Department of Health

Dr Jeff Young presentation

Summary

Dr Jeff Young is Director of the Bouverie Centre at Latrobe University and has worked, published and presented in the area of Mental Health for over 25 years. He has been the President of the Victorian Association of Family Therapists. Jeff talks about approaches developed at the Bouverie Centre to engage reluctant rural men, including No Bullshit Therapy and single session therapy.

  • 25 September 2015
  • Duration: 20:24
  • Size: 15.45 MB
  • Speaker 3: Jeff Young, Bouverie Centre, La Trobe University

    Thanks Pam, I too would like to acknowledge the traditional owners, the Wurundjeri people of the great Kulin nation.  I certainly don't present as an expert in men's issues, men's services at all.  I speak as a family therapist and as a family therapist you obviously have to engage men as part of families.  I'll also speak from some of the experience we've had for two - probably two significant projects.  One was the - our role in supporting all of the drought counsellors across Victoria in 2006, 2008.

    Also, quickly touch on a couple of interesting findings out of the work that we've done with the ADF.  It's been raised as another - apart from Rural Men, ADF is another area of - that we should be looking at.  I'll do the thing of- give the broad findings first.  The really broad ideas from the drought counselling supports project that we did was really a need to combine counselling and obviously focus on mental health and counselling issues.  Counselling with community development, the counsellors spent a lot of time.  They were employed quickly in terms of crisis, they all thought they'd be really working hard.

    People coming into the clinics, they sat there but no one came.  There was no information about it that hit the website.  They very much had to start doing community development work.  After about six months, people came - started coming in and as we know after a crisis like a drought, people are too busy sort of dealing with a crisis and it's only about six months later after the crises and they've done all the practical help through the important part of that early stage.  It's actually then that people start sorting of dealing with emotional issues.

    With things like drought that are really intangible and slow and chronic and not tangible like a fire or a flood, people don't even know they're traumatised by it.  They just start complaining that their wife's giving them a hard time or their boss is or work's difficult.  So people come in for counselling around those others things and it was actually linking it to the droughts is actually very helpful.  The other thing that once you do get - start to get people - contact people with - through the community development approaches, you need models of care that really reflect men's sensibilities, I guess rural culture as well.  The culture of the group that you're working with.

    We found that two models that we sort of trained up the drought counsellors in that was really worked well was Single Session Therapy and No Bullshit Therapy.  I'll talk a little bit about those as we go through.  With the Defence Force and I actually might start with that because it's a really quick little example of something that's helpful.  Once men - ADF members see active duty, they come back and there's a whole range of reintegration processes that's really quite impressive.

    But because there's a culture that you don't want - in the ADF you don't want management to know that you're got mental health problems, things - there's a thing - one aspect of the reintegration process that's called the post-operation psychological screening.  So it's a sort of a testing for post-trauma symptoms and everyone does it.  So that's one of the advantages, there's no stigma attached, everyone does it.  But it's seen in that it enforces a bit of a tick and flick, you do it but you sort of don't give anything away.  One thing that's helpful is there's a follow-up face to face with a psychologist of all the members after they've done for the forms.

    But that's helpful but typically this would happen.  Yep, so how's the reintegration process going mate?  Yeah, no it was a bit tough at first but yeah, no going well now.  Yeah, no all good.  Yep - yep, no fine.  They get very little information out of these meetings which take quite a lot of time.  There's a process of trying to make mental health services in the ADF more family orientated and I think family orientated approach - systematic approaches really is a good frame to engage men.   Don't - if you just think men by themselves, I think it's going to be a hard road and probably a - not as fruitful if you think men are often - well men are engaged in a community.

    They're engaged in groups and they're engaged in families.  We know that they're very stoic but they tend to worry about and want to do the right thing for other family members.  An example of a technology if you like that helped this with the POPs, we introduced a number of things.  But one thing that was really successful, a simple thing was circular questioning which is where you ask a person about other people.  So the POPs went like this all of a sudden.  So how's it going mate?  Yeah - yeah, tough at first but pretty good now.  Yeah, no okay now.  Oh yeah, so what would your wife say if she was here?  She'd say I was a real grumpy bastard.  Oh yeah, why is that?

    Oh I just haven't been sleeping at night and then she gets upset and she's on my case.  Yeah - yeah and so how do you respond?  Oh well, she's on my case so I just want to get out of there so I go to the pub with my mates, don’t have to explain anything, they understand it.  All of a sudden, the counsellor or the support person can do virtual family therapy without the family there but taking into account the family.  That created a whole lot of new information that otherwise they just didn’t get.  So I'll talk a bit about the drought project.  Really, the real researchers in the room have given the account of why responding to men's issues is important.

