• Secretary's update

Every Student Podcast: Patrick McGorry

29 June 2020

Youth mental health expert Professor Patrick McGorry joins Mark Scott to discuss mental health concerns in young people during the pandemic.

Transcript

Mark Scott

Hi, I’m Mark Scott, Secretary of the NSW Department of Education.

Welcome to Every Student the podcast where I get to introduce you to some of our great leaders in education. Today I am in conversation with Professor Patrick McGorry, a former Australian of the Year, a psychiatrist known for his development of the early intervention services for mental disorders in young people and for his role in reforming mental health services to better serve the needs of young people with mental ill health. He is Professor of Youth Mental Health at the University of Melbourne, Executive Director of Orygen, the National Centre for Excellence in Youth Mental Health and a Founding Director of the National Youth Mental Health Foundation Headspace. Welcome to the Every Student Podcast, Patrick.

Professor McGorry

Thank you Mark, great to be here.

Mark Scott

What a challenging year it has turned out to be and this year has thrown up a lot of challenges for young people and a total change to how we live our lives. What have you seen through the COVID-19 disruption so far Pat and how has it affected young people’s mental health?

Professor McGorry

As you and I know young people it is their main health problem even under normal conditions and the kind of things that we have seen with COVID-19 where contact with their peer group, which is almost like the life blood for young people, as well as their parents of course and their families is restricted.

If they are struggling, we have the social isolation as well and the loss of sources of pleasure and fulfilment in life too. There is the anxiety, which hasn’t affected young people as much – the anxiety about the virus – but anxiety about their futures, superimposed on their general anxiety about the state of the world with climate change and all these other issues that they are concerned about. Then the threats to their education and employment which is really going to be a realistic threat with a recession on the horizon here so I think a bit of a perfect storm affecting young people and it is coming out in the survey data that we are seeing as well.

At the same time, despite Telehealth, their access to care is reduced. We have mitigated that a bit, or a lot with Telehealth being funded by the Federal Government but actually the drop off in new cases presenting to Headspace for example is about 50% drop and about 25% drop for across the board.

Mark Scott

What do you think contributes to that?

Professor McGorry

I think it would be great to hear from Jeanti and Angelica who we will introduce in a moment but I think it is a mixture of reluctance to seek help in the current climate and also the difficulty in actually finding people to help.

The Federal Government has talked a big game in terms of “crisis lines” and “we are all in this together” type of rhetoric and “it is ok not to be ok” so positive messages about seeking help but when you go to seek help beyond the crisis line is a bit of a gulf and there are waiting lists in Headspace which the Government is also trying to address but practically for young people it is kind of hard to find the right sort of help at the moment relative speaking.

Mark Scott

It was such a traumatic summer with great bushfire disruption, concern about climate, an anxious summer for many. Is there a sense that COVID is an overlay on the underlying condition? So people were anxious, concerned, were challenged by mental health issues in advance of the pandemic, that the pandemic layers over the top of that and makes things worse?

Professor McGorry

That is a great question Mark. If you look at all previous disasters and I have actually been involved in a couple from a mental health point of view, especially the tsunami for example, you see a wave of temporary distress and mental ill health in everybody that is exposed and that is everybody in COVID and that settles down in most people without causing a need for care or professional health so we don’t want to pathologise that reaction too much.

On the other hand we do see an increase in new cases of people who haven’t been unwell before and exacerbation of problems with people with existing mental health conditions. There is a rise in need for care I would say about 20% to 30% in most disasters and in recessions it is even worse. The Great Depression or even the GFC we see rises in suicide and we see rises in mental ill health. It is not hard to predict and we have done modelling with Sydney University and also our own people to predict a rise probably about 20% to 30% in significant need for care. Most people get through it and they are resilient others really struggle.

Mark Scott

The circumstances of young people having to be at home for a period of time and perhaps with their parents suffering from anxiety or the stressors of life bearing down with parents that period of lockdown what are the risks and challenges for young people in that setting?

Professor McGorry

I have been doing Telehealth during this period and I have seen mixed reactions. Some of the young people find it has been okay and they have had more time with their families and they found it easier to study without the distractions of the school environment. Others have found it very painful because they miss their friends, they can’t wait to get back to school. With young people I have learned it is not a one size fits all and it will be great to hear from the young people here today about that too.

Mark Scott

Before we go to them one of the things that we have thought about and it has all moved fairly quickly the lockdown lasted several weeks but it is fair to say that we have got young people going back to school earlier than we may have thought when the lockdown began, what are the challenges that some young people might face on the return to school having emerged from home where they have been in the sense lockdown for weeks and weeks?

