PEOPLE: Providing mental health services in an overloaded industry during a pandemic

CONTENT WARNING: The following article mentions suicide and domestic violence. If this triggers something or you need to talk to someone, please called Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636. If you’re in immediate danger, call 000.

During the coronavirus pandemic, many are doing it tough, including the thousands of healthcare workers on the frontlines. Sarah Goulding is one of these frontline workers, taking on night shifts to deliver much-needed mental health services to patients, while homeschooling during the day. In this interview, she shares how she has seen the mental health industry evolve throughout her career, her experiences during the pandemic, and advice for others considering a career in this space.

  • Working in the mental health space, what are the major mental health challenges you’ve seen Australians struggle with and how has that changed over time, particularly now during COVID-19?

The major challenges we face in mental health are access to service issues and under resourcing. Access to community mental health services and inpatient beds remain an issue – long waitlists for community treatment teams, blockages in Emergency Departments for consumers awaiting and inpatient beds.

Staff are constantly under pressure to move people through the system as quickly as possible, to make more space for the high demand of patient flow. This has resulted in poor patient outcomes and high staff burn out rates. 

The majority of struggle during COVID-19 has been the sudden spike in mental health issues whether consumers have pre existing conditions or new presentations. When you have a system that is already overloaded and these unprecedented events occur, it can be quite catastrophic. Consumers have been struggling with a range of emotions, such as panic, hoarding, low mood, and anxiety. We also have to consider our consumers that have pre existing mental health conditions who have relapsed under the stressful conditions of social isolation. 

There have been reports of impulsive suicide in the community and for consumers in quarrantine. There has been a major spike in domestic and family violence cases. 

Over time we have learnt to adapt to staff shortages, bed shortages and lack of resources, however the rapid increase of mental health presentations and relapse in consumers with pre existing conditions has made it very difficult to manage. COVID-19 has required public services partnering with private services, cooperation and problem solving to try and attend to the needs of a community in crisis. My hope after COVID-19 is for more awareness on the fragility of our community especially post the bushfires, we need mental health services more than ever.

  • What are some of the signs people should recognize as indicators that someone needs professional mental health support? 

As a general guide, I would look for behavioral changes, mood shifts, food intake, sleep, levels of motivation and socialization, (even via Facetime during COVID-19) irritability, hopeless or helpless themes in conversation.

Risk issues can be a difficult conversation to have with another person, however if they express suicidal ideas or thoughts of suicide it is really important that they speak with a professional immediately to get advice. Options include your local G.P, telehealth services such as Beyond Blue, Life Line and Suicide Call Back Service. If there are imminent risk issues it is best practice outside of business hours to contact 000 and attend your local Emergency Department. Another challenge we are facing is that consumers that are acutely suicidal are very reluctant to attend hospital or be admitted to an inpatient unit for fear of contracting COVID-19, so there is a huge amount of pressure on community services right now. 

If there are changes in mental state with low risk, for more than 7 days and the symptoms are unchanged or worsening, the first place to start is with your local G.P who can link you to the appropriate support, and if there are ongoing issues, then there are alternative options for pharmacotherapy and more intensive specific therapies.

Secondly, pre existing mental health conditions and managing relapse are very much dependent on the diagnosis. As a community we are predominantly educated on  Depression and Anxiety, Diagnoses such as Bipolar Disorder, Schizophrenia, Personality Disorders and Eating Disorders are far more prevalent than most of the community are aware. In many cases most people would not know what to look for. For example, Eating Disorders have the highest mortality rate of all psychiatric conditions. I think as a community we are very uncomfortable about discussing suicide, self harm and challenging or difficult behaviours. We need to be more transparent and direct more attention to capture a better view and understanding of mental health outside Depression and Anxiety.

  • Particularly now, as many are struggling with increased stress, anxiety and loneliness, how can we help others in our life who may be struggling with these things, but who we can’t physically be close to at the moment?

Maintaining emotional contact with the people in your life is very important. Even though we may not be physically present, when we have presence, albeit, technology based, it does give us the sense of company and emotional contact. Using Facetime, Zoom and other social platforms are helpful in maintaining a sense of familiarity, connectedness and staying in touch with laughter, thought and conversational skills.        

Encouraging and assisting people in using technology online is also important – Online G.P reviews, telehealth appointments with Psychologists and Mental Health Social Workers.

Similarly, for the elderly setting up an ipad or sending videos if they have tech – or if not lending them simple tech and showing them how to use a device to maintain contact – is really helpful. For the elderly that don’t have these options, family, friends or carers, slip a card into their letterbox, phone them, check in with them. It makes a difference.

  • You believe diversity is important so we get a better understanding and appreciation of where people are coming from and their experiences. What are some of the best and worst things you’ve experienced in your work, where that understanding or appreciation did or didn’t exist?

