 Good evening everybody and welcome to this webinar on mental health and well-being. We would like to welcome I think roughly 200 people we have online at the moment and many more who I'm sure will be watching the recorded version of this when it's made available. MHPN would like to acknowledge the traditional custodians of the lands on seas and waterways across Australia upon which our webinar presenters and participants are located. I'm in Wurundjeri country in the Kulin nation and we wish to pay our respects to the elders past present and future for the memories the traditions the culture and the hopes of Aboriginal and Torres Strait Islander Australia. So Steve Trumple is my name and I'll be facilitating tonight's session. I'm a GP by training but my current role is as professor and head of medical education at the Melbourne Medical School here in Melbourne. I must say I am really excited about the panel that we've assembled for you this evening. It's the first time I've done one of these webinars with people who are so deeply involved in the topic and I'm really pleased to welcome and introduce our first panel member who's Warren Davies who has lived experience of the topic we're talking about tonight. Now Warren I'm intrigued. I've seen you referred to as the unbreakable farmer. Can you tell us just a little bit about how you came to become a public speaker in this area of men's mental health? Good evening Steve. Yeah basically through my own journey and my own experience as a dairy farmer in northern Victoria my challenges with mental health and also with adversity like through floods and droughts and also the challenges of a family break up on the farm all added to my experience that I now share as the unbreakable farmer as a speaker and a mental health advocate. Well Fabulous we're really looking forward to hearing what you've got to say about the case tonight and in conversation at the rest of our panel. There's a bit of a connection I guess between people in your own situation and the mental health professionals we have on the panel tonight we have Mary O'Brien who's a mental health advocate. Now Mary you and your organisation are you bogged mate. Us mental health professionals I guess are used to using various measures of mental distress, stress, anxiety those sorts of things. I need to ask you about the shitometer or shitometer I'm not sure which way you pronounce it. That's a fascinating concept I've not come across before. Can you tell us a little bit about that? Good evening Steve. Well I guess the the shitometer is using the the comparison to a tachometer or a machine and that we can't run a machine in the red it's it's not good for the machine and it's not good for us to to run in in the red either so the reality is that we can't sort of stay back in in the green zone that that's not life that's not reality that there are times we have to go into the red so it's it's just looking at the way we handle stress and things in our lives a bit like the revs on a machine. Great that makes you so much sense and I think David Walker our next panelist who's a GP in Longreach David I can only imagine that mental health care plans would be a lot easier for us to do if we had a useful measure like the shitometer rather than the K-10 but anyway I've got to ask where you've been and Queensland's obviously had quite a different experience at the pandemic and it continues to have its issues around Brisbane but have you noticed a change in the men who've been coming into your clinic in Longreach over the past 12 months? Yeah it's a really good question Steven look thanks for having me here tonight and welcome everybody um look I always wanted hard to make generalizations to be honest I think um I think I have seen more men during this period but it's probably in keeping with the fact I've seen more people overall I think many GPs have given the story that we're all um we're all very busy and there's a lot of people I think reflecting on their their health reflecting on how this pandemic um affects them I think here in Longreach and again difficult to totally generalize but a lot of people um are almost you know the pandemic feels like a long way away until today of course when we're all wearing masks even out here um so so hard to generalize but certainly I think definitely seeing more men how that um how that reflects the pandemic per se I'm not 100% sure but um it's been a it's been a challenging year for sure absolutely well I was great to have your input tonight and our final panelist to welcome is Dr Tim Driscoll now Tim you're a clinical psychologist and part of the um the Royal Flying Doctor Services Outback Mental Health team can you tell us a little bit about what that um mental health team actually does? Sure uh well I mean under that umbrella we've got um a few different services uh so one we've got a driving services that sort of looks at northwest Queensland central west Queensland and southwest Queensland generally and then we've got um the remote health service which really looks at putting mental health permissions on the plane with the doctors and nurses Sarah Charleville and Matt Iser so going to those smaller communities that don't have access to a GP of them flying in and a lot of the other focus that we have is mental health promotion and providing education things like mental health first aid is an example of that so really our area is just western Queensland generally. Massive area to cover obviously and a whole lot of issues to deal with there I hope we've wet your whistle everybody or wet your appetite I should say not wetting your whistle wetting your appetite uh with what the panel has to offer this evening before we get there though there's just a couple of things to cover off I'm noticing in the chat that a few people seem to be having some problems with their audio so if you are having problems there's a number to call 1-800-209-031 but also there's technical support available if you click on the information icon in the lower right corner of your screen and under links you click on webcast support and hopefully that will take you to where you can get some help if there are problems look out Kim from KSP counselling has live sound now so that's great and if we're reaching Narell on McLey Island I think we're probably doing okay so that's good news we're off off and away if the webcast does browse or sorry don't stop at any time please refresh your browser and if the whole thing falls apart it is being recorded hopefully you'll catch up with it at some stage but things should go well from here so that's great now this is a platform that I haven't used personally before so hopefully I'll navigate it okay there are various ways you can interact with us obviously we want this to be an interactive session you want to have your questions coming in your chat with each other please make sure you keep on topic within the chat because it's a good way to feed things to the panelists in real time as well as the questions coming in more formally I see your questions come in from Heather asking has the webinar started so yes it's the answer to that question that's the easiest one we'll have tonight I'm sure so please do put your questions in you do that by clicking on the speech bubble icon in the lower right corner of your screen the single speech bubble icon you click on that to put a question on our question page that we can respond to you can chat as I've mentioned with the other participants and you can do that by clicking on the two speech bubbles which are located at the top right hand corner of your screen please don't put your technical queries there you might get a lot of useful feedback from your peers but it won't be as useful as clicking on the i information symbol to get help there and yeah I just noticed that people are still having some issues but hopefully you'll find your way onto the sound there there are various other things you can do to change your view to slide only or video only I don't think I should run through those because it's probably complex enough as it is and there's a slide up there that tells you how to do that if you want to change your view anyway that's enough for now what we're going to do is get into the meat of tonight's session we've had a case that's been circulated circulated that hopefully you will have had a chance to read about Charlie and the issues confronting him on his property what we want to do tonight in terms of the learning outcomes you can see displayed there one is to identify the associations comorbidities and patterns of treatment seeking behavior of men who experience in difficulty with their mental health and well-being we're going to talk about some tips and strategies it's probably why most people are here for providing care to men who seek help or assistance with their mental health and well-being and finally which is always very important for this particular health professional network we'll talk about the importance of collaboration and appropriate referrals when supporting men's mental health and well-being but making the point right from the off here collaboration is not only with other mental health