Coming up on DTNS Tim Berners-Lee's plan to save the Internet, eBay sells off Stubhub, and Rob Dunwood shares why he chose Adele over the new Apple laptop. This is the Daily Tech News for Monday, November 25, 2019 in Los Angeles, I'm Tom Merritt. And from Studio Redwood, I'm Sarah Lane. I'm the show's producer, Roger Chang. Very happy to have cohost of the SMR podcast, Rob Dunwood back with us on the show. Welcome back, Rob. How's it going? Thanks for having me, folks. So we are going to talk with Rob about laptop choosing, something that Rob has a long history with. I know a lot of you are probably thinking about or have thought about or are going to think about again. Also, just now on our Good Day Internet show, we were talking about ham and turkey and power washing. Sarah had her first power washing experience.  Let's start with a few tech things you should know. Tesla's Cybertruck on veil last week included designer France Von Holzhousen successfully smashing two of the vehicle's armor glass windows on stage with a metal ball. They were not supposed to smash. Now we know why the glass broke. According to Tesla CEO, Elon Musk, who tweeted when Von Holzhousen smacked the metal door with a sledgehammer before the metal ball test, the impact cracked the base of the glass, which weakened it. This is why you always test the demo exactly the way the demo is supposed to go, although I guess maybe it didn't crack it in a test. The risk five foundation, which sets chip standards, told Reuters it plans to move from Delaware to Switzerland. Universities, governments, of course, companies outside of the United States helped to develop risk five's open source technologies. But some of them are concerned about possible disruption from US trade restrictions. While no restrictions are in place against risk five, it's possible that say a Chinese company could contribute to the open source technology and then be unable to take advantage of it due to a future restriction such as those applied to Huawei. So risk five's members have suggested it move to neutral territory, which it's going to do. Finland's Solcomp, which supplies iPhone chargers to Apple is investing 20 billion rupees. That's about 278.67 million US dollars in Chennai, India to make mobile chargers and other smartphone components starting in March of 2020. The facility was formerly owned by Nokia. The sales expected to generate 10,000 new jobs. And on July 18th, Amazon closed parts of its e-commerce operations in China to focus on cross-border sales and cloud services. Now, Amazon announced it will launch a pop-up store on Chinese e-commerce platform Pinduoduo. The pop-up will list about 1,000 non-Chinese products. All right, let's talk a little more about the big decision that came down in London today, Sarah. Yeah, kind of big story today. Transport for London announced it decided not to renew Uber's license to operate in the entire city, saying it found a pattern of failures by Uber. Specifically, TFL said that Uber allowed unauthorized drivers to upload their photos to other drivers' accounts, meaning they were often uninsured. TFL says that this happened on 14,000 trips with 43 drivers. Uber will appeal the decision and continue to operate in the meantime. Yeah, I've seen that described as allowing unauthorized drivers to do it, but I've also seen it described as a vulnerability. In other words, something Uber wasn't meaning to happen, but figured out a workaround or a loop in the system to do this. And the idea was you go to a friend's account and say, hey, I can't pass the background check, but I want to make some money. Let me use your account that upload that person's picture so it matched. But it really wasn't that person. And transport for London, I feel like, has been looking for a reason not to renew Uber's license, and they seem to have found it. Although, again, for now, Uber's going to continue to operate in London. It's got 21 days to appeal. It's going to appeal, and then it could probably end up working its way through the Supreme Court for a couple of years. So this is far from done. Rob, what do you make of this from your seat? So you characterize this, I think, perfectly. They were kind of looking for a way to not renew Uber's authorization to work in the city. So you had that working with you. And I don't want to minimize this. It is a big deal because security gets in there. You've got one driver that's been background checked, but you're somebody else that hasn't. It's showing up. I mean, there are definitely issues that could pop up from that. But yeah, I think that Uber is going to, this is the vulnerability. We're going to fix it. They're going to come back and we're going to hear additional court cases on this. I don't think they want to just give up and say, okay, well, we're done in one of the largest cities in the world. Yeah, I know that there's probably pressure being put on Mayor Kahn of London to fight Uber because the Black Cab people, the folks who have to train for years, who have to pass the knowledge where they have to memorize the streets of London in a six mile radius, don't like the