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The Mental Health Crisis: Promoting Wellbeing for Our Patients and Ourselves

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The Mental Health Crisis: Promoting Wellbeing for Our Patients and Ourselves

Almost half of all Australian adults will face mental health challenges during their lives, and 1 in 5 will experience one this year. How can we as practitioners support our patients, our communities, and even ourselves?

Introducing the all-new hosts of FX Medicine - Dr Adrian Lopresti, Dr Damian Kristof, Emma Sutherland and Dr Michelle Woolhouse – who come together for the first time in an episode moderated by Dr Lesley Braun,  to discuss the growing mental health crisis.

In our inaugural episode, the hosts discuss the shifts they have seen in their various practices around the growing mental health challenges, and how natural medicine and natural health practitioners can support their clients’ wellbeing. They also discuss what this crisis is teaching us about mental health, how some of the long-term effects of this might manifest in the coming years, and some of the strategies each host employs to keep themselves and their patients in a better mental health space. 

Covered in this episode

[00:08] Dr Lesley Braun welcomes the new hosts of FX Medicine 
[01:09] Introducing Dr Adrian Lopresti 
[03:08] Introducing Dr Michelle Woolhouse 
[06:03] Introducing Dr Damian Kristof 
[07:29] Introducing Emma Sutherland 
[09:23] Emma, Adrian and Damian discuss the increasing numbers of clients with mental health challenges  
[16:32] Michelle talks about the role of natural medicine in supporting community health 
[20:44] The ambassadors share how they manage their own mental health as practitioners 
[29:37] Discussing lessons learned and ongoing mental health challenges in the coming years 
[42:13] Key tips on how can practitioners help themselves and their patients through this time 
[46:37] Thanking the ambassadors and closing remarks 

Lesley: This is FX Medicine, bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr Lesley Braun, author of Herbs and Natural Supplements: An Evidence-Based Guide. And I've actually got a new little guide coming out very soon called Mental Wellbeing: The Essential Guide to using Herbs and Nutritional Supplements. I have the great pleasure of moderating today's discussion and introducing you to our four new hosts of FX Medicine: Dr Adrian Lopresti, Dr Michelle Woolhouse, Dr Damian Kristof, and Emma Sutherland. 

Today we're going to discuss a topic that's becoming both a national and worldwide crisis, mental health. Almost half of all Australian adults will face mental health challenges during their lives, and one in five will experience one this year. So it's the perfect time to come together and explore what different modalities and treatment options can do to best serve our patients and maybe even help ourselves a bit, too.

Before we get into today's discussion, let's take a few minutes to meet our four new hosts. Adrian, one of the things I think our listeners would love to learn more about is your background and your vast experience, but also why did you decide to become an ambassador? And maybe something that people really don't know. So, Adrian, tell us a bit more about yourself.

Adrian: Thanks, Lesley. I'm a clinical psychologist. I've been practicing for almost 25 years now. And originally, I was, I suppose, your more traditional psychologist where I do your psychological therapy, but I soon realised that we needed more than that, and I became extremely interested in nutrition and the role of diet on mental health. 

So that then led me to do a lot more research in the area. I did my PhD in in the area, and just become more and more passionate about it as I've gone along. So I continue to practice and see clients a couple of days a week, and I do a lot of research now looking at the effects of different herbs and nutraceuticals on mental and cognitive health.

Lesley: So you're one of those wonderful people that's actually creating the evidence that we all rely on when we go into clinic. That's fantastic. Adrian, why did you decide to become an ambassador?

Adrian: I'm passionate about education. I mean, I've got a cupboard full of books, and I continue to accumulate books. I don't know what I'm going to do with them now. There's just way too many, so, fortunately, a lot of them are going to e-books now, which is making life a lot easier. 

But I just really think that education and interviewing different experts around the world is great for us to be able to increase our clinical skills. And I suppose...I was a passionate user of FX Medicine, and I get now to drive it a little bit. I get to choose the topics that I'm interested in, so there's a bit of a selfish component to it, too.

Lesley: Yeah. No. I fully understand. Thanks, Adrian. 

Michelle, you and I have known each other a long time, but I think there might be some listeners out there who don't know about your background. You want to tell us a little bit more about yourself?

Michelle: Yeah. Hi, everyone. My name is Dr Michelle, and I've been an integrative GP for...oh, I've sort of lost count now, 22 years, I think. And my interest in a more holistic way of practicing medicine started way back in medical school, really frustrated by just that smaller framework that medicine tends to take, and was really interested in lifestyle medicine, nutrition, but in particular, mind-body medicine.

When I stumbled upon mind-body medicine, it was just such a great fit for me to understand the connections of the body and how all of the parts work together, and how we as humans work within our environment, and within the world, and between each other. So I've been practicing that particular expanded approach to medicine for a long time. And, yeah, I maintain my passion, and I always get really excited the more evidence and research that there is.