professionals who have a formal training in this we will be getting a lot of good information and tips from Warren and Mary tonight as well who I hope will finish up tonight agreeing people like that just so important in assisting men to take that first step but let's talk about that now the case of Charlie and you will have had an opportunity to read it I'm not going to go through it in detail classic 59 year old man nothing wrong with that who's attended his GP clinic after falling off his horse he's got a physical problem that's finally dragged him into the doctor but the reality is there are lots of things going on in his life that are impacting on his mental health and well-being so we'll go to Warren's presentation now and Warren this case of Charlie must be a very familiar situation that you've come across before what are some of the issues that are weighing heavily on Warren as he goes along to the doctor with his sore wrist yeah thanks Steve as yes it is that's something that I've encountered a fair bit out in my travels around Australia presenting in rural communities and particularly in drought communities Charlie is you know challenged with a number of things as he sits in that in that that doctor's clinic one of the things that would be weighing heavily on him is the drought and the impacts of that and one of the biggest impacts that I see through my own experience and also through the men that I talk with is you know that that loss of control with the drought one of the the things that you know that you feel that you're you're up against it and you can't control what's happening you can't control the weather and and you're at its at its mercy and and that's having a major impacts particularly as as someone who's dealing with livestock and you know the the challenges around feeding that life like that livestock and and also caring for his family that drought has you know financial impacts you know you're farming to business and you're in business to to make money and to support your family and once the drought takes hold in Charlie's case it starts to to create a you know a snowball effect of other issues and and and all these issues you know whether they come out in that first conversation or not are all weighing heavily on him particularly the relationships the breakdown of relationships with these with his wife and he and you know and the disassociation with these kids would be weighing heavily on it because he's obviously a family man and with the with the impacts of you know he's of the drought and the the financial pressures and that relationship breakdown has had a major effect on on his well-being as you know when I talk to a lot of men in rural communities that's you know that is one of the things that you know has a major impact is that relationship breakdown but one of the things that I can speak from personal experience but also reading the case study is that that pressure of being a generational farmer and the and the pressure that comes with that has a great toll when things start to go pear shape has a great toll on your on your mental health and well-being there's the you know it's probably only perceived pressure but pressure of being a generational farmer adds that a little bit more weight to it because you're holding up the family tradition and and as you start to you know fail and most of the time that failure is coming out of outside your control it has that impact if you could move to the next slide please his feelings you know are all would be all bottled up and it takes you know great skills in conversation and listening to be able to tease them out of someone particularly from the land that's you know fairly stoic in nature those feelings of failure and anger shame and guilt you know feeling that you're letting your family down you're letting your wife you know your your mates down you're letting yourself down because you know the the challenges that the drought is posing are feelings of frustration and hopelessness there are you know are really great particularly you know when you're trying to navigate through some fairly challenging situations that that feeling of of hopelessness is is real and looking looking to the future you're not able to see that clear future and and all these things start compounding which then adds to isolation and in that in the case study you see that you know Charlie is you know starting to isolate himself from his friends from his community and and that's that also then has a an ongoing effect on his mental health and well-being if you can go to the next slide please the people around him and and his and his support network as as Charlie's sitting there in that in that doctor's clinic need to you know know the signs and understand where Charlie's coming from he's a he's a strong stoic man if he's like any of the farmers that I've met and and opening up about his emotions and and his feelings is not something that's that you know blokes in general but particularly farmers don't do easily so opening up that conversation needs to be done with questions that are going to let Charlie answer his own in his own way I suppose you know and and that may take a little bit of teasing out because and I can speak from my own experience and and those men that I've spoken to in rural communities opening up that conversation is can be tough um because there's that um you know perception that it's a sign of weakness to you know to you know speak about how you're feeling but it's not it's actually a sign of strength and we need to keep those conversations you know going and not let it close up we need to be able to listen to what what Charlie's got to say he will be sitting there actually going to to the doctors especially with a non-related injury he's gone there that's giving him his in and he probably realises now sitting there that it's a good opportunity to speak but we need to listen to though to what he's got to say and support him and encourage him to be able to you know seek help and and telling that you know know that there's there there's people out there to support him there's there's pathways to be able to support him through his journey and and help him get back on track can move to the next slide please one of the things working in rural and remote communities with people and particularly men like Charlie is that you know communication is key we need to be able to communicate with each other and that's the importance of support networks in rural communities be able to talk be able to you know express your feelings and your emotions and communicate with your support network on you know how you're feeling and then they know how they might be able to you know be able to support you it's important to stay connected to your community to your support network that's these are the things that Charlie can do to help himself and importantly seek help and treat that help seriously you know don't get bogged down in the day to day running of the farm or the challenges you know you're the most important asset on your property and and you need to make sure that Charlie needs to make sure that he's looking after himself thanks Warren that's fabulous and you've given us the perfect segue to Mary the idea of the most valuable asset on the property being deeply bogged and the importance of I guess redefining the whole attitude towards speaking up about your mental health is not being a matter of shame but a matter of of pride Mary I've seen you on video gathering men around you and talking to them very positively and very directly about this what can you tell us about your perspective on Charlie's situation from a men's health advocate point of view look I think certainly for the the impact of that grief and loss so Warren touched or talked about this about the generational farmer thing and and that continuity of the family and so when we read his case study it really isn't that long since he's lost both parents in a reasonably short time and particularly parents in a generational farm situation would be sort of that that sounding board that mentor their friend their confidant so I think that's a really important thing to remember that even though it's you know in the last eight years that's not a long time particularly for anyone who's lost a parent but so there's that grief and loss this loss of his his marriage and his wife I guess and he's probably feeling ashamed of that in his community and his family as well the pressure that goes with all of that and he's probably feeling that that loss of faith and loss of trust and who can I turn to and that hopelessness of you know he is 69 years of age and he's potentially going to lose that farm we've got the you know the financial pressure of drought but potentially losing that farm and that pride is something that we can't underestimate particularly in rural communities with these rural men they are very proud people so the pride associated with seeking help or being in financial trouble or the breakdown of a marriage all of those things so we see in the case study that he's he's got all those avoidance tactics going on so he's avoiding catching up with people and that but I think and