General practice and CAMHS

Today I was a guest at Austin CAMHS, learning more about the interface between primary and secondary care and the trajectories of the young people who are  seen by CAMHS-to look at where GPs might have become involved at an earlier stage.Joining clinical case discussions always reminds me of how much I miss that multi-disciplinary way of working which is difficcult to achieve in general practice where so much of our clinical practice is conducted in isolation.

Above is an installation created by children attending the Austin school where the education programe supports the therapeutic interventions and is a fundamental pillar to the children's recovery.

Orygen-world centre of youth psychiatry

 Orygen  might be of international repute but it is still a target for graffiiti:  a recognized art form associated with young people, and fabulously displayed downtown in The Lanes  in Melbourne, as indeed in many cities.
As reported earlier, Victoria is moving to a state wide policy of designing and delivering children and youth mental health services for 0-25 year olds. Orygen has been a key research and clinical engine behind promoting  the extention of care pathways into early adulthood, in part as our understanding of neurodevelopment deepens and the plasticity of the brain is recognized as continuing well into the mid twenties .

A key focus for the centre has been the early detection of first episode pyschosis. This model is now being rolled out to other major mental health disorders, including the more common mood disorders of depression and anxiety and a number of research programmes are under way to add to our growing understanding of the trajectories of these conditions.

I also visited the Western Sunshine headspace site where I learnt more about the synergy, and inevitable tensions, between research and clinical care; and of the challenges of recruiting GPs in specialized settings. This is against a backdrop of a national shortage of GPs and a complicated funding system for payment where the option of salaried GPs has yet to be developed, in contrast to its mass roll out in the UK-which has its own problems.


Western Melbourne, Sunshine, Harvester Rd.

Back to business, Melbourne style

Monday was spent out at Geelong-which is a rural coastal town-[not featured above-that's hip and swinging  Federation Square in Melbourne!] where I visited the Clocktower- now a Headspace site: a flagship model for the national programme and hugely sucessful. I spoke to the team in depth, viewed the youth-friendly premises and met the outreach education programme leader who ran me through 'Docs and Teens'; an innovative programme which sees GPs and co-facilitators running workshops in schools. The aim is to demystify accessing health care from a GP and also aims to equip the year 9s with health information which  might empower them to promote their well-being. 

Monday night I was a tourist! Met up with Tammy from Durham who introduced me to the delights of south bank and  the  highlights of Melbourne's tourist attractions.I love this cool and trendy city.

relaxing in Adelaide

Returned to Adelaide to see my little Freya who is happy and thriiving. How nice it would be to have swimming lessons in outdoor pools...

We spent Sunday afternoon at Brighton eating gelato, blowing the awaycobwebs after an intense week of learning and thinking and walking the pier.

Ready for a new week ahead....

Australia'a first story:Take Two and and GPs in Juvenile Justice

 Spent a very instructive morning hearing more about Australia's first story as I met with the Clinical Director and Aboriginal Consultant of Take Two, a state funded service which provides therapeutic care for children in the care of the child protection services.Not surprisingly at least 20% of whom are indigenous children. Les and Rick discussed how when it can be facilitated ,returning a child to their people (or mob) can be the most potent therapuetic intervention available.

In the afternoon, after negotiating Melbourne's tram system....I accompanied a dedicated GP who works in the Juvenile Justice system providing primary care to young people, aged between 10-18, who are detained in youth detention centres, either awaiting a court appearance,on remand or on custodial sentences.
It is an extremely challenging environment in which to work-with the traumatized histories of the young people being at the centre and I am now highly motivated to look at what happens in the UK.
Heather then invited me back home for dinner for more chat, to meet her family and hunt out an Aussie Rules Jersey for one of my teenagers back home!

The flora and fauna continue to delight

Opportunities presented by the Churchill Fellowship

The chance to travel in order to fulfill the expectations of the Fellowship is a unique opportunity to discuss and share ideas with colleagues one would never normally have the fortune to meet.In the convivial atmosphere of Melbourne, and Australia in general it confers the opportunity to explore and revisit old ways of thinking. I was delighted to spend the day with Lena :seeing an aspect of clinical practice in action and then to share dinner (Malaysian noodles) at her eco-friendly  and inviting home, complete with lemon trees.

