 Good evening, everyone, and welcome to this webinar, and we're through that process. We have 463 people online right now, and the numbers keep jumping every couple of seconds, so it's great to have you all with us for this evening's webinar. MHPN wishes to acknowledge the traditional custodians of lands across Australia upon which our webinar presenters and participants are located. We wish to pay respect to the elders past, present and future, for the memories, the traditions, the culture, and the hopes of Indigenous Australia. Good evening, everybody. My name is Vicky Cowling. I'm the facilitator for this evening. My background briefly is having facilitated some webinars previously, and I have a private practice in mental health for children and families. At this point, we're just going to do a quick poll so that something will come up on the screen with a question of concerning it. So, 50% Metro, Regional, and about 150 people from rural and remote areas. Okay, thank you. We'll close that for now. Thank you for contributing that information to Mental Health Professional Network. My task now is to introduce you to the panelists for this evening. Their biographies were disseminated with material for you as part of the introduction to the webinar. And we'll start with Dr Peter McGuire. Good evening, everyone. And Peter is a rural GP who works in Narragan, Western Australia. He's a professional senior lecturer with the Rural Clinical School of WA. He's also chairman of the Board of the WA GP Training Provider and a rural GP representative for the AMA in Western Australia. His interests include medical education, emergency medicine, aged care and mental health. And Peter, I'm interested to know, given you are in a rural area, what kind of implications does that have when you are involved with a family where separation and divorce are occurring? You know, I wonder if you know all members of the family that had complications to think. Absolutely, Rikki. That's perhaps one of the, certainly one of the challenges. But, you know, there's some strengths in that as well. But quite often, we're quite often know the family quite well. That's right. Yeah. And how far is Narragan from Perth? Just under 200 kilometres southeast of Perth. Oh, okay. Not too far. Not too far, no? Yes. Thank you, Peter, very much. Next, I'd like to introduce Dr Catherine Bolland. Catherine is a clinical psychologist with expertise in working with children, young people and parents who are experiencing relationship issues and are in situations of family conflict and separation. Catherine is an experienced therapist offering services to families in court proceedings where children are involved. She holds a doctorate in clinical psychology, a master's of clinical psychology, and a bachelor of psychology and a bachelor of education. And Catherine, reading that, I wondered what kinds of advantages there are for you in having that kind of cross-disciplinary background and qualifications in the kind of work you're doing now? Yeah. Well, good evening, everyone. It's lovely to be here. I think that, in answer to your question, I think all of us working in this really complex and challenging area have to be very good at all sorts of cross-disciplinary collaboration, not just in terms of education, mental health, medicine, but law as well. And I think the capacity to communicate and understand the other disciplines has been my steepest learning curve and something I'm very grateful for. Okay, thank you. Thanks. Our next panelist is Vanessa Matthews. Vanessa is a social worker and family law specialist. She is the founder and managing director of Matthews Family Law and has the rare combination of social work qualifications and experience combined with nearly 15 years' experience as a lawyer, making her approach to resolving legal relationship issues as sensible and sensitive. Vanessa has extensive experience in complex issues that arise from relationship breakdown and works in partnership with her clients. And Vanessa, I understand you also have a commerce degree and as well as law and social work. So I guess there are advantages in that very cross-sectional background for you in this kind of work. I think that they provide the building blocks for providing prudent and practical advice to my clients. I'm also an accredited family dispute resolution practitioner and an accredited mediator. So I can offer a full range of dispute resolution services and incorporate my social sciences understanding, my commercial understanding of family law specialisations. So hopefully it makes a good package. Yes, yes. Very rich background for you to offer your clients, absolutely. And finally, I'd like to introduce Dr Michelle Phillips, who's a psychiatrist from Brisbane. Hi, Michelle. Michelle is a child, adolescent, adult and forensic psychiatrist who is now working full-time in private practice in Brisbane. Michelle completed her medical degree at the University of Queensland in 1998 and completed her specialty training in 2007. Michelle worked for five years at the Child and Youth Forensic Outreach Service, which works with young people who engage in offending behaviour, including sexual offending, arson and severe violence. She's also worked for two years at the Brisbane Youth Detention Centre in several years in community and inpatient mental health settings. And her practice currently focuses on psychotherapy. And I just thought about your background and experience. Michelle, I wondered what kind of systems and organisational challenges that you have experienced and that you perceive relating to families in family court situations? Well, there are obviously numerous, and it's often coming from predominantly a public background. It would largely depend on whether you had clients who were accessing a range of public services or whether they were predominantly private. Right, yep. I suppose I saw the aftermath usually in a community child and youth setting of children who had been damaged by a bad outcome and less so where it had gone smoothly and was kind of travelling well. And in the private sector, I've seen a lot more of the... some high-end cases where things are going terribly badly and then also a nice surprise is seeing a lot more of things where things are actually working relatively well and a few small tweaks can assist the process to go more smoothly. So that's been a nice change for me going from a predominantly forensic youth detention population where obviously worse things have happened in people's family backgrounds compared with a scenario where families are often more motivated to make changes. Yeah, I can see that. Well, thank you very much everyone and thank you for participating this evening. Now we're moving on to some ground rules for tonight. So I'll just let you read those for a moment. You can post questions and comments and we hopefully can address some of them. If you'd like to hide the checkbox, click the small down arrow at the top of the checkbox and do remember to complete the short exit survey which pops up when you exit the webinar at the end of this session. Here are the outcomes for this evening, recognising the key principles of intervention and the roles of different practitioners and we've already had a glimpse of that hearing from our panellists. Exploring tips and strategies for interdisciplinary collaboration between practitioners working with families experiencing mental health distress and identifying