Episode Summary
In this second part with Mel, she discusses her clinical work, the concerns over screen time, challenges facing children in guardianship care and the transition from adolescent to adult psychiatry.
Episode Notes
Dr Melaine Turner, or Mel to her clients, is a one of Adelaide’s few Child and Adolescent Psychiatrists. I the first part, Mel discusses more about her personal life and her time leading up to medicine. In this second part with Mel, she discusses more about her clinical work, the concerns over screen time use trends, challenges facing children in guardianship care and the process involved in supporting the transition from adolescent to adult psychiatry.
Dr Turner’s Practice
Transcript
[00:00:00] Michael: Welcome to the integration station, your go-to Pediatric Occupational Therapy podcast, brought to you by the O T F C group. This is part two of our chat with Dr. Melanie Turner. In our first part, we heard about Mel’s life and time leading up to medicine and a bit about her background. This part discusses more of Mel’s clinical side, her role as a psychiatrist, the people she meets, the stories, and also some of the challenges that come with working in the field.
Some of the clients that you work with. Mm-hmm. , do you find that there is a void of interests or they have a lot of interests or, you know, cuz obviously we see a number of clients in our practice and Yep. Obviously you would as well. Yep. . One thing I know I hear a lot of, and you’ve probably seen it is, is screen time.
Screen time gets used a lot. Mm-hmm. . Mm-hmm. . And it’s a big, um, I guess outlet for a lot of, a lot of kids, teenagers. Yep. What is your experience in terms of interests and, and the role of screen time for, for a lot of these kids now?
[00:01:13] Mel: Um, I lament the enormous amount of device time that’s emerged into all of our.
I think it’s a disadvantage for all of us, me included. Um, I, um, remember the time when the only place I could be contacted was when the phone rang at home. . You would’ve had a pager as well. Yeah, we had pages, . Um, and, you know, you only had to have your pager on when you’re on call. Mm-hmm. didn’t have a mobile.
uh, we’re working in bits of rural Queensland, which didn’t have a reception back then. It was no reception. Right. Um, and so your home phone would ring, or your pager generally would ring lived in a radius at the hospital. Um, and what I realize I miss, and I think children probably miss, is the freedom in your brain to know you are not gonna be interrupted.
Mm. And I like even just going shopping with my mum, you know, early eighties, you know, late seventies, you know, there was no way that we were gonna be interrupted unless she ran into a friend in the supermarket. And I remember the conversations that we would have, you know, the decisions we’d make about what we were gonna put in the trolley, you know, all that.
And then getting home and unpacking just this uninterrupted time that I realize we’ve lost that, you know, the true focus on a. , I think always in the back of our mind is the idea that we need to check an email or the phone’s gonna buzz or texting someone, and we didn’t have that. So I think that’s a negative effect on most of us too.
The truth. Um, and I think that, um, we didn’t know that at the beginning of mobile phones and devices and so I think we had no way of planning for that and we’ve just fallen. , you know, that this is what, you know, this is what happens. Um, obviously there are devices in my house. I have multiple roles and that actually come with multiple different devices.
So I have three different places that I work for, and each of them, I have a locked, secure device for each one. So if I have to go somewhere and I have three meetings, I’m carrying three laptops with me, which is crazy Town, but you know, is a symptom of where we’re at. Um, my boys also have devices and have phones, and I say that to my patient.
We’re not a device free home. Um, I think that the other challenge is that it’s a, it’s a passive way to stay occupied. And I think kids now struggle to be bored. I think they struggle to find self-direction. Mm-hmm. . Um, I think that it’s easy to look at something on your screen than it is to look within yourself and work out what you feel like.
what really sings to you? How do you feel that time? And I think that that’s why we need to help kids have time off devices. Cause those are such important life skills. Um, And then, you know, we get the kids that say, um, there are some kids that do use it for downtime. Absolutely. Mine included. But you know, kids who are, you know, a s d kids who have developmental disorders, it seems to allow them to shut off the outside wheel.
Yeah. And just kind of have zone out time. And I really appreciate that. But what we need to recognize is that can’t be all the minutes. that they’re not engaged in something else. We actually have to help kids tolerate boredom, tolerate uncertainty, tolerate being asked to do things that aren’t that exciting.
You know, the dishes, finding your shoes, you know, packing your jumper away in your bag. Um, so balance is really important. Statistically, if you look at the research which wobbles around with the place, they say, you know, anything more than a couple of hours a day isn’t healthy for kids’ brain. Um, and. . The kids I look after hate it when I say that.
Mm-hmm. , you know? Mm-hmm. have many a discussion. But you know, what I do do is some of the teenagers I look after, I’ll say, you know, can we do a device, social media, downtime, and tell me how you go. And it is really interesting to see what a much happier human is opposite me the next week when they’ve actually had time off.
Cuz the other thing is, you know, if you. Some of the other research, what is our, bro, I don’t know about you guys. Mm-hmm. But you know, Jerry Seinfeld did this great joke about, you know, he was on stage, but he knew his phone backstage was only on 28% battery . And that that, you know, and that made him anxious.
Mm-hmm. Right? So, oh my God, like, what am I gonna do? What? And everyone in the audience is laughing, right? Because we all knew it’s very related. It’s
[00:05:45] Michael: very Jerry Seinfeld sort of standup comic stuff.
[00:05:47] Mel: Yeah, yeah. Um, but it kind of is truly there for all. , where’s my phone? Have I got it? Did so and so text me?
All that kind of stuff. And so I, I think we have to do a better job of finding that. And that’s also about defining what is your work time? When can people contact me? Why aren’t our phones off at nine o’clock at night? Just someone really need to call you at midnight, et cetera, et cetera, et cetera. So that’s my very long answer.
Mm-hmm. ,
[00:06:14] Dino: we lived without it before. You know, a lot of us. Yeah. And I’m, I’m, we, we went away in 2016 for three months overseas, and I put mine in the safe. I switched it off and kept it in the safe. Mm-hmm. , wherever we went. Yeah. Didn’t touch it for three months. I had the best three months. Yeah. Didn’t answer an email.
