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The Hamilton Centre Podcast | Exploring Mental Health & Addiction is for service providers, individuals and family members dealing with co-occurring mental health and substance use conditions. In response to the recommendation of the Royal Commission into Victoria's Mental Health System (2021), the Centre was established to create a more inclusive and supportive system by promoting integrated care in Victoria, Australia.
Our podcast will feature interviews with service providers, individuals with lived experience, and workers who assist people with co-occurring conditions. We aim to promote holistic care throughout Victoria by breaking down barriers to treatment and through open minds and open doors.
This series features Gemma Turvey's composition, "Turquoise," performed by Gemma on piano, Craig Beard on vibraphone, and the talented musicians of the New Palm Court Orchestra.
Welcome to the Hamilton Centre podcast, a space where we explore the thinking of leaders, service providers, workers, and people with lived and living experience, shaping the landscape of integrated care and mental health and addiction services in Victoria. I'm Annie Williams, Hamilton Centre Transformation Lead and your host today. And I'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 elders past, present and emerging and acknowledge their unseated connection to land, sea and sky. We acknowledge people with lived experience of mental ill health, alcohol and other drug issues and of recovery and the experience of people who have been the carers, families or supporters of people with co occurring issues.
Annie:In today's episode, we will discuss the future of mental health and addiction services in Victoria, focusing on the experiences and the insights of 2 clinicians from the Hamilton Centre Clinical Network at Western Health. Dr Thileepan Naren Naran is a GP and an addiction medicine specialist with interests and experience in Aboriginal and Torres Strait Islander healthcare, custodial health and and Drug and Alcohol Management. His clinical work encompasses the Dame Phyllis Frost Centre, Cohealth HealthWorks and the Hamilton Centre as part of the Western Health Clinical Network. Also joining us from the Hamilton Centre Clinical Network at Western Health is the clinical lead, Tracey Wrigley. Tracey is a registered nurse with extensive experience in the AOD sector, as well as health service redesign and clinical education, both here in Australia and in the UK.
Annie:Her professional expertise and passion for the education and support of clinicians and for people requiring integrated care and treatment is a wonderful asset to her team. Thank you both for joining us today.
Dr Thileepan:Thanks for having us.
Tracy:Yeah. Thanks Annie,
Annie:I could start with you, could you tell us a little bit about yourself and your clinical background and experiences and what your role has been in supporting the establishment of the Western Health Clinical Network?
Dr Thileepan:Sure. So I initially trained as a GP many, many years ago. I won't say how many years ago. And then as part of my general practice experiences, I did a lot of work, with people with substance use disorders and developed a special interest in that area. And then after a period of time, I went to Western Health as an addiction medicine registrar and did my training there.
Dr Thileepan:And then after I completed my training at Western, I then stayed on as a consultant. And part of my consultant role has involved working with the statewide service for the last nearly year and a half. And, for the last year, I've worked in custodial health, working at Dame Phyllis Frost Centre, which is, Victoria's, largest prison for women. And I do a day a week at HealthWorks, which is a primary care service for people who use drugs as well. So that's 1 day a week.
Dr Thileepan:So a pretty, I guess, diverse bit of clinical experience. But, also, I guess, linking back to the Hamilton Centre, most of the patients I see in all those settings have dual diagnoses, struggle with mental health and substance use disorders, and the care people receive in general in the community is quite fragmented. You see 1 clinician for your health care or physical health care rather, and then you see someone else for your mental health care, and then you see someone else for your substance use disorders. And And that can be quite stressful and confusing for patients, and it can lead to patients sometimes missing out on the care they need. So a service like the Hamilton Centre, where people can get treatment for both their mental health and substance use disorders is is sorely needed.
Annie:So you're in quite a unique position across the primary and the public health care sectors, in the context of this integrated care, model. Can you share with us your thoughts on the collaboration between the 2, like the intersection of the AOD and the mental health sectors, and how important is this for delivery of care?
Dr Thileepan:I think it's vital. Before the Hamilton Centre started when I was doing ward work, we'd get quite a few referrals from our, psychiatric colleagues about patients struggling with substance use disorders, both in terms of managing withdrawals, but also for patients who decided that they wanted to, say, commence treatment for opioid use disorder, commencement of opioid agonist treatment, or patients who wanted some AOD counselling or community supports as well. So that was a large part of some of the work that we did. I'd I'd say the vast majority of referrals we actually got was from our psychiatric colleagues. So we already, especially at Western, I think we had a very good relationship with, the mental health teams.
