 Well, good evening everybody and welcome to this mental health professional network broadcast Talking tonight about navigating mental health challenges when living with physical disability We have I think a couple of hundred participants joining us this evening And hopefully some people are with others so that I can share the learning in small groups And also for those of you who are watching the recording Further down the track we welcome you as well MHPN would like to acknowledge the judicial custodians of the land sees and waterways across Australia Upon which all our webinar presenters and participants are located We wish to pay respect to elders past present and future for the memories the traditions the culture and the hopes of Aboriginal and Torres Strait Islander Australia I'm on Wurundjeri country in in Colton in So my name is Steve Trumbull and I'll be facilitating tonight's session Which is a little bit different to the webinars that we usually have and that there's no case for us to discuss tonight It is all about responding to your questions and having a conversation Between the members of the panel that we've put together for you tonight I'm a GP and over 20 years ago now I wrote a doctoral thesis on healthcare for people with developmental disabilities And mental health was a very large part of that the psychiatrists had pretty much grabbed the whole field But we're not really talking about developmental disabilities tonight as much as acquired disabilities as will become clear as we go through But so GPU by background, but my current role as the head of medical education at Melbourne Medical School You did receive the Panelist biographies with the invitation so we won't go through that in detail, but I would like to introduce you to them So there they are We'll start with Glen Bedwell now Glen you're in Queensland and you have lived experience of disability Can you tell us though about your peer support role and what this entails? Sure. Thanks, Steve. I joined a EpiT support group by the name of limbs for life a number of years ago Limbs for life is based in Melbourne. It covers Australia and New Zealand It as the name suggests it is it is a amputee support group providing information to amputees Obviously primarily new amputees, but also supporting amputees through NDIS, etc and Information in that direction a few years ago. I volunteered to become a peer support volunteer with them and Did did a bit of a day's training on what words to use and not use What happens now is a new volume a new amputee Sorry, maybe in hospital or their family quite often or doctor of nursing staff, etc Contacts limbs for life and asks whether there's anybody that has been through this process and Could possibly come and visit Well, during COVID was all done via telephone unfortunate which is difficult But but now I might get a phone call or an email Ask me to go and visit a new amputee who may be in hospital Or maybe about to become an amputee and and wishes to talk to somebody other than a medical staff So you I go along and just just talk to them about how they feel about what's going on try to Show them That mobility is still possible Tell them what I've done with my life since becoming an amputee so that they they are better understanding that are that are good Working life is possible depending upon their reputation of course And provide that sort of support along with a lot of documentation that limbs for life provides To also system that's great Glenn We're really looking forward to hearing what sort of questions you get asked us sure there must be Topics that come up all the time particularly relating to mental health So we look forward to hearing from you a lot tonight. So thanks for joining us next I'd like to introduce Walter a brainer who is also from Victoria as I am cleansing going to that This is a guest of psychotherapist and the carer of family member with a disability But what can you tell us how you see us playing a role in helping people who live with the disability? well Thank you and good evening everyone art For me was my saviour 25 years ago when the disability happened in our house And if I wouldn't have had art When I was on the brink of with very very Many suicidal thoughts and the fine line between staying and going was something which became familiar to me Which are you know affectively then pushed me into? Therapy myself and becoming a therapist and the appreciation I gained of Of my own healing and expression what art allowed me at the time to do because words weren't available to me Fero the therapeutic support wasn't really available what I needed and art allowed me a platform to Express myself to be heard to be witnessed to be and I felt seen and Because of that personal experience and the power of transformation Which I only took five days for me to experience to go back into the house and cope again and deal with what I had to deal with became then very much a focus in my Life and how I was working and how I used Textiles threads in order to provide a space for people to express themselves Thanks for trying to know definitely be asking you whether artists for everyone or whether there are some people who don't Find it the the support and comfort that you did so I'm sure will come to that as we work through The group's questions. Thank you for joining us tonight. That's great The next person I'd like to introduce you to is Katrina Pacey who is in Queensland. She's an occupational therapist So obviously working in rural and remote areas quite a bit Katrina How can it be different in rural and remote areas for people living with a disability? I'm not hearing Katrina. You're muted. Okay There's my there's my technical error for the night Probably the the biggest difference Steve is the most obvious one and that's the different the distance The impact of distance is felt fairly Systemically in the lives of people from rural and remote areas. It impacts on access to services The feeling of things being private and confidential It doesn't like there's not necessarily less professional services in Country areas, but knowing that someone doesn't actually know you makes you feel safe that your information is safe and and secure The distance in the bush also impacts on the need to travel for services timeframes between which services are able to be accessed and The support that service providers themselves might have access to They might often feel Isolated themselves, but there's definite benefits as well The closeness of community can be a really great positive factor in the lives of people who experience disability in the bush and the practical capabilities of the people that surround a person with a disability and the Realism optimism is a great thing but being realistic in terms of outcomes and still having hope is a marvellous thing and People in the country tend to be very practical. They've had to make do with what they've got for most of their lives Hmm. I saw a very practical Example of that just a couple of weeks ago up in Darwin where there's a ferry that goes across to Service a community on the far side of the bay there and it looks very convenient until you realize that the tides mean that Whereas you can roll straight off the ferry onto