 Good evening everybody and welcome to tonight's MHPN webinar self-care how to be a sustainable practitioner. Tonight we have a great panel joining us to have this really important discussion which I think Bill all agrees is really relevant and pertinent for all of us at the moment. So I'm your facilitator for this evening. My name is Nicola Pulfry. I'm a clinical psychologist based in Canberra and I'm excited to share with you our wonderful panel Dr. Roger Sexton and Hugh Kearns. But before we begin I wanted to welcome all of you that are joining us. We've got 850 and climbing participants which is wonderful given how much everybody has on at the moment. But first of all I want to importantly to acknowledge the traditional custodians and the lands of the lands on which we're all joining tonight. I would like to pay my respects to the elders of the none of all land from which I'm joining in Canberra to pay my respects to elders past present and emerging and welcome you all from the lands that you are joining us on tonight across Australia. So first of all I want to introduce introduce our panel to you so we can get into this. We've had the bios distributed so we're not going to go through the long bios because they take up precious time from the good content we've got tonight and also they're hard to listen to sometimes when you're the the panelist so I'm going to go straight into it and introduce you to Dr. Roger Sexton. Roger is a general practitioner but as many other strings to his bow and order work in this important area and Roger has provided us with a workbook that you all hopefully have had a chance to have a look at or if not you at least have access to. So welcome Roger nice to see you here tonight. I was wondering if you could kick us off tonight by telling us a little bit about the resource and how you think it may be useful for people joining us tonight. Yeah thanks very glad and welcome everybody great to have you here tonight and great to be here as well thank you for giving up your night for tonight. It's really about you tonight and the purpose of tonight is ready to reflect on ourselves and in fact we want you to be the case study for tonight. Your own silk will be the case study. We've hope you've had the opportunity to download the workbook and complete parts or as much of it as you'd like so if you haven't downloaded it maybe if you can do that now if you have a printer it'd be good to use it with the webinar otherwise you can do so later on and when you work through the reflective questions and exercises in the workbook in your own time. So the workbook is really yours to consider and reflect upon and ask you a series of questions which really ask you to I think try and put together those aspects of your life and to see how sustainable you may be. I'll talk about this a little bit later on but it's really a concept I think and a very simple visual that allows you to identify deficiencies and areas where perhaps you may be a bit unsustainable. So I think the workbook is there for you to use in your own way. It's a bit diagrammatic and there's questions and exercises through it but hope you find it useful and it's a reflective tool during and after the webinar. Fantastic thank you Roger. Yeah I think it's interesting we need to kind of use these tools that we often get our clients, patients, other people that we work with to do so we need to do it for ourselves so thank you. I look forward to you unpacking it a little bit with us tonight and I also want to welcome Hugh Kerns who's an educator and researcher joining us this evening. Welcome Hugh. Hello. Hi nice to see you. Just a quick opening from you Hugh. There's lots of different areas from our conversations that you've worked in. I was wondering what has drawn you into into this space around and self-care and sustainability for practitioners. Yeah well first of all hello to everybody who's here and just Roger and I are both here in Adelaide and just acknowledge that we were on the traditional lands of the Garner Aboriginal people here in Adelaide and yeah it's interesting why we do it. I suppose I've always been really intrigued the idea of why don't people do what they say they would like to do. You know that people know what they should do but they don't do it and that's an intriguing thing and I was always interested in why that's the case and self-care is really good of them. Most people know what they should do but don't end up doing it so I was intrigued by that and in particular the psychology of what makes that difficult and hard and so that's why I suppose I like working in that area because it's a very obvious one. People are very aware of it but still don't do it and so we'll talk a little bit about that later on. Fantastic thank you. It's a lesson for all of us why don't we follow our own advice. So the learning objectives I've got them for you there. We don't need to kind of read them out for you. It's really about how we manage our work and our work later professional and our personal lives and as Roger has outlined he's got a great framework for us to look at and use maybe to frame putting some conscious effort into this tonight. So I'm going to suggest without further ado I'm going to hand over to you Roger and you can direct me as we move through your slides give me a nod or next one please and over to you thank you Roger. That's great. So thanks. So this and I'm a visual person I like colours pictures and I think a picture tells a thousand words and this is a case where I think we're all aware of aspects of our lives that are we're trying to integrate a lot of things together to remain effective and very productive and it's nice to have a model to put this together. So really what this webinar is trying to do is introduce you to perhaps a new way of thinking about your sustainability as a mentally old practitioner over time. So by sustainability what I mean by that is personal and professional productivity and longevity. So more colloquially this is basically sticking around for a long time and doing great stuff and the model brings aspects of your life together in a sort of simple visual and it's just a way of highlighting also the missing bits the bits where you think they are deficient and that is maybe one reason why I'm struggling in a way. So your feedback on this would be very useful as we go through. So just the next slide. So there are four pillars if you like these pillars are interdependent the ingredients that contribute to growth and productivity over time we find that this underpins sustainability they're interrelated and they're interdependent and unsustainable individuals tend to often focus overly on one or more of these or not focus it all on some or all of them and remember as we go through this your workbook think about your own situation think of yourself as the case study tonight and what I'll be talking about in terms of this but when we look at this diagram we start with the inputs we start with what we need to get going and this of course are our inputs resources that we carry with us from preconception right through to each phase of our personal and professional life so you think of your genetics think of parenting think of your nutrition over your lifetime think of your personality traits for example your education as an input your post-grad training your life experiences as an input which you bring into your life and work wisdom these are the sort of things that going there's many many inputs for the easiest examples of those then we then how are we going to organize ourselves to put these resources to best use so for that we need an operating manual our own personal operating manual how we do things our motives operandi if you like our habits the choices we make about how we manage things and in this respect think about your own health how you manage your costs how you manage your stress how you manage your time something you'll be speaking about a lot later what are your lifestyle habits like how do you run your family life at home how do you manage your money these are all the things that you normally have in your operating manual that should optimize the resources that you bring forward in life and then what our rule book and our operating manual will help us to do and create is of course is our outputs what we do what we create what we do what we produce and how we behave our behavior is an output very important output and this of course is personal both personal and professional then finally how how do we know we're succeeding and doing things that are appreciated that are needed that are relevant that have impact and this of course is feedback if you like a form of performance appraisal and of course external feedback is very valuable internal feedback that little voice inside a head that sometimes overrides everything is is where there's often a lack of balance in unsustainable people and of course feedback then becomes a critical input and perpetuates the cycle this is the self-sustaining cycle which allows us to remain sustainable doing great stuff over a long period of time next slide so critical input for for us is what motivates us there are lots of these you'll recognize some of these no doubt in the least things that motivated you to to enter your career as it currently stands but