Social Work Spotlight - Episode 61: Jerome

Episode Date: July 8, 2022

In this episode I speak with Jerome, who has worked in Sydney’s mental health inpatient units and in community mental health. Jerome is currently Senior Social Worker at the Forensic Hospital, a high secure mental health facility on the Long Bay Correctional Centre campus.Links to resources mentioned in this week’s episode:The Forensic Hospital - https://www.justicehealth.nsw.gov.au/about-us/health-care-locations/the-forensic-hospitalForensic Mental Health Social Work: Capabilities Framework (UK) - https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/569389/Forensic_SW_Capabilities.pdfThis episode's transcript can be viewed here:https://docs.google.com/document/d/1gqyLYYbH8wwU1Cezt-xU4M2oOUrURBERwVABZuBW7Pc/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 each episode. I'm your host, Yasmin McHugh-Rite, and today's guest is Jerome, who was born and raised in Sydney's North, but lived in the UK for two years, working in hospitality and travelling, and then lived in Portugal, teaching English for two years. Jerome worked in Sydney's mental health inpatient units for three years, with some community mental health experience also. For the past four years, he has worked in forensic mental health, and is currently senior social worker at the Forensic Hospital, a high-secure mental health facility on the Long Bay Correctional Centre campus. Hi, Jerome. Thank you for coming on to the podcast.

Really happy to have you here and have a chat about the work that you do, which seems really interesting. Cool, thanks for having me. Yeah, I'm wondering when you first started as a social worker and what drew you to the profession. It's really hard to kind of answer that. I think it was a long time ago. And when I think back to that time, I originally wanted to start in psychology and I thought that that was an interest of mine. But then I very quickly realized after speaking to a few people that I didn't think that that's something that I wanted to do.

And I kind of signed up to social work because a school education person kind of pointed me in that direction and said, you know, what are your skills? And I said, well, I just kind of want to work with people, but I don't really know what else. And I didn't really know what social work was. And I kind of got thrown into university. and it was fine, but again, for the first two years, I wasn't really sure what I was doing until my first placement. So I don't really feel like I knew what was going on until my third year. And then I realized, actually, this is something that I have a bit of an interest in.

And I thought that I wanted to do a placement in anything other than mental health, but I got thrown into like a homeless shelter. And obviously there was mental health everywhere. Yeah. And actually, very quickly, I realized that it was something that I enjoyed doing. more so working with people who had mental health issue. I just found them really interesting. And I wanted to kind of find out more about their background

and where they came from and what had led them up to the point of when I was seeing them. Yeah. What do you think it was about mental health before you had that firsthand experience that made you guarded? I think it's probably actually a massive motivator for me for working mental health. And I think it's a lot of the stigma around it that we don't really understand it as a society. and people don't really like to talk about it. And the way it's represented in popular culture is horrible. And it's something that actually has been a massive force in making me want to change people's minds about it.

Because, yeah, like I said, people don't really like to talk about it, and it's not represented very well. Yeah. And so that was your first placement. What was your second placement? My second placement ended up being in a forensic mental health medium secure unit in Sydney. And again, I was like, you know, I didn't really know what that was and I didn't understand what forensics were. And I kind of thought it was something to do with fingerprints and some type of crime scene analysis because it's a very small part of mental health. And it represents a very small percentage of the population.

There I had a great supervisor who kind of introduced it to me. And I worked between a civil mental health unit and the forensic mental health unit. And it was a lot of information for me to kind of understand the difference between the two. and I really quite was drawn into it. I always had an interest in prisons and the corrective service systems and I tried to get a placement in there at university and they said no one was really offering it at the time. And this is the closest thing that found for me.

And so it was very different. And obviously, if I got put into the corrective services, I would have had a very different experience. But actually this is exactly what I was kind of looking for. It's a combination of, you know, the justice system and the health system and all the complexities working with, you know, extremely vulnerable, very small percentage, you know, this tiny little group of people. And when you say civil mental health, are you referring to the general population as opposed to

forensic? Yeah. So when you're in a mental health unit, you just call it a mental health unit. But when you work in forensic, you tend to refer them as civil mental health units, yeah. Okay. And how do you think the social work approach might be different in those two areas? So after I finished university, I actually worked in a civil mental health unit in the Sydney local Health District. And I worked on quite an acute, kind of like a mental health ICU equivalent. And I worked on the acute male unit. And we took lots of referrals from, you know, the police, people bringing people in who were, you know, really disorganized or committing some, you know, small offences in the public and getting arrested and being brought in. A lot of them were

court diversion. So people had kind of committed a small offense and the court had kind of said, look, you know, we don't think that you need punishment. It's very clear that you're unwell and we think that you actually kind of need treatment and they would be coming through this civil mental health unit. And a lot of the work was kind of working out, you know, what was going on, who these people were. From a social work perspective, it was more about kind of where were they living, you know, what was their financial situation, trying to find, you know, who were the people that

were their main supports and then trying to work out if it was possible to try and move them back into the community as fast as possible or at least transition them out of that. you know, acute mental health, you know. So there's a lot of collateral gathering and investigation and trying to work out who these guys were. Sometimes they'd kind of come in with, you know, nothing on them, no wallet, no ID, and they would be quite unwell. So you couldn't really work out anything from just speaking to them so you had to kind of do a lot of digging on the side. And often they'd come in with outstanding court cases and all these kind of things. So it was kind of very messy, but I really liked it. And I thought it was just really quite interesting and very fast-paced.

