 Welcome to the 924 people who have joined us for tonight's webinar and the viewers who are watching the podcast. My name is Dr Catherine Bolland and I'll be facilitating tonight's session. MHPN wishes to acknowledge the traditional custodians of the land across Australia upon which our webinar presenters and participants are located. We wish to pay respects to the elders past, present and future, for the memories, the traditions, the culture and hopes of Indigenous Australia. I'm very excited about tonight's self-care webinar. We acknowledge that many people have had difficult experiences in their interactions in the healthcare system and may not have received the kind of best practice care we're talking about in this webinar. The purpose of this webinar is to give a broader group of health professionals the skills they need so they can help people more effectively in the future. Personal stories of illness are very important and MHPN often includes consumers and carers on our panels. The chat box, however, is not a forum for personal stories. It's designed to complement the panel discussion by allowing the professionals to share resources and their experiences of practice. So thank you for respecting this. Also, if any of the content to tonight's webinar causes you distress, please seek care if you require it by calling LifeLine on 131114 or dialing 000. Be on Blue on 1300 224636 or contact your GP or local mental health service. I'd like to introduce to you a wonderful group of panelists we have tonight. You can read their biographies and the information that you have been sent, but I'm going to introduce them to you one by one. So tonight I'm pleased to have on our panel Professor Simon Wilcock, who is a GP. Simon, GP's have to cope with a wide diversity of clinical presentations, making it difficult to control the nature of your workflow. Does this create special challenges in terms of maintaining your own life? As with many careers, it's important to match your own personality to the circumstances that you're going to work in. I fondly refer to my sub-syndrome ADHD. It doesn't need medication. It just needs diversity. And in general practice, we certainly get that. I also acknowledge that for many of my specialist or consultant colleagues, they actually work in a much narrower field, but often with a much deeper understanding and skill than mine. And I think in a matrix format, we complement each other very well. From a primary care general practice point of view, and it's obviously not just doctors that work at the Colface in primary care as well, being aware that at any particular consultation, mental health issues may become part of that consultation, and that in fact, we should expect that we would be assessing those things as part of a standard or a routine assessment and interaction at any consultation is important. Yeah, I'm really looking forward to hearing your views on some of the topics tonight, Simon. You're very well-researched and knowledgeable in this area, so I'm hoping to take some things away from it myself. I'd like to next introduce you all to Catherine Sarris, the second Catherine on the panel. Catherine, in your role of working with nurses who be studying to work in the profession or going into the profession, how important is self-care when you need to mental health? Definitely something that I talk about when new nurses are entering the profession. Obviously there's going to be so many different challenges that they're going to face entering into mental health that they need to be prepared for, so engaging in some reflection around some strategies that is going to help them throughout the next year or so is going to provide the foundation for them to adjust to quite what can be a challenging environment. I'm sure, particularly in that early part of one's practice. Thanks, Catherine. I look forward to hearing you from you later in our discussion. I'd next like to introduce you all to Anne Evans, who is a psychologist from New South Wales and has extensive experience in this area and particularly volunteers, I should say. And how important is it for volunteers or phone councillors to have... Catherine, it's really vital. At Lifeline we talk a lot to our crisis supporters and we have about 3,000 of them around the country about the importance of both elements of self-care for their own well-being and for their ability to support others. They probably get a bit over us talking about it, to be honest. Neil Kitchenman from the University of Wollongong did some work on crisis-supported well-being for us and we've been able to make a really good case for how, just like in other professions, if you're psychologically distressed, if you're not coping, then you can't actually deliver that optimal support for other people and so that actually motivates people more than their own well-being, in fact, to do something about it. So we ask them to have strategies that work for them when they really need to process the stressing material and secondly, we also ask them to ensure that they have strategies used in place that work for them in looking after themselves in a bit more of a proactive way as well. So things like ways to see themselves after a difficult shift or doing something enjoyable to refresh themselves. We provide support and resources to help both of those sides of self-care because it's an occupational hazard in this sort of work. Yes, absolutely. For all mental health practitioners, I'm sure too, in fact. Yeah, that's really interesting, Anne. And I, again, look forward to your expertise throughout our webinar tonight. And finally, but certainly not least, I'd like to introduce Associate Professor Louise Nash, who is a psychiatrist in New South Wales. Louise has extensive research in the area of self-care, particularly as it pertains to doctors. Louise, can you tell our participants tonight what was the team's findings from your research? I did a study in conjunction with Simon, actually, looking at the key areas that people found stressful in the work that they did with 2,999 respondent doctors. And the things that came up, or if you had a current medical legal matter, so that was defined as any kind of complaint process through either your hospital or your practice, whether it was a formal legal matter or a less formal complaint or a coronal inquiry. That was a very stressful thing. Also, not having a holiday in the previous 12 months, working long hours and your personality style. And we also know from the literature that definitely personality style and the long hours and stressors between home and work are big key factors. So some of those things you don't have a lot of control over, for example, family history. But you can be mindful of the fact that knowing that certain disorders have a genetic component, you need to know that you may be more sensitive to finding stressful things might tip you more than some other people. So that's a family history. Of course, you've got your own personal history and you've got your own personality. And in medicine, we very much like people to be sensitive. We very much like people to be conscientious. And there are two things that are more likely to make you more prone to depression and anxiety, particularly throwing in the huge hours that are often expected of people. So we have certain vulnerabilities within the profession and within the structure of the way the profession runs that can make it more likely that someone will actually have some kind of psychiatric morbidity. Those sounds like the perfect storm of factors, personality, workplace structure, the nature of the work. Yes, and home life in balance. And some of those other things. Exactly. Very interesting work today. So you've got a great resource. All right, I'll move on a little and just refresh all of the youth who haven't participated in one of these webinars about a couple of rules and ways that this evening can work well for us all. First of all, to make sure that everyone has a good experience. The chat box is for general chat amongst other health professionals, as I mentioned earlier. We'll discuss resources towards the end of the webinar. If you have technical problems and you need technical FAQs, please use the technical support FAQs tab. And there's a number to call if you're