A psychiatrist’s view on internet dating

 

I thought I’d take time to write about internet dating, the kind that uses social media as platform. Its not intended to be a ‘fun police’ kid of discourse, but in an industry that is unregulated, with a myriad of available options that can have consequences, positive or negative on a person’s wellbeing, it is timely.

After living through the 2 decades during and since the time  “Sex and the City”  (SATC) was every girl’s best friend, I have noticed a huge change in the expectations and limitations of finding the right person and going on to live happily ever after. In twenty years the concept of dating has changed very little but the introduction of technology into the mix has been a total game changer. Remember that scene in SATC when a voicemail message from ‘Big’ on a clunky handset on the bedside table left Aiden and Carrie at the crossroads for the second time? I am sure 2018 Carrie would be the owner of a smart phone that could be silenced to avoid such catastrophes.

What I remember from watching every episode of Sex and the City, sometimes multiple times, is that meeting men was always random. The 4 main protagonists, Carrie, Miranda, Charlotte and Samantha would meet to discuss the men they were currently dating, lament, celebrate or remain ambivalent about being single or deciding whether to get married. The men that came into their lives in a perfectly orchestrated chaotic way, gave them something to talk about when they caught up at the café or over dinner. They would be introduced to a potential partner via a friend, be asked out at the gym, or while training for a marathon, and in Samantha’s case, after sharing a cab ride to the upper east side. Ex partners would painfully crush their sunny days as they literally walked into them on a Manhatton street. Partners came and went, sometimes coming back again, but the girls were frustrated they couldn’t really control the chaos. Watch this 20 second grab of the girls lamenting the inability to find ‘the one’

Twenty years later and during the in between, social media has evolved to create easily usable applications that bring dating to the customer (because that is what we are after all). Introduction agencies have moved into virtual solutions that can be downloaded within minutes onto our smart phones. With catch banners and fancy names we can be hooked to the certainty these sites offer, and guaranteed more certainty if we actually pay money as well.

The concerning part is that this industry is completely unregulated. The adage that one can find a very bad match in real life thus defending the use of online apps doesn’t make sense, as the apps are unregulated, the hard data about success and the terms and conditions are often terribly difficult to find. Purchasing a premium package online does not guarantee a higher quality of a match, it probably just shows which matches didn’t feel it was financially sensible to pay.

In addition, deleting an account does not mean you disappear from the virtual world. Consider this before you take that free “20 minute personality profile” guaranteed to make your chances of finding a compatible partner even more likely. Popular sites offer this only for the consumer to find  that the service has no functionality until you sign up and pay. Within those series of questions, these clever companies have learned more about you that you might not tell a partner until the their 3rd or 4th date. Via GPS, or by signing into other apps, such as Facebook® they know who you are and where you live. They know your likes and dislikes. Thy know  how many children you have and often how much you earn. By uploading profile photos they can see images or detail in the shot that may reveal more. In a world where we are quite rightly more concerned about privacy than ever, this allure of guaranteed success, a departure from loneliness and lack of intimacy on our terms may blindsight us to consider the implications of a rather explicit ‘tell-all’.

Also, If you take time to read the fine print you’ll notice you don’t get your information back when you delete your profile. Often profiles are left up despite being deleted, to increase the number of fish in the pool. So if somebody does not respond when you send a wink, kiss, smile or message, they may actually have departed months ago, and are currently down at your favourite café having a coffee alone and reading the paper. Also, your personality profile is the company’s data forever. Or until you go through the channels to demand it back.

More popular apps such as Tinder® have taken over the way older adolescents and young adults view meeting other people. In fact, Tinder® claims to be the world’s most popular app for meeting new people (via official website). In some cases this is the only way users know how to make new friends or communicate with others, outside of peer groups formed in school. Swiping right and left when bored or lonely is just the same as playing the poker machines waiting for the win. Chemical releases of dopamine in the brain, a neurotransmitter that is involved in the feeling of reward and pleasure, occur in those who achieve success with a match on Tinder® just as they do if they win $200 on the poker machines.

As a psychiatrist, one of the sad things I see is that patients with anxiety disorders such as social anxiety or body image disorders feel these apps are their best friend. They can be as confident as they like behind the phone screen. If they get a match they are temporarily exuberant, then crushed when this means they have to present their selves, ones they might not feel so comfortable about to a real human being. They are likely to ‘ghost’ their match, or be ‘ghosted’ or cancel just before the arranged meeting time. This causes a whole new range of emotions that can be experienced anytime we put ourselves out to meet others, but seems more common, and sadly more acceptable using apps. It is as if we have created a forum to showcase bad manners. More and more, my therapy sessions are spent helping a patient deal with rejection after an online swiping experience, and I am constantly dismayed by how more common and nasty this has become.

Some of the hardest experiences in life generate from the act of being vulnerable, liking ourselves enough to feel valuable and attractive to others and tolerating disappointment and loneliness. All of these experiences are essential to our make up as human beings. They are just as important as learning tools, springboards for growth as are happiness, exuberance, love and intimacy. With the creation of an era that seems to sell the promise of have the latter without the former, and in real time sends all of the wrong messages. A patient with social anxiety would be encouraged and supported in therapy to gain confidence, and try, step by step to move out more into the external world. A patient with a body image disorder would be encouraged to do the same. No therapist would collude with the pathology and suggest continuing with the isolation. If anything this would reinforce a disordered sense of self, one not worthy of all the love, acceptance, connection and happiness that is out there.

And, 20 years after Sex and the City, the yellow cabs of New York have not been replaced by ‘white knights’ in Ubers®, tracked via your app and delivered to your door with a customer satisfaction rating. Sounds absurd? The online customer expectation, or the one that is sold to you by the glitzy website, is trying to tell you it isn’t.

 

 

 

Leadership – What do we expect of leaders and how do leaders rise to the challenge?

A leader holding flag, leading team, and showing direction.

Recently, my son asked me if I thought leaders were born or made. He had to participate in a classroom discussion about leadership and was surprised to see that he was the only one who voted ‘born’. This led to some serious reflection on my part, someone who does consider themselves a born leader and the risk and responsibilities that go with that.

I focused on this a lot this past week, both in my professional and personal life. Life threw me a few leadership opportunities and I felt compelled to fill them. I also saw discussions in social media that, to me, represented a lack of leadership, or at least a difficulty identifying who the true leaders were. In addition, I discovered first hand what can be achieved when leadership and collaboration come together.

I naturally find myself saying yes when asked to fulfil leadership roles, but before I know it, self doubt and fear of failure tend to creep in. I wonder if this is true of all leaders. I presume I will be criticised or I will upset people. But because I have been born this way, I try and ignore the negative self talk and say yes. And if I am not truly sure, I always seek guidance from my mentors, brilliant leaders who often help me traverse the way.

It’s fair to say that leadership is expected whenever there is a an issue or a challenge that needs sorting out. It seems to be a common human trait to seek leadership in difficult times, and to assume there will be leadership. Anxiety and despair can follow if leaders are not tasked with the role in a timely manner, and are not authentic to the role they have been chosen to fulfil.

Some common assumptions seem to be:

  • Leaders are there to pick up the baton and advocate when we falter
  • Leaders are unwavering when we are vulnerable
  • Leaders know they are leaders.
  • Leaders unite people rather than divide them.