Professor McGorry

I don’t know, that is something I haven’t heard a lot from the young people that I have been looking after personally, again it will be nice to hear what Angelica and Jeanti think about that. It is change, it is an adjustment, some had to adjust one way and they have got to adjust the other way back. Things like bullying might have been a bit less, you would think, when people are home schooled although cyber bullying can continue but maybe some of the stressors were reduced and they would be re-exposed to them that is one thing that occurs to me.

I think everyone has been a bit strung out if I can use this highly technical term by the whole experience and people might be a bit exhausted and a bit over it by now.

Mark Scott

It was interesting one of the things that we found in NSW we had a deliberate strategy around a staged return to school so that we said lets have everybody in for a day a week and we did that for a couple of weeks and when we were questioned about it the answer was we felt that we needed to build confidence in the system again, confidence for parents, confidence for teachers and the adult staff who work at the school but also confidence for the students that the school was a safe place to be, we could get back to normal operational settings, we needed to build confidence over time and I think we look back on that now and think that was quite a successful approach and we are glad we did it and recognise that this had all been traumatic and disruptive and we needed to build the confidence in coming back into the system.

Professor McGorry

That makes a lot of sense Mark because even from a psychiatric point of view there is a thing called “graded exposure” which is a way of dealing with anxiety and phobias so you don’t throw people in the deep end you gradually expose them to a stress and give them time to adjust and build their confidence exactly as you have said so that was a very wise thing to do I think.

Mark Scott

At Orygen you have had a long career in working in addressing mental health issues with young people and part of what you do is engage young people to advise and support the research you are doing we are going to talk a little bit about that and introduce Angelica and Jeanti to us.

Professor McGorry

I have been working in early intervention for young people my whole career since the mid-eighties, gradually evolving over the last 20 years into developing new systems of care with support particularly with the Federal Government on that front and that is where Headspace came from.

What we learned over the last 20 years is that we absolutely can’t do this without the fundamental and central input of young people both in the clinical care sense, developing new systems of holistic care and also in the research sense because Orygen is the research institute as well as a provider and developer of clinical services. I have to say it has been an absolute joy and a revelation over the last fifteen to twenty years to have cohorts of young people like Jeanti and Angelica helping us, advising us, guiding us in how to make a service or a research project actually work so it is fit for purpose, it is focusing on the right issues and the culture of both the clinical care and the research feels right. You have just got to walk into one of these services where young people have had a voice and you feel comfortable, you feel welcomed, you feel at ease, that is the name of a Dutch copy of Headspace it is called At Ease.

You can’t really put it into words but I want to say we are so grateful to a whole series of young people over that period which also is a feature of all the Headspace centres around the country so I think we have been very, very fortunate to have the current politically correct term is co-design but it really is. Our new facility in Orygen which is like state of the art we are privileged to be in third world type facilities but finally we got a nice facility and was co-designed with 168 young people and won architectural and cultural awards and that is all down to the partnership that we have had.

It is a great pleasure today to introduce Jeanti and Angelica who are young people that are playing those sorts of roles.

Mark Scott

Welcome to them and thanks for coming along Angelica and Jeanti. The people who listen to this podcast are fundamentally educators, teachers and those who work in the Department of Education and research centres around the country, also parents as well, but we call it the Every Student Podcast and we are trying to put students at the centre of our thinking and insight.

Could you tell us what are the factors that you think we need to be engaged in around providing the right kind of support for young people, particularly young people who are dealing with mental health issues as they deal with the disruption of COVID-19.

Angelica

Thank you for having both myself, I am Angelica, and Jeanti on this Podcast, I think it is really cool that we get to have a voice on a topic like this. There are many factors that I believe should be focused on and I am going to speak on behalf of my many siblings, I am one of nine, I have seen it all now with their experiences in high school and primary school during this pandemic. One of the biggest things is it is really important that students mental health supports are clearly transparent to them and what is available to them is made clear from the beginning. What I have noticed in my siblings has been a very big increase in anxiety and worry and fear about the future, what the future looks like for them.

One of my brother’s is in HSC right now so deciding what he is going to pick for next this global pandemic has really impacted him and the way he has gone about his study right now so it is important that educators think about those factors and about the future and students not knowing what is readily available to them, making that clear and transparent to them and also the options that are out there in terms of supporting them with their future choices. Especially career going past Year 12, if they are currently in Year 12, that might just help to reduce a lot of the anxiety that some of the older cohorts are experiencing.

Mark Scott

Providing confidence, where the opportunities will come and in a sense universities and employers are going to be trying to look after young people and making sure there is awareness of the range of options that exist during the disruption.

Angelica

Yes definitely. On top of that you brought up before the impact of stress, the stress life of parents and other people in the household although some students may not have been directly impacted in terms of their mental health I know that their parents or their carers may have and that has a flow on affect and I have definitely seen that in myself let alone my own siblings, how they have been feeling having to cope with extra demands at home in terms of caring for each other, other roles, just supporting my parents as well so that just adds extra stress and worry. Just a loss in their ability to concentrate on school. Those types of things are really important to think about.