Warren spoke well about this about the impact of that drought it's really hard to explain that I guess the torture and the gauntlet of emotions that come with drought and that uncertainty the you know seems like it's endless and it's backbreaking hard work particularly when they're feeding stock when they knock off that they're too tired and exhausted to generally want to go everywhere which is another way we lose those connections the impact of that drought as well as either watching the stock die or sell them so they're watching years of breeding and bloodlines disappear so he probably feels like every every angle is attacking him and the financial side of it there's possibly pressure from the banks but with a pending of divorce or potential for divorce there there's the real possibility he's going to lose that farm and and again comes back to that generational thing you know my family's been here for generations yet I'm the one to lose the farm but I think one of the real positives we can get out of that case study and the situation that he's in is that he is help seeking so that is is a big positive next slide please so I think you know there's a range of options there but if he's going to consider that GP and go to the GP that's that's fantastic we've got the the family is he's probably less likely to go to the family because I guess he's he's feeling that that is shame and pride thing as well he probably doesn't want to talk too much to his children or his immediate family about it particularly if there's a you know marriage issues going on there so I really think in this situation that the the GP is potentially in a in a make or break situation with that presentation of a sore wrist and while we can't ignore that sore wrist I'd strongly encourage GPs to think of some other excuse to get him back and that gives them more time to build that trust and connection you know mate you're 69 years of age how long since you've had a full blood blood work or I don't know make something up I'm not a doctor but just something to get him back or let's you know let's get you back in a few weeks to check out this wrist and that gives that opportunity to build that trust as well obviously there is the do nothing option but in this situation I think his mates are a really good strong point as well as the GP option would be probably the the strongest two options that I see at the moment can we go to the next slide please so with the mates I encourage them to turn up and and don't ring him and ask oh mate do you want me to come over just turn up literally turn up because if you ring and ask him the answer will probably be no he'll be putting up those walls and those barriers so just a couple of mates get together turn up with some steak and a six pack or something and and help him finish off those chores and do some work on the farm that shoulder to shoulder communication so understanding that men communicate shoulder to shoulder women communicate face to face and I often say to men the next time you're at an event watch where the women are and how they communicate and watch where the men are particularly in rural areas the women will be sitting around a table looking at each other in the eye and communicating whereas the men will often be standing along a fence leaning on a vehicle and things like that so it's that turn up do something with him work with him finish that off then sit down light a fire force him to relax I guess so sitting around a campfire darkness is another really safe place for men to open up and communicate and they can lead by example by sharing their stories of what's going on for them and their life at the moment they can just listen and I have a lot of men who say to me I'm not sure what to say well guess what just just listen but certainly if they do think he is in the in that space of thinking about taking his life that to ask him that and really put him on the mat about that and and ask him so they're sharing what's going on in their life listening to to what he's got going on and that making that continual connection so making an excuse to come back or making a pact that look in two weeks time let's go over to Bob's place and we'll do the same and particularly in times of drought it's very hard for people to get away from the farm and and to have connections with other people so strongly encourage that sort of thing just that small catch up and again for the women to allow the men to have that time together one of the things that I find is really really important is for men to have man time and a time alone with other men and in that safe place where they feel comfortable to open up and I guess for people interpreting the way real men communicate most of these men are visual people so if you're trying to explain something to them show it to them draw a picture these are the kind of men that we don't give them the manual to drive the tractor we show them how to drive the tractor so remembering that they're a very unique demographic in the way they learn and the way they comprehend and understand things so that's yeah draw the picture rather than then give them the book it's yeah I think that's probably about it for me obviously his mates can encourage him to get help and you know discuss options of maybe the time that they got help and things like that so I think that's probably enough from me that's great thanks Mary and look both you and Warren have been getting really good rave reviews in the chat I think people have really appreciated Warren's honesty and your perceptiveness Mary of what's going on you've explained to me why it's so much easier to talk to with a mate while you're driving somewhere together shoulder to shoulder than sitting across a table so yeah it's made an enormous amount of sense so thank you for for that and explaining how I guess we've now got Charlie in the waiting room of the the clinic there in David's clinic he's come in and apologize for messing up the floor whatever it might be and he's presented his wrist for treatment so David how are you gonna how are you gonna work with with Charlie we're not hearing you David you muted my apologies it wouldn't be a zoom without somebody speaking against the mute so thanks for keeping things normal for us Charlie the quote of the last 12 months hasn't it sorry you're on mute so look you're hard to take up that sumtail with Mary's and Warren's insights but look if I when I approach the case I really tried to to give perspective I really tried to imagine myself sitting in my office and seeing him for the first time and I've put don't ignore the wrist pain with an asterix there for a reason because and I think Mary touched on this is that that's why he came I think you have to really respect the fact and and that that's why he turned up but don't feel you have to launch into you know being the wrist pain solving the wrist pain you've got time to actually ask a little bit more about it get a little bit more context talk to him about why he's ended up there and I think reflecting on on practices that as a general practitioner rapport is the is the it's the foundation stone of everything we do but you don't have to get it in an instant and you may be challenged with with learning the language you may not know much about what he does you may not understand his his enterprise is farming so take the time for me it's one of the the absolute joys of general practice is actually talking to people about their their their jobs finding what they do ask about words you don't understand and just take the chance to actually get to know him a bit because it's you know presuming it's the first time you've met him but don't forget his wrist so come back to his wrist and acknowledge the fact that's why he came and come up with a plan to how you're going to further explore it and then next time you see him you'll have some more to to work with next side please and I guess this slide kind of builds on that it's that again the luxury of us in general practice is that is that we don't have to solve everything in a day we're not an emergency department but if you don't get that rapport he won't come back and likewise you get whilst you get the luxury to tip away at things and to kind of have reasons to get him back and to work on um holistic aspects of his care you also can't you can't miss the risk if it's staring you in the face so you need to take the chance to actually really um just inquire about the risk to acknowledge it and I'll touch on a bit more in the next few slides but um come up with a plan as to how you're going to approach um both his wrist but also his kind of wider mental health issues as you're starting to acknowledge them from here on in next slide things so again Mary and Warren really touched on these um and you know I think hopefully we all picked them up in the case is that there's a lot of things here that stare at you from a background point of view and then there's some things that I'll touch on the next slide that are more kind of acute things that have popped up in a more recent term you know he's he's in his mid he's a middle aged male he's had a separation he's really drawing away from his