Researchers from Faculty of Medicine and Health and University Centre for Rural Health in Lismore say Northern NSW is facing a potential epidemic of mental health problems including depression, anxiety and post-traumatic stress disorder (PTSD) resulting from the recent floods.
Particularly at risk are marginalised communities, including people living with disability and their carers.
Research led by the University Centre for Rural Health documented the impact of the 2017 Northern NSW floods. It found people who were displaced from the floods after six months had double the probability of reporting continuing distress and symptoms of post-traumatic stress, anxiety and depression when compared to those who were briefly displaced.
The researchers are calling for long-term government support to sustain local health and community services for flood-affected residents. They say disaster recovery programs need to be designed to support affected communities in the long term, not just in the immediate aftermath of natural disasters.
Mental health and displacement - lessons from the 2017 Northern NSW Floods
Professor James Bennett-Levy says thousands of households in Northern NSW have lost their homes to flood and have been displaced, which renders them highly vulnerable to mental health problems.
"This is a cause of considerable concern - not just because of the economic, social and domestic hardships that displacement implies," says Professor Bennett-Levy, who is an expert on the impact of disasters on mental health and well-being.
A recent study led by the University Centre for Rural health of the 2017 Northern NSW floods found people who were displaced from their homes for more than six months had particularly poor mental health outcomes on depression, anxiety and PTSD.
"Furthermore, the more sites that were affected (e.g., a person's home, business, local community), the worse the mental health outcomes. For example, people with three or more sites directly affected had six times the odds of reporting continuing PTSD," says Professor Bennett-Levy.
"What can help? Our studies show the length of displacement should be minimised as people who were displaced for shorter periods had better health outcomes.
"Our research also shows that community engagement and support are vital, and the focus of the disaster recovery programs needs to be extended well beyond the immediate aftermath of natural disasters.
"Rapid resolution of insurance claims can really assist with mental health recovery and resilience.
"A particular vulnerability in NSW is likely to be the flood impacts on health and social-care professionals, all of whom have been directly or indirectly impacted by the floods.
"Housing stress and post-disaster related burnout are additional factors which are likely to impact on this workforce."
People with disability and carers should not be left behind
We need to make sure people with disability and carers are not left behind.
The floods have exposed and exacerbated existing social inequities and climate change means that there will be more frequent and severe disasters, says Ms Jodie Bailee, a researcher at the University Centre for Rural Health who examines the mental health and wellbeing of marginalised communities.
Ms Bailee says people with disability have a right to safety and wellbeing during emergencies.
"The Northern Rivers will flood again. In a survey following the 2017 floods in the Northern Rivers, people with disability and carers were more likely than others to have their home flooded, be evacuated and experience lengthy displacement.
"Disrupted access to food, support networks and essentials such as health care and social services for people with disability will further exacerbate problems without prompt access to recovery services.
"The lack of affordable and accessible accommodation results in people returning to, or moving into, unsafe accommodation such as homes with mould infestations.
"We need to make sure people with disability and carers are not left behind.
"Mental health concerns are a barrier to recovery, as they specifically impact on people's ability to navigate the systems needed to aid recovery. People with disability will take longer to recover from weather-related disasters, and require longer term tailored supports during that period.
"The vulnerability of people with disability and carers is further increased because they have not been systematically included in community-level disaster preparedness. It's time to intentionally resource Disabled People's Organisations to enable person-centred emergency preparedness tailored to people's local flood risk, living situation, and other support needs to increase choice and control during recovery."
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Extreme weather impacts marginalised communities the most
Dr Veronica Matthews from the University Centre for Rural Health says extreme weather events disproportionately impact populations who tend to be the least equipped to respond adequately due to the lack of finances or social supports.
"The 2017 Northern Rivers flood event was no different; the majority of people directly affected in flooded areas came from the lowest socio-economic groups - both in the Lismore township (82 percent) & Tweed region (50 percent)," said Dr Matthews.
"These socio-economically marginalised communities -including people living with a disability, Aboriginal and Torres Strait Islander peoples, LGBTIQ+, and/or those in receipt of income support - were more likely to be evacuated, displaced for long periods and suffered worse mental-health and wellbeing outcomes than other respondent groups.
"Respondents with a stronger sense of belonging, optimism and feelings of inclusiveness with community reported lower levels of probable PTSD, anxiety and depression. Marginalised respondents were among those reporting lower levels of belonging and optimism about the future, eroding the protective effect these have against adverse mental health and wellbeing outcomes.
"Given this, we must ensure connection with these groups throughout response and recovery phases and provide opportunities for social support/investment in mechanisms that ensure housing security and builds social connectedness and belonging over the long term."
Potential increase of mosquito-borne diseases
According to Dr Kazi Rahman, Senior Lecturer of Rural Research Education at the University Centre for Rural Health, mathematical modelling on the flooding in February 2019 in Townsville showed an increase in mosquito-borne diseases. These included ross river virus and barmah forest virus Ross River Virus and Barmah Forest Virus diseases, and disease reached its peak one-and-a-half months after the flood receded.
The study suggested that flash-flooding initially unsettles the mosquito habitat.
"The context, environment, seasonality of mosquito-borne diseases (along with the timing of the 2022 flooding) and ongoing vector control programs are different in Northern NSW to North Queensland.
"We have initiated an investigation using local data from the Northern Rivers to predict the occurrence of mosquito-borne diseases in the region in the near future.
"In the meantime, it is important to focus on personal protection from mosquito bites and the removal of mosquito breeding sites, including stagnant or stored water in and around household dwellings."
People displaced more likely to have PTSD and anxiety
People who were displaced for any period were more likely to have probable anxiety and post-traumatic stress than people who were not exposed to the flood, according to Dr Jo Longman, a social scientist at the University Centre for Rural health.
Dr Longman examines the health of people living in rural Australia, and the mental-health impacts of climate change.
She led a cross-sectional survey six months after the devastating 2017 floods in the Northern Rivers to examine how it impacted the mental health of affected communities.
"We found that people who were socio-economically disadvantaged and socially marginalised were more likely to have their homes flooded and to be displaced than those not disadvantaged.
"People who were 'still not home' after six months had double the probability of reporting continuing distress and symptoms of post-traumatic stress, anxiety and depression when compared to those who were briefly displaced.
"Insurance disputes or denials were an important stressor after the flood, associated with ongoing distress and depression.
"Of the 2500 people who took part in our survey six months after the Northern Rivers flood, 521 had their home or yard flooded and had insurance coverage. Of those, 18 percent had an insurance dispute or denial.
"People told us about their difficulties with insurance including: affordability, denial of a claim, lack of clarity and consistency in insurance policies and customer care including claims handling, dispute resolution and delays. For example, one respondent said: '… applications were lost, delaying any help for many weeks. This was a greater mental stress than the physical clean up'."
