Transcript: Information session on Towards Zero Suicides peer workforce

Speakers: Stephen Scott, Rebecca Burdick Davies, Tim Heffernan, Julia Smailes, Leif Carroll, Liz Newton, Tina Kenny

Stephen Scott: So this is an information session for the Towards Zero Suicides initiatives and the Suicide Prevention Peer Workforce in particular, that's being delivered through that initiative. And I'll start by acknowledging the Traditional Owners of the lands on which we're all meeting across new South Wales today. And also acknowledge people with lived experience of suicide and also acknowledge the mental health peer workforce and the important contribution you make to suicide prevention. Now just some Skype etiquette, I'd like to ask that everyone place themselves on mute during the information sessions so that we can improve the sound quality. I'll let you know that this is being recorded for its use as a resource going forward as well. And this will be placed on the New South Wales health website. So if you could make sure that you are on mute throughout the presentation, that would be much appreciated.

Now, just to let you know about the structure for the session. We will have 20 minutes of a presentation, 20 minutes of a panel discussion, and then 20 minutes of Q and A via the live chat function. So please use that live chat function to contribute questions, and we will get to those in this final third of the hour that we have.

Now, just to give you a very brief overview of the wider policy context for this work, I'm sure you're all aware of the Towards Zero Suicides Premier's priority and the target to reduce the suicide rate by 20%. That is grounded in the strategic framework for suicide prevention in New South Wales, which is our state-wide policy document and is supported by an $87 million investment over the three years of Towards Zero Suicides implementation as well. Now, just to briefly go through these 15 initiatives that constitute Towards Zero Suicides. So we have four initiatives that are being delivered through the New South Wales health mental health system. That includes Zero Suicides in Care, the Alternatives to Emergency Departments initiative, the Suicide Prevention Outreach Teams, and the Enhancement to Rural Counselling. There's two major initiatives that are being worked on with other New South Wales government agencies, including a whole of system training in suicide prevention outside the mental health system and the improved collection and sharing of data initiative, which includes the development of the New South Wales suicide register.

There's some major initiatives being delivered through the non-government sector, and these include some aftercare following a suicide attempt. Services, including a trial of a youth-specific version of aftercare and the post suicide support initiative for particularly bereaved families and friends. And then there's also a number of initiatives being delivered through the community, and this includes developing more local community collaboratives for suicide prevention around the state, the trialling of a local suicide alert system for people at imminent risk of suicide.

A significant new initiative through the Aboriginal Community Controlled Health Organisation sector for culturally appropriate suicide prevention activities. The expansion of innovative peer-led programs in suicide prevention. A number of gatekeeper training activities across the state. And finally, the community response packages for priority groups. And this would be tendered in the next couple of months as an open tender process. There's also a number of other components that support all of this work, including lived experience training being delivered around the state, a large evaluation program, a set of communications, and quite a significant governance structure as well. Now, talking very briefly about the context that we're all working in, in suicide prevention at the moment.

Of course we are experiencing significantly increasing suicide risk in the community because of the recent climate disasters, the social and economic consequences of COVID-19, and the unprecedented recession that we're experiencing as a result of that. And linked to this, I'm sure many of you would have noticed a few weeks ago the Brain and Mind Centre's modelling of at least a 23% increase nationally in suicides due to the economic crisis. And over the last few months, we have noted that there is increase in calls to crisis lines, Kids Helpline, Lifeline and Beyond Blue as well, compared to this time in the previous year. Turning now to the opportunities for current mental health peer workers in Towards Zero Suicides, this particularly relates to these three key initiatives you can see on the screen.

The first is Zero Suicides in Care, which is a quality improvement or change management initiative that prioritises suicide prevention in the mental health system. Secondly, the Alternatives to Emergency Department Presentations initiative, which is a total of 20 new services that provide a nonclinical alternative to people experiencing a suicidal crisis. And finally, the Suicide Prevention Outreach Teams, which are new mobile teams providing clinical and nonclinical support to people experiencing a suicidal crisis. And now in terms of those opportunities for current mental health peer workers throughout those initiatives, there is the co-design process for all of those initiatives taking place in every district. There is the funding of a position by the ministry within Being, to contribute to Zero Suicides in Care, and the other Towards Zero Suicides initiatives. And most significantly, there is new suicide prevention peer worker roles, in the alternatives to ED and Suicide Prevention Outreach Teams initiatives, and current mental health peer workers with lived experience of suicide are encouraged to apply for these roles, should they wish to. Just going into more detail now about those peer-based positions, related to the alternatives to ED and the Outreach Teams initiatives. This is delivering a total of 70 new FTEs state-wide, in peer roles. And there's a number of strategies in place to support this new workforce, and that includes the SafeSide suicide risk formulation Training, that's being delivered by Dr Tony Pisani, who is one of the world's leading suicidologists and psychiatrists in suicide prevention, and that's available to all mental health staff, including our mental health, our peer workers, as well as, of course, these new positions, in the Towards Zero Suicides initiatives.

