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"Never the Same" is an interview-based podcast exploring how different work streams intersect with suicide prevention, career development, and life lessons. The title draws inspiration from Heraclitus' quote, "No man ever steps in the same river twice, for it's not the same river and he's not the same man," reflecting the ever-changing nature of life and personal growth. Each episode features conversations with guests from various fields, highlighting defining moments and shifts in thinking. The podcast aims to uncover new insights for suicide prevention while offering broader perspectives on personal and professional growth.
[0:00:03]
Tony: Welcome to a special episode of Never the Same podcast, where today we'll be having the unique opportunity to speak with two of Western Australia's leaders in mental health. Maureen Lewis was appointed Mental Health Commissioner in July 2023, bringing extensive experience across clinical services, policy and strategic reform. She's worked both at the state and national levels, and Dr. Nathan Gibson, who has served as Western Australia's Chief Psychiatrist since 2013, providing independent oversight and advocacy for over a decade. Together, they represent the vision of reform as well as a clinical guardrails of accountability in Western Australia's Mental Health System.
[0:00:51] So, welcome.
Maureen & Nathan: Thank you, Tony.
We have viewers and listeners who are in many different countries from Nepal, parts of Africa, Europe, the US and many wouldn't be familiar with the exact mental health system here and how your roles work and so if we could just start with a bit of an explanation so that as we talk, people have context for the things that we're talking about. So, maybe start with the role of Chief Psychiatrist, which wouldn't be known by all.
Nathan: Sure. There's, each state in Australia has a Chief Psychiatrist but we're slightly different. I don't run Mental Health Services.
[0:01:36] I'm not the chief of psychiatrists but under the Mental Health Act, the mental health legislation, I'm charged with oversighting standards of care of mental health services, mostly public services but also private psychiatric hostels as well, both inpatient and community. So I have some powers under the act but have to work obviously directly with clinicians and the Administration as well.
Tony: So standards is like the quality of the care. Well, what else would that involve?
Nathan: Absolutely. Safety, quality, I'm a regulator in some sense and it's also understanding the interface between the mental health act, the law, and how that [0:02:22] translates for clinicians on the ground.
Tony: Okay. And how about your role, which is also a little different even within Australia?
Maureen: Yeah, absolutely. So, the Mental Health Commission of Western Australia, we are charged with commissioning all of the services across mental health and drug and alcohol for Western Australia, which means we purchase them all. So the budget sits with the Commission. In other states and territories that would be more of a Department of Health role, a Mental Health Branch, but we're like a department and a commission all in one. In other states, the Commissions are there to safeguard, to be the advocates, to monitor and report on system reform and to advise governments but the Western Australian Commission, yes we have that function but we also do the purchasing. So there's a little bit of a tension there in terms of we are the ones working with a [0:03:09] sector to make decisions, so it's a little bit trickier than to monitor and report from a hands off perspective, an independent perspective. But yeah, it's different but it's been the system since 2010.
Nathan: We like to do it different in WA.
Tony: Yes. Everything's just a little special. The special flower. And so how much do you interface in your work?
Maureen: So, we are in the same building. Nathan is in the building with the Commission. So, part of the Commission is to offer administrative support to the entities of which Nathan is one, Office of the Chief Psychiatrist. We also have the Mental Health Tribunal and then the Mental Health Advocacy Service. Those entities don't report to me, it's basically a relationship about [0:03:56] providing corporate support really. So we're in the same building but Nathan and I have known each other, we were just saying maybe 20 years? 20 years we've been around in WA forever.
Tony: How did you, yeah, how did you first come across each other? This is kind of fun. We don't usually have two people together, so this is really fun. So how did you first meet?
Nathan: We, Maureen's a nurse and I'm a doctor. We've worked intimately together in kind of administrative roles and then sometimes on meetings and we've bumped into each other on and off over the years in various different roles but that's WA. People kind of shift roles and you get recycled and you know people over a long period of time, so.
Maureen: Yeah and even when I moved over East for seven years, still had interface [0:04:44] with Nathan at various national things, so yeah it's been a long time really.
Tony: So here when people say over East what they're referring to are in your case, New South Wales, Australia which is where Sydney is. Yeah. And is on the East side and we're here on the West side of the country. What drew you back to Western Australia?
Maureen: So, family were all here. So, started and our daughter followed us to New South Wales when we moved there so I worked in the Commonwealth, so across the whole of Australia really and then more later at New South Wales Ministry of Health. It was COVID time, so I do know what COVID is unlike many of Western Australians, I am joking but COVID was COVID in Sydney. It was very difficult times and we couldn't get back to family.
[0:05:32] We used to always come back every few months and make sure we saw them. So that was like a catalyst to get us back a little bit sooner. We were always coming home. Kept our home and everything else but it was just, yeah, happened quicker because of COVID, I'd say.
Tony: Yeah, I think this was actually an interesting point to make because the state handled COVID quite differently and I think it does reflect something about the character of Western Australia. Do you wanna just talk about that a little bit, you would've been here during that time?
Yeah, so. We sort of heard about it from the outside and that we couldn't get in but what are your observations about that and how does it for you reflect the environment here?
Nathan: Yeah, look it is interesting. [0:06:17] It was very, it was a hard border as they say and we didn't have the same lockdown pains that some of the Eastern states did and I think that did probably shape how we saw COVID. Certainly some of the cruise ships that came in to WA, we are a cruise destination, were COVID ships and so we had to deal with that. There were lots of people in quarantine during that period so we had the pains around quarantine as well and I think WA when you think of things like the Bali bombings many years ago when WA played a significant role in the support of [0:07:03] that disaster, we do have a public health infrastructure that's very ready, I think, in many ways. And so, we were lucky in that regard but each Premier managed it differently in many ways on advice and I feel in some ways it was slightly easier for us but there was still some pains I think for many people during COVID here in WA, we can't underestimate that either.
Maureen: Yeah, absolutely. Just being dislocated from family and seeing what was going on in TV in other states and that fear that would happen here and I know the certainly levels of child and youth distress during that period, 'cause I was in New South Wales at the time.
[0:07:48] It was relatively similar in WA despite having a different way on COVID in terms of the higher levels of distress.
Tony: Yeah.
Maureen: So it's not that I've gone researching into that but there was a lot of conversations saying despite the differences of all the states and territories, some of those impacts were felt similarly across age cohorts.
Tony: That's interesting. We're actually presenting some work and have a publication under review where I was conducting a study that happened to go across COVID from the period of time where there was more restriction, including well after it and one of the things that we found was, we asked people the role that COVID might've played in their suicide attempts.
[0:08:35] We had more than 300 different people who'd have a suicide attempt in the research study and what we found surprisingly was that well after the pandemic, a number of people still saw things that had happened during the pandemic as a primary cause for their suicide attempt. And then a number more had it as a secondary cause. But actually I think it was like a full 11% which is actually quite a lot if you think about it who said, "that's a primary reason why I attempted suicide," where things had happened during the pandemic. So, we were really surprised to see that so much even far after the restrictions had lifted.
Maureen: Yeah.
Nathan: And certainly for WA, the kids suffered I think because they were taken out. [0:09:21] of school and they had lockdowns there and even though it wasn't as severe as the Eastern states, there certainly has been some ongoing distress from that period of time amongst our younger people, I think from COVID.
Maureen: Yeah.
Tony: So it's been 20 years that you know each other and you saw Maureen return to the state and you were there along. One of the things that we explore on this podcast as you know is how people change in their ideas, their approach to things, in their own careers or lives. Maureen, when you think about like when you left WA to when you came back, I wonder if you could just, I don't know if anything comes to mind that, reflect [0:10:08] on ways that you came back different, or?
