 Good evening everyone and a warm welcome to this webinar this evening hosted by MHPN. My name is Vicky Cowling. I'm getting some feedback. I'm afraid. Vicky, your computer might not be muted. Okay, I'll continue. Apologies for that. My name's Vicky Cowling and I'm facilitating this evening's session. I'm a social work and psychologist and have worked in the field of children and parents with mental illness and their families for about 20 years. My role is to facilitate this evening to introduce our speakers and keep us on time. I'd like to first introduce one of our first panellists, Amanda. Amanda Wigley is an independent mental health recovery consultant, trainer, peer recovery specialist and parent with lived experience and is wearing a few different hats for this evening's discussion. It's great to have you with us this evening, Amanda. Thank you. There are lots of different meanings to recovery, I understand. What, to you, is the most important aspect of recovery, the topic of tonight's webinar? I guess, for me, recovery is the lens in which I choose now to look at my mental health challenges and that it's about personal recovery, Vicky. Thank you. I'm joining Amanda is Angela Bredovich and Amanda is a social worker from Victoria and has been associated with children and parents with mental illness for a very long time. Angela, what are some of the best programs and innovations that you can think of during your association with the Copney field for the last 20 years or more? I think the development of peer support programs that incorporate the development of peer leadership to make sure that the lived experience sits alongside professional experience and service delivery. I think that's been a major development over the last 15 to 10, 20 years. Thank you. That's important. We have Mary Jessup who is a child and adolescent psychiatrist working in the private and public sector in Queensland. Welcome, Mary. Thank you. Tell us about some of the challenges you face in working with adolescents in particular and how you overcome these, particularly where adolescents have a parent with a mental illness now. I think one of the challenges for adolescents is often if they are their first contact with any services in relation to making sense of their parent's mental illness. Sometimes that it's often quite a way down the track. So I think it's very important to think about engaging earlier, but I think one of the really important things is really getting the unique and understanding of the unique experience of that young person and their family which certainly helps in the engagement. Yes. Thank you for that. That's important as well. And last but not least, we have Lisa Wiping and Lisa is a psychologist from Country New South Wales. What about some particular challenges you face, Lisa, in the area you work in, sort of, Southern New South Wales? Like metropolitan areas? Oh, there's not enough services, of course, in regional areas. And there's such a high demand for services, you know, for my service and for psychologist services that, you know, often we have to close our books or trying to get the time just to get out to different regional areas that your local area covers and see everybody and get literally just kind of have the time to do the job is really difficult. And then confidentiality in a small town is another kind of challenge too. Yes. I imagine that's very, very challenging for families. Well, thank you all very much for those introductions. I can see that we have 215 people online now, which is very pleasing. So the topic for tonight, of course, is mental health parenting recovery with an interdisciplinary group discussing this topic. Participants would have had a chance to read the case study and the learning objectives to which we're working tonight. So the next part of our presentation is each panelist will give a very short discipline-specific response to the case study. And there'll be questions the panelists will address to one another. And then to from between panelists and participants as well. So it's an interactive collaborative webinar that we don't have all the answers possibly but we certainly hope to engage you and contribute to further thinking and discussion about this important area. So Amanda, I'd like to start with you and your overhead so that take us through those. Okay, thanks Vicki. I guess first of all I'd just like to say as a parent in recovery I can really relate to having experienced trauma myself similar to Karen. What helped me in my recovery was staying connected to my children and that was really important throughout my journey. And I think we can also see how important that is in the case study as well. And I think someone helping me to talk with the children and the family about my experiences was also significant in my own recovery and I think we can see a need for that in this particular case. I think normalising of the experience should be quite a trauma and if we can use that recovery lens that I referred to that was quite helpful for me in the way that we look at the experience and that's extremely helpful not just for the person in recovery but for their family and children as well. So looking at peer support I think it's really important that a recovery peer specialist is not a psychiatrist or any other discipline and they don't try to be but I think this is one of the reasons why it works so well. We're professionals in our own right and it's a new and emerging workforce and there's lots of research there that shows that we hold the key to a successful recovery for the person. We don't scream, we don't diagnose. What we do is we connect and we talk and that's a really important element. We're just ordinary people with all kinds of backgrounds who've walked similar mental health paths and that's what we use to connect with our peers and at the same time every day we're fighting similar battles and similar struggles with our mental health and that shared experience is to connect. I think some of the challenges that I've come across as a peer specialist in peer support is probably the biggest challenge is the lack of understanding of the role and I think there needs to be a lot more education in regards to this. There's lots of research out there and I would encourage people to go to the INROC website up here if they're looking for that kind of evidence and research. I think that it's really important that peer support specialists and workers work collaboratively and one of our primary roles as peer workers is to encourage peers to engage in therapeutic relationships and clinical services and that's what makes I guess the work of other mental health professionals more efficient and effective. We're like bridges and that's quite significant. Peer specialists, we can engage one-on-one and really our role is to listen and emphasize and we encourage and inspire hope. I think the role of peer support for a person with no experience of a peer specialist or peer worker, it's really important that we clarify what our role is so I would be doing that wherever I came in and not just with other professionals but with the person with whom I'm working because even as somebody going through that we still may not have encountered any peer support workers in our recovery journey. My role often involves explaining that I have lived experience of mental distress and recovery and that I choose to be here