Yeah. It sounds like you had to be a detective almost. Very much so. And did you have much of an opportunity to speak with family, or sometimes it was probably you didn't even know where to start? Look, it's difficult at the beginning, but you would always be able to find out, you know, everybody has someone and you'd have to try and find that main person, and that would either be going through the police or trying to speak to them and calling around and finding, you know, homeless shelters and things like that.

And usually someone would kind of recognize themselves, like a few little things that you kind of had to do and a few tricks that you would learn, but eventually you would find that person. Usually they were very happy that I had contact them, were very surprised that this person had ended up in this place. And then you had to kind of deal with a lot more complex discussions, especially we had a lot of people presenting with psychosis that was mainly focused around drug use. And so it wouldn't kind of go on for very long, but would present in the same way initially upon assessment. And so they would be admitted, but then very quickly that psychosis would resolve and so they would be kind of moved out of the mental health system. And even though they're

kind of obviously related, I think the mental health units are kind of more looking to work with specific mental health related issues and drug and alcohol is for more drug and alcohol services. And even though they combine, they kind of manage slightly separately sometimes and it's hard to hold people under the act if their psychosis has resolved. And so it was me kind of having to speak to families and say, look, I'm really sorry. This person's coming back out. They're coming back out today. What can we do to kind of make this transition easier. And obviously they would always kind of say, look, we don't think this person is very well. We don't think that they should be coming out. But it's that kind of difficult balance of trying to explain that it's very challenging to kind of hold someone

against their will under the act if they're not displaying the things that you need them to be displaying in order to do that. Yeah. I can imagine for me coming out of university, yes, you've had those two placements in that area that you're working in. But I feel like as a as a baby social worker, I would have been quite intimidated and I would have felt like this is a lot to take on quite confronting for my first job. Did you experience that difficulty or for you, was it just a natural progression? Well, maybe I should just go back a step. So when I finished university in 2009, I, what did I do? I got a job straight away and I was on a sub-acute unit at a civil mental health unit and I worked there for about nine months and I hated it at the

beginning because I didn't really know what was going on. But then I realized that actually this is something that's very interesting and something that I was realizing that I enjoyed and felt that I was making a contribution. It was changing every day and I found it very colorful and exciting. But then I was living quite far away and I had to kind of commute close to an hour every day and that was breaking me and then sitting in traffic and I found myself getting very irritable with the driver in front of me and the driver behind me and my partner at the time kind of decided look this is not good for us we don't want to live in this city life we want to change and then we ended up moving to Portugal for two years or something like that's a very slight change yeah and so we just overcorrected

and we just did the opposite so we moved into the middle of nowhere and you know we're teaching english and we didn't have a lot of money and we were living in the bush and we kind of loved it and that's what we felt like we needed at the time and then after a couple years we kind of said look this might have been, you know, too much of an overcorrection. We need to go back. We need to get jobs. We need to kind of, you know, move back and see people that, you know, our friends and all the people around us and do something a little bit more. And so we came back and then I worked on that acute unit that I kind of mentioned before. So I was a bit older and I'd kind of, you know, lived in Portugal and seen some things. And I think that when I re-interviewed from my position,

which I did on a, like a Skype thing at midnight, actually, I remember. They knew me from before. and they just kind of felt that even though I had only worked on a unit for kind of nine months that I was ready because I had kind of grown as a person and I was a little bit older and then they kind of decided to put me on the unit. But yes, it was really scary at the beginning. It's, you know, there's a lot of violence and aggression and things like that and it's not for everyone. But I think my exposure to some quite acute patients on working on a subacute unit kind of

prepared me for all that. Did you have any ties to Portugal? My wife's parents live there. Okay. Yeah. All right. And that must have been a bit of an adjustment in itself, just getting used to a new language and new environment and away from your normal support systems. Massively, yeah.

It was really exciting, you know, and they live over there. And, you know, my partner's father makes guitars and they live on this beautiful farm. And, yeah, it was a really nice escape. So we still go back. Okay. I'm wondering whether you felt as though working professionally and, Portugal was an option for you? As a social worker?

