MindMatters Panel: Module 4.7 Who can help? 

Julia Zemiro:
Hello, I'm Julia. Welcome to the MindMatters panel. Almost 2,000 years ago, Marcus Aurelius wrote, "Very little is needed to make a happy life. It's all within yourself, in your way of thinking". Well yes, he has a good point but sometimes people need a little help and more information to change their way of thinking. So here to talk with me about the range of services and resources available are Brain and Mind Research Institute Executive Director and Professor of Psychiatry, Professor Ian Hickie, ReachOut.com CEO, Jono Nicholas, headspace School Support National Manager, Kristen Douglas, Deputy Principal, Rob Blackley, and school psychologist, Sarah Innes. But before we dive into it, let's see how Eagleton High engages with mental health providers.

Eagleton High clip:

PHILLIP
We're a school, not a mental health service. So while we believe that positive mental health drives our academic performance, we don't try and do it all ourselves. Instead, we reach out to all sorts of mental service providers that can help us extend our capabilities. Right now, we're adding a new provider, Madam Esmeralda.

MADAM ESMERALDA
I have found his problem: the Nine of Cups. You cannot perform in the school play!

JASON
I'm Romeo, and Ngaire Zia is Juliet! She's so hot!

MADAM ESMERALDA
She will destroy you! It is foretold.

JASON
Man! 

PHILLIP
Total professional.

Julia Zemiro:
So Ian, I'm wondering if you've got a Queen of Cups in there at all. Oh fantastic, no need to go fish. Oh look, that's ridiculous. That's obviously not the best choice of service provider, obviously. In the video, Phil talks about wanting to expand what his school can offer to students, including Esmeralda. What services are out there and is this the right thing to do, Ian? 

Professor Ian Hickie:
Not a good choice, Esmeralda.

Julia Zemiro:
Esmeralda, no. No. Possibly not, not clearly in this world.

Professor Ian Hickie:
There has been a great deal of difficulty for schools about understanding what providers are there, what level of intervention they can provide, and what's a quality service. So we in the health system haven't helped a lot in the past. Now, we have a whole new range of services online available information, new services like headspace and the development of Better Youth Services, and then special services behind that. So there are now many more services in Australia much more easily available but we've really got to engage with schools; what kind of services for what kinds of problems.

Julia Zemiro:
Kristen, you were really nodding there, going, "We haven't been good in that area". What got you so into that? 

Kristen Douglas:
Well, I've come out of education into mental health and it's a bit like trying to get giraffes and zebras to try to mate, Julia. It's really hard. And I think we've made it harder from a mental health perspective. It's such a busy marketplace, schools are bombarded. They're not quite sure about what is evidence-based and what isn't. And on the flip side, I think schools need to take responsibility about learning what's out there. I think in the past couple of years, couple of decades, we've just pushed kids out the gate, wished them good luck, sent them to a service but not known anything about it ourselves as schools. So there's two responsibilities on both sides of the fence.

Professor Ian Hickie:
There's a good place about where to start so people are already doing things. For example, young people who have been using ReachOut.com for more than the last 15 years. So people have already been doing stuff. People have been using GPs, people have been using youth services. So understanding the framework of what was already there, and then trying to sort out, very much from a school point of view, that you're organised for what kind of problems, who your preferred providers are, what are the communication systems, and who else gets involved, frankly. Parents, et cetera, are part of the partnership between schools and providers. So having a clear idea, the sort of problem you're identifying, if you're gonna need to engage a professional where do you go first, and how does it fit in with what’s already working in your area? The areas of Australia are really different in the range of services on the ground, which is where the development of online services and information has also been incredibly helpful.

Johnathan Nicholas:
We would love more teachers to know more about online services. I think that there have been some real questions in teachers' minds, in mental health professionals’ minds, as to whether young people should start online. And what we now know is that most young people go online for everything. Google is the answer to everything, whether it be a pizza or a movie or a mental health service, it doesn't matter. The question now is, if a young person's going online to seek help, what we want is them to come to an Australian evidence-based service that can provide the right information and support but also provide a gateway to all the other services online. I think the challenge now for teachers is to get informed themselves, understand what's out there, and almost put themselves in the mind of a young person seeking help: jump online, type in the search words that you think might work, and start navigating it from there.

Julia Zemiro:
I'm gonna ask a stupid question. Why is it important that it's an Australian-based service? Is it just simply because it's accessible and you'll find if you need to go and see someone you can or is information in this country different to other countries? 