The best experiences I’ve encountered in my work are seeing recoveries, and those consumers living their best life, having the opportunity to specialize in Eating Disorders and learning so much from clinical information to service design and implementation. Being invited to speak at a consultation group during the Royal Commission into mental health (Victoria) was a humbling experience to meet people you would rarely have an opportunity to speak with. CEO’s of NGO’s, Board of Health and Hospital Directors, the Commissioners – it was great to speak about a variety of my experiences in real time with people of influence and that have the ability to make social change. 

The worst experiences are obviously suicides of consumers we work closely with, and working with severely mentally ill consumers requiring physical or chemical constraint can also be very confronting. Involuntary detention is always an unpleasant way in which to work, however in some cases it is necessary for the safety of the consumer, their carers and the public. 

Mental health is a very difficult and complex profession. We often work in high pressure environments, making serious decisions in short time frames, working with severely distressed consumers and families. It requires a certain skill and knowledge level. We often work alone or in very small teams, and in the long term, on a sub conscious level, the cumulative effect of trauma is manifest through our interpersonal relationships, and workplace culture. I think at times this has led to very negative workplace dynamics which is hard to navigate if you are early on in your career and have not had time or experience to re frame and reflect.

  • Would you recommend a career in mental health to others? Why or why not?

I would recommend a career in mental health. If you are passionate about people, if you are passionate about social justice, and have a legitimate interest in psychiatry then it’s certainly a place where you will get to experience many different bio psychosocial scenarios, learn about different legislation, micro, meso, macro systems and public service structure and development. It is a multi-faceted career path and you do have the ability to specialize in different areas. 

However, in my experience, you will need a rigorous self-care and external professional supervision regime, be open to learning, adjusting and adapting to scenarios because unlike general medicine, Psychiatry is not linear, there are no direct cures only treatments. At times I’ve found this frustrating, but I do have hope that mental health will slowly get the full recognition that it deserves and consumers get the highest quality of service.

About the expert

Sarah Goulding is an Accredited Mental Social Worker and Family Therapist. She has spent the past 19 years working in public mental health services. She has worked on Inpatient units, Community Care Teams, Crisis Assessment and Treatment Teams, Emergency Department Triage, Eating Disorder Treatment and Recovery, mental health service design and development, private practice, telehealth and community consultation groups in Victoria and NSW. Her passion, commitment to quality, education, awareness and advocacy for mental health continues to guide her practice and she is always inspired and motivated by consumers’ strength and resilience, with the hope of continually improving the space in which we work. 


ADVICE: How to change the gender diversity ratios in STEM

While progress is being made in some areas, there is still a dire lack of diversity in STEM fields overall. Women still only hold about one in four STEM jobs, and many in the industry end up leaving due to hostility in the workplace.

We asked four highly accomplished women in STEM what can be done to drive change on this important issue.

  • In your view, what is the biggest thing driving the local and global shortage of women working in tech and data? What is the low-hanging fruit for each of governments, corporates, and individuals to improve the ratio?

Jamie K Leach, CEO, Open Data Australia:

The topic of diversity and equity in technology is a complex subject that requires many initiatives at multiple levels to address the disproportion.

  • Improve Education – A change in education from the earliest of ages to break down stereotypes and to bolster the number of girls studying science and technology from primary school, through to secondary school and onto tertiary education. Formal education, paired with exposure to real-world professionals through mentoring and work experience opportunities.
  • Champion Role Models – Champion role models need to be visible and accessible as both women in tech, and the male champions that support and promote equality and diversity in the tech industry.
  • Challenge Negative Stereotypes – Negative stereotypes exist from the earliest of years, with segregation in toys, entertainment and through the direction of play-based learning during infancy and early childhood education. Also, the perceived requirement for women to form women-only networking groups and forums and to separate the genders is continuing to exacerbate the gap. While support from other women can be nurturing and beneficial, it does not assist in breaking down stereotypes. It does not help in correcting the exposure to hiring executives and reducing the barriers that exist through network theory and segregation to decision-makers.
  • Create and Foster Networking and Mentoring Opportunities – networking and mentoring opportunities need to consider the following in their creation:
    • Exposure to decision-makers – executives and recruiters
    • Visibility to successful and passionate females in tech
    • The opportunity to showcase up-and-coming talent
    • A safe environment for females and students to ask open and honest questions without fearing judgement or retribution
    • The ability to celebrate appointments and promotions publicly to perpetuate success stories
    • Continuing education and development at the highest levels

  • What can today’s STEM leaders be doing to empower women and those of diverse backgrounds in their careers?

Dr Bianca Capra, Senior Aerospace Engineering Lecturer, UNSW:

There are many things our STEM leaders of today can do empower women and those from diverse backgrounds. Some are small, and some are large but all have positive impact. My advice would be to be mindful of your own unconscious bias and to openly and honestly listen to the challenges, experiences and opinions of minorities in your areas. We can all learn a lot by listening to others and reflecting on what we hear, and how we can each collectively act to improve and advocate for systematic structural changes so that diversity and inclusivity are core to our businesses.

