Transcript for
How can we do better? Supporting children’s mental health in Australia

Anne Hollonds (00:00): 

We need to understand that childhood is the most important prevention opportunity for all of the problems that we’re trying to solve in society, whether it’s domestic violence or adult mental health issues, or you name it. If we can get in early and to help during childhood as early as possible, help kids and their families, that is a very important prevention opportunity. And frankly, it’s being ignored. 

Narration (00:32): 

Welcome to the Emerging Minds podcast. 

Jacquelynne Lee (Host) (00:37): 

Hi everyone. My name is Jacqui Lee and you’re listening to The Emerging Minds podcast. Before we begin, I’d like to acknowledge the traditional custodians of the land on which this podcast is being recorded, the Kaurna people of the Adelaide Plains, and pay my respects to all Aboriginal and Torres Strait Islander peoples, their ancestors, and elders past, present, and emerging from the different First Nations across Australia. 

(01:00): 

I also want to recognise the care and wisdom that our Aboriginal and Torres Strait Islander communities have developed over more than 60,000 years in what my guest Cath Chamberlain referred to as a very long longitudinal study. 

(01:14): 

This episode is part 2 of our special 200th anniversary series, Exploring what the Future Holds for Infants and Children’s Mental Health in Australia. In our last episode, we looked at some of the key priorities and misconceptions that persist around children’s mental health. And we heard from young people and their parents regarding what they wish adults, practitioners, and service providers better understood about their wellbeing needs. 

(01:38): 

In today’s episode, we’ll continue to explore the systemic shifts and solutions that are needed to improve outcomes for children and families. In our last episode, Gaby, Hali, and Luke opened up about some of the things that worry them as young people today. I asked Gaby and Luke what adults can do to help them feel more comfortable talking about their feelings and concerns. 

Gaby (01:59): 

I think it’s really as simple as creating a supportive and safe, non-judgmental environment that can prompt openness for us to talk about our feelings. I think if adults can also role model this behaviour and it shows that it is really completely okay to be open and honest about our feelings, particularly around areas of concern or things that might scare us. 

Luke (02:25): 

I think just don’t judge them. Some people could carry shame because things that they’ve lived in their life or traumas. So if a person keeps showing up, being there for them, always caring for them, doesn’t treat you like you’re just a broken person sort of thing and makes it easier to talk, like treats you like they’re almost a friend or therefore you actually cares about you, makes it more personal in a way because they’re there to help you, not just to help everyone. Don’t just see them for what they came there for. See them as the whole person, get their whole story. Understand it. Yeah. 

Jacquelynne Lee (Host) (03:06): 

The siloed nature of service delivery is a significant barrier to improving outcomes for children and adults. I asked author, podcaster, and paediatrician Dr. Billy Garvey, and the National Commissioner for Children, Anne Hollonds, how the health, social, and community service sectors can better collaborate to support families more holistically. 

Dr Billy Garvey (03:25): 

Pro-active relationships. I think a lot of the time we hear about, say, clinically a kid that is drowning, he’s trying to set fire to the school, he’s been expelled from four schools or a girl that’s really suicidal and self-harming, or even younger kids that are really destructive and they keep moving around foster homes and all this kind of stuff, and then we meet each other professionally. And it’s just really ridiculous because how do we have trusting partnerships with professionals if the first time we’re meeting them is in distress and chaos for a family? And so I think we need to resource that. We need to think about making sure that, for example, every primary school knows all the preschool educators, the maternal child health nurses, the GPs, the occupational therapists, the speech pathologists, the family services team. That’s what it should actually look like so that everyone’s aware of the entire community. 

(04:21): 

And I think specifically for families that have experienced vulnerability or disadvantage, I think it is important to proactively go towards those families and think about how do we come around them and how do we make sure they understand that we’re there to help them. And I say that multiple times a day in clinic, I will say, “I’m paid to help you. My job is to help you. I get paid well to do it and I love doing it, but you’ll decide whether I’m helping or not” because a lot of these families are intimidated by those spaces. They’re grateful, they’re worried you’re going to be caught out, they’re worried I’m going to report them to child protection, those type of things. But for me to achieve success with them, I need them to trust me and I need them to see that I’m actually in a partnership with them, and that I’m being paid to do it by their taxpaying dollars. 

Anne Hollonds (05:12): 

I think we’re not rewarding collaboration or coordination or integration, which is what I would really like to see. We’ve got these child and family centres or hubs that have been set up in the early years usually, integrating health and early childhood education and social services. 

(05:33): 

But what I’d also like to see, and there are a few of these for schools to also be community hubs, so not just in the early childhood age group but primary school and even high school. Now there’s many fewer of those, but there are some. And I think the same principle applies and you see it in other countries in the world where they have whole of family health services co-located with a school and it makes a lot of sense to have health services in the same place. 

