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Grant Blashki - Lead Clinical Advisor at Beyond Blue

Grant Blashki | Insights from Industry Leaders

Lead Clinical Advisor at Beyond Blue

Grant Blashki is Lead Clinical Advisor for Beyond Blue, an Associate Professor at the Nossal Institute for Global Health, and the Melbourne Sustainable Society Institute both at the University of Melbourne, a lead editor of Future Leaders books, Health Ambassador for the Lord Mayors Charitable Foundation, Honorary Professor at Shenzhen Luohu Hospital Group in China. Grant is a public speaker and active media commentator on public health issues. His three themes of research are 1) Mental Health 2) Environmental Health and 3) Global Health.

Grant recently sat down with Ccentric consultant, Pam Lubrainschik to discuss his career.

What influenced you to study medicine, and then your fellowship in general practice?

I was very interested in medicine. I liked the idea of combining scientific knowledge with helping people. It seemed like a good way to spend your life.  I studied medicine and I had some really inspiring lecturers. I did a bit of hospital work, but as with most GP’s, I am fiercely independent and love the non-institutional nature of being a GP.  You could set your own hours and have all sorts of adventures. We’re pretty lucky as GP’s. You could turn up in any city in Australia tomorrow morning and by lunchtime have a job. I love the flexibility and focus on relationships with people. Yes, you need to know about illness and conditions, but you get to know people for many years, which is lovely.

Has the impact of COVID-19 highlighted areas, communities or sectors that need greater attention with regard to resources and support in Mental Health?

What a time we’ve had with this COVID pandemic, I mean who saw it coming. We were all cruising along like next week was going to be the same as last week and surprise, particularly in Victoria, where we’re still in lockdown. It’s been a really rugged few months. I think what I’ve seen as a GP and at Beyond Blue is there are some particularly vulnerable people. Not much fun if you’re single, living on your own if your family’s out of a state, or out of a country. Long haul, a lot of hours in the day and so we have spent a lot of time trying to help people who are lonely. Then you got your pressure cooker households. These are people with partners at home, kids are at home, you’re all at the kitchen table. Many people have bought these cool little inner-city apartments or houses that they thought would be great, but when you’re in it 24 hours a day it gets a bit much. Then there are your people that have mental health issues to begin with, of which there are many (two million Australians with anxiety, one million with depression). For some of them, this is their worst nightmare. The isolation and that sort of negativity, if they’re depressed, really feeds into this algorithmically driven news cycle and you can really go down the plughole of feeling like it’s the end of the world. They’re not having much fun either and I’ve been very impressed with the government’s decision to do telehealth. That’s meant being able to keep up with a lot of my patients who’ve had mental health conditions and get them to see psychologists. In Victoria, the better access program has been extended to 20 sessions of Medicare subsidised psychologists. That’s a great thing for people because this is a pretty tough time for people who have mental health issues. The last group I’ll mention are the elderly. I think for them not only are they most at risk if they get COVID because they’re the ones that get really sick mainly. But I think a lot of them have lost their confidence. They’re at home, maybe with a partner or maybe on their own and I think it’s all been pretty tough for our older members of our community as well.

How have you seen the development of digital health support mental healthcare and improve outcomes?

It’s interesting because we were cruising along and slowly adopting telehealth and thinking about digital medical records and a few sorts of online treatments and things. But as with any crisis, whether it’s a world war or a great depression, you see this explosion of innovation and embracement of the new technologies. What I’ve seen is that telehealth, which was a cottage industry has become absolutely mainstream now and almost all of the doctors are using it. This has great opportunities after COVID for access to care for people from rural/regional areas. We’re a bit lucky at this time in history that we’ve got some really good online resources brewing. Beyond Blue’s put an immense amount of resources into a dedicated COVID Beyond Blue website. We’ve also got a chat function and we’ve got this forum which we’ve had running at Beyond Blue for some years, but since COVID in March/April, we’ve had 1.3 million people who are on the Beyond Blue forums. These are moderated forums- so a safe space, talking about how they are managing all the things that are bothering them. Finally, there’s some very high tech coming down the pipeline such as artificial intelligence and chatbots. There’s a number of good online resources. A good source for people to go to is Head-to-Health, which is the government’s collation of all the online treatments; things like MoodGym, MyCompass, Chatbox. It’s a good place to start (Head-to-Health) if you want to get a sense of the suite of online treatments.

