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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 living and lived experience, shaping the landscape of integrated care and mental health and addiction services in Victoria. The Hamilton Centre acknowledges with deep respect all First Nations people and traditional honour groups within Victoria. The Hamilton Centre team also recognizes people with lived and living experience of mental ill health, alcohol and other drug issues, and of recovery, and the experience of people who've been their carers, families, or supporters. I'm Shalini Arunogiri, Hamilton Centre Clinical Director, and I would like to welcome you to a really special and meaningful episode on how workforce investment builds stronger, more sustainable systems of integrated care. The recording today is based on a panel discussion that was recorded on the 11/12/2025, during an in person forum that welcomed leaders and workers from across the mental health and drug and alcohol sectors in Victoria.
A/Prof Shalini Arunogiri:Today the podcast is really focused on workforce and what we can do to support our workforce in Victoria. In this episode you'll hear from the chair of the panel discussion that day, professor Dan Lubman, Executive Clinical Director of Turning Point and Professor of addiction studies at Monash University. He has over three decades of experience as an Addiction Psychiatrist, researcher, and policy expert in addiction with over 500 publications. Dan is chairing a panel discussion which is joined by three panelists, associate professor Ravi Bhat, who's Clinical Director at Goulburn Valley Mental Health and Wellbeing service, and Associate Professor of Psychiatry at the Department of Rural Health at the University of Melbourne Medical School. Ravi was recently recognized by the Royal College of Psychiatrists as a rural champion for 2025 for his leadership of mental health services in rural and regional settings.
A/Prof Shalini Arunogiri:We're also joined by Ms Maddy Harradence. Maddy is the branch secretary of the Australian Nursing and Midwifery Federation, the NMF, and is a registered nurse with extensive emergency department experience. Maddy has previously held the AOD portfolio with the NMF and led the branch's education and advocacy work for AOD training for nurses and midwives. To round out our panel, we're also joined by associate professor Lee Allen. Lee is deputy chief psychiatrist at the office of the chief psychiatrist at safer care Victoria.
A/Prof Shalini Arunogiri:Lee's chaired the oncology psychiatrist Victorian branch training committee for psychiatry trainees for over a decade and she has an interest in wellbeing and curriculum design alongside sexual safety, mental health workforce and collaboration of primary mental health. We hope you enjoy the discussion today and it's a really enlivening panel.
Prof Dan Lubman:Thanks, everyone, on a busy month at the end of the year, finding time to come and spend this with us this morning. And thanks to the amazing panel that we have. We're talking about the importance of implementing integrated care, and suppose today's discussion is about one of those levers which is sort of the importance of workforce. So I'd like to ask the panel, just zooming out a bit and thinking about integrated care itself, sort of what are the current challenges that you're hearing, you know, in your patch, particularly thinking at a system level and sort of what what is the impact that has on service delivery?
A/Prof Ravi Bhat:Yeah. I've been thinking about it a fair bit. And if if I get slowed down today, it's because I think the jet lag is just hitting. I think the Royal Commission reforms have undoubtedly increased workforce. There's no doubt about that.
A/Prof Ravi Bhat:The numbers have increased. We have more people. But at the same time, it's that how far behind we were. But it's also another thing, which is that, you know, my my research interest is in delirium and frail older adults. And and we have characterized frail older adults as complex systems on the edge of failure.
A/Prof Ravi Bhat:So sometimes, especially regional services feel like that. We are on the edge of failure. So as we have expanded, what I have observed is that the two parts of the system have been particularly difficult. One is at the center, the acute and pointy end, which is inpatient units and acute services. And then there is the periphery where all these exciting new programs are coming up.
A/Prof Ravi Bhat:So we have seen the movement of highly experienced clinicians from our acute services into these exciting programs because they have experienced burnout. They are very good at what they do. There are new opportunities, which is just as well. And that's what they have done. At the same time, though, at the periphery, and for example, in in Shepparton with with our work on integrated AOD and mental health care, right, building expertise is really hard, and it takes time.
A/Prof Ravi Bhat:And because the numbers are small, you just need one person to leave for that whole thing to collapse, okay, and get back at that. The other problem we have is the fragility of funding. So for example, if you take a look at medical workforce, ANZCP accredited our training program in 2012. We had a first register start in 2014. From one position, we have now 20 register positions.
