NADP Colleagues: Orania Tokatlidis, University of Melbourne, Australia

NADP works closely with our colleagues and  partners to network, share information and support our members. 

This episode finds Lynn Wilson from NADP chatting with Orania Tokatlidis from the Counselling and Psychological Services at the University of Melbourne, Australia. We find out how Orania and her team have developed the support that they have offered during Covid and their plans for the future.

Transcript

NADPVIC2021: Joining the dots of inclusive practice – what is the picture now?

NADP Podcast: Talking to our Colleagues

Lynn Wilson in conversation with Orania Tokatlidis from the University of Melbourne Counselling and Psychological Services about their service and their experiences of lockdown in Victoria, Australia.

Lynn: Welcome to the eighth in our series of NADP conference podcasts, these podcasts are a series of interviews where we aim to get to know our colleagues and partners and learn about their experiences working in our sector. Today I'm talking with Orania Tokatlidis from the University of Melbourne Counselling and Psychological Services. Welcome. 

Orania: Welcome. Lynn, thank you. 

Lynn: Okay, can you tell us something about yourself and about the role that you play in your institution where you're working?

Orania: Yes. So, Counselling and Psychological Services is a standalone counselling service at the University of Melbourne, and we're a pretty large university, we've got about 70,000 students. We have a reasonably large counselling service, if I add up everyone there, we've got about 30/31 people that work in the Counselling and Psychological Services Unit. I'm the manager of that unit, I'm a clinical psychologist as well, and I've been working in the tertiary sector for at least 20 years or so now but previous to that, as I said I'm a clinical psychologist, I really worked in the public mental health area both hospital and community based and a lot of mental health training previous to that so, yeah. 

Lynn: Is that a general role for universities in Australia, they have their own psychology teams, or do they usually buy in?

Orania: Most of the universities in Australia would have a counselling service. Some are connected to a health service so it might be a health and counselling, and some may be health counselling and disability services, but a lot of the universities have historically just had a standalone counselling service.

Lynn: That's a very different model from the UK because most universities are buying in their counselling services. Some, I know of a couple I think, that still have counselling services, but it must be nice to have that connection with the university. So, do the students get to refer to you from the university, or can they all self-refer and access your service?

Orania: Yes. We work on a model of not having any barriers to accessing the service. So, 99% of the students who come to see us would refer themselves, and they would just go online and book or ring us and book an appointment. We do have, sometimes, if there's really serious concern from academic staff members or, other areas like the student centre, they may contact us and say, “We have someone here who, it's really urgent they are seen” and just make sure they get priority, seen on the spot, or on that day. But, most, as I said, the vast majority of students would refer themselves, and we ask students “Did someone ask you or someone recommend that you come?” and sometimes they say “Oh well yes, my lecturer said that it would be good”, but again, even there, they say it was their own choice and we really hold that line that if you don't make the appointment, there's no buy-in. The student has to buy-in that this is going to help them, and it's going to give them something. Be of benefit to them and therefore they need to be the ones that want to come. 

We don't have mandated referral at our service. Nobody gets told you have to go and so it is about choice. It's about you deciding you need some help, and us making it easy to get in. So, we have a model that opens up new appointments every day. So usually, for the next day, for up to 24 hours ahead. This is so anyone who wants to come in, can come in easily. Once you're into our system then you and the counsellor can work out what's happening, what help do you need. Is it better to try and find somewhere else for you that does longer-term work or a specialist referral? Or is it something we can deal with in 3, 4, 5, 6 sessions, maybe? And that way, by keeping it in a more of a shorter-term model, it means we get a lot of people able to access it very quickly. I mean, we'd love to be able to offer more sessions than that, but then that would stop the through put that we need because it's a big university. It's about 70,000 students. 

We also see a few staff.  Members of the university have an employee assistance programme, like an external counselling service, that's available to them, but we also make ourselves available and have historically always seen staff as well. They would be a very tiny proportion of our appointments, maybe you know 4% or something. But staff get a choice. So, they can see us, and they can go to the external service. A lot of them do go to the external service, but a small number just choose to come in to see us as well. So, that may be different too. Yeah, a little bit of how other systems work. 