right now out of my compassion and passion to help others in similar situations. I explain how I've become an expert at my own recovery and this often can be really effective and profound not just on the peer but on their family and also other colleagues in the field. I don't profess to have all the answers. I've walked through it and I've come out the other end and I know the right questions to ask along the way. I know the language to use that can help the peer and the family member through the journey. The family recovery from my experience needs early intervention and if Jan or her GP even had access to a peer specialist in the community and I was contacted right from the beginning of something not being quite right, I would have gone out to the home within 24 hours of receiving a call from Jan to meet with the whole family and listen to everyone's story of what was happening. Once heard I would attempt to facilitate an open dialogue, a solution-focused family conversation. So what are we all going to do about this now? And I'd inform the family of the mental health services and professionals available in the area and encourage and support them to use that. This way of working is something that I've been trained in this open dialogue method and I would really encourage other professionals to look into it. It's well researched. Over 25 years of successful practice and the key is that the professionals go out to the home at the very first sign and we create some conversation and dialogue. How I would engage with Karen, I'd share of my story and my experience in an appropriate manner and I would also, I'd be saying to Karen that I'd like to learn about your circumstances. I'd be saying, Karen, what's happened? And I would also then, as a peer specialist with that lived experience, when I'm introducing myself as a peer specialist, often people will say, what's that? And that opens the door to lots of discussion and I find that that's most helpful. I would be looking at how I could connect with myself as a peer specialist that look at services or programs. We have a good program over here, the Parent Peer Support Program and so connecting Karen with other peer parents that are in recovery would be really important. It wouldn't just be up to me. I think that recognizing that however we can support Karen to hold on to that role of the parent right throughout her distress and in her recovery should take high precedence in what we do. I believe that when the eye is replaced with the we even illness becomes wellness and what are we as individual mental health professionals doing to support the whole family with whom we're working to keep and maintain that existing we in all that we do throughout a person's recovery journey because really we're only there as professionals for a short period of time and the Karen and her mother Jan all the family are the ones that are going to be there in the end and we're not looking at ways at how we can support the whole family in what we're doing, educate them then that's the best way forward. Thank you. Thank you very much Amanda. Many important issues there. There's a couple of housekeeping things for the panel. Could we please unmute your phones when you're not speaking and Amanda could you come a bit closer to the phone or turn it up so that people can hear you a little more clearly. Thank you. Okay. We'll move on to Angela Abradovich now in the social worker perspective. Thank you very much Angela. Hi everyone. I suppose I wanted to start by thinking about the way I'd be approaching this with Karen by just reflecting on what the profession of social work would what lens we would be looking through and that would be through the lens of social context and social consequences of mental illness how environment shapes someone's experience of mental illness everything from personality stresses and strengths at an individual level right through to their interpersonal issues and broader social issues including economic and structural issues but really our purpose is to look at restoring and promoting recovery well being across the individual family relationships to make sure that power is restored as much as it can be to somebody's control and in that being mindful of things such as stigma and discrimination being able to promote access to services people's rights and their ability to participate in a meaningful way in what's occurring for them and so most of the practice occurs at an interface between that individual and the environment that they're involved in and I would also be looking at it from a recovery approach and I've just suggested that the particular framework that might slay from the UK users the recovery approach which identifies a number of particular recovery tasks that an individual is likely to move through in their recovery journey is a good frame to use in thinking about current situation the focusing on making sure that a positive identity is outside of being a person with a mental illness is a focus meaning making in relation to framing the mental illness having a satisfactory meeting ultimately being able to self-manage a mental illness so moving from the transitioning from clinical management to taking personal responsibility for your own well-being and seeking help when you need it and most importantly developing valued social roles whether that's parenting or acquiring new roles and all of those are really underpinned by relationships and the importance of hope to that process so in that clearly the parenting role which is what we're talking about tonight is pretty intimately related to the recovery process it's one that in my experience is a very hopeful role it provides meaning purpose agency it's a very good vehicle for people to utilise in their recovery approach professionals nevertheless can be quite supportive in maintaining that recovery approach and that's generally through a collaborative process together with the consumer at every stage of working with them right through from assessment and planning and action including crisis and that's one of the things I wanted to focus on with Karen is part of her experience in an impatient setting often people believe that recovery is it's not a concept that equates to an acute episode people's traditional notions of recovery seem to override but in this case recovery absolutely I believe is important in a crisis and it's one of those places where we can definitely give very strong messages about maintaining as much choice as possible and as much personal responsibility and identity and not losing that so I would be looking at Karen's context overall and I think using a strengths and vulnerabilities perspective I in her story I'm seeing lots of things that are particular strengths that relate to recovery and identity and the supports around her the closeness of her family support system the history of that and the strong bonds that exist between her and her children and her mother she's experienced even in the help seeking to support her a GP who's provided some choice around how to access services during a crisis the previous assault that she's experienced has consistently been validated and acknowledged and attended to and despite the fact that she's been fearful very fearful about what's been happening to her and the circumstances of her her past relationship and the custody battle that's on at the moment she's managed to trust