Newsletter No 70

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This edition
MHYF Vic Newsletter No. 70 April 2020
Changes to MHYFVic due to COVID-19 Pandemic Coronavirus Mental Health advice Opinion 2020 Our Website
COVID-19 PANDEMIC
AND THE MHYFVic PROGRAM
The COVID-19 Pandemic has pulled the rug out from under the 2020 MHYFVic Program, as it has done for most other organisations around Australia.
Our three main events are all significantly impacted: The 2020 Winston Rickards Memorial Oration, a workshop on Borderline Personality Disorder, and our Annual General Meeting with an after-dinner speaker on the subject of child refugees in detention.
Work will continue on the development of our website mental health information resources. Our committee will continue to meet and plan our lobbying, and we will continue our newsletters. When the time is right, we will resume our public meeting activities.
In the meantime, a few notes on what is in the pipeline:
Winston Rickards Memorial Oration 2020
The 2020 Winston Rickards Memorial Oration was to have been given on 6th April in the Ella Latham Lecture Theatre of the Royal Children’s Hospital. It has been CANCELLED.
The Orator, Professor Frank Oberklaid AM, is a developmental/behavioural paediatrician with longstanding clinical, research and policy interests in child mental health. He is currently co-chair of the National Children’s Mental Health and Wellbeing Strategy.
We will notify you of the deferred date early next year. Its title and subject is:
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‘The elephant leaves the room: An increased (and belated) focus on policy and service reform in child mental health.’
Recent years have seen a welcome and long overdue focus on child mental health, which creates both opportunities and challenges for those of us working in the field. This presentation will outline some of the issues that need to be addressed if we are to achieve an accessible, equitable and evidence-based system for prevention, timely intervention and effective management of child mental health issues.
BORDERLINE PERSONALITY DISORDER
A recent edition of ‘Australasian Psychiatry’ was devoted to the topic of Borderline Personality Disorder. In its Guest Editorial Dr Jo Beatson, from the Spectrum specialist treatment service, referred to the major improvements that have occurred in treatments and outcomes. However, she also said, “Despite the positive findings, a major problem exists in Australia. Many people with BPD are unable to access appropriate treatment. Psychological approaches including individual and group psychotherapies are recognized as the first-line treatment for the disorder, while medication has only an adjunctive role for short-term relief of troubling symptoms. Yet in the public psychiatric system, at least in Victoria, psychological and psychotherapeutic treatments have been squeezed out by increased pressures affecting that system for many years. This has led to a focus on brief treatments, crisis intervention and rapid patient turnover at the expense of psychological treatments which are regarded as too time consuming. Patients with BPD have thus been robbed of essential treatment. A generation of psychiatrists in training has also been left poorly equipped to treat these patients. Let us get on and fix this problem now.”
MHYFVic supports the idea of better availability of appropriate treatment, and in collaboration with Spectrum is planning to hold a Workshop. The details will be announced after it has become safe to meet again in small groups.
ANNUAL GENERAL MEETING
We have planned for our AGM to be on Thursday 27th August 2020. The after-dinner speaker is to be Sister Brigid Arthur of the Asylum- Seekers Resource Centre, who will bring us up to date on what has been happening to the children and their families as the political games play out.
However, it is far from clear whether it will be safe enough to proceed at that time, so the event may have to be deferred.
Details of the event will be featured in our next newsletter.
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CORONAVIRUS – MENTAL HEALTH ADVICE AND GUIDANCE
Two important packages of information are presented here. The first notes come from ESCAP, the European Society for Child and Adolescent Psychiatry. The second package comes from the personal experience of our President, Professor Jolyon Grimwade, as a clinical psychologist.
Mental Health of Children and Adolescents during the Coronavirus Pandemic
Everyone is being made aware of the physical effects of the Coronavirus and what we should look out for if symptoms arise. However, the mental effects of the virus itself are not yet known nor are we able to assess the effects of the fear generated by potential contamination. Social distancing and isolation for weeks will also take a toll on mental health. The short, medium and long-term implications of the combined effect of these factors require study. Uncertainty provokes anxiety, fear of the unknown, stress. In the current global situation, everyone from young children to adults will be feeling a mix of emotions and some will be placed in environments and situations that are new or potentially damaging.