But these points can be debated, and are not always true.

I remember watching the Beaconsfield mining disaster unfold on TV in 2006. It occurred in a small town in Tasmania, and the wait for the trapped miners to be found and freed was a desperate and public plight. It needed a leader, and a swift appointment at that. In a small town, and with international media coverage, somebody had to carry the responsibility. It fell to Bill Shorten, who was the Australian Workers Union national secretary at the time. Bill’s presence did seem to calm those watching the rescue attempt unfold.  In that moment, with so much uncertainty and despair, his role was crucial to wear the pressure of what could happen.

In the last 24 hours, The Hon Min for Health, Greg Hunt MP has announced national changes to the the mandatory reporting laws introduced by AHPRA. As a staunch and unwavering advocate for this change, I was thrilled to see such strong leadership for what was a very concerning contributor and barrier to doctor’s seeking help for mental illness. I met him once,  as part of a Grand Round at Peninsula Health, and was immediately impressed by how much he understood about this issue, the concerns arising from the medical profession, the accounts of families who had lost loved ones to suicide, and how he enacted change at yesterday’s COAG meeting. He was boosted by strong leadership around him, leaders from their respective camps such as The AMA, AMSA and doctor’s health advocates, including Dr Geoffrey Toogood, Dr Mukesh Haikerwal, AC, and myself. True change happened yesterday, and it was thrilling to be part of it.

What happens when an issue arises and there is no leadership?

Recently, a paper was published that examined data pertaining to the number of reports against Australian doctors based on age. It was written about in the Australian Financial review. In essence, an examination of reports against doctors revealed that doctors practicing in Australia over the age of 70 were 40% more likely to be complained about than their younger peers. This is despite the same article stating that many senior doctors provide high-quality care well beyond the traditional age of retirement and the study showed almost 87 per cent of doctors over the age of 65 were not subject to any complaints. In addition, the author states complaints about mental illness, substance abuse and problems with procedures were higher among younger doctors.

With the publication of one article, aspersions about the competency of all Australian doctors over 70 have been cast.  The Medical Board of Australia has announced it will introduce peer reviews and health checks on all doctors over 70. How this will occur and when has not been announced.

The fact that this decision has been met with general silence does not necessary mean acquiescence or consensus. But as reported by Medical Observer, it has been viewed as such.

For some reason, the idea of introducing mandatory competency checks on all doctors aged over 70 has gained near universal acceptance among medical leaders – at least if judged against their silence https://t.co/YEY3ytMnXt pic.twitter.com/FSWJOFb4jg

 

But, another way of  viewing this point is captured by this tweet:

I am concerned this demographic of doctors will be subjected to what seems to be age discrimination if leaders are not identified with haste, in order to provide calm and reason, as well as uniting a very valuable and experienced cohort of doctors. Notwithstanding this, the personal impact of this news on doctors who are approaching retirement sends a very clear message that they are not regarded very well by some of our medical peers, and especially not by regulatory bodies. They need a leader to unite them and oppose this argument.

Being a leader in your community

If you are a born leader, leadership styles and roles don’t usually stop at work. And I have taken a big step in that regard over the past month. Others may see it as small, but I am cautious about the responsibilities although I am excited about the challenge.

In the last month my 11 year old son told me he no longer wanted to play AFL football, something he had done since the days of Auskick at age 4.  As a mum who juggles work with ‘mum’s taxi service’ that would mean a lot more free time for me. But I really wanted him to continue, and help him over this hurdle in his very amateur career. After all, he plays with friends he has known since early school years and once on the oval, he enjoys himself.

His team was a new mix of boys and it needed some pretty heaving hitting volunteers to help out. Largely relegated to the regular roles of timekeeper, and provider of the oranges and snakes in past years, I decided to take a massive leap of faith and apply for the role of assistant coach. I did this based on the fact  I have followed AFL football for about 40 years, can manage a group of 11 year old boys and assist the coach who has the ability to teach them skills.

I had no idea how this news would go, or if I would be laughed at. But as it seems, It has been well received, and tomorrow I assume my new role, on the coaches bench. The first mum to coach for the club. Am I nervous? Yes of course I am! But am I a leader – absolutely. So I am pretty sure I’ll be all right.

And I’ll continue to pursue more leadership roles, after all I was born that way.

Dr Helen Schultz is a consultant psychiatrist, author and doctor’s mental health advocate. She is also a passionate member of the Western Bulldogs AFL Club. 

This post is dedicated to the true leaders in the recent fight to end mandatory reporting of doctors to AHPRA, the ones who stood out for me ;

Dr Mukesh Haikerwal, AC, Dr Geoffrey Toogood (creator of the #crazysocksfordocs campaign) and the Abbott family, who out of a time of sheer tragedy became the most inspirational leaders of all.

 

 

 

Is it possible to be a ‘good enough’ mother in a profession that demands perfectionism? My keynote from #IWD18

Today I presented as a keynote speaker at The Melbourne Clinic’s International Women’s Day breakfast. I spent a lot of time deciding what to talk about, given the audience was built from members of various disciplines. But I knew I wanted to incorporate my struggles to get through medical training as a doctor and mother, on behalf of all female trainees who fear speaking up.

I was asked by some if I could video the keynote but I decided not to, for it contained a lot of personal information that I did not want to reach the public domain. Nevertheless, I do wish to share some of the points I made about the rigidity and inflexibility of medical training and how that impacts on all trainees. But given it was International Women’s Day, I focused on motherhood and medicine. And being in a psychiatry setting, I drew on the work of Donald Winnicott, a paediatrician and psychoanalyst who defined the phrase ‘the good enough mother’.

This article describes eloquently Donald Winnicott’s actual definition when using the term, ‘the good enough mother’.

a mother is neither good nor bad nor the product of illusion, but is a separate and independent entity: The good-enough mother … starts off with an almost complete adaptation to her infant’s needs, and as time proceeds she adapts less and less completely, gradually, according to the infant’s growing ability to deal with her failure. Her failure to adapt to every need of the child helps them adapt to external realities.

The article states that being a ‘good enough mother’ is actually better than being a perfect mother when it comes to a child’s well being.

So, to examine the life of a mother who is also training to be a doctor, is this attainable?

When exploring this idea, I focused on my own journey through training. Motherhood waited until all of my formal training requirements were out of the way. I was lucky and fortunate that life turned out that way. Women are often blamed for delaying parenthood for the sake of the careers, but when I was brutally honest about my own predicament, I knew that the way training programs and workplaces run, with the degree of inflexibility and dismal variety of part time positions, I had to be a realist and wait.

After speaking to many trainees I know that the facts are that women are often asked (illegally) when they plan to start families when applying for roles, and women are looked down upon and viewed as ‘not dedicated enough’ if choose to train part time. Training colleges such as the Royal Australasian College of Physicians hold the most critical of exams on only one day per year. With he surplus of medical graduates and the bottleneck to attaining valuable physician training places, men and women, parents or want to be parents put their lives on hold to study for 1-2 years. It is difficult to comprehend in such an inflexible system, how one can adapt to a child’s needs to achieve being ‘good enough’. In many cases ‘good enough’ has to be re-classified as absent or at the very least inconsistent. A mother in this position would require enormous practical and emotional support to be able to meet all the training requirements imposed upon them to pursue their careers. Not all mothers have that. And why should mothers be expected to meet these needs at all costs, when they are such a vital component of our workforce?

