 Good evening everybody and welcome to this webinar from the Mental Health Professional Network. We are, I guess, right in the midst of the COVID crisis, and this is a really good chance to talk about working with children and families during this time. I'll introduce the panel and welcome the over a thousand people who have joined us so far. But I would like to start by acknowledging traditional custodians of the land, seas and waterways across Australia, upon which our webinar presenters and you as our participants are located, with which to pay our respects to the elders past, present and future, for the memories and traditions, the culture and the hopes of Aboriginal and Torres Strait Islander Australia. So, Steve Trumbull's my name I'll be facilitating tonight's session. I'm a GP by background but my current role is the head of medical education at the University of Melbourne, Melbourne Medical School and thoroughly enjoying facilitating webinars for MHPN, although I guess for all of us webinars are not quite the novelty they were a month or two ago. I'm going to introduce the panel though and we do have a commitment to making tonight an interesting and entertaining and most of all educational session for all of you who are getting up your precious time with family and friends and just taking time for yourselves to have this conversation. So I'd like to start by introducing Andrew Leitch who's a general practitioner like me but on the other side of the country in which in Australia. So welcome Andrew fellow GP. Thanks Steve, thanks for having me tonight, it's great to be here. Great to have you and I'm just curious as a fellow GP what's going on in your practice and what are you currently seeing or dealing with children who have or who are I guess coping with the pandemic as we all are? It's changing. I never imagined general practice to be like this. We've seen a real shift, a real transformation in how we practice medicine and that's in a matter of four to six weeks. Something we weren't taught at medical school is how to do telehealth and so it's been a big learning curve for us. It's taken a little bit of extra work to try and get the history we need from parents, from families, even from children and to ensure that safety of those families. But Steve, on the other hand, there's been some massive benefits from having telehealth, being able to contact people easily over the phone and being able to take a little bit of extra history and a little bit of extra time to hear what's going on for them and check in on them and make sure they're coping with this whole event. So there's pros and cons and I'd like to sort of talk about those as we go through tonight, but general practice is definitely a different field of medicine at the moment. Yeah, well, we'll certainly have that conversation with the other panelists as well because there are some things that have changed in this that we might never want to go back from. There do seem to be issues of improved accessibility for some people with the use of telemedicine, but it will be an interesting conversation about whether there's a unique skill set we need to use in telemedicine or whether it's really just technology-enabled, good communication. So we'll definitely have that conversation, but definitely welcome. Now, the next... Great to have you. The next person who we will be meeting is actually not Julie, Anne, it's Nicola. So, hello, Nicola. Now, you're a clinical psychologist based in the ACT. How has your practice been impacted by the pandemic and what are you doing with children these days? Is there a difference? Well, I think... Hello, everybody, and thanks for having me tonight. I think what we're seeing with children and families in my work at the moment is lots of questions, I suppose. The things that existed before the pandemic continue, but there's lots of questions about what parents and families should be worrying about, what they should be letting go, what they should be prioritising, whether that be around home education, around wellbeing, and, yeah, trying to work out the balance, I think, is probably the biggest thing that we're hearing, that families want some guidance on. Balance is a really interesting word. I don't think any of us expected in our lifetimes the world to be quite so tipped. Everything is settled and obviously children, like all of us, are struggling to deal with that unsettlement. Well, it's great to have you, Nicola. Very much welcome. Now, Julie Ann. So welcome to you. Oh, thanks so much, Steve. Yeah. Ah, look out there. Yes, yes. And it's just wonderful to be on this panel with you guys. It's really exciting. Yeah, our work has changed. It's really interesting, actually. I've got, you know, managing quite a few kids who are really struggling out in the rural area here with internet bandwidth and, you know, computers freezing, they're trying to do their schoolwork, and, you know, we've had a couple of kids that haven't wanted to talk to us too because mum and dad have been around and they haven't been able to find a private space. So that's been a bit challenging in negotiating that. We're doing a lot of pre-phone calls to families and some of the younger adolescents too to check that they're okay and they're safe and they can talk clearly. Negotiating, you know, those that can come in too has really been interesting. And we're doing an awful lot more of talking with people in the preliminary prior sessions. So that's taken a bit of extra admin work. And I know it's end of the day. I'm feeling really scrambled, actually, by the end of the day. But I'm thinking, God, my desk looks like a dog's breakfast. And hopefully people can't see that here tonight. But at the end of the day, I think, God, have I done anything? And now I'm going to do notes. Is that a different way to put the way you're practicing or are you not getting a break from your desk and it's just all building up? No, I find I'm absolutely, Steve. I'm just here all the time because we're using whatever moment we can to catch people, especially some of our young. We've seen quite a few, you know, siblings are 12th, but in 14 years, 70, year 9. And they're really struggling between schoolwork and mum and dad and younger siblings being around. So we're trying to catch them when we can, when it's convenient. And I'm finding that that's proving quite tricky. And also negotiating, like I'm trying to have some different screens with kids. So we're doing different conversations. So I'm showing them my room. So I've got to learn how to pick my laptop up and move it around because I'm struggling a little bit with how to be, because I'm very active in my work with children. I move a lot in the room. I'm finding I've got to sit at the desk and get my hands up here and not look like, you know, who do you do of, you know, the muthers? You know, I find I've got to get my hands here. And I'm pointing the thing I hold up to the screen is backwards. Anyway, I won't keep talking. It's tricky. We're seven minutes in and Julianne's doing Swedish chef impersonation because I actually see there's a number of people joined us looking at the cat from schools. A lot of people who are school counselors, psychologists, pastoral care, there is like that. So I suspect there's going to be quite a lot of conversation. It'll be relevant to that group as we talk about schools. I just wanted to welcome to the three of you. I just wanted to run through a few platform issues to make sure that everybody who's watching can access the platform appropriately. You'll see that there's a number of buttons. Usually at the top right of your screen, there's a chat box button, which is purple. So click on that if you want to put something in the chat box that all your colleagues can see around Australia. If you've got a question, please put that in the blue box. There's also a light blue download box that will allow you to download resources at the end of the weather. There is also a help button, a big friendly help button. So please click that if you need assistance with the platform. I see some people are having some buffering issues, which will unfortunately be your end. Thank you to the MDN for that. And you can call with a number that you can call there as well to get assistance if need be. This is a different webinar to what we usually offer. This is actually not based around a case. To be honest, when it was being set up, things were happening so quickly that we figured any case was going to lack authenticity by the time it got to tonight. And we thought that it would actually be more useful for people who are participating tonight for us to have a Q&A-type conversation, like the ABC TV show, where we will respond to questions and the panel that you've got here tonight will be able to talk with each other in response to your questions. We do have some learning outcomes that we'd be very keen to cover over the course of the hour or so that we've got with the webinar. The first one, and I'll just make sure that I'm on the right slide there, which would be that one, is to outline appropriate language to use with children. And when we say children, we mean children and