Get Real: Talking mental health & disability
Get Real presents frank and fearless conversations about mental health and disability, including people with lived experience, frontline workers in the sector, as well as policymakers and advocates. Get Real is produced and hosted by Emily Webb and co-hosted by Karenza Louis-Smith on behalf of ermha365 Complex Mental Health and Disability Services provider (https://www.ermha.org/).
Get Real: Talking mental health & disability
Complex Needs: supporting people experiencing significant service gaps
The basis for this conversation is an important pilot service in Victoria called Assertive Outreach and Support (AOS), funded by the Department of Families, Fairness and Housing under its Multiple and Complex Needs Initiative.
ermha365 and ACSO Australia deliver the service in parts of Melbourne and regional Victoria.
Our guests for this episode are Cassandra Turnbull from ermha365 and Psychiatrist Dr Debra Wood, from Clarity Healthcare, who provides clinical governance for the team.
As well as hearing about why there is a need for this program, you'll also hear about what it takes to work in this space and Cass and Debra's experiences.
We recorded this at the Complex Needs Conference in March 2025.
ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.
Helplines (Australia):
Lifeline 13 11 14
QLIFE 1800 184 527
13 YARN 13 92 76
Suicide Callback Service 1300 659 467
ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.
We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.
Get Real is recorded on the unceded lands of the Boon, Wurrung and Wurundjeri peoples of the Kulin Nation. We acknowledge and pay our respects to their elders, past and present. We also acknowledge that the First Peoples of Australia are the first storytellers, the first artists and the first creators of culture and we celebrate their enduring connections to country. Knowledge and stories celebrate their enduring connections to country knowledge and stories.
David:Welcome to Get Real talking. Mental health and disability brought to you by the team at Burma 365.
Cass Turnbull:Join our hosts, Emily Webb and Carenza Louis-Smith, as we have frank and fearless conversations with special guests about all things mental health and complexity with special guests about all things mental health and complexity.
Casey:We recognise people with lived experience of mental ill health and disability, as well as their families and carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.
Cass Turnbull:It's in everyone's best interest, including the community, to support and build people's capacity to be able to engage with not just the service system but society. We're working with people that sit in a corridor between the justice system and the mental health system.
Dr Debra Wood:I'm very focused on how can we tweak this system of supports, or should-be supports, around this person to go the next little step towards perhaps getting them housing, mitigating their risk in order that they can go to a supermarket, stabilising the NDIS supports around them.
Emily Webb:Welcome to Get Real talking mental health and disability. I'm Emily Webb. This episode is about supporting people who experience significant barriers to accessing services for their daily living. The basis for this conversation is an important pilot service in Victoria called Assertive Outreach and Support, funded by the Department of Families, Fairness and Housing under its Multiple and Complex Needs Initiative. Irma 365 and ACSO Australia deliver the service in parts of Melbourne and regional Victoria. Our guests for this episode are Cassandra Turnbull from Irma 365 and psychiatrist Dr Debra Wood from Clarity Health care, who provides clinical governance for the team. As well as hearing about why there is a need for this program, you'll also hear about what it takes to work in this space and Cass and Debra's experiences.
Emily Webb:We recorded this conversation at the Complex Needs Conference in March this year. We're at the Complex Needs Conference in Melbourne. It's day two, the conference is sold out and there's some awesome energy here. Cass, Debra, welcome to Get Real podcast. Thank you so much for your time. What have been some of the highlights of the conference for you both so far? Cass, you were here yesterday. What have you thought about it?
Cass Turnbull:It's been such a busy but inspiring day and a half. So far it's been fantastic.
Emily Webb:And you did a panel about assertive outreach support yesterday. How did that go?
Cass Turnbull:Yes, we did so. Together with our colleagues from DFFH and AXO, we talked through the journey of an AOS client to really illustrate who an AOS client is and what it looks like on the ground, supporting them day to day. And Deborah.
Emily Webb:I know you've just arrived, but what do you think so far?