Two years ago, The Royal Australasian College of Obstetricians and Gynaecologists added the following topic for debate at an annual scientific meeting – “Membership before maternity leave: Should every registrar have a Mirena?” (an form of contraception for women). It was designed to encourage debate about the very issues I spoke about today. But it was brutal, and deeply hurtful for many trainees around the world. Because to many it described what is actually spoken about in the workplace, and flies in the face of colleges who purport to offer flexible training conditions. There was no parallel discussion about the need for male registrars to use contraception.

In addition to this, our work, our training, our ability to enter medicine requires a degree of perfectionism. Our patients expect we don’t make mistakes. We are asked the most intricate and minute details of medical conditions in our exams. Things we may never see in real life, but we have to be on top of to pass. How does a mum switch out of the behaviour of a perfectionist when approaching or juggling motherhood?

In my case, and I know for most doctors employed in the public system, we are employed on one year contracts. This is so we can’t accrue leave entitlements afforded to most other women. So when I went on maternity leave, I was given around 8 weeks. My contract was not renewed, and I was told to contact my training hospital when I ‘felt like returning to work’. I was therefore unemployed, despite paying ongoing fees to my training college. This had financial and emotional repercussions on my family, and I did not return to that hospital to complete my training. In 2018, working mothers are rostered to be on call but there are still no child care options after hours available to them.

I make these points because as a consultant psychiatrist I am safe to do so. Trainees can’t speak up. So we must combine our efforts to fight for their conditions, as our successors.

The rest of my presentation focused on two issues I hold very dear to my heart when it comes to my approach to being a mother.

  1. Normalising mental illness so my son accepts it is common and treatable. Just like colleagues in other specialties in medicine, he came to the hospital and sat in the nurses station while I did my rounds. He knows what a psychiatrist does which is better than many in the population. He knows his mum is a doctor and helps people.
  2. The vital role mothers play in their son’s life about teaching them how to treat and respect women. Leading by example, standing up for myself if feeling mistreated and talking about good and bad experiences in the playground or society.

I’ll elaborate on the second point, one of the most amazing ‘a-ha’ moments of my life, and the one I reflect upon when unsure if I am being ‘good enough’ when fulfilling these goals. My son had to choose a famous Australian who had made a difference in society to research when he was 10 years old. He chose the Former Australian Prime Minister, the Hon Julia Gillard, without my knowledge or influence, and some of the key features he elaborated upon were that she proved women could change stereotypes, and her advocacy for gender equality. I was thrilled to be able to provide her with a copy of my son’s work at a recent event.

So, is it possible to be ‘good enough’ in medicine as a woman and mother? I argue yes, but it is all in the timing. And until we afford women the same rights as in other professions it will remain that way. At the expense of losing a significant amount of doctors from the workforce when we need them, because they have chosen to be mothers.

Dr Helen Schultz is a consultant psychiatrist, author, public speaker and doctor’s mental health advocate. 

The anniversary reaction and doctor suicide. Why it matters

To remember those we have lost, who live in our memories and come back to remind us how important they were to us

This time of the year, and for the few months preceding Christmas I am usually helping patients come to terms with painful memories and themes of grief and loss around the festive season. And yes, while this work was undertaken in abundance, I couldn’t help but be drawn to the loss and suffering endured among colleagues within the medical profession due to doctor suicide. In 2017, a number of families spoke openly and candidly about losing a loved one to suicide, demanding answers, offering clarification to counter rumours and to beg that ‘something must change’ These actions became more common, unlike years gone by. And I have continued to wonder how they were, as we commiserate their loss and face anniversaries.

As human beings, we are hard wired to feel a range of emotions from despair, sadness, loneliness, anger and panic leading up to the anniversary of losing a loved one. And maybe we are hard wired like this for a reason. Maybe to actively forget, which appears appealing on the surface and in the moment of utter despair, may pay disrespect of the magnitude of how much somebody or something that we no longer have shaped our very being. That to be able to forget someone after a short while would mean their sudden disappearance would allow us to forge along with little consequence or impact.

A number of episodes of the Netflix® series, Black Mirror® attempt to examine ways of manipulating memories, often traumatic and repetitive, with horrific consequences. In reality we know, that for many of us living with memories and being changed forever because of loss is part of our make up as humans beings.

This article is dedicated to the concept of living with painful memories after loss, and in particular, the anniversary reaction, and how it manifests in the context of doctor suicide. This is because in the past week I am acutely aware a number of families would be struggling with this. In early January 2017 we lost four doctors in training to suicide, and in 2015, at the same time, another four. So that is eight families known about. With countless relatives, colleagues and friends affected. It makes me wonder if we can do more than commiserate and pay respect but to use anniversaries and the emotions attached to them to keep buoyant in this battle to stop doctors taking their lives.

It is also written in sincere respect to honour very significant recent anniversaries. The death of Dr Chloe Abbott, who died on January 9th 2017, days before her 30th birthday, her recent birthday on January 31st, 2018 and the ongoing grief and sorrow those who know her and loved her demonstrated via social media this past week. It also serves as a tribute to the four Victorian doctors (three psychiatry trainees) we lost 3 years ago. The article about the suicides was written by Julia Medew and published on this day in The Age in 2015.

At this time in 2019, we will be remembering the anniversary of Dr Frith Foottit, who according to his wife’s report in The Morning Bulletin took his life on Jan 1 2018.

We cannot comprehend how families continue on after any loss, let alone sudden losses that seem inexplicable to others. Death by suicide is particularly difficult to reconcile, as often those who suicide conceal their feelings, set a date in their minds, and appear well, to either ‘trick’ others they are OK and can’t be stopped, or because they are genuinely relieved their pain will stop. They are long past seeing themselves and their world they same way as others around them, and cannot be convinced otherwise. This compounds the terror for those left behind who cannot comprehend that their beautiful loved one couldn’t see they were special, meaningful and unique, and that nothing mattered more than them being alive.

Anniversary reactions are often not talked about, but are very real. The understanding is often derived from those with post traumatic stress disorder and who have survived traumatic events. Tragic and horrific events often capture media attention at the times of recent anniversaries, and one wonders whether paying such public attention to them traumatises those involved more or offers some peace – a collective bringing together of those who all experienced something somebody never should. This is particularly pertinent as we have just remembered and paid respect to the “Bourke St Tragedy” which occurred in January 2017.

What I have learned about anniversary reactions is that they might not always be so obvious, can be triggered by other memories and affect ones’ feelings and emotions out of the blue. Patients often ask for permission to feel a sense of panic, loss of profound distress on a day that has no ‘calendar’ relevance to the event of losing a loved one. They are often relieved to hear that the way our memories are stored and retrieved, particularly around negative events may be more random than that.

I lost my childhood friend in 1992, when she was 23 years old. We were born 6 months apart, our parents were friends who worked together, and worked out how to raise us together, before our siblings were born. I have photos of the two of us in high chairs with our first solid foods, me with my crimson red hair and a face covered in eczema. Photos of us playing under the sprinkler in summer, going to pantomimes, playing at Queenscliff all summer long, and spending our birthdays and Christmases together. Eyeing off each others’ gifts to see who got the latest Barbie doll, or nicest new shoes, and being happy for each other. We spent all of our holidays and special events together, and for all accounts, she was my cousin. She always received pink carnations for special events. “Hall and Oates” and “Blondie” were always the favourites for rollerskating soundtracks.

