Leah Wiseman: Hi, I'm Leah Wiseman and welcome to Episode One of our Albury Wodonga Health well-being and resilience podcast series - to help keep people connected, share our community stories of hope and resilience, and provide information about mental health and local services.
2020 has started like no other year in our memory. First the bushfires that impacted our community in so many ways, and now the local impact of the global COVID-19 pandemic. Today I'm joined by Russell Maher, and Renee Murtagh to talk about the roles they have with the Albury Wodonga Health mental health service, and how the unprecedented start to 2020 has had an impact on the work they do in our local community.
So I thought we might start with having both of you talk about your role.
Renee Murtagh: Thanks Leah, I'm Renee Murtagh. I work at integrated primary mental health service, and I'm a Mental Health Nurse and my role is as a Rural Access Clinician. So, I spend a lot of time traveling around the countryside and going and seeing people who have mental health concerns in the more rural and remote parts of our area.
Russell Maher: And I'm Russell Maher. I also with Primary Mental Health Service. I’m a Mental Health Nurse Practitioner, and my role is rural and remote access, as well as doing some health promotion activities.
Leah Wiseman: So when we know things happen, like has been has been the events of the start of this year, there's impacts for not only your work but also your personal life - where you live in the same community that your work takes place. I was hoping both of you might be able to just give us a quick idea of how the events of the start of 2020 have impacted you personally.
Renee Murtagh: Yeah, absolutely. I live in Wangaratta and have a farm there, but I also have a farm in the Upper Murray so when the fires started there was certainly a lot of stress for us around our property and whether the fire was anywhere near us. Luckily our property was okay and didn't burn. But, yes, certainly, whenever there's any kind of big event that happens in our region as a mental health worker we certainly are part of the community.
Russell Maher: I live rurally and have been affected by fires twice in my lifetime so far. Significantly it’s been nothing like what has just occurred. And I think was very early in the piece as a CFA Volunteer when I was in the back of a fire truck up in the Upper Murray, realising that it wasn't going be very long before I was off that fire truck and having to provide a service to those fire effected communities.
Leah Wiseman: So you know that that Russell's literally being on the fire track thinking about the impact this was going to have on your role within the mental health service. Can you tell us a bit about the specific impact these series events have had on the way that you deliver your service?
Russell Maher: I think when we talk about the insults that communities experienced, you know, having a devastating fire, as this was, and then to have the Covid virus soon or arrival has affected the way we provide a service. A lot of a lot of work is done around community development, things like that. Well, since the level three lockdowns large groups of people aren't allowed to congregate and when you use that as one of our platforms for delivering service, we lost one of the one of the key engagement tools to make communities healthy again. So it's been very much now an individual based service, which we provide anyway, but I can't wait for COVID to lift so we can actually roll out some of the some of the programs that we now have been affected in the past.
Leah Wiseman: Can you think of a particular instance where you thought fire recovery stuff’s gonna go back burner for a bit, for us to be able to focus on the issues at hand related to COVID-19?
Russell Maher: I think because we saw services having to withdraw for safety reasons, I think that that's when it was really reinforced in a thing called The Recovery Hub - where all services used to sit - and when it was decided it had to close for the health and safety reasons, I think that reinforced that this community was going to experience some significant difficulties. And the fact that people may feel like they've been left behind, but no one really cares because something bigger has taken over. I don't think that's an unusual phenomena in regards to fires because I think now we do a really good job of providing a lot of services in the first six months, and then you see those dwindle reasonably quickly but things such as Blaze Aid and Rotary and those fencing contractors that are helping with fencing, several people I've spoken to have said that was, you know, how are we going to do this on our own. They needed that community support and the support of those organisations who do a marvellous job.
Renee Murtagh: Unfortunately in our jobs, and in our region, Russel and I've had a fair bit of experience with bushfire recovery. Having worked after the 2009 bush fires in recovery as well, I guess we were thinking that all our learnings from 2009 we can apply to the 2019/2020 fires. But it's significantly different now because of COVID so we've had to really think outside the square a bit when it comes to how we deliver that service and, as Russell said, the individual counselling and catching-up with people can still continue but the way we've always assisted communities with getting back on their feet is by encouraging social gatherings and get togethers.
Russell Maher: And I think the methods of delivering service now have changed significantly we've done video conferencing, more health conferencing and we've always we've had a telephone service for quite some time - we've been able to use that - but a lot of rural people have to see face-to-face. I think one of the things that has been a breath of fresh air for us is that we haven’t withdrawn from that community. We have put in significant safety measures, but we are still providing an in-person service to the Upper Murray.
Leah Wiseman: You mentioned Russel about not wanting for people to feel like they've been left behind or forgotten about. Have you had anyone articulate that to you?
Renee Murtagh: yeah look, anecdotally I guess there's different opinions around that. So there's some people that are taking this time to, you know, take a breather and have some downtime and quiet time with their family. But there's other people that obviously still need their fences built, you know, still have building works that need to commence, and they're really frustrated with the lack of face to face.