There is the lived experience training that Roses in the Ocean are delivering, and the suicide prevention peer worker training that Roses in the Ocean is developing, as well, and we'll hear a little bit more about that, in a few minutes at the panel discussion. And there's also a Community of Practice being developed, for the peer-based positions, as well. And there is also more detail, on the essential and recommended training and support structures for these roles, that's listed in the guidance material that's been made available for the peer workforce roles. Now, just to refer to the basis of this approach, in our state and national policies. So, I mentioned the strategic framework earlier. There's a number of relevant components in there, either guiding principles, or key priority actions, and this includes that people with lived experience are involved in our suicide prevention work, that activities are well-coordinated and well-integrated, and that there'd be greater innovation for a stronger evidence base.

And at the national level, the Prime Minister's advisor on suicide prevention, Christine Morgan, has, earlier this year, released her first report, that details key themes and early findings, in her advice to the Prime Minister, and this includes a recommendation to build and develop the capacity of the lived experience and peer workforce, to help break down stigma, and provide person-centred supports. And in particular, she notes that people with lived experience of suicidal behaviour, who are trained and supported, have an important role in suicide prevention, including in delivering peer-supported or peer-led programs. The evidence for peer-delivered programs is strengthening, although it is more limited in suicide prevention, but what is required is best practice guidance on supporting people with a lived experience of suicidal behaviour. Integration with other workforces, and research to build the evidence. And so, we are particularly noting that advice in the approach that we're taking in New South Wales.

Just wanna turn now to look at some very interesting evidence, that's come from the Australian Bureau of Statistics, last year, where they analysed coronial reports from - sorry, from 2017, which incorporated 650 suicides that were coded for psychosocial risk factors in the coronial reports, for each of those suicides. And what they identified was a range of psychosocial risk factors, which are listed in order here of their commonality, and the first of those was history of self-harm, but followed very closely by a range of other risk factors that are related to family issues, and then, also, other associated problems to do with the law, or the economy, including unemployment, and some other factors, as well, including the onset of disability or chronic disease, and experiences of bullying. And this differed by age and Indigenous status, and they provided a detailed analysis by age group and gender, as well as Indigenous status. So, that's a very interesting report, which is available on their website.

But my reason for including this point is that, looking at that evidence, we can see that there's a wide range of people who are at high risk of suicide, and have a range of causes of suicidal distress, and this is by no means an exhaustive list of either of those, either of those groups, or the causes of suicidal distress, but we know that there's suicide affecting many different parts of our community, including people with severe mental health conditions, people in various high-risk industries, Aboriginal people, of course, have a higher rate of suicide than non-Indigenous people, and there are other groups, including LGBTI communities, people live in custody, men experiencing relationship breakdown or custody issues, and particularly of relevance at the moment, as well, is people affected by economic crisis, or natural disasters.

So, that evidence feeds into the quite groundbreaking approach that Ashfield, Macdonald, and Smith have written about, from the University of Western Sydney, and they describe situational suicide prevention, and advocate for a situational approach. And this approach acknowledges the predominant association of situational distress, rather than mental illness, with suicide, though in some cases the two are linked. And it's informed by, and responds to risk factors of a broad spectrum of difficult human experiences, across the lifespan, and wherever possible, seeks to address the contextual systemic and sociocultural risk and protective factors and determinants, the real world of individuals' lived experience. In particular, they note that the current narrative of mental illness, that has characterised suicide prevention initiatives, conflates mental illness and suicide, putting the main focus on illness, and that this has distracted much suicide prevention activity from its most important focus, which is the broader risk-associated spectrum of highly challenging but common life events and experiences.

