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Mental health and housing: critical concerns in the wake of New South Wales floods

Communities in northern New South Wales are facing wide-ranging health and social problems following recent catastrophic flooding, with concerns that “the housing affordability crisis is literally killing people”, as one academic puts it.

Health and community leaders are demanding long-term support for hard-hit communities, as well as climate action, reports Croakey editor Cate Carrigan.


Cate Carrigan writes:

As communities in the Northern Rivers region of New South Wales struggle to recover from recent catastrophic floods, they also face wide-ranging health concerns, including a surge in mental health problems linked to ongoing trauma and housing insecurity, and an uptick in incidents of domestic violence.

Experts are also warning about climbing rates of COVID infection in flood-affected areas and the risks of mosquito-borne illnesses, as well as highlighting the need to address inequities exacerbated by the floods. Meanwhile, residents are also bracing for the threat of further inundation – more heavy rain is forecast for the Northern Rivers over the next few days.

For long-time Lismore resident and local GP, Dr Andrew Binns, the number one concern is the mental health impact of the floods, with many still in shock after the trauma of escaping life-threatening floodwaters.

“Obviously it’s a very traumatic event for residents,” he told Croakey. “Many lives were in danger, and people were often rescued by locals in their tinnies … many more would have drowned but for the bravery and skill of the rescuers.”

Binns is director of the Goonellabah Medical Clinic in Lismore, which has been “flat out” meeting the demand of its patients and those from flood-hit practices. He explained that the poorest people, those who live in the flood-prone areas where housing is cheaper, have been hardest hit.

Many would be returning to houses deemed uninhabitable because they have nowhere else to go and having to start again with an empty shell of a house, he said.

Binns wants more counselling services to address the mental health need, saying services were stretched even before the flood and demand will now “crank up to a new level”.

Housing worries

The Labor Member for Lismore Janelle Saffin, who swam for her life to escape floodwaters, said there will be a huge demand for mental health services down the track.

Saffin said while housing and security were the immediate and key concerns of residents, there was a lot of trauma that would need to be addressed.

Many went through “pretty harrowing experiences … people were rescued off roofs, they got in attics and got stuck, banging to get out, ringing triple-0 all night and no-one’s coming – so there’s quite a bit of trauma there”, she said.

But the main issue for residents at present was around housing.

“For people who are displaced, that is the key thing. Most have no housing insurance so they are wondering whether they can go back home or rebuild.”

Saffin said the NSW Government’s supply of 120 motor homes – to a region where 3,600 homes have been deemed uninhabitable and thousands left homeless – had raised many questions. Residents were told the motor homes must stay in the caravan parks but that doesn’t suit everyone as they want to be near their families or their flood-damaged homes, she said.

Janelle Saffin

Saffin said the housing supply problem was already acute in the Northern Rivers before the floods, with a 0.06 vacancy rate, and now flooding would intensify the problem. Added to the issue are the rising costs of construction materials and supply shortages – fuelled by COVID-19, the Ukraine war and bushfires – and a shortage of skilled tradespeople.

The long-time Lismore resident wants a Reconstruction Commission established to oversee questions about how and where to rebuild, including making buildings more flood resistant.

She also advocates a housing buyback scheme in flood-prone areas and an insurance pool scheme like one operating in cyclone affected regions to make insurance affordable.

“If you have a Reconstruction Commission that’s backed by the government, they are tasked with putting these initiatives in place,” she said.

Jon Wardle, Professor of Public Health at Southern Cross University in Lismore and a member of the Public Health Association of Australia’s Research Advisory Committee, is currently hosting six flood-affected locals in his home. He said the flood was a story of inequity.

“The areas that were flooded are where the only affordable housing is and where the services for the homeless, and those with mental health illness and addiction disorders are based,” he said.

“I don’t think it’s an exaggeration to say the housing affordability crisis is literally killing people,” he said. Those who had died lived in flood-prone areas because it was their only option.

Photo supplied by Professor Jon Wardle

Climate canary

Describing Lismore as the “canary in the coalmine” for the impact of climate change, Wardle said the flood was essentially ground zero for the impact of climate and health.

His warning came as a group of senior retired defence and security personnel issued an open letter ASLCG Open Letter – Australian Security Leaders Climate Group calling for the risks of climate change to be a central issue in the federal election.

Ten key medical colleges are also calling for climate action, writing to Australia’s federal political leaders calling for a climate ready and climate friendly healthcare system.

The colleges, representing 100,000 clinicians, including GPs, emergency medicine specialists, physicians, psychiatrists and surgeons, are calling for a National Climate Change and Health Strategy, to plan, adapt, equip medical professionals, and establish a surge health and medical workforce in response to extreme weather events. Health leaders have been calling for such a strategy since 2017.

Wardle said climate change needs to be front and centre of future planning and urged governments to look at the unpredictability of major climate events and acknowledge that areas designated as safe from flooding were destroyed.