next slide over time the motivators can change throughout a working life away from the sort of altruistic towards more financial domestic security and if you're like working on the business side of things the next slide another important input is what we need and needs needs are highly motivating and there's a number of these i'm sure you're familiar with all of them there's the existence needs the basics of hydration nutrition that needs that are commonly neglect by unsustainable medical health practitioners who may come to work or particularly dehydrated underfield or overfield or suboptimally fed lacking sunlight and vitamin d lacking adequate exercise to feel well and a bit sleep deprived these are existence needs that are so such important inputs into our into our lives next slide we also need we have existential needs you're very familiar with these are many variations of these but these are four that I find are very important in in professional life certainly having someone to love it somebody loves you having hope a sense of something to look forward to a meaning a sense of purpose a reason to get out of bed in the morning to principally help others in in a case and control that is choice and autonomy so they have very important needs that are often lacking in unsustainable people next slide and mclellan you'll recall is a psychologist american psychologist in the 60s who postulated and he's acquired needs theory these are needs that emerge over our working lives and require combinations of some of all of these does a need for achievement people are drawn to say business startups projects enjoying really good clinical success research outcomes academic goals that sort of thing and next is our need for affiliation with people this is reflected in a choice of clinical work working teams or committees and that sort of thing and 30 power over others this is for people who like being managers bosses writing policies the regulators business owners the CEO type of people who like power over others and power through others are those of us who mentor who teach have a philanthropic view but these are all needs that are required they're very important inputs into into our toolkit of resources that we bring into our lives the next slide another really important input is our personality traits again you're very important that you're with a several dozen of these but there's three that seem to crop up very often in my concept with medical and health professionals and they had there are a double-edged sword they with the obsessional health professional often you know very far over very caring fear of making a mistake but with that hand in hand goes a propensity to anxiety and becoming quickly overburden burnout particularly the avoidant help mental health practitioner often can't say no we quickly build up a very loyal and long following and really hard to get rid of patients like that once they once you've completed treatment so very easily kind of come over burden to make a home at night and self-medicate with alcohol or benzodiazepines to sort of you know relieve them over the burden of the day and dependent mental health practitioners you know often really enjoy hearing the stories of other people sharing bits of their own lives and often develop quite close relationships with with people sometimes the point where it can become overwhelming and a depression a depressing and also the propensity to the circle boundary violations that you're familiar with so these are things that we bring into our into our into our toolkit next slide also we're a source of energy to our patients so how we energize ourselves is a critical input and you need to have ways of recharging yourself during the day so it's worth thinking about reflecting in your workbook how do you remain energetic so you can give the last patient the day exactly the same level of care as the first patient so is your consulting room energizing and uplifting or does it have depressing dated interior decor dying plants and no fresh air and no access to water so think about how you energize yourself in ways other than maybe drinking coffee the next slide so let's look now at the next pillar this is your operating manual this is how we do things your rulebook for how you live your life this includes your lifestyle chores it's next next slide all of these things are important it's incredible how you know a number of mental health practitioners neglect these and expect to to keep going often with huge work loads so coming to work sleep deprived as I said vitamin D deficient aerobically unfit dehydrated and malnourished is is not uncommon in busy health professionals next slide how do you manage your time he'll speak to this an expert next slide how do you manage your working week how interesting is this how some people work in a ridiculous way um you know do you control how many patients you see or you're under the control of your receptions is your working week interesting is a full of variety do you remain seated most of the week in the same room seeing people these are sort of ways that we can control how we work this is the rulebook of how we work in our lives next manage next next slide in stress management you know how do you manage this yourself I want this is obviously a huge subject and you know all about it but I just asked that question do you recognize when you are under stress how do you recognize that what are symptoms do you experience and what do others notice when you're under stress what what do you what do what would they say about you that indicates you're under stress so feedback about this is a critical pillar instead of someone saying Lord I think I'm just tired and a bit overworked others may observe you thinking you're clearly depressed and burnt out and so this external feedback is so important next slide and next slide again the other thing is how we manage our burden what I mean by burden is what we choose to carry around with us the bricks represent our unsolved or unresolved problems and responsibilities generally others have placed there or that we choose to place there ourselves and take on so as such the burden is not an app this is this is a process of how we choose to work we choose to take on other people's problems now how we deal with them is also another operating manual chapter I suppose but really we often see mental health practitioners who are carrying an enormous burden and examples of that burden are on the slide they may be studying have an academic burden there may be a tremendous flotilla of difficult patients who are very demanding a very worrying suicidal and a whole range of things we all know about patients like that we're only takes one of those to make life very difficult we may be carrying the burden of a complaint which we often take very personally and the burden of failure clinical failure particularly the burden of fatigue and how we manage that how do you manage fatigue there may also be debt related business etc the burden of success is an interesting one too where some people are so involved in things and they cannot extricate themselves from chairmen ships of this committee membership of that commitments often they may have found it very very difficult so just think about your own burden what you're carrying and and and everyone's very keen to dump their bricks into your barrel because you know it relieves their bird but it's whether you're prepared how much you're prepared to take on is how you run your life part of your operating manual next slide another most interesting year I see often is very poor for natural management how we manage our money again in the loop and operating manuals how we manage our money or do we get good advice do we spend everything and try and save later do we make poor investment choices do we take business risks these are critical things next slide how we manage crises again extraordinary how some health professionals have a sense of immunity to illness potentially mental illness too we treat it we don't get it not planning for emergencies at home or at work often practice is not planning for acute work for shortages and having to cover absent absence of others and key person risk a lack of income disability insurance most interesting how some health professions don't have that they think they'll never get it all and so next slide if you just imagine if this happens to you tomorrow if you came to you know an accident or full-on of also a vehicle accident if you are unable to work for six months would you be prepared for that it's should be in your operating manual what you would do if you had a crisis like this next slide now we're looking at your outputs next slide again these can be of course these are things we do in our personal lives in our professional lives and particularly how we behave and our personal roles are many i've only listed a few there but generally speaking work can sometimes squeeze these out so you may find your role as a wife as a mother as a sister as a as a daughter are being pushed aside by other things and certainly life is richer when you're able to fulfill these other personal roles these are an important output as an individual you have these personal roles and you fulfill his is a very important output next slide and then we have our professional