 Good evening everyone. My name is Steven Ginsberg and I'm your facilitator for the evening. I'm an aging GP born and trained in the UK. I've been in Australia for about 45 years and I'm speaking to you from the Marigal land north of Sydney and Welcome to the the sum of the two thousand three hundred people who have Registered and some will have joined us for tonight's webinar Trauma-informed care with older Australians and welcome also viewers who will be watching the recording. I'd also like to say a special welcome to the members of the Sydney north older Person's mental health network. That's a mouthful of which. I'm a co-coordinator and to other networks around Australia Who are meeting tonight to watch this broadcast? MHPN currently supports six older person's mental health networks across the country and Details of these networks and how to join them will be listed in the closing slides So we'll just go on to the the next slide here Get the cursor to work There we go So this webinar is the result of a unique partnership between 31 Australian primary care networks and the mental health professionals network and in a first in their history the 31 PhNs for folder consortium and engage MHPN to plan produce and broadcast webinars focusing on older Australians and mental health and I'll be facilitating all of these webinars and tonight is the first of the second series. We've had a series of three some of you may have seen them and The PhNs have agreed to continue the series due to its success So it's a bit like Netflix. We get onto series two More webinars will be delivered in the next 18 months. So keep an eye out for them This might be a good time to use the chat room to say hello to each other Share the name of the land on which you're beaming in from for this national webinar Being panelists myos were Posted when you registered Here we all are and you can see them all on the screen now So I'd like to begin by handing over to Judy for an acknowledgement of country. Thank you, Judy I'd like to ask us all to think about where we're sitting in the different parts of where we are in this land We now call Australia. I'm sitting in the visible viable land of the Greater Bungalow nation In northern New South Wales, and I'd like to give a welcome from the elders a person present But more particularly the people and the children of this place So wherever you are think of the children that are the heritage hold the heritage of where we're all going Into the future. So I welcome I Also acknowledge the ancestors the elders the people of this place and The youth and the children who are going to carry the vision of who we are forward I'm speaking from visible viable land, and I'd like you to think of Where you are and to name those people where you are at this time Thank you Thank you, Judy. Thank you very much Well, you know, I'll pause for a moment for us to reflect on that because the next slide is a little bit More digital I won't go through All of these I Encourage you By registering you've automatically agreed to the ground rules Sounds awful, doesn't it which can also be found in the supporting resources tab Thank you for sending in over 200 questions. So we've had to edit them down. These don't take offense if your question is not One of the chosen questions they were all excellent and oh that we had You know half a day to sit together and have a jolly good yarn about about things that we've Whittled them down to a handful for the Q&A section would be coming up in a moment We're not presenting a case study as I'm sure many narratives will emerge. I Hope that the Q&A session will go to the core of what the webinar wants to achieve Encourage practitioners who provide support and care for sectors primary care mental health and community to work collaboratively and assertively together in their work with older people and I always You know stress that word with I think it's it's so important I think we will try and do things with not to or for There's a learning outcomes, I think everyone's familiar these days with learning outcomes It's a lot to achieve in 45 minutes on such a broad and complex field But I'm going to start by asking each panelist to introduce themselves and their work And as I say their bios are in there in your registration pack. So Judy would you like to come back and just for five minutes or so? Just give you give us a bit of an idea So first of all, I'm a human fungelung woman with also Anglican German heritage and By choice I had decided to focus on children in the work. I do I have a PhD Which looked at violence trauma in communities in Queen's Lane particularly in Cape York So focusing on children is really interesting because once I focus on children I'm actually also sitting with the grannies and the granddad's and the elder people in the community And to that in fact is my my life Mission at the moment is just to hear the stories that are coming out. I Have a number of children and grandchildren of my own I've just been some time with my son in Brisbane, which gave me great joy in the way that I saw him interacting with the 95-year-old man across the road Sitting and talking with him. So this describes who I am I'm a mother her grandmother a great grandmother, but more particularly on particularly particularly as an Aboriginal woman concerned for our children They're the future of this country I'd like to Stop now and just hand over to Duncan or whoever else wants to now talk Well, that's a good segue Duncan Okay, well, thank you Judy and thank you Stephen and hello everybody. It's great to be here with you all tonight. My name's Duncan McKellar I'm a psychiatrist Specializing in the care of older people and I'm coming to you tonight from Adelaide So I'm on Ghana country the traditional custodians of the Adelaide Plains And it's really exciting to be able to be part of this webinar this evening in my work as a psychiatrist specializing in the care of older people one of the the groups of the populations or the groups of people that I work a lot with are People with dementia and in particular as a psychiatrist. I work with people who experience really quite severe to extreme psychological and behavioral symptoms that result from living with dementia and So this is a particular population that really are very close to my heart and I spend a lot of time with and so One of the things that perhaps we'll talk about as we move through is the impact of trauma in that population and how For people with dementia trauma is really important to be thinking about Think one of the questions that we're to start sort of thinking about at the beginning of tonight is what is trauma informed care and What does it mean to us? What does it mean to me as a psychiatrist? And I suppose For me trauma informed care is a really fundamental part of the way that I think about my work as a psychiatrist, but also My interactions with other people as a human being and One of the things that I think we need to be very aware of as we interact in systems of care and health and social care Is that anyone who comes into that