the wharf in the morning in the afternoon You've got to go down. I think five flights of steps and as the nursing staff put it to me there People just can't go to Darwin if they're in a wheelchair across the ferry They've got to go a couple of hours around the bottom by road So really practical issues, but as you say the dichotomy of distance in the bush being huge But emotionally quite close is really important. Thanks for that. So we're hearing a lot from you tonight as well I'm sure and finally we have Chris Basson who's in New South Wales a psychologist clinical psychologist So Chris, what's one of the first discussions you have with the client who's just acquired a physical disability? Nice question. I Start by Asking questions to get to know them I'll make it very clear that I want to find out things about them before their illness or injury or accident And And it might feel to the client like just a bit of a chat and that I'm interested in them but I'm as a clinician I'm hearing out for Listening out for things like what have they lost what they had before means that's what they've lost And then we're going to talk about that but also I want to find out about their personal characteristics that might have endured Their strengths that we're going to be tapping into who's around them social supports are vital And what efforts to adapt they have already adopted So yeah, I tend to start with what we might as clinicians called You know taking a pre-morbid history, but it's really just about I just want to get to know you is what it should sound like with a client Yeah, okay. Great. Thanks for that So we've got plenty to talk about tonight. We've received lots of questions, which are fabulous now We're not going to have a short discipline specific Presentation tonight because there's no case for us to discuss as I mentioned But I do want to take us through the learning outcomes. So if we go to the next slide, this is really important Through an exploration of mental health impacts on those living with physical disability their carers and family The webinar will provide participants with the opportunity to I should stress there that we are throwing the envelope here around all those people Who are affected by the physical disability the person themselves, but also those who are in their family in particular As well as those of you who work professionally with the people who have a physical disability But hopefully we'll give you the opportunity to describe the general principles of providing a safe and supportive environment for people living with disability Their carers and family if they do experience mental health challenges. We're also going to Work tonight to make sure that you can outline key principles in providing appropriate therapies and communication approaches to people living with disability their carers and family if they experience mental health challenges and Finally, we would like you to have a bit of a think and identify Challenges think of some tips and some strategies to build appropriate referral pathways to implement a collaborative response to assist people Living with disability their carers and family who may be experiencing mental health challenges So that's our goal tonight, but really very much what we do is going to be driven by you and your questions We have had a number of questions come through Before the seminar, so I think if we just go to the next slide There we are we'll just have that up that reminds you how to oh gosh, we're a very happy friendly looking bunch halfway That reminds you how to ask a question, but we do have a few questions to get us started with that came up the Pre-seminar submissions and I think I might start with Chris Baston our clinical psychologist just to sort of Let us have some indication of the scope of what we're talking about tonight And Chris are there any psychological challenges that are common across the wide spectrum of different disabilities? Well, yes, I think there are I mean it's so broad really But we can make some commonalities One of the challenges or one of the common experiences is sadness, it's the emotion that we have in response to loss But the beat of the real challenge for a lot of people is To legitimize their own sadness You know the number of times I do psycho education about How it's okay to feel sorry for yourself People find that really hard and how to do that in an adaptive way and why that's very different from Sitting around feeling sorry for yourself and in an in a negative way Another one is staying connected with others keeping relationships close and middle range And then the big tasks that come for most people the big commonality Across the board would be readjusting one's self-worth and readjusting identity So I think they're the big ones. I'm sure others will find more as well when they think about their caseload Okay. Well, thanks for that. So a sense of loss is obviously very important and understandable I would imagine that Glenn and then maybe well-traded it's very well-placed to talk about their experiences of disability and also Working professionally in the area what you see is commonly coming up with people who have experienced disability Either themselves or as a family member And what comes up in your conversations with them Glenn? What are your thoughts? Yeah Shock I guess is the first one that that hits it's the it's an amputee In my case, it's a little bit different because They try to save my leg for a month and then I then I had a car Extenduated I lost all my blood So when I when they saved me and I had been amputated I had no memory of the accident. I'd been involved with all the month that I'd been in hospital. So it was sort of Waking up without a leg and having no idea why certainly The initially it's the body issues Loss of self-esteem once you once you sort of get out of hospital and you get home Total Reduction or in income major increase in expenses I was I was the breadwinner Loss of career potential Which is what's what's a hard thing to swallow It moved on to difficulty and To exercise so you tend to put on weight so you even Get more greater loss of self-esteem And just learning how to cope with life and and the changes Each and every day multiple times you go to do something quite easily that used to be able to do and you suddenly realized You can't do it that way any more and you have to find new ways. So, yeah, just Almost everything in life is a challenge at first So well, thanks for that Glenn and you've actually touched on a couple of issues that have come up in questions from the participants already Jane Rosseter and Amelia Peters that I think have asked Some questions I guess which is about getting People or when is the right time to start getting involved with people particularly looking at mental health aspects of disability You've said that early on there was the valiant struggle to save your league Raise the issue about that the focus on rehabilitation recovery of previous functioning early on is about I Guess holding on to the hope for Recovery or reversal of some sort when do people then move to accepting that this is the way they're going to be I Think I was fairly lucky in the sense of it was very obvious Once once I became once I