 Hi, my name is Rhonda Wilson. I'm Professor of Nursing here at University of Newcastle, and I'm a proud descendant of the Rotary Nation. And tonight, I'd like you to join with me and pause for a moment as we offer some respect about the country that we're meeting on tonight and wherever you're watching us from tonight. Pause with me for a moment and remember the Aboriginal land that you and we are treading on tonight beneath the concrete, beneath the roads, and the tarmacs is Aboriginal land. It has been that way since Dreamtime. I'd also like to ask you to pause to reflect and to offer some respect to the elders past, present, and emerging. And I'd particularly like to offer my respect to the dark and un-nation where I live and work here at the University of Newcastle. Thank you. Thank you, Rhonda. And as you were speaking, I was also reflecting on the importance of connection, particularly at a time like this. I think that's something we can all learn from, from our Aboriginal and Torres Strait Islander partners. So thank you for your acknowledgement. And thank you to everybody at home, wherever that home might be, and for the wonderful people in the room here tonight to join us for this second in our series of the Looking Ahead Lectures, where we're also taking a minute to pause and reflect on better, healthier living. And particularly the way in which we might be able to care for others, to care for ourselves, and to care for our communities anyway, but particularly in this time that we find ourselves in. And so thank you for putting aside time in your busy schedules, in all of the things that we do during our day to also stop and reflect and join us tonight. And thank you to our wonderful panel who I'll introduce in a moment. But first, I thought I might talk a little bit about mental health and well-being. So that's my background. That's an area of passion for mine. I like to think I have a little bit of expertise, but I guess I'll leave that to the wider community to comment on. My name's Frances Kay Lampkin. I'm the Interim Pro Vice-Chancellor here for Research and Innovation at the University of Newcastle. I'm also a very passionate and committed mental health researcher. And so my colleagues here also have expertise in mental health and alcohol and other drug use problems and concerns. And even before we hit 2020 as a group and as a field, we were quite concerned about the mental health and well-being of the people that we love and also our nation and the world in general. And that's particularly for our young people, one of four in whom will experience a mental health problem in any 12-month period, but very few of whom actually seek treatment and support for the things that are concerning them most. And that's particularly the case for some of our young men who really only access mental health care at about 13% of the rate at which they might be experiencing mental disorders. But also across the nation, mental disorders and substance use and alcohol use disorders is something that are in the hearts and minds of us all with almost half of Australians reporting a mental disorder at some stage in our lifetime. So really that means even before 2020 hit us that our families and basically everybody we know if not ourselves is touched by mental disorders and their consequences. And particularly dear to my heart and of a particular concern to me is that interplay between mental health and substance use disorders, something that we call co-morbidity. And there are lots of ways you can describe that. But often people can be using alcohol or other sorts of drugs to help them cope with the symptoms and the experiences that they have. And sometimes it's the mental health concerns that can lead to some of those alcohol and other drug concerns. And when that all gets mixed up together for somebody, it really can make getting access to treatment that much more difficult and the recovery a little more protracted and a little more complicated. And the reason that that was a concern and that that's a concern even before we hit 2020 is that there is a worldwide shortage of available health professionals who are here and ready and waiting to help people respond to and help them cope with their needs for mental health support. In Australia, we only have about one psychiatrist per 1,400 people with a mental disorder. And for psychologists who do a lot of different work from psychiatrists, our national average is around 87 psychologists per 100,000 people. So if we have around one in four people in any one year who experience a mental health disorder that's of a sufficient enough threshold where we would like people to access treatment, we can quickly see that even before COVID hit and 2020 hit, there's a real shortfall in our ability to respond to this demand and this ongoing need. And that's certainly an area that we've all been working in for quite some time and thinking about ways in which we can respond to that gap. And then 2020 came upon us. I don't know what to say about this year. What we do know already is that we have some early emerging evidence, particularly from that first month of COVID-19 with a survey conducted by almost 14,000 Australians that we were seeing at least double the levels of clinically significant depressive and anxious symptoms. Lots of people thinking that they'd be better off somewhere else and really experiencing irritability, difficulties with concentration and real difficulties going about our day-to-day business. We have one in four people reporting quite moderate symptoms of depression and anxiety. And really, so these are new cases. So people who weren't feeling that way before COVID or 2020 hit, but for the most vulnerable people in our country and particularly those who have pre-existing mental health or substance use problems, they're really feeling the impacts of this year as it unfolds. To focus a little bit on alcohol and other drug use, we are also starting to see, and certainly we're earlier in the year, increased rates of alcohol consumption, particularly by us here in Australia. So around a third of Australians were reporting that they were drinking daily, and that's compared to about 6% of people pre-2020 or pre-COVID. And it seems to be particularly tough for parents. So I don't know if parents out there are joining us. I'm a parent myself, but really the added pressures of holding our family together, of the pressures that on our economic viability as a family and our work, and also with homeschooling and thinking and trying to create a safe space for our kids as we navigate the anxieties associated with COVID have really brought an extra strain on our families. And we're seeing that this is taking its toll in terms of, again, significantly increased alcohol consumption by parents as a result of these increased responsibilities. To talk a little bit more about that relationship between parents and children, we're really seeing also some very early signs of our young people and some of our very young people just struggling to understand what it is that 2020 means for them and their world going forward. Work by a group from the University of Melbourne has indicated that of this group who were surveyed a little earlier this year, that 81% of children in these families had experienced at least one symptom of trauma over the year in response to COVID-19. And that can be manifested in a number of ways. So I'm not sure if we've had experiences at home with kids with some trouble sleeping alone or maybe who might be acting a little bit younger than their years or a little bit older than their years. And these are the sorts of signs and symptoms we might be seeing emerge as our little people try to understand and cope with 2020. The difficult thing in thinking about 2020 and particularly COVID and what that's brought to bear on us is that some of the things that we've been required to do and that we need to do for the public health can actually have a longer-term impact on our mental health and wellbeing. So there are some negative factors associated with being confined at home with drawing from our usual way of connecting with people. And the fear of infection and the anxiety about what the world might hold going forward can really start to exert itself on our everyday life. And I guess that's what we might all be feeling as we come into the end of 2020 and think about what 2021 and beyond might hold for us. We might be feeling it's a bit harder than usual to concentrate. We might be a bit