It is also an opportunity to meet with the movers and shakers, as I was lucky enough to do on Tuesday. In the morning I met the State Minister for Community Services at the launch of an early Family intervention service at Geelong, at the invitation of the Director of Take Two: a state funded service which works with children assigned to the child protection services who are suffering significant emotional and attachment disorders. In the afternoon I met with the Chief Adolescent Pyschiatrist in Victoria, Dr Sandra Radovini, who explained the context and future direction  of developments in child and adolescent psychiatry in Victoria. The state is the first in the world to restructure its services around an age range of 0-25 yrs  and its progress will be watched with interest by clinicans around the world.

bikes and birthdays

 et volia-The Seven Seeds cafe: where I happened to bump into Tammy, an old friend from Anthropology in Durham whom I had planned to meet that evening to celebrate her son's 19th birthday....it really is a small world!

Making new connections at the University of Melbourne

The UK might not have the last word on collegieate cloistered squares  of scholarly learning but Melbourne certainly has the edge on cafe culture.....Today was spent getting to know some of the members of the Department of General Practice and presenting a paper on my work in the UK but it began with a coffee and cake in one of Carlton's oldest cafes, Buretti's where Lena (Sanci)and I shared our experiences of exploring how GPs might become more involved in promoting the emotional well-being of young people. It's interesting to see where the commonalities and where the differences lie-funding structures and organizational constraints play a part in explaining differences whilst the similarities sit more with the art and craft of general practice itself.
My paper was well received and was followed by a delicious lunch with two departmental staff, Kelsey Hegarty and Anita, in an uber cafe resplendent with bikes on the wall.Picture to follow....

The Melbourne phase of my wonderful aussie adventure

Although I have had to leave Freya behind in Adelaide it's good to be in Melbourne. The architecture of the town houses is delightfully quirky and reminiscent of Amsterdam.
Had a very fruitful day at Headspace head office, getting a real feel for one of Australia's major mental health initiatives  focused on young people.

aboriginal life

Am trying to make  a link between understanding more about indigenous culture and the growth of psychological therapies based on eastern traditions, whilst wanting to record the two day weekend workshop I attended on Interpersonal Psycotherapy. It was an excellent workshop, skillfully delivered by Prof Sue Luty from the University of Otago, New Zealand; who in the alloted time covered the key components of the therapy and manged to run through a significant number of clinical cases to make it come alive.
I am looking forward to putting it into practice-after first completing my own personal inventory...
It is not easy to make the paradigm leap from the western way of thinking and doing to appreciate the traditional cosmologies but we must do so in order to better understand what was once there and what has been lost.

GPs and children's education

I did a fair bit of walking today, dodging the rain showers, on the school run; on the hunt for a cuddly  koala for Freya before I fly off to Melbourne; dipping into the Art Gallery before meeting up with the GP Headstart education programme co-ordinator at the Women and Children's Hospital.

Very interesting to hear about the familar challenges of engaging GPs with young people's mental health issues in the absence of a lively local network of similarly minded GPs. I'm guessing its a global problem.....Still, it was good to hear about the Headstart initiative and consider its applicability to a UK setting.

Children, on the other hand, are far easier to engage with learning; so long as they are loved and cherished ; well-fed, clothed and housed. Freya is coping well with her new school and the social and scholastic challenges a new school and education system raises. Today was school photo day so she'll have an official record of her memorable experience for keeps. I love the welcoming friendly ambience at school-the disco music playing on arrival on random days with the sports hall open for the use of 'jump ropes' and balls; the open canteen serving coffee and oat cookies and the sign in reception which reads: ' Step inside-its warm in here!'.

Peri-natal and Infant mental health: the importance of early beginnings

Spring is in the air in South Australia and whilst there may be a torrential downpour as I write, the native plants are blooming and the weather is a balmy 20-24  degrees most days.

Today I was invited to a ward round at a mother and baby unit in Adelaide by a psychiatrist I had met at the conference. It was a fascinating opportunity to revisit the importance of supporting the promotion of healthy  attachment behaviours in primary care and how these act as a blue-print for all subsequent significant relationships; from infancy, through childhoo, adolesence into adulthood. There a number of opportunities for intervention as GPs and this is an area which needs promotion. The staff were very accomodating and invited me to join in their traditional ward round refreshments which included pear nougat cake-beats NHS custard creams!

I also visited the South Australia museum and have started to  learn more of Aboriginal culture through the impressive display of material culture the curators, Elders and anthroplogists have gathered. Indigneous peoples have inhabited Australia for 50, 000 years; it is a rich culture which has been slowly and steadily  eroded but which we can at least honour and celebrate in its public display at the museum.