outputs it's not uncommon for many of us to have roles across all of these areas we have our clinical work of course we have a research a research commitment for some of us you may be teaching you may be running a business and involving the ministry side you may have an academic commitment you may work for your college and it's not unusual for people to to basically say that you know they love research they love teaching but their um life is occupied by administration the whole day is full of paperwork and admin so they're really you know their outputs are in the wrong area next slide and of course our behaviors are now how do you behave when you're unwell how did your behavior contribute to the positive culture in the workplace and do you behave differently when you get home if so why why is that do you let them have it when you get home or uh are you really super nice at work and then you behave quite different when you get home these are things that are very important next slide because with some people you just don't know this is a Harold Shipman he's a GP in the UK who basically he killed 250 of his patients love you guy much loved and revered and appreciated he had this nasty habit of bumping off the old people in his practice and you just often can't tell with people how they're going and uh you know we may put up a uh a nice facade only to find that underneath we're dealing and struggling with things now the fourth pillar next slide this is the critical one this is the pillar of the poem which many unsustainable people have the least focus so the question here is where and from whom do you source feedback in your own case next slide this may be a GP very important feedback source for you in terms of your mental and physical health this is around your age appropriate health screening your risk risk profiling for cardiovascular disease cancer diabetes even cognitive risk and of course GPs are well equipped with recall systems and a great advocate for you in the wider health system next slide your supports are also sorry next slide again supports are a great source of feedback who do you seek feedback from amongst your personal supports the people in your non-professional support who does give you honest truthful feedback and the same profession who gives you that honest truthful feedback patients give us feedback colleagues give us feedback our own family members give us feedback and it may come from unexpected sources next slide like these I mean your hairdresser can give you tremendous feedback about all sorts of things and often giving your diary to your partner and saying just have a look at my diary and tell me what you think what a great exercise that is you may be shocked what they tell you they say this is ridiculous it's unsustainable so often having someone look at your life and say just tell me what you think of how I'm going describe your working week to a colleague and just see what they say tremendous feedback so next slide I think where people are unsustainable and where mental health professionals for sure is generally their inputs are inadequate their operating manual is flawed or they don't adhere to it their outputs may be way too narrow focus on one thing and working unsustainably in one area or way too broad and too excessive and the feedback is either weak or they don't adhere to it next slide a common study the Mable study is a Melbourne Monash University study about doctors particularly doctors um health and well-being and and work-life balance and there's a very common um there's a curve here that shows that the people are least satisfied at age of 41 this is where people often feel as though they've got to make some dramatic change to their life either running off with the secretary or changing their career or or doing something like that making some sort of rash decisions because they feel like they can't go on they say I just can't keep doing this and what they're saying is I'm not sustainable in with what's currently happening so when we look at this again next slide the reasons are that the inputs have faded over time much like the trajectory of a cannonball next slide their operating manual is flawed and it just encourages auto combustion next slide their outputs uh probably have come at a price so at the end of the journey they've actually chewed up a lot of themselves to get to where they are and this is obviously it's very suboptimal and finally next slide feedback they either don't seek it or they don't heed it when they receive it so next slide I'll just again get you to reflect on the workbook and think up you know where are my inputs currently from are they adequate for what I want to do do I have um systems in place in my operating manual that really going to help me uh use those resources to to optimise what I do in my working in my professional personal life my outputs am I doing too much in one area am I trying to do too much across the whole range of views and feedback where do I actually get that from here or listen to here tells me that I'm going great or I'm not going well and I think this is what we hope you'll reflect on in the webinar today so Nicola I think I'll leave it at that thank you so much Roger um it's fascinating when I was introduced to this model I think there's a lot for um all of us to to take in and I encourage everybody to um yeah kind of let that soak in a little bit there's a lot of areas and I think some things will jump out of this and maybe some asterisks on things that we think we might want to come back to and spend a bit of time and I think the one that um I'm just uh has is resonating with me is the balance of work you know in each of our roles we can get drawn into different different pieces but which bits of us you know to Marie Kondo or whatever her name is like what brings us joy you know which bits of work really sustain us I think is an interesting thing to look at and how much of that is in the mix of the have to do's and so forth so there's a lot to impact there and we'll get into it but um Hugh I'm happy to hand over to you so um take it away thank you thanks Nicola and thanks Roger for that and that was a good overview of all the aspects and I suppose what the one that I'm going to particularly focus in on is the operational manual that's where you do things and in particular I'm going to be talking about time and how people manage that or don't manage it in some cases as well so so welcome along look um a lot of people said to me that they're bad at maths in fact in my experience many people are bad at counting now what makes me think that well I'll work with lots of people whether it's gb's or professionals or whatever and they'll say to me oh I only work part time or I get home at six o'clock every day whatever and I think you must have all this time off you must be spending all this time on other things but then when you talk to them further uh you find out that on those other days or in the evening they're doing all this other stuff all this other stuff they haven't told you about like catching up on reports in the evening or out of hours meetings or preparing for that meeting tomorrow that you worried about or checking emails during lunchtime or attending webinars like this late in the evening when you're doing something else all of these things are work well people don't count them and these are what I call the hidden hours so so I've come to the conclusion that people aren't very good at counting their real hours so I'm going to help you out now a bit I'm going to help you count and um what I'm going to do is going to introduce you to the magic number of time and the magic number is 168 and that's the number on the screen right there and that is the number of hours in a week and I'm going to give you a little image now that'll hopefully last with you for the rest of your life because uh this little plastic tube that I have here I mean you need to look at the picture of me or the video this little plastic tube represents one week in your life 168 hours and time is a great democracy it doesn't matter who you are whether you're a patient or a clinician or a finance or whatever we all get the same amount of time so when you look at other people and think they have more time than me no they don't they have the same amount but the difference between us here this evening are our commitments against the time and that's what the little balls represent I'm not going to go through them with you now and so let's say this one is your clinical work you know seeing your patients or your clients whatever and someone can be a happy one or a sad one depending on how the day is going uh the orange and let's say that's for administration and paperwork and bureaucracy and all the things you have to do in life there's a little brain in here so that's that's for keeping up to date and policies and procedures and education and things I'm even more generous there's a little heart in here so that could be for your family and friends and people you care about I'm even more generous there's a little sports ball in here that could be for activities walking or swimming or something like that and you need to look at me in the picture and this one at the end this one is things like lunchtime and sleep and all those other things so what happened is the