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Wednesday, November 28, 2012

Haiku on Mental Health

If you know something
That improves your mental health
Keep on doing it

[Let someone else worry about the evidence]

Wednesday, November 21, 2012

I did not get paid by Queensland Health this fortnight

I just love bureaucracy.
I have been employed in Queensland since 1st September 2001 (about 11 years I guess). Its complex. I am a Professor at The University of Queensland, but also Clinical Director for Child and Youth Mental Health Services under the umbrella of Royal Children's Hospital (now under the umbrella of Queensland Children's Health Services, under the overall umbrella of Queensland Health). I have done two 5-year stints as Professor, but last time some bureaucrat at QH decided to renew me only for 3 years on the somewhat spurious grounds that I am classified primarily as a researcher. This is odd, because I have always thought of myself as primarily a child psychiatrist, a clinician, supervisor, teacher and manager. But 'they' (whoever they were) were adamant (maybe they had begun to think I am reaching my Use By Date).
So, most of my salary is part of a contract between QH and UQ and paid as a direct debit by UQ. No problem, it has happened routinely every month for eleven years. But I am also paid a clinical loading direct from Queensland Health, which includes extra payments when I am on call. This is where things get sticky, because as a result of the payroll disaster in QH there have been four episodes in the last eighteen months months where I have not been paid. It has always been up to me to sort that out...
I did not get paid for the last fortnight, which was slightly irritating. Jan said: "They will sort it out. You will only spend hours on the phone and get frustrated." I had a feeling that something was not quite right so I got on the phone.
Royal Children's Hospital (where I physically work) did not have a direct phone line for 'Payroll' registered in any listing I accessed. And the Queensland Government payroll form with lots of zeros in empty spaces sent to me by post, has no access telephone numbers. So I had to go through Royal Brisbane Hospital (RBH) switchboard; they do after all share a common campus with RCH, even if you have to get credentialed for each hospital separately if you are on call for both children and adolescents 14 and over, who are dealt with separately even if on the same campus. OK, that's another story.
So, after listening to muzak for 3 minutes ("all our operators are busy at the moment...."), I explained politely to Switch at RBH who put me through to Payroll at RCH. Well actually they put me through to Queensland Health 'Shared Service Partner' who handle all payrolls apparently. After waiting on the phone for 8 minutes ("all our operators are busy at the moment....")("all our operators are busy at the moment....")("all our operators are busy at the moment...."), I was joined by a very pleasant young man who took my details, typed them carefully into some computer - which could not find me! Somewhat perplexed, he explained that he was physically based at The Prince Charles Hospital (5 Kms up the road), who manage the payroll for Royal Brisbane Hospital but not for Royal Children's Hospital. He spoke to a supervisor, who noted I am on 'a contract', and Royal Children's Hospital handle their own contract staff payroll. So (having wished me 'a nice day'), he went to transfer me to RCH. The process failed, and (again somewhat perplexed) he came back on line to suggest I phoned the number direct. HE GAVE ME THE NUMBER (Gold Dust!!) which I have now squirrelled away for next time.
So, having listened to some more lovely muzak for a minute or so ("all our operators are busy at the moment...."), I spoke to a delightful young lady who took all my details and put them into her computer. She double checked the numbers, and came back several moments later, saying "I am so sorry, you're 'medical', and RCH does not handle medical contracts. Ipswich Hospital does that" (about 40 Kms down the road). So, having wished me 'a nice day' she gave me a number for Ipswich Hospital (which I have squirrelled away for next time).
I phoned immediately and, joy of joys, I got through immediately. Very nice young man took all my details and put them into his computer, checking that he had things right. "Oh", he said, "you're mental!" Well no, I am NOT mental, but I am a mental health worker. He laughed. "Have you worked any hours in the last fortnight, because there is nothing coming up on our system". Well, yes, I am known to work rather long hours in the service of my patients, and have been doing so since my arrival in Queensland. "Just hold on while I transfer you to Linda - she handles 'those'". ('Those' must be some sort of mental medical contract labourer who does not work much at all). More muzak.... "Look I am sorry but Linda is busy with another client. Can I have your number and I will ask her to call you back". I gave him my mobile number (not paid for by Queensland Health). "OK, thanks for calling. Have a nice day." Mmmm.
No Queensland Health phone ever gives you the number in case you want to phone back at some time. This can be problematic if you are one of those people who is wary of 'blocked' number calls, because you can choose not to answer on the grounds you do not know them. On this occasion I took the risk when, a couple of minutes later, a delightful lady with a light Glaswegian accent phoned using a 'blocked' line. "Did you work at all in the last two weeks?" I am always working. "Ok, mmm...., Oh, I can see what happened. The 'system' is supposed to give us a reminder every 6 months to 'renew' your contract. But no reminder came through". Well, I am to be employed for about the next 18 months until I retire; what can you do so I don't have this rigmarole again?  "I will have to work out a system to remind our system to remind us. I will fix it all up, and you should have a cheque in the bank within a couple of days - well, as long as you are with one of the big four banks..." I am... "OK, have a nice day..."