A/Prof Ravi Bhat:But more than half of them are entirely dependent on federal government's STP, ARTP funding. And the moment you get one letter saying that something, the funding is going to be reviewed, and if it goes, our registrar training program is gone effectively. Right? So that's the fragility that is there to the system. It's the same thing with nursing workforce as well.
A/Prof Ravi Bhat:Right? Senior mental health nurse has put extraordinary amount of work in developing the grad program. But, again, numbers are difficult. And and then to actually then get the sort of experiences that people need to be able to work well becomes harder. So, yeah, so that's that's my sort of broad reflection on this.
Prof Dan Lubman:Thanks, Ravi. Maddy?
Ms Maddy Harradence:Thank you. I would agree with a lot of what Ravi said. I think from a nursing midwifery perspective, you know, you can't be what you can't see. And I think the career pathways into AOD, mental health integrated care, sometimes are not so visible as they could be or should be. So I think that's a problem.
Ms Maddy Harradence:I think, you know, Pip mentioned it in her slides, we do have an inequity in paying conditions across the state in both AOD and mental health in private, not for profit compared to public. We have seen some really great models coming through, things like AOD hubs integrated into emergency departments. But I think that we just have this you know, the elephant in the room is that stigma still exists. There is a stigma, I think, that exists for nurses not being aware it's not part of the undergrad. You know, when I did my bachelor of nursing, there is very little to zero AOD included in that.
Ms Maddy Harradence:Mental health, you still have to sort of revert into that pathway. So I don't think we've really bedded down pathways. I think training and upskilling after the fact is wonderful, but if you don't integrate it from the start and kind of take that holistic whole of life career progression pathway, then you do it a disservice. So I think there's plenty of opportunities, but I think, yes, we do have to declare pain conditions, inequities that already exist, barriers in terms of career pathways. Like, we hear such great stories from members who are making roles within their health services, but they are required to do that, to do that business case and build up that support from the executive to get that role.
Ms Maddy Harradence:And I think the upshot of that is that we have a burnt out advanced practice nursing workforce. Nurse practitioners in AOD is a really good example. They are absolutely leading. You know, we saw an incredible one up on on the video. They're doing great work, but we cannot put all the pressure on those roles.
Ms Maddy Harradence:We actually have to have a bigger workforce that supports them. Ravi reminded me of a very hot topic issue for us at the moment, which is graduate nurses and midwives. Because, you know, here in Victoria, we have 2,000 plus graduating nurses and midwives who at the moment don't have a job. So when I hear and I, you know, am invited to speak about workforce, I think about the lack of modeling and workforce initiatives that we are doing to actually channel these people who are desperate to work, who are excellent future they're our future workforce. Let's channel them into places like AOD, integrated models of care with mental health.
Ms Maddy Harradence:They're out there. They just need to be funded and supported. So thank
Ms Maddy Harradence:you for reminding me about that, Ravi. I'll pass on to Lee.
A/Prof Lee Allen:Thank you for setting up this sort of sector. I have a role with regards to training for both medical students and psychiatry trainees through the College of Psychiatry in Victoria and in University of Melbourne. I'll follow-up, Mandy, with your commentary about the place of addiction within training as a first sort of point and thinking about integrated care. And I think I'd really highlight that, yeah, there's still a lot of systemic stigma that leads to addiction really not having its rightful place within the medical curriculum from what I can see within our medical school. And then I've tried to lobby for, and was very grateful for funding that came about through the Royal Commission to actually put some of this more in place within the board of faculty, and not just in medicine, and all of health care because you could put that addiction lens on many parts of health, not just mental health.
A/Prof Lee Allen:So with that, we've managed to also draw successfully in developing some tools to support the broader faculty within the health disciplines within the university to look at stigma and also to look at supporting placements. And the feedback from those different disciplines has been extremely positive. So if you don't expose people to other work, it's really hard to get the interest and integration of the work. So it's so it's and then I think about the integration within psychiatry training, and I I looked at my I was looking up your email recently, Shalini, and I found our email from 2011 when you transferred it to my region as our senior director of training and just recognized the the growth in psychiatry training over the last sort of decade or so, which has been really positive and pre, the Royal commission. And I think part of this was some flexibility on the colleges' part with regards to supervisory arrangements and strong advocacy from Dan, I think, within the college to look at.