[00:06:33] Mel: Yeah. And the world kept
[00:06:34] Dino: turning. Poor, poor Michelle, my wife. She would, she would, she would always keep in contact with, and I said, I’m here for the kids. I’m here on holiday and I’m not, I’m not gonna touch it. Yeah. It was easy. You know what I did? The first thing we did, we sat back in, back home, put my phone in charge.
Yeah. Got it ready. And you get back into that, you fall back into that very, very quickly. It’s a, it’s a practice to, to leave. I practice leaving the phone at home. Yep. On occasion, if we’re going out, and I think every. That would call me or I know is going to be at that party or that. Yeah. So I don’t need my
[00:07:05] Mel: phone.
Well, I make the, the statement for the kids. I go, everybody who’s the most important to me is sitting right here. And anyone other than that doesn’t need to call me now. So I turn it off. Yeah,
[00:07:15] Michael: I mean, companies technology, I mean, you look at an iPhone now, it’s got do not disturb mode. That’s built into the phone now.
So they’re encouraging that to happen. But for me, I’ve always found. . We are in a technological age, and I was talking about this actually recently with the UniSA lecturer who’s quite involved in, in the research on technology. And, and some of it is, and I agree, I think too much technology is, is detrimental.
Mm-hmm. . But what are you being exposed to? What technology are you using? How are you using screen time de depend, depending on how it’s used. Um, it can be quite supportive for a lot, for a lot of the clients, but it is you Absolutely right. It is a balance. Mm. Being in the front of a screen, playing a video game by yourself as opposed to in a room with five other mates Yeah.
Is a very different form of consuming
[00:08:04] Mel: screen time. Absolutely. So if you’ve got, I dunno if all of you’re in a team, you know, and you’re all on, you know, discourse together, you know, doing whatever it is. Yeah. I see that as, . I mean, don’t get me wrong, I don’t want people gaming all the time. No, no, no, no. It’s quite different than the kid who does 17 hours of just flicking through YouTube.
Yeah, yeah. Um, and I often say that to, you know, to parents and to kids. Is it social? Who are you connecting with? Is it basically friendship? Is it like having, like I have a chat with my mates? Is that what it is? Um, are we using the screen to facilitate connection or are we just using it because we need something to fill the space?
Or is it actually inhibiting us? Feeling a sense of freedom or a sense of choice. Um, and that, but that’s very hard because I’m also asking parents to reflect on that. And we are all noted. We’re modeling either.
[00:08:52] Michael: Yeah. Mm-hmm. We’re modeling screen time all the
[00:08:54] Mel: time and often. Yeah. You know, I’ll, I’ll have the kids will go, well, mum’s on hers all the time.
Yeah. Yep. Dad’s on his all the time. And sometimes people will be on it in the appointment. Um, not very often now, but if we think 15 years ago, you know, You know, people were still very much struggling to work out how to use mobile phones and stuff. People would, would answer phone calls in the appointment that I was having or answer them and just walk out the door and leave the child sitting there on the couch.
Um, and it wasn’t their fault. It was just trying to work out, do I answer this call or not? Is it rude to hang up? Is it not rude? You know, um, because if the phone rang at home, he picked. So there were people still working through all those mechanations. Um, you know, I try, we have a pH, we have a box. It’s called the phone box at my house,
And the phone box is meant to hold all of our mobile phones when we get in the door, um, with the idea that if we are home, We’re all together, they can go off. Um, my oldest has more time to his, cuz he texts his mates and, and catches up with them on the phone and stuff. But we have, you know, times and boundaries around that needs to go off and where that needs to go and, and stuff.
But, um, the school expects I think, most of the teenage kids to have a phone. So, you know, the bus breaks down the excursion’s late. I’ll let your parents know.
[00:10:15] Michael: They’ve all got computers now as well. Yeah. That’s just a,
[00:10:17] Dino: a standard. You can, and you can message straight from the, and you do in class. Yeah. Yeah.
I, I get a message from my son. Hey, dad, how’s your day going? Yeah. Good mate. What are you doing? Texting
[00:10:25] Mel: me? Yeah, yeah, yeah, that’s right. What are
[00:10:28] Michael: you doing? Be studying? Shouldn’t be working. He loves you. He’s saying
[00:10:30] Dino: hello. He, he, and, and do you know what? It’s nice. Yeah. Yeah. It’s really nice. Some, sometimes I, what’s wrong, but o.
That’s nice to, to have that message. My daughter lives interstate. Yeah. To be able to have her on FaceTime at dinner with us every night Yeah. Is, makes her life and our life. Yeah. Um, more manageable in this transition time. So there’s no, you can’t just sit here and we are not, we are not, um, sitting here criticizing technology and say, all right, take it away.
We’re saying it, it, there are elements here that are hard to navigate. Yeah. Our families have difficulty with, uh, understanding at times. how much of an impact it can have on the development of their child at certain ages. Yeah. And what that sets them up for And we understand the impact cuz we see it at, we see it through the, through the age range.
And then we have a 16 year old who is only in their room and has meals delivered to their door. Yes. And doesn’t shower and doesn’t have any connection with anyone outside of. , they’re direct family and, and the, I guess the de the depressive states that can develop and the anxiety that develops.
Absolutely. And then, and then your, I guess that your end, you are trying to help them and we are trying to help them. Mm-hmm. . Um, but we wanna prevent that Yep. As much as possible through education. Mm-hmm. At a younger, when they’re at a younger age, but they don’t see that, they don’t see that 16 year old when their child is two and is.
I don’t even know if they watch Teletubbies or Bluey or whatever they watch. Now, , um, obviously my children are a bit older. Um, and, and that you do have to manage that, that is our role as parents as well. Yeah. Yeah. That’s a probably a clearer message, um, to put through, is that we are not saying take it away, we’re saying be responsible.
