The Role of Power and Privilege of Psychiatric Leadership

In this episode, we will address the critical issue of power and privilege in psychiatric leadership. Power dynamics and privilege can significantly impact care, collaboration and co-leadership. We'll explore strategies for redistributing power, fostering a culture of inclusion and respect. Our conversation will cover the importance of self-awareness, emotional intelligence, and cultural humility in mitigating the effects of power and privilege.

Sarah Wilson is a leading international researcher in brain and mental health with a sustained track record in research translation embedded in co-design with people with lived experience. She is a Clinical Neuropsychologist with more than 30 years of experience in the Victorian public and private health sectors and has more than 15 years of executive and senior leadership. 

Emily Unity is an award-winning lived and living experience leader and advocate. They are passionate about creating change through disrupting traditional systems and amplifying intersectional voices. Emily is informed by their lived and living experiences, including mental ill-health, disability, LGBTQIA+, multiculturalism, neurodivergence, homelessness, family violence, and more.  

Dr Kerryn Rubin is Clinical Director of Mental Health and Wellbeing at Peninsula Health, an adjunct Senior Lecturer at Monash University, and a previous Chair of the Royal Australian and New Zealand College of Psychiatry’s Victorian Branch. Kerryn has over 2 decades of experience in public and private mental health services.  Kerryn is a passionate advocate for trauma-informed care, and the reduction of restrictive interventions, whilst maintaining safe and therapeutic hospital environments. 

Dr Phyllis Chua is a Consultation-Liaison psychiatrist at the Austin Hospital and Calvary Health Care Bethlehem. She has an interest in medical education and was involved in different teaching roles for university undergraduate and postgraduate courses as well as the RANZCP registrar training program. She is currently the chair of CEEMR. Her research interests are in neuropsychiatry and medical education. 

Resources:

• https://www.vic.gov.au/victorian-collaborative-centre
• https://healthsciences.unimelb.edu.au/__data/assets/pdf_file/0007/3392215/Coproduction_putting-principles-into-practice.pdf

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Disclaimer:
This podcast is provided to you for information purposes only and to provide a broad public understanding of various mental health topics. The podcast may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). The podcast is not to be relied upon as medical advice, or as a substitute for medical advice, does not establish a doctor-patient relationship and should not be a substitute for individual clinical judgement. By accessing The RANZCP's podcasts you also agree to the full terms and conditions of the RANZCP's Website. Expert mental health information and finding a psychiatrist in Australia or New Zealand is available on the RANZCP’s Your Health In Mind Website.

Episode Transcript

SPEAKER_00 (00:00):
We acknowledge Aboriginal and Torres Strait
Islander peoples as the FirstNations and the traditional
owners and custodians of thelands and waters known as
Australia and Maori as TangataFenua in Aotearoa.
We honour and respect the elderspast and present who weave their
wisdom into all realms of life.

SPEAKER_03 (00:23):
Welcome to another Psych Matters podcast from the
Royal Australian and New ZealandCollege of Psychiatrists.
Psych Matters is a series ofdiscussions on training and
practice issues facing traineesand fellows of the college and
other important topics in mentalhealth.

SPEAKER_06 (00:37):
Well, hi everyone.
I'm Sarah Wilson and reallydelighted to be here today as
part of this special podcastexploring a very complicated
issue about power and privilegein psychiatric care in
leadership and the experience ofthose from multiple different

(01:02):
perspectives.
So today we're going to begin aconversation about the many
issues that that bear on thiscomplex topic as a starting
point to get us thinking abouthow this relates to each of us
in our everyday work that we doin mental health and well-being.
And in no way are we going tocome up with all of the answers,

(01:24):
but rather hopefully provokesome good questions for each of
the listeners to think about howthis may relate to your work.
So my role currently is asco-CEO of the Collaborative
Centre for Mental Health andWellbeing, we've been set up
under the Royal Commission intoimproving Victoria's mental

(01:46):
health and wellbeing system.
And a key part of that work isbringing together different
perspectives onto these complextypes of issues because it's by
doing that we that we can beginto experience transformation of
the system, think differently,work differently, develop new

(02:06):
cultures.
So with us today, we have thosedifferent perspectives, and I
think that's core to having adiscussion about power and
privilege.
We can't understand it withoutbringing all those perspectives
to bear.
So my background, I'm a clinicalneuropsychologist and could be

(02:27):
considered to come from aposition of power or privilege
in the mental health system.
And this is something that I'malways very mindful of.
As you walk into a room to speakwith someone who might be
accessing services, that powerbalance is automatically there.
And I guess from the moment Istarted in my work, I was really

(02:51):
aware of what a privilege it isto go on a journey in treatment
with people.
I run a functional neurologicaldisorder clinic in addition to
my work at the CollaborativeCenter.
And I'm privileged to hear aboutthe amazing journeys and
inspiring stories of the peoplewho come to do work with me at

(03:12):
the FND clinic.
It's truly grounding and itkeeps me just constantly in awe
of human resilience and and thethings that people can journey
through, and it's a privilege togo on that journey with them.
So that's really where I come atthis.
But I'm going to pass now toEmily Unity to introduce herself

(03:36):
and tell us a little bit abouther perspective.
Thanks, Emily.

SPEAKER_05 (03:40):
Thanks so much, Sarah.
My name's Emily, my paranoia'sadam.
I'm an intersectional anddelivering experience advocate.
I currently sit on the college'scommittee for Victoria as the
consumer representative, but Ialso have intersectional
experiences of being a carer, aswell as being multicultural,
queer, disabled, neurodivergent,and a victim survivor.

(04:00):
My relationship to psychiatricleadership is both from a
personal lens as a help seeker,as well as my professional lens
as a co-leader in co-designingmental health systems.
And privilege and power are twoof my favorite topics to speak
about.
And I think that they're reallyopportunities for us to improve
the mental health systemtogether.
Psychiatrists have often beenthought of as the most

(04:22):
privileged and the mostpowerful, as opposed to folks
with lived experience, who tendto be the least privileged and
the least powerful.
But I think that when it comesto privilege, it's something
that we don't choose, but we canchoose what we do with it.
And that can make all thedifference in creating really
inclusive systems and spaces andpower as well.
It doesn't have to be used as atool for control, but it can be

(04:44):
a kind of tool for creatingmeaningful partnerships where
everyone is equal.
And I think the best leadersthat I know use their power and
privilege and leverage them toempower others, not to maintain
their own status.
But yeah, I'll pass on to Karen.

SPEAKER_01 (04:59):
Thanks, Emily.
My name's Karen Rubin.
I'm a psychiatrist.
And uh what I'm gonna do issomething I don't often do,
which is go through all of thevarious positions I hold because
they are part of the power thatI bring to this conversation.
So I'm the clinical director ofuh the mental health and
well-being service at PeninsulaHealth, which is the public

(05:19):
mental health service thatprovides essentially all of the
public mental health services toFrankston and the Monaco
Peninsula.
I'm also an adjunct uh seniorlecturer at Monash University,
and I have a clinical academicand research role.
Um, and I'm the former chair ofthe uh Victorian branch of the
Royal Australian and New ZealandCollege of Psychiatrists.