irritable compared to usual. We might be feeling a bit restless and a bit more nervous and quite worried about our future. And again, if we've had some mental health problems or some alcohol and other drug use concerns coming into 2020, then we'll be feeling these impacts even more strongly and severely. And some of the models that we're looking at now in thinking about what we might need to do to plan ahead in the years ahead in response to 2020 and COVID-19 suggest to us that the hard work is only just beginning. So for us as mental health carers and providers and people who organise and support those in service roles, we're really only just starting to see some of these impacts trickle through. And we've been talking recently about how our university and how our health services and how our organisations are leveraging and mobilising to respond. Because it is the reality and it will be for quite some time going forward that we don't have all the facts that we might need. We can't remove all the risks related to COVID-19. And we certainly can't promise that we're all going to return to normal or to pre-2020. And in some instances, that might be a good thing. We also can't eliminate all the worry and that underlying anxiety that we're feeling is we think about what might be next, what 2020 might hold in store for us next and beyond. And really, it's hard to kind of to think about and hold in our minds. Some of the juxtapositions that 2020 has thrown at us. So particularly, sort of any of these, resonating with anybody at home. But the kind of the things that are at odds or that tension that we might feel between what we need to do under COVID-19 conditions and what we might naturally think we need to do if COVID wasn't around. And so some examples where we're used to experiencing and thinking about hospitals and health services as places to go to get help when we need it most. But actually, we can't go there. When we've needed it most because of fears around infection and transmission for COVID-19. Some stores are closed, yet some are open. What does that mean? Everybody needs to stay home, but it's important to go out and get exercise. You can walk around with a friend in some cases, but not with your family if they don't live under the same roof. So all of these almost Jekyll and Hyde-type considerations that have been upon us through 2020 and might continue with us for quite some time have really led and increased this sense of what we call cognitive dissonance. So that real, as I said, Jekyll and Hyde between trying to reconcile almost opposing views or ideas about the way in which our world might work. And that can create even more anxiety, some irritability, some loss for that life we had and a life that might have been easier before 2020 hit us and lots of worry about what all that brings to bear. And if nothing else, it's just a very uncomfortable situation for our human mind to endure. And I think that we'll be in this state for a little while longer as we emerge from that first wave of COVID-19. So I think maybe that's resonated with people at home. It certainly has been my experience and the experiences of our panel here so far in reflecting on 2020. But what can we do about this? We wanna do talk about and acknowledge those experiences, but we'd also like people to think about hope and optimism and resilience in the face of what is a very real reality for us at least for the short term. And in talking and preparing for tonight, I was having a conversation with one of our amazing professors in the Faculty of Education and Arts, Professor Catherine Collaborn, who's a mental health historian. And really she has had some experience in looking back and reflecting on how historically we've responded to these sorts of challenges in the past. And certainly what she was able to say to me is that New South Wales in particular has a really strong tradition of extra institutional care, thinking about how we can wrap supports and resilience processes and programs around people for whether they're inside a health service or a hospital or out in the community. Certainly in historically and in the early part of this century, we were seeing some of the first innovative models of care for mental health and wellbeing, where people were discharged from hospital, being able to go home for visits or on trial leave. We saw aftercare support really emerge as a strength out of some early challenges that we faced in the early 1900s. And really an emphasis placed of the significance of the role of families and communities in supporting people through these sorts of crises. And so you'll see as we talk here tonight that these are all the same kinds of themes that we'll draw upon, that we've actually drawn upon from our historical past and that can take us through this next phase. And certainly it will take all of us to rally together and to support each other through COVID. So in thinking about that, we do need leaders like we've brought together to you tonight to think about these challenges and respond to the challenges of tomorrow. But first, we're going to introduce to you an emerging leader in our midst. Jake Jublin is a PhD student here at the University of Newcastle, who isn't able to be here with us tonight with his apologies, but really wanted to talk a little bit more about what 2020 has meant to him from his perspective and how it's been being a student in a very, very unusual and somewhat historical year. Good evening, everyone. My name is Jake Jublin and I'm a PhD student here at the University of Newcastle. I'm also a rifleman in the Army Reserves. And the year that I graduated with a Bachelor of Psychology was the same year that I deployed with the Army to conduct maritime border security operations with the Navy to the north of Australia. I was aware of the physical isolation that would come with this deployment. We were going to be spending weeks at time at sea with little to no contact with our family and friends back home. But what I wasn't prepared for was the mental isolation that would come with it. Given the chance to talk to your loved ones and your friends back home, which was limited in itself, you didn't really want to talk about the things that you'd been doing, some of the things you weren't allowed to even talk about. Some of your family and friends even criticised the role that you were providing from a political perspective. The only people who you could really speak to about what you'd been doing were the people who you were serving with. And when my deployment finished and my full-time work with the Army finished, I hadn't prepared myself very well. Uni had finished. I didn't have another job lined up and I didn't have a house to even go to. I was moving back in with my parents. I had no intention of returning back to Uni and I had no idea what a PhD would entail. But for some reason, I opened up an email from the University of Newcastle one day and they were offering a scholarship to conduct a PhD on the mental health of Australian Defence Force veterans. I hadn't worked in the mental health industry. I didn't have any postgraduate research or study behind me. I hadn't reached provisional registration as a psychologist, but I was a veteran and we were gonna be researching veterans. I was so nervous about my interview with my would-be supervisors that I considered pulling out at the last minute. But within five minutes of speaking with them, I realized something. Just by way of myself being a veteran, I already had a far greater understanding of the experiences of ADF personnel than they did. They had the research experience and the research knowledge and skills to build a research project, but I had that lived military experience and to their credit, my supervisors saw that opportunity and the value that my lived experience could add to the research team and decided to give me a shot at doing my PhD. About a year into my PhD, I got told that I'd be deploying to Afghanistan. I had to defer uni for 12 months and move to Brisbane and conduct my pre-deployment training and then I deployed to Afghanistan with the Brisbane-based unit for seven months. When I returned home, I was experiencing some of those same issues that I experienced on my first deployment. But it's important to note that none of these issues came about because of being exposed to any trauma or any sort of extreme violence or any loss of life. What I was experiencing was a sense of isolation, a loss of purpose and a lack of direction. I