become an epi-t. It was very obvious to me Okay, you know things are going to change somewhat I was fairly well driven that I wish to Retain a good life and and all that sort of things that I Was I pushed myself certainly My I attempted to get and I did actually get back to work In a very short space of time. I guess all those years ago I didn't have to do things like have a medical clearance to return to work what you would nowadays What sort of thing were you doing Glenn is that of interest? I was managing an airline in in Kansas in North Queensland okay, I Like I said, you know my career been mapped out. I'd already visited the the the next airports that I was being Suggesting was that I've been going to and I've been to London Tokyo and Singapore but that will change and I lost my leg so that that was that that's the psychological part that was Probably rather difficult to deal with in the time just to think that your life Your chosen career path has been taken away What about you? Well, you've indicated that it's now in 25 years since disability arrived in your family What's your recollection or what do you see professionally in those happening in those early days? Look, this is such a great question and this is how I actually wanted to answer it. It depends it depends on the Timing of Beginning middle and it seems to be for some people. There's no end like my husband is still in therapy today He has been on and off, but he has access to that. He is Paraplegia he's had a injury which resulted in paraplegia T11 and 12 quite high up and What I am hearing Glenn saying I am very much Seeing what happened for him. He had the support. I am here today very much with the carousel hat and I like to put a voice to the people affected family partners children and and How they get affected and how little support there was and I I feel still is there's an early Shock, okay, we're going to bring you lots and lots of soups lots of pies and lots of stuff turns up at crisis In front of the door You can't even if eat and freeze as what kind people bring you and then all of a sudden Three months down the road six months down the road all this dries up and disappears and you are supposedly should cope as a carer and by then The support needed for a carer a mother or the children or the father Depending also who is the affected person in the household? Is it the father? Is it the mother? Is it we both were working? I became the care the care the carer overnight for the whole house dogs and kids and my husband and also Had this burden. I am now the caretaker and the Income provider and that took four years for us to sort out and Resided in deep depression for both of us at the end of those four years So I feel that help is needed At the beginning to help you over the shock to so you don't stop breathing and then Definitely when the depression sets in and when everybody has left the boat Even the rats and the mice You need to be Called back in how are you doing? Thanks so much for that well treat I'm going to go to Katrina or Chris now Chris I saw you nodding your head when I think it was well trade referred to everything dropping away after a certain number of weeks is something that services need to actively prepare for that that Low after the initial frenzy of activity Yes, I've heard that so many times and well to describe that beautifully first hand So many people say that there's a rush of support And it also reminds me of another commonality is that a lot of really well-meaning family and friends They don't they want to help but they don't quite know how I'm one of the most common little bits of advice I might try to give somebody is to Help people to help you so let them know is like please don't give me any food now But I'd love a phone call in two months. You know, be be really directive. I know that's a bit too simple Simplistic perhaps, but I have heard that a lot before and that's why I was nodding What about you Katrina is that something that you're familiar with in your service? Yeah, it's it doesn't hit me first hand However, I know that We often become involved with people after they after they've been through the hospital system, they're back home in community and and the the role of the private occupational therapist is to identify for the NDIS the services that people most need and something that we have to be really careful of is to not Not color What the information that we provide too much with the wonderful informal supports that are around a person because the NDIS can grab hold of that and it's it's It's awesome for people to have informal support, but informal support is not a guarantee and We we just need to be very careful that we write in what people need and identify what people need if informal supports were not available if the if the neighbor has a bad day or goes on holidays or Their son comes to live with them and they can no longer provide the support that they've been providing How is the person going to manage if there aren't formal supports available? So there's actually a question that's come in From Michelle Butler who I think is down in the Latrobe Valley and she's asked I guess relating to that is about Accessing services, and it's a very practical question. I think we should probably think about it early on in the conversation Which is about what do you write as the primary disability and somebody who's got a mental health issue and a physical disability? very practical question Do we put down or how do we Game the system, but how do we get quickest service for our clients? Hmm Well, there's a couple of questions in that question so the quickest service is The one that's most available and we might not know what that is But in terms of what do you write as the disability bear in mind that there can be times when planners who do the work for the NDIS will grab hold of the primary disability and only fund What is listed as the primary disability if someone has a physical disability? That is the impairment that is going to cost them the most So I would write the physical disability and then include the mental The mental disability the mental illness or the mental ill health as a secondary disability and Really make sure that it is included on there the impact on function the NDIS is not about Providing things that treat or heal somebody's impairment. It is all about addressing function. So if the if the mental ill health of someone as a result or in addition to a physical disability is stopping them from accessing the local shops and is stopping them from completing a task such as caring for their child or Stopping them from from actively engaging in employment in the community Then those are the things that the NDIS will address and it must be addressed in a report in terms of function Okay, thanks that that's great to have that dealt with There's a question that was submitted before the broadcast that I'm keen for us to also address quite early on which was that Mental health services are by and large talking cures that they're the ones that work best But there are some people with disability who are non-verbal. I was wondering what the group's thoughts were about your Challenges your successes in providing services mental support to people who struggle