Maureen: Yeah.
Tony: Yeah.
Maureen: I think, look, it was really good for me to get away. I probably didn't know that at the time to actually go somewhere else and see how people might do things differently and meet different leaders, different ways of doing things. So I was exposed to many different things. I think the role I was in to start with was very much a Commonwealth role around policy.
So I got to spend a lot of time in Canberra with politicians and learning how to talk and work with different sort of people from that perspective where previously here I would've been not always clinical but in a different sort of role. So I think just being away, meeting new people, seeing new ideas, new ways of doing things, different systems and structures and as Nathan mentioned [0:10:56] before, in WA you tend to bump into a lot of the same people a lot of the time in different roles as time goes on and I saw less of that in over East. It seemed to be new people coming in and not the same people moving down different roles. And I'm not saying that's a good or bad thing but it kind of refreshed and invigorated things.
Tony: Yeah.
Maureen: So coming back, interesting coming back 'cause I ended up going back to a job before this one, which was one I did many years ago. So that was interesting, working with children and youth. Yeah. That was interesting coming back after about 10 years and then seeing some of the things that had been delivered, when I was involved in the early planning and they hadn't quite turned out the way I thought they were going to. [0:11:42] So it was interesting.
Tony: That is, yeah. I'd like to maybe follow up on that in a minute. I just wanted to ask though first, what did you learn from being in Canberra? Canberra, for those who don't know, is in the Australian Capital Territory which is where the seat of Parliament is and the... So what did you learn from being in Canberra?
Maureen: So, I think, it's cold. Super cold! No, that's not the only thing I learned but I think it was about, we spend a lot of time talking to various politicians across portfolios to try and get some, a better rub for mental health and understanding across the board. So that willingness to work together because of all of the central agencies are all together in Canberra as well, you know, everywhere you turned it was another government agency and department and we worked a lot together [0:12:30] in terms of those conversations. That happens here, so it sounds like it doesn't but It does but I think it's just so concentrated over a national level.
Tony: And set a national level. In the United States that would be like Washington DC.
Maureen: Yeah. Yeah and so different conversations really than just being about the one state you are in 'cause it was about Australia. It was different. It was about all of Australia but also you then got to see lots of similarities across this field and lots of struggles that we all have together. There's very similar themes regardless of where you are.
Tony: I think a lot of times people who don't have direct contact with politicians might not know what they're really like.
Maureen: Yeah.
Tony: People who are in elected positions or I guess what would you share about that? [0:13:20] Like, what have you learned about how they–so every one of them, everybody's different but–what were some things maybe or an example of a time where you had some interaction with somebody who is in a political role in relation to mental health or whatever comes to mind?
Maureen: I think, I mean, what I'd say is mental health and alcohol and drug challenges touch everyone. So many of those people, like all of us, know or have somebody in their family or a friend who have been touched by mental health or drug and alcohol challenges. They're human, very human. So despite what you might see sometimes, specifically answering or taking a tough stance on something, they're no different to you and I. They're tough. They work super hard, super long hours. [0:14:07] There from dawn to dusk and really I was super impressed with the passion no matter what portfolio they're in or given, they absolutely do what they're there for the people. So I was super impressed. Would it make me wanna be a politician? Absolutely not. And that's because, geez, it's tough. It's super tough. So I admire, you know.
Tony: What's, yeah.
Nathan: Look, well, our Premier's father is a psychiatrist so...
Maureen: Yes.
Nathan: He's got a
Maureen: That's right.
Nathan: an insight into
Tony: Yeah.
Nathan: mental health but I think our political colleagues have really built up a greater understanding around mental health in recent years because it's been such a prominent issue and people have been required to do that, I think so.
[0:14:53] And we have an interesting situation in WA now where we have our mental health portfolio has been split amongst a number of ministers to get the infrastructure right, to get the prevention right, to get the old age issues right. To get the research right as well as the broader mental health approach. So there's really an attempt I think to try and build, to fill out the mental health expertise at a political level.
Maureen: Yep.
Tony: So how have you seen that change?
Nathan: Well, I think years ago if I got to speak to politicians, they had no idea. They had no idea. They thought hospitals were where mental health occurred and that you [0:15:38] might get some of the psychosocial agencies that might work in the community but that was sometimes an the understanding but that's the general public understanding as well too, so, I think they've been brought along with the increasing wave of public education, not about everything. Certainly about anxiety, depression, maybe not about psychosis as much, that's still an area of, I think, public health we have a need to focus on, I think, but I think they've been part of that wave. But it's such a big burden on government as well, too from a monetary perspective. 10% of the health budget is mental health, over a billion dollars, so they've gotta know where the money's going as well.
Tony: Yeah. [0:16:24] So let's talk a little bit about youth. I know you both in different ways–as I was preparing for this was learning more. I'd known a little bit about what you had done, Maureen, but I dug into it a little bit more and I know that you've also advocated, especially in the forensics system for youth. So maybe just help me understand what's on the front burner for youth right now for you, where have you seen things go? Where are you seeing things go each in your own, sort of, portfolio?
Maureen: Yeah, I mean I think from our perspective and we're working with colleagues more nationally on this, is about that early intervention and prevention. So getting, because we've seen the rise in distress. [0:17:10] It's really about how do we get in early and turn lives around so they don't become just part of our system forever. And now there are people, as Nathan explained, who will have psychotic disorders who need our system for a very long time but if we can try and turn things around with the prevention and early intervention, talk to young people, yeah, really try and change things around because I think what we don't want is to wait till it's late and it becomes a way of life.
So yeah, I think that's a big thing. For me, mental health has changed so much from when I started as a nurse in the 80’s. Back then we still had the institutions and really what I would see then in [0:17:55] the people like catatonic depression, schizophrenia, severe bipolar disorder. It was a very different cohort of people that we're seeing in our mental health systems now.
And as Nathan explained, it's not just our hospitals but it's more broadly people who are putting their hand up and the stigma is less about, "Hey, I've had a mental health challenge" or, and I think getting back to young people, they are very, I find them very social policy minded compared to what I was when I was a young person. They are very different. It's very accepting. Open to talking about feelings and things, more so I think from when I was young but I'm not sure whether...
Tony: You said that you've seen that too?
Maureen: We're a similar age.
Nathan: Yeah. Absolutely. I think, well just generally can I just say that we are lucky in [0:18:43] WA because we are a rich state. We have a lot of money spent on mental health. We're a huge state and that's the challenge I think for us here. Our Country Health Service is the essentially the largest health service in the world for one service.
Tony: Geographically?
Nathan: Yeah, geographically it is. And so that provides its challenges particularly for youth and for a whole range of folk. We generally have a pretty good system, I think, and I say that because there's a lot of time and energy spent on mental health in WA. I often see things when they go wrong and so, and when they go wrong, absolutely, we need to focus on those areas.
So the areas I tend to focus on are those areas that we've seen [0:19:32] that perhaps aren't doing so well. And certainly in recent years there's been an increased focus on kids because of the increased rates of self-harm and the increased rates of suicide. In the Aboriginal community, the increasing rates of suicide, increasing rates of self harm within the Aboriginal community.
The increasing rates of hospitalisation of Aboriginal people so, I think Aboriginal mental health and Social and Emotional Wellbeing is a really critical topic area. We do know from the work by Julian Trollora in New South Wales that people with intellectual disability, neurodevelopmental issues like autism or fetal alcohol spectrum disorder are over-represented in [0:20:22] the mental health sector as well. So I have a real interest in seeing us expand our understanding of how we serve that group of folk.