(05:41):
So all of those things mean thatboth in a general sense, but in
within my profession as well, II get to sit in one of those
really powerful seats andtalking about it here and
acknowledging it as a is animportant step for me because
like many people I actuallydon't like being in a powerful
position and yet I am.
So I'm hoping that starting offwith that acknowledgement helps

(06:04):
paint a picture of what power isand those huge power
differentials that can exist.
My particular passions arearound working, you know, with
people, and particularly aboutbuilding a public mental health
system that is not about powerand control, but is about
supporting people, supporteddecision-making processes, um,

(06:28):
creating the least restrictiveservices.
And so I can't help, but I I Istress in every setting I'm in,
probably the thing I'm mostproud of that that I've done in
a professional sense is I workat the only mental health
service in Australia where wehave eliminated the use of
seclusion as a practice in ourmental health units.

(06:48):
And I'm not going to go intothat specifically today, but
that is fundamentally aboutexercising power and control in
a manner in which many people,not just people from a lived
experience perspective, will sayis ultimately harmful for
people, not questioning theintentions of why people do it,
and the intentions may usuallybe good, but the importance of

(07:10):
recognizing that the exercisingof power in and of itself
creates a really importantexperience in the person who is
less powerful.
So I'm not going to talk anymore about that.
We'll have lots of time forconversation.
I'll hand across to Phyllis.

SPEAKER_07 (07:25):
Thanks, Kieran.
So I'm Phyllis Trua.
I'm a consultation liaisonpsychiatrist at the Austin
Hospital and Calvary HealthcareBethlehem.
And I've also had an interest inmedical education and I was a
senior lecturer at MonashUniversity and I've left that
role and I'm adjunct there.
So I've always been interestedin and have been involved at the
university in undergraduate andpostgraduate courses, as well as

(07:47):
at the college registrartraining program.
So I'm currently the chair ofone of the education
subcommittees, SEMA.
And also have a researchinterest in neuropsychiatry and
medical education.
But how I came to be involved inthis panel has been an
interesting journey.
So I have to admit that, like soseveral years ago, when I was
involved in education, the termlift experience was new to me.

(08:11):
I'm happy to declare that.
And I think it's kind of thrownaround now.
And at the time I was thinking,oh, this is interesting, because
I you know we knew about the youknow using the term consumers.
But one of the reasons it wasinteresting to me was that I'm
in one of my research andclinical interests in
Huntington's disease.
And when I first started in thisarea back, I don't know, over 20
years ago maybe, I rememberattending a conference where the

(08:32):
clinical presentation was opento people, you know, who had
Huntington's inner carers.
And I thought this is a veryinteresting kind of setup.
And this is like over 20 yearsago, where we have people living
with Huntington's inner familywho are, you know, who are
welcome to attend our meeting.
We were also welcome to attendtheir their day.
I remember thinking that, well,one day do you know will this

(08:53):
happen in psychiatry?
And then fast forward like twoor three years ago, I attended
another uh meeting where theneurologist and the person who
at Huntington's had written abook together and they're both
presented on stage togetherabout you know their different
experiences as someone who hadbeen tested positive for
Huntington's, their journey andthe neurologist's experience.

(09:13):
So, you know, I think there ispotential there.
Um we're still not there yet,but I hope that this
conversation today is is thestart of that kind of thinking
about, you know, is that kind ofpossible for psychiatry?
And how I can't be involved isthrough my education.
I I was fortunate in being ableto lead the development of a new
course, which was done alongsidepeople with lived experience of

(09:36):
mental illness and carers.
It was very successful and youknow, people, the students
actually were very engaged withhaving people with lived
experience of mental illnessactually facilitating and also
helping develop the content.
And I've really enjoyed, and ina way, it's kind of felt much
more authentic in the educationsort of space.

(09:57):
And I'm hoping now that I've nowmoved more to clinical work and
that that will also translate tothe clinical space where in the
mental health sector that weknow that the lift experience
workforce will also grow.
And I'll be interested to hear,you know, Sarah and Emily's
thoughts about this as well.
So Kira and I being, I mean,he's a director of you know a
service, and I have to say, oneof the things I wanted to clear

(10:18):
also is that I've never had aclinical leadership role.
I mean, I've led things in uhacademic settings, but what what
I'm I want to highlight thatbecause I think this podcast is
not just for people who want tobe a formal leader.
I think as psychiatrists, theminute we get our letters, or
even before that, we are kind ofleaders in different ways.
And even that one-to-oneinteraction with each patient,

(10:42):
sometimes we we we are a leader.
And I think this is hopefullythis will open for the first
conversation topic about how dowe get this part and privilege?
I mean, what do you the rest ofyou think about this question?
How how do psychiatrists end upbeing in this position?

SPEAKER_06 (10:55):
And yeah, it's a great question, Phyllis.
I mean, I think, you know, inour lead up to having this
podcast, we were just startingto talk about this idea that
this is one of those unspokenthings.
It's um something when we'redoing our work that we don't
automatically think about.

(11:17):
Psychiatrists, and I think Karenmade this reflection, don't
often realise that they're inthis position of power and nor
do they feel comfortable withit.
But yet within our currenthealth system, the medical model
of care places that powerdifferential or brings it into

(11:38):
the room.
And so we have to bring thatinto our conscious awareness if
we are in that position, whetherwe like it or not, and then deal
with it.
And and so, Emily, I wonder ifyou can share with us, if you
feel comfortable, what it feelslike to be in that space when

(11:58):
you're accessing a service or ortreatment or care or support.

SPEAKER_05 (12:02):
Yeah, sure.
So I'll speak sort of like howpower and privilege have
manifested in my personalinteractions with psychiatry and
then also my professionalinteractions kind of co-leading.
So in my personal interactions,often power and privilege, if it
hasn't been checked orunderstood or addressed, is
really present, particularly asa patient seeking help.

(12:23):
It feels like a one-wayrelationship and it feels like I
need to fit into a model ofcare, not the care needs to work
around me.
I feel like often power can bewielded in a way that reinforces
assumptions and bias.
I feel like often the systemtells me who I am rather than
asking and listening to tell myown story.

