Discussing suicide with Jon Tyler and Paul McNamara

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Episode: 18
Guests: Jon Tyler and Paul McNamara
Duration: 58:53
Tags: Suicide, mental health
SoundCloud: Episode 18 Discussing Suicide with Jon Tyler and Paul McNamara

Suicide is a tragic, sad, confusing, and often desperate and complex way to end a life. This is why we have considered this issue and how to talk about it for a long time. When a nurse or midwife dies as a result of suicide it has a deep impact on the profession that at our heart cares for others. 

It often raises more questions than provides answers. Could I have done more? Should I have known there was something wrong and intervened? Should I have been there for them? And on and on our questions go. 

To provide support for you in relation to this sensitive topic we developed this two-part podcast series to discuss suicide in relation to nurses and midwives.

Part 1: Identifying and dealing with suicidality

On the first podcast of this series I talk to Jon Tyler, Manager Specialist Clinical Services Turning Point Eastern Health. Jon is a Social Worker with extensive experience supporting those at risk of suicide and teams impacted by the suicide of a colleague.

Jon and I discuss suicide and support for nurses, midwives and students at risk of suicide and following the death by suicide of a colleague. 

Researchers led by Deakin University’s Dr Allison Milner published the study ‘Suicide by health professionals: a retrospective mortality study in Australia, 2001-2012’. We discuss the astonishing results of this study, along with signs of suicidality, risk factors for suicide and what you could do if you suspect a friend or colleague is at risk of suicide.

Finally, we examine the range of emotions experienced by people after the suicide of colleague, family member or friend and what support is available.

Part 2: Suicide Risk Factors and Complexity

In the second part of the podcast series I talk to Paul McNamara, Mental Health Nurse from the Consultation Liaison Psychiatry Service at Cairns’ Hospital, nurse educator and digital citizen.

Paul and I recorded the podcast on World Mental Health Day 2019 at the International Mental Health Nurses Conference. We discuss his extensive work supporting and educating people about the risk factors related to suicide, stigma, mental health, resources, support and his blog on suicide on his website Meta4 RN.

As Paul states: Suicide is a complex matter that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who are feeling suicidal. The data suggests that health professionals have an actual or perceived barrier to accessing these existing supports. I wonder what that barrier is?”

We explore this and broader experiences of being a nurse or midwife and some of the pressures we experience that relate to mental health and wellbeing.

Please access Nurse & Midwife Support if you are worried about suicide or any issue this sensitive topic raises for you on 1800 667 877. 

Note: this podcast is a two-part series that runs for just over an hour, if you find any of the podcast difficult to listen to, please take a break and reach out for support.

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support

Jon Tyler

Jon is the Manager of Specialist Clinical Services at Turning Point, he is a qualified social worker and has a Masters degree in Public Health. He has extensive experience supporting those at risk of suicide and teams impacted by the suicide of a colleague.

Paul McNamara

Paul McNamara has been a nurse since 1988, a mental health nurse since 1993, a credentialed mental health nurse since 2006, and a fellow of ACMHN since 2008. He works as a consultation liaison CNC at Cairns Hospital. Paul also tinkers online quite a bit; he has a social media portfolio built around the homophone “meta4RN”, which can be read as either “metaphor RN” or “meta for RN”.  

Mark Aitken: Welcome to the Nurse & Midwife Support podcast, your health matters! I’m Mark Aitken, your podcast host. I’m the Stakeholder Engagement Manager with Nurse & Midwife Support and I’m a registered nurse. Nurse & Midwife

Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free. You can call us anytime about any issue you need support for: 1800 667 877. Or contact us via the website at nmsupport.org.au.

Trigger alert: this podcast contains information regarding suicide which may be unsettling for some people. This is a two-part podcast series on the sensitive topic of suicide in relation to nurses and midwives. The two podcasts are just over an hour in total. If you find any of the podcasts difficult to listen to, please take a break and reach out for support. Nurse & Midwife support: 1800 667 877 or LifeLine: 13 11 14.

In part one of the podcast series, I talk to Jon Tyler. He’s the Manager of Specialist Clinical Services at Turning Point, Eastern Health. Jon is an experienced social worker with extensive experience supporting those at risk of suicide and teams impacted by the suicide of a colleague. Jon and I discuss suicide and support for nurses, midwives and students at risk of suicide or following the death by suicide of a colleague. We explore signs of suicidality, risk factors for suicide and what you could do if you suspect a friend or colleague is at risk of suicide. We discuss a range of emotions experienced by people after the suicide of a colleague, family member or friend and what support is available. We also discuss the impact of grief following a suicide (on the people connected to a person who dies as a result of suicide) and the importance of communication and support. We acknowledge that this is a difficult topic for many. If either of these podcasts raise issues for you, please reach out.

On part two of the podcast series, I talk to Paul McNamara. He’s a mental health nurse and Consultant Liaison in the psychiatry service at Cairns Hospital. As well as a nurse educator and digital citizen. Paul and I recorded the podcast on World Mental Health day, 2019, at the International Mental Health Nurses Conference. We discussed his extensive work supporting and educating people about the risk factors related to suicide, stigma, mental health, resources, support and his blog on suicide on his website meta4rn.com. As Paul states, suicide is a complex matter that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who are feeling suicidal. The data suggests that health professionals have an actual, or perceived, barrier to accessing these existing supports. He asks what that barrier could be. We explore what that is in this podcast, please listen and let us know what you think: [email protected].