Lesley: I think that people often forget the role of the mind. It's so huge. I know when we look at doing randomised trials, I mean, a placebo is really mind-body medicine in some ways, isn't it?

Michelle: Yeah, absolutely. I mean, the placebo effect, and the nocebo effect is incredible as well. So the opposite of the placebo where we can actually promote the negative effects of something that we might take into the body. And I think learning about that and embracing that just helps every practitioner almost embrace how effective they can be by the relationships that they form with their clients and their patients. And it's empowering as a practitioner knowing a lot about that space.

Lesley: Absolutely. And, Michelle, why did you decide to become an FX Medicine ambassador?

Michelle: I love education, and I love the opportunity to really shape story for practitioners and for the general public. I think still, I get frustrated by sometimes the narrow approach that we can take as a community, and really expanding that and understanding how much empowerment we have in our lifestyle choices is incredible.

Sometimes when I think back to some patients that I've seen, and just making not insignificant changes, but significant changes in their lifestyle has really made a profound effect on their whole health not only for themselves, but their families, and sometimes even their communities. And I just think there's just so much room for education and expansion of this model of care, which is why I think I took up this opportunity to really, I guess share my experience, but also to learn more about how different practices are evolving. And I think, as a group, there's just so much more that we can do.

Lesley: Damian, you've got such an interesting background. I think everyone's going to be really keen to learn more. Tell us a bit about yourself.

Damian: Thanks, Lesley. I'm so excited about this whole podcast. I think it's going to be a great opportunity for people to engage with, I think, just different values, and different approaches, different sets of eyes. People might not know that I started out studying to be an accountant.

Lesley: No.

Damian: I found it a little bit too boring, and began my experiments with herbal medicine as I spent more time at the beach, that kind of thing, although I don't know if you can call that medicine, but I had a lot of fun. 

But that then also then meant that I was interested in understanding how the body could improve and be better because I was eventually sick from my lifestyle and behaviour. So, as many naturopaths, and chiropractors, and mainstream medical professionals have done, they've had a health crisis themselves.

And so I went through the health crisis, studied to be a naturopath. I practiced naturopathy for a number of years and then decided to become a chiropractor because I thought that that might bring me further into the mainstream, but I didn't realise that chiropractic was fringe. But I love chiropractic. I know. But I love it, and I've been practicing chiropractic now for 13 or 14 years. I've been a practitioner for 23 years. And I don't feel that old, but, definitely, I love educating and I love speaking about what it is that we learn and what it is that we know.

Lesley: You bring such broad experience, it's going to be fantastic. Emma?

Emma: Hi, Lesley.

Lesley: Tell us a bit about yourself.

Emma: Thanks. Damian, I had to have a chuckle because you and I have something in common. I, too, went to university and studied accounting, and I have to say the world is definitely better off that I dropped out of that pretty promptly. 

So, I've been a clinical naturopath for about 18 years now, and I'm based in Sydney. And my holistic health clinic is called Studio You, and there we really specialise in two areas. The first is helping women get their mojo back, so women getting that sense of just energy and vitality, and feeling good within their own bodies.

And the second thing is helping families raise vibrantly-healthy children. I'm so passionate about this area of paediatrics, and I just feel if we can change a little person's life for the better, the long-term effects of that is absolutely profound not just for the individual, but the family and for the community. So I really love working with my little patients.

And joining the FX team, I am so excited to be amongst the company that I am. I'm just so excited. Being on the coalface, seeing patients in clinic every day, I think it's so important that we bring the conversations to life about the research, the people doing great work in our industry, and really have those vital conversations. So bringing that clinically-relevant information to the audience is something that I'm looking forward to.

Lesley: Thanks, Emma. And I agree with you in terms of a great start in life through a healthy pregnancy, and then in the younger years, is the most amazing and important part of preventative medicine. So really keen to hear what you've got to say down the track as well. 

I’m going to open up the discussion for today, and I thought it would be really relevant to talk about mental health.

If you think about it, we've been going through this COVID-19 pandemic for what seems like a really long time, but also, there's been another pandemic that's been going on at the same time, and that's the mental health challenge that this has brought with us. 

So I'm really curious to understand from everyone, what's been going on in your clinics? What has changed over the last 12 to 18 months? Are you seeing a different type of patient come through the door? Do they have different needs? But also, how have you responded to this challenge within your clinic environment, as well? 

So, Emma, I'd love to start with you. What are you seeing, and what have you been doing differently?