Dr Debra Wood:Yeah, I had the privilege of attending the panel this morning chaired by John Fain and where the conversation was around Indigenous cultural safety, so it blew my mind. The conversation was around Indigenous cultural safety, so it blew my mind. Eminent speakers, I am touched by the kind of personal nature of the conference and I notice, even within the attendees there's a vibe that I've not felt at other conferences where there's usually a sense of ticking a box. You know, I get the real sense that this is a real energy.
Emily Webb:Yeah, I think the energy's been pretty great. A lot of people have been commenting about it. So this conference came to be from the work that Irma 365 and AXO Australia is doing in the complex needs space. The Assertive Outreach Support Service, which we call AOS, is a pilot funded by Victoria's Department of Families, Fairness and Housing, DIFA or DFFH, and works with people who are referred to the program by the Multiple and Complex Needs Initiative. Cass and Deborah, let's find out about you both before we talk about AOS and your work with Irma365's team. Cass, tell us about your work. I'm always interested in how people come to work in the mental health sector. You've been with Irma for a while now.
Cass Turnbull:So I have been with Irma for just over 10 years now. I started off, funnily enough, in a pilot program supporting people who were frequent presenting to emergency departments and experiencing chronic homelessness. That really ignited a passion for a highly vulnerable cohort. I was early on in my career and from then on it really progressed from there.
Emily Webb:And Debra, can you tell us about your practice as a psychiatrist doctor and your specialisations?
Dr Debra Wood:I'm what they call, in the field a dabbler. I'm what they call in the field a dabbler, trained firstly as a psychiatrist and I ended up working in the forensic area. So I was six years working mostly in maximum security prisons, and then had a career and midlife crisis retrained as an emergency medicine physician, and I suffered burnout, mostly through workplace violence, and so for the last two years I've gone back to my roots and I'm back doing psychiatry, but my passion is in psychotherapy, but I can't help but feel that there but for some good fortune, I might have gone as well. I was homeless in my teens and I can't get out of my mind either a conversation I had with a mum of a young 18-year-old who had schizophrenia. This is going back more than 20 years and she said it's like a living death. This young man, who was this gorgeous, gregarious A-grade student, had very severe schizophrenia and was about to become homeless and I thought you know, we could all be that person. We could all be that mum.
Emily Webb:Debra, can I ask? You said you were homeless in your teens. What happened then, where you followed the educational pathway that you did?
Dr Debra Wood:Well, this was back in the day where universities were free. I had been singled out by the state school system as one of those quote unquote gifted kids, and so everybody said you should do medicine, and I was accelerated through school. But I thought that gets me a profession. It gets me a guaranteed income and a guaranteed profession, and so I. It wasn't probably what I should have done, but it's what I did for pragmatic reasons, and the first three years of my degree were paid for by the government, and then I had to work and put myself through the rest.
Emily Webb:That's some going and it's really powerful. What you said about, yeah, but for the you know fortune or what's the saying? The grace of God, I mean, you know, I'm just saying that because that's what you hear, but yeah, it's like any of us could have that happen if there weren't certain circumstances. Yeah, I think being at the conference really highlights that for me, that there's just so much going on in people's lives. Cass, can you give us an overview of how AOS came to be and the intention of the program?
Cass Turnbull:So AOS kicked off in July 2023 as a 12-month pilot, then was extended in its pilot form, and what AOS is really aiming to do is to engage people who are deemed an unacceptable risk to community, as well as experiencing significant service gaps, so they're highly disengaged from the service system and often, as Deb said earlier, experiencing potential multiple diagnoses and challenges that prevent them from engaging with the service system that they so desperately need. So our aim is to really, yes, bring the service system and the client together. So often it's building the capacity of the service system around the person to respond in a meaningful way, as well as having the person feel heard and understood, and that timing as well correct timing to be able to deliver supports when needed is really important.
Emily Webb:And you explained a bit about who the people are that access AOS or are referred to AOS. Can you go a bit? What would someone in the AOS program? What would be happening for them? I guess I know that everyone's different. Nothing would be the same. So, cass, I'll ask you first, and then Deborah, I'd like to get your thoughts because you work with the AOS program and we'll talk a bit more about that.