You know, parents still need to be responsible Yeah. For their children. On that.
[00:12:20] Michael: Mm-hmm. , obviously as a psychiatrist, you, you know, people think maybe you’re in, you’re involved more in the medication side. Mm-hmm. , if we’re gonna put labels on it, but how much parent education do you then provide in your consults about something like that?
Or, or providing understanding that there are nonpharmacological supports and techniques that are also needed in addition to the medication being. .
[00:12:43] Mel: I’d like to think that I do a lot of talking about that. Yeah. Um, I mean some often when people are coming to see me, medication’s, part of the discussion. Yes.
Because often my particular specialty are the only ones that will be the prescribing treating practitioner. Yep. So other people might have already declined to do that. A GP or a pediatrician or whatever. So often that’s part of the conversation. But most child adolescent psychiatrists, a lot of what we do is around the therapeutic non-pharmacological approach.
And, um, reflecting on, you know, the parent-child relationship, developmental kind of stages that people are at, you know, perspective taking, um, you know, what are appropriate tasks that children should be able to complete, et cetera, et cetera. Um, and I think that, um, I suppose that. . I, I always think that we need to support children to have the most successful developmental trajectory that, that they can have.
We only get one go. Yep. At the child brain. Um, and I say to them, you know, so once you’re 25, you know, your brain grows but nothing like it does between, you know, zero and 16. So we’ve gotta grab all of these wonderful brain opportunities. And so that’s what I talk about. You know, we set the tempo for our brain now.
And so, you know, that’s why we can’t have all screen time now, cuz when you’re 25 and you go, I don’t wanna do screen time, all the wiring in your brain and all those learning parts have, we’ve missed that. So, um, I often talk about the importance of, you know, social connection. , the importance of actually spending time with family of learning.
How to sort of understand yourself and your own principles and ethics, what you’d like, what you are good at, um, you know, have an interest and understanding of where you fit in the community. That’s a really hard one for some of these kids that are really stuck on their screens. They’re really, uh, separate from where they understand that they fit.
and I certainly noticed with Covid, you know, with everyone encouraged to kind of really not socialize and not connect an unintentionally Yeah, yeah. I’m not saying that the, that’s medical reasons. Yeah, yeah. Um, that, that encouraged people to be insular. So I’ve had to do a lot more work around non-pharmacological interventions.
So, um, one of the biggest things I think is. Family connection and family relationships is a lot of what we talk about cuz some of the children we look after have quite significant impairments. It can be really challenging to parent a child who has really high needs. And so, um, looking at how you can help parents reflect on what they need.
how their feelings affect the relationship with their child, why their child might trigger some of the challenging responses they have, what the child might be seeking from a behavior or might be seeking from the language they use. Um, Talking about how that affects other siblings looking at sibling relationships.
Um, we do lots of that in our child and adolescent based work. Um, and then sometimes I pull out, you know, the Maria Montessori list of, you know, what kids can do at different ages. Now I’m not a Montessori zealot. Yeah, right. But what I do like is her view of children, as, you know, people that can achieve and do task.
what, what can kids do? So I think she’s got this, you know, she’s got like a pictorial diagram, I’m sure you guys a checklist of Yeah. Mm-hmm. , like at the age of 10, I think she had, you could, you could prepare a meal. Yep. So for some of the, the, the families where we are struggling to work out what’s fair to expect of their children.
Mm-hmm. And you guys probably have the same mm-hmm. , you know, is it okay that I expect my eight year old to unpack their school bag? Is that what other eight year olds do? And certainly in Covid, a lot of people weren’t able to compare. You know, parenting cuz you weren’t doing the drop off and the pick up and the school excursions and stuff.
And people felt quite, you know, separate from that. So we go, well what, what does a normal eight year old do? Um, and the kids who look at me when I say, well look, maybe at 10, you know, do you, could you make toast for everybody for breakfast? And for some families, the the thought that that would be a reasonable expectation.
Was, you know, I, I was like, I was asking an enormous amount. Yeah. Mm-hmm. , so I wasn’t talking about like a three course meal. And it’s not that that family were wrong, it’s just that they’d been so worried about expecting too much from their child. Sometimes the kids then don’t learn those extra skills, you know?
So, um, like I was talking to my mate last night and she was talking about her youngest who didn’t wanna unpack the dishwasher because he hates it. And she said, okay, well I’m about to clean the, the mirrors in the bathroom so you can do the. if you want to. And he went, yep, I want to do the mirrors. And she went, no worries.
So they swapped tasks. Now, he didn’t do a fantastic job, but he’s nine. But he cleaned the mirrors and she said, but she knows that, you know, he’s nine and he’s learning. So you don’t tell him off for the slightly crappy job he did. No. Yep. But what you do is you then keep having him do that and chip away at that is an extra skill.
It’s not standing and having the argument about the dish. , do you know? Mm-hmm. like it’s about how can you move that forward? So I also talk about a lot of that with families. Some of those practical, what are the skills they can do? How can we help give children autonomy, give them success, give them a strong sense of self?
And we do the same discussion at school school’s meant to be a positive experience where they have a sense of success. So if you are going to school and you are failing everything and you have no mates, and you get told, , it’s not a surprise. You don’t want to go. Mm-hmm. . And I often say to the school, if that was your workplace, if every time you showed up to work, absolutely.
You did everything wrong. The boss threatened to sack you and nobody liked you. How many days would it take for you to resign? And they go, well, I would never go back. And I go, well, there we are. We can’t expect the kid to want to go to that. So how do we make it successful? How do we move from the dishwasher to the, you know, to the window?
Is it if he can’t do his mass in class, where can he do it? You know, that’s that. Reshaping. Reforming. So that’s another big part. Lots of child and adolescent psychiatry is about, ,
[00:18:51] Michael: it’s about educating
[00:18:51] Dino: the education system as well. Yeah, I do. We do still,
[00:18:54] Mel: it’s ongoing. That’s ongoing. Yeah, it is. Absolutely.
