Distress and heightened anxiety was clear in communities of the NSW far south coast during the chaotic aftermath of the Black Summer bushfires.
Batemans Bay general practitioner Michelle Hamrosi said she began to see the ongoing symptoms in her patients — difficulty sleeping, prolonged anxiety and the struggle to cope with daily challenges.
"Now, I'm seeing people who probably needed support a lot earlier," Ms Hamrosi said.
The disruption of COVID and the more urgent demands of clearing and rebuilding have pushed mental health into the background for many survivors in the two-and-a-half years since the fires.
For some, this year's floods in Queensland and NSW have triggered unresolved trauma from the bushfires.
For others, finally moving into their rebuilt homes has allowed space for the shock and grief to rise to the surface.
And for those who are only now realising that they need mental health support, the available options are winding down.
The federal government committed $76 million to mental health support measures for individuals, families and emergency services workers affected by the bushfires.
It included up to 10 free psychological therapy sessions without the need for a GP referral or diagnosed mental illness.
The program is due to be concluded at the end of the month.
From July 1, Medicare rebates for up to 10 counselling sessions will continue to be available with a mental health care plan from a GP.
But Dr Hamrosi is calling on the government to extend the Bushfire Recovery Access Program, which does not require a GP referral, for at least two more years.
"We are in a real crisis right now with our health care system, and being able to access timely and affordable GP appointments is a major barrier for many people," Dr Hamrosi said.
Community pain remains
Sue Norman thought she was coping OK six months after her community in Kiah was devastated by bushfire.
Then she started crying in the car.
"It was just so terribly, gut-wrenchingly sad."
Her partner Mick Harewood had saved their 130-year-old timber cottage, but Ms Norman, an artist and historian, lost 40 years' worth of her work.
Sketches, paintings, oral history recordings and documents were destroyed when her mud-brick studio burnt down.
With 40 of the 70 homes in Kiah destroyed, the couple were living without their neighbours, surrounded by a dead and dying forest of old-growth trees.
A friend told Ms Norman about a bushfire counsellor who she could see without a referral, and over the next few months she began to understand what was happening to her mentally and physically, and learned strategies to regain her equilibrium.
"With trauma, the amygdala in your brain kicks in and overrides your frontal lobes, your reasoning," Ms Norman said.
"You don't even know why you're behaving the way you are.
Ms Norman said she hoped to share what she had learned about the physiological and mental response to trauma with people in her community still healing after two-and-a-half years of upheaval.
"So many people are finding life a lot harder," Ms Norman said.
"The pain is still there, the loss is still there, the grieving is still there. And the support is still needed."
Government says help available
Labor MP Fiona Phillips said advice from health experts was that it was appropriate for bushfire impacted people who still wished to access mental health services to do so through a GP Mental Health Treatment Plan.
"People who currently access these services will be able to access additional Better Access sessions, including via telehealth - up to 20 sessions through their GP," Ms Phillips said.
Public Health Network-commissioned trauma counselling services will remain in place for bushfire-affected regions until December 31.