adolescents. We're going to try to cover the full age range for those who might be involved with preschool, primary and secondary school children, as well as, I guess, young adults even. But what are the appropriate words to use when we're talking with children, when explaining coronavirus, the pandemic, and also what's happening within their current world and their future environment? The next learning outcome is that we would like to talk about specific tips and strategies, some practical tips and strategies that can help a child feel safe and secure during this outbreak, as much as we possibly can. And the third learning outcome that we would like to achieve by the end of the webinar is just the importance of collaboration and appropriate referrals when supporting a child and those who care for them, who are having concerns around their mental health during the coronavirus outbreak. So it's a big ask, but then again, we do think that a sort of a Q&A type approach is going to set us up best rather than trying to keep to a case which might have been not terribly realistic at the stage of the pandemic, because who knew how it was going to turn out from a month ago where we are now? So let's jump in now to the questions that have been popping up. We do have some questions and we did get some questions coming through earlier that we'd like to talk about. But actually, Anne Tange has gone straight into one of the areas that we were keen to talk about and I guess this is as good a time as any. It's about children with special needs and I guess that would include everything from children who might have been on the autistic spectrum or causes of intellectual disability, learning difficulties and things like that. And what Anne was particularly asking about was the disruption, I'm sorry, was the disruption to the dynamics of family in school, all those very carefully established routines which have been thrown out the window. And whether any of the panelists are able to talk about what their approach is to working with families with children who have special needs, who are put in a word discombobulated by the world being turned upside down when order seems to be the better way to go. So any of the panelists like to take on that one? Nicola, is that something that you would respond to? I think one of the things that we are aware of is the disruption to routines and for some children with special needs, the reduction in social interactions and having to negotiate that every day can be a benefit. And I think in all of these discussions tonight, it's also helpful to look, as we've mentioned before, at the benefits of this. So some children may benefit from it, having to have less to negotiate each day, I suppose. But I think I'm going to defer to the other panelists because it's certainly not my area of expertise. My notion would be that the families and health professionals that work with children who have particular special needs, whatever they may be, I think it's really important for families to keep engaged with them and to work with them around what they can set up if they're operating from home, how that can get some support in what that modification could be because it could feel quite overwhelming, but that's what the supports are there to do. But I know that my other panelists have got more experience than me in this particular area, so I'm going to pass over to them. And you can throw me some curly ones later, Steve. I know you don't play much in Australian rules in OCT there, but I think we call that a handball, hand pass, but that's fine, and it's good actually. Yeah, I grew up in Tassie. I know what a hand pass is. OK, you're all over it. Maybe even add to it a question that David Poon's asked about how we would notice that a child's having problems, now a child with a disability or a child without, that's likely to, I guess, occur at school or for a problem to be brought to the general practitioner. I'm wondering if you'll add to that. Oh, Andrew, yes. Yeah, I was just going to answer that first question as well. And I think, Nicola's spot on, these children need as much support as they can get. So from a general practice point of view, these families really need to reach out and see their GP or talk to their GP and discuss the concerns they're having at home and what challenges this is bringing up for them as the routine is shifted and changed and as they lose some of those other contacts and supports, maybe this is a really good role for a GP to coordinate that help, but to also continue that collaboration with the team and usually children with disabilities, have a team around them already engaged with them and really making sure that that's continuing in the background that, you know, amongst all the chaos, there's still that therapy going on. And whilst we've changed the way we do that therapy in some situations, there's still some benefit from having that support and having that knowledge that you can talk to someone about it. And I know from parents that have talked to me, they've said, it's just so helpful to know that we can call up and get some help if we need it and to be able to talk to your health professional about what's going on around us. And I think, so their parents are looking for reassurance and they're looking for that contact and that ability to contact and still be engaged with therapy and that's probably my viewpoint on it is continuing that therapy and continuing that collaboration and support. And I know that children are more prone to anxiety during this period, especially those children with disability or with developmental concerns or developmental delay, children with autism spectrum. I know that anxiety is more common when things like this happen and so general practitioners would hopefully be asking, how are you coping? Are there any signs of anxiety and being a bit more proactive about that to get a bit of an understanding of what's going on and then treating that anxiety accordingly and looking at strategies to try and work with that anxiety? And as Nicholas said, look to the positives in this struggle and look to some of the important things that you can do at home to try and calm that anxiety that help. And there's a toolkit that you probably already have as parents and as health professionals that you can use that you can do at home and that don't involve going out and about. And so, you know, drawing on some of those skills that you already have. And as you say, hopefully the GT actually has an ongoing relationship with the family and understands the child's situation. If the child is bothered by a lack of routine and is disruption to routine, at least having some consistency in the person they're working with might be a positive thing. I think hidden in there as well is also the realization that, you know, this is nothing incredibly specialized. This is a skill set that really I'm imagining that people on this webinar would have. I can see you nodding, Julianne. Is there something that you agree with that this is something that most people can do if they just step up? Yeah, and look, I agree with everything that we've all said in the comments. Steve, it's really important, I think, you know, these special needs and sort of being observing our children. But as us as clinicians, in order to enable therapy to continue, you know, this is a unique environment during the online environment. So we've got to be really mindful of what does it look like from the child or the young adult's end? What are they seeing rather than what are we seeing? So I think we've always got to place ourselves out into their world. And so I'm really conscious of making sure they've got a lot of these kids with special needs. We do a fair bit of, you know, movement work, especially around emotional dysregulation and helping them with their mindfulness or anxiety techniques. So we've said to the parents, make sure they've got a large space, not a small room, not in the kitchen, you know, perhaps in the lounge room or somewhere where they've got place to move. Doesn't matter if they're not in the screen, the screen doesn't matter. So sometimes the screen's a distraction, so sometimes it's better to have something different for them to look at. I'm really mindful of grounding the kids too so that they feel that they know where I am, what I look like, what I'm wearing. There's a real thing about real time with the kids. Is this real or is this weird? You know, and you really hear or you somewhere else, I often say to them, look, I can see the clock behind you. You know, it's six o'clock, what is it from you? Can you see, what can you see in my room? So that we're really, really trying to tap into the children's visual cues and also get them some confidence that, you know, we know where they are and where in their space because this is the trickiest bit, I think, is not knowing what else is around for them, what else is happening is when they're in our room, our clinic, we control the environment. And I'm really conscious of this is one thing we can't control a lot of, the external distractions and influences that are happening for them. So I think, you know, kids with special