 Hello and welcome to the social isolation and loneliness collab lab. My name is James Ibrahim and J R as my co-host Before we begin I'd like to take a moment to reflect on the meaning of place and in doing so Recognize the traditional owners of the lands on which we work and live I'm at the moment on the lands of the Ngaro people and I pay my respects their elders past and present I'd also like to take this opportunity to acknowledge all the all of those living without support in the community And those suffering from social isolation loneliness and the impact of that So welcome to the collab lab. It's great to have you here It's a big audience and we know you're here from all parts of the country and many different disciplines professions job roles And it's excellent because the spirit of today's session is to learn as much as we can about the sort of interdisciplinary and collaborative care and Hopefully by the end of the session. We've got a bit of increased confidence to participate in Interdisciplinary collaborative care when responding to mental health presentations where social isolation and loneliness is a feature and also a better understanding of how Interdisciplinary collaborative care can contribute to better outcomes of people Who are experiencing isolation and loneliness? It's a three-part activity in part one will all be together in this main meeting room where we'll be your co-hosts We'll provide you with an overview of the field of social prescribing and loneliness at the moment and in particular You know the impact of you know COVID climate change and and and other Impacts on health in part two This is where the fund begins and you'll go into moderated breakout rooms The task will be collaboratively developed developing a mental health plan for a few vignettes And they're developed specifically for this activity you've been safe hand to the moderators we've selected for the task to whom you'll be introduced to shortly and We'll also be dropping into the breakout rooms who might see JR myself pop in there in part three We're all going to return to this main meeting room and we'll share those learnings and insights about the challenges and Merits and hurdles in engaging with collaborative care care in this field Mindful as large numbers interaction in parts one and three will be limited to a chat feature Located on the right-hand side of the screen While will not be fielding content related to questions here You can share either by direct message to an individual delegate or to everyone your own information that you wanted to share But you can also ask for tech help in here and one of our tech supports will get to you in part two the breakout rooms There'll be a lot of interactivity and each moderator will negotiate how this happens directly with their breakout room That would be one of your first tasks So we asked when you enter that room if you'd keep your camera on and your microphone muted as soon as you join the breakout rooms So yeah, follow the lead of your moderators to establish how you're going to work together in these breakout rooms J.R. Okay Next slide, please so Welcome to the social isolation and loneliness collab lab. I suppose Loneliness in particular seems more topical particularly in the sort of post-COVID time we're in at the minute one out of two Australians have felt has felt more lonely post-COVID and When you add to that all the sort of the last four or five years honestly with natural disasters and bushfires and flooding and those sorts of things What tends to happen in the aftermath in the initial period people bond together to show that sort of socially cohesive In resilient sort of practice, but afterwards when you lose the things that you used to the places you work or the places you go and have your leisure and those sorts of things the impacts are quite severe sometimes in terms of that that social bond we have and the Measurable objective and subjective sort of feelings we have around our relationships and our connection. So loneliness is Sort of a reasonably simple concept really it's just that that perceived feeling about the number of quality relationships you have so Where social isolation is actually the objective sort of measure in terms of a lack of social context or a social Participation activities They both sit in that broader umbrella of social health and there's other aspects and domains like social support Reliable alliance those sorts of things in that But why is it a problem? Well without relationships with others There's links to poor mental health increase healthcare utilization increase hospitalizations multi morbidity and mortality Mental health since this is an interdisciplinary group of professionals is an easy one to kind of talk about so some people with severe impassistant mental health Sometimes there's less opportunities to engage in the workforce and therefore you lose that set of social connections and potentially friends Similarly, if you're in the workforce and you have a long-term workplace injury that disconnection you feel can result in that isolation from your previous social networks, but also that feeling of loneliness as you recover from your injury and Need those sort of Instrumental and emotional supports in place Next slide please So in terms of you know, why is it a problem as J. I was saying There's always been an understanding that it has an impact on health But really until now not until now really are we starting to appreciate the the full extent of The impact of of loneliness and isolation and health in concrete terms So given that the vast majority Are this this here is just a graph showing loneliness rates by age And and just obviously it's important to make that differentiation between loneliness and social isolation where loneliness is