Now, building on this, in terms of our rationale for a peer worker approach, it's noted that all our staff and services, whether they be clinical or peer-based, should be able to respond to situational distress and suicidality, that occurs outside of diagnosable or diagnosed mental illness. But, the peer workers have a particular utility, of course, in providing a situational approach to suicide prevention. So, what we're attempting to do, with the Towards Zero Suicides approach, is to build on the pioneering work of mental health consumers, in developing the mental health peer workforce as a legitimate part of the system. And we note at the same time, of course, the districts are already supporting the development of their peer workforces in various ways, and that there's new activity taking place at the state-wide level, to further support the workforce, as well. And just further to that, the alternatives to ED and Suicide Prevention Outreach Teams initiatives are seeking, at least in part, to reach the 40 to 60, or even greater percentage of people, who die from suicide, without prior contact with the mental health system. And this is really tapping into that situational distress approach that we would like to provide, in addition to the excellent clinical responses we have, where they are needed, which is a nonclinical, peer-based, and lived experience of suicide approach, similar to the approach that Western New South Wales have taken, in their lived experience of drought work, and we'll hear a little more about that in a few minutes, as well.

So, to summarise those points more broadly, people with severe mental health conditions do have a high risk of suicide, so they're a very important focus for our work, but there are also many others that we need to support, too, and the lived experience movement has advocated for many years that people with lived experience of suicide be included in the workforce. And there's also emerging evidence supporting this approach, as well, that we have noted, from overseas and interstate, and we've received very strong advice about this approach, through the trials that have been taking place, of Safe Havens in the UK, Melbourne, and Brisbane. We note the peer enhancement work that's going on, too. Beyond Blue's The Way Back Service, for people who have made a suicide attempt, and in particular, we're very informed by the Crisis Now program in the USA, that provides a triaged nonclinical crisis response, via outreach teams and nonclinical crisis alternatives. And just broadly, as a kind of a conceptual point, I guess, we, I think, are best served by considering the relationship between suicide prevention and mental health in the way that this diagram is representing that suicide prevention is not merely a subset of mental health, but a unique field that has a significant overlap with mental health. And although, of course, this is a contested point, suicide prevention does continue to be especially placed as a responsibility of the mental health system. And so our challenge is to adjust the way we respond to suicidal people by incorporating a situational distress approach.

Now I'm just conscious of the time and I don't wanna chew into our panel discussion too greatly. But over the next few slides, there's a range of frequently asked questions, which I won't go into all of the detail of now. But you will be able to view this material later. Some of these questions include whether mental health peer workers are excluded from applying for the suicide prevention roles. And the answer to that, of course, is no. Whether it would be easier to just have clinical positions in our Towards Zero Suicides initiatives, whether there's a separate system for suicide prevention peer work being developed and this question about why would we use peer workers when most of our suicides are among particularly certain groups of men across different industries and social groups, and finally, whether there is a risk of fragmentation to the peer workforce as well. So, some of these topics we may come back to in the panel discussion and the Q&A. Now, I will just move on to the panel discussion now.

So, our panel is quite a distinguished line-up of people. And among them are Rebecca Burdick Davies from Suicide Prevention Australia, who is the director of policy and government relations there. Tim Heffernan, the deputy commissioner at the New South Wales Mental Health Commission and peer coordinator at South Eastern New South Wales PHN. Julia Smailes who is the manager of the clinical services team at the mental health branch, which includes the peer worker portfolio. Leif Carroll, who's the clinical leader of the Drought Support Team at Western New South Wales Local Health District. And Liz Newton who is the mental health redesign and co-design lead and Zero Suicides Program lead at Hunter New England Local Health District. And also Tina Kenny from Roses in the Ocean who is a peer worker lived experience consultant and educator and a qualified trainer and assessor in the Cert IV in Peer Work. And that includes the development of numerous courses to support peer workers, including MHCC Fast Track Certificate IV in Peer Work as well as the managing workers with lived experience course. And Tina is currently working on suicide prevention curriculum development project with Roses in the Ocean.

So, thank you to all of our panellists for participating in the discussion today. And I'll start with Rebecca from Suicide Prevention Australia. So Rebecca, Suicide Prevention Australia has a well-developed national policy on many of the topics we've covered in the presentation just now. As the national peak organisation in suicide prevention, could you give us an overview of the relevant positions that we're discussing today from the Suicide Prevention Australia perspective?

Rebecca Burdick Davies: Sure, Stephen. Well, I'd like to just kick off my response by saying I think you've covered it very nicely in your presentation in terms of the detail. I have to say that I was very pleased to be asked to join this panel, even if it's just to convey the fact that at Suicide Prevention Australia, we really believe that New South Wales is at the forefront of workforce development and capacity building in suicide prevention. And so, I'm really pleased to be a part of this discussion. I have to say I'm really looking forward to hearing from Tim and Julia and Liz and Tina and Leif later on in the panel discussion today as well. But if I were to talk about our work at Suicide Prevention in Australia, there is really, I guess, a key foundation document or piece of work that guides everything that we do from a policy and advocacy perspective. And that is our National Policy Platform. So, the National Policy Platform was published prior to federal budget last year, in 2019. And it contains three pillars, so we kept it simple. And the three pillars are, first of all, that we need a whole of government, a whole of community approach to suicide prevention.