Lynn: I did a big research project with NADP last year on the wellbeing of disability staff at universities, and one thing that came up on the results was a marked difference between the treatment for students and the staff. And that sounds like a wonderful compromise you've got there in the fact that they can come on site and see you, but if it’s something they don't want recorded by the university, they can go externally. That is… that shocks me! I think that is a really great solution, a really good way of doing it.

Orania: Yes, and I think the other thing that helps with that is we have a standalone health service. We have a standalone disability and support unit as well, but we are all part of the wellbeing suite of things that's offered to the university. The other thing that's important with all of that is we have our own clinical appointment system and our health services have the same. So, the appointments are not put on the student enrolment records. That’s real confidentiality, you know, keeping separation so that people, our staff, and students feel confident that coming to see us is not recorded on any sort of central university appointment system. We have these separate systems too and I would say one of the biggest comments we get… questions we get is “Is this confidential from the university if I’m seeing you? Is this kept separate?” and it's just reinforcing that this is a confidential service, as is the health service and we don't release records to the university about who's attended or anything. Obviously barring any immediate major risk issues, but other than that, no it's very confidential.

Lynn: Well, that’s great! Well things must have been a bit different in the last year, I know COVID has been handled really well in Australia. With my wife being Australian, I've kept up with what's been happening in Victoria, especially. But Victoria has had lockdowns. So, how has that worked for you and your team? And how have you been able to continue to support students? 

Orania: Yes, like many services in many universities, it was a very sudden ‘everyone has to work from home from tomorrow’ basically, last year. The university supported us, so we were able to take a lot of our equipment home: monitors, computers, office chairs, a whole bunch of equipment, because we knew it was going to be quite a while that we would need to stay at home. So that was one of the things. They also supported us to make sure that all our systems worked in a totally online capacity and, as a counselling service, we didn't really have online appointments before this period. But that first week in March when all of this was happening, we worked very hard with our IT services and our clinical system, it's called Point and Click, but we worked really hard for a few days to get everything converted to work online so students could book online, and we could do all our clinical work online in a secure way. So yes, I feel like we were supported. We did set up everything, and we did end up working from home for a long time. 

Here in Melbourne, Australia, we've had four lockdown periods. Now I know in the UK you've had much longer and sustained lockdown. Ours weren't as long. Since the start of this year, we've sort of slowly come back to working on site, but we've had a couple of brief two week lockdown periods. We're just coming out of one at the moment. With these brief ones, people haven't taken their whole office home because it's just a week or two. You think ‘I'll cope with whatever I've got’, but for the big periods we did. I had two monitors, I had my desktop, I had my office chair, I had everything from my office that I really needed, and so did most of my team. 

So, that's how it has been but we are back now like I said, we've just had this brief lockdown now but we're back working on site, and trying to incorporate all the good things we learned by working off site and working online so we can offer a blended model going forward where we may have things in person, as students return to the campus, but also retain the really good things that have worked well. It forced us to evolve and adapt to new ways of offering things. We moved our whole workshop programme to an online format, and we've had massive increases in attendance, people can attend workshops, sometimes more easily, if it is online. Obviously, group programmes, they've been okay, but I think that people would prefer to go to a group programme in person. We found that some of the staff mental health training that we do a lot of, the staff want to come in person and do the Mental Health First Aid training, for example. A lot of the students thus far are still enjoying doing it online. So, I feel like it's a transition, and it will take time. As things settle, we'll be much clearer about what is possible to do going forward. Right now, it's a blend of things, we're just starting our in-person appointments again; we're starting some in person mental health training; and a few workshops but the online offerings are still really well attended, so we'll certainly keep those going as well.

Lynn: We're finding over here that the number of no-show appointments has dropped dramatically because people are accessing from where they are. We are also finding that universities who have said ‘we can't offer out of hours appointments’ for evening students and people like that, because of the working from home, it's much more secure to actually be able to offer appointments in the evenings, if you've got evening students. So, some of those look as though they're continuing. 