(06:07): 

I mean, schools don’t have to do it all themselves. We wouldn’t ask schools to do that. But in every community there’s some level of service provision, but we expect families to go out and find them. There’s a lot we could do really to operate these services in a way that meets the real life human needs of human beings rather than the siloing that we have out there is only designed to meet the administrative needs of governments. That’s all they are. So we have to challenge that and integrate what we’re doing with other services. 

Jacquelynne Lee (Host) (06:46): 

Billy also spoke about how collaboration and communities of practise can help professionals who are feeling overwhelmed by the complexity of the challenges faced by the children and families they’re seeing. 

Dr Billy Garvey (06:56): 

I mean as a clinician, I have to say that is a valid feeling. And I have it, and you should feel like that is a strength within you that you can tap into that and say, “This is really overwhelming me.” It’s also not because you’re failing or because you are not trying hard enough. All of us as professionals in this space meet those families that think it’s just because they need to try harder and how destructive that mindset can be, but there’s too many professionals out there that are isolated or they sit within organisational structures that don’t actually support them in thinking about how do we make sure… 

(07:33): 

And we’re trying to build this out more through the hospital I work at, but also my social enterprise. How do we proactively build communities where the professionals that are overwhelmed can come in, share that experience and get that support, but also build their capacity so that they go, “I’m really struggling with new mums and unsettled babies. How do I build my skill set in how to support them?” And then we go, “Sweet. That’s what we’re going to deliver. We’re going to build capacity around that cohort or mental health first aid or whatever it is.” 

(08:09): 

Yeah, you even spoke earlier before we started this about facilitation training, and that’s been one of the best things I’ve done because it’s helped me go and share my learnings and what I have experienced in clinic with other professionals in a way that can actually be helpful. So thinking about that. 

(08:26): 

Relational practise is another one. We train a lot of people in that space because the technical expertise is, if at most, it’s half of it. But if you don’t actually understand how to communicate and build partnerships with the families we support, you constantly feel like you’re failing as a professional. “Why is this parent not listening to me? Why don’t they go home and do what I’ve said?” And relational practise shows us how to do that. How do we make sure their voices out in clinic? How do we make sure they don’t feel intimidated by our authority? How do we share power? Restorative practise. Once again, we really misunderstood. A lot of professionals don’t have a good understanding of how to do it. It can be destructive when it’s done poorly, especially in schools and things like that. 

(09:13): 

So there’s just so much opportunity, I think, for us to do this better by collaborating better. And the professionals out there that are feeling overwhelmed by the complexity, it’s not because something’s wrong with you. There’s lots of people including me that I feel like that, but how do we address that by building communities where we can support each other and build our capacity? And I think that’s the beautiful thing that I’m starting to get through more and more of. And I love sitting in clinic meeting kids, but I think the stuff I do outside of clinic is more meaningful. 

Jacquelynne Lee (Host) (09:43): 

Cath Chamberlain is a Trawlwoolway woman and the professor of Indigenous Health at the Melbourne School of Population and Global Health at University of Melbourne. She explained how the Relighting the Firesticks project is promoting integration and collaboration among perinatal care services for Aboriginal and Torres Strait Islander parents. 

Cath Chamberlain (10:01): 

We’re piloting a see one, do one, teach one model with just try and support other services. The aim of that is to really support some of the amazing innovation that’s going on in this sector with the whole birthing on country movement. So working with services that want to implement improvements in perinatal care for Aboriginal and Torres Strait Islander women to… So we’re supporting those services to have a look at what’s going on with other services that are doing similar things to what they want to do, supporting them to implement those changes. And our hope is that then they’ll be able to support other services who want to do the similar same things because there’s a lot of innovation and great programmes being done around the country in pockets. The problem that we have is that it’s not widespread everywhere, and we need to somehow get that across everywhere so that all families have access to that kind of really great care. 

Jacquelynne Lee (Host) (11:07): 

Brad Morgan is the director of Emerging Minds. I asked him about the most promising models of care that he’s seeing today and what policy or structural changes are needed to support them. 

Brad Morgan (11:18): 

Say some of the really promising opportunities and models I think we’re starting to see internationally, but also locally as well, is these ideas of wraparound and systems of care that can provide support to families that recognises children and their parents or their other family members aren’t isolated from each other’s needs. They actually interact with each other and have an influence in each other. And so rather than just individual support about how do we set up structures that are very much focused on wrapping around the whole family and the family’s needs and the connections of those needs, not just mental health but with other social health cultural needs that sit within families. But I think within Australia, we obviously need the governance structures and the systems to enable that practise. And I think that’s something we hear a lot from workforce and from families. 

(12:11): 

This is the desire. There’s a need for this. There’s even evidence and strategies and frameworks to do this, but unfortunately we don’t have necessarily organising structures or funding structures that enable that and make it easier for that to happen. In fact, I think a lot of people talk about it actually prevents them from doing that type of work that they know is needed and works for families.