system? whether it be somebody who comes in in order to Receive care or whether it's somebody who's actually in that system delivering care is that any one of those people May be carrying with them the impact of trauma within their experience and that trauma can then Play out in all sorts of ways in the therapeutic and the interpersonal Interactions that occur within that system for that person and the people that they're working with and this is as important for people who receive care as it is for those who deliver care because Depending on which study you read it's anywhere between 55 and 90 percent of the population have experienced Significant trauma within their lives at some point in time and so for me Thinking about trauma-informed care is a fundamental component of us Moving forward and and doing our work and living our lives as clinicians and as human beings And the other thing I'll say before I hand over to Johanna is That I work with older people and one of the things that really strikes me when we think about trauma We often do think about younger stages of the lifespan And what often happens for older people is that we can Minimalize the trauma that that may have impacted their lives and how that might actually impact them There are things that happen in older life That we we just take as a normal part of aging so take for instance things like forced relocation Well think about moving into residential aged care for instance, and that that becomes a forced relocation often times for people Acquiring a disability so think about the onset of of Frailty in older age of physical disability of cognitive changes. These are all potentially Significantly traumatic changes for older people. I think of losing a life partner And there's something that often happens I and I see this a lot of the time where when something happens for an older person We tend to minimize all that's part of getting older And we can we can fail to to recognize how significant an impact that might be on that person's life And how traumatizing that would be now if that if that same event happens to somebody who was 35 or 40 we would see it as a tremendous Trauma as a tremendous Imposition upon their life and their well-being and it's an interesting to think about when we come to this idea of trauma-informed care For older people is how easy it is to slip into societal Agest kind of ways of thinking that actually Marginalize and minimize the impact of trauma on older people and that's where I'll leave it for my starting comments Thank you. That's Johanna Well, thank you And so welcome everyone. It's so nice to be with you all this evening I'm I'm a GP and I'm calling in from Kwandamuka country the eastern suburbs of Britain I'm a GP who spent the last 15 years of my Working life working with adults who survived childhood trauma and neglect and as Duncan was speaking I was thinking of a patient that taught me such a key Lesson about trauma-informed care. She was a woman in her 70s and her Event that had really frightened her was being locked inside a cupboard while she was playing hide-and-seek as a little girl and All these years later. There was something that was really still distressing her and I guess I come to trauma the concept of trauma-informed care as a GP who Has witnessed many when people stories telling me about events that other people would have written off as not traumatic But for her as a little girl She thought nobody was going to find her and that she might die on the cupboard and it had been tormenting her for decades and Her message to me really was that the traumatized person gets to decide if it was traumatizing Not some artificial DSM diagnostic framework that was usually written by somebody wanting to minimize their insurance costs and That When we are with people it takes time to get them to be in a place where they feel safe enough even to tell us About things that they might find shameful or distressing about their their life stories So I come to this space of trauma-informed care after years of working here With a strength-based approach thinking that our main goal when we're with people is how we help them to feel safe in the world again We don't have a job of being a journalist or a judge Making sure we've what some people say taken the history from someone and I had the lovely person remind me We receive a history from the people we listen to And so there's this Place of sitting with and holding Suffering while we help people to feel safe again in the world I've just completed a PhD that looked at distress because we sometimes divide Human distress and suffering into little diagnostic boxes that means we miss the deep story of what's been going on for the person and So I went to my PhD with a question from my community, which was how do we help people to feel safe again? Looking at a shared language that crosses disciplines called sense of safety and I asked the respondents from that process Two main questions what causes threat and how do you sense that you're safe and What came from that is a really broad understanding of People's environment a lot of people talked about injustice and The processes of racism and dispossession of country and you know I hope tonight will get a chance to focus and learn from Judy around the experience of stolen generation elderly people and So that place of of environment Including connection to the land that Duncan kind of Gave us a hint about when we get moved and translocated without our wishes and then noticing that the Incentality of relationships and how people relate to one another and how traumatizing we can be towards one another by ignoring or Disconnecting just as much as we can when we invade or confuse one another And how our bodies are a place where we can feel distress from pain from illness from frailty and Again, this is something that's really important for us to notice as Duncan alluded to earlier and I guess I'm also interested in my work in general practice So with with how people treat themselves what they think of themselves and how they talk to themselves Because we can traumatize ourselves on the inside by how we minimize or dismiss or attack ourselves And what we sense and perceive in our bodies and our inner experiences our memories are such a part of us and When we only focus on thoughts and we only focus on the thoughts or memories that have been made overt or explicit we miss out on the memories that are hidden inside our bodies and Of course how people make meaning and how they face spiritual things Which becomes sometimes more distressing as we age existential distress that can be quite traumatizing So I guess I come to this as a generalist who wants to help us see this wide picture and watch for patterns of how people heal and how we as human beings no matter what kind of profession we come from could Do a little bit more in that space to to respect and honor and Include see the strengths, you know post traumatic growth is a whole area of study And so the strengths of those who have survived traumatic things that we can honor in the elder people