You mentioned the forensics as well. People in prisons are often the forgotten folk. They are doubly disadvantaged. They're in prison and if they've got a mental illness, it's really tough. And there's been a shift recently, in recent years to try and redress that balance in WA. I think we all acknowledge we're still behind the eight ball but it's something we need to do. So, and just generally for me, restrictive practice in mental health services...
Tony: An important part of what you've been working on for many years. Yeah.
[0:21:07]
Nathan: Seclusion and restraint in Mental Health Services in inpatient units, trying to reduce that. Trying to work towards eliminating that as well and I think that's what they call a lag indicator. So it's an indicator of downstream of the type of care that's happening upstream. And so if we can actually reduce our seclusion or restraint, we are actually doing better.
Tony: Yeah.
Nathan: Better upstream care.
Tony: Say more about that. How do you see, like what do you see in the care that would reduce these restrictive practices or what do you see that might increase them?
Nathan: Well the interesting thing is the work that was done 15-20 years ago, when we went across to America and went across to the UK and looked at services [0:21:55] that had reduced those restrictive practices, they didn't have extra money. They were old crumbly services but it was about the work with the staff I think and the focus on lived experience I think that made the difference and looking at the data.
And so we've used that and right across Australia we've reduced that but it's important because if someone's having a seclusion or restraint, it's gonna be bad outcome for them. It's traumatising for them. It's traumatising for the staff and so what we're trying to do upstream is trauma-informed care. That term is thrown around a lot.
Tony: It is.
Nathan: What does it mean, “trauma-informed care?" But if we're actually acknowledging that 70% or more percent of folk that come into mental health services have a significant [0:22:44] trauma in their lives prior to this, then that's a real focus to support them.
And if we can actually turn our minds and turn our therapeutic energy into focusing on trauma, we are less likely to have bad outcomes down the track in inpatient units. So that's the kind of thinking around that, I think.
Tony: Well, what does that, what does it mean to you, trauma informed care? What would you say that includes for you?
Nathan: Well, there's different phases. There's if you like the ‘understanding’ that trauma is involved. Then there's the ‘identifying’ that trauma is involved for a person. And then it's actually being able to do something about it. And I think sometimes we're at the understanding phase but we don't actually identify it and we don't do anything about it necessarily and some services
[0:23:33] do but I think it's about staff being able to understand that's a critical component of our core work if you like and our professional development, I think. And even our funding focus, I think, will be useful to actually build that workforce capacity, I think, around trauma. Staff are compassionate. They want to do the right thing.
Tony: Yes.
Nathan: High quality staff, we need to make sure they're armed with the tools to be able to address some of the key issues.
Tony: Yeah. Yeah, I really see that as critical in suicide prevention as well. I'm curious as you're speaking, I have to say one thing that strikes me is that [0:24:20] there's a particular kind of disposition that somebody has to have to take on the problems of a mental health system. I mean, you described it as like, that you a lot of times comes to your attention when things aren't going right. I'm curious what suited you for that?
Nathan: Well, it's interesting, I come from a background of blacksmiths and my father was a world class ballroom dancer so–how did I end up here? But, I always had a sense of kind of social justice. I always had a sense of interest in people's stories, an interest in narratives, an interest in how people worked psychologically.
[0:25:09] That was at medical school, that was psychology, it was in fact my favourite, pre-clinical subject and so that's what led me down that path but it's not just having that kind of interest, it's also then about how do you do something about it, and how do you do something about it effectively, I think, and that's often the shift from us as clinicians, as a psychiatrist working as a clinician, moving to a leadership role is you can take your clinical thinking but you have to also think strategically. So how do we, how we gonna fix this as well?
Tony: Yeah. How did you learn that thinking?
Nathan: Well, I don't know about you, Maureen, but I kind of fell into it really. I think if you use that term, I was unconsciously incompetent when I [0:25:57] started to say as a leader and I've started to develop some competence. But it is about, leadership is a separate skill in many ways and I think leaders are made not born. I think you actually have to train as a leader. I think you have to have the theory training. You have to have the supervision and you have to make mistakes as you go along.
Tony: Yeah. Reflect on that.
Maureen: Yeah I think for me, like Nathan, sort of accidentally fell into leadership roles. I started off as a clinician on the ground and I would always have a two or three year time that I was gonna be somewhere and what I wanted to deliver in that time and then, it's not that I would become bored in a disrespectful way but I needed then to go and learn something else and go somewhere else.
[0:26:44] So I never tended to stay anywhere too long because I'd learn a set of skills, I’d come in and I'd have a thing to do and then I would move somewhere else. But I don't think I ever thought I want to be a leader one day or be in this role or in any other role.
I was very comfortable being the 2IC always. Probably the last, I don't know, 15 years of my career has been that person helping the person not just look good but deliver well and be in that background. And it's only now that this is the first time in, you know, getting old, that I've actually stood out front. So that's been an interesting shift and with that comes a whole pile of new skills you have to learn in doing that. You can't hide.
Tony: Yeah. Let's dig in a little bit because actually some of the comments that [0:27:32] I've had from people in some of our previous episodes is people are really interested in how leaders think. How do you become a leader? And particularly about strategy. So I'd love just to camp there a bit. You mentioned you have to be strategic in addition to clinical. How do you learn to be strategic? Can you think of times when you, kind of, where that skill like took a leap forward or something?
Maureen: For me, I learn by watching other great people do it.
Tony: Anybody come to mind?
Maureen: There's certainly a psychiatrist I used to work with in the National Commission. Just watching her with people.
[0:28:18] How she influenced her style, her manner, sometimes I could get quite frustrated and that's not gonna get you anywhere if you become frustrated to other people. So just watching her style manage how she managed to do things. So I think for me watching, learning, having good role models but you don't always know 'cause when you're younger you think you are doing it well until you realise you get a few fat no’s and so I guess, yeah.
Tony: Do you have a mentor now?
Maureen: I still contact the people I respect in terms of leadership people who I'll talk to when I'm annoyed or frustrated but I probably don't do it well enough to be able to have regular sessions where I'm going to debrief. It tends to be as something comes up.
Tony: Ring them up.
[0:29:04]
Maureen: I'll ring them up, phone a friend, rather than something I regularly sit down and do and think about.
Tony: You have mentors?
Nathan: I do. I spent 20 years in my leadership career not doing any strategy, not really. It's only perhaps in more recent years, I think, that I've come to understand the value of that and the incredible importance of time. It was in fact by my mentor who was the previous chief psychiatrist, Ron Davidson, who said, "You need thinking time in your role." The system is chaotic.
The system is complicated. There'll be pulls on your time. You actually have to have thinking time. That's the value of your role. And that's really stood me in good stead and I think that's the basis of strategy. You actually have to have time to think and incorporate and [0:29:53] analyse to develop the strategy. If you don't have that base, you can't.
Tony: Yeah. How do you do that?
Nathan: You create time. You shut the door.
Tony: Yeah.
Nathan: You have to, and you build it into the assumption within your workplace that that's valuable as well.
Tony: That's the thing you can bring.
Nathan: Yeah. That's the thing you bring and you bring other people into the learning around that and they value that as well too.
Tony: So what does that look like for you? Is that writing? Is it, like, what does thinking look like for Nathan Gibson?
Nathan: Well, I think it's two things. One is, it's the processing at the end of the day of the things that have gone on and then the preparation going forward for the next day.
[0:30:40] But it's also in the acute moment as well, too. Something will be, there’ll be a media issue, there will be a crisis and rather than just jumping in, it's the–it's almost like the war room. You're actually, you're saying, okay let's get the key folk together, let's shut the door, let's spend this time.