subjective level of Satisfaction with those around you and social isolation is more objective decreased contact And so this is a graph of loneliness across the lifespan. You can see that the younger people 18 to 25 year olds are quite affected almost just as much as those between the ages of 56 and over so We know that it's a huge link to health and that most health outcomes determined by the social determinants of health, but Most people don't know that it's as lethal as smoking 15 cigarettes a day Now, obviously it's not causal, but there's associations there where we know that loneliness has an impact on health equivalent to that similar impact on premature death as obesity There's it carries a 50% increased risk of dementia and You know 30% increase risk of coronary artery disease and stroke And it's you know a 26% increase in all-cause mortality As you know health individuals and people in that role Across different fields. We often screened for many things that determine health outcomes like smoking alcohol Diabetes You know, we might measure weight. We might look at other things But loneliness isn't one of those key metrics that we've yet integrated into the standard way of monitoring Physical health outcomes, but we're just starting to appreciate that So how we measure this JR will run through on the next slide So sometimes the simplest way to measure things is just to act direct question asked direct questions Are you feeling lonely at the minute or how often do you feel lonely? There's a number of tools The more the more sort of popular and common ones are the ones like UCLA loneliness or Dijon In terms of social isolation, that's really just about the number of support someone has How many friends do you have or do you have friends outside of work or those sorts of questions can give you sort of objective measures? Those things and if you're looking at broader things like social support social provision scale By the same authors as the UCLA loneliness scale It gives you a sense of different dimensions of constructive and emotional sort of supports people can provide In general the the more questions you ask people and I suppose there's a survey fatigue In the present sort of time where people get asked to rate things all the time. So sometimes for Efficiency I suppose but sometimes just to avoid fatigue if you're asking someone to do a k-tan and phq and then you're out on the loneliness scale At some points it feels like that person might be lost as a person and becomes a measure So sometimes just that human connection is sufficient to elicit those sorts of things The other thing with loneliness. I suppose is it's it's a bidirectional sort of thing. So sometimes Life events can lead to loneliness and sometimes loneliness can lead to life events some of the sort of more protective factors tend to be living with someone else so having a partner those sorts of things and I Guess in the context of recent sort of natural disasters and some of the environmental changes Sometimes it's not as great to live in in regional and rural communities because there's an inherent sense of isolation Particularly when disaster strikes of feeling separated from those supports and structures So those things can have a bit of a compounding effect Next slide, please so this is really just to sort of illustrate that from a policy perspective and from from from a Systems change perspective The landscape is changing and there is momentum behind this In Australia, it's still a little disconnected There are a lot of driving forces to suggest that they're going to be some systemic change to address Loneliness and social isolation Over the next few years. So some of the documents you can see here international sort of recommendations guidelines consensus sort of Models and frameworks to implement social prescribing internationally, but then there's also a lot of our own sort of domestic You know system influencing papers and stuff like that. So we've got the You know, 10-year primary care reform recommendations, which mentioned social prescribing multiple times throughout as a way of changing Necessary change within general practice the self-care for health national blue national blueprint, you know that that mentions it There's the Queensland Inquiry into social isolation and loneliness The national preventative health strategy the work that our CGPs done and not to mention the national The Mental Health Commission productivity review which mentioned Multiple times that this kind of thing needs to change The you know, the understanding that I've got at this stage is that it's likely to be Addressed systemically in Australia probably through PHNs, but there may be other you know funding frameworks and so But there isn't yet a sort of Single model that we can confidently implement into our nation That has been proven in Australia yet, but there have been pilots and those pilots were learning from and so it does require We're at a stage where it still requires a bit of creativity and nuance to work out how to implement this into your the way you deliver everyday care next slide so As a GP myself, you know, there are many factors that drive my behavior some of them in not a very positive way when it comes to delivering care so I Think we all work in models where there's things that influence our behavior if someone's supposed to ask us You know, would you like to do this? We'd say yeah, we'd love to do this. I'd love to address this more. I'm very passionate about this But if you will will you do it? You know there that depends on things like How much time do you have? You know? What sort of funding model do you work in? is Would it be considered part of you know loneliness screening as part of your standard workflow? How would your clients or patients