Russell Maher: I think what you find after any natural disaster, and this has been a big one that people run on adrenaline for a period of time. When that adrenaline peters out, which it does, ultimately people then saying that they can use that time more beneficially with their families and things like that is not always the case, it is for some, but for a lot of people I know that they fall into probably some habits which aren't useful. Alcohol consumption across the state has gone up just through COVID, and I would suggest that after the bush fires and in this period that alcohol consumption probably has increased but I don't have that particular evidence to prove that we just know that bottle sales are up.
Renee Murtagh: Yeah and previous research after the 2009 fires showed that there was an increase in alcohol consumption, but also in family violence, because the interpersonal relationships tend to be the things that suffer a great deal when people are stressed because, you know, we tend to need to vent to somebody and unfortunately not everyone does that in a way that's helpful.
Leah Wiseman: And we were talking before the podcast about the power of people's thoughts at times like this and, from what you're saying, this increased time for people to be alone with their thoughts you both have used Acceptance and Commitment Therapy as a way to work with people around that. Can you give the listeners some idea of what that is?
Russell Maher: I’d say you'd fit it into the, what we'll call the more popular psychological strategies at the moment, and they are reasonably focused. A lot of people will be familiar with cognitive behaviour therapy. Acceptance and Commitment therapists takes those very useful tools out of cognitive behavioural therapy, and some that we find much more difficult to enact probably excludes those. If you talk to a true behavioural therapist they might probably disagree with that, but I find it particularly useful psychological strategies, given that they are very common sense. And when we explain these to people we actually say that Acceptance and Commitment Therapy is, they're just good life skills, and I've been using it in the rural environment for a long period of time. Some people will accept that some people won't. I think what does get misinterpreted in that is, it's about happiness and Acceptance and Commitment Therapy is really about making, putting meaning, and fulfilment in your life as best you can, and knowing that these things aren't perfect because your mind is too powerful. I think that's, you know, you might learn these skills and do really well at them and the more you practice, the better you get at those. But at the end of day your mind is so powerful that it will lead you up a memory path at any time. And so for those people listening to this podcast at home and say ‘god, what’s this bloke on? What’s he talking about?’ I have some of my older farmers who sort of glazed over but I think we sell ourselves and what we have to offer in a way that makes it palatable for most.
Renee Murtagh: I was just thinking then Russell, when you're talking about, you know, farmers looking at you with that look on their face that, from what I've heard Acceptance and Commitment are more palatable terms though than cognitive and behavioural, and so there is that ability to make sense of at least even the acronym in more of a day to day way then there might be with CBT.
Russell Maher: Yeah I think you're right there, I think that one of the selling points of Acceptance and Commitment Therapy is that you can divulge a little of yourself, not details about your life, but how you would use it in your own life as an example to how it might be useful for this person. And to let them know that their mind is very powerful and it never stops it never shuts up. Getting people to recognize that how they’re thinking drives their emotions and things like that. It's really quite important, and in bushfires it's probably useful in the early stages but down the track where people actually start to dwell on and ruminate about what has happened to them. You cannot get rid of memories, unless you get something like a horrible condition of dementia. It’s how do we take the power of them. And we use a lot of metaphor in this, in explanations and a lot of skills to say your mind isn't all conquering, you do have some control over it, you know, thoughts aren’t like clouds that just cross through your head and drive these things. We gives people a way to actually look at that and say, oh here it comes again. Retrospect and hindsight, they’re torture techniques, they tell you how you should have done something.
Renee Murtagh: Services and supports that are offered to people after events like the bushfires, and counselling’s one thing that often comes up as being an important way for people to seek assistance.
Leah Wiseman: Could you just touch on the difference between counselling and intervention like ACT?
Renee Murtagh: Yes, certainly. After bushfires there's a really big push straightaway for funding to go into councils, and we certainly do need them straight away for some basic psychological support for people to help them to sit with their story and, you know, listening ear for the person. But there's a bit of a difference between the person that will provide some kind of psychological first aid, and also someone who's going to provide some more directed or targeted therapy. I guess the people that we initially saw straightaway were people who were in high distress and who really needed someone to listen and support them through those early stages. So some people will also go flat out, be really busy getting things done, and down the track they fall in a bit of a heap. Sometimes people will benefit a lot from these more targeted types of therapies.
Russell Maher: When we land in a community it's about getting to know people, getting to meet them, having a relationship and then if we feel the need for a more targeted strategy, then we can actually start to introduce that. And the word counsellor is very interesting because in the rural context counselling is often viewed in very different terms of what it looks like and what it is. I remember in the 2009 fires when we were doing a lot of work out there and an old farmer, and he heard that the counsellor was coming. And when this chap who, you know, is a fairly rough and tumble sort of fellow got out of the car the man started to laugh. He said what's wrong, he said you've got a girl's job. So the view of this man was if you are counsellor, by the nature of counselling you should be a female. And so I think we've come a long way. I think we dispel a lot of myths about mental health and counselling when we’re out there.