While as the chaos is going around, to actually say okay, well how best can we be of value? And you play out scenarios. You think of all the factors. You think of all the stakeholders, all of those things. There's formulas for those but it's just creating an expectation that that's valuable and reflecting on the value with your team around that strategy.
Tony: One of the things I've think I've seen over time in my own leadership is, you [0:31:32] develop kind of principles to lean on. Kind of, first principles so that when something comes your way, you have a bit of a framework or to start with. It's not just every problems a new problem for the day and sometimes bringing people along with, let me tell you how, let me take a step back from this, I find myself taking that step back. Are there some principles or frameworks that you tend to find yourself leaning on?
Maureen: I probably try and not react straight away. You know, like jump to some thing just from a kind of gut feeling. So take some time, think about things. You can't always have the time but where you can just have, be a bit [0:32:20] more thoughtful, considered about it. Always very thoughtful about the other people involved and how things, what I say or do or the decision I make will impact on them. So really to give that some thought of something I might think.
Tony: Take a little inventory. Like how am I, how is this going to impact?
Maureen: Who is it gonna impact? How's it gonna impact? And even if there is gonna be a bad impact, it's about really then how do I do the groundwork to prep people for that beforehand? So yeah. It's kind of yeah, being less reactive than I probably would have and I think after being a clinician in services where you did have to make those calls, a call you made could really have a devastating outcome for patients or others, now being in these roles, yes, it could have a devastating impact [0:33:10] but probably on me or something else. It's quite, I feel far more relaxed if that makes sense because it's, I haven't got that human being in front of me where I've.
Tony: It's really hard.
Maureen: Yet I know I still am impacting on human still things in the long run. But, so it's, kind of different. I say to myself all the time, right now there's a panic about something and it's, you know, we're not in open heart surgery... just stop. Let's think about it and let's... Gives you greater objectivity. Yeah, exactly. And you're not in that panic sort of situation.
Tony: How about you–principles, frameworks that you tend to find yourself?
Nathan: Yeah. The framework that I tend to come to use came from when I was working as a psychiatrist in a general hospital. And I had a framework of how to deal with crises there. And it's simply, it's about the collection of information, number one.
[0:33:58]
How much information will you get and do you need? And there's always a compromise. You never get as much as you need. The key question is, what's the timeframe for this? How long have you got to think about and manage this so that you've got a frame?
Then the other component, who are the stakeholders here? Who do we need to think about in this and then you can start to role play. Not role play, but scenario play, where you can go if we do this, if we do that... And then you can, often it's finding the least-worst scenario because there's often never a perfect approach. But then there's also that capacity to shift once new information comes [0:34:45] in, so an ongoing reflective process.
So that's the kind of, if you like broad framework that I tend to use in those situations.
Tony: Yeah. Let me break that down. So it was, information. What information do I need and how much can I?
Nathan: It probably starts with time.
Tony: Okay, so how much time do we have?
Nathan: How much time do you have?
Tony: Maybe we'll flip that. There's time. Then information. Then stakeholders. Stakeholders, yeah. And then scenarios. Yeah. Yeah. That's really helpful.
Nathan: And then the flexibility you’ve got–
Tony: And then pivoting.
Nathan: You've gotta have that capacity.
Tony: And adjusting, adapting as you going.
Nathan: Yeah.
Tony: Another helpful framework for me has been, is it a one-way or a two-way door? I can't remember where I heard that but meaning, if when we make this decision, is this something that we could backtrack from or not?
[0:35:34]
And then, so I think that does interact with the time dimension that you were talking about because we don't have to spend quite as much time on decisions where there's a two-way door, where we could make a decision, where we could change it later. Yeah and that's one of the first things I often will ask myself is, like, whatever am I doing here, is this a one-way or a two-way door? And then put the amount of resources into that, sort of like, based on that. And it turns out there's actually a lot of two-way doors.
Nathan: Yeah.
Tony: More things than we sometimes think could be pulled back later if you're okay not always being consistent over time to adjust and adapt.
Nathan: And the big, kind of confounder now is the changing media space [0:36:21] and social media, I think, and how much that reflects a capacity for people externally to comment on, critique any move that you're making in real time, literally. And that's the challenge I think, that's one of the strategic challenges.
Tony: Have you had that?
Nathan: It's less of an issue for me. Probably more an issue for Maureen, I guess. Given that Maureen has the money.
Maureen: Yeah.
Nathan: And I don't know, Maureen, your thoughts?
Maureen: I think, yeah, you've gotta be super careful. Like the, I dunno if the two door's always there. You say something or you might quote something or give advice that's going to make a big impact.
Tony: So you feel like a lot of times you don't have that? Can't take it back.
Maureen: No, because once it’s out, it’s out.
Tony: Yeah.
Maureen: And now, yes, you can go back and explain that but often media aren't interested in [0:37:08] the explaining it, they're catching the,
Tony: Yeah.
Maureen: the two words that someone may have used or taken the wrong way.
Tony: So how do you handle that?
Maureen: I try to be careful. I try to be mindful of what I'm saying and also I'm certainly always very about being really clear upfront. I'm not intentionally ever, there's no intention for me to ever use things in a bad way or say things in a way if I do it it's a more ignorance.
So it's like a, you know, 'cause often you will do it in certain spaces, say the wrong word which upsets people particularly, I have to be very careful in the Aboriginal space that you're, not deliberate, but you're not saying something that–but, we've been [0:37:54] going through cultural training to try and, you know, be more relational and get us across that to make sure your impact.
But for me, I don't have a piece of my body that would deliberately want to be malice or treat, or say something to hurt someone but sometimes you can.
Tony: Yeah.
Maureen: But yeah, sometimes it's too late once you've said it. It's not too late but it's very hard to pull back from.
Tony: Yeah. Well, that's helpful.
Maureen: Yeah.
Tony: Well, let's talk about that a little bit you mentioned before about some of the wanting to be tending to the mental health of Aboriginal and Torres Strait Islander people. I noticed that you have your...
Maureen: Yes.
Tony: It's reconciliation week here
Maureen: Yes, absolutely.
Tony: in Australia. Maybe we could explain that to people who might not know what that is but, so [0:38:40] I'd like to talk a little bit about what your observations, thoughts, what you're seeing and hearing about Aboriginal Mental Health but, maybe start with your flower?
Maureen: The flower. Yeah, so obviously in Australia this week it's National Reconciliation Week. It's about a time we all come together and it's not just the only time but it's a time where recognising there's things that have happened in the past historically that haven't been good for Aboriginal people and it's about us coming together to try and make a difference and change that way we work together.
The policies we will make, the impacts we have and walk alongside our Aboriginal colleagues and recognise what they've been through. The staff of the Commission made this little flower, it's a hibiscus. They had crochet clubs for the last week or so
Tony: Oh, really?
Maureen: to make the hibiscus for today, so it's a coming together of all the staff and [0:39:28] not led by Aboriginal staff either. It's led by our other staff 'cause it's our job to put our, kind of, 'do better' in lots of spaces so it was a lovely event this morning we had and really it's about that commitment about what we're gonna do in the future and how we're gonna walk together and change the way things have happened in the past for Aboriginal people. But Nathan, you...
Nathan: Yeah, I think I the kind of epiphany for me was the relationship and working with some of our local Noongar Elders. So, we're on Whadjuk Noongar boodja which is Whadjuk tribe of the broader Noongar Nation. And boodja is Land. So it's the land of the Mother, where we are here at the moment and this place we're in here, I don't quite know the name but just down the road is, it's Gunderup. [0:40:16] It's called Gunderup. So that's the kind of, Whadjuk name and so that understanding of the depth of knowledge and that there is in fact a different way of learning, a different way of understanding, was the real shift for me and in fact, seeding my thinking a little bit to understand how folk who've been here for 60,000 years have been able to thrive for that period of time.