There's actually a lady there that we knew that was a friend of ours that was a child psychologist and I hadn't planned on working in social workers when I left the city. I just kind of wanted to escape everything. Right. Not because I hated social work. I just, it was kind of actually probably just the traffic, Sydney traffic. And I kind of explored some of those options but because you can teach English when you get taught to teach English, you teach in English and you don't have to learn the local language.

and that's just the way that it works. But for me to have work as a social worker in Portugal, I probably would have had to have learned Portuguese. And I did, but not very well, and nowhere near the ability that I would have had to have, you know, to actually get a job in health. Yeah. So, yeah, I thought about it for a moment,

but I never really explored that. Okay. And so you came back to Sydney. You started working again in the justice and forensic mental health space. What does that look like? What's your current role? what do you do on a regular day? So it's the justice health and forensic mental health network,

which is kind of a, it's a strange LHD because it covers all the different justice network, say all the different jails, they're all over the state, which I have not visited. So I've actually only known a very small part of the network, which is the forensic hospital. But if you think about it, it's just kind of any kind of health-related coverage for places within the justice system. for me, that just means the forensic hospital, which is kind of next to the Long Bay Correctional Center. I mean, the forensic hospital is a high, secure mental health facility run by justice and health, and it just deals with individuals who have committed usually quite a serious offence, but then similar to what we discussed before, they get arrested, they go through the court system,

and the court kind of says, look, we don't think that you need punishment. We understand that you are quite unwell at the time of your offence. We can see your history. You've had multiple admissions. went on your medication and, you know, they get a few experts to kind of come in and make all these assessments over a period of time just to make sure that they've got it right. Once the court is kind of happy with that, then that person will go on a wait list to come to the forensic hospital. Not everybody comes to the forensic hospital. Lots of people go through the court system and they

get this, what they used to call NGMI or not guilty due to reasons of mental illness. They've changed it now, so it's act proven but not criminally responsible. It's very long terms. It essentially means, you know, hey, yes, you committed the offence. We know that you did, but you weren't well. You need help. You need treatment. We're going to send you into this. Some people can be managed as forensic patients in the community. So once you have that status, you've just become a forensic patient. Some people can go to medium secure units. So there's a few medium secure units around Sydney. But if they feel that this person probably needs high secure, then they'll put them on the weight list for us. And they'll come to us. We have six separate

units and there's a social worker on each of the units so each of those roles are very different yeah so we have like an adolescent unit we have a women's unit and then we have four male units and it's kind of based on like a phase of illness model where you will start at the beginning and work your way through you have different multidisciplinary teams through each of the units so you'll have to kind of meet a new team each time as you move through as we get to know you there'll be kind of less and less restrictions and more and more access, you know, it's a kind of recovery focus rehabilitation place. And a lot of the focus is on the risk management side, which is very prominent. You can feel that with all kind of restrictive practices. But, you know, the spirit of the hospital is to kind of look at, hey,

you know, what are the reasons why you came in here? Let's try and minimize the chances of that happening again. Let's look at what you can do and what is some of your strengths and your skills and try and build on them. So it's all that upskilling people in order for them to kind of of move into community and, you know, live a meaningful life. That's the overall hutching aim. But obviously what that actually looks like practically is quite difficult. Sure. And it would be different for everyone, I assume.

Yes. Yeah. So if you're in the high dependency unit, does that mean that you're sort of the more intensive side of things and then your job is to try to support them as they move further down that letter? Yeah. So the women's unit has multiple sections within that, but there's a high dependency section and then I'm on the beginning of the male units which is an acute male admissions unit

and so yeah we do a lot of the admission process and trying to find out a bit more collateral information about you know who they are and what's led them to kind of come in here we do a lot of you know family assessments so we're looking at part of my role sitting around this table of these all these other disciplines is trying to work out you know where they were living before and some of the trauma that they might have kind of come through and their upbringing and how that might have affected some of the decisions that they made in life. And that's some of the collateral that would be part of the social workers job in order to bring it to that table. You know, psychologists would be looking at other things and the OTs might be looking at more education and work and all that kind of stuff.

It's, you know, it's a very well-resourced facility. And so we do have access to lots of different people as part of your team. And so in the community, you might have 30, 40 patients and you're everything to them. You know, you have to do it all. Whereas here, you have to have. kind of a smaller segment of things. And so in the community, some of the social work roles might be diluted with all these other things that you kind of have to do. And in here, it's very specific. And they're kind of like, you do these things. We have access to too much

information. You know, working at the civil hospital, you kind of are trying to work out anything and get any information that you can. But now we have the problem of having too much information, so many different assessments and trying to kind of go through them and find out what's actually accurate, what's relevant, and how we can kind of best use it. I imagine part of that role then if someone's first coming into the system, and they haven't been part of this system before, is setting expectations and being able to tell them and their families or support people what to expect going through the system

and what your role is if they haven't come in contact with the social worker before. And also you'd have to have really strong handover skills and be able to then pass that information onto your colleagues. so that they're not having to start all over again. 100%. I guess that relates, you know, directly to having too much information. So we've been trying to kind of create more uniform pathways of information. You know, we have more specific documents around psychosocial assessments

and things like that that we can share. Part of my role is the senior social worker from the Frenzy Hospital has been trying to connect with the other medium secure units and other social workers within the network to kind of say, hey, like, we're each having to go through all these things and take all these histories and collect. all this information. We need to kind of have them put into the same kind of document so that we can share it and it's the same everywhere. And, you know, those guys were saying the same thing to us.