family supports his isolated he's got the classical succession planning challenges and and I think that that concept of a generational farmer is is a beautiful one and really one that is hard to describe until you hear people like him talk about um how it impacts him he's got the impact of the drought and again I'm presuming you know this concept of being asset rich he's got a property that's probably worth millions of dollars but may not necessarily have much cash in the bank to even buy the essentials he needs for day to day so that concept of being asset rich and cash poor um drought and stock losses and again I think both Mary and Warren really touched on it it I remember talking to a patient once about about losing cattle in a flood and it was really touching to me to realise that despite it being a business his stock meant everything to him and you know he was so emotionally attached to the stock it was really um really moving to actually hear and talk about them so I think I think being very wary of um when people tell you that they've lost stock because it's usually very emotionally tolling um and also acknowledging that he almost certainly has firearms I'd be enormously surprised if he doesn't next slide things and again I guess more kind of um acute things things that have popped up more recently is that he's increasing his alcohol um he is and I guess exploring how much and what that means to him and how long that's been going on he's not doing the things that he actually finds fun and I think one of the commonest questions I ask people is what do you actually do for fun and more often than not um people in his situation stare at me and go well I haven't I used to do this and this but I haven't done that for many years and and exploring why and how that came to pass is actually often quite enlightening in itself um he socially withdrawed as we touched on and again as I alluded to it's really important at this point to to think about whether he's actually suicidal so is he starting to get thoughts are they fleeting how quickly can he can he deal with them what are his um what are the tools and strategies he uses to get rid of them is it alcohol is it distraction um or are they becoming really quite pervasive are they actually interfering with his his ability to do his day-to-day things so they're certainly the things that I um that occur to me when I was considering his case and I I really um I'm really interested to see and the questions that you might throw up from the floor thanks David look I might toss one in immediately before we go on to Tim only because it's come up a couple of times in the various chats which is about involving other therapists in a way the use of the the wrist injury may be involving people have been mentioning physiotherapists or occupational therapists with you know splints or um tap turners or something like that but maybe there are other mental health or other health professionals who might have a different um uh appointment system who'd be able to spend a bit more time chatting while they work on the focus task of manipulating the wrist or teaching exercises or something is that something that you can do there in Longridge yeah yeah definitely so um again one of the joys being in a country town if you get to networks that you can rely on and actually interestingly um one of our most kind of trusted people within our network was our actually our pharmacist and the pharmacist would seemingly have this ability to tap into people coming for medication to kind of especially people that had already um you know been diagnosed with something and they would she would help monitor their mental state and really keep track of how they were traveling and um we developed a quite a um a quite a close feedback method just to kind of keep track of people who who might not be doing quite so well. Sure all right and look there's a few other people are asking about etOH which is uh shorthand for alcohol it's a great way of writing that you're concerned about somebody's alcohol consumption without them knowing that's what you're saying but it's the um organic chemistry formula for alcohol so that's what that's about and also the suicidal issues and the access to firearms and Mary will expand on some of her approaches to that um in the in the Q&A but uh you know obviously resources are limited in most places of Australia but a a territory is challenging as um Western Queensland has to be particularly challenging now Tim Driscoll let's say that uh David has referred uh Charlie to you or um somebody like Charlie you would have dealt with I think we've got over a thousand people online at the moment and they've all met people like Charlie I'm sure let's have your perspective on the case of Charlie. Sure I mean I don't think there's anything new in terms of you know the things that I've noticed that have been a cause of concern I think they're very consistent across people um but obviously we've got him being isolated and alone um through bereavement from his parents uh separation from his wife um also some geographical distance from family uh other members of the family as well so he is very isolated in that way and he's also not interacting with people in town too much he's very much keeping to himself uh financially stressed through the drought um and more generally he's drinking more uh and he's injured and in pain um so I don't really want to spend a huge amount of time on this slide and then there's a basic snapshot there that um there's a few things that jump out immediately so what what does um sort of identify itself as being a little bit more unique to the situation really um is that we've got three generations um on the lines we've got a property that's been in that family for three generations and and what that can mean is that a lot more identity is tied to that role um as a producer in that area um and also the history of that person is very very much tied in with the family so it's very uncommon that um those businesses um obviously have three generations as you see in agriculture but it's also not so common that your home is also your business um so those things are tied up together in agriculture much closer than they are anywhere else um and the other thing is that you know considering the future here is that um it doesn't really seem clear that there is succession here that there is a plan going forward for the property that this is going to continue um he certainly sounds like he's sort of on his own in the situation and the other thing is obviously what we're looking at is there's a potential loss of a way of life um and that's particularly concerning we've got someone in an age bracket which is he's got a very um strong set of skills in a particular area and that's not necessarily transferable depending on what his financial situation and his age you put those two together it means you've got someone that's had a very strong role in a community potentially finding more difficult to get to get work so the there's a huge issue there in terms of just the financial side as well if if he was to come off the land obviously if if you know just selling the property was not necessarily an option at that point um or it might take some time that's the other thing while the property might be worth money doesn't mean that someone's necessarily going to buy it anytime soon so it is a real um problem in that way and also at the end of that what I've said is um you know it's a way of life on the line but obviously life itself as well in terms of we've got someone in a very risky situation here um in terms of just the basic demographics we've got a rural male who's very isolated um some of those signs are suggestive of depression uh and the other problem about here we mentioned firearms which is a which is a big issue obviously um but also time and space and opportunity to spiral down so if you've got someone that's by themselves um and um you know have that that time and space where if they do end up in a spiral he's got quite a few different areas that could end up spiraling for him down is that there's nothing in to endure up that so whether it's a firearm or other methods if suicidal thoughts are there um you know it is very very scary and it's it's scary for this age group and older and often we don't we don't necessarily identify that but um you know older men are at huge risk um in that category and particularly when they're isolated like this gentleman is so I'd be very concerned in this situation so we'll just move on to the next slide um so one of the the key things to think about here I think is that um you know our main concern is not that therapy doesn't work our main concern here is that we're going to have a real hard time keeping the sky on the line in terms of actually coming in and continuing the therapy actually the most likely thing is that he will not either present or he might come once and then and then not continue so that that's actually our main issue in this situation in terms of providing therapy from a psychologist one of you is that this guy is actually going to be really really difficult to continue to engage and that's going to be