And I think it's a real paradigm shift for us. I think if we do the stuff the same way we always did, it just hasn't worked. [0:41:04] For folk around the world we have things called Closing the Gap targets. How do we actually improve the Health and Education, et cetera, for Aboriginal people who've suffered since what was for them colonisation and the effects of colonisation, the effects of children being taken away from their families, the effects of discrimination in some ways still ongoing and Reconciliation Week is interesting because some people say we've never ‘conciled’ in the first place, so how do we reconcile? So, and it very much is a learning process.
[0:41:51]
It will take years and one of the kind of strategies we've understood from our Elders is the term Dabakarn which in the Noongar language means slowly, slowly. You gotta do these things slowly. We wanna rush it, we all wanna rush it.
Maureen: Yeah.
Nathan: And we all wanna improve things but it's that idea that we have to build trust, build relationships and work with, side by side with an Aboriginal Social Emotional Wellbeing paradigm. So it's a real challenge for us, I think, to shift our thinking so that we can actually begin to work in a more effective way. Same for First Nations people elsewhere as well.
[0:42:38]
Tony: Yeah, you're right. Certainly where I come from. Yeah and I'm gonna be talking with Professor Pat Dudgeon, who was actually the first I learned about any of this was by reading her papers before I started working so extensively in Australia, and I don't know if her episode will come out before this one or not but she wrote really influential papers called about Decolonizing Psychology, as you probably know. And for many of us who at the time didn't have experience in Australia, that whole term really blew our minds.
[0:43:28] I learned so much and started becoming really intrigued by that and I continue to this day trying to learn and there are many similar themes with Native American peoples where I live versus First Nations people in Canada, which is I live right near. But there are definitely subtle differences but I'm increasingly really trying to, without taking this, I might sound like a taking over thing but I hope it's not.
But really seeing that heritage also part of my heritage. Like that I live in, we live in this country together and that's part of my history too. [0:44:17] Can I find some of my identity in that too?
Maureen: Yeah. And I think for me, I was born in Scotland so came here round age 16 years, so I didn't know a lot about the Aboriginal culture.
Tony: Yeah.
Maureen: And mind you, neither did a lot of people in schools back then and now our young kids are being taught from day dot and school. They speak Aboriginal language. They sing in Aboriginal language. Not in all schools, it's being rolled out gradually but certainly I have a daughter who's 27 years. It wasn't taught in her time in Australia in schools.
So I think you learn things everyday. Kind of today, The West Australian, our local paper, I read it every morning when I get up just to see what sort of day I might have. And today was the best day ever 'cause it was the first 8 pages were all about [0:45:02] celebrating our Aboriginal leaders, our Aboriginal artwork, stories about football jumpers and just, we should be doing that all the time, not just in this week. Just to, I guess to educate and learn and there's so many amazing stories. So, and also the National Reconciliation Talk this morning, I learned all about Fremantle, the whole history of it and I'm from Fremantle which is while up but yeah, so many things I didn't know.
Tony: And fremantle's here in Western Australia just a bit down the way.
Maureen: Yes, it is. Yeah.
Tony: So let's talk about then in mental health. Maybe we can get a little more specific about things that you've worked on or visions that you've had or been shown by the community that needs that there are?
[0:45:53] What do you see there?
Nathan: Still looking at within the Aboriginal Community?
Tony: Yes, still within the Aboriginal Community.
Nathan: Absolutely, and that's the issue. It's the community saying what they need.
Certainly in Australia we have Aboriginal controlled community health organisations which have shown to be often a lot more effective than other traditional public sector strategies. So having local Aboriginal controlled organisations meeting the needs of their local communities. So that's been a really important shift in Australia. The other issue for us was in fact as I said, I think the relationships, developing the relationships.
As an office, we really did not have a good understanding or a good relationship [0:46:40] with the Aboriginal community, with the Noongar community, with the broader communities in WA until recent years and then we actively sought that. But we needed guidance and we needed guidance from the Elders. We needed them to begin to trust us and that takes time so that they can vouch for our organisation across the Aboriginal community, that's the key. And we're still building up that trust as we speak at the moment.
So I think that's a strategy for health services is the building of the local trust through the Elders, through their communities before the Aboriginal community accepts them. For example, I went to school with Noel Hayman, who's a doctor. The first Aboriginal doctor at the University of Queensland.
[0:47:27]
I'm a Queenslander from over East, by the way, sorry. But Noel, and that was quite some time ago, I won't say how long ago but Noel was a I think a Wakka Wakka Kalkadoon man from Queensland and he took over a public Primary Care Clinic in a very large Aboriginal area in the south west of Brisbane. I think with a huge Aboriginal population.
Tony: Which is an area that has yeah, sorry. Finish explaining.
Nathan: But they had very large Aboriginal population. They had 12 aboriginal clients out of this whole population. Now, 25-30 years later since he's taken that over and changed the model, they've 6,000 Aboriginal clients coming through that clinic.
[0:48:14]
It's the same, it's in the same place. It's meant to be serving the same sort of function and yet he's been able to provide a more culturally safe, service for that and so he's won lots of accolades and interesting one to interview if you get a chance.
Tony: Yeah, I'd love to.
Maureen: Yeah.
Nathan: But he, I think has shown that over time you build that trust with the community and that you can operate with a Western System but provide that care for the Aboriginal community in collaboration.
Tony: Wow, that's really powerful.
Maureen: Yeah. I mean for me it's all that, it's the doing with, not to.
[0:48:59]
We, as well, started on the Commission when I started a couple of years ago, we've got a long way to go. Our Aboriginal staff hadn't been feeling, you know, enough was happening for Aboriginal people, same with our commissioning processes for the Aboriginal Community Controlled Organisations. We commission in a very Western, white person way in terms of what we measure, the outcomes which doesn't fit at all and so we learn lots about the Social Emotional Wellbeing Framework and how to work with people. The connection, what's important to land, culture, family. So we are really starting from scratch and changing the entire way we do things. And you can still get the results. You can still meet all the government, in fact you get better results but you also still meet the government requirements for doing things.
[0:49:47] But we do it in such a different way but we are at the beginning. I'm not gonna pretend we're– we've got a long way to go but
Nathan: We do, yep.
Maureen: we are willing. It is all about the relation being relational not some bureaucrat.
Nathan: But not transactional.
Maureen: Yeah, exactly.
Nathan: Not transactional.
Maureen: Yeah. So, we're learning and I have to say some of our staff who went through that were quite uncomfortable for a while because you're used to as a public servant being a public servant, not giving anything away, saying the right things and it's not how, we can't work like that in this space in mental health and drug and alcohol services. And it has to be an uncomfortable process to change, doesn't it?
Maureen: Yeah.
Nathan: Otherwise you didn't get the change. Otherwise you're just gonna be doing the same thing.
Tony: Yeah.
Maureen: Yeah.
Tony: Interesting. So, Maureen, I know that you established an Assistant[0:50:32] Commissioner for Lived Experience.
Maureen: Yes.
Tony: Can you tell me about that and what difference you're seeing it make in policy and your day to day?
Maureen: So, the Mental Health Commission is always probably for the state led the way in terms of engagement with lived experience and not to say that they've always got it right or perfect but certainly
Tony: None of us do.
Maureen: compared to my other agencies, colleagues, they all look to us for what to do in this space, in their portfolios. We had a governance review in the Commission and there was the voices of 4 particular groups we needed to raise in terms of feeling how they were involved in decision making, policy making and being part of the I guess representing the community.
