In this episode of the Care to Learn Podcast, we sit down with Geoff Ahern, a senior mental health clinician and educator. Geoff speaks to us about the impact of unconscious bias in mental health, why taking the time to listen to each individual's story is vital, and how mental health clinicians are increasingly involving the patient and their families in their care.

Podcast Transcript

Wayne: From Ausmed Education, hello and welcome to episode nine of the Care to Learn Podcast series.

I’m Wayne Woff and each month I sit down with interesting and influential professionals working within healthcare and education.

In this episode we’re sitting down with Geoff Ahern, a senior mental health clinician and educator. Geoff splits his time between responding to mental health emergencies with Victoria Police, and educating health professionals and members of the community about mental health, substance use and addiction.

In today’s episode we’ll discuss:

Why all clinicians in mental health must learn to leave their unconscious biases at the door and start and finish with the individual client’s story;
How workplaces can develop a positive culture of learning from the inside; and
Why we, as health professionals, must learn to treat ourselves and each other with respect.

So, let’s get into it.

Welcome, listeners, to our Care to Learn Podcast. We’re very excited to have Geoff Ahern with us here today. Welcome to you Geoff.

Geoff: Thank you.

Wayne: We’ll kick off as we traditionally do. If you’d like to give our listeners an idea of your professional background and journey for you as a health professional.

Geoff: Sure, I can do that. Nursing obviously, I started out doing my Bachelor of Nursing. Then worked in emergency and trauma for four or five years, from memory, and then slipped across to mental health. I’ve spent the rest of my career mostly in crisis mental health intervention work.

Wayne: And in terms of education, which is very much a part of your professional practice now, has that always been a passion for you?

Geoff: Yes. It probably started out with learning – educating myself passionately, researching and learning and trying as much as possible to be on the cutting edge of professional practice.

Then about 10 years ago a colleague had to pull out of a job. He was presenting, talking about psychopathology, and asked me to jump in for him. He gave me the slides and everything, and I just fell into educating as a result and found out I quite enjoyed it.

Wayne: You caught the bug, and education was going to be the way forward for you?

Geoff: Definitely. It’s not just about educating; every presentation you put together, you learn more yourself. So, it was just another way of learning, forced learning if you like, when you have to put a presentation together.

Wayne: And I would totally agree with that. I think there’s a huge amount of learning for educators: learning in the preparation, learning from the audiences. Would you agree that there’s a hell of a lot that any educator can receive back from the audience that they speak to?

Geoff: Yes, particularly in the breaks when you get people coming up and wanting to talk one-on-one. To hear about their experiences, there’s a shared journey for all of us working in this field, so I can learn from their stories and maybe they can learn a little bit from my story too.

Wayne: And in terms of mental health education, could you speak to us a little about what you consider to be some of the emerging trends when it comes to modes of education, methods, strategies, what you’ve seen that’s remained the same but also what’s changing in that space?

Geoff: What I’m starting to see is in the public system – which is where I work – people starting to take education and learning more seriously.

Historically, you take the ward setting and you’re really busy, there’ll be an in-service planned and it gets cancelled at the last minute because everybody’s so flat out. But also, managers taking it more seriously and being able to provide you with the conference leave you need to attend conferences and pay for things like travel and accommodation. Some, at least.

Wayne: And when it comes to your philosophy on teaching and mental health issues, what would you consider your key pillars or foundation principles that are your starting point for any education that you do?

Geoff: I think that without a doubt, and we were talking about this earlier, it’s the client: starting and finishing with the client.

When I did my undergraduate nursing many, many years ago, my mental health lecturer actually made a comment to us:

‘If you’re going to choose this field, choose not to become cynical and angry and burnt out, but choose to see the best in every client that you work with, and choose to see that it is absolutely possible that every single person can recover’.

For someone to say that over 20 years ago when we weren’t really talking about hope for recovery was pretty forward thinking and has never left me. I think the person’s journey, the person’s story as well, in the work that I do you spend the first 20 to 25 minutes just hearing their story, and that will guide our practice in terms of how we can best support them.

Wayne: I remember a phrase given to me early in my nursing career that was: unconditional positive regard. About clients, about their situation, whether they be a prisoner with mental health issues, whether they be a homeless person, whether they be a blue-collar worker or a white-collar worker, always maintain that unconditional positive regard. That really reinforces what you were saying there.

Geoff: And I think it can be tough to do that working in mental health. We see a lot of clients with significant mental health problems and significant substance use problems as well. Having unconditional positive regard for someone with a substance use problem when we get such negative messages in the media, I think can be very challenging. And if somebody is unwell and withdrawing from a substance, they’re not always the nicest person to deal with, so that can make it pretty challenging to keep up something like unconditional positive regard for them.