Every country is facing its own challenges and many associations are providing information resources for psychiatrists and allied professionals on how to deal with people with existing mental illnesses and those experiencing new mental health issues related to the current situation. ESCAP is fully aware that this global situation will have profound effects on the wellbeing of many children and their families.
Children will look to their parents or caregivers for answers and explanations, parents will be bombarded with information that is hard to digest and perhaps not completely factual, some children will be isolated in an already abusive environment, physicians and medical health workers are strained and delving into the unknown. All of this will take its toll.
A resilient and connected community requires global knowledge exchange of intelligent and innovative views that will help relieve the unprecedented burden on the public and professional healthcare providers. We hope that providing these links and information will allow us to build up this connected community and promote mental health for all during the pandemic.
"Mental disorders can be severe or life-threatening disorders, therefore our treatment facilities must stay open as long as possible. E-therapy and e-counselling services allow us to maintain our therapeutic relationships with many of our patients and their families. Health systems all over Europe have to react and adapt to incorporate these approaches" Professor Joerg Fegert, ESCAP Policy Division Head.
ESCAP, along with the support of other associations have compiled a list of links that offer guidance and advice to psychiatrists, allied professionals, parents and caregivers, school staff and other professionals that are providing care and support during this time. We thank those who have taken the time to put these websites, documents and information packages together.
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The following links are in English, we advise psychiatrists who are seeking specialised guidance in their own language to contact their national society or association; many of which can be found on our member page. Each link is indicated with ‘public’ or ‘professionals’, to explain if the link is steered towards advice for the public or professional health care workers.
If you would like to add to this list or have a comment, please contact our editor at editor@escap.eu
Anna Freud NCCF
  • Supporting Young People’s Mental Health during Periods of Disruption [Public]
  • Supporting Parents and Carers through Disruption [Public]
  • Supporting Schools and Colleges through Disruption Video. [Public]
  • Supporting Schools and Colleges during periods of disruption pdf. [Public and professionals]
  • Self-Care Resources [Public]
    AACAP America Association for Child and Adolescent Psychiatry (site currently under construction)
  • News and Children by AACAP [Public and professionals]
  • Disaster and Trauma Resource Center [Professionals]
    APA America Psychiatric Association
    • APA Coronavirus resources and practice guidance for COVID-19 [Professionals]
    ACAMH The Association for Child and Adolescent Mental Health
    • ACAMH podcast: Dr Jon Goldin on the coronavirus and child mental health [Public and

    professionals]
    BPS British Psychological Society
Advice to Schools, Parents and Carers to Help Children through the Uncertainty of
School Closures [Public] Importance of talking to children about Coronavirus [Public and professionals]
Top Tips for Providing Effective Therapy via Video by DCP Digital Healthcare Sub-
Committee [Professionals] BPS guidance - Talking to Children About Coronavirus
BACP British Association for Counselling and Psychotherapy Coronavirus anxiety: how to cope if you’re feeling anxious about the outbreak [Public]
Carlat publishing
Coronavirus and Mental Health podcasts for mental health care professionals, useful links in article. [Professionals]
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CDC Centers for Disease Control and Prevention • Manage Anxiety & Stress
Child Mind Institute
  • The Child Mind Institute has a specialised site ‘Supporting families during COVID-19’[Public]
  • How to Talk to Kids About the Coronavirus by Child Mind Institute [Public]
  • Talking to Kids about Coronavirus [Public]
  • Supporting Kids during Coronavirus Crisis [Public]
    Mental Health Foundation
How to look after your mental health during the Coronavirus outbreak [Public] Talking to your children about the Coronavirus pandemic [Public]
Royal College of Psychiatry
• Information for psychiatrists and other professionals working in mental health settings (COVID- 19) [Professionals]
Save the Children
• Press release: Save the Children: Millions of refugee and displaced children in overcrowded camps as coronavirus spreads globally [Professionals]
UNICEF
UNICEF - COVID-19 - What you need to know about how to protect you and your family [Public]
• UNICEF - Press release: COVID-19: Children at heightened risk of abuse, neglect, exploitation and violence amidst intensifying containment measures [Professionals]
  • Coronavirus Outbreak Video with Priyanka Pruthi [Public]
  • Coronavirus disease (COVID-19): What parents should know [Public]
  • How to talk to your child about coronavirus disease 2019 (COVID-19) [Public]
Studying at home due to coronavirus? This is how young people around the world
are keeping their mood up [Public] How teachers can talk to children about coronavirus disease (COVID-19) [Professionals]
WHO World Health Organisation
COVID-19: IFRC, UNICEF and WHO issue guidance to protect children and support
safe school operations [Professionals]
  • Key Messages and Actions for COVID-19 Prevention and Control in Schools by UNICEF, WHO
    and IFRC. [Professionals]
  • Mental health and psychosocial support during COVID-19 [Public and professionals]
    WPA World Psychiatric Association
    • Special Update from the WPA President - useful links in article. [Professionals]
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Other links:
Covibook - Supporting and Reassuring Children Round the World [Public]
Handbook of COVID-19 Prevention and Treatment by Zhejiang University School of Medicine, China. [Professionals]
L’encephale online - Crise Covid-19: Recommandations pour les soignants et patients en sante mentale [Professionals. Page in French].