challenges to an opportunity for collaboration where families are going through separation. Now the next part of our session is each panellist will go through some slides to give their perspective on the case of Belinda and Brian and their children. So we're focusing on Belinda, a 39-year-old woman whose husband Brian left her after having an affair. They've been struggling to agree on child access arrangements after Brian requested more access. Belinda has withdrawn from social activities and is drinking, and her daughter Jessica has been difficult after visits with her father and her younger son, Tom, is showing signs of Belinda at school and is waiting the bed. So our first presenter will be Peter, our GP from WA. Thank you, Peter. Thank you, Vicki. So, yes, greetings to everyone from World WA. It's still early here. So, as I said earlier, I'm a GP in a fairly standard rural practice in a small-ish town of about 5,000 people. So it's interesting that this isn't a particularly common scenario for me. Maybe that's because I'm older, I'm not sure, but it's not something I see every day, so I wouldn't pretend to do any great expertise. And I think it is interesting that Belinda presents partly with a physical illness, and I think many people almost regard it as a physical illness being a valid entry ticket to the general practitioner. Perhaps one doesn't automatically see it as legitimate to bring life issues like this to the GP. So it is interesting that she actually came along having had a three-week cold, and there's a risk that the GP doesn't even get past that if the GP doesn't respond in an open fashion. And I can imagine that if you're very rushed or perhaps if I've got a student with me, that might just put the patient off. But, yes, as I say, it's not a particularly common scenario. And I suppose on the positive side, I mean, I do see a number of people who've been through this situation and have weathered it without too much trauma. So on the positive side, it's not always as difficult as this. So it is interesting that it's Belinda who presents, and I think in my experience it is often the female partner who presents in a sort of traditional partnership, and we don't often don't see the other partner. So I'll just move on to the next slide. I hope I've got the right thing. Yeah, it worked. Good. So as I mentioned earlier, it's a small town that I live in, and I've been here for five years. So sometimes I feel like I know everybody in town. I'm sure I don't, but I do know my patients pretty well. And that can be, there are some good positives in that. I mean, hopefully there has been built up over time a good therapeutic relationship and a relationship of trust. So hopefully the patient feels comfortable coming along and talking to me about what's happening. The challenges in that are, I guess, fairly obvious, that I'm not necessarily very neutral about this. I will have my own feelings towards both of them. In some cases, I may even be, I have quite close social relationships with people, and that can certainly make it difficult to work with someone in this situation. And I guess to be aware sometimes when it may be better that having sort of had that initial consultation saying to someone, look, I think I'm actually too close. I should ask someone else, one of my colleagues to see you perhaps. So I think it is important that I'm aware of these things. One of the issues that I think we might discuss a bit later is to what extent it's a family issue and to what extent it's Belinda's issue. I guess, as Chief, we're used to dealing with an individual presenting patient, and certainly it's not too often that I'm dealing in a family dynamic situation. I don't pretend to have any great expertise in it, but equally in this situation, if other members of the family are presenting, how do I balance some of those issues and how do I tread carefully between the confidentiality issues and being careful not to take sides? Again, here we go. So what do I do in this situation? I'm aware that people come to me largely because, particularly in a small rural town, I'm the most accessible, in many cases, the most affordable initial contact. People know where I am and they've seen me before. So I'm hopefully the entry into a variety of other professionals who can help. So I think my first role is to be open to listen carefully and to find out about the situation, make sure that the patient feels that she's understood and that I've heard what she's saying and make appropriate responses, that this is a difficult situation, that strong emotional reactions are normal in the situation, that it's going to be tough for a while and that I'm accessible and I will help where I can. I think how it's... I'm very aware of the pressures doctors are under to medicalise things and be careful not to over-medicalise situations like this where they're really a normal, unpleasant part of life. So I do hold my hand back from the prescription pad if it's appropriate. But equally, obviously in this case, as you've read, there are some aspects of this that strongly suggest that De Bullender might be depressed, including her past history and her family history. So I'll be watchful for that as well. And the mention of alcohol reminds me that I have taught myself over the years to ask about alcohol. I'm sure I've missed it many times in the past. And funnily enough, I think I have more of a blind spot to female patients drinking. I assume that the bloodstream... I tend not to ask the questions there. So that's an issue that I'm aware of. But I think one of my key roles is hopefully to be aware of the services that are out there. Who can help people in these situations? What are the local services? How easy are they to get to? Are they affordable for patients who aren't well-healed? Now, for those... For the 45% of you coming from rural and remote areas, I'm sure you're painfully aware that services are not always easily accessible. Our public health... Our public mental health system service here, which is very good, but is heavily overstretched and is unlikely to see this woman or this family any time soon and are likely to ask me to refer them to the clinical psychologist if needed to better access Medicare programs because they're not going to be able to see them. So there's certainly a limit to what's around, but equally the mail services, and it's not that far from Perth. So I do need to have a good database of who's who. And I must admit, one of the interesting things about this session, I think, with the legal perspective, I don't think I would know much about accessing legal advice, really. I guess GPs were sourceful. I bring up my local solicitor and say, okay, we've got a problem with who do I talk to? So the other question was engaging the family. As I mentioned earlier, I often don't see the man and I don't see the kids. I'm not sure whether I should try harder to do that. I try to leave the door open, but I think often it just doesn't happen. The family issues that are raised in this one, the family conflicts over access and sort of family courts type of issues about financial support and looking at the particular interests of the children in the case, certainly I don't feel particularly expert in this. Over the years I can think of one particular case about 10 years ago where this got, which is very similar to this case, and I was writing legal letters to the lawyers and talking... So that's only once in a 20-year