Jan you were right!
I did get frustrated, but if I had not spent 37 minutes on the phone, I would have stayed on their 'mental medical contract labourer' for weeks until someone noticed, and then it would have been Christmas! I just hope 'they' are prepared to pay me for the 37 minutes I wasted on their stupid payroll system.

Don't suppose any of you young things remember Flanders and Swan and "The day the gasman came to call"....

Don't you just love bureaucracy... ?

Sunday, November 18, 2012

Swimming in a storm - hail and all...

Over the last couple of days there have been physically destructive storms sweeping across Queensland from the West. I guess they have not been as bad as Sandy (NY), but they have caused trouble.
So all last night there were storms - probably 3 inches of rain, lightning and thunder ++. Then, at midday, the sun came out, the pool was 30 degrees, so Jan and I went for a swim. Lovely
Then the sky began to darken very quickly, then it began to rain, and then following some massive droplets, it began to hail - many stones about a centimetre across. Wow. We could not get out for fear of being hit, the temperature had fallen drastically, but it was nice and warm in the pool. So what do you do? Answer - stay in the warm. Luckily we have some 'sails ' across half of the pool, so we could sit and watch the anger of the heavens from under a canopy. All very exciting, and just a bit terrifying.

Possible disastrous closure of longer term Inpatient Unit for Adolescents with life-threatening mental health problems

Queensland is struggling financially as a state and, rightly, the new government have set out to reduce debt with drastic changes to services. A part of the debt was due to the debacle over the Queensland Health electronic payroll system (IBM) which set out with a bill under $50m, went wrong, and now is costing somewhere over a billion dollars to put right.
It is interesting that this and other disasters were not of the people's making yet, of course, it is up to the people to suffer in order to put things right.
So the current government have done some hard things, but are also choosing some easy targets. In general, mental health services (amongst others) are being asked to cut costs. An easy target? Of course, nobody ever stands up for people with mental health problems; they are always down the list of problems to be solved.
Another target is young people with problems. They also are an easy target? Nobody ever stands up for young people; they, too, are always down the list of problems to be solved.
Add the two together, and you have young people with mental health problems. Nobody really wants to know about them; it is all too hard, too complex. You have to work so hard to understand how the problems evolved, and who really cares if over 300 young Australians between 15-24 suicide each year?
The Queensland Government wants to close the only long-term inpatient unit for young people with serious mental health problems - by 31st December 2012. These are the kids who have repeatedly been to the other inpatient units for short term admission, the ones who are the most difficult to treat, the ones mental health professionals fear will suicide if not helped. But Barrett has a 30 year history of success with exactly this kind of problem.


As a kindness to young people with serious mental illness, would you please consider signing this petition to try to stop the possible disastrous closure of Barrett Adolescent Centre in Queensland?

http://www.parliament.qld.gov.au/work-of-assembly/petitions/e-petition?PetNum=2016

Saturday, November 10, 2012

Sick of failed attempts to get more funding to further our Voice Movement Therapy research

I am sick of repeated failed attempts to get more funding to further our Voice Movement Therapy research for young adults who self-injure... :-(
Then I read an article in the Sydney Morning Herald about how Australia ignores implementation of innovative projects.
http://www.smh.com.au/opinion/political-news/australia-blind-to-the-innovation-boom--beattie-20121109-2936i.html?

So I wrote to Peter Beattie as follows:
Peter,
Really enjoyed the dialogue in SMH about Australia's investment in implementation AFTER the original research.
We have devised a novel expressive therapy for self-harming young people. I could not get money from anywhere, so I funded it myself from private practice funds. 4 10 week groups with 10 week follow-up over 2+years. Great results, and the paper is currently in press with Music and Medicine (an international journal), despite small numbers.
Given the results, I tried for an NHMRC this year (LOL). They said our work was 'non-competitive'. I have tried other formal funding bodies here (like BeyondBlue) and in the US (like the American Foundation for Suicide Prevention who had previously given us funding for self-harm research), but no-one seems interested despite an estimated cost of self-harm to the Australian taxpayer of somewhere around $60m pa. Ah, the ironies of life.