respond to you asking these kind of questions? Can you find a way to incorporate it the right moment the right time the right part of the sort of patient or consumer journey? What do you do when you when you'd find out about something, you know If you don't know where to send someone what's next so do you have the tools or awareness or understanding of How then to address something when you identify it in this realm of loneliness and social isolation and I mean, are you comfortable with addressing this or do you feel like it's outside of scope? Internationally, there's so many different models where there were sort of social prescribing towns Social prescribing is just one of the models of addressing loneliness is probably the most widely accepted and that's the act of you know referring people out to programs and activities to improve their health and well-being and So a lot of people can do that There's no it doesn't necessarily require professional expertise to make a recommendation and Sometimes we're just so preoccupied with things that we might see as more pressing like Housing employment, you know more more obvious presenting high-risk needs rather than addressing someone's social isolation or loneliness And it's just easier and quicker to focus on the biological and psychological factors, you know referral to a psychologist the medication script It's much harder to focus on the social environmental Factors that impact on someone's health Next slide things So social prescribing as James said is one of the opportunities I suppose to address some of the issues around loneliness as one of the components and also any other non-medical things They get in the way of well-being for a person So it's it's non-clinical it complements the general health and medical care someone gets it's directed by the person It's holistic and it's sustainable in the sense that it uses existing community resources So as much as their actual actually sustainable on their own right So it is possible to exhaust the local sort of community capacity to support each other in the current way We do things and that sort of funded system. So over time. I think there'll be opportunities to look at how to Reinvigorate some of that community-led and volunteering sort of well social community development work in Australia Next slide, please So social prescribing in particular addresses a number of the social determinants of health By taking that sort of holistic approach and asking people about the things that would improve their quality of life You can get a sense of the various aspects. You can make a difference Just looking at this one getting around if someone can't get to see their friends or family with transporter or Because they can't afford with debts or financial issues To actually have a car get the train take a taxi or even their rent Those sorts of things do tend to get in the way of that social connection and also can kind of blur the The sense of quality of life and well-being someone has Without things like employment Or even engaging in exercise groups things like that you lose opportunities for social connection and integration So all those determinants can have impacts in their own right, but all of them tend to be funded in different systems Which creates a sort of complex environment where you have to be aware of the opportunities available across each of their systems to be able to Access them and the people who are generally the most aware tend to have the most of those things in place Anyways, the most sort of financial ability and access to transport and those sorts of things So the real trick is says to describing is to try to actually create greater health equity by helping people access the things They need a next slide, please There's lots of different ways to connect people back into community resources So in some cases people go for assisted things that the top path is really just the Traditional way of finding community signpost is sort of resources. So there's databases Or local networks or even council websites that give you a sense of community things available The middle path is the most common social prescribing model the link worker assisted one where a health provider GP social worker Psychologist psychiatrist Etc links a person to a link worker who does that individual plan to look at the sort of things that would be interested needs and links them to the appropriate activities Alternatively, there's also models where there's digitally enhanced sort of things So you kind of have the health provider link someone directly to digital databases and or directly to the activities they run So for example, some GP practices overseas have had a garden where they might link the person right into the gardening program or down in Gippsland There's a GP who takes clients and patients out walking. So that's a direct sort of referral into a community activity Next slide, please So who is social prescribing good for I mean technically the answers anybody because all of us would probably benefit from Looking at what quality of life means to us and then trying to find out what's available to get there but in terms of overseas sort of models and then things to Developed in Australia over the last decade it tends to concentrate in different groups of people People living with mental illness. I'll be it tends to be mild to moderate people tend not to like to Try to to take the more difficult side of trying to create opportunities for people with more severe and enduring mental illness, which is interesting Chronic diseases so in southeastern New South Wales eliminate with Coordinaire We're doing a large program around anybody with a rat risk of chronic health condition and upcoming There's a panda study, which is currently metabolic health and