Mental Health In The Top End with Geoff Radford, CEO NTMHC

Geoff Radford is the CEO of the Northern Territory Mental Health Coalition who joins us for this episode from Darwin.

The coalition is the peak body for community-managed mental health services across the Northern Territory, also known as the NT, The Territory or  the Top End.

The Northern Territory is a unique part of Australia and we find out why from Geoff, as well as what this means for mental health services in this vast region of the country.

MORE INFO:

https://www.ntmhc.org.au/

Enough Talk, Time for Action - award-winning social and emotional wellbeing program for Aboriginal and Torres Strait Islander men. 

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.

Transcript

Acknowledgement And Welcome

Speaker 0:00

Get Real is recorded on the unceded lands of the Boonerong and Warundjury 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.

Speaker 1 0:28

Welcome to GetReal, talking mental health and disability. Brought to you by the team at EMA365.

Speaker 6 0:34

Join our hosts Emily Webb and Karenza Louis Smith as we have frank and fearless conversations with special guests about all things mental health and flexibility.

Speaker 5 0:48

We recognize people with lived experience of mental ill health and disability, as well as their family and parents. 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.

Emily Webb 1:12

Welcome to GetReal Talking Mental Health and Disability. I'm Emily Webb. I'm so pleased that co-host Karenza Louis Smith is here too for our conversation today Geoff with g Radford, who is the CEO of the Northern Territory Mental Health Coalition. The Coalition is the peak body for community-managed mental health services across the Northern Territory, also known as the NT, the Territory, or the Top End. The Northern Territory Mental Health Coalition's origin story goes back to 2007, starting as a project role under the auspices of the NT's Council of Social Services in recognition of the specific and complex needs of its mental health sector. Now the Northern Territory is like no other region of Australia, and we will be delving into this with Jeff. In the organic way that most things happen in community and social services, six people from the sector came together, and from these beginnings, the Northern Territory Mental Health Coalition has grown and become its own entity. Now, Karenza, before we get into our conversation with Geoff, it is so good to be hosting with you. And it's a bit of an understatement to say that you've been extremely busy.

Karenza Louis Smith 2:30

Thanks, Em, and it's so exciting to be back co-hosting. I love GetReal. I've so missed it. Yeah, I've been a bit busy because I've become the group CEO now of our fabulous group, and uh there's been a lot of things happening and going on in our sector. And some of those things I think we're going to talk about on today's podcast. So it's awesome, Em. I love, I love this stuff.

Emily Webb 2:51

Yeah, we certainly will be getting into it now to our guest Geoff Radford.

What The NT Mental Health Coalition Does

Emily Webb 2:56

Welcome, Geoff.

Geoff Radford 2:57

Thanks so much for having me on.

Emily Webb 3:00

So, firstly, so listeners who may not be completely across the vastness of the land known as Australia, Karenza and I are in Melbourne, Victoria, and the distance between us and where Jeff is in Darwin, the capital city of the Northern Territory, is around 3,800 kilometres. So it's big. Jeff, firstly, tell us more about the Northern Territory Mental Health Coalition and your role.

Geoff Radford 3:27

Great. So the NT Mental Health Coalition, as you said, has been around for a decade or so and is largely focused on advocating for the rights of people with mental ill health in the Northern Territory. It's a community-managed organization that's member-based, that's made up of organizations that are delivering mental health supports around the territory. So we've got 28 of those, I think, and some of the mainstream providers who have mental health as part of their suite of services, some who are focused on just mental health. And we've got NDIS providers, we've got Aboriginal community-controlled organizations and a social enterprise. But what they all have in common is the need to advocate for greater supports for people experiencing poor mental health. And unfortunately, in the territory, there's a range of factors that mean there's lots of people who experience poor mental health and aren't getting the supports that they need.

Karenza Louis Smith 4:20

I think that's really interesting, isn't it, Jeff? And I'm going to come on because we like to get to know our guests a bit. So I've got a few questions to ask you. But Em, you said something really interesting that, you know, Darwin in the top end is really quite different to other parts of Australia. And you're absolutely right. I mean, obviously I'm English, I've got a British accent, I've been here 27 years, and Australia is so massive, it's like different countries within one big, huge country, or in our case a continent. So I think as we start to have the conversation, Jeff, I think it'd be really good to look at it through that lens because things are, I think, quite different.