My friend was killed suddenly in a motor vehicle accident by an unlicensed driver who was profoundly intoxicated and recently released from prison for drink driving offences. It happened on the weekend of Mother’s day 1992. Her birthday was Valentine’s day. So I suppose I thought I understood why those days, all these years later made me think of her, as they were public days celebrated by Hallmark cards and intense feelings like love. Thanks to consumerism, there were memories everywhere.

However, in May last year, I had a very profound dream about her and woke up with panic and a sense of foreboding. It was 12th May 2017. I immediately began searching the records at the memorial park where she was placed after cremation. Somehow I knew I needed to do this, after never visiting that register  Her funeral was on 12th May 1992, exactly 25 years before. A quarter of a century had passed, her life trapped in a time warp with 80’s music, big hair, shoulder pads, and Christmas holidays at the beach. I drove to the memorial part the next day after hunting for pink carnations everywhere to take her- and I found her plaque and sat with her, placing the carnations next to others of variable freshness, a sign others had remembered too. How or why I was reminded that it was important to mark 25 years since her funeral is not understandable to me. But it didn’t matter, because it allowed me to spend an afternoon with her at her plaque and think about how she would respond to a world post 1992, what she would look like, and how much I missed her.

So I guess I am writing this blog about suicide among the medical profession, to join the countless other articles currently circulating around this very significant topic. But I write it from the perspective of a psychiatrist and as a way of trying to ease some pain that feels quite tangible this week. Also, as a way of examining whether we can take some of the sadness from anniversary reactions and help us in the doctor’s mental health space stay true to the cause.

I also write this for three very different and important audiences:

1. To the families, friends and colleagues of those lost to suicide. Never be afraid, or embarrassed to grieve, stop still or pay respect. Practice kindness and compassion to yourself every day. Don’t try and over-interpret why certain memories may reappear – maybe it was a song from your past, or a recipe, or even a flower. Just pay respect to the fact you can remember. The harder we fight to forget, the louder and more pervasive the memories will be.

 

2. To those who find themselves at a state where the really see no reason for living, get help right now. I can promise you that you are not seeing clearly and you are not seeing yourself the ones who truly matter see you. The ones who will do anything to help you get out of the state you are in, provide practical and emotional support while your point of view takes on a whole new meaning. The ones who will have anniversary reactions forever if they lose you.

 

3. To the administrators, politicians, figureheads and lip-service enthusiasts be warned – we will never give up fighting to prevent suicide among our medical colleagues. For all the reasons above. I personally have not forgotten losing three psychiatry registrars, one a friend, in early 2015, although I see little has changed. But I will always use their anniversaries as a force of strength, to keep me on track, to keep me determined and to keep fighting.

 

This blog has been written by Dr Helen Schultz, a consultant psychiatrist and author. She has worked in private practice with many patients to enable acceptance over traumatic life events.

She sees medical students and doctors in her practice, MindAdvocacy, offering after-hours appointments with utmost confidentiality for medical students and doctors.

She is currently meeting with families who have lost a medical colleague to suicide (whether it be their father, mother, sibling, child), using her knowledge of psychiatry to identify key factors as to why suicides occur at such an alarming rate in the medical profession. She hopes this work will clarify where initiatives and support are best placed to prevent more suicides. If you wish to speak with Dr Schultz, please contact her at her rooms on (03) 9428 8321.

The only way we will make real change in this space is by talking about suicide openly. However, if after reading this, you feel unsafe or need to speak to somebody, please call myself on the number above, your GP, Lifeline on 111314, or BeyondBlue on 1300 22 4636

Christmas – #itsjustanotherday so make it the day you want it to be

Full Length Photo Of Santa Claus Lying On Psychiatrist's Couch, Wallpaper in background.There is a photo of swinging pocket watch on the wall.The image was shot with Hasselblad H4D

As Christmas approaches, and after 7 years in private practice it’s time to get real. I am not trying to be a Grinch but in fact write this piece as a way of empowering many of us to say no to a lot of the drama that happens at this time of year. Yes Christmas is a magical time, especially for children, but only if we allow ourselves to make the day and the season to be what we want it to be, rather than feel obligated or guilty about doing otherwise.

I can only recall a few patients over the past 7 years that have been excited about the prospect of seeing some of their family members over Christmas. Or even having a strategy to handle the practicalities of leading up to the festive season and providing a perfect Christmas day celebration with excitement. It is more common that as soon as the carols begin to play in the department stores many begin to feel an unease or in some occasions notice their mood plummet.

I once spoke to a psychiatry colleague about this phenomena, which many health professionals working in the mental health space would be familiar with. The sadness, the loneliness, the repetition of trauma and flashbacks in some patients was too significant to overlook.

He tried to answer my query with humour:

“Have you heard the story about a bunch of psychiatrists sitting around in the dead of a European winter, sometime in January, lamenting that there was no work to do. Nobody was venturing out into the cold to see them. So they came up with the notion of Christmas as a way of bringing families together and business boomed forever”. 

It would be funny if it weren’t so true.

Most of my clinical work around this time is helping those who have been products of dysfunctional families, and sometimes even victims of abuse. The saddest cases are those who have been abused as children but are obligated to see the perpetrators at this time while the family keeps secrets and pretends nothing happened. In not so sad but still stressful occasions, relatives who are largely avoided for most of the year come together, with awkward small talk until somebody finally loses it. Family rifts, financial pressures and sibling rivalry add fuel to the fire for those who are tired, stressed and would rather be anywhere else that day.

Why do families do this? Why do we have to believe that it is OK to acknowledge, accept and avoid certain behaviours for every other day of the year, only to tolerate them on 25th December?

Why do we feel we have to be inclusive because we are related to people?

Excusing bad behaviour

Some of the reasons why bad behaviour should be tolerated and excused include the following. On any other day they would not apply.

  • Let’s do it for the children. We’ll be happy for them (whilst the grown ups fight in the corner and believe children are ignorant).
  • We really have to invite uncle so and so. Yes we don’t like him and he upset us last year, but if we don’t he’ll be alone on Christmas day (isn’t that uncle so and so’s problem?).
  • Let’s do it for Mum/Dad/Great uncle/Grandmother etc. They’re getting older and we don’t know how long they’ll be around (news flash – nobody knows how long anybody will be around regardless of age).
  • Yes cousin so and so drinks too much but if we get the food out early she’ll be manageable (whilst everybody pretends not to notice her demise).
  • Yes aunt A and uncle B don’t contribute or host Christmas but we can’t leave them out – They’re FAMILY!  (well actually you could call them on it and arm them with a task, no matter how menial. Shopping for Bon Bons is a good one).
  • I am happy to do all the cooking for everybody, and offers to contribute will be politely declined so I can have that melt down I needed to have all year. After all I’m the superhuman sibling – IT’ S WHAT I DO (everybody has the right to say no).
  • Yes grandfather did horrible things to mum when she was a child but he’s old now and we need to move on. (Move on? When most of the year the victim has been working in therapy to heal?)
Practical tips that may help minimise or avoid problems on Christmas Day

If you know it’s going to be tough, tackle it head on. Nothing is worse than walking on eggshells waiting for the explosion. Any strategies to make the day as happy for children should be attempted. My patients often recall horror stories of Christmas’s past, many that could have been avoided if the adults remained as adults. Don’t fight around children. Ever. The old adage “If you can’t say something nice, say  nothing at all” applies here.