career, so a 30-year career. So it's not something I say hello or, but I think the big thing for the GP, I think, is to know the landscape, to work out one's local support systems So many times I won't see the patient very often. I'll put them in touch with someone and they might not see them for a while. In this case, I would certainly encourage them to come back and really look into that depressive illness aspect of it. And if need be, say, a geographic referral, if I feel appropriate though, again, it is difficult to achieve from where I sit. So that's my thoughts on how I would approach the case. Vicki, that's over to you. Sound your presentation next. Catherine Rowland. Well, good evening. Thanks, Catherine. Thank you. Thanks, Vicki, a little bit of a sound delay. I guess I'd like to welcome everyone again and talk a little bit about a perspective from a clinical psychologist. I come from a slightly different perspective in that I specialise in this kind of work. So I appreciate not all psychologists or mental health professionals specialise exactly in this work, but I think that all of us undoubtedly have come across the issues that are involved in this case, which are, in my view, pretty typical, actually. And I think in thinking about if Belinda presented to me and how I would approach this, I have quite a systematic way of thinking about how am I going to treat this woman? Should I treat this woman? What are the complex issues here and in which order should I treat them? And what are the professional and ethical issues and role boundaries that I need to be aware of? Because in family law and in cases where parents are separating and there are children, one thing I'm well aware of is that there are a number of professional traps that we can easily be lured into. In the best intentions to help people. So in this case, I think that in Belinda's case, I think as a clinician the first thing I would be concerned about if she presented to me as an individual is sort of triaging where her mental health is at, both in terms of her family history, her personal history and her current symptoms. And I think there are some pretty worrying indicators in the material or in what she presents with, trying all the time, potential alcohol problems, possibly a depressive or adjustment disorder, possibly an anxiety disorder, and possibly as almost always goes hand in hand with separation, a massive grief and loss issue. So there's been thinking about all those possible things. Where does one start? And I think that going through a fairly systemised way in your own thinking about how you will approach this is really important. The other thing that I always do when women or men or children present in the context of separation is do some sort of screening for family violence. And it is often an issue that individuals will not bring up unless you ask about it sensitively and you ask about all aspects of family violence beyond the scope of today's discussion to talk about that, but in the resources section I think you can find some good material about how to conduct that kind of screening and ask those sorts of questions of men, women and children. The other thing that I'm aware of in this case is that Belinda may require quite immediate treatment. She may need a referral to a psychiatrist. She may certainly need the advice and suggestion of a legal practitioner because of practical things such as knowing what her parental responsibilities are, understanding what family law is, understanding what the best interests of the children are, understanding how she's going to have access to money and what her rights and responsibilities are. And I suppose the other thing in this case which is clear to me is that the children are presenting a number of potential psychological, educational and social concerns and so I would be also thinking in another hat how do I need to supply some referrals for these children? I guess this lens, this once I have sort of triaged the immediate symptoms and worked out what order I might approach this, the next consideration I have is understanding and thinking about how am I going to respond to this family system in the context of separation? And I would think to myself, do I or should I involve both parents? And there are risks and benefits to involving both parents in a family system from a family system's perspective. Obviously, the benefits are, clinicians or any professional can provide parents with really important and timely information about how children respond to trauma, how children respond to deprivation, loss and grief and what might be sensitive and appropriate parenting practices for those children, not just in terms of the practicalities of how time is organised and divided, but in terms of emotional achievement to the children and responsiveness to their experiences. But of course, there are real risks to involving both parents and one of the things I'm aware of in family, but when people are involved in the chaos of separation and the grief and loss and difficulties that that can bring up, is it often people are so confused, chaotic, hurt and in pain that they very much want their practitioner to be very empathic to their side, to endorse their perspective and their point of view and any attempt to reality check their perspective, to challenge them or to posit alternative thoughts can often be felt like a real rejection. So in trying to be a neutral practitioner, sometimes you can get people offside very quickly. Equally, another risk is if there is family violence, if there are issues of trauma and you are seen to be neutral and not advocating for the perspective of the victims and or the children, then I think you can be corroborating violence in some ways and one needs to be very careful about that. I think the other thing that I would be thinking about in this case is what are the benefits and risks of engaging the whole family system including the children in a collaborative effort and I can't answer that in this case because I obviously haven't met the people and assessed whether it's a suitable case for individual versus family therapy but I would go through a similar sort of thinking process. Equally, I would want to know a little bit about the nature of the conflict in this family system, so whether it's coercive controlling violence, whether it's low level conflict, whether they are, you know, able to conduct reasonably logical, calm and considered conversations, the parents that is about what is in the best needs of these children and as I said earlier, providing these parents with some psycho education. I think the other thing I would like to raise to the participants tonight and think a little bit about are the ethical and professional considerations that therapists and others working in this field need to be fully informed about and need to respond to. One of the difficulties sometimes when you work with people who are extremely high in terms of their emotional intensity and are at the acute stage of a separation is that emotions can drive a lot of things and they can actually be very contagious for the therapist. Generally, most people have gone into our profession because we are helping people and we want to be helping professionals but I think that it's also useful for us to learn to sit on the fence of caution in the way we engage in family conflict, particularly when there is a separation. I talk about as being an entrapment risk and I think that