Emma: Well, unfortunately, we have been seeing much greater levels of anxiety and depression in our patient demographic, and this is across the board. But one thing that does disturb me quite a lot is that I'm seeing it in my younger and younger patients, you know, 9-year-olds telling me that they're having panic attacks and they can't breathe. And so it's deeply touching when you hear these stories about how the pandemic is impacting families and children.

And I've got to say I've really struggled at times in working out how to support these patients as well as I can, and one thing that I have definitely noticed is that collaborative care is even more important. So I almost feel like my role is to triage people in the right direction in these situations, and to liaise with their GPs or liaise with their psychologists and get them the support and help that they need because it goes beyond my scope of practice a lot of the time now. And so establishing the working relationships with other practitioners has never been as important as it is now.

Lesley: It makes a lot of sense because we can't be all things to all people, so building that network, as you've described, of healthcare practitioners around you that you trust, that you can refer to and can refer to you, makes a lot of sense.

Emma: Yeah. I've also got to say, I've never ever dispensed as much magnesium, or Withania, herbs and nutrients like that than I have in the last 18 months. I mean, it's just astounding.

Lesley: I've even got my daughters saying to me, "Mum, what's Ashwagandha? All my friends are taking it." So it's actually really hitting the mainstream, isn't it?

Emma: Yeah. It's great.

Lesley: Yeah. Thanks for that. Adrian, I'm really keen to hear what's been happening at your end.

Adrian: Yeah. Obviously, I see a lot of anxiety and depression even prior to the pandemic, and I think it's probably skewed more towards anxiety now. And my concern, I suppose what I'm really seeing is just the changes in coping skills that people are using, which can have a negative impact on their mental health.

I see that they're watching a lot more media. They're more focused on the news, and that uncertainty is probably fuelling their anxiety. And they're not quite sure what to do next, even in terms of weddings and parties, and those types of things. It's really having an impact on their ability to plan for the future, and just socialise and be with others. So that's my thing that I'm seeing with a lot of my clients.

Lesley: That makes a lot of sense. Now, I've been talking to people about this, this sense of planning, and how definite can plans be? And looking at it as more of an intention rather than a definite. I'm sure you've been giving people lots of good tools about how they can work with that?

Adrian: Yeah. I mean, certainly, when it comes to anxiety, it's uncertainty that fuels the anxiety. So, really, then, I'm really encouraging people to still set goals, but maybe they're more short-term rather than longer-term, and really just trying to have a greater balance in terms of, obviously, their social connections. It hasn't been so bad in Perth where I practice, but with the lockdowns and so forth.
But because they're not going to necessarily be able to improve their mental wellbeing through social connections so much, there are other things they can still concentrate on, like your sleep hygiene, and like your physical activity, and engaging in activities that might boost their mood. Those are the things I'm really trying to concentrate on with my clients.

Lesley: So it sounds to me, Adrian, like you develop a lifestyle prescription for people. You've talked about sleep, you've talked about exercise and social connection. I'd be really interested to learn more about that down the track. 

Tell us a bit more about what's been going on for you, Damian.

Damian: I have seen so much sympathetic dominance, and so that's a thing I really want to unpack with the listeners, is what's happening to the nervous system as it becomes overcharged and overstimulated, and are people able to relax? And that sort of thing. So, I'm finding people are suffering not only from more upper back pain and neck pain, and what would appear to be an acute flare-up of an old neck injury, for example, even a low back injury where their back has become quite sensitive.

They're sitting down a lot more in front of computers, poor posture, not moving as much as what they could, maybe missing that opportunity to move into a third space. So they're not really downregulating or switching off, and so they go from the bedroom to the kitchen, to the study, I suppose, or even back to the bedroom to work from the bedroom. So there's a whole lot of overcharging of the sympathetic nervous system, and people are forgetting to breathe, and relax, and chill out, and so we've got digestive discomfort and disruption, and so on and so forth.

So I'm seeing a lot of people that are stressed and anxious as well, a lot of people that are failing to breathe deeply. They're really shallow breathing, so that means that you're getting a lot more upper muscle fibres in the thoracic spine, and the cervical spine becoming tight and tender. And then the consequences of that being the inability to take it easy and relax, and see what is actually beautiful still out there, and focusing on the things that are, I suppose, a little bit more challenging.

Lesley: Damian, I'm wondering about just a couple of things that you said there, and one of them is that people are obviously sitting for longer periods. They're going from their bedroom to the kitchen, to the study, to the kitchen, to the bedroom. But also, I think people are walking more than ever before to get their two or three hours of exercise. Are you hearing a bit more about that, and the consequences of lots more walking?

Damian: Oh, yeah. Absolutely, Lesley. One of the great consequences is that people are getting out, which I love, and where they might have spent an hour traveling to the office, they're now spending an hour walking in the morning, which, I think that's fantastic. One of the problems, though, I suppose, with that is that people are moving, but there may be a negligence to stretching.