in our community Would be where I'd end there And thank you, Johanna. That was that was a lovely description of your work and your life And it reminds me of Something once taught me always always think of compassion for one's own chronic disorder That can be helpful And another thought that came up while you were talking was I don't want to recommend TV programs, but Currently there is on Netflix a a series called made With when you said cupboard it You know, I thought Duncan's nodding his head. Perhaps you've seen it, but a cupboard plays a very large part in in the story And it is about trauma and And how it sits in there. So so if any of you out there are Netflix watchers I think it could almost be used as a teaching tool. I've been very impressed by it So moving on As a schoolboy I was always told to look up a word in the dictionary even if I thought I knew what it meant So the other day I looked up trauma And My dictionary tells me that it's the greek Cal comes from the greek word for wound But it's used for and I quote a disturbing experience such as to cause a mental shock dates from a reference in psychoanalysis from 1918 so That diction is pretty careful in trying to find out when A word has been used for the first time In language in the english language. So can I ask each of you and perhaps start with you, junie? What is your understanding of the meaning of trauma and As one of the questions that came into us How do you approach trauma informed care now you've described some of that But if you are a wide open field to Say a little and then we'll Give your Your view on that So first of all trauma is embodied And quite often and I'm now talking specifically about aboriginal and Torres Strait Islander people and people with the cold background Quite often it's about history And I just wanted to describe something that I experienced in a hospital to Bring my point forward I had a fall and Not that long ago a couple years ago. So it was in my 70s. I had the fall and I was taken to hospital And beside me in the room beside me was an elder aboriginal woman At my age, but the nurses had decided that she had dementia And as I sat and listened to her Found my way into her room to sit beside her It struck me in a very painful way that what she was acting out was some very very painful Childhood experiences. She had been removed as a child and placed in institutions And she had experienced sexual abuse And other forms of abuse and she was acting herself in different ways that Only made sense to somebody who knew the history Now I think what I'm naming here is not just for aboriginal people Trauma is embodied. It's generational. It's memories and it's the experiences that have been passed down But in this case this woman had been removed as a child, but also people who come from other countries Who come from our zones to live in in this place we now call Australia will have Memories and experiences with extreme trauma which Can't be expressed because people don't want to hear it People do not in this country want to hear the experiences of aboriginal people From a massacre from a war zone From children as children being placed into care and then being seriously harmed And what happens is we get old those memories become stronger within us and we act them out Um, so trauma is a generation And I'm talking about aboriginal people and I'm talking about people from other countries called um, it's generational It can be developmental in the case of this older woman who had these incredibly distressed feelings Traumatic experiences of the child being abused in many different ways when she was placed in care the care of the state Or coming from a war zone if you're coming from another country It can Be complex in the way that we uh, don't understand ourselves sometimes what we're Experiencing what we're living with my background history from my own family is Survival on my great-grandmother's side of the Hornets Bank massacre And I've just come back from placing yourself wails Where we were talking about what was happening and how the children were acting out in the school um, some pretty distressing behaviors And then sitting with their not their parents because generally they weren't with their parents their grandparents End of the shock and the distress and the shame that was in the the grandparents experiences and on the way home Uh, as I was driving home with the uh, the psychiatrist who was working with me um He said what is this? And I said Do you know the history of this place and he said well, I read and then he named the books on them I'm not going to name the book because I don't want to Have your own understanding of the location of what I'm talking about And he uh, he said, you know, there was this big massacre and I suggested was and what else happened And he couldn't answer me And I said go back and read the book and you will find that At the time of the massacre they reached the women and the children as well the girl children and the boy children And that is being acted out now And I'm then referring to that woman Uh in that hospital bed And the nurse was talking about her as though she was a problem and she had dementia And I said, okay, let's just go back together and we'll sit here and have a talk and you see if you can hear The stories that she holds see within her body Of what happened to her as a child when she was removed and placed in place in state care And when we left that time The nurse the two nurses said to me my god I had never thought of that So I guess I'm wanting us to think about these things and how we start to respond to them In ways that we make no judgment, but we are responding in deep therapeutic ways. What's the story? Yes, I need the pain How do we respond to that story? How do we respond to that pain? Thank you yeah So Johanna, do you want to uh Give us a an insight into your understanding of the meaning of trauma Yes, well, I actually have been influenced by Judy in my thinking around trauma And she has a beautiful phrase that she says behavior is language And I guess my sense is that for those of us thinking around dementia and Times of life where it's difficult to put things into words that Key thing that Judy mentioned there about it being embodied is something that we can take forward with us. I think I also I'm reflect on the word wound when I think about trauma because I think it just brings it back to a human understanding of the word rather than a What might be a more medicalized use of the language or perhaps a more technical use of that word That I think then disconnects us from what we as ordinary people can do to help And it becomes like a specialized area of work that um Although I know that that the specialized work of learning how to care for the severely traumatized Is a special skill set that requires ongoing training and supervision I also don't want our community to lose the skill of sitting with one another's wounds and I in my thesis asked In when I asked what causes threat There were three key themes of what makes people feel Threshold and one was feeling