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The Hamilton Centre Podcast | Exploring Mental Health & Addiction is for service providers, individuals and family members dealing with co-occurring mental health and substance use conditions. In response to the recommendation of the Royal Commission into Victoria's Mental Health System (2021), the Centre was established to create a more inclusive and supportive system by promoting integrated care in Victoria, Australia.
Our podcast will feature interviews with service providers, individuals with lived experience, and workers who assist people with co-occurring conditions. We aim to promote holistic care throughout Victoria by breaking down barriers to treatment and through open minds and open doors.
This series features Gemma Turvey's composition, "Turquoise," performed by Gemma on piano, Craig Beard on vibraphone, and the talented musicians of the New Palm Court Orchestra.
Welcome to the Hamilton Centre podcast, a space where we explore the thinking of leaders, service providers, workers and people with lived and living experience, shaping the landscape of integrated care and mental health and addiction services in Victoria. I'm Annie Williams, Hamilton Centre Transformation Lead and your host today and I am thrilled to have a conversation with some of the brilliant minds behind our centre. We begin by acknowledging the traditional custodians of the lands on which this episode is recorded, Naarm, the Wurundjeri people of the Kulin nation and we pay our respects to elders past, present and emerging and acknowledge their unseated connection to land, sea and sky. We acknowledge people with lived experience of mental ill health, alcohol and other drug issues and of recovery and the experience of people who have been the carers, families or supporters of people with co occurring issues. In today's episode, we're going to discuss integrated care delivery in Victoria's Alcohol and Other Drug and Mental Health sectors.
Annie:Joining us are 2 guests from the Hamilton Centre Clinical Network at Austin Health and Goulburn Valley Health, Professor Ed Ogden, PSM, an experienced alcohol and other drug consultant, and Alison Szarejko, a mental health nurse and clinical lead of the Austin Goulburn Valley Health Clinical Network. Firstly, let's welcome Ed whose extensive experience in the AOD and mental health sectors offers crucial insights into integrated care.
Ed:Thank you.
Annie:Ed, could you begin, please, by telling us a little bit about yourself and your background?
Ed:Certainly. Look, I started, my clinical career in general practice, doing a little bit of forensic work on the side. And, after almost 10 years, I was persuaded to move into place headquarters. I practiced as a forensic physician full time for the next decade and stayed on with Victoria Place for another 17 years. During that time, I was responsible for the health care of people in police custody, 70% of whom have a lifetime of addiction to one substance or another.
Ed:And so I became increasingly interested in and involved with the management of addictions. So when I left the public service, I transitioned quite naturally to the Department of Addiction Medicine at St. Vincent's, and the story goes on from there.
Annie:So what, has your role been in, relation to to supporting the establishment of the Austin Golden Valley Clinical Network?
Ed:Well, I think the fact that I work, half my working life in Shepparton and the other half at the Austin means that, I I'm across both services, and it's made it, I think, easier to develop some of the linkages to the rural, network.
Annie:So you're the conduit between the city and the country?
Ed:Absolutely.
Annie:So as a leader within the the AOD and the mental health, clinical and research sectors, You've seen many changes over the years. What do you see the Hamilton Centre bringing to this space and most importantly to the provision of integrated care?
Ed:I think it's the the opportunity to work, with and within, mental health services rather than, being an external consultant, but actually spending time with people in their specific service to understand their needs and, how we can make a contribution if that's something we can do. Certainly, it's something that we've, I think, done very successfully in Golden Valley, which is probably easier because it's a smaller service and everybody knows each other. It's more difficult in the complexity of, metropolitan hospitals.
Annie:So those that relationship building has been important.
Ed:I think it's key to the whole thing Yeah. Is is to to build relationships with individuals so that they know, you know, who we are, what we have to offer. But equally, we understand what it is that they do and how their service works, because it's a collaborative venture.
Annie:And I guess having insight into the cultural nuances of rural and regional, clinical services versus the city is also an important part of this.
Ed:Sure. And and the the difficulties of, you know, staff shortages and consultant shortages and the tyranny of distance. You know, some people have to travel enormous distances either to see a practitioner or even something as simple as to get to a participating pharmacy.
Annie:And we are all aware of the challenges facing the rural and regional, communities in accessing mental health and AOD services. But what makes working in these regions so rewarding?