tube is full with all those balls and then out of nowhere another new ball appears and this could be somebody giving it to you or sometimes you even go out and get them yourselves but you should know that when people give you opportunities they tell you lies and the first lie they always tell you is this won't take any time at all this will be really easy and the second lie they tell you is um we'll help once you say yes the help disappears and the ball goes into your tube along with all the other balls and they all squeeze up a little bit what you have to notice is they don't all squeeze up equally so the clinical work seeing the patient that doesn't get any less the paperwork that's probably got more now because you've taken on more things so the ones that do get squeezed up will be your education your pressure development your planning and your family and friends haven't seen them for a while and what you tell yourself is this is just a busy time when things settle down i'll spend more time with my friends or family or whatever interests while i used to go walking or swimming haven't done that for a long time must catch up and on that again when things settle down a little bit i've got bad news for you this is not a busy time this is your life it's always going to be like this i'll bet last week was like this the week before last year was like this it's always going to be busy it's one of the things for high achievers they just take on too many things so that's the first thing is you have to count how many balls are in the tube and i'll bet for most people it's just too many commitments so then what happens is people come to this workshop and they say i know what i'll do i'll take all the balls out of the tube i'm going to reorganize my life and you get up early in the morning and try and do your email before you get started and check your reports during lunchtime and you move them all around and that is going to work for about two days and then very quickly the laws of the universe reassert themselves 168 hours a week and just move things around if it doesn't really solve the problem if you're doing too many things doing different order doesn't particularly help so that's the first thing everyone has to do is just count how many balls are in the tube and again that's one of the exercise rod you would have there you don't think about all your commitments all the things you have to do however despite the tube being jammed full like that then out of nowhere comes this lovely new shiny ball and this is the nicest one you have ever seen it's where someone says we'd like to get involved in this research project would you like to take on the chairperson role of this new committee or something like that and you go oh look at that one it's the best one i've ever seen and then you start lying to yourself oh look i'm sure i could squeeze it in won't take that much time because of course the concern is if you let that one go there'll never be an opportunity like that again the problem for all of you is not lack of opportunities it's too many opportunities if you just close your eyes and let that one go about 10 minutes later there's another new shiny ball there's another project so the deal is if this is such a great opportunity which of these ones are you going to get rid of because it's not as well as it's either or you can't do it all that's the illusion i can do it all so that means yes i'll take on that role i'll join that group or do that extra thing but i will give up my family probably not a great choice i see that happening with professionals all the time work work work this is just a busy time i'll take that one on but i'll give up my health can't imagine nobody do that with it see that happening all the time people this is just a busy time so we don't do it by choice it just creeps up on you so the deal is if you're going to do this god give something else and that's when all of you are going to say but i can't give up any of those well then you can't do this it's not as well as it's either or and that leads us into the difficult situation of having to say no to shiny balls and i just have to explain to you from a psychology point of view why that's difficult and uh because because when somebody's there asking you to do something at that moment about 90% of your rational brain cells completely disappear and the only brain cells left are the ones that are saying if you say no something bad's going to happen and before you know what the word yes comes out of your mouth and then they go off really happy and about 20 minutes later your brain comes back and says why did you agree to that because too late then because now you got it and you try and talk as i've been to it so the strategy i suggest you learn is learning how not to say yes to things i give you an example i did what you need to buy yourself a little bit of time to think it's look look thanks for that um look i'll need to check my diary i'll call you back kind of get back to you a bit later and then you can look at options can i do it now maybe i don't want to do it i can do it not now but in next week i can do it or maybe i can do a part of it or i can delegate some part or maybe i'll say yes or no but at least then you're looking at reality rather than automatic have to do everything that comes along now uh this sounds really easy to say that but of course this is really hard when the persons they're looking at you because you have all these doubts and worries you know they'll never ask me again um they'll be so disappointed they'll be annoyed i'll miss out on something i really want to do this i should be doing it i have to do it all these doubts and worries and so that's when you need to buy yourself a little bit of time to think and look is this really true or is it accurate so so that's so that's one to set up but of course this is really hard in practice and i just want to get uh nicola to move on to the next slide there because you can say no but the problem then is your brain is still thinking about all the things you should be doing and you're not actually even enjoying the time off or the boundary and uh i like this i used to work with uh gps with roger and group and i remember talking to the partner of one of the gps once and she said our a said uh patients get the best and we get the rest well that means you're giving your best energy to people you don't know very well and then you come home late in the evening and you're lying on the sofa like a wet sock and your family sees the worst of you which is probably not the way we'd most of it wants to be so uh how do you switch off and especially all that guilt all the doubts and worries that are going around so we just have to talk about that and um so uh i'm just going to get you to uh move on to the next slide nicola there so i suppose some strategies for switching off or first of all it is almost impossible to switch off if you have 24 hours a day seven days a week news cycle and that's stuff coming along so switching off means switching off alerts alarms notifications and particularly at the moment it means going on a news diet you cannot be okay if you're constantly getting overwhelmed by all this bad news so you need to limit your taking on that next slide nicola is about boundaries and that's switching off and uh i suppose we're talking about two types of boundaries here uh one are time boundaries and place boundaries and time boundaries is a certain amount of time when am i going to stop not when i think i've done enough but it's going to be five o'clock or six o'clock not whenever i feel and place boundaries are where do you work and this is particularly hard for many people who are working from home at the moment because it's almost impossible to have the boundaries but you need to have a little place where work happens and it doesn't happen and if you're sitting on the sofa watching tv answering your emails you're not switching off next slide nicola uh and then other strategies are supposed to help get rid of the guilt the worries are as roger pointed out most of us are very sedentary so exercise is really good for your physically but it's also good for your mentally because when you're out there walking you're not thinking about the stuff behind you next slide nicola uh activities uh whatever you like to do whether it's running or creative writing or knitting or sleeping watching movies it doesn't really matter but anything rather than your mind going off into all the guilt i should be doing something else and so learning how to switch that off next slide and then other distractions are good ways our music music is great because it creates mood and when you make you feel good uh listen to instead of listening to the news listen to podcasts or audio books watching movies reading and i'm talking about reading books if you want something to wind down tonight to help you go to sleep put away your kindle your ipad and get out a book and read that because you won't get any notifications as you're going along um okay next slide the other one i think in terms of doing this is especially is noticing your early warning signs and these are the signs that are starting to get stressed and uh you'll all be familiar with road rage one of my early warning signs is furniture rage that means getting angry