that is a real... I feel this keenly when I engage in this sort of work. The other thing I think that happens to me frequently and I'd be interested to hear others' perspectives about whether this happens to them also is often when you've been working with an individual who is going through a separation and suddenly they're in the midst of a legal case that you are then asked to do something such as write a report or write a letter to the court or somehow support their legal case and they often can pose a real therapeutic conundrum particularly who have developed a good rapport with a parent or a person but to do that would be either ethically improper or you don't feel that you can act in that forensic role and I think that can really thwart or make difficult the therapeutic relationship and it's a difficult thing. One of the other things I think that practitioners do need to have at front of mind is a broad understanding, not a legal understanding but a broad understanding of the family... of family law in Australia and I, you know, obviously... we'll talk about this later tonight but I think that one of the basic understandings that one should have is that in Australia the law and practitioners working there regard the children's best interests as a paramount concern and so in thinking therapeutically, in thinking about how one might assist the family always try to have that at front of mind that it's my job as a professional here to remind the parents, to remind myself that actually these vulnerable children are the ones that need to be guiding some of the things that our behaviours, actions and responses. As Peter indicated earlier and in a little bit we'll hear from Vanessa, I think you need to develop a network. If you're working in this area particularly you need to develop a network of lovely professionals around you both in the legal community who are also family therapists or individual therapists, psychiatrists, family consultants and just an understanding of the people who can help you deal with the complexity that these cases bring up. And I think that in closing I would say find supervision and support for yourself particularly with someone who has had experience because these can be the cases that you lose a lot of sleep over, they can be the cases that take up in an ordered amount of therapeutic time and concern and often it's very easy to slip down the slippery slope of despair with the people because the issues can seem to be complex and overwhelming but we have an incredibly important role to play particularly as advocates for children, a specialist in mental health who can guide parents and children to a very turbulent and difficult time. So I think that's over and out for me at this point. Formative, thank you. And we move on to Vanessa now with her perspective from a social work and legal point of view. Thanks Vanessa. Thanks Vicky. I'm approaching my discussion with you tonight from my substantive role as a family law specialist and my thought is that if I was to meet with Belinda it would either be in my role as a family lawyer or in my role as a family dispute resolution practitioner but for tonight's purposes I'll concentrate on my meeting Belinda as a potential legal representative and we keep data to see where our referrals come from and we mostly find that people appreciate a personal referral to a family law specialist. So that's either going to be perhaps a family member, a friend, a colleague who's been through the family law experience or someone close to them has been through it and they're able to provide that personal recommendation and the difference between somebody coming to meet me for the first time with what we might call a warm referral, having been recommended to come to see me is markedly different to somebody who might have found me through say the internet and a Google search looking for a family lawyer. So the referral process itself is really important and here I think that's a good example of the client having their own personal network of collaborative support, family, friends, colleagues and so on. The other issue is of course the accessibility of family law advice to clients. Yes, the reality is that legal services, legal advice is expensive. Private practitioners charge an hourly rate. Some will charge, will provide perhaps a first half hour or first consultation free of charge but an hourly rate will kick in after that. So the cost of private legal services and can be a real barrier to clients accessing those services. The other option is that legal aid may be available to Belinda or to other clients particularly in relation to parenting matters. Generally speaking, if there's an asset pool to be divided through a property settlement, the parties will probably be ineligible for legal aid. And actually to remember that only one person can be represented by legal aid. The other is that people can access their community legal service for legal advice that might be enough for them and then they might get a referral to somewhere say like Relationships Australia where they can receive a means tested mediation service and those community-based services at the family relationship centres, centre care and so on are excellent for people who perhaps might not have the most complex of issues to be dealt with. But if I was meeting Belinda for the first time and I would be very welcoming of her bringing a support person with her to our initial meeting, that might be a sibling, a parent or a friend. But I often say to people that bringing that, I always invite them to do that when I speak to them on the phone when they're making their initial inquiry because there's so much information to take on board in that first meeting. So it's great to have a support person to do the hard listening and retaining while the clients say Belinda is busy trying to just process what's being said, my questions and she's the one who's distressed in that situation. So a support person is a great resource for a client. Just briefly, the key legal issues that I would identify for Belinda in that first meeting would be parenting issues and I note in particular the age of Jessica and Andrew being 14 and 11 respectively. And I put it to you that the wishes of Jessica and Andrew would carry a lot of weight in any judicial determination that might eventually be made on behalf of Belinda and Brian if they weren't able to reach a consent resolution about their parenting arrangements. There's no specific age when children's wishes come into play. The Family Law Act doesn't define when a child's wishes should be taken into account, but we'll look at issues such as maturity and we'll also look at issues like coaching or influence of the children. So Jessica and Andrew will play a part in that. Spousal maintenance will also be of critical concern for Belinda and we can look at spousal maintenance on an urgent and interim and also on a long-term basis and that can be organised by consent or by court order if necessary. Child support will be another concern for Belinda and I note that Brian is perhaps believing his paid employment to start up a business. That presents real financial risks to Belinda and the children and I would recommend that she make an application very quickly through the Centrelink office for child support and deal with that process administratively. She'll also be looking in the long-term for appropriate settlements and that might come down to issues like whether