Ed:Oh, I think the really rewarding thing is that you can actually achieve things, that that you can actually work with a with a team who are collaborative and, in the same place, you know, both both physically and operationally so that you can bring services together for an individual more easily and in a more integrated way than you can in the complexity of a tertiary
Annie:hospital.
Ed:Mhmm.
Annie:Mhmm. So in if we think about the some of the recommendations from the Royal Commission in to Victoria's Mental Health, one of them was the development of the workforce, that you've just alluded to. What advice would you give young clinicians who are aspiring toward a career in, alcohol and other drug mental health sectors?
Ed:To use opportunities to build networks, to to work with your colleagues and every opportunity you have, understand how other people work, what their service is, how you can bring skills together. One of the early successes we've had in our region is to bring the nurse practitioners together across the region so that for the first time, they're able to to share and collaborate. And we've done something to reduce their sense of professional and social isolation.
Annie:Mhmm. So the importance of a community of practice is Absolutely. Underestimated.
Ed:I think that's the key to to actually the developments that were envisioned by the Royal Commission.
Annie:Yep. Yeah. Ed, as part of, your work with establishing the the team, for the clinical network at Austin and Goulburn Valley, could you talk a little bit about who is actually on your team?
Ed:Certainly. So there's there's, 3 of us part time, as consultants at the Austin Inn with supported by Alison and some administrative staff. But probably the most exciting part of our team is that at Shepparton, we have a psychiatrist with a lot of experience in in addiction, who is part time with the team in Shepparton. It means that we've been able to very early show leadership as to what can be done by by integrating someone within the service.
Annie:And do you, have any plans to add any lived experience, workers to your team?
Ed:Absolutely. I mean, certainly, the team I work with in Shepparton, we have a number of people with lived experience who are really valuable members of the team. And it would be really nice to see people with lived experience, both of, addiction and mental health, but also as caring for people with addiction and mental health to provide that extra level of support for families and, and loved ones who the system often doesn't look after very well at the moment.
Annie:Yes. That's right. There is significant gaps in those areas of care. Now let's turn to Alison whose role as the clinical lead at the Austin Goulburn Valley Clinical Network contribute significantly to the advancement of integrated care.
Allison:Hi, Annie. Nice to be here. Thanks for having me.
Annie:Allison, if you could change one aspect of integrated care in Victoria, what would it be?
Allison:Well, my first thought to that question would be that, you know, wish we had done this a lot sooner, to be able to better assist our, you know, consumers through their journey as well. So I know, you know, looking into the integrated care and the recommendations and everything else, I know that, you know, the DHS has provided quite a substantial amount of money on, you know, building the supporting workforce of psychiatry registrars, mental health nurses, etcetera. However, I I do feel like they need to kind of provide a few bit more incentives to try to get that kind of workforce into the AOD sector as well.
Annie:You know? Do you see that there needs to be a bit of education, for the workforce about what integrated care actually means?
Allison:I do agree with that because a lot of, you know, we we want everybody to work and communicate together but, you know, actually seeing how that works and how everybody works together to create that, I think there needs to be a lot more education around for people to actually fully understand it and know what it means.
Annie:So what what is your team doing around that too?
Allison:Yeah. So pretty much what we do when we get our referrals through, the first thing we do is, you know, say, for example, if it's a primary consultation, we set up a secondary, speak to the referrer, any kind of other treating teams that have, that are a part of the, you know, consumer's care just so we can get a full collaborative amount of information and understanding about the consumer before we go in, you know, because they do tend to see quite a lot of, you know, clinicians and physicians and, you know And it goes overwhelming. It is. And, you know, you just don't wanna be that other one and, you know, have having to go in not knowing anything and, you know re traumatize them or you bring things up or anything like that. Going in knowing you know at least the majority of the information about their history and what they're going through and what they're needing is important.
Allison:And also after seeing them, letting the teams know and having that multidisciplinary communication between everybody is also incredibly important for the consumer
Annie:as well. So so in in actual fact, it's a bit sort of around the the wrong way. A secondary consult sets it up to to create a safe and, sustainable environment for the client for their primary consult.