with the furniture you know you walk through the house and you bump into the table bloody table the table's fault it's just that i'm not paying attention some of you might have physical signs and they're really helpful like headaches or pains or increased appetite they're important in terms of i suppose feedback really and very common ones are shortness of temper or getting irritated or a loss of sense of humor you know they can irritate with small things now if you don't know what your early warning signs are here's a fun exercise for the evening ask your partner or family member or whatever and they will delight in taking out a big sheet of paper and making a big long list and you can do the same for them and you probably won't talk to each other for the rest of the evening after that next slide nicola uh so when you do notice your early warning signs then what do you do well first of all some time out you know go and boil the kettle walk around the house for a few minutes whatever it might be just a moment or two just to calm yourself down next slide this is going to be really good to have a support group someone you could talk to a friend or someone else you could talk and again next slide if you don't have someone to talk to writing it down helps it just gets it out of your head so you don't have to keep thinking about it and again that tool that roger shows is really helpful when you write all those things down you get a bit of picture of what the whole thing looks like so that helps now hopefully that might help but sometimes those thoughts are very very persistent they're hard to get rid of so next slide and i'm sure all of you uh next slide again um Nicola i'm sure all of you are familiar with the statistics now one in five people like to be experiencing mental health issue that means one of five more people here this evening as well and when you are not going so well of course the last thing you want to do is reach out you want to isolate yourself and not ask for help but next slide the good news is there is support but you have to ask for it and that's where having your friends and having mentors having supervisors or clinical supervisors the counseling services psychologist whatever it is really important and that's when things aren't going well not just tell other people to put doing it for yourself as well and the last one and next slide again last slide is it's important to look after yourself but i also think we have a big obligation to look after each other as well and that's our colleagues you know asking them how are you going when you see one of your colleagues isn't going so well just say how is it going for you are you okay because um the last thing i suppose i'm going to say is i started off by saying people can't count or don't count but remember the magic number i'm going to finish off by saying people do count you count all of us here this evening count you are important to look after your enough to look after yourself and finally it would be good if we could count on each other and that means when things are going well that you have someone to call on or actually support as well so i'm going to leave it there back to you Nicola thank you so much Hugh um it's a lot to to go into there um yeah um i feel like i said i said yes to a shiny bobble this week so i'm just sitting here thinking oh yes it resonates um so thank you very much um that was wonderful got guys i really um enjoyed listening to it and i'm just juggling questions and screens and things so you've got to forgive me if i'm looking looking down a little bit in working from home printing things out is not as easy as it is otherwise but we um you need to be congratulated because you stuck perfectly to time which is wonderful because it leaves us with time for questions so a couple of things to acknowledge we have a number of questions that have come through through registrants that i've got here and i'm going to group together in and fire them off at the panel we've also got questions so the q and a button is there for people to send through their questions keep the chat if you want to chat chat in the chat box but if you have some questions for either Hugh or Roger um please send them through i do want to just say there's a little tip that if you want to make that slide smaller and uh panelist bigger which is probably nicer for q and a there is an icon with two arrows inside it two arrows inside a circle um in the top right hand corner of your window so those of you at home might want to do that so we can see um Hugh and Roger while we fire some questions at them i'm going to start with um one that has come through and Hugh it might be a good one for you Andrew has asked he's a GP and he's heard his psychologist colleagues talk about clinical supervision um or professional supervision and he's just wondering if we could cover off what that is and what that may look like for a GP please yeah well look i again if anybody who's in a sort of a medical role or a caring role needs and i would advise them to have some supervision for for two reasons one for you know legal purposes to make sure you're giving good advice so that you're checking it out but also just to be able to debrief to talk about things to get out there because if you spend all day working with other people giving them advice and giving them all these things that's going to wear you out and and often you're going to take on things from the people you're working with as well and so you're sort of loading all this up and health professionals and medical professionals mental health professionals think i can take on all this stuff and it's not going to affect me and of course that's crazy really you you know well it's going to affect you you cannot expect to take on all these problems and and just be fine and so that means some way to unburden yourself as i said talking about it talking about with a colleague talking about a supervision or somebody like that and and in some fields you know in psychologists you are you're required to have some sort of clinical supervision or somebody you can go and talk to and that's also again it's helpful from a legal point of view but also just from your personal point of view to be able to unload and get it out there as well so i would encourage anybody who's going to be in that role a caring role or a providing role to get supervision from that in some way or other so that that's for anybody i think roger might more talk about from the gp sort of world but in my view and especially with mental health protection because it's such draining work emotional work and you need to be able to and people think you have to do that when you're under stress or when it's when it's got critical i think that needs to be part of routine part of what you do and as one of the things roger talked about where you get your feedback from so i'll hand over to roger on that on that for the gp side yeah that's a great question really is around i mean it gets back to i guess if i refer back to the model i mean supervision is a form of feedback it's external feedback absolutely critical remember you'll we've all got the little guy in our left shoulder saying telling us what we think is going wrong with us what we should be doing it's our internal feedback it's not useful it's often critical overly critical and too narrow so we must seek external feedback from somebody and a supervision of any sort is appropriate for any age through from student years right through to pre-retirement we can all benefit from that so that feedback becomes a very important input and then the input of course translates into our operating manual so that the supervisor can say i'm just going to watch you working today and what they'll observe is how you work in other words where you work why you work you know how you arrange your day how you arrange your appointment system how you manage your patients uh so if you're for example very avoidant and you uh you've had great difficulty saying no to patient requests and or you may be very a dependent personality type you really enjoy as people both of those things may mean you you become very very thorough and you take longer than you booked so you may run over time for example isn't example so you're running over time one patient and then you run over time with a second one and your supervisors they're watching thinking why why is this happening and they might say to you it's obvious you're spending too much time with each patient and you're so like i you know they need my advice i really enjoy i really enjoy working with people uh so someone externally can say but you're running over time all the time you've got no time to write your case notes thoroughly so you clearly the way you're working you're operating man you're telling you that you're giving us all permission to run over time so that's a flaw in the way you work which may suit your personality type but it's making life more difficult at work and the other thing they may do is look at your outputs they might think look you know having someone look at your working week and sit down and watching how you work and how much you're doing what roles you're taking on and say look you know the way you're working it's just it's incredible but it's just ridiculous it's ridiculous and you're