Wayne: And in terms of teaching professionals, students, whoever they be – just picking up your point about substance use and that clients can present in a manner which is incredibly challenging – what are some of your key messages to them in terms of how they can best cope with that?

Geoff: Patience. Be patient and spend a lot of time listening. It’s amazing that if you let somebody vent for a while when they are really distressed, and they can tell that you’re listening and taking the time to genuinely invest into active listening, they start to drop their guard and tell you more of their story. They relax a little bit and maybe become a little less hostile if they have presented in a hostile manner. It’s very easy to be knee-jerk with a client like that, and almost be hostile in our own responses. But being patient and giving them some time is really important.

Wayne: It segues very well to a point that we’ve discussed in a few of these podcasts and that’s the balance in terms of the skill mix needed between what might be characterised as soft skills (communication, listening, negotiation, mediation) and clinical knowledge. And in this area, talking mental health today, those soft skills are incredibly important. Would you agree?

Geoff: Absolutely, yes. And the education of those clinical skills actually underscores those soft skills. I might be actively listening to you, but I might be actively thinking about where we’re going to go with this in terms of how I can best help this person as well. So, that’s coming from a clinical perspective in terms of the best options for them in treatment.

Wayne: Moving a little to the left, what do you consider to be the most significant impediments in terms of staff embracing ongoing learning in your field of mental health?

Geoff: My personal observation is that there’s still this kind of subtle resistance amongst some staff towards education and the important role that it actually plays in your development as a nurse or clinician, whatever role you are in.

I see that as a barrier because that will hold people back, when you hear people making negative comments. Somebody might learn a new skill and it comes out in their documentation, and then somebody might make a negative comment about how they’re showing off with their new skill.

That kind of subtle pulling – the tall poppy syndrome – still seems to be there in a few places that I’ve worked in.

Wayne: So, the environment to which they’re taking their learning back to becomes quite critical in terms of the peer situation.

Geoff: Yes, absolutely.

Wayne: And whether that is recognised or embraced. Or whether it’s seen as ‘you’re trying to be the smart one in the group’.

Geoff: Yes, and it’s a terrible thing.

Wayne: And do you think there are ways, and it would be more difficult in your situation if you were providing external education, but have you ever been in the situation where you have been in those units and been able to influence that through education or through consulting with those units and trying to break that attitude down?

Geoff: Yes, I certainly have with education.

One thing that I’ve found to be really effective is getting alongside those people who want to learn and almost, in a clandestine manner, make a commitment to change the way that we view education in this particular unit, for example. You know somebody who’s got your back.

I’ve seen this work really well – when people band together and say, ‘we’re going to make this a priority, and change the culture within our unit’. And you can do that very gently, you can nudge people. You don’t have to come in all guns blazing and putting people offside, it can be done quite gently.

Wayne: And I think it’s sometimes how you approach the other staff.

A colleague of mine taught me early in my career that sometimes you need to put it to people to choose not to embrace it. So, the wording that you use: ‘I learnt this terrific new skill, I thought I’d share it with you. What do you think, do you think we could apply it?’. When people push back and have to say no, they’re less likely to do so if you put it in a very constructive way rather than trying to impose it on them. So, I think you’re quite right, sometimes it depends how you go about that, in terms of the minefield of other staff and their willingness to jump on the education bandwagon as well.

Geoff: Definitely.

Wayne: Along with that conversation around the impediments to staff embracing ongoing learning, is another conversation that we’ve been having regularly on the Care to Learn Podcast about barriers to the translation of knowledge into practice. It’s one thing for people to be well-educated, to attend seminars, to do lots of readings, but it’s a significant challenge to see how that translates into practice.

What are your comments around that space and your learnings over the journey?

Geoff: I think one of the reasons it fails to translate is because, again with nurses, we seem to be hard on ourselves and compare ourselves with other health professionals and put ourselves down. We see ourselves as a lesser profession rather than an independent profession. I think that can impede you from applying your clinical knowledge for fear of what other people might say. Things like, being able to go back and look at the policies and procedures on your ward and practice to the scope of your practice. Practice right to the edge of it, because you’ve got the skill and it is a part of the policies and procedures of our unit.

But I think we can be our own worst enemy sometimes because there still seems to be this undercurrent of seeing ourselves as a lesser profession than other health professionals.