Please access Nurse & Midwife Support if you’re worried about suicide, or any issue this sensitive topic raises for you: 1800 667 877 or via the website at nmsupport.org.au.

My guest today is Johnathan Tyler, manager  Specialist Clinical Services at Turning Point, Eastern Health. Hello, and welcome John!

Johnathan Tyler: Hello, how are you?

MA: Good thanks. Thanks so much for being our guest to discuss this very important topic. Today we will discuss suicide and support for nurses, midwives and students at risk of suicide and following the death by suicide of a colleague. John, please tell our listeners about your background, your expertise in suicide prevention, suicide work, support and your current role.

JT: Thank you Mark for having me today on what is a very important issue for us to have discussions about. In terms of my background, I am a social worker and I spent around 15 years working in a range of regional and metropolitan mental health services both in adult and child and youth mental health followed by a transition into working at Turning Point and becoming a manager where I have the privilege of being the manager who has been working with a whole range of nurse and midwife colleagues in developing and implementing the Nurse & Midwife Support Service.

MA: Thanks John, you’re actually the overall manager for Nurse & Midwife Support so it’s a great honour to have you on the Nurse & Midwife Support podcast as a guest. Thank you very much. 

JT: Thank you.

MA: We’ve just celebrated our third birthday, hopefully you’ve all seen our video. We’re incredibly grateful to the nurses and midwives throughout Australia for your support and for your contribution to the success of the service.

JT: And I thank you. It’s been really important, for me. I’ve been very lucky to have some, primarily psychiatric nurses over the years who have both trained me and given me opportunities in learnings and career skills that I will be eternally grateful for. It’s been a wonderful experience and it’s been wonderful to work with such an amazing group of nurses and midwives. 

MA: Thanks John, I’m sure that nurses and midwives listening to this podcast will really appreciate those kind words. In 2016, a retrospective study was released entitled Suicide by Health Professionals, A Retrospective Mortality Study in Australia from 2001 to 2012 by researchers led by Deakin University’s Dr Allison Milner. The results of the national study were disturbing, as they revealed that the rate of suicide for female nurses and midwives was almost three times higher than females in other professions. The suicide rate for male nurses and midwives was almost twice as high as males in other professions. The study states that some of the reasons for the higher rate of suicide by female and male nurses is the particularly demanding nature of the job. Contributing factors such as long hours and work/life balance play a prominent role, with anxiety also being a potential risk factor for suicide. John, what are your thoughts about this?

JT: It’s very powerful, what Doctor Milner and her co-researchers published in relation to health professionals. Primarily, when it comes to those psychosocial stressors that they discuss, about work and family conflict, long hours, high job demands, the fear of making mistakes at work as well as the association of the psychosocial job stressors that commonly can have a relationship with anxiety and depression. It’s no surprise that we have these rates of suicide and it really is concerning, you add as well the exposure and risk of trauma, vicarious trauma from patients and their families as well. It’s really important for nurses, midwives and the organisations that support them to appreciate the complexity of what they do and look at the ways in which we can work on our health and cultural health to prevent, as much as possible, this from occurring.

MA: Jon, what are the signs of suicide in a person that we could be open to and mindful of seeing?

JT: It’s a really interesting space, in terms of trying to find a checklist or having something that could really help us to understand when someone is presenting as suicidal. In our discussions, it’s really important to address the uniqueness of each individual who experiences these thoughts. Unless we can have an environment whereby a person feels comfortable and has that capacity to talk about their thoughts and feelings, it can be really difficult for us to notice those signs. In terms of mental health risk assessments, when we look at some signs in my career, we used to break it down into three factors. The ideation, the thoughts that a person may have in terms of suicide. The plan, understanding what that plan may be. Then, the intent. Within that, you can really capture what’s going on. But without those discussions, it’s really difficult. Beyond Blue summarises it nicely.

Some of the behavioural and physical changes that someone can present with, talking about some of the non-verbal indicators, may be:

• social withdrawal
• a drop in mood
• disinterest in maintaining their own personal hygiene or appearance
• reckless behaviour
• poor diet, rapid weight loss
• being distracted
• anger
• insomnia
• alcohol and drug abuse
• giving away sentimental or expensive possessions

Some of the indirect verbal expressions may include:

• hopelessness
• failing to see a future
• believing they are a burden to others
• saying they feel worthless or alone
• talking about their death or wanting to die

This is not an exhaustive list.  Often, we have to be guided by our own instincts. Knowing the person, being aware of their unique challenges. Or just being familiar with what’s going on. It’s a really tricky situation and it is no surprise that when we have the awful situation of someone dying, in terms of suicide, often people are left surprised (in terms of it occurring). So, it’s really tricky.

MA: And what are the risk factors for suicide?