was feeling physically isolated from the people I'd deployed with. They remained in Brisbane and stayed in the Army full-time. I was now back in New South Wales and going to uni. I felt mentally isolated from the people who I was now engaged with because I felt they weren't on the deployment with me. I didn't really want to talk to them about the things that were going on on the deployment because I didn't think they'd really understand. I was experiencing that loss of purpose and a lack of direction because for the last seven months, I'd been a rifleman, a soldier in Afghanistan and all of a sudden I wasn't. And if I'm not that soldier in Afghanistan now, then what am I? When I returned to my studies in early 2020, I was quickly deployed to help with the bushfire assistance and cleaning up in the rural areas affected by the bushfire emergency. The devastation that I'd seen on the TV was now I was seeing in real life and the physical and mental isolation of the people affected by the bushfires became obvious. The physical isolation was obvious in one bloke that we spoke to when we eventually cleared the road down to his arm-isolated property. He said that he hadn't seen anyone for three weeks. The mental isolation was obvious as well. We were going door knocking on people's properties, asking if we could help or seeing if we could assist them in any way. Most people were happy to see us and would take up the chance to put us to work, but for some people, they'd lost so much and the devastation was so great that the sheer thought of even trying to rebuild and move on was just too much. And for the people who had lost their businesses and their houses and sadly some of their loved ones, they were experiencing this loss of purpose and lack of direction as well. Pretty much as soon as the bushfires wrapped up, we were again deployed to enforce some of the lockdowns and the isolations due to COVID-19. It was becoming pretty clear that society as a whole was experiencing this sense of isolation, this lack of purpose and a lack of direction. We are physically isolated from our friends and family. We're mentally isolated because this pandemic has had its own unique individual effects on us. And people who are losing their jobs and losing their businesses are experiencing this lack of purpose and loss of direction. And we're all living in this extreme uncertainty about the future. My research focuses on helping veterans to maintain positive mental health in uncertain times. We do this by building and maintaining a routine around positive, better, healthier lifestyles such as fitness, nutrition, mindfulness and sleep. The need for such a tool in greater society is fast emerging. And when we talk about looking ahead and better, healthier living, we can consider some of the statistics around the veteran studies that we've been looking at. We see ADF personnel who are trying to leave the Defence Force and transition to the civilian space. They often maintain positive mental health throughout that first 12 months. But when the excitement of leaving the Defence Force, looking for a new job and relocating and reconnecting with old friends, once that subsides, we start to see a decline in their mental health. And we should keep this in mind when us as society start to emerge from this lockdown and isolation. Let's not let the excitement of heading back to the pubs and reconnecting with our friends and going traveling. Let's not let all these things mask the fact that we may be suffering from some negative mental health issues brought on by this pandemic. And to all the mental health researchers and workers, we're going to be getting contacted by countless people over the next few months and maybe even years who are still struggling with the lasting effects of this pandemic. And so I urge you all to draw on your experiences and your struggles throughout this difficult time and try to use that lived experience to understand the population or the group of people that you're trying to support. Because much like my acceptance into the PhD program, your lived experience might be that little missing piece that allows your research team or your healthcare team to provide effective care. Thank you. And we say thank you to you, Jake, not for recording that just remarkable insight, but for all of the service and all of the work you've done to keep all of us safe and your counterparts at the ADF too. So thank you. It's a nice segue now into introducing to you all the rest of our panel who have joined us here this evening to add to Jake's reflections on 2020 and the hope and the optimism and the opportunities we have as we look ahead to beyond the pandemic. So I'm joined first by Professor Liz Sullivan who's sitting here on my left. Liz is the Acting Provost Chancellor for the Faculty of Health and Medicine and has really been instrumental in leading the Faculty of Health and Medicine's response to COVID-19, particularly through 2020. And you've been doing some particularly important work in readying our undergraduates to respond to COVID-19. So will you tell us a little bit about that and why that's been so important? Yes, thanks, Frances. And I'd just like to acknowledge Jake's talk. It's so critical of things he's talked about. So we've been looking at really being able to support a surge workforce, a surge health workforce. And of course, that's quite critical because when first COVID was coming on the scene, we saw what was happening in Italy and other parts of the world and the enormous stress it placed on the clinical workforce. And part of our role is the next workforce. So we're the pipeline and particularly with our nursing and with our doctors being interns. It was really critical that our final year students would be able to actually be able to enter the workforce in 2021. So we led a number of initiatives, now working with both government and with the local health districts in partnership. I'll just mention a couple of those. So there was the assistance in medicine. This is a program that was Jenny May and Brian, both from the faculty were very much instrumental in, working with New South Wales Health and other universities. And that was about really almost like a trainee intern. And so that was where the workforce was looking at final year medical students who would have a specific role. They would be assigned to a junior medical doctor and they would be able to learn the skills of being an intern so that they would be ready to join the workforce if we needed a surge in 2020 or to start as interns in 2021. There were also technical assistance and this was the role where students, health students could apply and work with the local health district and they might be involved in supporting contact tracing and doing testing that we've all seen. And also just really doing basic activities around the hospital. A third thing we did was we were very clear about making sure that our students were both kept mentally fit but also were able to do a former clinical placement so that they would be ready, be it both virtual, telehealth or in face to face. And so what was developed was the embedded medical, seeing a medical student program. And this is where our final year medical students are able to be assigned over a long, over a long time period to a particular team and are able to get a clinical experience. Critically, they would have like a boot camp before that which was a week of intensive training which allowed them to sort of get the basic skills they needed particularly around personal protective equipment and being able to operate within I suppose a different type of circumstance that COVID-19 does in the clinical setting. We also looked at assistance in nursing as well and with our final year nurses also being able to provide a surge workforce particularly in places like nursing homes and also the hospitals. I think lastly, we also looked at being able to have our clinical staff, so our clinical academics being able to actually, if needed, be available to take on from being more part-time to full-time activities within the hospital to support their other clinicians. So there's some of the initiatives but I think critically we've had great support from our colleagues in the local health districts to allow us to be able to maintain training and clinical placements where possible for across all our health disciplines and also I think for us to be able to show that we can add value and support them as they are at the front of this fight against