Social Work Spotlight - Episode 35: Lachlan

Episode Date: July 23, 2021

In this episode, I speak with Lachlan, an early career Social Worker whose final placement saw him working in a youth drug and alcohol NGO providing specialist homelessness services. This piqued Lachlan's interest in the social complexities of this client group and saw him working as a new grad Social Worker in an Opiate Treatment Program based in the inner city, where he has found a passion for domestic violence, mental health, institutionalisation, and homelessness.Links to resources mentioned in this week’s episode:Mental Health Carers NSW - https://www.mentalhealthcarersnsw.org/South East Sydney Local Health District Drug and Alcohol Services - https://www.seslhd.health.nsw.gov.au/services-clinics/directory/drug-and-alcohol-servicesMethadone use in Australia - https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-meth-toc~drugtreat-pubs-meth-intWayside Chapel - https://www.waysidechapel.org.au/Kirketon Road Centre - https://www.seslhd.health.nsw.gov.au/services-clinics/directory/kirketon-road-centreThe Montreal Cognitive Assessment (MoCA) - https://www.mocatest.org/Psychiatric impairments and the Disability Support Pension - https://www.ejaustralia.org.au/wp/social-security-rights-review/psychiatric-impairments-and-the-disability-support-pension/Psychosocial NDIS Access Project - https://www.missionaustralia.com.au/servicedirectory/193-mental-health-recovery/psychosocial-ndis-access-projectPsychiatric Emergency Care Centre (hospital-based) - https://www.seslhd.health.nsw.gov.au/psychiatric-emergency-care-centre-pecc-0The Body Keeps the Score (Bessel van der Kolk) - https://www.besselvanderkolk.com/resources/the-body-keeps-the-scoreMedically Supervised Injecting Centre - https://www.uniting.org/community-impact/uniting-medically-supervised-injecting-centre--msicThis episode's transcript can be viewed here:https://docs.google.com/document/d/14D1mR1KOt4adxKUaebO31fTLGqKQdswNCAuxAwKdtlg/edit?usp=sharingThanks to Kevin Macleod of incompetech.com for our theme music.

Hi and welcome to Social Work Spotlight where I showcase different areas of the profession in each episode. I'm your host, Yasmin McKee Wright, and today's guest is Lachlan. Lockland is an early career social worker who completed a Bachelor of Social Work Honors at UNSW in 2018. His final placement saw him working at a youth drug and alcohol NGO providing specialist homelessness services in the eastern suburbs of Sydney. This piqued Lachlan's interest in the social complexities of this client group and saw him working as a new grad social worker in an opiate treatment program based in the inner city, where he has found a passion for domestic violence, mental health, institutionalisation and homelessness.

Lockland also completed a COVID-sacconment in a regional-based hospital covering all wards including ED, ICU, medical, surgical, pediatrics and maternity, and he continues to work casually in this role. Thank you so much, Lachlan, for coming on to the podcast. Very excited to have you here and have a chat with you about your experience so far. Exciting. Can I ask when you started as a social worker and what brought you to the profession? I started at the beginning of 2019.

I was a bit confused when I was going into UNSW. Sort of thought, maybe I want to work in commerce, marketing, HR, something like that, because that's something that I did business studies at school, and I just found like I was drawn to it. And I grew up in on Rajory land, not an Aboriginal person, but in the town called Griffith. So I was sort of, I think I was drawn to things other than that. I think the corporate world, the busyness of this city. And I think there was an allure to that for me.

So I got into UNSW and sort of found myself going, wow, this isn't really me at all. And it was extremely competitive to transfer from a Bachelor of Art into a Bachelor of Commerce at UNSW. And I was like, oh, this is just not fitting me at all. And I was thinking maybe education, and I was thinking maybe secondary education, legal studies, in the humanity somewhere, because both my parents and teachers. And what was happening at the time as well when I was in year 12 and had a gap year and moved to Sydney, UNSW, my brother was going through a lot of quite significant mental health issues, depression, anxiety, was taking a big toll on the family and I was one of his main carers.

And at the time, he was still studying why that was all happening. So he was studying at CSU in psychology and social welfare. And he was doing, they've got a social work degree there as well. And he was talking about, hey, you're really great with me. And I think it'd be really great if he gave social work subjects to go and gave them a go. And it was like the life turned on. I was just made sense. I think it was a great outlet as a carer to learn more about it.