Dr Thileepan:But a service like like this where it's almost a bit more formalized and it's rather than just the relationship between 1 health service, but where we can kind of have a sector where we're we're collaborating and trying to deliver health care supports across the state is is vital.
Annie:So if we like, moving leading on from the, the sort of that collaboration which you've developed with your, you know, colleagues within
Annie:what what would you say the main barriers to achieving is, like, a seamless integration between primary and public health and the mental health and addiction services, and and how can we move towards overcoming these?
Dr Thileepan:I think there's a couple of potential barriers. 1 is education. Sometimes people aren't aware of how to both take a drug and alcohol history appropriately or identify someone with a substance use disorder. So some people fall through the cracks. A lot of people feel shame about disclosing Mhmm.
Dr Thileepan:Substance use as well because people fear they're gonna be judged or stigmatized. And that's not, unfortunately, that's not an unreal occurrence for for a lot of the patients that we see, but also for clinicians to know who they can refer to as well. Sometimes when someone's disclosing substance use issues, people can feel a bit overwhelmed or a bit frightened or not know how to manage the information or act on that information as well. Mhmm. So I think, decreasing stigma is obviously a major thing, but also increasing the education of our colleagues in in both the hospital and primary care about how to manage substance use disorders, but also highlighting appropriate referral pathways for people to refer patients who need further support.
Annie:So in you know, with raising this awareness, where do you see the Hamilton Centre, participating in this process? What does it bring to this space?
Dr Thileepan:I think the Hamilton Centre is a really good platform as essentially a state based dual diagnosis service that's funded to try and improve the health outcomes for people with dual diagnosis. I think the Hamilton Centre plays a pivotal part in trying to manage patients who otherwise might not be seen or treated and trying to make sure we can get that health equity for for our patients. So I see the role of the Hamilton Centre in seeing and treating patients who otherwise aren't gonna be treated as really a cornerstone in in the treatment of patients with dual diagnosis.
Annie:So giving really giving a voice to the marginalized. Absolutely. I just wanted to, talk about your ex your experience in moving from, the, you know, being a GP and then going into training, as an addiction medicine specialist because 1 of the, Royal Commission recommendations, was the development of workforce capability. So what advice do you give, clinicians aspiring to work in the alcohol and mental health space?
Dr Thileepan:I'd say in general, it's a really interesting place to work. It's, of course, I'm biased, but I think it's I think it's I think it's the place to be. The amount of input and, I guess, the potential to change someone's health trajectory, particularly in addiction medicine, is so huge. And I think a lot of the time, we underestimate the impact we can have on people's lives and how rewarding the work is. And, also and people don't say this a lot, but how much fun the actual work is as well.
Dr Thileepan:Like, you really can see patients over time longitudinally, be a part of their lives, and really make, positive impact on people's lives. So for anyone who's interested in doing addiction medicine training, and this is I think addiction medicine is is fortunate in that there's so many different pathways. You can be a general practitioner or a physician, a psychiatrist, or a fellow of many other colleges, and you've got 2 different pathways that you can go through. So I think for anyone who's considering being, an addiction medicine specialist, there there's certainly an established pathway. I'm certainly happy to be contacted, but we also have Fergal Armstrong at Eastern, who's the statewide coordinator for addiction medicine training, who I'm sure would love to be contacted to provide further detailed advice on how to apply for addiction medicine training and where the positional vacancies are.
Dr Thileepan:So I think for anyone who's interested in doing it, they should definitely do it. And, also, I've I've gotta hasten to add, you don't actually need to know all that much about addiction medicine before you start the training as well. It's a training program.
Annie:Mhmm.
Dr Thileepan:So I think an interest, being open minded, nonjudgmental, and curious would probably be the qualities that would be useful for training, but you really don't need to know all that much at the start. We'll all train you up through our programs.
Annie:So for GPs that that are, you know, in their day to day working life are seeing people who really need, opioid substitution therapy. How do you generate enthusiasm and interest in that cohort because they're already, you know, overworked? And, how do you create an environment for them to to want to take on those those roles?
Dr Thileepan:I think that's the, that's the really difficult question in the sense that I think in general, this sector has been trying to increase the number of, OAT prescribers for for some time with with limited success. I view it as a part of general practice. So general practice encompasses everything within women's health, pediatrics, dermatology, substance use disorders, and treating substance use disorders with evidence based treatments like OAT, in my view, is just part of general practice. And, also, just because you do OAT doesn't necessarily mean that in some GPs or what, contact me and are worried that that will be all that they do. That's not necessarily the case.
