My name's Robin Wardle and I am currently the CEO of Family Planning welfare NT. I'm coming up to 30 years working in this organization next month and can’t believe that because it wasn't something I planned in my early nursing career.
My background is as a nurse and I've also got a Graduate Diploma in Adult Education and Diploma in Governance and another number of certificates that are always helpful like Work Health and Safety and HR. When I became a staff member of Family Planning it was as a nurse working in the clinic and then I just merged into other areas. Probably my favorite position in an organization in this health service is education.
My name is Catherine I'm a registered nurse and I have over six years’ experience in the nursing sector from emergency nursing, to community nursing and now to Cancer Council NT.
My name is Kylie Ella and I'm the Mental Health Promotion manager at TEAMhealth. My qualifications and background is I did my Undergraduate in Psychology in Sydney and following that I did a Masters of Public Health also at Sydney.
During that period I also worked all in health so from Health Administration and then during my Master's and managing a Women's Health Practice as well and then I moved to the Territory almost two years ago.
Hi, I'm my name is Jack Wallace, I work at Cancer Council NT as a cancer prevention coordinator.
In terms of my qualifications, I studied in Melbourne in a Bachelor of Health Science and Bachelor of Business first of all, majoring in public health and marketing and then I did a Masters of Occupational Therapy after that. So a bit of an indirect path to where I am now.
My name is Chrissie Inglis and I'm the education services manager at Healthy Living NT and my background qualification is Registered Nurse and I've also done a Bachelor of Coronary Care Nursing and a Graduate Certificate in Diabetes Education Service.
I’m Simon Dixon CEO of the Heart Foundation I've been working the primary health care sector for about I think about 23 years now
I started in pathology in which I worked for a large pathology organization for 18 years before coming to the Heart Foundation and I've been with the Heart Foundation now for five years
My background, I did start a Science Degree but was given management opportunity in which time then I changed and did management and I'm in the midst now of completing my Master's in Business Administration .
Family Planning Welfare has been in the Territory for 42 -43 years now. It's a global organization that has uniquely started up in India of all places to give a service for
reproductive health to women.
It's a health service that globally helps women achieve a pregnancy and achieve a termination of pregnancy. It offers contraception and offers reproductive/ fertility assistance and also helps with the burden of some of the infections that we have across the globe and in the Territory
In the Australian scene it's a health service that also delivers a lot of education and health promotion to the community.
Cancer Council NT, we have a mission that we provide support, information and education to anyone affected by cancer and encompassing health promotion as well.
The focus of our health service at Cancer Council NT is basically to reduce the impact of cancer on Territorians. This can be done in a number of ways through support services for clients who have had cancer diagnosis, and also working with the community in order to drive prevention of cancer- because prevention is always better than cure.
Healthy Living NT is a charitable organisation, our real name, or our incorporated name is Diabetes Association Northern Territory. We have a membership base of people that generally have diabetes or have family members with diabetes and our basic emphasis is to be here for people with diabetes and their other services.
About 2002 we extended into cardiac services so we've provided diabetes education services for more than 20 to 25 years and since 2002 we also now provide cardiac education and rehab services as well.
Our main purpose is to be here for the community so we are outside of hospital doing community work and that's both in Darwin, Alice Springs and we do go to rural and remote communities as well to deliver diabetes and cardiac services there.
Our one service that is in hospital is our inpatient cardiac education service for people who have had recent cardiac events.
TEAMhealth that is the Top End Association for Mental Health, we support people in mental health in a range of ways. We have accommodation services where people are living in; we have a short term and long term. A subacute program, which is a step up or step down from the Cody Ward and back into community. We have early intervention Child and Family Well-Being services where we are looking at people who are potentially at risk and keeping them well, and we have a Carer Support Program, which is obviously caring for people who are suffering with a mental illness and supporting those people in the carer’s role.
Then we have a range of adult mental health services, in Darwin and the rural area as well in urban and then we have community settings as well.
A number of the programs that we have so for example the Child and Family Well-Being services which is that early intervention and support that we have is across a few areas.
It is in the Darwin, Palmerston, Litchfield area then we have a service in Katherine and then one in Gunbalanya and Kakadu.
In terms of the adult mental health supports, we have what has called a Personal Helpers and Mentor Program and a Recovery Assistance Program.
Both of those programs operate in an urban setting and then they go all the way out to Adelaide River and that Darwin rural area, and then we have a program in Maningrida and Recovery Assistance Program as well in Katherine.
We try to reach the Top End and Top End Association for Mental Health so we try to make sure that people in isolated communities are supported and that obviously has its own unique challenges but also its own unique rewards.
The Heart Foundation has been around for almost 60 years now right across Australia but has been in the Northern Territory since 1986
Our focus is primarily around cardiovascular disease as well as peripheral vascular disease and stroke
We're looking at the prevention and reduction of that disease within the population.
Our client groups varies, our priority group for the Territory is definitely youth and currently statistically we see about 28% to 32% of our clientele are youth, and youth is-defined as under 25. Other clientele is about 8% indigenous women attendance which is higher than the national Family Planning statistic of about 2%.cvWe see very few men unfortunately, we would like to increase our men attending our clinics and our education courses and currently it's about 3% of clients.
We're interested in getting people into clinics and education so they are aware of the right information, that they have the right resources to send them out there and they know and feel comfortable and have some sort of self-esteem to talk to a doctor in another environment. They don't always have to come back to us, we would like to set the scene for them to have confidence and the right information and then they can go out and see other health providers and not necessarily come back to us
Our main clientele is cancer clients, family, friends and carers and anyone in the wider community that's been affected by cancer.