And I knew that I had some skills because I was doing it a little bit. But the thinking and the way that the degree even started to change my worldview was lining up with how my worldview was developing anyway. So just sort of came together a little bit. Yeah. And how was that transition from Griffith to Sydney? That must have been a big change. Yeah, big time. Big time. Very nerve-wracking. It was also, I think I was quite lucky in my gap year. I worked consistently so that I could go to one of the colleges at UNSW, and that meant that I was dropped into other country kids that were away from home and knew no-on, so big social

element there that gave me a community because in Griffith, I felt very strongly and connected to the community because of both my parents being teachers. Generations are from Griffith, so I think that I really sought that community. I don't think I could have been someone that could have dropped myself into a sharehouse, and I think that would have felt really homesick if that happened. So that sort of fighted that off a bit and made a really close group of friends and met some colleagues there as well and helped me sort of figure out my personal self and, yeah, my professional self.

Would have been hard to go from somewhere where if both of your parents were teachers, I imagine everyone knew you. And so all of a sudden you're going from somewhere where everyone knows you as the teacher's kid and then you're going to Sydney where you have to recreate yourself in a way because you're recreating all those social connections at a time in your life when everyone's just trying to figure out their own stuff. I think that's probably a great opportunity for you to them figure out, well, do I really want to be doing this or is this an opportunity to try something else?

Completely. It's so interesting, you know, thinking back, I think when you're 19, 20, 21, especially as a male, I don't think I understood that completely. I think I carried some anxiety about it all, but I don't think I really understood it like what was actually happening for me, you know? Yeah. Can you tell me about your placements then while you were studying?

Yeah, so I had my first place, my level three placement. I started off at Sub-Aute Mental Health Unit in Western Sydney. There was things happening in that unit that meant that I transferred to an older person's community inpatient mental health service in the eastern suburbs. And that was phenomenal. Like I loved seeing the variety of... life experience in an older person with either enduring or new mental health issues, a lot of storytelling, a lot of wisdom, and it was a great space to learn because naturally being a younger

person and, you know, learning from your clients who are older people, it was like an organic place to learn, I reckon. So that was my level three placement, and that was great. And that put me in a position where I was an aged care support worker for my third year and fourth year of uni in the community, which was a really fun job and got my, to personal skills up. And then my level four placement was with a youth homelessness service in the eastern suburbs of Sydney. And I think that's when I really, my skills sort of started to come together. And the theory to practice was like, okay, this is making sense now. I didn't have a social work supervisor at that placement. So I had external supervision, which was great,

I think, because it meant that I had to find my own feet and understand theory without the ability to bounce off someone else and then go to the external supervision and have everyone else's experience of applying theory to practice. So it made me independent in my application of theory before even going into the workforce. I was so lucky I landed in that placement and yeah, it was good. And it probably forced you to reflect on the cases in a way that you might not have if you had an internal supervisor. So you would have had to almost provide a case report or a case study to your supervisor of this is the person that I'm discussing and this is their context. So it's a really good way of kind of starting that discussion.

And by talking about it, sometimes that helps the processing. And I think you feel like you're more of a valued member of the team because the social work skills and theory are a little bit more scarce. So you've got to contribute them. Yeah, great. And there was probably a lot of overlap between your third and fourth year placements because so many people with mental health issues are homeless and vice versa. Yeah, entirely.

I was quite surprised as well. I thought, you know, I was quite naive and said, oh, homelessness, I'm just going to be helping people do a housing application that can't do it themselves. Very naive. But, you know, I didn't stop to think before that placement what that actually meant how intergenerational trauma was playing out in people's lives and how that had implications of people's mental health. It became so much more nuanced than I ever considered.

So it was a good place to land. And I guess in terms of social justice and policy, it would have given you an interesting application of understanding how things affect people intergenerationalally as well. Yeah, yeah, definitely. It's like hearing people's stories about where their parents live and how they got to live there and their story of homelessness and where they only got a house when they were three or four

because that's what they had to do to keep, kids and their care and, you know, their parents. It was really, it was eye-opening that, you know, the intergenerational trauma, but also intergenerational disadvantage. It was very eye-opening. Yeah. And you also then did some work with mental health care as New South Wales and formally a rough for me, but how did you get into doing charity work and supporting that organisation? That was. So when I moved from a Bachelor of Arts with Bachelor of Social Work, it meant that I couldn't do a full subject load and I was like I didn't want to sort of stand still

I was feeling quite passionate about it and knowing mental health carers because being a mental health career myself and supporting my family as mental health carers saw a volunteer opportunity and I was like okay let's let's give that a crack and I supported them with some fundraising was a really great opportunity as well

I could there's got like a carer's hotline that still exists potentially you can call and that is basically a space where carers can be pointed towards like an appropriate service to support them further. But a chunk of the time was listening to people's experiences on the phone, which was really a variety of, you know, walks of life, people sharing their lived experience of being a carer and not coping within their relationship.

