WayAhead

Mental Health - Education, Support and Prevention

Mindfulness, Meditation and Mandalas

Adult colouring books have become widespread in recent years, driving up book sales from one million colouring books sold in 2014 to 12 million in 2015 (based on US statistics).[1] Adults are using the simple, nostalgic pastime of their childhood as a way to relax, unwind and even to ease stress or anxiety.

Adult colouring books differ from children’s colouring books because they do not feature cartoon characters but intricate and repetitive patterns, such as mandalas, which encourage adults to focus on the process, not the outcome.

Despite the rise in adult colouring book sales, there is relatively little research into colouring therapy. In 2005, Nancy A. Curry and Tim Kasser (Knox College in Galesburg, Illionois) completed a study into whether colouring mandalas could reduce anxiety in adults.[2] The study used a test sample of 84 university students split into three groups to test the theory. One group was given a blank sheet of paper, another was given a mandala pattern and the third group, a plaid pattern to colour for 20 minutes. Stress and anxiety levels were recorded before and after the experiment.

Curry and Kasser hypothesise that colouring therapy combines both elements of art therapy and meditation as it helps individuals to organise their ‘inner chaos’ with structured, patterned lines.[3] Their results showed that there was little to no change in anxiety levels within the free-form colouring group, but interestingly, there were similar results of decreasing anxiety in the mandala and plaid patterned group. Curry and Kasser (2005, p. 84) surmised that the mandala and plaid patterns helped to decrease anxiety because they provided structure which drew participants into a meditative-like state.[4]

Wayahead spoke to Dr Stan Rodski about adult colouring books and play therapies. Dr Rodski is a cognitive neuroscientist and creator of the popular Colourtation Anti-Stress colouring books for adults. A combination of colour and meditation, Dr Rodski explained that Colourtation is backed by neuroscience-based research work of what happens in the brain when we focus on singular tasks such as colouring.Having worked as a therapist for corporations, he observes that adults are increasingly leading busy lives. He believes that the technological advances of today place too much focus on a computer screen and has made many simple tasks obsolete; tasks that were once considered relaxing and therapeutic, such as knitting.“It was not only a necessity but also very therapeutic to just sit there and knit because it’s got all the elements: patterns, repetitions and control. But now it’s easier to buy our knitting,” Dr Rodski said.

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In 2013 and 2014, Dr Rodski conducted an experiment with 522 executives to compare the effectiveness of the Colourtation method and a standard ‘mindfulness’ based stress program, focusing on breathing techniques. His study found that the Colourtation method provided a viable stress-relieving activity, as it was an easy activity to pick up and maintain over a 6-month review period, whereas other activities, such as relaxation breathing techniques, generally decreased in practice over time.

However, while colouring therapy is popular and trendy, it does not equate to the application of traditional mindfulness training in mental health treatment. WayAhead also spoke to Alice Shires, the Psychology Clinic Director at the University of Technology, Sydney and Head of the Mindfulness Integrated Therapies Research Clinic, who thought that the term ‘mindful’ is overused.

“I don’t think it is accurate to apply it to colouring or other activities that involve some concentration or focus and perhaps serve to assist relaxation… [It is] fair to say that the rapid increase in the use of mindfulness as a description for activities reflects the enthusiasm for it but, as it has become popularised, it has lost some of its meaning and has been overused for what might be better described as relaxation or concentration activities,” Ms Shires explained.“I believe for it to be used therapeutically, it needs to be very clear with what the rationale and mechanisms of change are.”Dr Rodski also supports a wider response to maintaining mental wellbeing, clarifying that colouring books were a therapeutic process, not a treatment for mental health.

“I am an advocate of meditation, yoga and traditional mindfulness techniques but in the lives of busy people, colouring was a quick way to relax when you don’t have an hour or so to spare. Just focusing on colours and patterns bring control and balance to the mind which achieves homeostasis – a meditative-like state,” Dr Rodski explained.

By Cindee Duong

[1] Statista, 2018, Unit Sales of Adult Coloring Books in the United States in 2014 and 2015 (in millions), viewed 30 January 2018, <https://www.statista.com/statistics/531094/adult-coloring-books-sales-usa>

[2] Curry, N. and Kasser, T. ‘Can Coloring Mandalas Reduce Anxiety?’ Art Therapy Journal of the American Art Therapy Association. 2005, 81-85, viewed 30 January 2018, <https://eric.ed.gov/?id=EJ688443>

[3] Curry, N. and Kasser, T. ‘Can Coloring Mandalas Reduce Anxiety?’ Art Therapy Journal of the American Art Therapy Association. 2005, 81, viewed 30 January 2018, <https://eric.ed.gov/?id=EJ688443>

[4] Curry, N. and Kasser, T. ‘Can Coloring Mandalas Reduce Anxiety?’ Art Therapy Journal of the American Art Therapy Association. 2005, 84, viewed 30 January 2018, <https://eric.ed.gov/?id=EJ688443>

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When local Indigenous communities lead the way – The Weave model

Nestled beside the skate park in Waterloo, inside a metal-encased building which looks like a piece of public art, is a dedicated team of people serving their local community. The building is home to Weave Youth and Community Services, a community-driven organisation that has quietly been going about its work for the last forty years.

Earlier this year, the organisation won a Mental Health Month Award in the Aboriginal Social and Emotional Wellbeing category for their Stories of Lived Experience project. Almost 65 per cent of their clients are Aboriginal or Torres Strait Islander.