A/Prof Lee Allen:We didn't have enough specialists to provide the supervision. It's there's there in
A/Prof Lee Allen:the background of being aware of
A/Prof Lee Allen:all this stuff as well and really lobbying to ensure that there was flexibility to ensure that people were able to be supervisors and that we worked really well, addiction specialists, being involved in supervising trainees, as well as psychiatrists. And we now, I hear from Vicky, have, you know, a number of addiction psychiatry specialists, but the jobs are still kind of siloed into specialist areas rather than really being fully integrated into the area of mental health services. And for me, as a youth psychiatrist, bread and butter for me is addiction practice alongside and an ongoing enduring relationship with young people and their families. So I think we've still got a long way to go in integrating it into more of a harm reduction model within area of mental health services.
Prof Dan Lubman:Thanks so much for those insights. I think we just talked about the importance of the growth that we've seen since the Royal Commission and sort of some of the challenges that we're all seeing. I suppose my question is is really about sort of sustainability. So how we're in a climate where often sort of we often have, you know, have terms like, you know, system has to work on its culture, but but there's a recognition in the royal commission around moral injury and sort of the impact on workforce. We often you know, we're seeing increasing demand across the system, and often the workforce is sort of saying that you're not working hard enough or we're not seeing the impacts that we expect from the Royal Commission.
Prof Dan Lubman:So I suppose the question is is how do we support hope and optimism in this sort of environment, and what are some of the things you're hearing about or things that you're implementing to sort of continue to sort of support the workforce sort of it, you know, as we try and implement integrated care and the recommendations of whole solution. Yeah. So
A/Prof Ravi Bhat:there was a piece of work that was done across St. V's, Goulburn Valley Health, Ballarat, and looking into workforce turnover. And what that work found was leadership was crucial to all of this. Right? And and how mental health leaders imagine their workforce should be and, what level of support is provided to staff so that we minimize workforce burnout and and moral injury.
A/Prof Ravi Bhat:Right? And the intention to stay in the workforce, especially in regional areas, was particularly influenced by the total mass of the workforce. So if there were more people leaving, that meant that the existing people had more work to do, and that just created problems. So that that's the sort of crucial. So then the question is, how do you sort of stay get people to stay and and work on?
A/Prof Ravi Bhat:If you look at our service in Goulburn Valley Health, the reason that we continue to survive is because of the nursing program, and because of the psychiatric training program. So if you look at our nursing workforce, I think retention of the grad nurses from the grad nursing program is in the order of about, 70 to 85%, depending upon which year you look at. And we managed to sort of retain most of the people who had finished their specialist training in Shepparton as psychiatrists as well. I think the crucial element with nursing has been the extra funding that has come for the roles of clinical nurse educators that has actually transformed the availability of supervision. An observation that I'd made about fifteen years ago that nursing training differed from psychiatry and allied health training in that supervision was not a important element of what people did.
A/Prof Ravi Bhat:Supervision was often seen as, oh, I've done something wrong. You know? Are you supervising me because I'm incompetent? And and mercifully, that has changed. That attitude has changed.
A/Prof Ravi Bhat:And now we have got grad nurses looking forward to supervision and building that supervision. So I think that's been crucial. And leadership supporting supervision as an essential element of work, I think, is absolutely important. And it's the same thing with with psychiatric trainees as well. We have managed to scout some money to actually increase the amount of time that our site coordinator training has.
A/Prof Ravi Bhat:Because as it has increased, that's been a problem. I think the the other thing is what you discuss on a regular basis in your governance and leadership meetings. Often what happens is that we are so preoccupied with the latest KPIs and answering to executive about what's gone wrong. It we often fail to look at what needs to be done on an everyday basis because we are too preoccupied with the various fires that we want to sort of put out. And and I think thinking about workforce on a regular basis, having a standing agenda items, I think that's been very helpful in just maintaining focus in all of the things.
A/Prof Ravi Bhat:So those are the two things that I'd like to point out. Back over to you.
Ms Maddy Harradence:Thank you. You know, I'm reminded of some research, I think it was 2020, 2021, out of Northwestern Mental Health looking at resilience in mental health nurses. Kim Foster led that research, and ANMF and HACSU and others department sponsored this research. And part of what it said, you just reminded me again, Ravi, was places that had low turnover had a high sense of belonging. And I think that comes through no matter where you work, but, of course, I know nursing industry, that's my industry, where there is a culture of feeling trust and there's strong leadership and you feel like you belong.