professionals and those around her and commenced some treatment and she's been exposed to the lived experience the lived recovery experience of a peer worker while she's been in an acute setting nevertheless her picture also her story also reminds us that she's had intimate relationships that are very much a feature of conflict and violence the role that she finds the most joy in is the one that's under threat and I think really importantly is the power of a mental illness to thought connection is apparent in here her help seeking and that of her mother's has been limited to some degree by the existence of the battle around custody about the experience of her trauma and the stigma that's associated with a mental illness and psychiatric treatment so we can see very much a fear of judgement and the fear of relationships being disrupted in people's attempts to work through what's happening and we certainly had children exposed to violence and concern about them and their separation from their mother an issue that Jan particularly has had some concerns about so focusing on that inpatient unit stay one of the things that I've provided a resource for people is a thing called the keeping in touch with your children menu that we use in our inpatient service to attend to that issue of separation being traumatic for parents and for children and the families around them and we know from research that this is a particularly important issue maintaining connection and reducing the disruption to that parent-child relationship is important reducing the silence and the stigma that's associated with it and we do that by normalising it expecting the topic of conversation to occur and this particular menu talks about different levels of contact as the patient or the consumer is ready to move from simple phone calls to visits doing all of those things with a thoughtful approach prepared and with the parent fully involved at each stage it's a very recovery focused trauma informed approach that would ensure that children at home are knowing that mum is thinking about them and she is not left uninformed about how they're going and being able to provide them with some reassurance about how things are for her and then as well I would be as part of that and then in community work looking at the other major intervention then that is promoting keeping this conversation going making parenting a normal conversation topic rather than one that is stymied by fear and by guilt and by judgement a fear of judgement from others and this particular approach called let's talk about children which was developed in Finland and the National Cockney Project is currently about to launch an e-learning course on is a very recovery focused approach particularly to help making talking about children and parenting part of a natural conversation and alliance between the worker and the parent and it utilises a developmental log to help promote the discussion and to allow a practitioner to take a step back and allow the parent to inform them as the expert on their child about their child and to allow that to trigger further conversations about future planning looking at supports that the parent might need or goals that they want to focus on and that might move into considering how children understand their parent's mental illness of demystifying that for them the parent is the most important person to deliver that information the most potent person to deliver that information it's one approach but along with that there are others that also promote those conversations and planning family focus which is another evidence based intervention that you can hear about or learn about on the COPME website parent peer support programs that exist in many states and supported playgroups starting really quite early and making sure that parents with a mental illness are able to experience a playgroup environment that's sensitive to the needs that they have and allows them to build to further networks and supports themselves through to peer support programs for children and teenagers where they can share their own lived experience be more informed about mental illness develop their coping strategies and they're all essentially peer and interactive programs that I would be looking to support Karen in considering. Thank you very much Angela it highlights the need to think of the family each individual member in the family we'll move on to Mary Jessup now for the perspective of a psychiatrist on this topic thank you Mary I'll be talking from the perspective of my work as a child analyst and psychiatrist and also as part of the Child and Children and Parents with Mental Illness program that I work for because I think what often I'd be if I come involved with a family like this when someone might contact the service asking for advice as to how this family can be supported so coming from that perspective one of the critical things that we consider is that the children are at increased risk of mental health problems but also that the risk can be reduced so keeping that in mind in the work that's recommended or supported for the family so we very much support a family focused approach I think you're certainly thinking about parents and recovery is that for them to have a sense of increased or regaining their sense of effectiveness in their parenting is one of an important aspect but if a child or young person in the family is already experiencing mental health problems or other emotional behavioural difficulties this presents an additional challenge for a parent within the recovery phase so it's very important that these issues be identified that risk be reduced but also parents be given information about how to support the development of their children through a time that can be quite challenging so the signs of outline some of the interactions between parental mental illness and child outcome consider that in relation to Karen's case the first is the importance of considering it as bi-directional so that if the children in this scenario we know that Karen is finding it increasingly challenging to maintain her primary care role her mother is starting to take on some of the roles and so we have some sense the younger child is becoming we know that Tom the elder 19 year old is assuming some role in supporting his mother we don't have a full sense of the middle child is responding now these children are responding in a way in which there is increased emotional distress or behavioural difficulties this presents an additional stress for the mother and she may start to interpret may contribute to increase in guilt may result in her feeling less effective as a parent and these are important factors to be aware of we also know some children may already have existing disabilities so when there is an environmental stress they are more at risk of having difficulties so certainly the most beneficial thing within the family as a whole is for Karen to be supported into recovery as quickly as possible in terms of receiving the appropriate treatment to support from both we are aware she has got a diagnosis of depression and psychosis and beginning treatment but there is also a situation of the impact of the trauma and how that will continue to affect her after the depression resolves we have a sense that she was functioning quite well previously so one of the important things has already been mentioned is that how critical