With mental health and housing seen as major health risks in the aftermath of the flood, a team from the University Centre for Rural Health in Lismore (UCRH) has warned the two are inextricably linked and the length of time out of secure housing compounds mental anguish.

Dr Veronica Matthews, who is from the Quandamooka community at Minjerribah and a senior research fellow at the UCRH, told Croakey that research into the 2017 Northern Rivers floods found that people who were displaced from their homes for more than six months had particularly poor mental health outcomes on measures of depression, anxiety and Post Traumatic Stress Disorder (PTSD).

Matthews, a resident of Lismore on Bundjalung Country, who also heads the Centre for Research Excellence – STRengthening systems for InDigenous healthcare Equity (CRE-STRIDE) – said the more sites that were affected (for example, a person’s home, business, local community), the worse the mental health outcomes.

She said marginalised groups such as the financially disadvantaged (making up 82 percent of those flooded in the Lismore CBD area in 2017), Aboriginal communities, those with disabilities and LGBTQI+ communities were disproportionately impacted, with greater risk of having their homes flooded, being displaced, and reporting elevated rates of post-traumatic stress, depression, and anxiety.

“For those families still displaced at six months, they had double the risk of reporting continuing distress, post-traumatic stress and anxiety, and depression compared to those displaced for a week or so,” she said.

A colleague of Matthews, Talah Laurie, 22, a Gumbaynggirr and Yaegl woman, was rescued along with her dog ‘Boo’ by a neighbour in his tinnie as floodwaters entered her East Lismore home. She told Croakey of the importance of knowing there would be mental health support available into the future.

Dr Veronica Matthews and Talah Laurie (photo provided)

Local leadership

Laurie, her mother, and her three younger siblings, who are 17, 12 and 9, are now staying with Matthews while they await renovation and repair work on the house they purchased in February.

“The material loss has been immense and significant – it’s a lifetime of collecting and figuring out how you fit into the world creatively,” she said.

After confronting her own mortality in the floods, Laurie said she, and her mother, a specialist Aboriginal trauma counsellor, had only just started to address their own emotional and social wellbeing.

“Mum and I know and understand how holistic social and emotional mental health and wellbeing works and how it looks and feels. We’re doing a lot of holding work with the kids,” she said.

Laurie praised an initiative of the local Aboriginal community – the Northern Rivers Community Healing Hub, which has opened in response to the floods and is available to all. The hub, a network of Indigenous and non-Indigenous community members and professionals, is grounded in the trauma-informed, grounding and regulating practices of First Nations peoples.

“It’s awesome and is all about connection, and I have found it’s been more responsive than other services,” she said.

Professor Jon Wardle also highlighted the leadership provided by the Indigenous community, including by the Koori Mail newspaper. “They have been central to the recovery efforts, in fact the Indigenous community as a whole is really leading this recovery,” he said. “I do think the Indigenous leadership in this response is a story worth celebrating.”

Infectious diseases

Local GP Dr Andrew Binns knows of many people like Talah Laurie who have been terrorised by fast-rising water and having to scramble to survive. Among those rescued was his granddaughter, who was staying with friends when floodwaters began threatening their house.

“This is just the beginning. It’s going to go on and on. I’m telling you about the people we are seeing but there are many we have not seen yet,” he said.

Practitioners in the clinic, situated in a higher part of Lismore out of the flood zone, have been flat out seeing their own patients and those from practices closed due to flooding, with all GPs helping each out “as best we can”.

Binns is concerned that the routine work – check-ups and management of chronic disease such as diabetes and cancer screening – has been put on hold while patients and physicians deal with the trauma.

Medicines and other pharmaceutical supplies are also a problem as Lismore’s major pharmacies were inundated by floodwaters, so some patients haven’t been able to get their regular medications.

Exposure to dirty water as volunteers and others clean up after the floods means the clinic has also been treating wound infections, which can lead to conditions such as cellulitis.

Mosquito and water-borne-illnesses are also of concern, with a likely upsurge of cases of Ross River and Barmah Forest virus in coming months.

COVID was also still spreading and Binns cautioned the community against “letting our guard down” against the illness.

Supporting the carers

With the community facing such immense challenges, Binns also cautioned about the risks to health professionals.

“I think all GPs have rolled up their sleeves and are doing their best. Most GPs will be working long hours, but they need to look after themselves and try not to burn out.”

Prof Jon Wardle

SCU’s Professor Jon Wardle said the mental health issues are going to be significant and that people haven’t even started to deal with it yet as they are still “in clean up mode”.

One of Wardle’s seven-year-old daughter’s friends witnessed her father using an axe to try to break through their ceiling as the flood waters went a whole storey higher than what was thought possible, he said.

“It came up just so incredibly fast, it has shaken even a city more used to living with floods than most,” he said.