Some immediate practical advice would be to mentor, promote and advocate for those in all minority groups that work for you – look for the differences people bring, value these differences, and help them develop and find their voice and passion.

Take the manel pledge! As a female aerospace engineer that was never taught by a female at university level, and regularly attends conferences where all keynote speakers, and most session chairs are male I say enough is enough! Women have always, and continue to, contribute to engineering and STEM more broadly. Be bold as STEM leaders and wear your values, don’t agree to sit on panels that don’t include true diversity and be open and honest about your choices. Without this visible and vocal support of our STEM leaders we will not be able to enact effective change. 

Understand that the system we are working in was designed primarily for one demographic only and that as a result the structures and mechanisms supporting this system are inherently biased. By recognising and accepting this, our leaders can then make effective change to promote greater diversity, such as introducing flexible working for all, supporting staff who are returning from long career breaks, looking for and valuing the knowledge and experience that diverse teams bring, and redefining the metrics we use to measure success so that it is reflective of all.

Give women and others from diverse backgrounds the tools to succeed – showcase, highlight and value the ideas and thinking they bring to teams. Importantly, empowering women and those from other underrepresented groups requires showing your current staff the important role we all have in creating a more inclusive and equitable work environment.

I would like to add that leaders and influences come in many forms. Parents, teachers and peers all have a key role in shaping the identity and self believe of the young people around them, so in my opinion these are also today’s STEM leaders. Listen to the passions of the young around you, use inclusive language, encourage and support their interest in STEM, and never say ‘never’ or ‘yes but …’.

  • Why do you think there is a lack of diversity in STEAM (science, technology, engineering, arts, maths) fields? What can practitioners, organisations, and communities do to overcome these barriers? 

Dr Kudzai Kanhutu, infectious diseases physician, telehealth Clinical lead and Deputy Medical Information Officer at the Royal Melbourne Hospital:

It boils down to meaningful opportunities and informed choice. Where there are historical power imbalances it can be very difficult to shift the balance and provide everyone with equal opportunities.  If I had my time again I may well have chosen to study Engineering and not Medicine. However, I wasn’t in a position to pursue that option because I didn’t really understand at the time the incredible opportunities that might be available if I chose engineering, physics or pure maths.

We need to get better at communicating what is available to people and how it can apply in their contexts, finding creative personalised ways to teach and foster STEAM curiosity.  Often the best people to come up with creative solutions to problems are those most affected by it.

  • In your view, what is the biggest thing driving the local and global shortage of women working in tech and data? What is the low-hanging fruit for each of governments, corporates, and individuals to improve the ratio?

Courtney Blackman, CMO, YBF Ventures:

There are so many layered factors that have pervaded modern culture for millennia including hiring practices to media portrayal of women as to what constitutes a “male” job and what constitutes a “female” job. Historically, tech has been framed as a “male” job. From a media perspective and more recently in regard to popular television shows focused on the STEM (science, technology, engineering and maths) world – The Big Bang Theory and Silicon Valley, which concluded their final seasons last year, were both hotbeds of same-old tropes with men taking centre stage and women being the support characters. It was only in later episodes of The Big Bang Theory that female scientists were introduced as characters, where previously, it was four male “geniuses” and a blonde woman who was both a waitress and struggling actress. I’ll put my hand up and say I’m as guilty as anyone for watching shows like these and I’m fully aware of the gender biases slipping stealthily into my own brain. Unfortunately, these biases will permeate through to the next generations as they will forever live on through re-runs (both on television and the way people think).

When hiring, everyone from the founder of a tech startup to HR departments in larger companies already have biases in place, and more often than not, the pool of potential tech employees is an omnipresent visual of masculinity. Females, regrettably, are more reticent to put themselves up for tech roles as the roles are deemed and enforced as “not for them”.

With that said, there are so many inspiring women working in tech, but sadly the turnover is twice as high for senior women working in tech than men. And three times more males found startups in Australia than females, according to Startup Muster’s 2018 annual report.

Education targeting young women in STEM will certainly help with a future inclusive workforce, but today, programs need to be put into place to retain female tech leadership, which would in turn have a positive impact on recruitment and retention for junior tech roles.

I’m the CMO (and sit on the Executive Leadership Team) of tech and innovation hub, YBF – which has offices in Melbourne and Sydney. The company upgraded its leadership at the end of 2017 and one of the key pillars of the new leadership was to take an active approach to gender equality. When I joined the team at the end of 2017 there was one female on the team. With the hiring of me, that number was inched up to two, but our new CEO wanted to see parity. Over the next six to twelve months we worked together as a team on recruitment and by mid-2018, we reached gender parity. We have fluctuated a few times where we’ve actually had more females on the team then male, but normally the average is 50-50. This has been an incredible achievement – to shift the entire culture of Australia’s most renowned tech and innovation hub from being primarily male to being gender inclusive. In 2018 when we did reach parity for the first time, one of the men on the team was actually moved to tears as it was never a priority for the company previously and he realised how important it was.

