a decrease of 43.5% from the same period in 2020 (Figure COVID.8).

Figure COVID.8: ReachOut weekly website visits per 100,000 population, by jurisdiction, week, January 2020 – September 2021

Figure COVID.8: Line chart showing the rate per 100,000 population of average daily website visits per week to ReachOut from New South Wales, Victoria, Queensland, and the rest of the country (i.e. all states and territories excluding New South Wales, Victoria, and Queensland, and excluding missing and unknown jurisdiction) from January 2020 to September 2021. The rate of average daily website visits per week from New South Wales, Victoria, Queensland, and the rest of the country show a similar pattern from January 2020 to September 2021. The rate of ReachOut weekly website visits for New South Wales decreased from a peak of 416.8 in the week beginning 30 March 2020 to a low of 196.9 in the week beginning 21 December 2020, greatly fluctuating in subsequent months with a rate of 235.1 services in the week beginning 13 September 2021. The rate of weekly website visits from Victoria decreased from a peak of 372.8 in the week beginning 18 May 2020 to 146.9 in the week beginning 21 December 2020, greatly fluctuating in subsequent months with a rate of 191.6 services in the week beginning 13 September 2021. The rate of weekly website visits from Queensland decreased from a peak of 307.8 in the week beginning 20 April 2020 to 136.4 in the week beginning 21 December 2020, greatly fluctuating in subsequent months with a rate of 134.1 services in the week beginning 13 September 2021. The rate of weekly website visits from the rest of the country decreased from a peak of 292.7 in the week beginning 11 May 2020 to a low of 131.3 in the week beginning 21 December 2020, greatly fluctuating in subsequent months with a rate of 166.9 in the week beginning 13 September 2021.

Visualisation not available for printing

Notes:
1) Rest of country refers to visits identified as having originated in WA, SA, Tas, ACT and NT.
2) Rates are based on estimated resident populations as at 31 December 2019 for 2020 and 31 December 2020 for 2021.
3) Data points represent week commencing date.

Source: ReachOut.

Emerging research

A number of organisations have studied the impacts of the COVID-19 pandemic on the mental health of Australians since March 2020. The Australian National University’s (ANU) COVID-19 Impact Monitoring Survey Program conducted surveys in February, April, May, August and November 2020 and in January, April and August 2021. The ABS has also conducted The Household Impacts of COVID-19 Survey on a monthly basis (survey ceased, final release published 14 July 2021) and University of Melbourne’s Melbourne Institute has looked at the mental health impacts of COVID-19 in its weekly Taking the Pulse of the Nation survey. These surveys show similar findings about the impact of COVID-19 on the mental health of particular groups within the Australian population, for instance, young people and women are more likely to report higher levels of psychological distress.

The ANU’s COVID-19 Impact Monitoring Survey Program collected information on attitudes to COVID-19, labour market outcomes, household income, financial hardship, life satisfaction and mental health (Biddle et al 2020a, Biddle et al 2020b; Biddle & Edwards 2021a). The ANU was able to compare results with data collected via the ANUpoll on psychological distress prior to and during the pandemic. Data on psychological distress were collected from 2,500 respondents in 2017 (February), and over 3,000 respondents in 2020 (April, August, October and November) and 2021 (January and April). More information on the results of the ANUpoll are available on the Suicide and self-harm monitoring website and in the Australia's welfare 2021: in brief publication.

ANU’s COVID-19 Impact Monitoring Survey Program study found that psychological distress fell from November 2020 to April 2021 (Biddle & Gray 2021). In August 2021, following the most recent outbreak of COVID-19, psychological distress worsened but remained lower than April to October 2020. The increase in psychological distress between April and August 2021 was greater for women than men (after controlling for levels of psychological distress in April 2021). Also, after controlling for other factors, women had higher levels of psychological distress in August 2021 compared with men (Biddle & Gray 2021). Psychological distress in August 2021 was not significantly different to the pre-pandemic level observed in February 2017 (Biddle & Gray 2021). In other words, the average level of psychological distress had returned to pre-COVID-19 levels. However, there were differences by age.

In August 2021, ANU published The impact of COVID-19 on child mental health and service barriers: The perspective of parents which focused on the effect of the pandemic on children (18 years and under). The report stated that less than half (about 2 in 5) of parents/carers of children aged 2–4 years saw a negative impact from the pandemic on mental health, whereas a majority of parents/carers reported a negative mental health impact for children aged 5–18, with higher proportions reporting this for older children (about 3 in 5 pertaining to children aged 5–10, and about 7 in 10 pertaining to children aged 15–18) (Biddle et al 2021).