Secondly, that we require accurate, reliable data on suicide and suicidality. And lastly, that we require a holistic workforce strategy and planning. And there's two pillars, I guess, that are particularly relevant for the peer workforce, the suicide prevention peer workforce development underway in New South Wales. And the first is that whole of government, whole of community approach. So, the first facet of that is, of course, that we believe every part of government should make suicide prevention their business. And that is because, as Stephen said, suicide is not merely a manifestation of mental ill health, although of course it often is. It can also be a manifestation of a variety of different crisis or issues that arise in someone's life. Those situational factors. So we believe a cross portfolio approach is a way of tackling those psychosocial factors. The second aspect is that whole of community aspect. And that is really, I guess, if I were to sort of put that in a nutshell, it's really putting the suicidal person at the centre of everything that we do. So that consumer-driven approach. And if we are to take a consumer-driven approach in suicide prevention, then of course, that means the voice of lived experience has to be central. That other pillar of our National Policy Platform that is particularly relevant for our discussion today and which we really think is being taken up wholesale in New South Wales, is that area of workforce strategy and planning. So, again, when we think of the suicide prevention workforce, I really liked that Venn diagram, Stephen, that you threw up a moment ago.

There's a nice intersection, of course, between the mental health workforce and the suicide prevention workforce, but they are not duplicative. And we believe that a proper comprehensive responsible approach to suicide prevention workforce strategy and planning it really demands a departure from that mental health approach and the need to build capacity beyond the mental health and acute care systems. Again, lived experience is at the very centre of this because we recognise that the experience of suicidality, personally caring for someone who has died by suicide or being bereaved by suicide is a unique experience. And it's one that we need to draw upon within the workforce. It's one that often differs from experience of someone who has had mental ill health but not an experience of suicidality. So, again, we applaud the approach that's being taken up in New South Wales. We're really interested to see what that peer workforce will look like and, I guess, the detail of the organisations that might be involved. But we'd love to be involved in any way we possibly can.

Stephen Scott: Great, thank you so much for that summary there, Rebecca. I think there's been some very salient points that you've raised there, and in particular the consumer-centred approach and putting the suicidal person at the centre of our work. I'm gonna turn to Tim now. And Tim, you have long standing experience as a peer worker and, of course, hold a key leadership role at the New South Wales Mental Health Commission. So, can you comment on the evolution of peer work into the suicide prevention field and discuss some of the issues for integration and governance that are of importance for the mental health and suicide prevention peer workforces to coexist.

Tim Heffernan: OK, thanks Stephen. I'm very pleased to be here to be talking about the peer workforce. I think the evolution of perhaps a term that is not necessarily misleading, but I think in peer work, suicide prevention has always been a core part of the mental health peer workers' work. From my own decade long experience, I think it is important to understand that people with mental health issues, a lot of those people, including the peer workers, have that experience of suicidality or suicide attempts. So, it's been there. But I think it's really important to understand the need to articulate in this field how different experiences match as a peer, I suppose. So, you know, with the ministries previously invested in peer support or transfer of care peer workers, people who do the hospital, the home work in mental health. So generally, that's really helpful if people have had an inpatient experience, who could work with people and provide health for them as they're going out into the community.

And similarly, I think it's essential that peers are working from that position of having to have experience of suicidality or suicide attempt. But I do like to look at, you know, we've got a whole of government. I think we have to really focus on the whole of person and the whole of humanity. I'd like to think that we're moving towards framing the way we are in mental health and suicide prevention about this Indigenous concept of emotional and social well-being and understanding that things are intertwined. And even I think in mental health, we've moved away from this understanding of mental health as being mental to do with diagnosable mental illness. So there are a lot of peer workers who'd identify as having a diagnosable mental illness. I do know, having been working on the National Mental Health Peer Workforce Development Guidelines, for instance, that the person who's leading that always looks more at defining a lived experience around being a lived experience of mental health challenges or mental health distress that causes life, as we know it, to change and that we have to re-imagine ourselves.