idea that somebody can just sign up for Uber, pass a background check, and be competing with them out there. So there's pressure on that. And I think there's also a little bit of the political backlash where you're seeing the Labour Party, and they have an election coming up December 12th in the UK, the Labour Party sort of pushing against technology companies as part of their platform. And here's an example of a Labour Party Mayor pushing against one of those technology companies. And I'm sure that is, even if it doesn't play a part in the decision is certainly going to be used in the campaign. No doubt. When you look at the numbers here, 43 drivers, 14,000 trips. So that's a lot of people taking a lot of trips supposedly being those 43 drivers, which they in fact were not. This does not seem like a widespread problem in London. You know what I mean? And it's definitely on the company to figure out how to make sure that this doesn't happen in the future. But it does seem like a small number of people saying, huh, we can game the system. I can't drive right now. You drive for me. You'll just be me. Well, and certainly these kinds of, it's sort of an arms race with this sort of thing where people will come up with workarounds that you didn't anticipate, and then companies have to figure out how to crack down on them to prevent them. I don't know enough about the situation to tell you whether this was an unanticipated thing about Uber or if there was some amount of negligence, if they knew about it and let it happen. But I do know that under Kosar Shahi, Uber has seemed to be more attentive to this sort of thing. So I'd be surprised if they just turned a blind eye to it. That's more the Travis Kalanik era of Uber. Kalanik. Yeah. There have been some harsh words with some media figures about Dara Kosar Shahi based on these recent events. And again, like you said, Tom, it's, listen, if Uber knew about it and turned a blind eye, that is one story. But it doesn't really sound like that's the case. It sounds like some folks in London were figuring out how to get around some stuff and Uber's being punished for it. Well, we'll all circle back in 2021 and find out what's really happening with the Supreme Court. Meanwhile, Tim Berners-Lee launched Contract for the Web, a set of nine core principles meant to fix the internet and prevent a digital dystopia. The initiative has received the backing of more than 150 organizations including Google, Facebook, DuckDuckGo, the Electronic Frontier Foundation, Microsoft, the governments of France and Germany and Ghana. It's a widespread of backers here. Governments are called on to make sure that everyone can connect to the internet, that it's available at all times. In other words, don't shut it down. And that fundamental online privacy and data rights are protected. Companies are called on to make the internet affordable and accessible to all. Respect privacy and personal data and develop tech that supports, quote, the best in humanity and, quote, challenges the worst. And then we, the people, citizens are asked to be creators and collaborators. Well, check here. All four of us are doing that right now. Build strong communities that respect civil discourse and human dignity and fight for the web. Going a little easier on the citizens, I feel like here. What do you think of this platform, Rob? It's very grandiose in its aspirations. I'm all for it, but at some point, you're going to have to get down to, how do you determine what is one thing as compared to what is another thing? There's going to be disagreements. For example, what is acceptable from an expense standpoint? What's acceptable here is not necessarily acceptable in India. What's affordable? How do you figure those things out? What is being a good citizen as compared to not being a good citizen? How do you figure those things out? So I'm all for this. I like that there are big company names that are signing on to it. But as with everything, eventually when you get down to the minutiae, it's like, okay, what does this mean really? I think that there's a lot of things that would have to be figured out with this just because it's kind of vague in how these edicts are being pushed out. A lot of these, well, I say a lot of these, Tim Berners-Lee's contract for the web is its own thing. But you see this come up over time because people get upset and sort of disenfranchised with the way that the internet works these days and the corporations and the manipulation and all the things that come along with it and we're all used to it. Some of us are better at navigating it than others. I love this idea. I also think that the altruism of it is just, it's very hard to get a, I don't know, a majority? No, I do. I'm just saying. I think it's really hard to get a lot of people on board who are doing things another way already, whether or not it's the right way. No, I think you're both hitting on something that I've been thinking about too, which is, gosh, it's Tim Berners-Lee. So that's somebody who doesn't give up, right? He pushes hard for things. It's 150 organizations that are spread across a lot