Lismore and the Northern Rivers will be the epicentre for a new $3.8 million federal government grant for research at Southern Cross University to help heal those affected by the devastating 2022 floods through PTSD.

In a world-first approach, the researchers will implement a stepped-care model to support over 200 people still living with PTSD (post-traumatic stress disorder).

Member for Lismore Janelle Saffin represented Federal Minister for Health Mark Butler MP at today's launch. Ms Saffin lauded Lead Researcher Professor James Bennett-Levy: "James Bennett-Levy has an international reputation for innovative mental health approaches and a commitment to the well-being of rural Australians, particularly the residents of the Northern Rivers Region."

SCU Vice-Chancellor and President Tyrone Carlin said Professor Bennett-Levy was an SCU alumnus and, in fact, many of the other people deeply connected to the research are also SCU alumni. The stepped-care model research is another example of SCU progressing towards its vision of becoming a leading Research and Education hub for Lismore.

(Professor James Bennett-Levy, Member for Lismore Janelle Saffin, Vice-Chancellor and President SCU Professor Tyrone Carlin and other key Compassion Trial people at today's trial announcement)

Professor Bennett-Levy completed his PhD at the Lismore campus and had already completed a research project on the 2017 floods while working for Sydney University at the University Centre of Rural Health. So, he has good data from which to begin this current research.

"We can expect high levels of PTSD, high levels of depression, anxiety in our community," Professor Bennett-Levy said, "So what we know, particularly from the '22 floods, are the thousands of people out there with PTSD. That their lives are severely affected through no fault of their own."

Professor Bennett-Levy spoke about climate change and the impact it has had on the Northern Rivers, with three of the six largest floods in the last seven years, and that this research would help communities throughout Australia, not just the Northern Rivers.

He explained that the aim of this research is to develop better ways to enable people to recover from the trauma of climate-induced disasters. A National Disaster Mental Health Wellbeing Framework was released in May 2023 just as Professor Bennett-Levy and his team were writing the grant application which recommended the stepped-care approach.

"So what we have here is a world-first trial of stepped-care in a post-disaster context. Stepped-care is, in a nutshell, a graded approach to treatment, starting off with what's called low-intensity interventions, which are much more population-based or community-based. And then, if people need individual treatment, then they get stepped up to a higher-intensity intervention."

"What we have, at the first stage in the stepped-care, is a visual arts or nature-based compassion program. So what's compassion got to do with it? One of the things we found in the 2017 study, was that people who were hard on themselves, very self-critical, had worse outcomes. So, if you lacked self-compassion, you tended to have worse mental health outcomes. And there's lots of other research basically showing that facilitating self-compassion really enhances mental health for all of us."

"Step two, if people still have PTSD, treatment-resistant PTSD, then they'll be stepped up to, if they're eligible, to MDMA-assisted therapy."

While some people may find this slightly controversial, Professor Bennett-Levy said that the TGA (Therapeutic Goods Administration) in February last year, rescheduled MDMA for clinical use by approved prescribers for PTSD quite specifically.

"So, this again will be a world-first trial of MDMA-assisted therapy in a post-disaster context. There is kind of a Step Three as well, which is actually a hidden component of this trial, which is that everything that we're doing is group-based. So, group-based art space, compassion, group-based nature-based compassion, and even the MDMA-assisted therapy with which the medicine sessions will be individual, but that will be surrounded, encompassed by groups of six people who will go through the whole process together pre and post, as it were."

"Again, why are we doing that? Because, what we know from the 2017 research and from every other bit of research that's done on disasters, is that what predicts good outcome, best outcomes is social connection. And what happens, of course, in disasters, is you get this incredible social disconnection as people get displaced and communities are really impacted. So, social connection is really the sort of hidden third step as it were, that embraces the whole the whole project."

Professor Bennett-Levy also explained what triggers PTSD for flood-affected people.

"The three things we found in 2017 research that predicted PTSD. Firstly, what's called the peri-traumatic experience. So, if you are trapped in your roof, and particularly if you are fearing for your life or fearing serious injury, or for your partners or children or relatives, or friends, fearing serious injury, then that was a key predictor of outcome."

"A second predictor of outcome, which kind of goes with that, was inundation. So, if your home was inundated, your business in undated, then again, high predictor. And the third predictor, which is also incredibly relevant, especially after the 22 floods, is displacement. So, long-term displacement. So we found in 2017, that people who were displaced for more than six months had much worse outcomes. We've got thousands of people displaced in various ways we had probably fifteen or twenty thousand right at the start."

"One of the difficulties after 2022, is it was so enormous that nobody has been able to collect accurate data as to how many people were displaced and where people have gone. A lot of people have left the region, how many we don't know, and of course, a lot of people are staying in various (accommodation), everything from housing pods, through friends, through to in their cars, and we just don't know those numbers at this point in time. And it'd be really helpful if we did, but we've always been playing catch up basically."

Professor Bennett-Levy believes that the two-and-a-half-year lag time between the big flood and the trial will help the research project.

"One of the things you need to do effective psychological work is stability. Housing stability.....and that brings a certain amount of psychological stability. So, if you're still trying to work out where you're living and how you're going to feed yourself and your family and so forth, that's not great to do psychological work. So, actually, as it happens, this is really timely, this trial. It's sort of between two and five years. Also, the other thing we know from other research is that some of the major difficulties in communicative recovery are actually in the two to five year period. One of the reasons for this is because different people and groups get treated differently in various ways. So, who gets buybacks, who gets retrofits, who's in housing pods? This tends to happen in this, sort of, two to five-year period that people kind of get a sense of being treated unfairly."

Professor Bennett-Levy is hoping that the publicity this trial will receive will also help those suffering PTSD to get help.

"One of the things that happens with PTSD is avoidance. Because having PTSD, your self-esteem goes down and the last thing you want to do is confront the very triggers for the trauma experience. So, avoidance is actually part and parcel of it. I think one of the things we would hope is that the publicity from this trial gradually enables people to have confidence to approach services because although we have no data on it, my belief is there are many more people out there with PTSD, who haven't accessed services at this point in time than have accessed services."

The Compassion Trial is not ready to begin immediately. Professor Bennett-Levy and his team have to write everything down and submit that paper to the Ethics Committee to be reviewed. They will then make recommendations. This process will take four to five months while at the same time recruiting nature-based leaders. It is hoped that September or October will be the start date.

People can register their interest in participating by emailing [email protected].