Jeff’s Path Into Community Mental Health

Karenza Louis Smith 4:55

But we like to get to know our guests. So, you know, tell us a bit about you. You know, how did you get to sit where you are today as the CEO of the coalition of all of these community-based mental health services up in the top end?

Geoff Radford 5:07

Well, I'm originally from Lareba in far north Queensland. But I've lived in the territory for 13 years now, five in Alice Springs and now eight up in Darwin, where I'm privileged to be raising my two little boys who are three and one. I've got a background in disability and and youth work, but mostly I've in the territory I've been managing programs that are working with people with disabilities or or young people. But the the common factor through that has that has been complex trauma. In all of the programs that I've managed, you know, even you know, youth diversion, things attached to the criminal justice system, you know, f programs for families and young people. All all of them have had a had a common thread of people experiencing complex trauma. I've been in my role for four and a half years now. Um and prior to that I was in the Commonwealth Government Department of Social Services for a few years, managing all the grants that come to the territory through those programs.

Karenza Louis Smith 6:02

So you've had a really interesting career, Jeff, it sounds like, and lots of things. And uh I think it'd be great for our listeners to understand what is it do you think that makes that kind of top end? Like whether you're in FAR, you know, North Queensland, whether you're in Darwin, the Alice, any of those places, why is it or what is it that that is so different from other parts of Australia?

Why The Top End Feels Different

Geoff Radford 6:23

I think the most obvious first step is the weather, you know, particularly in that the build-up part of the year. So, you know, between the end of September and February or or March, or you know, as climate change gets more of a hold, it seems to go on and on. You know, that that feeling of when you get off a plane and you just get slapped in the face with humidity, you know, like uh everywhere around Australia experiences hot weather from time to time, but the humidity is just something that, you know, it really drains you. And, you know, you you try to cool off by having a shower or jumping in a pool, but then you get out and you're just it's continuing to sweat. But but you know, there's there's lots of other positive things that people love about the top parts of Australia as well. You know, the the six months of the year, the weather is amazing. And it's beautiful sunny days in the twenties, and people have a more relaxed attitude and you know, they're comfortable wearing shorts to to work, even you know, senior leaders and people more flexible and accommodating. And it's also I live in a capital city, it's also a bit of a country area, you know, and you can you can gauge that however you like, but I gauge it by, you know, when I'm driving around and I just pop up a couple of fingers off on the dash to say wave hello, you get a wave back. And that's not something you experience in an urban setting, I've found.

Karenza Louis Smith 7:34

Yeah, it's true. It's got a really nice feel, hasn't it? I've been up in both seasons, you know, like the I've been up in the wet where you're right, you are just saturated and it's not from the rain. Yeah, I don't think I've ever sweated so much in my life. That's hard, I think, living in that kind of tropical environment, you know. And then you and then you're right, then you've got the nice season where it's everything's chilled and qu and quite calm and laid back. But I think the challenges a around mental health, it's interesting. There is there are similarities that I've felt that existed in different parts of the country and up in the top end as well. And in Victoria, where Emily and I are today, we've had obviously a Royal Commission into the state's mental health system. It said it was broken, you know, it was a bowl of spaghetti, it's really hard to navigate. Good luck. It's hard to work your way around. And you've got what we call the missing middle, people f falling through the gaps and the cracks, not enough services, long wait lists. In New South Wales, we've obviously got a crisis happening there when it comes to psychiatry and in the hospital system. What's happening up in up in the Northern Territory? What are the things that you're seeing?

Acute Focus And Remote Service Gaps

Geoff Radford 8:36

Well, the system in the territory is really geared towards acute. I suppose that's true in lots of jurisdictions. You know, there's very limited early intervention in pre prevention programs. Lots of low to moderate programs end up working closer to the acute setting just because the the need is there. And the lack of services mean that people are presenting, you know, when they're in just particularly acute distress. And the system here is also geared towards urban settings. So Darwin, you know, the whole of the territory's got a population of 250,000. 150,000 of that are in Darwin and the rest are you know quite spread out. We've got regional centres, but then there's lots of people living in remote areas. That makes it really difficult to practically service people in remote regions. You know, some regions are, you know, like our springs, have you know quite good hubs. Catherine, for example, is has a hub, but it's a really big, big rivers region with uh quite a quite a lot of remote communities to sort of service from there. And and also Catherine is sometimes serviced from from Darwin, three hours away. So it makes it a real challenge to um provide services to people in place where they are to have their needs met, you know, if the services are only traveling out there. Or if people are only getting those needs when they're acute.