(12:43):
And it's really hard to tell mytruth when it's filtered through
someone else's bias before I'veeven spoken.
Especially in really crisismoments, power and privilege
really can sometimes conflictwith compassion if they're not
checked.
They can really be hindrances toproviding effective care and
seeing someone for theirstrengths, not just their
weaknesses, um and seeing themas a full person rather than

(13:05):
something that needs to befixed.
I think that that has led tomany systemic and broader
issues, such as inflexibletreatment approaches and
barriers to general trust andengagement.
But I think there have been verypositive interactions that I've
had in personal settings wherepower and privilege have been
wielded to see who I really amand see my intersectionality, my

(13:27):
identity as something to harnessand really listen to.
And it's that kind ofself-determination and the
giving back of my autonomy thathas shifted the conversation
from what's wrong with you towhat do you need and how can we
work together.
I think that that's a brilliantuse of power and privilege.
As for like professionalinteractions, um, I'd say that

(13:50):
there is a real resistancecurrently to co-leadership.
I think once people getcomfortable with a certain way
of life, just humans generally,um, it can be hard to change.
But I think the resistanceco-leadership isn't about taking
away power, it's aboutredistributing it for better
outcomes.
It's about welcoming indifferent voices and not seeing
them as competition and doingthat in a way that's really

(14:13):
equitable.
So if we're co-leading betweenpsychiatrists and people with
lived experience, it's it needsto be really trauma-informed,
acknowledging that power andprivilege have worked
historically in a way that mightbe really harmful, and to
acknowledge that and reallyleverage people who are
privileged to create more equalpower balances between everyone

(14:34):
that's in the room to ensurethat we don't just all have a
seat at the table, but we reallyall have a voice at the table as
well.

SPEAKER_07 (14:41):
Thanks for sharing Emily.
I mean, as I hear you talk aboutall those points and and your
experience of being a um apatient or you know, the
experience in interactions ofconscious, I kind of say all of
them make sense, but then youknow, when I think about when
I'm actually with a a patient,that I think you do get caught
up and you don't realise that.
And I think that's one of theyou know, discussion, you know,

(15:03):
what discussion points here thatsometimes you don't realise you
have that power and privilege inthat individual interaction with
a person.
You don't realise that's how theperson perceives you.
Because I think my psychiatristsdo try to be compassionate and
caring, but you know, I thinkthat relationship's already
predetermined in a way.
Like before we even walk in theroom, you probably kind of
think, well, the psychiatrist'scoming, and you know, especially

(15:26):
um if someone's unwell, I mean,I think we are all vulnerable,
whether it's physical or mentalillness, just a bit more
vulnerable just in general.
But the whole setup is alreadyhas that kind of puff
differential that's somehowdefined before we even meet.
Does that is that right, Emily?

SPEAKER_05 (15:43):
100%.
I think uh privileged psychiatryoften manifests through
dominant, unseen cultural normsthat shape the profession and it
can really lead to ahierarchical structure that is
not necessarily explicit butoften implicit.
And this re really reinforcesone-directional flows of

(16:04):
communication where people livedexperience feel like our
experiences are being dictatedrather than explored.
And I think that if power andprivilege go unchecked in
psychiatric settings, it canreally create barriers to trust,
um, barriers to meaningfuloutcomes and more
marginalization and harm.
I think that these sort ofstructural systemic issues need

(16:27):
to be brought into the light andspoken about, um, acknowledge
that everyone has power andprivilege.
Lived experience have their ownpower and privilege in their own
way.
Whilst I come from a number ofdifferent backgrounds,
identities that might be termedas underprivileged or
marginalized, I still have a lotof privilege and power in
different ways.
English is my native language,I'm well educated.

(16:48):
Um, I think that there's waysthat I can leverage that power
to amplify voices that are lessheard than mine.
Um, and I think thatpsychiatrists, just like any
other person, can also do thesame.

SPEAKER_07 (16:58):
Yes, I agree.
Because I think palm privilegedoes come from like some
individual characteristics thatwe all have, whether it's gender
or race.
You know, as you were sayingthat I was thinking that within
under medical hierarchy, thereis this hierarchy that we all
kind of adhere to.
It's just part of our training.
That, you know, we train withtrainee, then as a consultant,
then we have the you know, thelead clinician.

(17:19):
And I guess that's how we uh doour training, it's just
automatic for us.
But I I hope that you know,being more aware, and I think
that's part of that leadershipframework to kind of lead
ourselves and be that thatself-awareness.
So to acknowledge that we dohave that power or privilege,
how is that kind of affectingthis relationship that we're

(17:40):
having with whoever we'reinteracting with, whether it's
the person with lived experienceor the consumer, and just kind
of be aware of how maybe itmight impact on on the care that
we're trying to give to theperson.
So I think just kind ofacknowledging it, perhaps is the
first step.
And and and as you said, likeit's sort of there.
So it's not like we want to getrid of it, it's just more being

(18:00):
aware of it and how it'simpacting on on this particular
relationship.
Would that be alright?

SPEAKER_05 (18:07):
Absolutely.
I I think the first step in allof this is just awareness and
education and understanding.
It it often is one of thebiggest barriers is people just
unaware of the privilege thatthey carry.
Um and that's not necessarilytheir fault.
But I think for me, a lot ofharm can be really unintentional
if it's not checked.
But I think we all have aresponsibility to check our own

(18:28):
privilege and power andunderstand the way in which it's
being wielded, whether it's onpurpose or not.

SPEAKER_07 (18:35):
Can I just ask, I mean, when you say harm, can you
I mean, is there anything thatyou can think of that we I mean,
you don't have to talk aboutanything that you don't want to,
but yeah.

SPEAKER_05 (18:43):
So coming from many different backgrounds, my lived
experience is difficult tounderstand for most folks, just
as it's hard for me tounderstand other people's lived
experiences.
But I think there have been alot of times where I've been
inadvertently harmed by someonenot understanding their power
and their privilege, notunderstanding how, for example,
our differences in culture, ourdifferences in education biases

(19:06):
can affect the way that I'mbeing labelled or diagnosed and
therefore being treated.
I have been handled betweenservices, misdiagnosed,
mistreated, and it has resultedin some things including
seclusion and restraint thatcould have been avoided.
I think that there's a lot ofinadvertent harm that comes from
people who are doing things withthe best intentions, but not

(19:28):
with a lot of curiosity, if thatmakes sense.

SPEAKER_07 (19:31):
Yeah, I can see I'm sorry to hear about your
experience.
And I know personally, like nowthat I'm trying to be more
self-aware and um Asianbackground and being female.
Um I'm I guess more sensitive tosome of the intersectionality
kind of issues that that you'vekind of referred to.
But recently I was aware that Ihad made these assumptions about
a refugee and you know, camewith PTSD and depression.

(19:51):
I thought, yes, it's all kind ofwar-related.
But then when I spoke to them,it was just the trauma you might
see, you know, the experienceanywhere else.
But you know, I was kind ofhorrified in a way that I hadn't
made that assumption, eventhough I was trying to be, you
know, to deliver holistic careand kind of um be empathetic and
compassionate.
And but I had come with thatlens or thinking, oh, you know,

(20:13):
this is a person's refugee.
And so it is very easy, I think,sometimes to just fall in that
trap.
But rather than beat myself forit, you know, I think it's part
of what the framework talksabout, that kind of being aware,
the self-reflection, and youknow, you we're always kind of
learning along the way, and wewe can't learn everything, and
and things are dynamic andchanging.
And you know, this was the firsttime I met someone from that

(20:35):
background, and now I know notto kind of make assumptions
about people that I see.
Definitely, like when you knowbetter, you can do better.