needs, it is, as you said to me, that is our core business, we do it every day, but it's just with that unique environment of this screen in front of us and being flexible enough and creative enough to make it a bit of fun. Not to, because they had screen overload. Most of them from the age of five right through to year 12 are on screens, you know, six or seven hours a day, they're schooling at home, at home. So then they get up and we don't want to be like, how's that anxiety going? Are you having trouble with sleep? You know, they want to make it a bit of, you know, we've got to step it up and make it a bit of fun for them. Yeah, it's interesting seeing some of the chat comments that are coming in while you've been talking. People have been saying it might be possible for a child with a diagnosed disability to access their core funding through the NDIS and even to draw upon other professionals such as occupational therapists who are very much about creating structure and giving some routine and environmental adaptation for people. That might be one way we could spread the referral network, I guess. Yeah, I agree with you with that. We've got a strong NDIS business with the work that we do to balance up the Medicare. And we're using a lot of core funding in order to bring in other clinicians and getting some great work with some teachers that have got some additional skills working with kids. So we might do some co-consultation there. So I agree with you, yeah. If they're on an NDIS package, it's a bonus, it really is lovely. I'm immediately struck by some of the conversations going on in the group outside about the... Well, it's the levels of complexity, I guess, and some people who are already working with bushfire-affected families in the pandemic hits, people who are working with refugee families and in the pandemic hits, people who are dealing with families who are stuck overseas who dread the thought of coming back to spending two weeks locked in the mantra or whatever hotel's being used. And these are very real concerns. Does anybody in the panel have any thought about how we might help families who have got sort of multiple struggles going on with their children being impacted by so many things in this horror year? This is Nicola. I'm happy to have a bit of a chat. We've been doing some work. Go, Nicola. Bye, bye. I said I'd take one. I thought that the group that we were referencing then in terms of communities that I've been working quite a bit with are communities that have been impacted by bushfire and well, communities that often had drought before bushfire. And then Julianne and I are kind of interchangeable, it seems, on the video, but I'll look at Julianne while I chat. That's a bit confusing. Yeah, so working with communities that have that kind of cumulative events over the last couple of years, what we were seeing certainly in a month or two ago towards the end of last term was an incredible amount of fatigue amongst those providing health or educators, providing provision to families because they just have had almost a relentless stream of adversity. So years and years of drought often fires, often floods and now COVID. And COVID's kind of coming in on the back of communities that potentially are trying to pick up and implement their recovery strategies, which are all about connection and bringing communities together and spending time together and so forth. But that's challenging. Obviously we can't do that with physical distancing measures. So I think one of the things is just to acknowledge that and to acknowledge the limitations. But one of the things as professionals supporting those communities is we have to try and give some of that flexibility of thinking, some of the ideas, because the people in those communities are so worn out. They, if you can't think flexibly and creatively when you're completely exhausted. So recognizing and sitting with the despair that's there, it's real for these communities. I think the other thing is an acknowledgement and a recognition that a lot of communities feel left behind. So you had communities, it seems crazy that it was only a couple of months ago that everybody was around the world, absolutely gobsmacked by what our communities went through with the bushfires. And now that's been usurped by a global pandemic. But that doesn't mean that we've run out of compassion for those communities impacted. So I think as clinicians, it's really important that we articulate that and acknowledge it and at a community level, an individual level, at a family level and validate just how difficult that is and then try to move on. What can we do about it? And you're as a clinician trying to provide some of those ideas. Well, adolescents are really good at connecting online. We used to tell them off for it. Now we might learn from them. How do they have those connections and relationships and opportunities for joy and feeling like they're moving forward in these times? So I think there's a job that we do is giving a little bit more of that top brain that can be creative and thinking particularly, that's easy if we're not in those communities because if we're in those communities, we've been impacted ourselves. So that's the other thing to recognize. All the educators and health professionals in those communities are trying to do all of that whilst having their own personal impact. So yeah, I think it's a collaboration, sitting with acknowledging the real difficulty but then trying to move forward and you can only move forward if you feel like you've been listened to and taken seriously and that's whether or not you're five or 105. And so the power of empathy, but you mentioned giving a sense of joy. How are you giving people joy when everybody seems to be impacted and turned upside down? So completely. Well, I think joy comes through silly giggles, right? You know, there's joy in lots of different ways. There's a big push around, you know, through social media, the kindness, pandemics and those sorts of things. But I think the simple joys, I saw something on ABC for kids today. I don't know if anybody else had watched that gorgeous old person's home for four year olds that was on talking about the intergenerational play, the kids that were four going into the old people's home. They've done an update of those kids now in COVID, writing letters to the friends that they made with the people in the old people's homes. And so I think it's sharing stories of humanity. It doesn't have to be super complicated. We can all have a giggle, like we're all giggling at TikToks or stuff that we never used to. So, yeah, I suppose they're finding the moments of enjoyment in those bits and pieces that's what we can do. But, yeah, other people might have good ideas as well. Certainly, actually, yes. Andrew, you were gonna say something further about finding joy. Yeah, I've heard a few patients about that gratitude and gratefulness and finding gratefulness in the good things of the days. And that's been a popular one and certainly helps to put a positive energy around the house. So, lifting one or two things you're grateful for at the end of the day and really trying to change up the perception of things and, as I said, shift that focus. And certainly, it's been a handy tip that I've heard across the board with parents and families using it. Absolutely. Anything, Julie, on your approach here? Look, yeah, I agree with Nicola and Andrew, too. I think it is tapping into how the family finds, celebrates and looks at things that are funny or humorous. And I think for us as clinicians, to ask about that, what do you do to have a bit of fun? You're playing games or, I agree. The joy thing is really interesting, isn't it so personal? You know, what makes that particular family, that particular person experience joy can be different from one person to the other. So I think it's linking in with them. You know, I just love to play with the kids and say to them, oh, I'm really feeling really funny on this screen right now. You know, how are you feeling? And what else is going, or asking what else is going on for you, what fun things did they do? And I agree, actually, it's just going back to the bushfire thing. In our region, a lot of our communities have been impacted by bushfire. And there's two things. One is, you know, our other clinicians are sometimes a little bit confused about which Medicare item we use. So that's always a bit of a laugh at our end. Oh, we covered bushfire or better access. So that's always like, oh, I don't know, take a pic. But from the families that have been impacted by bushfires, look, we're finding that they're loving to engage and chat about stuff that's improving, stuff that's happening. We've had a bucket load of brain up in our region. So it's now shifting to look what's happening while we're getting back into cropping or, you know, things are different. Like, I just think being human with some, I just love the fact that we can tell them that this is really, really tricky. And tricky's become my new favorite word. When I don't want to say anything else that might be not acceptable. I said, gosh, it's really tricky. What do you do when things