Stories of Lived Experience was just one of the many projects that showed community members that Weave was listening and was committed to sharing their voices with others.

“It’s about working with clients and community. We have families here – as you see in the stories – with grandmothers now, who as a child, came through the service. Weave was there for them during their hard times, and their children went, and now their grandchildren are accessing the service. It’s about being in a community that has established that relationship. You see the story in the Lived Experience

“If it wasn’t for Weave, I wouldn’t know where I would be.” And you see people classing Weave as part of their family as well,” said Melissa Merritt, the Team Leader of the Creating Futures program.

“That project was an evaluation project across the programs at Weave and across the lifetime of Weave as well. We really wanted to do that to find out what had worked well and what more could we do. The only way to do that is to consult with the people who use the service,” Kylie, Fitzmaurice, the Team Leader of the Speak Out program, explained.

“It was so beautiful, the stories and the photos from the launch. Everybody who participated and who was interviewed had a beautiful portrait taken of them with their kids or with their grandmother or on their own. They were black and white and they were absolutely stunning. They were all hanging up where we had the launch. Some of my clients participated in the interviews and they just felt so empowered by that. It’s so important to give people a voice. There’s so much that needs to be said and taught to Australia about the Aboriginal story and the culture and that was a way to help them to be able do that, to give them that platform…It’s very moving.”

The work that Weave does is based on centring the clients wishes and their needs. Projects arise organically out of needs that have been identified by members of the community. Indeed, that is how the organisation first started in 1976, when local Aboriginal parents advocated for a youth service to support the welfare of their children.

“We have a bottom-up approach. People in the community are the experts of their own lives,” said Kylie.

“It’s about us, as workers, walking alongside our clients on their journey, not dictating to them what we think is needed for them. It’s about them telling us what they require, what their needs are, and working with them on whatever is needed on their journey to help them achieve their goals and overcome those barriers…It’s important that we listen to community. The community feed back to us. We have that rapport and trust that’s been established over forty years,” Melissa added.

The program Kylie leads, Speak Out, works specifically with young people to support and empower them to achieve their goals and deal with challenging circumstances. The young people involved with Speak Out have been dealing with both mental health and alcohol and drug conditions themselves or in their families. The program includes intensive casework and counselling but there are also a number of projects. These include outreach art therapy groups at mental health units, including ones treating eating disorders, groups at juvenile detention centres that focus on health and wellbeing, and a six-week pilot program at schools about good mental health.

“We don’t look at people from a deficit-based model, we look at them from a strengths-based model and how their strengths can help them to overcome the challenges they face and also help them experience life in a new way and themselves in a new way,” said Kylie.

This approach is something that also informs Melissa’s work. The program that she leads, Creating Futures, supports young people, aged 18 to 30, who have been incarcerated to reintegrate into the community. The young people and the team will sit down together to work out what is needed.

“Usually it’s simple things such as identification, Medicare, a bank account, applying for housing – a lot are homeless or living with family that have overcrowding within in their home – so we’ll advocate for them with Housing to sustain their own accommodation and tenancy…We find that a lot will engage with counselling with our psych in-house as well – we have the benefit of that here, within Weave – to address their years of addiction, the trauma within their family and what they might have been through as a child and what’s led them to where they are today.”

As with all of their work, the work that the team at Weave do more broadly in supporting mental health and wellbeing is also very much led by their clients.

“We don’t work in diagnoses here unless that person wants to talk in that language. Even in the little things, having the flexibility in language to speak about a person’s mental health in a way they feel comfortable and safe is so important – and so small, and so easy to do – but there’s quite a resistance inside, for example, the hospitals to speak in that language. I think it is changing which is great and I think that the trauma-informed movement is really beginning to gather up more people and that will become part of the really important and systemic change we need, to work with people and families.”

The way that Weave supports clients is heavily informed by the principles of trauma-informed care. The staff at Weave recognise that although they might not always know what has happened in the lives of their clients, there is an awareness of what they might have gone through.

“I think that’s been a way that we’ve always worked without necessarily being able to label it, but we can now. It means that we have the awareness of the trauma that our community has experienced over many, many years, it’s intergenerational and also the personal trauma, the racism that Aboriginal people experience daily,” said Kylie.

“You might not necessarily know the story but you need to have an awareness of what has happened to the people that we are working with, over their lives, and how it is impacting on their mental health and their journeys today…You don’t see a person for their problems, you see them as a human being who is amazingly resilient and who has had to survive lots of terrible things.”

The team do face challenges, often due to the wider structures within which they work, as well as a systemic lack of awareness of a lot of the circumstances that their clients are dealing with.

“It is very challenging working with the systems that we have to work within. A really big part of our work is advocacy, making sure our community has a voice and we do have to fight pretty hard sometimes just to get their voices heard. It’s a really exciting time right now to work in mental health because I think it is really changing. With advocacy, there’s a lot of system change. There’s a long way to go though,” Kylie says.

“I think there’s more awareness now than previously. Especially with things like celebrities and footy stars talking about it and acknowledging it,” says Melissa.

The changes that are being made in parts of the community sector, in recognising the importance of mental health and support for people beyond just diagnoses, is something that is key to Weave. The organisation’s ability to work with clients on what best suits each person, and helps them on their journey towards their goals, is a hallmark of what they do.

“We can be really creative in the work that we do and we can think outside the square. We don’t have to sit in the room to do counselling. If somebody loves art, we can take them to the art gallery and we can do our session on the art gallery lawn,” said Kylie.