it is for maintaining connection through that period of the mother's illness one of the really important things to consider for child outcome is how quality of the parent-child relationship in parenting again we know that there has been a change in this one, the mother has been unwell but certainly if there can be maintain connection to try and support that relationship becoming we are being reestablished if there has been any breakdown conflict is going to be very important we also know that parenting style is also by depression and often parents become less confident they may become more indecisive there might be increase in hostility at times and those things are important to think about and supporting the family there has been some additional stresses for these children both related to the mother's illness but also unrelated we don't know whether this family is isolated from the community or in the school environment and that's an important thing to consider we also we also know that there has been exposure to domestic violence as Angela has mentioned so what we are trying to do in the approach is to support the building resilience in both the children and the family so we know that if these children can be supported to maintain age-appropriate tasks maintain relationships with peers that's going to be valuable but one of the other important things to consider is the children's self-understanding their ability to make sense of their environment through the time when their mother has been unwell and a lot of that self-understanding is established within the family context so again thinking about the family what's the belief systems of the family how do they organise themselves along while the mother is unwell but also one of the really important things is it's some grandmother has taken on a lot of the primary care role how able is the grandmother to gradually reduce that role as the mother becomes more capable of managing the role herself and one of the really important things in all of that is how well things are communicated and problems solved within the family just putting a problem that's moving my slide on OK so what I'd be advocating for in this family is really it's normalising the struggles of parenting and we often know parents with mental illness will perceive themselves more negatively and often think that other parents aren't having the same struggles so it's really important to normalise that it's very important that parents have the space to reflect on their parenting role and that children's strengths, their vulnerabilities to have a think about what might be helpful in supporting their child's development providing information about that and that is the importance of children having a way of making sense of what's happening so the importance of talking to children about parenting and mental illness is quite important here there's a focus on the family's style of communication and problems solving and how able and willing the family is to access the supports when needed the other thing is part of the the COPDME program is actually providing a psychoeducation peer support group the COPDME program offers it to young people but also there's been increasing focus on having psychoeducation peer support groups for parents which can be very valuable so I just wanted to highlight Angela's already mentioned let's talk about children and think one of the aspects of that is that it provides a really good guide for for how best to communicate with children about parental mental illness and really thinking about how the language is directed and how the children understand I think one of the critical things is that children is what children expose to and giving them an explanation of those things it's also important that discussions are solution focused and that there's it's really important that there's an ability to have communication and over time within families so I certainly would advocate the use of an intervention like talk about children because it not only provides those guides but also addresses a number of the other things I mentioned in terms of things that would advocate in working with families thank you thank you very much Mary we'll move on to Lisa's wife now and Lisa's psychology perspective on Karen's family situation thanks Lisa sorry I better unmute myself yeah look this was a tough one the five minute short short version of how to do therapy with a client like Karen or any client so by the time Karen gets to me she's met just about everybody in the known mental health universe in the Vega Valley in my area anyhow or in Pittsburgh so when she gets to therapy she's facing the challenge of trying to get back to normal life in her small community and after a traumatic illness and a traumatic crime so my main role as a clinical psychologist I think is a bit more individualistic than what you can be when you're supported by service it would be to establish Karen's therapeutic goals and then provide psychological therapy to treat her depression so we're kind of aligning if you like the clinical recovery and the personal recovery look it involves three parts essentially it's assessment it's treatment and it's collaboration with this slide look the assessment a good assessment is crucial and it's ongoing with psychotherapy so in a nutshell we want to know how Karen defines her difficulties we also want to assess her mental state looking at her mood, her affect behaviour she'll be used to this because she would have been through this all the time in the inpatient unit we want to look at risk factors too and I think given her background she's going to be assessing for trauma symptoms along the way too then I would be looking at the biopsychosocial factors that would then be relevant across these four domains for a psychological formulation so predisposing factors that what are they that might have rendered her vulnerable to the illness in the first place like is there a family history of mental illness what about a previous volatile relationship it's possible she's a survivor of childhood sexual abuse but we think the precipitating factor in this case was the sexual assault but was there something else I mean it was a violent assault it might be the trigger might have been someone walked past and didn't help that could be the thing that really got her so I think it's always worth checking and then of course what are the perpetuating factors that are maintaining any kind of dysfunctional symptoms at home so negative thoughts like I can't cope like I used to or avoidant behaviors like staying home all the time and then there might be more external factors like she's got the stress of a custody battle and then other things like you know it's a small town was the perpetrator well known well liked, well respected how's she going to be treated or believed if she tries to tell people her story but then flip side you know here's her protective factors what are they and they're most important in your formulation because they're often the foundation which you tailor your strategies upon for Karen so you'd be looking at things like her connection to her kids her previous resilience and her coping strategies intelligence and then her more external support like mum, her peer support worker other support workers around her and you know some friends in the community too now just randomly I googled Pitsworth and it says when you live