I wanted to mention also I have one sibling who is in an inclusive education school and I have looked at things very differently because of how his school has approached it. He has an intellectual disability and how this pandemic has affected him is that he has had a deep loss in connection to his teachers, to friends that are really important to him and his development. Although he can’t communicate how he is fully feeling in terms of mental health you can see it in terms of his behaviour. He is feeling more anxious, he is feeling much more worried, on edge, a little irritable when it comes to specific things and that change from suddenly stopping school to then going back, he didn’t go back immediately like my siblings did in the staged model, he went back when there was the full return just that switch, that transition is really difficult for a lot of these students that go to these schools as well and have these feelings that affect their mental health so it is really important to think about how transition affects students that go to these schools too.

Mark Scott

Thanks Angelica they are great insights. Jeanti, Angelica was talking about the challenge of HSC students thinking about what lies immediately ahead for them, do you think young people have been overwhelmed by the broader context of what is happening not just their own work or their own studies but look this is a pandemic sweeping the world, it comes on top of climate change, we have all these protests that have been erupting in recent times about entrenched racism in our community and the way authority has acted in the face of that racism. It is an age of anxiety and reasons for anxiety would appear to be apparent for all members of the community.

What about being a young person in the context of concerns rampaging all around us?

Jeanti

Young people are in a position where you can look forward to the future, usually there is that excitement of where are we going to go, what is going to happen and especially now young people are having a really important role in shaping what happens and I get that with working with Orygen and being on the Youth Research Council. It is amazing that older adults are engaging us now but I think just everything adding up, the climate emergency, Coronavirus, the bushfires, the Black Lives Matter movement, it can be quite overwhelming and for a young person it can be hard to see where to start when there is so many layers to what is going on in the world. Just looking forward instead of that excitement there is now trepidation especially for people in primary school or younger. Usually the world seems like an exciting place but I think now it is weighing on people a lot more and that of course negatively impacts their mental health.

Mark Scott

Pat, what advice should we be giving to teachers and parents in helping young people who might just feel overwhelmed wherever they look and that has been their experience of the last year and it just all seems to be getting worse in some respects. How do we help young people just be secure and confident in the moment?

Professor McGorry

I think just listening to what Jeanti was just saying, having honest conversations is really important, not patronising young people. A tendency to patronise young people from our age group or their parents maybe and not really understand but listen, listen to what they are saying but probably maintain a pretty hopeful attitude for the future. Just picking up on what Jeanti just said hope is an incredibly therapeutic commodity and that is one of the things I found when I first got into psychiatry there wasn’t much hope there when people developed a mental illness. Hope is a lifesaving commodity. It can’t be blind hope it has got to be something that is dealing with the issues that you and Jeanti both raised.

There is a realistic issue here with all these things that have come up like racism and climate change and so on, and even the pandemic is a threat. Life is tough at the moment so being honest, being prepared to face it but knowing that people have got through these periods in the past it is a bit of a rollercoaster life even individually and certainly collectively it can be like that. Parents can take that approach and try to be strong and hopeful and the parents would be struggling as well, we can see that too. They are drinking more that is for sure.

Mark Scott

One of the things that we were talking about the staged return and one of the reasons we wanted every student to be in the school at least one day a week was so that teachers could eyeball them, could see them, we know that that connection between teachers and students at schools are is important.

If there is a lot of reason for a concern in society what should teachers and parents really being looking out for with young people if in fact they are concerned that the young person is really struggling with an anxiety in a significant way? What would you research and experience show are signs that parents should be alert for or teachers should be alert for?

Professor McGorry

That was a question that was very relevant even before COVID. I have a colleague who has done research with teachers in rural and regional Victoria and found that teachers are very worried about the mental health of the students. I thought it was very touching in the pandemic lots of teachers were saying how much they miss the students, they really care about them, they have got a bond with them and they know quite often when a student is struggling. They get trained by Beyond Blue with Be You program and stuff like that and how to recognise stuff, so teachers are very good at recognising when a student is struggling but then they don’t necessarily get enough backup in helping that student. There might be school counsellors but they are pretty few and far between and the prevalence of the need is much greater than the availability of contact.

In Victoria there are things like doctors in schools and Headspace has been strengthened a bit to respond to referrals but that step in the pathway getting some expert help and how to do it in a non-stigmatising way that is the challenge we haven’t mastered yet and I think it is very, very important we build that.

In some smaller communities you might have a Headspace in a country town of say 20,000 to 30,000 people but then there is a few communities up the valley where there is maybe 7,000 or 8,000 people and there is a school but the kids there can’t get to the Headspace. There is an access problem there for the next step in the pathway of a student needing help and the teachers need to be supported and have someone to talk to about kids that they are struggling with in the class perhaps as well. There is a lot more work to do on that front.

