As remote communities closed, much of the mobile workforce also disappeared due to travel restrictions, leaving some communities in a further state of disadvantage. Although the rapid expansion of tele/video health has filled the gap in services in some areas, the coverage outside major regional areas is patchy at best. In some remote locations, communication is reliant on radio transmitters. Again, this brings into sharp focus the lack of investment in infrastructure, capacity building and workforce development in communities.
Access to health services is already limited, particularly in remote locations. Under these pandemic circumstances, the capacity for medical evacuations is complicated and the availability of intensive medical care is limited in regional and remote Australia. Recent experiences of racism and discrimination in health services have already been reported in the media. In larger regional or urban centres, there are concerns as to whether Indigenous people would receive the equitable and culturally appropriate care called for in the Aboriginal Ethical Position Statement if resources become scarce. In the G08 COVID-19 Roadmap to Recovery Report, it was estimated the health needs for Indigenous Australians is 2.3 times higher than for other Australians and called for needs-based funding. Is this possible during a pandemic when this issue has not been adequately addressed for the decades prior?
At this point in time, we have been extremely fortunate to have controlled the spread of the virus in our Indigenous communities but the journey is far from over. With the easing of restrictions and the possibility of a second wave, are our communities safe? We will need to weigh up the risk of returning to the new normal versus the possibility of staying in isolation for prolonged periods of time. We will also need additional resources to manage the unintended consequences of isolation such as the potential worsening of other health and mental health conditions. People are less likely to seek out health services or have reduced access during this pandemic period. Routine screening or treatment for other conditions will diminish, resulting in the worsening of many health and mental health conditions over time.
Mental health experts predict a significant increase in mental health challenges and suicide as the full impact of the pandemic and the associated measures are experienced across the country. In the 2018 AIHW report [PDF, 0.56MB]on Australia’s Health, 30% of Indigenous people reported high or very high levels of psychological distress compared to 11% for the non-Indigenous population. The levels of psychological distress and associated mental health challenges will worsen with the associated anxiety and aftermath related to the pandemic. Currently, there are limited available, accessible and culturally safe mental health services for Indigenous communities, especially in remote locations where there are very few trained staff available. This is even more critical given the shortage of mental health services for Indigenous children and youth, with the potential for long-lasting effects well into adult life.
There have been many ethical challenges associated with the pandemic with difficult decisions made in order to safeguard the community. The COVID-19 pandemic has further exposed the many gaps that still exist and the tenuous nature of some services reliant on a mobile workforce without the infrastructure and capacity to sustain services once borders are closed. Given the continuing impact of our historical legacy, any ethical framework for decision making during this pandemic must consider equity and the plights of Indigenous communities during such difficult and life-threatening circumstances.
What we have also seen, however, is a population that can act swiftly, mobilise resources and change models of care to maintain the health and wellbeing of the nation. We have also seen the great strengths of Indigenous organisations and communities coming together and acting quickly to protect their families. If we can do all of this, then surely we can solve the long-standing health crisis and disadvantage that impacts on our Indigenous Australians to ensure the future wellbeing of all our families.
Helen Milroy is a descendant of the Palyku people of the Pilbara region of Western Australia but was born and educated in Perth. Currently Helen is the Stan Perron Professor of Child and Adolescent Psychiatry at the Perth Children’s Hospital and The University of Western Australia. Helen has been on state and national mental health and research advisory committees and boards with a particular focus on Indigenous mental health as well as the wellbeing of children. From 2013 to 2017 Helen was a Commissioner for the Royal Commission into Institutional Responses to Child Sexual Abuse.