nature-based activities Loneliness and social isolation. This is obviously the topic of the day, but it overlaps with all the things Inherently the idea is to connect people to things so they feel less isolated and a better quality relationships with others and then all the social determinants of health we just talked about which They don't there's not a ton of systems I suppose that help people figure out how to navigate anything from housing to each care to transport to Education so that it exists in little bits everywhere So send a link has bits and pieces and my age care has bits and pieces with care finder and all those sorts of things But there's not a single place people can go to make a plan for themselves The types of activities people can access are quite broad. So there's just group or social activities like a gardening group or a walking group specific profending services like compere Navigation services, which is quite popular. I suppose in the health space to look at care navigation But now there's things around practical assistance to access things like my age care self-sufficiency and skills development classes For any of the ot's in the room obviously It's always good to look at developing capacity and capability to do the day-to-day living activities And you see the psychosocial funding across all the ph n's for mental health Reinforce that idea of creating opportunities to gain new skills Healthy living the most popular one for purists in the health system The sort of healthy living and exercise and park run sort of activities And time banking effectively a broader system where people exchange their time to do something to benefit another person Someone might do gardening for someone and they might help someone else with their with their taxes. So that sort of thing Next slide, please So in short the simple model of how social scrapping works here is there's things they get in the way of well-being on the left side it doesn't matter if it's financial stress or mental health issues or substance abuse or just feeling isolated and someone Links them in It doesn't need assessment of some sort and links people to the services that meet those I'm at needs So it's a pretty simple sort of system in a sense Really, it's entirely person led if done correctly And it really is aimed at improving those various domains of what quality life is for that person Next slide, please And does it work? Well, yeah, the answer seems to be yes every every time someone does it But the tricky thing is it's it's not easy to do rcts and stuff with these sorts of things. So In Australia, there's been some work. We did work with people with long-term work cover claims So disconnected from work for some period of time and also people with severe insistent mental illness and complex needs and other groups Some of the things we found obviously reduced hospitalizations and reduced primary care utilization and allied health utilization the the workers compensation Work we did made it easier to actually measure that because they have access to all that medical utilization data So we could actually see After a little spike in in that sort of more health literate behavior Taking care of their own health and well-being a quick drop-off in terms of utilization of health services and an increase in social participation and activities Overseas likewise a fallen A&E attendances following referrals and reduction GP visits In most places you'll find general improvements in quality of life and well-being And in various measures of psychosocial wellness in Australia tends to be things like k10 phq those sorts of things In terms of a novel thing that work readiness and social participation So i'm in Australia led the way in social prescribing in terms of um long-term workplace injuries and social prescribing So gratitude to new south world's government and i care for for funding that sort of research early on People felt more ready and able to work after attending things like Arts on script or photography groups things like that Equine therapy more satisfied with the social supports And they actually participated more in activities as you'd expect And and felt more socially connected and had more people they could count on so overall that They calculated that to be a net social return of just under four dollars for every dollar invested Next slide, please so one one of the struggles is uh It sounds fantastic, but how do we actually put this into practice? When we're facing all the pressures myself for example, um busy gp 15 minute appointments patients waiting in the waiting room Um, you know, it's not easy. Um, but I found this particular Junctures in my clinical care. Um, for example at the point of doing a mental health care plan or At the point of an over 75 health assessment where there's It's it's highly appropriate because i've got that time to talk about preventative health and health screening and it's More acceptable patients are sometimes thrown off. Why is the gp asking me about loneliness? What's he gonna do about it? um, but More often than not it's probably the most um You know the room falls silent and and and and people find uh, there's a lot of stigma behind it still to say Yes, I am lonely but You know, it's it's very difficult. It's it's very difficult to share and uh, and it's a privilege when people share this with you so They need to be given appropriate time and space. Um, it can't be a tick box question, um, which you brushed through um, so All all of you will have some sort of you know, um intake assessment stop gap discharge planning point in the care and uh Interaction you have with your your you know, the consumers that you work with And just considering at what point would it be appropriate to address this? Where can I do this in my system