still having difficulty. And I am going to encourage you to provide us with feedback at the end of tonight's webinar by completing the feedback survey, which is located under the survey tab at the top of the screen. So, a couple of important rules. We're going to tonight do things a little bit differently because the topic is so big and we've had so many questions from many of you. We're unlikely to be able to answer all of the questions. We'll do our very, very best. But we're going to use the case study that you would have all received as a stimulus to participate in a panelist discussion for the bulk of tonight's presentation. And so, by the end of tonight's webinar, what the learning outcomes are, what we hope you will do, is be able to identify challenges, tips and strategies for self-care to reduce stress and to maintain your well-being, to be able to describe the importance of regular self-care when working in a mental health environment, and importantly, to identify key components of a self-care plan and ways to avoid a crisis both for yourself and the colleagues that you work with. All right, so I'd like to remind you all about our case study, the story of Carolyn, the clinical psychologist. You'll remember that Carolyn is a clinical psychologist and university lecturer. She has two young children who are aged six and three, and she's been in her practice for 10 years, as well as doing two days on the side of university work. So she works three days in her private practice and two days at the university job. The case study tells us that five years ago, there was a new practice manager who was hired who insisted that the clinicians for eight clients per day. So Carolyn has a very heavy workload, but she perseveres, and the clients are often difficult with personality disorders and post-traumatic stress disorder. The case study also tells us that on the home front, her partner Nick had a serious car accident in the undergoing rehabilitation, and that means he has many appointments, reduced work hours and income, and so there's less help available for Carolyn with children. He has therefore been supplementing the household income with extra work at the university. Her symptoms at the time we find her exhausted, she's not sleeping well, she's been making mistakes, feeling stress, and very reluctant to confide in her colleagues. Her colleague Maria asks Carolyn if she's okay, and Maria eventually suggests that Carolyn sees her supervisor, but Carolyn responds that she doesn't have time. So Carolyn's intending to go and see her GP to get some sleeping medication to help improve her sleep, and that's where we find her. So let's talk a little bit about why, in this case, self-care is so important. I'd like to start with you Simon Wilcox. Can you tell us a little bit about what is self-care and why it's important, particularly for those of us with short-term mental health? The term self-care is one we have to be careful about because I think sometimes people translate it that as self-treatment or self-management, and obviously it shouldn't be for any medical condition, but particularly if somebody's experiencing psychosocial health problems. However, I think of self-care as sort of self-acknowledgement and self-awareness, acknowledgement that our patients and clients have a right to good treatment and support, particularly during times of particular stress or illness, whereas clinicians also have that same right. But we need a vocabulary to understand what we may be experiencing. It sounds a bit like a no-brainer that as mental health professionals, we don't actually understand the terms that we may be using with our patients and clients every day. But the reality is many of us aren't used to stepping into that patient role. And the first thing to do, I think, when you're attending any sort of practitioner, such as myself at GP, is to say, look, I know I'm another doctor, slash psychologist, slash mental health nurse, but at this particular point in time, I want you to treat me just as you would any other patient. Good practitioners do that in any case, but I think it really helps to acknowledge that when you do go and talk to somebody for help. In Caroline's case, I mean, any one of the factors in her life at the moment could be considered a significant stressor and disruptor in her life. So it's going to be really important, I think, to recognize that in a simple request for something like hypnotic medication or sleeping tablets, there's actually so many more issues that we need to plumb and you'd probably spend a lot of time teasing out the various stresses in her life. I think, and I think it was Anne that alluded to it, there's been a number of studies both here in Australia and internationally that have shown that if you're actually burned out or not performing well yourself, you actually provide a lower level of care to your clients. It's sometimes hard to engage people who are feeling under stress and indeed burnt out in finding time to take care of themselves but by reminding them that they're actually not providing the care they wanted to their clients, it's often a good way of engaging them. I'll leave it there. I won't talk about strategies at the moment because I assume we'll come back to that. We sure will. On that topic of burnout, if I could ask you and Evan, what is burnout? What do we mean when we use that term and what burnout is going on? I think there's a lot of confusion around some of the terms that we talk about in regards to burnout and vicarious trauma and all kinds of other terms that we banding around here and some of those terms are often used interchangeably. They can indeed impact each other but one way to understand it is to see vicarious trauma as a reaction to being exposed to traumatic material that's shared by others, resulting in a traumatic stress reaction of some sort and obviously that can be quite normal initially but it can develop into a more serious issue. Burnout, in fact, appears to be a bit more of a common phenomenon that can be a bit harder to pick up because it's not quite as obvious. The symptoms are not quite as obvious to start with and it often develops over a period of time. It's linked not so much to traumatic material although it can be but to excessive and prolonged stress which seems to be what's happening for Caroline in this case study and obviously I'm simplifying that a little bit but some of the symptoms that you might find are things like feeling overwhelmed, being physically and emotionally exhausted, the sense of isolating or wanting to isolate yourself from other people and not making those connections that you normally would have done. Forgetting why you do your job and losing your motivation is to have a sense of negativity and questioning your own competence in your job, doubting yourself. So also other things like illnesses and aches and pains can be more common and certainly pleasing difficulties as well. So all of those sorts of things seem to be consistent with what Caroline's going through. Mm, yeah, for sure. And I can really see the link between what you're saying, those signs and symptoms, what I would say earlier about the reason that quality of care is going to be compromised, obviously if you're dealing with all of those things. All right, so talking about the sort of illnesses and propensity to having a physical toll, I might ask you, Catherine-Sarris, about what the impact overall of chronic stress is on the body. If we think about the brain in regards to, you know, how we manage stress and going back to our reptilian brain and thinking about light, fright or freeze, I think what happens, you know, our brains have a pretty good way of restoring themselves after an adversity. However, in the case of Caroline, I think, you know, I've always already feel overwhelmed reading how many issues that she actually has, that I can see what's happened for Caroline is that she's what's happened is she's actually stuck in that position of being permanently in a fight, flight or freeze response. So what's going to happen is this is just going to create a chronic stress situation where she is not going to be able to manage the emotional requirements of the work because she's so consumed with everything that is going on in her life. So what we hear