MIND - Coronavirus and Your wellbeing [Public] NICE - general guidelines on COVID-19 [Public]
Place2Be - Guide to helping parents answer questions from their children and to support family wellbeing [Public]
Young Minds - Talking to your child about Coronavirus and 10 tips from their Parents Helpline to support family wellbeing [Public].
MY TELEHEALTH STORY, with comments on technology and tips for practitioners.
Over a period of forty years, Professor Grimwade has used teleconferencing in his clinical psychology practice. He describes the evolution of his use and understanding of the strengths and limitations of this technology. This is a fast-track for newcomers to the technique.
Now, in this Coronavirus pandemic, the use of this technology is relevant not only for clients in remote areas but also for young people in isolation. But few clinicians have had any experience. The second section of Professor Grimwade’s paper shows how common strategies like drawings, puppet play, therapeutic card packs and squiggle games can be used in teletherapy sessions.
As this paper is too long for publication in a newsletter, we have made it available as a downloadable pdf document from our website. Go to mhyfvic.org visit the “Hot Issues in Mental Health” page, and you will find it in the MHYFVic Papers section, titled “Tele Health”.
OPINION
Our Mental Health system needs bottom-up change.
The important, major enquiries of the Commonwealth Productivity Commission (CPC) and the Royal Commission into Victoria’s Mental Health system (RCVMHS) have produced draft or interim reports for commentary. Mental Health for the Young and their Families (Victorian group; MHYF Vic) encourages all Victorians to read these reports and make
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comments. The CPC is taking public submissions until 23 January, 2020. The RCVMHS will hold further consultations in April/May, 2020.
MHYF Vic is an advocacy group of professionals, former professionals, consumers, and carers that seeks to improve the quality and quantity of mental health (MH) services to Victorian families. We seek improved services for families with younger children, and people of all ages, as they all belong to families. A first reading of each report seemed to imply that young children and the elderly do not have MH problems; on second reading the reports imply spending priorities lie elsewhere.
There is much in common between the CPC and the RCVMHS reports, especially concerning adults who undertake risky behaviours including suicide attempts. MHYF Vic supports any initiative that reduces the numbers of suicides each year (which is twice the rate of road traffic deaths)! The two reports emphasize the need to build purpose-fit facilities that can provide longer-term care for at-risk people. The two reports also note the difficulties of living in rural and remote areas and the high rates of MH problems among Aboriginal and Torres Strait Islander peoples.
Crisis services need effective crisis response protocols and facilities to keep at-risk people safe. The overall MH system is badly in need of more funding, better facilities, and greater coordination, with relevant leadership. The RCVMHS proposed the establishment of new coordinating bodies to oversee implementation of the new system and the new facilities. MHYF Vic is suspicious of the implied top-down solution model. We do support new governance and facilities, but real change will come from the development of new protocols for action that have professionals on the ground responding to consumer and carer needs in transparent and timely ways that ensure safety. The RCVMHS may recommend such protocols for action.
We are very concerned about the creation of a body to oversight the provision of MH services for indigenous peoples. The history of dispossession, which is acknowledged by both reports to be at the heart of the MH problems experienced by indigenous peoples, has been from top-down, treating all indigenous peoples as having the same needs. Homogenizing and directing Aboriginal nations is very unhelpful. It was the “gubbers” (government employees) who took away the children. Regionalization of services is necessary, as different nations have their own practices that need to be engaged, constructively, to deliver appropriate services.