And the teachers do, you know, work very hard with what they’ve got cuz they’ve also obviously got this entire national curriculum they need to teach, which is an absolute requirement and lots of kids with different needs, so, and they’re not therapists. So, you know, how do we meet all of that and
[00:19:11] Dino: every couple of years, Mel, we have to train for naplan.
Don’t forget, oh, we have to train for
[00:19:16] Mel: nap. . Yeah. I’m not a net plan fan. Mm-hmm. , um, personally as a parent, it’s not an issue in my house. I’m really fortunate that my kids, you know, are, are fine school. Okay. And it goes okay. Yeah, yeah. However, you know, for most of the kids, I look after the anxiety about it is huge.
Um, and you know that lots of, lots of discussions about should they sit that shouldn’t they, some schools want everybody to sit at some, want the kids to not come and sit at trying to help. Not sit it by me writing a, a letter to exempt them from it and then having to support that decision with school and and so on.
Um, I am still lost as to how nap plan is actually helpful for the school or the children. I truly think most teachers know the, how the children are going in their class, and I truly think most parents.
[00:20:09] Dino: That’s another, that’s another government initiative. And, and we, we understand about processes and the importance of having, you know, legislation and, you know, but at times some, and, and that doesn’t only happen in, in, say, in that plan with the, with the education department.
and the on flow then to the families and the kids. Mm-hmm. , but also in other sectors, um mm-hmm. of Health as well. Mm-hmm. , we, we speak, you know, we can talk about Medicare and we can talk about N D I S. Mm-hmm. , we understand that they’re important structures that are in place. They don’t always work well for the, um, private practitioner in healthcare.
Mm-hmm. and we’ve, we’ve spoken a little bit off air about how. how it’s changed in 20 years. Mm-hmm. . How, yeah. You know, I think you asked me do I still love it? And I said Absolutely. And I said, now hang on, I don’t, don’t love it as much since life, you know, life has changed since these initiatives. And then I think, well I feel a little bit guilty for saying that sometimes.
Cause then I think about how many families we’ve been able to help who would never have been able to access, say, N D I S funding over the years and, and what that’s meant. But we’ve suffered like, I think, you know, we haven’t suffered financially, but in terms of how we deliver services mm-hmm. , um, and how much time we can allocate to working with families has changed.
Yeah. I left the government sector because I felt that I wasn’t able to have enough contact with mm-hmm. with children, with people, with and helping people and said, well, if I’m in private practice, I can dedicate as much time as I want to, to working with mm-hmm. , you know, kids and that worked for so many years.
It’s changed again, and you just have to adapt. I think you, you think overall you’re still making a difference and you’re still having that contact. But if we don’t work and then that plans the same. If you don’t work, if the schools don’t work in that system, they’ll suffer. They’ll get poor results. And then, you know, potentially teachers will get tapped on the shoulder saying, you know, they’re at a private school, whatever school, and you’re not doing a good enough job.
It has an on flow effect. But we, we have to work and live in those, I guess, in those constraints, in those those situations, and do the best that we can. Yeah,
[00:22:11] Mel: yeah. Yep.
[00:22:18] Michael: You work both in the private and public sector.
[00:22:22] Mel: Why don’t. See patients in public sector. Yeah. So I only see patients in private, private sector.
[00:22:26] Michael: Yeah. So what, what are the, the, the differences there in terms of maybe the, the structures, the set up or, or your experience of, of both those settings? Um mm-hmm.
and given that you only see patients in the private sector, what is it about the private sector that affords something that the public sector doesn’t?
[00:22:45] Mel: Yeah. Um, so I moved into private practice. Well, I was working for child and Adolescent Mental Health. I had a wonderful team, really enjoyed lots of parts of my job, but, um, what I really liked the most was doing psychiatry, sitting, you know, doing the actual clinical therapeutic work.
Um, and just by the nature of the structure of child and adolescent mental health, the minority of staff are psych. And the majority of staff are allied health nursing. And so, um, even though I like that kind of senior role providing mentorship and um, supervision and, and that sort of thing, I found myself sitting in more and more meetings and looking at more and more policies and documents and things, um, which I felt was eating into my time to build my skills with kids.
Cuz when you finish your training, , obviously you’ve done lots and lots and lots of training, and then you come out as a specialist and I think you then need to solidify your skills as a specialist where you’re no longer under supervision, where you’re, you know, doing things yourself. Um, and at the time at cams, not only did you step into that, but you then sort of stepped into this kind of leadership role that had all these other bits to it that you really didn’t have a lot of training in.
So there was a, there was a change in model of of care at cams. At the time. They were looking at psychiatrists being the people who really just did a one-off assessment for each person that came through providing a really, what they called a consultative model. And I looked at that and went, yeah, that’s not me in 10 years.
Yeah. Like that. If I do that for 10 years, All of the skills I’ve just built over years and years and sacrificed time with my family and my kids and all that stuff will be gone. And, um, I will not fulfill the, the job that I wanted to do, which was to be a psychiatrist for children. So I sat, you know, long and hard and had a look.
And then, um, I also really enjoyed working with Neurodiverse kids. And at the time, that was not something that Cams. So children of neurodiversity, you know, genetic disorders, intellectual impairment, were not seen at child and adolescent mental health and um, I you, we were able to have a right to private practice.
So that meant that a section of the week you could choose to see patients just yourself, rather than having them accepted by the wider CAMS team, which was the policy back then. And so I said, yeah, I’m happy to see kids with whatever. And boom, like the referrals were, we’re quite big. And, and I realized, you know, I started seeing some kids who were gender questioning.
I started seeing kids with. A s d and fetal alcohol syndrome and seeing more indigenous kids and seeing, um, you know, people with all really different, you know, needs than what I’d actually been seeing at camps. And I went, hang on. There’s all this population that I didn’t really know was out there and I really like this work.