Our main client group groups are very broad so we actually literally do from baby, so zero to 18years in our Early Intervention Programs.
Adults, and we have adults of all ages in a number of programs that we have, and we have Aboriginal clients obviously in our community-based settings.
We do focus on some humanitarian entrance in our early intervention as well.
Then we also support the aged, we have Home Care Packages, which is where we go into Aged homes, and support them to live independently so they do not have to go into a care setting.
As I mentioned before our main client groups are those Territorians who have been impacted by a cancer diagnosis and are seeking support in the community/ psychosocial support.
The population that I work with is actually the wider community, so within different community organisations, work places. Basically members of the general public that I engage with in health promotion.
Our main client groups are people and their families with diabetes, anybody with a cardiac condition. Those are two service groups that we cover under the Department of Health, Northern Territory Government, we've got contracts to deliver services directly to them.
Then another service that we provide is under the PHN (Primary Health Network) and Closing the Gap funding to people with diabetes and cardiac conditions in remote communities and remote areas.Those are our main focus groups for those services.
We also run “Life Be In It “services which are generally based around physical activity and general health, and upskilling. Getting other people motivated, increasing the baseline level of activity. That's generally focused at seniors, children, toddlers, so gross motor skills, kids at school, it's basically general community.
Our main client is the whole of Australia we look at the whole Australian population but primarily we look at those who are high risk of heart disease
We look at culturally and linguistically diverse groups Aboriginal Torres Strait Islander groups as well as rural and remote Australia and the general population that are aged above 45.
Our health care system is basically on a two tier, it's a clinical system and an education one. The clinical environment of Family Planning globally is all about doctors and nurses doing cervical screening breast examinations, breast referrals. Not that we do breast examinations much, it’s more about breast awareness and educating women. We do contraception, we do pregnancy supports and assisting women in decisions. We also do a lot of menopause. And for the men we do a lot of health checks for the prostate and their testes checks and STI's, Sexually transmitted infections (STI’s) is a big part of our clinical service.
The other side of it has an education focus. We have a separate lot of staff and the education involves delivering professional courses to professional health groups such as doctors, nurses, health workers, pharmacists, and social workers. We have given a lot of workshops to different groups and then we also have health promotion in a community that provide to the disability sector, the school sector, the school's students. Some schools will still get us in to talk to students and do various workshops with them and other schools we might just see their teachers to give them information and get them to do the educating themselves.
Our healthcare system at Cancer Council NT is first of all structured in we have a CEO and we have multiple different sections at Cancer Council NT We have a fundraising section, who obviously raise funds for us to provide support services. We have the administration and ostomy section, ostomy being we supply all the ostomy supplies for everyone in the Northern Territory.
We have a support services section which encompasses two-and-a-half registered nurses, and three information and support officers. We are based in Darwin, Katherine and Alice Springs, kind of spread out across those locations and we provide the support emotionally and practically to clients. Then we have health promotion section as well, which is covered by another staff member.
Our services are structured at this point-in-time as teams, so we have our Board and our CEO, and then we have a Management Team
Each of the services we offer also have a team of them of their own, and they all have Team Leaders and then they have support workers or key workers that are actually working on the ground with people and to support them in their mental health.
At Cancer Council NT, our services are structured in a way that best reduces the impact of cancer on Territorians. So that's done through two different ways at our organisation: through both our support services, actually working with our clients who have been faced with a cancer diagnosis and their families. As well as through prevention and they are the two main tiers of our service.
Like most services running community we have funding that comes from a body where we will have objectives to meet under that funding criteria. That really does direct what level of services you can provide
Within that you also then do a bit of a needs analysis of your of the community, and what you're actually trying to achieve with it. Your services are then usually benchmarked and delivered around what are your KPI's (key performance indicators) and what are you trying to achieve.
We’ve been doing the services here for quite a few years and they have evolved over time depending on what the community's needs are and how things have changed over time.
The Heart Foundation has been around for 60 years in Australia We're currently operating under the For All Hearts Strategy until the end of 2017.
This strategy covers four key focus areas which is: Healthy Hearts, healthy hearts looks at tobacco, reduction in tobacco use in Australia; it looks at overweight and obesity, food and nutrition as well as physical activity as important parts of prevention.
We have our second pillar which is Heart Care which looks at the clinical space or the tertiary space and we're looking at things like acute coronary syndrome things like absolute cardiovascular risk as well as warning signs of heart attack.
Our third area is equity so ensuring our culturally/ linguistically diverse Aboriginal Torres Strait Islander populations, as well as our rural and remote populations are considered in all the work that we do at the Heart Foundation.
We’ve also got our fourth pillar which is research. The Heart Foundation has around and funds around 13 million dollars’ worth of research every year.
In this health system we have mainly nurses who are educators as well as working in the
clinics so they have to be multi-skilled. We have nurse's with qualifications, they don't have to be teachers we actually give them that skill base. If they had come along as a nurse and they are qualified in having completed some of our courses then we will give them the support and the training they need to become educators of their peers. So we do like nurses and we do like health workers. We've had health workers previously working within the organization. We've got doctors and we have medical students, nursing students and otherwise it's all of an administration/receptionist skill base as the other group of workers
We also have a Board of Volunteers. Family Planning work with the Board so they are the ones that govern us. I'm responsible for management, but basically the Board will govern and set the policy and the course direction and the priorities and the strategic direction of the organization. The Board are complete volunteers in this organisation, so we do rely on a lot of ask for help for free.