she can in fact afford to retain the house and refinance the mortgage into her name I note also that Russell and Jenny, the maternal grandparents are heavily involved in the family and providing support and just as a piece of advice for you grandparents have their own standing to make an application under the Family Law Act so if you meet a client who perhaps you might meet a grandparent who says that they have been excluded from having a relationship with their children those grandparents are able to make an application in their own right to the court for grandparents spend time or live with orders. It might also be that you have a parent or two parents who are unable to adequately care for the children and it might be that the maternal grandparents take on parenting responsibilities under a family court order made through that particular power. So that's just a quick overview of some of the obvious legal issues that will be of real concern to Belinda at this early time. I'd also discuss with Belinda the non-legal issues addressing in particular how she was feeling herself her health issues, her mental health issues. I would always ask a client whether they're receiving some supportive counselling. A lot of people will say to me I've got great friends or I've got great family and I'll always put it to them that that's great but that I would always be recommending that the support that can be offered by a counsellor, psychologist whatever the particular title of the person might ultimately end up being is a really beneficial opportunity for them. If I have particular concerns about the acute mental health of a client at that time as I did in the last couple of weeks I would find myself in a really difficult position because my solicitor client confidentiality prohibits me from taking steps that some of you might be able to take on behalf of the client in maybe being able to contact parents or other people, the spouse or other people who might be able to provide support or vice versa where I'm contacted by basically say Belinda's lawyer and I'm then contacted by perhaps Russell and or Jenny asking me what my thoughts are about Belinda and her mental health and the constraints on me. All right, I need to move on. I'm sorry I'm spending too much time there. So working in collaboration, Peter really talked and Michelle really talked about the importance of having a great network of people that we can draw on and I'll always be looking to people as councillors, mental health professionals, accountants, property valueers and so on. But if I move on to talk about the limits of my ability to collaborate due to that solicitor client confidential privilege relationship it does place a constraint, a very significant constraint on my ability to collaborate and I will always have to obtain my client's written consent before I can talk to anybody about their matter and the particular issue that we might want to be talking about. If I'm working as a family dispute resolution practitioner the privacy and the confidentiality afforded under the Family Law Act is absolute and everything that's discussed in it is completely confidential and can't be repeated and my file can't be subpoenaed. I will then, if we are involved in family court proceedings we might need to obtain a family report to get some more information about what are the recommendations for the children. That might dovetail with an order that is a psychiatric assessment to be conducted or a psychological report prepared as to the parents or even in relation to the children's well-being and their development and specific issues and alcohol report might also be indicated. One of the important issues about confidentiality for you to understand as mental health professionals is that everything that is reported to you by your client whilst you and the client might treat it as confidential as between you is not confidential as between you, the client and the Family Law Act. The exception to that is if you are working in the capacity of a family councillor where that role meets the definition of a family councillor and family counselling under the Family Law Act. So I think it's important that your clients understand that for all intents and purposes it is a confidential relationship but that if they do become involved in family court proceedings then you can't offer them the protection of that confidentiality any longer. A, you might be asked to prepare a therapeutic report by that client. B, you might have your file subpoenaed. C, you might be actually subpoenaed to give evidence in court and bring your file to the court. So your understanding of confidentiality must be always informed by the limitations to that if you become involved in family law proceedings. So I will move on quickly and talk briefly about the sorts of reports and evidence that you as a family mental health professional must request it. We've got the family report which will be ordered by the court where the parties and the children will be managed and assessed by you in a report and recommendations made to the court. Again, as Michelle said, always based on the children's best interest in seeing the paramount consideration and with psychiatric evidence and child development reports as necessary being fed into the family report process. The family report writer often being given liberty to inspect any of the subpoenaed documents that may have been produced to the court, for example, the DHS file, the alcohol rehab treatment facility file, the hospital mental health file and so on. So this is the difference between a court-ordered family report as opposed to your client requesting that you provide a report on their behalf for the purposes of their family court proceedings. And one of the issues that often comes up in these discussions is what to do if you're asked to meet with and provide assistance to the children of a separated parent. Under the Family Law Act, all parents have what we call Equal Shared Parental Responsibility. And unless that responsibility is removed by a court order, it is a given that that is a joint responsibility. A child being taken to see a mental health professional falls within, falls under the umbrella of Equal Shared Parental Responsibility. So my advice would be that you always do your very best to obtain the consent, the written consent of both parents before you embark on meeting to assess a little-owned treat, children, mental health professionals often say to me, but what if I can't get the consent from the other parents? Then I think you need to tread very wearily and you need to keep very good file notes of all the efforts you may to contact that person, that perhaps the uninvolved parent, or if the primary parent is reporting family violence to you and you make an assessment that the child's best interest requires you to override the joint parental responsibility obligation, which would usually mean that you obtain the consent of both parents. And I'll move on now to my final slide, which is for you at the outset to advise your clients as to the limits of the confidential nature of your therapeutic relationship with them. I've had mental health professionals tell me that they ask their client to sign off on an initial engagement contract that acknowledges that in writing and also some that they also advise the client at the outset, I do not do family court work. And if that's what you want to do, if that's your position, I think that should