our biggest challenge um and some of those barriers are obviously we've got someone who's you know very proud and very independent um very very good approaches to life generally um you know that that's a great approach to life until it stops working so if you've been really really self-reliant and then it's not working anymore and you're not used to getting help from other people it's a dangerous situation so a great approach usually but when it stops working it's a real concern um it's very likely that you know he won't want to talk particularly you know a therapy environment if you imagine what Mary was mentioning at all if you imagine what a classic therapy room looks like face to face across the room maybe with a couple of chairs in a room so it's certainly not shoulder to shoulder often so that that can actually we believe more more confronting a very unnatural environment the other thing that we're looking at is he's coming about his wrist he's not talking about what's going on his head he's talking about pain in his wrist and we certainly wouldn't really be ignoring that that's where he's come to the the doctor with and I think another thing that's useful in terms of just thinking about how we might approach this is that I mean it's a bit of a sort of cliche here in terms of men have problems when women have feelings but what I mean by that is if you want to keep a man involved in therapy you have to look at it from a problem focus point of view so you know you want to get to a solution that's the focus and I know it's a generalization is say that but women are much more emotionally literate much more willing to talk about their feelings men want to find a solution to the problem they're in that's the that's generally that the way it goes so if we're looking at keeping this person involved in therapy we're going to make sure that we've got some sort of a problem focus here in terms of how am I going to deal with this situation it's it's quite unlikely that it's going to be so feelings focused with a man now the idea with women get sick and men die now this is from general medicine you know women go to the doctor men don't and that's really what that's what's that talking about is men wait to get much much sicker before they get help with their physical health often particularly in rural areas you know it's probably strong with mental health so one of those things is that men wait much longer and that's really exaggerated in rural areas so that's important to remember as well as that we often necessarily won't see a person until things have got a lot worse and I think another key thing is that if we imagine mental health clinicians generally or psychologists or you know various other mental health professionals that do go into these areas many of them aren't from a rural background it's actually quite uncommon that people are from a rural background so the other thing is that what does that psychologist or mental health clinician know about life on the land can they relate to me can they understand where I'm coming from and that that can be a big issue so it's important that people obviously know a little bit about the area that they're going into because if you're going to build rapport you need to have some understanding of that person's life and understand what they're actually you know telling you so we'll just move on to the next slide so looking at all those barriers I guess the other thing we need to look at is we've got someone that might be very difficult to engage look for a psychologist absolutely so what are our cards what's our way to get through here well our first card to consider is a GP now a GP has absolutely got a lot more respect we could say street cred than a psychologist psychologist generally there might be more concern about how much they're going to be able to help they're very very rare that someone would go I know a GP just couldn't help anyone anytime but you'd hear that about psychology you know frequently enough so a GP is certainly someone that you know is respected and accepted that you know this is someone that can you know help in many situations so if we've got the GP selling that service in terms of you know referring on so we've got that person selling the service very important to us so in the clinic that we're talking about we'd be looking at RFDS flying in so the GP would be one of our GPs the other thing is we've got our nursing staff now the nursing staff are going to have an additional benefit as well in terms of the other people that go into the community more often so the GPs move more often so there's a greater change over in the GPs whereas the nurses actually live in the in Charleville on our eyes are generally and so they're more regularly at those clinics so they've got the personal connection and so do the community nurses in terms of the nurses stationed in those towns so they've got a personal connection the other one is that using the even the pilot so the pilot is often male often a person that people are very interested in talking to and often also familiar face because they're also living in the community and they have been more often that the people at those clinics more frequently so they've got the connection but they're also someone that men are more interested in talking to as well so we've got them on side so promote mental health that's a fantastic opportunity as well and really right after that it's sort of psychologist after that so we need everyone else to basically sell us before we might be able to get a foot in the door and essentially you know that the key thing there is that we do actually pay some attention to the person we're talking to realizing that you know dropouts very likely but also making sure that we have some understanding of what that person's going through in that context so getting some understanding the other thing is have we got time and really the people that can set that up for us are the GP and the nurses in terms of bringing him back so that's the other thing because the other thing is he's unlikely necessarily to come back for another psychology appointment but he might hang around if he's got to get a blood test or another check on that wrist so that's how we can get a bit more time and just moving on to the next slide and I really think this is just something useful to think about this in this case and as a sort of generalization to you know producers in general is that so pushing forward is you know really resilient approach but sometimes what it can mean is that we're digging a deeper hole so if we're continuing to do the same thing and it's not working it's not really resilient it's false resilience because what we're doing is we're ending deeper in the hole so when we need to think about resilience we need to talk more about it in terms of adaption particularly in terms of how things have changed this area particularly drought so we've already seen you know huge financial pressures if we continue to do the same thing and it's not that we've got no control over the drought but if we just had someone going that's resilient he just pushes and pushes and pushes it's not really resilient it's actually you know falling into a deeper hole so if we keep doing something that's not working even though it's worked for three generations if it's not working in the current context it's you know it's no longer resilience and I think we really need to think about adaption as part of resilience because it would give people the idea that you just need to push and push and push eventually the wire breaks you know that everyone has their limit and I think that can be a problematic message sometimes if we think about resilience it's just keeping on going we have to think about it as adaption we have to think about you know making sure that our well-being is part of that in terms of going into the future so pushing no matter what's not always an ideal scenario it works a lot of the time but when it doesn't you know it's a bigger problem and that's I think that's it for me thanks Tim you've really pulled it together well and I think there's such a great parallel there between your analogy of pushing and pushing and getting deeper and Mary's analogy about revving it into the red and just spinning your wheels deeper into the bog those are the sorts of visuals and realities that men do seem to respond to as a few people have said and I think you know your comment about you know men having problems and women having feelings I think Mary's also says about you know men dealing in facts rather than feeling so that's what you talk to them with a few questions have popped up and bringing a few of them together it's actually well two things one is the other people in the rural community who could be recruited and Tim you mentioned the pilot people have been mentioning bush chaplains pharmacists people who might not be immediately visible as mental health professionals and might not carry some of the suspicion that I believe mental health professionals can carry Tim I see you smiling Mary you're smiling is that something that there is a bit of suspicion about mental health professionals or reserve that maybe