are tricky in your life? And lots of things have happened. Tricky's a really good word, isn't it? Because it's sort of, it's a mystery. But it's also sinister. It's just a piece of RNA when it all comes down to it. But there is a degree of unpredictability and trickiness about what the pandemic does and how unpredictable it is. I think it's a really interesting word to use. I'm going to take us, I guess, from joy to a bit of despair. There's been a fair few questions asked about the other end of the spectrum when you've got families in these lockdown pressure cooker situations and things, people talking about everything from family violence through to what happens in such an un-private environment for children who are still not comfortable revealing their sexuality, gender identity and things like that. You haven't got a lot of privacy in order to deal with those emerging issues that you're reconciling within yourself. Does anybody have any thoughts for the audience on the issues relating to the situation that families are now locked into? Just Julianne here, if that's all right. Yeah, Julianne, particularly I guess on the family violence side of things. Is anybody seeing this coming in? Yes. We've had a couple of situations where that's come to life and we're really finding it hard as clinicians because we're feeling so helpless and isolated and we're really, you know, after a session thinking, you know, and I hope, you know, I'm sure it's what everybody's feeling is that sense of despair ourselves that we're really not able to do a lot. We're doing a lot of phone calls back to the GP. So, you know, to try and get some additional help in for some of these families and it's really hard sometimes to gauge the level of risk when, you know, you're just aware of things might not be right or you're really trying to look extra hard at the situation and, you know, ask questions that might not get the kids into trouble by saying something that's not appropriate in front of whatever parent or caregiver. I'm struggling with it myself from an ethical perspective. But then on the other flip side is, you know, with my clinicians that I work with, you know, we're often saying, look, let's ring the GP. Let's get the GP involved. You know, we're getting some safety plans with the ED at our local hospitals so that if they present or telling them, look, maybe you go to a hospital or ring access line. But we're doing a lot of access line calls actually, getting some plans in with the access line people so that people know that if they ring, there's already a history for them in access line. That's been quite useful. And also having a relationship with our, we're so privileged in a small rural community to have access to our GPs at the local hospital. So if people present, you know, there's a bit of a history there, you know, we're pre-born them that things might happen. So I don't have any great answers except it's a really, really tricky spot. Yeah. Again, you've used the word tricky nicely done, Julie. And you've deployed it by the fact. Yeah, because our GP relationship has been crucial, though. Yeah, just following on, Julie, and you said linking to the GP and it's... And that's an important network that we create for these more vulnerable patients. I've certainly had a few cases of children developing quite severe anxiety at the point of aggression. Family members not feeling safe in the house. And I've had to really assess that risk carefully over the phone. And that's, as you said, it's actually a really hard thing to do. It takes a lot of work. And you have to be quite careful with how you do it. And I think that trying to use that telehealth for a general practitioner is important. Try to touch base more regularly than you might normally would. Making more phone calls, being a bit more engaged with that family knowing they are on a bit of a risky situation and sort of securing that sound, trying to really work with them to secure, to make sure that they're safe and secure. And that may involve different ways of communicating, as you said, Julie, and that may involve talking differently to the children about what's worrying them or talking to the parent, the caregiver about what's going on. And it might mean having more conversations. And so, yeah, it's time-consuming. It's stressful. It's very different. There's ways that we can try to help. And any help is good. And I have certainly had more phone calls with psychologists. We've actually done group calls with psychologists. You can add people into the telehealth, which has been something we've never, ever done, as well as more local services, such as CAMHS and the hospital, as you said. So, a lot more networking going on. And maybe that'll be a good thing in the future that we've actually been able to do this now and learn what's out there. So, that's my take on it from a GP. I'm struck by a question that's come in from Felina Pestillo, I guess, going a little bit further into this area, where Phil's basically asking about the women, in particular, who are doing triple duty, who are, in many cases, running a family, doing their job and overseeing the education of their children who are learning from home. I mean, a lot of us use the daily commutes or the popping out for a coffee or whatever it might be. There's a little bit of a way of shifting scenes between roles. I guess, when it's all happening within the one house, there must be a risk of burnout for people who are really having to pull triple duty without that rebooting and refreshing that we can put some barriers between the roles. Any comments from the panel about that one? I'm happy to have a chat about that. I think one of the things in that scenario is that if you're doing a triple role, you can't be doing any of it perfectly, and I think that's a really important thing to acknowledge, I find there's a lot of conversation, narratives going around, which I think is really unhelpful for parents, around the pressures of homeschooling. It's actually not homeschooling. Homeschooling is a different thing than having to be at home while your children are getting education delivered online. And the expectation that you can sit by your child all day and I see their education and work full-time and rent a household is completely unreasonable. And so I think the narrative that's an expectation that that is really important, that everybody is on top of all of it, is unhelpful. I think the more important narrative is to prioritise relationships and connection with children. I think obviously when kids are in year 12 and so forth, there is greater stakes. But even then, this is not... So if your child gets struck with a significant illness and misses two terms of school, then there are safeguards in place around what is going to happen to them. They will catch up in a certain way and there will be accommodations made for them missing that school. The whole universe is going through what we're going through now. So universities, educational settings, workplace settings are going to have to accommodate for what is happening at the moment. And I think there's not enough discussion around the universality of it being something that allows us to think, okay, if we don't hit six classes a day and on top of every curriculum point, I've got good friends who are freaking out about their seven-year-olds. You know, they can't get them to do that every day. Of course they can't. They're seven years... They're tweeting as well. So there's two of them and they're kind of not engaged enough by that. But they can play and learn and they've got amazing imaginations and they're creative but they're striving their mother's bonkers and that's not helpful for them. So I think there's a really important... I think it's missing and I think that part of what's happening in Australia is the conflicting... Everyone's getting focused on the conflicting messages from centre school, not centre school, true centre school, not centre school and that's distracting from actually what the message I think could be which is regardless, we're going through something that's unprecedented. Forget about performance at the moment and focus on how we're all travelling and you talk about how can you find those transitions or coffee breaks or space breaks. Like, I think it comes back to that joy conversation. Each kid in whatever year they're in, part of their curriculum is sports or mindfulness or downtime. Like, that's worked in there. So, you know, if you're a mum at home with your kids, can you try and, you know, do the go-get-together and have a laugh with it? You know, get on the dress up and do an 80s aerobics dance. I don't know, like just little snippets where you're merging the two but having a bit of a sense of humour about it and taking that performance pressure which is high enough at any time, I think. But at the moment, I just think it's really unhelpful and unrealistic to expect anyone to do and I think there's a real role for a stronger narrative around giving everybody a break. Absolutely. I'm keeping my medical students deeply amused by splicing music of the new romantics into the webinar audience but I'm finding it