  1. If there are tensions or rifts, plan to have balanced discussions about them as a way of mending what can be repaired prior to the masses arriving on the doorstep. Acknowledge disagreements and try and find mutual understanding about what topics will be left to talk about another day.
  2. People choose their own behaviour. If a family member continues to disrupt celebrations, consider leaving them out. It may even be helpful to explain this to them and they may actually learn something from it. They may even have the capacity to reflect and change.
  3. Share the load. It’s 2016 and very few people can do everything. Consider a roster or task list (preparing the vegetables, doing the dishes, setting the table). In most cases people feel less awkward if they have something to do. For financial reasons, ask family members to contribute to the lunch. Very few families can afford to provide the lunch depicted on the supermarket ads, regardless of special deals, and neither should they. Or try a more low key affair, such as a barbecue, donating the savings to a charity the family agree upon. For those relatives who ‘expect a traditional lunch’ let them know they are more than welcome to provide their own.
  4. Call out bad behaviour before it happens. If somebody is prone to overindulging in alcohol, set some house rules. Offer plenty of alternatives. Or switch lunch to brunch. Remember the children are watching.
  5. Pro-actively manage your time, down to the hour if it helps. Start the day with a walk to be mindful of the things you are grateful for. Drop in to see relatives rather than accept invitations to stay for lunch or dinner if only doing it out of obligation. Take the children to the park to play with their new toys rather than stay in the house. Think about how you want the day to be before it happens. Control what you can and don’t own the rest.
  6. If you decide to stay away from your family because of past trauma or intolerant behavior, do so with pride. Do something really special just for you to mark the occasion. Honestly, you are not the only one alone on Christmas day. And it is, really, just one day.

Hopefully you are reading this and it feels very unfamiliar. Hopefully you belong to a family who can behave and genuinely enjoy celebrating time together. But this piece is written for those who don’t, or find it hard to say no to guilt and obligation. Out of respect for those who truly find the day very distressing and feel at odds with the world as if there is something wrong with them, I write this piece. And for the brave and tenacious patients who work so hard all year in therapy, keep your boundaries and be confident. If it’s tough, we can always reflect again in the new year.

Share your ideas on Twitter for an authentic Christmas day that avoids conflict, using the hashtag #itsonlyoneday. Post photos of what you are up to. You’ll be supporting others as brave as you.

Merry Christmas,

Helen x

 

A new way of thinking about Psychiatry. Moving from tertiary to primary models of care within Primary Health Networks (PHN’s).

It’s been a long time between blog posts and upon reflection, I feel it has come about as I have wavered about a sense of direction. Working as a psychiatrist in clinical practice is extremely rewarding, but I find that I need time away from the intensity of the work in order to write.

The last 6 months have been filled with some tremendous opportunities. Opportunities that I could never have imagined, but in some way have been working hard towards, and have come about from one single tweet.

The tweet was on the back of a blog I wrote about regarding the establishment and funding of Primary Health Networks (PHN’s) by the Australian Federal Government. When I heard about the development of a new layer of ‘care’, ‘service delivery’, ‘approach’ or ‘solution to the mental health crisis’ I was angered. Upon reflection, the anger stemmed from this deeply held belief of mine that as psychiatrists we were being overlooked and undervalued for what we did. That if only a new layer of bureaucracy was introduced the ‘mental health crisis’ would go away.

That federal politicians knew more about caring for patients with mental illness than I did.

So I decided to take this one to Twitter and made a request of the Hon Minister for Health, Ms Sussan Ley.  I invited her to come to my private practice in Melbourne and see what psychiatrists do. I wanted her to understand that myself and my colleagues probably weren’t that excited about precious dollars going to a new service model. We wanted funding to do more of what we did well.

She said yes.

After our meeting in January 2016, as promised, Ms Sussan Ley introduced me to the Executive Director of the North Western Melbourne Primary Health Network. My ‘PHN’. So, rather than continue to criticise, I was able to learn more about what this PHN in particular wanted to achieve.

All of this has been quite revealing to me, because it is a really powerful example of what happens when you presume others know what you do, or what you can offer. When you presume you command a certain level of respect and you find out, you don’t. See, in my world that is private practice, the best I can hope to achieve is to make a difference on an individual level. I become consumed with the needs of the patient, and become blinkered to what else is happening around me in the mental health arena. I lose sight of the fact that I cannot presume to have a role in the delivery of services to those with a mental illness at a systemic level purely because I am a psychiatrist.

Because, as I have found out over the past few months, most people within and without the mental health space see psychiatrists as largely irrelevant.

Very few psychiatrists have been consulted about what they feel patients with mental illness need since the era of de-institutionalisation. Some revolutionary ones have set up services they believe in and are proud of. Most psychiatrists I know feel completely defeated by the amount of work and the lack of funding that defines mental health care in Australia.

And the lack of funding and sheer amount of work that psychiatrists must encounter has led to a very dangerous mis-perception in society. That mental health services can function without our input.

We are described as inaccessible, scarce, and unavailable to meet the needs of many Australians with mental illness. We are seen as a ‘last resort’.

Hence, why I believe most of the mental health reform that has occurred within Australia has involved all the other mental health professionals out there. And yes, we desperately need multidisciplinary approaches to patient care, but there is a level of ignorance that during this time we have maintained our relevance and authority.

We are in fear of losing our most highly valuable place within the psychiatric multidisciplinary team.

And the proof is there. In the PHN that I work within, the population groups are as diverse as the field of medicine. There are areas of some affluence, but also marked poverty. The network covers five correctional centres, accommodation for refugees, homeless people, significant amounts of Aboriginal and Torres Strait Islander people, as well as people with gender and identity issues. Substance use disorders are prevalent across all of these groups. There are layers and layers of trauma. There are also plenty of skilled clinicians working as best as they can for these very diverse and vulnerable patient groups.

Very few services, away from major metropolitan hospitals, would have any access to a psychiatrist.

So, I now have this opportunity to take an in depth look at the services within my network and evaluate to role and value that psychiatrists bring to it. I want to think about caring for patients in a different way to the tertiary care model. I want to know what services and their patients think about us. I want to know if psychiatry trainees feel they can manage these complex areas of mental health care, or if they feel their training and exposure to such areas is missing or substandard. I am excited by the challenge and have embraced a new way of thinking, that is, bringing services and care to the patients, rather than the other way around. I could continue to resist, but at the end of the day I don’t see that the way we are currently meeting the needs of those with mental illness is working anyway.

Dr Helen Schultz is a consultant psychiatrist and author of “How Shrinks Think”. She begins her new role as Independent Expert Advisor, Mental Health, NWMPHN this month. 

 

The plight of psychiatry IMGs as they hit our sunny shores.