other people don't carry I definitely I think and there's a few reasons for it is that you know mental health clinicians are generally other than people so if you think about you know for a primary health nurse for example much more common to see someone that might have grown up in a rural area but it's very uncommon for someone to come off with property and then go I think I'm going to go away from cattle and become a psychologist it's sort of it is rare in that way so you will get those experiences of just sort of people going in to see a mental health clinician and they just sort of go they just didn't have any idea what I was talking about so there is that sort of direct experience but also I mean the other thing that's really important is that most mental health support doesn't actually come from mental health clinicians it comes from your family friends community members that's where most of it comes from I think we you know we really that's really important to remember people that certainly touched on that as well confidentiality has come up as well what are people's thoughts on what happens if I mean is the pilot bound by the same confidentiality that binds other mental health professionals does it matter I mean can we and people talk without breaching privacy yeah I mean really what we're looking at is for the pilot to talk up the idea of saying a therapist so in terms of confidentiality I mean I think this general human decency becomes in there obviously there's not you know binding you know code of conduct in terms of you know keeping that confidential but I mean I think we're looking at this sort of basic human decency really there yeah that's a hot topic this week about basically being a decent person so that's clearly what is being reflected here that you know you don't have to be trained in these things that if your heart's in the right place and people see you as a an honest straight down the line character that can carry a lot and I think that's what Mary and Warren have also mentioned but I'm really struck by one of the images that just come up in the chat in several postings about the risk of suicide the image of the farmer dispatching his stock with a rifle and thinking you know I'm ending suffering what about me Mary you are going to talk to us a bit more about access to firearms yes I think the firearms or the the ownership of firearms is a massive blockage to seeking help and particularly going to mental health professionals because I don't know if it's one of the standard questions that they ask but I have so many men say to me I'm not going to go and talk to someone because they'll take my guns off me now this is not just for for primary producers or gun owners I've also spoken with you know police and detectives and the first you know as soon as they present and say look I've got some mental health issues the first thing they do is take their gun off them now the bottom line is particularly to rural men taking their guns off them is it's an insult to their intelligence if you think that's the only way they're going to do it so I don't know what the requirements are for for the medical profession and doctors and psychologists if they do have to ask that question and if they are required to notify I don't know but I know it is it is a big blockage that these men think that that's going to be the first course of action and the cops are going to turn up and take their guns off them and and so they won't go and get help because of that just because they don't want to lose that and it's it's not that they necessarily want to hang on to the gun to actually use it on themselves but some of these men have generational collectible firearms you know a firearm that their grandfather used in the war and they don't want to lose that and they would rather suffer than lose that treasure so yeah that's that's one of the blockages I see thanks for that very serious issue also there's been a lot of discussion about the physicality of communicating with men and how that might differ from women and the setup of the room now Tim you touched on this but David I'm curious your general practice consulting room do you consult across the desk or David are you with us I think you might have frozen yeah I thought I was I was blaming you Steve for freezing but one of us froze yeah I think I think I caught the question just to just clarify if I've got it correct and just with the setup of the room and whether it's a kind of a really traditional over the desk thing or not is that how you that's pretty much it I mean the GP is the way the GP sets up their room the way they set up their appointment schedule often communicates I guess about how available they are or how available their patients want them to be what's your preferred consulting setup yeah so I I consult over the corner of my desk if that makes sense so I actually kind of um so I've got the computers on my desk facing me and then I have the patient sitting to my side so they kind of sit at 45 degrees and during the consult especially if I know that it's primarily about mental health I just I really try to avoid the temptation to touch my computer it just it just if you just take the time to look at the patient and listen and just you will catch up on your notes you will get there you'll get a chance to write them I just think it is it is incredibly distracting for the patient to just be typing notes coupled with that I can't type so when I type it's just a it's a flurry of activity as I try to hunt and peck I think is the correct name for my typing style or I hunt for the keys and then peck at them like a chicken so for me it's much better to actually take the time to sit and talk to the patient and then I will catch up with the notes yeah look I think it's really important there's actually a whole body literature that talks about the shared space of the desk and what is the man's what is the the doctors and what's termed the keyboard shove the power of just pushing the keyboard away and really attending to the man and saying you know I'm really here for you we'll deal with your wrist but we'll have a much time you need is a really important message but difficult in the way general practice is structured and a number of people have identified other people in the community who might be able to support like social workers mental health social workers the rural fire service SES other groups do have counsellors and supports who can be helpful if the the man happens to be involved in that but a number of questions have also come up about gender and obviously this is about men's health I'm just wondering what the panel thinks about the different approach we've talked about a few things to do with the physicality interaction we've talked about the focus on facts rather than feelings and things like that now there are any other issues people wanted to mention about what makes relating to men particularly in this situation rural men different to what might occur in the city or with women I should say um yeah I'll have a crack at that one Steve if you go for a berry I think it is it is very much about understanding that shoulder to shoulder for men versus face to face and when we ask men about things you know or how they have things are going for them I think we need to be able to interpret that man speaking so much as if we ask a woman how her weeks been she will go to the emotions so you know I've been stressed I've been tired I've been happy I've been sad whatever it is but if you ask a bloke and particularly a country bloke of how's your week been well you know the fence fell down and the ball got out and the dog ran away like it's about the facts and so from what he's telling us in the facts we can glean the emotion we will get to the emotion but we have to let those facts come out and we can expand on those as well I guess and um yeah and I think the the room set up that that David was talking about and you asked before was is quite important um I know that when men come to talk to me and want to express something or tell me something that they need to get off their chest they will come over and look me in the eye and shake my hand but they will immediately turn to the side and and fold their arms and either look into the distance or look at the ground and so that's where you know potentially if we have a man like that it it's possibly better for the clinician or the the medical professional to be to look away at something I mean pretend you're writing notes on a piece of paper or something I mean you can scribble that's what doctors do anyway isn't it so it's um yeah because staring them in the eye is is often the worst way to get these or the best way to get these men to shut down um and I know when people talk to me or men talk to me in particular it is my natural instinct to want to turn and look at them in the eye but um I've become quite accustomed to stand shoulder to shoulder and yeah just fold your arms and look off in the distance or whatever so it's being able to interpret that man speak um whereas if you weren't looking at a woman she'd probably think you weren't interested or you weren't listening but often looking