in Pitsworth you very quickly become a part of a community of warm and passionate people so given that description of Pitsworth I'm going to assume that some negative social evaluation isn't going to happen for Karen look as far as treatment goes I'll let me not skip ahead here you do have to consider how many sessions you've got do you have 10 sessions with the Medicare Better Access Scheme or has she accessed more through a victim service program so it's sad but true that you kind of negotiate around how much time you have with someone and that's where the collaboration can be very important too you can hand over some of your work but look I'd be firstly validating Karen's response it's not her fault she was assaulted it's not her fault she became sick and it's a thousand million times harder to manage your regular life roles when you're in recovery as well you know it's a hard enough job being a mother you know especially a mother of boys they're so active so look psychoeducation is really vital like sometimes even explaining a client's diagnosis can just be really therapeutic in itself and open up a whole conversation and I mean by the time she gets to me hopefully she has a good understanding of her diagnosis but you can never assume that it's worth checking and how she understands it and she might have some disagreements and perhaps you might want to involve some family members in this conversation too this is the tip of the iceberg you know 200 psychologists online probably going I wouldn't do that I'd do something else but this is my kind of idea usually I'd be practicing some CBT or acceptance commitment therapy and mindfulness skills for symptom management and stress tolerance in depression it depends on the person on the strategies that you use really be targeting the negative automatic thoughts because they can perpetuate an anxious mood state as well as a depressive presentation so I might use some strategies like some cognitive diffusion techniques from ACT or using Karen's identified strengths to help start chip away at some of these cracks and her negative perceptions start to gently challenge those they can be quite effective look and there's more functional things with depression too like your motivation daily routine, sleep so you want to address all of those things too and we could be as a whole webinar in itself I won't go into detail there I guess on my next slide I think I've indicated the Maastricht approach again I don't have time to go into that but just on the off chance that her auditory hallucinations are still present the Maastricht approach is awesome it's a technique that interprets voices as having a relevant meaning to an event that's happened in someone's life or events and created by people who hear voices so it's very effective particularly for people who have had a negative relationship with their voices moving on from that values work I really like values work as part of acceptance commitment therapy that would be addressing with Karen what are her core values in how she'd like to live her life and then talk about the negative thoughts and negative beliefs and behaviors that maybe they're helping her cope in the short term but they might be getting in the way of her values in the long term for example she might have been really active in her community but in the short term she might be avoidant of any kind of social contact for fear of that negative social evaluation which is not going to happen in the woman embracing the pitsworth but maybe in another small town parenting here is most likely to crop up in the conversation and I would definitely try and incorporate some of the ideas from the Let's Talk program you're limited really in private practice I've tried and I'm still trying very bloody hard actually to try and get Let's Talk to happen in private practice and it's difficult because of the limitation in sessions but certainly the concepts around strengths and how to talk to her kids about maybe what's happened or she might have done that already but maybe how she's feeling now why she wants to sleep why she doesn't want to face the other parents at school things like that so also speaking of moms what's her perception of her support from her mother like you know has Jan been helpful has she been not helpful enough has she been a bit paternalistic maybe you know so just kind of clarifying how she perceives how Karen perceives the support she's getting and then of course you know is Jan herself being cared for by a carer support service depends on the size of the town as to whether those resources are available to you so look I've just written a bit of a list of people who might be involved and read through it and then technical oversight has actually fallen off the overhead before I sent it off and I apologise but the peer support worker has disappeared off my list here but actually in my experience peer support workers have been subsumed by you know located within a mental health support service and the NGOs like the Psychosocial Rehab Service so certainly wouldn't be discounting collaborating with a peer support worker because that's probably the one that you know maybe one of the people who's having more and someone brought up just I noticed on the comments earlier someone brought up legal support for when she goes through court and of course we know that stress you know increases your chance of relapse and so look it's probably beyond the scope of this conversation maybe but collaborating with their legal team I haven't put it on the list but I think it would be quite important you know I don't know who would do it but I did suggest you know in some areas there's the women's court support service I know this one in the Valley I'm not sure if it's specific to here anyway so something else to consider in terms of collaboration and look finally to collaborate or not to collaborate it's all good in theory and really there's no bad sides to collaborating in itself it's just the practicality of the time that it takes especially in private practice and especially if you're quite isolated in private practice and you're not working with the GP who referred her or you're not working with other psychologists who know the case for instance so look in terms of the benefits there's certainly benefits to being clear about what everybody's doing so then you don't duplicate tasks but also Karen needs to be clear about who's doing what and then what you learn from your other practitioners involved that informs my treatment so I get a cross-section of pretty good accurate information which then takes the guesswork out of my formulation and then I can incorporate that into the treatment strategy for Karen's depression too and of course all the way through therapy like are we hitting the marker we bit off the mark how are you feeling if you're depressed as ever what are we doing wrong it's always kind of checking in there too and checking in with the other workers about look there's something else going on that I'm missing I'm not really sure Karen still feels a bit the same and look as far as the challenges there's a real demand for services particularly in a regional area there's demand for services although they don't exist but sometimes you can't get your client into a service to then have difficulties collaborating with them confidentiality of course is a huge issue so they might be assigned a worker