of different viewpoints. So it's got a chance of actually making a change. But a lot of times these sorts of calls for action just end up being words and not actions. So I'm hoping this will be the exception. I'm quietly optimistic, I guess. Not even cautiously, just quietly optimistic. But yeah, yeah. And I don't want to throw water on something that I think is a very good idea. No, it is a good idea. So I'm going to hope that I'm wrong when I say we will never hear about this again. Well, moving on to eBay, who announced its plans to sell StubHub to the Swiss ticketing company ViaGoGo for $4.05 billion in U.S. cash. ViaGoGo CEO Eric Baker co-founded StubHub. So we're going full circle again here. But he left before it sailed to eBay back in 2007. Once completed, StubHub and ViaGoGo will sell tickets in more than 70 countries. eBay plans to use the proceeds for stock buybacks, dividends, and merger and acquisition investments. The acquisition is expected to close in the end of Q1 of 2020. So there's two ways to look at this, Rob. It's either bad for consumers because you've got consolidation or good for consumers because now you've got a bigger ticketing competitor to companies like Ticketmaster that have sort of dominated it historically. So I am a fan or have been a fan of StubHub. I just hope they don't mess this up. There is a reason why I would rather get tickets via StubHub than Ticketmaster when possible. Sometimes you just can't. You have to go to the really, really big guys on the block. But I just hope that this doesn't mess things up because there's a reason why people like it as compared to some of the other places where you can get tickets. Yeah, and Beatmaster is pointing out there was a UK regulator brought a case against ViaGoGo for some practices that they said were anti-consumer. Those accusations were dropped. A lot of people still think that maybe ViaGoGo is a little bit shady, so hopefully that doesn't affect StubHub as well. We'll see. Yeah, it's an interesting situation.  True, but I mean, that's something that's kind of similar to the Uber situation earlier, where you have to wonder if that's just an arms race. In a 4-3 ruling, the Pennsylvania Supreme Court ruled that the Fifth Amendment bars people from being forced to turn over personal passwords to law enforcement. The ruling overturned a lower court that ordered a suspect in a child pornography case to turn over his 64-character computer password. The prosecution argued that Fifth Amendment protection did not apply in the case due to what's called the foregone conclusion exemption, where the government already knows of the existence, location, and content of the sought after material. In the decision, Justice Deborah Todd wrote that since the password has no physical manifestation, it is treated as the content of the mind, like the combination to a wall safe, which Supreme Court precedent in the United States finds to be testimonial and therefore protected by the Fifth Amendment. I can't incriminate myself by saying the contents of my mind. Both the lower court and the Pennsylvania Supreme Court relied on the US Supreme Court precedents, even though they are in confliction on their ruling. Previous courts have ruled differently on the relationship of the Fifth Amendment to passwords and the whole content of the mind argument. Supreme Courts in Indiana and New Jersey are having similar cases before them right now, so this is going to end up in front of the US Supreme Court at some point. It's just a matter of when. Yeah, this one's a big one. Actually, before this even showed up in our show notes, I was kind of aware that this was going on, and it just seems like no matter how many times there are rulings this way, prosecutors are going to try to figure out how to make you tell them something that you know. It just seems like they are just pressed on that. To me, it seems like the password is something that is in my memory. I don't have to tell you what's in my memory. I can choose to remain silent, or I can just not incriminate myself by telling you something. In no way am I supporting what this person has done, but I don't think that you should be able to compel someone to tell you what is in their mind. So I'm kind of glad that this is going, at least the way that it's going right now, but we'll see what happens when it gets to the Supreme Court. I know this is obvious, but if I say, Rob, you need to tell me what's in your mind right now, what's your password? I mean, you could just be like, it's this. That's what's in my mind, whether or not it's the right one or not. To compel someone to do that is not really to force their hand in any way. The other side of it is the password was 64 characters long. What if you actually really forgot it? Are you going to be held in contempt of court because you can't remember the ridiculously complex password that you... That's up to the judge to decide if you're faking it or if you really can't remember. 