SPEAKER_06 (20:43):
I think this conversation is so great because
what it does is it puts the onusof power sharing on on each of
us, right?
So understanding our privilege,as Emily has so beautifully
described, and then making adecision about how we use that,

(21:04):
are we going to use it for goodor not?
And of course, we never intendnot to use it for good, but if
we're not aware, then that mightbe the outcome.
And so as you were talking, Iwas thinking more broadly.
So, what does this mean forreform or transformation of the
mental health and well-beingsystem in Victoria?
Because we know that a lot ofharm has happened under the

(21:27):
traditional models of care.
And the whole point of the RoyalCommission was to really stop
that from continuing to happen.
Once we become aware, we need todo something about it.
Uh, we can't just keep repeatingthose patterns.
And here I'm talking about achange in our mental models, a

(21:49):
cultural change in the way wework and practice and bring that
reflective practice into all ofour conversations.
But also the importance of thelived and living experiences,
perspectives and workforces inthe system to be present with

(22:11):
us, to be having thoseconversations and pointing those
things out for us.
And for us to have an open mindand not to feel too threatened
by that or intimidated by that,because of course the flip side
is that often if we've been inthese positions of unaware
power, then if someone pointsthat out, we might feel

(22:33):
defensive about that.
Um, because of course that wasnever our intention, but that
serves to exacerbate the problemrather to rather than come to a
point of problem solving orchanging how we work.
And so I'm going to pick up thisidea that, well, we're in this
system and we can't do anythingabout it, because I actually

(22:53):
think we do have some things wecan do about it, and I actually
think we must if we're going tobring transformation and to
really change this fundamentaldynamic which sits at the heart
of our challenge for reform.
So, Karen, I'd be interested tohear what you think about that.

SPEAKER_01 (23:14):
Look, I've really been listening with interest,
and particularly thatconversation with, you know,
Emily and Phyllis there aboutthose experiences.
And I think one of the thingsthat makes it hard for people to
recognise their own power andprivilege is people, we don't
talk a lot about power andprivilege, and people don't
understand what the things arethat contribute to power and

(23:34):
privilege.
And and they often think aboutvery limited things.
And I think Phyllis touched onthat, that you don't feel
powerful when you see yourselfas junior in a hierarchy, but
actually you're not seeingyourself in a much broader
sense.
So the the the concepts that weoften think about, and I'm
acutely aware of that in in thisroom and in most rooms I go
into, you know, there's someprimary things that exist across

all parts of our society: gender, race, country of origin, (23:56):
undefined
cultural or religious issues.
But then there are the otherthings that factor into the
power that people have.
And Emily's touched on some ofthose things, such as one's
educational background, um,income, social capital.
But then particularlyimportantly for psychiatrists,

(24:16):
and even more so forpsychiatrists in leadership
positions, there is role, androles come with inherent power.
And as psychiatrists in allparts of Victoria, and I'd say
in all parts of Australia, thereare actually also the legal
structures that invest you withvery special, incredible powers
that almost nobody else in oursociety has.

(24:39):
And if you don't recognize that,that automatically means that
you generate the kinds ofexperiences that Emily was
talking about, not just with umpeople who are coming to you
seeking care, but you createthose experiences in
multidisciplinary teams whenyou're working with people.
You create those experiences ofpower, unacknowledged power

(25:02):
differentials in people'sfamilies, supporters, carers.
Um, I extend that up again.
I was talking about I sit in apowerful role.
In Victoria, the Mental Healthand Wellbeing Act has a position
of an authorized psychiatrist,which I also am.
I should have listed that um inmy list of titles.
I have legislated powers, andI'm referred to specifically in

(25:23):
legislation as having all ofthese incredible powers that,
except for Phyllis, none of youhave.
Phyllis has those powers becausean authorised psychiatrist
delegates them to her in herpublic role.
So wow.
It doesn't matter.
You could create a person withmy roles who didn't have that

(25:46):
sense of power from theirupbringing, you know, from their
background in terms of gender.
Education's a tricky one.
You don't get to this kind ofjob without ultimately having
had privilege around education,regardless of where you started.
Social capital, all of thosethings, the very nature of your
role means you're normally themost powerful person when you
walk into a room, up untilreally you you kind of get into

(26:08):
my jobs where you then start toengage with that level of power
that sits above you.
And suddenly you you you oftenaren't the most powerful person
in the room.
And then the problem with thatis you take that into the other
rooms you go into.
If you spend all your time inrooms where you're not the most
powerful person, you forget thatwhen you walk into a room where
you are the most powerfulperson, you don't think of

(26:29):
yourself that way.
And so, you know, a lot ofjunior or mid-career
psychiatrists who don't seethemselves in leadership
positions and don't recognizethe most junior psychiatrist as
a leader, don't feel that senseof power and wonder why other
people respond to them as ifthey have power.
So self-reflection and insightaround what is power and what is

(26:52):
privilege, I think is the realstarting point.
That's kind of what I take outof this.
I can't help myself.
It says something about mybackground.
This is where I quoteSpider-Man.
Um, with great power comes greatresponsibility.
Um and the first responsibilityis recognizing your power so
that you don't harm people withit.
Unintentionally, with the bestof intentions, unaddressed power

(27:15):
is harmful in clinicalrelationships, but it's harmful
in leadership structures aswell.
And you can't do goodco-production that puts lived
experience at the center of whatyou do without without an
acknowledgement of power in eachand every interaction you have.
So that's kind of where where Isit around this.

(27:35):
And I'm really interested,Sarah, with your role, how this
fits into, you know, yourunderstanding of, you know, what
what you're trying to do fromboth inside and outside the
power structures to addressthese things.

SPEAKER_06 (27:47):
Yeah, and and I love the way that you've reflected,
Karen, on the fact that yourpower shifts depending on what
context you're in.
And Emily, you touched on thattoo, that um in different ways
you recognise you also have thatpower.
And so the onus, again, is onall of us to understand how that
plays out in a given context andto be ever mindful of that for

(28:12):
all the reasons we've spokenabout.
I mean, that was really one ofthe reasons that I was so
attracted to the co-CEO role atthis newly established Victorian
Collaborative Centre.
It is a completely differentmodel, and the Royal Commission
were very brave in putting itforward, and I think showed
great vision, but also set usall a huge challenge.