JT: Once again, there’s evidence there that discusses things like:

• Previous suicide attempts
• History of substance abuse
• History of mental health conditions (like depression, anxiety, bipolar, PTSD)
• Situational events (relationship problems, familial conflicts, conflicts at work, legal and disciplinary problems)

As well as that, other risk factors can be the access to harmful means (such as medication). There are some common themes as well in terms of:

• Recent deaths or suicide of close friends
• Ongoing exposure to bullying behaviour
• Physical illness or disability

When you talk about risk factors as well, it’s important, once again, to be cautious and acknowledge that it’s very very complex. The factors of influence for someone can vary. It can be none of these things. It can be other things that we haven’t included. The other thing, in terms of risk, we talk about risk but it’s also about looking at protective factors. Different things that may reduce the likelihood of suicidal behaviour and improve the person’s ability to cope with different circumstances.

• Social connectedness, having peers that they can trust and talk to
• Family members, a child. 
• Motivation for an event

It can be quite complex to quite simple protective factors that also have an influence in terms of a person and their risk of suicide. 

MA: Thanks John. Lots of us have observed friends or colleagues with some of those risk factors, what would you recommend that we do if we recognise some of those risk factors and suspect that a friend or colleague is at risk of suicide?

JT: In The Conversation, there’s an article from 2018 by Anthony Jorm and Betty Kitchener. They published this wonderful article which discussed how to ask someone you’re worried about if they’re thinking of suicide. It’s a very interesting article, because there are some myths out there and a lot of it is based on how comfortable people feel with this topic. A lot of the research indicates that talking about one’s suicidal thoughts can be a relief to a suicidal person. It gives them a chance to talk about their problems and put them in a space where they feel like somebody cares for them. Another thing that we know is that although we know that health services play an important role in helping people at risk, research indicates that many people who die by suicide are not in contact with a health service in the month before their death. So, in terms of the discussion, what they speak about is that it’s important to know that everyone of us is likely to have a close contact with someone who is suicidal. It’s important for us to get to a point where we feel comfortable talking about these things. They talk about a very simple three step process. 

1. Talk to someone, directly, about their suicidal thoughts and intentions in regards to suicide. 

Using statements like, “Are you having thoughts of suicide?” Or, “Are you thinking about killing yourself?” With the aim that, hopefully, asking someone about their suicidal thoughts will allow them the chance to talk about their problems and show them that somebody cares. The important thing when you’re asking these questions is to avoid leading in judgemental ways. I think that this is sometimes why some people are nervous about asking the question about suicide. I think it’s really important to acknowledge that it is a really hard thing to talk about. You worry that you don’t have the right skills to be able to ask them questions. Their (Jorm and Kitchener’s) advice is that it’s important to have questions that open with, “Are you…” instead of saying things like, “You’re not thinking about doing something stupid…” or putting judgement forth. 

2. When you listen to someone’s response, do it without that judgement. 

You let them talk about why they want to die, and this can cause relief. Don’t try to convince a person that suicide is wrong, or tell them that it will hurt their family if they die, because this can really shut down communication and the opportunity for the person to get support. 

3. Really emphasize to the person at risk that you, as an individual, care and want to help them. 

Ask them how they would like to be supported. Is there anything that you can do to help? They talk about these things and it’s easy for us to write them down but I had to reflect on my own career. Particularly in the beginning, I think that it is important (for the nurses and midwives who maybe listening to this, or their family members) to explore how comfortable you are with this. I have the story that I often tell the clinicians that I work with that it took two years before I felt comfortable talking to people about suicide. This can be a really difficult thing for all of us to talk about. There is a lot of stigma around suicide and mental health. There’s also a lot of anxiety around what to do with the information once we’ve got it. 

Mental health first aid is training. It’s a wonderful way in which people can get some development, education and familiarisation. It can really help with getting the literacy, but also the comfort from working in this space. It’s the hope that, similar to basic first aid that addresses a cut or a bruise or a snakebite, that we can have just as much comfort when it comes to people’s mental health and these obstacles that we all naturally have. So, if you do feel uncomfortable and you do feel ill prepared, I really encourage people to go down the path of looking at mental health first aid. It’s a wonderful opportunity to get a bit of skill in these things. It’s a wonderful way of helping in terms of changing the culture from something that’s hidden to something that you can freely speak about in your organisation.

MA: Yes, these are really good points Jon. There’s lots of training around now, in relation to mental health first aid. So, the chances are that your organisation runs this. Or your professional body runs it. Have a look out for a mental health first aid course. I almost think that it would be good if universities made this a core subject for undergraduate degrees for health professionals.

JT: Oh, wouldn’t it be wonderful? Today, I’m trying to talk about some practical one on one things that we can all do together. But, you can’t have these discussions without having a discussion on the cultural shift that we have to make around mental health. The stigma and fear that we have around it. The more that we can readily talk about it and feel comfortable talking about it, the better it is going to be for everyone.

MA: Indeed, a lot of work has been done in this space to try and destigmatize and enable people to be open and honest about mental health. But it seems to me, in healthcare and especially for nurses and midwives, that there’s still an element of shame around talking about it. I’ve really thought about this for quite a while now, I wonder if it’s because we’re in the service and care of other people so often we don’t put our own needs first. Or, we don’t make them paramount. We actually think that we shouldn’t succumb to something like a mental health condition. 