So, yes, you might be moving more and exercising muscles, but as a result of doing that, the muscles get stronger, and as a result of that, they need to be stretched, because if they don't get stretched, then they get shorter, and then, of course, pull. And so, the pulling of the muscles on the joints creates that pain, discomfort, the stiffness that people are feeling. So, yes, we're getting out and about, which is good, but there's things that go with that to prevent injury and to make us feel fantastic.

Lesley: Yeah. Makes a lot of sense. If we step out of the clinic and take a more macro view about what's been going on in the community, Michelle, I'm really keen to hear from you what you see the role is for integrative medicine, supporting the general community mental wellbeing.

Michelle: Look, I think the whole society, particularly here in Victoria, and currently New South Wales are really suffering from fatigue of rules, and from the breakdown of their social connections, and as Adrian mentioned, just not being able to plan ahead. And I think it's actually revealed to us a lot of the cracks within our society because of this extra pressure that people are feeling, it's actually revealing to people their own stress management skills.

So I think we've got an incredible opportunity to actually almost expose our anxiety and expose our skillset, and see whether we can really embrace the issues that are not going to go away quickly, and see whether we can actually learn from our bodies and what they're saying. 

So, for example, what Damian was saying about extra tension within the body from excessive walking. Learning about things like yoga and stretching, and learning about our sleep hygiene, and learning about how nutrition and our diet, and how important it is for mental health could be an opportunity for integrative medical space to actually share that lifestyle medicine approach to health and wellbeing rather than looking at medicine as, "I've got a problem. I need to fix it.” So that kind of "one plus one equals two" solution, and see our mental distress as an opportunity to really embrace change going into the next couple of years. 

Because I think the issue with what we've got with this pandemic is that, I think what what's really tipping Victorians over the edge at the moment is the double-year of uncertainty. So last year was very difficult for us, but this year is even more difficult, and that fatigue is setting in. And next year we're really going to have to dig deep and really get resourceful in terms of our skills of how we manage our mental health.

Lesley: I was just thinking about one of the things that you said there, and that's about sleep. And there's been some reports showing up until about 2017, 2018, that half of Australians reported they were having inadequate sleep. I'm wondering if we're getting more sleep than ever before because people aren't commuting as much. And maybe that's a good thing, and maybe that's having some kind of counterbalance. I don't know, but I'm wondering if it's worth exploring down the track.

Michelle: Well, yeah. I mean, sleep is probably like...I see it as a foundational aspect. It's like looking at what quality air we breathe, looking at exercise and movement, sleep is so important, and nutrition is so important. And they're the absolute pillars of not only our mental, but our physical health. And I think sometimes, though, for what I've seen as well, is sometimes there's an excessive laziness that's coming in to the community at the moment, like with this lack of planning and this lack of scheduling, and we've lost a little bit. So sleep could be even looking into a bit of an excessive sort of laziness that's occurring.

And so, again, we're just talking about the importance of rhythm in our body. We talk about circadian rhythms and sleep being the most obvious one, but just the rhythm of life has been disrupted. You know, we're humans, we're dancers, so we all have this beautiful ability to move through life, and I think when those movements stop, it affects us deeply to our core. Rhythm, I think, is very important to look at in life in general, and sleep is quintessential to that.

Lesley: Yes. It reminds me of a very well-known article that was written in "The New Yorker" a couple of months ago, and it was entitled something along the lines of, "Are We Languishing?" And we're starting to hear that a lot in the public discourse. 

Speaking of which, we see a lot that's written in the media about severe mental health issues, but one of the things we don't get to hear a lot about is the health and care of the healthcare practitioner.

So the question I always wonder about is, who cares for the carers? I mean, we're all human, aren't we? Well, when you're in this profession, it's very much a caring profession, and we're giving day after day to our patients, to our peers, but how do we look after ourselves? 

I think it'd be really good to explore this a little bit further, and I'd like to start with Damian about, what are some of the things that you've incorporated into your life to support yourself during these changing, challenging times?

Damian: Lesley, it's such an important thing to consider, and I'm one of the fortunate practitioners. I'm a tactile person by nature, and a lot of the people that I see in practice, obviously, if they come to see a chiropractor, they're also, to some extent, tactile. They enjoy someone's hands being on them, and I enjoy giving touch. So, for me, that's a great refueller, and so there's an exchange of energy between me and the patient when they're on the table and I lay my hands on them.

So that's a great thing. I think that's kept me somewhat sane. But I've had to be very, very mindful of ways in which I can bring myself back into calmness. And so I use a foam roller, and I lie on a foam roller, it runs vertically down my spine. And I stretch my chest muscles out, so my pec muscles, and I take in the deep breaths every evening. And I do that every evening as a practice to try and bring myself back into, I suppose, a better sympathetic space. And so it enables me to, I suppose, think more clearly, connect with my wife, Amber, and make sure that I'm not charged up about the day or anything else that might be going on, or a press conference that I might have overheard at some point in the day. But just that practice is really important.