away from the man is the best way to get him to open up. I have heard people talk about the power of eye contact and how you can really regulate the interaction by making eye contact when it's important and then detaching to give people I mean you don't want to be too stylised about it I wouldn't have thought but it's there's a rhythm to the conversation where when you're really making an important point you know like if you're going to ask them about suicide risk I guess you have to make some eye contact to show it's important but then disengage not disengage but just pull back a bit so that they can talk freely and make a kick a bit of dust around. I think the other thing is very important is um personal space as well certainly the further we get into rural areas the bigger the personal space so you know city people are much more comfortable having a conversation closer together but you know once we start going to Declan Currie or Julia Creek you know six or seven feet apart is quite okay and normal so yeah. Absolutely other people's reflections on that what about you Oren what are your feelings and the men you speak with how do they feel about the trust for mental health professionals who they can talk to how they like to be engaged with? I think yeah it's understanding like Mary said that that communication is probably a cliche to say that men don't communicate but we probably do and it's just in a different way and and it's understanding you know those key things and I think it comes back to I think either I think either David or Tim said about really understanding a bit of the background of maybe the area that you're working in or you know some of the challenges that they that they may face it's something that's really an important thing that I do if I go into a community to try and understand what are the challenges that that community is facing. Generally you know it doesn't matter where you go in Australia there's probably three similar ones in every community but then there'll be you know regional or community based issues that are that are challenging people so it's under understanding the area but then understanding how the male or the farmer communicates you know with you and some of those things like like Mary I think alluded to like you know just understanding like you know the fence you know these compounding issues like you know the fence fell down the bull got out you know the you broke down you know the tractors bogged in the paddock and all these things are just an accumulative build up that he's all adding to the stress and adding to the you know I suppose the eventuality of the the person presenting at a clinic. Now and Charlie's on his own his relationship's broken down his kids don't see him much anymore but the question's been asked by Melissa Duncan about the people's partners men's partners and whether they or what role they play I guess in encouraging their partner to seek help or I know it's generalising but how do men in Charlie's situation but who do have a partner with them how do they generally respond to being encouraged to seek help by their their life partner. Can I have a shot at that one? Yeah sure Warren and then Tim. Yeah yeah just like that is hard particularly in a situation that Charlie finds himself if his wife is still with him is that you know you're both going through the same situation the drought having the same impact on on you and being able to you know lean on on your partner or vice versa it's really hard because you know I know from personal experience that you know I knew that my wife was going through the same as me I was just dealing with the challenges differently to her and and adding the pressure of me you know letting her know that I wasn't travelling really well was something that I didn't want to do but I know that in that case that you know someone that's just there reassuring you that they're there so in Charlie's case this is one really major factor that you know that's a real alert for me is that he's had a relationship breakdown so he hasn't got that person there to you know to lean on or you know or for them to reassure him that you know he's okay and that he's got support close by so that's a real a big you know alarm bell for me especially in this case study there where Charlie is now at a relationship breakdown he hasn't got that person there within which I know is vitally important to me eventually seeking help. Great thanks for that Tim what about your thoughts? Well I think it's one of the most common reasons that men get help at all it's their partners drive that but on the other side of that we have to be really careful that we don't end up in a situation where it's got to the point where someone's been dragged there and what happens in that situation is that you'll you'll get a man who can come into the room who fold his arms and basically what's going on in his head is that I knew it was going to be rubbish and it's even worse than I thought it was going to be I don't want to be here and it's just as crap as I thought it was going to be so you know they are the absolutely women of the the drivers of men ending up in therapy particularly but you have to be pretty delicate in the way that that's handled in terms of if someone's pushed in there not only is the appointment a waste of time it also makes it much much harder the next time to try and get them in when they might need it even more so it's absolutely the way that they get in there but if we push too hard it can become really counterproductive so it has to be handled fairly delicate. Well that's been a clear message from this evening hasn't it that it's all about people being supportive of the man seeking the healthy needs or it's just not going to happen you can have your mental health care plan and your psychologist sessions all set up but getting him there and getting him to participate rather than just sitting there is going to be really important so so much of what you talked about tonight has been about preparing for people to make best use of that that opportunity. I'm just thinking about other things that have come up there's the idea of telehealth now we've been pushed into telehealth through the pandemic but does the remoteness of the video consultation assist with men in the sort of shoulder to shoulder type concept or is it more confronting Tim or David you've probably shifted a fair part of your practices online through the pandemic how's it gone with men? I might kick off Tim if you're happy. Yeah look I think look again it's a really hard one to generalise I've got some patients who some men who do really well on telehealth and I think in general I would say that once you've had some initial face-to-face consultations it's easy enough to continue it certainly is one of the things that can be that can be hard over telehealth I personally think I think it can be difficult at times to draw things out of people video helps but again that's got its challenges with regards to bandwidth and making sure you've got enough enough connection I've had an unfortunate situation in the past and anecdotes everything obviously that where the connection became so poor that it just became incredibly frustrating for the patient he was trying to relay something that was really important to him and the lack of connectivity actually just really sad the whole experience so look I've had mixed experiences to be honest. Tim yourself? Yeah I think Tim I think you're demonstrating the problem. Sorry Tim I think you're demonstrating the problem that David was referring to with the technology. Tim that was someone's in a situation. Can you hear me clearly now? Yeah no that's good we were talking about demonstrating things rather than talking about them you've done a fantastic job for some of the problems. Sure. Was it similar to what David said about for some people it's great for others it's not so choice is important. Yeah absolutely I mean I think the other thing is that you know telephones are a large part of that as well you know we're talking about you know video conferencing a lot but a lot is still done on telephone in terms of people we've met before and many people still prefer that so most men in terms of you know mobile remote clients if they're doing sessions they'd prefer to do it over a mobile phone than over video conference and I think that you know video does help in terms of you know that assessment phase in terms of you know seeing how the person's interacting and you lose a lot of that whether it's video or phone obviously you've got a tone of voice which can help but if you freeze like others just doing on a video conference it gets really really difficult to keep the person involved particularly if you're discussing something that's got a lot of emotion attached to it because people get very frustrated very easily in that situation so it is a barrier in that in that regard. Yeah so you need the technology to be invisibly in the background rather than taking all the all the attention absolutely look it's time for us I mean not to be honest but it's time for us to wrap up I'm just interested if each person could give us in a couple of minutes