from a women's support service and it might be their neighbour so it's really difficult you can't guarantee confidentiality really and personally I find that nothing's sacred when you've got school aged children because your worlds collide all over the place so look time to communicate with each other is a huge challenge as well and even travelling the country miles to get to case meetings practically it's impossible often in private practice so keeping up to speed with other people's treatments and making sure that you're all still on the same page we're all still working towards the same goal it's still Karen's goal practically speaking it can just be really difficult so look there you have it that's assessment, treatment, collaboration or 101 in the short short version but essentially I'd see my role as helping Karen achieve her personal recovery goals by treating her depression but collaboration with everybody else helps to inform my treatment to give me a more complete picture to be able to do this thanks Vicki Thank you Lisa and thank you all for such a comprehensive coverage of Karen's family situation there's been some very animated postings on the general chat and we'll come back to some issues raised in that in a little while I'd like to move now on to some questions the panellists have of each other and I believe you have a question Amanda that you would like to put to the panel generally Yes thanks Vicki I'd like to ask the panel whose responsibility and who will assist Karen to speak with her mother and also her children about her situation and about her recovery and when would this happen so who might be best to start that off I can jump in there if you'd like Great thank you I think as soon as possible that discussion needs to happen and certainly I imagine part of it would have started because both Jan and Tom have been involved in Karen being able to access help in the first instance and I would be looking for any opportunity to normalise the fact that family conversations and discussions between the people that support her are critical to supporting Karen so discussions with Karen about that being a well known aspect of good care for her and seeking her support and consent around that is part of that conversation but nevertheless Jan as the carer of her children while she's in hospital for instance and Tom assisting that clearly have a need for information that goes beyond just the role of caring that they have they need to be able to be on the same page in terms of Karen's situation so the inpatient setting definitely would be one where you would be wanting to promote those discussions with mum together with Karen at times perhaps separately so that questions can be explored in depth as they wish and then in relation to her children I think they'll be most of the panel would be very much talking about preparation for that what Jan and Tom can talk to the children about at home what Karen can send messages home about to the children and her getting ready to explain to the kids why she's in hospital and how she is feeling and how she's being helped to get home as soon as possible and then when she leaves hospital as Lisa's mentioned far more of that conversation can continue it's an absolutely essential part of stopping the silence from taking control and lessening everybody's ability to connect Thanks Angela Just leading on from that Mary could I just ask you are there particular issues to think about given the difference in ages of the three children in talking to them as Amanda has asked about their mum so we have an 18 year old and 8 year old and a 5 year old Yeah I think it is really important to consider the developmental stage and clearly you know the 19 year old Tom is really a young adult and quite capable of taking on a lot of a lot of the adult language about various things that are happening with the younger children again you're looking at different stages of being able to understand but the really good starting point is really looking at what the children may have noticed and what language may already exist within the family and talking about those things you know I think about the little 5 year old that has been required she hasn't been doing some of the things she's been normally doing and sometimes it's really a lot of it comes back to the parent trying to establish what language they would or how they would like their child to understand what's happening it's not necessary to use technical terms what's important is that children have a sense that their parent has been unwell or they may choose to use a different word the parent is getting treatment and that thing will improve and that's probably one of the really critical things with the younger ones Okay thanks Mary Angela you had a couple of questions one of them was for Lisa would you like to pose that question to Lisa? I was wondering and Lisa's referred to this already if you've actually seen Karen in private practice before she'd been admitted to the inpatient unit what sort of opportunities do you see you might have been able to have as her primary care worker in liaising with the inpatient team things that you might have been able to do even from a distance that might have facilitated the recovery process while she was in there To be honest once someone is on the inpatient unit I've tended to have a bit less to do with them and a little bit more to do with people when they're discharged and they've got that kind of short term case management but I think certainly if I've been involved in the referral to the inpatient unit then I want to make really sure that they're taking bloody good care of my client so I guess the first thing is I'd be giving them a treatment history with Karen's consent of course and especially regarding like pre-morbid function like so looking at her strengths what does she do really well before we know this woman can get back to this really amazing level of confidence with her kids hopefully it's a bump in the road can give them an indication from the sessions that I've had with her about what I know should be important to Karen most likely this is going to be her kids and encouraging probably hoping to encourage that make sure her kids can visit make sure there's a conversation about you know what's happening to mum and normalising it a bit your mum's been through a really hard time and sometimes people go you know they shut down a bit you know they can't be normal mum for a little while because they're just coping with a lot of stuff and that is that's fine it's not forever you know it has to start a middle and an end hopefully for most people and I reckon I'd also be letting them know about the concerns about the custody battle because that's probably going to be something I don't want to mind in the background too little on recovery and the kids and all of that too but you know that I think it's in a case study about if she worried about oh no you know they're going to think I'm crazy how's that going to impact on my custody so really kind of making sure that there's a focus on her strengths in the inpatient unit and that that's something that's worked on I think yeah whether they've got time to do that I don't ever think I'm not even sure if there's a psychologist in our inpatient unit here in Vega I don't actually think there is hoping for the psych nurses to pull their weight there Thanks Lisa and did you have