Cass Turnbull:AOS work with people who have come in frequent contact with the criminal justice system. They often have substance use disorders as well, and not in all cases, and the way that can impact people really varies from person to person. Often they are transient as well, so often experiencing chronic homelessness, and I think it's really important to say, whilst there are people in our community that experience a lot of those complex issues, a lot of the people that we support actually the majority of them have service-wide bans because the service system is exhausted from being able to respond or they're deemed too high risk, which further prevents them to engage with the support they need.
Emily Webb:Debra, you work with the ermha team doing the AOS program and it's a good collaboration. How did you come to be working with the team and what is it that you support them with?
Dr Debra Wood:So I work with Clarity Healthcare as a psychiatrist in North Fitzroy and Irma had approached Davis Lemke, who's our CEO, about some clinical governance or clinical supervision, and I think I happened to be in the corridor at the right time. There are only three psychiatrists there, one of whom has a great deal of experience working with a homeless team in London, but he was happy for me to participate in this as a pilot. I think I have experience in forensic, in drug and alcohol emergency services. I've done some administrative psychiatry and worked for mental health review boards and tribunals, so I think I'm the hack who's dabbled. I've done some administrative psychiatry and worked for mental health review boards and tribunals, so I think I'm the hack who's dabbled in lots of different areas, and that mirrors some of the service systems that our clients are involved with.
Emily Webb:And Cass what's been the great benefit of having Debra on the team.
Cass Turnbull:It's been quite significant in so many positive ways. That benefits not only the staff, the wellbeing of the staff and the practice of all of our AOS practitioners, but also the outcomes of the people we support. I think Deb is a great fit for AOS and Irma and all the experience that you bring to that space. So I think it's also that clinical lens with the day-to-day that can be really practical. So we meet with Deb twice a week and staff will bring the people we support and some of the challenges that we're experiencing to really put it on the table and get Deb's recommendations and advice and often support just around the day-to-day work.
Emily Webb:And with the people that AOS supports. And at this conference we've heard a lot of stories about really great practice, some of the challenges, innovative thinking and people who are at this conference. They want better for people with complex needs, they want systems to work better. They want more recognition of how complex it is to work with complex needs. But in the general community there's really not a lot of goodwill for the people that say AOS would support the cohort that we work with in this space. And we hear it from media, politicians on social media, that a lot of the time people with complex needs should be given nothing like no sympathy. Who cares? I'm just pricing that, lock them up, get tougher, and we're seeing that happen with bail laws and things like that. I want to unpack this more because it's not just about helping the individual. There's a bigger picture. Deb, I'd like your thoughts first, because you've worked in prisons. You've worked in prisons, you've worked in public hospitals, in emergency departments. You've pretty much seen it all.
Dr Debra Wood:What are your thoughts about that? I can sympathise with the general public who are seeing episodes of violence or unacceptable kind of public behaviour, for example, exposures or verbal abuse. I don't believe that the lock them up, give them nothing. Strategy works, because I've worked in prison and they do eventually come out. So the way that I view this space is that the community is also our client.
Dr Debra Wood:We have the client who's been referred to Irma In my mind. Our clients are that person also, and the general public and the services that are interacting with them, which includes emergency services such as police and ambulance. It includes Centrelink, housing, council, child protection. All of these services that our clients are needing to interact with are also our clients in my view, and so I don't hold a view that we just, you know, send them on a trip to Hollywood if that's what they feel like. It's not like that. You know, what the person thinks they want isn't always what they get. Sometimes they don't get it because they should get it and it would make a difference. Sometimes they don't get it because they should get it and it would make a difference. Sometimes they don't get it because that's just not how the world works and Cass.
Emily Webb:What about your thoughts about that? Because I guess, working in the mental health space and with the people that you do, you've got a passion for it. You know the public opinion and community sentiment can play a role in how you're able to support people. So what are your thoughts?