And it was really great. It was a good experience there. And telephone counselling is obviously very different to face-to-face. So a lot of other people have had to adjust to that, especially last year during COVID. were shutdowns, but I guess you had a good opportunity to test the waters with that and see what sort of difference you could make in that format. Yeah, completely. What's your current role and what would you say a typical day's like for you? So I work at a drug and alcohol service in southeastern Sydney. We cover from, I'm in the northern sector, so we cover from Vaucluse

all the way down to La Perouse, to cover that chunk and going into Surrey Hills as well. So within that, I work in the opiate treatment program. So we do methadone, suboxone, and buvodal dispensing. And I'm a social worker, social work case manager within that team. And do you have social workers who are not case managers or case managers who are not social workers? Yeah. So there's three social workers in my team and we're all case manager social workers.

We all strongly identify as being social workers fulfilling a case management role. and the rest of the case management team are nurses. And linked strongly in with the team is all our doctors as well. So they're really integrated within the team. Because naturally within the opiate treatment program, people are prescribed their medication, and that's our core business. That's the reason that they're there.

So to manage their opiate dependency. So people will be prescribed methadone, and that's the core aspect of their treatment to manage their dependency. but their case managers are a big part as well. So determining risk and assessing the appropriateness of the medication and changes to their treatment is always happening with the doctor. So they're really amongst us, which is good.

And I imagine within that population there would be quite a lot of homelessness and mental health issues, domestic violence, child protection. What are the kinds of cases that pop up for you? Huge variety. So my niche, I think, I tend to find myself. assessing and bringing on clients who are younger, so maybe 30 and under, and two have been just released from custody because we're a discharge location for people that are on a program in custody.

Say they put down 2,000 as their address or a family member's house in Maroubara, and they go into homelessness. So they'll be discharged to us, and they'll come to us, and they'll try and find their feet in the community. So a surprising part of the role for me was that it was supporting people with institutions. or coping in the community following a really long jail sentence, finding their feet, reconnecting with their informal supports and helping people, yeah, sort of find their meaning again, I guess. That's a big chunk that I feel strongly about, but 25% of the people with

NI service identify as being Aboriginal. And that's a huge passion of mine as well. I find it really interesting and I find it really challenging. And I really have a lot of respect for the Aboriginal clients in the service because they're really clear in communicating their needs to me. And I think there's a lot of value in that. They allow for a space to tell me when I'm not being appropriate and sort of pulling me back into line and working in that kind of space where, you know, reapplying respect and, you know, being continuously more critically effective is really, really meaningful. Would many of those people be on community treatment orders then? Is that how they come to you?

No, so we can't operate within the bounds of the Mental Health Act. Some people are on community treatment orders, but purely for their mental health depots. And we support some people with their mental health depots, but people that won't engage and will continue to be traumatized are going back into hospital via police. But, yeah, the injections, the treatment is completely voluntary. So if someone drops off treatment, that's okay. Off you go. This is how you re-refer and supporting people with that. I think a consideration that I've had to get my head around is that because we're a major

discharge location for justice health from custody, a lot of our clients are on intensive corrections orders or parole orders, which means that being on the program is a part of their parole. So although being voluntary within legislation, their corrections order means that it's a part of their conditions if they don't want to go back into custody. And there is an opportunity within that to go to a corrections officer. And I've been surprised how great a lot of them are when you go, look, this isn't working, this isn't what they want. This isn't suitable for them anymore. This is how we're going to transition them out. This is what their plans are. And I haven't had any

kickback from that previously, which is good because it's important to keep it very voluntary because it's quite significant, you know, holding someone's opiate dependent. Yeah. So there is some flexibility there. in terms of how you manage the program as long as you've got adequate justification and you've got a good relationship with the parole officers? Yeah, yeah, I think so. Did you have to do sort of a quick course on justice and how all the legislation works? Very much on the fly.

My team is so supportive. I'm in a brilliant team that's retained a lot of stuff for a long time and it's really great place to work. So there's hardly a moment that I can't go, I don't know if I can be saying this to parole. I don't know what it means if I say this. and get some clarity around that. And they're developing great skills to speak in hypotheticals. I imagine then working so closely with doctors and nurses,

you would learn so much about the different pain management strategies and the different medications. And what I know about pain management approaches is it's so much about balancing that risk versus reward. So that would be, I imagine, part of the discussions that you have with people in terms of the type of medication, or are you really just looking at the social aspects and supporting them through that? I think when people come to get on a program,

there's a big chunk of them that have had significant physical health issues. But a chunk of people, it's separate to their pain, their physical pain. They're over the grind of daily heroin use. They're sick of the fear of hanging out from opiates and how that feels. They're sick of committing crime. they want to regain their relationships, and each medication has its own function. And a lot of our clients know people that have been on a program, methadone, suboxone, or bivitol the injection.