Karenza Louis Smith 9:53

Yeah, and I imagine that when you have like obviously all the tropical rain and things and you know, road closures, you know, heaps of areas basically kind of cut off from those big centres, that must exacerbate, yeah, and make the problems even more tricky and challenging.

Geoff Radford 10:07

Absolutely, it does. You know, when people are more isolated, it always sets recovery back. But if people are continually naturally isolated by the weather and those impacts for quite some time, it means that they don't have access to, you know, some of those natural supports or family that can provide those supports or, you know, be able to go into the regional centre in order to do their shopping or have their healthcare needs met. It often means they're then evacuated by, you know, medical transport to get that support rather than having something close by where they can lean on those, you know, those other supports.

Medicare Telehealth Rules And Barriers

Emily Webb 10:42

Well, that just leads us beautifully into the next question Corinda and I had, because obviously you've mentioned the vast distances of the outback. And we know that generally access to health care, let alone mental health services, is so much more challenging for people in rural and remote Australia. So we read some articles, you know, it's becoming apparent that people in rural areas are delaying mental health care or going to emergency departments in crisis, and that happens in metro areas, but it's happening more in rural. And that's because of some changes with Medicare late last year that inadvertently created barriers to treatment, stuff that we were just talking about before. So the changes now require patients to see a GP at least once a year in person to access mental health care via telehealth. And telehealth's obviously opened up access in so many ways. So, what should be done to better support rural and remote communities when it comes to mental health supports, especially what you see up in the Northern Territory?

Geoff Radford 11:48

The cost of providing those services is, you know, quite significant. So telehealth is presented as one of the options that can have an impact here. And and that's great. And it's a, you know, it has opened up some more opportunities. But the reality is that uh people aren't well versed in using telehealth to meet their needs. It's not the choice that they would make to access support via telehealth. And it requires familiarity with lots of systems that that mean that it's a it's a barrier to access, you know. And I'm talking through the the technology itself. You know, there's a number quite a number of communities in the territory who still don't have regular telephone coverage. So to be able to have a quiet spot where you could speak to a GP or or somebody located in another region isn't that practical. But it also means that at the other end of the line, the psychiatrist might want to see you exactly at 2 p.m. on the dot, but you might not live your life in a way that means that appointment at two o'clock is important to you. It might be that you live your life in a way that means that you know you might get to something today or tomorrow or in the afternoon. So to provide telehealth effectively, it requires people on the ground to help to do that facilitation and support. And I think there's a real opportunity to have peer workers embedded better in our healthcare system to help to facilitate that. You know, if there was a peer worker located in a remo remote community that could coordinate with the person and make sure they're gonna be ready on time and give them a pre-briefing and have them then attend the appointment and then afterwards talk about, well, the psychiatrist said a lot of things. I've written them down here, and here's some of the things we're gonna do. You know, I can help you to take you to get your medication, but I can also talk about other parts of your social and emotional well-being. Let's go and talk to Auntie to see if we can get you back out on country and do some cultural activities that might help your well-being as well. There's an appropriate way to help to facilitate both the cultural determinants as well as the medical needs in.

Peer Workers And Practical Support

Emily Webb 13:42

The next question I had was actually around betting living experience in mental health services, which is one of the Northern Territory Mental Health Coalition's policy positions. And you mentioned obviously there is a big need for Aboriginal and Torres Strait Islander mental health in the NT. So it's very different to some of the things that we see in other parts of Australia. So what's happening in this space right now around, I guess, you know, the lived and living experience workforce, peer support in the mental health sector, where a bit of a way through it in Victoria at the moment. We're we're doing okay, you know, there's a lot of things that can be done better, and but it's certainly growing. So, yeah, what's happening in the NT?