COVID-19. It's a genuine partnership I think where everybody has benefited and including our community members. Thanks, Liz. I'll just point everybody's attention at home to the QR code which we can see above our heads here but hopefully is displaying on your computer or television screens. That's the way in which you can access our team here and ask us questions live. So I have a device here and the questions will pop up as you ask them at home. You just need to get your camera from your phone to take a photo of the QR code. You'll be then taken to a platform where you can enter your questions indirectly. If any of them come up, Boston, any of our experts are talking. Thank you. Liz, you did mention telehealth. Can you expand a little bit on the use of digital and those sorts of technologies in the context that you've just been speaking about? Yes, I think one of the unexpected, I suppose, good things to come out of COVID is it's really made us push on to sort of be much more digitally engaged and to look at being able to use simulation more so that our students know how to get their skill sets before they are in with clinical patients. Also to look at telehealth. And telehealth, both from a training perspective, is a really critical thing, but also to do service delivery. So, for instance, with nutrition and dietetics, we now have a telehealth clinic where students and staff members are able to provide dietary consultations which both satisfy the students' learning attributes and their experiences of being how to become clinicians but also provides for our community opportunities to talk about diet. Another example is with occupational therapy, where we've been using telehealth also. So if going from previously a face-to-face clinic, which is, I suppose, the traditional clinic, to being able to start, being able to do occupational therapy over using a telehealth principle. And that's really where you have... Your patients can be on Zoom or something equivalent, so in their bedroom or in their house. And then we are in a setting where we're able to interact and actually do a full clinical assessment. So that's been quite exciting. And I think also the training of students being able to get virtual experiences when we weren't able to have face-to-face clinical experiences. I think that's something for the future where we'll do a lot more of clinical placements virtually to make sure we get upskilled with basic skills before we go face-to-face. Thanks, Susan. I think selfishly reflecting on some of the work that I do, which is bringing technology to the point of care for mental health and substance use, to have these sorts of technologies embedded in the training programs for health workers, for many of the future health workers is really important in being able to better leverage those sorts of technologies once people are out in that workforce. It's almost taken COVID for us to make that necessary leap, in a sense. I think it's given us the opportunity to try new things and to try them quickly at scale. And I think critically one of the other interesting ones when you talk about mental health is virtual ward rounds. Medical students being able to go through virtual ward rounds, which again allows it to have a lot more people engaged in the process and in learning activities. Thanks, Liz, and that kind of leads me to something I'd like to ask you about, Ronda. So thank you again for our acknowledgement of country and to introduce you formally. This is Professor Ronda Wilson, who's a professor in nursing and midwifery here in the Faculty of Health and Medicine at the University of Newcastle. So you've been doing some really interesting and important work supporting our frontline clinical staff during COVID-19, embedding sort of disaster principles and mental health principles and digital technologies into your work. Can you tell us a bit more about that? Yeah, well, we're really, really interested in the health workforce and I guess from a nursing perspective and with the nursing workforce as well. Because the nurses are spending a lot of time with COVID patients, for example, and doing testing at testing stations. And it's quite an anxious experience for a lot of people. We are hearing reports. The Premier of Victoria is saying today, as indicated today, that the health workforce is at significant risk of acquiring transmission of COVID-19. And so the health workforce is really in these very uncertain times and in the front line of COVID-19. And so it is, it follows that people are going to be very anxious about that experience. And we can do a lot of training and work to support people with personal protective equipment. And, you know, and that's very, very important. And at the same time, we want to try and keep the social distance. And again, it links in with all of our digital technologies as well. If we can better leverage the digital technologies, then perhaps we can keep people at sufficient distance, but kind of socially close enough to be able to do high quality health assessments. But for our health staff and the anxiety and the uncertainty about whether they might bring COVID home, for example, to their own families, it's been very distressing for people. In the mental health area, where my expertise lies, we, and across all of the mental health professions, we talk a lot about something called clinical supervision. It's a professional development or a way of being able to look after ourselves and make sure that as we do that, we can also be a therapeutic agent for others. And being able to maintain ourselves, our self-care in order to provide care to other people in a personable way, requires us to manage our anxiety and distress and to not put that onto others. So at the moment, we're doing some research to look at how we might be able to develop, to take from some of those knowledges about mental health and mental health nursing and how we care for ourselves and retain our therapeutic agency to give to the people we look after, our patients, our clients, the consumers. And we want to be able to share that with our frontline nursing colleagues in the first instance, to be able to support them with some clinical supervision, some professional development. And of course, we want to be able to do that in a way that allows them to, it's convenient for them to access. They can access it at a point of need. And so it naturally follows that a digital platform of some type is the most suitable way to try and provide that support. So at the moment, we're piloting a new intervention to support, particularly nursing, but as we go forward, we're hoping to be able to do that for other parts of the health professions as well. So that people will not only have in their workplaces the appropriate resources in terms of their protective equipment, but also they'll be emotionally protected as well as we try and provide some surge support, I suppose as well, to borrow Liz's word, to support the workforce as we deal with these very uncertain times. It is really important, isn't it, that building resilience and those protective factors because I think we'll be in this state for quite some time. Some time. So apologies to people at home. It sounds like we've had a spaceship land in the other room, so I'm not sure if that's coming through on the audio at home. But bear with us, and I hope you can still hear us okay. And just a reminder to keep sending your questions through to us using the QR code that hopefully you'll be able to see on your screen. Rhonda, that's really critically important work, and I do love the way that the digital platform can enable those resources and tools to be there whenever the person is ready and has the time or the space to interact with them. It does open up that flexibility, doesn't it? It really does open up a great deal of flexibility, and I think that we're in mental health in particular, we've been using digital platforms around the world for some time to administer digital interventions, to support people with mental health conditions, particularly with anxiety and depression. We've got some very advanced work around the world in that area at the moment. And I think this COVID-19 gives us an opportunity to think about that in many more shapes and forms. And I think as we do that, we start to think about the other health professions that might be able to enhance some of that work. And so some of the work that we are embarking on at the moment is starting to include infection, prevention and control