with speech Come on. I'm happy to speak to that. Oh, well, Trent. Have you have you worked with people who are non-verbal? As a matter of fact, I have a client in this very moment for about a year now He suffered a stroke Three years ago and was in rehab for a year and now and has he's always been interested in in Suiting like he used to make shirts and he wanted to be engaged in some sort of creative endeavors in order to find another way of earning money and He is learning how to make hats because in my former life my very first Occupation from the age of 25 onwards. I have been a miller and I have and travel also rural country in order to provide head-making and this client has Found very much that this for him This has become a therapy because he can't sit and talk about his issues But he can use this in head-making and in head-making as many different techniques You might be using a sandpaper You might be using Stanley Knives and scissors and and colors and wire and steam and and you pull it and you Work it so he has an ability to express his emotions into the material and several days and several hours we have tears running down his face because it releases something and He the touch and the tech darkness he can Access with the material and then having a finished product because he actually is having he has taken To it like a duck to water there's an outcome and he's starting to make money from it He's selling the products. So it's very much a an expressive tour, which does not need words All right, thanks for that. Are there any other thoughts from the the panel about Experiences you've had working with people who do not communicate through through speech. I Can probably answer a little bit just from my own experience much of my my experience as an IT's been with adults with intellectual impairment and and very limited access to communication so First things first don't don't assume that You can't know what someone's communicating when they don't have words to say And and stay very very open to learning You need to observe the person and allow space Not not space for speech but space to allow a person to look with intent or to To make a movement so that you can see where their interests lie Learn from the people around the person because they're with them all the time They know what every little grunt or grown or or movement of the body means And if there's a speech pathologist involved, please do talk to the speechy there It's exactly what they're trained to do to determine what what form of Communication system is going to work best for this person and how can we make that Accessible to them and to the world around them Great. Thanks for that. I must say speaking as a GP probably the most challenging moment of my whole career was many years ago When a young man asked fire his mother for me to kill him because he had cerebral palsy and he Didn't want to go on and he communicated by a communication board that his mother sort of interpreted That was an incredibly difficult thing. But the thing I really remembered from that is the The small despair the cortisol seeping through his pores of how distressed he was It's something as a GP that I realized there are lots of other Sensors open to us to try to understand what's going on for somebody who is just in such a terrible place in his life at that time And have to do that to his mother. It was an incredibly challenging thing for him Chris I've given you an almost impossible lead in to follow there. What were you guys? I Had some thoughts but Katrina said nearly all of them and said them better than me. That's right There are I've found and I've learned through supervision that there are non-verbal ways to communicate There's lots of non-talking forms of communication And I also learned the hard way to be patient, you know If somebody's got a desire three or a speech for it They can speak a little bit is to just give them lots of time to have a go have two goes have three goes or to write it out And you just give and have the time sometimes it helps to have somebody else in the room But I agree with Katrina's thrust and what drugs is to Find you know, if we're open to Opportunities will find ways to help aid communication And I think you've hit upon one of our potentially top tips for this evening Chris Which is about the importance of continuing to focus on the person even if they're accompanied by somebody who might be assisting with speech to be able to Continue speaking directly to and listening to the person who is struggling with speech, but who deserves that human respect of that direct consultation rather than trying to do health care via satellite, which really doesn't work all that well actually Maltred you mentioned when we were chatting last week that there was an app I think that uses QR codes that you're familiar with which can help people Lead others to a page which explains their communication preferences. What? Yes There is two resources one actually is being developed in Queensland and That one is called search C e r g e with an epistrophe top And and the other one I speak to that one first It's a it's a quite a new app and it depends on the uptake of people of course and The you you have this on your phone and you can you have to get shops involved There's some shops in Queensland because it's a Queensland app who are involved There's not that many down here in Victoria and it's up to anyone with Disability or who is on this webinar for example who could next time say to the show, you know And the shops they go to do you actually use this app? And if not, why not it allows the person with the disability and who has special needs to call ahead by pressing a button and It will announce that they are arriving and what their needs are in order to shop in that particular Establishment the other card is the national Assistance card it comes out of Hobart and that is a card that costs money About 45 dollars or something like that you get that card To that card attached is a web page people can access by taking the cue card the cue code are Our cue code of the cup and and that will then allow the person who owns the cup to to put them What they want people to know, you know, I can speak don't walk away. I can't speak but I understand everything Don't walk away. I'm happy to conversation. I make hats. I do this. I cut hair here You cannot you can get in contact with me so whatever Information they want to put up there will be there and and that's a way for them to communicate without having to Have somebody else there interpreting for them That's great. Well, I suspect you would probably Resonate with Gayle Pemberton who's put a question there about sand play therapy and saying that sand play Is a great way of people who are non-verbal being able to express what feelings they might be having even though What they're actually expressing might not be immediately apparent to the the therapist But for the person who's putting a structure into the sand tray That is meaningful to them as would be a hat or whatever it might be the person's making Very much so and on that point if I may please those kind of therapy like sand play therapy or play therapy or weaving or Art therapy Alexander techniques They are old therapy