Geoff Radford 14:28

Well, like many things, the territory's quite a bit behind the times, but we're playing catch-ups quick smart and learning from our colleagues in other states to try to do that. We have only just recently incorporated the first ever peak body for mental health lived experience. The shout out to the NT Lived Experience Network, who we've been working alongside with for a number of years now. And that that's meant that there's an advocacy body that can support them. They're still not totally funded. They're they've been in a partnership with us. But we have a really limited number of peer workers in our system. There's none in the territory health setting. And community-based organizations are working on building their own peer workforce, and there's a range of systemic barriers and stigma barriers that we're having to work through in order to be able to do that. You talked about Aboriginal and Torres Strait Islander perspectives of mental

Lived Experience Workforce In The NT

Geoff Radford 15:21

health and social and emotional well-being. And I'm reminded of what Tom Brideson said uh very recently at a conference I was at. What works for Aboriginal and Torres Strait Islander people often works for everyone. You know, I I think that social and emotional well-being approach is one that we can all sort of adapt to and think about, you know, those broader, those other areas of our life that we can be working on to help us to be able to manage our well-being, not just specifically related to our mental health. And I think that supports a more community approach rather than a clinical one.

First Nations Leadership And Consultation

Karenza Louis Smith 15:53

I'd like to talk about um, I guess, that sort of First Nations lens. So, I mean, if we think about it up in up in the Northern Territory and the last census, about 26 to 30 percent of the Northern Territory's population identified as either Aboriginal or Torres Strait Islanders. So that's almost a third of the state. As Emily and I were thinking about the conversation with you, we were we were, you know, just reading some of the things that were happening, and we see that the country Liberal Party government has released its Aboriginal affairs framework and its priorities for First Nations communities over the next three years. It looks like, it seems like this has not been received well actually by Indigenous leaders and the Aboriginal peak organisations, and who've said there's been almost no consultation with communities and key stakeholders. And again, I think that's this big piece, isn't it, about lived and living experience? So I mean, look at the national agreement on closing the gap targets here in Australia very significant. They can't be achieved without that lived experience, leadership, and consultation and that that phrase, you know, nothing about us without us really, you know, is really, really strong. How can you make decisions about people without involving people in the decisions that are being made? So can you tell us a bit more? What's the reality at the moment about that sort of genuine system reform when it comes to, you know, almost 30% of the community who identifies as First Nations here in Australia?

Geoff Radford 17:13

Unfortunately, Aboriginal and Torres Strait Islander peoples are way overrepresented in mental health care needs and underrepresented in in service access. And that that's a real challenge for our services, both Aboriginal CUNY controlled and mainstream services, to make sure that what they're delivering is culturally safe. And so best practice, of course, is to create strong relationships in community and to have community-led services that have strong engagement and consultation and ownership of the services and programs that are being delivered to them and to their people. So unfortunately, when a framework's developed without any consultation, of course, people are going to be upset because they're feeling disempowered and it doesn't align with w what's needed. You know, there's there's lots of strong evidence over a number of rural commissions and r and reviews and Senate inquiries that have indicated how how best to um provide programs and services to support vulnerable groups, particularly Aboriginal and Australian under people, but unfortunately that evidence continues to get uh ignored.

Karenza Louis Smith 18:14

Which is kind of fascinating, isn't it? When you think, as I said, you know, pretty much nearly one-third of the the entire community in the top end identifies as First Nations people. So it look it astounds me. While we're on that topic as well, you mentioned overrepresentation as well, underrepresented in some areas, totally overrepresented in

Justice Reinvestment Over Incarceration

Karenza Louis Smith 18:35

others. And one of those areas we know is obviously in the criminal justice system. I'd like to talk a little bit about incarceration rates in the Northern Territory. And experts are warning that mental health reform in the justice system is crucial for improving community safety in the long term. I had a long, long time ago now, a really interesting guy from America, Jerry Maddon, I think was his name. He was a senator. And he had the catch cry, don't build more prisons, they cost too much money. And he was talking a lot about justice reinvestment, and he said, for every dollar that you spend by putting somebody in jail, you actually build, you know, this pathway that keeps people incarcerated. You build the cycle and it doesn't change. But actually, if you take that money and you put it in the community, and instead of sending people to jail, you actually do things as that diversion piece, you get a significantly different outcome. You'll spend less money, you'll lock up less people, and you'll have far better, you know, communities. So, you know, you see that psychiatrists and doctors, they're calling for mental health diversion programs to prevent, in particular young people, from entering the criminal justice system. What are your thoughts on this? And what are the sort of members of the coalition telling you? Is this something that they think the territory government should be doing? Is the focus on locking more people up not the right one? What are your kind of thoughts around that?