What about the people who aren’t tech-savvy (e.g. the aged)?

One of the difficulties at the moment is that it is great that things are going online, but what I’ve observed with my older patients is whilst some embrace it, there are people who are not digital natives. They find that the online resources, even if it’s trying to go on Zoom to talk to family or get on the government website to check something out, they don’t find it easy.  I think the best way to think of it is like someone who is learning English for the first time in their mid-70s It’s going to be a little bit of a struggle to get just even the basic grammar. I’ve been spending quite a lot of time encouraging my older patients to get some of their younger grandchildren or children to spend some time with them, help set them up properly because it’s sort of not optional at the moment. It’s their window to the world, that’s their way of connecting, they can just jump on Zoom and go “ah okay, great”.

When are we going to see if digital health has been able to improve mental health outcomes?

When we think about the outcomes of digital health, we think about it on a lot of different levels. So, when you think about the sort of digital resources that are there, some are about diagnosis, some are about monitoring, some are about treating, some are about predicting (prognosis). There’s certainly some good research around some of the online treatments now, particularly, one of the online approaches is called MoodGym, which uses the cognitive behavioural therapy approaches, great randomised controlled trials, very, very helpful. At Beyond Blue, we just reviewed in two documents, one called a Guide to What Works for Anxiety, and another one called a Guide to What Works for Depression. We reviewed all the randomised controlled trials with the University of Melbourne and came up with a guide for people about what works. It seems like these online treatments work best when they’re accompanied by clinicians. A hybrid model seems to work very well. However, a lot of people will get benefit just from going online on their own. Now, what’s going to happen after COVID, there’s going to be lots of research. We’ve got this big natural experiment that we never would have wanted, where we’re going to have a whole lot of pre and post data on health utilisation, on clinical outcomes, and how people are managing telehealth or changes to the health systems. I’ve been privileged with some colleagues to publish in the Medical Journal of Australia and in September, we have an article called ‘Crisis is Opportunity – how the health system can reform following COVID’. We talk about how sometimes a big hit like COVID throws all the cards up in the air and you relook at the health system, how it’s working and how it could work better.

There is often a stigma around speaking about mental health. What do you think we can do to encourage more open and honest conversations?

I’m very aware that stigma is a big issue, and not forgetting as well in Australia we’ve got a big community from different cultures, and there’s some pretty heavy stigma there about mental health, about mental health as a weakness and a shame for the family. Still in the broader Australian community as well, there are a lot of myths about that if you put your hand up with a mental illness you are somehow weak, or you should just snap out of it and that it’s something trivial. Unfortunately, that’s not what the research tells us, and that’s not what I see as a GP. Someone who’s got unmanaged depression or anxiety can spin their life right out of control, their relationships, their work, their general functioning. From a research point of view, we know that in the big studies, the burden of disease that look at disability-adjusted life. Mental health issues are just not trivial, they’re really serious and actually have a big effect on people’s lives. The stigma is still out there, but I am aware of how far we’ve actually come. My father is a retired psychiatrist and was a GP in the 60s.  We’ve had some talks together about how different it is in the way people present with mental distress then and now. Now I’ll have a plumber come in and say “G’day doc, I just can’t sleep. I think I might be getting depressed”.  It will be right upfront. In the old days, not a chance that plumber would have come into the doctors and say, “I’ve got depression”. People came in with all sorts of somatic manifestations and the doctors also weren’t quite sure what to do with them. They’d give them rose water or do lots of tests. I think that we have evolved, but there’s still a long way to go. The media have a great role in this. I think one footy player talking about mental illness is worth about one hundred professors like me. It resonates with the community and particularly in trying to get out to young men. Rock stars and insta-famous people talking about mental health, it’s much more part of the conversation. We’re getting there on stigma, but there’s still a way to go.

