For first responders and people who lived through the Black Summer bushfires in 2019/20 it only takes a hot wind to blow, for memories to leave goosebumps on your skin.
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And if it's not a hot wind, it's media reports of bushfires breaking out in spots already devastated, well before the summer months have even hit.
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Is that PTSD [Post Traumatic Stress Disorder]? Or is it just a normal anxiety response to something that is feared?
Either way, the Black Dog Institute has been Government funded to provide the necessary tools to diagnose and treat those living with lingering effects, especially in regional areas.
Dr Mark Deady is a Senior Research Fellow at the Institute:
He said there was a group of Australians particularly exposed to the trauma during the Black Summer bushfires, and also previous natural disasters.
"But I think that what's inherent to anyone who was in some way affected, even it was marginally, there is still an awareness that brings a degree of anxiety and trepidation that may not be at a diagnostic level for PTSD and the like," Dr Deady said.
Those would be people who may not meet the requirements of the actual trauma itself, however Dr Deady said that didn't prevent a degree of heightened anxiety, in the context of a number of associated triggers.
He said for people experiencing anxiety not only was there a potential for triggers in terms of symptoms and distress.
"What we're seeing now is the climactic change and predictions around the in-coming bushfire season," Dr Deady said.
"I think it's important to recognise that when it comes to bushfire first responders, they've continued to work in these roles and continued to be exposed to high-risk incidents and traumatic events during that time,"
The Black Dog Institute says the evidence shows that ongoing exposure to and frequent exposure to traumatic events increases the risk of PTSD.
"So that idea of cumulative risk is an important one," Dr Deady said.
"At the Black Dog Institute one of the major projects that we undertook as a result of those Black Summer bushfires, we were funded to develop a support service for emergency workers."
That was originally the Bushfire Support Service but has since been expanded to the National Emergency Workers Support Service funded by the Department of Home Affairs and then the Department of Health and Aging.
"It's a nationally funded initiative at both levels," Dr Deady said.
"What it offers is a range of services but primarily free and confidential support for emergency support workers and volunteers," he said.
It's also extended to retirees and there are a number of aspects to the service involving GP training to help them identify and treat PTSD, especially when it appears in first responders.
"There are a number of reasonable and evidence-based gold-standard treatments for psychological PTSD," Dr Deady said.
"Ideally individuals will receive some sort of trauma-focused exposure therapy and behaviour therapy. There is also pretty strong evidence around other forms of treatment, including EMDR, which is eye movement desensitisation."
These treatments are sometimes paired with other therapies but many times individuals receiving treatment aren't getting the gold standard when it comes to treatment.
"One of the major pushes with the service we provide is to offer the GP training," Dr Deady said.
That's an online portal which can refer individuals into evidence-based treatment both at the Black Dog Clinic and at the Traumatic Stress Clinic at the NSW University in Sydney.
"What's particularly unique is that individuals are not only put through to evidence-based treatment but treatments that are designed for this population as well," Dr Deady said.
"They're able to receive 12 sessions free of charge and without a mental health care plan, and that's particularly unique and a valuable resource."
That helps individuals to determine if they need further treatment based on their mood and other related symptoms.
"It comes off the back of work we've been doing in the mental health research team and along with a lot of work with the Trauma Stress Clinic," Dr Deady said.
"It was set up as a direct response to those Black Summer bushfires."
South Coast Register asked Dr Deady what the findings of his research was to date.
"When we co-designed this service working with first responders to do that, one of the big issues they face is they want it to be highly private and confidential," he said.
"We strongly support this although it does sometime limit what we can then get back out of the individuals that come through. But what we do find when it comes to those individuals who have gone through one of the programs ... is that the outcomes are really strong."
He said that both the remission rates for PTSD at the point of completion are about 80 per cent no longer meeting the criteria for PTSD and even at a long-term follow-up that stays reasonably strong.
And this is reflected in Rural Fire Service volunteer statistics.
An RFS spokesperson said there were 30,000 volunteer enquiries leading to 8000 new recruits during the Black Summer 2019/20 bushfire season.
"The Service has consistently maintained more than 70,000 members over the past decade," the RFS spokesperson said.
"The RFS has a total of 70,838 volunteer members as of August 31, 2023 with 76,319 at June 30, 2020."
The lack of mental health support in regional areas has been well documented but Dr Deady said the idea behind the Institutes programs was for them to be open and used across the nation, including regional areas.
"The services are set up to provide face-to-face care but also telehealth in the wake of COVID really changed things," he said.
"Regional people is one of the groups that we know is under resourced and certainly in need, particularly in times like this where they're going to wear the brunt of impact.
"That's obviously been hugely important to us," Dr Deady said.
In closing Dr Deady reiterated the importance of individuals seeking help where the feel they may be struggling.
"Seek help wherever possible," he said.
"What we offer is a very useful program but it isn't necessarily going to be everyone's first choice to jump onto a computer. They may prefer to speak with their GP but it's important to flag and throw up your hand and seek help wherever possible.
"That's the first step, and there's a range of options and treatments available. Never enough sadly but the importance of early intervention must not be under estimated," Dr Deady said.
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Sally Foy
Regional reporter based in the Southern Highlands. I am also a mother and advocate for children with a disability and epilepsy.
Regional reporter based in the Southern Highlands. I am also a mother and advocate for children with a disability and epilepsy.
