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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 in mental health and addiction services in Victoria. I'm Annie Williams, Hamilton Centre transformation lead, and your host today. I'm 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 their elders past, present and emerging and acknowledge their connection to land, sea and sky. We recognise 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.
Annie:Today's topic of discussion is the role and the value of lived experience workers in an integrated care model, and our guests are part of the Hamilton Centre Clinical Network at Eastern Health. It is my pleasure to introduce Sally Chin, the clinical lead of the Hamilton Centre's Eastern Partner Provider. Sally is a mental health nurse with considerable experience in the alcohol and other drugs sector. I would also like to introduce Lee Ann a dedicated lived experience worker whose insights and perspectives are enriching the team's understanding of holistic care. Lee Ann shared knowledge and contributions to the interdisciplinary team are so valuable.
Annie:Thank you both for joining us today.
Sally:Hi, Annie.
Lee Ann:Hi, Annie. Thank you for having us.
Annie:Sally, could you share with the audience how you became interested in the provision of integrated care?
Sally:I guess because throughout the years, I have noticed that the prognosis of client with co-occurring mental health illness and addiction issues worsened than people who just having these, stand alone, diagnosis of mental health illness or substance use. I also noticed that the care coordination for client with co-occurring mental illness as well it can be complex and require a lot of input from specialist services. And, consequently, it actually made people fall between the gap of our healthcare system because of the siloed practice between each services.
Annie:So when you talk about outcomes for people with co-occurring issues, what does that mean?
Sally:What I mean by that is people tend to be presented with issues of, like, single issues. For example, if people turn up to the emergency department saying that they are looking for support with alcohol and withdrawal management. However, behind that, there tend to be a lot more that happening in a person life. Could be the person might have severe anxiety or depression, have other stress related in life that the person not ready to discuss that with clinician yet. So when people are providing support, a lot of services really just focusing on, the presenting, issues, not looking at the person from the holistic approach.
Annie:Mhmm. Behind the story.
Sally:Yeah.
Annie:Yeah. Could you share with us a particular story or a particular person that stands out for you, in your career that that really drives your work in this area?
Sally:I remember a client who presented to the emergency department. This is in 2021, right after COVID lockdown. And in the person past history, the gentleman doesn't have any, history of substance use or mental health issues. During my assessment with, the person, he disclosed with me that he started drinking alcohol because of COVID lockdown, because he feel lonely and also the stress from losing his job. So what we did at the time was offering him a 28 days phone follow-up just to make sure that he is doing okay and also to support linkages between him and GP and psychologist as well.
Sally:At the end of my 28 days phone support with him, he reported that he maintained abstinent for about 2, 3 weeks. He started going back to the gym again. He started looking for a part time job at that time. So reflecting from that experience, I can see that it is very important to provide that integrated support to clients, carers, and also the service navigation that also play an important role in a person care.
Annie:And you've given us a really great example of where there's, you know, 3 presenting factors really, not just the the story that he must have spoken to the front desk about. So what excites you about the work you're undertaking with the stakeholders in your catchment?
Sally:For me, it is the opportunity to meet new people and also learn about different services that different organisations offer.
Annie:So I imagine you're going far and wide because I think your catchment area is quite big.
Sally:So for the eastern team, we do travel down, to, Latrobe area. So we this month, we also have a plan to do an overnight trip to meet our stakeholder around Bairnsdale as well.
Annie:They must be looking forward to that. Yes. So as far as the, engagement work's concerned, what team do you have with you? Who do you take with you on this?
Sally:We pretty much taking turn, like, wanting to introduce everyone in our team to our stakeholders. So sometimes, we have, like, our senior pharmacist coming along with me. Sometimes, we have, Lee Ann, our peer worker, coming with me as well. We also have, a nursing staff or a consultant that come along to meet different stakeholders, and it also really depends on everyone availability in the team too.
Annie:So these are medical consultants as well as the nursing staff Yeah? That's a very comprehensive team then.
Sally:Yes. In our team, we also have an AOD nurse practitioner as well. We have addiction psychiatrist. We have addiction consultant, a medical registrar. They are either a addiction registrar or addiction psychiatrist registrar.
Sally:We do have a another mental health AOD nurse, and myself also have come from a background of mental health and AOD area as well. We have 2 lived experience peer workers in our team.
Annie:Fantastic. So why is integrated care so important for people with co-occurring mental health and alcohol and other drug issues?