Now, that happens with people who have experienced suicidality and people who have experienced mental health difficulties. I think, so the evolution is about, I suppose, making it more specific and saying, OK, this is my job, and this is my expertise. And I'm working in that area. In Primary Health Networks, we're looking at a definition of mental health and suicide prevention peer workers. But within that broader set, obviously there's room for specialisation. And certainly in peer work globally, you're looking at peer work in disability, you're looking at peer work in Housing and Community Services in Veterans Affairs. A whole range of different ways of working from your own experience of being able to provide that hope that people need. And so, to integrate, I think the integration of the two workforces well, it's about integrating it into that whole of government, whole of health, whole of mental health approach as well. This is an add-on. This is an innovation that we need because we know things aren't always working. People are not often wanting a clinical service or they've had bad experiences with clinical services. So we do need something else. But in doing that, we have well established, in public mental health, you've got the first peer workers appeared at Rozelle Hospital in 1993. Peer work really evolved out of the first national plan. In mental health, you have the existence of structures within the ministry and within local health districts like the Consumer Worker Forum or the Consumer Worker Committee, where people can be supported in what can be a difficult space. So, it's my hope that we can work really in an integrated, collaborative and coordinated way to ensure that we are looking after that whole person, that we are accepting that this work is important across the whole spectrum. And we respect the individual experiences of each person, whether it be mental health challenges or suicidality.

So, I think it is vital to also recognise that this governance, this integration is occurring through our regional mental health and suicide prevention plans so that combination of the Commonwealth, the state and also your NGO peer workforces. So, for instance, in South Eastern New South Wales, we've got peer work networks who meet up physically across all those to support each other. And that includes a suicide peer workforce in aftercare down here in the Illawarra and South Eastern New South Wales. So it's an evolving thing. And I really am excited by these 70 new peer workers. And I just know that we can work together to make sure we're looking after those individuals, that whole person.

Stephen Scott: Thanks very much for that, Tim. That was an incredibly comprehensive response. And many points in there that signal the opportunities for integration and coordination, a lot of mutual benefit, I think, to these different forms of peer work that are emerging at the moment. Just building on that, I'll turn to Julia now. And Julia, we all know that the ministry's clinical services team is working on other activities developing the mental health peer workforce. Would you like to just provide a brief overview of the status of that work?

Julia Smailes: Yes, thank you. Thanks very much, Stephen. And thank you all for coming to this event, which is incredibly important. And from the ministry point of view, from a clinical services team, we've had a new state-wide peer workforce coordinator appointed earlier in the year, which is Daya Henkel, who I'm sure is known to many of you. And that has meant that we can now really press on with the New South Wales peer workforce framework which is intended to support the emerging peer workforce. And I think that, I'm sure that we will be working closely with your team in collaborating on how we integrate this new suicide peer workforce under the framework in some way, shape or form. And how we best support all the peer workers who are currently in the LHD so that everyone is supported to do the best work that they possibly can for the people that they're supporting. So, the big piece of work for us is the development of this New South Wales peer workforce framework which really will guide and support the peer workforce.

Stephen Scott: Great, thank you so much for that, Julia. That does, I think, point to a really critical piece of work that I know many of us are really looking forward to seeing further developed. And just to turn now to Leif, we touched earlier on some of these more innovative approaches that are going on in the peer workforce space, in particular, this matching of peer workers to local contexts and community needs. Can you discuss what Western New South Wales has done in relation to lived experience of distress from drought being incorporated into your district's drought response?

Leif Carroll:

Yeah. Thanks, Stephen. Well, from the very start, we looked at ways to engage with this population because historically, this cohort hasn't engaged well with Mental Health, Drug and Alcohol services. So, we come up with the idea of having a group of peer workers, they are called Drought Support Team. We have six peer workers, six FTE peer workers, one FTE senior peer worker and a clinical lead, which is myself, that provides the clinical overarching governance of that team in case there needs to be an escalation of care or if there's any risk involved in that presentation. So really, we have a team of, as you were saying before, it's more a specific targeted team, like they have a lived experience. And it's all around the team members have a lived experience and insight into rurality and adverse effects of drought conditions which result in psychological distress. So we're looking at a team that is subclinical.

There's a low threshold for entry into this support. And with having that specific relatable team, it brings an insight and we feel an increased level of empathy, so that when they're dealing with people, there's that relatability around that engagement. Once we establish the best way to facilitate and build a relationship, and in the report, there is a cohort, we wanted to ensure that the approach was a true bottom-up approach. That is like the top-down approach is all about a diagnosis centre and an illness centre treatment plan, and it's a very clinical plan. But the bottom-up approach is more about building capacity in the communities. We have these drought support workers geographically and strategically spread all over the LHD. And there are people who have invested in their local communities, or they have good existing networks. And they really live it every day.