expertise, and also disaster health. And as we start to bring these areas, these kind of siloed sometimes in health professions, areas together in unique ways, we find that new knowledges can emerge and new interventions can emerge. And so as a researcher, that's very, very exciting. So to draw together infection, prevention and control, my area again is mental health. And so I'm a registered nurse, so I am very interested in infection control. It's the bread and butter of nursing really. Good hand hygiene. And we're always talking about those infection prevention, but I didn't ever see myself working very closely as a researcher with infection prevention and control. So there is a new angle to explore, how can we support people better as we bring these ideas together, as we bring disaster health into that as well. And some of those principles are about preparation for uncertainty and managing a whole pandemic, a whole response around how do we manage this and come in together. I'm sorry, I'm losing my voice all of a sudden. I think that spaceship is... Indeed, indeed. It's longer than a 10-second countdown to lift off, isn't it? It is really, really important. And in talking to you before tonight, I'm also remembering speaking to you about your experience working with Aboriginal communities who've also been benefiting from some of the digital approaches, but have had somewhat of a different experience in response to COVID. Yes, and I think this is very, very interesting news indeed. I think what we've seen in Aboriginal and Torres Strait Islander communities in Australia in relation to COVID-19 gives us an opportunity to think about some of the strengths of First Nations peoples. So one of the ways of knowing in Indigenous cultures is very oral narratives, storytelling. And stories are a past in families and communities and mobs. And one of the memories and one of the stories that a colleague was reminding me of recently was that there is a memory that Aboriginal people have of what happened with the Spanish flu in the beginning of the last century. And so those stories have come forward in families now. And of course, some of the memories were really quite horrific. The way that Aboriginal people were treated in that time were really quite horrific. And so there is a memory. People don't want to walk down that, travel down that road again. And so when a pandemic, something like Spanish flu, came along again in the form of COVID-19, we were very, very fast as Aboriginal and Torres Strait Islander people in Australia to respond in a way that put a ring around our most vulnerable. We cared for our elders and our vulnerable people. And a lot of that narrative came through in social media, for example. We are getting aware that Facebook, in particular, has been particularly useful in passing on the story and the caution of, we've got to look after it, particularly our elders. And so everybody came together and physically distanced, but came together socially in order to be able to provide for those needs. So it's given us an opportunity to reflect and think about this from a health promotion perspective, which is really interesting because if Aboriginal communities can manage in such a way and such a rapid deployment of a health promotion strategy that is self-determined, then there is probably some very good knowledge that we can draw forward to the whole dominant population to say, here's some strengths about health promotion that we can draw forward. And if applied to the whole population, would it be a good thing? Would it strengthen our approach? So we're interested to understand the social media stories around health promotion around the country. And interestingly, and I'm afraid I didn't get a chance to check the statistics today, but the last time I checked the statistics for Australia, the epidemiology, the statistics in Australia, we had no Aboriginal or Torres Strait Islander death related to COVID in the last, I'm thinking back a last couple of days and we've had nobody in ICU. Now that's an extraordinary statistic and we are absolutely underrepresented in the best possible way. So it gives an opportunity for us to amplify a narrative of strength in Aboriginal and Torres Strait Islander communities at the moment. My word it does. Thank you, Rhonda. I'd like to throw now to Dr. Hazel Dalton who's joining us virtually from the Centre for Rural and Remote Mental Health where she, that's out at Orange in New South Wales where she's the research director out there. So Hazel, I guess, thinking about Rhonda's reflection on Aboriginal communities has gotten me thinking a little bit more broadly about our rural, remote and regional Aussies out there and how that strength of community in Indigenous communities has really protected them from COVID-19 and some of the impacts that the rest of us are feeling. Is this also true in terms of what you've been seeing in your context in the rural and remote areas particularly of New South Wales? Thanks, Frances. So I guess from our perspective we have the benefit of distance in populations which is somewhat protecting us from the challenges. I would certainly think that community strength and cohesiveness has helped with adherence and really pretty positive behaviour. One of the worries we have I guess is we've had a boom in domestic tourism so that poses its own challenges in terms of will there be infections from Sydney Siders coming up over the mountains and things like that for me in Orange or in other places. So there is that aspect but I think from a community perspective it's been pretty strong. But for us it's actually at the back of a whole series of adversities and so in some respects rural and remote communities are pretty prepared for dealing with hard things and getting on with it and probably be one of the comments I'd make. So yeah, I'll throw it back to you, Frances. Thank you very much. I'm just making sure that you can hear us again. It almost looks like you're sitting in the spaceship that was landing here which I'm glad that stopped now but Hazel, you do say you did mention that rural adversity I guess for one of another way of describing the experiences is not all that uncommon for people in rural and remote areas and you touched on bushfires and floods in addition to COVID and then that need to sort of protect the community at the same time you want to encourage people coming to the community. There's been lots of different roles and different ways in which people in rural and remote areas have been able to embrace or otherwise their roles. Has digital technologies assisted with that in your areas? What are you hearing from the rural mental health workers particularly that you work with and some of the initiatives that have come out of your centre or that have been supported by your centre in the face of 2020? Sure, I guess one of the things I would state would be for us we look at this sort of disastrous once in the lens of rural adversity because they tend to be experienced not in isolation is these really discreet events but as more of a continuum. So we've come off the back of quite a long and extensive drought it's not over and then we've had the unprecedented bushfires some places have had flooding and as we said we're dealing with COVID right now. So from our perspective that's the lens in which we look and we run the rural adversity mental health programme here from the centre and that's in partnership with rural local health districts. So we've got 20 staff out in the field who do this sort of disaster preparedness work disaster response work. They train community members in mental health literacy and this kind of work as well as community development work. So they're embedded in their communities and so I guess one of the big challenges for them is in the time of COVID when you've got physical distancing and the inability to get out that they're unable to do the work as they would normally do. So we've been really grateful that the centre has a strong comms and social media presence and so that ramp has been able to connect with its communities virtually. And we've also had to adapt the training so it's now online and we can do that in a still and engaged way because it goes via Zoom. It's not self directed but we can connect with our communities and targets that way. And I guess one of my reflections on things is given this for our ramp coordinators who are normally out in the field they actually really struggled with this changeover. It was an initial