How about confidentiality and things? I know I did some of my PhD research online and I had a big security backup for it in the fact that, if in the middle of a distressing conversation, the connection goes down, is it because the connection went down? Or is it because the other person's really upset and has cut the connection? So, we actually had a backup of, “if the connection goes down, we'll both email each other to make sure that everything's okay”. So, how did you manage that? 

Orania: Yeah, we have similar challenges. One of the things we've always made sure, at the start of every session, is we make sure we have a phone number so we can, if the Zoom or the online medium just falls down, we can always speak to someone by phone. Sometimes there's people who are international so we can still dial internationally to be able to connect to people. I mean if we need to, we can use email, but we generally don't use email because it's not as secure. So, we generally use the phone or the online platform that embeds security in it. 

But even with things like you were saying, it is challenging sometimes, because one of the things we found is that a lot of students don't live in places where they can have a private conversation. They may live in a crowded share house or in a family situation or they live with a partner. So, I do think that online is great for a lot of people but for some people it does actually add other challenges, and sometimes people are saying, “I'm talking to you from sitting in the car in the street, because that was the only private spot I could find”. 

The university has tried to open up, even during the very difficult lockdown periods, tried to open up some safe spaces for people who absolutely had to be somewhere else so that's also been a bit helpful. But yes, confidentiality, and how do you do all that, and how do you manage risk if someone's quite distressed and, suddenly they drop out. 

One of the other things we've tried to do is to get some emergency contact numbers and one local one of wherever they happen to be. If you've got someone in the room with you and there are some major risk issues, someone's quite suicidal, they're not coping very well, they're right there and you can kind of do things but when it's a medium that’s online, it's very difficult for the counsellor to be able to think of ‘what am I going to do with someone who's just disappeared off the screen who's highly suicidal’. So, having that security of having a local contact, which is very rarely, if ever, used and obviously with permission. The client gives us permission to do that, but it's just an added layer of if there is any major security risk or concern and the person disappears, we do have more to go with, in terms of being able to try and get help and find them and everything. 

So, it's a big learning curve for counsellors too. We've all had to learn how to do things differently and some of it has been really great. We will definitely be using it. For example, I know our disability service improved the applications for special consideration for adjustments system because of working online. They improved all of that and certainly they're keeping all of those improvements. It used to be quite a heavy process. People would come to your office, it'd be lots of paperwork to be printed out and scanned, and all of these things. Everything's improved quite dramatically because of the necessity and we're keeping a lot of those improvements. So, I think everyone's happier, and we can still do further improvements, of course. But we're certainly not going to go back to where we were. So, I think that's one of the positives of the whole thing.

Lynn: I think we're finding the same. Disability practitioners are reporting that assessments in particular, have more flexibility with different options rather than sitting three-hour exams in a big room which has been really helpful, and we really want to hang on to a lot of that for our students. 

Orania: One of the other things you mentioned about the no-show rate. The fail-to-attend rate has also improved a lot because what we find is in the online world, if someone cancels an appointment within five minutes, someone else has booked that appointment and they're able to attend. Whereas, in person, if you don't know till five minutes before that appointment is not happening, it's highly unlikely someone's going to walk in during that five minutes. Whereas online, people are constantly looking to see when's the next available one. And, as I said, we just see an appointment being cancelled online from the student, and within a minute someone else has got it. Someone else has booked it. So, it is very efficient in that way. It just allows those vacant spots that we couldn’t physically get anyone into the office that quickly to come in, so we don't waste that appointment. Now, people just online they will just book that appointment so that's really helped a lot too. Yeah.

Lynn: We're also finding in the UK that some students, and perhaps not always the expected ones, have really appreciated the lockdown and doing everything online, whereas others have really struggled. Now we've already mentioned that those who are at risk at home or in group situations will find it difficult to access counselling, but we're finding students on the autistic spectrum, there's quite a  high percentage who are saying, ‘Well this is easier for me. I can be more relaxed. I can listen to my lectures and actually think properly rather than being anxious, sitting in a lecture theatre”. And surprisingly as well, we've also found that Deaf students are appreciating it because if they're a Deaf sign language-user, they actually know their sign language interpreter is going to be there, and they don't have to negotiate their way into university without assistance. They can actually access it online. But others have really struggled with their mental health, not being able to connect with friends and family. Are you finding that a lot of people have struggled with mental health or are you finding that some are reporting benefits?