Ms Maddy Harradence:And I think these are not sort of fair off concepts. It's it's how you build a strong culture and it keeps people. The other thing that I was thinking of around sustainability was, you know, training and support, of course, but pathways in. So there is a model that here in Victoria we've had for a number of years now called the Ruson model, Registered Undergraduate Student of Nursing. We've also got Rusons, but this really evolved through COVID.
Ms Maddy Harradence:You know? And I often like to think, what did we actually learn out of COVID? We have to remember that as opposed to just thinking, never talk about it again. And one of the things was the Ruson model. So I think pre COVID, we had about 10 programs across the state, and it was very sort of limited to sort of medical surgical nursing.
Ms Maddy Harradence:After COVID, we had about 60 programs up, and we had mental health Rusons, we had midwifery Rusons, we had Rusons working in EDs, we had Rusons everywhere. And we've actually had research now done out of the University of Melbourne that shows that a nurse that is a Ruson, so an employed student in a health service working in a clinical area, has a higher likelihood of retaining in that health service, so retention is higher. But reduced transition shock, improved integration into the health service they know, they feel like they belong. So I think we can think about different elements, and I think I'll get to the sort of training and upskilling of current health workforce as well. But I think that that first foray, that first exposure, undergraduate, during your while you're studying, what pathways we can do.
Ms Maddy Harradence:And I think Rusons in an integrated AOD mental health space is something that we haven't mapped and we should, and it should be funded and it should be considered. Liz, Hello there. So I think that's something that we haven't really, really turned our mind to and we should. In terms of training existing staff, there is a program that we have run since 2016 with Turning Point. I know there's lots of Turning Point people in the room.
Ms Maddy Harradence:That is a dedicated nurse midwife AOD training program. We've trained over 4,000 nurses and midwives in the state since it was introduced. And what I think is fantastic about that training, you know, funded by the department, it's free, it's accessible. We've taken it out to regional Victoria before. We've run lectures out in regional Victoria.
Ms Maddy Harradence:That was pre COVID. Now we have sort of a hybrid online face to face model of education and it's core AOD and then it's master classes. So we're trying to support our existing nurse practitioner, clinical nurse consultant group, but we're also trying to attract and introduce people to AOD and integrated care. And I think that model has been very, very successful for a number of reasons, partly because it's been funded, and we've had ongoing funding. Thank you very much, again, just reported.
Ms Maddy Harradence:But, you know, I think these models, we should we should if we're thinking about sustainability and we're actually being serious about this, we need to make sure that we have ongoing funding for training models that actually work. And how can we replicate them for other health workforces, as an example? So those were kind of the two things that I think of in terms of cultural leadership and that sense of belonging, but also existing staff and upskilling. Because we get a number of nurses that apply for that training who work in emergency departments. They work in community health.
Ms Maddy Harradence:They might work at WADS at Royals Women's, a real diverse group that apply. And I think if you consider, like Lee said, if you haven't been exposed to it, it's hard to understand it. You might feel too far away. But if you can actually come in and do some free training, it might encourage them. Now when we've surveyed members who have or nurses and midwives that have attended that training and asked, are you now working in AOD?
Ms Maddy Harradence:You've come and done a series of training with us. We also used to offer a grad certificate through Monash University in addictive behaviors. We asked those students, you know, are you now working in the sector? And a number of times they weren't, which I think is something you should explore as well. So these are people who've gone and done a postgraduate certificate.
Ms Maddy Harradence:They'd come and done training. They might have been an experienced nurse for ten years, and they were still struggling to get in the door. So there is also a problem there of, you know, why aren't we bringing these people in? And we ask them, you know, you're applying for jobs. What's the response?
Ms Maddy Harradence:Well, I don't have enough experience. So I think there's something in that too. There is one thing I know about nurses and midwives is that if you give them a taste of something, they will run with it. They love learning. You know, we run scholarships for all sorts of postgrad, and we just have an exhaustible number of applicants.
Ms Maddy Harradence:Like, nurses and midwives love to learn. I know it's very similar for others in health workforce. So if you give them a taste of it, they'll run with it, but they need to be supportive of jobs at the other end of that. So I think that's another opportunity and something we need to think about.