    Suicide's one of the leading deaths in rural Australia and rural Australian's suicide at a higher rate than their international counterparts.  Although they - and higher than urban people.  So we could talk about lots of other conditions but if you really just go to suicide as an indicator for the need for help.  Indigenous health as we know and I could talk about I was at the SNAICC Conference up in Cairns last week and we could talk about a whole lot of difference ones.  But this one actually came - I think it's right from a talkback radio where someone was talking about superannuation.

    An Indigenous guy rang up and said look really, the system needs to change because on average life expectancy of Indigenous people mean that they would never claim their superannuation.  For some reason that really hit home to me.  The drought project, we supported all the drought counsellors across Victoria in all of the regions eventually and also a telephone counselling service.  We did some training - Single - No Bullshit Therapy and Single Session training.  We had a two day conference to kick it off, a two day best practice conference.

    We gathered a whole lot of information and knowledge and practice wisdoms from that.  A - the main thing was a qualitative research where we - someone from Bouverie Family Therapy Centre hosted Co-operative Inquiry Groups locally of drought counsellors, recorded them and then each month, we did that in each region and this shows in each of the - each region.  We then - all the facilitators came back to Bouverie and debriefed about the key issues and took those from each region back to their regions on a monthly basis.

    So this happened 17 times over 18 months.  We recorded information and put it out in newsletters.  I would acknowledge too both there'd be - lots of men and women working with men's issues on the ground doing real tough work in this room, more than what I have.  If you do a promotion or a service development project to try and help develop men's issues, don't - acknowledge the local people doing the hard work - front end work.  Engage them and try and connect them up with others doing that work as part of the project because we went into this project not having much experience of rural issues.

    Not much experience in drought and it was one of the most helpful things that could have happened.  We had a process to gather - practice wisdom and you gather a huge amount, newsletters and again with humour, simple language.  Allowing people to initially on the ground publish in these places and it could be done electronically.  We'd probably do it electronically now.  All of a sudden, rural people who - I was packing myself, I thought rural people are going to hate me coming, I had a farming background which was lucky.

    But coming from a city centre and a university, people are really cynical about academic work until I had the opportunity to write stuff up themselves and all of a sudden then it was a real status symbol and something that they loved doing.  So those sorts of things of engaging the ground is really important.  What we found is that - first of all as I said, combined counselling with community development and whole of community approaches.  Simple things like just the workers having capacity of the discretionary funding made a huge difference.

    Wasn't a small - wasn’t a big amount but being able to maybe just respond to the needs at that time.  Like a washing machine for a family.  People would be owing money, millions of dollars on their farm in drought conditions, the biggest thing that they worried is that they didn't have enough money to send their kids on the school excursion.  So $50 could help save their sort of emotional sort of situation and desperation rather than a blanket, 10 per cent off their energy bills.  Whatever it takes, minimum red tape - be Dr Ironwoods' idea of no appointment necessary, absolutely just being able to go in straightaway, absolutely helpful.

    There's - there's a method that builds on Single Session work that's actually called walk-in therapy developed in Canada where there's no appointment.  You just go in, it's like an emergency room for counselling.  You go in, no appointment, you get whatever it's - you get done in that first session which is like Single Session principals and then you leave.  No follow up, nothing.  But you can come back just as easier and that's had really good outcomes in Latino populations and populations that aren't therapy lovers as I call it.  You need flexible work conditions to be actually able to go out.

    Services that were set up that you had to be centre based, see so many people in the centre and they were - it was wasted money.  Coordinated funding across - everyone knows there's local State, Federal funding.  We had the situation where the - after six - after 18 months, the State funded drought counsellor that really engaged well with the community, were starting to get lots of referrals in counselling.  The funding dried up just as Federal funding came up for more drought counsellors through the GP divisions.  They had struggles to recruit, we had people there, we weren't able to connect it up and it drives people in the bush nuts.

    But counsellors really need different skills, they have to really get out of their comfort zone.  Work in the - out in the stockyards, in businesses, go out on farms, pair up pigeons, work next door to the farmers which worked really well.  Providing practical help and then that would lead to engagement.  Assertive outreach was a farmer who sort of said if you don't actually go out to them, it'll be 50 per cent of the people that really need it just - you'll never get to and that was the case. Assertive outreach, the counsellors struggle with that especially the higher trained - the psychologist, the social workers, the more professionalised groups really struggled with that.