JT: Absolutely. It’s this this sense that like, I often talk about it. I’m someone who, myself, personally has gone through a space of working with my blinkers on trying to help people to a point where I recognize the impacts of the traumatic events that I was constantly witnessing day in day out. In terms of my work, at which point I transitioned to therapy and getting a bit more insight and awareness of the impacts of this. The thing that I noticed, particularly later in my career, we often have this cultural badge of honour instead of acknowledging that this has an impact on us. So, you have your first death and it’s like, welcome to experiencing this. Instead of us recognising that these things often have long lasting impacts. These are things that we need to work on and understand. We can’t hide from them or put them behind us, they do have an impact on us. This is a change, in terms of what we need to do in this space. Talking about it and recognising as a nurse and a midwife the expectation is the fact that there’s a lot of stressful things that we will see and witness. The trauma that one will see, and witness, there are ways to continually work healthily in these areas as well as manage it and have support through therapy and supervision. Whatever it may be, it’s acknowledging that we’re not invincible. We can’t be.

MA: Absolutely. What should a nurse or midwife do, Jon, if they feel suicidal? What supports are available for them? 

JT: I hope this doesn’t sound cliché, it’s on social media a lot, but it is really important to emphasize that you are not alone. By that, the statement of it is that, for some, having a mental illness or ideation or attempts, you often feel alone and you feel incredibly isolated. You often are struggling to connect to the closest little networks. Or you feel so helpless that you don’t. It’s really important to know that there’s lots of different services and it just depends on how comfortable you feel with speaking with people. At first, it’s really good to be able to speak to your family, friends and colleagues. If you can. If you can’t, your GP. There’s psychologists out there. If that’s too much, then there’s other services like LifeLine, Beyond Blue, MensLine, Kids HelpLine (for those under 25), Suicide Call Back, QLife. As well as that, Nurse & Midwife Support is available for people who are experiencing these thoughts. We can be supportive, if you really feel that you need that peer to peer based support and acknowledgement in that space. So, there’s lots of different levels. Worst case scenario, there’s emergency support. Going to the hospital, all of our emergency departments are equipped to be able to support someone who isn’t feeling safe. It’s just about finding something. There’s lots of things out there. The hardest thing is often just making that first call. Or that first discussion with someone and sitting in that space.

MA: If you’re listening to this podcast and you feel like you’re at risk of suicide, or that you know a colleague who is or suspect they might be, as John says, please reach out to Nurse & Midwife Support or any of the various services that John has spoken about. We’ll put those links that John has spoken about up on our website as a part of our podcast at Nurse & Midwife Support: 1800 667 877 or via the website at nmsupport.org.au. 24/7, anonymous, confidential and free. All of our nurses and midwives who answer the phone are trained to support in relation to this really important issue. So, as John says, reach out to a service as soon as you can. Thanks John, I think that that’s really important.

John, after a person dies as a result of suicide people experience a range of emotions. Grief, guilt, post-traumatic stress disorder, sometimes anger. There may be a big impact on people and workplaces after a suicide. What are the ways to manage this? What support is available for workplaces?

JT: It’s an incredibly traumatic time. It’s really important, when discussing this, to talk in two components. There’s your individual needs: as a person who is going through this. Then there’s the organisational and how management can support this. When it comes to a co-worker dying or even attempting suicide and survives, there can be those overwhelming feelings of guilt and grief. It’s also important to know that it can also impact those within the organisation. They may not even be close to that employee. So, employers need to really consider these impacts to the overall psychological health and safety of their workplace. There’s a whole range of factors, a lot of employers have a whole range of processes that they go through. 

Some give co-workers the option, if it’s appropriate, to attend a funeral or memorial service. Keep watching your co-workers’ reactions and seeing how it’s impacting them. Providing a collaborative response, whether it be through grief counselling or group trauma or individual counselling, it’s really important to work with the service and show that you’re being reactive in terms of their needs. But also, be sure that it’s appropriate to their needs at that moment in time, in providing that help. It’s really understandable that a reaction can vary significantly from employee to employee. That’s really important to note, that people respond differently. People respond at different times. People are triggered by different things. We have to really consider the uniqueness of that. 

It’s also really important to acknowledge that it’s not just coworkers. Managers can also feel huge amounts of guilt and grief related to a suicide death. We need to support them as well. It’s really really tricky, it’s important just to be observant of this. Providing education is a really useful mechanism, improving people’s ability to undertake mental health first aid is a good example. Often, these resources are implemented at these times. If appropriate. For an organisation, it’s really important for us to determine if there are any workplace factors that are associated with the death and for us to ensure that we’re open to this and we use the mechanisms that are there for us to really ensure that we review and unpack these, at times. Sometimes, I’ve been in organisations where we had a tribute and that has been really healing. So, there’s lots of things that you can do. It can be a very important time to be considerate and this is healthy for the organisation. For something that is just awful, for the organisation that have experienced it. 