A/Prof Lee Allen:Thanks, Maddy. So I think workforce is really fundamental to a lot. I suppose this is more of my OCP hat as I'm a deputy chief psychiatrist, and what I've been trying to do, having had the opportunity working within the training and workforce area for a couple of years and bringing those relationships within the department to the office of the chief psychiatrist. It's and, no, my view is narrow with regards to medicine as opposed to the broader workforce, but just how important workforce is in the performance of our services. So the psychiatrist has started to work more closely with performance commissionings, of which oversees sort of the operational side of our area mental health services.
A/Prof Lee Allen:And part of that is, for me, has been trying to bring the lens of what's happening in the medical workforce, which is my only area that I've got knowledge of, but to those meetings. Because it's all very well to have your KPIs or what's happening with how long people are in ED or or whatever it might be. Often these are very much driven by throughput.
A/Prof Lee Allen:It's not driven so
A/Prof Lee Allen:much about the quality of the work, but it's it's about managing the throughput. And how do you do that when the when the workforce is at different stages of being a very stable workforce or a very genuine workforce or one that's under pressure in some sort of way. We're a long way in being able to truly integrate that, but I think from a systems perspective, that's important to keep in mind. And I suppose in thinking about those things from a systems perspective, the sustainability thing is also for truly integrating mental health and substance use disorders is getting data from both of those areas and what's being measured and monitored. And I think that very much like a one diagnosis kind you know, for the limits and acknowledging the limits of diagnoses as well.
A/Prof Lee Allen:But given that the department does look at these things, that we really should be thinking about how we're measuring more accurately if a morbid sort of substance use, because I think it's the data brings money, and I'm thinking from a sustainable sort of perspective, that's a really important thing going forward. And there are opportunities, obviously, within the reform sector in thinking about how the local area mental the local services are going to be able to sort of work, again, integrating with the area mental health services, not just with mental health but substance use. And the models there are, again, have been quite varied about the governance of those different locals, but we've been working with the department to try and meet the expectation, I suppose, of the Royal Commission was for this to be an integrated sort of seamless transition. So people need it either up or down the areas of what people might need. I would I would also agree, though, about funding.
A/Prof Lee Allen:I think that is a really - Jean's nodding in the background there -, that that's been really hard for services and knowing the security of funding. It's hard to build something and develop the trust and sustainability if that funding isn't secure. And very much appreciated the commitment that's been shown. We've we've managed to triple the number of psychiatry registrars since pre COVID. And within that, we've also been supported to provide funding for the services for the first of three years for each new lot of of a percentage of these trainees coming in.
A/Prof Lee Allen:And within those first three years, there might be opportunity to leverage should there be some AOD exposure within that. Because there are things that are exposed that are required from the college's training perspective. But, you know, from a service perspective, maybe that's something else that could potentially be flagged or at least sort of trialed in some areas. Ravi also spoke about STP positions. So these are federally funded positions for psychiatry training.
A/Prof Lee Allen:And I think when we and and they are likely they're under review, and next year are vulnerable to being removed. And that that's, I think, equates to about 11 addiction positions in Victoria. So that's a significant impact, and it obviously has a significant impact for rural funding and for rural pipeline funding. The messaging I've heard is a bit more positive about pipeline funding, but I am really concerned about addiction funding. I think that needs sort of ongoing sort of advocacy from a from a state level and college level as well.
A/Prof Lee Allen:I think the other things in thinking about belonging is very much about delivering a sense of commitment and passion that I think people working in this area really do have, and it's sort of championing that and certainly championing, you know, some of the innovations, whether it be through the through the pill testing, know, the range of things that are sort of happening that are shifting people's attitudes. Like Uber driver was able to give me a really quite broad formulation about all the reasons why people might be using substances in the community, and it was really pleasing. It was different than in India, apparently. But yeah. So so I think, also, we should be tapping into society's changing perspective about addiction and really calling, you know, health services to account to being responsible for the probability within their communities.
Prof Dan Lubman:Thanks, Lee. That's a really interesting idea around doing stigma reduction from Uber.