“We meet them upstairs [in our rooftop garden] or outside or at a coffee shop,” adds Melissa.

“We know that the people we work with know what’s right for them. We’re just here to share our knowledge on how to get to those places that they want to get to. It’s a really beautiful place to work,” says Kylie.

http://www.weave.org.au

By Tasnim Hossain

 

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Enjoying Christmas with a mental health diagnosis: An insider’s view

Dylan is a volunteer at WayAhead with a lived experience of mental illness. Here he shares his insights into what it is like ushering in the festive season and how to make the most of Christmas.

Christmas is often a time for celebration. It can also be a time of stress, especially for those of us with a mental health diagnosis. Although there are many aspects of the holiday which we may enjoy, parties, shopping and presents can all contribute to stress.

Christmas parties are aplenty in the December period. More food and drink can be enjoyable but it is a well-known period of weight gain, so for me, it is important to be careful. Most people can enjoy parties but there are some of us, both with and without mental illness, who may be a little shy or experience social anxiety. Happy, friendly people can make us feel like we are a part of the celebrations.

Christmas shopping can be both enjoyable and expensive. I love to buy presents for those that I am close to. For some, they are able to afford the presents they wish to buy, but there are those with a major mental illness who may be receiving the Disability Support Pension. These people may struggle to pay for the things they want to give to their loved ones.  This can add to the stress. One way around this might be to make presents, especially for people who are good with craft or cooking, or to offer “gift vouchers” where people offer to do things like household tasks or teach a skill they might have.  People might appreciate having their lawn mowed or being taught how to play an instrument.

There are certain Christmas parties that may involve a Secret Santa, everyone buys a small gift of $5 or $10. You then give a present to someone else and choose one for yourself. It is a nice way of giving and receiving gifts without spending too much money.

Some of the Christmas parties I have been to in recent years, and will be going too again this year, involve a whole bunch of people. The managers, case workers and the clients of mental health services all get together at this time and have food and drinks together. It is a good chance to meet some of the other clients and case workers. I often see some of my old caseworkers which is nice, and lots of other people I have met along the way.

The Christmas period isn’t all about gifts and food. It is also a very soulful period. Many religious people will be attending church sermons and in general thinking about the time as a matter of the heart. I have met many religious people who have been diagnosed with a mental illness. They are very soft and kind people who care a lot about life and everything in it. They create a more serious tone to the mood of the period.

There is more to Christmas than just presents and get-togethers and religion. Some don’t believe in Christmas at all. These people may or may not celebrate Christmas but many do admit that they love it when questioned. For the children, there is always Santa Claus. This paternal figure of giving has warmed the hearts of many a child, possibly even yourself when you were young.

The malls are full of Christmas decorations that lighten up the mood when shopping. People catch up with old friends they might not have seen in a while. Everyone seems to be happier. It is a good period to be friendly instead of keeping to yourself like at other times of the year.

So Merry Christmas to all,
Dylan

 

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Kicking goals for mental health in AFL

The AFL Player’s Association (AFLPA) consider themselves leaders in the Australian sporting industry as a representative body for professional AFL players, whether they are male or female, currently playing or formerly played. Over the past 44 years the AFLPA has strongly advocated for AFL players and the broader community, contributing to many key milestones, like negotiating Collective Bargaining Agreements, and officially representing female AFL players ahead of the inaugural AFL women’s competition in 2016. Their contributions to the development of the game are significant, but it is their work on mental health and general wellbeing which elevates them to what many perceive as a leader among player associations.

There is a misconception that athletes are less susceptible to mental illness because they are seen as resilient and strong in their professional lives, or because of the wealthy, celebrity lifestyle that is assumed to come with being an athlete. However, a 2015 study of 224 Australian athletes found that the prevalence of common mental health disorders among them was comparable to the Australian public, with approximately one in four athletes considered to have a mental illness. Thus, it is important for the AFLPA to consider the mental health and wellbeing of their members as part of player welfare.

The AFLPA has a comprehensive range of services available for current and former players. They oversee an independent and confidential network of mental health clinicians and wellbeing practitioners that is readily accessible. They also work closely with AFL clubs who have their own internal resources – club doctors, player development managers, and in most instances their own club psychologist, to ensure the wellbeing of players are taken care of.

AFLPA also focuses on transitioning retiring AFL players into the wider world. Athletes often struggle with life after sport as they lose the sense of identity they significantly invested in for the first 20 to 30 years of their lives.

Despite the comprehensive offering AFLPA provides for players, there is only so much they can do. Mental health and wellbeing are often ignored by players themselves due to the perceived stigma of mental illness, and their fears about the potential impact on their job security if disclosed. As a result, these services are often underutilised.

“Players are not always willing or ready to make use of these services, and that’s the challenge we [AFLPA] face.” Brent Hedley, AFLPA Mental Health and Wellbeing Manager, said.

“We try to focus on educating players and providing preventative services, but often players are coming to us on the reactive end of things. We’re trying to change the conversation in getting guys to engage in it on a more proactive level.”

The AFLPA are working towards improving the mental health literacy of players, highlighting the benefits of being open and supporting help-seeking behaviours. With some of most celebrated players sharing their mental health struggles, such as Lance Franklin in 2015, the conversation about mental health is gradually changing for the better.  AFL is one of the biggest sports in Australia, so the AFLPA hopes to use the players’ stories as a platform for change in the broader community.