Jacquelynne Lee (Host) (12:33): 

Commissioner Hollonds emphasised how our current education system in particular is failing children and young people. 

Anne Hollonds (12:39): 

Again, those in the most vulnerable of circumstances are dropping out of school around about the age of eight or nine. I never met a kid in detention centres who’d gone past year seven by the way. Some of them had stayed through primary school because they really liked it and they had a good relationship with their teacher, but of course they lose all of that when we expect them to change to high school. So the model of schooling really is not fit for purpose for them. 

Jacquelynne Lee (Host) (13:06): 

Here’s Billy again. 

Dr Billy Garvey (13:08): 

It’s really about from as early on as possible, how do you involve the community in talking about what their needs are? And that’s one thing I really learned about from the PhD for example, was that it wasn’t a universal one-size-fits-all. Schools that were within a kilometre of each other had completely different needs. Even simple things like how you talk about language. One of the privileged schools was to get the parents interested, talk about child mental health and the school less than kilometre down the road that was a disadvantaged school in terms of socioeconomic components of their students. They said, “Whatever you do, don’t mention kids’ mental health because the parents won’t come. They’ll find that too threatening. That’s not a word or phrase they find helpful.” And so we spoke about how do we help all of our kids to succeed and then they came. 

(14:02): 

So it’s a really interesting thing, I think, that we kind of have our own bias in we know what will help these kids and so we go in and want to do that, but actually we should go in and ask how do we help? Also, how do we just better use our existing resources? I think there’s so much siloing of different groups doing exactly the same thing in the community. They start competing for the same resources instead of actually collaborating and being a stronger offering to the community. Simple things like how do we communicate what each other are doing? How do we communicate across services? How do we do that? But I think a big overarching thing is we just need to prioritise supporting the social and emotional development of our kids more. There’s a bunch of professionals that actually have the expertise in that, and it’s usually only accessible for the kids that are really, really, really struggling often that have the finances to access it. 

(15:01): 

Inverse care law shows us that the communities that have the most money also have the easiest access to people like me and other therapists such as speech pathologists and psychologists and occupational therapists. And those are amazing professionals that kids and communities need to have better access to. 

Jacquelynne Lee (Host) (15:20): 

Brad agreed that the short-term nature of funding is driving competition amongst services. 

Brad Morgan (15:25): 

So I think the systems, the workforces, and the resources we have available need to grow substantially to meet that unmet need. But certainly if we organised the services better, I think we would have a better capacity to grow and support and meet families needs where they’re at, knowing that many of them present with many different needs at the same time. And all services aren’t necessarily equipped to navigate those connected issues, so that’s really a responsibility of government to be able to look at funding, but also organising those services and frameworks so that it isn’t a competition between this service or this service available to families. It’s actually both services are equally important, but we need some way to fund and organise them so that families do get that wraparound support. 

(16:12): 

So I think there is a lot of work to do. We do have some promising steps. I think having a national children’s mental health and well-being strategy is a really important document for us to be able to lever off of. That’s actually described an intention from government to do that wraparound to focus the attention on this population. 

Jacquelynne Lee (Host) (16:29): 

I asked Billy how shifting from a diagnostic to a needs-based model of care could help to improve outcomes for children and families. 

Dr Billy Garvey (16:37): 

I think one of the problems is that the diagnostic model that I’m trained within and that we use for things like how many kids statistically have a clinical mental illness is that on an individual level, it’s very deficit-based. It’s like, “What’s wrong with you?” That’s one problem with it. 

(16:55): 

The other problem is it’s very rigid. So it says you have to be experiencing this for this long and things like that. And we know that if we can catch signs of emerging mental illness for example, it’s an earlier way that we can put in resources around kids. We need to put less intense resources, and those resources won’t be needed for as long. So waiting until kids cross the clinical threshold is not a great idea. 

(17:25): 

We also know that it puts a lot of pressure on families if they find out, “Well, the only way I’m going to get therapy for my child is if they have a diagnosis of autism,” for example. And I think it’s a pretty awful way to go through the assessment process if right at the start you’re thinking, “I really hope that we get the assessment and support at the end that’s based around a diagnosis.” And we know that stigma is associated with labels. Early intervention is really evidence-based. The sooner we put evidence-based supports in, the better the outcomes are for these kids. But we also know the younger a diagnosis is made on kids, the more likely they are to experience stigma around that. 

(18:09): 

And we were talking about a kid having a really hard time, a teenager who has an intellectual disability, not severe enough to get supports. He has autism at a level where he could get supports, but he really hates the idea that he’s got autism so he refuses to have that acknowledged. And he’s gone through all these expensive assessment processes and no one’s actually prioritised what’s this kid’s experience, what are their preferences, how do they want to step through this process. So I think the model that currently exists is not great at saying what are the individual needs, as you’ve said, of this child, family, community that we’re trying to help. 