Prof Dan Lubman:So we'll take that on board. Can I just I suppose, you know, what we've heard from all of you is that, you know, there is opportunities for skill development and that people really embrace that skill development? But I think when we're talking about integrated care, there's issues around how that gets implemented and those skills are allowed to be applied on
Prof Dan Lubman:the ground. So can can you maybe just talk a bit about some of, you know, what you see works and some of the challenges in terms of how do we translate that skill development into actual changes in practice in systems? And how do you support that?
A/Prof Ravi Bhat:Sure. Yeah. I think to start with training first, as you know, the in psychiatric training, the College of Psychiatrists just ask you to do some modules for addiction. You don't really need a full rotation for training.
A/Prof Ravi Bhat:So one of the things that we have done in Goulburn Valley Health is that every registrar has the opportunity in their stage two training to have a six month rotation with our addiction service. Okay? And addiction medicine specialist, Professor Ed Ogden, has gone ahead and done his RA and ZCP supervisor training as well, so which is very helpful. So so I think giving a good duration of experience is is critically important in developing the interest, because it takes time to understand what's actually happening. And we have done the same thing with our grad nurse program as well.
A/Prof Ravi Bhat:So our guide nurses have a six month rotation, similarly with our addiction service so that they are actually there embedded learning in place. And I think these kind of initiatives are crucially important. The second thing I would say is how you design your services. Often, what happens is that these subspecialties, if I can call that subspecialty services like addiction psychiatry or addiction medicine, is that it's based on a referral only model. That if you think you have a problem, you refer to us.
A/Prof Ravi Bhat:We'll take a look at it. We'll then figure out what to do. So, we were quite fortunate that the first person to train, in addiction psychiatry in GV Health, she worked with other colleagues and came up with a design to say, no. I don't think we need to do it like that. We need to actually have an in reach model.
A/Prof Ravi Bhat:So integrated AOD and mental health clinician actually sits in the clinical team review of the adult community mental health teams. He goes to the inpatient unit for the handover, and in the process, identifies people who might actually benefit from further support and work, and then has a discussion with his team to figure out how to actually do that. Sometimes it is in the moment consultation to say, hey. Maybe you could do this. Sometimes it is taking on to say, I think we'd like to do a joint assessment of this person.
A/Prof Ravi Bhat:And at other times, it will be providing brief interventions. So I think that kind of that kind of integration appears to have worked for us. People are happier knowing that the consumers that they're helping with are actually benefiting from the expertise that is available at the moment. The third thing is that, again, it comes back to leadership. I think leadership has to recognize that whatever happened in Victoria and more generally in the West, I would say, this artificial separation between addiction, psychiatry, and addiction medicine.
A/Prof Ravi Bhat:I think it's a quirk of history. There are many places in the world, including the country where I was born and trained in India, where you actually it's part of your psychiatric training. Right? And you learn to do everything. And I think that the leadership has to recognize that it is important.
A/Prof Ravi Bhat:It's not like there are three a person with three different problems back into that integration thing. It needs three different approaches. Okay? Maybe that they have come to the service, and they need the same help. And and that recognition, I think, drives what how they think about the system and what are they trying to do.
A/Prof Ravi Bhat:So so, yes, I would say those three things bottom up.
Ms Maddy Harradence:Yeah. I'd absolutely agree with the dual graduate year with mental health and general medical addiction. There is examples of that across the state under Alfred as well. Have, I think, eight grads at the moment that come through. I think that's really important if you're kind of looking at integration in practice.
Ms Maddy Harradence:The other thing that I keep thinking about, and I'm not sure that we've kind of gone there yet in this panel, is primary care. So much of primary care is integrated care, and there's been some really interesting discussions in the media recently. We saw what happened with co health, and we're very obviously appreciative that the federal government stepped in with some interim funding. But what our nurses in those GP clinics and the GPs and the GP clinics, those models are integrated models. They are preventative.
Ms Maddy Harradence:They are keeping people out of hospital. They are doing opportunistic motivational interviewing. They are doing integrated, getting them in and helping them out with welfare and social support. It is truly comprehensive integrated care in the primary health care setting, and I do think we need to start having that conversation more and more in Victoria. The Royal Commission talked about services in the community close to where people live.