They were saying, you know, your handovers are like this, but we're getting them, you know, they're slightly different from each different social worker. Can we make them the same? So we've been working quite close with them to get something that's more streamlined. It's hard even within the hospital between the units to have systems that are the same, let alone different hospitals. And so we try and work in not in a silo kind of situation. have more connections with each of the social workers and all the units are all doing the same thing. Yeah, and also feeling more support, I would gather. Exactly. Yeah. And I can imagine there are people, a lot of people with disabilities on top of

their mental health, whether it be a developmental or intellectual or physical. How does that play into that vulnerability of the population and the complexity of health needs? It's very challenging. So I think because once you have that kind of forensic status, as a patient can be very difficult to kind of move out of the system. In order to move through the forensic hospital, you need to kind of display almost like a checklist of things in order to progress. You know, you have to have a pretty good understanding of your mental health. You know, you have to show insight and say, hey, yes, I've got a mental illness. Yes, medication makes me better. You know, have to have some understanding around your own aggression and kind of limit that

and be able to get on with people. You have to be going to groups and engaging with that. lots of different groups are available and you need to kind of say, hey, you know, we're doing all these things as you're here to work with us in order to kind of progress. And when you have people with significant cognitive impairments and intellectual disabilities, they're not going to be able to go through these things, these checklists. And so they're always going to struggle to come through our system because they don't fit. And I know that lots of nurses and other clinicians are kind of from the UK and they say they have, you know, specific units for people like this, whereas we don't have that at the moment. And so it's really hard for us. And so when

they do come into our service, they struggle because they can't go to the groups. They're not going to be able to engage with a psychologist. They're not going to be able to show, you know, kind of insight around their mental illness and things like that. You know, you can put behavior management strategies around them, but usually lots of their challenge behaviors can be very difficult to alter. And so, you know, going back to that checklist, they're not going to be able to progress. And so luckily, over the last few years, you know, with the NDIS and us kind of trying to work out

what that actually was for us and how to use it, we've been. been able to get a lot of these guys directly out of the hospital. And so I know we talked about pathways before moving from high secure to medium secure with these guys in the NDAS. Often we're kind of moving from high secure directly into the community because we're kind of saying and arguing with the mental health review tribunal to say, hey, look, there's no way these guys are going to go through the hospital. They're not going to be able to do these groups. This is it for them. This is how they're going to continue to present. Yes, they have challenging behaviors and they require a lot support, but they're not going to be able to go through this rehabilitation.

So we think it's the less restrictive, less secure environment for them is for them to go directly out. And so we've been using the NDIS to be able to do that. And what does that look like? Is that more support coordination? Is that more attendant care support when they first leave hospital? What sort of supports do they most need? And how does the NDIS cater to that?

It's a very tricky thing with the NDIS and language because, you know, we use the language of risk. We're talking about what are his risks? and it's his history of violence and all these kind of things. Whereas they're more looking on functioning. You know, what's their functioning? They don't really care about risk so much. It's more like, you know, how is this person's level of functioning

going to impact their decision making and how they live in the community and what supports they need. So we've had to learn a lot about that language. But a lot of these guys, they spend a bit of time with us. So they just need, you know, you don't want to call it security. It's more just, you know, supports. And they need it to be a secure environment, usually. So the doors need to be locked and all that kind of stuff.

Access to sharps and all that kind of stuff. but it's, you know, all very individualized and that's not a problem for everyone. But it's more like they kind of need this quite high-level support when they transition out of a high, secure environment at the beginning. And then that's something that hopefully can kind of taper off into the community. But it's usually just people that's around them kind of all day, helping them with the medication ADLs and things like that and also trying to engage them with, you know, therapy,

activities and things that they enjoy. But then you draw a fine line between risk mitigation and restricted practices, and at what point do you have to go to a formal tribunal or an external body to say this is actually what we need to do to protect this person? Yeah, it's hard. Yeah, yeah, yeah.

And a lot of that is kind of taking out of our hands because we're used to, like in the past, we would say, hey, this is the kind of stuff that this guy needs in the community. He needs this many people for this many hours a day based on these assessments. But now at the moment, the NDIS are doing their own assessments and their own behaviour supports plans.

So they're coming in and doing that themselves and then kind of making decisions. We make recommendations, but really it needs to fit into their own kind of template. So they're the ones doing it. And when we go to the tribunals, we're saying, look, we feel this way about it. We agree with them.