So they talk to each other and they go, get on the done, I'm on the done. Suboxone is really great. It's really worked for me. And there is definitely different considerations to make within a trauma-informed perspective because methadone is a full agonist, which means that it still has a sedating effect, similar to heroin, not as sedating as heroin, but it still gives you some level of sedation. And it's recognizing that people are using opiates, and that have since a lot of our clients and so it's 9, 10, 11, 12, 13, and average age of the program is, you know, 35, 40.

So that means that people are using to overcome their trauma and to manage the psychological distress and to withdraw from the world in some way. I think I really view my job as I'm a trauma social worker in a way because everything is connected to that. And the clients really view their opiate dependency as a way of managing their trauma. So for methadone, more sedatings, it is going to give you some relief in that sense, whereas suboxone is a partial agonist, which means that it isn't as sedating, so it can make you feel more alert and more wide.

and that can resurface a lot of traumatic experiences thereafter. So being really informed and communicating really clearly with the client about those things. And that's sort of where I'll leave out. I talk about people's other experience and the medication. And then I hand over to the doctor that this client has a significant trauma history and they have insight about their drug use being connected to their trauma. And this is one of the reasons why they want methadone or this is one of the reasons why they want suboxone. Yeah.

You mentioned a lot of issues come up around long-term institutionalization. What would you say is another challenging thing about the work that you're doing? Or even how is it challenging to work with someone who has been so institutionalized and such a part of the system that it's really hard for them when they're trying to transition from a prison system to the outside world? Yeah, entirely. So people on methadone or nosoboxone, if they're dosing into clinic, will come in every day. So when they're released, I'll do their assessment, which is like a 45-minute-hour psychosocial assessment,

and I'll have an opportunity to then see them most days that I'm there and work with them from a social work case management perspective. So you really see someone's transition to coping or not coping in the community or seeing them beginning to cope and things are going okay and they're reconnecting, their world's reconnecting, that something's happened and it's meant that they can't cope anymore. So it might be they've reconnected with an ex-partner or they've tried to request supervised visit from DCJ, but that's been rejected. So an escalation of drug use happens and from their further stresses occur and that feeling of not coping in the community gets more significant. And it's challenging to see people fall into a spiral. And often I'm trying to catch people before that spiral, move them on from that spiral. doing that by having initial conversations, really open conversations about their level of

institutionalisation and what it means for them when they're in the community and how long they last when they're out. So the challenging bit is when the wheels fall off and just watching it happen for a few weeks or a month, them getting really mentally unwell or their physical health declines or their drug use significantly increases to a point where they're completing significant risk of harm to themselves and some very important people in their life. it's challenging to know that you're watching it all unravel in the way that they knew might happen and they don't have the ability to cope with that and eventually returning back into custody reaching an older or committing another offence and yeah seeing them go back inside yeah i remember when

many years ago i was working with a client who we would see in the hospital regularly who was homeless had been for most of her life and she was would come out of prison and just not know how to cope and so she would commit something petty so that she would get picked up again by the police and incarcerated again. And that was just a cycle of this is how I know how to cope. I've never really had to look after myself before. Entirely, that's really relevant. I attended an Aboriginal men's group last week. One of the members invited me sort of a project officer consumer worker of the Langton Centre. And I was chatting to one of the fellows there from Wellington. And it was a lot of the fellow's there from Wellington

and it was coming up and sort of dropped into the group. And he was saying that for himself, he felt as if going into custody was a right of passage. He felt as if there wasn't an opportunity for Aboriginal people in his community to have men's business. He saw an opportunity for women's business to occur, but he didn't find that there was a space within his immediate community for that. And he found that really distressing.

And he said, as men, like we need. to find ways to have men's business, and he sought relevance of that men's group. And he doesn't view himself as being institutionalised. He's been in custody before, and he's got a lot of stresses in his life. But it was just, yeah, very challenging to hear that it's not only colonialism's incarceration of people,

over-incarceration of Aboriginal people, which is significant and really evident, but the institutionalisation, he recognised as being intergenerationalisation, And that was quite distressing for him to share with me. And he acknowledged that. It's like it's hard for me to say that to you because you're a white fella. And having to sit in that space with him was really, that was a challenging part of the job.

And it was quite meaningful for him as well. He thanked me for listening. And I think he felt like it was acknowledged. He saw how colonialism had caused like intergenerational institutionalization for him. That sounds really confronting for you to be part of that. but also how incredibly insightful of him and it must have felt good being able to be a sounding board and really listen to his experience. Yeah.