Cass Turnbull:I think it's really important that I touched on it earlier just around hearing somebody and tailoring the support to someone's life and what their experience is. We all want to feel heard heard. That doesn't change for someone experiencing complex needs or if they're, you know they're going through a tough time. I would also agree with deb in terms of it's in everyone's best interest, including the community, to support and build people's capacity to be able to engage with not just the service system but society. We're working with people that sit in a corridor between the justice system and the mental health system and they don't quite fit any box, and nor should we. We shouldn't fit into a box, but they do. They sit in this corridor that is unsupported and it's in everyone's best interest to be able to build capacity for this cohort to contribute to society in a meaningful, positive way and engage in life and what that looks like for them.
Dr Debra Wood:The other thing I'd add to that, emily, is that it's in the interest of all of the services that service all of us Centrelink, banks, supermarkets that this group is catered to, because this is the one person who ruins your day. If you're a GP receptionist, if you're a council worker, this is the person that comes in and makes you not want to come back to work tomorrow. If we can actually provide services for this group, support them in you know there's a myriad of ideas we have around that then that makes it better for everyone, including the regular service systems.
Emily Webb:Deborah, I want to go back to something you mentioned earlier that you'd retrained in emergency medicine, which is amazing, but you left because of burnout due to workplace violence. So you know what you're talking about here and what you said is really powerful. Do you want to add anything about that?
Dr Debra Wood:I once said to one of my senior nurse colleagues in emergency who was built like the proverbial, like a very big unit, and I said to him do you what? I felt safer working in prison than I do working here? We tolerate worse behaviour in this emergency department than I ever saw tolerated in prison, and his eyes popped. And so I think in services that are front facing, that are public facing, particularly if we're talking about social services, there's a lot that gets tolerated and I think it's a bit like you know the boiling frog it gets incrementally worse each year. And I think there's a culture within services which is a bit like we were talking with cultural safety. That's a bit tokenistic. It's like, oh, if we put a massage chair out the back, if we give you a yoga ticket, if we teach you square breathing, then you should be able to cope with this, Like what's wrong with you, and the implicit message is that it's the worker that's the problem. You should be able to tolerate this and I push back very strongly against that.
Emily Webb:Now, thanks for sharing that. I think about workplace safety and workplace violence a lot since working at Irma 365, but also I've got daughters, teenagers, who both work in customer service jobs. Both have worked at a well-known fast food establishment and the older one has worked at a supermarket for a couple of years now and some of the stuff that happens there is pretty scary. And these are usually no one's older than like 19 who is on shift.
Dr Debra Wood:So, for example and Cass is a better person to speak of specifics but sometimes people go into Centrelink offices and they totally lose their proverbial because they came in yesterday and they were told to come back today and whatever was supposed to happen isn't happening and so they lose it and it's incredibly distressing for the person, the staff, the other people who are witnessing that. And sometimes it's as simple, as you know if we had a worker go in who established beforehand that that thing wasn't available, then we can avoid all of that. We can say, well, tell us when it is available and we'll bring this person back for an appointment rather than have it go unchecked. It's just a simple example of how you know, tailoring services to this particular group can avoid a lot of grief yeah, sometimes it's obviously the behavior is not great, but why is the behaviour happening?
Emily Webb:Are the systems? Are the structures not supporting a best outcome? I guess is what I'm trying to say, and it's always blame the person or blame the worker, as you said. Deborah, you're right.
Cass Turnbull:There is always a why. I think it's really important to acknowledge this is really difficult work and at times there can be potential for quite high-risk situations. But it's important to acknowledge that and here at Irma we genuinely walk the talk safety first, last and always. But it's important to acknowledge that and we've been very fortunate to be able to put additional supports in place for the psychological safety of our staff. That includes consultations with Dr Deb that their occupational violence is not to tolerate. Being sworn at and calling it for what it is. It's occupational violence. It's not ohs, it's not whs, and what I mean by that is simplifying it into an acronym, because it can be really serious. It can affect someone's long-term mental well-being. We have a responsibility to our staff to ensure their safety, but not minimizing. Minimising that it's acknowledging. It's there so we can put in strategies to help mitigate and manage but, importantly, support the staff. They're human beings and it's really important to put that on the table.