(18:52): 

So yeah, I could talk for ages about that, but yeah, I definitely agree that we need to shift away from this label-based very rigid set of the only way you’ll get help as if you meet this criteria. 

Jacquelynne Lee (Host) (19:02): 

It’s sad to hear that story about that young person as well who has obviously internalised an idea of what being autistic means, and that’s quite negative. 

Dr Billy Garvey (19:14): 

I know. And we’ve done that as a culture where you have made this, like we’re getting better at it, but we have set this idea for people that don’t know what they’re talking about of what autism is or what that is. The way that we undo that is by genuinely celebrating neurodivergent children for who they are. And it’s a real pet peeve of mine that inclusion is pitched as this kindness, like, “We’re an inclusive school. Aren’t we great?” And it’s like, “No, no, we’re a stronger school because we’re inclusive. Little Billy doesn’t learn the same way as everyone else, but we’ve figured out how he does learn. We’ve figured out how he does communicate his needs. We’ve figured out how he does succeed socially. We’ve set up an environment that occurs in, and we are stronger because of it.” 

(20:13): 

My PhD is in this space. I think educators are the most important professionals in our entire community. They should be paid more, supported more, trained more, but the evidence shows this schools that expel kids are worse for the kids that stay. And people, some educator, I remember an educator was like, “Well, I’ll just drop them off at your house then, the kids that are playing up and acting out.” And I was like, “Yeah, we’ll probably can’t offer that type of health, but trying to understand what those kids’ needs are is the best way we can set them up to succeed.” 

Jacquelynne Lee (Host) (20:44): 

Professor Andrew Whitehouse is the deputy director of the Kids Research Institute and the director of CliniKids. He agreed with the need to reconsider diagnostic thresholds for accessing support. 

Professor Andrew Whitehouse (20:59): 

I think in terms of how our systems support kids and families, the biggest thing that our systems need to need reform in is to support kids and families for who they are, not what diagnosis they have. What we’ve seen through our education systems around Australia, but also through the National Disability Insurance Scheme is the sort of gravitation towards diagnosis, that diagnosis is an entry point for providing support. That was not what diagnosis was ever designed to be. Diagnosis is there to help the parental and the child understanding about the journey they’ve been on to that point, but also to inform clinical management going forward. It was never designed to be a threshold, that if you meet this criteria, then you get support. 

(21:50): 

But for understandable reasons that were once understandable, but now really unforgivable would’ve used diagnosis as a gateway. That you get a diagnosis, then off you go to support. But what that’s done is driven wait lists, which means that families need to wait two, three years on a wait list before often they receive any kind of meaningful clinical support. 

(22:13): 

What we do know through neuroscience, that two to three year wait list in the context of a two-year-old child, two, three-year-old child, that’s half their life by the time they get to five and that so much of our wonderful opportunities to support that child have gone past us. 

(22:31): 

So what I think is the most important thing we can do is to actually treat families and kids in particular for how they come. If a child is developing differently and requires support, irrespective of diagnosis, they need that support, they need it promptly, and they need it through an evidence-based lens. They need evidence-based support at a time that they need it. 

(22:52): 

So I think that’s the biggest reform that we can do is to remove diagnosis from our systems. Diagnosis is an important part of understanding the child and their development and also ultimately in the end for that child and the family to understand themselves. But in the context of early childhood, we need to provide kids support based on who they are, their strengths, their challenges, not on what diagnostic criteria they meet. 

Jacquelynne Lee (Host) (23:17): 

When I asked Luke how he’d like the adults in his life to support him, he shared how his ADHD led to him being mislabeled and written off at school and how that impacted his educational outcomes. 

Luke (23:28): 

For example, when I was in school, my whole life, it was just labelled as the trouble kid even though I was really smart. I was always really smart in school. I had a very smart brain. I was labelled as the trouble kid and they’d put me in the corner and just sit me on the computer because they didn’t want to deal with me and I’d play the game and I didn’t even have to do work. So instead of doing that, they could have actually had someone like a peer that had ADHD, like I said earlier, to be there to support me and say, “Come on. Look, do it like this, or do you want to write like this?” sort of things, and believing me instead of just putting me down and labelling me as a troubled kid because it’s not just a troubled kid. It’s like, it could have been from the life that I’ve lived mum and dad fighting and I’ve learned these behaviours from that. 

(24:13): 

It’s like when someone sees potential in you and sticks buy you, it changes everything sort of thing. You know what I mean? Instead of them just putting me in the corner, if they had sat me down and said, “No. Do it like this. Just come on, keep doing,” I could have made it further in school. I only went to year nine, but if someone had have sat there and told me, “No, stop. You got to listen. You got to do work,” stop labelled me as a troubled kid, it would’ve made it easier in school, I think. 

Jacquelynne Lee (Host) (24:41): 

I asked Billy about the role community spaces play in supporting children and young people’s mental health. 