But the other practice which has been super important to me is to make sure I have a daily routine of walking. Not being able to play golf has meant that I'm down on kilometres per week, so I've had to go out and walk, which has been really good for me. So, as much as I get that connection, and that touch, and that ability to meet with people on almost a daily basis when I'm in practice, the practice of getting back into a parasympathetic zone before I eat or before I engage in conversation when I'm at home has been fantastic for me.

Lesley: Thanks, Damian. What I've really loved about what you said there is you've recommended two things that are really accessible. So, walking, everyone can do that, just need some runners, and I think everyone's got a pair of runners these days. And those foam rollers. I hadn't thought about that. That makes so much sense. Thanks for that. Emma, what have you been doing?

Emma: Well, to be honest, some days I don't manage it. So, some days do become overwhelming, and I think they're the days where I have to stop and catch myself, and think, "Well, what am I not doing that's resulted in me feeling like this?" And often I think about it, and the way I view the world is through a lens of fun. And I usually find that when I'm feeling overwhelmed and feeling stressed in that way, I haven't been having enough fun. I've been too serious, and I haven't been laughing like I need to laugh.

And so, in those moments, I usually go and hang out with my daughter, because she's very fun, and makes me laugh a lot, and I do commit to doing yoga three times a week. And there's some mornings I wake up and I just don't want to get on the mat at 6:00, but I do it because the point is to turn up no matter what, no matter how I'm feeling, and to have that commitment to being on that mat three times a week.

Lesley: It takes a lot of self-discipline, doesn't it?

Emma: It really does. Honestly, some days I do not want to get up, but I always feel better for it afterwards. And I may not be full of endorphins, but it's when I breathe the deepest for the day. It just works for me.

Lesley: Yeah. And there's so many amazing apps now, and Zoom classes as well. I think yoga has never been more accessible.

Emma: Yeah. So true.

Lesley: Thanks, Emma. Michelle, tell us all a bit about what you've been doing yourself.

Michelle: Well, I'm in the fortunate position of being, I've just set myself the task of writing a book, so not being in clinic has been really helpful from a mental health perspective. But I'm a little bit of a combination of Damian and Emma because I'm a little bit of a yogi and a meditator, and I walk every day. In fact, I've walked so much that my hamstrings are sore, and I've had to go to a chiropractor.

Lesley: I know a good chiropractor.

Michelle: Oh, yeah. I mean, I've actually been going to a chiropractor, too, to help me with that, so that's been fabulous. 

But I think the biggest thing that helps me from a mental health perspective is giving myself self-compassion. And I do that through a meditation process myself, but even just minutely by just taking the pressure, my internal pressure off myself and to give myself room to be enough, rather than put this, "I need to do more, and more, and more."

And as much as sometimes, like, a little bit of internal pressure can be helpful to get us up if we're languishing, like the word that you used before, Lesley, like, are we languishing? But at the same time, also being gentle and knowing that we're going through a very unique experience in the human journey. And just giving myself permission to sometimes, you know, to be okay with that, to take off the pedal. And sometimes if I am feeling like I'm having a bad day, to actually make that okay. So it's a little bit being comfortable with sometimes the discomfort that we're feeling.

Lesley: So it sounds like being kind to ourselves, with a little bit of a dose of self-discipline as well, so that we don't fall into languishing, might be the formula. Thank you, Michelle. 

Adrian, what have you been doing? And, look, your experience, I'm sure, has been quite different because you're in WA.

Adrian: Yeah. I mean, we haven't experienced the lockdowns of the other states, so I've been able to, kind of, work still as usual most of the time, and which has meant that work has been incredibly busy. And I know that's been the case for a lot of practitioners out there, particular, lot of psychologists. I know that they are overrun with seeing people and getting a huge number of referrals, and that really means that we've really got to take responsibility for taking care of ourselves. You mentioned earlier who takes care of the carer? I mean, ultimately, it's us, and we want to be able to take responsibility for that. And I've had to ensure that I've put limits on how many cases I take on, how many clients I take on, because I do need to look after myself.

And that's something that, maybe in the past, I've been susceptible to bringing work home, and...I mean, definitely been susceptible to bringing work home and working late at night. And I'm just really trying to put limits on that these days, and just making sure that I have enough time to do the things that make me feel good. And for me, that's exercise, and interacting with others and my family, and so forth, going out for dinners. And, unfortunately, a lot of the foods I've eaten haven't been overly great, so I probably can't recommend.