be dated at the outset that you're not going to get involved, you're not going to write reports if that becomes a later development. If there is an order asking you to prepare a report, then I would suggest that you read the report order very carefully and understand what it is that you're being asked to report about and also to be always aware of the limits of your expertise. This is a potential area for cross-examination where a mental health professional may have strayed beyond their expertise and may have recommendations to make comments or findings of facts that were beyond the scope of their expertise. And again, I reference that again, the final point there, cross-examination and propenas. And what to do is you are served with a subpoena to produce your file and or to attend court to give evidence. And I'm happy to discuss that later if that would be of interest to you. But I'm mindful of the time, so that's this very quick overview of the work of the family-loyal family. Thank you, Vanessa. That was very comprehensive and thorough. That was terrific. Finally, Michelle, from a psychiatrist point of view. Thanks, Michelle. I can't hear you, Michelle. Sorry, I will start all that again. I think I was on... Sorry. I was just commenting on the fact that I had some questions for Vanessa. And one of the things that I think I was confused about was I had attended a medical legal... or presented a medical legal conference last year and my understanding that I took away from that was when it came to medical issues, including counseling, that it required one parent's consent for the child to obtain treatment. So that's the... I always try to involve the other partner, but that's the understanding that I've been proceeding on, so I may or may not be wrong on that. I think that the issue of confidentiality is very important. And I think the further you go along, the more we realise that there are quite marked limits to confidentiality, not just in a family court perspective, but also in the implications of seeing a mental health professional and reaching a diagnosis. So there's not just implications for your... your data might end up in court. It might be subpoenaed by an insurance agency. Getting a formal diagnosis might have an impact on whether someone could get income protection insurance or even for the children where they may or may not necessarily consent to attending your treatment terribly willingly. It can have an implication to whether they get into something like the defence forces or police. So that's a minor thing. Why a child psychiatrist? Because that's what I am. I also see adults... In general, when an adult is referred to me, it's usually by random chance that I happen to have an appointment available. But there are some advantages because you can potentially assess and treat one or more family members for mental health difficulties including medication if that's indicated. It can provide family therapy. If I'm treating the parent for their own issues because I've got the understanding of children's developmental needs, I'm able to keep the needs of children in mind. In terms of affordability, seeing a psychiatrist, it's usually a fairly large upfront cost depending on whether people have crossed their extended Medicare safety net threshold. But if they have crossed that threshold, which is about $600-something for any family where someone is on a healthcare card or if they're receiving family tax benefits, then they get 80% of their out-of-pocket expenses back. So if a family member happened to be in that scenario, seeing a psychiatrist would be about $30 for the session. So that's more affordable than many people realise. Compared with psychologists in private practice, you can see any patient for 50 sessions per calendar year for a psychiatrist and more than 100 if they happen to have something like a borderline personality disorder. Or if you start to get in this scenario, which unfortunately you sometimes see where people are batting up for multiple therapists, then the family can cross their threshold. Okay, so who to see and who to treat. I've talked about warning about confidentiality. It's very hard to get separated fathers to attend for appointments about their children. Often, if the mothers are resistant and they may or may not be able to be in the same room, they may come for information gathering about the children. I would probably be referred Belinda first and she seems the most likely on the available information to have a depressive illness. And when I see her, you could also potentially gather information about individual children. So my practice in private practice, if I have a child referred is I always have a first session appointment with the parent first, even if it's a 17-year-old, to gather background information because you just never know how complicated things are in the family. Not everyone takes that approach. Some other child and adolescent psychiatrists, if they're over 13, they always see the child first and then see the parent later. But that's just my practice that I've stuck to and the times that I have not done that, then I've come unstuck and it's turned out to be more complicated than what I had anticipated. So in general, if people balk at that, there might be a reason behind that. Occasionally, someone will come to me for a referral for a child and the parent will be so very distressed that I might say, why don't you stick with me and I'll refer your child onto a colleague or sometimes I see more than one party. I think it certainly does make a big difference as to whether someone had... Vanessa referred to as a worm referral and I've had a few from family lawyers where I've had consent and the lawyers have wound me up and said, this is a scenario. Would you be willing to see this family or this person? And I've said yes, and that's helped the situation along. So it's also very useful if a GP or if a psychologist or someone has said, go see her, she's nice as opposed to here's a list of names, pick one, pick the first available, I think that makes a big difference. So for Belinda, I would assess and treat if indicated for a major depressive disorder or for an adjustment disorder with depressed mood. As Peter said, I'd be very careful to point out a normal adjustment in her situation, trying to assess her parenting and her changing role as a single parent. Therapeutically, you'd probably start with something to address her symptoms, but she's had a huge life transition and it might morph into something where she actually wanted some longer-term therapy to address some issues about her identity and where she's going in future with her life. And... I don't know what I meant by, in terms of action where appropriate. And Brian, do I attempt to engage him? Peter's talked about the pros and the cons of trying to have both parties involved. It's very hard to actually catch a 40-year-old man to get him in the room and actually ask questions about depression, anxiety and substance abuse. Sometimes I will be in the scenario where if a child is referred to me, I might have both parents separated within the room and I might send one party out if I'm concerned about someone's... For instance, if I had Brian and Belinda in the room and Brian was looking a bit teary, I might actually send Belinda out and ask Brian some personal issues just to see if there was anything going on there. I wouldn't try and treat therapeutically both separated parents. I