We have a CEO, we have two fundraising officers, we have one administration officer, multiple volunteers and one ostomy support officer, three cancer information and support officers, two registered nurses and one casual registered nurse and one cancer prevention coordinator.
The great thing with our organization is we have a huge variety of team members. We have people from all kinds of educational backgrounds and we have Occupational Therapists, we have people who have done psychology, we have people who've done teaching, nursing, a huge variety of people which bring a really vast skill set as well and different backgrounds.
I think when you're working with people with potential mental illness, for supporting people in their mental health it's great to have that variety of skills and backgrounds so you can relate to a broader population.
Health professional wise we employ diabetes educators, cardiac educators, dieticians and health promotion officers, which often have like our current Health Promotion Manager a background in physical activity education.
Within our service we have a Cardiovascular Health Director and that person looks after all the cardiovascular health in the Northern Territory
Under that we have a Healthy Hearts Manager as well as a Heart Care Manager and that’s primarily focussed in Health for the Heart Foundation here in the Northern Territory
The primary healthcare that's provided in an organization such as Family Planning is mainly preventative such as cervical screening. We're trying to prevent some of these cancers forming and infections such as chlamydia that can lead to infertility. It’s nothing is going to kill someone but it will certainly give them problems in 10 or 15 years even 20 years so we're trying to avoid that.
The organization doesn't deal with a lot of chronic diseases such as diabetes or heart disease. We are a specialized service, so we really focusing on the fertility side and the prevention of infection and screenings. Because there is the great public message in Australia with the cervical screening and we've done well at that to prevent the number of deaths from survival cancer across Australia.
Clients who come to our clinic end up with a longer appointment time.
It’s a service that actually gives some time to talk about anything they need. If they've got menopause issues, some women will want to have a talk about their relationship problems and their sexual disability or their sexual issues that they're having trouble with. Whether it be themselves or in a relationship.
So the unique thing about the organization is that we give them skilled doctors and nurses to talk to and we've given them time which is often what they don't get in a GP setting or environment.
Cancer Council NT provides a range of psychosocial and emotional support services and practical support services. We provide access to nurse counselling from registered nurses, we can also provide our clients with access to a psychologist for brief intervention.
I myself, as a cancer support nurse visit Alan Walker Cancer Care Centre in Darwin and the medical accommodation Barbara James House in the city on a regular basis to provide emotional support to clients. We also link clients with practical services, that can be from other organizations or from ourselves as well, practical services such as wigs and breast prostheses, legal and financial assistance.
In primary health care, things that work well with us, particularly in the urban services is being part of that bigger Primary Health Care Network. Generally speaking the GP’s (general practitioners) are the central area of care we all funnel into and then we have lots of different services that funnel out depending on the client needs themselves.
Part of our role in primary services to actually engage in with that bigger Network and all work together collaboratively to do that. Communication works well to build that.
It's a similar service but slightly different in the fact of cardiac because often people come here post-acute event, so we've already engaged them through the acute care sector and then we're getting them back into community living and to managing their cardiac condition in the real world.
I suppose we have a range in terms of we have primary health care in terms of early intervention where we are working with the 0 to 18 age group.
They work with a family member as well so that is why we are looking at keeping families well.
If there is risk factor, we want to make sure families are safe and keeping well and that includes a variety of things from early parenting skills to one-on-one sessions on the different factors of keeping a family strong and healthy.
It could be things like cooking skills so there is a range of things that come into that primary health care setting.
Then we do secondary as well, more the acute end of mental illness, so we have a variety of adult based programs where people are unwell when they do come to us, if they have been referred to us.
It might be severe and persistent mental illness that we are dealing with then, and supporting them to try to manage that so that they do live a full and valued life, there is a lot of things that come into that.
There is the child mental health which is the family setting and then with adult mental health we have a lot of outreach, so you might be going and seeing someone on one on one and having a talk about what in their life they practically need in terms of assistance to help keep them well.
That is things like assisting them to gain employment or to keep employment, relearning new skills and that could be cooking or even just getting out into the community.
Social isolation is often something that you'll find people experience with mental illness and it's participation and sometimes what that means is getting a variety of adults together from across our services and coming together and having a barbecue together or doing some mindfulness practice or doing a yoga or Tai Chi session
Getting them out in communities, participating and just engaging again because sometimes they are just stuck at home and they can't get to where they want to go to in terms of transport logistic wise and sometimes they just become so stuck in their ways of being at home and that’s so rewarding I think seeing them and then you know in their in their happiest moments out just having fun and just engaging in the community.
Then we have the Day-to-Day Living Centre at Rapid Creek and what we do there is a lot of art and music lessons, they cook, the participants there cook together, eat together.
We do things like go on excursions, maybe to the museum or educational places, go for walks on the beach, just everyday stuff that people enjoy doing whether it's an educational focus or just participating in the community
Our main focus for a small not-for-profit organization like us here in the Northern Territory, we focus mainly at the workforce that can actually impact and have the greatest impact on client or the population.
We work well with Aboriginal Health Practitioners through the Batchelor Institute
We have some resources there that we supply and educate that workforce to pass on key health messages into the environment.