So, one of the things that come out of this is we're starting to use the term the living experience, because the team members are living it, as well as coming to work and supporting people that are also living it. So, around this being a very specific type of support, we've had to ensure that there's formal and informal support structures, as in clinical supervision and building teamwork. And yes, we work really hard on that. And the network between the team, because they're remotely located, we're trying to really build on that network and that teamwork approach so that they can support each other. Basically, like the bottom-up approaches are saying, it's all about building social, cultural and human capital and basically increasing and strengthening of the capacity in that community. And if you can do that, and it's relatable, if an event happens in the future, we feel that the community is just that much more stronger and able to deal with something that comes up in the future. It could be a drought, it could be a fire, it could be a flood, it could be a suicide in a small community.

But yeah, we really feel as though that's important. We wanted to make the conversation between the peer worker and the client as seamless as possible. We saw there are a lot of stuff going on behind the scenes, but we just wanted to make the interaction just like a neighbour talking over the fence or someone sitting on your front veranda. And really taking the time to build that relationship and really getting to know people.

And a big part of the team is once we've established that relationship and understanding of the person and that shared lived experience, well, then we have a resource kit and we can link to appropriate special services or supplies. And the whole thing is about normalising what people are feeling and how they react to situations, and also about destigmatizing. Because we could speak to a client and we could ask them what sort of a day they're having and they could say doing it tough. But doing it tough could be like hitting a brick wall. So, if they can access trusted others, such as peer workers, and get this information about services out there, and they can ground themselves in the present. And the peer worker can walk beside this person in helping that grounding and look at a way forward into the future. And as I was saying, it's really important to really focus on one-on-one support, building relationships. That shared unique lived experience is invaluable. And walking alongside people. And yeah, thank you.

Stephen Scott: Thanks Leif. That's just an excellent description there of what I think is a really important example for the suicide prevention space to look at the way that you've deployed peer workers in a really innovative way that responds directly to the needs of the local community in a specific way. And you've mentioned so many fantastic concepts that I think provides a kind of a theoretical foundation for what you're doing there, in addition to the really meaningful real world way that that's experienced. And I think it taps into one of those frequently asked questions I mentioned briefly earlier, which is, can we look at directing these peer worker positions as resources that can reach parts of the community who are at quite pronounced risk of suicide that we're maybe not reaching so well now. So, thank you for that. And just turning now to Liz and the Towards Zero Suicides implementation in particular. So Liz, there in Hunter New England, you've progressed quite strongly in the implementation of Towards Zero Suicides, especially in your recruitment of the peer worker roles. So, can you describe the approach you've taken in your district firstly, but also mention any challenges that you've encountered and any solutions that you've been working through to solve those challenges?

Liz Newton:

Yeah, sure. Thanks, Stephen. So, yeah, we're at the point of advertising. In fact, we've got interviews for the support team peer workers next Tuesday, the non-identified position, I might add. So we are a little ways along. But just to give you an idea, and I'm happy to talk with other people beyond this meeting as well, if people want to sort of have further discussion that from the outset, I guess, because we've had a well-established peer workforce here, I don't think there were, for a number of years, I don't think there was, at any point, any question around should we do this or shouldn't we do this or any concerns around that. It was automatically given that we would go ahead and recruit peer workers, knowing that there would be some challenges in that process. But we were happy to go ahead and do that. So we were fortunate, I guess, to have an exec sponsor who's quite engaged in the peer workforce. And as allied health director, the peer workforce does sit under her portfolio. We are also really lucky to have here a senior peer worker so, a head of discipline for peer work, if you like. And we also have an Aboriginal mental health manager and workforce lead for Aboriginal workers here in the district. So, knowing that those positions, we are also gonna be able to assist in the recruitment and the figuring out what the peer workers, how we would support them, how we would recruit them and what sort of onboarding requirements might be needed. It was really critical to make sure that we would have those people there at the table.

So, also as well, through various forums and networks within our LHD, it had been identified. So, for instance, Aboriginal Health Services, external to our district, had been really clear in various forums around, if we wanted to be meaningful around closing the gap, then we wouldn't just target positions, we would actually make some of these positions identified. So we have done that. So, taking all of this feedback into the mix, we've had a number of conversations. It has not being a particularly smooth journey by any stretch, just getting to the point even of recruitment. With the more stakeholders you engage in anything, the more conversations have to be had. And I think the thought we had in our minds at the start of this process versus what we'll have at the end will probably be quite different. So, we have had some toing and froing around position descriptions, particularly taking, not just the nuances of what a peer worker does, but then the nuances of what an Aboriginal peer worker might do on top of that. So there's that extra layer of consideration that we needed to work through.