hilarious. I don't think they're quite so sure. But one thing I did find amusing this week and it was done very sincerely was Peter Doherty, the immunologist whose eponymous institution at my university has been very much involved in the battle against the pandemic. People might have seen this. He put on Twitter just the line Dan Murphy's opening hours thinking that he was off to. Now, that caused much hilarity but some people are appropriately questioning in the question manager, he had a question box here about the use of alcohol than other drugs. Money has come in through government grants to families who might have some problems with discretion in their spending. There's a surge in drug and alcohol use as people try and manage with these things. Is this something I mean, imagining Andrew, you're probably seeing this in general practice or also with the physical effects of drug and alcohol use. Is that something that's had a bit of a surge? Yeah. Then it's something we would normally screen for anyway with the work we do but noticing now there are people turning to alcohol in particular as they try to cope with the stress of what's happening and maybe that's become their coping mechanism and I've had some quite large, I've heard people having quite large amounts of alcohol and that's, I guess, from a GP point of view, it's concerning about it that they're obviously struggling at home and they are looking to other ways to deal with maybe the stress or the boredom or the different long time that they're spending at home and this is their go-to and so I would be on to that quite quickly and then look at other coping strategies, early referral to psychology, really getting that support in place early knowing that they are in that sort of period of isolation and the same with drug use and especially looking down to the teenagers I'm seeing a little spike in drug use as they sort of spend more time maybe with themselves and that's concerning as well. So, yeah, just getting that support in early and dealing with it and looking at where this is coming from and if there is an emerging mental illness that possibly is starting to arise as they struggle with what's going on and that's also worth looking at as we explore that with them. Great, Andrew, and it's quite remarkable the 2,626 people who are having a conversation on the side or I guess coming up with other solutions that people might be interested in looking at as well. One that I've just noticed here that somebody mentioned is can we think of something that came up when we were discussing before the webinar started or a week or two ago? What about the child for whom this home lockdown is seen as a bit of a boon for the school refusal or the child who has anxiety issues about going to school? I mean, we will have to talk before we finish this evening about how we're planning for return to school and the anxiety about returning into that sort of environment but are people seeing anything at the moment about children who are sort of saying, this is great, I know our dogs and some cats are saying that but what about the child who's finding being home with mum and dad and everybody if that's their family setting are as happy as Larry? Steve, I found the younger children seem to be a little bit more resilient, maybe a little bit less aware of what's going on and this is obviously very child and family dependent but as a father of a 6th and a 4-year-old I've definitely noticed a bit of ignorance with what's going on and perhaps that's a good protective factor that these young children have and sort of really distracted in their own little world and not so much of what the world is like around them and maybe also minimising media exposure in the house helps a long way as well and trying to just keep things in perspective with this age group whereas the older children that I've seen in the clinic here tend to be the ones that really latch on to these terms like pandemic and crisis and the death rate and all that and I've had children today, young teenagers and that older age group who've said they don't want to go back to school because they don't want to be spreading or catching it from other children at school and that's obviously the differences between age groups is the awareness of that older group. So what sort of words are you using with that age group, the teenagers who are spreading the pandemic? I still think it's important to be honest and let them know what's going on and be upfront about it and to let them know there is a virus going around but also offer that reassurance and let them know that this is something that will pass. This is generally safe for children and you will be okay and we're seeing that it is safe to return and so to sort of gently support them through that and understand where that anxiety is coming from but really open, honest language and being direct about it and these kids already know probably a lot about it anyway without us speaking to them but trying to find out what they know and what they understand about it and then to clarify anything that's not clear or being exaggerated. I think it's important to think about temperament as well. I was just going to say temperament has got a lot to do with it but also location. We've been told at the ACT today that there's zero cases. We've had three deaths. Everyone else has recovered. So it's very situational, dependent. So if you're in a situation here in the ACT I've got two teenagers at home they're fine. We can still go outside. They can go and shoot if they don't go out and exercise regularly. They go stir crazy but there's still a lot of freedom for them and they're quite comfortable I think and them and their friends they think they're doing the right thing. It all feels relatively okay. They worry if we go out. They worry if I go into the hospital setting for my work and they want to know why I'm going but I think you're right those conversations and temperament as much as age I think is going to drive kids to concern about these and also what their loved ones do. If we can tell them your parents do this or your grandparents like the auntie it's going to be very different versus living in a situation perhaps where there's clusters or your grandma's in a nursing home where there's some of the really frightening things going on there. We can't assume anything that kids are going to be a uniform response because it's not that young kids aren't worried and older kids are or vice versa I don't think and even kids within the family we all know just because their siblings doesn't mean they have the same temperament or the same event so that's why it's worth checking in because you might have one kid who's completely blasé about it and a bit of an extrovert meanwhile your other child is quite anxious but isn't raising it because they might feel silly because everybody else feels it feels like that's not what the dynamic is. So checking in I think is worth doing and I know Giuliani would talk a bit about I haven't come across this myself but kids having that conversation is the fear of being spreaders themselves. Well actually let's just think about some words I'm not sure if others are getting the same image of Nicola that you look like you're being rendered by a French Impressionist painter at the moment quite a fetching look which we'll leave you with but that's really interesting one of our learning objectives is about the terminology used now Giuliani you use the word tricky which I just love because it has that sense of sickness and wolfiness and unpredictability and I think Nicola has appropriately reminded us that all children are different have different personalities and different ways of going about the world what about with the 6-7 year old who is anxious about being told that they might infect and maybe kill their grandparent that was the early history what sort of words can we use for them to reassure them to re-engage with their grandparents when that becomes a nationwide option I know you've been through it so maybe you can talk from the heart about this one Well as I was relating to you earlier when I visited my grandchildren just last night over you know I haven't seen them I haven't touched them for about a month we've been doing the whole waving from the veranda dropping off care packs and just doing the whole distancing and then my kids and all my grandkids are really really worried about me still working too so I've actually had to guarantee my children and I've got a husband who's got some chronic health issues so they're really worried that I'm not going to kill their father and their grandfathers that's always been an ongoing conversation which is interesting and I have to guarantee them I show them my sprays, my hand gels I talk to them a lot about actually one thing I've got is a glitter bug so the best thing we've got in this practice for this is where you actually put the blue light on your hand I wash them with I put the blue light on my hand so I can actually see my hand you can see now and you can see how much bugs are on my hand and I wash them under soap and put them under water then I put the glitter bug on it and you can actually