We also work with the hospital staff through the Cardiac Nurses as well as a Cardiologist to ensure that Clinical Guidelines are up to date and that they're aware of all those Clinical Guidelines. We also work with General Practitioners in that clinical space as well, through warning signs of heart attack and we've got Absolute Cardiovascular Risk Assessment which looks at the risk of a person having a heart attack within five years That works in the primary healthcare space as well.
There is a few main challenges that I could touch on, so firstly you have the logistics of being in the Territory, so the broad spaces that we work across because we do go out into communities as well.
Then you have the high turnover, though Northern Territory tends to be a transient place and people do not always come for a long time they come for a set period or for a specific reason often you will find.
I think when you have someone who comes into the organization and has skills and talents to offer we have to think of it as quality not quantity so let us enjoy and embrace what this person has to offer for the time that they are here and get the most out of that period.
One of the other challenges would be the budget constraints that we deal with working in a not-for-profit organization/ non-government organization where our budgets and funding contracts are dictated by the government and the contracts that we get.
They have been one year, two years and if we are lucky three years.
That means that recruitment and being able to put into place sustainable projects, over a period can be difficult because we often do not know when we are getting our funding.
Right now, we're in May, our staffing contracts end on the 30th of June for example and until I've got a new funding contract I can't give those staff surety about their employment until I know what funding is coming my way
That just makes logistics tricky sometimes because people want security, so retaining good people it can be difficult in that sense as well.
Usually communication of health information, that is a biggie. We are not part of the public health system and obviously the level of information that we can give and education and support that we can give is reliant on their level of information and health information that we get. The more we know the better our information and the better our education.
Sometimes that is a challenge to get the right information at the right time.
Because individual people and part of all of this is also reflecting back on to the clients are people that we see in the community, and that their understanding of their own condition is really important when they're traveling around different services.
Because if they don't know and we don't have the information then nothing can get done, you know we really limit ourselves and how we can be effective.
I guess its lack of knowledge of people knowing that there is support services out there and sometimes people wanting to take on board the support is quite difficult, I guess getting people to want to receive support and to understand how beneficial it may be.
We can overcome that only through further education of the wider community that we are a support service and we are available to anyone who needs us. It not a means tested service, it’s for everyone.
From a Northern Territory perspective some of those main challenges are the turnover of workforce here in the Northern Territory and ensuring that the workforce has the level of understanding of the role of the Heart Foundation and the tools and resources that we have available. That’s probably our greatest challenge here. It’s making sure we're constantly talking to the workforce.
There’s a lot of work being done in the Primary Health Care sector here in the Northern Territory it's about coordinating that sector.
I know the role of the Primary Health Network is to coordinate that sector but there seems to be a lot of silos work going on within the primary health sector in the Northern Territory which probably could be better coordinator from our perspective in terms of our resources and our messaging going out.
I think they need to be aware that there's a health service in the NT that focuses on 97% women’s issues We also advocate for women's issues. We've currently been advocating for five years for the changes to some legislation in the Territory. It's an exciting place to work, if you're interested in some primary health care nursing it's one of the services that does primary healthcare well. It leaves you knowing that you've worked autonomously, you are not subservient into a doctor. You have your own client list as a nurse, doctors have their client list and that you deal with issues. If a nurse has an issue then a doctor might end up sorting it out but at the end of the day the nurse has their own client base and can focus on helping and empowering.
We do see a lot of young people so it's a happy place and sexual reproductive health is sort of the fun place to work in a way because there are some really fun stories. You see healthy people, basically you are seeing healthy clientele. They're not coming in with health issues, like hepatitis or if they do we can sort that out but they're not coming in with a chronic disease that needs a lot long-term management
We're talking about a healthy person who wants to come into the clinic and find out what was an contraception that she can choose that's better than the one she's on. Or she just needs a health screen today or she's concerned about an episode of sex a couple of nights ago she might have got an infection what can she do about it. So they're here because they really want to be and they're in a preventative health service
As a registered nurse, I think it's important for health students to be aware that they need good clinical experience before they step into a more psychosocial/ emotional support environment and clinical experiences is essential. Not just specifically for the cancer area I think clinical experience in general is essential
I think what's important for health students to be aware of in a mental health setting in terms of primary health care would actually to just get out into the community and know what's around you, know what organizations there are.
I know when I was a student I had no idea about some of the NGOs and non-government organizations that existed and the work that they do.
Talk to people, research, get online, have a look what is out there
Ask further, if you have someone who you know works in the sector ask them if you can come along have a chat or you can just go check it out
I think it's important to be aware of mental health because no matter what health industry you're working in as a student, mental health is always going to rear its head, you're always going to have someone who's suffering with mental illness or who's mental health could be better or that you could promote because let's face it each and every one of us is going to have something that comes across in our life in terms of mental health or where we could improve
It does not matter what area you are in, so I suppose be aware of it in mental health know who you can refer to, know how you can refer people there.
Often it's a case of people can refer themselves, but they don't know where to go so if you as a health care provider or health professional are aware of the different services and the different range of services you can refer people there and you can give them a choice.
You can say this organization does this type of work, whether it's if you want to get out into the community and participate or you want to learn how to , you want to do art and cooking just because you know you need to decrease isolation for someone because you find that's what they're struggling with.
You give them a broad range of options and I think that is powerful and is empowering for people.