It is pleasing to see the AMA take up the fight for probably the most disadvantaged and discriminated group of medical colleagues. International Medical Graduates (or IMGs) are doctors who are currently working here in Australia but have completed their basic specialty training in a country outside Oz. We know that IMGs make up at least 25% of our medical workforce and are over-represented in fields of psychiatry, general practice and obstetrics-gynaecology. IMGs and their families are unable to access our Medicare system for health and cannot access public education. A parliamentary report, entitled ‘Lost in the Labyrinth’ provided a concise and thorough understanding of the current predicament facing many IMGs, and reflects my thoughts 3 years on from the time of writing. The report, like myself, has no problem with regulatory and professional bodies having high standards for doctors wishing to practice in Australia. Both my thoughts and the recommendations tabled in 2012 reflect the ongoing issues of transparency, streamlining of accreditation requirements and substantiation of the costs associated with this. Another concern is the variable ways of appealing decisions made by these bodies. I speak after having extensive experience coaching and mentoring psychiatry IMG’s.

I have met many IMGs since I began coaching and training them for the RANZCP fellowship examinations. Over this time the way they are assessed has varied, but for about 10 years they have been assessed on requirements that are the same as local trainees, however their results are segregated from those of local trainees. When IMGs were segregated for their examinations, the premise was that they would receive extra time in the examinations due to linguistic challenges, and the standard expected on the day was much higher than of a local trainee, taking into account their experience and qualifications overseas. However, over this time, the pass rates for IMGs remain consistently lower that than of local trainees in the two types of clinical examinations set by the RANZCP, the OCI’s and the OSCEs.

Psychiatry IMG’s and local trainees are now following a 2012 training pathway with the RANZCP. Those who have not progressed in time on the 2003 pathway, which ended in October 2015, have moved into the 2012 pathway. Some trainees may be repeating requirements and some are waiting to hear what their requiremement wil be. I know this as I have spoken to many psychiatry IMGs and local trainees in this position.

A ‘bermuda triangle’ for many psychiatry IMG’s

 

Psychiatry IMGs and their plight on our sunny shores
Traveling to Bermuda Perfect Beach

After spending many hours with IMG trainees I conceptualise the problem to be one of “keepings off” between 3 main players; the Australian medical council/regulatory medical boards (AHPRA), the state hospital system that employs them, and the RANZCP (our college for accrediting psychiatrists). IMG’s must meet certain criteria to obtain residency status in Australia, state hospitals have their standards and fill vacancies with the IMG workforce, and the RANZCP administers it’s requirments and standards when it comes to deciding whether they can work as psychiatrists and obtain an Australian fellowship. All 3 organisations have their own set of criteria and benchmarks that IMG’s must fulfill, but they are raley streamlined, leading to confusion and misunderstanding.

Performance in RANZCP examinations

Many IMGs facing repeated attempts at the examinations. It is not unusual for me to coach an IMG who has failed 5 times. they find themselves in the category of ‘failure to progress’ through to the Fellowship as the RANZCP moves onto a new training pathway. many are waiting to hear what their pathway will look like as of 2016, and whether they will indeed be able to make it to fellowship.

Psychiatry IMGs have endured low pass rates despite being provided an exam with extra time to help with linguistic difficulties. Many have attempted the examinations more than three times. In October 2015, the last round of the ‘old style’ clinical examinations or ‘OCIs’ the pass rate for local trainees was 55%, and IMGs 20%. In July 2015, the pass rate for local trainees was 60%, and IMGs 29%. Similarly, the pass rates for the July 2015 OSCE clinical examinations, which will continue under the new fellowship pathway were 80% for local trainees and 48% for IMGs.

Many of these IMGs who are failing repeatedly are working as psychiatrists in regional, rural and remote areas of Australia, with limited access to training and supervision.

Fees

There appears to be wide disparity between the fee structure for local trainees and IMGs. An IMG will spend over $15,000 in fees to the RANZCP in order to practice in an area of need.  They must pay $5030 for an assessment, including an interview. Their placement fee is $9370. This is over and above the fees imposed by the Medical Board of Australia, and on top of other administration fees imposed by the college.

Morale

Of recent times as I continue to coach and mentor IMG’s I have noticed a drop in morale amongst them. I know that for cultural reasons they find it very hard to speak up if struggling, and I have seen them crumble when they tell me how difficult it has been for themselves and their family. Many have been practicing psychiatry for years before coming to Australia, and moved their family here as part of a requirement to achieve fellowship in India or Sri Lanka, only to find they cannot get through the training program. Many that I have come to know over the years are now at a stage where their children are older and they are facing decisions of splitting the family so a parent can return home with the children for education, or whether they all go home.

Workforce

AIHW data shows that in Australia there are roughly 13 psychiatrists available for every 100,000 of population. In rural and remote areas, where I have spent some time working as a locum psychiatrist, the figure drops to 2 or 3. Because of restrictions on where IMGs can work, most of these spaces are filled with IMG’s or locums. If IMG’s choose to leave Australia there will be a dearth of service and care of those with serious mental illness. Many regional centres exist solely on a locum workforce, with very few or no permanent psychiatrists. I have been a locum in FNQ and then diagonally across to Lower Great Southern WA. I know we are facing a huge problem already that is only going to get worse.

Summary and recommendations

I am not singling out RANZCP by writing this article but this is the experience I have after working with many psychiatry trainees, whether they be local trainees or IMG’s. “Lost in the Labyrinth’ made recommendations, and provided evidence of similar situations occurring within RACP and RANZCGP. I write to support all IMG’s in general, as the AMA has recently done as well. But I think it really is time for action, the recommendations have been made and the IMG’s won’t stay forever to help our workforce if we don’t get it correct. The recommendations  outlined in the 2012 report “Lost in the Labyrinth” are really worth a read as they speak to simple strategies that would go a long way to removing a bermuda triangle on our sunny shores.

http—www.aphref.aph.gov.au-house-committee-haa-overseasdoctors-report-combined full report

http://www.hwa.gov.au/our-work/health-workforce-planning/health-workforce-2025-doctors-nurses-and-midwives

https://mhsa.aihw.gov.au/resources/workforce/psychiatric-workforce/

 

 

 

Keep talking because people are listening.

Hi all,

Yes I am home, but my head and thoughts are still in Bali, keeping up with supporting those who are stranded, and those home but finding it difficult to cope.

This unmitigated customer service disaster, and it is a disaster, is continuing to make a big impact on ordinary everyday tourists. It is very clear that customer service and communications departments within airlines and insurance companies are struggling to cope. This is no excuse for their behaviour, and big multinational companies, more than any other companies have the finances and resources to outsource this if they are overwhelmed.

After almost two weeks, if a major company cannot streamline its communication it is time to outsource. Even for the selfish reason of protecting their brand.

I have made it home and lodged my formal complaint with the airline carrier that has since cancelled both my flights home. If I did not make the decision to purchase a one way ticket via Kuala Lumpur on Thursday night I would still be in Bali. I would be facing a second week of being stranded, and the very real risk of my patients becoming unwell at home without my care would have caused me fury, anger and sadness. I know that because I have watched the departure details, not on the airlines website, but on the official Bali airport page. I realised about one week ago that because the airlines are not updating their pages regularly, and often doing a ‘cut and paste job’ on information, the Facebook pages and Twitter feeds are out of date and unreliable.