about the sleeping problems that she's experiencing, that would just be one of many sort of physical, psychological and other symptoms. So if you're experiencing chronic stress over a longer period of time, can lead to both physical, emotional and behavioural symptoms that you may or you may not see. So physical symptoms, you may experience, say, more headaches or you may have high blood pressure. Some of the emotional symptoms that you may notice are a lowered mood, a lack of focus in your work that you would usually have in attention to detail and anxiety. I recently had a a graduate nurse call me yesterday actually who's returned to work from holiday and just out of the blue, she said, I've just been having a lot of anxiety and panic attacks and I'm feeling really tired in my work and so I think we see these types of emotional and physical symptoms and there are also maybe behavioural symptoms that you may see with a longer term stress including an increase in maybe alcohol use to assist you with maybe issues with sleeplessness. So you're sort of using one measure to counteract the other one or not very healthy ways of managing your stress. Yeah, which I imagine has a snowball effect on things. And it sort of leads me quite nicely, if I may, into you, Louise Nass, because I know you've done very specific research on doctors and incidentally on alcohol use in doctors as it turns out. What I want to ask you, Louise, one of the factors that are associated from your research with poor psychiatric outcomes for mental health practitioners. Well, some of the things I've mentioned already that are very clearly in this case. So it's that overload between work and home. It's not at working the long hours, which she's doing. She's got the double whammy of the stress at home with her husband. And for some people, as Catherine was just saying, some people actually opt for a negative coping style. And alcohol use is one of those things. And certainly in the study I mentioned before with Simon, we did find that people who had a current medical legal complaint, they did have a higher alcohol use. Now, that was chicken and egg. We don't know it was a professional study, so we can't tell which way that directional went. But it did seem that people were drinking more under stress for some people. So we have to be very mindful about resorting to a negative coping style, whereas there's another study that Simon and I are also involved in again, where we looked at different coping styles and we found that many people were using exercise as a positive coping mechanism. So there are different ways you could go and that's obviously a positive coping style and spending time with friends. So if people are able to, I'm not saying in this case study, she's struggling to just keep going. So from her point of view, we need to, for her, to somehow reduce her stress. And that I would think the logical thing, if she could manage it, would be to reduce the hours at work. So reduce what she's expecting of herself and what other people are expecting of her. So I would actually opt for that being the first thing is to drop down her hours and try and sort of settle down that stress. Yeah, it's a real challenge. So I think the case study does represent many of the stressors that most of us feel when you have, you know, economic pressures or a new workplace practice pressure and the nature of the work itself can be difficult. And then as you said in your study, it can be a personality factor or other home factors which are sort of snowballing as is evident in this case. I might just tap into you, back to you, Simon. And I want to talk about the term resilience. I know that the term is quite a loaded one, but what does it mean and what does it mean to be a resilient, practical... I think the first comment I'd make, again, Catherine, would be self-awareness, knowing what your own particularly strengths and vulnerabilities are. I think if you use an athletic analogy, if I wanted to play high-level basketball, my height would be a definite sort of factor working against me. So I would have to develop other skills, and certainly there have been plenty of shorter basketballers on the courts as well. So self-awareness is important. There has been some negativity associated with the term resilience in the last year or so, particularly among medical circles. And I understand that because sometimes telling people to become resilient is interpreted as saying that's a cop-out so that the system that creates those stresses doesn't have to change. There's no expectation of systems change. And any of us who work in complex health systems, particularly working with clients with mental health problems, know how complex and difficult those systems can be and how they're often one of the most significant, if not the most significant, contributed to our stress. So talking about resilience doesn't deny the importance of systems change as well and support from within systems. But it does speak to self-awareness, knowing what your own strengths and vulnerabilities are, and we all have them. And that's one of the things I'm sure we all find as health professionals working with clients is helping the patient who sometimes, or the client, who sometimes feels quite hopeless and helpless to identify what their own, what I call islands of excellence are, what their own strengths are, and then to build a sort of resilience strategy based around those particular things. Equally, they need to recognise what their vulnerabilities are. Louise has talked about the characteristics of healthcare practitioners and, you know, the things that we screen people in for when we're recruiting them to training programs is we like people who are emotionally sensitive and empathic, but we also know that that increases our risk of burnout and emotional exhaustion. So we need to have that upfront discussion with our colleagues and say, look, the very things that make our clients like us and value their contact with us also make us vulnerable to burnout. And burnout's such a particularly important construct because some of the research I did 20 years ago, but others have shown as well, is that burnout tends to come before the negatives to clearly the depression, the anxiety, the social isolation, and some of the other things that we associate with sort of poor workplace outcome. If you have a vocabulary, if you can recognise burnout early and manage it, it's also a state characteristic rather than a trait characteristic. I could be really burnt out on Friday afternoon, but if I have a good weekend and somebody supports me, that my burnout levels can have considerably dropped by Monday morning. So from that point of view, I think knowing who you are, what your past behaviours have been, what your particular vulnerabilities are, sharing your experiences, particularly with junior colleagues, I think is incredibly useful. I think for anybody entering the workforce to hear from senior colleagues about the difficulties and the experiences that they had and the struggles they sometimes had to develop their own resilience is extremely powerful. Yeah, it's so refreshing to hear you being so candid about that, Simon. I sometimes wonder whether all of us, and maybe I have a prejudice that's more prevalent in medical professionals, we have a culture of coping. We're somehow sort of saying I'm burnt out or I'm not coping with this as being as a sign of weakness or professional weakness. I know that one of the, someone has been mentioning on the discussion, panel discussion, sorry, the text line has been saying that their GP told them, but you're a psychologist and you should know how to cope. And I guess there are pockets in any profession where we don't get optimal care, but it's very refreshing to hear you talking so candidly about the need to talk to your colleagues about that. I just want to come back to you in the ways, Nash, for a minute, and just tell us about the personal and professional or other risks if we don't manage our self-care. Well, it's not just your self-care because there are times, as Simon's alluded to, where the structure of the workplace may actually have a negative impact on you. Sometimes the workplace itself can be stressful and distressing and that's hard for an individual to change, but