think that might be a bit complicated. I do often try and see separated parents together and they want to try and resolve how they're treating each other, take the heat out of some of their emotional reactions. And I suppose as a father, I would see if he can be motivated to step up his involvement with the children. And if one or more of the children do have psychological difficulties, I'd like to see if he can be motivated to be of more assistance because often what you get in that situation is you've had a father who's taken a very passive role in the parenting. It's all being directed by the wife and some of them really step up after separation and have a meaningful relationship with their children and some of them find it difficult to accept a new role or if they're somewhat unwilling. With the kids, Andrew has not been really identified with children. Jessica, you'd wonder if she's depressed or anxious or having trouble adjusting. Tom's got a definite decline in function so you'd probably be the first one that you'd want to assess. And I think you have to be aware of offering too much therapy to a family because they're in a definite state of chaos. I've certainly seen families of five individuals, each individual in their own family, in their own therapy. It's usually the mother who is driving the children to the therapy appointment sometimes trying to balance that with having a job. Maybe more, if it's appropriate, more bang for your buck to do some family work. And my approach often with younger children is to actually treat them with a parent in the room if that seems like that's going to be a good fit. How are we going for time? We don't have long left at all so if you could... Maybe we should turn it over to questions. Sure. Thank you very much, Michelle, that was terrific. Well, given that you talked about Belinda and the family just then, but we have seven pages of questions from panelists and much of many of the questions in a way have been addressed indirectly or directly by the four presentations you just heard. But moving along, somebody asked and any panelist can respond to this. How would you help Belinda see the benefit of Brian having increased care of the children? How would it be beneficial for her well-being and the children's well-being? I'll answer that, Vicki. Thank you. I think on a number of different levels. I think, first of all, presuming that we've engaged with her empathically and addressed some of the other things that are potentially more precious to her is to talk to her a little bit about the benefit. I'm assuming that she is a mum who really cares about her children and wants the best for them. And I would talk to her a little bit, do some psychoeducation about the benefits to the three kids of having, knowing that their father loves them, knowing that their father hasn't abandoned them, is interested and involved in them from every aspect of their development from the seven-year-old white through to the adolescent and why that is important to them as developing people. I think that would probably be most motivating for the mother from the material I've read. And the secondary thing for her in terms of getting her life back together is on a practical level. It affords her more time to, you know, go and do the social things that she needs to do to look after herself to get some exercise, to have some time out. And I think that on those twin sort of levels, a lot of, rather than seeing that as a threatening or a dangerous thing, as a really pro-child thing, I think she could be encouraged. The only concern here in this case, and we haven't really discussed this, the father's repartnered, and it looks as though, from my reading of it, that sort of repartner was happening around the time that they were still married. And I would imagine that this mother, Belinda, is going to have some pretty intense feelings about not just her ex-husband having the children, but his new partner sort of defect those parenting the children. And that might be something that a therapist would need to explore and discuss with her as well. And there were implications of the partner's children as well and the influences they seem to have on the children. Exactly. Exactly. Yeah. Thanks for that response, Catherine. Let's move on to other questions, given there were so many from our participants. Somebody raised the issue of grandparents, and one of the questioners asked about grandparents' point of view, and it was obviously raised in this case study of Belinda and Brian. So would anyone like to talk from their experience about what the issues are for grandparents? I can think of quite a few myself, but one of the panellists like to respond to that. Impact on relationships, what it means to the grandchildren, what it means to the grandparents. I can comment. It's Michelle. Thanks, Michelle. I think in this case it seems like the contact is going fairly nicely and the grandparents are having a very good supportive ongoing role. I think where you sometimes see it being more of a problem is often when the mother has primary contact and then there's some difficulty in allowing contact with the paternal grandparents, and that can be quite distressing for everyone involved. And I guess it's a loss of the relationship, which is hard to know. And trying to stress the importance of, for the parents in understanding that so much has changed, that it's very critical to keep as much as possible the same. And there's often, for example, I saw a family last week where the father was determined to move to children's schools because he's repartnered and it's going to be much more convenient for him to have them in a school closer to where he's living and then trying to say, well, everything is unstable for these children. Why don't we let them keep their school if at all possible and try and minimise the amount of change overall for the children if that's possible and trying to get a bit of a perspective going there as to what relationships can be fostered and also the idea that people aren't disposable, I suppose, and that's a good point. I mean, grandparents suffer loss and grief as well in their situations. Because, Peter, can I just ask for that? Yeah, go ahead. I see a lot of older people in my practice because I'm the oldest GP there, and I do see grandparents quite significantly affected here. I don't think people, I certainly learned that grandparents have perhaps more rights in this situation than I was aware of, and I'm sure that they are aware of as well. An interesting situation, I think, is that grandparents often do feel quite a lot of grief about the loss of the in-laws, so to speak, that there may be quite a social network around this relationship, which is now being disrupted. It's not just the parents and the kids. It's quite interesting. There's an extended family who are all impacted by this. Vicki, if I could add in there that in my experience, often when the separation is acrimonious, the grandparents find themselves almost having to or being asked by their child to take a side in effect, and that's really, really difficult situations for grandparents to find themselves in, particularly if it matters going to court and things are so strained between everybody, and the families in the middle. Terribly difficult for people. You dropped out there a little bit, the rest of the team. Okay. Yes, just moving along a little bit to another question which is an interesting one to think