Lesley: COVID kilos?

Adrian: Yeah, exactly. But I think that's the key, I think, for us, is really about going, "Okay, we've got to take responsibility for our own self-care. What are we doing to improve our mental and physical wellbeing?" And that's really needs to be individualised based upon a person's own preferences.

Lesley: Yeah. No. That makes a lot of sense. I really liked what you were talking about in terms of calendar management, making sure that you've got time in your day to do these things, but also that you're managing your caseload a lot more actively, because I think that very often in our professions, we're constantly wanting to give. We don't want to turn people away. We really just want to keep the door open. But making time to say, "No. I need a bit of me time," is so important. Must have been hard when you first started to do that?

Adrian: Yeah. I mean, this is where what we need to keep in mind is, are we providing a quality service to our clients? And it's not about quantity. And there's a point where there's just way too many clients that potentially you may be seeing, and that impacts on the work that you can do with that person. So saying no, you may feel bad saying no to a new referral, but ultimately it's probably better for the other clients because you can provide that quality service.

Lesley: Yeah. That makes a whole lot of sense. 

Let’s move forward. Let's look to the future, because these lockdowns and everything we've been going through is going to eventually revert back, and we're going to start to get a lot more freedoms, and life is going to change again. But I guess the question that everyone's pondering is, is it going to revert back to what it was back in 2019, or have we become a little bit wiser? And, what have we learnt along the way? So, what might be some of the opportunities that have arisen that we want to keep into the future? But also, we do need to keep our eyes open about some of the challenges that going to remain for quite a long time to come. 

So I'm really keen to hear from everyone about what have been some of the biggest lessons that you've seen, and what might be some of the ongoing challenges we're going to need to deal with for several more years to come? So, Emma, for example, I know that your naturopathic practice has changed significantly, as I'm sure many naturopathic practices have, adopting telehealth in a way that was never really embraced and adopted before. Do you see that continuing, and do you think there might be other opportunities that have arisen for naturopathy?

Emma: Yeah. I think people understand that you can still conduct your appointments and you can still do your great things through telehealth. And I think there was a lot of reservation before because naturopathic medicine is so personal, and having that face-to-face, one-on-one, it's so intimate. But I think people have really understood that we can still get that same connection through telehealth. There's still ways that we can get that happening. And distance and location, it's not a barrier to accessing great healthcare these days.

And I think that that is such a positive. I think that, you know, initially I see so much social excitement, and over-indulging, and probably more weight gain, so I think we've got to keep our eye on that. And I'm already starting to talk to patients about, "What are your strategies for when things open up? How are you going to handle that social overexcitement?” So we've got to start thinking about that. 
But longer term, I think there will definitely be a greater awareness around mental health, which is good. Unfortunate that the awareness has come because so many people have been impacted by it. So there will be more ongoing awareness of mental health, and I think opportunities are definitely this more collaborative work style, having more people caring for that patient, and being able to cohesively talk between the practitioners and have that rapport so that the patient feels very well cared for.

And, of course, as Adrian said, new strategies for stress management, and thinking more about how we can implement these preventative strategies, because for our collective nervous systems to heal from the last 18 months, we really need to focus on preventative strategies. And I really feel that this is where naturopaths can really offer so much in that space, in implementing those strategies with patients. So I see a lot of really fantastic things moving forward. I just think we have to have some very clear and direct conversations with our patients, and just be walking alongside them.

Lesley: It sounds like whilst it's been a really challenging time, yourself and your practice has adapted to make the most of it, and like you say, there's a lot of good things that are going to be coming out of this, besides obviously the burden of the type of patient that we're seeing. But I'm helping people to get through that better. That's so interesting. Yeah. 

Damian, being both a chiropractor and a naturopath, you certainly see a broad range of people. What have you picked up, and what do you see for the future?

Damian: Well, it's such an interesting thing, isn't it, to think that maybe as soon as restrictions lift, that we'll all bounce back? But there's a great saying that I'd like to remind people of, and it was a quote by Ralph Waldo Emerson. And he said that the mind, once stretched by a new idea, never returns to its original dimensions. And I've always held that true to my heart that once you learn something, you can't unlearn it. Once you hear it, you can't unhear it or unsee it, that sort of thing. 

And so this will be the same, I think, for these COVID times, moving forward. I think people have some nervousness. There'll be a greater awareness of anxiety, and a greater awareness of poor sleep, and a greater awareness of one's nervous system, I think. And maybe even just symptomatology. I think people are going to be very sensitive to what's going on inside their body and in and around them. 