I think a really important thing to note in an organization like Cancer Council NT in the Territory is that it's a bit of a smaller organization than anything that might be in other states and territories, so we don't necessarily have the same amount of staff and level of different specialized areas. It does involve a bit of flexibility in your work and also working with the population which is dispersed over a very wide geographical area -so having to account for that in your service provision
Regarding health students we do have a lot of students that come through here doing placements on their courses. Usually a lot of the information that we get is about consistency of messages. As an education service, we don't need to muddle things up with extremely technical terms and make it very difficult.
A good example on the cardiac side is there's about 15 different ways to say the word heart attack and if every health professional uses a different term that doesn't help at all in trying to get some clear messaging through. From the health service student’s perspective, seeing some of the consistent clear messages that we have and how we educate people is probably something that's beneficial on that side. In the Northern Territory, while you're in one university what you will experience is the common language of the lecturers and of everybody else around you. However the real world, particularly if you're looking at somebody who's working in a hospital setting or in a community setting it's rare to find two people have actually been trained by the same people. In fact you're getting to know people from all over, not only Australia but all over the world working here and we've all come from different terminology backgrounds.
Getting to know what is the consistent wording here is really important.
Particularly with our indigenous clients where English might be a third or fourth language in the first place. If we muddy things up with cardiovascular disease, coronary artery disease, acute coronary syndromes, old fashioned heart attack, unstable angina and the words just keep dribbling on and that muddles everything up, we need some nice clear messaging.
I think the important point is that primary health care is quite broad and that there's a multi-faceted approach within the sector to patient-centric care and ensuring that the patient is at the center of the primary health care pathway.
Well again probably just having a good solid clinical background, and knowing that it is very specific to a certain chronic disease. So your field of practice will be narrowed to the specific chronic disease.
I think some really good advice for health students who are wanting to work in my area of work is really to get as much experience as you can while you're at university through doing volunteer work. Go beyond what the university offers in terms of placements and things like that go out there and get some other experience.
Also when you're considering getting a job, really try and think about what your generic skills are and try to relate them to the role. So kind of step outside the square when you think about employment opportunities. Just be really flexible in the role and willing to take on new knowledge and have a willingness to learn on the job.
For students who would potentially come working for an organization such as TEAMhealth there is a variety of qualifications that we would look for.
We generally look for someone with some tertiary qualifications and some people have just certificates, but it is also about the variety of skills that someone has it's not just about the education.
If you volunteered in a particular area and you know you have skills in other areas you can bring forth, whether that's sporting or art or different skills, we know that there's value in that.
I think it is about having a broad range of activities on your CV (curriculum vitae) as well that you can offer.
I think volunteering always shows that you actually you’re keen to participate with people in the community as well and so I'd encourage people to get out there and just be active in the community.
In addition, when you do come if you do go for an interview, do not only focus on the education that you've got, do talk about the different skills and things you're interested in.
If I'm interviewing someone it's an attitude as well, if you've got a positive attitude and you're not scared to try and tackle some of the stigma issues that we face on a daily basis then that's great, if you can see that the population, everybody has strengths you know so as someone's got a mental illness don't see them as having a mental illness, yes there are some concerns that they're facing with their life but what are their strengths what can we bring out for them.
Get a good overarching background of life in the first place, because the people who we see here are real people in the real world. Chronic diseases, everybody's got a comorbidity nobody's just got one problem they've got multiple issues in their life that they're dealing with.A good background in behaviour, mental health side of things is really important because there's no point in educating somebody or didactically talking to people if they don't have the skills to be able to deal with it as well.
Or you can be able to teach them some of those behavioural modification skills and changes, and be able to connect and be able to make it relevant to them.
Typical messaging is there's no point in telling somebody to give up smoking if it's not relevant to them, or they’ll just wall you off and walk away.
A background in understanding a bit about behaviour change is really important for education.
Also just as I said, know people have comorbidities and lots of them. It’s no good just being an absolute specialist in one field and know absolutely nothing about anything else because they all interrelate to each other. Sometimes our role isn't about getting perfect management for their heart disease or their diabetes but about having it managed enough so they can deal with their other problem like their cancer treatment
There's a bigger world to think of as well.
Mental illness in itself is often chronic in nature, whether you are talking about depression or anxiety or schizophrenia, it can be episodic and people can have really well times and they can have unwell times as well.
I think in terms of managing mental illness from a chronic disease perspective we need to make sure that our participants are prepared for their worst days.
So we're not setting them up to fail.
When they do have those hard times that they're going through, they've got a plan in place; these are the people that I can contact at the moment if I'm having a really bad day or these are the things that will keep me well or to prevent me from having those bad days so it's about preparation and having a plan for them.
I think setting goals for them, if they've got goals that they're working towards and they're focused on those they've got direction and they're feeling motivated by those things they want to do. I think that is also important in terms of keeping them well.
Chronic disease management at Family Planning can be a bit limited. We don't deal with all of the chronic diseases that are we faced with every day such as rheumatic heart disease, diabetes. We are a specialist service so we do concentrate on the burden of STI which is sexually transmitted infections and we have high rates of that in the Territory. That's because we have a young population and a mobile population.
The other chronic disease management that seems to come through the clinic is a lot of mental health. So we do focus on a lot of people's relationship and the connection with mental health in that environment
The others are very rare, a doctor can still sort out someone's chronic disease management if they're here for another issue and they can try and address some of it, but we tend to refer them onto a GP or to a specialist if it’s needed. We have picked up a number of chronic diseases but it's certainly not something that we specialize in, we're not a full GP service.
Cancer is the main chronic disease we work with at Cancer Council NT. Cancer being one of the leading causes of death in Australia. We obviously always promote self-management, we are there as a support service and not a case management service.