switch once upon a time and for some therapy still today Voodoo therapy's, you know, they kind of haven't got really big place Often the mental health field places over when they hear tapping or Alexander techniques or drumming or sound healing All those voodoo therapies were for me a lifesaver if I wouldn't have had them In my pocket back then. I don't know what would have become of me now Those voodoo some of them like tapping EMDR. They all have become very scientifically researched modalities and are very useful and And and we often say the therapist Has to can only take the patient as far they have gone themselves I kind of would like to invite Therapists who are here health professionals to do a little workshop to try it out to see what this is about To have a sand play therapy for a weekend or to do a drumming workshop or do an Engaging an out there a beauty space Because something will it is a visual understanding and it is not a textbook Trying to learn a technique Great. Thanks for that. There's certainly a broad range of things out there and as I think we mentioned earlier It's a matter of finding what best suits the person Speaking of which there've been a couple of questions coming up about the range of disabilities and whether each of you might use a different approach For example, if you're talking with somebody who has a congenital disability rather than an amputation or a spinal cord transaction But was born with a condition and they don't know life without that condition does that alter our therapeutic approach and How early in a person's life do we start to talk to them about mental health when they've either acquired or Have a congenital disability which is impacting on them This is open to anybody Chris Katrina I can jump in there immediately because As it so happens again, it depends obviously on age And my darling grandchild who is two years old she was born with extra and polydactyl syndrome for The ones who don't know what that means is she had too many fingers and not enough toes and so she had some amputated fingers and one they had to amputate to a little stump and She a little trooper as she is she would carry on as normal and she's now two and four weeks ago All of a sudden she stood and looked at her hands and she went Oh Baby finger And she named it she noticed it for the first time She named it and now this is the baby finger So I think at the beginning it is again watching the developmental needs Where are they at? What do they what what does the affected person in that case the child? What are they dealing with and the Parents they already need support Like in my case they knew through under pregnancy This was going to happen which was so they had time to process Some parents don't have time to process because it is a shock just as a an accident or an acquired injury people have to deal with And therefore the needs again there's the family need and then there's the need for a child And there is thanks god liquid child there now. There's children books which we We in my age did not have available when my children needed it because they were five and eight And now I have children books for my grandchild I can sit with and she can look and identify with different disabilities So what about Katrina and chris do either of you work with children and do you have a sort of a An early age that you start to be concerned about mental health in a child with a disability? Do you want to go first chris? I'm happy for you to Katrina I think It really it depends so much on the child but the I remember this little guy who We were asked to work with him because he he had some real behavioral challenges at the daycare center Where he was going and mum and dad were starting to get concerned but the So When he was when he was two he had open heart surgery and the the types of behavioral challenges that we were seeing were things like Lots of difficulty paying attention lots of difficulty following instruction not being able to sit still and when we observed him he was He was incredibly hyper vigilant So it made it very difficult to be close to other children So for example on matt time made it very difficult for him to stay still if a teacher approached him and got down on his level So that they could speak to him when he didn't look like he was paying attention and in reality He gave every appearance of being of being a very happy child but He displayed traits of very high levels of anxiety And when we looked at the The impact on open heart surgery. He was taken to a strange place by people who he trusted He was he was he woke up in a strange place surrounded by people. He didn't know and And it was all because people he trusted put him there So I think it depends so greatly on the child and the family and the supports around them, but We we look for What's what's going on like are there behavioral indicators that say hey This child or this young person or this adult really needs some support Okay, thanks for that chris. You've now had time to google your response for the UK Hey, goodness, that's right Um, what yes generally a good rule of thumb is that the younger the age of onset the The easier it is for adjustment as a general rule of thumb um So for instance a new you know a new acquired injury when you're 15 and you've got all of the demands and tasks about a lessons is very different from being born with the same thing However, we do also find if somebody's got a congenital or early um, you know infant onset issue When they do become adolescents it might finally rear its head And we do tailor. I think most people would tailor their interventions You might use roughly the same approach but the intervention would alter so classically For a younger child We would intervene a lot with the parents and make sure that they're giving the right verbal and non-verbal Messages to the kid about their self-worth and their identity and all the things they can do it should be about ability Messaging about ability not disability. How do you convey that to your child in everyday actions? You don't have to tell them you don't leave it out and then give kids little Pithy developmentally appropriate sentences so they can understand what's going on for them and share it with a friend You can just get it over and done with for little ease and the older the person Yes, the you tailor that and maybe the intervention would become more individual and more sophisticated right Actually, can I can I add to that steven? the I worked with a A young guy. He was ten when we started working with him and he's a he's a young fellow with a fairly mild form of cp um But one of the things when he came to us was he wanted to be able to to explain his disability And to to deal with the depression and anxiety that he was experiencing because he was different to his peers and That was that was an eye-opener for me because I had assumed that having grown up with cp and he was a very high functioning young man Um, he was an athlete who regularly went away for 800 meter events. He's been to the the junior para olympics He's he's He does a lot of amazing things that other kids his age will never get the opportunity to do but um But he's he was experiencing all of these Um Emotions about being