Wayne: I think that’s very true. Just going back to the work that you’ve done in the alcohol and drug abuse space, and the education of clinicians in that area. What are some of your observations and some of your approaches that you’re using in that educational space, particularly in teaching people about clients who are suffering from those situations?

Geoff: I think getting people to understand – whether it be a nurse, a doctor, a social worker or any other discipline – that every person has a story, and there’s a reason they’re using that they’re using a particular substance. And there must be a pretty big darn upside with that substance use if they’re prepared to use it despite the downside.

So, the person who’s misusing alcohol, we turn around and infantilise them and we tell them, ‘don’t you realise alcohol is causing problems to your liver?’ Of course, they know that. Every grown adult in Australia knows that alcohol misuse damages your liver. So, we can be quite patronising towards the person.

But, if somebody is using alcohol to the point where it’s causing significant harm to their liver, there must be a big upside to that. And that upside is born out of a story, and often that story is mental health problems or trauma or loneliness or isolation or unemployment.

There’s a story behind every person we work with, and I think we fail to get their story and really delve into it. And I think we can be quite patronising towards them. Not intentionally, I don’t think it’s done maliciously, I just think that people don’t stop to realise that that approach can actually add to that person’s sense of shame and stigma around their substance use.

Wayne: And that concept of shame and judgement is huge in this space, particularly within that conversation around alcohol or drug abuse, and how we’re able to set our judgements aside becomes enormously important, I would imagine.

Geoff: Whenever I talk about substance mis-use I always start by talking about unconscious biases that we have that we’re not aware of.

A good example is that the average person in Australia won’t give a homeless person begging for money, money. They’ll give them food for fear, or because of this unconscious bias, that homeless people are going to buy alcohol and other drugs. We actually know that in excess of 50 per cent of people, if you give them money, they’ll buy things that they need, they don’t actually buy alcohol and other drugs.

But we don’t stop to think about these unconscious biases and how they sit there, where they’ve come from and why we might think that way.

Wayne: So, your educational approach to that area is that you try and unpack that with your learners? Have a conversation about them, get them to look at their own biases, their own situation, how they would think about certain things?

Geoff: Yes, as a starting point I love getting us to stop and think about our views first before we actually move forward. There are so many myths and urban legends out there about things like substance use.

But even getting back to mental health, only last night I was watching something on Netflix and a professional gentleman was giving advice in court and he had an undergraduate degree, a master’s degree and two PhDs. But then they found out later in the court case that he had schizophrenia, so the court case was dismissed because his evidence wasn’t considered to be credible.

That type of message that we keep getting given about mental health and alcohol and other drug use, it’s so pervasive and we don’t even stop to think about that. Somebody can be highly functioning and just as intelligent as any other person and be living with schizophrenia at the same time.

Wayne: And if staff, health professionals, nurses aren’t acutely aware of some of those biases it can be a real impediment to giving the sort of quality care and service that the client is in need of.

Geoff: Absolutely. I tend to start with the unconscious biases and then finish with a slide that’s a comic of people standing at an airport waiting to pick up their luggage but the big sign above it says, emotional baggage.

I love finishing with that point before moving on to the clinical stuff and make sure you leave you own emotional baggage at the door, so it doesn’t impact your practice when you’re caring for somebody. It’s very easy to let our own personal emotional baggage impact our practice.

Wayne: And potentially your clinical decision-making can be hugely impaired by those things.

Geoff: Absolutely.

Wayne: The last couple of points for discussion today, Geoff, the first one being learning from our professional missteps or mistakes. From an educational point of view, how important do you see this?

Geoff: I think the answer is in the question – that we actually step back and learn from it, asking ourselves what we can learn from this particular misstep or mistake, rather than being so critical and harsh on ourselves and giving ourselves a hard time.

I think most of us tend to be the biggest bully in our own lives. We tend to put ourselves down and give ourselves a hard time. And it’s very easy to do that when we make a mistake. We all make mistakes; I still make mistakes after all this time working in this field.

But stepping back and asking, ‘what can I learn from this’ rather than just beating yourself up and putting yourself down.

Wayne: Absolutely. The final thing we wanted to look at was education and support of clients and families. Is that something that is on your radar when you’re talking to the groups that you do – their ability to educate clients, educate people who are suffering from mental health issues, to speak to families and bring them into the conversation.

What would you have to say about those areas?

Geoff: Absolutely. I think that a part of our job is to educate, depending on how critically unwell the person is.

I was listening to a podcast with a cardiologist by the name of Doctor Joel Kahn from the US a couple of weeks ago, and he was saying that the average cardiologist won’t advise their client to change their diet because they think their client’s not going to change their diet. That’s a big assumption to make.