We promote self-management by encouraging people to receive peer support and encouraging them to question/to ask their doctor, and giving them the information and letting them make the decision once we've given them the proper information.
Whether it be in regard to treatment or different options that they may take, or if they want to access other complementary therapies for instance, and giving them the safest advice in regards to that.
Chronic disease management is our bread and butter here.
Most people have at least three comorbidities so we're talking diabetes, heart disease, renal disease, potentially some cancer, potentially some other issues.
Mental health is a huge elephant in the room half the time.
If people are dealing with mental health issues they have no capacity to be able to put the resources they need to managing any chronic disease, no matter what it is.
So, you know it all works in together and having that general understanding of how they all interrelate is really important because they all propagate each other's problems.
The rewarding aspects of working with patients with chronic disease include obviously seeing a great outcome, seeing someone who has had their cancer surgery or their cancer treatment and that they are now well and they can live hopefully a long life.
I guess the more challenging are the harder cases, people with cancer that is a terminal cancer and trying to support them and their family and friends through the various stages that they’ll go through .
This is an extremely satisfying job. You get to see people from initial diagnosis, whether it be up in the hospital having a heart attack where they've never had a problem before and they’re shocked
The next thing you know you're working through them with their acute episode.
Then seeing them here, doing cardiac rehab on the outside after they've either had medical management or an intervention like a stent or bypass surgery whatever it is.
Then you're getting them back into, teaching them about safety because most people are so worried about having the next heart attack and not causing more dramas.
Some of the most challenging things when working with people with a chronic disease such as a mental illness which can obviously impact someone over their lifetime would be that when you're working with them sometimes it feels like progress is slow.
From our perspective sometimes if we are working with someone who is unwell, it can seem slow to you and people often suffer setbacks and I can see that sometimes people who are supporting those types of people in the community can get a little bit frustrated by that.
I suppose it is just about realizing that there will always be setbacks; you just have to prepare for that.
Some of the most rewarding things when working with people with chronic disease will be when you do just see them living their best life.
When we talk about recovery and mental illness it doesn't necessarily mean I don't have a mental illness anymore, what it means, I think my understanding is that they've recovered in terms of they are living a really valued life, they are living their best life and that's different for everybody
That's rewarding when you do see someone gain accommodation or you see someone you know gain some employment that they wanted or learn a new skill or just getting out with their friends in the community and enjoying themselves.
Because that sometimes something they have not done for a while, so that is definitely rewarding.
Health education strategies and practices are critical to improving the health and wellbeing of the Australian population. Health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (WHO, 2016).
Probably the primary piece in terms of public health education that we did deliver was A Warning Signs of Heart Attack Campaign which ran from 2012 through to 2015.
It was a mass media campaign combined with a push to clinicians as well around getting people to understand the warning signs of heart attack and to act quickly once those warning signs had been recognized.
The key to that was obviously through the media and actually getting out there and actually running advertising.
Those are more of a population health approach to this problem around warning signs of heart attack.
We do certain targeted education as well so we do have our Absolute Cardiovascular Risk which is focussed at Practice Nurses and General Practitioners as well as Aboriginal Health Practitioners.
That is around getting that cohort to assess patients on their risk of having a heart attack within the next five years.
Looking at diabetes, blood pressure, smoking status, height and weight and then calculating out of risk of having a heart attack for the patient over the next five years
We also continue to do education in Hypertension Guidelines.
When our guidelines come out around acute coronary syndrome or hypertension we work with people like the Primary Health Network and our cardiologist and our general practice network to ensure that we hold our education sessions to make sure that sector is up to date with the latest guidelines coming forth.
We have a variety of ways that we provide education.
We have a Youth Suicide Prevention and Education Program and the clients tend to be a variety of people, whether that is schoolchildren and to focus on youth or professionals working with youth to educate them.
Some of the courses that we deliver our Youth Mental Health First Aid, Mental Health First Aid, Safe Talk because I think the more people in the community who are aware of mental illness and how to keep people well and promote good mental health the better
In a less formal way, the sorts of education that we provide would be for example the Carers Program that we have.
We might have a range of allied health professionals come in whether it is a psychologist or an OT to educate them on how to be better prepared in their caring role.
They might not be too aware of the effects of medication for example for the person that they're caring for, if we can help them understand that better through a psychologist coming in and having a chat to them about that or someone who's across an area that they are struggling with.
They are the sorts of education that we can do, as well.
Then generally in our adult based programs different types of education can be provided whether that's life skills, gaining employment, how to do a CV, practical life skills that people need as well in terms of educating there.
Health education is really based on sexual reproductive health, that's what our main focus is and it's definitely accredited courses we teach. We teach doctors, nurses and we have health workers in attending our training programs. What’s worked is we do a lot of that training face-to-face.
A part of our training is in a 2 tier about theory competency and in a clinical environment. We have to offer a clinical service to help train student nurses and doctors who have undertaken a theory and health education/ education programs.
When we are speaking with our cancer clients we are always promoting healthy eating and exercise. We obviously always continue to promote cancer screening that is available; any type of screening that is available and exercise as well.
In my role, the main type of health education I provide is under the umbrella of prevention. At Cancer Council we promote all the different lifestyle factors that contribute to reducing someone's risk of cancer. These can range from things like healthy eating, exercise, as well as being SunSmart, not smoking, you are probably pretty familiar with a lot of these kind of messages and these are the kind of main messages that we promote.