Don't suppose he will have time to respond... :-(

Monday, November 5, 2012

On Mindful Grandfathering

I was on Lifeguard duty yesterday for my youngest grandson, aged 8. He is actually very competent in our home pool, more like a dolphin than a boy. So I was there for emergencies, like if he misjudged a leap onto a floating body board, or slipped on the tiles around the pool. Despite my residual minor paraplegic symptoms, I can swim, I do have a an ancient life-saving certificate, a less ancient first aid certificate, and I have been a doctor for 45 years.
The truth? I was just there to be, quietly sitting on the swinging hammock reflecting (and watching with interest).
We had been cleaning the pool with a Barracuda - an erratic device that goes all over the shop, but does seem to reach everywhere eventually - rather symbolic of an 8 year old boy rushing hither and yon. The main cleaner, and most of the connectors had been removed, but some of the blue 1 metre tubes remained floating on the surface. He filled up the tube and blew through one end, creating a fountain. This was repeated again and again. Then he found some ants on the pool surround, and methodically went round the pool flushing them away by blowing the water through the tube. Not satisfied he went back round the pool again. No commentary; just quietly involved in small boy play - calm, composed, content. I observed.
Changing tack, he whacked the water with one of the blue tubes, then whacked a large floating blow-up ball, then repeated it all. Then he joined the two ends of the tube to make a small circle about 30cms across, and put it over his head, wriggling through - again and again. That was apparently easy, but I was asked a question: "Grandpa, do you think I can get through this?" (after 20 minutes, the first acknowledgement of my presence). "I am sure you can." (Gosh that was a clever deduction) He wriggled through again and again, each time not unmaking the circle, and with a grin from ear to ear. The game changed. Standing on the side of the pool, he jumped through the hoop a dozen times, mostly surfacing with an intact hoop, and that grin. The game changed. He dived from the side of the pool, full of confidence, through the hoop, again most times surfacing with it intact, and that grin. Then he went back to searching for ants to blast away with gushing water. "Grandpa, I can't wait till midnight tonight. They are releasing 'Halo 4' and my Dad pre-ordered it. We should be able to get it tomorrow, and then we can play it. It's my favourite game."
Then the game changed. He noted the round circle of plastic on either side of the large blow-up ball: "That's just like an eye." Me: "So it is..." He retrieved a soccer sized plastic ball, and repeatedly aimed it at the eye. "Yeah, got you" Again, "Yeah, got you" Me: "Mmm, I think you missed by 2 inches that time" Big grin: "No I didn't...." Repeated success, all the time keeping afloat in the pool, keeping his balance. "Yeah, got you" Me: "Mmm, Got a feeling you missed again" Big grin: "No I didn't...." The game changed. Leaping out of the water, he punched the eye each time it appeared. "Yeah, got you". Then, with varying success he kicked Karate style at the eye - repeatedly.
"Grandpa, I loved this weekend. Wish we could stay here all the time." Wow, what a compliment...
So what did I do? Not much, except watch and reflect. My grandson did not need me to ask questions about who paid for the water he was 'wasting' on the ants, he did not need me to say: "Poor littler ants; what do you think you are doing?" Or: "You won't stop them, they will always come back." He did not need me to say: "Careful, don't slip when diving like that." He did not need me to reprimand him: "If you go on like that you will burst that blow-up ball." He did not need me to curb his enthusiasm or his aggression, or challenge his excitement over 'Halo 4' (whatever I may believe).
He needed me to understand the need to be aggressive - just to get it out of your system. He needed me to know just a little about 8 year old boys who may need to 'regress in the service of the Ego', from time to time, pretending to be 5 or 6 year olds. He needed to release loads of energy, while pretending to be a dolphin for nearly 50 minutes. He needed this short time of release before going back to school tomorrow (where his teacher has made the mistake of thinking he had ADHD, rather than acknowledging the boredom of little boys who are too bright, too quick for their own good, and get frustrated). He needed this time of replenishment before doing battle with the other 8 year old boys at school.
Oh, and he needed the optimism related to playing Halo 4 with his Dad tomorrow.