(28:36):
Because, again, in reflecting onwhat we've been talking about,
it really calls upon us to startand practice and work very
differently.
If we start from this basis ofpower and privilege and
inadvertent harm that can arisefrom that if we're not keeping
it at front of mind, what it'sreally calling us to do is

(29:00):
question the model of care thatwe're in and and and how we do
that and to move away from thesemore traditional hierarchical
models where there's someone whoneeds, as Emily said, you know,
to come in and say, What's wrongwith you?
And someone else to say, Well,this is how I'm gonna fix you.
So the fixer and the the fix-e,if you like, and to start and

(29:22):
think about relational models ofcare.
And relational models of careare all about the human
relationship that exists betweentwo people and understanding
where they are, each in theirown lives, you know, and they're
both gonna bring perspectivesand pearls of wisdom to bear on
whatever it is that they'reinteracting to work on, and

(29:44):
they're gonna learn from eachother.
It's not just ever one way.
And this is where even thetherapist role, I think Emily
has an inbuilt um power in it asa as a uh psychologist who does.
Does therapy, you get to know alot about the person, but they
get to know very little aboutyou.

(30:05):
So there's an imbalance in thattherapeutic relationship.
And that was kind oftraditionally set up to avoid
there being a scenario where thetherapist just goes on and on
and about themselves, and youthat actually becomes unhelpful.
But at the same time, it alsocreates this opaqueness, which

(30:26):
again leads to a powerdifference for therapists and
clients or consumers of therapy.
And so how I like to think aboutit, and I kind of alluded to
this when we started, is workingtogether, being on a journey
together.
There's a reason that therelationship works, and not all
therapeutic alliances do, butfundamentally what sits

(30:48):
underneath it is that humanrelationship of two people
exploring issues at a time andin a place that is hopefully
going to help both of them moveforward and learn and reflect.
And so at the collaborativecenter, relational models of
care and lived experience are atthe heart of all of our work.

(31:13):
And promoting innovative ways ofworking that reduce or
eliminate, in fact, seclusionand restraint are all about what
we're here to do and toencourage across the system.
And so important for us at thecollaborative centre is to walk
the walk, not just talk thetalk, because it's easy to say

(31:34):
these things and much harder todo them.
So the Royal Commission builtthis co-CEO model into the
collaborative centre structure.
It also put a board in placethat has a chair who is
non-lived experience, but aco-chair who's lived experience
and many people with livedexperience around the board

(31:56):
table.
This is quite an atypical thing.
You're not going to see this onstandard boards in organizations
in the community.
It has at every level of thecenter's work embedded lived
experience, shared decisionmaking, shared reflective
practice.
And then it has the livedexperiences advisory panel, or

(32:17):
leap, as we very warmly refer toit, the leapsters, who provide
advice to the board and to theteam in all of our work, and
this is core to the way we thinkand do things.
So what this means in real timeas a co-CEO is that you really
change the way you work.

(32:37):
You don't come in and makedecisions and just write, we're
going to do it this way.
There's this stepping back fromthat, what might be a
traditional leadership model anda deliberate seeking space for
discussion and reflection andtaking time to confer.
And Carolyn Gillespie, myco-CEO, Lived Experience, who

(32:58):
can't be here today, but I do mybest.
I don't do it well, but I do mybest to channel her thoughts.
She would talk about ourreal-time discussion and
decision-making and how we'rekind of doing that just in the
daily work.
And that really brings thisconstant reflection about the
power and make sure, you know,that that relational way of

(33:22):
working, reflection, decisionmaking, shared power is caught
of the model.
And we have to really work hardto do that because it's easy for
us to be very busy and go, we'llsplit and conquer and divide.
But actually, as soon as we stepaway and do that, we've lost the
essence of what we're there tobe doing.
And so what it means is that wehave to be deliberate, we have

(33:45):
to be intentional and consciousabout it, and we have to build
in extra time because you knowthe pressures of the clinic or
the the organization or theleadership role or what wherever
you find yourself mean that youyou naturally get pulled away
from that.

SPEAKER_02 (34:03):
I hope that you're enjoying this podcast.
If you have a topic suggestionor would like to participate in
a future episode of PsychMatters, we'd love to hear from
you.
Please contact us by email atpsychmatters.vback at
ranzcp.org.

SPEAKER_06 (34:21):
So, Emily, I'd be interested to hear about your
reflections of LEAP and howthat's gone in terms of the
structure more broadly for thecollaborative center, given your
core involvement as the deputychair.

SPEAKER_05 (34:34):
I think one of my favorite things about the LEAP
is that I often forget I'mdeputy chair not because of the
responsibility, but because itis very much shared leadership
and acknowledging that everyonehas something to bring and
learn.
I think that's something that Ireally enjoy about being in that
space is the humility thateveryone practices, the

(34:55):
curiosity that everyone brings,and how we're always working
towards the same goal ofimproving the system.
We're hard on the system butgentle on the people.
And I think that that'ssomething that I hope to see
more in reform spaces.
The leap is something that Idefinitely value as a space
that's representative ofintersectional lived experience

(35:18):
leaders.
And it's really an amazingopportunity to be able to work
with people who do not identifywith lived experience or
predominantly haven't worked inthose sorts of designated roles
and to really challenge anddisrupt power and privilege in a
way that is curious rather thanpunitive.
Because I think thatconversations around power and
privilege, they don't need to bescary.

(35:39):
I think that some people arereally uncomfortable engaging in
these conversations because theyfeel that it's going to end up
as a personal attack or fearthat it's going to be giving up
control or diminishing theirrole.
But I think it's about anopportunity to grow and to learn
and to improve with moreperspectives, especially to make
room for people who historicallyhave not been heard but have a

(36:02):
human right to be involved indecision making that affects
them.
I think my kind of main messageto people who might be hesitant
to engage in these sorts ofconversations, it's important to
highlight that addressingprivilege isn't a one-time,
immediate radical change.
It's small reflective actionsand remaining curious about not
just the people around you, butalso about yourself.

(36:25):
And I think it's maintainingthat active care towards you and
the world around you that canreally build a system and a
society that's really foreveryone, not just for the only
people who have decision-makingpower currently.