invaded And that's not just invaded. It's not given being trapped in some way Uh, and the second was feeling disconnected from other people And so this one something that often gets missed when we use the word trauma to mean an event where somebody hurt us with a Like a car accident or a rape or a Uh, and so disconnection from other people but also from land and from ourselves We can get disconnected from our own bodies in the way we are are in the world and uh, so That's that's another key area where we can Experience traumatizing and then the third is when things are really confusing Um, and that can happen when we grow up somewhere where there's no rhythms or routines or Where there's intoxication of some sort that makes people unpredictable or Emotions that aren't regulated and so you the people around you react at times. You don't expect them or they switch or dissociate in front of you But it can also happen with intentional confusion like gas lighting that happens in domestic violence where people's own intuitions are intentionally Groomed to be they no longer trust them up their own gut Um, so for me trauma we need to remember. It's not just an event And we don't we're not sort of picking through people's life stories to find events that were traumatizing They can be deep emotionally distressing processes that happen between us and other people That um, we may not even pick up as being something that's unusual if we've lived with it our whole lives I'll often find people who've been experiencing emotional neglect And yet they would think um, I don't need to be here. There are other people who are more more need needy than me Because I wasn't raped Um, and yet for those who've never received kindness and compassion and connection They're extremely difficult to treat with um, because they're not used to human beings providing something safe for them Um, so I guess my sense is again to keep this vision that Trauma is anything where we lose our sense of safety in the world Um, it's it's a I use it as a code for in medical language. It's a paradigm shift for no not get not getting caught up with with trying to get diagnostic labels and look for cure And put some people into dive so diagnostic classifications that were Have lots of holes in them scientifically And instead to be focusing on comforting and caring for the people that we're with Yeah, yeah, I remember reading somewhere. We are our woos Yeah Yeah Yeah, look, I think um, those those comments are wonderful actually and just to sort of echo I guess what johann has just been saying. I think one of the things to um, to really be mindful of in terms of trauma informed care is The degree of subjectivity that exists in the concept of trauma and I really think that's what what johann is Johanna is talking about when she's saying, um, you can't just sort of sift through somebody's life looking for the events Because there's such a myriad number of events that can actually be Experienced as a source of trauma for people and it's really about the impact of those events on that person and on their psychological and physical well-being and their resilience and their Whether they feel where they're there sort of sense of being able to cope with that that experience is overwhelmed And so what I think that means for us is that we really need to then think about how we come to people with a curiosity and An openness to listen to their story and to understand what has occurred for them So, um, we're sort of asking about what is what has happened in your life rather than sort of Decide this sort of more diagnostic idea of well, what's wrong with you and how can we fix that? so I think that recognizing that trauma is very broad And it is very subjective in that it it's really about what is the impact of these Experiences for this person and what might be Overwhelming for one person might not be overwhelming for another But we really need to be mindful that that that doesn't negate or reduce the the potency of that experience and that For that person who has been overwhelmed by something And steven, you know, not not that we want to spend all night at in netflix But if we come back to your Reference to that what is actually a really wonderful limited series made it's really from a from a fantastic book written from You know the the author's own experience as a single mom and a victim of domestic violence One of the things that really struck me in that that story was how The central character really struggles with this idea that she's been traumatized Simply because she actually hadn't been hit by her domestic partner And so there's some really quite powerful scenes where she's interacting with With some of the people that are sort of trying to work out. How would they help her? And she's sort of saying but i'm i'm you know Essentially saying but i'm not a victim of trauma because i haven't met a certain set of criteria And i think that just brings us home to this idea that actually Trauma is diverse and it is broad and it's really very very subjective in terms of it's about what is the impact being on that individual Yeah No, well, thank you One of the questions that came in Was what are your strategies to help an older person unpack that trauma? You've given us some clues on that Particularly when should you not in inverted commas go there? I'd love to jump in on that one steve I I thought oh, that's one of those trauma-informed myths that we have to unpack things Yeah, and i say it's not it's definitely not about unpacking uh, and uh for me It's around again the main goal being trying to help someone feel safe in the current circumstances that they're in and and Now that might be quite difficult if they've just been transported into a nursing home or they are Have have just had a loss of their their partner of 40 years or Have you know watching something happening to their grandchild that they're finding very distressing So I I guess I would be saying what our task is to be looking wide at their current environment You know where they're sitting and what they can see in here and Learn from and their current relational environment and being quite wary of families that Look very well behaved in the end of the bed, but actually have not at all helpful in other settings and so Trauma-informed care of older Australians is also being aware of how they might be currently being Traumatised by people in their in their family and circumstances And then you know wanting to know about their memories And if there's anything that's bothering them there to let them talk or not depending on how they're feeling But to me the whole goal is that we're trying to make whatever they're experiencing inside whether it's their nightmares or dreams or or things coming into their mind unbidden images That we're trying to help them feel safer about that about who they are as they reflect back on their life And have regrets or things didn't turn out how they wanted As well as those sort of deeper existential questions So for me the goal is to help them feel safe enough to grieve what really happened