Johnathan Nicholas:
ReachOut actually operates in Australia, Ireland and the US. What we found is that the base level content is the same. Depression is depression is depression, anxiety is the same. But these things are culturally mediated. What might drive anxiety in a remote town in New South Wales is very different than if you're living in South Central LA. We have different experiences of how people will seek help. Most importantly, we have a very different health system. So if you're actually, to Ian's point, asking yourself "How can I get further help?", an American site is actually of very little use when you've gotta go through private providers, there's no real public health infrastructure. So that's really the challenge: how do we get the right information? And how does that right information lead to the right action, which might be still self-care but it also might mean getting further help from a psychologist, from a headspace service, from a GP. And you want that to be localised.

Professor Ian Hickie:
What do you do if you don't have access to local services, Kristen? 

Kristen Douglas:
Oh, Julia, that's hard. And look: there's lots of communities that don't have comprehensive numbers of services. I think, try to be creative. And look, one of the best strategies I've seen in school communities is talking to principals up the road, talking to schools up the road, sharing resources, that sort of stuff. I think there's lots of creative strategies obviously online, but I also think that there's lots of national services that will possibly come to you. So if you're creating a mental health hub, you can talk to different national services, hopefully, advocate for funding through government, that sort of thing.

Johnathan Nicholas:
One of the challenges that we've got in mental health is, when someone is going through a tough time, we almost automatically think they have to talk to someone. Now that's actually not true of our own experience. Most people actually get through tough times by reading, by thinking it through, by talking with their family and friends, and getting the right strategies. So then the opportunity there for schools and for teachers is to think about this holistically, understand, "What are the options available to me, in my community? When are those options available?" And make sure ultimately that we can spend time working with the young person to find the right service for them whether that be online, whether that be telephone or whether that be face-to-face.

Professor Ian Hickie:
So one of the keys issues is not everyone needs a specialized service. You don't need to get to a specialized children's hospital for every kid that gets sick. So I think one of the mysteries about the mental health area is, "My God, it's a mental health problem. I must get a very specialized psychiatrist, clinical psychologist, and I can't find one locally." I mean, that's a misunderstanding. And most communities in Australia do have good local primary care sort of services and the school is an important part of that. And often, people don't know who's up the road or what other service is actually there. They just haven't got organised, a bit like in the picture board behind...

Julia Zemiro:
Yeah, Esmeralda.

Professor Ian Hickie:
Esmeralda. There's everyone there, but no one really knows what that is. So what you actually see in regional Australia is often a better sense of the co-location of services. Often, we can be quite chaotic in the city, and in fact in competition with each other around services.

Rob Blackley:
I'm fortunate in the area we're I'm working up in Melton, that we've got a very active youth services where we have very good communication channels between us; where they openly would come and promote what programs are available or what services are available within our local areas. So for many of the staff, they would be unaware that a lot of these services are available. So it's also about educating the staff, and that would be a particular function and role as we spoke about this morning about our action team is actually taking that to the staff, so that they are aware.

Julia Zemiro:
Sarah, you're also in schools? 

Sarah Inness:
Yeah.

Julia Zemiro:
What other services have you used? 

Sarah Inness:
Definitely, local government, community services to do within our local council, headspace, ReachOut, local GPs I know of who are really good with young people. I’ll often make that referral. I have a good team of psychologists within the community who I speak with regularly, and refer to. And so it's a huge broad range there.

Julia Zemiro:
What should schools expect, and what outcomes should they expect, Kristen? 

Kristen Douglas:
This needs to be an architected space. It needs to be planned for. As much as you plan for literacy and numeracy, you need to plan for mental health and student well-being. So at the beginning of the year, at the end of the year, privilege the same amount of time that you give other subjects and other faculties, and considered thought about how we're going to engage services. Maybe request some expectations of that service. I think the big thing that sometimes we forget at schools is continuity of care. You're allowed to hear how that young person went. We talk a lot about privacy and confidentiality, and sometimes that gets in the way of actually that young person coming back, to say, "They suggested I need to try this strategy or this strategy." And the teachers have no idea that that was said to that young person yesterday. So continuity of information: you send them off, actually get some information back about not only can what the young person do to improve their situation, but what can we as a school do to improve our situation? 

Johnathan Nicholas:
To build on that, the other part of it is be persistent. You are a school principal. You are a teacher. If you call up a service then that's going to be likely a different response than if that 16-year-old in high distress or their parents who are incredibly worried about their child, call up, and may not get the right response. But just as a teacher would not simply say, "Look, this child has a learning difficulty, I'll call one service once and then we won't talk about it again", you accept that this requires persistence and engagement. It requires talking to the parents more than once. It requires putting in place a plan. And like all systems, the health system may not be as responsive as we like it. But if you are persistent, if you are calm, if you do look to engage, then there are lots of people who care, who will try and help you navigate that system as best they can.