Allison:Yeah. And I I honestly feel that, you know, doing that, the you know, our doctors are able to have more information going in there, not just kinda going in cold and having to kind of start fresh as well. And it's just like, you know, this is what we're here for and this is how we can best help you. And, having that, you know I think that's really important, what I feel. Because I've had a lot of, from a psychiatry perspective, having them come in and kind of rehashing everything with our consumers.
Allison:It's quite confronting. You know, if they had taken that, you know, just even 10 minutes just to go through notes or read things or anything like that, it would have made a world of a difference.
Annie:So trauma informed care from the get go. Yes. 100%. Yeah. Can you tell us a little bit about some of your training and your the experiences that you bring to your role now?
Allison:Yeah. Well, I started my, nursing studies in the States, and I moved to Australia, finished here. And then I was working at Monash University on their, inpatient wards, for psychiatry. And always had an interest in mental health and kind of have always seen how AOD and mental health just kind of blend together. And, I started to
Annie:So almost like what comes they come together. What comes first?
Allison:Yeah. Well, it's almost simultaneously. It's just kind of yeah. And I noticed a lot of people that weren't really educated on, you know, opioid replacement therapy, and there was still this stigma around it. And what do we do?
Allison:And, you know, consumers come in and they're withdrawing. And I found it to be really interesting and fascinating and wanting to gather that information to best help our consumers and educate our clinicians on what's the best way to be able to treat this person because, you know, they're in withdrawal. They're uncomfortable. They're unhappy. How do we best manage and mitigate this, you know?
Annie:And do you see the role of lived experience workers as integral to that?
Allison:100%. I actually find that a lot of our consumers tend to downplay their substance use when they speak to clinicians as well because of, again, because of the stigma around it. You know, when you're actually open and honest with them and you have those lived experience workers that say, I know exactly what you're going through. It's just kind of like this breath of fresh air and their guard just kind of drops, and then they actually fully disclose, you know, their information with them because they have that commonality. Yeah.
Annie:Yeah. It's a really powerful 100%. Conversation to have, isn't it? Yeah. Yeah.
Annie:Yeah. Can you share some of the highlights of the stakeholder engagement you've been undertaking, in the regional services that are part of the Austin Goulburn Valley catchment?
Allison:Yeah. We've done quite a lot so far. I know we've taken a big presence in, Bendigo at the moment. They have, you know, not a lot of addiction services up there. So our help to them is, you know, just an integral part of their care, which is fantastic.
Allison:So reaching out to them, and, of course, our other, region in Mildura, which is quite a hike. So we're hoping to planning on getting up there quite soon enough to do our face to face meetings. But, yeah, we've gotten quite a few referrals up there, and they've also expressed the need for, you know, addiction services, and same with Albury and Wodonga as well. So we've done a lot of work on our area mental health, our locals, and our AOD sector as well. So we're getting very positive
Annie:feedback. Welcomed you with open up? Yes. So very similar to what Ed was talking about with the Shepparton, involvement as well.
Ed:Yes.
Annie:That's fantastic to be able to help start fill a gap.
Allison:A 100%. Yeah. Yep.
Annie:If you could fast forward 5 years, what's your dream for what the Hamilton Center can achieve for the Austin Goulburn Valley, clinical catchment? Yeah.
Allison:The first thing I, you know, thought of was, you know, you just kinda want everybody to know your name.
Annie:You know,
Allison:when you walk in, you're like, oh, that's everybody from Hamilton Centre. You know? You know, getting that good feedback that you're actually, you know, helping your team the you know, their teams and the consumers. I'd love to eventually see the Hamilton Centre kind of expand their services to, you know, include psychology or counseling in that aspect as well because I think that would be beneficial for some, you know, when we're, they're in our care. Also, I would love to see some of our regional hospitals actually have, you know, little Hamilton Centre hubs or locations and such as well, just to kind of branch out of it.
Allison:I know that's, you know, probably a little bit longer in that 5 year time frame, but think that would be a really fantastic resource for a lot of our rural and regional towns.
Annie:We'll have that. We're in a time of change, so any create any creative options that Exactly. Are client focused are going to be, well received.
Allison:And it'd also be good as well, you know, to see the Hamilton Centre upskilling more of our, you know, psych registrars or getting our mental health nurses involved in AOD and upskilling that workforce as well to be that kind of powerhouse to be able to do that.