64 character password, though, I'm going to guess is written down somewhere. Maybe it's in a password manager, which then would have a password that he remembered, and it kind of obviates it. But if it's written down on a post-it note, well, that's a physical manifestation, isn't it? So I don't know. This is why it's going to be interesting when this finally comes before the Supreme Court, because basically a password is neither the contents of your mind nor a key to a lockbox. It's somewhere in between those two things, and it either needs its own law or the Supreme Court's going to have to come up with some new brilliant way of categorizing it, because otherwise you're going to constantly have people seeing it one way or seeing it another, depending on the situation. Next story, also a bit of a headscratcher. The South China Morning Post reports that in October, China's government removed cryptocurrency mining from a list of activities set for elimination at the end of next year. This came after China's President Xi Jinping publicly endorsed blockchain. Operating cryptocurrency exchanges are banned in China, but mining is not, and Chinese miners make up about 70% of global cryptocurrency mining operations. India's number two at just 4%, so quite a discrepancy there, and the US number three at 1%. Chinese companies, Bitmain and Canaan control more than 90% of the energy-efficient mining hardware markets. Yeah, I think probably the biggest part of the story that stuck out to me was just how dominant Chinese companies are in the mining part of this. I mean, I've heard that before, but I've never seen these discrepancies between China at 70% and India at 4%. That is a much bigger lead than I would have guessed before I knew this. And I think it shows that China realizes the difference between mining, which allows them to economically benefit from cryptocurrency, and exchanges which a lot of governments, not just China, worry would undermine their own cryptocurrency. So China, of course, cracking down on that, saying, no, you can't pay under the table with cryptocurrencies, but we'll happily mine them for the rest of the world to undermine each other because then we benefit, and we're pulling money into our country. Yeah, I read that as, one, really good at doing this. Two, we control the hardware. That does the thing that we're really good at. Three, we're going to continue to allow it to happen in our, you know, within our borders. And you're absolutely right. They're not, you know, endorsing the exchanges or allowing the exchanges are just allowing you to make, you know, to mine money that goes into them or mine cryptocurrency that goes into those exchanges. So, yeah, this is probably going to be around for some time in China. Yeah, and part of the reason is cheap power. There's a lot less expensive power in many regions of the country than there are in other places of the world. So it's not exactly subsidized, but effectively a different situation that you might have elsewhere. I'd be interested to see, I mean, India's 4% because it also has some cheap power arrangements as well. Be interested to see if they can make any progress on that. They certainly could have, if China had remained banning mining, but they kind of realized the gold mine, if you'll forgive the expression that they would have been giving up there. If you want to get all the tech headlines each day in about five minutes, be sure to subscribe to dailytechheadlines.com. All right, Rob, before we get into this, real quickly, you've got some experience purchasing a laptop. How far back do you have in buying laptops and making decisions about hardware and that sort of thing? The first laptop that I purchased for myself was a PowerBook 520C, which is actually a Macintosh laptop. I believe I got that in 1992. So what is that? 27 years ago, 26 years ago, somewhere in that time frame. So I have been using, and then I was using PCs before that, you know, there weren't laptops since I was a kid. So I have personally been using computers for pushing 40 years. So they're not new to me. I've had many Macs in my experience, but over the years, I have tended to be more on the PC or Linux side of things, just because of some of the work that I was actually doing. And here recently, what I use just really doesn't matter to me. I could just as easily and effectively use a Mac as I could a PC. So when I decided that it's time to get a new laptop, I said, I really should go and look at the MacBooks, particularly the MacBook Pro, which is right at one of the best laptops you could do 4K video editing on, which is one of my use cases that I have for any high-end laptop that I was going to be looking at. So I was actually really earlier this year contemplating getting a Mac. And Allison Sheridan, a friend of the show, she told me, you might want to hang out a little while, because around the Thanksgiving time frame, Apple always comes out with, generally comes out with new MacBook Pros. You might want to just wait to see what comes out to either potentially get that or see if you can get a price reduction on you know, the previous year's model. So that's exactly what I did. And so I waited until the MacBook Pro 16 inch came out, looked at the specs and the main reason, I know we'll start a conversation here, but the main reason I decided not to go with the MacBook was simply because of the Apple tax. It was significantly more for the same hardware than what I was getting into Dell. And I know that, you know, right now, Dell offers a ridiculous discount because of Black Friday deals that is, you know, you can buy a Dell cheaper at this time of the year that you can in the other time of the year. But that's still something that exists on the Dell that did not exist on the Mac.   