Ms Maddy Harradence:You know, of course, we need to look at the acute sector and have that available and integrated, but I just am very conscious that I think primary care has been leading the way for so long on a shoestring budget, let's be honest. And we can look at those models and, in fact, replicate those models and expand those models in the primary health care setting. Because we always will need hospitals, but I think we'll need hospitals less if we actually put more funding into primary health care. That was just my reflection.
A/Prof Lee Allen:Yeah. Absolutely agree. But we're also very aware of the of the limited with the Royal Commission, the limited focus on the acute end and the impact that it has on people with very severe mental illness, and often many of them with very significant comorbid substance use problems as well. I think, you know, when I've seen this work well, I think reflecting on what you've all spoken about, that it really does relate to the relationship. And I think it's very much the relationship with the or for myself being as a clinician with people that I'm working with and thinking about their care, and then I pivot on that relationship and thinking about what might be some of the drivers that might be and the workiness between you know, people's lives don't fall into neat buckets, maybe budgets do, but and services to get developed because of the the buckets of money and maybe our our different, you know, training and expertise, but people's experiences don't come like that.
A/Prof Lee Allen:And so it really is pivoting on supporting the relationship between the often the the clinician and the consumer, and then the clinician needing to to pivot on their relationships with other experts to kind of inform what is needed to be able to reinforce that relationship and outcome for the individual. And I think when I've seen it work well, that's very much modeled on that where there's a really strong relationship between services that allow for that better delivery and coordination. You know, that comes with battle between services or these different ideologies. So I think we have to also not just work on our relationships with our people using our systems and very important about that, but we really need to focus on how we relate to each other in different disciplines, in, you know, primary, tertiary, addiction medicine, and psychiatry. So so that would that would be one thing.
A/Prof Lee Allen:I think, you know, I think we have a great model with the Victorians training, and I know Vicky Phan in the room here being involved with the training program for psychiatry in addiction and and the interface with addiction medicine and the interface with psychiatry addiction sort of nationally. So I think that's a really good model thinking about communities of practice that really support these strong relationships. But I also reflect on my Pilates teacher's partner who's an addiction counselor, and the challenges he's spoken of of moving much more into the trauma space for addiction work and just what the the, yeah, the the challenge the the burden, I suppose, in some ways, he's felt in in having to shift the way in which he's working. And he's a very compassionate man and just what the the emotional, the unknown or unrecognized sometimes emotional burden that that having a trauma lens or feeling a a responsibility for the trauma has and and who's skilled in being able to manage that and how, again, they need to lean into other relationships and supervision, etcetera, to be able to support that.
A/Prof Ravi Bhat:add something to it, if that's okay. Yeah. Maddy, you reminded me of primary care, and and I thought that's sort of another thing that has worked in the integrated AOD management sector is the work that we have done in developing the ECHO program or Project ECHO. Some of you would have heard of it. It was developed in Albuquerque in New Mexico as a way of developing a community of practice using really telehealth models.
A/Prof Ravi Bhat:And GV Health is now a Project ECHO hub. And we all, Ed and I, along with two AOD nurses and two of our mental health staff, we got trained in ECHO just as the pandemic was taking off. So we came back and and and started the first the Joint Addiction Mental Health Echo or Jam Sessions, as we like to call it, in July 2020. And it's been a success. I think we have created a lovely community of practice across our region and beyond, where we have a range of primary care practitioners, doctors, nurses, and people working in community health centers who have sort of come together to have these discussions.
A/Prof Ravi Bhat:And I think that's been critically important as well. So yeah. So while we haven't reached Uber drivers and
Prof Dan Lubman:Thanks, Ravi. And we might just take a couple of questions from the audience. Just just a one sort of commentary is around obviously, our panel's very medical and nursing heavy.
Prof Dan Lubman:So just sort of acknowledging the important role of allied health and experience in our workforce and remembering their roles and how to support them in this work. We've also talked a lot about how passionate our staff are. So and when we've talked a lot about top down processes, do you wanna have a bit of a reflection around how do we better empower our workforce to drive some of these changes and how might we do that?
Ms Maddy Harradence:I do think it comes back to the conditions and pay and remuneration and culture. And the team that I'm thinking of is, you know, at the Royal Commission, it was, you know, an expansion of in the home for mental health in the home programs. And I'm reminded of we've got some great members at the Barwyn Mental Health HIT program. And it is a truly multidisciplinary program. And it is a really strong team with good workload measures, obviously, paying conditions under the public sector mental health agreement.