We use the ministry briefing paper as a sort of starting Bible, I guess, in writing position descriptions, taking a lot of that information that you guys had already pulled together, and using that to inform what we wrote in the position descriptions. We've also, I guess, talked through the emphasis of lived experience of suicide in the position descriptions. And one of the conversations and discussions we've had locally has been around that. Can peer workers who identify as having mental illness also apply for these roles? And naturally, there was a bit of backwardsing and forwardsing and some debating around that. But we've reached, obviously, the same conclusion as what's been presented here today, that the one can also apply for this role. But we do also need to bring in people who have lived experiences of suicide only.

In one of the conversations we had, we had to work through what we mean around the definitions. And again, there was work happening at a state level with Roses in the Ocean and the ministry as well determining what the definition of lived experience meant with regard to these peer work positions. Obviously, people who have experience as a carer are gonna bring very different skill sets or understandings to an interaction as someone who has had suicide attempt. So, we've had to work through that stuff as well. I guess one of the things that's kind of always been a bit of an issue for me, I have worked as a peer worker, many moons ago, but I have worked as a peer worker and worked in the space of lived experience. My roles have all been lived experience roles for the last sort of 11 to 12 years. One of the things that's really important from my perspective is we don't fragilize other peer workers to the point where, often in conversations that are had, it's let's prepare for the inevitable crash and burn that will happen or let's prepare for making sure we don't create trauma and we don't do that. And I'm absolutely in favour of that, but I'm also of the belief that a person who is self-actualized and has personal autonomy, and personal resilience, and personal strengths, who has experienced those things and survived those things, generally aren't gonna put their hat in the ring for a position that they don't think they have something to contribute to, and a sense of their own self-care and self-safety that they implement on a daily basis.

So, from my point of view, the risk is of trying to make sure that we create all of these supports for these people in terms of the vulnerabilities that they experience. You create such a sense of otherness when they come to work alongside the clinicians that they're working in. Thus, it's really hard to create a sense of team. So, the risk of being supportive, you actually create a workforce or a workplace that doesn't feel ready for receiving these people. So, I've been trying to balance how we do that in my thinking and in some of the conversations that have been had. So, going back to our processes with our external advertising for these roles, we've made sure they've gone out to sites like Seek and other platforms, the recruitment platforms so that people further afield and just in LHD can access. Health district's Facebook page and social media platforms have advertised them to also try and get the reach. And in our position descriptions, we've been quite clear, I think, around the level of expertise that they bring, as well as their lived experience.

There is an expectation that there is a specific set of skills. And yeah, we have probably pitched it to a more senior level of peer work than perhaps other positions might be, but that's because we want... the support team is gonna be stressful, in your face, quick high pressured work. So, with a number of different things that will be occurring simultaneously. So you want the people, as with any job that you are advertising, you want them to bring several skills to the table, not just lived experience. We've made all our positions part-time, again, to assist with that potential for burnout or to diminish the potential for burnout. So what we will be recruiting in total is 12 peer work positions, three of which will be identified. And that's across the alternative to EDs and the support team. So, that 12 covers off on all of those initiatives.

In terms of obstacles, I think, just quickly going back to recruitment, in terms of trying to make sure there's a sense of integration and team from the outset, `the positions we've advertised for the clinician, workers for the support team has got reference in there throughout that you will be working alongside peer workers. And one of the essential criteria we've asked them to speak to is their understanding of a peer workforce and what a peer worker does. So we're setting the intent really early on with the clinical roles as well so that, I guess, when they come to the table, they are already hopefully thinking about what their team structure and dynamic is gonna look like. We also, in any conversations with people who have applied for the clinical roles for the support team, when they've phoned or emailed, I've been really clear in stipulating that again, and that there will be an expectation that they will attend training, the Mental Health Coordinating Council training around working with and alongside people who have got lived experience.

So, again, upfront, being really transparent around the expectations. We've started the conversation, the head of discipline for Peer Work Aboriginal Mental Health leader and a number of other stakeholders within the district have started conversations around what support systems will be in place for the staff when they start. We know we have to have really clear lines of reporting for clinical, for operational and for professional. For their professional needs, they will be linked in with the head of discipline peer work and have the opportunity to attend all of the, I guess, district-wide activity meetings, peer supervision, group supervision, structures that are already in place. There's also, once they've attended the Roses in the Ocean training, they will also be able to, I guess, participate in the Roses in the Ocean Facebook page, which is a closed support group. In terms of, we'll also be looking at developing a community of practice as well, which will be local to us. So I know there will be the state-wide one. But is there a benefit of having a community of practice locally, which may also engage some of our CMOs sector peer workers to participate in that. So you are sharing that wealth of knowledge and support.