What can employers do in sharing the responsibility for the mental health and well-being of their employees?

Employers have such an important role with regard to mental health, and the truth is that most of us spend a lot of our lives in our workplace. One thing that I’ve learned working for Beyond Blue, is that I’ve evolved from thinking (as a clinician) that mental health, mental wellbeing lives somewhere inside your head, to realising that in the workplaces, it really is in the organisational culture. There are workplaces that are just great to work at, the culture’s great, the leadership’s great. There are things leaders can do, such as leading from the top and speaking about their own vulnerabilities. They don’t have to bare their soul to all their staff, but to give their staff a particular moment, a sense that they are just a human being doing their best and having their own difficulties too. Bring in speakers on mental health topics and remember, when someone gets sick in a workplace, mentally unwell, everyone’s watching what happens. Is that person sort of side-lined or does the workplace help them get back to work? Don’t forget, getting back to work is sometimes one of the best things for that person’s recovery. It’s not all about psychology, a lot of it is about good governance. If you’ve got impossible workloads or deadlines, then you will get people who get mentally stressed, and I see them in general practice. They’ve got an impossible job to do and eventually, the heroes start to wither a bit. Then the obvious, but needs to be said, is zero tolerance on bullying and discrimination. So many of the people I see, and it’s a nightmare for them and a nightmare for the business when someone comes in on stress leave because they’ve been bullied. It’s really messy, It’s not comfortable for them, often the workplace becomes very defensive and it’s just not a great situation. So really, setting a culture that doesn’t allow bullying, discrimination, isn’t a culture that’s encouraging gossiping and putting people down. We’re not in fairyland, we live in the real world. There are difficult personalities and once you get enough people, some of those people are going to be very difficult people. But within that, try to keep a good workplace culture. PricewaterhouseCoopers says for every dollar that you put into making a mentally healthy workplace, you get $2.30 back ultimately, because less absenteeism, less presenteeism, presenteeism where people are at work but not really and less sort of claims. Lots of good governance tips, a really important area.

What do you think the challenges and opportunities will be for Beyond Blue over the next 5 years?

I’m really enjoying working at for Beyond Blue. I’ve been impressed, I work there as their lead clinical adviser and I’ve been very impressed by the governance. Even when COVID came along we were all set up with laptops and working from home in week one. I remember thinking that they’re a bit in overdrive here. But of course, it’s proved to be that we were so well prepared that when the government tapped us on the shoulder, only weeks later and said “can you expand and create a new coronavirus phone support service, can you make a new website”, we actually worked incredibly effectively and did that transition well. I’m really enjoying working with them. Great leadership from Georgie Harman our CEO, and I’m quite enjoying watching how a good organisation actually runs. .As an organisation -priorities, early intervention and prevention. Getting in early. We’re doing big programs at schools; the BEU program’s fantastic and is currently at over ten thousand schools. More and more we want to help people navigate a complex health system. We could spend a long time, but if I refer someone to psychology, it could be anything from the Beyond Blue New Access Coaches, private psychologists and public psychologists. There’d be demographic limits on where that might go and costs. So, we then have to address the question of how someone who is unwell or worried about a family member can get the right help when they need it.

You have international links with countries such as China, Indonesia, Israel and Italy. How does Australia’s mental health system compare to these countries and are there any lessons we can learn from them?