Geoff Radford 19:53

Yeah, absolutely. Unfortunately, we're always in this narrative where when people feel unsafe, you know, they they feel like they need a strong response back after, you know, there's been a been a crime committed. And, you know, you could say that not just in the Northern Territory after a particular incident, but in many states and territories. You know, unfortunately they've been happening quite frequently and it it creates fear and shame and stigma, particularly around people with complex mental ill health. As you said very clearly, it's it's not the answer. You know, it's it's very costly to lock people up. But unfortunately, this the same people doing the numbers on how much it costs to incarcerate someone in a year, you know, aren't using that same math to invest in support to keep people out of that system. The territory governments invested heavily in corrections here in the Northern Territory, pushing us further into deficit without addressing some of the root causes of crime.

Karenza Louis Smith 20:46

Just, you know, doing a really cheeky little Google search as we're talking, $160,000 is the average cost to in to incarcerate somebody for a year. And we know that the recidivism rate, so for our listeners, that's how many people will return to jail within two years, half of that population. So we spend $160,000, and then two years later we spend it again for half of those people that we've sent to jail. So it's this cycle that doesn't seem to break. And yet, Jeff, if I said to you, here's $160,000 for, I don't know, 10,000 people, what what would your mental health providers say? They would probably, I imagine, have a whole bunch of programs that they could do where you would have a major change on that return to jail rate.

Geoff Radford 21:33

Yeah, absolutely. And I'm sure you know yourself exactly how much it costs to support a, you know, an individual for tw uh for 12 months in a range of different intensive and low to moderate programs, but it's an enormous amount of money. The unmet needs report for people missing out on the NDIS, you know, of the back of the productivity commission report recommended, you know, somewhere between seven and sixteen thousand dollars per participant to provide them support for approximately. Three months. So what that demonstrates is that community managed providers can provide those supports on the smell of an oily rag, and they've been doing it for decades. The evidence of the impact that these programs can have is also there, but continues to be ignored, you know, for corrections programs, you know, trying to work on things through a criminogenic lens rather than a untrauma-informed one.

Karenza Louis Smith 22:24

Just on my little calculator then, that 168,000, if you spent 11,000, you could actually work with 25 people versus sending one person to jail.

Emily Webb 22:34

On that, I mean, we just briefly mentioned the NGIS, and we will be getting to that because there's been some uh big announcements about that.

Mental Health Week Awards And Innovation

Emily Webb 22:43

But something that I'm really interested in is the fantastic Northern Territory Mental Health Week that the coalition does every year. It includes awards for the community mental health sector. Can you share with us, Jeff, some of the great work by organizations, individuals, advocacy initiatives that have been highlighted through these awards? You mentioned one where we were having a bit of a chat before we uh were planning this podcast episode.

Geoff Radford 23:09

Oh yeah. Every year we continue to be surprised and delighted and learn more from the nominations that we receive. You know, we've got a category for lived experience, we've got a category for Aboriginal and Torres Strait Islander Social Emotional Wellbeing, you know, we've got a category for leadership, and there's just some really fantastic individuals and organizations that are creating and responding to the needs of the community in really innovative ways. And, you know, because they are delivering programs on the smell of an early rag, it that that encourages that innovation. And if they're doing things in a best practice model of strong community consultation, then they'll know what trends they're seeing and they'll be hearing from people with lived experience in their own community around the types of services that they want to receive. Now, the the one that we spoke about is called Enough Talk Time for Action. And it's a group of men who started it in Daily River, which is 150 kilometres and maybe a few more from Darwin, between Darwin and Catherine. But essentially the the premise was we need to we need to intervene now, we need to impact on this. And they have been delivering programs on country, so taking people out into their community, restoring their connection to family, their connection to community, making sure that their needs are met. And there's a range of reasons why their identity as a person or their cultural identity might have been disrupted through family systems, through grief and loss, through incarceration, as we've talked about. And they've been working with Flinders University for a couple of years, and Flinders found that they had impacted all seven domains of the social emotional well-being wheel through this program. It's outstanding and remarkable. And they've done it on a on a very, very small budget.

