Issue 1: Connection

Dear Team, Welcome to Mentate. How connected are you? Consider this definition: “I define connection as the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgement; and when they derive sustenance and strength from the relationship”, Brene Brown. How connected are you? In this time characterised by profound disruption, uncertainty, isolation and danger, we know that connection is a key to managing the impact events have on the self, in the now and in the future. It appears that connection mitigates the effects of trauma, as explored in the contribution below by Australian trauma authority Psychiatrist Dr Richard Benjamin. News about COVID-19 is everywhere, day-to-day life for every Australian is becoming increasingly restricted, and healthcare workers are at the frontline of the pandemic every day. Much of what is being written about and shared involves information about the virus and the associated illness, how to avoid it, and the effect of the virus on jobs and the economy. Fortunately, more is now also being shared about the effects on the community, and on mental health, which is incredibly important; most of us have never seen anything like this, and it is almost impossible to predict what will happen next. This unpredictability is particularly relevant for healthcare workers, who, by the very nature of their jobs, and their dedication, may be looking after people who are very unwell, frightened and isolated, while at the same time repeatedly exposing themselves and their families to the risk of infection, illness, and death. Additionally, they are now subject to a range of additional pressures regarding infection control and workload. When I was asked to contribute to this initiative, I was re-reading Ben Shephard’s epic history of Military Psychiatry, “A War on Nerves”; I am sure this was no co-incidence. The current pandemic and the responses required are, in many ways, much like a war. The scenes of chaos and devastation in Italy and Iran are difficult to comprehend, and the virus is spreading across many more countries at alarming rates. In response, command centres have been established, resources are being mobilised, and supplies are being rationed while new supply lines are under development; much of this is occurring within the healthcare landscape. And healthcare workers under these conditions – hospital doctors and nurses, GPs, specialists, allied health staff, and support staff - should be expected to experience a wide range of emotions. It has been pointed out already that fear is a rational and adaptive response, often leading to the development of creative solutions. Anxiety is, of course, completely normal, and it is important to also note that, prior to the pandemic, many healthcare workers were already under enormous workload pressure. Each healthcare worker also brings their own unique personal and family situation to this crisis, which will, by necessity, direct their perspective and responses. Rationing of medical supplies and treatment brings its own very difficult challenges for healthcare staff; this raises the issue of “moral injury”, where ethical and moral beliefs are compromised in the delivery of healthcare services. Availability of ventilators in Intensive Care Units is seen as the most obvious example in the COVID-19 setting, but confronting media footage, for example, of people struggling to breathe on city streets in neighbouring countries, also raises significant moral issues. Every healthcare worker feels a need to help, is driven to help, but it is not always easy to know exactly how to help, and there are always priorities to balance. I have worked in Australia for 30 years in the field of mental health. I have been particularly interested in the experiences of adults, and of the long-term and often hidden effects of childhood abuse and trauma in adults presenting with severe mental illness. What I have learnt is that sometimes we need to see past the disease model of illness, and to hear the personal stories of the people who present to us. The initial responses to all traumatic events in children, and adults, are adaptive. When the responses do not resolve over time, they are often seen as “symptoms” when a medical lens is applied, which leads to misdiagnosis. A more holistic perspective leads to reappraisal of the responses as repeated attempts to cope with the initial insult, or insults. When we are most thoughtful in our approach to people who have been traumatised, each person is understood and recognised in their own right, and every attempt is made to enhance feelings of safety, control and choice. Understanding the responses of healthcare workers to the inordinately challenging COVID-19 pandemic may benefit from a similar approach. Healthcare workers, fully cognisant of the virus and its potentially lethal effects, will be repeatedly exposed to dangerous and unpredictable situations, will have to negotiate significant resource constraints, and will often have little time to process an array of associated emotions. The “Mentate” initiative has come about to provide information and support for healthcare workers at the frontline of service delivery during the COVID-19 pandemic. Many experts will provide advice. Connection of all kinds will be of paramount importance, even more so in this era of substantial social isolation. In the military setting, “collective factors”, particularly unit cohesion, are often seen as critical with respect to mental health, and they too will be important in the current crisis, as the health professions unite in their response to the pandemic. In this context, I was reminded of the many Australian soldiers who returned home from Vietnam by sea journey, on the HMAS Sydney (III). The HMAS Sydney made 25 trips to and from Vietnam between 1965 and 1972, delivering over 16,000 Army and RAAF personnel, as well as many thousands of tonnes of equipment. The ship landed at Vung Tau in South Vietnam and was affectionately known as the “Vung Tau Ferry”. Each trip took between 10 and 12 days. On the way over, soldiers were prepared for battle. On the way back, after a lengthy tour of duty, soldiers were able to relax together, they had time to reflect on their experiences and to adjust to non-military life, and they were usually met by dignitaries on disembarkation, where their efforts were formally recognised. Soldiers who returned by plane, a much shorter 10-hour trip, were deprived of all of these experiences, and, anecdotally, did not fare nearly as well. Dr Richard Benjamin, Consultant Psychiatrist, Principal Editor of “Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches”. How can you connect in the context of physical distancing and isolation? How do other forms of connection, like connection with the media, impact on making and sustaining human connections? Mentate sits (or is connected, if you like) within a larger framework providing support and care for frontline staff during the COVID-19 pandemic. Hand-n-Hand Hand-n-Hand is a group of doctors, nurses and allied health with a background in psychiatry & general practice helping to establish effective peer support for healthcare workers during this incredibly difficult time. Hand-n-Hand is a free pre-clinical service and does not involve any medical or psychiatric treatment, but rather is based on peer support and mentoring. Hand-n-Hand have brought together great minds from specialty colleges, beyondblue, MHPN, Doctors Health Services, Many Hats Network and the AMA. Their team have some terrific champions including Dr Kym Jenkins, Prof Brett McDermott, Prof Pat McGorry, Prof Samual Harvey, Dr Kieran Allen and Dr Tahnee Bridson as part of the broader #PandemicKindness wellbeing response. The link to receive peer support is here. The link to volunteer as a peer supporter is here. Mentate is a confidential referral network linking doctors requiring clinical assessment and treatment with psychiatrists. And finally, for good measure, our first YouTube video is a refresher on terminating panic attacks. Stay safe, The Team at Mentate “There is simply no pill that can replace human connection. There is no pharmacy that can fill the need for compassionate interaction with others. There is no panacea. The answer to human suffering is both within us and between us.” Dr Joanne Carriatore