Part of my specific role in shifting our company’s culture was developing and directing the Lift Off Awards. The awards take place annually in Melbourne and they celebrate gender and cultural diversity in fintech. To date, the awards have gained endorsement from incredible female leaders including Melbourne’s Lord Mayor, Sally Capp, Australia’s first Fintech Minister, Senator Jane Hume and the Chief Executive Partner of Lander & Rogers, Genevieve Collins.

PEOPLE: Dr Kudzai’s ever-evolving career in infectious diseases

Amid the coronavirus pandemic and extensive discussions around the impact on the global healthcare industry, Echo Chamber Escape reached out to Dr Kudzai Kanhutu, an infectious diseases physician, telehealth Clinical lead and Deputy Medical Information Officer at the Royal Melbourne Hospital.

In this interview, Dr Kudzai shares her career journey, how her passion for the field has evolved over time and why “the world needs you” if you’re considering a career in infectious diseases.

  • What first instigated your interest in infectious diseases? How has you interest and passion for the field evolved since then?

I have always been motivated by the ability of good healthcare systems to restore equity. Infectious diseases lends itself really well to achieving meaningful social justice goals. From vaccination through to providing fresh water and basic sanitation to populations. Everything we do in infectious diseases is ultimately community and population minded as opposed to being narrowly focussed on the “patient” or “consumer”.

At first I thought I would end up treating weird and wonderful infections on some tropical outpost. Not so much in practice! Which is not to say there isn’t buckets to do. From managing post surgical infections, dealing with a gastro outbreak in a nursing home or refugee health immunisations. My passion and interest in infectious diseases has really only expanded to become even more esoteric.

  • What excites you most about the infectious disease and biotechnology sectors? What do others entering the industry have to look forward to? 

Infectious diseases is an incredibly holistic field that encompasses the full spectrum of STEAM (Science, Technology, Engineering, Arts and Mathematics). I am insatiably curious about how things work and infectious diseases allows you to indulge that spirit of adventure.

Working at the intersection of biotech and infectious diseases you are always at the frontier of innovation and some truly extraordinary discoveries. The way that we are using big data and digital platforms to strengthen our approach to the pandemic is extraordinary. From identifying the virus, developing rapid test kits, tracking disease spread and vaccine developments.

  • “COVID-19 has heightened people’s awareness of the importance of the involvement of doctors, medical professionals, and biotechnology experts in impacting and contributing to public policy.” – Do you agree with this statement? Why or why not? What are your reflections on this topic? 

I agree to an extent. The general public have always been very open to doctors being involved in public policy decisions. We often rank as the most trusted profession, with politicians as we know ranking very poorly!  However, from within the medical fraternity we often have an ambivalent relationship with politics and advocacy. There has been a tendency in the past to focus on our neutrality and the patient facing aspects of care rather than the broader socioeconomic context. I think the Covid-19 pandemic has highlighted the need for us to be more deeply ensconced in directing the narrative and decisions around resource utilisation and healthcare planning.

  • For people currently undertaking short courses or tertiary studies in infectious diseases, what is your advice to ensuring a rewarding and successful career in this sector?

Be very open to using your skills flexibly. Over the years I have done locums in the private sector, worked in call centres and sexual health clinics. Don’t allow your course to narrow your possibilities. Always be purposeful about broadening your horizons. The world needs you! 

About the expert

Dr Kudzai Kanhutu MBBS (Hons); BA/BSc; MPH; FRACP is an infectious diseases physician, telehealth Clinical lead and Deputy Medical Information Officer at the Royal Melbourne Hospital. A self-confessed health tech nerd she is a current board member for the Health Informatics Society Australia and clinical reference lead for the Australian Digital Health Agency.

Her desire to apply technical solutions to health problems arose from her professional and personal experiences of health inequality in her birth country Zimbabwe and working in rural and regional Australia.

In 2017 she was jointly awarded the Victorian Public Healthcare award for excellence in Culturally and Linguistically Diverse care in 2017. This award acknowledged clinical innovation through the development and implementation of a purpose-built electronic health record as well as a telehealth model of care for remote management of refugee patients.

Kudzai’s current research undertakings are in the areas of virtual care, digital literacy and the impact of housing stress on refugee health outcomes.

Outside of work Kudzai enjoys a number of eclectic pursuits. As the reigning Kensington Primary School parents’ dance off champion, she is equally comfortable in the forward pocket doing goal kicking practice with her kids as she is fronting an academic conference keynote.