doing way too much i really admire what you're doing but it's not sustainable you see so that that supervision can be really wonderful external feedback in those four pillars that you have to look at and set something you may not see yourself thank you both Hugh and Roger um just a quick note yes you will get the slides um everybody who's asking um the slides will be available as well as the the workbook and so forth one of the things that's coming through in the chat is the yes but um which we anticipated um because we all struggle with it and that's exactly why we're doing this tonight um so i'm just going to read one of the questions which i think sums it up and this is from Brooke these are nice theories that we know we have to do and we all have to do more self-care but it doesn't change the real issues being in the stressful environments we work in and the incredible time and financial pressures we are under without the overarching problems changing i don't see how we can implement these smaller ideas so any um we had a number of questions around this in the registration it's kind of external pressures um how do we anybody want to offer a comment on that that they're the kind of external that can push our good intent Roger yeah i'll start uh that's a really good question and how you know we can all relate to that question um we're working in a stressful environment that we can't change so you're caring a really good caring person working in a very demanding environment that you can't change and how common is that think of you know working in a clinic environment where as i said before you're dancing to the beat of the reception this drum who keeps you know overbooking you you may attract a cohort of patients because of the sort of person you are you're a very nice person who people can tell anything to and they love coming to see you and you're popular you're the much loved middle-earth practitioner so you draw this cohort of very demanding patients and we all get that and you get the same sort of complex demanding patients who come to you because you're so good at it you're so kind and nice and you run over time all the time to give them everything that they want so you might have to do what he's saying no as Hugh's pointed out refusing so you're in an environment that you think you can't control but in fact you've actually chosen to be in that environment most often you've chosen to be there and that's your your operating manual has directed you to say i i'm going to work in this way i'm going to work in a busy environment where care is required and where the booking systems aren't ideal for me but i'm going to put up with them and uh you know i'm going to take work home another decision is in your operating manual i'm going to take work home because i can remotely log in from home and tidy up those notes or just you know follow people up and maybe come in on the weekend or work on a Saturday to catch up so how we work is often much up to us and uh you think well if you're working in a very stressful environment you've got to ask yourself why am i here is this where i'm producing my best outputs or am i paying a price for this am i burning all my carriages to to get through the day so that's where feedback comes in and having a mentor having an advisor having a supervisor is showing somebody and saying this is how i'm working this week and this is where i'm working and a lot of people say well why are you working there it clearly then environment doesn't suit you you're a person who needs time in an unhurried environment where you can be thorough and detailed and practice the best mental health professional work that you can but why are you working such a busy place it doesn't suit you so very often that you're in the wrong place thank you Roger here did you add anything to that yeah look at back of everything Roger said and us was it it's almost the perfect storm really because you have people who want to help who like caring for people but also probably high achievers so they want to do it really well and they do a very thorough job very uh whatever in a system that is infinite because in health and in mental health no matter how hard you work you're never going to get the end the illusion is somehow going to get there and the reality is no you're not going to get there in fact probably the harder work the more you're going to create the more require more demand and so forth and it's infinite and again we talk about the system and isn't it awful and whatever absolutely you know we can all talk about trying to change the world but it's a really tough system to change so then what you have to do is go back to what can i change and control the control was here i can't do everything what can i do and that's roger just pointed out some of the things you can do you know that we do have some choices often we don't like the choices but there are some choices and you have to make decisions about that and understand and again going back to my my tube of balls you know people said i've got no choice well if you have no choice you better not be doing new things you know you have to limit what you can do you're going to get a small area of discretion so you better choose that really wisely so we usually have a little bit more than we think and again that's where jarred roger talked about seeing a supervisor or a colleague or a mentor they can give you a bit of advice on that maybe there are because when you're in it often you don't see the options you think this is the only way it is i just have to keep going i've got to get through to the end but the sad illusion is you're never going to get to the end there's always going to be more and so that's when and this is where the guilt kicks in for a lot of people is but i should be doing more and that's this is when it becomes very unsustainable because if you think personally you are going to change everything you're going to burn out and roger and i see this all the time when in the gp land you know where people just burn themselves i'm leaving i can't do this anymore and then it doesn't help at all and so that's where it's that ability to say this is a limit this is what i can do be comfortable with that and then come back tomorrow and have another go yeah i can't drink from an empty cup and that's exactly right yeah i should know what um we we say to others that we don't think we've got a lot of questions so i'm going to keep going on i'm just going to address one really quickly because i think you guys have addressed it mariano is asking about optimizing working processes that is taking a lot of time to do clinical notes i think you guys have answered that get a mentor ask us some help you know get get a colleague or somebody else to look at your notes they shouldn't they're taking an excessive amount of time then some people are really good at it and you know we need to draw on that expertise of others i think as well but i'm really interested um a number of questions have come through on this around practitioners themselves reaching out for help you know if they out what you know one in five or they're experiencing mental health issues themselves or they're concerned about colleagues um and the stigma and so forth associated with that how can we help ourselves help each other in that space um maybe roger you first and hear if you want to add on yeah that's a a very broad question um and it goes to the heart of what we do i mean we are we are we are lovely people practicing uh clinical care on on quite complex people and um you know we're drawn to this because we're people people we like working with people we like helping people and caring for people and we like good outcomes we don't like harming people we don't want any poor outcomes it really upsets us to have someone uh you know um suffer demise under our care it's it's it's something we avoid and instead before we draw into it because we are often obsessional and the previous question around detail if you're obsessional you're going to take very detailed notes and there might not be time to do that which is part of the stress or you may be avoidant or dependent and all those other things that we we know about so we we're drawn to our work in a way that that we want to do really well at it we want to um care for people and have good outcomes and yet we we are expected to work in a whole range of different work places um some of which are hostile and toxic and and unfriendly and unhelpful and they're harmful and they're full of workplace health and safety hazards full of them violent think violence think uh drug drug using patients um you know think uh we can remote locations uh there's so many pressures on us that add up and the burden I spoke about earlier is often we take on a lot of burden and there comes a point where your barrier your wheelbarrow is full of bricks which are the problems that you we we take on choose to take on and that can become exhausting uh and then people say well what do I do what where do I go because in in our pursuit of um clinical excellence and working in our careers we often do forget about ourselves so we don't we may have lost contact with our GP we may have ignored our good lifestyle habits and perhaps set aside exercise and good eating and maybe we may be drinking a little more