“We have a real alliance with the industry’s stakeholders, so we hope that with the relationship we have with our players, we can use their profiles to raise awareness and understanding.”

An example of such is Better Out Than In, a digital campaign developed by the AFLPA, beyondblue, the Movember Foundation, and MATES in Construction. Aiming to reduce the stigma associated with depression, it is a website housing a series of personal stories of construction workers and AFL players. AFLPA hopes to reframe the conversation, highlighting openness, acceptance and hope, instead of shame, stigma and secrecy.

Not only is the AFLPA responsible for the players’ role within the game, but they invest significant resources for the mental health and general wellbeing of their players. They hope with time that the conversation amongst players and the broader community, about mental health is no longer stigmatised but, rather, celebrated

By Johnny Wang

The possibilities of virtual reality in treating mental illness

Virtual reality (VR) has recently exploded into the consumer world with devices like the HTC Vive, Oculus Rift, and Samsung Gear. It refers to the complete immersion within a virtual environment, so that users are able to virtually move, touch, and experience various stimuli. Popularised within the gaming industry, VR has enabled gamers to control virtual characters through their own physical movements, allowing a deeper and more immersive experience with the game. However, the increasing accessibility of VR has also opened up other possibilities and applications that were not previously tangible.

VR has allowed for more accessible and novel methods for treating different kinds of mental health issues. Cognitive-behavioural therapy (CBT) is typically used for the treatment of anxiety disorders. A vital component of CBT requires patients to undergo exposure therapy in order to confront stimuli that trigger their anxiety or phobia, whilst preventing the use of defence or safety mechanisms. There are an endless number of situations where anxiety can arise, such as social situations (interviews, public speaking) and phobias (fear of heights, spiders, small spaces), so creating real-life environments for exposure therapy can be extremely inefficient and impractical.

VR technology overcomes these limitations by providing patients with a fully immersive environment, albeit, virtual in nature. Penate-Castro et al. (2014) analysed the efficacy of CBT with VR exposure compared to CBT alone amongst patients suffering from chronic agoraphobia. The VR component of this study involved exposure to four virtual environments, including an airport, elevator, beach and carpark, which caused the patient the most anxiety. Penate-Castro et al. (2014) found that both treatments showed significant clinical improvement post-treatment and six months later. The interesting findings were the treatment dropout rates of CBT against CBT with VR exposure. Of the thirty patients undergoing CBT alone, sixteen out of thirty patients dropped out (53.33%), as opposed to only seven of thirty patients dropping out of the CBT with VR exposure treatment (23.33%). Greater adherence rates within the VR exposure group suggest that the approach was less confronting for patients, whilst still providing significant clinical improvement in anxiety levels. These findings have also been supported with studies involving patients suffering from social anxiety disorder (Bouchard et al., 2017), post-traumatic stress disorder (Rothbaum et al., 2014), and schizophrenia (Rus-Calafell et al., 2014).

The possibility of significant clinical improvement in CBT treatment with VR exposure is promising. Virtual environments can be developed and tailored to a patient’s specific needs, as opposed to real-life scenarios where there are variables that cannot be controlled. Furthermore, it appears that using a fully immersive virtual environment does not lose any of the vital components required for exposure therapy, suggesting that VR is just as effective for treatment. As a result, utilising VR technology can be significantly more practical, cost-effective and time-efficient.

Although there is significant evidence to support use of VR for exposure therapy, there is limited evidence for its use in treating other mental health disorders. To date, there are only two studies examining the use of VR and depression (Shah et al., 2015, Falconer et al., 2016), both preliminary studies examining whether VR can be utilised as a medium. VR has also been used to treat eating disorders, with the idea that VR can help with body image, but so far, such studies have not been considered methodologically sound (Freeman et al., 2017).

Considering that VR has only recently gained popularity and widespread use, more time is needed before we can utilise the technology as an effective medium for the treatment for mental health. However, the practicality, effectiveness and cost efficiency of VR provides a promising outlook on delivering significant improvements to mental health.

By Johnny Wang

 

References

  1. Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., … & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. The British Journal of Psychiatry, 210(4), 276-283.
  2. Falconer, C. J., Rovira, A., King, J. A., Gilbert, P., Antley, A., Fearon, P., … & Brewin, C. R. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. British Journal of Psychiatry Open, 2(1), 74-80.
  3. Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 1-8.
  4. Peñate Castro, W., Roca Sanchez, M. J., Pitti González, C. T., Bethencourt, J. M., de la Fuente Portero, J. A., & Gracia Marco, R. (2014). Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia. International Journal of Clinical and Health Psychology, 14(1).
  5. Rothbaum, B. O., Price, M., Jovanovic, T., Norrholm, S. D., Gerardi, M., Dunlop, B., … & Ressler, K. J. (2014). A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans. American Journal of Psychiatry, 171(6), 640-648.
  6. Rus-Calafell, M., Gutiérrez-Maldonado, J., Ortega-Bravo, M., Ribas-Sabaté, J., & Caqueo-Urízar, A. (2013). A brief cognitive–behavioural social skills training for stabilised outpatients with schizophrenia: A preliminary study. Schizophrenia research, 143(2), 327-336.
  7. Shah, L. B. I., Torres, S., Kannusamy, P., Chng, C. M. L., He, H. G., & Klainin-Yobas, P. (2015). Efficacy of the virtual reality-based stress management program on stress-related variables in people with mood disorders: the feasibility study. Archives of psychiatric nursing, 29(1), 6-13.