Sadly I am not able to upload any further images-more to follow soon. Goodnight! 

health and education for children in australia

Monday 11th Oct: My adventurous daughter Freya joins other school-aged children in S Australia to return to school after their October mid-break. She is now a fully fledged member of Parkside school and appears to be loving it-school in Auz is 'cool'. She's also sampling the After School club, the delicious healthy lunches of Megan and sports aussie style. Her new sports teacher described her as a 'lovely, happy child'. I'm a proud mum!
In the meantime I have been visiting the Northern Division  of General Practice in Elizabeth,a socio-economically deprived area of S Australia and attending a training day with the Emergeny Department staff at the Womens and Children's Hospital. Adelaide is an elegant city with gracious colonial architecture and the Torrens river dominating the centre . There is much to explore and our list for weekend jaunts grows ever longer .

 

hanging out with the region's child and adolescent psychiatrists in south Australia's wine growing valley....

The view from my room: the Barossa valley was stunning. as was the weather, the wine and the academic scientific programme. The theme was attachment and the effects on child development when it is ruptured but we were remined that there is always reparatory work that can happen. We saw examples of experienced masters of attachment theory in practice, learnt of the creative ways in which we can respond to distress and questioned our own forms of clinical work which at times benefit from being refreshed and re-examined.

I delivered my paper on Sunday morning to a responsive audience and was inspired by the level of interest in GP liason work which many colleagues expressed.

I also have a lovely anecdote to share regarding the legacy and life changing sequelae of  a Churchill Fellowship. The conference dinner was held in The Farm function centre, run by Maggie Beer's daughters, one of the most renowned  and loved Australian chefs. The conference chair invited Ellie Beer to speak as we took our seats and imagine my joy and amazement when she explained that her father had been awarded a Churchill Fellowship to learn how to raise pheasants which he had fruitfully put into practice in beautiful South Australia.Out of his labours had grown the gastronomic sucess of his wife and daughters, Ellie and Saskia Beer; who remeber Churchill reunions at Adelaide zoo. See Ellie below after having supervised a meal made in heaven and yours truly at the waters's edge of the restaurant lake.

The conference [RANZCP child2010] was a hugely enjoyable and intellectually stimulating 4d jamboree  for which I remain extremely grateful for the WCMT's award. Remember to check out the site http://www.wcmt.org.uk/

getting to grips with general practice Aussie style

Monday saw me having lunch with Dr Cate Howell, specialist GP (mental health), academic at DGP, UoAdelaide and co-founder of C&M consultancy. Now have a better grasp of the blended system which operates here and the (dizzying) heretogeneity of options for practice. Cate was very generous and has also offered me the use of her bolt hole at Gawla should time permit.

Tuesday I met with Dr Jon Jureidini and folk at the department of Psychological Medicine and learnt more about GP registrar education and mental health in the curriculum.I was invited to present a paper on the role of GPs in supporting the mental health and emotional well-being of children and young people which was well received and provoked a lively discussion.

Today Megan and I attended a lecture on 'the welfare quarantine: conditional social benefits and their effects on well-being' and then had a wonderful afternoon with the girls and Cameron getting to know the wildlife of Australia : kangeroos, emus, kaolas, bandicoots, potoroos and dingoes. The eucalyptus trees and mega-succulents were impressive, animated by the fairy wrens. The afternoon was topped by a drive to Mount Lofty and some incredible views of Adelaide and its foothills.

Just a quick line as its late. We took advantage of the spring sunshine on Sunday and hit Maslins' Beach-the clad section! and then enjoyed a  delicious BBQ dinner-Adelaide is a great foodie place.

I have more notes to add re meeting Dr Cate Howell on Monday-a bank holidays did not deter us from talking 'general practice and mental health'; and presenting at the Dept of Pyschological Medicine, Women and Children's Hospital, King William St today-I will up catch with further detail on Thursday.

 

In the meantime, good night from me and the possums who inhabit the garden at night

finally arrived

We have arrived in Adelaide-after 72 hrs travel, safe and sound to a cloudless blue sky and a warm welcome party comprising Megan, Freya B and Evie. The journey unfolded as predicted although being  offered red or white wine with spicy chicken curry for breakfast , care of Malaysian airlines gracious air hostesses came as a surpise!

We are settling into our new home in Myrtle Bank care of Megan and Cameron's kindness, and their two sweet daughters.Freya D has already met her new Head teacher, looking very relaxed as he hosted a family BBQ in the spacious school grounds.

Already I appreciate the warmth and informality of  South Australia with more to come I'm sure..