Dr Billy Garvey (24:47): 

It’s an interesting thing even if we think about spaces like our clinics, our community health centres, our schools that we don’t own them. Community owns them. We as professionals going into those spaces are invited guests and visitors. You know what I mean? I think imagine if hospitals looked like that, that you walked into them and you were like, “This is our community space to have our physical and mental health needs met,” as opposed to like I’m given a time. I have to come at that time if I’m five minutes late. “I thank you for seeing me,” all of that stuff. And a lot of families, that’s what school’s like because when my dad was spoken to by the teacher, I got hiding when I got home. I’m just trying to keep my head down, all of that stuff instead of being like, “No. This place is meant to make me happier, more successful, feel safer, enrich my life, help my learning, help my development, help my wellbeing, all those things.” 

(25:46): 

And that’s how every space should be, including all the sporting clubs. The best thing the footy club does is not teach the kid how to kick a goal or win a grand final. It’s make them feel like they’re in a place that celebrates them and that they’re safe and loved. That’s been my experience spending a lot of time in those communities. 

Jacquelynne Lee (Host) (26:05): 

Billy went on to discuss how improving mental health literacy and upskilling community members could help to alleviate some of the burden on our mental healthcare systems. 

Dr Billy Garvey (26:15): 

Another big thing that I believe in and the evidence shows as well is how do we get the expertise out of doing one-on-one stuff and into the community and sharing their knowledge and their experience? Because I can see a dozen kids a day that have waited two to three years. Or I can go out in the community and try and meet them earlier in their difficulties by speaking to their parents, by speaking to their teachers, their footy coaches, the amazing GPs and maternal child health nurses and preschool field officers, and all those people that actually are the ones doing all the work. If I can share what I’ve learned in clinic and my training with them, my reach is much better. 

(26:58): 

And so I think there’s so many of us that are nervous as professionals going outside of the clinical room, but I think that’s one thing, including in the media. The media is just saturated with experts that have no training, especially in child mental health and development, but they’re out there advising the public about how to bring up kids, how to respond to anxiety, how to build resilience. And it’s potentially harmful because parents are investing in strategies or communities are investing in resources that are occurring instead of things that are actually evidence-based or developmentally informed. 

(27:38): 

And so it’s a bit of a boring answer, but that’s kind of where I see the hope, not we train a handful of fellows every year that they will not meet the need of developmental peds out there. We need the people with the training to go out into the community, understand what their needs are, and then build relationships with them, but then build interventions and evaluate them properly with randomised controlled trials. Making sure we pilot them first, making sure they co produced so that the people that will be experiencing those interventions are a part of the whole process of designing them and evaluating them and delivering them. 

Jacquelynne Lee (Host) (28:18): 

Community is really coming through as a theme, not just in this conversation, but in other conversations that I’ve had for this episode as well. 

Dr Billy Garvey (28:26): 

Yeah. Well, I think a lot of us worry about that really isolated family. I grew up in that experience. A single mom, didn’t finish high school, waitress, all that kind of stuff. But there were people in her life that she trusted. It’s just that they didn’t really understand mental health. They didn’t understand how to support her and all that stuff. So I think if we can give all of the people in the community that understanding and those skillsets at an appropriate level, then you can really get to support and help and understanding around even the most isolated families. 

(29:05): 

I often joke that I think hairdressers do more therapeutically than I do, including my own hairdresser. And they’re often, they’ve got the relational skill set because they’ve just done it for decades over and over again, hearing stories about someone’s not comfortable telling anyone. And if you gave them the ability to say, “This is how you do mental health first aid. This is when you’re beyond your capacity and you need to say, ‘Hey, this GP down the road is phenomenal. Call up. Say that I sent you. Say that I’m worried’,” the hairdresser can tap that clinic on the shoulder and say, “Hey, I’ve known Billy for years. He’s in a really tough spot. He needs some support. Can you find a gap?” That’s what our community should actually look like. 

(29:50): 

For everyone that’s interacting with people, they actually understand this. The problem is, without getting too much on my soap box, there’s so much snake oil out there. It’s like just buy an ice bath and your anxiety will be gone or you’ll feel… And it’s the same. There’s so many men, for example, that just exercise a lot, but don’t actually see a therapist. And it’s like, exercise is great for wellbeing. It’s not great for clinical depression if it’s not combined with other evidence-based sources or you’ve been exercising for a long time and it’s not getting better and maybe getting worse. It’s not about hitting the gym or beating yourself up more when you don’t. It’s about, how do I actually reach out and get some of the support from the professionals that have that skill set? 

Jacquelynne Lee (Host) (30:34): 

Yeah, it’s making me think of that analogy, it takes a village to raise a child. It’s making me think of what a traditional village used to be like. 