just a final comment what what you would say to Charlie when he first approached you and said you know what can you do to help me what would you what would you say Warren? I think if Charlie approached me it's just opening up building that rapport and opening up that conversation with him and listening and supporting him and not being judgmental to his situation understanding that you know the challenges that he's facing and having empathy for those even if you've never been through something like that before for me you know the relationship breakdown with his wife it's something that I haven't experienced but I could empathize the loss and the grief that he would be feeling and encourage him to keep that conversation going and and whether that's with with me or his support network understanding that he really needs to understand that you know there's people that are around him that love and and want to support him and he needs to let them in and then obviously then ongoing once that rapport's built is then encouraging him to seek help from a professional person to um you know to help him you know get back on the road to recovery great thanks Warren Mary is in the chat there's a a poem that's really caught my eye from Ken it's dry all right said young O'Neill with which astute remark he squatted down upon his heel and chewed a piece of bark which pretty much captures the male country psyche I guess so O'Neill has come up to you at one of your sessions and said you know I need some help what what can you do yeah I think that's um that's part you know as as Warren said is is empathizing with them but um it's it's sitting into that into that hole with them I guess and and giving them the space and the silence to do that um and particularly with um with women trying to help their partners I find a lot of women sit them at the table and and stare them in the eye and he's and tell me he won't talk to me and I'm like you're doing it all wrong um and the men often won't share with their partners because they don't want to burden them as as Warren said but I think um yeah if Charlie came up to me I'd be um encouraging him to to offload that and to empty the bucket as I call it get that stuff out um sit into that foxhole with him and listen to what he's got to say and um you know directing him to the appropriate services and I guess really using all the analogies that I talk about with the emptying the bucket and you're only bogged mate we don't need to burn this vehicle we can get you out of this um and and yeah you are the most valuable asset on on your property and um you know look it doesn't matter how big the machine is or how heavy it is we can get it out um and I often talk about driving in the dark that we we can head down the road um and I think when we're in a good headspace we're confident that we can get from one town to the next but we can't see the whole road and we can't see the next town when we turn the lights on but when we get bogged we tend to forget that there's a road there and we forget the next town is there so it's a bit like driving at night I tell them that it's you know you just if we keep going down the road we'll see a little bit more at a time but that's where our friends our family and um the professionals are there to light up a bit more road for us and to remind us that the road is there so yeah um I'm a big advocate for sit sit into the foxhole with him and and have a listen so that's great Mary and I think you've you've hit upon a really important point there about the the sympathy of a friend sharing the experience the empathy of somebody who can see the problem and that the person knows they've been understood and then moving I guess to the compassion of the health professional and the concerned friend actually doing something to help so David your two-minute summary about what you see as being the key points here look I think along similar lines I think it's about acknowledging that he's come and and you know thanking him for come and coming up with coming up with a plan to address his risks and why he's actually been there but the thinking of the long game how job is to really engage him to make sure he that we take the time to get to know him and to to deal with some of these things in the more longer term so I wouldn't let him kind of as a key takeaway he wouldn't be leaving my surgery without an appointment to come back and see me ideally at what time it suits him with a plan in place of the things I would like him to do beforehand whether that's something simple like an extra for his wrist but a plan to come back and then I'll be taking up the conversation again but it's really just take your time this is a long game in most cases and then connect him into the other services once that rapport has been established I mean it is that a lot of our audience are too young to remember fax machines but you've got to make that connection that handshake and actually get things connected so that people can then communicate what needs to be communicated so Tim your couple of minutes last statement before we finish up yeah I mean I think you know finally out where he's coming from is also you know really really important in terms of working up his perspective what's happening obviously as a starting point for for therapy but one of the other things that'll be really key here is you know not appearing too strange myself in that way in terms of you know making sure that that's a comfortable more normal feeling conversation because I think that can be an issue when people do seem too therapist in terms of having a more natural feeling conversation do one of the things that I'd be really keen on I mean I don't tend to have a specific approach when I'm talking to someone in terms of you know that assess but I really follow where they take me because I just find that is a much more smoother way of getting additional information if you follow where they're going you understand them better and it just flows better and you get everything you need and the person has a better experience of it but really a lot of it is really about making it seem more natural you know it could seem like a very foreign experience first time going into into therapy so making that feel as natural and comfortable as possible being upfront in terms of you know what we can what we can provide but really just making sure that it feels like a normal natural conversation sure look great thank you all so much I must say if Mary or Warren if you ever thinking of standing for parliament I don't care which party I'd vote for you both look absolutely fabulous tonight please don't leave us everybody there's a few things just to finish up on there's an exit survey and if you could give us feedback please do that there's a pie chart type icon in the lower right corner of your screen beside that speech bubble so please fill out the survey or just hang on and a message will pop up inviting you to do so when the webcast ends you will receive an email from MHPN that has the details of the recording a few people have asked about the recording so you will get a link to that and please do pass it on to colleagues or or friends who might be interested in what's been discussed tonight because there's been a lot of really important things that we've covered tonight tomorrow night upcoming activity it's the second in a series of culturally and linguistically diverse webinars and the ones this one's about interdisciplinary conversation exploring the meaning of healing and recovering what that means to different people 7th of April there's an emerging minds challenging communications with children session 15th of April MHPN coping with life transitions in young adults and the new episodes of MHPN's podcast series trauma and resilience series resilience was spoken about tonight they're now available on apple spotify or directly on the MHPN's website so there you go if you would like to join discussions with other professionals at your local level then there are project officers who are available to help you establish or join an existing MHPN network and that's across metropolitan regional rural and remote Australia there are 373 networks around the country so please visit the online map on the website and see what's close to you or contact Jackie whose email address will be on the website and you can also go to the map by following the link that will pop up once you complete the survey so time for us to finish for a couple of minutes over but i'm not going to apologize for that because i think there's been so much good content from each of our four speakers tonight thank you all very much indeed before i close i would like to acknowledge the lived experience of other people and carers of those who've lived with mental illness in the past and those who continue to live with mental illness in the present so please everybody keep an eye on your shitometers keep it in the green um and don't get bogged um be careful with each other be careful with yourselves we wish you all very well thank you to the panel again and thank you all for participating have a great evening and a great break coming up if you can get one goodbye