In terms of obstacles, as I have already mentioned, the more people you engage in creating these positions and figuring out what they look like, the more concerns these people, each of us have our concerns we bring to the table. So you've got to work through those, but it's a valuable exercise. Lots of conversations do need to be had and a willingness to kind of go backwards and forwards. And as I said, certainly, I think all of the people in the mix have had to adjust their expectations a little bit. So what they started out thinking these positions would look like and how they'd be advertised isn't necessarily how it ended up. But that's OK, I feel as though there's resolution within our LHD. I think, also, what we've learned is if you actually rely on the process of recruitment itself, it does, by nature of the process, eliminate and resolve some of the concerns anyway. So, have reliance on the recruitment process. So the preparation of position description, applications, calling of applications and all of those things.

Also, what we've done is we used some of the unspent funds from last financial year with Zero Suicides to book and pay for all of our peer worker training up front. So, when they've been recruited, we can actually spend the first couple of weeks of them being here in doing that training and completing that training, so that that's done and dusted and everyone is on the same page. And also, I'll just finish up with this, recognising that our support team service is not actually going to launch, and nor will our hubs. They won't launch until late October of this year. So the peer workers will be engaged in the co-design process of the services. So, by virtue of actually participating in the co-design of the services, they will be working in alongside their team members and other peer workers and clinicians and operational staff, the hope is that that will actually then start the process of place making, understanding role in the organisation, understanding the organisation, having some ownership over the team that they will be working in, having some confidence that they understand the team that they'll be in. So once they actually start operationally working within the support team, they will be very clear on the expectations of their role there. That's all I've got to offer. I will put it out to people again, if you do wanna have a conversation with me directly out of session from this, I'm happy to, just let me know.

Stephen Scott: Great, thank you so much for that, Liz. And thank you for that offer to the other districts in particular. There was such a rich description there of the policy issues that you've been working through. And a really great example, I think, of the way that Hunter New England has taken these peer worker roles or resources and adapted them to your local circumstances in a really appropriate way. Now, we are running a little behind time, but I'll be aiming to wrap this up today at 11:15. So, just in the final moments that we have, I will turn to Tina. And in particular Tina, noting that the ministry has engaged Roses in the Ocean to develop a peer workforce curriculum to support districts with training suicide prevention peer workers, can you please discuss the rationale for the curriculum and provide an outline of its content briefly? And perhaps also just mention the anticipated timeframe for finalising that curriculum. Tina, are you still with us? Maybe you are on mute.

Tina Kenny: I'm so sorry. Stephen, I was just saying I'll just hit a few important points, I guess, about the rationale and what's in the course.

Stephen Scott: Thank you.

Tina Kenny: So, I guess the most important thing to understand about the rationale is that the purpose of the course is not to create a different breed of peer worker. And actually, we're going to really be working with those really important skills, principles, approaches that peer workers have already learned about in terms of this support and in the certificate IV in peer work. And not about replacing those, but rather providing an opportunity for peer workers to explore how they can apply those principles and approaches in a suicide prevention context. So, it's very much about providing that safe space that a peer worker might not feel they have to ask questions in the workplace about things that they're finding confronting about their work. In terms of what's important, rather than go through it, I might just give you a few examples of what I mean by taking existing principles and approaches and applying it in that suicide prevention context. So, one of the things we look at is recovery principles and recovery philosophy, because so often when a person is supporting someone who's thinking about ending their life, those principles go out the door.

So, looking at how we can actually honour those principles in the way that they need to be honoured, even when it becomes really challenging because somebody is thinking about ending their life. We also, for instance, look at fostering new thoughts about the future because we (INAUDIBLE) peer workers in goal setting and setting smart goals. And that's always appropriate for somebody who doesn't have a concept of (INAUDIBLE). And so looking at alternative ways that we can use our peer work skills to help people think of abilities and help foster optimism without maybe taking that structured approach to goal setting that so often we follow. I'm just thinking what would be, I guess, there are some very specific ideas that we need to explore that we look at, and of course, how we might adapt peer support for the specific needs of someone who is thinking about suicide, how someone needs are different when they're thinking about suicide compared to when they're not thinking about suicide. And the importance of recognising those different experiences, how it's different from perhaps other mental health needs and how a peer suicide intervention is very different from a clinical intervention. And what we do as peer workers in order to respect that difference and to promote that difference, cause there's a lot of value in that difference. So there's just a few examples, Stephen. I guess, the entire three days of the course is going to take schools and approaches and values that are very familiar to peer workers and we're gonna really explore how they might work in that suicide prevention context.