break that had a very long season of dealing with bushfires and drought and things like that but after that initial break, they're extroverts, they're independent people and they don't like sitting idly by so that was a real challenge from a mental health perspective was looking after those workers and keeping them connected, keeping them engaged, having some virtual morning teas and catching up as a general group to keep connected, things like that. Justing you say that because it is true that some of our natural ways of being in the world or our personality traits one another way of describing the way we are in the world can either work for us or against us in a range of situations and that transition to working from home and then that transition back again has probably been a bit of a challenge for me and I think for people around us and I wonder if that's also been the case from your perspective Hazel. Definitely. I think it was really interesting that here at the centre we were able to switch to working from home rather quickly and it was done very smoothly. We'd been using Zoom quite a lot before this because we serve rural and remote communities so we can't always get to everywhere we want to go and so we all picked up tools, got home and worked really well but when it was time to come back to the office I found that some of the staff that were struggling most to go struggled most to come back so the transitions were difficult and it's been thrown up a whole pile of challenges for the group to think about how best to manage that and how best to keep connected. Are you home because this is best for you or are you feeling having anxiety and then transition back phase so that's been an ongoing thing for us but I think it's done really well. Yes, I think it'll continue to be a bit of a tension I think as we might have to move into and out of those sorts of working from home or other arrangements and I'm wondering, Adrian, I'll introduce you now properly Professor Adrian Dunlop who is a con joint researcher associated with the University of Newcastle but also is the clinical director of our drug and alcohol services here in the Hunter New England local health district so when you're managing a clinical service and you're through this type of pandemic what has been your experience and how have you transitioned in or pivoted to support this changing work environment and potentially, I guess, an increase or has there been an increased clinical need for your services during this time? Thanks, Francis. So I think from the start it's important to acknowledge that we're part of a much larger healthcare system and we have very good infection control advice very good public health advice and that's been present since that date in March that I can hardly forget now so that's been a really important part of it to have that good support and advice and to know where to go to to get additional advice for our health staff working with the community really from the outset and I think places has placed us and will continue to place us in a good position if we do see more spread throughout our Hunter New England area. So I have to say that to start particularly I guess a couple of issues of patients who have drug and alcohol problems and present to healthcare so one of the things that's a little bit different that I think wasn't seen as much with other healthcare services is we didn't really see a drop-off in presentation so not to emergency departments and not to people formally presenting for drug and alcohol treatment. You were making the case before with mental health and it's additionally true for drug and alcohol that people tend not to present to services. There's a lot of stigma, there's a lot of shame, there's a lot of embarrassment about having any sort of substance use problem and unfortunately that translates into people generally not presenting to services or if they do present to services they're leaving in a long period of time and unfortunately things can get a lot worse in that time before they do present and formally ask for help or some sort of assistance. So that was a problem before the pandemic and the pandemic hasn't made it any better. We don't really understand yet other impacts of substance use during the pandemic because we don't have really good high quality data that maps those sorts of changes, especially even at a local level over that time but suffice to say, I think what we tried to do really from the outset was to make sure that we could provide as much access as we can so we tried to make our services more accessible so that was particularly important at the Marta Hospital where there's now a daily clinic that's very accessible for patients referred from GPs and the capacity for that service as the patients increased quite significantly but then also across the district the different sorts of services that we run we've tried to make sure that they remain accessible and available and have done so sort of since the word go. We've also thought and this is part of the sort of influence and support from people in infection control and public health of trying to have isolated teams that there's not too much stuff crossover so if we had one team where there was a need to isolate stuff for a period of time that wouldn't knock out a third or a quarter of our service but that we could have a backup team that could go and replace them and so we're at suitable we've had people working from home we've had and we've shifted largely not entirely but largely to telehealth consultations so most of our staff are doing telephone or video consultations now there's some negative aspects to that so there are some patients I was talking to you before when people are ambivalent about presenting or asking for help or find it really hard to ask for help you could imagine making that leap to go and see somebody might be even more difficult if it's to a video camera not to a person sitting in a room so that's a challenge and in some parts of our service we try to make sure that that option remains to see somebody face to face so there are the things we've sort of done from the start we have had training in some parts of our district to provide or to do nasal swabs for patients who might find it difficult to present to one of the hospital clinics or one of the university clinic or another clinic to get testing so we make it easy for people to get testing because that's clearly an important message throughout the pandemic if you think you've got a symptom go and get tested early in the piece not late in the piece so yeah there's a mix of things I think we've been doing from the start but it's exhausting for healthcare staff there's no doubt about that and we don't really know how far we are into the pandemic we're all really hopeful for a vaccine or more effective treatments but who knows when that's going to arrive indeed so we had a question a few questions come through from people who are joining us from maybe it's home, maybe it's somewhere else which I think I might bring in here just for a moment because the comment is that as health and related professionals have we been gratified by the increased recognition of the importance of public health and medical roles that has come through COVID but I wonder if particularly there's an opportunity for us to influence the conversation around help seeking when you're feeling mentally unwell or mentally threatened or in trouble and to encourage people to access the alcohol and other drug use services that we do have available before it's a long way down the path in their experience so maybe that's a yes from you Adrian but I can see Sarah talking in the background as well so I might quickly introduce Sarah Bartlett from Every Mind representing Every Mind who is a national organisation associated with the Hunter New England local health district but who also does a lot of work with the Mind Frame project which is about how do we talk safely and encouragingly about mental health about suicide prevention and about drug and alcohol use in the media and in open outlets and maybe you both might like to comment in response to that particular question Thanks Francis I would like to encourage our communities to feel prepared and able to have a conversation with a loved one with a partner, with a colleague or with anybody in the community around help seeking but we need to understand the risks around certain types of conversations and particularly language language is so important words matter