Professor Ian Hickie:
You've gotta plan. I mean, if you ring out once in a crisis and expect somebody else to respond, you got no idea of what would happen. So the smart schools have worked out with preferential providers, with systems, what they're actually doing. There's a lot out there. We've seen a massive expansion in psychological services under Medicare in the last decade. There are a lot of people out there. It's better if it's organised like through a headspace system and you got some organisational relationship. Then when stuff happens, it's not just one kid. You got a whole system of working through the information sharing, the disclosure, and ways of working. Common things that come back, so that it's not the first time teachers had to deal with implementing this particular recovery program or that particular sleep/wake program, or dealing with substance abuse in your school. It's the 15th kid from your school that's actually been admitted to the emergency department over the weekend. Do you think you might, at the school level, start to do something on a number of these issues? So you get involved in not just the individual issue, you get the familiarity. What's your role? What's the legitimate role of the health provider? That way, the health providers themselves, in fact, are more responsive in those situations. They've developed a relationship.

Julia Zemiro:
Who can refer? Can teachers send students to these services without parents? 

Kristen Douglas:
I think best practice (doesn't always work), but best practice would be...

Julia Zemiro:
It's good to start with best practice. I think it's good...

Kristen Douglas:
We'll start there, would be that obviously, you talk to the family or the parent before you make a referral because you want them to be part of the plan, to be a part of the action. Sometimes that works, sometimes it's a good idea. Some, for whatever reason, sometimes it's not. I think the other space is, if schools set up internal processes that you don't want just garden variety teachers randomly making referrals without talking through the process of, "Should this go to the wellbeing team? Should this go to the leadership first?" So you want them to come through an internal avenue. But look, at the end of the day, anyone can refer. It's about how you share that information to the team that's going to support that young person when they come back.

Professor Ian Hickie:
I think schools can really help here. A lot of parents don't know. It's the first time it's happened to them, their kid. Where schools say, "Oh look, don't worry we've been through this 15 times before. We've worked with headspace and we've worked with our local youth service, or we've worked with some other provider. This is how it actually works." That's actually really helpful to a lot of parents who don't really know. It's okay, the kid doesn't have to leave the school. You get the professional help. “We're going to work on staying in school. We know what we're doing.” It's great anxiety reduction for parents who otherwise haven't got a clue.

Johnathan Nicholas:
And thinking less about referring and more about safe handover of responsibilities. And one of the things that can often happen in here is we tell a distressed young person or a distressed family, "Here's the number of the GP or here's the number of the service: you go and make the appointment there."

Julia Zemiro:
Off you go. Good luck.

Johnathan Nicholas:
And what we know from our own research, particularly with young men, is that someone's willing to make the appointment there for them. "I'll do all the logistics, you just turn up at this service at 4:00pm. Can I give you a lift? Is there a friend you would like to go to that first appointment with you? Can I take you around to the counsellor's office?" Then the young person is increasingly likely to do it because that's the experience that will best get them there.

Julia Zemiro:
Well, I was gonna ask, what if the student doesn't want to engage with an outside service? You're actually saying well, you've gotta really be direct about it. Make all those things possible and then get them to go.

Johnathan Nicholas:
I think one of the issues here is we can forget that most young people are pretty reasonable. They want to get help. They want to get better. Which is why they've told you. So it may mean that they may not react incredibly excitedly about going and seeing a psychologist the first time. But if you take the time, explain the benefits, explain how to make an appointment, explain that you don't need to pay, then they will start seeing the process and see it going through.

Professor Ian Hickie:
This is where information matters though: it's demystifying things. So then, from a lot the research and the online research, if you go somewhere like go online and start discussing the issues, the health system, you turn up to the health system and you've got information, you know what you want, that's what you'll get. So you need to be informed consumers of the health system.

Johnathan Nicholas:
And this is the great thing about online resources, is a teacher could sit down with a young person and say, "Let's download the fact sheets." Or one of the great stories I heard from a teacher, who was saying, "Let's jump on the stories. You read the stories on ReachOut and you tell me which are the people in the stories that most feel like you," and so all of a sudden they’re getting a connection around language that that young person can start telling their internal world, which is pretty hard in a story sense. And then it’s about, what are the actions in the fact sheet? What can we do together? So automatically the young person is getting more informed, they're starting to tell their story and they're then leading on to action and from a young person's point of view they're driving that process. And that's always a great thing whenever you seek help, whether it be for a physical health issue or a mental health issue.

Julia Zemiro:
So, to wrap up, I will give the final word to Kristen Douglas from headspace. What's your one takeaway for school staff? 

Kristen Douglas:
Julia, it's simple. Be well-planned in your partnerships. Go and actually meet services before you have any problems or referrals. And I think the golden rule is simple: If there's a service, could you measure whether you would send your child there? Do you feel comfortable in that space, providing? And there's nothing wrong with getting services to come to you and having that as a local trusted space. I think that's the key message.

Julia Zemiro:
Thank you.