Sally:From my experience and my observation as well, you cannot just providing support to the person from, like, from one side of thing. You cannot focus on just the addiction issues alone or the mental health issues alone because they tend to have a correlation between them. And a lot of the time, the social complexity of, you know, each person's life play a big important role in a person recovery journey. And you cannot, you know, like, forget to looking after the person physical health too. So overall, for our team, when we're providing support to our client or referral, we provide a, support from a holistic approach.
Sally:So, Lee Ann, would you agree with that? Why is involving lived experience workers so important for integrated care?
Lee Ann:Yeah. A 100%. But further to what, Sally said, being a peer worker means I have lived experience and having been a service user myself. I know that, when you're moving from addiction to recovery, it does take a village.
Lee Ann:So you do, it is really an advantage to have one service that offers all different aspects of services that you might use.
Annie:And so when you're talking about recovery, that's that's an individual thing. There's no one size fits all
Lee Ann:Yeah. Not at all. So that's why, lived experience is really valuable to have them part of the team because we have actually been through, addiction ourselves, and we've also been through recovery. And we've been through all the stages of change, including lapse and relapse.
Annie:So in essence, you speak the language?
Lee Ann:Yeah, so we've when we speak to our peers, like, we speak from a place of experience and having been a service user ourselves. So, when we talk to them about recommending services, we speak from a place to from having sat in the same chair that they are. So, also, when we speak to them about, say, a residential detox or residential rehab, I know in my experience when I had to go for the first time, it was really daunting. So I can see how in my recovery, it would have been an advantage to have a peer worker because they could tell me what to expect.
Annie:So that was not part of your experience. The job you're doing today, that wasn't available to you in your journey?
Lee Ann:No, not in my personal journey, but that's why I, like, I'm really happy and privileged to be a peer worker because I can walk alongside people. And then when, they wanna when they get to that stage where they want to move into recovery, I can actually demystify what to expect in a residential detox or what a day looks like in a certain rehab. And then that way, they can go into it being a bit more comfortable because they've got an idea of what they're walking into.
Annie:And can you also see a change in the way that the clinicians might interact with the with the individual because of the influence that you can bring to the discussion?
Lee Ann:Yeah. Definitely. So, I just remember the first day I met our addiction doctor, and he was so welcoming. And he said to me, like, welcome to the team. I'm like, you've got a really unique perspective because you've been through it, and I'm really excited to see what insight you can bring to the team because, you've got information we don't have.
Annie:You're a valuable asset.
Lee Ann:Yeah. And that really blew me away because for me, my addiction was always something I was ashamed of. And, now I'm in a really supportive workplace where it's, seen as valuable and
Annie:So almost destigmatizing the experience for you as well?
Lee Ann:Yeah. Really. It's sort of made me really change the way I see myself as well.
Lee Ann:And really felt empowering to hear that from a qualified, like, experienced doctor, and it was yeah. It had a profound impact on me.
Annie:And I'm sure that then would flow onto your, conversations that you have with the clients that you're meeting with.
Lee Ann:Yeah. Because I think, me and my fellow peer worker, because we've been through it, we can speak from a place of authenticity and meet them where they're at, and we can walk alongside them. And we know that, recovery is hard. It does take a long time, and it feels like climbing a mountain. So,
Annie:it's really important then to have someone who's who knows just how hard it is.
Annie:Yeah. Can you tell us
Annie:a little bit about, some of the training that you did for for this role?
Lee Ann:Yes. So, when I it kind of coincides at a previous workplace when I realised I wanted to be a peer worker as well. So, I was working at a residential unit for 16 to 24 year olds, and there were some young people who had, just come out of a residential rehab. And I saw, like, their just for today books, and they woke up early and had really good structure and routine. And I felt like saying to them, like, oh, that JFT was my recovery bible, and are you really on the right track having such good structure and routine?
Lee Ann:And also, like, some of them had depression and would spend all day in their room, and I wish I could say, like, you know, I know what it was like when I couldn't get out of bed. Yeah. But because of the limitation and boundaries of my role, obviously, I wasn't a peer worker, so I couldn't divulge that.
Annie:Right.
Lee Ann:And then, at that same workplace, they advertised for peer work training for for existing peer workers, and I really advocated for myself to do that and was able to do the training. And the more I did the training, the more I realised that was where I wanted to be.
Annie:So intuitively, you could see the value of it even before you started your training.
Lee Ann:Yeah. So since then, I've done intentional peer support training. And, also, I've just completed, the shark training, which is the self help and recovery service centre. Sorry.