[0:51:19]
So the voices were about lived experience. So Lived Experience Consumer. Lived Experience Significant Other, so family. Also Aboriginal Affairs and then Drug and Alcohol. So it was felt that they were a bit silent from the previous work of the Commission and so where I've been over East, we had commissioners, other commissioners apart from the 'bureaucrat commissioner', not the bureaucrat that sounds terrible 'cause I'm not a bureaucrat.
Nathan: We're all bureaucrats.
Tony: Speak for yourself.
Maureen: But, like the person who isn't like the CEO-type position and accountable for everything, to bring Advisory voices in and in fact Aunty Pat Dudgeon is one of those people who was a National Commission with me quite some time ago
Tony: Yeah.
Maureen: in the National Commission.
[0:52:04]
So we decided Assistant Commissioners, so they are not public servants. They're people to come in to I guess work with the leadership team, work with the entire Commission about elevating the voices and giving us guidance and advice. So it's been in play for probably about a year now and the ones for lived experience, are Lived Experience Consumers. So someone with a lived experience of mental ill health and the other is on significant other. So someone who's been a carer for her loved one during her, I guess, being a mum.
So how have they influenced? So they're a big part of the Commission. We consult them on all the work we do. They spend two days a week in the Commission. So, in previous roles where we've had commissioners, they would come [0:52:49] in once a month for a meeting or and be with you for certain things. We actually have embedded them into the Commission and the work of the Commission and part of the team.
Now, how do I think it's going? I think it's going well. I think it's, they’re certainly across everything the Commission does, work with us, but there's also a conflict in that for them with their people in the community and sector. Great expectations on them to, if the Commission does something that people don't like in the sector or the community, it's very tough on them because they're caught in the middle and we did talk to 'em about how do we protect them in that sense because while the Commissioners are offering advice, Assistant Commissioners, they're not decision makers if that makes sense. So we listen of course, take things on board but sometimes the decisions [0:53:38] might not end a certain way. So it can be fairly challenging for them as well.
The Commission staff absolutely love speaking to them, consulting with them on all matters, engaging them with their teams. So look, I think it's baby steps at the beginning. Is it perfect right now, absolutely not. Can two people represent lived experience for everybody that we work with and
Tony: Yeah, gosh.
Maureen: the community that we serve, but it's a start. It's a start and I think we'll need to look a few months down the track in terms of what next, 'cause two people, it's very tough for two people and for them to go back to their communities to then actually be able to take that all on board so, I don't think we've got it perfect but it's a meaningful, it comes genuinely a [0:54:27] meaningful start in terms of how we engage differently.
Will it be the end model? We don't know yet but yeah, we're learning. It took a first few months for people to feel comfortable but now, they're part of our team.
Tony: Well, speaking of being accountable to the community, I wanted to shift a little and talk about accountability and measurement. How do you think about holding yourselves accountable? What kinds of metrics are you accountable for to the community? I think people might be really interested to hear and what part does that play in your kind of head space about your work?
Nathan: Yeah, well certainly for us, my role is an accountable role as an accountable agency.
[0:55:15]
Tony: That's part of the, it's your whole gig.
Nathan: Absolutely. Leadership is a critical component of that in that you have to foster and also be incognisant of the importance of leadership around accountability. I think with accountability you have to think about, okay, what's the most effective approach to that? And for us, we understand that if you like a more Just or Restorative Just Culture you might use that term is an important approach because in services, health, mental health is very complex. We're dealing with human emotions. We are dealing with human variability. The data that we've got is helpful but doesn't tell the whole story.
[0:56:01]
And I know about data 'cause we receive all the data of all the when things go wrong in mental health services, we receive all that. So we get lots of data and it's very helpful but you need a broader understanding of accountability, which is that there are different people in this. There's the person, their family, the clinician, other workers, other people involved. We have an accountability to all of those folk. Each person has their own accountability in that as well. So I guess what I'm getting at is that you have to have a system that accepts that if things go wrong, there will be a learning process. And that accountability is not about individual blame.
[0:56:46]
Don't get me wrong. If there's been misconduct that's a separate issue but certainly if you're under trying to understand how to build a system and improve a system it's about trying to reduce the blame which encourages people to learn, encourages people to change. Once we get defensive about our practice then we lose the ability to learn really, I think. So the accountability is a double-edged sword. It is about holding folk accountable but it is also acknowledging their need and capacity to learn and to improve as well. So that's the kind of paradigm which we work on.
Tony: Yeah. I just want to, for viewers or listeners who are interested, you used a term [0:57:33] Restorative Just Culture and we'll put some notes into this with some references and resources about that. SafeSide, the organisation I founded, has a whole program encouraging that and the Commission have been asked just to, for tomorrow we'll be holding a session just about that. But it's really been a one of those like how have I changed in the years, like eyes opened to a whole new way of thinking about it.
So, we'll put a bunch of resources for people who wanna learn more about that in the notes. But what were you gonna say?
Maureen: Just from accountability. Obviously, our aim and vision is about delivering a mentally healthy WA for people with mental health or drug and alcohol challenges.
[0:58:21]
Tony: Big charge.
Maureen: It's a big charge and sometimes it can be overwhelming about all the things you've actually got to do, not got to do, but community is saying they need and there's finite resourcing and there's finite, in terms of the human workforce, in terms of dollars and in terms of what you can do at once. So it's, yeah. I do feel super accountable but the way I look at it is to try and in bite-size pieces, try and incrementally make things better, make those shifts. But we disappoint a lot. As in, we get feedback a lot that it feels like we might not be listening, we might not be going a certain way but sometimes it's not because we don't want to or it's sometimes 'cause we can't.
So I think being very honest with people, particularly with our lived [0:59:08] experience in communities about working together, about what's possible and how we all get there together. It's the conversations we have with them about what's possible and what isn't. But also, then my job is to advocate at the highest levels to make things possible as well.
Tony: And I think when you're trying to make improvements across a whole community or state, it's very challenging and I know when it comes to suicide prevention, everytime I see that numbers are not moving, I wanna cry. I take it very–I'm not in a position of responsibility but I do consider being a researcher a position of responsibility.
[0:59:53]
We're supposed to be producing enough ideas and science that we can make a difference here and if it's not, it's heartbreaking. I can imagine when you have a specific locality whose mental health you wanna promote. It is a lot. Yeah. It is a lot. It's a privilege. Yeah. To be able to... Absolutely. Yeah. serve it, but it is a lot, and–is that feeling towards the mental health of the state, is that something that is like talked about around the office?
Maureen: Well the responsibility, accountability? Yeah, absolutely and look, things like suicide or when things go wrong, people take that, it's hard to take that on board, as you say.
[1:00:42]
Because I suppose there's a feeling that you might be, not that you're failing but somebody has been failed somewhere.
Tony: Right. Well, we don't know how to prevent every suicide.
Maureen: Yeah. And then we've gotta disconnect between what we purchase, not purchase. That sounds like in a very monetary sense but what we commission,
Tony: What you support, yeah.
Maureen: what we commission, what we've got and where it's allocated versus what actually happens day to day in services. We are very connected to our services but we're not there delivering those services so that sometimes challenges 'cause it's...
Tony: And people's lives.
Maureen: Yeah, people’s lives.
Tony: People’s lives also just happen.
Maureen: Absolutely. Yeah.
Tony: I saw you.
Nathan: Yeah. I was thinking about the values of organisations and lots of government organisations have similar values. Our values are leadership, integrity, respect, accountability and commitment.
[1:01:29]
But the question is always, what does that actually mean unless you actually live those. Unless you actually discuss them with your staff regularly, unless you actually work out what that really means for you both internally and for how we interface. So values are actually critically important and I think it's a throwaway term to some extent but unless you actually, really think about how you are implementing those
Tony: Yeah.