different and not looking or feeling the same as his peers Look that that sense of otherness is just so Reminded of you another patient of mine from many years ago a young man with a disability who used to Still from you to life He would take boroughs and just hack away at his forearms and his mother was forever Bringing him in for me to bandage up his forearms while these gouges Healed and I had no idea what was going on until eventually his father brought him in and his father was home from the merchant navy And he had tattoos up each forearm And this kid wanted to be like his dad's so for the first and probably the only time in my life I medically prescribed a tattoo For this young man because that's what he wanted It was uh And another one who wanted a pea plate like his brothers had pea plates That was part of the rite of passage returning 18 in victoria And he was quite happy once he had a pea plate on his Large truck which is how he got around Because that for him was a rite of passage. It took us a while to figure that out It was only when he went into a nearby pub and smashed the windows of all the cars with red peas on them Just not a good strategy He was communicating that he actually wanted to be like others of his age and that was his distress Glenn do you ever go and visit people like i'm thinking of a child who might have a an amputation due to an inter-cocus or something like Really can't help you with that steve. No, I haven't had any experience with that at all. Sorry Are there um childs or junior members of your group who do go for The yes there are and that's that's part of what limbs for life try and do is match up male for male age group Similar amputation etc. So there's not a hope at all. They're gonna send me to see a child. I'm a little bit older than that Yeah, no, it's always a bit confronting when you realize that a younger person sees people of our age as being just impossibly remote and distant and Would never want to grow up like that's fair enough to speak the same language. Yeah Maybe I can offer another tool what I have worked with when there's a person with a disability And I would have benefited from is now With family meetings not family therapy to actually call them family meetings Bring the family the whole family identify who is in the family that could be chosen family brothers and sisters and partners and a friend and A Coach that act as a coach as the therapist for about five or six meetings and provide space and to tease out that everyone gets a chance to speak about their feelings where the feelings can be Respectfully be held just the way you asked the panel or to ask us all at the beginning to have that within the the whole family To give voice to the ambiguous loss and I did not understand about ambiguous loss Which is not just for the person has lost things The carers have lost things the children the friends we and the losses They keep coming in waves because those losses are permanent If you have a wheelchair in the house, you will never furnish the house the way you want to furnish the house This is lost forever. You can see a chair there, but you can't book it there because the wheelchair can't get passed And so it would be for children And by providing that space as a family One can tease that out and more will come out Earlier than over the years where everybody has to fight for themselves Thanks for that Walter and Glenn just hearing Walter mentioned the chair there I think when we were chatting last week you mentioned that going into a wheelchair Immediately rendered you deaf and mute and that you were no longer part of conversations. Everything went literally over your head That must be absolutely. I'm down there and the people we'd meet in the street would talk to my wife and ask her how I am And because we weren't on eye to eye. Yeah, it's it's a it's the weird situation But I must say as well and on top of everything else something that has always struck me is The person with the disability Gets everything pushed towards them or you know, they get assisted all the way through in many respects The family get left behind Especially mental health I know my wife suffered something severe And nobody recognized that for a long time And I'm sure my two sons did as well Yeah, what do you think was the basis of their Issue if it's not too it might be too personal to talk about tonight, but Thought where those feelings arise from I think it well is As far as my wife's concerned, obviously it was a a redistribution of family responsibilities That was unplanned etc etc So she went from We went from making joint decisions on anything even reasonably important to to her having to manage everything And of course also the physical with the with the kids and that sort of thing that I couldn't do For met for a long time. So there was you know, it's a big burden on her shoulders and of course She's trying to remain strong for me and strong for our two sons And and hiding all of that from me. So That that had a mental torture on her So how how do we expand our therapeutic umbrella if you like to cover? The whole family. I mean gps are meant to be considered family practitioners, but It's sort of hard to know. I would have thought how far you can spread that and I know Katrina in another conversation you were talking about getting the whole community involved But obviously not to the point that it makes those Pavement conversations difficult and awkward in a smaller community. How do we balance that? How to engage with the whole family while not and about their mental health? While not overstepping our bounds and I'll focus on our particular client Yeah, you got you got to take care of the patient, but you got to be aware that the patient's got family and friends around them and and and they've got to be I guess educated Um with regard to the situation along with the patient If I can speak from a carousel hat and also from a with a therapist's hat, it's about Ask just listening just asking the question And the if somebody would have said But five minutes as they went out the door every time they see and see my husband for anything new wheelchair new bed new whatever I don't even know they are coming And they if they would find me And where are you right route in the kitchen and how are you doing? How are you hoarding up? That is enough It would make you feel oh Yeah, I I exist too. I I Somebody is actually asking how I am. It doesn't have to go into An hour, but just every time and how are you doing? I think that was one of the most useful things I was to be early on was the concept of Empathy in small doses and that in fact people don't always expect you to completely solve What's an unsolvable problem? They expect you just to understand what's going on for them And if they can see that you understand that's often the support that they need at that point And then to be able to do something is obviously a step further on from that I'm not the australian how I am mate Because you know, I don't answer to that at all Because it's a hello. Well the response to that can only be uh can't complain. Yeah, that's her. All right You actually told them how you were or is that is that is that a risk? I suppose going in as professionals or as peer