as it is now? um working out Your local available resources, so I mean the easiest sort of map for a gp has been sort of going to p h n Ask them about the commission services looking at local council youth groups live local library And then you've got sort of more formal listings like on ask is he or my community directory or those kind of databases and then um You know creating your own sort of community assets So, you know if you have the provisions to looking at um bringing people together Or tapping into existing or linking with existing community assets and resources next slide. Thanks um and so You know what's on the horizon in australia? Uh, well looking at um Linkwork social prescribing to be trialed at scale and evaluated So p h n's around australia are looking at these sort of link worker models um capacity building a massive thing so um national community and capacity building and Uh, and and there are also other emerging models like the asset-based community development and behavioral activation um funded programs where you know health coaches or you know, um behavioral health clinicians are located within Areas to you know health other health Places like you know gp clinics and uh head spaces and places like that um I'd also just mention education. Uh, it's just starting to work its way into um the literacy of you know Of doctors and and things like that where they're learning about social prescribing There's now social prescribing student collectives in medical schools and things like that. It's fantastic that it's it's starting there So I think the new breed will have um increased awareness and it will be a bit more business as usual Next slide. Thanks. Uh, yep. So this is just a list of summary sources. There's lots of things you can I mean if you google social prescribing, um, you'll get a list of general resources and if you're out australia You're getting a list. Um, I know colleagues at adma who are in the moderator rooms would probably also suggest you Just search adma and social prescribing to get a list of local examples of social prescribing in different parts of the country Uh, and as a lead in I suppose, um, as the next thing I'd like to introduce to you are moderators for the next part of this Uh, christine calahann, chryslines, kailey and ryan and slade who will lead the breakout rooms Welcome back everyone. Um, so Uh, I'll just give it a couple of minutes till everyone joins this uh, this group session Um, we were all back in together with the moderators um, so As I was a fly on the wall, uh across the different sessions. Um, what was What was most interesting was the how how varied and experienced? Um, the people that are attending this um conference are and I think out of respect of that, um experience and expertise. Um, what I'd like to hear from the, um Uh breakout room moderators would be as we go into this next stage in australia and hopefully start to implement this um, what was some interesting insights or Or things that you'd want to share with the group, uh, that some of your breakout room members Shared with you. Was there anything in particular in terms of considering how this is implemented? The way in which uh, it's it's delivered to people because I heard many different Thoughts and considerations. I'd like to hear from the moderators What were some special insights? Um, that some of our wonderful experienced, uh, You know conference attendees, um might have shared with you It's christine here. I'll kick off. So, um, I would just like to, um reflect as well that the group was You know incredibly diverse but had so much knowledge, um and kind of understanding of the range of supports and I think they One of the things that really kind of interested me was the kind of the way it was was reframed in in some ways um becoming lonely and isolated was almost um as an impact of loss of role identity so at major transition points in people's lives and you know, we talked a little bit about all the The different transitions that you know, you go through in in your life So really thinking about you know from the from a social prescription angle, you know, it's absolutely critical at those major transitions So how do you build capacity in the system? At major transition points for people. I think with another was a really important kind of element um, I think the other thing that I saw from everybody that spoke was um very much a focus on person centeredness So I think that overwhelmingly people were you know, it's about what that person What what's at the heart of that person? What did they love to do before? What do they love doing now? What might they love doing in the future and and going on the journey with them to kind of experience that rather than you know, just A service system that kind of this is what we have and therefore this is what you get It was much more about just you know that kind of co-design. I suppose And really I I loved the concept social prescription as a way of recreating an identity And that to me was a beautiful concept. So thank you for The person that said that you know, it really is about recreating identities that might have been lost and you know reframing empowering people And capacity building in the system. So that was some of the great things that I heard That's okay. Is that all right James? Yeah So I just wanted to echo the point around sort of the really understanding where people are at That you picked up christine. I think So first of all, thank you group art is ed for being such a great group to work with So I think really what I heard was sort of people really thoughtful about where people really understanding Where's this person at what's going on here and actually You know, what's really going on here because I think what we all know is that somebody