SPEAKER_01 (36:41):
I'm really interested, Emily, listening to
you and Sarah.
And I've got a bit of a questionfor you in this one, Phyllis,
but I kind of want to put thisto all of you.
I think we're we're talkingabout that personal
responsibility people have inchecking power and privilege, in
self-awareness.
But for psychiatry as aprofession, I think there's also

(37:01):
that responsibility for theprofession to be self-aware
about the impact of power andprivilege on our leadership
structures within psychiatry andand within health services.
And so I I come back to kind ofthat same rough list I sketched
before.
Worry that when power structuresand leadership structures are

(37:22):
not reflective of, you know, themembers of a group, when they're
not respective of the broadersociety that they're part of,
that's that's another way inwhich power and privilege
manifest more subtly.
So you know, I can meet the mostlovely, reflective leader and
always thoughtful about powerand privilege in my personal
interactions with people.
But if I don't recognise I don'tjust have power and privilege in

(37:46):
those spaces, I have aprofessionally, and I'll use the
example of, and and I mean nooffense to any of my colleagues
who will be able to identifythemselves for what I'm about to
say.
But I spoke about one of myprevious roles, which is the
chair of the Victorian uh branchof the College of Psychiatry.
And so when I first joined thatVictorian branch committee, I'm

(38:09):
gonna say maybe 16 or 17 yearsago, there was not a female on
the committee.
And uh certainly nobody uh wasidentifying as uh non-binary,
uh, so it was both binary male,not not heteronormative, but
certainly very cisnormative.
And when you look back on it,that had just been how it always

(38:30):
was.
And there were ways, myexperience of it coming on as a
very young person back then,that the ways of conducting that
committee propagated that.
So the times of day that it washeld at created imbalances in
who who would nominate becausethey could or they couldn't
attend.
I do remember when a, you know,a female colleague of mine

(38:53):
joined and she eventually leftthat committee, and one of the
things she said was it was anoverwhelmingly masculine
environment.
It was just eventually too toxicand unsustainable.
Predominantly a mixture of, youknow, when we looked at racial
background, it was men, most ofthem much older than I was at
the time, sadly the age Iprobably am now, and a mixture

(39:13):
of predominantly European andIndian background men, which are
the two groups that seem to berepresented in power structures
within psychiatry in Victoria.
And there was nothing being doneto actually change that or
address that.
Um, before I was the chair ofthe branch, there were some
other, you know, much moreforward-thinking people who
went, There's a problem here andwe need to do something about

(39:34):
it.
I'm going to talk about mypersonal approach, not to big
note myself, but as an exampleof it, like how we have to
approach these things broadly,was there was a recognition that
there were issues with this.
There was a recognition thatwhen we looked at who'd been the
uh speakers at conferences overthe last decade, it was
disproportionately weightedtowards men, when in fact our

(39:55):
membership was closer to 50-50.
Um and when you looked attrainees, um, there were more
women than men, and there weremore people identifying as
non-binary than you know, thathadn't existed well uh for
people uh up until a certainpoint in something that you

(40:16):
could identify with.
People still identified thatway, but not openly and not in
in more public settings.
So we were not representative ofthat as all.
So one of the we you know, weput in place clear policies that
said you have to have evendistributions when you run a
conference.
And we put in when we put inplace a succession uh strategy,

(40:37):
we were really clear that thenext chair of the branch was not
going to be another man.
Because until your positions ofpower are representative of the
people you're representing, youyou're perpetuating those power
imbalances that exist within oursociety each and every day.
So I think it's lovely that I'minterested, uh talking a lot to

(40:59):
kind of his background, but I'minterested in how you've seen
that play out or not play out inhow you approach things at the
collaborative center.
And I'm really interested inPhyllis's and Emily's
experiences of how that's playedout in the psychiatry leadership
settings, because both of you indifferent ways um interact with
psychiatry leadership all thetime.

(41:19):
And hopefully it's not as quiteas toxic as it appeared to me 20
years ago.

SPEAKER_05 (41:24):
Understanding power unpacking it, um especially in
the way that you've describedit, Karen, to understand that
it's kind of societal and theindividual and the formal and
informal.
There are kind of two axes.
So if you imagine like they-axis going from like informal
at the top to informal down thebottom, and then the x-axis from
the left to be individual andthe right to be societal, that

(41:47):
kind of creates four quadrantsof where power can kind of
manifest.
The first quadrant of likeconsciousness, which is like
individual and informal, itthat's that sort of like
checking your own power andprivilege.
It's understanding it, beingempowered in your own self and
be able to do that at theindividual level, in at the
informal but the societal level.
There's like culture and therepresentation, the visibility

(42:10):
of who is actually inleadership, whose expertise is
being valued, and what isactually being counted at as
expertise.
There's also like individual butformal, which is stuff like
resources, who's being paid toactually be giving their
expertise, who has access toopportunities to provide their
expertise or technology orinformation, and then uh formal

(42:31):
societal, which is those kind offormal rules and policies such
as like governance andprocedures that dictate things
such as who needs to havecertain qualifications in order
to attend meetings or be goodenough in order to give their
expertise.
I think interrogating thedifferent ways that power can

(42:51):
manifest is really important toaddressing them.
And it is very much sometimesreally explicit, um, such as
like policies and governance orrepresentation at board levels.
But sometimes it can be reallyimplicit and at at societal and
both individual levels.
So yeah, I I love the way thatyou kind of unpack that, and I
hope that my verbal explanationof this framework kind of helps

(43:12):
a little bit.

SPEAKER_01 (43:14):
That's been lovely.
I I kind of tend to have a brainthat thinks along those lines,
but probably not as umstructured as as you were.
So that's that's really given mesomething lovely to think about.
I'm interested, Sarah Phyllis,as well, your your
understandings and how this hasplayed out for the two of you.

SPEAKER_07 (43:31):
So it's interesting.
So I I don't want to point thisout to you, Karen, but you're
the only you're male in thepanel, and you are also not uh
Australians.
But I mean I was just thinkingabout you know how you kind of
were able to transform, youknow, the Vic branch and the
community.
You started from a place ofpower.
You know, you were part of thatthe the group that held the
power.
Just to highlight it is hard forthe people you know who who

(43:53):
might be at the other at otherend of that spectrum that Emily
kind of outlined.
And and and it's great to havethis collaborative centre now
and some other changes in thekind of role that the World
Commission has initiated becauseit's very hard for one person,
particularly the person that'sat the bottom of that hierarchy,
to try and make you know, dotransformation, which is what
you're talking about, Sarah.
And like for me, like I am justa clinician on the ground, and

(44:17):
although I'm trying to do mybest of the patients that I see,
you know, the thought of tryingto you know transform the whole
system.
I mean, that's just impossible.
And one of the things you'vehighlighted is that by
legislation, I have the mostpower.
So as much as I try not to dorestrictive practice and
everything, the law has given methat responsibility.
And I think it's something a lotof psychiatrists, clinicians

(44:38):
struggle with that we have thisultimate power and
responsibility, because powerdoes come, you know, with
responsibility and it does sitwith us.
And it is very, very difficult,therefore, to share that because
unfortunately the responsibilitydoesn't get kind of passed on.
Like legislation, we are theones who sign off.
So if anything happens, like isit possible that maybe in the

(44:59):
future that could be more thanthat psychiatrist who has input
into making an assessment orderand you know the TTR?
You know, is that gonna belegislated?
I know we're supposed to takeinto consideration different
people's you know points ofviews and including the you know
the the patient, but but someonewho's really unwell and who's
been deemed to have you knowdon't have capacity and if it it

(45:20):
is very difficult.
So I have to kind of I guesskind of n not defend as a role
of psychiatrist, but it is uhone of the big challenges, like
in terms of co-leadership, thatas well as giving the side the
power, do we also share thatresponsibility?
And I mean I think that is aslight shift, the idea of
dignity of risk and sharing thatrisk.
But at the end of the day, it isalways in my head that you know

(45:41):
we are the one who's signingoff, and if anything happens,
then I'm the one who's gonna beyou know caught up in court.
That's there are challenges atthe kind of systemic level
still.
I mean, and hopefully that mightchange with time.
So from my perspective as a as apsychiatrist on the ground, even
though I might have the power atthat practical level, that that
you know, there's somechallenges that we face.