Emily Webb:Yeah, I think that's really important. I mean, the staff are amazing, but they're not superhuman, are they? It's not like Teflon, it's just take it, it take it and and yeah, irma's done some really interesting work in this space where we're challenging the ideas about workplace violence. Oh, it's part of the job, or you know, I don't want to report it, I don't want the client to get in trouble. It's been a really interesting piece and I want to move on further from that, because you did say, this work is hard and frustrating, heartbreaking, probably also satisfying. But how do you both hold out hope for the work that you do? And, deborah, I want to go back to something that we talked about when we were discussing doing this podcast. You know know about bringing awareness to some of the challenges within this work that is not spoken about, and also sustaining the workforce. So, yeah, could you talk about that please?
Dr Debra Wood:In terms of hope, because I'm not a front face worker for Irma, I'm doing a clinical supervision role and so I think that makes it a lot easier for me. And the way that I think about it is what is the next little step? So I'm very focused on how can we tweak this system of supports or should be supports around this person to go the next little step towards perhaps getting them housing, mitigating their risk in order that they can go to a supermarket, stabilising the NDIS supports around them. So my focus is very much just on the next little step and it's quite process focused rather than outcome focused. The other things I think that are on the periphery is an awareness, but not necessarily spoken about is that not every client is going to have a good outcome.
Dr Debra Wood:A, b. Sometimes a person might end up back in prison and we don't necessarily regard that as a catastrophic failure. Sometimes and I'm not trying to be an advocate for incarceration, but what I'm saying is that sometimes that is the only service that can stabilise somebody enough, keep the public safe enough in order for us to have a chance to engage with the person such that next time when they're out we have a chance of having a different outcome, and that's the controversial thing for me to say. We're supposed to say prison is toxic, it's irrevocably bad, it's always a bad outcome. So I guess what I'm saying is I consider the community to be one of our clients and we have a criminal justice system for a reason.
Emily Webb:Cass, what about you? It's tough, but how do you, I guess, hold out hope for the work that you do, sustain the workforce but also balance that being realistic about what you do?
Cass Turnbull:Being able to work collaboratively in what can be a really complex service system to navigate is really important. But, as Deb said as well, sometimes prison court provides us a safe place for our staff to go in, get in front of somebody and start to build that rapport, and it's those little glimmers of not going into prison, but those little glimmers of being able to engage somebody in a way that's meaningful for them. These are people that extremely distrustful of the service system, are often traumatised by the service system, and we're providing a service to help, to support them in a life that's meaningful for them. So I think, by holding out hope, I think it's focusing on what the purpose of the work is and what we're aiming to do. But the reality is we're not going to have extraordinarily positive outcomes for everybody. But that doesn't stop us from trying, because the benefits are huge for the community but also the individual.
Dr Debra Wood:The only thing I would add to that and it's kind of taking the conversation a bit sideways is the idea of complexity. I was struck by cass's comment earlier in the conversation about the services that a person so desperately needs, and I was thinking the person themselves probably doesn't think they desperately need them in fact, any at all. So we somehow need to find a way of bridging this gap between what the social system provides including a service such as Irma to try and link people in and what a person feels that they need in order to live as cast so eloquently put a fulfilling life, which I think is really what we're hoping for, and I think that's a space that needs a whole lot more research and conversation.
Emily Webb:For this podcast. Corenza and I will often ask our guests what works for them looking after their own wellbeing, their own mental health. So what do you both do to fill your cup? Take care of yourself. Just get a bit of respite. Cass, I'll start with you how do you take care of you?
Cass Turnbull:It's a really important question to pose, I think, to everybody in the sector, but also just-being in general and what you actually do, but with intent behind that sort of, as Deb alluded to before, it's not going to a yoga class once and it all will be okay. I think it's cumulative and it's part of practice that you need to consciously integrate, and I don't always get it right. I don't think anybody does. If there's anyone out there that does, please let me know. However, I think what I do is I do practical things by asking myself at the end of each day have I done everything that I can before I close my computer or before I finish that you know that contact or that appointment with that person? That's something that I do every single day, but also tasks like I really am a bit of a nerd here. I really enjoy building Lego and I've recently picked up building book nooks, which are book nooks.