I took my son to his basketball match yesterday and I felt true exhilaration that I was home and I was back doing all the normal stuff. A basketball match. I won’t forget that feeling for a very long time. It has taught me that my life and what it entails is the most important and central part to me. Familiar faces, routines, my own bed, my own home cooked food, all combine to make me feel like I belong. I know that being delayed and not getting back to familiar territory is fertile ground for an exacerbation of anger and helplessness. This is something the airlines and insurance companies seem to miss.

Yes there is the risk of flying into an ash cloud. And yes there is risk in leaving people stranded. Everybody is talking about the latter but the airlines are not listening.

Now, more than ever, we need to keep talking. There has been an absolute tragedy in Europe and although people in Bali are not directly affected, as humans we are affected as we see more and more acts of terror across the world. Because these attacks kill and maim tourists we can’t help but relate. I am not trying to make people more anxious, I am acknowledging that many of us will be having these thoughts anyway, and it is best to talk about them. What is imperative right now is to share your feelings, and perhaps minimise how much you watch footage of the tragedy in Paris. It will only serve to increase anxiety. It won’t help.

I feel so sorry for the staff of the airlines and insurance companies on the front line, handling customers who are beyond being polite and reasonable. I hope the companies are looking after their staff’s well being. Staff members did not envisage this happening either. These companies need more than ever to take control and display true leadership. By no means stop calling the airlines, keep talking but think about the language you are using. Some call centre operators are probably on the cusp of going out on stress leave, which is awful for them and may mean longer delays getting through. If you are beyond and completely frustrated, get a note pad and pen and start writing down all of your concerns and interactions. Write down dates, times, names of people you have spoken to and what was communicated. This is your book of power for when you get home and feel more powerful. Keep conversations with call centre operators brief and civil.

Here are some of the ways that may help improve communication in this extremely difficult time;

Communicating in person

  • Keep talking to each other, now is not the time to pitch against each other and take our out your frustrations on each other. If you are feeling very frustrated, take some time out and go for a walk and let other know when you will be back. If others are upset around you, given them permission to have a break. Stay in the moment. Don’t argue around your children as they will be anxious themselves.
  • Organise times to catch up with fellow guests you have met at he resort, in cafes or at the airport. Those who listen when you communicate. Perhaps delay talking about the disturbance until you are all together, and try and do other things such as reading and walking when not with the group. Hearing and thinking about the same thing over and over will lead to burnout and worsen fatigue.

Communicating via social media

  • Just because airline social media channels are not being manned as professionally and pro-actively as desired, don’t stop using them. If you are not receiving replies to your posts, don’t stop sending them. Keep screenshots of communications. If you need to find something to do, check out software such as Hootsuite that can schedule posts. Schedule a pile of posts, tagging who you are trying to communicate with at 5-10 minute intervals. Then leave the software to do its job.
  • Learn about the power of the hashtag. Hashtags are really, really useful. If you don’t know what one is, here is a quick run down. A hashtag is like sticking a ‘post it’ note to a piece of paper. Imagine some ‘post it notes’ in different colours. Pieces of paper with a blue ‘post it’ note contain shopping lists. Red contains information about your favorite hobby. Green for recipes you’d like to make, and so on. Now imagine throwing all the pieces of paper on the floor. Want that recipe for spaghetti bolognese? ( I always crave spag bol when I am travelling) Look for the pieces of paper with…green ‘post it’ notes. Want your tweet or FB post to come up in a search about your predicament? Use a hashtag. Hashtags are not owned by anybody. Sometimes they can be registered as official but anybody can use them. You can use them to search for information. Say if you want to find out more about the ashcloud, enter #ashcloud into the Twitter search engine and all tweets related to the hashtag will come up.
  • Hashtags and ‘@’ signs are different. An ‘@’
  • sign before the official address (called a ‘handle’) will send your tweet to the right person. An example of this would be this tweet I could post on Twitter or enter into Hootsuite to keep sending every 10 minutes;
    • Hi @VirginAustralia, any chance of flying today? #Bali #ashcould  The staff managing the tweet at Virgin will see it as it has been sent to them. Whether or not they read it is up to them, just like if you get your bills out of the letterbox and don’t open them. They kind of still exist, and you still have to pay them, even if you decide to keep the envelope closed. The hashtag means that anybody searching for information about Bali or the ash cloud will see your tweet.
  • As a word of caution though, do not send a tweet containing your personal information or flight number unless you want the general public knowing your movements. And only send urgent information to a handle if you know the handle is checked constantly.

Communicating to the universe

  • Keep the conversation going. Hot topics today are old news tomorrow. Search for a hashtag you like such as #ashcloud or others that official groups like Bali Travel Group recommend. The more traffic on a hashtag, the more it will ‘trend’ and will capture the attention of those whop present the news. Like it or not, that is how things work nowadays.
  • Send out positive stories that will inspire and motivate others to keep going. Positive accounts will spread as well as negative ones. If somebody on a call centre has gone the extra mile (pardon the pun) acknowledge that. Send a thank you note or email when you get home.
  • Keep in touch with everybody at home waiting for you. Let your friends and family know how things are going. If you are heading off to the airport let people know if your flight is on time.

And a final word, as a doctor and psychiatrist. Keep talking when you get home and let your GP know if you are not coping. If you are in real trouble in Bali, and very concerned about your health and safety, contact the Australian embassy. If you have a mental illness and have run out of medication, seeing a doctor as soon as you arrive should be your first priority.

Stay safe, keep talking, force the airlines to listen. Don’t talk about compromising safety but about alternative ways you can get home. And educate them that there are very real consequences to your health should you continue to be delayed that go way past inconvenience.

 

 

Disrupted passengers both ways. We’re all in this together.

Today I thought I’d write about those that have had a really difficult time during the recent volcanic eruptions in Bali, disrupting their travel plans. Those who couldn’t get here and those who are stranded in Bali draining every cent that would have been put towards future holidays.
As a psychiatrist, I see first hand the emotional and medical consequences of banking up a sleep debt, rest debt and ‘catch up with family and friends debt’ all the time. So many of us, including me, continue to put off what is immediately beneficial and rewarding. How many times have we thought about how much we enjoy having a coffee with a friend, only to lament about how long it has been between drinks? Finding time for a coffee and a catch us seems insurmountable yet the benefits last longer than the coffee does. Likewise, planning a break from relenting commitments, daily schedules, obligations and structure can often be the only way we cope with it all.

I think about how exhausted I was before heading to Bali. I didn’t even realise until I almost collapsed into the lounge by the pool and couldn’t move. Daily morning yoga was a total struggle; I hadn’t practiced yoga for over 2 years and my busy mind made me lose my balance way before my muscles did. But after about 3 days, I was, surprising to me, completely relaxed. After 5 days, one of the guests, soon to become a friend alerted me to the cancellation of flights and the volcanic disruption occurring all around me. Because, from the resorts in Bali, there is no evidence at all there is an ashcloud.  From that morning on as speculation grew we all succumbed to the lack of daily updates, uncertainty and the very real situation that we wouldn’t be returning home on time.

But what about if it was a week before? What if I hadn’t made it to the yoga mat?