So all of that came together. I left and went into private practice. Moved into a pediatric practice with Brian Conway, who’s a fantastic pediatrician. Um, and I said to him, do you know, do you think I’ll get enough referrals? And he went, ah, yeah, yeah, yeah. He just laughed at me in a very lovely way. Um, so I moved into his practice for a year to really get things started and get an idea of what private practice was.
And, uh, yeah, I. So many referrals of this amazingly interesting group of people with different stories and trajectories and, and, um, I kind of went, yeah, this is what I trained for. Like, this is my skillset. I think, and I think I’m good at this. And it’s very hard in the public service to feel good at your job at times because the frameworks and the bureaucracy can be so big that you do.
You can. Perpetually inadequate
[00:26:58] Michael: as a, as a clinician. As a clinician, yeah. Yeah. You know, limit it. Yeah. But obviously in your, in your public sector roles, you, and, and even in, um, say some of the, the organizational bodies you’re involved in, you’ve, you are having an influence in terms of policy or how things are changing.
Yeah. Which is that, that high level and based on your clinical experiences is really important as well. But I’m hearing deep. . Mm. You got into psychiatry to be a clinician, to, to work with those kids, to work with those families. And, and, and that’s what you
[00:27:27] Mel: love. It was, and look, it was really interesting because I was finishing, um, uh, I was talking to my supervisor at the end of, I think it might have been my second year as a, as a, what we call basic training.
So the first few years of training before you pass your, a certain set of exams when you’re advanced trainee, it’s different now, but. And I had my child and adolescent psychiatry rotation coming up. And here in South Australia you get one rotation as a basic trainee of six months. Done. You have to do it, it’s a requirement for the training.
And at the time there was a a, an areas like a bit of a bottleneck cuz there’s not a lot of child training positions, but it’s mandatory. So, , you know, it was, well how do we pick the people to take those spots And, you know, and cuz otherwise you might have to wait an extra six months, which means you’ve actually done an extra six months of basic training, which delays your advanced training, which delays you becoming a specialist.
Right. Um, and I was super keen as I, my mother always says how incredibly impatient I am with getting things finished. I was super keen to get my training done, get it done, go on, get it, yeah. Yeah. Um, sat with my supervisor and said, , you know, my child and adolescent training, you know, is meant to be what’s coming up next.
And I’d worked really hard to get, you know, really good feedback and good reports hoping that, you know, that would, and he went, oh, you’re gonna hate that. I said, really? He goes, everybody hates their child and adolescent psychiatry. It’s just naughty children. And it’s, you know, oh God. And I went, oh, that’s, you know, that’s no good.
Yeah, really? That’s what it’s, you know, and so, and cause I’d not done any child and adolescent psychiatry at that point. Um, and I. I will, you know, gotta do it Anyway, I’m pretty pragmatic, you know, this is what we do. And then they, and then I got offered a spot, you know, so myself and, and three or four other in my training group, we all got offered this next rotation.
I went, okay. And they said, and you’re gonna be at Northern Cams? And I went, right, no worries. I can do that. You know, and uh, I went up and the first couple of days, and. . I really like this. I think this is where I fit. This makes sense to me. And uh, so I sat with my now new supervisor cuz I’d changed jobs and sat opposite my supervisor.
And I said, so I was told everybody hates these rotations, but I think I really like it. I said, you know, and he just went, yeah, I think it’s great. And, and then I, and I never went back to adult psychiatry. Yeah. Um, and so I, um, I really enjoyed it and what I enjoyed, I think, you know, yes. I, I loved the honesty of children
Um, I liked. There was a, I got to work with family, so we know that we should be working with family right through the age range, right, until people die. Right. But when you go to adult psychiatry, you don’t do that. There’s a lot of solo work. I also liked the fact that there were other people, the community’s interested in children, so you could talk to a school or a gp and it was a collegiate approach, but I also just really found the work kind of fun.
Um, and you. Children are keen to be well generally, and they are keen to succeed and they are keen for a good outcome. It’s not quite the same in all adult health pathways. And so I really felt that we could work truly as a team and I, so I missed that when Cams was kind of leaning towards this mostly assessment pathway.
I thought, I’m gonna lose that. Um, and I love my work. Um, I, um, decided that just being in. Private practice, I needed to do something a bit extra that was not just clinical. So that’s when I got interested in working with the College of Psychiatry in a committee role. And that then led me to being on the exam committee.
And then, um, there was an ad for people to be on the medical board of South Australia. And so I thought that might be a good role to do. Um, and that then started my non-clinical. Kind of pathway. So, um, I, that’s what I, so I have roles like that now, which I think is a good compliment. Finding
[00:31:29] Michael: time for that would be hard, but obviously you manage to , find time for all those, all those
[00:31:34] Mel: roles.
Yep. , I do my best. How
[00:31:38] Michael: many hours
[00:31:39] Dino: do you sleep a night on
[00:31:40] Mel: average? Oh, . Um, you know, I, uh, I don’t need many. Um, I can probably get away with. But, uh, I love my sleep ins, so on the weekend, cuz my kids don’t get up early to do sport . Ha ha. So, uh, , that’s why
[00:31:59] Michael: we’re here today. We’re
[00:32:01] Mel: able to That’s right. Yeah. So, um, um, but no, I mean, I’m a, I’m a probably, you know, bed to 10 or 11 o’clock getting up at con of quarter to seven kind of person.
Um, when I was doing my PhD, um, I was probably going to bed at sort of one or two. I was working when the kids were asleep. , um, to get those things done. Um, same if I’m marking papers or, or doing paper reviews. I usually do it when the house is quiet. I do a lot when I’m traveling now. Work a lot on a plane, work a lot in the lounges.
Mm-hmm. ,
[00:32:33] Dino: make, make good use of the time you have. Yep.