When it comes to the individual, particularly nurses and midwifes who are naturally focussed on the care of others, it’s really important to be mindful of the impact that this is having on you. It’s important to give yourself permission to be healthy. Take time and breaks for reflection and healing and recovery for yourself. It’s important for us to have that permission to do that. It’s important to also pace it the way you do. Just because someone is reacting in a certain way doesn’t mean that you have to necessarily react that way. We’re all individuals and we all have different grief responses. That’s how each experience is unique. It’s that balance between not minimising your own grief because you want to help and be of service, or you feel that you have a responsibility to do so. It’s about acknowledging your own needs. But also, not being concerned because you’re not reacting that way. We’re all incredibly individual and different and there’s no right or wrong way to go through a healing process.

MA: Really important points Jon, thanks for that. Well, we’ve come to the end of the podcast, this is a very important and complex subject that needs discussion. So we’ve covered a lot of points today. We’ve talked about suicide, the study of suicide by health professionals, the retrospective mortality study in Australia from 2001 to 2012, the risk factors for suicide, the factors placing nurses and midwives at higher risk of suicide than other professionals, mental health first aid, the impacts on others after the death of a person from suicide and the importance of Nurse and Midwife Support. Indeed, the other services that are available to support people at risk of suicide. John, any final words of wisdom? 

JT: I think it’s important for me to acknowledge those who have been impacted by suicide. It’s so prevalent in our nation and I hope that some of this can be useful for others to prevent it from occurring. It’s important to acknowledge that there’s very few people who haven’t been touched by the impact of suicide in our country. I just hope for those who are listening, if you can reflect on this here today that you’re in my thoughts and I’ve always been passionate because of that. Please, if you have any feedback don’t hesitate to reach out and contact us at Nurse & Midwife Support. 

MA: Thanks John. You’ve been a really informative guest. I know that our listeners will benefit from your wisdom and experience, speak to you next time. 

-Outro-

MA: I’m at the Australian College of Mental Health Nurses 45^th International Conference in Sydney. My guest today is Paul McNamara: Clinical Nurse Consultant, Consultation Liaison Psychiatry Service at Cairns and Hinterland Hospital and Health Service. Welcome, and hello Paul!

Paul McNamara: G’day Mark, thanks for having me.

MA: It’s great to have you here today Paul. Today, we will discuss suicide and support for nurses, midwives and students at risk of suicide and following the death by suicide of a colleague. Paul, as you report in your blog on your website (meta4rn.com which I’ll get you to talk about shortly) you cite a retrospective study into suicide in Australia from 2001 to 2012 that uncovered these alarming four findings:

1. Female medical professionals are 128% more likely to suicide than females in other occupations.
2. Female nurses and midwives are 192% more likely to suicide than females in other occupations. 
3. Male nurses and midwives are 52% more likely to suicide than males in other occupations.
4. Male nurses and midwives are 196% more likely to suicide than their female colleagues.

They’re incredible statistics. Quite disturbing I think, Paul. Would you please tell our listeners a bit more about that? But also, your role and meta4rn.com and why you wrote the blog about suicide that you’ve titled Nurses, Midwives, Medical Practitioners: Suicide and Stigma.

PM: Sure. The hospital that I work in, I’ve been there off and on for nearly 20 years now. Back in the early 2000’s three of the nurses who worked there died by suicide. That was a bit of a shock to us all. It happened within a fairly short amount of time, about 18 months I think it was. It felt like knock, after knock, after knock. A lot of us, myself included, were standing around looking at each other. Looking at our colleagues on the nursing team and thinking, “Oh Christ, what could we have done better? What could we have done differently?” That’s really stuck with me. Then with my role, I work as a mental health nurse in the general hospital. Not everyday day of the week, but certainly every week of my working life I will see people who have attempted to take their own lives and have survived it and been admitted (medically or surgically) to be patched up. While that’s happening, I’m providing the mental health input.

I guess that suicide is just an everyday part of my working life. A bit more than I would like, sometimes, to be honest. When it effects my colleagues, that gives it an extra resonance. It was with those thoughts bouncing around my head when I saw that paper come out with that data. That was published in November 2016, it was written by a pretty impressive bunch of people. They were all doctors on the team. I think one of them was a PhD doctor, not a medical doctor, but the rest of them were medical doctors from various specialties. The bits of that story that were picked up by the mainstream media were about the escalated risk to doctors of suicide. The mainstream media didn’t really pick up on the escalated risks to nurses and midwives, which were actually a bit higher than the risks for female doctors. Interestingly, male doctors don’t kill themselves at a greater rate than blokes in other professions. So, it was very much about nurses and midwives. As we know, most nurses and midwives are females. The whole thing has just got a bit of a resonance for me. It worries me. I guess the title that I gave it, it was speculative. I wonder about the stigma around suicide as we (nurses and midwives) get exposed to suicide stuff so much. I wonder whether we stigmatise ourselves around that. That was what the blog post was all about. 

MA: Thanks Paul, I think you make some really interesting points there. Would you tell our listeners a bit about meta4rn.com? People will obviously want to access this blog once they listen to this podcast. I think it’s a really important blog, so what is it and why did you start it?

PM: This could be the cleverest thing here today Mark..

-Laughs-

MA: Apart from us.