I think if I hadn’t made it to my holiday in the first place I would have needed to have thought of a pretty good plan B by now. I admit I have fallen into the trap of ‘it’ll be OK, just get through this week, this financial quarter, this year’, wishing days away waiting for a break. When we do this we take a toll on our own health, often silent, succumbing to more viral infections, or mildly raised blood pressure, chronic fatigue, and so on. We somehow justify that things will all rectify themselves, once we get on that holiday.

In this current situation, many people just like me have banked up the same amount of debt but unlike me just didn’t get to Bali, or did, but are trying to rationalise the situation by eating into funds for the next holiday. If you are one of these people I am sure you have struggled with the uncertainty, the hope you’ll depart then the disappointment when you don’t and by now are absolutely fed up.

Faced with the certainty of a volcanic eruption, completely at the hands of mother nature, it is time to take charge of some certainty over your predicament. Because, if you were operating on limited reserves like me up until now, it’s time to take back some control.

Some things to try;

  • Sit down with your family and work out what it was that you wanted from the holiday in the first place. ‘Chill out’ I hear you say. Reflect on what it is in your daily life that doesn’t allow you to ‘chill out’. Write it down and save for later. Now is not the time to try and make the most of things. You need a break right now.
  • Negotiate your way into a new holiday, whether it be shorter or to a different destination. I’m not saying to put yourselves in debt, but desperate times call for desperate measures, and I know the airlines are very happy to offload passengers to another destination to get them off the queue. It may be shorter, and it won’t be Bali, but it will be something.
  • If you now have unexpected days at home, use them wisely. Don’t try and overload them but instead spend them doing things you always put off.
  • If you are on an extended stay in Bali, live in the moment. None of us know what next year will bring. There is no reason to believe that this delay due to no fault of your own, means you will never holiday again.

Remember your thinking is probably clouded by your current predicament. It won’t feel like this once you do come back from your holiday or get home. 

The one thing I have seen most in medicine is that none of us know our fate and despite our best plans, sometimes things just happen. As humans we don’t think about this that often, until the inevitable happens. As a word of advice, it might be best to avoid call centres as much as you can. Lip service right now, when you are as frazzled as I am, is not going to help. The operators have to behave a certain way, and we all know, if they just said they didn’t know we would all be happy. I understand that the most frustrating thing right now is not feeling heard or understood.

Take care and find your yoga mat, it is waiting for you.

Dr Helen Schultz is a consultant psychiatrist currently stranded in Bali. She has had the most amazing time and met some fantastic people but it is time to go home. 

Am I OK with #RUOK day? If rhetoric matched reality then maybe.

As a psychiatrist I am not so sure about public disclosures of mental illness.

Today is #RUOK day. It’s also a week where two of the top headlines in media have some sort of personal and professional significance to me. A famous AFL player asks for leave because of ‘mental health concerns’. And the Royal Australasian College of Surgeons (RACS) admits to widespread bullying and harassment of its members by members.

Why do both these topics hit a sweet spot? Well, both highlight the point that society functions better when we adopt the approach ‘do as I say not as I do’. In both instances, the message is the same. Don’t tolerate what is bad behaviour, don’t tolerate stigma, and practice open disclosure if you are struggling.

If only,

As a psychiatrist who works with patients with psychiatric illness every day, I know more than many the personal impact of mental illness on the lives of those experiencing it. That’s why I strive so hard to manage my patients and advocate for their rights and wellbeing. Why I focus on recovery. Why I care. Because I know that mental illness is common and treatable.

So what has got me feeling like I live in a parallel universe? It’s the imbalance of the strong public health messages such as asking ‘R U Ok?’, and the real life situation for many victims and patients who feel they have no voice or no audience. Because they have practical, tangible reasons to keep silent.

So, this week Lance Franklin has been given leave from his professional career as an AFL footballer as he is struggling with something. As he should. What I disagree with is the notion that one is brave only because they speak up and ask for help in a very public way.

I have seen many patients who have disclosed to their employers that they have a mental illness. Patients who need to see me and need a medical certificate to substantiate their whereabouts away from the office. Patients who are actively managing their mental illness and getting better. I have seen the same patients become victims to harassment in the workplace, and I have been placed in the untenable position of providing reports to validate that my patients are ‘safe’ to be at work. When I am not the employer but the treating doctor and confidante. Some of these patients actually work for organisations that donate large sums of money to organisations that work to reduce the stigma of mental illness. Hence the parallel universe.

In one tragic example, an organisation knew an employee was seeing me because my name and contact details were on a medical certificate I provided. They contacted me ‘as a courtesy’ prior to sacking the employee to ensure that they made attempts to keep the employee safe after breaking bad news. Without the employee, my patient, knowing anything about it. I knew the patient was to be sacked before they did. I was placed in an impossible situation, and was furious at the way the matter was handled. On numerous occasions I have been asked to be involved in workplace assessments if a patient of mine is recovering from an episode of mental illness and returning to work in a graduated manner. Very quickly, reports turn into assessments of competency and performance. My role shifts between keeping my patient from relapsing or suffering untoward as a result of these behaviours and explaining to employers why I will not compromise patient confidentiality. In some difficult cases, my notes are subpoenaed and confidentiality is broken anyway.

So, see why the public health message does not add up to the real life experience?  Although everybody knows what is the correct way to act. That is, ask for help if you need it.  Of course I agree because I know help is available and is lifesaving. I just really implore people to be careful who they are telling.

This year has also shone light on the impact of mandatory reporting of impaired doctors and doctors asking for help. New AHPRA guidelines outline that doctors must be reported to our regulatory body if one suspects they are practicing whilst impaired, thus placing the public at risk. Doctors are under intense scrutiny to prove they are competent to work, as they should be as health professionals. Yet they endure monitoring from both their employers and the regulatory body, AHPRA. There is data emerging that this will only serve to drive doctors who are suffering underground, away from care that will help them. As a doctor that treats doctors I know this is a defining factor in whether or not to tell anybody you are struggling.

And now RACS have been shown up to harbour bullies within their ranks, at a rate that would close down any other organisation overnight. We doctors are not surprised. We all have scars from the misuse of power whilst training whether it be from surgeons or senior members of other disciplines. Hopefully RACS will choose to ‘do what it does not what it says’ and out the bullies, rather than asking trainees to speak up. They have enough knowledge and information now after all, and can no longer pretend to be ignorant of these cases.

I know if had done the ‘right thing’ during my psychiatry training and spoken up about bullying, I would not be a psychiatrist today. The bullies do determine your fate.

So, how do I feel about campaigns such as #RUOK in the light of recent events? It would be lovely to believe that we exist in a world where stigma about mental illness can be overcome. That we can move from choosing celebrities as  role models to accepting that 1 in 5 people go through an episode of mental illness. That it is just as much of society as is the common cold. That bullies can be exposed and dealt with by organisations with more power than an individual. That people can speak up about having a mental illness or being bullied without retribution but instead complete compassion. I will continue to try and traverse both universes, yes I will continue to ask my patients, colleagues and friends if they’re OK beyond today.

But I will offer the sage advice based on experience and my own journey;

Ask for help because you deserve it and it is waiting for you. Ask because you only have one crack at a rich fulfilling life. Just seek out the right people to tell. They are waiting. And ask in a way so you feel empowered, safe and above all, cared for.

Dr Helen Schultz is a psychiatrist in Richmond, Melbourne, Australia, and author of “How Shrinks Think”.