No rise in suicide but GPs reminded to be on alert

Anastasia Tsirtsakis

31/08/2020 4:34:36 PM

Newly released data show the number of suicide deaths has not increased as predicted. But experts warn it is still early days.

Man with his head in his hands.
There has been a rise in the number of self-harm cases presenting to emergency departments in Australia.

‘GPs should be very aware of the reality that suicide can come unexpectedly, and to be open to looking for it.’
Dr Cathy Andronis, Chair of the RACGP Specific Interests Psychological Medicine network, is very concerned about the community’s mental wellbeing.
Since the coronavirus pandemic began, she has noted, both in her Melbourne clinic and anecdotally, an increase in people reporting feelings of isolation, hopelessness, stress, anxiety and depression; and an increase in alcohol and drug use – all of which are ‘ingredients that promote suicide’. 
‘Isolation has become a significant factor now because it’s been almost six months [in Victoria] and it’s very unnatural for us to have such a prolonged period where we’re essentially separated from normal socialising,’ she told newsGP.
‘We are relational beings – we need other people.’
Despite modelling from May by the University of Sydney’s Brain and Mind Centre predicting a 25% surge in suicides as a result of the pandemic, new data released by the Coroners Court of Victoria on 27 August showed the number of deaths by suicide has so far remained steady. Between 1 January and 26 August, 466 Victorians took their own lives – two less compared to the same time last year.
Lifeline chief executive John Brogden said the stability is likely reflective of government initiatives and investment into mental health services.
‘Governments, to their enormous credit, state and federal, came to the party really quickly to joints like Lifeline because they knew that calls would go through the roof,’ he said.
‘And our calls have gone through the roof. But the hope here is that we’re getting to people, we’re getting the services to people so that they aren’t getting to the point of suicide.’
Dr Andronis agrees, but says it is still early days, warning the flow-on effects of unemployment, financial stress and isolation can set in later on.
‘The normal course of distress in a community during pandemics or major disasters starts off with a really sort of acute stress, often called the “honeymoon period” when people go into action and do lots of things and organise themselves to manage their stress and anxiety,’ she said.
‘Action can be quite a good antidote to anxiety because it feels like you’ve got some sense of control about some things.
‘But when that fails to fix the situation, people then go into a very long, prolonged period, often of disillusionment. And so during that period, people can become very despondent, very hopeless and helpless.
‘In any case, it’s great to see no rise in suicide numbers. [But] GPs need to continue to assess their patients as individuals with unique risks and vulnerabilities.’
Stage 4 lockdown in Victoria without a clear end in sight and talk of extending the state of emergency beyond 14 September, while a necessary step, has made it more challenging for people to process, Dr Andronis said.
That is reflected in Beyond Blue’s data.
As Victoria reintroduced Stage 3 restrictions, contacts in July about anxiety spiked 50% and those about depression doubled. While in August, two in three contacts to the Coronavirus Mental Wellbeing Support Service have been coming from Victoria.
However results from the Australian Bureau of Statistics’ (ABS) first monthly Household Impacts of COVID-19 Survey, released on 31 August, show the emotional toll of the pandemic is being felt across the country.
Conducted between 7–17 August, more than two in five Australians reported feeling nervous (46%); restless or fidgety (41%) and that everything was an effort (41%) at least some of the time in the previous four weeks.
The findings are in line with Dr Andronis’ experiences at her Melbourne clinic.
‘In fact, I’m seeing lots of people who normally consider themselves to be highly functioning, very productive, happy and optimistic people who have been very surprised that they’ve been as affected as they are,’ she said.
‘They hadn’t anticipated that they would become anxious and depressed. And if that’s very new to you, it can be very overwhelming.’
The Government’s 10 additional Medicare-subsidised mental health sessions for people in COVID hotspots and the uptake of telehealth has expanded the reach of mental health services.

Dr Cathy Andronis says GPs are well-placed to reach out to vulnerable patients.
But Professor Patrick McGorry, executive director of youth health service Orygen, told Victoria’s public accounts and estimates committee he expects suicide risk to increase between 25–50% if demand for face-to-face services is not addressed.
‘There are indications that that surge is really happening now,’ he said.
‘We already know that there’s [a rise in] self-harm presenting to emergency departments ... and some suicide clusters.’
Dr Andronis believes that GPs are well-placed to reach out to vulnerable patients, and to pick up on patients who may be having suicidal thoughts.
‘People who have suicidal ideas feel often very distressed and even ashamed about having those ideas, and they won’t openly seek help,’ she said.  
‘However, we know that when people are asked directly about whether they have ideas of hurting themselves, and whether they have any plans to hurt themselves, they’re often quite relieved that somebody is interested enough to ask and to have that capacity to share that with somebody.
‘Once that’s done, a lot of people are able to then accept that they may need help, and that help is available and that can be offered to them.’
She says it starts with asking some simple open-ended questions.
‘It’s a question that GPs should ask when they are speaking to somebody about any medical condition: “So how are you going with all this COVID business? How are you managing things? How are you feeling about it?”,’ she said.
‘The fact that somebody even bothers to ask you “How are you feeling?” shows that somebody cares enough and that can be enough of a positive to make you feel a little bit more hopeful.’
However, with research suggesting that impulsivity plays a far greater role in suicide than previously thought, Dr Andronis says sadly, not all cases can be prevented.
To assist GPs in supporting communities affected by suicide, the General Practice Mental Health Standards Collaboration (GPMHSC) has a useful resource.
‘From the GPs’ perspective, having some guidelines to follow and knowing what sort of things you could do, ask or facilitate can increase your sense of autonomy and agency, that you can do something helpful for the bereaved people,’ Dr Andronis said.
‘That can make it easier for GPs to manage the whole situation.’
She says it is also vital that GPs themselves reflect on their own mental health, and reach out for support when needed.
‘We all need to be realistic about our own self-care and address that actively,’ Dr Andronis said.
‘If you hear enough distress stories over the course of a day, a week or months as it’s gone on, then we have to slow down. Make sure that we’re getting enough time out, enough sleep and exercise.
‘Recognising that we’re also part of that community, and we also have to look after ourselves as well.’
The Coroners Office has said it will release monthly reports on suicide trends to continue the dialogue around suicide and suicide prevention.

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