PM: That’s right. Meta4rn.com is a homophone, it’s a bit of a play on words. It can be read two ways: metaphor, as in using an analogy to get a point across. A lot of education happens that way, where we use metaphors. I think particularly amongst nurses and midwives, you’ll be at a nursing station saying, “You do it this way because it’s a bit like a…” We use that kind of language a lot. We use metaphors a lot, and I threw on RN at the end because that’s what I am, an RN. Another way to break down that name is meta, which is like if we were having a conversation about another conversation. That would be a meta conversation. A lot of the stuff I talk about on the blog is a conversation about nursing conversations. That was where the idea for the name came from. Every now and again, I feel a bit self-conscious about it because it is a little bit wanky. 

I came about setting up that blog because at the time I was working in perinatal mental health. By definition, my patients were women aged somewhere between 15 and 45. That demographic had the best and quickest uptake of social media and smartphones. This is going back to 2009/2010 when I first started mucking around in that space. If you remember back to then, iPhones were still a relatively new idea. I think they had been on the market in Australia for a year and a half, two years. It was women within that age bracket who were buying them first using social media the most. I was saying to the organisation that I was working for at the time that we, as perinatal mental health, should be getting in that space where the women are. But it was a government organisation, bureaucracies are a little bit sluggish. They didn’t really want to act on that, so I left the organisation behind and just set it up representing myself as a nurse (not the organisation). But I put myself up on social media in that space. Initially, because I was still working in perinatal mental health, it had a focus around that. But the funding for that role disappeared, so my focus has become much broader since then. 

MA: It certainly has grown, as has your following. You’ve got a lot of subscribers to your website and I get regular emails and information. 

PM: Yes.

MA: If people want to subscribe they can just google meta4rn and they can become a subscriber to your site and get access to some of the great information on your blog?

PM: Yes, and look, only if you want to. It won’t be too spamy, I tend to write about one blog post a month now. So, you can do that. If you don’t want to subscribe, if you’re like me you’re probably sick to death of too many emails. Just have a look around and see if there’s anything of interest for you.

MA: Navigate it via the website?

PM: Yes.

MA: You’re an excellent speaker about the importance of nurses and midwives blogging, or being active on social media. Indeed, Paul and I are at the 45^th International Mental Health Nurses Conference in Sydney. We have been here since the beginning of this week. We’re recording this podcast on the 10^th of October which many of you will know is World Mental Health Day. So, happy World Mental Health Day to you all! May you commit to your own mental health self-care and support. Paul, I think that’s vital. You gave a great session yesterday about nurses and social media. Could you talk a bit more about that please?

PM: The session was 45 minutes long so I definitely won’t give you that much information. But look, the short story is that we (as nurses and midwives) now have access to telling our stories and more access to the public conversation than what we have ever had before. I used some data to back this up, so it’s not just a dopey opinion. But I think maybe if we went back 10 years in time it would be frustrating to hear mainstream media talking about nursing issues without actually talking to any nurses. That still happens now, of course. But, from my point of view, I think that rather than getting frustrated about the mainstream media why don’t we take control of what we do have? This is things like social media; Twitter, blogs in particular, YouTube, Facebook. Make it separate from your personal accounts. I find Instagram a little bit harder to use in a professional sense, but I’m playing with it. I’m probably the wrong demographic to really be good at Instagram. All of these social media platforms are free to access and give us the opportunity to get our voice out there and join in on those conversations. People get to hear from us now, whether they want to or not. I think that’s a really important power. I think that we’d be foolish to ignore it.

I’m not suggesting for a moment that each and every nurse, midwife or student listening to this podcast should go out and create a social media portfolio. That’s not going to be everybody’s cup of tea. But there were some people who were wondering about it, and I would encourage you to explore that space. Nurse Uncut, the NSW Australian Nurse and Midwifery Foundation companion website, they’ve got a blog role there that includes some great examples of nurses and midwives who have got blogs out there. Some of them are really really good, many of them are much better than mine in terms of the way that they look and the clarity of information that they present. But I think that if you’re thinking of having a go, have a go. My only suggestion or caution around that, as a mental health nurse so of course we’re big on boundaries, if you are going to go and do that be really intentional about setting up a professional social media portfolio quite separate to your personal stuff. So, my holiday snaps and what have you, to show off to family and friends are not under my own name. You wouldn’t be able to stumble across them easily, but if you were to Google Paul McNamara mental health nurse or Paul McNamara Cairns you will get bombarded with stuff that I want you to see. I’m mindful that some of my patients, colleagues and bosses will search for me on Google. Usually not with sinister intent, but more out of curiosity. I want to be in charge of what they see, and that’s what that’s all about.

MA: Thanks Paul, I think that’s really useful information. It’s a bit outside of our key or core topic today but it’s still some very useful information for nurses and midwives. Also, I would add that there’s some very useful information on using social media and blogging effectively. But also, in relation to your regulatory requirements on the Nursing and Midwifery Board of Australia website. So, if you’re kind of worried about how you’re presenting yourself, check those out first to make sure that you’re considering the regulatory requirements of your registration.

PM: And, look, I feel like those are fairly common sense guidelines. The short version is: don’t be a dick, and you’ll be fine.