But other than that, everything else was, you know, was apples apples. And I'll be honest, I have the 16 inch MacBook Pro, which did not cost me $4,000. Thank goodness, in the configuration that I got. But, but that 16 inch screen doesn't feel that much bigger than the 15.4 inch screen that I was using before. So I'm not sure how much of an advantage that would be to kind of, I probably depend on the person. But one thing I've noticed, and this occurred to me when you were talking about the comparison, it's always really difficult to make a, I want to say apples to apples comparison, of course, hilarious jokes will ensue. But, but to make that comparison between a MacBook and any other Windows because you can never quite get the configuration to be exactly the same. And what I've found is when you get close enough, you're usually within a margin where the Apple product is more expensive, but not considerably more expensive. If you're doing base models, as soon as you start adding more RAM, more storage, more process, or maybe that's when things really start to get ridiculous with Apple, because they charge you a lot more for RAM and storage than the configurations do at other places like Dell. That's exactly my experience. I believe that like the base models, the difference in price was straight 400 bucks. If you're not looking at the Black Friday deals that you're getting this week and last week. But when I started, you know, because I'm going to be doing some fairly intensive video editing on here, I bumped the memory up, I bumped the processor up, bumped the video card up, and it's like, man, this is like, you know, goes up $100 here, $100 there on the Dell, it goes up $400 to $600 on the Mac. And it's like, you know, and then the other thing too was that when I threw in like three years of Apple care, which is the max that you could get, at least the max that I thought that I could get, as compared to four years of next day Dell, with accidental damage, that really jacked the price of that MacBook up as well. So when I started to look at that, it's like, man, it's like for the price difference, I could just get this. And yeah, the monitor is a little bit smaller, but how often am I not going to be plugged into an external monitor anyway? I'm not a road warrior. This is something that just so that I can, you know, I can be mobile when I need to be. But you know, my use case is not going to be working out of a coffee shop doing 4K video editing most of the time. Most of the time, this thing will be sitting on my desk plugged into a 4K OLED monitor. Well, that makes a big difference, right?  But knowing that you've kind of got a place to be, got solid internet, you got an external monitor, I recently got a Mac mini for the same reason where I was like, you know what, I have a lot of other stuff here. I really just need, I need the box. That's all I need. So, and the other thing too was that, you at some point I might meet more GPU, but I want to plug an external one in. Same thing I would have to do with the Mac or I'm going to, you know, maybe I want a second OLED display. Same thing I would do with the Mac. So, you know, really, you know, I wanted enough of a base configuration that I can be out in the field and edit a 4K video and not literally want to just slam my head into the desk. But, you know, I'm not going to be doing it so much. Now, I will say this. If you are, if you're that wedding photographer and you're trying to get stuff done while you're in the truck at the wedding, you know, one of the huge benefits that I saw to the MacBook and it wasn't just a 16. This is actually previous models of the MacBook that when you're running Premiere, they work off the battery, literally orders of magnitude faster than what you get, you know, on the Dell XPS. The Dell XPS, it needs to be plugged in. The thing is very power hungry. But as long as you can plug it in, the Dell does just as well, or in many cases, actually a little better than the MacBook does. So, when I just looked at my use cases, am I really going to pay that premium for not ever really being in a situation to where it's going to, going to make sense for me. So, that's why I decided to, you know, go with the, you know, if the Dell literally didn't take long as like when I saw the price, just like I just, I can't spend that much more on a laptop that's not going to do any more for me. Now, the last thing I want to ask you before we move on is about longevity. One of the things you'll hear Apple fans say quite a bit is like, ah, but the Macs last longer and then you can amortize that price out over the years. How