Emily Webb 24:55

I'll uh definitely share the link to that in the show

Partnership With Aboriginal Community Control

Emily Webb 24:59

notes. And just before we get to the NDIS Corenza and our subsequent questions, I will disclose that Irma 365 does have some services in Darwin. And something I really wanted to ask is what's the reality for community mental health providers or community service providers who are not coming from an Aboriginal controlled position, community position in Victoria? When we do services, we partner with an organization, an Aboriginal controlled uh community organization, rather than necessarily go, oh, we need an Aboriginal peer worker or something and then embed that in our organization. I mean, what is the reality for organizations when they want to be doing stuff in the Northern Territory?

Geoff Radford 25:50

I'm so glad you talked about partnership and the Aboriginal Peak organizations of the NT. So that's made up of the land councils, the Aboriginal Medical Services Peak body. They have some partnership principles which sort of set out the best ways to work alongside with Aboriginal Torres Strait Islander people and they're they're publicly available. But essentially it's about establishing relationships with community, long-standing relationships, that you're not just pulling together at the last minute to meet, you know, a tender time frame or an expression of interest, that you're actually genuinely working with people on the ground in a long-term manner to support them to have their needs met. So the mandate of the Commonwealth Government and the Northern Territory Government has been transitioned to Aboriginal community control as well. So over decades, local communities have been establishing their own boards and working with some existing medical organizations or community-managed organizations to establish themselves as a community organization and then start to deliver programs. In some cases, it's meant they've, you know, they've been delivering medical programs, or it might be that, you know, a local council has now picked up community services type programs in particular. And we've seen a range of different examples of that. And mainstream organizations have played a part in helping to set up and establish, provide governance and training and other supports with a view to, you know, for that support ending and for the organization to stand on its own true right in a manageable period of time as well. That doesn't make it feel rushed and that it continues to have close relationships and support of the community.

Emily Webb 27:30

That sounds great. Karenza, shall we get on to the NDIS? I'll let you go for it.

Karenza Louis Smith 27:36

Well,

NDIS Changes And Foundational Supports

Karenza Louis Smith 27:37

first I want to just say, you know, the programme that you described sounds amazing. And I I think, you know, that mental health programs and services can really be life-changing. You know, they really can. And I think this is what's probably so important in in this next part of our conversations about significant changes to the NDIS. And I'm keen to have a bit of a chat about people with what we call psychosocial disabilities found themselves in the NDIS initially when the NDIS was first started. And I think there are lots of different views on that. Was that the right thing to do? Should people with mental illness and mental ill health actually be supported by the NDIS or shouldn't they be supported by a mental health sector who has different skills? But we did, we, you know, as a country, we we moved a large chunk of people with psychosocial needs into the NDIS. And now we're going to change that. And we're actually going to move some of those people out of the NDIS back into something which at the moment is being called foundational supports. And there's obviously some good things here and some challenging things here too. And obviously want to acknowledge that for people in the scheme, it's a really, you know, quite a scary time at the moment. Lots of changes are being announced, and certainly what we don't want to do is alarm people. We want people to feel safe and feel secure in the supports that they're getting. What do you think that these changes might mean in the Northern Territory, for example, or even across Australia? Because we know that we're going to see a change for people with what we call psychosocial disability.

Geoff Radford 29:06

Unfortunately, it hasn't been as clear as we would like. And as you said, it's it's raised anxieties and insecurities for people who rely on these supports in a r in a range of ways. In the Northern Territory, the analysis has indicated there's already 8,140 people with severe and complex mental ill health who are missing out on the NDIS. And we know from other reporting as well that people with psychosocial disability aren't being accepted onto the MDIS in the same rates as they once were previously. So that creates further distress for people who are missing out on those supports. Now, if the supports were to be taken out and delivered by, you know, state-based or by the community managed sector and the Aboriginal controlled sector, there would be strengths and weaknesses in in that. But ideally it would allow for, you know, a greater mental health lens rather than a disability lens to be applied to those supports. Now I've talked about Aboriginal and Torres Strait Islander perspectives of social and emotional well-being, which are really relevant here and allows for local place-based context of that. The challenge, of course, is then if things are going to be lot funded by a community rather than individual, will that create the capacity for us to be able to respond to those unmet needs and also to appropriately develop the workforce that's needed to provide those supports in an urban setting or in a r in a uh a regional centre? The answer is probably yes. But in a more remote community, it'll require targeted work to be able to meet that unmet need. But there's an opportunity there to create peer workers to do that work on the ground.