It's a constant reminder that Aboriginal people are so incredibly acutely aware of the level of disadvantage that they experience. It's every day, every second. Yeah. What do you love most about your job then? Probably my team. We have a lot of fun. We are all fun, hilarious.

I really enjoy being at work with them and sharing experiences with them. We're really good friends. I think that's the first thing. I love being a resource for my nursing colleagues and the doctors as well. I love feeling valued and someone that they can go to openly and have a conversation about a client and feel it out, soundboarded and, you know, have a chat, get something meaningful out of it. I think it's so important to feel valued obviously, but also just to enjoy what you do and enjoy the people that you're spending half of your waking hours with.

That's good to hear. It sounds like you support them quite a bit, but how do you receive support in that space? My mentor, Chloe, she's phenomenal. We have this relationship where we either are in, you know, quite intensive informal supervision, or we are absolutely debriefing through humour and always seeing the funny side of things and enjoying each other's company. I think stepping really quickly from, well, Chloe, like I've just had a really full-on experience, sharing with her the conversation I had with that original man in the men's group

to having to just be able to switch quickly from that into seeing the personal side of each other. I think that's how I see a lot of my support. Also, I got a great partner, enjoy playing tennis, like cooking food, just being aware of the really important self-care things. My boss and team is really great. I'm pool time. We do four 10-hour days, and we accrue enough time that we only have to work four days a week. So today was my day off, and, you know, I did my washing, had a coffee, prepared for this, cook some food, marinating the chicken. And I had my own base, you know, like, had some.

some brain space. Yeah, just time away from it all, sounds like. Have you seen many changes or have you heard from your colleagues about changes in this field over time? Yeah, there's been quite a significant change recently. So methadone has been around since the 80s, literally, and it was quite significant in coming to Australia. And, you know, my director says, I don't think it would happen now.

I don't think where the political environment is too conservative. I don't think it would allow for methadone to exist. Suboxone came about 20 years ago, and a new medication, so suboxone is bupiphernorphine, that's the active ingredient, and new medications come out in the past two years. That PBS funded and can be prescribed at public clinics and by GPs called buvodal, which is a weekly or monthly injection of bupiphernorphine. And that's been, you know, significant. People usually were attending a public dosing point or community pharmacy every day,

or eventually getting to a level of stability where they would have takeaway doses. This means that people can attend the clinic, have a weekly injection. The opiate dependence is completely managed to have no symptoms of withdrawal, same active ingredient as suboxone. And that means that people have their life back, have less of a reliance on having something every day. They don't have to, you know, their drug used started when they're in their early teens of heroin use and move to daily dosing at a pharmacy or at a public clinic

or picking up takeaways and having something every day. But now it's flexibility. Now it's getting a job, spending time with their family. They can travel. They can go wherever they like. Their world is opening up. Yeah. And do you have an opportunity to conduct welfare checks

if someone hasn't turned up to the clinic for a while and you're worried about them? Definitely, yeah. So there's opiate treatment guidelines which say how many days based on their risk-creating what we have to do. Of course, that's clinically indicated as well, but someone's not coming, and they've got an address that you know

that they're staying at a lot of the time, sending the police around and seeing if they're okay. And, yeah, that's always an option. But I think it's about connecting with people's informal and formal supports rather than sending the police. A lot of the time, calling, you know, services in the cross, like the injecting centre. Have they been there?

or Vice-Side Chapel, Kyrton Road Center, St. Vincent's, you know, seeing it to access the hospital setting, or getting your release of information previously so you can call someone in their family to, you know, check that they're right. And where do you see social work continuing to make an impact in this field over time? I think I can see the change within drug and alcohol services, pulling itself away from the medical model, which is really great. I think it's so important. and it's really important that I think the medical model stays there a little bit

because we're prescribing Schedule 8 medications that are very dangerous if they're prescribed incorrectly and if people aren't supported incorrectly. So I think there is a level of validity to having it. But finding a blend between the two I think is really great. It's happening, which is exciting. And it's an exciting thing to be a part of where I work as well. I can see, you know, looking back and I can see how attitudes are changing. and moving and it's definitely a respected part of the work and very valued and seen as a key step.