do you feel about that? And especially considering Dell's longevity? So, I was talking, you know, to a friend. She told me that, that's uncertain, you guys know her. She just sold, I think, a five or six-year-old MacBook Pro and got like 700 bucks for it, I believe. She told him seven or 750. So, the resale value on a MacBook as compared to a Dell, yes, you're going to get that. But I look at it like this, if I keep it the same amount of time, well, I paid $1,300 less for it up front. So, that probably is about a wash. I know that in six years, I'm not going to be able to sell this thing for 700 bucks. That's not going to be the case. But I'm not paying that premium for now. And my support is going to go longer. Because I believe that the Apple care was only three years. I've actually got the Dell Complete Care for four, which because I am going to be doing like work functions on this, that was important to me to make sure that, you know, I'm not three years in, I'm not ready to go to a new machine yet, but because I have an issue, I really have no choice. It's going to cost half as much to get it fixed as it would to, you know, to just replace it. So the actual support was probably the thing that pushed me over. Because when I factored in just getting that Dell, you know, support next day, I was able to, you know, get that for practically nothing with the Black Friday Dills that were going on. Nice. Well, thanks to everybody who participates in our subreddit. We talk about computers there all the time. You can submit stories and vote on others at dailytechnewshow.reddit.com. You can also join in the conversation in our Discord, which is very lively, I might add. And you can join by linking to a Patreon account at Patreon.com slash DTNS. All right, let's take a look at what folks are saying to us out there on the wider internet. Yeah, speaking of Patreon, Damian wrote in on your recent editor's desk, Tom, and said, I too have recently observed myself being resistant to change in tech. My last Android phone is dying for the first time in many years. I didn't buy a flagship since Sony is practically non-existent here in Australia. That's where Damian lives. I decided to change to another brand's ecosystem for future upgrades, options, Google Pixel 4, no fingerprint reader, face unlock, not supported by banks, deal breaker, Samsung S10, reviews say fingerprint under glass, unreliable. I don't like their custom software either. Nokia 9, reviews say fingerprint under glass is unreliable. By this stage of the process, I've already decided not to buy a new phone. I want the change. I need the change, but I'm so resistant to giving up the things that I am used to. Yeah, and the editor's desk he's referring to is one where I talked about the idea of having a certain amount of resistance and a certain amount of acceptance when you go into different things, like movies and TV shows, but also technology. So it was interesting to get Damian's perspective on that. Thank you for that. Yeah, thanks, Damian. I think we all suffer from that. It changes stuff, even if it's going to be better on the other side. Hey, thanks to our patrons. Special shout out at our master and grand master levels, including Jeff Wilkes, Sonya Vining and Tony Glass. Also, thanks to Rob Dunwood for being with us on the show. Rob, where can people keep up with the rest of your fabulous work? Oh, they can check me out over at smrpodcast.com. And then I'm just at Rob Dunwood on pretty much everything. Twitter, Instagram, Facebook. So hit me up there. Come check our show out. You'll like it. Yeah, it's always a good time. It's smart guys doing it and having fun. You'll feel better if you listen to smrpodcast. Say this from experience. You guys cheer me up some days. I really appreciate that. Folks, don't forget if you sign up to be one of our patrons within the next couple of days you have till November 28th, we'll send you some Freeland Peralta art, our holiday card, a special exclusive drawing that Len did just for this card of me and Sarah and our holiday wishes that'll be in your mailbox if you sign up or remain a patron and give us your address at patreon.com slash pledges. Look for DTNS. Make sure you've given us your address or just sign up and give your address when you sign up to become a patron at patreon.com slash DTNS. Feedback at dailytechnewshow.com is our email address. Email us early and often. We're also live Monday through Friday, 4 30 p.m. Eastern. That's 2130 UTC and you can find out more at dailytechnewshow.com Back tomorrow with Patrick Beja. Talk to you then. This show is part of the Frog Pants Network. Get more at frogpants.com. Bob hopes you have enjoyed this brover.