there are times when that you may actually need to be out of the workplace. So, Louise, could I just interrupt you? What do you mean by the structure of the workplace or what are the specifics that would make it something that was going to have an effect on the mental health practitioner? If you have an overload, as I mentioned before, between work and home, let's say some people might be expected to do 80 hours a week work. It's not usual, but it can happen. And that, on top of family expectations, is a very difficult thing if you're on call and overnight shifts have that expectation. So, and if there's work shortages as happens in some of our medical professions, then you feel you can't let your colleagues down. So you are on a... Doing more than your fair share, then there's also the burden of the exam processes that our juniors have to go through. So, these are work structures that the individual is within. So, then there are things... So, that's what I'm saying. It's hard. And also, we do, as the press is aware from some kind of shocking stories that happened two or three years ago, we have in the medical workforce and also, I think, in the nursing workforce, but I'm not aware of the direct studies on that. We do have a high rate of bullying and harassment. And that often happens in very hierarchical workplaces. So, this is another, when I talk about work structures, this is another one. And so, there needs to be... And fortunately, certainly in New South Wales, we're trying to improve the system, whereby if you have a difficulty at work, particularly if you're a junior, and the logical reporting line is that you discuss it with your supervisor, but if you can't talk to your supervisor about it because either it may involve your supervisor or you think your supervisor may not be supportive of you and don't forget the supervisor signs off on the progression. In New South Wales now, it's been set up that there will be, or there are, there's a phone line that will enable you to be connected to advice from a senior doctor who has nothing to do with your workplace from a different whole hospital system. So, there's a way you can get help. There's also, of course, the kind of doctor's help lines that are available. So, we're trying to provide structural change for that. But, and we've got better with safe working hours, but we've still got stories of people having car accidents on the way home when they're falling asleep. So, they're the kind of structural things that need to be addressed. Right, yeah, that's absolutely true. And I think it's true, you've highlighted something, a particular workplace, but I know from some of the earlier questions and comments we were getting on the chat line about some of the particular workplace toxicities or toxic people, workplace politics, unrealistic demands. We might talk about that a bit later. I'd like to come back now to our case studies. I'm a member of Paul Carolyn. And I'll come back to you, Simon, because Carolyn has come to you asking for medication to manage her sleep. How, in the first appointment with her, assuming that you've been her GP for a while, how would you manage this request or how would you first go about assisting her? Thanks, Catherine. That's a really important question to ask. If I was lecturing to trainee GPs, as I often do, and I gave them this scenario, I suspect what they'd say to me is, oh, look, we know that hypnotic sleeping medication is bad, you know, you can become dependent on it, and we'd actually counsel the patient against using it. This is not going to be helpful to Carolyn in this particular circumstance. She's already feeling guilty from all of the stresses that she's under in her own sense of underperformance. So I think it's really important to use that sort of trigger, the ticket of entry in the sense that she's used into the consultation to gently help her talk about all of the other things that are happening in her life. So in this particular scenario, I think the useful thing to do would be to say, tell me about your sleeping. And from that would be tell me about what's happening, what else is happening in your life. As you've said, if I'm a regular GP, I presumably know about the stresses, particularly the significant stress of the husband's injury and ongoing disability, but I may not be aware of some of the workplace stresses and hopefully she'll feel safe enough to start talking about some of those things. I must admit, if I managed to elicit all of the things in the scenario, I would be thinking this was really a crisis situation at this particular point in time. There are so many things that are potentially going wrong in Caroline's life that I would probably be counselling her very early on that we need to time out. We need to create some time for her to rest, to re-evaluate, to recharge her own sort of emotional and physical batteries. The sleep side of things would probably be not the main focus, but certainly I wouldn't dissuade her from addressing that and may even use medication in the short term. She knows she's a mental health professional. She knows the potential risks associated with it. But I think the really important thing is not to devalue the very thing that she's felt that she can come and talk to me about. Gosh, Simon, I do hope that Caroline has a GP like you. So empathic and considerate in that response. I'm now going to talk to all of our panelists and we'll start with you, Anne Evans. I want you to tell me or tell us all a little bit about some specific useful self-care strategies that we do talk to our crisis supporters in particular about particular strategies before, during and after a challenging interaction. And I often use these sorts of things myself, but I'll take you through the kind of approach that we would use with our crisis supporters. And basically what we would do is ask them before they're taking a call or a chat or a text, making sure that they ask themselves if they're in a good emotional place to do that as the very first thing. And make sure that that is the case before, in fact, they go on the phones or they interact with someone in another context. Then the next thing really would be to give themselves a bit of time to get settled and be present for that particular interaction. And that might mean taking a short break between calls or just giving yourself a few seconds to just be present. And I think sometimes when we see people back to back, that is a bit of a trap that we fall into and feel kind of emotionally in the last interaction and we're going into the next one. I think it's really important to do that. And then just give yourself a relaxation or mindfulness technique, a really short one, a grounding exercise or the thing you might give to clients just to make sure that you are feeling calm and present for that particular interaction. I really think that it can make a difference. Then during an interaction that's challenging, you can't do an awful lot, but you can notice what's happening for you. You can notice the reaction both in your body and also your emotional reaction. And sometimes it takes a bit of practice to do that, but the more you do it, the easier it becomes. And then we ask them just to practice a simple technique they can use to stay calm and remain present, focus on what's going on now and focus on the health speaker because that's obviously the most important thing in the moment. But then afterwards, we mustn't forget to do something about what we've heard. And the most important thing is really to reflect on what happened and on your own reaction, including that reaction in the body, which a lot of people, a lot of our crisis supporters, it's been a bit of a change for them to think about actually, this stress is actually happening within my body and then also the emotional reaction that they're having through that. And again, some people are better at naming that than other people. And it's something that we like to teach people to be able to name it because there's other people to be some evidence if you can understand it and name it and recognise it, it has less of an effect on you. We also, do you mean naming the emotion or naming the state you're in? What could you tell me what you mean? I guess naming your feelings. I mean, there are some individuals