MHYF Vic submitted extensively to the RCVMHS on needed change in Victoria and will be providing extensive feedback to the CPC. We have described methods for practical action at the service delivery level that will engage families at times of crisis, but also engage families in preventive and early interventive programs. Both the CPC and the RCVMHS reports advocate prevention and early intervention, but do not describe how this could happen. MHYF Vic, following the work of Nobel economics laureate, James Heckman, and ARACY’s
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report on the first thirty months, have advocated population wide monitoring of maternal, child, and family MH, through maternal and child health (M&CH) centres and pre-schools.
MH prevention can be done at the M&CH and pre-school centre because the family is engaged in establishing healthy living at this time. After this time, families are less receptive to intervention with regard to children at-risk for behavioural and emotional problems. Ordinary health checks, over time, give the M&CH nurse or the early childhood educator a window on family development and they can recommend collaborative, professional intervention. Engaging with families has a great economic benefit as resources focussed on individuals-only preclude contributions from wider family members and community members.
MH is a developmental challenge across the lifespan and is a family matter. Too many resources focus on adult individuals who have become estranged from families; early intervention with families builds family confidence to solve problems through the sharing of resources. Individualism also focusses attention on the biological problems of MH and upon psychopharmacology. Drugs do help, but need family or community context to enable recovery.
The MH system needs to be collaborative, transparent, coordinated, and integrated from the bottom-up; including consumers and carers as legitimate participants alongside the professionals. Coordination needs to be encouraged between child and adult services and between private and public practitioners.
We fear that final RCVMHS recommendations will focus on bricks, mortar, and lines of direction, rather than upon human processes of communication and respect that work bottom-up. MHYF Vic has submitted many practical suggestions for making MH services accessible and well-suited to the needs of families and their members. We seek constructive engagement with these bodies to enable these resource-saving and life-saving initiatives to be implemented.
Professor Jolyon Grimwade, PhD,
Clinical Psychologist and Clinical Family Therapist, President, MHYF Vic
Jo Grimwade has worked in clinical psychology in urban and rural settings in four states and taught at three post-graduate institutes. Currently in private practice working with children of all ages, on-line across Australia, and in clinics in Melbourne, including First Peoples’ Health and Wellbeing. He has been MHYF Vic President since 2010.
MEMBERSHIP SUBSCRIPTIONS
Annual membership of MHYFVic runs for the Financial Year. Only paid-up members are entitled to vote at our AGM, normally held in August each year. Friends and associates who are not paid-up will still receive our electronic newsletters and notices because it is our mission to promote improvements in mental health for the young and their families.
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However, it is important to reflect upon the difference between paid-up and non paid-up members.
Membership subscriptions of $50 per annum enable the organisation to maintain its website, mailbox, telephone service and to undertake its administrative tasks. If you value the work that MHYFVic does, we need your financial as well as your ethical support.
Our mail address is PO Box 206, Parkville, Vic 3052. If you prefer to pay by Direct Funds Transfer, the BSB is 033 090 A/C Number 315188 with your name in the Reference tab. It would be appreciated if you could also send a confirmatory email to admin@mhyfvic.org
OUR UPDATED WEBSITE
After much thought our website has been significantly revised to give casual visitors immediate information about what we do and what we stand for, whilst at the same time allowing members to go straight to specific sections such as Projects or Newsletters or Events, without having to navigate past reams of information.
Now that the main revision has been implemented we are working on tasks of development of Projects to give us the evidence base for our advocacy. There are quite a few items under development at the present time which are not yet reflected in the website but over the next few months we expect to see a burgeoning of activity.
Visit us on mhyfvic.org
2019 MHYF Vic Committee
* President : Jo Grimwade * Vice-President : Jenny Luntz * Past President: Allan Mawdsley * Secretary : Cecelia Winkelman * Treasurer and * Membership Secretary:Kaye Geoghegan * Projects Coordinator, Allan Mawdsley * WebMaster, Ron Ingram * Newsletter Editor, Allan Mawdsley * Youth Consumer Representative, vacant * Members without portfolio:
Suzie Dean, Miriam Tisher, Celia Godfrey.
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