Another big one is also screening programs as well, so we promote all the Cancer Council supported screening programs which include breast screening, cervical cancer screening, skin cancer screening as well as bowel cancer screening. They are the four Cancer Council supported screening programs that we promote.
It's something that we've been doing for some years.We've shortened our courses, over time we've learned that we used to have two and three week courses and people having time out now is just too challenged and we have looked for a number of years of putting half those programs online but we just don't have the money yet to make that happen. There's a new world out there and training in different ways face-to-face or online or webinars. We’ve thought about it and that's a future for us but at the moment we're still doing some face-to-face and we're still getting the numbers to attend the training programs because some people like that environment of learning.
Every now and then we'll just do a half day workshop and their updates for medical staff, I mean we have a pharmacist that is coming and undertaking some training programs. We’ve had social workers we had youth and Disability Support Workers we've had a guardianship workers we've had prison officers.
Sexual and reproductive health is a topic in so many environments in fact I think it's in every single workplace. Even schools have come to us to address students because there's been maybe a rape in an year 9 class. So the issues are coming across every day. Even Victoria family planning has worked really successfully with sports stars and so they've gone to the sports AFL and the NRL clubs and given men's health programs. There's different ways of getting to different groups and at the moment our education is very reliant on how many human resources we have so if we had the more funding we would offer more.
I guess with anything to be successful with education delivery, maybe getting them to repeat what you said to them, and giving them the knowledge such as this is where you go and get your bowel screening kit, this is how often you need to have pap smears and that sort of thing. You’re giving them the knowledge, I think to help promote them to be successful.
I think to make health education successful; it needs to come from the participants themselves.
Education historically tends to be a little bit authoritative in nature but I think if we can ask a participant, what they want education on, what is missing in their life, what do they need and also what are their strengths that we can build on.
Rather than saying, I know this and you do not, therefore let me educate you.
I think we need to be person-centered in the way that we deliver education and make sure it is actually meeting the needs of the people we're working with.
I think it's really important to try and encourage repetition as much as possible in health education programs and not just doing things the once off, but building a bit more of a sustainable program and having follow-up action within the programs in order to really have an impact.
Also I would say it is really important to tailor the program to specific organizations because not all the health messages we have will be appropriate for every subgroup in the population
Health promotion is something that we're funded for so we like to think we do it well when we when we're given it. It’s again a little bit reliant on how many people we have to be able to manage all of our requests.
Basically, how Family Planning NT works is health promotion requests come in, they may request like I mentioned earlier from disability groups, support groups and organizations such as Anglicare and maybe from schools. There's certainly some schools that gets us in every year in/year out because they think their school students are understanding it, and they have good evaluations of the classes, and that the children feel that that curriculum has been met. We've had teaches that have said that they feel more relaxed about having that possibility, if a student comes up and divulges that they've been touched inappropriately then how can they manage it, how can they handle it, and they feel confident because it's not a skill that someone will maybe give them in their three years at the university but it's a skill they need.
When a request comes in we just see who's available at our education team or community educator and can we do it. Can we meet that need or can we change the date, so that's how we book it. We try to do as much education around the Darwin, Palmerston, Alice Springs regions and Katherine. We have education programs out bush in the community, we'll maybe offer some sort of community health promotion.
We’ve done that with Strong Women and certainly in some remote communities, we've met with Strong Women and talked with their young people to give them information about women's health, and what they should be looking out for, when they should go and see their doctor or nurse in the clinic. So, it just depends on who needs us, and usually a lot of groups do and we can't meet the demand.
As we’ve said before we really hone in on the seven things that people can do to cut the risk of cancer so all those lifestyle factors: quitting smoking and getting regular screening, being sun smart, living a healthy lifestyle through exercise, and healthy eating and maintaining a healthy weight.
One of the main programs you might be familiar with is the SunSmart program which is run through schools and early learning centers throughout the Territory. I do a lot of work in schools running education sessions with the schools, also working with the schools around policy development as well in terms of putting together really good sun protection policies for the schools. Making sure that they keeping up-to-date with best practice as well and reviewing their policy on a regular basis.
We've recently gone into health promotion and under a different bucket of funding from the Department of Sports and Recreation. We do some services in in the general community for increasing physical activity and health education. We pair that with some of our dieticians doing some work
As a recent example, we did a six-week group with physical activity and healthy eating with the dietician and the health promotion officer for COTA which is a seniors group. That ran that over a period of time just to get some more physical activity involved. Then some easy ideas for that group particular issues are small easy to manage meals that aren't overwhelming for them to make so short and easy making it easy
Health promotion is something that we're going into more and looking at more opportunities. There’s so much out there to be done, it's a big area
When I think of health promotion TEAMhealth, because we are so broad in the supports that we offer I think that we are tackling many of the different social determinants of health.
Whether that's a combination and safety so obviously people need housing and safety and safe place, and exercise, a healthy lifestyle, good food in order to have good mental health.
We have our accommodation services obviously supporting in that area.
Then if there is thinking of specific projects for mental health promotion an example that we did recently was a collaboration with an organization called Mind Blank, and what we did was a Northern Territory or Top End tour.
Mind Blank is a performing arts organization based around mental health and mental wellness and so we went into a range of schools.
I think we reached about 3,000 students so we went to Darwin, Palmerston, we went to Daley River community, Gunbalanya and Belyuen communities into the schools there and more broader sort of just community shows that we did.