who find it difficult to express and talk about feelings and sometimes even to name what that feeling might be. So that churning in the pit of the stomach, naming it as anxiety, for example. It's just important to actually have words for it and to be able to explain it. The other thing I guess it's really important from our point of view is to sit with the uncomfortable feelings. And that's a bit of a difference from some of the self-care literature that you'll see out there that is all about feeling better and distracting yourself in a way, but it's really, really important to process what's going on. And so we try and get people to reflect on their reaction and sit with it and not try and push it away because obviously we've seen a lot of work in the literature too around the fact that if you don't process, it will kind of come back with a vengeance. And so that's a really important part of what we do and we give people tools to reflect and to process what's been going on. The other thing I guess is if it's really strong, making sure that they do seek some sort of assistance from a supervisor or from somebody else and we can talk a little bit about what that might look like later on. But then finally, I guess afterwards, taking some time to recharge and so recognising that it's been a tough day or it was a tough call, making sure that there's something you do to refresh and recharge yourself and I'm sure we'll talk about it and see about that later as well. Yeah, yeah. They're really helpful in situ kind of strategies that are good for us all to remind ourselves of and. I might turn to you now, Catherine Faris, and ask you about what you think some of the most useful self-care strategy is for reflecting on everything that was being saying. And I think that I was thinking about a young male graduate nurse that I was working with recently who experienced a really significant traumatic adverse event in the workplace. However, he was very reluctant to seek assistance. So we have this terrible issue about mental health professionals having our own psychological trauma and being able to seek help with that. So I was very acutely aware that he actually is a... He does... He's a sportsman and so he does a lot of sports. So I tried to talk to him about if he was playing sport and he physically injured himself, would he require to see a medical specialist to be able to get back into his sport and he was able to see how I was trying to frame that he's been so traumatised by his experience that he did require to see a mental health professional outside of work. So I think it's just trying to normalise that us as mental health professionals, that we too experience a mental health issue. And so I just try and be really compassionate when I'm listening to the people and try and normalise those experiences for them. OK, great. Thank you. And I might now come back to you, Louise Nash. What are the specific or the useful self-care strategies that you've already mentioned and it ties in with this case? If you're working long hours and not getting enough sleep, we know that that's a problem. The sleep issue that this case has is a very common one. And we know that if you have a disruption in your sleep, that can lead to a mood disorder. If you have a disruption, if you have a mood disorder, that can lead to a sleep disorder. So they're very cyclically linked and anxiety and mood also kind of wrap around each other a lot as well. So we want her to have some self-care techniques and we know sleep is really important. Louise, what would be the sort of practical manifestation that what would be the techniques that you would help Carolyn, Will or someone with a clinician is having trouble with their sleep? Is it sleep hygiene? Yeah, well, you start with sleep hygiene, but the more important thing would be to try and do as Simon was saying, I think we need her to reduce or stop for a while. You talk, of course, go through the sleep hygiene similarly to Simon. It may be that she may benefit from short-term of some kind of sleeping agent, but you've got the other things to work with as well. And the fact that she can talk to you may help her as well. She may have a supervisor, I think that's mentioned. She says she has not enough time to go, but supervision in these circumstances is hugely important because she needs supervision to help her manage her caseload and I think there's some mention there that there's some concern she might have missed something or done something not as well as she normally would. She needs supervision for her clinical work but she actually needs treatment. She needs management of the stress she's under herself and the two things are very different. You don't go to a supervisor for your own personal self-care. That is to reflect on things and to look at your clinical decisions. I think in psychiatry I think we're very lucky we have something called peer review groups and I think that was mentioned at the start. And particularly when we work in emotionally challenging areas as we all do in mental health, in the mental health professions, having a peer review group or colleagues that you can bounce ideas off is actually a great way to help you manage the stress of the workplace and of the kind of client difficulties we can have. So I think it's a really good thing. It may not be what she needs in the acute now, but I think that they asked other things that are helpful from a self-care point of view. It's sleep, eating well, exercising. They're all good yoga, relaxation techniques, mindfulness. There's all evidence to show these are helpful in moderate to mild depression and certainly helpful in anxiety. So they'd be very useful to use some of those proven techniques but if she's moved more into a more severe state then she needs more than that. Personally, she should start with some of those self-help techniques. That's really helpful. And Simon, back to you. Have you got any short-fire self-care strategies that either you use yourself or that you would recommend? I use a fairly sort of simplistic model and I work a lot with men, both young men and older men as well and I often use the car analogy and sort of the question to ask is do you have a car and do you get it serviced? And of course everybody says of course they get it serviced because the implication is otherwise you wait for something to fall off before you sort of trundle it in. And then once people accept that it's sensible to look after themselves or what sort of things, the same way that when you take your car to the service station you may not know exactly what they do but you know they're going to check the lights and look under the hood and check the tyres and do a few things like that. So I usually say to people, what about your physical health? And Louise has mentioned a number of those things and that's often the least threatening thing to talk about because it's sort of eating well and exercising well and sleeping well. And then their emotional health, how do they cope with feeling frustrated at times and do they get angry at times and what triggers that and what sort of techniques do they use to manage it? Social or community health is a really important one I find and that's where people are often very isolated. They may work in a busy organisation or live in a very big city but they may actually not be part of any community and Louise referred to you as sort of a peer group but a peer group in a sense is that sort of community that you develop around yourself with some shared experiences and understanding of what the other people are going through and making sure that people do identify often say to them, who's the person that you would go to if everything went pear shaped and preferably who are the two or three people and if they can't immediately tell me then they need to go out and find them because while life's going well we're all fine but we don't know when things are going to go pear shaped and the other two domains I talked to them about are the sort of intellectual cognitive health what are the things they do to stimulate themselves and finally their spiritual health what gives their life meaning and purpose and again it comes back to vocabulary that a number of us have spoken about if people recognise that there's this sort of