to them And grieving is in the natural process that we all can do if we're feeling safe enough We get stuck with it if we're not feeling safe Uh, and so as as people in the community I'd see our main goal is to help people feel safe enough to to say the things they need to say and Feel the things they need to feel In order to feel safer There's another one of those diagnostic categories complicated grief Yes Yeah, and I I would say complicated grief is grief that has got stuck Uh, and we when we normally grieve beautiful some Dutch researchers have shown it's a movement It's a movement train looking at something that we've lost And then looking at restoration where we're the next steps And we oscillate between those two things as we slowly adjust to acknowledging what's happened to us And uh, people can get stuck looking at what they've lost or they can get stuck looking at only what's going on at next Or they can get stuck paralyzed in between the two unable to move Uh, and so providing safety is what helps that that oscillation to restart A new Judy I'm sure oh there we go. I was about to bring you into the conversation, but you're you're there Judy Um, look, I just want to draw out that there's a complexity in all of this as well um, I was Asked to do some work after there's been a group of suicides and young people in a particular part of Australia and the the most senior member of that family who was 90 in his 90s Um came along to be part of what we were doing And there were two points I want to make that he said to me At one time after he had shown me the places where I was I was able to walk and Places where I couldn't walk in this country. Um, there were parts of it that I couldn't walk across because of the the sacredness of it, but he said to me You can't stop them, you know, and he was talking about the young people who had just completed suicides He said we couldn't stop the white men when they came with their guns And now we can't stop our young people from doing What they're doing Was his grand to group to grant until he's suicided The point I'm making here was that he felt incredibly powerless In every way in every part of his life At the same time the In particular the the uh Father of the two young men. He was the grandfather Um, also felt totally powerless not able to even talk about it to anybody because it was too painful for the elders to hear Now, I guess what I'm asking is to do is to find a way that we can truly truly listen Um, so that what needs to be said can be said and we can hold that space Greeting happens when people feel safe When the stories may or may not come out We don't have to have the stories as much as we we respond to the pain that's there and we make sense of in some way The loss and grief is a major part of most people's lives. We all of us and I'm At 78 now I'm kind of lots of regrets about what I could have done differently in my life But what I know is that each of us are making sense of the world in which we live and I'm talking specifically about Abbas on Torres Strait Island of people and I'd also like to suggest that those who've come to this country um As refugees or whatever that they're bringing those kinds of stories to that are overwhelming at times and so Our capacity or the capacity of all of us to just listen Just listen and hold space doesn't mean we have to do anything big Because sometimes the trauma The first time the trauma is spoken about It's the first time the person themselves Has wanted to have been safe enough enough to express it when we respond By just holding space with them and crying and I've done that as I did the better that woman That I was talking about with the two nurses beside me as they came to an understanding that she Was acting out something she'd never expressed before in her life. I think that it happened to her as a child um and again the the the elder that I just referred to he's deep deep Embodied sense of power and we couldn't stop the white men with their guns. We can't stop our young people now today Putting a rope around their neck Um, I think it's how we can sit and listen and hold space um It's me and for me personally and this may sound crazy as a A professional that's one of the greatest tools I've had was to be able to cry with somebody Listen and then cry together and then see them starting to plan what they want to do And I'll just finish by saying this is that um in each case that I've talked about Um with the woman, you know that I was talking about she asked if we could sit and just talk about the rug on her bed For example that somebody had crocheted for her and the different colors in the rug and that you never had anything beautiful When she was a child and that rug meant so much to her and the nurses never had a thought that you know A rug that somebody had crocheted in given to her would have meaning Um when they had just decided that she was just an old woman with dementia and back with uh the other place I talked about uh that that old man of 90 in his 90s sat with his um Son-in-law and they cried together um When they started to talk about the the loss of life of two of the the grandsons and the sons of that the grandson of the olden enemy and and shared how they wanted to make some kind of Changes go out and talk about domestic violence talk about the things that they can do Uh to create bring back culture the old fellow was talking about bring back culture um, I want to I don't think it's complex. I think it's our capacity to uh To create safe places for stories to come To be able to hold those stories. I don't want to put You know, like this is complex trauma. This is developmental trauma I'm asking is that we just hold those stories And sit with people as they grieve together Um, and they start to make sense themselves of what they can do with each other The loss and grief is immense Sometimes the trauma is constricted by the immense layers of loss and grief in people's lives. And I'm talking again I just want to make this point point. I'm talking Specifically about Evershaw and Torres Strait Islander people who have lost so much And finally we reclaim with we reclaim Accapacity to grieve and celebrate and heal together I just want to thank you Yeah, that's a very powerful Moments of your compassion. Thank you. Thank you, Judy Can I pitch a question to you Duncan the one that's come in? um The question says I work in psycho geriatrics providing inpatient care for patients with dementia Experiencing bpsd. I always have to think what those letters mean behavior and psychological symptoms of dementia Often these behaviors are a result of or indicate past traumas Especially in early life that are triggered by being in nursing care And which are not easily expressed by the person with dementia Can you provide any insights into how trauma-informed care can augment dementia care and who it is touched on this Yes, no She's absolutely set it up beautifully for me. Um, and I think I'd really In answering this question I think the best way is to pick up on Judy's point around it's it's really in the story Of