Dr Thileepan:As with anything in life, you can kind of set parameters about how many patients
Annie:Mhmm.
Dr Thileepan:1 sees. But I would view it as a as a part of being a comprehensive, well rounded GP. Mhmm. Doing the training and trying to treat patients that you have or even sharing the load because we know that there are large oops. Sorry.
Dr Thileepan:Let me take that back and say that there's actually a small number of OAT prescribers who hold a large number of patients.
Annie:Indeed.
Dr Thileepan:And that kind of model of care is unsustainable, and it makes much more sense to broaden the pool of prescribers so that patients can be seen promptly, get appropriate treatment, and also have backup and contingencies, and the option of seeing alternate prescribers if they want to.
Annie:So almost destigmatizing the role for the GPs as well. So it's not only the patients who are experiencing stigma, but the, clinicians.
Dr Thileepan:Absolutely. And I think once you start doing OAT, I think a lot of stigma falls away, and a lot of negative perceptions can be laid to the wayside because it's that was certainly the case for me where I started with very few patients. And then you see the impact that OAT plays on people's lives and how it can really reset someone's trajectory in life, to be honest. And it really does become quite rewarding, and it used to be especially in general practice, used to be the favorite part of general practice. I guess, hence, why I'm doing
Annie:addiction medicine now. Thank you, Thileepan. And, Tracy, if we shift the focus to you, can you share a little bit with us about your background of working in UK health or the UK Health Service and then relocating to Australia and how you became interested in the provision of integrated care.
Tracy:My career in the UK wasn't involved with AOD work at at all, really. I was predominantly involved in primary health care in, a area in the UK, and my role really was around service redesign. So my background there was, looking at services for, children and children with complex needs. So there was a lot of work around needs analysis where these, children with complex needs were living and and making sure that services were in an appropriate area to be delivered to those, children and families that were in need. When I came to Australia so my nursing, I did some nursing in the UK, but I, did my degree again in here in Australia.
Tracy:So I was a mature age student, so I picked up nursing again at 45.
Annie:Oh, sensational.
Tracy:So my, yeah, my nursing sort of year started fairly late on, in in my I, was part of my grad program. I actually and I think sort of, as the leap had mentioned, HealthWorks earlier, I did, 1 of my rotations as part of my grad program at Healthworks at Footscray. And during my degree, I guess I was quite open minded. I have no particular desire to work in a in a specific specialty. I'd, knew that ward work wasn't necessarily what I wanted to do, but I didn't know what else, really that I wanted to do.
Tracy:Went to HealthWorks as my rotation and loved it. And so HealthWorks, for anybody that doesn't know, is a community health service, based in Footscray Cohealth from the service, and it's a, service predominantly for injecting drug users. Never had any experience at all working with this particular client's group, but very quickly realized that, it was an area where you can have a huge amount of impact on it. Thileepan sort of mentioned this similar sort of thing that, you are working with and and meeting clients, consumers who probably had a pretty rough ride, in in in their life, experienced a lot of trauma, a lot of disadvantage because of their, substance use. And to be able to be involved in their care and, make a huge impact in their care and treatment, was just, yeah, amazing.
Tracy:And then these rates satisfying. Absolutely. Yeah. Just, yeah, such a, yeah, a great and because of the, often, the the, stigma that they experience in mainstream services. You know, coming and talking to you, being treated like a, you know, a human being with needs and and and, you know, that often are not met in in mainstream services.
Tracy:And, again, that sort of shame and stigma around not wanting to necessarily disclose those sorts of, health issues and concerns to be able come into a setting where they can be open and honest about, what their needs are is, yeah, is a very, very
Annie:Yeah. Satisfying. So if we think about, your points before around destigmatizing, bringing your life experience into this new role, and making a safe space for consumers to come and talk about their, well, their trauma and and their substance use. Can you give some examples of where your, Hamilton Centre team's collaboration with different health care providers has led to improvements in client outcomes? What what's the feedback from clinicians been?
Tracy:I think the clinicians that they've worked we've worked with so far, I think, particularly, obviously, our our main area of work so far have has been working with area mental health services. And so they perhaps have not been as confident in dealing with clients who, have substance use disorders. So, they their primary focus, obviously, being somebody's mental health issues. And as we know, you know, a a large number of consumers with mental health issues also have an an underlying substance use disorder somewhere in their, history that may be current, maybe not.