we have the Mind Frame guidelines that really outline the importance of safe language and real health and suicide so we really need to provide literacy and understanding to our community so that they can feel informed about these issues but also feel able to have a conversation and that means linking people up to help when they need it being able to provide time and a safe sensitive space to really have a safe conversation to be a listener a non-judgmental listener and providing someone with a help pathway and it's also really important in the media at the moment sadly, you know, our Australian communities have just been inundated with very distressing news coverage from the drought from the bushfires from COVID and you know that's the media's role, they have a public interest in telling the story of the day what is happening so we need to be able to ensure whenever we're providing a news story to this effect that there's always help seeking information available for vulnerable audiences whether that be the lifeline number, suicide callback service or the 1800 alcohol and other drugs hotline people need to know where support is available for them they certainly do sour and if people stay till the end we'll be able to provide some very practical tips and options for people to source and access that type of support from so I wonder if now that the spotlight is on mental health and medical responses to COVID-19 whether we can actually control that conversation a bit more away from, for example in the media about drug seizures and drug busts towards we have an increased demand for our services, let's put effort and time into reducing the demand for alcohol and other drugs and encouraging people to seek treatment early and I think it's about providing our communities with an understanding of what treatment looks like so that's obviously going back to where we started the voice of lived experience and being able to share those perspectives obviously treatment's going to look different for everybody but being able to share with our broader community how people got through difficult times what help they sought how they've come out the other side and are now obviously back to feeling like they're living fruitful and productive lives and that treatment is the pathway to that we've had another question come through and it's actually been on my mind particularly this week and does come under the banner of safe conversations and how we encourage those with the community at large so somebody's asked what we might advise when we share with our children and all the uncertainties that we faced particularly in the last six months and that we could be dealing with this indefinitely you've got any thoughts on that particularly maybe Sarah to start with and then I'll throw to the panel look I think first and foremost there are so many amazing youth focused organisations in Australia so we've got kids helpline lifeline, sorry headspace and reach out that have a whole range of tools and resources available for parents to help shape those conversations that would probably be better placed than someone like myself but I would be encouraging parents and community members to seek out that support and you can actually access the full range of support services if you go on to Life in Mind the suicide prevention portal it's got a link to all of those services for people at home Thanks Sarah I'd more like to weigh in at all on any helpful tips before I offer my two cents worth about how I had these kinds of conversations with my kids at home I think connection is clearly really important Francis feeling connected to others reaching out and continuing that connection throughout this long period I've got a lot of family in Melbourne it's been particularly challenging for people in Victoria and Melbourne really since the start of the pandemic but especially more recently so we can't have the same face-to-face contact that we might have once but trying to continue to have conversations on the phone or using one of the social media platforms or whatever is important and trying to reach out and remain connected is really a big indicator of how people cope and how people survive with that as well I think connection and I think some of the stuff earlier said too about maybe routine and connections where there maybe might be an activity where you're allowed to do it so some sort of physical activity, sleep and also different types of connection I've got older children I think it's also keeping in contact to not so much an are you okay but really an are you okay type of conversation, what have you done today because I think one of the things is that people who are working have either often been really having intense work or having much less work and the isolation of being at home for sort of six months compared to being in a work environment where you get all your sort of interactions I think has been incredibly distressing and disruptive for people and so that connection with phone calls Zoom, whatever face-to-face really makes a massive difference but it needs to be constant and I think I agree with all that the panel was saying absolutely but I think it's okay to be honest with children and say I feel a bit uncomfortable about this as well and in doing so build a narrative around coping and resilience and being able to draw strength and agency in order to get through all the practical things so important to look back on a day and find something that you can look back on and say that felt really satisfying I did that really well that was a really nice experience it might just be a small thing and that's okay but it's having those things that you can reflect back on and be satisfied with and draw the strength from that that helps to carry forward to build the resilience to cope and I think that's a really important message for parents out there who are working with children who what was good about today and try and build a strengths narrative into the family conversation I think that's really important absolutely one of the other questions that's come through has been a little bit of a contrast the sort of conversation we're having but that somebody's commented that their mental health actually improved a little during lockdown as they felt like they'd been given permission to slow down a little bit and maybe I might go to Hazel first to see whether she has any reflection on that or maybe commenting on the role that the busyness of modern life might have on poor mental health or whether that might also be true is that the real remote way of life potentially is to slow things down and tolerate some of the ambiguity and uncertainty in response to what we're seeing thanks Francis I actually have a short comment from the previous discussion certainly in our house spending a little bit more time deliberate time with your children is really helpful just to give them the space to come back and connect with you and let things emerge from them so you can provide support and for me it means a little bit less sleep because of the younger party but the other thing in terms of linking to resources for that would be emerging minds for children as opposed to young adults they have excellent resources if anyone wants to have more concrete tips and tricks but with respect to improving being good for our mental health I certainly found the lockdown provided a much better opportunity for physical exercise I don't know if we're so idle in the country but maybe more cognizant of things out of our control certainly hasn't been less busy for me during this time but it's just been different and a bit like it's not the same thing at all but you know farmers during drought their workload often increases things go up to feeding animals so it's not so much that you find yourself idle you just find yourself adapting to different things and putting in different strategies I guess one of the other things is then really reaching out to that support understanding that your community is in the same boat is really helpful in making sure that you're helping others because as soon as you're helping others it certainly makes it easier on yourself it takes the lens off allows you to be of use and that certainly is actually useful to yourself as well my comments Hazel and I do really take your point about about slowing down and the important impact that that might be able to have on our kids no matter how old they are and just taking that little bit of extra time to talk with them about their feelings