the person and and there's no substitute for actually listening And connecting with the person's story and I think the look I I wouldn't want to say that all behavioral and psychological symptoms that might Be experienced by a person living with dementia are due to trauma However, in my experience, there is a very high prevalence of the impact of trauma that is expressed In all sorts of ways by a person who's living with dementia and so the and the best illustration I can give you is actually a story So if you'll indulge me, I'll tell you a quick story And this is of a woman called mazy who from whom I learned a tremendous amount Mazy was born during the second world war in the uk She came with her family to australia after the second world war as 10 pound poms As so many people did They moved around australia quite a bit and it was quite a disruptive early life And they eventually settled in a south australian coastal town And what was a hidden secret within their family was mazy's sexual abuse at the hands of her father That remained a secret through all of her childhood But she grew into a Clever and talented and beautiful young woman. She won a beauty contest Always dressed herself, you know with with great care Married before she was 18 And then had her first of three marriages Had three young children by the time she was 22 And was already caught in the cycle of domestic violence And significant trauma And look and that was repeated numerous times through several relationships in her life She alleviated a lot of her own distress by Uh Drinking a lot of alcohol She experienced significant depression. It's not difficult to understand why she would have And life was difficult Later on in her in her third and final marriage for most the most part. It was a much happier time and then um Around the time of her father's death She experienced a lot of sort of revisiting of her own trauma That was really when that trauma sort of emerged for her from her childhood And as a result of that her her third marriage um fell apart Around that time she experienced a significant motive in a vehicle accident had had to treatment for post traumatic stress disorder And then just a short time after that when she was in her early 60s, she started to experience significant Cognitive and functional changes and was diagnosed with dementia And so by the time she was in her mid 60s She was really not able to live at home very successfully And she started a really difficult journey in and out of hospital age care She was quite estranged from her children because of the impact of their early life In such a difficult circumstance And so she found herself with very few people members of her family able to support her She had a brother who was very faithful to her And I met mazy You know at the now very shamed oakton older person's mental health service in adelaide's north Which was you know, this is in back in 2017 when I was part of the oakton review panel Right in the oakton report, which then of course became the trigger for the royal commission Some time after that and when I first met mazy she was disheveled She was She looked like a wildling. She had dried foods down the front of her her Clothing she was dressed in mismatched clothes. She she would spit and swear at anybody that came anywhere within her vicinity She'd really been marginalized and and written off as this person who was violent and aggressive But she was severe bpsd and that's how she was seen and that's how she was marginalized within a system What happened after the oakton report was we you know that that service was closed We I was part of setting up new services in in adelaide and mazy came When we closed oakton, she came over to a new service where we were seeking to really learn a much more trauma informed much more person-centered way of working and What happened was as this this News group of staff who were informed by different set of values Started to work with with mazy and started to be curious about her story and what had happened in her life We we uncovered all of this terrible story of of trauma of abuse Of loss of grief of hardship And one of the things that was most difficult for her was um around the care of personal hygiene So she had at at the worst in her times when she was at the oakton campus. She'd had up to seven people Holding her limbs and compelling her to be washed And this was a time of terrible terrible crisis and trauma for for the staff, but Without a doubt for mazy and her behavior was it wasn't that it was aggressive It was highly defensive because she was absolutely terrified And what happened is the staff started to understand this story They realized that every time they did something with her from a therapeutic from a supposed caring point of view They were retraumatizing her and they were taking her back to all of those bodily experiences that happened earlier in her life And she couldn't she could no longer express What was happening for her in words? She couldn't understand it But the the trauma experience was played out in every one of these behaviors And as they learned to give her care differently. So what they would do is they would never unclose her One person would go to her and would talk quietly and and calmly about this is what we're going to do to to Give you a shower now and they would keep her always wrapped up in warm towels. They would never unclose her What happened in a really quite remarkably short space of time is that her whole presentation was transformed She was no longer dressed like a wildling And that that young woman who had been so careful about her appearance started to reemerge And we rediscovered this beautiful person She you know, she would was really underweight. She started to to eat well to put on weight. She reconnected with her family And and despite the fact that dementia had meant that she had lost her language skills That she'd lost her ability to sort of communicate in normal ways She actually taught Our care teams so much and transformed the whole sort of paradigm I love that idea. Johanna's idea of a paradigm shift She she shifted the paradigm and how we actually looked at the story of the person and what what underpinned behaviors and And you know her care was transformed But what was more important actually Was that the understanding of the person and the way that care was conceptualized and then delivered by a whole team of clinicians Was transformed And it was a truly wonderful experience and it was such a privilege to be in a A situation like that where we learned from the person living with dementia And the trigger for that was a curiosity and an openness And a sort of attitude of inquiry about wanting to understand and connect with her story Thank you, thank you so much for that story. It's a hopeful story And we lovely just to Broadcast that into every aged care facility Yeah, absolutely and it just tells Yeah, great great point Simply you know, it wasn't there's nothing clever about it at all. It was simply it was very human. I think was the wonderful thing It was about Just connecting