So we might actually find that there's maybe some catastrophisation of some things going on with people as things start to settle because we're going to be let out into the wild again, which is exciting, but people may find that it's a little bit wild out there, and they might want to retreat back into their homes. They might enjoy the safety of being back in home, and they may not want to go back into the workspace, into the office space. So I think we're going to see, I suppose, a continuation of this stress piece. We're going to definitely see an increase in anxiety, and then everything that goes along with that, digestive discomfort, and bowel dysregularity, and hormone dysregulation, all those sorts of things. I think we're all going to see all those sorts of things in practice, and with our patients. 

But with ourselves, I think it's really important that we continue to check in just to find out how it is that we're actually coping with the change of the demands and the change in the conversations. People are looking for a whole lot more from their practitioners. That connection that they might have had from flippant relationships they had in the workplace, they might be looking for more from their practitioners, and so we need to be mindful of how much we give and how much is taken from us.

Lesley: That's really interesting, Damian, especially when you're talking about that transition period before we find our new normal as well, and what might be picked up at that point.

Damian: For sure.

Lesley: Michelle, you made the very big decision this year to step out of general practice after so many years, so some really big changes for you. Are you seeing other people also reappraising their life decisions?

Michelle: Yeah, I am, actually. I think what's occurred over the last 18 or so months has actually allowed a lot of people to question what they previously held as normal. So a lot of people, particularly...and it's not to exclude men, but women with children in the workforce tend to have a huge burden of responsibility on them because of their home life and their family life. And we adapted to that stress response. We adapted to that pace of life of getting up early and perhaps exercising, and then work, and then shopping, and food, and housework, and children's, getting them to sport, and all of that kind of stuff.

And I think a lot of people are realising that we were potentially over-scheduled, and that there was excessive amounts of pressure on our time. And it was that simply alone that stopped us from enjoying the things that we previously enjoyed. And I think this room of less commuting and more autonomy of time for many people has allowed us to question our motivations. I think our motivation, and also our opportunities for change as well.

And I think with the less, I guess, time to spend money to buy...when retail was closed, when restaurants have closed, and so we've had an opportunity to actually look at our financial health as well. And a lot of people, I'm hearing, are saying like, "I don't actually need as much money as I thought that I did to live on." And I think that people are questioning the use of their time, the amount of pressure on them, and the stresses that they might have in their workplace. And I think there is going to be a shift towards a new engagement with some of their career choices or their potential workload.

Lesley: Michelle, that's something that's been picked up in a lot of the workplace statistics. It's being called the Great Resignation, and also the Great Re-engagement.

Michelle: That's right. And it's not just women, but the reason why I mentioned women is that I know that the burden of housework tends to fall on them. I'm sure Adrian and Damian, they're absolutely equal in their home, so it's present company excluded, but statistically say that there is a burden on women at work and in domestic non-paid jobs. And then child...

Lesley: Home schooling.

Michelle: And then home schooling, as well, to add to the top of that. And I think the adaptability of knowing how much we can achieve online, knowing how much opportunity there is for technology has really potentially paved a way for a new way of thinking. And I think that there is going to be a great opportunity to shift our mindset to really what matters more.

I think that there was potentially too much emphasis on financial and economic success at the detriment of our social connections and our social successes. And I think that any kind of crisis like this can open an opportunity for at least just to answer or ask more questions, or different questions so that we can look at ways that we adapt and become more flexible with our choices.

Lesley: Adrian, as a psychologist, I'd imagine that more people talking openly about their mental health, and also the greater general awareness of resilience. I don't think I've ever heard that word bandied around as much as I have in the last 12 months. I'd imagine that's a good thing, but I'm keen to hear what you've observed, and what you think might happen next.

Adrian: Yeah. Look, I've got absolutely no idea. I mean, it's created the opportunity for us to become more aware of our mental health and the importance of it, but the key word is that opportunity. So, unfortunately, as humans, we can have short memories, and I think initially there's going to be really positive effects in the short term, but what happens in the long term, it really depends on what changes we really incorporate. Are there positive habits that people have developed, and will they continue with them? Are there not so positive habits that people developed, and will they let go of those?

And that's really...I think this is an opportunity for people to be able to assess what things they've learnt from COVID, and to get a piece of paper or write it down, and for them to really try to remember what it's been like, because when life goes back to the new normal, people may forget, and they may forget the importance of social connection and what they missed, the fact that other things mattered more than work and finances, and so forth. But people can forget. So that's one thing, I think, that we really need to be mindful of.

I'm also concerned about children. And we know that their view of the world is really moulded during the early years. So we really need to concentrate on ensuring that their mental health is taken care of, and that we can support them as they grow because there may be an epidemic of ongoing anxiety for children as they grow older. But we'll see how that progresses.

Lesley: Well, one of the things that I'm picking up from all of you is that this transition period is really going to be very important for practitioners in terms of supporting people through the transition to start understanding what their needs are, where they need bolstering of skills, what decisions and, I guess, lifestyle and dietary decisions they made through this period that should continue on or might need to change.