Orania: Look I think overall, most people have struggled and particularly this is our fourth lockdown here in Melbourne. So, I think for all of us, and the counsellors are struggling. We're all struggling, staff are struggling but there have been some benefits as you said, for some things like lectures recorded so you can listen to them is a good thing. The interpreter is there. Everything is there. So, what we're all looking forward to is going forward with some of those benefits still there, but really getting back to the connections because I do think for Melbourne, our university being very much a ‘campus rich’ experience university that their real aim is to try and make sure that people can come back and connect and I do feel for those students who started last year. 

So in Melbourne in Australia we work on a calendar year. So, the start of the year is February for us and the end of the year is November. Students last year, who it was their first year of university, they've really struggled because they've not had a chance to come on campus hardly at all to connect with people. If you already had done that the years before, you kept those connections. You could keep talking to your friends and connecting online, but if you're very new to the university, I do feel sorry for the students who started last year, I just feel like their experience has been quite different from any previous year and part of this opening up, again, is to create opportunities for those students. It's all those incidental things. It's after the class hanging around. It's chatting to people about the class. It's having a cup of coffee with people. It's bumping into people at the library or at the cafeteria, walking around campus. I think those opportunities for that kind of connection, have been very difficult for most people, but especially new students where they didn't have a chance to do any of that. 

Yes, but in terms of keeping some of the things that have worked well because yes, for some students, we've heard comments like, ‘I didn't realise how easy it is to learn when I'm not chatting to people in the class’, all of those other behaviours that if you're paying attention to something of course it's going to be easier to absorb the material. So I would say the vast majority have found, that difficult, a small group had found some things easier, and I would say that's across the board for even our counsellors. Some of the counsellors are saying, “I'm enjoying being home, and I can see the benefits of this in the long term”. 

I think across the board for most people, though, what made our university an outstanding experience was being there and doing all this interacting that's been quite difficult to do so. So yes, I'd say the vast majority of people have really suffered. We've had other groups, I mean I can give you some idea of, for example, graduate research students doing like a masters or PhD, mostly PhDs. They make up something like 7% of our students at Melbourne, and in terms of our clients they've made up 14% of our clients. So, it's like double their proportion on campus. So, I think they've really struggled. Some of them have been locked out of the labs. Their whole research is their lab work, and they haven't been able to get into their labs. Others, their research involves going away and doing observations and a whole bunch of things that they haven't been able to do. So, I think certain groups have really struggled with the whole experience of the last year. So, I think for all of them it will be better to come back and come back to in person.

Lynn: Yeah, well, we're hoping to get there too with vaccinations now, because you’re right, research students have really struggled here, not being able to continue their research. And our research councils who fund some of our research students have been offering extra funding and extending courses and things.

Orania: Yeah, one of the ways we've tried to support students too is… So one to one appointments is one thing, and attending a group programme, but it's also online resources. So, we've really spent a lot of time last year really sharpening up everything we had that is about supporting people who are going through stress, anxiety, and uncertainty. For example, one of the resources was a tip sheet we created that we had something like over 100,000 unique views of that tip sheet. We've never had anything like that before. So, it's things like that. It made us think that actually the counselling is great, we see 4000 or so students in counselling, but we have 100,000 looking at a tip sheet and it's open to anyone, so anyone can have a look. Counselling is one aspect of it but there's such a broad range of other things you can do with self-help resources, might be going to a webinar or workshop. So, you can support people in a number of ways. 

The university has tried really hard to provide things like extra funds for people who needed funds or food. We've had weekly food pickups at the university. We never really had that before but people who haven't been able to work or are stuck in some small apartment, things like picking up food every week has been a huge need that the universities tried to support students. So, yeah, there's a whole range of ways to support people. 