anchoring term that they can build something around and again none of us is perfect in all of those domains and I think sharing your own inadequacy at times and saying I really struggle with X, Y and Z helps people to realise that none of us are perfect but if we one by one build up some of these resources then we're less likely to be impaired by the experiences that we have. That's a very holistic and lovely way to look at it I certainly feel less imperfect in all of those domains but it feels good to hear, I'm not the only one. Alright, I want to just come back again to Carolyn and talk about the fact that she's in a very difficult work environment and it illustrates a common concern for many of us where there's a dilemma of a very heavy client load and in the case study Carolyn's practice manager has insisted that she sees eight clients per day I want to turn to you now, Katharine Sarris and ask how do you think practitioners should manage their self-care if they're in a difficult working environment for example like Carolyn is or other sorts of difficult working environments so some of our participants have talked about workplace bullying, harassment or toxic people or very unrealistic demands or sort of onerous administers there's a real dilemma that private practitioners have between balancing seeing clients and administrative and other aspects of their practice so how do we manage self-care with those kinds of institutional or organisational stressors? It all sounds very overwhelming doesn't it? So I think it does, yes and I really liked what Simon was saying about putting all of those strategies in place around self-care and maintaining the things that you had done previously So I think what's really important is to always know that there must be someone there that can help you throughout these times and it's okay to ask for help I think we try and soldier on but obviously in the case of Carolyn that it's not working so it's going to be really important for her to get help at this time and also to really set some strict boundaries around what she can and can't do at this stage and that might be... it sounds like the person that's checking in with her, Maria is quite concerned with her so maybe if Maria and her have a close relationship they could sit down together and work out some strategies about how they could approach the practice manager about how this is really impacting on her and maybe even the other members of the team there that it's just unrealistic and you're not going to keep staff when they're just so burnt out like this Yeah I think that's a common concern it's certainly something that some people have a lot of concerns about from different professions about so I think what I'm hearing in everyone's view about this about Carolyn is that something's got to give and it seems that she needs to cut back on her working and certainly seeing eight clients a day especially given all the other things going on her life is an unrealistic demand Yeah and even just with the family situation is there people in her home environment is there respite opportunities who in her family networks can she ask for help from as well I think you know she's really not asking for help a lot in this situation so I'd be really wondering what that's about as well That's a very good point actually Actually you've raised with Carolyn one of the issues I wanted to touch on next which is our relationships with our colleagues it's often in our workplaces where we see our colleagues struggle or where colleagues would notice the first people to notice the deterioration in our wellbeing so I guess I want to ask a number of the panelists and I'll start with you Simon about how we can best assist our colleagues if we're concerned about them Quite a literature that shows that the closer that you work to somebody the more likely you are to pick up early signs of distress rather than true impairment we did a neat little study with junior doctors about 20 years ago which showed that the medical administrators and the nurse unit managers could tell if the doctor was dangerous or impaired they had no idea that if the doctor was just distressed and worried by things but the nurses on the ward and their peer junior doctors knew that they weren't themselves so that's the first thing to say that if you're working in a workplace with a person you will pick up those early subtle clues and often they're just signs of distress not anything major but that's when it's best to intervene I think the second point to make is that if you are going to intervene and you need to think about what your rights and responsibilities are we're not our brother or sister's keeper we're not responsible for their outcomes so we have to define in our own head what the level of our approach might be but making it clear when you talk to somebody I call what hatch you're wearing if you're in a supervisory role it can be quite threatening or intimidating to say to somebody you don't seem to be yourself so in that situation saying look let's have a cup of coffee I'm just talking to you as a peer or a friend now I'm a bit worried about you or you don't seem to be yourself can make it much easier for somebody to talk about what's affecting them or what's troubling them at the time if there's some confusion about whether you're somebody who's also going to be assessing them or potentially performance managing them down the track and then the final comment I would make is the one that I think Louise referred to about having a community of your other professionals around you they know what you're going through and making sure that you normalise that process of periodically sitting down and talking about balance groups and things like that periodically talking about the inevitable stresses that we experience when we're actually working in mental health and normalising a discussion around it without having to necessarily personalise it I think often practitioners find and get really worried about the sort of professional obligations to report on their colleagues can you tell us a little bit about the professional responsibilities if you are really worried about someone's standard of care Yep, very happy to speak to that because it is something that makes all of us very anxious and I chair the board which is a community company which deals with a lot of sort of concerns and complaints about health professionals particularly doctors I think the reassuring thing here is that we don't actually have an obligation to intervene or to report our colleagues unless we directly observe behaviours that I think any of us would consider needed an intervention so if you observe somebody directly who's working under the influence of alcohol or other drugs or sexual boundary particularly a personal or sexual boundary then there's an obligation to report that person but that's actually a very very high bar and I don't think most of us would have problems of actually complying with that just being concerned about somebody does not meet any sort of threshold in terms of an obligation to report I think from a moral point of view if you are concerned or you are hearing things talking to somebody if you are concerned about or somebody else to see what can we do and how can we engage them I think that's the really important thing to do and the earlier we do it the better the outcome is likely to be for the individual but from that point of view none of us should be worried in fact I think there's a lot of evidence that by being worried that you might have an adverse effect on somebody by saying something actually tends to lead to worse outcomes because it delays the implementation that's really reassuring actually Simon it's very educated for all of us and Evans I want to ask you now how you think we should best approach our colleagues how should we approach them this way I usually find that the best way to approach it is to be quite straightforward and to talk about behaviour you've observed because not too many people can argue with that if you've seen a change in their behaviour if you've seen them not coming out for coffee if you've seen them doing things differently working longer hours whatever you've noticed that's usually what I would start with and people can't actually get too confronted by that