Joiner's model of desire and capability is used to explain the high risk period that health practitioners face when they have had a notification to AHPRA (any health regulator for that matter). Manaan explains the training that is on offer for health regulators in this episode.
We also take the opportunity to welcome listeners from the English Schools Foundation in Hong Kong as we start a 12 month journey to support 22 schools embellish their suicide prevention pathway through skills training for school counsellors, Principals, Heads of Years and Teachers.
Connect with Assoc Prof Manaan Kar Ray at https://www.linkedin.com/in/drmanaankarray/
Follow us on www.progress.guide
Joiner's model of desire and capability is used to explain the high risk period that health practitioners face when they have had a notification to AHPRA (any health regulator for that matter). Manaan explains the training that is on offer for health regulators in this episode.
We also take the opportunity to welcome listeners from the English Schools Foundation in Hong Kong as we start a 12 month journey to support 22 schools embellish their suicide prevention pathway through skills training for school counsellors, Principals, Heads of Years and Teachers.
Connect with Assoc Prof Manaan Kar Ray at https://www.linkedin.com/in/drmanaankarray/
Follow us on www.progress.guide
Host: Good day and welcome to episode 26, I am Mahi your host and with me as usual is Manaan, head of faculty for Progress Guide. Today we are going to take a break from the sequence of podcasts based on the Critical Conversations in Crisis Care Course. We will return back to the sequence in a couple of weeks time, and that is because there are quite a few exciting things happening at Progress.guide which we want to share with you all.
Expert: Don’t worry we will return back to Critical Conversations in Borderline Personality Disorder Course, the break from the sequence might give you a chance to practice some of the skills write back to us with questions which we will fit into our future podcasts.
Host: So two major pieces of work coming to fruition.
Expert: More like the beginning of the journey, but yes major training events, it does get quite busy with events in August and September with world suicide prevention day on the 10th of September, so we are packed to the rafters.
Host: We are recording this podcast on the 6th of August, it will air on the 12th, which is the Friday, by then the first major event would have happened.
Expert: Yes, the event is on the 10th of August and that is being organised by AHPRA, Australian Health Practitioner Regulation Agency, I have been working with them on an Expert Advisory Group for over a year.
Host: Suicide prevention in doctors and nurses is a particular passion of yours.
Expert: Absolutely, health practitioners are always caring for other, who is caring for them. Martin Fletcher AHPRA’s CEO is on a mission to make AHPRA a compassionate regulator. He has put together a great team. Susan Biggar does a lot of the heavy lifting but the amount of work this team has done in a year is phenomenal. Dr Anna Van der Gaag from School of Health Sciences in Surrey, UK, brings in her expertise and the team here at AHPRA have been in touch with the GMC, General Medical Council in the UK to understand the lessons they learnt from similar work they undertook.
Host: The focus is on making the regulatory process more compassionate?
Expert: Yes, and to prevent suicide and suicidal distress in this very difficult time in a doctor or nurse’s or allied health professional’s life when they have had a notification to AHPRA
Host: Being a doctor or a nurse or any health professional is so central to their identity, a notification must be extremely threatening.
Expert: Indeed, and for AHPRA it is very tricky as well after all they are regulators, they have to ensure that the standards of acceptable practice within the profession are upheld, so inherently notification leads to adversarial positions and Martin is very keen to find creative ways in which the regulatory journey is embedded in the same principles of kindness and compassion which we want health care practitioners to engage in every day.
Host: Must be such a difficult balancing act.
Expert: Absolutely, but it is so important to get the balance right by identifying those intensely stressful trigger points that can spark a suicidal act
Host: But there will be so many of those and many health notifications are about mental health and addictions challenges so the person will be already predisposed.
Expert: True and If you look at Joiner’s Interpersonal Theory of Suicide, in order for someone to take their life through suicide they have to have the desire to end their life and they have to have the capability to overcome the strong life force that lies within each of us.
Host: By life force you mean the desire to avoid pain and death
Expert: Yes exactly, so if you look at the capability to overcome this life force, doctors, dentists, nurses, paramedics are a bit like soldiers, they develop what we describe as acquired capability because of exposure to pain and death.
Host: You mean they are desensitised to the idea of death
Expert: Yes, and it is easier for them to cross this threshold from ideation into action, not to mention the access to means and the knowledge they have of human physiology which means that they can do some serious damage to themselves.
Host: And the notification or events in the regulatory process can trigger that kind of suicidal thinking?
Expert: Absolutely, under the heading of desire, Joiner talks about failed belongingness and perceived burdensomeness. Now think about what happens following a notification, often the health practitioner is not allowed to practice, they cant talk about something that is under investigation, there is a huge amount of shame attached to a process like this.
Host: And as we were discussing being a doctor or a nurse or a psychologist is so central to their identity
Expert: Absolutely, you cant go to work, you don’t belong to your peer group anymore for many, so you can see if your entire life or waking day revolves around delivering care to others, suddenly your purpose in life is gone, your identity is stripped away from you, you don’t belong anymore to your identity group and for many who are self employed like general practitioners running their own surgeries they are not getting paid if they are not seeing patients, so they are not providing for their families and that creates perceived burdensomeness.
Host: My life has no value?