I’ve been lucky to have some international connections, I think the strongest ones I have are probably in China, where I go a couple of times a year and we teach GPs. I’ve got a PhD student, Kendall Searle, who’s looking at how Chinese doctors actually think about mental health in primary care. I’ve really enjoyed working with them. It’s really interesting. The first thing to say is I think Australia does do very well and particularly around this COVID time. It’s pretty impressive that we’ve got on the front foot on mental health and said that this is a serious issue, this is part of the pandemic response. Like all systems, there are things that we could improve, but it’s pretty amazing that you can go along to a GP, the Better Access Program, go and see a psychologist 6 or 10 times and have pretty strong hospital systems for people who’ve got severe mental illnesses. Are there problems? Absolutely! There is still stigma and under-resourcing and inequities e in parts of Australia where people can access mental health care. Lots of things to improve, but from an international perspective, we do pretty well. The UK has been interesting, I had a PhD student compare Australia and the UK system. In the UK, Gp’s have patient lists, which can work and not work. You can get stuck with someone you like very much. But on the other hand, I think with some of the mental health conditions, one of the risks here is patients can be sort of everybody and nobody’s patient, they can fall through the cracks. One strength of having someone allocated the doctor in that system, is that person is responsible for keeping an eye on them and chasing them up if they relapse. Lots to learn, a lot to improve from the overseas experience. A quick mention of Indonesia. They have these big primary care centres called Puskas BAZNAS. Diana Setiyawati came and did a PHD with us and looked at how we train psychologists to work in primary care.  They have psychologists in these big primary care centres. It’s been really fun working with them and teaching them some sort of basic CBT skills, some real sort of community mental health skills, so that’s another model that’s evolving.

Who or what has inspired you the most in your career?

It would probably be my good friend, the late Professor Tony McMichael from the ANU and previously the London School of Hygiene, who really was an absolute pioneer in realising what a big problem climate change is for the health sector. I’m fortunate at the University of Melbourne to work in the field of what’s called planetary health. Planetary health sounds a bit hippy or maybe a bit like astronomy, but it is actually a real topic and is about how the basic environmental ecosystems need to be ordered for human health. Tony’s bit was such a world leader. The unfortunate thing at the moment is that we are seeing the impacts of climate change starting to play out with the bushfires in New South Wales. It’s becoming less of a theoretical issue and more of an actual issue, and I think the health sector has a very important role to be part of the solutions in terms of leadership. You don’t realise but 10% of our carbon footprint is to do with the health system. There are all sorts of things we can do with hospitals, primary care, ways in which we could reduce that footprint. Tony McMichael was a lovely, intelligent, generous fellow and a great mentor of mine.

What are your top tips for aspiring leaders?

It’s interesting, I think people who have had some success with their careers often over attribute their own efforts and our freedoms. It all looks good in retrospect, but it’s usually a pretty messy non-linear approach. I think that really my approach has been to find awesome people and hang around them. That’s basically it. You find really good people, find out how you can collaborate with them. That might be making tea initially, but eventually what happens is the convenience bias and that you’re around, and they go “I’m working on this paper, you’re a good person, do you want to help me?” it’s more about that. For young people, with my master’s students this year we spent a lot of time talking about vocations because there’s no point having a unique degree and then asking, “where are the jobs”? They need to be building up their profile, their LinkedIn needs to be up to date, find people who they want to work with and approach them in any capacity, they could even say, “Can I career interview you?” Most people love talking about themselves for five or ten minutes. “Can I ask how you got into your job?”. I’ve been recommending my students do that. They’re a couple of tips of mine, but in the end, you need a bit of luck as well.

I’ve also got a not-to-do list as well, maybe I can define it in the negative. On my not-to-do list is, don’t try and collaborate with people that are conflictual, crazy egos, annoying people, just run a mile. Especially as you get more senior and you’re not stuck with them. Try and collaborate with people who are generous, have good hearts, good minds and want to work together. I’ve got lots of colleagues who are these absolute gems, and you just know that if you work on anything with them, it will be excellent. The follow-through will be great, relationships are in good faith. I think that the culture of excellent people to my mind, I love this idea of pockets of excellence, so even if you can’t change your whole organisation, if you can find some great people to do some good work with, a)that is fun -because life’s too short to work with annoying people and b) It will be very effective, and you’ll get some great work done.

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