Mark Scott

We were talking earlier about the need to be honest and to provide a pathway to hope but in a context of the reality in which we are dealing with. How open do you think the discussions need to be around mental health and mental health challenges facing young people and that is part of the dialogue in a school setting? Angelica how important do you think it is that we are talking about all these things at school with students?

Angelica

I think it is extremely important and I know students are, from what I have seen in my context, ready to have more of these conversations and I know the teachers are too. Just following on what Pat said teachers are doing such an amazing job right now trying to connect back to students the way that they had connections before. Capitalising on the fact that all of us collectively in schools want to see hope for a future so let’s talk about it. Given everything that is going on and I know right now my siblings are already having conversations about how racism has impacted them in the school setting on top of the pandemic, and on top of the bushfires, and on top of the climate change the situation that was going on and having that more openly with their teachers now. I have seen a change in their confidence about where to go forward. I definitely think we have a good chance now as a society to really have more of an open conversation whether it is on individual level or with students in year groups only or as a whole, I think trying it all would be good really to just make sure that as many young people are able to talk about this and really reduce the stigma that exists regarding talking about mental health and that is inclusive of parents too. It is important to have parents in that conversation as well so that when students go back home they are able to have more of an open conversation on mental health and how all these situations have been impacting them.

Mark Scott

It was one of the striking things about the public debate that emerged through the disruption through teaching and learning around COVID-19. Yes there was concern about students progress, and literacy and numeracy and preparation towards the HSC but just as relevant I think and central to the conversation was the wellbeing discussion and the sense that attending school, and the connections made at school were a pivotal part of the wellbeing of young people. As Pat said teachers missed the kids but the kids missed each other, and missed the school, and missed the teachers, and missed that important part of supporting infrastructure that perhaps we have underplayed in the past.

Professor McGorry

We use the term scaffolding, how do you get to be a grown-up adult? It is like a building and to achieve that milestone you have to have scaffolding around you as you move from childhood to adulthood. The parents and the family are one part of that, the school and the educational structures are a very important other part of it and when that is taken away like it has been recently, that scaffolding is kind of missing a bit, it is an analogy that we often use, and we have got to try and strengthen the scaffolding and if young people develop mental ill-health then people like me and my colleagues become part of the scaffolding for a while.

Analogies like that are really helpful to understand what roles people actually play in this process.

Mark Scott

Pat in the time I have known you, you are a tireless crusader for appropriate investment in mental health research and support service around mental health. Given the disruption we have seen and given the pressure that COVID-19, climate change, bushfires, now Black Lives Matter, brings to bear on the community what do you think are the important public policy priorities to supporting strong mental health in our community now?

Professor McGorry

I think there is two foci. One is the preventive one that you have alluding to, how do you reduce the threats and the impact so in that sense, sticking with young people, we have got to make sure that scaffolding is protected as best we can whether it is education or employment over the period of the recession that is the biggest threat, it is very, very potent and the Government is trying to do that with Job Keeper, Job Seeker and those sorts of things and it is a huge investment and support especially around the tertiary sector too because universities are in deep trouble now, so that is one level. What can we do to reduce the impact of this recession that we are entering now and the disruption and threat?

The second thing, if we can’t prevent something whether it is heart attacks or cancer then we have got to provide early intervention and a safety net so the people get expert help as soon as they start developing the need for it and in mental health as you know, we talked about it before many times, it is just not there in the same way as it is with physical help. The Government has built some parts of the safety net, so give them some credit, I think Greg Hunt has been a particular strength in Headspace but there is a lot of holes in that safety net and it needs to be much stronger if it is going to stop people falling through.

Mark Scott

I want to thank all three of you today for your contribution to our conversation. Angelica, Jeanti and Pat, this has been a central issue for our teachers and school leaders, how we create an environment where young people can flourish so that every young person in our schools is known, valued and cared for. Thanks for your leadership, thanks for your great research and thanks for joining us today on the Every Student Podcast.

Professor McGorry

Thank you Mark.

Angelica

Thank you.

Jeanti

Thank you.

Mark Scott

Thank you for listening to this episode of Every Student. Never miss an episode by subscribing on your podcast platform of choice or by heading to our website at education.nsw.gov.au/every-student-podcast or if you know someone who is a remarkable innovative educator who we could all learn from you can get in touch with us via Twitter @NSWEducation on Facebook or email everystudentpodcast@det.nsw.edu.au.

Thanks again and I will catch you next time.

Mark Scott

About the Secretary

Mark Scott is Secretary of the Department of Education. He has worked as a teacher, in public administration and as a journalist and media executive. He is committed to public education and learning environments where every child can flourish.

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