[00:32:35] Mel: Wherever. Yep. Yeah, I’m pretty good at making use of all those things, but my brain always has to be busy doing something.
[00:32:52] Dino: Now, I, I really wanted to ask a question because it’s part of our practice and the clients that we see, and it’s probably gonna move into a little bit, bit heavier section. Mm-hmm. . Um, and I’ve always. , I’ve always had my own opinion about this, but I, I really wanted to ask this question of you and hope that you’re okay to answer it.
And if you’re not, we can certainly edit this out. Um, we see a lot of families that have a history of trauma. Mm-hmm. , um, um, domestic violence, abuse, whatever it might be. They’re in, um, often in guardianship care, um, under the minister and. With those families, they’re difficult. You know, they, they can range in age from, you know, two or three years of age to, you know, adolescents.
But the most common thing I’ve found over, over the last 20 years is that I’ve found that the difficulty of progress with those children, if they have had ongoing and regular contact, The, um, perpetrator. Yes. And it’s usually, um, a parent. Um, and I’ve never quite understood why we keep exposing reposing or why that was, why that was ongoing, why, why that was important.
And I, I, I, I try not to judge, but I do, I do find it incredibly frustrating, um, particularly when I’ve found that the children that have often made the best progress in terms of their development in. have often been those that have never had contact with their biological mm-hmm. family member that, um, have been a perpetrator.
So I what, do you have an opinion or do you have any experience with that or what, do you have any thoughts about that?
[00:34:40] Mel: Um, yes. I think all of us in psychiatry, particularly child adolescents, like oh tree, have exposure to that ongoing. Um, and, you know, I. If we look at the goals around, you know, you know, how do we get the best outcome for children, we would say, you know, a trusting, caring, reflective, developmentally appropriate environment is the best way they.
grow up. The problem obviously when we’re exposed to abuse is if we look at what our attachment relationship is meant to be, you know that being the big primary relationship we are meant to form when we are younger, is that children. Have this all-encompassing trust and they have to, because we are born as non-independent beings, right?
So we at zero weeks old, can’t go and get our own food or keep ourselves warm or do any of those practical things. We’re not like animals where, you know, you have a baby lamb and it stands up and off chs, right? Um, so biologically we have to. the people around us to some level. Otherwise we would die.
Right? So there, you know, and it’s not just when you’re an infant, it’s, you know, that follows you through into toddlerhood and you know, and when I teach their medical students, I say, you know, it’s why we get you to not eat snails and lick the floor and jump out the window. And all of those things that we do isn’t just parenting, it’s, it’s actually that attachment relationship when a child goes to do something that we think is overwhelming.
and a risk, that’s when our attachment system kicks on and we intervene and, and save them. Now, the problem obviously with a, with abuse is that children are expecting that when we jump in to do things that we’re doing protective actions, saving actions, caring actions, but when we have an abusive action or a traumatic.
That means that’s really confusing for the child because when you thought you were gonna be fed but you got hit in the face, you know, your little brain goes, so what signal did I give that was, hit me in the face signal? Because we are learning communication, right? So the child continues to try to modify how it’s gonna communicate with that person because you know, their little brain convinces them that there was something about what they did or said, literally.
To, to have those reactions. Now, of course, that’s not how it’s worked. It’s it’s completely sitting within the perpetrator’s actions. So they’re not responding to a communication, they’re responding to an internal need of their own. So there’s no way the child can ever work out well on Earth they did cuz they did nothing.
Um, so the problem with Reposing children to that trauma is that you are reinforcing that same self-blame and confusion, which is why you see. , you know, over and over. And the why, they misinterpret you and misinterpret me and misinterpret the school teacher. And you have, we don’t know what their triggers are and we don’t understand why they ran off last night, et cetera, et cetera.
Um, so if we look at, you know, what the research says, some of it says we need to remove children very, very early on, very early, you know, before a few months of. To protect them. So when we, when we hear about children being removed, you know, and you know, residing with someone else from birth or from a very early age, there’s often been a decision made by what is the.
What is department child protection? So DCP here about that, that longitudinal risk is too high and they’re gonna take them. Now, the challenge is that if, if those things are not flagged early, if instead it’s at five years of age and after 15 different reports and whatever that that brain wiring.
Remember we talked before about, you know, those magical years of brain growth. You know, that brain wiring, if you imagine zero to five’s worth of those confusing signals, we cannot undo that. We can do our very, very best to repair and retrain and comfort and and whatever, but unfortunately, that poor child has.
That their communication is wrong, their expressions are wrong, their needs are wrong, but not just emotionally, but literally. Um, and so the reason why kids are re-traumatized is that we start to get some repair. We start to get some trust. You’ve developed your and, and you know, foster parents, whoever have developed a language that works for them.
then all of a sudden we put them back with the perpetrator and the broken language comes back and then we are back to where we were before. This is just the, the male neuroscience, I’m obviously filtering neuroscience, but Yeah. Um, why do we not just decide to take them away and not have that exposure and that, that’s very complicated and kind of sits with, but can we have some positive relationship with that person if there is some positive relationship with that person?
can we repair some of that broken communication? Can that person take some responsibility for it? Can they help the child understand it wasn’t their fault? Can we repair some of the blame and therefore allow the child to mature on Now? That’s a lovely thought. It is. Have I seen that happen? Not really, because a lot of the adults who’ve done this were the same child.
Mm-hmm. in their childhood with their own broken wiring. Right. So, Which is why I like child psychiatry and that it is that whole family kind of approach. Um, and it’s also why doing, you know, parenting capacity assessments, which is working out how well parents can parent, is part of the DCP process. It’s why people do attachment, which is that relationship based work.
So you can do that just with a parent. Work on their own relationships before they work with the child. The other complicating third layer of all of this is obviously family court, so there’s a whole array of if Department of Child Protection or poli, whoever is not involved, and it’s literally a custodial decision.