and their views on what's happening because they don't miss much these days and if their little minds are left to their own devices to make sense of what's happening then maybe they can get caught up in some different ways of thinking about the world than the ones we might want to help them develop so I think helping them talk their feelings out loud I think reflecting on the good things that have happened during the day as opposed to the distresses and worries that we might be having in our front of mind and then as you say taking the time to connect are all really really important things that also sound really easy to do as we're all sitting here in a lounge away from our families at the moment but I think reminds us all about the importance of doing just those basic somewhat basic things in the face of COVID we've also heard had a question come through about the person said some wonderful assessments of the challenges COVID-19 has presented for our human minds and just wondering if the panel can contact our comment on how we might be leaders during these ambiguous and uncertain times and what we might do to support our teams as leaders during such a time so as a clinical leader of a clinical service Adrian I might throw to you first and get you to talk to us about the approach that you've taken Sure, thanks so probably the most important thing that just immediately springs to mind is that this is really a very chronic anxiety provoking period of time that gets better and worse depending on different announcements different statistics and different things that are put forward but it's a long period of raised anxiety for a whole lot of people some people are really effects actually but all of us are effects so probably the most important things in terms of leadership is to recognise that and to try even harder to make sure that your staff work well with each other and recognise people get stressed and to try to look after each other that's the most important thing I think we can do And a concept that comes to my mind is the concept of psychological safety so we might not be able to protect physical safety so much but it's maybe that's a little more out of our control but maybe if we can create an environment where people feel like they can talk without fear of getting ridiculed or in trouble or there being stigma associated saying in that workplace then that might be something that we can do and encourage that certainly sounds like the approach you've taken Hesley you moved your microphone down to your mouth is there something you'd like to add in terms of leading teams through COVID-19 and I guess ongoing adversity I think one of the things you said to me earlier on before we started tonight was that perhaps the bigger cities are getting a bit of an insight into what it's actually like to live in a rural and remote environment of constant threat or exposure to different droughts and floods and other adversities Do you have anything that you'd like to add? Certainly in terms of that's my reflection is that cities finally having that sense of what it's like to live with uncertainty although this is it's completely uncertain for us as well tremendously difficult time when you look at decisions made or not made regarding the economy and what we can depend on what we can plan for so it's challenging on all fronts I think in terms of that sort of adversity frame and being used to uncertainty it really is about you know it's interesting to talk about preparedness when you're in the middle of a disaster but preparedness is one of the things is all the safety that you can put in place but preparedness for the next one starts whilst you're in the current disaster because partly what you're doing is responding and as Adrian said you know it's uncertain it's going up and down and so your responses are varying but as you get to come to grips with it and we respond and adapt to the new conditions we then learn from the previous situation what we will do differently now some of those things are very structural and large like policy things how we manage our water in terms of economic recovery and things like that but other things are small and in terms of your individual family your community adaptations as well so there's a real opportunity to learn and grow in these difficult times the challenge sometimes comes when there's back to back to back and you're in constant response mode and how do you recover from one when you're dealing with the next and that poses an ongoing challenge for us to work with but in some respects adaptations have cross-protection I would guess you know good self-care good family care, good planning and unfortunately sometimes all the planning doesn't help with things that you can't imagine coming your way Indeed and I think so what people are seeing at home now is a slide that really lists some of the ways in which our group here has rallied together and launched new tools and resources to support mental health and well-being of Australians and so I would really encourage you to access the range of support programs and online tools that you can see listed there to move I guess from that almost disaster or an acute phase and into thinking about coping and building resilience as we move out of that acute phase so thanks to everybody here for providing access to those types of resources I'll just particularly draw people's attention to the breathing space community on the slide there which is a social network that we've set up especially for Australian community members who want to connect with others and share experiences and ask questions of experts and I guess keep the conversation that we've had here going a little bit after we finish tonight because unfortunately we are at the end of our time together I could talk about these issues and questions and opportunities with this wonderful panel all night but unfortunately I can't maybe my kids at home are jumping up and down with my hubby and saying great mum will be home soon but thank you very much for your time for your thoughtfulness and for all the hard work and effort that you've been putting into strengthening our community and supporting our community in response to COVID-19 and beyond I know we've talked a lot about challenges tonight but I actually have a lot of resources and a lot of effort going into helping us through that next phase and so as I wrap up I'll just draw people's attention at home to some of these more general tips and advice for safeguarding and protecting our own mental health and well-being and resilience and certainly these are the types of things that we can start talking about with our families and our friends if and when we need to so it might look like a bit of common sense up there and hopefully it is common sense in the fact that we're all doing these sorts of things but it might be a timely reminder that we don't forget to do some of these simple things and if we can string those together we can put ourselves in a better place for our mental health and well-being so thank you so much all for your time and your effort and your thoughts tonight and for sharing those with us thank you all for joining us at home or from wherever you're joining us from and we hope that you've enjoyed being part of this conversation as much as I have enjoyed participating in it I'd like to draw your attention to our next lecture in the Looking Ahead series which will be on Tuesday the 22nd of September and will focus on climate change in challenging times and I think one of our questions from one of our community members brought to the panel tonight alluded to some of the positive impacts potentially that COVID-19 might have had maybe for their mental health and well-being but some of the opportunities to slow down a bit and take the business out of our lives and certainly I'm sure we've all seen as I have some of those images from around the world of the beautiful impact that reducing that business and that external activity has had on some of our most beautiful environments around the world so Professor Paul Dastour will be leading us through that next lecture in just over a month's time or just under a month's time I think talking to us about climate change in those challenging times so I hope you'll join us all then please go out there into the world and take care of yourselves and take care of each other thank you again for joining us tonight and we look forward to seeing you for lecture three in our series thank you very much and good night