The Household Impacts of COVID-19 Survey, conducted monthly by the ABS from March 2020 to June 2021, collected information on the impact of the pandemic across a range of key areas, including psychological distress. During the pandemic, women have consistently reported higher levels of concern due to COVID-19 than men, and people aged 18­–64 years have reported higher levels of concern than people aged 65 years and over. The survey also reported:

  • 20% of respondents experienced high or very high levels of psychological distress in June 2021, essentially the same as March 2021 (20%) and November 2020 (21%). The groups with the highest levels of reported psychological distress were Australians aged 18–34 years (30%), people living in Victoria (27%) and women (23%).
  • In November 2020 and March 2021, fewer Australians reported feelings that had an adverse impact on emotional and mental wellbeing than in August 2020, however around 1 in 5 respondents still reported high or very high levels of psychological distress (ABS 2020; ABS 2021).
  • Women were more likely than men to have experienced high or very high levels of psychological distress in the past four weeks (25% vs 16% in November, and 22% vs 17% in March).
  • In March 2021, fewer respondents (27%) reported feeling nervous at least some of the time, than in August 2020 (46%) and November 2020 (30%).
  • In May 2021, 21% of respondents self-assessed their mental health as fair/poor, essentially the same as January 2021 (22%) and 27% of respondents reported putting more priority on their mental health during the pandemic; with 72% reporting that they used one or more strategies, excluding formal services, to manage their mental health during the pandemic.
  • Worse mental health (compared to before the pandemic) was more likely to be reported by: people in Victoria (27%); those aged 18–34 years (24%); people who reported a mental health condition (32%); people with disability (23%); and renters (24%).

The University of Melbourne’s Melbourne Institute conducts a weekly Taking the Pulse of the Nation survey that began in April 2020. In the initial survey, 20% of respondents reported feeling depressed and anxious most or all of the time. Employed parents whose youngest child was aged 5–11 years reported higher levels of mental distress than parents of younger or older children, nearly quadrupling from 7% in April to 27% in June (Broadway et al. 2020).

In December 2020, the Melbourne Institute released the report Coping with COVID-19: rethinking Australia, which highlighted key findings from the Taking the Pulse of the Nation surveys throughout 2020. The report found that rates of mental distress had a similar pattern to financial stress over the course of the pandemic. The rate of mental distress in November 2020 (24%) was slightly higher than in April 2020 (22%), and over double the rate of mental distress in the Australian community prior to the pandemic (10%) (Melbourne Institute 2020a).

Taking the Pulse of the Nation survey published on 10 July 2021 (reporting on the survey taken in the first week of July 2021) reported 1 in 5 Australians reported depressed or anxious most/all of the time while 23% of Australians reported financial stress (difficulty paying for essential goods and services) (Melbourne Institute 2021a). The survey published on 10 June 2021 was conducted while Victoria was in lockdown. Data collected 31 May 2021 to 5 June 2021 showed that 44% of Victorian respondents reported feeling depressed or anxious some/most of the time, compared with 40% nationally. The highest proportion of respondents feeling depressed or anxious some/most of the time was in South Australia with 46% and the lowest proportion was in New South Wales with 36% (Melbourne Institute 2021b).

The Headspace National Youth Mental Health Survey 2020 of 1,035 Australian youth (aged 12–25 years), published 27 June 2021, showed that the proportion of young people feeling lonely (lacking companionship) has been increasing over time, from 49% in 2018 to 54% in 2020. Those aged 12–14 years saw the most substantial increase in feeling they lacked companionship, rising from 41% in 2018 to 52% in 2020. Young women reported higher rates of feeling isolated than young men across every age group except those aged 22–25 years (Headspace 2021).

Studies by other researchers have focussed on the longer term mental health effects of COVID-19-related impacts, restrictions and lockdowns. These studies are reporting that initial increases in distress lessened for some demographics, as evidenced by indicators, such as suicide rates, life satisfaction, social connection and loneliness remaining largely stable throughout the first year of the pandemic into now. However, many pre-existing inequalities in psychological distress remain and being near or experiencing COVID-19 infection, struggling with financial uncertainty introduced by responses to the pandemic, and spending more time home schooling, engaged in chores, or reading pandemic-related  media has been associated with more psychological distress and worse subjective well-being (Aknin et al. 2021).