see the difference it makes so I do that a lot when I get the kids in the room and I've used that with my children and said look you can be guaranteed I'm being very careful we're doing the elbow touching we're spacing out I put my arm out a lot to show this my distancing and I'm normalising it and making a bit of play about it and as I was telling you earlier my grandchildren we got the first hug yesterday and my 11 and 10 year old granddaughter said grandma have you been sprayed yes I have been sprayed the advantage of that to all your people listening is a spray bottle with alcohol in it and my son's been using it to spray everything because it kills everything so yes I spray my hands with David's special alcohol and so the kids were quite happy that I'd sprayed and if I'd sprayed I could then hug them because then it was quite humorous and I'm going so I guess it's a specialisation of what this looks like I mean the President of the United States has struggled with understanding what the actual enemy looks like here but what you've done is give them some visual representation of what it is that we're struggling with something the physical tactic sort of pragmatic they can do in dealing with it and I think that's a really interesting idea and I mean we did talk about I guess the early messaging that went around and in some ways for those of my age group it was reminiscent of the HIV or the AIDS epidemic that started that you know the issue about you know killing other people through your behaviour and the fear and marginalisation that caused I do see a question that's coming from Sarah Mason now we've been so lucky or so well managed with the pandemic I guess that the death rate's not been nearly as high as we were worrying it would be when planning this webinar there is a question about highly populated Aboriginal areas and the importance of observing funerals and community gatherings has anybody had to deal with a family that's not been able to engage in their usual ceremonial acknowledgement of death during this time and children particularly we had a family here we had one deaf in our community and it was a huge amount of outpouring of his family had been affected by bushfires and lost all their possessions and then grandma was on one of the New Zealand ships and then died which was really quite tragic for the family and the anger and the frustration have one not been able to touch her and be with her as she was dying because obviously she was in isolation the family were gowned up one at a time it was very traumatic for them what I've done with that is done use narratives and doing some of that grief work with them and storytelling with the grief work connecting bonds and continuing bonds you might not have been there but what grandma was thinking getting stories about her life and ways that they would connect with her we're doing a lot of that narrative grief work with people that have been through this terrible tragedy of losing somebody and just trying to explain to them about this is something that will pass we can celebrate them later I've got another lady who's got her husband's ashes she just picked up the other day she doesn't know what to do now for memorial so it's just talking through very very gently I think holding people I often feel our job is to sit there and just hold this grief and let them stay and just agree with them and have that sense of connection of human to human in this state and just really let them know that this is so sad and there's no other word for it it is so sad it's unavoidable then when it passes what will we do well that's certainly a topic we will be talking about what happens with the re-entry to society because there are a number of questions and chats about what about the withdrawn child who is just very happy in their room and that they're going to really be in front of it maybe we should talk about that now if it does center the topic it's coming up a lot how are we going to prepare their children for returning to whatever is considered normal on the other side of this pandemic the thoughts about that has anybody started any of the three of you started preparing families given that we don't know if there's going to be another surge or not but what sort of messages have you been giving families I'm happy to have a quick chat about that I think one of the work that we've been doing looking at supporting children around not necessarily yet returning to school but I think we have a lot that we can draw from and I've been looking at a lot of the work overseas as well around supporting children following community trauma events so disasters floods terror events and so forth and we've spent the last couple of years of my life working in this space and so the pandemic can be characterised as a community trauma event an international event so we do have a lot of science and knowledge to draw on in terms of what supports children returning to schools following mass incidents so whether or not that might be unfortunately in the States have a lot of work around terrible shootings and so forth but in Australia we were doing a lot of work with schools already around returning to school following the bushfire season and so there is a lot of knowledge out there around what supports children's well being there will be separation anxiety on both sides from children and from parents there is after disaster there will be after a pandemic I think along with a lot of what else we've been talking about tonight is for people supporting families is you know how to do this we know how to support an individual like we've all worked with children and young people who experience separation anxiety and how to help them get back to school and so as practitioners it can feel like we've never done this before but we have done it before it's just doing it in a different context and so the things that we would be suggesting around supporting children and families to get back to school are the same that we would be recommending on an individual level if we had a child that was suffering you know had been refusing to go to school for months at end whether or not an adolescent or a young child routine connection relationships they sound simple but they're the things that we know that are really important preparation choice and control where we can offer it and scaffolding kids back into that situation is best practice and what helps so working at how they can go back in the one thing that we know in the disaster context that helps is the universality of it that a whole community has gone through it so actually coming back in together and having those around you that have been through the same thing is a huge source of comfort and reassurance for kids they might not think it's going to be but having that taste of going back in and having connection and story sharing about what went on and what happened and what it was like and so forth so I think taking courage and reassurance that we actually have done a lot of this in the past not at this level but we've all returned to school after tragic events or educators have poked with these sorts of community events all the time whether it be a death of a student or a suicide in a community these sorts of ruptures unfortunately happen all the time this is a big one but the practices that support families remain the same so we can draw on that knowledge and I think there's some really good work being done around the application of that work and science around community trauma events that's being that we can draw on in these times. Absolutely and I think one thing that's becoming apparent too in talking to other clinical colleagues is that people are presenting with the everyday issues and I'm sure Andrew is seeing this in general practice some people have been mentioning in the chat the fear I guess of the impending surge of suppressed mental health issues or things that have been set aside and that whether part of the emergence from this quarantine period is going to be an overwhelming load of unmet mental health needs Andrew is this something that you're expecting and are preparing for? I was just thinking with what you said there about people sort of shying away a little bit from medical care we were very quiet to start with in that March early April period at the point where I started ringing a few of my regular patients and saying where are you what's going on and the answer was we don't want to bother you we don't want to we feel like the things we have we're silly we don't want to come in or we don't want to go into a medical environment because we're scared you know so it's it's taken a lot of work through out April to really provide some reassurance that you know medical clinics are fairly I tell them that's cleaner than cold we have a lot of cleaning going on we're a very safe environment and so we do have the opportunity now to see people face to face but in answer to your question I'm cautiously waiting to see what happens next trying to get in early now to support families through what could come next and to let them know that we are available for those routine healthcare needs as well as any mental health needs as