sometimes Might say to us what's going on because they think that's what we want to hear Whereas it's not actually the truth And actually they're sort of trying to put a brave face on it or whatever. So I think these things are really important So I think that was um one piece I think the other piece also that I heard coming through our conversations loud and clear was not Not being in a hurry to rush things And really understanding where somebody's at and understanding that these conversations take time And so it's that sort of duty care of understanding what's what's happening here But also, you know, I just was sharing with my group I've just been off to London with NHS England, etc And we were at Bromley by boat one of the days And they were talking about the fact that it said it wasn't until the fifth conversation With a link worker that sort of information was coming through about what was really happening And so we can't rush these conversations sometimes and it's a balance I think when you're working with people They're not sort of trying to sort of get to solutions too quickly And it's managing that cadence of where they're at versus sort of Where, you know, we might be At and I think that's just an important reflection for all of us And I think then the last piece in terms of some of the questions but around collaboration I really loved the way that You know, the team was sort of thinking about different people in their community who were supports And how those supports work together but also making sure then that that Person is got a warm referral But then there are no gaps Because I think sometimes, you know, the community needs to be wrapped around a person And it's making sure that they're getting the support that they need and there's an accountability there And so again, you know, I just wanted to thank the group for just being so honest and really very thoughtful The vignettes we looked at were number one Which was Patricia and then number six, which was If I've got it right is I can perhaps say Brad, but let me just check myself, Nick So quite different situations and by the way, I suppose the other thing James just mentioned, you know, we had You know, 72 year old lady in our first example Increasingly isolated and withdrawn and risk of falls and then in scenario six We had a gentleman first First First immigrant coming into Australia He'd lost his job and then sort of lost his sense of belonging and also had financial worries. So, you know, sort of thinking through, you know female male Different context of what that might look like and what might be going on Hi, sorry. I had a bit of trouble getting into the room again I'm having major internet problems today, which I normally don't have. Sorry about that um, so We had we looked at um, Patricia as well Sean So vignette one and also Brad So an older lady and then a younger guy We talked about the range of wonderful services that are available that you can Reach out to including neighborhood houses libraries men's sheds etc We did touch on how feeling Product as a person who's experiencing this It's about feeling productive feeling You know some worth. What can they share with other people? When they're feeling isolated. What did they got to give? So, yeah, we spoke we touched a lot about You know providing something having something to offer And that feeling of productive a lot of those lines we also talked about As you touched in your opening presentation about that sense Of belonging because you can be in a group and then not necessarily feel like you belong in the group We also spoke a little bit about how there might be some specific needs for men so and the way men might Seek out help or want help We all know and and even just interacting with each other We did discuss about the iceberg stuff. We all acknowledge that social isolation Yes, tip of the iceberg, but also that social isolation can then lead on to serious social anxiety, etc. So it's about sort of addressing it proactively What else did we talk about? We did get some further to add further to the directory discussion We did get some advice that this lifeline also have a service finder And Again, just to reiterate what I heard Sean say I was really grateful to hear have the conversation with everyone. So thank you Great and Chris Yeah, thanks to our Yeah, I think I'd like to thank the group as well. Um, there was some valuable contributions. I think James was in the group when one of the key themes came up for us, which was around It was on the back of a conversation around You know, I had people Communicate loneliness without stating I'm feeling lonely and then now you don't create a system there With a sort of loneliness navigator that becomes the the touch point I think one of the most interesting And powerful things that came out of that group at the end was very much There was a conversation a discussion about how we create Intentional environments for social connectedness opportunistic Um and incidental connections. We used case study three Which is sylvie which is a very case study. It's about a rural situation in the rural community So I do create those Which You know as everyone on this panel knows talking about the creation of environments to facilitate social inclusion is a whole different conference Not the sort of 20 minute conversation that we had a chance to have then um So yeah, I think they were the key takeaways for me from my group wonderful, um Okay, any closing thoughts from any of the moderators? Um Before we say farewell Just just one thing which I think was really heartening and it was great to just hear about the lifeline service find it because there's a lot of um great resources out there and Certainly people in in the group that that I had the pleasure of moderating would