a question for the panel generally another question I just thought it would be useful perhaps to explore people's understanding of the difference between the traditional notions of recovery and traditional practice and one that's informed by personal recovery yeah great idea maybe Amanda you could start that off I think we're at at risk of colonizing this whole word recovery because of the misunderstandings around it we're referring to personal recovery not clinical recovery and I think you know we've got to be careful not to replace rehabilitation with recovery and that's what we're experiencing in lots of different contexts so for a person in recovery it's an ongoing journey it's about educating it's about growing and learning and I think if professionals can be mindful of that then that will be most helpful especially in the language we use the way in which we explain that to a person thank you do you have anything to add to that no I reckon Amanda summed it up beautifully I think a clinical recovery as far as I'm concerned doesn't differ too much from personal recovery it comes down to function and if a person feels like they're functioning to a level that they're happy with in their life I'm happy with that I've worked a lot with people in the past who have been hearing voices all the time and managed to work and get on with their life especially if their voice is a good one who wants to get rid of that one okay thank you there are some questions on our Lisa you had a question sorry also for the panel generally I think that might have been answered by Mary just about the most appropriate information for different levels of children I'm an adult psychologist I'm a bit confused about kids so I'd be probably wanting to collaborate or get a second opinion but I think that's also where the let's talk stuff comes in really well too like okay Karen let's talk to your 5 year old how much do you think they would how much do you think they could take in and if Karen's unsure then I'd be wanting to get some help from someone else about how to guide her with that can I just add something there just in terms of because I think it is often quite tricky and just to highlight there's a whole lot of information on CODME website that's focused on particular age groups and how to communicate with them and what is helpful ways of explaining so there's sort of a good guide for people who might want a little bit more information about that thank you very much yes fantastic resources on that website there are some questions from participants that we have one talked about support for and it's been covered a little bit but maybe there's something extra that could be added support for Karen's mother and Karen's children we've talked about groups for children what about Jan her mum in particular what sort of support do you think she might need and where might that be available for her Ange would you like to start that out yes I this of course will be different according to states and cities resources but there are a variety of CARA support programs everything from commonwealth funded CARA links programs that provide funding for respite through to agencies such as a RAFME or MIND where and in Victoria Victoria specific counseling services for CARAs as well so that if there are issues that are separate from their involvement with their family member for the CARA themselves they can access counseling so there are there are resources available but they will vary very much from town to town and country to country and accessing a more general peak to see what is available in the local area would be fairly important and often run they often run CARA support groups of different sorts either activity based or ones that provide specific courses in things like managing difficult behaviours right to psychoeducation in itself dual diagnosis they're usually available if you do a bit of googling Thanks Angela I understand that in Australia at least 40,000 grandparents caring for their grandchildren so it's an enormous number that's increasing in this country and elsewhere I just wanted to add along Sure Having worked with the CARA consultant I think that often it's worth following up to see whether that CARA consultant can make some contact with Jan would be useful as well and that can often be the first sort of call for that contact which I think we all agree at the earlier that support can be offered not just to Karen but also to Jan I think it's really important and following up with the CARA consultant either in the inpatient unit or some are out in community services as well as helpful I guess maintaining her health and well-being is very important given her role in the family someone has actually if Jan wasn't around what opportunities are there for care of the children what sort of community or other opportunities are there for the children to be looked after I mean would foster care be an option maybe more distant family members so I guess that's quite a dilemma for people working with this particular family if Jan wasn't around would Tom be expected to have a caring role any panel member can jump into that one I think you can comment if you like it's a question with the 19-year-old may be capable of looking after quite a big ask but I think the only other alternative is looking at crisis care services child safety unless there is extended family that can be contacted who are in a position to assist it's very problematic because you risk the children being separated from one another as well yes and it adds another layer of challenge for a family and that's where it's really important one of the things that's strongly advocated is parents particularly if they have a history of becoming recurrently on well and needing hospitalisation is that they actually be actively involved when they're well in establishing a plan of what would be appropriate care for their children and the event of them coming into hospital and sometimes it may be a well you know neighbour who's quite involved with the family who provides that support but it also gives parents when the family support plan is completed it also gives information about the likes, dislikes the extracurricular activities and other things that might help create a little bit more sense of continuity or stability for the children so they're not completely disconnected from their usual life lifestyle I guess that forward planning has various terms for advanced care planning and that sort of language is potentially supported for a family if things become a bit unsteady thank you Mary look earlier on there was discussion about the compartmentalisation of services and dilemmas that poses particularly say adult mental health and child and adolescent mental health given you're there right now Mary there's something you'd care to say about that because it came through in quite a few posts as being quite a dilemma can't hear you Mary oops, I forgot to unmute but it is a very big dilemma we have many services that are either child focused or adult focused and unfortunately it's often difficult for people to bridge that gap in meeting if they're identified client as a parent how do you meet the needs of the children and the other way around and it's not I mean that's a particular issue with the adult services and child and youth mental health services because in fact they're not the same clients often accessing these two different