Dr Billy Garvey (30:43): 

Yeah. And also, there’s similar quote to that is that, the kid that doesn’t feel the village’s warmth will burn it down. And you look at the kids that are in the community around Australia now and everyone’s saying, “Well, they need tougher consequences for their antisocial behaviour. They need to be criminally charged for what they’re doing and all that stuff.” We know juvenile re-offending rates are really high, putting them into juvenile detention centres does nothing to help them. And also these kids send up hundreds of flares for years and years saying that they were struggling. I meet them as toddlers. And if we don’t realise, the kid that is struggling to socialise pro-socially in kinder or early primary school is at really high risk for antisocial behaviour as a teenager, if we don’t catch them then and give them that skill set, modify the environment, all that stuff, then our entire community’s at risk. And punitive consequences is not what the answer is. It’s about bringing those kids into that village and saying, “We’re going to figure this out together.” 

Jacquelynne Lee (Host) (31:47): 

Billy’s reflection echoes the findings of the Australian Human Rights Commission’s Help Way Earlier report, which we discussed in part one of this series. The report found that crime committed by children is a symptom of social disadvantage, and the policy responses need to focus on ensuring children’s basic needs are met. You can find a link to the report in our show notes. 

(32:08): 

Connection and a sense of belonging are essential for everyone’s mental health, but they’re particularly integral to Aboriginal and Torres Strait Islander people’s social and emotional wellbeing. I asked Cath how she’d like to see governments and services leverage community as a protective factor to support First Nations families. 

Cath Chamberlain (32:25): 

One of the things that we’d really love to see is just real practical, genuine commitment to self-determination for Aboriginal and Torres Strait Islander people in driving the changes that communities really want to see. So that might be talked about the importance that you can’t do things to the people involved and affected by the services need to really have a proper say in how these services are designed. Includes things like birthing on country and other community controlled-led family support programmes that are out there. And there’s a lot of fantastic ones. And other support like we’ve talked about, having culturally and safe trauma-informed mainstream perinatal care services so we’re not re-traumatising people. There’s a lot of great things like the Connected Beginnings programme that connects up different community services to support families. Having the early child care is fantastic, and affordable housing and basic income we need more of. 

(33:28): 

And I think a huge gap at the moment that really needs to be addressed is the psychological support for those that need it. We talked about there being lots of different support that parents need, but psychological support is really important still. And the trouble that families are having in accessing mental health services really a crisis at the moment. There needs to be serious look at that. 

(33:54): 

Investing in parents’ mental health is investing in the whole family’s health, so we really need to be able to provide that care, but people just can’t access it. The waiting lists are huge and the costs are high. This, I think, would be really important for our communities and generating a whole lot of really new innovative approaches that would benefit outside of our communities as well. 

Jacquelynne Lee (Host) (34:22): 

So we’ve discussed how more integrated services collaboration between professionals, upskilling communities, and a shift away from diagnostic thresholds can all improve mental health and well-being outcomes for children and families. I asked Cath and Commissioner Hollonds what actions we need to take now to achieve these outcomes. 

Cath Chamberlain (34:42): 

The first thing and most important thing is really listening to and supporting community-led solutions in line with the priority reforms. So the Closing the Gap Priority Reforms, it doesn’t all need to be done by community organisations and in community organisations, but it’s really important that all services and organisations are involved and that the decisions are driven by communities and community organisations, which of course would’ve been a lot easier if we have had a voice to parliament. That was the whole aim of that. So we were all really disappointed that that opportunity’s been lost, but now we need to find other ways to really make sure that we can have the intent of that realised. 

Anne Hollonds (35:27): 

We have a national child mental health strategy. So first of all, we can scale evidence-based approaches by implementing that strategy. But I guess I’d also just simply say that we need to understand that childhood is the most important prevention opportunity for all of the problems that we’re trying to solve in society, whether it’s domestic violence or adult mental health issues or you name it. If we can get in early and to help during childhood, as early as possible, help kids and their families, that is a very important prevention opportunity. And frankly, it’s being ignored. 

(36:15): 

I mean, we need more mental health professionals, absolutely. And we need more of them who are trained to provide support for children because there’s miniscule numbers of psychologists and psychiatrists trained to do that. That’s important. But we also need to address those basic structural inadequacies in society that are causing the harms and the vulnerabilities that add to the load of mental health issues that are out there. And that I think requires a bit of societal mind shift from seeing mental health issues as just an individual thing. Like an individual has mental health concerns or problems to seeing that there are structural and systemic factors that contribute and that we have a broader responsibility to address those factors. 

Jacquelynne Lee (Host) (37:16): 

Commissioner Hollonds went on to describe another barrier to acting on the evidence we have around what supports children and family’s well-being. 

Anne Hollonds (37:24): 

[inaudible 00:37:24] earlier, we did a small project that informed that report where we analysed 12 years worth of royal commissions and inquiries that were focused on child protection and youth justice. And we found over 3,000 recommendations, many of which were repeated over that 12-year period in 61 reports. So that’s quite an important finding. 