SPEAKER_06 (46:02):
Yeah, and Phyllis, you've touched on that dilemma
or that tension that existsreally beautifully, and you've
captured that that even in aposition of power you feel
powerless because this systemchange seems to be um above and
beyond where individual capacitylies.
And and and Emily beautifullydescribed it in her, you know,

(46:26):
two axes model.
One of the new models of carethat we're trying at the
Collaborative Center, and aspart of the strategy that we
have, we have a translationalresearch strategy for Victoria
that we're rolling out tosupport new models of care that
are built around theserelational models.
One of them is the open dialoguemodel that we're doing in

(46:51):
partnership with the RoyalMelbourne Hospital.
And I know there are otherservices across the state who do
variants of this type of model.
But it gets to this nub of thetension that you were talking
about, Phyllis, that what doesit mean to deliver care for
someone when they're perhaps ina position where they can't make
informed decisions when they'reacutely unwell?

(47:15):
And then how do we address thatso that we can ensure that we do
make decisions that they wouldapprove of or that they have,
you know, had direct input intoso that the decisions that are
made when they're not in thatperhaps state of mind to be able
to contribute, nonetheless, thedecision reflects what they
would want.
And so the open dialogue modelis all about these models of

(47:38):
community-based care wherediscussions are had around that
as part of the model.
So, how is it that you want tobe cared for in the different
phases or states of yourcondition?
At certain points, yourwell-being will be higher, at
other points your psychologicaldistress will be higher.

(47:59):
And how is that to be bestmanaged?
And talking through that andreally having a shared model of
care that comes out of that thatthat reflects the needs and
wants of the consumer, that alsohears the voices of carers and
supporters and kin and bringsthe team together so that power

(48:21):
sharing is held across the team.
And Phyllis, in a sense, thatactually is better then for the
psychiatrist as well, because itwhat we haven't spoken about is
the moral injury experienced byclinicians as well.
So these practices are not justharmful to consumers and
families and carers andsupporters and kin, they're also

(48:42):
harmful to clinicians andpsychiatrists.
Because the last thing thatcertainly I ever want to be
doing is creating thesescenarios where, you know,
seclusion or restraint might bethe option that we end up in, as
I'm sure exactly your sameexperiences, Phyllis and

(49:03):
Karen's.
And when we get into the systemas it currently works, kind of
leads us into these scenarioswhere that seems to be, you
know, we we're led down thispath and the moral injury, the
the the distress, how can thisbe happening?
This is not what I signed up todo.
I signed up to go on journeyswith people and to experience

(49:24):
the highs and the lows and thejoys and the dismay with them
and to learn and to to walkalongside.
I didn't sign up for other typesof experiences, and yet here I
am now finding myself doing thisor having to do this.
And we know a lot of clinicianshave left the system because of
this, right?
Because of the moral injury andthat the harm that they've had

(49:45):
out of it.
So I think before when Ireflected on this is a necessity
that we all have to work towardsfor all of our benefit
collectively, because we know atthe moment getting people to
stay in the workforce is one ofthe biggest challenges, the
retention rates, the burnout,the psychological impact.

(50:06):
And then again, that leads toeven worse experiences for
people who are then accessingservices.
So we get into this downwardspiral rather than stepping back
and taking a completelydifferent approach.
So it's kind of radical at onelevel, but I guess it's what the
Royal Commission saw, the pointthat the system had come to and
is asking us all now to grapplewith.

(50:28):
I don't think it's an easyanswer and I don't think it's a
quick fix.
I think it's complex, it's hardwork and it's going to take a
long time.
And the best way to do it iswith all the voices in the room
and and from really elevatingthe lived experience so that we
we don't repeat the samemistakes.

SPEAKER_07 (50:47):
Um, thanks for that, Sarah.
I think that it it's it'sreassuring to hear that there
are sort of like models,alternative models of care being
trialed.
Um and you know, thatincorporates that co-leadership
element and it is true, it it isa bit of a relief, you know,
because it is one of the thingsthat makes the job quite hard
when you've got someone whodoesn't have the capacity to

(51:08):
make decisions and you know, umif they especially don't have
carers, like what do you do?
And we know we don't want tocome to work and do restrictive
practices.
Um that's not why we signed upto do psychiatry.
So that it's nice to have thatvalidated.
Um because I think the pictureof psychiatrists in public is
often often the opposite.
And I think with a framework,you know, that's why we're
hoping that that psychiatristswould sort of reflect on their

(51:31):
own practice, but also how theirown role within the system.
And you know about Karen, I ifwe do see that there are issues
and how do we as individualswell not like take on the whole
Vic branch, but maybe just makemore changes.
And it could just be a simplething like that, you know, like
how we to participate, are theopportunities maybe just start

(51:52):
sharing that that power.
Karen, would that be all right?

SPEAKER_01 (51:56):
Yeah, look, uh so there's always opportunities.
And but I want to pick up kindof connecting what you've said
and and some of the things Sarahsaid to what Emily was saying
about the you know theassumptions that dominant
cultures make.
And so one of the things thatbothers me, I'm going to use
that specific example becauseit's come up a few times and
it's dear to my heart,restrictive interventions.
The dominant culture inVictoria, both inside and

(52:20):
outside of the health system,dominant culture supports some
kinds of practices as necessaryin making sense in certain
situations, and therefore peoplefeel, as you've described, feel
less like there's no otheroption.
But frequently the dominantculture is wrong.
The dominant culture doesn'tmean that something's right.
It means it's what everyonebelieves is right, or it's what

(52:42):
everyone has, you know,developed to a point of thinking
makes sense.
But but from an evidence baseand from other perspectives,
it's often really wrong.
And I think this is some of thestuff the Collaborative Centre
is teasing out with differentmodels.
For me, it's it's that obviousthing around, you know,
restrictive interventions.
There is nothing from amedico-legal perspective that

(53:06):
says you should be doingrestrictive interventions, and
if you don't do them andsomething goes wrong, you did
the wrong thing.
But that has been the culture,and I'm not saying from just
within psychiatry, but the waycoroners and a medical culture,
so both medicine and and legalcultures, have examined when
things go wrong.
Um and that comes right down tothe fact that some of the

(53:26):
methods that are used to analyzethings look to find a cause and
essentially to lay blame whetherthey see it that way or not.
But there are other approachesto this.
And, you know, you know, thereare restorative justice cultures
that take a really differentlook at what it means when
something has occurred.
And so there are things that arereally deep within our culture

(53:48):
that lead us down the wrongpath.
And so I think power and powerstructures and not being aware
of them is really one of thosethings.
Um they often lead in the wrongdirection because they assume
that the people with the powerhave the knowledge and therefore
what they want to do is right.
I was in a co-leadershipposition for a few years, Sarah,

(54:09):
and I always used to say I feellike a fraud here because one of
the principles was that I wasmeant to be developing
leadership in people with livedexperience as part of
co-leadership, but I learned farmore than I imparted, I always
thought, that actually I I itchanged the way I work both
clinically and as a leader,working in co-leadership.