Annie:But definitely co occurring.
Tracy:Yeah. Yeah. That's it. Yeah. That that that it is, yeah, co occurring.
Tracy:So I think, the, referrals and the clinicians that we've worked with so far within the mental health services have been really, We do a, very much a mixture of secondary and primary consultation. So, the recommendation initially may be chat with the clinician, secondary consultation. And that also offers an opportunity to, provide some education to the clinician as as well. You know? So when our addiction medicine specialists or addiction psychiatrists are having those conversations with the clinicians, it's obviously with the, I guess, the benefit of treatment for the client in mind and, yeah, and the offshot of that is, I guess, that sort of training education opportunity with the clinicians as well.
Annie:But it's all capacity building and then confidence building
Tracy:before the clinicians as well. Yeah. Yeah. Mhmm. And, you know, we get multiple clinicians, you know, who, you know, refer back in with clients with, you know, different substance use disorders that they're after some, you know, additional advice.
Tracy:Well, as we know, you know, treatment pathways and treatment options are different, very different depending on the needs of the needs of the client. So it's good that we get, yeah, multiple referrals, not just from the same clinicians, but from within the same team. So we've had, you know, positive feedback from those teams with the input that our clinicians have had into those cases. And, that positive feedback has been has discussed with the rest of the team there, and and the fact that they're rereferring other clients is has been great to see.
Annie:So the Hamilton Centre, referral option is probably present in their clinical
Tracy:review settings. Yeah. Absolutely. Yeah. Yeah.
Annie:And what do you think, are the benefits of including people with lived and living experience of addiction and mental health issues into the interdisciplinary team for these discussions?
Tracy:I think it's really crucial. We don't currently have a, a peer worker in our in our team, although it's part of our plans for later on this later on this year. I know that, peer workers in our partner organizations, you know, sit in the clinical review meetings. They form part of they they sit in the education sessions that we've been providing very much part of the, integrated care team. And I think, you know, have are able to provide such a, tremendous amount of value and richness into the care that, clients are are receiving.
Tracy:So we're looking forward to certainly, from a Hamilton Centre Western Health point of view, we're really looking forward to, having a peer worker as part of our team.
Annie:Oh, that's tremendous. Yeah. And how do you see the role of client advocacy and empowerment, in promoting integrated care models When you you've already sort of alluded to the fact that you're giving the clinicians confidence, they're re referring, but if you're going into these clinical review meetings and advocating for the client, do you actually see that that it is, educating the clinicians around the value of integrated care?
Tracy:Absolutely. I think, that Hamilton Centre is able to demonstrate really well about the value of that integrated care model, and we're very lucky, within our service to have a, a really great group of clinicians. We have a couple of addiction psychiatrists. And, I guess, within our own team, you know, with addiction medicine specialists, with a fairly new nurse practitioner, I think within our own team, there's lots of value in that sort of crossover and learning with with each other. But, yeah, I think there's a a tremendous amount of value in in that, yeah, integrated care.
Annie:And it's really it's really exciting to hear about a broad team with, you know, broad range of experience but with a common goal to improve services. Yeah. Can I ask you both, if you think about, service redesign, what advice would you give other service providers, looking to implement or improve integrated care, initiatives within their own systems? And obviously, we've got to, you know, always be thinking of of the bottom line and capacity within their workforce. Thileepan, and if I can get you to
Dr Thileepan:respond. That's a tough question because it it's always contingent on resources and what's available. But, ultimately, I think, if we center some of the care models around the people that we're meant to be caring for and trying to create a model that's accessible for the people that we seek to serve. I think that's a good starting point from there. So I think in 1 of your earlier questions, you talked about the importance of having, peer workers or people with lived experience, involved in meetings, And I think that's really central in developing a model of care, actually talking to the people that we're trying to to serve and making sure that what is implemented is something that is wanted.
Dr Thileepan:It's something that is accessible and something that will add value, to people with, in this case, dual diagnosis. And, also, to try and be flexible around the care that's delivered rather than being in, in a hospital ivory tower, being receptive to people's needs, going out to primary care services, going out to outreach, services, trying to be innovative in delivering what care can be done, and trying to be flexible as well with appointment timings, and meeting people where they're at. I think those are, in general, good principles.