But according to their assessments, that's the amount of money that they're able to get. If I submitted a report, it might not be in the right language and I'm not going to be able to get as much money as they might be able to them. So it's a bit tricky because at the end of the day it comes down to their reports

and the funding that get given to them. And also you're looking at it from a different lens of mental health perspective, whereas they might be looking at it from a disability perspective. And some of the recommendations that they've made might not be things that your patient may be able to follow through with from a cognitive or behavioral perspective. It's got nothing to do with their disability necessarily. Exactly. It's very challenging. And for these guys, you know, they come from corrective services and it's a completely different system.

And then they come into the forensic hospital and we're a completely different system again. then moving out through the NDAF, it's completely different again. They're having to relearn all of these different systems. It's a nightmare. Yeah, I can imagine. There's an overrepresentation of Aboriginal and Torres Strait Islander people in the criminal justice system. What other supports do you have internally to be able to make sure that their experience and treatment is appropriate to their needs? Yes, so we, similar to corrective services, there is a huge over-representation.

of Aboriginal patients within the forensic mental health system. It's not as big as corrective services, but it is still quite significant and still an over-representation. We have multiple cultural support services that kind of come in. We've had external people coming in, and we've also employed kind of full-time Aboriginal mental health care workers within the forensic hospital specifically. So there are ones within the kind of Justice Health Forensic Mental Health Network

across the state, but within the forensic hospital we have, So one full-time clinical lead for Aboriginal mental health. And it's a bit tricky for them because they have to kind of cover all of the 135 beds. We are trying to recruit them all. But essentially, we've had different people coming in through that role. And they do one-to-one work with individual Aboriginal patients throughout the hospital. They can help with, we've done these things like compassionate leave. So if we have to take people out for funerals, often we'll ask them to kind of help us negotiate with the families

and make sure we're doing everything from a culturally appropriate lens when dealing with the families. They do one-to-one work, as they said, and they run kind of a, it used to be called the yarning group. And so you get them, everybody from all the different units and they go to a single place. And they can do lots of different kind of activities based on what they feel at the time. I think the last one they were doing was they were getting individual patients to present each week. So they'll say, hi, this is my name, this is my mob, this is where I'm from, this is my language. And actually, you know, this is a little bit about my area. And what they were doing in the lead-up to that is that the Aboriginal mental health care workers would kind of get them to prepare their presentation, do a bit of research around their identity and, you know, whatever it isn't about their culture and the food and whatever it is from their specific place. And then they'll stand up and kind of share that information with the group.

Sometimes it's very casual and informal, just a space for them to kind of connect and kind of hang out and drink coffee and tea and all that kind of stuff. They've got specific days throughout the year, close the gap and all that kind of stuff. it's okay. I think, you know, there's a lot of work to kind of be done in that and we just need, you know, more resources. But yeah. Do you stay in the hospital or have you had a chance to go out to the courts or the prisons just to see what that environment's like? Yeah. So I've been to silver water, I've been into Long Bay just to kind of see what that's like and see where people come before people come to the forensic hospital that have to be assessed just by one of our psychiatrists that's part of the help, you know, with the transition.

So usually they'll bring the registrar, someone from Allied Health, a peer worker perhaps, we'll kind of go up there. It's quite informed. We're just to say, hey, you know, these are some friendly faces. We're going to be working with you, how you're feeling. Get an assessment as well of, you know, things that we might kind of need to help us manage them when they come across. So I've kind of been able to explore that. We've done quite a bit of discharge to lots of different places all over the place.

So we often get to take people out and we do things like therapy leave in order to help prepare people for moving to the community so we get to take patients out and stuff like that as well. That's really good. That's probably even more flexible than your average hospital social worker role. For sure, I think it's a bit weird coming across because in civil or in regular mental health units, they say, you know, whether they kind of spearhead of the discharge planning. That's what we do. Whereas in the forensic hospital, there's not that much discharge, you know, kind of going on in comparison. We only get like kind of a few a year and they're very complex and most people are kind of moving through to medium secure units.

Some people are going out like the guys that we kind of spoke about before. Usually they're moving to kind of less secure facilities. Fortunately as well, I was able to, we had a guy who came across from Lebanon and he became a frenzy mental health patient, but he wasn't really able to stay or get a visa and things like that. So a few years ago, we actually had to kind of plan him going back to Beirut, which is very exciting. And they allowed us to go.