about. How do we assist couples to use mediation as opposed to litigious processes to facilitate resolution of issues? Maybe you'd like to start with that, Vanessa. How do we encourage people like us to use mediation rather than going and being litigious? A number of years ago, the Family Law Act was amended to make pre-court mediation compulsory for parenting matters. So it means now that anybody who wants to go to court with a parenting issue has to first of all have tried resolution. There are some exceptions to that, for example, drug, alcohol, and family violence and urgency issues, but that really has diverted a large number of people away from the court system. There's a whole group being caught up in the legal system with family dispute resolution. So I think that's a really effective strategy. Mediation will be offered in different forms. We offer, for example, round table court, more formal mediation, arbitration, and so on. So mediation is certainly considered along the way of a matter. And I'll often work with clients who are attending mediation, say, at Relationships Australia, and the mediator will recommend to both parties that they obtain their own legal advice in the background so that the mediation can progress with the parties making informed decisions along the way. Okay. Does anyone else have a view on that, on the mediation approach? Yeah, it's Catherine again. I just wanted to comment, and Vanessa, you might have some views on this as well. I know that it's quite common for mediators to offer child inclusive mediation, and these are the sorts of mediation where especially trained mediator with perhaps a background in child development or psychology sensitively talks to the child, and then that person attends the mediation to present the child's perspective. And I think that that can help clients really focus on meeting the needs of their child and understanding the developmental grief and loss issues that the child is facing and to formulate parenting plans around the child's perspective. And I think that's a great initiative, as well as those lawyers who practice collaborative family law. The child inclusive practice is an excellent service, and it needs to be requested at the time of referral, or it might be that it's suggested along the way. But I think it's an incredibly powerful way of providing parents with objective feedback about how their children are travelling, what their children's wishes are, if the children are of an age and of a maturity that they can express those wishes. So child inclusive practice, I think, provides an excellent add-on service to mediation for parents with parenting issues. There's one final question about access, which is a very funny one, I imagine. It can be done when children refuse contact with the non-custodial parent because of abuse of the family court order, which says that access must happen. So the family court is saying access must happen, but the children refuse. Is there what are people's kind of approaches or beliefs about that? Can I jump in again, Vicky? Yes, sure. It's just a topic I know a little bit about. It's an extremely complex topic, and I can't possibly do justice to it in a sort of small answer to a question, but it does happen. And my first thinking about that is use caution because we don't know the reasons why the child is refusing contact. In some cases, that's a really justified response to a very traumatic situation and it's incumbent upon us to use caution. But in other cases, there are cases where the child has been so caught up in the conflict between the parents and is in such a loyalty bind that to show loyalty or allegiance to the parents who they don't live with causes them such internal trauma that they have to do, they split, they do a splitting sort of action and refuse contact. There are a number of practitioners, myself and some colleagues in Victoria who are working therapeutically with families like this. It's enormously complex and very difficult and the success rates, I'm afraid, are very low, but they involve working with both parents and a number of professionals to try and assist children and motivate parents to understand why children maintaining family relationships... I'm talking about in the absence of trauma and violence, but children maintaining family relationships is good for their mental health. Yeah. Thank you very much. We've only got five minutes left, so I was just going to ask for any final thoughts in about 30 seconds each about this case or about the tracks and the tips and so on. So would you like to start, Peter? That's very briefly. Thanks, Vicky. I'll be very brief. So that's been really interesting. I'd love to ask for participants' help as well. Very useful discussion. I would love to have my fellow panellists near by that I can refer to. I must admit, I think it does really underline the importance of having that network of good people around that you can call on to help in a very complicated situation. Thank you. Adding on to that, participants are encouraged to have their own network and especially in relation to this very difficult and challenging topic where supportive colleagues is undoubtedly of benefit. Vanessa, would you just like to make a closing comment? I think that we're all working towards the same goal, the family, and I don't think that any of us is working in opposition to the other. We help clients to access all of these amazing services or advice roles that are out there, and I think it is one of our responsibilities to assist and inform people about the services. For example, the child inclusive practice, meeting services that are cost-effective for them, et cetera. Thank you. Yes, thanks. Catherine, any final words from you, please? Yes, I've really enjoyed it. I've just been scrolling through some of the questions on the general tap. My gosh, there are so many questions. I wish we could have touched on answers and all of them. I guess what I can see people talking about, and I agree, such a complex area, such a huge area, an area that touches on all of our lives in many ways. I guess if you're working in this area, look after yourselves, develop the networks, and find yourself. Thank you, Catherine. Finally, final comments. I just have really appreciated the opportunity to be part of this, and I think I've learned a lot today. Yes, thank you. Thank you. Look, I think perhaps we didn't discuss the case as such a lot, but I think many of the comments that our panellists made impinged on that case and certainly responded to lots of the questions, as I said, that came in before this evening session started. So I'd just like to remind you again to check out the resources that were available at both of this webinar. Please do fill out the exit survey, and do set up a mental health professional network in your area, if there isn't one, or Skype arrangements may work for people outside metropolitan areas. In October, there's a collaborative approach to regression and violence in adult males. That's a webinar then. And one in November about working together to manage methamphetamine use. And I'd like to acknowledge the consumers and care who have lived with mental illness in the past and those who continue to live with mental illness in the present. And thank you to our panellists very much indeed, and to our 711 participants who are still online at the moment. So thank you indeed for your participation this evening, and good night. Good night.