MA: Good point Paul. Paul, you and I have been speaking about suicide and our concern for the profession, for nurses and midwives in relation to this since we first spoke at the beginning of Nurse & Midwife Support in 2017. In fact, you contacted me and raised your concern in relation to this issue. Indeed, the effect that the suicide of several colleagues at your health service had on you and other members of the team. Would you please share with our listeners why you think this issue is important for us to discuss? In relation to nurses and midwives? Indeed, getting it out into the open. 

PM: I was really thrilled when Nurse & Midwife Support launched. I don’t know whether it’s a coincidence that that launch in March 2017 coincided with that paper I was talking about, which was published in November 2016. It was probably too short a lead time to have caused an effect, but the timing was great anyway. The advantage that Nurse & Midwife Support have over the Employee Assistance Programs or going off to see your GP is that it’s specifically targeted to nurses and midwives. It’s 24 hours a day, 7 days a week, which reflects the shift working nature of our jobs. For many and probably most of us anyway. Having that great degree of flexibility is really important.

A downside is probably that it’s all phone based. For a lot of us, at a time of emotional distress we’d really appreciate that face to face contact. But this is a good first step and I’m really pleased that it’s there. I’m the mental health guy who wanders around the general hospital, and I hear mixed reports about peoples experience with the Employee Assistance Program. Some people have had a terrific service, but not all. Particularly, if people are carrying concerns that they think may jeopardize their employment or their registration, accessing support via your workplace is scary. Being able to go beyond the workplace, far far away down to the other end of the telephone has that advantage around that. So, if the way that you manage your stress is that you’re really hitting the booze or doing something that might get you judged poorly in your workplace, I think it’s a great advantage to have somebody far away from the workplace that you can have that conversation with. So, if you do need to go back to your workplace and discuss that part of the issue, you may be able to go back with an at least partially formed solution. I think that that’s the great advantage.

MA: Thanks Paul. Just to clarify for our listeners, Nurse & Midwife Support provides brief intervention counselling and referral pathways. If you phone our service and you need face to face counselling, as Paul suggests, then we’re able to give you some referral options so that you can access that service. But I think in the first instance, it’s often really useful to phone a service like Nurse &Midwife Support, talk through the issue and get some options in terms of where you may go next. Paul, you state in your blog that suicide is a complex matter, that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who are feeling suicidal. The data that you cite, and the research suggests that health professionals have an actual or perceived barrier to accessing these existing supports. You posed the question, I wonder what that barrier is? Paul, what is the barrier?

PM: I need to really clarify that I don’t know, that’s probably something for another team of researchers to explore. I can’t pretend that I know for sure but I imagine, through conversations with colleagues, that one of the barriers is about embarrassment. Shame. Nurses and midwives tend to be empathetic creatures, but because we’re so immersed in other people’s traumas we sometimes put up barriers which sometimes include some really irreverent defences. Like, if someone comes in after a suicide attempt, I have heard people say, “Why don’t they do it the proper way?” Stuff like that. When we say stuff like that, in front of each other, it doesn’t really give us permission to disclose that we’re at that point or getting close to being at that point. So, I think that sometimes the defences that we use so that we can go back to our job from day to day may accidentally stigmatize accessing support for each other. That’s what I was really trying to argue in that blog post. That we should just be a little bit careful about the ways in which we talk about suicide, for our patients and/or vulnerable colleagues. Let’s reach out to our colleagues, give permission and actually encourage them to come out and say that it’s ok to put up your hand if you’re going through a really rough spot. It would be foolish to pretend that that alone would make a big difference, but it would help.

MA: Thanks Paul. Do you think that there is a specific stressor, or there are stressors that prompt nurses to commit suicide rather than seeking help?

PM: Again, I’ll throw in the disclaimer that I won’t pretend to have all of the answers. But think about us, as nurses and midwives, and think about our psychopathology. We’ve probably got more empathy than the general man in the street. We’ve been attracted to do a job which almost in essence means that we’ve got to put the needs of others before our own needs. Anyone whose held their bladder for an 8-hour shift would recognise that. While you’re running around putting in catheters for other people, it’s not unusual for us to put the needs of others before us. I wonder whether that’s a part of the reason that nurses and midwives are overrepresented in suicide data, we’re not good at putting ourselves and our own needs first. Throw in on top of that, many of us do shift work so being sleep deprived makes us more emotionally vulnerable. We get exposed to other peoples’ trauma face to face. We’re up close and personal with our patients physical and emotional traumas. We’re the people who go behind the curtain and get exposed to those really raw emotions. For us to pretend that that’s not going to have a knock-on effect, would be a little bit foolish.

MA: Thanks Paul. On this day, World Mental Health Day, the 10^th of October, we obviously place the spotlight on mental health. Do you think that there’s a lot of untreated mental health amongst nurses and midwives? Or indeed, untreated mental illnesses amongst nurses and midwives?

PM: Yes, we’re overrepresented in those common mental health problems such as depression and anxiety. We’re more likely than our patients to experience depression and anxiety, and I’m guessing for some of those reasons that I was just talking about before. There is, yes.

MA: Do you think that a more widely utilised facility for clinical supervision for nurses and midwives would improve their mental health and wellbeing?