Yeah, we didn't want them, that particular person to be taken by immigration, all that kind of stuff because it might not have been so pleasant for him. So you got to support him on the plane. Exactly. You know, we had quite a good relationship with him. We knew him well. We knew his risks. And we kind of argued, hey, like, it makes more sense for us to be able to transport him

back. And it was a very complex plan, but we, yeah, took a registrar and a nurse and were able to take him home. And then had to turn around straight away and come back? Pretty much, yeah. I have this impression of working in a high security facility as being very, very sterile and, you know, leave your things at the door kind of thing. Is it very different, do you think, to a regular hospital environment? So when you're actually inside the unit,

it's not massively different. People think, oh, it's high school and it's going to be very different. It's not massively dissimilar to other mental health units that I've been to. The big differences is from the outside. So even though we are run through Justice Health, you know, the internal structure of the hospital is essentially a health facility. no security guards or anything like that, all kind of everything's managed by the staff within the walls. When you come in from the outside, you notice some big differences that you kind of wouldn't really notice at a regular mental health unit. There's a big wall and you have, you know, a lot more security. You have biometrics and, you know, your eyes and your fingerprints and things

like that. There's a big long list of stuff you can't bring in, which is probably very similar to other units anyway. Staff, though, can't bring mobile phones and all that kind of stuff. So it can be quite hard, but it's also quite nice because you kind of... Disconnected. I checked out from the real world, you know, and you have a bit of time away. So it is a little strange. But other than that, it's not massively dissimilar. That's good.

What do you think you enjoy most about the work you're doing? There's lots of stuff I miss from the regular mental health units, like, you know, the amount of admissions and meeting more people and all that kind of things. But I think forensic mental health is very exciting in its own way, because it has extremely complex patients. And to be able to discharge someone is one of the more challenging things and a lot more complicated than kind of anything that I had done before. Taking that guy to Lebanon was, you know, took kind of a year of planning.

Took another guy to Mexico City as well. And it's very challenging. So I think kind of just working with, you know, extremely small but extremely vulnerable part of the mental health kind of population. lots of people have mental health issues, but a very small amount of them ever kind of ever get admitted to a mental health unit and even smaller, you know, percentage of them ever go to a forensic mental health unit. So I think you're working with a, it's a very specialized kind of field of work. And I think I quite like the idea of, you know, social workers find

themselves working in places that they don't really feel should exist, you know. From our perspective, it's like all these places that we work, we don't really agree with, you like jails and all these kind of horrible places. And I think it would be the same for, you know, to kind of justice health. I'm not sure how I feel about, you know, the prison system and it's affecting us on, you know, rehabilitation and things like that. But I know that a lot of the work that I've seen within the forensic hospital is amazing.

And I think it's very complicated, though, because it's that balance of restrictive practice and risk assessment and trying to work in a very potentially very dangerous environment with people focusing on something that. that someone's done, often many years ago, and a lot of their interactions are based around that single moment and talking about the risk and all the deficits of someone and from a social work lens, trying to bring in people's strengths and what people do well and, you know, people's potential to kind of move forward and have meaningful lives. I think it's, you know,

it's that challenging environment, trying to balance the both. Yeah. You mentioned that there's not as much turn around, as you would normally see in a regular hospital. What's the length of stay like on these wards? It's really hard to say. So some people stay only for a couple years and some people will stay for a very long time. So there's a wide range between that and it's very difficult to talk to families about that because you know, you want something a little bit clearer. But I guess it kind of depends on lots of kind of different things, but it depends on kind of

how their admission goes. And it's very difficult to be able to say a specific. time. Did you say a couple of years? Yes. Wow. That's a long, long time. Yeah. So you are really getting to know these people very well. Absolutely. And you get to know their families very well and you get to know everything about them. It's all about kind of gathering lots of information about their past. You've already mentioned some of the things that frustrate you about the system that you're working in and the way things are structured and the sort of legal components around how people are moved through the system. But what's the thing that you find most challenging?

Look, I think kind of what I was kind of saying before, I think it's as a social worker, coming from a social worker lens, coming from a trauma-informed care lens, trying to focus on people's strengths in such a restrictive environment, also having to manage a lot of the stigma around mental health, but specifically forensic mental health. I think my main challenge working within the forensic hospital, within the network, is coming from a social worker lens and perspective from a strength-based, trauma-informed background,

because I think working in such a restrictive environment and balancing the risks and strength is really hard because on one hand you're constantly doing, you know, a risk assessment, risk management plan on all of the things that they're very kind of negative focus and they're focused on the potential for bad things to happen when really you want to kind of focus on all the other side. So I think from an allied health perspective, really, it can be quite a difficult place to work because of that balance and navigating between the two. Do you have much of an opportunity then within your network to support

early intervention or is it a lot of backpedaling once you've got into that crisis situation? Well, where I'm working is kind of end of the line. So it's the Friends Gospel people have already kind of come through. I know that the network does a lot of work in early intervention within. So youth obviously they put a lot of work into that. There's a lot of funding in that. So they'll kind of be going out to schools and people who are exhibiting challenging behaviours at a really young age. They'll try and sell a lot more of that early intervention approach. We do a lot of work, like more consultancy work with mental health units as well. So I know there's a community forensic part of our service. And so if you get guys in regular mental health units who are