had lots of great ideas There was so many ideas about you know, where you could connect where you could go to And even in some very like rural and regional communities resources from the council the resources at libraries You know online tools to they access services and supports for people That they are there It's it's just looking for them and finding them so that you actually have access and and certainly from just from the conversation I think the people in the group had so many different ideas and thoughts about how they could link people To services and supports that would really make a difference To their connection and you know address isolation So if there's a lot of stuff out there across the board Okay, well, I suppose. Thank you to the moderators in particular and um Do the great job. Obviously everyone had their own style, but it was a pleasure to watch you to view um with your groups Um Look for me. I found it particularly interesting because I know a lot of those people in those case studies Whether they're from New South Wales or from Queensland and it's always interesting to hear how other people talk about people, you know Just uh, it's a bit surreal sometimes. Um One of the things that identity thing comes up a fair bit and I definitely get that And it's not just the identity of the people who are actually getting the social scripts It's also the identity of um the link worker in the Australian context is an interesting thing We don't really have that link worker model as Sean said here So it tends to be the nurses and the the psychologists and social workers and the doctors doing that that prescribing And linking all in one fell swoop And it's a bit outside of the comfort zone sometimes because we all have skeptics of practice in ways we work So it's a bit unusual to have to have that secondary identity um, and I know colleagues at university Queensland, uh, like uh, Genevieve Dingle published papers on this more recently in terms of that sort of complexity of the link worker role in the Australian context, but um James your thoughts Look, I mean from a from a general practice perspective and again from a health perspective, um when you've got sort of 80 to 90 percent of health outcomes determined by the social determinants of health Why We like there isn't a specific, you know social worker workforce incentive payment for gp clinics to have social workers co-located just boggles me um, so You know, we have that for nurses for chronic disease But when addressing the sort of underlying social determinants of those chronic diseases Um, it's it's a shame that we don't have that level of integration of that kind of workforce that kind of skill set um With what is unfortunately, you know the front door of health care in australia and where often those in greatest need tend to only go to um because of you know their health literacy issues, etc um I was struck by an interesting dichotomy in the chat groups so um in uh christis group, um I think her name was jenny um in the chat. She was talking about um, uh A quote by cormac russell and he was talking about someone who worked He worked with who feared being a burden More than he feared being lonely And I think this is about like how we how we deliver this in a palatable way and um, how He said he'd engage with someone with that fear was that he suggested shifting to you are needed not you are needy um The community needs new rather than you need, you know the community and I think for a huge percentage of those with um lower kind of intensity health needs, uh, or lower intensity social assistance needs that kind of Bringing their value to the community is something which um, I fear when this is rolled out in scale May be lacking that kind of angle yet in um In christine's group, uh, I think it was mary uh mentioned that on the other hand the identity as Of someone being an injured worker could be very validating. I am injured. I had an injury I need to recover it was significant um, it affected my functioning And therefore they needed to recreate themselves, which was a very different kind of um You know and I think from a from a user experience perspective, you know the idea of a someone being a consumer very transactional and their Engagement with whatever is sort of offered to them depends on how they how they how easily they identify as As a consumer as an injured person as someone in need of social assistance or Someone that the community is in of you know is in need of And I think from a my subjective opinion is is to catch The most amount of people that could benefit from this You know you you'd focus at a large proportion of it on the lower intensity You know and that is really sort of to me early early low intensity mental health Management when we're looking at you know, the community needs new you don't necessarily identify someone who's you know objectively socially isolated or lonely But um, they'd certainly need your skills assets and experience Um, so it was interesting to sort of hear about the different ways And I and I'm sure in the rollout. There's it's much easier to set up a framework around those who are consumers And identify as such, but I suspect that to be the minority. What do you think jar? I think you raise an interesting point. It's um As a community, uh, you know Australia is a community oriented sort of country and I sometimes wonder it is sometimes easier to be in those groups to actually deal With the stigma that's attached to everything. We have a long way to go as a society towards actually Making every place just safe and normal to be you And it's a bit of a shame to be honest because um the stigma is everywhere to be honest. Um so I I guess um Reflecting on some of the qualitative literature that one of my phd students thames and