professionals sports We are saying we are genuinely asking and genuinely interested in how you are But even how are you doing? It's it's different to how you are How are you it's yeah, I'm all right You know, how are you doing? I'm going to having to say a little bit more I'd like to just add that um plenty of mental health professionals are trained To protect Confidentiality and privacy Uh and it become and and I think we can over apply it It means that we we don't want to go into the kitchen and talk to somebody else because we think oh, that's a clear breach of The alliance the therapeutic alliance this the sanctity of that with my client The way to get around that would be to say just be really open and just talk some talk people through it and say um How well you go depends on many variables including things like Your attitude and how hard you work at rehab and do you do goal setting? But actually it actually depends a lot on support from others. So I would like to get to know Anybody who you live with And I won't share anything about you. There's certain things that are private But maybe I could talk to them and connect with them and make sure they're doing okay Is that all right and then you've got permission and I think it's all legitimate And and often and I think a lot of when I if I've ever done that A lot of the people ask go Of course, why are you even asking? And I know I get a bit too precious maybe about so well, it's not too precious. You have to watch your confidentiality It's critical, but actually our clients are like Go for it. Of course you would Well, there's one area that I was tipping around last week and while Pratt gave me a good schooling on it Which was entirely inappropriate, which was intimacy Yes sex not intimacy sex Because intimacy we can be intimate You know in so many ways But is sex only one expression of intimacy? Are there other intimate connections we can have with people even if they're not Totally totally but sex is also a very important one And and how do we do that and we get shut down at the dinner table That's how I broke all the rules all the time lost friends over it because I wanted to talk about sex and nobody wanted to talk about sex Um, not my friends. I embarrassed a lot of people and I shamed a lot of people And and I feel that's an important part in the therapeutic space to actually ask also a question And how are you doing with intimacy? What's going on? You know So again to do that proactively because it might not be offered. So we have to ask What sort of do people have any thoughts about possible referral options conscious that We have an audience right across the country and that um services are quite limited. Does anybody have any success with Sex therapists or an approach to dealing with um, uh, sexual dysfunction or sexual concerns Chris, what would have you got can I can I to answer that question? I think it it's helpful to Think about that as being maybe You know step four perhaps And a clinician can only get there if they've had a really good frank conversation about it um A lot of the audience might be aware of the placid model which is an acronym for ways that health professionals can bring up talking about sexual activity With anybody at all, but it's really helpful with people that are where their sexuality is affected by medicine Just so that you know, there's a link For you in the resources folder you can follow. There's a nice little article. It's quite short very readable And in brief the p for implicit means this is our our gateway the way we get into this is to just ask permission and say Maybe using normalising language like sex is a part of most people's lives and it can be quite important but hard to do With your medical condition or your injury Um, uh, I suggest we talk about it. Would you like to see seeking permission to talk about it? But but leaning heavily onto it and normalising then li limited information is the next step where you might start to do a little bit of Education let them know there are things that can be done then specific suggestions Is the ss and then the it implicit is intensive therapy and that's where the referrals come in Which is why I wanted to jump in steve and say you can so it depends whether it's the male or the female or You know, if it is at the same sex relationship, etc, etc and finally and There might be a there are medical solutions to some problems Or some really relationship Solutions to problems that you don't need a medical intervention like a urologist or medicine or tablets Um, so once you've got that permission to talk about and you can identify the nature of the problem Then you'll know where to go for the referral Right, right. Thanks for that There's been a number of questions coming up about chronic pain as an example of a disability I suppose but a disability that doesn't sort of stabilise and lead to sort of loss of function chronically it's more about chronic pain as an ongoing problem Does anybody have any thoughts About whether we have to alter our approach to mental health issues that arise? I mean, I know chronic pain would be considered a mental health issue But are there any approaches that people have used in working with those who have the daily Grind of chronic pain on top of their disability And for me as as a Gestalt therapist, it's uh, I look at pain very much as a psychological Can be psychological can be chronic pain because of injuries and disabilities And I have found that tapping Has incredible Results and outcomes And there's just a new paper a research paper been done from the bond university On tapping and and chronic pain You might be interested to I forgot to give you that resource so that I can You can look that up on tapping I'm sorry for the ignorance there, but what is that particular approach? Should you say oh tapping Where where you you you tap the acupuncture points and you can tap on anything Children Would be very useful to train them already at school Because they that is a tool at hand at all times they start off with tapping on their hand We you basically set up the session by asking how high is the pain on a on a One to ten ten being the worst give it a number And then what are we going to tap on on a headache on on anxiety on your back pain? And then you start on your hand and you say I am accepting my Top top top pain whatever it is Completely and utterly and then you start off with your with your eyes here and you just in your mind Repeat the word Headache headache and and you do it here and you do it here and you do it here and here and here and here and finish here Is something there in in dolphin release obviously, which is very practical It's a very practical And and it's a practice You want to you want to support the person to get into and they have that at hand just like mindfulness breathing Exercises what what can be an immediate tool for many things and the more you practice it The more benefits are being reported I think you're you're correct when you say that a lot of people Have trouble accepting it as a as a as an evidence-based Intervention it's nice to know a study has been published. I think for every study that on that there would be 60 studies Against them and not against it. No, I don't know