 

Four ways to work mindfulness into a daily routine

Anxiety and stress are common emotional reactions experienced every day but they can become detrimental to a person’s health if they are not dealt with before they become too overwhelming. Mindfulness is a meditation technique that can help manage anxiety and stress. Research has found that practicing mindfulness produces beneficial effects for psychological and physical functioning (1), and so is often incorporated as a vital component of various psychological interventions, like Cognitive Behavioural Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR).

Mindfulness is the state of being present and aware when experiencing your surroundings. It involves keeping a level-headed and non-judgemental perspective whilst processing your thoughts, emotions, and sensations of the things around you. Mindfulness is said to be an inherent human ability but it requires practice to be able to utilise it as a form of meditation.

Mindfulness meditation doesn’t require any additional resources; you only need yourself and a bit of time. Next time you’re feeling overwhelmed and you’re struggling to focus, here are a few mindfulness techniques you can use:

  • Focus on how you are walking, on how your body feels relative to the ground. Remember to stay in the present and let any lingering thoughts go. As you breathe, be aware of how the wind brushes against you while you walk. Notice the sights and sounds of your surroundings, like the cars and other pedestrians going past or how the sky appears.
  • Lying down before bed. Pay attention to your body relative to the bed. Notice how the blanket covers you, how your clothes feel on you. Focus on how your breath goes in and out of your nose.
  • Next time you have a meal, imagine as if it is the first time you are having this meal. Take in the flavour combinations, texture, smells, and appearance of the food. Focus on the muscles used to move your mouth while you chew.
  • Brushing your teeth. Focus on getting to all corners of your mouth. Feel the bristles brushing against your gums and teeth. Notice the sounds you make as you brush, how fast and slow your brush strokes are at each angle.

These are all examples of being mindful of what’s around you. It allows your mind to focus on the present, so that other stressors and thoughts can’t intrude on your mind. By focusing on the task at hand, the build-up of anxiety or stress cannot overwhelm you as you are not giving any focused attention to them. There will be wandering thoughts unrelated to the task that will come by. It is important that you acknowledge that they are there, but to let them pass without too much thought and judgement. It can be quite an effort and exhausting in the beginning to avoid overanalysing everything when you try to be more mindful. It is important to remember to only be aware of such things, and not think about what, why, and how these things have come to be.

Mindfulness is a unique form of meditation. Rather than striving to empty yourself of thoughts or channel your spiritual mind, its aims are to pay attention to the present, or task at hand. It can be more useful compared to other forms of meditation because of its practicality. You can apply mindfulness to a task at work, conversation you are having with a friend, or even when you have some alone time at home.

App:

Smiling Mind – a modern app with creative ways of mindfulness meditation. You can track your progress as you continue your mindfulness journey.

 

 

 

By Johnny Wang

 

References

  1. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on psychological science, 6(6), 537-559.
  2. https://luria.ucsd.edu/xmca/attachments/1905/mindfulnessmediation.pdf

Reflections from five years leading the NSW Mental Health Commission

During July, WayAhead, Being and Mental Health Carers NSW hosted a farewell lunch at the joint Collective Purpose office for outgoing NSW Mental Health Commissioner John Feneley.

Before the lunch Mr Feneley spoke to Mental Health Matters about his time as Commissioner, a role he has held since July 2012, and the achievements of the Commission in that period.

John with Liz 2017

“Our first big achievement was producing Living Well, the strategic plan for mental health in NSW. That was what the Mental Health Commission Act legislation told us we had to do first. We asked more than 2000 people around NSW – including 800 people with personal experience of mental illness – what needed to change in the mental health system and how, and it was the most inclusive consultation on mental health ever done in NSW. That is something I remain proud of. The NSW Government accepted the plan in 2014 and so all those voices are now guiding Government decisions and funding.

John with Liz and Sharon at the WayAhead Workplaces 2016 Annual Forum

“I’m also really pleased to see that some key areas that we identified in Living Well have made tangible gains in the five years I’ve been Commissioner. Suicide prevention is a big one – when I started there were a lot of people working very hard to save lives but the left hand didn’t always know what the right hand was doing. Some of the things the Commission has done, like funding the proposed Suicide Prevention Framework for NSW and forming the Suicide Prevention Advisory Group, are not things the public has necessarily heard about. But they have helped make suicide prevention in NSW more coordinated and I believe we’ll see evidence in the next few years of lives saved because of that effort.”Workplace mental health and wellbeing is another area where Mr Feneley has seen significant improvement, particularly when employers have taken a leading role in creating and implementing wellbeing programs.

“Workplaces are a wonderful example of where the message of mental health and wellness has community benefits too, because people take what they have learnt at work about mental health and wellbeing into their home lives, leading to a community change.

“The work that WayAhead has been doing in this sector for years now is just tremendous. WayAhead has been able to work with employers and workplaces to help their staff return to work and not leave unnecessarily or early. These are all key elements in ensuring the health of employees and the health of the business.”

Mr Feneley emphasised that much of the work the NSW Mental Health Commission has done since its creation has been about empowering people with lived experiences of mental illness and their carers to be more involved and informed about their condition and treatment options.

John presenting at the 2016 Mental Health Matters Awards

“How do we help people have self-agency? How do we help people feel like they can have a conversation with their doctor as an equal? How do we change the system so that it supports people to identify and achieve their own recovery goals? A lot of our projects, like the review on medication and mental illness and our carers’ forum this year, are about exactly those issues.

