The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness.

With already wide disparities in physical health and life expectancy, COVID-19 presents people with mental illness with additional threats to their health: decreased access to health services, increased social isolation, and increased socio-economic disadvantage. Each of these factors has exacerbated the risk of poor health and early death for people with mental illness post-COVID-19. Unless effective primary care and preventative health responses are implemented, the physical illness epidemic for this group will increase post the COVID-19 pandemic. This perspective paper briefly reviews the literature on the impact of COVID-19 on service access, social isolation, and social disadvantage and their combined impact on physical health, particularly cancer, respiratory diseases, heart disease, smoking, and infectious diseases. The much-overlooked role of poor physical health on suicidality is also discussed. The potential impact of public health interventions is modelled based on Australian incidence data and current research on the percentage of early deaths of people living with mental illnesses that are preventable. Building on the lessons arising from services' response to COVID-19, such as the importance of ensuring access to preventive, screening, and primary care services, priority recommendations for consideration by public health practitioners and policymakers are presented.

Mental health and well-being impacts of COVID-19 on rural paramedics, police, community nurses and child protection workers.

OBJECTIVE: To investigate the impact of COVID-19 on the mental health and well-being of rural paramedics, police, community nursing and child protection staff. METHOD: An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. SETTING AND PARTICIPANTS: The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. MAIN OUTCOME MEASURES: The main measures of well-being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID-19-related stress. RESULTS: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2-3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. CONCLUSIONS: COVID-19 has increased the workload and stress on rural front-line community staff. The major sources of stress were related to organisations' responses to COVID-19 and not COVID-19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.