with another human being not seeing them as somebody Different and other to ourself, but actually just recognizing it's a human being with a story And when we when we connect with that story it changes everything Well, there's there's the tip that's mentioned in the learning outcomes Can our audience learn a few tips? Well, there's a tip Very strong one. So so that's great. Yeah, Johanna, Johanna, would you like to um Uh Round up your your sort of section by By answering one of the questions that's come in which is why is it important for our whole community to understand that older Australians Might have been traumatized Look, I think again building on what Duncan is saying there about a paradigm shift I think if we don't notice that people have been traumatized We are at risk of reducing people to objects Who might have diagnostic labels attached to them and often many many labels attached to them when they come to see me And I I think as a community we need to understand the importance of life story and relationships and meaning On our well-being and unfortunately the Look what I the reifying, you know, they're making into something special of diagnostic naming and the ways that those Names are considered valid and the the capital e evidence we use to To measure them from outside with objective measures and reducing things so that we can study them and Means we ignore things that actually are part of making us human Ignore where we are who we're with What it means to us And so I guess my sense is I think it's important for us to acknowledge that life story is a key element of how we relate to one another And our older Australians have a gift. They can give us they can give us advanced warning on how life goes and Um, they can teach us things about how to how to cope with things that are really overwhelming um, I notice um, when Duncan was speaking earlier. He talked about overwhelm, you know, when we're overwhelmed from The things that are in our life that can be a traumatising and Judy mentioned a man who just really had lost hope That he could ever change something And I guess I sense that that our goal is to to To to care for people in those places where they've experienced that kind of suffering I Read a quote that's attributed to Hippocrates and he says That when we're healers we cure sometimes we heal often But we need to console always And I guess my sense is consoling is is something that all Australians can learn how to be towards one another You don't need a special degree or or a medicare item number to be able to deliver consoling to one another Uh, and it's not just the skill set of a few practitioners All practitioners should be trauma informed in how they see the people that they care for Some will be trauma specific in their training and have skills that we can refer to But all of us should know who those people are in our neighborhood and be able to Notice when somebody needs their help um, and I guess all people have the capacity to console others in their suffering and I sense that um This is what us as a community a a way of being with our older community means we also notice the strengths that they've endured through their trauma and so Um, I guess I'm my sense is this is important for us to acknowledge I I was I leapt at the chance to speak about trauma informed care for older Australians Uh, because it's central to how we as a community treat one another If we don't notice it in our older people who can speak or who speak through their body Then how I hope have we to notice in our younger ones who don't feel free to tell us their life. So Um, thank you for letting me speak No, no, it's great. I um, I'm a uh been been working with the concept of compassionate communities for many years and uh, we reintroduced a meeting to large group of people and uh There was an Aboriginal colleague there and um, We talked and we talked about compassionate communities and at at the end that she came up to me and she said um, how come you didn't mention that that we lot have been doing compassionate communities for 80 000 years and more So Judy, I I reckon that uh, we need to learn that consolation compassion Care for each other from from First Nations people would would you like to? uh Speak to that, you know in in your conclusion on on the uh On the session I think there's two things I'd like to draw out. Um, I think when we're talking about compassionate communities I'd also like to name that From my experience, there's almost an overwhelming time because What I'm seeing is uh, our elders who are holding space for the generation their children who are also deeply traumatized So they're holding space for their grandchildren um, and so many of our elders are bringing up and looking out to our grandchildren their grandchildren Now what a compassionate community is to me and it's been something that's happened for millennia Is that how people start to then work together? We've been working a lot on what would be a community of care a care caring community that looks out for each other and supports each other now that's part of culture How do we when people are in overwhelm and the mother or the grandmother or the grandfather who's lost something How do we hold that space so grieving can happen? So that people can go back to the stories that are truly painful A compassionate community to me is also when we took a group of young Children into an old people's home in uh, Kansas in northern Queensland quite a few years ago And there was a woman sitting there Who couldn't speak she was very clearly from one of the remote North Queensland Cape York community She couldn't speak she was just sitting there and The children wanted to engage with her I'm talking the Aboriginal children wanted to engage with her And as they tried to talk to her her attention came to the faces of the children I realized that they didn't have her language and she didn't have Our language that in fact she was in an old people's home with no language None of the teachers could none of the nurses could engage her But as the children Gathered around her and started just singing to her sing songs She started to get a sense of engagement and I would say the word excitement but a big connection Now I guess what I'm talking about when you're talking about a compassionate community is that across generations people Support each other care for each other and look out for each other I just keep coming back to The sense however in The the woman I talked about in that hospital bed beside me Who couldn't communicate and she's been like she's been pushed aside But somebody knitted to her accrossed to her A beautiful rug which she was so so proud of That's a compassionate community. Just somebody seeing something they can do and giving her a gift A compassionate community is when children see that there's an older person who just needs some love and care So that it started to sit there even though they couldn't speak her language and she couldn't speak english And they are at this stage in her life. I'm not quite sure what was the why But they sang