“Someone who has been a carer for five years for their son with schizophrenia, for example, will have a terrific understanding about medications, about their son’s needs, about what works for them and what doesn’t. Yet I commonly meet carers who have been caring for 10 years and say that no one has ever had a proper conversation with them about this. We want to get it to the stage where the clinicians will work with the person with a lived experience and their carer at the time of treatment. We want clinicians to think of best practice as when a consumer or carer asks for help, clinicians respond by saying ‘we trust your judgement and understanding of the situation and we want to work with you on a path to recovery’.”

John at the WayAhead Mental Health Expo in Chatswood 2017

Looking ahead, Mr Feneley acknowledged the next few years are likely to be a time of even more change for the community-managed mental health sector.

“With the National Disability Insurance Scheme (NDIS) rolling out it’s a time of big reform and uncertainty, and we will all need to be watching closely to see what happens. The work of the mental health peak bodies like WayAhead, Being and Mental Health Carers NSW has perhaps never been so important.”

Mr Feneley finished his term in August 2017 with former Deputy Commissioner Catherine Lourey succeeding him.

By Benjamin Graham

Responding to refugees’ mental health needs in South-West Sydney

Fairfield is best known for its vibrancy and diversity of its residents, with a large proportion having a migrant background. Migrants have continually gravitated towards Fairfield for its long history of providing a home and a community for migrants. Since 2006, Fairfield City Council has welcomed 10,484 humanitarian entrants – the most of any local government area in NSW and almost double the number in Liverpool, according to the Settlement Reporting Facility of Department of Social Services.

In September 2015, the Australian government announced that it would resettle an additional 12,000 refugees in addition to the Refugee and Humanitarian Program, as a response to the global refugee crisis. It was estimated that about half of this special intake would be resettled in Fairfield, a suburb of about 18,000 people in the south-west of Sydney.

WayAhead spoke to Professor Newman about the challenges that refugees have experienced including trauma and trauma-related depression or stress when settling into the community, as well as the necessity for increased resources to respond to their needs.

“I have seen the whole spectrum of mental health issues displayed by refugees. I think they are very poorly understood and need more dedicated trauma-related mental health services because the impact of fleeing their homes for another country can be very damaging and long-term,” Professor Louise Newman explained.

Professor Newman has a background in child psychiatry, and worked with child refugees in south-western Sydney when she was conducting research around children and their mental health. She also worked with the Immigration Department Advisory Committee in 2013, working on reforms with the immigration policy amid growing concerns about offshore processing and detention centres.

“It is hard for refugees to reintegrate within society with these mental health issues. Some people come from certain countries and may not understand what mental health services are. They may not have had access to such support in their countries of origin but many refugees will accept mental health services if help is offered.”

Currently, all newly-arrived humanitarian entrants are eligible to receive initial, intensive settlement assistance through the Humanitarian Settlement Services (HSS) program in their first year of arrival. The services provided to help refugees settle in Australia generally include linking them to community programs to get assistance with finding accommodation and registering with schools, banks, Centrelink and other social services. When refugees show a need for mental health services, HSS may refer them to the Department of Health which offers the Programme of Assistance for Survivors of Torture and Trauma (PASTT) and NSW Services for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS).

STARTTS has a state-wide reach and provides a variety of services to refugees with a background of trauma. Their services include a balance of both community development activities and clinical approaches.

“We acknowledge that trauma impacts on individual’s ability to participate in their community and on the community’s ability to support individuals and families,” said Jasmina Bajraktarevic, the Community Services Coordinator of STARTTS. “We believe that intervention at any level of social system will have impact on the community level and will contribute to community strength.”

CORE Communities Services, a local organisation dedicated to refugee advocacy and policy work, assists refugees in navigating the Australian system including finding housing, employment, education and recreational activities to increase their social connections.

“I think there should be both investment in indirect and direct services addressing mental health for refugees. We plan activities to help refugees be more connected to the community, for example, excursions to different places of interest, like museums, or hold sporting activities that have great recreational benefits. These activities and outings have positive effects on refugees’ mental health as they are able to form social bonds and participate in the community,” explained Morlai Kamara, the Community Development and Policy Officer at CORE.

However, with the recent intake of resettlements, Fairfield is struggling to provide adequate resources for resettlement in such a short timeframe. “Indeed, [this is] five times our average annual settlement rate,” a spokesperson for Fairfield City Council said. “This translates into extraordinary pressure on the numerous community services and charities who are approached to help the new arrivals.”

“Immigration is a Federal Government responsibility and the settlement of refugees and migrants across the country is a national matter that requires open dialogue and action from the top tier of Australian government,” the Council said.

Demand for services is high with organisations having to expand to meet the need. Last year, STARTTS opened a new office in Fairfield in response to the growing demand for mental health services. In spite of increased pressures, the community in Fairfield remains open to resettling refugees and many non-government organisations continue to respond to their needs.

By Cindee Duong

The impacts of unemployment on youth mental health

Caught in the cycle of ‘need experience to get a job; need a job to get experience’, mental health issues such as stress, anxiety and depression are rising alongside unemployment rates – and young Australians are among those who are the most affected.

The Participation, Job Search and Mobility survey conducted by the Australian Bureau of Statistics (February 2016) shows that around 819,400 people were unemployed at the time of the study.(1) A closer look reveals that of the 819,400 unemployed, 15% were aged 15 to 24 years and 21% were aged 25 to 34 years.