What that was an interactive theatre, so how that was promoting mental health was they told a story of a young girl and her how her life sort of unfolds and she ends up very unwell and suicidal.
They re-tell the story and allow the children, that's school-aged children ten and upwards and we did have some adults as well, to interject in the story and say well what could we do here which in terms of health promotion it's making it okay and comfortable for children to talk about mental health in front of their peers which is really important.
Then secondly, to actually see how the story unfolds when a different Road or a different behaviour or caring for someone in that sort of vulnerable position that they might have been in makes a difference it's like that fork in the road
I think there's so many youth at the moment who are in that position like that whether they're being bullied in the playground or whether they themselves know they've been at times a bit of a bully they know all this could actually be that fork in the road for someone else.
It was a powerful performance in that way, so that was a fantastic example that we did recently.
I think good health promotion is really delivering of a person who knows the information and feels comfortable in talking about it. Sexual reproductive health is a very delicate topic, a lot of parents cringe at even thinking about their children asking the questions to them so we've had parents. We've had educating parents to sort of say look don't think of it as something special it's just part of normal life and it’s just a process that everyone will go through. Sexual reproductive health has always got a bit of a stigma attached to it, like oh my gosh it's something that we don't want to talk about.
We have people out there that want to use the wrong terminology of body parts, we don't believe that should be the case we think that the educators that we send out use correct terminology. They make it not look like some sort of special topic that needs to be laughed about, it is a normal process of life and it's something that we shouldn't be frightened of and I think that we do that well. I think all the Family Planning around Australia and the Globe do it well because we are comfortable with the topic and I think that's where it can get a little bit out of whack .
I know that when we have question time with different groups we've often put question boxes in to try and make it private so people don't get laughed at if they ask a very unusual question. Some of those questions are really out there, and someone’s written that down and really wants to know about it and they're not going to find that in a magazine. Some of the questions that we ask we've been asked questions like and for example why is sperm salty. How do you get twins. Can you can you get pregnant underwater, I mean it's still myths around there that have been going around for 50 years and even though education says yes, you can get pregnant if you have sex under water they still think that you don't.
We seem to have the next generation is better than the last but we still need to make it better.
Some of the challenges with health promotion in the Territory are how much of a diverse community we've got. Culturally diverse as well, as I said before the Territory’s a very big place and the population scattered all over the place so I'm trying to engage all those people around the Territory in an equitable manner and really getting out there getting health promotion messages heard.
I think another challenge in terms of delivering health promotion in the Territory is changing people's stands on certain issues, sometimes people can be quite stubborn in their views on what what's good for them so changing attitudes and behaviours. As I said before repetition is really important in that sense, so drumming the messages into them.
Some of the biggest challenges for health promotion in the mental health sector would be, I’d say stigma is one. I suppose with your more physical health areas people tend to think it is external factors or the environment or something that has made people unwell. Whereas with mental health obviously people tend to internalize or blame the individual which is really not the case, and so I think when you are trying to promote mental health people tend to move away a little bit from it and think well that's not me and that's them That can make actually promoting mental health or your service in the community a little bit tricky or they don't want to be seen with you and those sorts of things can be challenging so I think it's up to us to continue in the way that we are to normalize it
Because you know having poor mental health at one point or another in your life is normal, we're all on a continuum of good and worse or poor or whatever however you want to talk about it mental health. I think the more that the community is aware of that, the better it is for everyone and the better we can actually promote it.
Evaluation we do in a few different ways so I think getting feedback from the people we work with is hugely important. We do yearly survey called Your Experience of Service Survey from as many participants as possible. We’re doing this for the second time this year where we asked them a lot of questions about the impact the service has had on their well-being, a range of things like how welcome they felt, how safe they felt, and just to basically evaluate whether our services need particular improvements or changes that we can make for the following year and putting those into practice.
We also evaluate projects that we do, so the example that I gave of the collaboration with the Mind Bank, the performing interactive theatre, at the end of each show we gave all the youth that were there just a really simple feedback form to ask them did they learn something about mental health that day, do they feel more confident to then go out and practice help seeking behaviours following the performance.
Has what we've done made a difference, has there been an outcome or a change and so we do try and do feedback pretty consistently across the projects that we do
It’s a problem with a lot of services is we want immediate result, if we don't get immediate result we decide to throw it in the bin and walk away.
It also means then that a lot of programs are cyclically funded, they don't make that result really quick we don't get refunded, five years later someone comes up with exactly the same idea and it gets funded and we just repeat the churn and the wheel over and over again.
We need to have a bigger broader look at lots of different strategies to engage different groups in different ways that they need and think of it as an overarching policy and way forward rather than just nitpicking little individual things.
Evaluation is extremely hard and to do a proper evaluation you need to put a lot of resources into teasing out all the areas. That is a challenge for health promotion.
Another challenge is of course the immediacy of acute care funding needs, means that you always pull from the buckets, then we’ll fund that later when we've got the opportunity to fund that.
If we just resourced it properly and let it be to grow and develop as it needs to and not cut it every five years because of a budget problem we would get a lot further down the track, so that's a personal bugbear.
The key to is success of any health promotion is evaluation and every project that we do we evaluate the outcomes. The biggest challenge to good health promotion is ensuring that the message particularly from cardiovascular perspectives is the messages that we're trying to get out from a public perspective are understood and translated.
Then from a clinical perspective some of those challenges are ensuring with the amount of information for clinicians that is in the market that we can be heard in terms of the importance of the health messaging for cardiovascular disease.
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