Yeah. Given that you've had experience with people who have psychiatric conditions across a spectrum of ages, how do you see those conditions affecting older people versus younger? Yeah. It's really interesting within the opiate treatment program because some people have been on the program for a long, long time and I've had very, very challenging lives in their physical health. Mental health has really deteriorated because of that. So it's quite rare that we will see any of our clients live past 70, very rare. So an older person for us is someone that 45, 50 and above presenting is someone that it's 70. So I think for a lot of our clients, the long-term impact of trauma, like post-traumatic stress disorder, comes to show when they're step out of the drug scene and look after their physical health.

so the level of detachment from the world around them. Significant hypervigilance now that they're not using and they're having to look after their physical health, extreme anxiety, very low mood, suicidality, creeps in for, you know, our inverted commas, older clients, all that really heavy, lifelong, complex trauma just comes to the table and can be seen more, I think. So what you're seeing is not so much people developing mental health conditions,

later on in life, but someone who's had it for a longer period of time. Yeah. And I think, unfortunately, for our client group, perhaps the ones with the really complex mental health issues, they don't make it to older age. They die from overdose, or they die from a physical health issue, like significant comorbidities, or they are not on the program as well because they've completed treatment successfully. And they've transitioned out from a public clinic to a community prescriber and a dosing

you know, quite consistently, but the client group that we catch is the ones that are sitting in instability. That's the function of the program. So I think for us, we don't really see the ones that make it to older age. Sure. And I was talking a couple of episodes ago with Graham Simpson, who's a researcher more predominantly in traumatic brain injury. But what he was saying is that there's such a crossover between people with brain injury and people with substance abuse concerns and often they kind of feed into each other or especially I imagine people incarcerated would be subject to more trauma and more assaults. So would you say that a large portion of the people you support might have a traumatic brain

injury in addition? Yeah, significantly, significantly. Nearly all of them have had a head injury, whether it's traumatic or not, perhaps they don't know. Part of a drug and alcohol system is an acquired brain injury. screening. So you're asking people about big knocks of the head, long periods of unconsciousness, so half an hour and above, head injuries that's meant that they had to go to hospital, and screening from their cognitive risk factors and offering the opportunity to

complete a mocker. We're lucky enough that we've got a neuropsych on site as well, so we can refer internally to that neuropsych and have an assessment completed, which is really, really important for people. And I think that gives them really big purpose because they've never had an opportunity to understand what is actually happening for them cognitively. They know they've had big knocks at the head. They know that they've had maybe hypoxic brain injuries as a result, you know, overdose, where they just woke up two hours later. And they know they're not right.

And beyond, you know, anecdotes from other consumers and understanding maybe when they were growing up that they had ADHD, you know, behavioral issues or they're in special classes at school, that's often where it stops for people. They don't have a lot of information about what happened in their childhood because it was so traumatic or they're not connected with their family anymore to gain that information. So you don't work with much and you give people so much. Part of the job that I didn't think was there and then I kept finding it and I was like, oh, this is an exciting space to being in with clients.

Yeah. I imagine also from a medical perspective it might be hard to tease out whether something is a result of withdrawal or a neurological symptom like tremors or unsteadiness on their feet. So you'd have to kind of, as part of the assessment, I imagine, figure out exactly what's going on in order to treat it correctly. Yeah, so often I'm trying to pull out what's what, trying to understand what impact their homelessness is having on them. Are they couch surfing and that to them considered quite a comfortable space to be in?

Or is that causing significant distress to the point where doing a mocker and you're doing neuropsych testing isn't actually going to be a fair representation of their cognition. Pulling that apart with the client, what implication does their, you know, significant trauma history have on their thinking? Are they a candidate to perform neuropsych testing, maybe? Like, and having skill about, you know, really discussing there with the neuropsych and their prescriber and their case manager about what's what and what role does each one of those

things play ongoing drug use, what role does that have on people? because that's an important part of the program as well as that people can continue to use substances when on the program. They don't have to stop. That's okay. We'll support you with whatever drug use you come to us with. That's often a goal of people that I've got to back off in my eyes use because I want to do the cognitive testing. I need to stop drinking because I want to get a good idea about what my thinking is like when I'm not drinking. And I guess you want to weigh up the benefit again of what's the point in doing this test?

It's going to stress me out more. What are we trying to achieve here? Yeah, often, as I'm sure people listening to this, and you would understand, like, doing an NDIS application for psychosocial disability is very, very challenging. It's very hard to evidence. And so the neuropsych testing is often, it's the key to the door to the NDIS. Right.

So that's often to be motivator. I need more support. I'm not coping. I don't want to go back to jail. You know, I want to get my kids back. I need more support with my kids. I don't want to have to rely on my violent partner again. I don't want to have to go back to him because I can't look after myself.