It is an incredibly unusual time, and we're hoping now with vaccinations everywhere that people can come back to, I have to say that Australia has been lucky we haven't had the extent of what's happened in Europe or in the UK, or North America. But even so, even 112 days or whatever it was our lockdown in Melbourne last year that was a really long stint of a very hard lockdown where you couldn't go 5k away from your house and were allowed one hour of exercise a day and that was quite tough for us here. But, I mean I do see what's happening in other universities and, I understand how for other areas it's been even more, as you said 18 months almost of living this way. So I do understand that speaking from an Australian perspective we've been relatively lucky in having quite contained numbers of COVID but also the cost of that has been very locked down borders. We've got students who are stuck overseas and can't return, students who had to go and visit a parent who was unwell last year thinking they'll be able to come back and they're still not able to return to Australia. So that's been a consequence for us where there's a lot of students that are still stuck overseas and can’t come back, or even they've enrolled and can’t come to start their course. So that's the cost benefit of closing borders and having, containing the spread of COVID in the country but at the same time not allowing people to come into the country.

Lynn: And it's been the same between states as well hasn’t it, in the fact that coming back in Victoria has been difficult too?

Orania: Yes, that's right. So, I'm not sure if that's happening elsewhere but our states here are very quick to close down. So these last two weeks Melbourne has had a few cases where COVID has gotten to the community through the hotel quarantine program, and quickly all the other states shut their borders and no one from Melbourne can go. So even now, you can't go to most of the states, if you're from Melbourne, you just can't go to South Australia, you can't go to Queensland, you can't go to Western Australia. So, it's very quick here to shut everything down and, yeah, so school holidays are coming, and I know a lot of people have got plans to go to warmer states for the winter school holidays here but at the moment it's up in the air, whether they'll be able to go next week. So yes, we're very good here about locking everything down quickly, which has worked I have to say, it has worked for us. Yes.

Lynn: Yeah, I can actually hear in my head, some of the voices from our delegates over here who would rather have a bit of a quicker lockdown over here too. But anyway, we'll move away from the politics slightly now otherwise I think I will start ranting! 

The other thing we're actually looking at now, and it might be different from you because you haven't had quite such a long lockdown as we have, is we're working here on transition back to campus. Now we're hearing reports that many of our autistic students and staff are saying this is going to be difficult and so, there's quite a few programmes going on looking at slow introductions to campus, coming in at weekends and coming in when no one's around, in order to ease that transition back in. Is anything like that happening in Australia? Because it's been kind of in campus, off campus, in campus for you.

Orania: It is happening. So most of the other states, they didn't have very big interruptions to their on-campus experience but Victoria, Melbourne where I am, we have had but even us this year some portion of classes started returning to in-person, particularly tutorials and labs. So, most people would have had at least one or two or three classes in person, and that was the transition path for us.

Obviously now we've locked down for two weeks, and everyone's had to go back online, but certainly in July/late July when second semester starts here, our university is looking at a majority of classes being in person. Now some of the other universities in Melbourne, RMIT, Deakin. Some of them are still saying well, ‘We will still offer a lot online, our transition will be more gradual’, but these last three months, what you're describing is what really happened here, where you would have had maybe two or three classes a week only in person, so it means you would have to come in for that. Obviously if you weren't able to come in, there would be an online equivalent, but part of it is to try and entice students slowly to come back and also make people feel safe to come back. 