“The whole community needs healing … cars were overturned everywhere …there is the infamous caravan in the tree and aeroplanes wrapped around trees … the entire city still stinks.

“People are running on fuel and adrenalin, they are muddling through in crisis mode and it will be some time before a lot of those mental health issues do come up.”

Wardle said 27 of the local mental health physicians and counsellors were displaced in the flooding – losing their homes or practices (or both) – leaving them to deal with their own trauma at a time there is an acute need for their services.

“So, supporting the supporters is something we need to look at – not just professionals but carers, disability support workers all in caring professions.

“Usually, it’s about six months after the fact and usually we see the government funds initiatives for six months and that’s when things need to be ramped up, not pulled back. What everyone here is petrified of is that when they do know what they need and try to seek that help, the circus will have moved on,” he said.

Public health responses

The Director of the North Coast NSW Public Health Unit (NCPHU), Dr Paul Douglas, told Croakey that the NSW Government had invested significant resources into mental health resources, and they would be ongoing.

Douglas said a mental health team had been sent from the mid north coast, the NSW Government had deployed mental health clinicians from the metropolitan areas and throughout the state, and put together a mental health support package.

Acknowledging the number of local mental health professionals who’ve been busy dealing with their own trauma, Douglas said the deployed clinicians were currently meeting acute need, although many were working hours that won’t be sustainable long term.

The State Government was also allocating $7million for trauma-based therapeutic programs supporting young people, older residents, and some of the Aboriginal communities, and $3million to support Headspace and Lifeline and employ mental health response coordinators

On other public health needs, Douglas told Croakey most services were back up and running, including Ballina Hospital (which was evacuated amid fears of rising floodwaters and closed for two days),  COVID vaccination and testing, and most community health services. The liver and sexual health clinics had been shut due to flooding but have been relocated in hospital outpatient areas.

A number of public health team staff had been impacted but others had been redeployed from across the region to ensure the delivery of services, with eight to ten people working seven days a week on the public health response to the floods.

Acknowledging the impact on the unit’s key clientele, those from low socioeconomic and marginalised communities, Douglas said needs would increase over the coming six to 12 months.

Alcohol and drug addiction issues, domestic violence, and sexually transmitted diseases would all be on the rise, and public health teams would have to target those areas through health promotion activity and by providing services through our clinics.

Dr Paul Douglas

Hazards

Douglas said the immediate concerns were about contaminated water, floodwater, sewerage and overflowing septics – heightening the risk of skin infections and gastro-enteritis – and the build up of mould in houses.

Regular public health messages were being put out via the NCPHU website and media, including boiled water alerts. Information was being shared about ways to use diluted bleach to sterilise water if there wasn’t access to power, the importance of covering septic tanks and keeping children away from puddles.

When cleaning up houses, Douglas encouraged residents to wear boots, gloves, face coverings against splashing mud, and long-sleeved shirts and long trousers, to protect from abrasions and mosquitoes. People are also urged to avoid scents and use repellent to deter mosquitoes.

There was also advice on how to get rid of mould and how to remove mud build up.

Douglas said the other key message was about the need to take precautions against COVID-19, which was on the rise, with NCPHU surveillance testing showing infection rates of three to eight percent in some communities.

While people were understandably focusing on their immediate needs – cleaning up, housing and essentials – the unit was encouraging them to implement COVID safe measures.

“We know in the Northern Rivers that the vaccination rates for COVID haven’t been as high as other regions and we know there is a large group of people who haven’t taken COVID seriously,” he said.

Douglas said there is going to an uptick in COVID infections, which would be worse in the Northern Rivers because people had dropped precautions.

Trauma education

The SCU’s Professor Jon Wardle said the floods and increased risk from climate change was going to have “a massive ripple effect” through services, highlighting the importance of trauma-informed care, now and into the future.

“I don’t think there is a university in Australia that has adequately prepared its student health cohort to properly deal with the trauma that climate change is going to bring us,” he said.

Wardle said the university had discussed embedding trauma-informed care in student training so they could be prepared for the new reality.

“Trauma is going to be a much more common experience for pretty much every health profession in the future,” he said.

“It is something you need to be adequately trained to be able to handle appropriately because you can make things worse if you don’t have the skills.”

Beyond politics

For Lismore MP Janelle Saffin, climate change should be beyond politics. “It’s science not politics – we were told we were going to get bigger floods and fires, and these issues need to dealt with properly”.

Saffin said a major element of the work of any future Reconstruction Commission should be to ensure communities are prepared for more of these events and equipped for recovery efforts.

Communities also needed to be front and centre of planning and implementation.

“If we are going to have to rely on our ourselves, we need better resources,” she said. “In terms of the recovery, you can’t leave communities out, they must be at the centre of consultation and implementation.”

Photo courtesy of Professor Jon Wardle

See Croakey’s previous coverage of the 2022 floods.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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