250 people attended the first free Community Mental Health Symposium last Thursday at Ballina RSL, with a range of expert speakers from various organisations explaining the dimensions of the problem and how best to move forward.
The event was organised by the Rotary Club of Ballina on Richmond, led by Dave Harmon, in response to the growing mental health crisis in Australia, which is particularly affecting young people in the Northern Rivers of NSW.
Disappointingly, there were no politicians in attendance. Invitations went out to Ballina Mayor Sharon Cadwallader, Lismore Mayor Steve Krieg, Page MP Kevin Hogan and Lismore MP Janelle Saffin, but all were apologies on the night, with only Ballina MP Tamara Smith sending a representative.
At the back of the auditorium, organisations such as The Buttery, CASPA, The Healthy Minds Club, Batyr, headspace Lismore, and Northern Rivers Suicide Prevention Group each had people present to answer questions and share their expertise.
Rotary’s Dave Harmon opened proceedings by talking about the mental health impacts of COVID and floods on the community, which also postponed the symposium three times. He pointed out that the evening was a rare opportunity for different organisations working in the field to be in the same space at the same time, and hear from each other.
‘If nothing else, we’d like to try and break down the stigma of mental health and encourage conversations between families, friends and colleagues, so we can all support one another,’ he said.
MC Sandra Jackson introduced University of Adelaide Emeritus Professor Michael Sawyer, who gave a ‘broad situation’ of mental health in Australia, with a particular focus on children and adolescents.
He spoke about the lottery of life, and the inability of reversing when things went wrong, with reference to ‘John’ and ‘Jane’, two people whose childhood situations, genes and life experiences meant they had little chance of avoiding bad mental health outcomes, at least without the right support at the right time.
Professor Sawyer described good mental health as ‘the central prerequisite to achieving and maintaining a well educated and self sustaining and productive society.’
He said the scale of mental ill-health among children and adolescents, severe enough to impact quality of life, had been hovering at around 14% of the population since good figures had been available in the 1990s.
Professor Sawyer also said there were clear associations between mental disorders and substance abuse, as well as mental ill-health and physical ill-health, but the current treatment model was designed to artificially separate these areas into different boxes.
He said there was evidence that the system was failing those who needed it, with less than half the young people in need of professional help getting any at all, and most of those with severe mental health disorders not getting nearly enough.
Professor Sawyer suggested the result was ‘we’re losing a heck of a lot of our young citizens, because the years of healthy life are being taken away from them.’
He explained that it wasn’t just a problem for the young either, with one in five Australians being likely to suffer some type of mental illness disorder in any year, including severe anxiety, depression and schizophrenia.
Local psychologist Katie Burgess said she came to work in mental health after the suicide of a family member, and had come to believe that many psychological issues had their roots in trauma. She has since studied the neurobiology of trauma and the effects of trauma on the developing brain.
She said that young people often appeared to be coping surprisingly well during traumatic situations (such as the recent floods) but that symptoms and damage might only appear later, after people come out of survival mode.
Ms Burgess said trauma-related symptoms could present as ‘sleep and appetite disturbance, reduced motivation, reduced concentration, brain fog, decline in academic performance, intrusive thoughts or rumination, persistent sadness, hopelessness, helplessness, a loss of hope; withdrawal from families, family, or peers, and inability to control and manage strong emotions.’
She said this could lead to meltdowns, self harm, intense anger, disruptive behavior in school, antisocial behavior, and persistent fears and worries. She said children and young people typically presented with multiple symptoms, with mental issues often taking the form of physical pains as well.
Ms Burgess explained that over-triggered fight or flight sections of the brain could inhibit higher executive functions, making it literally impossible to think.
She said rapport, safety and trust were vital in any therapist seeking to deal with these issues, regardless of the treatment modality used.
Simone Balzer said her organisation headspace delivered about 40 programs in the community, free of charge, based in Lismore.
‘We work from people in utero, all the way through to some of the elderly population.’ She said headspace was increasingly working in the digital realm as well.
‘It’s a big misconception that when a young person or anyone comes to see us to get support, that we all of a sudden dive into all these ways of treating them or doing things. A big part of what we do is have a chat. What is mental health? What does that actually mean for you?
‘We like to keep young people in control of what we do,’ she said.
Ms Balzer said negative perceptions around mental health, shame and fear of discrimination were all contributors to stigma. She said mental health actually existed on a continuum, with various states edging into one another, and the best time to act well before things reached a state of crisis.
‘There are different signs and symptoms to look out for,’ she said. ‘We talk about thoughts, we talk about emotions, we talk about the physical, and we talk about actions; in other words, the behavior.’
Referencing the mental health ripples of the flooding in Lismore, Ms Balzer said, ‘Thoughts might be shock and disbelief, feeling overwhelmed, they might be having trouble concentrating, not feeling safe, feeling like they’re a burden on someone or their parents re-experiencing things that have happened recently.’
She said there were seven key tips for young people and their families to build healthy headspaces while also opening opportunities for communication:
- create a routine.
- set achievable goals.
- stay active.
- stop and be present.
- find ways to relax.
- talk to someone (not necessarily a parent).
- reach out for support.
Ms Balzer emphasised that reaching out for help needed to be normalised. ‘Reaching to support is actually a sign of strength,’ she said. ‘It’s a sign of resilience. And support needs change over time.’