We’ve now made a very strong link between mental health and diet/nutrition, but we still don’t advise our clients of this, we don’t talk about things like diet and exercise, we make the assumption on their behalf that they wouldn’t do anything about it anyway. And I think, when you think about it, that’s quite patronising – to presume that the person won’t change their life.

So being able to take that information and use it as education, whether they use it or not is their choice then, but actually giving them something practical that they can do. And I think often we forget that, and we do make an assumption that they won’t change their life or their behaviour.

Wayne: And could you also just touch on support of family members and partners in the mental health conversation and the way we bring in those people to that conversation.

Geoff: Because I’ve only moved to Melbourne five years ago, I’m not overly familiar with the history of their Mental Health Act.

But I was in New South Wales when they changed their Mental Health Act in 2007, I think. We were then legally obligated to involve families in the care of our clients. Even if the person said that they didn’t want the family involved, we were legally obligated. I think that is incredibly important.

The last five years that I’ve been working on the road with Victoria Police, responding to mental health emergencies, you get to actually do that because you’re going into a person’s home. You get to actually see how disempowered the family actually feels and how confused they are and how overwhelmed they are by the situation. Because for us the unit or setting you’re working in is very familiar to you, but very unfamiliar and scary to them. So, I think it’s critically important. And seeing it as not just a legal obligation, but it’s an important part of the person’s care – involving the family and easing their burden and distress as well.

Wayne: And my final question in this area is about how well we’re educating health professionals, nurses for example, in this space about the education of families. Are we giving enough good information and support to the staff involved in these situations about how to approach this, how to do it, setting up a good framework for them.

Geoff: Certainly the area I work in we have a families representative, and part of his role is continually reminding all the staff that we need to get family involved. He’ll send information out to all the staff about support programs for families. So, certainly within my area that I’m working in we see that happen a lot more. I can’t speak to other areas but I would imagine that it is starting to happen, partly because we are legally obligated, but partly just reminding people: ‘don’t discharge someone from an ED without telling a family member’. We don’t want people just turning up on their doorstep at 3 o’clock in the morning because that would be incredibly distressing, I would imagine, for a family member to find out that we had not even contacted them to talk about this.

Wayne: So, as a general observation we’re doing it better now?

Geoff: Certainly better than we ever have. I think we’ve still got a long way to go and part of that is documentation. We’ve seen some coronial enquiries here in Victoria recently, where the coroner pointed out that there wasn’t enough evidence that we had made really good attempts to contact family and get family involved. Even though it might have happened, as far as the coroner’s concerned if it’s not written down it didn’t happen.

Wayne: We could spend a whole extra podcast, I’m sure, talking about the fraught nature and the challenges of documentation within any clinical area, but particularly within that mental health space – the need for clarity, objectivity, contemporaneous documentation et cetera. But that’s probably a topic for another day.

We will conclude our podcast today with our traditional final three questions. The first one of those: what’s one thing you’ve learnt in the past month, Geoff, that has really stuck with you?

Geoff: I have been thinking about that question, and my answer actually has nothing to do with the clinical work that I do. I spoke to a group of parent about two weeks ago here in Melbourne – a local council ran an evening on anxiety in young people. And I could see so many of these parents were anxious about their anxious teenagers. In talking to them – because there was lots of one-on-one after the presentation – we just need to relax a little bit. Particularly if you’re new to mental health, we just need to take a big breath and relax. Everything will be okay in the end, for the vast majority of people that we care for.

Wayne: Terrific advice, and I think my own personal anecdote in seeing all four of my children through Year 12 was just how much anxiety was generated by parents. When I got together with parents, just speaking about it and how that can reflect back to the children. And I think that principle of taking a deep breath is hugely valuable.

The second of our final questions: what’s your favourite personal learning tip?

Geoff: It’s very simple – listen. There’s some really interesting research out of the states looking at nurses and doctors and their listening skills and it’s quite appalling, actually. We don’t listen very well to our clients. We need to be doing more of that because it directs our practice in terms of getting good outcomes by listening to their story.

Wayne: And our final question: what’s the best piece of advice you’ve ever received about continuous learning?

Geoff: It was actually from one of my grandads, I remember him saying to me when I was still in high school, ‘the day you stop learning is the day you die, Geoff’. Nothing to do with my career at all, but I’ve never forgotten it.

Wayne: Fantastic advice from Grandad. On that note, we thank Geoff for his time, we’ve had a terrific discussion today with some great insights, in this edition of the Care to Learn podcast. Thank you, Geoff.

Geoff: My pleasure.

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