For staff, lecturers and academic staff to feel safe and of course there's a lot of COVID safety in place. So every building has got a QR code that you have to scan when you're going to any building in the university. From a counselling service, we've got a couple of monitors in two of our rooms, and they measure our airflow. So they're measuring airflow, they're measuring carbon dioxide and part of that strategy is, as we start, we've only had one appointment a day in person in the last, well not the last two weeks, but just before that we were just starting to have people come for in-person appointments. But having the monitors there so we can measure how the airflow is working, because I think ventilation is a huge thing for people that have appointment-based services where you sit in a room with someone for up to an hour, 50 minutes to an hour. You want to know that the ventilation is actually doing the job it should be doing, because ultimately, we don't want to be sitting there. We want to get to the point where we're not wearing masks. So, that's something that I think is a really good thing for most places to consider. Getting some sort of ventilation monitors in there. I think that will make everyone feel happier seeing that ventilation is up to the job. Our rooms don't open, we don't have windows that open in our buildings, most of the buildings. Some other places do have a window that opens, that's great. So, I think those are the things. We've tried to do other things - like obviously there's sanitizers everywhere, and I think part of the gradual return is that we're not going to start up with 50 appointments in person in one day, we're going to have maybe five or a small number, see how that works. Make sure everything's working well and everyone feels safe, and then we can slowly build up. 

I know with the classes they're really careful. If there's 15 in a tutorial, they've got a massive room. Everyone can be safely spread out. I think the lectures, probably that's one thing that won't come back, nobody's going to sit in a lecture hall with 800 other people. I think that has had its day. So, I think all the lectures are recorded as they have been for a while, and some people may choose to come and it's a big auditorium and that might have 20 people in that's fine, but it's the tutorials, the labs, the practical classes, they're the ones that they are trying to make sure they've got enough space for everyone there, and if need be to wear masks. I think that's fine. So, I think that's what's going to happen and just gradually building that up and encouraging students to come in. I think that at the end of the day we all want to get through this and have some better system in place and I think, at counselling, we’re obviously available to see anyone who may feel that for them it's a particularly difficult thing to come back, and we could do online appointments with them and see what's happening there. Is there anxiety there? Some people may have other reasons, they may have medical reasons that they can’t come back, that's okay we can work with all of that, and there will be the online component of course, but the university is really trying to encourage people to come back and make sure we can practice in a safe way and really have that community that's there. 

The student associations are really working hard to try and have lunchtime free food, barbecues and music to try and encourage people to just feel comfortable and safe and do what universities are known to do. It's a great place to meet people, to connect to people, to join things. So that's what we're all working towards and how to do that so that we’re all safe, including staff, students, and everyone else. I think that is the challenge, but yeah that's what we're working towards here in Australia.

Lynn: One final question, and this one is about you and lockdown. How's it been for you? Have you changed the way you do things? Have you any insights into what you actually like best now? 

Orania: Yeah, I found that I can work from home, and I can see that there's a bit of benefit some days in doing that, but I actually really like going into work. I found that there's something about really good boundaries when you leave your home, and you're in your workspace, and then when I leave work, I can just finish everything and just leave. And I found that working from home, it just blends everything in so it's like you're never fully at work, but you're never fully at home, it's just always there. So, one of my insights has been that if I had the choice, I would like to be in a workplace, and it's the incidental conversations in the corridors, in the tearoom, having lunch, having a coffee with people. I mean, I find that really energizing I realized, I mean I sort of knew it, but it really heightened it for me, that yes, obviously we want to be safe but if we can be safe and be at a workplace, I get a real buzz out of being at a workplace. So, it's really just highlighted that for me that there is something really nice about, being able to do that. I enjoy being with my team members, and yes we have meetings and all of that stuff when we're working from home, but it's, as I said it's the incidental stuff that is really nice and I really miss that. With so many psychologists in our service, I mean everyone could work from a private practice way they could be at home just doing private work, but they choose to be part of this service because they like being part of the team, and I just think that is harder to sustain in the longer term if everyone's working from home, assuming that was possible. You’re part of that service because you like working with other people, you enjoy that, you enjoy the interactions, you enjoy being able to do things together, and so, I think that I'm looking forward to doing more of that when we're back fully. Yeah.

Lynn: Thank you, that's been really interesting finding out the way you've been working, I really appreciate your time. So pleased that we managed to find a time that worked for both of us with our slight differences between the Australian and UK time! So, thank you very much.

Orania: Thank you Lynn. I've really enjoyed chatting to you as well. Thank you. 

Contacts and Resources

https://services.unimelb.edu.au/counsel/home