People are really open about seeking support from people that aren't good influences for their recovery. So that's often a big key. The DSP is a big key. Psychosocial disability for the DSP is very hard to access as well. So that's a big key. Housing, doing a housing application, it's a big key. And it makes my job way easier. And the other case manager's job way easier to have.

have a neuropsych report to go. There you go. Actually supporting someone at the moment who has been previously really resistant to doing a mokka in neuropsych testing, he dropped off the program, sleeping rough consistently. Previously had a housing property but couldn't manage the tendency to do that we think because of his assumed cognitive impairment and sort of anecdotal comments from him about a significant trauma history that he agreed last week to do a mokker. We did a mocker and he got a score that indicated impairment

and he's due to see the neuropsych tomorrow, which is a very exciting thing, I guess, for us in a way, but also knowing what might be coming for him to get an idea about why he hasn't been, why he's always felt different because he thinks, you know, I've always been this way and I don't know why. I want to get help with the big things in my life,

but I don't know how and no services will touch me. And largely I can relate with him about that. Sounds like you'd have to have a really good relationship with local Central Inc offices, housing offices, NDIS coordinators or people who are doing applications as well. Yeah, definitely. Yeah. NDIS access teams, like with Mission Australia, have a good experience with one of those

teams. And Embark, who supports people with homelessness and mental health, access the NDIF is a big one. But yeah, build in those supports because I, realistically, I'm a, I've been out for two and a half years. I don't have the skills to put together. I really specialize in DAS application, recognising and being honest and probably don't have the time to do it properly. So can I refer out and will that refer will that refer will work

or who do I need to support me if that can't happen? And are the NDIS eligibility criteria for psychological illness really clear? Or is it kind of up for interpretation, therefore it's really hard to prove? Yeah, it's a bit grey. Yeah, it's a bit quite hard to prove. And it's naturally hard to prove like psychosocial disability. And, you know, the psychological disability that comes with that because it's all of our clients have never seen a psychiatrist.

Don't have a diagnosis but have very obvious mental health issues and sometimes psychotic features that they don't engage with. Don't get unwell enough to present to the hospital setting. And if they do their in peck for two nights or one night or in an acute unit doesn't give them an opportunity for further understanding about that psychosis other than drug-induced psychosis, which is quite hard to do an application with because it's viewed as temporary. Sounds like it's so hard, almost like a double-edged sword as well for people who are trying to be really open and transparent about how much their condition is affecting their lives,

but also trying to demonstrate that they have capacity to have custody of their children and carry out everyday functioning. So that must be really difficult to balance. I think if it wasn't for the opportunity to see someone through their journey, so see someone when they come out of custody or when they come onto the program as a self-referral and watch them move through their life and in the good and the bad, it would be really hard to get enough rapport to have an open, honest space. So you've got to be quite unwavering because they've had people in their life leave them,

that couldn't cope with them when they become unwell or when they're using a lot of substances. So you've got to be the same as when they're good as they can be and when they're really unwell. So you've got to be very, very consistent. And I think that builds trust and openness. I know that you're only just getting started and it sounds like you've really found your happy place with this role. But are there any other types of social work that interest you? Yeah. I, um, when I've been at my current role for like a year and a half, I was like,

geez, I really need to be in the hospital setting. What am I doing here in the community? Like I got restless and I think I felt a need to challenge myself with the hospital setting. And at that time as well, my brother who I spoke about previously, he was going through another period of unwellness. And my other brother just had a baby that was, you know, one and a half. And my dad was having knee surgery. So I actually applied for leave without pay for my current role and went home to Griffith

and worked as a locum at the Griffith Base Hospital for a bit for three months, which was really fun, really good. So that covers 116 beds and it was ED, ICU, a medical ward, surgical ward, maternity, paediatrics as well. It meant that I got to touch all of the other bits of the hospital setting and feel out what I liked and what I didn't like. And that was really valuable. That was really good.

And I'm going back there for June as well because another baby is going to be bought in the family. So I'm going to be going back there and working and having a little taste of it, keeping my hospital social work skills up. But I feel like my headspace is really different to when I did that to CECOMET last year. I really, it brought me back to the community

and going, I love having enduring relationships with my clients over two, three years. years and watching them come back, drop out, come back, or find success and move from homelessness into a property and into, you know, starting taste or more contact with their kids or developing skills with people to work through their domestic violence issues and slowly watching that strength build up. It's really meaningful. Yeah. Are there any projects or programs that you get to work on in addition to your normal work? Yeah, sort of at the moment working with the consultant and one of the registrars on a case series,

a review of cases of people that transferred from daily dosing at a public clinic on methadone or suboxone to the injection and specifically with clients with social complexities. So unstable, housing, domestic violence, child protection issues, significant mental health issues that impact on their recovery. all those big social things that happened for our clients. And what it means for those clients who have now started, moved from daily dosing to only come into the clinic once a week or once a month. So we're reviewing the doing file reviews on a chunk of clients and understanding what did work, what was successful.