alcohol than we should be so these with these things are all out so over time we get to the point where you think look I what do I do so through our training we think well I shouldn't be getting this or I can handle this myself so it's not unusual for mental health practitioners to manage their own uh stress problems you know fairly in a way that others might say you should have stopped doing that six months to go in other words we may manage self manage our problems way past the point that we should and we may be reluctant to seek help because one we don't know who to go to we may have lost contact with other health professionals and just don't know how to access them there may be fear of notification to the to the board to the to drapera there may be embarrassment about going to another person and saying well you know and they might say how could you let yourself get into the state didn't you couldn't you've done something more to help yourself is this sort of embarrassment that that might be the case there's a many many barriers that stop professionals going to another person to help but a great you know in my experience you're running a doctor's hill program is it the physical and the mental are very very much a part of distress you cannot say on just mentally unwell you'll always be physiologically challenged in some way and the five things that they like vitamin d hydration nutrition aerobic fitness sleep deprivation all of those are very very common so having a good holistic appraisal of your health is a great starting point and and to connect with a general practitioner it takes time as we know to find a good general practitioner but they're very connected with a health system and once you found one or a practice that you work with that's a very good start but the temptation is to over manage our own problems i've seen this so often way past the point that we should and very often we get the diagnosis completely wrong completely wrong we get it so wrong because we we the little guy in the shoulder says you've got fatigue you're just you know you're tired or you're just overworked whereas an external feedback might say you're clinically depressed or you're burnt out from the point where you must stop work now and have two or three four weeks off so we i mean there's some of the aspects i think the options thank you roger here did you want to add to that particularly perhaps about if you're concerned about a colleague in the average yeah first of all uh i just was picking on roger's point there is you know by definition you know if you're something sort of a mental health issue or you're feeling depressed you're probably not making very good decisions because the thing you need to make the decisions is impaired it's not working so well that's when you're probably not your best doctor your best sort of supporter for yourselves that's when talking to somebody else the other thing i wasn't supporting colleagues i think it is that we need to support each other and i think this network the mental health professional network it's a really good idea people should be a part of that because you'd like a profession where people looked after each other not just looking look on itself but look after colleagues as well and i remember working with a person once and they said you know they were joined this practice and they said i thought i was joining practice but i was actually joining a room which means you go in every day and you sit in a room and see patients you don't see any of the colleagues at all yeah that's where as a group or as the practice or you can actually support each other and that means having morning teas together having lunches together social things like that and when you notice one of your colleagues isn't going so well there what you have to do is ask the classic question that you will ask other people are you okay and again don't have to fix their problem but just just say how are you and just allow one the person to talk about that and bring it out there and sort of get that discussion going so i think again this is one of the things you can control you can't control the whole system but you could actually reach out and support your colleagues look after them and encourage them to do things as well and so that's what i think one of the first things is because the person themselves might not be making a good judgment that's when you as a colleague and i would encourage all the people here tonight to think about the people you work with is there someone there who maybe you should be saying how are you going do you want to have a coffee just have a chat and especially i think in these lockdown days when you don't see them so easily you know they're they're already probably stressed now isolated as well and that's where a call or a phone call or an email or whatever might be useful i just i just pick up their point here that's such a strong point is um it is a lot of us work in practices or in clinics but we often work in isolation we're often quite lonely in those rooms and you know you're in a busy place with people shutting doors and opening doors and but very often there's that isolation from your colleagues and peers and yet one thing we all value the most is to sit down with people who understand our world they get our world and you say look this is what i had a patient like this that i'm like oh i've got i had exactly the same person last week or i know exactly what you're talking but you need that sort of understanding and if it's work related that's very powerful huge idea and a peer group a phone group um a peer support network is very important just to talk about the sort of difficulties of being a person um and if you you'll see colleagues to i'm sure everybody tonight who's listening would know somebody they work with or maybe working with at the moment who they're a little bit worried about but the thing i've observed certainly with doctors is that they are they withdraw and they're very good actors they're very good actors so if you um they can cover up their distress very easily and if you go out to them and say you know how you're going they'll say oh fine fine fine but you've got to be inquisitive and persistent uh and because most health professionals will put up barriers because they're worried about being notified reported embarrassment all the things i spoke about so if you're inquisitive you'll find that they are extremely responsive because they're often desperate for someone to help them get through what is maybe a professional problem or a personal problem so having a pathway for those colleagues i think is very important and as a practice you can work out as a group what you will do is someone becomes unwell i think there's also um somebody make a comment which is you know you can have a fine time you have to make time and i've noticed in in my work uh well working remotely um and not necessarily in direct clinical work we're supporting clinical work um i've been in a number of meetings recently where the agenda has actually gone out the window we've actually spent the majority of the session actually checking in and and and not saying how's everyone okay let's go and actually stopping and pausing and um my observation is that if that's done with genuine curiosity and a willingness to to listen um it's amazing what people will share if they feel safe to do so and it's we're not fixing it in that moment but it's actually acknowledging that this is a real thing that is happening um at the moment where people's fatigue is getting the best of them and just stopping and actually thinking you know the agenda can probably wait perhaps for a little bit because none of us are as productive as we would like to be and to Hughes point around productivity so i think we should never underestimate as well just carving out a little bit of time to actually you know maybe not book yourself back to back and say well i don't know guys how about next week you know the practice we all come together and have morning tea together and those protective things don't have to be massive but they can they can really add up if we will they add up if we don't have them but they can add up in a positive way if we do prioritise them i think yeah the little things make a difference i'm the other point i'll make is if you feel as though you're experiencing some distress odds are over 50 of your colleagues will be feeling exactly the same thing if you say to meeting oh i'm absolutely exhausted yeah yeah me too or i like to work see one patient less per hour oh yeah i'd love to do that too so if all you need to do is break the ice and you get people saying right we're all suffering the same thing let's do something about it and that permission i've noticed that in my work in the last week somebody said i took the you know whirlwind day were offered and i spent it and i felt restored you know it's not i don't need three months off necessarily but if i take a day off that might give me a couple more months before i really do need you know i might need that um i want to make on that for everybody as well is this is not normal so that means don't be expecting your normal output yes you're not going to see as many people you're not going to get as much done and that's the reality is it's not normal but people think