Annie:Which is one of the remits for for Hamilton Centre.
Allison:Yeah. Correct.
Annie:So, Ed, if I could just come back to you, and fast forward 5 years, what would your dream for what the Hamilton Centre can achieve for the Austin, Goulburn Valley community be?
Ed:I think the most important thing would be that we start to attack the the stigma and misunderstanding associated with both mental health and, substance use. In the, substance use area, there are people who who don't really understand very much about mental health, and and clearly, there are people involved in the treatment of mental health who don't understand much about substance use. And and taking it more broadly, general practice and the community needs to have a broader understanding of of what substance use and mental health have in common and what it is that they could do to support, people who's are living with one or both problems.
Annie:And where would we start?
Ed:I think we started. You know, I think the fact that we're having these conversations, the fact that we're now able to talk about, the attitudes that people bring to the table when they're dealing with people with mental health or or substance use issues, and that we can challenge that and and get people to think about, you know, the baggage they've brought with them and and how they can approach someone who who has a problem. You know, I always start teaching about substance use by saying that you need to ask not what stuff the person's using, but what the stuff does for them. What is the underlying issue that people are using drugs for? Because if you understand that, then you've got an idea of what direction you might take to assist them.
Ed:Mhmm. So I think it's having those conversations that allow people to to think about substance use and mental health from a new perspective and think about them as not being frightening with something that they can actually make a contribution to.
Annie:And I wonder if that also makes them more aware of their own unconscious biases.
Ed:Well, I think that's what's uncomfortable about these conversations, isn't it? Is that you have to think about what do I bring to the table? What what's my attitude to people who, you know, sleep rough, use drugs, have a a mental illness, perhaps people who don't want to be engaged in treatment. How do we respond to someone who's rejecting? Here I am.
Ed:I'm a helping person. Yes. Someone doesn't want my help.
Annie:I can't fix it.
Ed:Well, I think that's one of the things that makes some practitioners very uncomfortable is that is that they've joined the helping profession because they want to help people get better. And there's an underlying assumption, of course, that people want to get better as we see it, not necessarily as they see it. Yes. And sometimes we don't have the knowledge or tools to help people achieve what they want. Mhmm.
Ed:Mhmm. And sometimes we have to evaluate the fact that what we think is best for them may not be the way they see the world.
Annie:Yes. And, Allison, if I can just ask you, within the nursing profession, have you seen similar instances of this unconscious bias?
Allison:Or Yes. I have. You know, both working on the wards and in community as well, you know, you get a lot of the novice nurses that come in, you know, straight from uni and they're very unfamiliar with, you know, substance use and all of that because they don't teach it in university. Really, it's a very brief, maybe just short conversation And you go into the ward and they're like, you know, what is this, you know, methadone or Suboxone? And this person's quite angry because they're not getting it in time.
Allison:And, you know, and it's they're they're quite uncomfortable in themselves and you kinda have to sit down and explain, you know, these are the reasons, you know, and, you know, a lot of stigma around, you know, why can't they just stop? And it's like, well, it's it's you have to look at the big picture of things, you know, like Ed was saying. You know, what what brought you to that point? You know, you know, if somebody wants to live, you know, rough or use substances, that's fine. You know, you have to kinda broaden your horizons and open your mind and see things from their perspective, and that's how we best help them.
Allison:You've said your kind of, you know, opinions or thoughts or anything like that, you know, to decide. Lead with empathy. Oh, 100%. No. And I and I always found that that was the biggest thing and, you know, we're not here to, you know, try to, you know, change their life, you know, for what we think is best for them.
Allison:We do what's what's best for them in their journey. You know?
Annie:So yeah.
Ed:Well, it's interesting, isn't it? Because these these major community issues of mental health and substance use are pretty much you know, you said something. They're gall steeper in nursing.
Allison:Oh, you don't you don't you don't discuss it. It's it's like a, oh, yeah.
Annie:This is opioid replacement.
Ed:It's like when we were young, you know, you know, you know, that will get
Annie:scents. Yeah.
Allison:No. And that's exactly right. And even in my master's course, when you're doing all your mental health nursing, there's nothing in there about substance use or AOD or anything like that, you know, and it's really unfortunate. They it should be a subject because when you're teaching mental health, you know, substances go hand in hand. I mean, don't don't get me wrong that every person with a mental illness uses substances, but the vast majority do.