Annie:And I imagine that with the lived and living experience expertise, those individuals bring you a lot of education and experience that, you know, would not have been part of your life experience. So are they involved in creating these models? Are they you know, should they be involved in creating these models, these policies?
Dr Thileepan:Absolutely. So I think in in my life, I think I've learned far more from my patients than they've probably learned from me in in many respects. But speaking from a Western health point of view, when we're thinking of doing an intervention from an addiction medicine point of view, we do seek out support, from patients or people with lived experience to make sure that our ideas are actually, valid.
Annie:Relevant. You know?
Dr Thileepan:Absolutely. We all think we've got good ideas, but then when you put it towards someone else, they might think that that's not a practical or a valid solution or the problem that we're seeking to solve is not a problem that needs to be solved. Mhmm. So I think it's paramount to have that lived experience voice.
Annie:And, Tracy, with your, service redesign head on, what what advice would you give service providers trying to implement an integrated care model?
Tracy:I think probably just reiterate what Thileepan has said. It's about making sure that we are not making assumptions about what we think as clinicians is needed, and about making sure that we, are not just in a tokenistic manner, but that we really, that that our, our consumers who are, you know, lived experience workers, are there from the very start and that they're an integral part of that, planning and decision making process. I think that even though at Hamilton Centre Western Health, we don't currently have a peer worker, I think the the peer worker model is is certainly very much been integrate integrated across, not just other Hamilton's. I know other Hamilton Centre services already have, have worked well with their peer worker models. I think at Western Health as a organization, they you know, we have a, a peer worker, team now working out of Sunshine ED, which is where the mental health AOD hub is located.
Tracy:And they're doing some amazing, work with clients, you know, doing some outreach with them. I think, yeah, Western Health too have have got a quite a good they've got a a community participation manager. So they are definitely is an organization very much consider consumer, participation as part of their service model redesign and and those sorts of things. So I think
Annie:It sounds very forward focused
Tracy:I think we're in quite a good position. You know, we're we're able to I guess, we're in a fortunate position. We can tap into some of those resources, tap into some of that, sort of expertise, in, yeah, in creating our models.
Annie:With with this established culture of of welcoming lived and living experience workers, you're moving towards that destigmatization
Tracy:Of
Annie:your, services.
Tracy:Yeah. Yeah.
Annie:Yeah. So can I ask you both, what excites you most about the future of Hamilton Centre?
Dr Thileepan:I think I'm looking forward to the expansion of the Hamilton Centre outwards. So it's been in a tiered manner rolled out, but I'm looking forward to the stage where we're getting out into the community, into health care centers, into places where patients, go but aren't really seen.
Annie:Yes. Yes.
Dr Thileepan:And trying to actually add some value to, people's lives, hopefully, and hopefully improve their experiences with the health care sector and increase that contact. So I'm really looking forward to an expansion that gets us far further out of the hospital sector and far more into the community sector.
Annie:Yeah. So an agent for change, really, in the the way that, this integrated care is delivered.
Dr Thileepan:Absolutely. I think that's what we all want. I think we all want to try and see and treat the patients that have thus far not been able to access treatment.
Annie:Yeah. It's a lovely idea to think that the equity would be there across rural and regional as well and not just so focused on metropolitan.
Tracy:Yeah. Yeah. I think yeah. That's I think getting out to those, and being able to to, you know, so far reach out to those, areas where they have had very little support. I think from a certainly from an an AOD point of view.
Tracy:But, yes, supporting their mental health clients has been interesting. Even not too long ago, we had done some, training with a, service out at Camperdown. That was 1 of our, regional areas, and and it was really well received. And I think they have, for some time, perhaps, been, forgotten when it comes to, you know, I guess, where resources have been, focused. So being able to, yeah, have that sort of impact with some of these more regional areas is, has been exciting, and I'm looking forward to, yeah, working with those partners in a bit more over the over the next whenever.
Tracy:12 months.
Annie:More live. Whenever. Yes. But I mean, everyone's motivated and everyone, is just waiting for, you know, sort of workforce capacity to be able to deliver this. So, yeah.
Annie:So I'd really love to thank you both for sharing your insights and experiences with us today. It's been an absolute pleasure to have you on this podcast. Thank you, Lee.
Dr Thileepan: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. Visit our website www.hamiltoncentre.org.au and subscribe to our newsletter for a journey into transformative mental health and addiction care.