PM: It’s about the only thing that stopped me from going mad. I probably am still a bit mad, but my clinical supervision has been such an important part of my practice. In Queensland, anyway, clinical supervision has been available to any mental health nurse working in the public sector since 2009. Interestingly, in the guidelines before that which were implemented in 2003 in Queensland, nurses were explicitly excluded from it. The rationale for that was a really good one, which is that it would cost a lot of money. But, it’s really important. We do emotional labour. We need to make sure that we look after ourselves. 

Clinical supervision, just for those who don’t know a whole lot about it, it’s a bit of a dopey name. The analogy I use is say, a lot of our listeners will hold a Bachelor of Nursing or a Bachelor of Midwifery. Some of our listeners may hold a masters in this space, but not many of us will actually be bachelors or be masters. So, the name doesn’t necessarily accurately reflect what’s going on now. Clinical supervision was named about 100 years ago by psychotherapists. They were addressing their patients, one on one, who were talking through their problems. If they didn’t feel 100% confident that they weren’t making mistakes with the way that their sessions were progressing, they could tap a trusted colleague on the shoulder and be able to discuss the case with them. The colleague was then able to give supervision and support, to minimize the risk of harm to the patient. 

That’s where the name comes from, it’s a bit icky for nurses and midwives. We’ve come from a fairly bullying culture so the idea of supervision sounds like scrutiny. It’s not. It’s very much about support and I was really thrilled to see in April this year that the College of Nurses, the College of Midwives and College of Mental Health Nurses in Australia put out that joint statement saying that Clinical Supervision should be available to all nurses and midwives, not just mental health nurses. All nurses and midwives in Australia should be given that opportunity to reflect on their practice so they can care for themselves. It’s not a self-indulgent thing, as this will enable them to provide better care for their patients.

MA: Thanks Paul. Just to pick up that point you made, because I do hear this when I’m around the traps talking to nurses and midwives around the bullying culture in nursing. I know some of our listeners will be very interested in this. 

PM: I’ll be fair dinkum with you about this Mark. I think as a bloke, I kind of have managed to stand apart from that. It’s a bit weird, we’ve got two men here talking about nursing and midwifery. I think 89% of general nurses are female and 99% of midwives are female. So, it’s weird that blokes are talking about this, and I think that as a man I’ve probably dodged most bullets around bullying. But I hear it from my colleagues. A lot of it isn’t necessarily intentional. It’s about what happens in our workplace, we’ve got this busy stuff going on in busy wards that are crisis driven. There’s always a crisis going on. When something that would normally be addressed with empathy, kindness and calmness. Being met with an invitation for tea in the staff room, I think nursing has a culture where it’s like, “I can see you’re upset, but let’s get on with it.” I think that that emotional neglect is probably the biggest source of bullying that I’m aware of. But I know that through my gender, I’ve got blind spots around bullying.

MA: Thanks Paul, and what are you doing to look after your own mental health? A part from clinical supervision?

PM: Well clinical supervision is number one. My wife Stella is also a nurse, so we speak the same sort of language. We kind of look after each other. We’re really good at going to restaurants and going on holidays. We make a point of doing those sorts of things, to give ourselves treats. We’re working to get a benefit out of our nursing work. A personal benefit. More recently, I’ve recommitted myself to being a bad tennis player and an awful guitar player. Bought myself a new tennis racket and a new guitar, and I’m determined to be a little less crap at both.

MA: Well I look forward to seeing you in a band soon Paul. Just one last question, do you have a cut through message that will support nurses and midwives to seek help? Who may be at risk of suicide?

PM: Yes, don’t leave it until it’s too late. I think we’re almost predisposed to go; “Oh she’ll be right, she’ll be right, she’ll be right.” Don’t leave it until it’s crisis point would be my idea. If you’re going through a bit of a rough patch, don’t be shy about picking up the phone to Nurse a& Midwife Support. If you’ve got a decent GP who you can have a yarn to, that would be the next best port of call. He or she can make a referral to a credited mental health professional such as myself or maybe a psychologist or someone who can provide that one on one emotional kind of support. Just prioritise your health. I’m playing a tricky little emotional blackmail on your listeners now, but even if you don’t want to do it for yourself, it would be really good for your patients if you’re not overwhelmed by depression and anxiety. If you’re a bit motivated by helping others, you can do that by helping yourself. 

MA: Thanks Paul, great advice. Well I can’t believe we’ve come to the end of another podcast, we could talk about this all day! Thanks Paul, we’ve had some great conversations since we met in 2017. We’ve talked about Nurse &Midwife Support today; mental health, suicide and the barriers for nurses and midwives accessing support. We’ve talked about stigma, the research, we’ve provided some strategies for overcoming stigma and the elements to supporting nurses and midwives at risk of developing mental illness and suicide. Paul, do you have any final words of wisdom for our listeners?

PM: Wisdom? No. But look, good luck out there. We know it’s a difficult job. You deserve to be cared for.

MA: Thanks Paul. If you found this podcast useful, please share it with other nurses, midwives, graduates and students. Feel free to rate us on whatever platform you’re listening on. That will help to elevate us and for other people to actually find our podcasts. This is important, because your health matters. Look after yourselves and each other, we’ll have some information attached to this podcast that will provide you with access to Paul’s blog, his website and indeed some services that can support your health and wellbeing. Take care, and I’ll speak to you next time.