Ms Maddy Harradence:I think if we're talking about empowering people, we need to start with their entitlements, their wages, their conditions, make sure that they actually feel valued because that is attached to how valued you feel. If you know you make $11 less an hour working at the GP clinic, which might be doing absolutely the work of an AOD clinician because majority of the clients that you see might be people with substance use issues or psychological distress, but you are making considerably less money an hour. You are not gonna feel valued. And if all the talk is always about the hospital work and it's not about the work that happens in those GP clinics who do incredible work, then I think we're not giving them the value that they need. It's not an integrated system.
Ms Maddy Harradence:We're not empowering them. So I do hear and see good examples of good culture, bullying, trust, rapport. And the obvious answer to that then is that there's people that want to work in those teams, and they don't have the same shortages, which, of course, cause reduced and delayed access for consumers and clients. So a there's there's a fault flow on effect with not looking at workforce from that ground or grassroots level. Sorry.
Ms Maddy Harradence:Throwing my papers everywhere. In that, we don't actually have fully staffed services to meet the needs of consumers and clients. So it's a domino effect. I think if you don't look after your staff, then you aren't gonna have those comprehensive services that people deserve and people need. So I think I'm probably echoing things that we've all said a few times, but it does come back to remuneration, feeling valued, feeling respected, feeling safe.
Ms Maddy Harradence:You know, people do need to feel safe in their workplace, and that's a broad term. But I think there's a lot more work to be done, and I know there's a strategy that's come out, AOD strategy, workforce strategy. I think there is momentum, and I think there has been momentum after the commission, the Royal Commission. But like Pip said, there's also been so much reform. We started from back here, but the workforce is tired.
Ms Maddy Harradence:So asking them to do more is a challenge, and I think we have to prioritize a bit more about what we actually need to focus on moving forward. I'm not sure if I've answered your question, but I think I've probably talked around it.
Prof Dan Lubman:just in terms of we're running out. We can have this conversation all morning. Maybe we can continue a bit later. But let let's just finish with one question just before we finish. We're twelve months away from election.
Prof Dan Lubman:If you could get politicians from across the aisle to commit to one big thing in terms of getting us closer to delivering integrated care, what would that be? Leave you with so sorry for the short nudges. That's alright.
A/Prof Lee Allen:thank you from your comment to me about a model of integrated care. This would be something that would ensure that this is more embedded in community mental health services rather than acute inpatient services and setting up a clinic that works alongside the clinicians within the community mental services, recognizing they have that reach and closer relationship with locals over time as well. So leaning into that in being able to provide truly skilled in both psychiatry and in or in mental health and in addiction to be able to deliver coordinated care for individuals. So it's not just a consultation. It's actually taking over the full care of individuals in those settings and having a team built around them to do that.
A/Prof Lee Allen:So a little bit aligned to I think Vicky's just like the clinics, but, you know, we have, you know, 21, I think, area mental health services. Or has it gone to 22? I can't remember. But, you know, something like that, I think, would be that was lovely, but I think also that we're gathering data on the number of users in our systems.
Ms Maddy Harradence:Oh, it's hard to reduce it to one. I would say I would probably say dedicated funding for an integrated Ruson, but a model that could be replicated for other workforces. So a dedicated undergraduate integrated role carved out in the budget to start those pathways. I think that's what I would ask for.
A/Prof Ravi Bhat:I'm gonna cheat and add two things in one. So I think from a regional perspective, it's security of funding. I think that is crucial.
A/Prof Ravi Bhat:This kind of, you know, funding for two years, three years, then we'll see what happens is is too difficult to sustain workforce in a regional area. Along with that, I think from a regional perspective, is focus on outcomes rather than processes. Because the rural regional areas differ significantly from metropolitan areas. And the politician should be more interested in how we are influencing outcomes rather than specifying this is how you should do things. Right?
A/Prof Ravi Bhat:And and let's figure out how we would spend that money.
Prof Dan Lubman:What a great panel. What an ongoing discussion. We take this moment just to thank our amazing panel members.
A/Prof Shalini Arunogiri:Thank you for joining us on today's episode. Visit our website www.hamiltoncentre.org.au and subscribe to our newsletter for more information on how we can support you in your work and for training updates for the AOD and mental health workforces.