kind of looking like they might be heading in the direction that might not be so good, then these guys might come out and do their own assessments, make their own recommendations, you know, with people who might already have some contact with the justice system or a risk of having contact with the justice system. So there's a lot of early intervention work there. For us, it's a little a bit hard from our own perspective because we are kind of within the forensic hospital. What sort of support do you need then to be able to keep up your motivation in that setting? At the moment, there's a big push for us to have discipline-specific supervision because it's offered through the hospital and you can get supervision from a psychologist or a nurse,

but I think they're quite keen for social work-specific supervision. So the previous senior social worker, she has helped me out a lot and I kind of reached out to her after she left and so I'm seeing her at the moment and it's been really good. Yeah, awesome. So she has a really good understanding of what it's like to work in that role. Exactly. And so if I'm having a hard time with specific people or within specific systems, she understands. Do you have group supervision then with your other five colleagues? Yes. We see each other a lot, but we do have specific group supervision, yes. Nice. And you mentioned some education opportunities. You're trying to set up some sort of online education or even if it's just reaching out to other social workers in forensic settings.

I think that would be great if you could get that started. But what other professional development opportunities do you have? The network's pretty good. So like, you know, when trainings do come up, they are quite supportive of us kind of attending things. We've been to a few workshops at the University of Willowong. There's a project there that do things on, you know, personality disorders and stuff like that and we were able to kind of get sent down there.

as you mentioned, we're trying to formalise our connections with other social workers all around the state. And we're also trying to get kind of a national conference going. Because Melbourne held one a few years ago. It was a forensic mental health social work network conference. It was really nice. But obviously, COVID's been really challenging for the last few years. And so we're trying to get that going again. And there's lots of kind of emails bouncing around, around things that we can kind of connect around education and more professional development. That's good to hear. Given that you are in touch with people who have been working in this space for a while

and in the time that you've been working there, have you noticed many changes in the way that social work is delivered or the way that our profession is seen? 100%. Because I think years ago, I guess when it first opens, say 12 years ago, I think a lot of the staff kind of came over from corrective services and the other half probably came over from health. And so you have different views on how things should run. Within corrective services, you know, you don't have social workers, you have welfare officers.

And they do different things. And so I think there's a view from lots of people that, hey, you know, social worker welfare, it's the same. You guys do the exact same thing. So you can go and, you know, do the shopping for this guy. Or you can, you know, you can go and, you know, get this guy's cash out and do his banking and do his buyups and stuff like that. and that's all you can do. And that's, you know, like, it's fair enough for some people not to completely understand the difference between them.

And a lot of our role has been coming in. And I think with the discharge planning and the NDIS and all of the family work, there are kind of big hitters within the phrencing network where we can say, hey, we know, we do things a little differently. We have a better understanding of family dynamics and we're able to offer a better understanding of some of the complex issues that might have led, you know, to this person to make some of the decisions that he continues to make today and help manage a lot of those challenging behaviors.

and I think lots of the staff now kind of realize actually it's very different and they've removed that kind of welfare side of it. Inevitably, you have to deal with a lot of that stuff wherever you go. You can't avoid it. And that's fine. It's part of the role. But we're trying to kind of highlight the fact that we can do other things which are kind of outside of that space.

Like I mentioned, with the NDIS stuff as well and the discharge planning, I think a lot of staff were able to kind of see that we were able to, you know, work outside of that space. we're still trying to do a lot of work to kind of move away from a lot of the welfare type things because that's kind of work that can be shared amongst other disciplines anyway and doesn't have to be social work specific because it isn't, you know. Yeah. And so I think especially over the last few years, we've had like a lot of big successes around kind of the promotion and the role.

And I think people are having a better understanding. Because I think, you know, when you use some of the general social work values and ethics, people get a little bit confused, you know, they're like, well, you know, what is an advocate for social justice. What does that actually look like? What, you know, what are you doing day to day? What, like, show me. But, you know, we kind of introduced in, it's 2009, there was like a New South Wales, like the state election, all the guys used to always get fines in the mail for not voting. So we said, hey, you know, this is a basic human right. This comes under our umbrella. We're going to bring it in. So we got some voting booths in and everybody was able to vote.