There’ll be parts of that, um, court order that will. the child, which I do find very frustrating. I’m happy to say that as a child and adolescent psychiatrist, that will require the child to share their time with their parent even if they don’t want to. Yeah. And so, um, I come across that a lot. You know, they’d only want, they don’t wanna see X, they wanna just spend time with Y or they, you know, want to, and, and, you know, depending on how the court order is written, you know, that requires one parent to continue to go back to court to reshape that.
which is its own trauma in itself. Mm-hmm. . So there’s lots of problems within that system. So that’s kind of why we do it. You know, I find it very frustrating. The kids find it very upsetting. Um, and I know that lots of the systems, and we’ve got a psychiatrist involved here in South Australia, in that you’re trying very hard to do really good as assessments, supervised visits, are they appropriate?
What is successful? Um, but it’s a grow. Process. And the other practicality is, and it’s an extremely expensive thing to do, cuz a lot of these people don’t have the money and funds for that sort of input and therapy. So that’s obviously something that’s paid for, managed, offered by SA government. And then we need our practitioners to offer it.
We also need those people to attend the actual appointments. And I’m sure you can imagine the,
[00:42:07] Dino: it, it’s a, uh, I guess it’s, it’s a thing that I often. Think about a lot and think about how, you know, I, I’m not, I am critical of the system. But then I think, well, what could change in that system? And, uh, it’s like one of many systems that sometimes the broad approach is there to protect the majority, but doesn’t always.
Help some of those individuals that we see. Yeah. And those families that, that we see. And, and often I feel sorry for the, for the foster parents, um, who have to deal with the child after for a period of time after they’ve had that contact. Yeah. And they often say for three amazing weeks, but we are going into the week just before and we’re gonna have to deal with the week after.
and it’s consistent and it’s really hard to then, you know, be as positive as you would want to be. Yeah. Um, when they ask you what are the prospects, you know, for my child, do you think that, you know, do you think they’re gonna be okay? Are we gonna be able to have, you know, um, meaningful relationships? And I say, well, that’s hard to tell for anyone.
But I, I often say that, that there is a huge challenge here. Yeah. Um, but you are, you know, you’re doing the best that you can. And I think that’s, I think that’s the hard thing. I think for parenting in general. I often think as like the majority of parents and the three of us are parents here, and certainly mine are older and don’t need me in the same way that they did when they were younger, but.
Guilt. I, there is parent guilt all the time. Yeah, absolutely. And I often, I, I once said to my, my own dad, I said, why didn’t you tell me that being like being a parent was this hard mm-hmm. , I said, because I don’t know if I would’ve actually honestly had children if I’ve, because you can’t not experience pain when you have children.
You experience the joys of being a parent, but you often also experience the pain. I think. It’s not always easy to deal with when you like, where you’re a person who likes to have control or can manage the things that you can manage or deal with the disappointments if they’re based from you. But when you have kids, you, it’s really difficult and I think doesn’t matter what background you have, whether you’re a child psychiatrist, whether you’re an ot, specializes in working with children.
You are the, at the same level when you’re a parent. You don’t come with a training book. No. And I think parents like that when we, when we say that, say we, you know, we’re struggling a lot, you’re struggling. We just maybe are not struggl. Right now because this is my role and this is my, my job and this is what I’m good at.
Yeah. But, you know, we have issues and difficulties at home with our own kids as well, but it, there’s a lot of guilt. I don’t know, do you experience, ever experience parent guilt
[00:44:38] Mel: forever?
Oh, look, the long run up for that one. Yeah. . Yeah. I, I don’t, I think, um, so I say to parents, you know, good parents feel guilty. . Um, because you know, we wanna be everything all the time for our children, but we know that we have other responsibilities outside of that. Um, and that, you know, it’s not healthy to feel guilty all the time, but it’s reasonable.
Like we are all sitting here right now. We are not with our kids. Yeah. Right. And so is there some guilt that we’re all sitting here right now? Yes. Is it okay that we’re all sitting here right now? Yes. Do our kids need to be okay that there are other parts of our lives? Yes. Um, that balance, I think, is it really important.
And my children, no, they don’t wanna be doctors. Um, and uh, that’s, that’s absolutely fine. My parents weren’t doctors. My husband’s parents weren’t doctors. Um, but you know, they know. , I’ve always been really transparent with them about not the content of my job, but they know what my job is. They know when I’m working, they know when I’m talking about committees.
As my kids have gotten older, they ask me about my day. I use the names of the people that I work with, you know, um, point to the buildings where I work at. You know, they, I think it’s important they know that there are these other aspects of their, their mom, but what I tell parents, particularly worries me when, when young teenagers are pregnant because parenting is the most intense experience, particularly when you bring that baby home and the door shuts and you’re not at the hospital and you’re in your house and you go, right?
Mm-hmm. . Okay. This is mine now. Yeah. I don’t, there’s no, I’ve gotta work this out. Yeah. , and you can read all the books that you like, but there is no book that says at 3:00 AM when Aiden has pooped through 15 outfits and my wife is vomiting in the corner, what do I do? Mm-hmm. , right? There’s no book for that.
Um, there’s a, there’s a lot of, you know, trust in your relationship with your partner. Trust in yourself as a, as a sufficient person, trust that your baby is actually healthy. And I think that that’s why teenage parenting is so overwhelming because I don’t think it’s. , I had any clue of, of how to do any of that.
I barely had a clue at 29. And I’d been married and I was a doctor and I was not poor. And, and, and, and, and, and, um, and so I talk to people about, it’s that intensity of the relationship that pushes the buttons, the absolute reliance on you to solve every problem for that baby, you know? And I remember the two o’clock in the morning going, I have nothing else left on my list to try.
So we just walk up and down the hallway in the dark as we’ve all done as parents. Um, yep. So yeah, it’s, it’s, it’s full on.
[00:47:32] Michael: It’s a tough gig. Yeah, it is a tough gig.
[00:47:35] Dino: Michael, do you have something to bring us home?