Nathan: as the core of your work.
Tony: Can you think of some specific way that does happen for you or in your office?
Nathan: Yeah. Well, I guess leadership, let's take that as a particular value.
Tony: Yeah.
Nathan: So the question is, okay, what is the leadership and the Chief Psychiatrist? Nice name of ‘Chief Psychiatrist’ but we don't have the money.
[1:02:17]
We don't run services. So what does that actually mean? So it actually means when we actually deal with a terrible outcome we are reaching out to the leaders and we are trying to understand how they within their service can actually learn from that. So it's a real connection issue. Recognising the importance of leadership. No shame.
Tony: They're part of the solution.
Nathan: They're part of the solution and so–
Tony: A forward looking accountability.
Nathan: Absolutely and within the office, for example, where there's issues that might not sit quite within our remit, the question about leadership is do we reach in, do we lean in a bit to those things?
[1:03:03]
We can't lean into everything, of course, either but it's that idea of where is it needed at the moment and what's our responsibility for that? So we think internally about leadership and we think externally about engaging with leaders as the solution, as the drivers, as the people that can bring their services.
Tony: That's really helpful. So, we've been touching on a lot of different large responsibilities, difficult decisions. We talked about making hard calls and what frameworks you use. I wanna get a little bit into for you in the day to day. What does your day look like? What's your morning like?
[1:03:48]
How do you get ready for a day of the kind of things you are taking on? I think, we all take on different things in our own lives and I think it can be helpful to hear about those things from other people. So, maybe you each kind of share how do you get ready for a day as the Chief Psychiatrist? How do you get ready for a day as the Commissioner?
Nathan: Maureen's got the whole state so you may as well start.
Maureen: Well, I think a lot of it's about obviously preparation and being prepared for your next day as well as you can. So making sure, you know your week, your month looks like.
Tony: How do you do that?
Maureen: Scheduling, diaries. Got staff who help me and in terms of looking at that.
[1:04:34]
Making sure that each in particular meeting and then some days it's back to back the entire day and I do say sometimes to the staff when they've booked them like that, I'm talking for the entire day. Like, I haven't stopped for one minute and then I go home and don't speak to my husband for two hours because I've been speaking for all day to people. But you're just gonna be prepped. You've gotta know your audience, who you're going to. That you've got the right things, that you're actually honouring the people you're going to meet with. I always love putting in mixes of service visits. Visiting the people who are delivering the service.
People are doing all the hard yards out there to meet people - to see the great work they're doing. That revives me every single day and making sure I've got a balance of not just the not boring meetings, the necessary meetings, the kind of [1:05:19] governance type things but also a good mix of what's happening and a good mix of innovation about planning and what we need to do in the future and what does the next month look like and meeting with my teams and trying to bring people on board.
That invigorates me as well but my favourite bits are my visits to services. Meeting with people. Meeting with the consumers of our services. Meeting with the families. Hearing what the challenges are and then you've got a real drive that you need to do something about that.
Tony: Yeah. That preparation that you mentioned, I think is pretty important.
Maureen: Yeah.
Tony: So when you look at your day,
Maureen: I go, ohhh...
Tony: You're like, okay. This is an intimidating day.
Maureen: Yeah.
Tony: Yeah, how do you take that on?
[1:06:07]
Maureen: I think I'm fairly energetic and I feel fairly relaxed about most things I'm going into. Probably 'cause I've been doing this for a long time and I don't take that for granted but a lot of situations I've maybe experienced before.
Tony: Seen them before or something like that.
Maureen: Have a good content knowledge about so that's helpful in my role 'cause sometimes in these roles there isn't content knowledge and that can be even trickier when you have no clue what people are talking about. Saying that, I don't then think I know everything. Yeah. And go in and I've got nothing to learn, it's not how it is but I start by reading the paper, checking what kind of day I am gonna have, you know, 'cause that can tell you where you, if you might end up with a whole pile of inquiries. All lines of inquiries and then yeah, really just making sure...
Tony: How do you look after your health?
[1:06:54]
Walk my dog. I've got a cute little dog so if I get to walk him in the morning and at night that's good. Sometimes I don't.
Tony: What's his name?
Maureen: Yogi. He's a little Shar Pei. You know, all the wrinkles. He's gorgeous, he's so cute but yeah, that helps. Talking to family. I commute like I drive for an hour to work and from work because of the traffic. So I connect with my family over East or colleagues over East. I use that time. I don't just sit there. Sometimes I'll sit there quietly if it's a really big day and I just need to think through my day but for the most part I use it like my office both ways. So...
Nathan: But you do focus on the road?
Maureen: I do focus on that, of course. Yes, of course.
Tony: Very much so.
Maureen: Yes. I absolutely, it's all hands free.
Tony: I've heard you're excellent at focusing on the road.
Maureen: It's all hands free and electronic, and...
Tony: That's what you're famous for.
[1:07:39]
Maureen: Yes, exactly.
Tony: How about you, Nathan?
Nathan: Yeah, I think in some ways your day is framed by the strategy and the priorities for the office and I think historically I would turn up for work and just get into it and just barrel on and just be busy, and just busy.
Tony: Yeah.
Nathan: I used to think that was a good thing. But then, understood that you framed the, what your priorities are and what the key issues are and then that will assist on a day-to-day basis. And when it starts to get phonetic, you have to kind of recalibrate that as well. And it's about what's value to other people. The greatest value, can I be clear? The greatest value comes from the relationship between families, patients, consumers, clinicians, other workers.
[1:08:25]
That's where the hard work really happens. Our job, my job, is to add value to that. Make sure that can be done as safely, the greatest quality as possible so understanding where the importance is a good start. The second is, as I said, I think making sure what's going to add value? What are the priorities that–
Tony: Yeah, you mentioned that before, that you, it sounds like you think about that a lot?
Nathan: Yeah. And so, that's the way we can recalibrate on a regular basis. So the day as morning,
Tony: What time do you wake up?
Nathan: 5:30.
Maureen: 5:30.
Tony: 5:30?
Nathan: Do some exercise.
Tony: Aha!
Nathan: And not always consistently but you know. And so it's dropping my son to school.
[1:09:13] Using that time to spend with him because that's one of the times that he’s a captive audience.
Tony: Love that car time. Yeah.
Nathan: He and I can have a chat and then it's those issues you described. How much time are we gonna spend actually out in the services actually seeing and being with people? How much time do we have to think, as I said, that reflective time? What are some of the key business as usual stuff we have to get done during the day? Yes, meetings. Yes, letters written. Yes, ministerials, et cetera.
So it's finding the space. Some days are busier than others, of course, but again it's that thing if it's just getting overwhelmed it must be a recalibrate too because that's [1:10:00] about effectiveness I think in the role.
Maureen: Yeah.
Nathan: I wonder if I can get some advice from you? Because, so, in order to focus on things that add value that you're, sort of, maybe not a hundred percent uniquely where you're equipped to and your job is to add value to. I find that sometimes in order to focus on those things, I have to disappoint people who are waiting for other things. I dunno if you face that at all? But I'm just wondering if you could give me any advice about that?
Nathan: We disappoint people every day.
Maureen: Yes.
Nathan: And I think it's, the first thing is the listening to people to [1:10:49] understand what their needs are. You're then best placed to be able to, as Maureen described, authentically say what you can and can't deliver rather than imposing something out there. So the listening's very important in the, if you're gonna disappoint someone, if you've listened and been able to engage, that's...
Tony: They're waiting for something from me and I can't get it to them.