(54:29):
Again, I think that's one ofthose dominant assumptions that
it's uh it's more one way thanthe other because of the power
differentials.

SPEAKER_06 (54:36):
Yes, absolutely.
And and in fact, I would bethinking that going forward this
should be the model, you know.
It we should have co-leadershipin all our mental health
services from the top and allthe way through the system.
And uh that's what we mean byreally putting lived experience

(54:56):
at the heart.
It has to mean something andhave impact and really change
the way the system works, andand that's the way we're gonna
move towards this, I think,better place.
Is there anything more, Emily,you'd like to reflect on, or
would you uh like to sum up somekey points?

SPEAKER_05 (55:14):
It's been a really amazing conversation.
I absolutely loved it.
But I I think um something I'dlike to point out about this
conversation is that uhprivilege and power, it's not a
conversation about blame.
Each of us in this conversationhave different types of
privilege, different types ofpower, and I think it's about
being curious about yourself andthe people around you, how

(55:36):
systemic structures caninfluence our privilege and
power.
And I think we've reallyrole-modeled that, and I hope
that that kind of is the flavorthat other people take on into
their conversations.
They're really big things,privilege and power, but it I
think each and every single oneof us can do things to address
that at an individual level, andthat can really ripple out.
And my kind of favorite threesteps that I like to give folks

(55:59):
when like first talking aboutprivilege and power is to first
learn about yourself.
So understand how systems affectyou.
Everyone has their ownexperience of gender, sexuality,
race, education, employment, anda whole lot of other
intersectional factors.
So learn about how those factorsaffect you.
And then second, learn aboutother people.

(56:21):
So I think it's important tostep on first because otherwise
we will leak over ourexperiences into other people's
experiences.
So we need to hold ourselvesapart from other people and
really learn about who theyreally are without ourselves
being put over them.
And then the third step is tospeak up and show up.
So really leveraging your powerand privilege where you can
speaking not for other people,but with other people, and

(56:44):
really amplifying voices thataren't often heard.
Yeah, I will throw it over toKaren.

SPEAKER_01 (56:51):
I have a view or a perspective that the best
leaders are leaders who don'twant power.
The problem with being somebodywho doesn't want power and being
in a position of power is itfeels really uncomfortable.
Sharing power is the best way toaddress that.
And be that in your day-to-dayclinical practice, be that in
leadership positions, sharingpower, there is uh there's

(57:12):
wonderful evidence that, youknow, a group of competent
people will generally come upwith better solutions than one
really smart person.
Um so sharing power, sharingprivilege where you can
ultimately leads to betteroutcomes.
That's kind of my key take home.
It's a more sensible way forwardto get better outcomes that are

(57:33):
actually more pleasant toachieve.
If you're like me, I do muchbetter reading things than
listening.
Um, though I do listen to a lotof podcasts, so happy to do one.
Um if you want to haveco-leadership, you need to make
sure that you're investing inpeople developing into
leadership positions.
And so I think that is one ofthe things we haven't spoken
about here is that there has tobe both a systemic and a

(57:56):
personal investment in consumerleadership from psychiatrists
and leaders.
Um I'll throw it across to you,Phyllis.

SPEAKER_07 (58:03):
Thanks, Karen.
I think those two words that Ithink Emily mentioned as well
about humility and curiosity.
And although that's not kind ofpart of the framework, I think
that is something to kind ofthink about.
I mean, it's not something thatcomes naturally to everyone.
I think doctors in general tendto be curious, but you know, not
all humble in all situations.
But I think, you know, to beable to share power, you need to

(58:24):
think about being a bit humbleand and curious and and where
this could lead you.
And certainly at a on a personallevel, I mean, it's been very
enriching from going not knowingwhat lived experience meant to
then the last few years beingactually throwing myself into it
in educational and in myclinical space, it's been very
enjoyable and sort of moreauthentic and you know it's what

(58:44):
I signed up for originally whenI wanted to be a psychiatrist.
And I Emily was one of thepeople I've worked with with the
frameworks.
But I I I think, you know, likebeing curious about what the
opportunities there are andhaving the difficult
conversations, because it alwaysdoes start with difficult
conversations, but I meanhopefully this podcast enable
people to think about it andhave that conversation.

(59:05):
You know, when everyone doesn'tknow where we're gonna end up,
but the fact that we canactually openly, honestly, and
respectfully have thatconversation is I think, you
know, is a good starting point.
So that I think that's the mainmessage I like to people to take
from this podcast.
Thank you.

SPEAKER_06 (59:20):
Yeah, and just just to finish off and uh tie all of
that together, that hopefullythe listeners today have heard
that you have the authorizingenvironment to do this wherever
you are in the system.
The really important thing toremember that a system is just a
set of humans, and it's thehumans who ultimately, if we
work collectively andcollaboratively, can start to

(59:43):
make the system work for usrather than us working for the
system.
And we have the authorizingenvironment to do that, and we
have heard at large from thelived and living experiences
communities how important it isthe Imperative to do that.
And so to take away thatinspiration, enthusiasm, or

(01:00:05):
sense of purpose from thisdiscussion that this is where we
we need to be headed.
We do need to grow the livedexperience leadership in our
community and opportunities andworkforces and really have them
integrated into our clinicalpractices and service
deliveries.
We haven't yet, I don't think,fully perfected that, so we need

(01:00:27):
to continue to do that.
And as we do this, we all needto recognize we're on a learning
journey and we're going to learnfrom each other.
We're going to make mistakes,but we can be courageous and
open to acknowledging that andthen learn in an iterative way
to do better as we go and havethat compassionate approach.

(01:00:47):
So show up as humans to do thework together to make the places
that mental health treatment,care and support is delivered
better for all of us.
So on that note, I'll thankeveryone for tuning in to Psych
Matters and the discussion.
I've certainly enjoyed it.
I hope others have too.
And to thank the other people inthis podcast for all these

(01:01:10):
amazing insights that we'veshared.

SPEAKER_04 (01:01:13):
We hope you enjoyed this episode of Psych Matters.
Feel free to share it withothers and keep an eye out for
future episodes.
Psych Matters is produced by theRoyal Australian and New Zealand
College of Psychiatrists.