they arise and certainly amongst families I see I've had some kids and families say oh we didn't know the GP did that we didn't know you could help with that so just letting them know we are available we can do mental health care plans as if needed we can involve psychology but just being able to as Nicola said really nicely being able to hold a family and to have that connection with them is sometimes therapeutic on its own in terms of what happens in the future we don't know I'm trying to think about today and the present moment and what we're dealing with today we don't know what's going to come but I can only hope that we're starting to build a system now that helps with what might come and as a team we work towards helping these children what do you think Julianne Oh look I'm lovely listening to you both one who I'm so engrossed in the content and how you're talking it's just beautiful work look some of the things we're doing is using a lot of St Luke's innovative resources to with families I'm finding they're fabulous but as Nicola was talking I was I've been so struck since I've met you and found out it was only just before we started working with this I got on to the emerging mind website and found you have no idea the amount of amazing resources are on that website and your podcast think I listen to a new one every night in preparation for tonight as well and honestly because they are fabulous resources and I've actually been showing a lot of my family the podcast and saying download this there's some fabulous things to listen to and really you've done an incredible job with the resources on your site for families and children I've absolutely loved it and I think some of the advice in your podcast has been fabulous from me as a clinician as to how to sit with people and what to expect and how to prepare for what might come through the door tomorrow and just to have things ready is quite crucial so yeah it's just I agree with everything that you've all said it's getting through today knowing we've got lots of amazing resources the things that I've found I've just found another amazing resource today come and see where I found put it and I'll send it through to the panelists but it's just there's some great stuff that we can use but what I've been using a lot with my kiddies and I've been playing around with getting very savvy with the computer now is putting up those loose innovative resources on our shared screen with them so we can do things around and they've got some great stuff and anxiety and great things around coasting there's one about dealing with waves so we're using metaphors to deal with what might be happening yeah that's all I can think of at the moment I know that'll be good actually one thing I did want to talk to the people about is the issue of privacy while consulting this is something that we all discussed in planning for the webinar which has come up a number of times in the questions and discussions about how we do actually assist people to get some privacy when you've got a newborn baby in a three year old climbing up your leg and you're trying to talk about really emotional things has anybody found any good strategies for trying to encourage people to find a private space to have that conversation Steve we do a lot of work with the families we've got our admin girls are working so hard they do we've got a protocol that we've got in place they've got things to ask so we ring the week before like today was Thursday so the admin girls would be ringing all the clients for the week four or five days before we make sure they understand about privacy we make sure we get a consensus emailed out and in we tell them about setting up a private room are they worried about privacy is there something they'd like to do later you know we're really unpacking that for them and saying it's really important that you have a space to talk you know if there's important things that you can tell a thing you know I've got worries about you know people being there we talk to the parents first as well or whoever the caregivers are the morning of as well or you know about two or three hours before the session just to make sure that the things that we talked about earlier in the week is still okay today so it's taking a lot of extra work to ensure that people are safe and secure but I think it's well worth it and it's also another contact with the family or the young person and I'm finding fantastic engagement the kids are talking to me about their rooms or their lounge rooms or they go outside they're downloading zoom on their phones so their older teenage kids can go outside or go to a private space I've spoken to a few adults about the importance of giving them privacy and not walking around the corner I've actually had to be really angry in a very polite way with some family and just say look you know you've got to understand this is their time you know and you're impringing on their time so sometimes I've understood mother as well or the stern counsellor and impact you know really stressing the importance of this and also impressing on the kids too that what I say to them here where I work is private but what they say to me is not listened to by a colleague or others so that's important too I think and then I'm not taping it Steve sorry to interupting but I was just going to say from a GP perspective I try to keep it simple we do get a consent before we start talking this is a telehealth conversation it's not recorded it's for our benefit to have this discussion and if it isn't a mum or a dad I'm talking to I'll ask them is it okay to talk at the moment are we free to chat would you like to step outside before we talk you know making sure they've got that their own privacy in their own world if it's a teenager and Julia and you mentioned sometimes teenagers actually talk a lot more on a telehealth consult and some really fascinating discussions with some of the adolescent age group that I would never have had face to face in the clinic here and trying to let them know that if you want to talk on your own please go into a private space so we can do that not always perfect we just do what we can do and do our best and that's all and any therapy is better than nothing totally agree I'm seeing a few questions families who are broken by all sorts of issues and maybe caught interventions and things like that grandparents often can be kept away from children because of disputes within families have any of the three of you seen situations like that and have you got any tips or strategies that might be helpful in trying to maybe not reconcile families but help them cope with this added burden we've had quite a few and we've got several families that's being on the border the kids are in another state they've gone to a family member and haven't been able to come home because the borders were shut down so those families are really really really struggling and where there's some difficulties between the relationships but I don't have any answers to this all except I keep saying to the families that come in this must be the hardest thing and just engaging with them but also giving them I've had to find an awful lot of stuff out myself this is not an area where we've done a lot of work but we're now seeing a lot of people coming in but finding out about the course of family court law places that I can refer them on to so they can get advice and information so I find the law courts with a legal aid online things I'm sending people to that a lot it's been really hard for the fathers who haven't seen their children for quite some time what I've been doing with some of those is just actually doing some grief work over there they think they often can't change so how do they cope with uncertainty and think they can't change so a lot of it is that humanity person to person engagement I think I don't have a lot of answers for some of this I'm not sure whether Nico and Andrew or even yourself Steve have any other great insights into what to do even about families who I guess have been impacted by job losses now that's another whole pressure on families I think the any of those complex situations you know in my clinical work you've done a lot of work with families that are separated and going through family court and you know quite adversarial and so forth and I think what we're talking about is this is further complicated by the current situation it's a bit of a combination I think of validating it and trying to move people forward because often when families are stuck in that really adversarial circumstance before coming into what's happening now there's not often a lot of capacity in those families in the adult full flexibility of thinking there's a lot of hurt a lot of grief and a lot of rigidity and a great tendency to blame the other partner for how bad things are going none of which is in the interest of children so I think part of our role is to listen into it as you say validate how difficult it is but try to shift them into what can you do about it and offer that advice or that recommendation that whilst you may not be able to see your children at this time that what a great benefit it is