Illawarra resident Sarah* has long suffered from severe anxiety and depression, yet never so acutely as during the COVID-19 crisis.
Concerns about the pandemic combined with strict self-isolation and social distancing requirements has meant she feels more anxious and alone than ever.
Moving from face-to-face to telehealth consultations with her psychiatrist due to the threat has also been hard and the young woman feels like she's "gone back to square one" with her recovery.
"When you already have anxiety, a global pandemic just makes it go through the roof," she said. "You wake up every day to new statistics, and are gripped by the fear that you - or someone you know - may end up becoming one of those statistics."
Sarah has also worked hard to rid herself of her social anxiety by getting out and about and involving herself in community groups.
"Lockdown for someone like me is actually welcome, but it's not healthy," she said. "Now we're coming out of lockdown it's going to be harder to re-establish all those relationships again, and get out and be social. It's a challenge all over again."
Sarah is not alone. More than three quarters of people claim their mental health has worsened since the outbreak of COVID-19, a new study by the Black Dog Institute has revealed.
A quarter of the 5000 people surveyed during the peak of the outbreak in Australia in March/ April said they were very concerned about getting sick themselves; and just over half were very concerned about their loved ones contracting COVID-19.
Eighty per cent said they felt very uncertain about the future; while more than half reported feeling lonely, and 50 per cent were really worried about their financial situation.
Study lead Associate Professor Jill Newby, of UNSW and based at the Black Dog Institute, said the survey results raised concerns about people's mental health in the aftermath of the pandemic.
"What we know from past pandemics is that it can have a major impact on people's mental health, so we were concerned that this would happen here during the COVID-19 outbreak," Assoc Prof Newby said.
"We wanted to see how the pandemic affected people's mental health in the short-term but also longer term, so we will be conducting follow-up surveys to look at how people's mental health changes over time."
Assoc Prof Newby said high quality research into people's anxiety levels, and how they were coping with the outbreak, was vital.
"It helps to inform government and ensure the appropriate resources, supports and treatments are available," she said, "particularly for those who are most vulnerable and at risk of experiencing poor mental health outcomes during and after this pandemic."
Over two thirds of those who took part in the survey had prior history of mental health diagnoses/problems and results showed they had significantly higher fears of COVID-19 than those without prior mental health issues.
"Given that loneliness, social isolation, and financial stress are significant risk factors for poor mental and physical health these findings really are concerning," Assoc Prof Newby said.
"We don't know what the outcome of this pandemic will be on people's mental health but these results certainly give us an idea."
Within the Illawarra Shoalhaven Local Health District (ISLHD), both public and private mental health service providers are reporting an rise in demand from existing - and new - clients.
Meantime calls to Lifeline South Coast have spiralled since the start of the pandemic according to CEO Renee Green.
In March, the service received more than 2500 calls (an increase of 22 per cent on the previous March); in April there were 2900 calls (up 37 per cent) and last month there were almost 2800 calls (up by a third).
"We've been experiencing significant increases in calls from the start of the year due to the bushfire crisis, and then the pandemic," Mrs Green said. "People are experiencing heightened anxiety around concerns for their own health, and the health of their loved ones.
"There's also issues associated with self isolation, with many people being unable to access their usual support services - whether that be family or friends, community, public or private health services."
Mrs Green said the good news was that people were reaching out for help, and she said Lifeline telephone crisis volunteers had stepped up to meet the demand.
"We would encourage anyone who's feeling overwhelmed to contact us," she said. "The research shows that communities that have experienced consecutive traumas - such as the South Coast with drought, bushfires, floods and COVID-19 - are likely to experience longer term impacts.
"For that reason we're expecting the increased demand for our service to continue for some time."
Dr David Alcorn, clinical director of the ISLHD's mental health service, said public hospitals and facilities had seen increased mental health presentations.
"We've seeing increased demand, both from those already receiving treatment and others who haven't previously presented," he said.
"The stress of the pandemic and the deluge of information people are receiving, as well as the lack of social supports due to the lockdown, have added to people's anxiety and depression.
"The impacts have been different for people in different age groups - children and adolescents have voiced their anxiety to parents, carers and teachers; older people, with limited supports, have also been vulnerable.
"Meantime the affects on those who have had direct life-threatening experiences - those who've had complications from COVID-19 or have lost a loved one - will echo for months and years."
Dr Alcorn said another group in need of additional mental health support was those on the frontline - health workers and first responders.
"In the ISLHD there's a lot of supports and tools available for staff," he said. "For instance we're training all our staff in psychological first aid, and how to practise that with colleagues who might be distressed."
There's also been increased demand for mental health services at South Coast Private Hospital.
Consultant psychiatrist Dr Karen Williams said many patients had struggled with the social isolation measures put in place, and has seen a corresponding rise in anxiety, PTSD, drug and alcohol abuse and domestic violence.
"The pandemic has had a profound affect on my patients, even those who were doing quite well have deteriorated quite a lot," she said.
"They've missed the face-to-face consultations; telehealth has been necessary but it hasn't got the same therapeutic value. And they've struggled with the lack of social contact.
"Social isolation measures have also meant that some of the treatments we usually encourage - such as gym classes for exercise, yoga for relaxation or getting out and socialising - have not been possible."
Senior psychologist Merrylord Harb-Azar, the and PTSD co-ordinator for the service, said the uncertainty - and lack of consistency around messaging - was compounding people's fears.
"The unpredictability and uncertainty of this pandemic has fed into people's anxiety and stress response, their trauma response - this is especially true for those with pre-existing conditions," she said.
While Commonwealth and state governments have announced additional measures and funding to support the mental health of Australians at this time, Dr Williams said more was needed.
"The psychological supports available are woefully inadequate," she said. "There needs to be more funding to allow for individual therapy and inpatient care if required - or we are going to see a lot of people with mental health issues going under the radar."
If you or someone you know needs support, call Lifeline on 13 11 14; Kids Helpline on 1800 55 1800; Beyond Blue on 1300 22 4636.
* Name changed by request
The story Sarah was already battling anxiety and depression. Then COVID-19 happened first appeared on Illawarra Mercury.