Lee Ann:And I feel that the training is really necessary because your lived experience is, essential. However, it's kind of like, I guess, like driving a car. Like, you need to do your lessons and, read your book in order to drive it safely. Yeah.
Annie:Yeah. Sally, can I just quickly ask you, have you noticed, a change in the team dynamic from having such experienced peer workers on the team?
Sally:A big change. So at Turning Point, we have introduced lived experienced peer worker for many years now. This is from my experience when I was still working in the inpatient unit when, peer worker was introduced to our service, we can see a big, different in, client willing to engage with our team and also, with, reducing number of, premature discharges as well. For our current team, like, the for the Hamilton Centre Eastern team currently, we can see that, both Lee Ann and our other peer worker really bring a different perspective to our team, especially during our clinical review and intake meeting. They able to share their lived experience that our team kind of, like, see in different way and also be mindful of using big medical term when we discuss things during the meeting.
Sally:Their experience not only just changed the way that we practice in our team, but also have a positive impact on our engagement with our stakeholder as well. A lot of our stakeholders share with us that they really appreciate the support and kind of, like, the motivation that, Lee Ann have shared with the clients and also the team. One of them is around positive words that people need to be more mindful of, and that make a big change in how clinician, providing support and care to clients.
Annie:So, really, important to focus on on positive language, and but make sure that the language is appropriate for the individual as well. Yeah. So, Sally, we're aware that integrated care has been a much talked about aspiration for the mental health and the Alcohol and Other Drug sectors. What excites you about the work that the Hamilton Centre's doing in this space?
Sally:The thing that I'm excited about the most is the commitment to make changes in the way the services work and also to promote integrated care. From what I can see is, the Hamilton Centre really put, having a lot of resources to provide to both clinician and also provide clinical support to clients that I've never seen before. For example, like, we as as part of the eastern team, we do have a senior pharmacist that are able to offer a medication review. We have lived experience peer workforce that able to offer 1 on 1 support with client. I've never seen this type of support before.
Sally:So it really, like, promote and closing the gap in our services that we no longer practicing, you know, providing care alone. We actually work together with our stakeholders, like mental health locals or our area mental and wellbeing services, our AOD, residential services.
Annie:And what sort of education, when you talk about resources, what sort of education are you able to provide to these different stakeholders?
Sally:Really, the topic of education in service depend on, the need of each individual team.
Annie:So you can tailor it to the individual? Lee Ann, if I just turn to you, what what excites you most about the work that the Hamilton Centre and the clinical partners are undertaking?
Lee Ann:I would just echo what, Sally said. I just think it's really good to see another service that's addressing co-occurring needs. And as mental health and substance use disorder used to get treated separately, and it's a bit of a vicious cycle whereas they go hand in hand. And it's sort of a case of what came first, the chicken or the egg.
Annie:Yeah. Yeah.
Lee Ann:So it's good to see them being addressed simultaneously, also that we have so many, different services within the Hamilton Centre. We can address such a huge catchment. And with the lived experience team, we bring that experience of having used the services, and we can walk alongside the people knowing that we've had a similar journey to them. Yes. So, touching back to the training, what makes a lived experience worker so effective is we, learn how to share our experiences through purposeful disclosure.
Lee Ann:You make sure your peer and yourself both have boundaries, and they're both respected to create a safe space. Yeah. Like, now there's we recognise that the service user is the expert in their own recovery, so we use motivational interviewing, strength based approach.
Lee Ann:We understand the importance of therapeutic language and trauma informed care, and that goes for the whole team when we are when we're helping our service users.
Annie:So when you say trauma informed care, is that something that you can then influence the rest of the clinical team about?
Lee Ann:Yeah. I think that's really important nowadays because, the last thing you wanna do is retraumatize someone. So trauma informed care and therapeutic language, are really paramount as, therapeutic language, moves against stigma
Annie:And provides a more respectful environment for the service user to engage?
Lee Ann:A 100%.
Annie:Could you just elaborate a little on therapeutic language, and perhaps give us a couple of examples of of that type that style of language that's used in the consultations.
Lee Ann:Yeah. A 100%. So I've just given you an example just before rather than client. We use service user, peer, consumer, in terms of, like, particularly when we're talking about harm reduction, for instance. So we meet, our service users where we're at where they're at.