to her and she engaged in the music beautifully um The compassionate community is a community of care A community that cares for each other and sometimes we put That care to the experts outside others when in fact it's already there um And my experience is and I'll leave it at this is that sometimes the most wounded of us Can be the ones that bring caring to others and in that we heal together in the sense that in the points I'm wanting to make about The history that still remains in this country that is still unresolved still unhealed um in the times of first invasion and the seven and eight generations now are Kind of mapped with deep deep trauma the historic trauma the complex trauma the developmental trauma in children When we come together and we share stories we hold stories we build stories That's the compassion that we need for each other, but more particularly It's the compassion we need for ourselves Because we're part of the pain and we're part of the healing Beautifully said thank you. It's um and you know we heal all the time about uh workforce shortages, but uh You open the space for of course the community Uh being the healers as well as the professionals, but you open that space. So so brilliantly. Thank you um so um We're certainly coming near the end of our time duncan. Would you like to just say a few? A few words to sum up from your perspective So I I think um after judy such beautiful words. I'm I'm quite reticent to say anything actually season, but um, look, I suppose if I I think about this wonderful conversation that I've really enjoyed being part of this evening um, that idea of of compassionate community is so important and One of the things that strikes me is because you know, we you know You even just intimated this yourself and we've sort of this dichotomy that we have between what is the professional world and who are the helpers And those who are those that are helped and I just really think we should quite intentionally Just break that concept all apart because indeed we are all those who Help and we are all those who are helped because we're all just the same We're we humans making our way through life together and What we actually need is a compassionate community and that doesn't mean that we we don't value the role of clinicians and people who have therapeutic skills and have training and knowledge That's all part of the community, but We're part of that that continuum of community and and living and working together and and having that awareness that trauma is part of our experience And affects all of us in different ways is just so important and so for me That's I think that's that's what sums up this conversation from my perspective And that brings us back to that shared appreciation for the story that the human being that that I come into interact with Repeatedly day in day out That's so important. And so for me More than being a psychiatrist or anything like that I'm I'm simply another human being and I'm curious and inquiring about the stories of those people who Might give me the privilege of being part of their lives and listening to them and their experience Yeah, I would say I just I've just loved being able to share stories with you tonight and to listen I wish we had longer to listen to each other's stories because I think we embody uh Hope around healing and hope around what it means to work together And I'm going to leave tonight with a beautiful phrase that Judy said which has said to create safe places for stories to come And to help people make sense to reclaim our capacity to grieve and celebrate together I just was really struck by those words Judy. You have a way with words And I treasured your phrases and that's what I'll be taking from tonight. Thank you Well Judy a last word a last word to you. I think If I had a magic wand I would Wave it and tell us all across Australia that we need to just sit together with us into each other and we need to grieve together and crying and finding songs um And just being together. I think that we would build a country that we all want to leave to our children and great-grandchildren and Great-great grandchildren into the future. So if I had that magic wand, I'd say let's just come on come and sit with me sit with me and share our stories and We're doing the work of the so-called experts because the story is as we listen we hold each other That's the healing Thank you. Thank you all so much. Um, I couldn't hope for More stimulating and and moving session And we've had I hear from The chat room that the audience appreciates your stories your your compassion Your souls so much. So thank you all Thank you Yeah, thank you. Thanks table So we're not over yet We've got some resources recommended by the panel That you can get by clicking on the Resources tab top right hand part of your screen trust you can all find that and Local networking This is very important because it allows us to share Oh, I hope I'm here still Can you all hear me? Oh good something happened to you know, something else came up on my screen. So Uh, the um, that's thrown in for a moment if I can just see I can bring back the screen So you were talking about the the older person's networks Absolutely, so I'll come back to it even though I can't see you maybe you can just move the slides along for me, Julie um, so the mhpn Supports the engagement and ongoing maintenance of practitioner networks Which allow much of what what we're talking about this evening about sharing where clinicians From different disciplines meet regularly with other mental health practitioners share tips and resources Build local referral pathways and engage in cpd activities Our group in north and sydney has had a lot of fun running sessions from sessions on art and music therapy film nights To presentations by psychiatrists and other mental health professionals on the challenges that we all face in our daily work And we've also had people from community come in and talk about their experiences of mental health In their lives So I'd strongly encourage you to join or form an older person's special interest network And if you're interested you should make contact with the mhpn mental health professional network By the network section of the website They provide support to run these groups And um, I just want to let you know that there will be two more webinars in 2022 by way of the partnership between the 31 ph n's and the mental health professional network so please keep an eye out for future communications and I think the last thing assuming that that slides come up is to encourage you all to fill out the exit survey We we really appreciate hearing from you what um, what you've felt about this evening and Your comments in the chat room are very much appreciated and we'll inform how we plan future webinars You are the community and um, I think it's been made clear in this in the last part of the conversation community Is so important in ensuring good care So, um Thank you all for your attendance and um, I wish you a Good evening and a safe A safe rest of the evening. Thank you very much