services so I think one of the really important things is sometimes a little bit of information can go a long way and that's why I think the Cotney website direct people to parents to a whole range of resources thinking creatively about how they might be able to access additional support but I think it really is an important issue because unfortunately the alternative is that intervention comes for these children and young people quite late when difficulties become entrenched and if you wait for them to present your child mental health and focus service often there's a whole lot of opportunities for intervention that they missed Yeah that community based family support type and other kind of community based agencies yeah we're running out of time I can see so could I go back to you Amanda and ask if you'd like to just have any final comments and observations about the webinar we've enjoyed this evening Yes thank you Vicky I think it's really important that as professionals we reflect on our own practice and how we can look at ways at including family more that whole family approach I think as a person with lived experience of recovery what's been extremely problematic for me on my journey has been that silo effect where there was those services there for my family there were services there for my children services there for me but the fact that they weren't all talking to one another they did have a big impact on my family and my recovery so I can only urge that we have more of these discussions in the future and really as each individual practitioner we reflect on how we can be doing that more thanks Vicky Thank you Angela Final thoughts and ideas from you I might just pick up Amanda's because it's a topic close to my heart and that is the concept that somebody who works with adults only works with an individual I think is a concept that needs to be put in a coffin it's probably now far more reflected even in Victoria recently with the changes to the mental health act where there are at least three principles that underpin the concept that other people involved in the life of a consumer with a mental illness including the needs of their children need to be taken into account and so the challenge is there, the resources are there, the training is there I really think we're well beyond the hidden children staying hidden and the parents being silenced by fear of judgment I think time for us to all step up have those conversations that are family inclusive and peer and lived experience informed Well we're moving slowly in that direction Can I jump in next there Vicky? Yes of course Angela has just been still panicking me thinking oh shit however I haven't got time to talk to everybody in ten sessions with the Medicare system so I'm just going to reiterate the importance of collaboration there and make sure I'm doing a wonderful job of talking to everybody else who's involved to make sure that what I might pick up is being the kids interests being addressed through the more appropriate kind of family support services and things like that in the area but Amanda said something earlier on too about inspiring hope which she sees as an important part in her role and I think it needs to be an important part in all our roles which sometimes you might forget it in your day as kind of client after client or something like that but remembering that you might have the client sort of in your mind a lot on your work day but they come in once a fortnight and you're all about them so you've got to be really present there and remember what do they want to do they want to get through this and they want to get back to their normal life and the reason they're getting support is that it's hard to do it on your own and they need to know that everybody around them believes in them that they can do it therefore I'll see what I can do with that 10 sessions the word hope comes out and in material I've read about the personal recovery pathway hope is one of the key elements yeah thanks Lisa Mary do you have any final closing thoughts that you'd like to add here I think if the awareness builds up of the benefits of the family focus practice both for the parent and the children I think that's a really important thing and people take the opportunities because I think it is very difficult it's difficult to get the funding and the adequate resources but if people working in this area consider how they might link people or might be able to do a little bit of the work themselves that can go a very long way and the child's development and the family's function thank you we do have a few minutes left and we've got a few questions but I think I'll just sum up what has come through for this evening obviously collaboration is incredibly important but achieving that in some settings in some locations is very difficult partly time, partly constraints of working under better access arrangements and the allocated appointments that go with that and the limitations of working outside metropolitan areas something that did come up was balancing the needs of parents and children the parent is the client in this case but the children have needs the grandmother has their needs how does one juggle all of that especially if you're working with limited resources we've talked about the compartmentalizing the need for working with the whole family but also somehow identifying needs and issues for each family member we have at least five people here the grandmother, the mother and her three children they all have different one could say developmental needs individual needs educational needs and that's an enormous enormous workload if you look at it in terms of assessment and treatment and intervention the fear that parents have of their children being taken away has been long discussed and is still very pervasive for many parents another issue that I've been studying myself recently is grandparents we actually use the word the children not being hidden anymore grandparents are kind of quite a hidden population still and they don't identify themselves for many reasons such as maybe embarrassment or guilt that their grandchildren have to come and live with them cultural reasons why grandparents care for their grandchildren so what is there to kind of talk about it's something that we do it's part of our culture so that's we've found another hidden population if you like almost so I think that and yeah especially balancing the needs of parents and children I've just noticed another little note I made about when a parent's in hospital and the need to help the parent on the pathway to recovery while supporting the children having appropriate access to parents seeing the parent mother or daddy how do you manage that many many complicated aspects to consider we're going to finish a minute or two early but that's what we're going to do so thank you all too we've got 240 people online still thank you all very much for your very energetic and lively contributions to the general chat there are questions we haven't answered but hopefully the discussion will continue do go to the Kotli website there's masses of material available from that website there's free e-learning materials available accompanying this webinar there have been lots of resources available to you so please make sure that you access those as well it's been a pleasure to facilitate this evening thank you all very much and good evening