Nathan: Yeah, so it's then being able to,
Tony: Listening.
Nathan: to work out what is going to help them most. So for me, I think that's the key. Is the listening is the key to disappointing people less or helping them understand the disappointment. But I think it's also it's, these are difficult conversations you might say and the issue with difficult conversation is to try and [1:11:35] understand where that person is coming from, not to bring your own agenda. We all have our own agendas but is to actually understand where they're coming from. You are then best placed I think, to be able to engage in a mutual space about what's reasonable, what's not reasonable.
Maureen: Yeah. And look, I try, mostly, to get back to people even if I haven't got an answer for them or I tend to get back with a response or make sure if I can't, that somebody else does. So that people aren't waiting and thinking you're ignoring what it is they're saying to you or so yeah.
Nathan: Can I just say, you do.
Maureen: Yeah.
Tony: That's a very important... Right. It'll be three words, but you're getting it back, right? And that's really important. Yeah.
Maureen: Because then people know...
Tony: Is that an important value for you?
Maureen: It is for me [1:12:20] because it's frustrating if you're sending things into ether and nobody gets back to you. It’s kind of, so, it's even if you can't give people exactly right then what they want, you can get someone else to help or say, "Hey, I'm onto this." And Nathan often sends me things.
Nathan: I do.
Maureen: And it's like noted, onto it, Nathan. We'll action it. So, because, you know, they're important things and nothing worse if no one's reading something. Yeah. No, you always–no matter the situation, you've got back to me. Yeah.
Tony: So I think as we begin to land the plane here. There's a prevention program that our team works on called Connect Program and it builds healthy relationship networks between people. And one of the progressions that happens in that program I want to progress [1:13:10] to here which is that it builds from awareness of individual strengths to being really aware of the strength of the group or the strength in others, as a kind of a progression.
And so, I wanted to progress about that. What do you each see as the strengths of the other? And maybe of the office or area that the other oversees?
Nathan: Number one, I think you've got the toughest job in mental health in the state, Maureen. So, I mean I think that's the–so, I see that as being really difficult. So, the fact that Maureen actually gets up and fronts up, and every day, is a big [1:13:56] ticket item for me.
But also, I think the strength is, Maureen, you get back, you do, you respond, you are responsive. I think also you seek to understand where the person's coming from. So the response is not a, “This is what I'm gonna do,” the response is, “This is what you're asking for.”
Maureen: Yeah.
Nathan: “How can I do that?” So I think that's a real strength and it's from that that the rest comes. Because Maureen's got great leadership skills, et cetera.
Tony: Lots.
Nathan: So you got all that stuff but I think they're the core things for me.
Maureen: Yeah. And I think, Nathan, obviously for me, Nathan's a lot more polished than I am. [1:14:45]
He's very considered when he talks and I'm not saying that I'm always not, but you always sound like you're very considered and very thoughtful and everything.
In terms of, Nathan offers such great guidance in terms of the safeguarding of our patients and our services– to the services–offers support to them but obviously guidance as well. Now, sometimes that isn't always taken in a positive way 'cause people sometimes feel it's like creating work for them and you're not creating work for them, you are actually making it a better place for our patients to be when they're in the services but also to help our staff provide better care and to protect them as well in terms of the work they're doing.
But, yeah, Nathan, he will always speak up, no matter–we are in lots of cross meetings and things so Nathan will always advocate [1:15:32] for the patients and for the services to make sure he's clear that's what his role is and as Nathan says too, he has a very different role to other chief psychiatrists across Australia, from that regulatory thing and with that sometimes comes people not being happy about regulatory things. So it's tough compared to, I've worked with other chief psychiatrists who have a very tiny team with a very fixed remit. Nathan's got a super broad role, but again, Nathan is always polite, gets his point across.
Nathan: I'm not always polite, Maureen.
Maureen: Well, you mostly are. You mostly are to me. He mostly is.
Tony: Yeah.
Maureen: So just the way Nathan carries himself.
Tony: Respectful.
Maureen: And respectful. Yeah, which isn't always around in all public servants.
Tony: So, as you look forward into the next couple of years, maybe longer, [1:16:25] what are some things that give you a sense of hope or optimism about mental health, or mental health services, however you wanna take it in Western Australia?
Maureen: For me, there's a much better understanding if i've mentioned when I was a student nurse back in the 80’s. It wasn't very well understood and it was all, it was the boards at the back of a hospital or the old institution and things. So, it's a lot better, understood. People are a lot more willing to listen. As Nathan said, we are very lucky. We have governments, we have state politicians who listen. It's part of their business in terms of mental health, whereas that didn't used to be the case a long time ago. So I think we've got a lot of hope in that sector.
[1:17:11]
I think lived experience is so much better understood now in terms of the importance of that but we've got a long way to go in terms of making that meaningful in lots across the whole sector, not just in particular pockets where we might do it well. And yeah look, I'm just hopeful. I'm always a very hopeful person anyway. You can't do these jobs if you're not hopeful and positive and it's really incrementally, I think, if I think back to the old days of institutions to where we are now, lots of good things have happened, but we still have a long way to go. And so that's what drives me.
Nathan: Yeah and I think our workforce is our gem, really. [1:17:56]
I think, our lived experience is our guide, our workforce is our gem, I guess, and I think we've got a very highly competent workforce. We are short in lots of areas, so that's a challenge. But I actually have faith in the workforce and that's what keeps me going as well.
Plus the fact that the Commission has offered an opportunity which it has to protect mental health funding and to build mental health funding. So that's often a very unique opportunity around Australia, I think to do that. I think, I think WA is open to flexibility. It is open to change and I think that's also a strength for us.
[1:18:44]
So we will consider changes in models, changes, we will sometimes lead the way around that so I think that's a strength which bodes well for the future as well.
Tony: Yeah. So, just final thoughts from each of you or anything accept complaints or comments that you have for me about this conversation or takeaways for you?
Maureen: I mean, I think the takeaway for me is this has been great to do this. When you first asked me, I was thinking, oh God, podcast. But, I'm glad I'm doing it alongside Nathan. We've known each other for a while but we have very different roles. So hopefully it's interesting for people listening. But I have great hope for the future.
[1:19:31]
When I started a long time ago, it was mental health institutions and that was it. It's so exciting about what's out there now, the different, as you said, models of care, the ways we can work differently. Focusing on the prevention, early intervention and really elevating the voices of the people who we are here for.
Nathan: And look, thank you. It's been a great opportunity and these, it's that reflection thing. These times are always a great time for me to, as I'm talking think about and formulate in my own mind where we're going. But as I said earlier, I think we, WA is in a good space. I think, I know when things go wrong that it doesn't always seem that way but we are in a good space. And I think with the development of the state plan [1:20:19]
Maureen: Yes.
Nathan: coming out soon.
Maureen: Yes.
Nathan: That's a great opportunity for us, as well. We have a receptive government. We have a receptive commission, and so, I think we're in a better place than we were some years back.
Tony: Yeah. Well, it certainly feels that way. I get to, I’ve the privilege of going to many different places and getting a feel of the energy, whether there's a spirit of innovation, and you after a while you get to see patterns and it's certainly been a privilege to be here in West Australia so far. And I'm still really at the early stages of learning.
But it's been a pleasure and it's been a real pleasure to talk to both of you. You inspired me. You inspired me to make sure I have more thinking time [1:21:04] and so, thanks so much for being here and I look forward to continuing these conversations as we go.
Maureen: Yes, thank you. Thanks, Tony.
Nathan: Thanks, Maureen.
Maureen: Thank you, Nathan.
Nathan: Thanks very much.
Tony: Appreciate you both.
Maureen: Thank you.