thomas. She's um working through at the minute She's Pulled out vignettes of people saying. Yep. I didn't think I was interesting And I didn't feel I had a place to talk. Um, and now now I realize I do have something to say and people do want to hear it And thinking back to the um, the workers compensation work with christine Years ago when she was on the government side of the coin, um A lot of it was just I forgot how to socialize. I didn't you know socializations like a muscle that I haven't worked I don't have a place to use it. I don't know what I'm doing anymore and I'm not confident so There's comfort in finding other people who are going through the same sort of difficulties But at some point it'd be nice as a Cohesive society if we could actually somehow pave the way that everyone can just actually be themselves And they don't have to to go into that identity group formation thing and they can just Be but anyways, that's a whole separate side comment. Um So yeah, no, I think it's been a fantastic session and thank you to to everyone. I think we're nearing time so um I might just what do the others think in terms of, uh Sean and christine christen catbook came in in terms of When when we're implementing this, you know, is it to consumers? Is it to mental health consumers? Is it to The general population would would you would you use this service? Would you engage with it? You know, um, how should should we lean it towards health or lean it towards for everyone, you know I think I'd probably um if I can jump in I'd probably take um, I guess a A population health approach in terms of Primary prevention secondary prevention, etc. And to be honest, I think this applies to the whole population because I suppose in a population um Health thinking you want to catch people before they fall. So if I think about sort of um our case with nick, for example, you know, he's his whole sort of um Persona orientated around his work colleagues lost, you know, when then sort of lost his colleagues, etc A couple of people had suggested around men's sheds and these types of things But I suppose, you know, if there's that piece of how do we build capacity? And I think jru and james both raised this instead of as we talked originally is sort of helping build Some of those connections so that people You know, things do go wrong that there are that there are rather avenues because I think the problem is when Things do go wrong people are less inclined to reach out And so I suppose in my view anyway, it's catching people before they fall and sort of how do we build capacity Into the system with different levels um Easier said than done. I know Um, but I suppose I take that type of view I mean in the broader sense I think we could all link each other into what what opportunities exist and if we were just nice compassionate communities We could skip most of this People who work in bureaucracy and spending so from on behalf of whoever is stuck at the government paying for the bill for this Honestly, uh, I think a neighborhood could sort most of it out and most of us shouldn't be here talking about this That's that's my real sense and bottom line. But unfortunately I have to spend money and put complicated frameworks and then look at safety and governance and then spend tons of money To to be good people to each other. So Anyway, um, I've just popped in the chat It was so nice to see from francis in the chat and also kaleen your group brought up the sort of um issue with men in approaching this and I've just popped in a link to Uh, mr. Perfect. Um, he's got a fantastic men's health directory Um, so if you if you if you can't find that link in the chat, it's Mr. Perfect's dot org dot au and this guy has compiled a most amazing directory specific for sort of um, you know Men with difficulty in terms of starting that conversation and engaging with others and yeah That's great to see that theme brought up today as well Yeah Can I interject too that we've just k and r in camber today and actually um, so Simon Jarvis who's the CEO of mentoring men Has been with us and again, you know, we had the same conversation come up. Um in terms of this I think yeah, it was really important to sort of understand what resources are out there and how to connect people And you know One size doesn't fit all so different Different resources are going to be working for different people So I think the more that we know about what's out there the more we know what we can connect people to Okay So, uh, probably just nearing time. So, uh, thank you to all of our moderators all of our guests And colleagues and the people making a difference every day For everyone in their communities Thanks a ton for joining us for this collab lab. I hope you enjoyed the session and took something out of it and You can continue this discussion tomorrow in the uh, the networking hub the uh, the informations on the screen there I'll be at one of the tables if you want to talk more Also, I'll just put a link on the side the mhpn national network on search prescribing There's a link you can click to Register interest there. I can have a chat tomorrow There's also a guide to the monthly session in 15 minutes at 5 15 And don't miss this evening's panel discussion. The next is between climate change and mental health at 6 p.m melbourne sydney and hobart time Uh, please complete the survey about the session to the right of your screen Um, or the one you'll receive by email next week about the whole conference just to inform future conferences and again on behalf of myself and um James thanks so much for your time and uh, feel free to reach out To discuss anything else and thank you for whoever uh suggests that I should be prime minister. Appreciate it Mum would be happy. All right. Have a great day. Thank you