if anybody's found anything against it, but in support of CBT, which is probably the most supported intervention Where the goal isn't to treat the pain necessarily but to help people to change their relationship with their pain and be less distressed by it less focused on it and less disabled by it And mindfulness can be embedded in the CBT That can be used across the age spectrum As well so that would be the go-to and it's really quite learnable and trainable and anybody that's had exposure to CBT You can learn how to apply that to chronic pain Which can be quite disabling absolutely ongoing And always changing so thank you so much We do need to move to the wrap up part, but there've been so many good questions I want to ask just one more before we wrap up the session And this is one that's come in from Louise Ohie, I think it is Who's asking about people who have a disability that comes with a stigma Such as up to follow their following bariatric surgery and they carry The stigma of being overweight But there are other things as well. She's also indicated the lung cancer, I guess is Maybe you have a respiratory disability which people see as Self-inflicted does that bring complexities to our approach to supporting people who have those so-called self-inflicted disabilities Which they're not I think Something to bear in mind when we're when we're talking about stigma and the impact that that makes on our mental health is that it's The work that we can do Around that is on accepting ourselves So when you're working with someone where there's The the stigma that they experience for the the impact of a stigma Um on their mental health is working through well, how how can I love myself? How can I accept myself? How can I be okay with who I am? um Because what other people think of me is Might it might actually only be what I think other people think of me because uh The impact of a stigma is made so much worse by how we regard ourselves In the light of what we expect to be a stigma Thanks so much for that comment Glenn I don't know if you had an amputation due to peripheral vascular disease from smoking. Do you think you'd be viewed differently? uh Yes, I think you probably would actually We're talking with people. Yes, it would seem self-inflicted where uh Mine was that mine was trauma. So it's totally different. Yeah, absolutely So what about a final comment from you? We'll go around the panel just in the last few minutes Just in one minute each Glenn any final thoughts you wanted to share with the group about the topic Uh, thank you very much. You've opened my eyes up a lot. Um Uh, and I guess these sort of discussions are I tend to learn a little bit more about myself as well. So thank you Oh, fabulous. Thanks for your contribution Uh, Walter, what about you anything final will you like to share with the group? I I see other what I would like to leave you with Is that as every injury doesn't matter what it is is unique There's no two spinal cord injury is the same. There's not two people who have taken the leg of the same Uh, this as much also is each person Carer family member different and each time they step into my therapy room I am seeing trust A new person I see them new each time they come to the session and and that is something Which is helping me to stay present and listen and feel what they are presenting with That's what it's all about. So thanks so much for that comment Katrina a final final word from you Um, yeah, I think it's vital to keep in mind That in our response to people with a disability and the people around them Our role needs to be one of empowering and enabling rather than one of doing four And so asking questions but being very okay with Silence Because sometimes questions won't be easy to answer and people need time to allow People need time to allow Themselves to get comfortable with the question you've asked before they can give an answer Yep, absolutely. Thank you for that for everything you've said tonight. Chris the final word with you in your last minute For everybody who wanted to come obviously there's an interest already my parting comments would be that If you haven't worked a lot in disability area I believe you will have skills that you can use in this um, clinical field um Straightaway you if you know, you know how to empathize and validate people's emotions. It's absolutely critical and that goes a long way You know how to do it build up a good case formulation So you can understand the problem and present it back to your client or the consumer And then form a collaborative relationship Where together you decide on what you want to change emotions and behaviors And you'll find a way to do that. We even with the most Remarkable injuries or illnesses or disabilities. So I'm glad that you're interested in that. You're here Fantastic I'm now going to close things up. But for four people leave us I will ask you just while I run through a bit of an update about what's coming up and what's a very busy remainder of the year Can you please complete the exit surveys? Click on the pie chart icon in the lower right corner of your screen next to the speech bubble So while I'm talking if you could do that, that'd be great Or if you hang around you'll get a pop-up message when the webcast ends You'll also receive an email from mhpn with a link to the recording of the activity If you want to review anything or share with with colleagues now November is a frantic time next Webinar is the 7th of November at 7 15, which is from com care looking at collaborating with the work to enable good work for your patient client We also have breaking the silence the back rainbow queer robbery series on the 3rd of november at one o'clock 7th of november is it's never too late to diagnose adhd And then as you can see they're emerging minds Supporting social and emotional well-being of children with higher weight Is on 17th of november And then on the 6th of december The primary health care network series has non-medical supports and programs for older Australians So keep an eye out for all these things and how you can register for these websites I'll go to the mhpn page and also to remind you that a podcast was released today called a firefighter's experience of ptsd Which has been released recently. So that'll be a wonderful one to have a listen to So mhpn's networking program does support practitioners to meet a network with others from the local community There are 350 across the country and around 30 have a focus on perinatal and or women's mental health Because that's such an important topic that they're listed on the slide and mhpn will send more details about these in the post webinar email There isn't one in your area and you want to start one up rip in and you can send an email to the email address their networks and That's a great way to connect with people in your area So before we close I would like to acknowledge the lived experience of some people in carers Who have lived with mental illness in the past and those who continue to live with mental illness in the present Thank you so much to the panel tonight and to all of those online who have been such active contributors Thank you all for your participation and have a good evening. Goodbye. Thank you