And, Adrian, as you point out, children. I guess, at best, maybe children have learnt a lot of wonderful things, some independence and some self-discipline. Maybe they've also learned a few skills about how to cope because they've been going through change. I guess, at worst, it could be quite a different situation. 

What I thought I'd do just to end with our four wonderful ambassadors, is to go out with a tip, one tip from each person about how practitioners can help themselves, but also help their patients. We've covered a lot of ground today, but if you had to distil it down to just one key tip, what would it be? 

All right, I'm going to start with Damian.

Damian: One of the greatest tips I give to everybody, which I think we can all be guilty of not doing, is drinking enough water. And I just always ask people to drink more water and drink more than you think you could. And I think this is true for the practitioners. It is true for the patient. If we drink more water, we're more aware, we're more mindful, our body's in a better place to heal, and I think that's really important as a great place to start from.

Lesley: Great. And, Damian, do you have a target for people when you talk about drinking more water?

Damian: Well, I, kind of, go on the 25 mils per kilogram minimum. You know, I'm not very good at maths, that's why I didn't do accounting. So 25 mils by 100 is 2 and a half litres. So if you're 100 kilos, 2 and a half litres. And if you want to drink less water, lose weight, if you need to drink more water, just suck it up, I reckon. So that's, kind of, where I say that you need to go, but it's around 25 mils of water per kilo body weight is what I've read.

Lesley: Thank you for that. Michelle, your top tip for everybody.

Michelle: Well, my top tip would be not to take things so personally. I think we have a tendency to often, particularly as healthcare providers, really take on that responsibility and that burden. And for me, what I do is I have a little mantra that I say to myself that “I'm trying my best." And when I say that to myself, or my husband's actually my greatest kind of flag-bearer, is he says that “You tried your best,” or “You're trying your best.” It actually...I can feel my whole nervous system relax, because what I acknowledge when I say that to myself is I actually am trying my best. And some of the problems are bigger than me. They're bigger than the system, and we're going through such an enormous time and pressure. 

So that's what I would recommend, is to know that to try your best and to not take it all so personally, and just manage that sense of responsibility that you have. And reach out and connect to all of the other healthcare providers, but to your family, and just really embrace your own heart space, and give yourself that self-compassion and kindness that we all deserve.

Lesley: And we probably never do enough of.

Michelle: It's really important.

Lesley: Adrian, what would be your top tip?

Adrian: I think mine would be balance. So, ensuring that people have the right balance in terms of their social and work life, and how much time they dedicate to themselves, how much they took time to dedicate to others, and using their mind and their body as feedback. So if they're feeling anxious or depressed, then the balance is not quite right, and they need to revisit their different areas of life, and maybe put more effort in one area and less effort in another. So that's probably my top tip.

Lesley: Balance, and taking stock of things and readjusting. It sounds like it is something we need to do for the rest of our lives. We should be already doing it, but I think we always forget. We often forget. Thanks for that, Adrian. 

And, Emma. Let's leave with Emma's words of wisdom. Your top tip about how practitioners can look after themselves a little bit better and help their patients.

Emma: For me, it is always to find some joy and to have some fun, because when you're doing those two things, all those incredible neurotransmitters and endorphins that are just running loose around your body, you can't help but feel just happy. And when we feel happy, we know our parasympathetic nervous system is completely...like everything just lights up like a Christmas tree. Everything just is in flow.

So, find something that brings you joy. If you don't know what it is, just watch a cheesy comedy movie. It doesn't matter what brings you joy or makes you laugh. Just find it. And sometimes it's about just being a big kid. Just bring that kid out and just let it loose. Put on the music.

Lesley: Does sound like fun.

Emma: Yeah. Put on the music, have a dance, whatever it is that brings you that sense of joy.

Lesley: Yeah. I guess we can all dance in our living rooms, can't we? Thank you, Emma. And I just want to say a big thank you to our four ambassadors: Emma, Damian, Michelle, and Adrian for today. Really appreciated your words of wisdom and your advice, as well as the personal insights that you gave everyone today. Thank you.

Emma: Thanks so much, Lesley.

Damian: Thanks, Lesley. It's been great chatting with you today.

Adrian: Thank you so much, Lesley. I'm so excited about all of this. It's great.

Michelle: Thanks, Lesley. It was so gorgeous to chat.

Lesley: Thanks, everyone. Thanks for listening. Make sure you never miss an episode, so subscribe to FX Medicine on YouTube, Apple Podcasts, Google Podcasts, and Spotify. You can let us know what topics you'd like us to cover through our website, which is fxmedicine.com.au, or via Facebook and Instagram. Thanks, everyone, for listening.


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