She said people should consider the different mental health services that were available as a jigsaw puzzle, with different combinations of approaches being needed for different individuals.
Francis Pidcock, Clinical Operations Manager at The Buttery, spoke about her organisation which has been helping people at Binna Burra, just west of Bangalow, since 1973.
‘It started off as a drop-in center for young people to connect and recover and have a meaningful life without the use of drugs and alcohol,’ she said. ‘Since 1973, it’s grown. We now have some statewide programs, we employ over 100 people and we help over 2,000 people every year. Our mission is to enrich lives and connect communities.’
Ms Pidcock said The Buttery was mainly known for its residential programs, three focused on drug and alcohol, and one on mental health, as well as 15 outreach programs servicing many young people across the region (from Tweed Heads to Port Macquarie), with funding from state and federal levels of government.
She said there were a range of programs focusing on everything from the psycho-educational to the psycho-social, from family reunification to redress for child sexual assault, and from employment assistance to suicide prevention.
Ms Pidcock said the outcomes across the board of the Buttery’s programs averaged approximately 80%. ‘By that I mean 80% of the people that are in our programs achieve a statistically significant outcome. For example, a decrease in substance use and harm,’ she said.
‘An improvement in mental state means they are less likely to have a diagnosable mental condition, or they have an increase in quality of life.’
She said increased social connection was also a focus, because ‘social connection is a significant protective factor for suicide prevention. We’re very, very interested in that for our participants.
‘And our satisfaction scales are always amazing,’ she said. ‘The best feedback we always get is about our staff on the ground, who are just unbelievable.’
Ms Pidcock gave the example of a successful program that merges mixed martial arts with counselling and gestalt therapy. Other recent innovations include surfing-based programs, rhythm therapy, foetal-alcohol education and anti-vaping initiatives.
She said that if people weren’t sure where to start or what was right for them or their loved ones, then Buttery staff were more than happy to assist over the phone. Contacts and further information here.
Giving a voice to the elephant in the room
Alex Farquhar and Rhys Smith from Batyr explained that their youth mental health organisation was named after an elephant in Kazakhstan who was very good at communicating. The name means ‘hero’.
‘So we’re giving a voice to the elephant in the room, and that is mental health,’ said Ms Farquhar. Unlike other organisations, Batyr was started by young people, aimed at young people, and run by young people.
She explained, ‘At the start of most of our programs we ask, “what’s the first word that comes to your mind when we say, what is mental health?” And the most common three answers that we get are depression, anxiety, or suicide.
‘Which is funny because we never asked, “what comes to mind when we say mental ill health, we say what comes to mind when we asked you about mental health?”
‘This shows us that there is still a stigma existing within society around mental health. So we deliver a program to young people to try and address that stigma.’
Rhys Smith said Batyr’s model was peer to peer led. ‘We want young people to be able to reach out to their friends, their family, but also to the local support systems that may be inside their school institution, or the university or in their community.
‘We’re really encouraging them to begin those conversations with each other, so that they can have this focus on leaning on each other for support before they may need to get to some sort of intervention process.’
Mr Smith said, ‘We start with lived experience. That’s the core of what we do. And we do that through our Being Herd workshops, which is where we get young people typically between 18 to 30… and they learn how to safely share their story of lived experience with mental ill health.
‘From there, we empower them to share this story to young people across all of our programs, but also on our app, which is OurHerd. It looks like TikTok feels like TikTok, but it’s a lot safer than TikTok!
‘It’s about creating a place where young people can have a conversation about mental health,’ he said.
Alex Farquhar added, ‘In terms of our impact, we’ve reached over 300,000 young people to date. We’re really proud of that. And we’ve had over 1,000 young people learn how to share their story in a really safe and impactful way.’
Mr Smith said Batyr was already active in high schools, and had many requests to go into primary schools as well, with programs available for teachers, parents and the wider community, as well as youth. ‘We believe the community is the way to make this change sustainable, so we really do like to have a community-wide approach.’
In the panel Q&A, there were questions about school refusal in a time of COVID and natural disaster, how to discuss taboo subjects like suicide, whether things were getting worse or whether people were just talking about mental ill-health more, and what to do about the problem at a society level.
Professor Michael Sawyer said that despite the severity of the mental health problem in Australia, he wasn’t convinced things were getting that much worse, with Socrates lamenting the rapid downward trajectory of youth mental health thousands of years ago.
He said there were three things that could be done. For each region, he suggested, ‘There should be enormous effort in saying, what outcomes do we want to try and achieve? And to what extent are we achieving them?’ He said this could only be achieved in partnership between people with diverse skill sets and experience.
He said once the problem was properly understood, a strategic balance of targeted services (aimed at those at risk) and universal services (for everyone) needed to be deployed, while remembering problems were usually accompanied by other problems, none of which could be dealt with in isolation.
Professor Sawyer also emphasised the importance of learning from other models that have worked, with the COVID response providing useful real world examples of countries that have successfully balanced universal, targeted and clinical approaches to health care.
Meanwhile the other elephant in the room remains government funding of mental health services, particularly in regional areas, which appears to fall far short of what is required, despite a flurry of recent promises.
As with other disasters engulfing the region, Rotary’s first Community Mental Health Symposium showed that strength of community is likely to be all-important as we collectively find a way forward.