(37:50): 

It really highlights that our problem is not that we don’t know what to do. The problem is that we are not acting on what we know. And this is something that I’ve spent a lot of time thinking about. And firstly, it’s pretty evident that there is no accountability point within government too that would be responsible for acting on recommendations from royal commissions and inquiries that relate to children’s needs. We have no cabinet minister for children at the federal level. And so those of us who are advocating for children have to speak to all the different ministers who all might have a tiny bit of children as their responsibility or children’s policy as their responsibility. So I’m talking about health, education, social services, indigenous affairs, et cetera. But there is no one who is responsible, and that’s how they get away with not in implementing 12 years worth of royal commissions and inquiries. 

(38:59): 

We’ve seen a recent playing out of that with the crisis in the early childhood sector, the safety concerns that have emerged this year through media exposes and then the police actions that we’ve seen. And we’ve also, even now the public understands that 10 years ago there was a big royal commission that made a bunch of recommendations to improve the safeguarding of children across all sectors, including early childhood. And they’ve literally been sitting on a shelf for 10 years. Of course, there’s been other inquiries since then and other recommendations that have also sat on a shelf. So now as a result of that crisis, it’s kind of been revealed the answer to the question, what does it take to get action on the evidence? Because that’s what a lot of people have been wondering. 

(39:53): 

And so out of this example, we saw that it took a crisis, unfortunately. It took children being harmed who didn’t need to be harmed if they’d acted earlier. Then we saw strong leadership from the Commonwealth government. And then we saw the state and territory officials, the ministers, also stand up and admit their failures and commit to collaborate with each other and the Commonwealth to fast track the implementation of those long overdue reforms. And it really is a scandal that this happened, but I think there’s some learnings there for policy across the board relating to children. And we need to keep the pressure up. That’s what all of us need to do, is to keep the pressure on and to use that example of what happened with early childhood is a positive model of what you can do. 

Jacquelynne Lee (Host) (40:49): 

I asked the commissioner how organisations and frontline workers can use this example to advocate effectively for systemic change and improvements in infant, child, and young people’s mental health. 

Anne Hollonds (41:00): 

I think it’s really important that local members of Parliament understand what the problems are currently. We shouldn’t assume they know anything because they don’t pretty much. So those working in the sector, I often say it’s like you have a superpower. You have knowledge about child development, children’s needs. You understand about mental health concerns. You understand all of those things that the average member of parliament doesn’t. So that doesn’t mean they’re bad people. They all want to help, but they need to be educated. 

(41:37): 

So if you’re able to go and talk to your local member, I would encourage that. If you’re not able to because of your role in work through your organisation and your peak bodies and your unions, unions can be very good as well at standing up for reform. 

(41:56): 

And then you can also pull together in new alliances. So one of the new alliances I’ve been part of initiating is called Act for Children. These are advocates who’ve come together and service providers have come together from across sectors to call for things like a cabinet minister for children. That will help everybody’s objective. If we had someone in government who we could talk to whose job it was to look after the wellbeing of children, then things would be a lot easier than they are now. 

Jacquelynne Lee (Host) (42:32): 

Absolutely. 

Anne Hollonds (42:33): 

And sorry, can I just add that if you do go and talk to your local member, I can give you a suggestion of what you say because sometimes we’re a bit shy to go, we don’t know what to say. So you could just ask them, remembering that a lot of them are new after the last federal election. You could say to them, “Did you know that child wellbeing’s not a national priority?” And then you can explain why, why you say that. “We have no cabinet minister for children. Child wellbeing’s not a priority at national Cabinet” as two examples. And then you can ask, “Well, what are you going to do about that?” That’s all you have to do. You just have to plant the seed. And then, or you might want to add, “Could you have a quiet word to the prime minister next time you see him?” 

(43:20): 

And look, I’ll tell you one other quick anecdote to illustrate that it does make a difference. I was speaking to a senator in Western Australia last year and this senator said to me, “Commissioner, you need to know, I’ve had 20,000 emails about sheep.” Luckily it was an online meeting because I sort of nearly fell off my chair. I thought she was exaggerating, and it was probably about their live sheep export issue in Western Australia. So she said, “You need to know I’ve had 20,000 emails about sheep. I have had no emails, not one, about children.” So basically she told me that to set a challenge, but it did illustrate that they know, they know the numbers. They know if they’re being lobbied about something. So don’t ever underestimate the power of what you know, your knowledge, that’s your superpower. And the fact that the more that the backbenchers, especially here from constituents about these issues, the more likely it’ll rise up to the level of ministers who are making decisions. 

Jacquelynne Lee (Host) (44:33): 

I asked parents, Fiona and Michelle, what one thing they’d like policymakers and service leaders to know about supporting children and families. 

Fiona (44:41): 

Listen to lived experience, really have lived experience voices because we’ve lived it on the ground. And textbook support doesn’t work for families that have been through crisis. I feel like they need to walk… We need services to walk alongside families, not just in a crisis and keep with families and offer just holistic support. I really feel like listening to lived experience will equal a brighter future for kids. 