for you to connect with them in some way whether that be through phone calls or old fashioned letters or text messages or so forth so I think there's a role we can play as listening but also helping to move people out of that stuckness because that's not helpful if adults are stuck in a place of hopelessness and resentment about the situation then that's going to flow through and make kids even more anxious now that happens without COVID in really acrimonious situation so I think again those skills that we know we're working with two parents or two families and we all do that quite a lot and kids are going back and forth and back and forth the principles that we talk to parents about don't make the children the messenger you know put your children's needs first focus on the relationship you have with the child and you know all those prioritised those sorts of things I think those messages stand we can be compassionate about it but also I think our role is always around pulling into focus on the needs of the child and what's in the best interest of children and you know we all sit with a hope that all parents want to do the best by their children and so we can listen with it but we also need to move them a little bit into that space of working with what we can because otherwise I fully agree I do want to pick up on a question from Alice which is a very practical point about the iron records the consultation at their end without you being aware of that it's interesting that for a lot of us I guess every time we meet with the clients and they put their smart phone down on the desk you know I think that might be Nicola is that your microphone picking up your breathing maybe just move it through your mouth a little bit or somebody really enjoying the conversation otherwise but that's something I guess which is no different here we've got to make an assumption that a client is recording what we're saying and obviously we wouldn't be saying anything that we wouldn't want to be or we wouldn't be comfortable being recorded does anybody have any practical experience on that I guess I presume you're being recorded if that's the situation Steve I think that's good advice I actually can say that's not something I had thought of that the client would be taping so I'm glad it's come up tonight because I've not thought of that and I agree with you just assume you're going to be recorded and ensure that you know you're safe whatever you say is okay be very measured and make sure in any clinical situation that what she says is okay we contact our solicitors when they first started about you know is the information the therapy and the advice given covered by our insurance and they did guarantee a therapy a therapy advice regardless of the setting or the mechanism of delivering it but I'm honestly I hadn't thought of that Melissa is also struck by that it never occurred to her that this would have happened during after something I need to be aware of others are also saying that this might be an opportunity that sometimes with a teenager particularly like those of us that have taught our children to drive to sit beside a teenager is sometimes a better way of conversation like when you're out walking this might actually be some people have said that there could be some improved communication with people who you're not as face-to-face with that the technology might actually assist with the communication see could I say something yes of course and yeah one of the terms we use in general practice is the safety net patients and just a bit of an extension of what you're saying about you know potentially a patient's recording I do like to ensure that we are and we have to go a little bit a little bit more sorry with this on the phone but safety netting and letting them know where they can turn to should they need it in terms of health and support and protecting yourself as much as you're protecting them so you know are they aware of the local contact numbers emergency help numbers lifeline beyond blue do they have those numbers on their phone available to them so I just um yeah just wanted to touch base on that as well okay so obviously being concerned for our client's health is important what about ourselves I mean we've talked about how this is affecting everybody do you have any thoughts for the participants about what we might do to look after our own health at this stage maybe this is we're in the last few minutes now what are the thoughts of each person on how we can look after ourselves during this time do you know what I've loved from Covid we've got a couple of sites and we do a Friday afternoon zoom drink and I'm loving it I've never had such fun with my colleagues before as we try to get on the screen and share whatever perhaps it's a copy to your I prefer bubbles and we we've never done that before we play in the Christmas mid-year event we're doing a Friday six o'clock downtown we last client gone hopefully and and we are really loving it we laugh and joke we're not allowed to talk clients for work we talk about stuff and it's been the best part I actually now look forward to Friday night well I do anyway but this has been really good fun I wouldn't have done that with that Covid a bit of that joy we're talking about before any thoughts from Andrew or Nicola I think we all need some mental space we've got the added pressure of being on the front line of this and taking that home some of us have families as well and the dual role there and so I I think creating some mental space has been one of the most beneficial things to myself that might be as simple as a few minutes you know to yourself through to 30 minutes where I can do a bit of exercise or do something else that I enjoy that's positive just getting that energy back and being able to focus back on what we're dealing with and I try not to watch the news every night and do those things that really absorbs you more and I try to have a bit of an escape from it at home and I think that's it so just buying that little bit of time to yourself is a great investment that was certainly a tip that came up for clients as well about limiting screen time for children and media time and being reasonable not being completely immersed in the pandemic all hours of the day Nick, are there any final thoughts from you in our last couple of minutes? I think one of the things is when we go physically to work we have some boundaries in place when we leave that workplace and if we're working from home they might not be as set in stone so I think being very conscious of that and having some signifiers not all of us can kind of leave even you know to a separate part of the house or so forth but there's some privacy if you're going to be doing consults and so forth you know what are you comfortable sharing about yourself and your personal space it can be helpful to share a bit but don't share more than you're comfortable and then have some signifiers breaks and so forth as much as you can but you know we don't need to dress up necessarily you know might have the pajamas on the bottom but you know work over on top but I think there's a helpful thing to get out of that at the end of the day so put your most comfy thing on at the end but also try to be really disciplined about not checking emails 24-7 and just because it's available I think we tell clients to do all the time to establish boundaries and stick to them and prioritize some time to ourselves we have to kind of walk the walk otherwise we'll all fall over and then we're no good to anybody Absolutely so thank you to the three of you so much I must say I've really enjoyed chatting with this evening it's been an excellent for the session so from a personal level thank you very much indeed there are just a few things to finish up on which is to ask people to complete the exit survey and to provide feedback now there's a survey icon at the top right of the screen if you could fill out that survey or wait for it to pop up there are some webinars coming up if there will be a huge interest to people next Monday there's one on Aboriginal children and the effects of intergenerational so a vital topic on the 4th of May and then also very practical building on it recently haven't gone into huge detail on the technology tonight is there is another webinar coming up on the 18th of May Monday in two weeks time with bits and strategies in using technology for mental health consultations and that's on Monday the 18th as I say one thing that I wanted to finish off on though is just I guess the final reminder a few slides just have flipped through there those are just the ones I was talking about there but also just the final reminder that I would like to acknowledge that all of us in this together as has been said by a lot of people in our past few weeks and I would like to acknowledge the lived experience of people and carers who have lived with mental illness in the past and those who continue to live with mental illness in the present so thank you so much to our presenters this evening for all of you who have been so active in the chats look after yourselves and say socially safe thank you for your participation tonight goodbye