The bushfires that consumed so much of Australia this past summer may seem a distant memory for those not directly affected, now that the world has been laid low by the coronavirus pandemic.
But for those who did experience the trauma of the fires, directly or indirectly, although the immediate aftermath is behind them, new difficulties in coping day-to-day and more lasting mental health impacts may be emerging.
It is common for people who have experienced a disaster to begin to experience psychological difficulties some weeks or months down the track, even if they seemed to cope well earlier. This is particularly the case for first responders and health workers involved in the initial response.
Now is the time for health practitioners to be alert for signs that patients are experiencing the after-effects of bushfire trauma, as well as checking in on patients known to have been affected by the fires to provide support as needed.
Some people presenting to their doctor or other health professional now may not link their current difficulties with the trauma of the bushfires, especially given the additional stress of the coronavirus situation and its implications. So in order for practitioners to understand the origins of the presenting problems, they should enquire about any stressful or traumatic experiences, and specifically about experiences during the fire season.
For practitioners not located in the fire-affected regions, it is important to be mindful of the possibility that their patients may also have been impacted by the fires; remembering that many thousands of non-residents were affected, such as visitors to the areas during the holidays, as well as emergency responders.
Patients may present with a range of psychological and related issues. Psychological issues include depression and anxiety, anger and irritability, relationship problems, poor sleep, and substance abuse. Other challenges may include parenting, employment and financial difficulties, and the stress of dealing with insurance and other agencies involved in bushfire recovery.
Signs of posttraumatic stress disorder (PTSD) may be appearing for some people now too, and it is recommended that health practitioners be aware of what to look out for. The main symptoms of PTSD are: 1. re-living the traumatic event, 2. avoiding reminders of the trauma, 3. negative thoughts and feelings, and 4. feeling wound-up.
A PTSD screening tool is helpful to identify if a patient has probable PTSD. The Primary Care PTSD Screen for DSM-5 (see list of resources below) is a reliable, simple and brief screen.
If a patient screens positive for PTSD, practitioners should conduct a thorough diagnostic assessment, including for comorbid issues, and provide the patient with information about effective treatments and assist them to access appropriate therapeutic services. If it is not possible to conduct screening and assessment, then the patient should be referred to another GP or mental health practitioner.
In these current times where everyone is consumed by dealing with the effects of the coronavirus pandemic, it is easy to lose sight of the impacts that the recent bushfires had on thousands of people. Practitioners can avert the development of long-term mental health problems by checking in on patients known to have been affected by the fires, and with new patients, remembering to enquire about the possibility of bushfire trauma playing a part in their presenting symptoms.
Even if screening, assessment and treatment is not possible, by referring on, practitioners can assist patients to receive the timely support that they need.