Lee Ann:So when we're recommending, like, needle and syringe programs, so if they're not if they're still choosing to use, we want them to use as safely as possible. We steer away from using language like clean and dirty syringes.
Annie:Oh, right.
Lee Ann:We instead we would say you can get free wrapped needles. We don't like to label people, so it's not addict or alcoholic anymore. There's a little saying, labels are for jars, not for people.
Annie:Oh, fantastic. And, Sally, is that your experience that over the years, the clinical terminology and the words that are used by clinicians has changed?
Sally:Yes. Of course. I have seen, especially within the past 6, 7 years, we like, for our team, we really influence the language when people writing progress note, when people, writing a recommendation letter. For example, we no longer using, the label of the person father is an alcoholic. We are using a positive words by describing that the person have a family history of substance use.
Sally:To be specific, it's around alcohol use. So we don't want to label the person or their family because each individual journey is different, and we also want to reduce the stigma as well. The other, thing that like, another example is, we tend to, like I used to see a lot of note that describe the person as fell off a wagon. We are no longer using that term too. So we rather use some term like the person have, reported that the person relapsed or having a lap.
Sally:So yeah. So really just allow the client or the service user to explain to us what's really happened in their life, what made them start using again rather than just using one term to label the person experience.
Annie:And and I guess along the way, you're focusing on destigmatising that person's experience.
Sally:And that will also encourage the person to engage with, support the person to engage with services better.
Annie:Because they're not feeling judged. Would you agree with that, Lee Ann?
Lee Ann:Yeah, a 100%. Even, on occasion, I've had to correct some of my peers. Like, I'm not gonna say the word because it's a dirty word, but one of my peers referred to themself as the j word. And I told them, don't talk about my friend that way.
Lee Ann:You're suffering from substance use disorder.
Annie:Yeah.
Lee Ann:Or you're substance dependent. You're definitely not that way.
Annie:So even peers and clinicians. Yeah. A bit of a reminder. Lee Ann, do you have any final insights that you could share with us about your role as a lived experience peer worker?
Lee Ann:So sometimes, when you're working with your peer, they start asking you about how you decided it was time to move into recovery and what you did. And that's sort of like a magical moment. It's like you can see the wheels turning in their head, and it's like they start thinking about the negatives rather than the positives.
Annie:And that must be quite exciting.
Lee Ann:Yeah. Because then, you can use motivational interviewing and, strength based conversations to help them identify goals and, yeah, help them move towards those goals and, hopefully, recovery.
Annie:So you're really involving them in the process?
Lee Ann:Yeah, a 100%. But we always we don't try to move them through the stages of change. We always support them where they're at. Because as peers workers, we know what it's like in our substance use disorder days when the substance overwhelms you and takes over. And to begin with, you're driving the substance, but then it gets to a stage where the substance drive is driving you. When I was doing my first lot of training, there was another peer who shared a really, really great mantra with me.
Lee Ann:And I wish I remembered her name or knew where she worked so I could credit her.
Annie:So we'll give them a shout out if they're listening.
Lee Ann:Yeah. I know. She worked in the forensic space, but this really resonated with me. She said her mantra was celebrate early, celebrate often.
Annie:That's fantastic.
Lee Ann:Yeah. Because particularly when you're in early recovery, as I said earlier, recovery is like climbing a mountain. So anytime you tick a box, anytime you have a small accomplishment, that should really be celebrated.
Annie:So that's the reward? The smallest accomplishment.
Lee Ann:Yeah. Because early days, you're counting literal hours or days. But anytime you get an achievement, if we can hero that and skip them, like, a little boost, it really helps you it just really helps that positive reinforcement that you're on the right track.
Annie:And gives gives you confidence as well.
Lee Ann:It gives you confidence to keep going and just makes you think, like, yeah, I'm where I need to be. I'm going on the right path, I guess.
Annie:That's great. And that's a fabulous note to end on, and I hope that that peer is listening. So Lee Ann, I'd really like to thank you for participating in the podcast today. Your perspective as a peer worker has added immense value to our discussion, and I'm sure has raised a lot of interest about your role with our listeners. Sally, I'd like to thank you as well for sharing your insights and your expertise with us.
Annie:Thank you both for sharing your journey and the way that you collaborate together. It's very exciting, and we look forward to hearing from you in the future.
Sally:Thanks for having us.
Lee Ann:Yeah, thank you.
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. Please visit our website, www.hamiltoncentre.org.au and subscribe to our newsletter for a journey into transformative mental health and addiction care.