COVID-19 has highlighted the importance of mental health and wellbeing, as well as its vulnerability to external or societal threats and its gendered nature. While there has been no shortage of clickbait on how to maintain mental health during the pandemic and lockdown (“Exercise regularly! Get adequate exposure to natural light! Stay hydrated!”), mental health and mental health challenges are complex, dynamic issues that require holistic, whole-of-population health interventions.
The social and economic repercussions of COVID-19 has significant implications for mental health because it has increased. The stress and anxiety associated with insecurity, social isolation, a loss of routine and a sense of losing control are all exacerbated by ubiquitous exposure to the news and disaster stories through television, press conferences, radio, print media and social media.
While these issues are affecting most people, COVID-19, the lockdown and temporary closure of workplaces, schools and other services have highlighted existing social disparities, including those related to gender. Women have been more likely to be made redundant as a result of COVID-19. Women are more likely to be frontline workers in healthcare, food service and other essential industries and thus are more likely to be exposed to the virus. Women are also more likely than men to shoulder additional childcare or schooling supervision as a result of school closures. Experts have raised concerns that COVID-19 may increase the rate or severity of violence experienced by some women in the home, and limit opportunities to seek help, as perpetrators are more likely to be at home now than before the outbreak of COVID-19. Job losses, financial stress, parenting stress and experiences of violence or abuse are all risk factors for poor mental health outcomes that disproportionately impact women. Some women are particularly vulnerable due to intersectional and multidimensional experiences of disadvantage such as women with disabilities, refugee and migrant women, women in the LGBTIQ community and Aboriginal and Torres Strait Islander women who already have reduced access to employment, education and housing for example, thus intensifying the impact of gendered risk factors.
The federal and state governments have responded with additional funding to maintain optimal mental health and to address mental health challenges, including funds for women’s health organisations. However, it is important to acknowledge that COVID-19 has merely exacerbated an existing trend: in pre-COVID contexts, women already experienced higher rates of mental illness and distress, and most mental health prevention efforts or services for people with mental challenges inadequately addressed women’s unique risk factors or barriers to accessing care. It is true that boys and men are often socialised to repress sadness, to avoid expressing emotion or discussing their feelings, to avoid seeking professional help, and that as a result, men have higher rates of suicide.
While this is alarming and urgently needs to be addressed we must also acknowledge that mental illness is more prevalent among women. Girls and women are significantly more likely to meet the criteria for a probable serious mental illness or be diagnosed with anxiety or depression. Women are also more likely to develop an eating disorder or poor body image, and to be diagnosed with obsessive compulsive disorders, particularly those related to cleaning or cleanliness. While suicide is more prevalent among men, self-harm is substantially higher among girls and women, and increasing. Women who experience racial discrimination, ableism, homophobia or transphobia and other forms of bigotry are at greater risk – post-traumatic stress disorder, depression, self-harm and suicide ideation are higher among women from culturally and linguistically diverse backgrounds, people from the LGBTIQ community, women who are incarcerated or in contact with the criminal justice system, and Aboriginal and Torres Strait Islander women. Women who have reduced access to primary prevention services or mental health support also experience poorer mental health outcomes, including women from low socioeconomic backgrounds or those living in regional or remote areas.
An intersectional feminist analysis of the social determinants of mental health and illness is critical to understanding the disproportionate prevalence of mental illness among girls and women. We may be some generations away from a time when Australian women were considered the property of their fathers or husbands, when they couldn’t vote or file for divorce, when they weren’t entitled to equal pay for the same work. But sexism is still built into structures and institutions at every level of society, and reflected in widespread social attitudes that attribute certain behaviours, roles, and expectations to women and men based
on their gender. These social or environmental factors can play a role in mental health outcomes. For example women are still expected to assume primary carer responsibilities for children, sick or elderly family members while maintaining paid employment, often at a lower pay grade than their male counterparts. Unequal carer responsibilities and unequal access to economic resources cause stress, and are risk factors for mental illness. Women’s bodies continue to be objectified and sexualised in the media and public spheres, and women’s value is still linked to the extent to which they adhere to narrow ideals of “beauty.” Women are more likely to be exposed to male violence, to be subjected to sexual harassment and gender-based discrimination, all of which are risk factors for mental illness.
It goes further. Just as gender is a social determinant of mental illness, it also influences the kind of care women are able to access to treat mental illness, and the way in which people respond to their diagnosis. Limited access to financial resources and time away from work or unpaid caring responsibilities restricts the ability of women to seek professional support. Additionally, research suggests that girls and women who engage in self-harm or attempt suicide are more likely to be dismissed as attention-seeking, insincere or manipulative than boys and men, and less likely to be taken seriously.
What is the solution? There is an undeniable need for greater resourcing of primary prevention and early intervention to improve mental health across the board. But we also need a feminist analysis of mental health and illness that seeks to address the social determinants of women’s mental health outcomes, and reduce the disparity between women and men in mental health. In order to really impact women’s mental health though, we need gender equity.