And popping that into the literature, because there's a big gap in the literature in that tense. There's not much content about it at all. And that hopefully gives the opportunity for other prescribers and other. clinicians in drug and alcohol to go, they don't have to see you every day, it's okay, they can successfully be on the weekly or monthly injection and be okay. And what's the best audience, do you think? Where would that be submitted potentially for publication?

I'm not sure. And probably it will likely be in one of the medical journals because it would be focused towards prescribers and the relevance of the medication for socially complex people. I think that's where it's going to be leaning. towards. Really lucky where I work that we have like a research team inbuilt to the service and they work on a level above us. So they've got great links in and consultant and the director are really research focused. So it means that I get too, um, throw my social work two cents in and make sure that we have the social work feel in in some of the literature that we're putting out.

Yeah. Sounds like such a great opportunity. Be silly not too, really. Yeah. And if anyone was interested in reading more about, about social work in this area, or even things like trauma-informed care, because it sounds like you use that as such a basis for what you do. Where would you direct people? I've been slowly chipping away at the body keeps the score by Vesville Vandekot. It's just so heavy. It's so, I read two pages and I need to stop and just, like, think and connected to things.

So I'm slowly getting through that. That's a big one for me. There's a lot of literature that connects the opiate treatment program. and trauma and homelessness and drug and alcohol issues and domestic violence and drug and and alcohol issues. It's very mixed in. So I think there's literature that always comes up. And I find that somehow easier to digest is like reading an abstract, flicking through down to the discussion and see what's worked than reading a book. I think I'm distractible. So I can go this, that, yep, okay, and then just get chunks of things. I find that work for me. Are there any

any movies or shows or media where you feel like people get this area really wrong or really right in terms of pigeonholing or assuming something's the way it is. Surprisingly, a movie that I can think that focuses on OPEC, use his train spotting. It's a really great movie. And I watched it before I worked at where I work now and after, and I understood a lot more about it. But that depicts the chaos really well, I think. social housing, disconnection from family, all those big things.

And it very briefly mentioned methadone and how the court was telling him to do it and how it wasn't working and he wanted to go back to heroin use. But it's not very sexy, is it? Opiate use. It's very stigmatised. It's really underworld. I think one really, anyone's ever in Sydney. I'd highly recommend going to see the Injecting Center at Kingscross

when I was on my last place when I attended there. And I was like, well, this is super interesting. You really get to see, like, the harm minimisation full on. It's a really great space to have a walk around. Yeah. Well, I think it's so interesting to hear about the different types of treatments that are available for people living with opiate dependence. I think you've explained that very well. But I love your perspective of social work in this area of helping people find their feet

and helping them find meaning and reconnecting with their communities and their families. families, and it's lovely to hear that you feel so valued and respected in that space as a professional, and you feel like you have a really important role to play on the team, and you've developed some really enduring relationships through doing that. So that's really fantastic. People are so often providing information about the negative of their jobs. So you'll say, oh, that sounds really difficult what you do. Tell me about how that's difficult.

Instead, what you've said is I provide or I try to provide a stable and consistent influence for people whose lives are otherwise incredibly turbulent. So even just seeing it from that perspective of I have a real contribution here rather than this is a really challenging area of social work. I think that's what helps you get through those really difficult cases and keeps you coming back and keeps you interested and makes it interesting and fresh every time you present something. Yeah, yeah. I tend to a great actually. It's a good way to look at it. Well, this has been wonderful. Thank you so much, Lachlan, for taking the time. And I'm sure everyone else will get just as much out of it as I have. I think it's a great area of social work. You've obviously got the capacity to work really well with a team, a multidisciplinary team. Great that you have the opportunity to do some research as well and get social work's name out there a little bit more.

And I look forward to seeing where it takes you. Beautiful. Thanks, yes. And I appreciate you having me. Thanks for joining me this week. If you would like to continue this discussion or ask anything of either myself or Lachlan, please visit my anchor page at anchor.fm slash social work spotlight. You can find me on Facebook, Instagram and Twitter, or you can email SW Spotlight Podcast at gmail.com. I'd love to hear from you.

Please also let me know if there is a particular topic you'd like discussed, or if you or another person you know would like to be featured on the show. Next episode's guest is Ben, a PhD candidate at Western Sydney University with a social work practice background in community mental health, group work with men and boys, and community development with the Penrith Panthers Rugby League Club. He is the founder of two social work-focused podcasts, social work stories and social work discoveries, and has been tutoring across various social work subjects for the Masters and Bachelor's of Social Work at Western Sydney University since 2017. team. He has just submitted his PhD, which investigates the complexities of relationships between men and boys in a dynamic group mentoring program at the Penrith Panthers called Building Young Men. I release a new episode every two weeks. Please subscribe to my podcast so you are notified when this next episode is available. See you next time.