    But that was helpful.  Once you then go out and start chatting to people then it becomes skills of moving from chat to counselling.  That's actually quite a challenge, just try it, start talking to someone at a barbecue and have a chat and then start trying to solve their mental health problems.  You do - you finish up with a chop in your face.  Some of things that people found were funnelling like this was something that just came from the drought counsellor themselves that you start really broad of saying things like oh yeah, how's the local community going?  Oh yeah, then funnel down, how's the local cricket team going?  Oh yeah, they're struggling a bit.

    Oh yeah, how's your neighbour?  Then how's your family?  Then how's your - and then some people just gradually get into that.  Red flagging so having a conversation but you sort of notice that there's really sensitive issues but you don’t go there too quickly.  Because you haven't got the mandate and people are a little bit sensitive.  You then tag it and come back.  Just being informed.  There was a real thing with - five minutes - going into local communities of whether you're insider or an outsider.  We changed that to saying that there's - rather than just insiders and outsiders that creates a huge amount of sort of battles.

    That there's close insiders and close - close insiders and distant insiders and close outsiders and distant outsiders.  Close - distant insiders and close outsiders were actually the most effective.  You didn't want to talk to your neighbour about your financial problems or your emotional issues but another farmer from a different region would work.  You could talk to someone who'd made an effort to get to understand your situation and that was a close outsider.  Things like the bowerbird effect that we developed where you'd start to ask the first farmer oh what are the issues?  Then share that with the next farmer, by the time you were down the track, you'd feel pretty experienced and informed.

    Single Session Therapy, actually it was very helpful because most of the encounters are one off and this - people - single sessions are a very surprising stat, system.  It was based on three research findings that's a challenge to the field.  It's the most common number of sessions is one as you can see, this is community health counselling, it's 42,000 clients that come once then second, third, fourth.  That's the contact data that most services around the world have in any health service - mental health service where the severity - irrespective of severity or condition of diagnoses.

    The second is that people come once and then drop out.  They're not drop outs, most of them find that that was - one session was enough and they're helpful - and found it helpful for that time.  The third finding is that you can't tell who's going to come back and who's not.  So you treat each session as if it's your first and last and interestingly this both appeals to men - rural people.  But men and it fits with the research that show that people will help push men into a service but the thing that'll determine whether they'll come back and use it again is if you've been helpful especially in that first session.

    No Bullshit Therapy is sort of what Tass was talking about with the research with the website.  It's negotiating an absolute direct approach but combining warmth and care, acknowledging any constraints to the work and not having any jargon.  It's actually helpful to engage people who are therapy haters.  I think in a way rather than just thinking men and women, I actually think a more helpful way of thinking about it is that there's in our field therapy lovers and therapy haters.  It's the therapy haters where you need very different approaches.

    In fact the therapy haters, you need almost to take the opposite approach to therapy lovers to engage them. So the therapy haters and it's a continuum obviously.  But you're actually rhetorical rather than collaborative.  They actually don't want to be there, you haven't got a mandate, they're often partner mandated.  Go to therapy or I'm out of here.  So saying how would you like to work?  Doesn't work because they don't actually want to work.  So saying well this is the way I work, I practice No Bullshit Therapy and they used to say, what's that?  Oh that's where I'm really direct with you and I hope that you'll be direct with me.  So it's sort of a mutual thing.

    That sets the context for being able to raise really difficult issues upfront.  Therapy lovers, you need to be collaborative.  Therapy haters you actually start with the business and then go social.  Okay, this is what we're on about and I know you don’t want to be here but dah-dah-dah.  Therapy lovers, you go to the social and then to the hard stuff.  Start with the really tough issues with therapy haters, they actually trust you more rather than thinking you're sort of trying to manipulate them by being friendly and nice and avoiding the tough issues.  We do full day workshops.  So that's just a little bit of a feel.

    I'll just finish with saying that it's great that Beyond Blue are doing a promotion, that was one of our recommendations for - from the drought because this is an example of - there's a document - a research document with the Birchip Cropping Group, real farming organisation.  Had found that - really good research, randomised interviews with farmers and that - in the document they said that farmers hate counselling.  In the same document, they found that of the 60 people they'd interviewed,13 had actually had counselling in the past, 100 per cent had found it helpful.  Sixty six per cent, I don't need it but I think it should be available for those who do.

    Twenty one per cent said it's of no value and yet that becomes the dominant narrative.  So I reckon actually getting people talking about how it's helpful, being able to start to explore that people in the bush and men actually often get a lot out of counselling even though it's not narrated.  Okay, I'll leave it there, thank you.

Reviewed 20 September 2021

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