i should carry on as normal and that's not this is not normal we can say for sure i just want to pick up there's been a couple of comments as well and this is probably the last question before i'll get you both to wrap up is a little bit about the the current context and that some people are talking about the the extra are other people finding it more fatiguing to do telehealth versus in person and so forth and i think you've chatted a little bit about it here but that that notion of i think the other thing that's really interesting is the parallel experience you know i have talked about this in the session today the um as help providers we're experiencing the same adversity that all our patients and clients are so yeah how we might manage that or i don't know name it you guys got some insight about about the current circumstances that we're all in yeah so do you look at my comment is that this is not normal some people are coping really well you know like it suits them the more introvert of purple thinking this is great it's got it i've got a name for it now a lot i love it but most people aren't finding it okay you know they're missing connections whatever but also the workload has increased and people talk about working from home and that's not what's really happening what's happened working from home used to be a treat it used to be a day away from the office where you could sit quietly but no one interrupting you now people are at home trying to work under difficult circumstances and you're just not going to get as much done so i would think yeah if you're finding it hard at the moment there's a good reason and so that means all we can do at the moment is be kind to ourselves and our colleagues and realize you're not going to get as much done and just accept us the case and sadly as well in the mental health area the demands are increasing and so the pressure is even more but despite that if you try and meet it all you're going to be not sustainable yeah what did you want to add something on that kind of yeah that's so true and again a great question because COVID has added an extra burden to us all and if you try and link here's a metaphor with mine around the balls and the all the 168 hours in the weekend so what COVID's done is that has if you look at the outputs side of the four pillars we've had to work or had to work harder in COVID I mean the demand on mental health mental health practitioners has gone up through the roof it's been extremely high so there's a huge obligation to respond to that by working harder working longer hours etc and the feedback is when you say well the guy's actually working pretty hard just help you can't stop really because it's such a demand you know so many people now have got mental health problems that you just you know you need to keep going so in here's 168 hour week when work goes up often the important inputs go down so our exercise goes down our diet may deteriorate time with family time with friends time with creative activities goes down so your inputs are weakened in COVID and then going up to your operating manual how you're working what you're having to work very differently you know and you do telehealth now and I've done that and I don't enjoy it it's exhausting you can't build rapport with people you can't read your body language it's it's hard work boy so COVID's meant we our inputs are reduced our operating manual is had to be rewritten to to do work differently our outputs have increased and no one's listening about feedback so no no wonder all suffering a bit but the way I'd say is go back to your inputs to do more work in a more difficult thing you need to be fit rested you know eat well vitamin D exercise it goes back to those basic physiological inputs that I think are often forgotten and often make life jolly difficult so if it's getting tough back to the basics eat modest amounts of good food get seven hours sleep a night two and a half hours of exercise a week if you can vitamin D and don't watch TV oh I'm with you until the end there if I do all the other things can I watch some TV I'm gonna ask you both for some final thoughts anything that you haven't covered that you'd like to make sure that we share with I think we've had 1,300 people joining us tonight um over 1,300 which is wonderful um yeah any any leaving thoughts or additional thoughts that you want to cover off I'll go to you first you yep you look what my thoughts are health and mental health the demands are infinite no matter how hard you work you're never going to fix everything however your time is finite there is only 168 hours in the week so just remember every time you say yes to one thing you're saying no to something else and sadly in what we say is people are saying no to my family your interests and your health so you need to learn how to say no and when you do say no you have to learn how to switch off how to switch off that guilt especially all the thoughts and worries and I'm sure most of you tell other people how to do this and now you're not doing it for yourself and so learn how to switch off that sort of nagging voice that's telling you what's all wrong and so forth so all the things you do for other people you need to turn it back on yourself thank you Roger yeah or good I just have one point is uh what is full-time work this is something I've thought about a few bit so if you ask many of you listening tonight will probably be working in varying ways you might be doing so many sessions a week or however long a session is sometimes a session to be three hours or five hours or but it's very often people underestimate how much work they're doing and the work the sort of work we're doing in mental health is very very very demanding it takes a lot of cognitive effort and we're often in a sedentary position where we're we're not moving around a lot so it's very important to not underestimate how much work you're actually doing if you say to somebody I hope you're working full-time or part-time at the moment I say I'm working part-time and so how many sessions a week you're doing so I'm doing about seven or eight you think right well that's about you know 1.3 FTE already so some are working five days a week in mental health is doing about 1.5 FTE I'll tell you add up all of the stuff associated with consulting the amount of time it takes up in your 168 hour week it's more than full-time so don't underestimate how much work you're doing I'll get back to the four final messages the inputs often the basic ones around our physiology are critical and they're the ones that are often forgotten how we do how we run our lives is full of choices there how we do things if you're finding you're working in a stressful environment maybe that environment doesn't suit you you're not suited to it get out and do something else your outputs often people do way too much and get feedback from someone independent external and hate it and you know listen to it and I think that way you'll be a little bit more sustainable thank you thank you both Roger and Hugh I think they've given us a lot to reflect on and think about and encourage everybody to you know have a look at the the handouts that have been provided and prioritize a bit of time to working through them what is it you've got to slow down to speed up or whatever the comment is to be efficient all right we are out to the last minute I'm going to run through thank you everyone for joining us tonight thank you so much Hugh and Roger I think it's been wonderful I've certainly taken a lot out of it please those of you that are still here click on the pie chart icon and give us your feedback it's really helpful it is we do take it on board and it helps us to shape future mhpn content and also improve our content as we go along you will get a statement of attendance and we will send out the resources and so forth that associated with this webinar so don't worry about that you will get all the fantastic information and resources as well as other resources that Hugh and Roger have put together for us we've got upcoming webinars I'll let you read through those because my mouth will be full of marbles if I read all of those so please keep your eye out for them coming up over the next weeks and months we also mhpn have got a podcast called book club six past series so please get into that and I've checked it out there's some great ones in there some really interesting content for all of us to have a look at and lastly if you'd like to continue the discussion you can look at our peer networks and mhpn are actually seeking expressions of interest to set up a peer network so you can provide feedback on that or you can contact I'm going to just find on my third different screen please contact Jackie from mhpn you can see her email there about that otherwise I we're wrapping it up for tonight thanks everybody for your interest and participation before I close I'd like to acknowledge the lived experience of people in carers who have lived with mental illness in the past and continue to live with mental illness in the present thank you everyone for participating please I think the phrase I used to use a lot with clients and from you guys tonight is extend the kindness to yourself that you do to others so thanks very much everyone take care and stay well good night