I think there's a bunch of people, like, it's like 20 people that never voted before and they were able to vote and lots of good voting politics chat going around in the lead up to it and everyone's very excited and yeah it's just like a really kind of positive experience for the hospital and people are able to kind of see hey hey that's a social work thing because it's a basic human right and it's not something that we usually promote because we're in a very restrictive environment but actually if you highlight it and you can talk about it then yes this is something that we want our guys to do and some members of the general public will say hey they shouldn't vote you know they're crazy or they're insane and, you know, we, you know, we don't trust their judgment, but actually,

you know, all the staff would agree that's actually not the case. And, you know, it's written very clearly that they do have the right to vote and something they are able to contribute and cast their vote and make their call. And the staff was supportive of that. And then I think as soon as we highlighted it, they were kind of able to see, actually, this is a social work domain. This is social justice. You know, this is something that they were able to do. And they're like, oh, okay, get it. That's so great. What a great initiative. I think also, I was surprised to hear when you spoke about the court corrections versus incarceration. So you've got all these assessments and alternatives considered to having someone be put in jail when they could be in the

community completing some rehabilitation and the effect that this would have on the system in general, but also them as an individual. So I can imagine that's a thing that's over time developed, whereas previously they wouldn't have put the resources into that. With court diversion, you mean? Yeah, I think, so I don't know how many courts there are in New South Wales, but I know that there is an increasing amount of specific mental health clinicians being placed into them in order to help move individuals away from being put into the jails. And that's great, and that's awesome. And I used to work with a couple of them, and it's a very challenging job, and they often work by themselves.

And, you know, they can't get to everyone. But I remember one at Burwood local Gorgey, had to see almost so many people every day. She would see the list and say, I know that guy, I know that guy. He's been to that mental health unit, and she would go and see them and kind of and say, actually, you know,

I'm going to do an assessment on him. I would go into a mental state examination, get a bit of history and would clearly say, hey, this person should be going to jail. He doesn't need to do that. Let's go and send him to a mental health unit. And, you know, it's a massive job for them. And, you know, that's part of justice health.

But it's, you know, my understanding is that they're trying to get more and more and more into, you know, each of the courts. Because it must be happening kind of all the time and the amount of people that get missed, you know, that do get stuck in corrective services. It's a nightmare. Yeah. This is really the only social work role that you've had.

You've always worked in mental health. Can you see yourself working in any other area? Not that I've seen so far because I love it here and I love what I do. And I, you know, I can see myself working in a regular mental health unit again. But I haven't come across another job that I have any interest in just yet. But, I mean, I didn't have any interest in mental health at the beginning anyway until I got thrown into it. it's possible that if someone just makes me do something that, you know, I will be excited about it and get into it, yeah.

It sounds like you've landed in the right area, though. Do you get a chance to be part of any projects or research or programs at the hospital? Yes, I mean, there's always kind of research projects going on. I'm not a massive researcher. It's not a big passion in mine, but I know there's a few people around me who are very interested in. There's always kind of secondment opportunities and things like that. But yeah, they're very open to that.

There is, you know, quite good support and funding. if you have an idea about something that you want to do that you think that will, you know, make an improvement to the service and systems. And they're quite supportive of that, yeah. Like with the voting thing, there was no question, you know, they were just like, absolutely, that is brilliant. Write a brief, get it done, do it. Nice.

And the repatriations is the same thing. Like, it's expensive, but they were like, you know, once we kind of highlighted clearly that this was the right thing to do, they were very supportive. Yeah, no, that's really good to hear. Is there anything, any other really good resources that you might, recommend for people that are interested in this work. You've brought up two fantastic approaches, strength-based and trauma-informed anything anyone else should read if they were interested in getting into this area. If somebody does have a particular interest, I'm happy for them to contact me.

My Super Bowl actually recommended there's the UK Forensic Mental Health Social Work Capabilities Framework. Obviously, it's written from the UK. It's a pretty good outline about a lot of the themes and a lot of frameworks for specific social work interventions in the forensiciment health setting, which is quite good. So you can just Google that. Yeah, that sounds perfect. I really love your passion for changing perspectives. So even from the beginning, you're talking about that stigma relating to mental health and your work that you're doing to try to change those perceptions and try to allow other people to see things from a social work lens, your colleagues, and also being able to really relate to family members and help to bring them into the team. It's good to know that these supports

exist in these settings and the multidisciplinary support is available to people when they need that help the most. So that is reassuring and completely interesting for me to hear about how that forensic system works and how it differs from, I've worked in hospital settings and it's just, you know, it sounds very similar in some ways, but also very different in other ways. So yeah, I hope that other people get a lot out of this as well and learn a lot and even come to you with questions that they might have. But thank you so much. This has been incredibly interesting.

And I think it's a different part of social work that we don't get to hear about a lot. It's a very niche field and even mental health is a big part of social work. And so I think the more we can champion our role in these settings, the better. Absolutely. Thanks so much for having me. Thanks for joining me this week. If you'd like to continue this discussion or ask anything of either myself or Jerome,

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 Marie, an accredited mental health social worker, family therapist, presenter, podcaster and trainer. Her focus is on supporting adults to have better relationships with the teens and young adults in their lives. She is committed to improving mental health awareness, reducing stigma and promoting prevention and early intervention in the field of mental health. I release a new episode every two weeks. Please subscribe to my podcast so you'll notify when this next episode is available. See you next time