Karenza Louis Smith 30:48

And that's something that you said earlier in this conversation, wouldn't, you know, it would be quite incredible to actually have some peer workers, people who've lived and living experience out in some of those more regional and remote communities who could actually support people to navigate the various different parts of the health and mental health service systems.

Geoff Radford 31:08

Absolutely. You know, that that relational piece of therapeutic work is the most important part. You know, there's an old capsular I used to work with who said the therapy is in the relationship. And so for me, that's the most important perspective in that that social emotional well-being, Lens. The clinical part, I think, is the easier part to buy in, you know, through Kelly Health or other means to help people to have those needs met. But that relational piece is the most crucial part.

Karenza Louis Smith 31:32

I think the bit that's really important is when you're having, you know, I'll use the word crisis. Let's say you're having a mental health crisis, your mental health is worsening, you're not able to manage or cope with the things that are happening and going on. What you need is access to support. You don't want to wait for a long period of time. You you need to be able to know where to go, how to get help, to get to the right people and get the supports that you need, because we know that mental ill health can be episodic. It can go up and it can go down, it can fluctuate and vary. What you need changes in different times, which which in my mind is different to the NDIS in some ways, because then you can tailor your needs, your supports up and down as you need them. But I think what we're seeing is some of that certainty of supports being potentially changing as to how that might be and how that might happen. Obviously, foundational supports as we know them hasn't yet been really defined or described. What role do you think that you might get to play and as the coordinating, you know, coalition here up in the top end to shape what that might look like?

Footprint And Early Intervention Measures

Geoff Radford 32:36

Well, for the future bilateral agreement and for those foundational supports, you know, top of my list is footprint. Let's get services out to the regions where there's currently nothing. And let's build the capacity of services in the regions where there is something, but it's underdone. We really suffer from that economy of scale everywhere in the bush around Australia because services cost more and we don't have that capacity to more easily respond to that unmet need. You mentioned about the NDIS and it's always been focused on individuals. And that that's meant things like developing strong networks, communities of practice, early intervention and prevention work that can happen through a community development lens hasn't been there. We also haven't been measuring things in the in the right way. I've been advocating that we need to measure things like help-seeking behavior. Do people know where to go, where the services exist for them? And what's their experience of that been like? You know, I think unfortunately, all too often, lots of services at different points have had a poor reputation or people haven't had a good experience with uh an organization or part of the system that hasn't met their needs at the time. I think we can respond back to that by having a more investment in that early intervention space so that people have a bit more time to work with an individual to develop that relationship and help them to feel safe so that it keeps them coming back, so that they're not avoiding going to get that help. They can go and get it when they start to feel unwell or when a friend or colleague notices that they're not usual themselves.

Emily Webb 34:04

Oh, as a comms journalist background person, I agree with you so much. Like the answer isn't just putting some stuff on social media, you know, this and this, because I honestly feel like people I interact with, like when I'm at my daughter's footy, you know, you're just talking. People are like, oh, you know, even the urgent care clinics, which Medicare has opened and they're great, by the way. People are like, oh, I didn't know they were around, but once they do, it's like word of mouth. And I always think there's just so many ways that are not just like the comms plan, you know, you've got to have like social media tiles and this and this and this. It's like you've got to get out on the ground. Even in urban areas, I worked for a large metro council, you've got to be meeting with the community, you've got to have multiple options for communication. Even if like only four people show up, that's just kind of what you've got to do.

Geoff Radford 34:57

And and if that investment has meant that those four people remain well, then that's a that's a good use of that time and energy. Because if they also then have the capacity to to hold and support others, that places less strain on the system and reduces the impact that it's having at that really acute emergency end. You asked me before about what will we be thinking about in terms of those foundational supports.

