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Tower lockdown ‘confusion and distress’ could have been prevented: GP
Nine Melbourne public housing towers may have emerged from hard lockdown, but the focus must remain on residents’ mental health.
GPs can support their patients from CALD and refugee backgrounds living in the towers by keeping in regular contact, according to Dr Joanne Gardiner.
‘Nothing has changed.’
That is what one resident of a North Melbourne tower block reported since coming out of hard lockdown in early July, the most stringent coronavirus restrictions the state had implemented to that point.
These public housing towers, dotted throughout Melbourne and other major cities around Australia, are home to some of the country’s most vulnerable people.
Many living in these buildings have been left traumatised by the lockdown, during which they were not allowed to leave their apartment for any reason for five days.
‘There will be no one allowed in ... and no one allowed out,’ Victorian Premier Daniel Andrews said at the time.
‘If you’re in one of those towers … you will not be allowed to leave your unit, your dwelling within that tower, for any reason.’
That lockdown has of course ended, but some residents are too now scared to go outside and at risk of self-harm. This issue has been further complicated by the fact many come from culturally and linguistically diverse (CALD) backgrounds and require an interpreter or translated information on the latest COVID-19 updates.
When police descended on nine towers without warning on a Saturday afternoon, around 3000 residents were locked inside. A strong police presence triggered more fear than a sense of safety among many in the community, fuelling questions over the wisdom of such an approach.
Police treatment of residents during the lockdown is currently being investigated by the Victorian Ombudsman.
Dr Joanne Gardiner is a GP with a special interest in refugee mental health. She runs an immigrant and refugee assessment clinic at the Royal Melbourne Hospital and is part of the medical team at cohealth.
She told newsGP that despite many tower residents feeling scared and distressed by the lockdown, she also witnessed some strong resilience.
‘People reacted in various ways to the lockdowns. Some were certainly traumatised as the situation directly triggered their previous experiences of torture and trauma,’ Dr Gardiner said.
‘Whether that was in detention or jail in their country of origin, the presence of the police as either a trigger or because some residents of the towers [are aware of or] have had difficult experiences with Victoria police, some felt stigmatised and distressed that for a few days at least, their basic needs were not being well met and there was inadequate communication, which heightened fear.
‘In contrast, some people that I spoke to seemed calm and coped extremely well. Most refugees are extremely resilient individuals who have learnt the capacity of “bouncing back” and just want to get on with their lives.’
The strong police presence triggered more fear than a sense of safety among many in the community, fuelling questions over the wisdom of such an approach. (Image: AAP)
In her work at the refugee mental health clinic at Foundation House offering counselling and healthcare for torture and trauma to refugees and asylum seekers, Dr Gardiner also had reports from patients of ‘irritation’ over multiple phone calls from various authorities and concern over when the lockdown would end.
‘How would that be determined and how would they be notified in order to get back to work?’ she said.
The strong police presence may have also triggered some trauma associated with authority.
Dr Kate Walker, Chair of the RACGP Specific Interests Refugee Health network, says that existing patient–GP relationships for patients with a trauma history are ‘invaluable’ during the pandemic, particularly in providing ongoing support, access to translated information and other important health updates.
‘Rapport and trust are important prerequisites to care, which are harder to build through telehealth in the acute setting, particularly from the health departments for those that are COVID-positive,’ she told newsGP.
‘GPs can prevent further transmission of COVID-19 by following up their patients [who have tested positive] and their close contacts, and ensuring they understand the details of quarantine requirements.
‘In addition, GPs’ knowledge of past medical and psychosocial history is important in supporting and monitoring their COVID-positive patients.’
For GPs who have vulnerable patients living in the towers, Dr Gardiner believes they can help ‘enormously’ by simply staying in contact.
‘Phone calls from their known GP and offers of assistance are warmly welcomed,’ she said.
‘Patients who are refugees or asylum seekers deeply appreciate efforts by clinicians to empower them, which shows respect and confers dignity, which assists in the healing of physical and psychological trauma.
‘Offering choice and negotiation in terms of referrals, scheduled appointments and further management, [as well as] empathetically dealing with chronic pain and psychological suffering, can lead to a profoundly rewarding therapeutic encounter.
‘The key is to offer regular review and active follow up – including on the welfare of household members and family member overseas – and work as a team with nursing, allied health and specialist colleagues, so that the client experiences the support not just of one clinician, but of a team who are on the client’s side.’
A significant model of support both Dr Gardiner and Dr Walker offer is to ensure access to interpreter services and collaboration with local community members to convey health messages in the appropriate language.
‘It is essential that CALD communities across Australia are able to access COVID-19 health advice in their language, including information about testing, how to self-isolate, quarantine and contact tracing,’ Dr Walker recently told newsGP.
‘Asylum seekers, refugees and undocumented migrants face greater barriers to care and may be more mistrustful of government and reluctant to get tested.’
Dr Gardiner agrees.
‘This is vitally important, and a proactive approach to this may have prevented some of the confusion and community distress [resulting from the tower lockdowns],’ she said.
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