conversation or not as confronted as if you perhaps went up to them and said you're looking very depressed just talk about no what you've observed so whatever you've actually and let them know that you're concerned about them and that you want to help I think as Simon was saying it's far more important to show concern and to actually intervene then it is to have all the right words or say all the right things if people aren't asking them and reaching out to them they may feel even more isolated so it's just really important to say what you've noticed ask what's going on and show that you really are concerned to them as a person what's going on but for them as a person and just let them talk when they're ready and obviously if you're not the person that they want to talk to encouraging them to reach out to somebody else and to talk to somebody else about it that's really good advice Louise, Matt how do you approach or do you think we should best approach colleagues if we're concerned or wish to assist them very much the same as has just been said I think we've got something then that's appropriate but showing you care is the most important thing and that you are concerned for them and I think there's like the I think the best thing is to encourage someone to seek help whether that be medical help, psychological help legal help that's a good step so for example in this case the fact that she's gone to the GP is going to open up it's appropriate help seeking the other thing I want to mention it's a little bit off track from what you've asked but it's been raised there is sometimes a fear within the health profession of help seeking and there was a big beyond blue study that most people will have heard of was that I think 12,000 again it's a medical study about 12,000 people responded doctors and medical students and 53% said that they feared seeking help because of confidentiality 37% because of embarrassment and 34% because of concerns over registration and I completely agree with what Simon said which is that issue about the mandatory reporting laws the bar is high but what we want to do as has also been said we want people to seek help early and so that things don't become more severe and then more difficult I'd much rather be treated by someone who has a depressive illness who is receiving treatment that's not an issue to me at all so we want people to seek help have appropriate treatment and fortunately we have excellent treatment yeah yeah I guess one of the things some of the comments from the chat have been in good respect to our case study Carolyn is saying well the strategies we're talking about are good but Carolyn has very real conflicting demands what if she can't reduce her work hours because she needs money working she's got two young children I guess I'm going to open this up to anyone who wants to answer on the panel how do we deal with those very real conflicting demands or someone like Carolyn who when Maria approaches says I'm too busy I don't have time but we can recognise and see what would any of the panel like to comment on that it's Louise Louise speaking in an ideal workplace I appreciate she's got the clinical load but she's also got her university load and there are maybe someone could help relieve her a little bit of work maybe she can take sick leave so there are depending on her contract if she's there two days a week she will be entitled to sick leave and yes that will overload her work colleagues but at the moment she may not be quite as effective as if she actually had some time away got better and then came back so I think that there are ways and someone else mentioned has she got other help that can be drawn on to help her at home so she just simply needs to reduce the load expected of her at the moment and sick leave is one way to do that so I just think she needs to be working less or not working for a while and she may actually part of the problem is that as I mentioned in the literature is that work home overload her home life at the moment two small children, unwell husband it's huge so some help needs to come from somewhere the finances sure they're problematic but she needs relief at the moment I think that's so well put thanks for addressing that concern alright I want to now turn to something that we're all confronted with and some of the panellists might have referred to specific situations where we are confronted with very traumatic situations because of the nature of our work Simon I'll start with you how should mental health practitioners plan for or prepare for traumatic or adverse events and Catherine I'm assuming that we're referring to sort of the adverse events happening to themselves or in terms of their own coping skills because I think probably day to day we deal with clients who are at varying levels of stress and distress I think again it's helpful to have the discussion with your colleagues you don't say if you had this happen you say when this happens because unless you're a real outlier on the bell curve we're all going to have situations where for a whole range of maybe work related reasons maybe personal reasons there's going to be the crisis day where everything falls apart crisis plans are useful I've already referred to my sub-syndrome ADHD and I don't work terribly well with sort of detailed plans that have 37 components and every box has to be filled in but I think some general principles and some of them I've already alluded to who are the three people you would call when there was a crisis in your own personal life how would they help you what sort of things would you unload as a healthcare provider and I think anybody on the webinar can be involved in this what would my role be what would you like me to do in this particular situation and that's where you can start introducing the idea of time away from work or time away from your stresses as Louise has suggested and start introducing the idea that there are safety jackets if you like stowed under the seats if something happened then you do have sick leave and we could access that who would help with your children if both you and your husband were significantly unwell at the same time it's a not uncommon phenomenon in crisis situations where what I say both partners have their flat batteries and neither of them is actually in a position to recharge the other and in that situation okay who's the external person who's the family member that you could turn to who could support in that situation and everybody's circumstances are different but from that point of view I think getting people to normalise the idea that you can't work in health I often say you can't work in health and eliminate stress you know if you're working in health you're dealing with people who are dealing with difficult situations doubly so you can't work in mental health you can't deal with stress and we have to be the role models that show to our clients that we experience it too but we also have strategies for dealing with it and that we're not Robinson Crusoe we don't ever try to deal with it solely on our own so it sounds like the crisis plan from your perspective is a real contingency plan these are my go-to people this is what I would look out for and this is how I would kind of potentially manage those situations and depending on the absolutely and depending on the circumstances where you go from there might be quite different sitting down and seriously reviewing your work situation I mean if I was understanding Caroline's work situation when she was feeling more comfortable and a little bit more robust herself talking to her is this actually the right work situation for you if you've been in a situation for a number of years where you feel you've got an unsympathetic unsympathetic practice manager maybe it's time to rather than wait for the practice manager to change maybe we need to consider what your options are you don't see that at the first consultation or the first encounter because she's already feeling very fragile and vulnerable but if you've got that initial crisis as you say contingency plan then you build the other components longitudinally mental health as with any illnesses is a journey where as a practitioner the care provider I think the visual analogy and I'm a very visual person is of walking beside the person