In 2015, Roy Morgan Research also released findings that found that as the youth unemployment rate rose, mental health issues among young people simultaneously rise.(2) The key findings in that report showed that there had been a 9.7% increase in rates of stress as well as 8.1% increase in depression amongst young Australians since 2010.

The Group Account Director of the Roy Morgan Research, Angela Smith, said that the mental health impacts of unemployment for young Australians were severe.

“At this critical stage of a young person’s life and career, failure to find a job can have serious implications on their self-esteem and general mental health. It is not coincidence that stress, anxiety, depression and even panic attacks have sky rocketed in incidence over the past five years among 18-24 year olds as unemployment rises.”

Looking at the Foundation for Young Australian ‘The New Work Order’ report, the situation looks even more challenging because young Australians (aged 20-24) are about to face the biggest disruption to the workplace since the industrial revolution.(3) Young people will be disproportionately affected by digital disruption and automation, with the report suggesting that 70% of entry-level jobs are at risk of automation while 60% of young people are currently studying for jobs that will be affected by automation.

High unemployment rates, coupled with the growing mental stress and anxiety from unemployment, mean that young people are even more vulnerable to being locked out of the workforce. Young Australians are staying longer in education and are more qualified but are unemployed or underemployed.

Raise, a youth mentoring foundation, offers best-practice mentoring programs for students in high school who are at risk of disengaging with education. The Career Program was piloted earlier this year featuring soft-skills based workshops in partnership with mentors from corporate companies. These workshops focus on setting goals, interview skills and career planning.

The Program Officer, Jenny Moulder, said the Career Program hopes to empower young people to become resilient, capable and connected through workshops.

“It makes a really big impression on the students because some of them have actually never been to the city before so they get to see the options available to them…They feel much more confident than before in their career choices for life after school.”

Ms Moulder understands that more young people are likely to experience anxiety, whether due to their personal circumstances or uncertainties regarding their futures.

“At the heart of what we do is that we know suicide is the biggest cause of death for young people and we don’t want a young person with mental health difficulties to get to that stage where they think of suicide as an option. We want them to think ‘you know what, I’m not okay but I will speak to someone about this’.”

If you are a young person experiencing distress or if you are concerned about your mental health, please contact Kids Helpline on 1800 55 1800 or Lifeline on 13 11 14. You can also take a look at their websites at kidshelpline.com.au or lifeline.org.au

By Cindee Duong
  1. http://www.abs.gov.au/ausstats/abs@.nsf/0/49A83FBC3DF528CACA257FD800129321?Opendocument
  2. http://www.roymorgan.com/findings/6244-rising-youth-unemployment-increasing-anxiety-stress-depression-201505220539
  3. http://www.fya.org.au/wp-content/uploads/2015/08/fya-future-of-work-report-final-lr.pdf

Cabramatta Mental Health

For many years, Cabramatta was known as the heroin capital of Australia. Crime on the streets was rife, so was racism, and people were scared. I have many memories of wanting to play in the park but not being allowed to because there were needles on the ground.

There are lots of those stories in the media, and elsewhere, but there is also an untold story. One about the community’s mental health.

A Little History…

Before Australia opened its borders, there were only about 700 Vietnamese people living in Australia, mostly tertiary educated students or wives of the Australian Defence Force from their time during the Vietnam War (Department of Immigration and Citizenship, 2014).

But by early 1980s, the Vietnamese community had multiplied exponentially. Currently, there are about 190,000 Vietnamese immigrants (Census of Population and Housing, 2016) now living in Australia. In particular, Cabramatta is home to the largest concentration of Hoa Vietnamese immigrants in southwest Sydney. Hoa Vietnamese people are a minority group in Vietnam with Chinese ancestry, with which I personally identify. Since the fall of their government to the Communist regime in the 1970s, about two million Vietnamese fled their homeland by boat in search for freedom.

One of their destinations was Australia.

Cabramatta Mental Health Issues

According to the Australian Social Trends 2014 Report (ABS, 2014), a total of more than 20,000 residents were born in Vietnam and are now living in Cabramatta and surrounds. It is the third-most populated local government area of Sydney and the fourth-most disadvantaged.

Since leaving Vietnam, some Vietnamese people have been through war, violence, isolation, racism, stress and difficulty adapting to their new country. Looking back on its history, it is unsurprising that existing mental health studies of Vietnamese refugees have found to have high levels of depression, anxiety and post-traumatic stress disorder (Hinton et al, 1993). The Fairfield City Health Framework 2012 reported that Fairfield City residents have high incidences of suicide, mood disorders and other mental health issues.

But interestingly, this is not reflected in their access to mental health services where it was reported in the 2009-2010 Social Health Atlas that Fairfield City residents accessed psychiatrists at a much lower rate than elsewhere in Sydney.

Dr David Rouen, from the Bankstown Anxiety Clinic, treats two major cultural communities: the Vietnamese and the Arabic. In his experience, considering the long history of trauma and displacement, the Vietnamese community is very underrepresented in the clinic. He believes that psychological treatment does not fit well with their cultural understanding as it is traditionally not acceptable to seek out treatment for things such as anxiety disorders.

Because of this, patients often misdiagnose themselves. Dr Rouen explained that sometimes when a patient is having a panic attack, they will call the ambulance, believing that they are having a heart attack. Once the hospital confirms that their heart is fine, then that is the end of that. They cannot see that their symptoms could be anything other than a physical illness.