Michelle (45:14): 

Understand the audience that you’re dealing with, better regulations around aspects that pressure mental health. There’s a lot of policymakers out there going, “We’re just going to cut their social media. We’re going to make the world great again.” But have you stopped to consider what’s the next fall-out from that? And I think that’s a bigger mental health challenge than where we are today. 

(45:39): 

You might fix a problem for a certain age group or generation, but you’ve got the other generation to look out for as well. So fast-forward to a few years time, we’re about to embark on taking social media away from a generation of children, which is a line in the sand, but we’re going to have a pocket of kids that have been exposed to this high-frequency area of their life, which you can’t just shut off. So trying to deal, I think, in that space is going to be very tricky for this generation. 

Jacquelynne Lee (Host) (46:15): 

I asked Billy, Brad, and Cath what their hopes are when it comes to infants and children’s mental health in Australia. 

Dr Billy Garvey (46:22): 

I think we can lead the world in this space because of some of our strengths. I think also there’s so much beautiful stuff happening in the community that we miss sometimes, and we need to probably get better at highlighting the achievements that some of the community projects are having. 

(46:41): 

As I mentioned, I don’t think this is about more funding, it’s about using the resources we have better understanding that even as professionals, we need proactive relationships where we collaborate and combine powers. And my hope is that we will start to see an improvement statistically in things like how many kids are developmentally vulnerable at school entry, how many kids are presenting to emergency departments with self-harm and suicidality, adult mental health. Hopefully we’ll see that flow on that. We see reduced rates of adult mental illness because kids experiences through childhood and adolescence are better and parents are having an easier time and just getting to enjoy their kids more. I think that I’m really optimistic because of the half a dozen models and different projects that I’m currently involved in. 

(47:32): 

I’m seeing so much beautiful success in that and positive feedback about it that I think if we can keep going with those things and keep finding the energy to put into them, but also evaluate them, refine them, iteratively learn how we can do better with them, then that’s amazing. And I always feel really privileged to have the opportunity to get to do the stuff that I do, including having this conversation. It’s really amazing. And yeah, I just hope that it gets to those families out there and changes the trajectory of those kids that they’re supporting. 

Brad Morgan (48:05): 

Well, the biggest hope I have is that we are able to support any child no matter where they live, and their families to have access to the resources and supports they need for their mental health, which is positive, good mental health, but also when things happen or when they’re struggling, is that those supports are there and at the moment, depends on where you live, is determines whether you have access to some of those things. So that would be an important goal that I think alongside of that is recognising what children and families need as well, is finding places for connection in their communities and addressing some of those issues, which we know are getting in the way of that for a lot of people and children and families. And so I guess within infant and child and adolescent family mental health, we know that the quality of those relationships that children have are really what shape their mental health now and into the future. And so finding and protecting that, I think it’s going to be a really important part of the work as well moving forward. 

Cath Chamberlain (49:04): 

Well, my deep hope and sort of broad hope thinking about it broadly, is that Aboriginal and Torres Strait Islander children can once again thrive in this abundant land that we now share with so many people from across the world as they have for thousands of generations prior to colonisation. So I’d really like to see that happen again. 

Jacquelynne Lee (Host) (49:23): 

And finally, what message do Gaby, Hali, and Luke have for other kids and young people who might be having a tough time right now? 

Gaby (49:31): 

Really, it’s important for them to know that you don’t have to pretend to be okay if you’re not okay. It is really crucial for you to share how you’re feeling with people that you trust because you are never alone. If you are having a tough time, you should know that it’s okay to ask for help, and you have the strength to seek help. And of course, a reminder to always be kind to yourself. 

Hali (50:03): 

I think everything will always get better. Whatever happens, the world isn’t going to stop spinning. There’s always going to be some form of help that you can get. And if you’re having a bad time, just ask, let someone know because there’s someone there for you. And it’s not embarrassing to talk about your problems so you shouldn’t be afraid to. 

Luke (50:27): 

Well, what you’re living in now doesn’t have to… Try and make that not your future. You know what I mean? I grew up in drugs and violence and stuff, but I want something completely different from that. And I’ve got to 20 now, and it’s like I can start to see the change, and I’m starting to see that. I don’t want to live in that at all. And if you find someone that you can trust and you can talk to and help you get out on the other side of things, then it definitely makes a difference and you don’t have to carry it all on your own. 

Jacquelynne Lee (Host) (50:59): 

Thank you for listening. We hope you’ve enjoyed the special series: Exploring the Future of Infant and Child Mental Health in Australia. If you liked this episode, please consider leaving us a rating or a review in your favourite podcast app or sharing the episode with a friend or colleague. Take care and we’ll be back in your feeds in a fortnight. 

Narration (51:18): 

Visit our website today at emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The Centre is funded by the Australian Government Department of Health, Disability, and Ageing, under the National Support for Child and Youth Mental Health Program.