[00:47:37] Michael: I do, yes. Can, can I get one really quick snippet? Couple of minutes. The transition from childhood psych to a adult psych.
That period, that adolescent period at that intermediate period. We find here is, is such a tricky, when does it go from one to the other? What’s, what’s your role? And, and just really quickly your, your experience in that position,
[00:48:02] Mel: as in, if you’re seeing someone and they’re gonna be turning 18 Correct. How do you navigate that?
Or what’s that like for them? Or where do you send them? Yeah, where do I say in them? Um, there’s a, so the short answer in, in South Australia is that we don’t have enough psychiatry. , which is why it’s very hard to find places to send people. Um, and what do I do? I start planning a year ahead before I know I’ll be at least a year ahead before I know I’ll be closing a file of someone and I start talking to the person in the family at that time about whether they want slash need.
I wanna look for adult psychiatry or not. In my circumstance, there’s often a degree of distress or grief or something on some part, because it’s very often I’ve had a pretty good relationship with them and saying goodbye and leaving is a, is a big thing. Obviously people need to graduate out of seeing me.
Mm-hmm. , um, I actually often see people till they’re, you know, 19 or 20, because 18 is young for most of my. , they’re not really at an adult psychiatry stage because most adult psychiatrists expect to see you on your own. They expect you to be the person who gets the scripts and the reminder texts and and stuff and that.
So I have to prepare them for that. So we do a lot of talking and scaffolding around consent and. Being an adult and I, we move their phone number over to, they’re the ones with the reminders, et cetera, et cetera. So I’ve gotta do a bit of that and, but I get to do that in my setting. Yes. What does the community other people do?
I don’t know. Yes. Um, I try to look for a psychiatrist as that I know, and I always ask first. if they can read through the person that I’m thinking of sending to see whether they think it’s their cup of tea. So for me it’s lots of planning. So I might talk to two or three different, usually by email cause we’re always in appointments, you know, I’ve got, you know, Bob and he’s 20 and he’s got a s, d and anxiety and you know, he got to year 10 and he did flow for a while and this is where we’re at and this is the family and this is the plan and this is what I think he needs.
Does that sound like. , you know, and I’m really fortunate that generally I seem to pick the right people to fit the right ones. Um, then I then talk to the family, then I write a referral, then I let them have an appointment to meet the person. Then they come back and see me, and we do the therapeutic talking about.
Meeting a new person, how challenging that is, how we are finishing up bloody, bloody blah. And then usually they move on to their next person. So that’s why. Yeah,
[00:50:36] Michael: it’s a very scaffolded, safe approach.
[00:50:38] Mel: Yeah, because it needs to be, I find it does, and I find most of the time that’s successful. However, despite that, I will still have people ring me a year later.
Can I come back? Say, yeah, yeah. Can I come back? Or that they’ve, you know, sacked their psychiatrist and they need me to find someone else. Mm-hmm. or I’ve got a parent who says they’re unhappy with the psychiatrist. Their child is child. Oh, sorry. Who’s now an adult. Yeah. Yeah. Um, you know, He’s now 20. Yeah.
But can I find someone else cuz the parent doesn’t like them. So I’m still navigating that stuff. And do I find someone new at that point? No, I literally don’t have the time No. To be, to that concierge kind of role. I just can’t do that. Um, whereas the sticking point is that I think that adult psychiatrists are more comfortable getting those sorts of transfers from me, knowing it’s scaffolded and it’s planned.
And it’s not a rush, it’s not a handball. That’s right. I. It is much harder for them to feel comfortable taking those referrals from gps or psychologists or whomever because, um, you know, the youth, young, young people, particularly young people that have had significant needs, um, it’s a really specialized area to know where to pick that up at 18, 19, and 20 and, Adult psychiatrists, some of them are just very good with youth.
Like all of us, you know, in, you know, that’s their cup of tea. For some people, that’s not how they connect or not how they do therapy. So they might be used to 35 year old, full-time working people coming in for appointments. And that is not the population that I’m referring. So you know, it, it can be a really challenge.
Now, Headspace was meant to assist with those transitions. Many people find it. Many people find it, it’s not enough psychiatrists. There is no particular youth training program for psychiatrists either. So the only people that get official training in looking after people under 18, a child and adolescent psychiatrist, and we get right back to the fact that there’s so few of us in the state.
Um, and so, um, the, I find probably the most effective transition is that if they have. Psychologist and the psychologist is able to be there, then um, then often that’s a much better move to then continuing psychology and moving on to adult psychiatry because some of the psychiatrists don’t do that same psychotherapeutic young person work in the same way we might do.
Um, so I literally have to talk through for some people about how their parents won’t get the text reminders. and why that will happen and how that will happen and what that looks like. Whereas if you make an appointment with an adult psychiatrist, none of that discussion occurs because it made the assumption you already know those things.
But I still have people with that developmental gap. Um, so if I don’t do the scaffolding, it just falls down. just, you know, if I just go, you’re booked to see Dr. Smith in seven weeks time. See ya. That’ll never happen. never.
[00:53:38] Dino: It’s a lot more complex than is, than what it looks from the outside. Yeah. A lot of work.
Yeah. But it’s good
[00:53:44] Michael: just for me to hear that, that insight and for, for our families listening to hear that for yourself. And I’m, I’m sure very few people would go to that level, but just how much care, and that just shows the care you have for your clients and how much you want them to continue to have the support that they need.
Um, but it is a long process. It is a long process. Thank you so much for listening and for your continued support. Please subscribe to the integration station on Spotify, apple Podcasts, or wherever you get your podcasts. And feel free to give us a short review if you have 30 seconds. If you have any questions you’d like to discuss, Dino and I hope to have a q and a episode in the future.
So please send any questions to the integration station email podcast otc.com au or via the otc. OT FFC group dot comu slash podcast and we’ll try and answer them on an episode. And as always, shout out to you fledge. Until next time, it’s goodbye from me.