Leah Wiseman: I think it's really good to make the distinction between counselling and act for several reasons, and primarily because what you two seem to be describing is something that people can then have some strategies that they can take with them for life, and apply it to a whole heap of different contexts and experiences. So I was hoping that you might be able to give us some examples of ways you've used ACT in practice
Russell Maher: ACT is, as I said, it's very common sense. How we would use it in practice - our aim here is to increase this person's psychological flexibility. We don't use those terms for people because we lose them fairly quickly when we start to use jargon and lingo, but some of those things that people often forget about, are those things that they already have inherent in themselves, and the things that we often use are values a lot. What does this person stand for? What matters to this person? We're often asking, you know, who are you as a person? And we don't want to hit, Fred Bloggs who, played in three grand finals for Cudgewa, did this and was a rough and tumble, we want to know what he actually stands for. And so we tried to get to the bottom of that and we use a lot of exercises. How we might clarify that. The other thing that people find is that we often do not live in the present mind, and being in the present moment is not going and doing anything you feel like at this given time because life is short and all sorts of things. It's about taking notice of those things around you, being here in the moment. When we talk about that we use a lot of brandings to get people to be concentrating on the here and now, because the past is actually history we cannot change it. The future is a bit of a mystery. But what is important, how do we get things done, it’s in the here and now and to listen to what that means. Probably talk a little bit about acceptance. Having to open up and accept some of those things you cannot. You know we use this really well with things like anxiety when we get people to sit with their anxiety, we don't try to get them to go away. So often Russ Harris who I believe is the guru, and he would disagree with that because it doesn't fit with Acceptance and Commitment Therapy, you know, some of his short YouTube clips, and one’s called The Struggles which really does talk about turning off the internal struggle in the back of your head. You know, if you had a switch, we could turn it off that would be great. What we do here is to get people to sit with some of those things, anxiety, the more you want to get rid of it, the more you argue with it, the more you feel like you're inferior for having it, the more it amplifies.
And so in some of those things if you took anxiety as an example, we will get people to sit and actually look at it - feel what it feels like. Where do you feel it? Is it inside? Is it outside? Is it hot? Is it cold? Pinpoint their anxiety. And when anxiety is there, we get them to use their values to saying, why am I doing what I'm doing? Because it matters and they sit with anxiety a lot better.
There’s a lot of techniques we use. One that I find particularly useful is called the fusion. Watch what you're thinking. Get them to use techniques to take the power out of it. I had one chap who had been through a fairly horrible marital breakdown and divorce. But this is 15 years ago. And he was still really, really angry and I tried multiple different techniques. And he looked at me and he said, mostly your stuff doesn't work. And I was with him and I said, okay, how can we best try and take the power of it. So I thought I'll try a technique I probably wouldn't have tried probably because of my fear of how he would react to it, a technique of trying to watch his thinking, and one of those was this thought that came up with his ex-wife and all the horrible stuff that used to go with that thought and it caused him a lot of damage, and legal problems as well. In the past, because the thought came back you can still drive emotions. I said to him - think about your thinking, what I want you to do is one of three things. I want you to see it as it's on a TV screen. I want you to hear it to a song that you think is really silly. Or, I want you to hear it in your favourite cartoon characters voice. And about three weeks later I went back to see this chap and he looked at me and said, it's still there, it's still rides me, and I still have emotions to it, but I'm doing a bit better. I can actually break from it. And I said, what did you do? He says I hear my divorce story in Homer Simpson's voice, and I thought I didn't think you'd be able to use those sort of measuring techniques to be able to do it. And it worked quite well.
The other thing that we look at in Acceptance and Commitment is that nothing changes unless you do something about it. We call that committed action. So we want people to do what works. So in that we asked them a lot of questions about - how have you tried to get rid of these thoughts and feelings? In the past, what have you used? And have they gone so that they never come back again? And that really does start and so when we talk about some people say alcohol. Of course they didn't go away and they came back with interest.
Leah Wiseman: I’m hearing Russell when you're talking about those examples that it's something that could be applied to trauma, grief, loss, whether that be associated with the fires, anxiety, you know, related to COVID probably more at the moment. And I'm also hearing a real lot of connections with the mindfulness movement for one of a better term that's really popular at the moment as well. Can either of you comment on, I guess the flexibility and the way that you can use ACT in all those ways?
Renee Murtagh: Yeah, absolutely. I first started using ACT back when I was working as a drought counsellor. So working with farmers around losses that they've had. And I guess the first thing you want to do is try and take the pain away or, you know, try and help them to make some change but a lot of time, you know things are way outside of anyone's control and it really is about accepting what you can't change, and you know finding a way of thinking about things differently. So, particularly at the moment with COVID, things are really outside of our control you know there's restrictions on our movements. There's, we don't have the ability to connect with people like we used to be able to. A lot of the things that we would normally do to stay well, we're not able to do so it's about being flexible in the way we're able to think about that because if we're just angry about it. We're not going to get very far very quickly.
Leah Wiseman: Thank you to our guests on today's episode of our Albury Wodonga Health mental health podcast series - A sense of connection, mental health, well-being and resilience. You can find our contact details, an exhaustive resource list, and the entire podcast series at awh.org.au under the mental health tab.