Workforce Turnover And Continuity Of Care

Geoff Radford 35:20

So, you know, not just the footprint, it's about the the types of services that we want to see here in the territory. You know, is there an opportunity with foundational supports to have more steps in our step-down model? You know, at some points our step-up, step-down model, at some points it feels like some of those steps are really, really big. And it'd be great to put some little steps in between them. And the other part of that is workforce. You know, we're nationally, you know, we're in a 30% deficit of workforce. And in the territory, we know that 30% of our entire workforce turns over every year. Now that's in every industry. And economists said that. In health and community services, it's closer to 40 or 50. And that's people changing roles or being promoted. But that makes it really difficult to get any level of continuity of care in those supports and systems. So we'll be advocating to to grow that workforce and not just by attracting and and trying to bring people here from interstate. Now that's a small part of it. But we need to to grow from our workforce of people here in the territory and really ask the question, you know, what what is it that we really want to value as territorians, but also as Australians? I think there's been a missed opportunity to really heavily invest in health and community care workforce and value the the skill set, the relationship. Love and care for someone isn't a workforce. We need to wrap around those people as well.

Karenza Louis Smith 36:40

We're kind of coming to the end of our conversation,

Self Care And Closing Calls To Action

Karenza Louis Smith 36:42

Jeff. But one of the things that Emily and I always talk about is, you know, self-care and well-being. And I think in particular, even more so today, when I think about the disability community, how they're feeling, the sort of level of anxiety and concern and worry that that exists around changes to the NDIS. What are the things that you do, you know, to take care of your own mental health and well-being?

Geoff Radford 37:04

Love this question, and I'd I'd love it if we, you know, we got asked it a lot more as well. So exercise is really important to me. I have less time for that with with little kids, but I'm also involved in a local rugby club here in Darwin, the Pirates. And even as my age increases, you know, there's still a there's still an enormous value in that for me. If I went for a run of my own, I might slacken off or cut a corner here. But if I'm training with other people, that's a good motivator. And also provides me with a social community and connection as well, which is really important. Now I've got a dog that I walk in the morning, and that's a a great way to start the day. But I also take advantage of living in the top end because we've got such beautiful nature. So that time in nature, getting out and about, you know, really experiencing the bush, spending time in waterfalls is another really important thing as well.

Karenza Louis Smith 37:52

It's a beautiful, beautiful part of the world up in the Northern Territory. I could not agree with you more. Well, Jeff, thank you for your time. And I'm not sure if there's anything else that you wanted to ask, Jeff, what we've got hidden this afternoon.

Emily Webb 38:05

No, I'm just really grateful, Jeff, for your time. And I'm sure we will be speaking again and, you know, interacting. It's it's a really great relationship we're building. I know Irma 365 is part of the coalition, which is awesome. But yeah, is there anything that we haven't covered that you wanted to say? Final thoughts for now?

Geoff Radford 38:24

Oh, I feel like we've only scratched the surface on so many, you know, a thousand conversations that we could be having. But you're doing some really fantastic work as an organization and this podcast as well as is reaching people to learn and grow and understand and build our own capacity and understanding and championing community mental health. So keep up the good work.

Karenza Louis Smith 38:43

So, Jeff, if people want to join the coalition or find out more about what you do, how can they get in touch?

Geoff Radford 38:49

Yeah, so jump on our website, NTMHC, that's the Northern Territory Mental Health Coalition.org.au. You can have a look at the different programs and different things that we're doing, who our member organizations are and what they get up to as well. You could jump on our Facebook or our LinkedIn as well.

Emily Webb 39:07

Awesome. Excellent. And Jeff, we're uh if I'm hopefully up in the top end, because I always like saying to Karenza and others, I want to go to Darwin, I need to go to Darwin, send me up there. So maybe when all this wildness with uh the world is maybe a bit better, I will get up there. I have been before, and it's just beautiful. Huge thanks to Jeff Redford for joining us for this episode, and we'll have details in the show notes about the coalition and some of the other things that are mentioned. And thank you for listening to this podcast. It's not often that you have a CEO who started a podcast, so thank you, Karenza, with your community radio and community services background. So, you know, amazing. So please share our episodes with your friends and family or even rate and review Get Real. It helps more people find us and listen to these conversations. So thanks a lot.

Speaker 1 40:00

You've been listening to Get Real, talking mental health and disability brought to you by the team at Erma365. Get Real is produced and presented by Emily Webb with Karenza Louis Smith and special guests.