Allison:And the nurses, we need to know this, and same with doctors. I mean, it's just kind of a general thing I feel that, you know, we we need to have it.
Ed:Well, it's still kind of a taboo subject, isn't it?
Allison:It is.
Ed:You know, the the universities, you know, who are responsible for most of the teaching of professionals, don't talk about substance use and mental health, all that interaction. Correct. And yet we know that it's a significant subset of the community. I mean, if it's, you know, if a survey of, 3 86 general practices says it's 19% of their patients, If surveys of general hospitals say that it's 20% of the patients in the hospital, why is it a more substantial part of the debate that goes on in the teaching of undergraduates? Yep.
Annie:Well, I wonder whether that's because the teaching of of undergraduates has got its origins in a fairly conservative mindset, and that just hasn't grown with
Ed:I think that's absolutely true. Mhmm.
Annie:Community experience.
Allison:No. 100%. Like, you know, you have 2 subjects on mental health, and they, you know, talk about all the diagnosis and, you know you know, patient centered care and everything else like that, which is great to have as a base. They're teaching you theory, but, you know, when you're actually going out there and you're doing the work, you need to know these things. Like, even in the grad graduate program, there is literally nothing in our at the university that I went to.
Allison:I won't say the name. But, you know, there's nothing in that graduate program about substance use. There's nothing. So, you know, you're they're basing it on us, you know, senior nurses in pharmacy or even the hope that doctors have this knowledge as well, like, you know, on the ward to explain these things and what these medications do and why, you know, these are the substances, these are the withdrawals, or this is what they look like. You know?
Annie:There needs to be really good clinical education to support assessment and also to allow the individuals to have that support from the staff.
Allison:Correct.
Ed:And and acceptance. I think it's back to that sort of sense of, you know, why are we stigmatizing a subset of the population? It's
Annie:because we don't understand them. Yes. Yes.
Ed:And and therefore, they make us uncomfortable. Somebody comes into your consulting space, whatever your profession is Yes. And you don't understand what's going on, it makes you uncomfortable. Yeah. And you therefore tend to be angry and pushing them away because of the discomfort they're causing
Allison:for you.
Annie:Mhmm. Mhmm. And reinforcing that stigma. Absolutely. That they're not welcome.
Allison:And that makes them have their guard up as well, and they don't wanna fully divulge any of their information to you.
Ed:Very much self reinforcing, isn't it? Because if they feel that they're under attack, then they're going to be defensive and aggressive and
Annie:Yes.
Ed:Which may well reinforce your ideas about this other group of people.
Annie:Fit your stereotype? Absolutely. Yes. Yes.
Ed:So there are great opportunities, I think, in in education, you know, for all of the professions to to, you know, open their minds to to the complexity of of of these issues.
Annie:And to the complexity of people's lives, I think I think a lot of, individuals in these helping professions perhaps have not had the life experience that, our client group may have, and to even entertain the thought that, there is a more complex life experience out there is.
Ed:I think that's why the role of people with lived experience is so crucial because it brings to the to the treating team, whatever the team is, a sense of of understanding of of a different experience, a different lifestyle that if people have come to, if you take my profession, if people come to medicine from a fairly middle class y background with, you know, obviously high educational expectations to get in, then their lived experience might be very different from some of the people they're working with. And having people working alongside them who can bring that the wisdom of lived experience to the table is really important.
Annie:Indeed, yeah. I really wanna thank you both for such an engaging and insightful conversation today and I really look forward to, I hope another opportunity to discuss, the progress of the Austin Golden Valley Clinical Network with you, and also for your, commitment to advancing, integrated care. It's really inspiring. So thank you very much for sharing your insights with us.
Allison:Oh, thank you, Annie.
Annie:Thank you for joining us on the Hamilton Centre podcast where we explore the thinking of leaders, service providers, workers and people with lived and living experience, shaping the landscape of integrated care in mental health and addiction services across Victoria. I'm Annie Williams, your host today, and we can't wait to share these insights with you. Visit our web site www.hamiltoncentre.org.au and subscribe to our newsletter for a journey into transformative mental health and addiction care.