Emily Webb:Tell me more.
Cass Turnbull:You build them. Often you can buy them at a game shop and it's what would you call it a book nook that goes into your bookshelf and it looks like a little world. So I built one that looked like the Harry Potter Diagon Alley and you can light them up and it looks like a little world within your bookshelf. Oh my gosh.
Emily Webb:I love it. Cass and Debra just high-fived. You can't see that, but I wish you could have. That is so awesome. I absolutely love that. Now, debra, I want to hear from you. I don't know if there's Lego building in your life, but how do you look after yourself and what works for you? I guess it changes, doesn't it? Life's life changes, so what do you do for yourself?
Dr Debra Wood:I'm so boring. By comparison, I think I'm getting much better at this as I get older, and there are a couple of reasons for that. One is that I feel less indispensable, which I think is to say that my influence on a particular person or on a particular team is less than I might previously have thought it was, and so that released me of a great deal of pressure. I'm also much better now, after several years of therapy, at looking after myself and having mindful practices. So I live in the country on acreage and, yes, I have a chainsaw, yes, and also I like to stay learning. So I've got a history degree and my latest thing is, after finishing my gestalt training, I've started doing training in inner relationship focusing, which is the bee's knees.
Emily Webb:Can you just explain what gestalt therapy is?
Dr Debra Wood:Yeah, in a nutshell, it's a psychotherapy and philosophy style that emerged in the 1950s by some psychoanalysts who repudiated psychoanalysis almost wholesale, and it was born from a humanistic movement. So it came from that idea of the human potential. You know, we all have potential for growth. We are oriented towards growth. If only we just got out of our own way. And so Gestalt as a psychotherapy is very oriented in the here and now. You know what do I do? That just avoided that difficult emotion over there. Did I even notice? I did that, for example.
Emily Webb:That sounds like something I need to be honest, I can't lie like get out of my own way, something to make me notice things. Phyllis, I'm interested. What's your history focus? What particular areas of history are you passionate about?
Dr Debra Wood:I love modern history because I love the materials. I like to still be able to use written materials. I wrote my honours thesis at the University of Melbourne on why the big old mental hospitals in Victoria closed. At the time it was very fashionable to blame Geoff Kennett, but in fact it all began in the 50s and the 60s as part of a worldwide movement.
Emily Webb:I must read that. And yeah, Jeff Kennett does get blamed for that all the time. Right, the Kennett years. But that sounds really fascinating. Now we're going to wrap up soon so you can both get to some sessions, and I'm very grateful for your time. Have you got any final thoughts before we say bye-bye?
Cass Turnbull:I think it's really important that, yeah, there is always a why and to tailor support regardless of someone who might be identified as complex, whatever that looks like for them, or defined as complex by the service system. The Centrelink example that Deb gave before is fantastic. So these are things that are small, or seemingly small, outcomes that can have quite a significant impact for the person as well as the staff at Centre Link and the community. So that why is incredibly important, but also, from a workforce perspective, really putting on the table the challenges of this work and some of the additional supports that our staff need to be able to sustain this work but also support each other, build on their practice, look after themselves, Thanks, Cass.
Emily Webb:And what about you Deb? Any final thoughts?
Dr Debra Wood:Final thoughts about the conference are that this is the first conference I've been to where the keynote speakers have been in jeans and runners, so to me that's like five stars.
Emily Webb:I love that because I was a bit worried about what I was wearing. Because I just wanted to be comfortable, I've got my like bamboo black pants on and I was like, yeah, everyone's just rocking their own style here. So I'm all for that. Deb and Cass, thank you so much for your time and, yeah, we will speak again.
Cass Turnbull:Amazing. Thank you.
Dr Debra Wood:Thank you for having us.
David:You've been listening to Get Real talking mental health and disability, brought to you by the team at Irma 365. Get Real is produced and presented by Emily Webb, with Carenza Louis-Smith and special guests. Thanks for listening and we'll see you next time.
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