“Sometimes the only way we get into contact with the Vietnamese community is when their doctor or GP has to convince them to go but by the time that they do, we find that it is a much more severe psychological illness,” explained Dr Rouen.

It is hard for a community to see an invisible mental health issue when they often have more pressing matters at hand such as work or family responsibilities and teaching their children not to play with things they find on the ground. Dr Rouen also often wondered if the underrepresentation of patients could be attributed to their work ethic and strong sense of self-diligence as the Vietnamese community prioritise their work and family responsibilities over engaging with their mental health.

Barriers

I asked my mother recently, what she thought mental illness was, or whether she knew anyone with depression or anxiety. I struggled to describe the conditions to her and she struggled to understand me.

There is relatively little research into Vietnamese communities utilising mental health services in Australia, contributing to a greater cultural divide and miscommunication. I found a study into the research of the characteristics of Vietnamese patients attending an anxiety clinic in Australia and it found that Vietnamese people did not differentiate between concepts of ‘stress’, ‘anxiety’, and ‘depression’, believing that they were synonymous with each other (Wagner et al, 2006).

Like my mother who came to Australia from Vietnam, many Vietnamese people have very traditional beliefs about mental health – that it is a shameful and humiliating thing that must be kept hidden within the family for fear of ‘losing face’.

‘Losing face’ is an interesting concept; it means losing pride or respect and it is seen as a weakness – it is a shameful, dishonourable thing to admit that you need help. Social stigma has a strong hold and Vietnamese families prefer to hide their mentally ill family members until the problem becomes severe and professional help is needed (Chiu, 1994).

Apart from internalised stigma, external factors such as a lack of cultural awareness can also hinder communication (Sozomenou et al, 2000). According to one study, consumers thought that health professionals generally lacked cultural awareness when dealing with a diverse community.

Overcoming Barriers

Some of the barriers could be overcome by addressing the lack of knowledge about mental health services within the Vietnamese community. Transcultural Psychiatry (Wagner et al, 2006) suggests that by educating the community on these issues, including doctors and primary carers, would lead to better identification and treatment of mental illness. It is through education and awareness that mental illness can be destigmatised and understood.

In a western society, there is a reliance on the western biomedical model which is based on biological factors to the exclusion of environmental and social factors. This model, while very successful in treating illness in most western countries, could be incompatible or inappropriate for certain cultures. (Sozomenou et al, 2000).

It is also very important to have trained bilingual staff and interpreters who are able to overcome language and cultural barriers as they encourage more access to mental health services for those who share the language (Sozomenou et al, 2000). Jacky Yeung, a Fairfield Community Mental Health nurse, believes that their capacity to accommodate patients with a migrant background by having bilingual workers allows for better communication and engagement. Without this bridge, Mr Yeung says there are wild misconceptions about the mental health industry.

“Unfortunately, what I find with the Vietnamese community is that if there was no hospital or police involvement then we won’t know about what is happening; they tend to hide it within their family and we don’t know about it until something big happens because they think don’t trust mental health services. . . They think that they are being experimented on or that we are conspiring against them,” he said.

Concluding Thoughts

On a Sunday afternoon in December, we celebrated International Human Rights Day in Cabramatta. Many Vietnamese people came on stage in true Vietnamese style, took hold of the mic and belted out songs about their suffering and anguish since the fall of their country. While not understanding much of the lyrics, I could hear the emotions flowing through their words and heartbreak through their falsetto. This says to me that the community in Cabramatta is still recovering from their history and they are still dealing with their mental health.

But I also understand now that this community is dealing with its mental health every day but in a variety of different ways. They like community gatherings and they like karaoke.

From my findings, it is clear that mental health services are not very popular, but it is still important to provide access to such services that cater for this community because they experience mental health issues just as any people of any culture would. With continual training for professional staff alongside education and awareness in the community, Cabramatta will know where to seek the help it needs.

By Cindee Duong

 

Bibliography
  1. Sozomenou, P. Mitchell, M. H. Fitzgerald, A. E,. Malak, D. Silove. Mental Health in a Culturally Diverse Society. National Mental Health Strategy, Mental Health Consumer Participation in a Culturally Diverse Society 2000, 89-131.
  2. Australia Bureau of Statistics, 2014, Australian Social Trends 2014 Report, viewed 11 September 2016, < http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features102014>
  3. Department of Immigration and Citizenship, Community Information Summary: Vietnam-born, Commonwealth of Australia 2014, viewed 17 September 2016, <https://www.dss.gov.au/sites/default/files/documents/02_2014/vietnam.pdf>
  4. Fairfield City council: Social, Health and Housing, 2012, Fairfield City Mental Health Framework, viewed 30 September 2016, <http://www.fairfieldcity.nsw.gov.au/downloads/file/384/fairfield_city_health_framework>
  5. R. Wagner, V. Manicavasagar, D. Silove, C. Marnane, V.T. Tran. Characteristics of Vietnamese Patients Attending an Anxiety Clinic in Australia and Perceptions of the Wider Vietnamese Community about Anxiety. Transcultural Psychiatry 1996, 259-271.
  6. W.L. Hinton, J.D. Chen, C.G. Tran, J Miranda, S. Fraust. DSM-III-R Disorders in Vietnamese Refugees: Prevalence and Correlates. Journal of Nervous and Mental Disease 1993, 1113-1122.

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