Expert: Yes, a really dangerous concoction with failed belonginess due to lost identity, perceived burdensomeness from not being able to fulfil one’s life’s purpose whether that be delivering care to society or providing for your family, overridden by guilt and shame, acquired capability from desensitisation to the idea of pain and death, access to means, knowledge of human physiology in a person in intense emotional pain.
Host: Not that hard to see is it, how such a person can cross the ideation – action divide. But as a society we also need health regulation and a body to enforce such regulations so no harm comes to public
Expert: Yes, and professional standards are upheld, and there in lies the challenge for AHPRA, they are regulators and the circumstances under which they interact with health professionals is a really difficult time, how do you strike a balance between your regulatory obligations to society and your humanistic obligations to the person you are regulating.
Host: A challenge indeed, so what are you providing in terms of training and who are you providing it to.
Expert: Well, the training is for the Clinical Input Service, it’s the health management teams. It is bespoke for health regulators as we focus in on certain aspects of PROTECT which are most relevant to health practitioners.
Host: So at progress guide we have the suite of training for health i.e. the training for health professionals and the parallel suite for education – professionals working in schools, colleges and universities, I am assuming this is in the health stream.
Expert: Oh yes, this is the PEARLS training for health professionals, but it is a slightly extended version than the one we deliver for general hospital staff to spot the emergence of suicidal ideation and as I said it has been adapted for health regulators and can be used anywhere in the world.
Host: I am assuming we will hear more about how the training went in the next episode.
Expert: Oh yes, we will do a wrap here, cause we generally tend to record at the weekend so that will on either the 13th or the 14th of Aug and the training is on the 11th.
Host: Ah so right before the big week with English Schools foundation in Hong Kong.
Expert: Big indeed.
Host: This is a good time I assume to welcome our listeners in Hong Kong as this episode will air on the 12th.
Expert: Actually, that’s correct. English Schools Foundation is a conglomeration of 22 international schools in Hong Kong and we have been designing their suicide prevention programme since April and we are going to have a big bang training event in the week starting the 15th of August and then we will work with them for an entire year to build up the skills and competencies of school counsellors, principals, heads of years, teachers and even students. So it is a major program and we are delighted to be partnering up with ESF who are so committed to student wellbeing. They are an enlightened bunch and it has been so refreshing to work with the likes of Tracey Chitty, she is the safeguarding and wellbeing adviser at student support services, an absolute kindred spirit, I really wish we had more people like her in our schools who have this real fire in their belly to make our children more resilient so that they can navigate the ups and downs of life that we will all inevitably get.
Host: 22 schools, that is massive.
Expert: I think it is over 18,000 students and 1500 teachers, I am not sure of the exact stats, but it is big.
Host: So all of this is adding to your goal of 10 million lives touched by 2040.
Expert: Ha ha, yes my geometric progression of 10, 20, 40
Host: You should have done 10, 20, 30
Expert: One has to be realistic but you never, the way the podcast is going maybe we will be able to touch 10 million lives by 2030
Host: Amen to that, so please do keep spreading the word, it will help us in achieving our goal. During this busy period we will do shorter podcasts, today you learnt about the work that AHPRA is doing and why it is so critical to support health care professionals when they are undergoing a regulatory process, you learnt about Joiner’s interpersonal Theory and how desire and capability come together, failed belongingness, perceived burdensomeness and acquired capability in a person who has access to means and has knowledge of how to take one’s life, that is a dangerous mix.
Expert: And that is why suicide prevention training for regulators is so important, they often come from a legal background and an understanding of the psychological pain of healthcare professionals can make such a difference to the interactions that happen in that process.
Host: We will do a wrap up of the health regulators training next time but perhaps more importantly we will delve into suicide prevention in schools and universities. Although these episodes might be slightly shorter Manaan is doing a number of events in the lead up to the world suicide prevention day, we can post the details at www.progress.guide, from memory there is one on the 31st of August for Lifeline Western Australia, that’s at 7:30 pm Australian Eastern Standard Time, i.e. Brisbane Time and there is a big event, I believe that is an overview talk PROTECT LIFE PEARLS: Practical Suicide Prevention Skills from Hospital to Schools and then you got the big event on World Suicide Prevention Day itself.
Expert: Yes, that’s the UK Suicide Prevention Summit, hosted by the Mental Health Academy.
Host: So that’s on the 10th of September, Brisbane time 8 pm, have you decided yet what your topic is for that.
Expert: No not yet, I was discussing with Pedro Gondim the CEO of Mental Health Academy what would be most relevant, I am leaning towards the AWARE framework and the Critical Crisis Care Conversations, but I am sleeping on it and procrastinating making a decision.
Host: Yes that would link up nicely to the podcast series as well. That brings us to the end of today’s episode, hope you are making plans in your organisation too as to how to observe world suicide prevention day on the 10th of September, its an important observance and is central to getting the word out there that suicide prevention is everybody’s responsibility, over the next month you will hear me say this as a broken record. Every 40 seconds a life is lost to suicide and awareness about what we can individually do can save a life, a life who is someone’s father, mother, brother, sister, son, daughter, husband, wife, friend, you can play a part in the fight against suicide, I hope you do, catch up next Friday and keep smiling, you will keep getting smiles back.