helping them through the journey. One of the nice things about working in health is that our clients actually often help ourselves and I'm not talking about boundary issues and things like that I'm talking about the value that we get from knowing that we're helping our clients. Yeah, yeah that taps into some of the domains you were talking about earlier about the sort of rationale the spirituality of why we do what we do. Yeah, I think it is important in this discussion I mean I know it's not sort of answering the crisis mode that Caroline finds herself into but perhaps later down the track that's a really important self-reflection exercise. Alright, I'll turn to you Catherine Faris and ask you what do you think about a crisis plan and what should include or involve? Yes, I was quite fascinated when I saw this question I mean I don't personally have a crisis plan that I have however I think as maybe someone mentioned earlier about self-awareness so understanding yourself and having a really good awareness of some of the things that you may face and you may experience when you're under a lot of stress and so just putting your hand up and saying I need some time out here you know there's just too much going on and so really owning that and I mean I don't write it down I think intuitively I know myself when I'm experiencing a lot of stress within my work and then I know that for me personally if it's something it may be a conflict with a manager or I will then totally actually stand up remove myself from my desk and I'll take myself for a 10 minute walk and just breathe and I think that just gives me the time and the clarity to breathe and relax and then come back to the situation I think because sometimes for me I can get quite caught up in my own head space and I get triggered and then I get hooked into this scenario in my head and I'm saying to myself I'm bad, I'm useless I'm hopeless they're going to fire me I hate everyone and I go through all these thoughts however taking myself away and having some space it's probably not that bad as I'm making out so that's what I do and I also always just challenge my negative thoughts as well am I is this situation real here or am I creating a bit of a conspiracy theory in my own head based on just little points in the conversation and then I make up this big story so I'm just always checking in with myself and trying to self-regulate my emotions That's really helpful Catherine and what about you, do you have a crisis plan or do you think, what do you think a crisis plan for a mental health professional should involve? I haven't, like the others I haven't really written it down but I guess I try and follow the same sorts of practices that we've talked about with our crisis supporters as well I have people that I can talk to both in the professional environment and personally and different people for different things if you like so it's really important when I'm feeling a bit overwhelmed to make sure that I connect with other people and it's really important to choose who those people are as well because there are friends you can have a cup of coffee with and you feel completely drained afterwards and there are friends where you can have the same sort of interaction and you feel really energized and quite different about the world so it's about choosing those people really well and I also know the importance of processing my reactions to my work so when I'm feeling overwhelmed what I'll do is I will take some space and time and I really thought the idea of going for a walk is a really good one because that's one of the things that I do importantly I used to go for walks for exercise and I'd make all the phone calls that I hadn't made during the day now I don't do that I turn the phone off or onto silent and I just let myself be and that really works for me I'm processing I'm letting my mind go where it needs to go and I'm just disconnected from everything else that is happening in my world and that's really really helpful and then if it has been a difficult day whether I feel like it or not at the end of it I'll try and do something fun even if it's really simple like watching a silly cat video or something like that there's nothing wrong with silly cat videos Anne I don't feel quite as useful as a holiday and some of the other maybe not but maybe there are on a personal level Louise, Nash what about you do you have any tips for us or for our participants in terms of a crisis plan the importance of one or what it should involve a bit like as Anne just said I have some trusted colleagues that I can call on at any time day or night for help and I've been very lucky that I have those and similarly in my private life I have people I can call on and call for help and I would do that so I feel very fortunate in that I have those relationships I also learnt early on that a bit like our case study I had small children while I was working in psychiatry and it was emotionally too much so I learnt early on that I could not do a full load of clinical work so I've worked more in a preventative way rather than an acute crisis way so I found that I could not give if I was going to I could not give to my children what I felt I needed to give them if I had given it all at work so I therefore learnt very quickly that I could not do this kind of work more than a couple of days a week but I've been fortunate to have a and I imagine the same in all of the health professions I'm fortunate that I've got a balance of my academic role and my clinical role and that's a lovely thing for those people who have some kind of teaching or supervision role that's a lovely thing so having a career where you have some diversity within your professional role I think enriches you and also preserves you so that's my tip that's great Catherine Faris I think you wanted to make a comment about this yeah so I was just thinking I teach the graduate nurses this also so I say to them which has been helpful for me if I've had something significant happen and I'm coming home from work driving home I'll pick a landmark on my way home and I'll say that's it I'm leaving that behind me now however if I go past that landmark and I'm still thinking about this issue I know that that's when they really need to then go back and seek clinical supervision or reflect with someone as well so I think that's important to really differentiate what work is you need to leave that at work and separate the two really strongly and find something that really separates the two I like that physical barrier it's fantastic well I have learnt so much tonight from this brilliant group of experts the CAT videos the landmarks on the way home the crisis plan and the importance of a holiday I think that I'm going to take away I also thank you all for logging on tonight and giving us your good time I'd like to please remind you to completely exit survey and give us feedback so we can continue to produce high quality webinars for you that are relevant and I invite you to participate in future MHPN webinars so keep an eye out for notifications the next MHPN webinar will be on engaging with parents and infants in the first thousand days which will occur on the 17th of September and soon after on the 26th of September another webinar on BDD self-injury and suicidality so you can register for those webinars we know that practitioner self-care is a very important aspect of working in mental health MHPN supports balance and peer support groups where practitioners from a range of disciplines meet and confidentially present cases in a respectful, supportive and non-judgemental environment and we've heard how important that is tonight so please download from the resources tab below if you'd like to learn more about that and again, if I could encourage you to complete the survey at the top of your screen you will be emailed a certificate of attendance for this webinar within four weeks and you'll be emailed a link to the online resources associated with this webinar within two weeks before I close I'd like to acknowledge the consumers and carers who've lived with mental illness in the past and those who continue to live with mental illness in the present and thank you to everyone including our panellists and all of you for your participation this evening good night