Good evening everyone and welcome to the Mental Health Professionals Network National webinar for tonight. I think that was a lovely introduction to the Mental Health Professionals Network for those of you who are not familiar with it and the local networks are excellent if you have that opportunity. So tonight's webinar is working collaboratively to support students experiencing exam anxiety. My name's Mary Amalaes. I'm a general practitioner and psychotherapist from Cairns in Far North Queensland. It's really exciting to see so many people logged on. So there was about 2,000, over 2,000 people have registered for tonight and so far there's about 640 different logins and it's excellent to have everyone joined together in this way. MHPN wishes to acknowledge the traditional custodians of the lands across Australia upon which our webinar presenters and participants are located. And on that note I do want to just note that there are a lot of people from regional and rural Australia logged on which is excellent. And we wish to pay respect to the elders past, present and future for the memories, the traditions, the cultures and the hopes of Indigenous Australia. And on this particular topic I also want to acknowledge that Indigenous people have a particular view around social and emotional well-being which I think is really relevant for our conversation tonight as well. Now you did have an introduction to our panelists tonight in the, their bio was sent to you when you registered. So I'd just like to welcome each one of them individually first of all and then I'll explain to you a little bit about the structure of the webinar. So first of all I'd like to introduce Associate Professor Craig Hassad who is a GP in Victoria and he also works at Monash University. Craig you have a special interest in mindfulness and I wondered if you just wanted to tell us a little bit more about your mindfulness programs at Monash. Well yes we're bringing it in very much as a part of the core training for nearly all of our degrees by now as core curriculum but because it's really a life skill that helps in so many ways and mental health obviously is relevant tonight but also to help to function in challenging work environments and for those who are interested as well the FutureLearn course, the free online course that we have running through Monash and FutureLearn is just went live again on Monday so people may be interested to have a look at that. So that's one of the initiatives that we're offering to the world. Thanks Craig and we're really pleased to have you with us this evening. I'd next like to welcome Paul Jameson who's a school social worker. Now in our preparation for this Paul told us that he works across 24 schools which I find astounding. Paul can you just tell us a little bit about the kind of work that you do in schools and perhaps the range of schools that you work in? Sure Mary, I do work in a network of 24 schools but I don't actually visit all 24 very often at all and I have main schools that I work in. The kind of work we do we support students from government schools, all government schools so including special schools and we help students that are experiencing difficulty at school so that might be due to mental health problems, might be due to learning difficulties, maybe due to a disability of some kind or other difficulties that students have. So we work primarily to help children experiencing difficulty at school and helping them to overcome those barriers to education. Thanks Paul, it's great to have you with us for this particular topic so thanks for being here. Next I'd like to welcome Jodi Nielsen who's a clinical psychologist from Far North Queensland. Jodi, you got an interesting addition to your training in that you did a degree in anthropology as well and I just wondered how that influences your practice as a psychologist. Absolutely, I did a lot of social cultural anthropology so it just adds to the cross-cultural dimension so it means that as a psychologist I'm always thinking culturally which is beliefs and values as the kind of centrepiece of how we construct the world that we live in. So just basically I think with every person that I see I'm thinking so how are they seeing the world. Okay and that's great to have you here as well. I know that you do a lot of work with year 12 students. Loads at the moment actually. I'd say May is the really pointy part of the year with year 12 students. Yeah and I would also like to welcome Professor Valsa Eepen who's a psychiatrist from New South Wales. Valsa you do a lot of academic work and you have a special interest in ASD I understand but also a lot of interest in young people with anxiety. Is there anything that's of particular interest to you in your work and your research at the moment? Probably the most important thing that's relevant for today is the comorbidity issue when you have autism with anxiety or obsessive-compulsive type of symptoms or depression that's comorbid with a neurodevelopmental disorder particularly autism, how do you differentiate, how do you manage and those kind of things are of particular interest. And it is a bit of a challenge sometimes. Recently we were thinking about how suicide risk assessment might happen in a young person but also autistic traits and how difficult it can be in assessing risk. So particularly maybe overlap between the different neurodevelopmental and anxiety depression. Thank you and I know Valsa our audience submits questions when they register. I would just note that we cannot address 2,000 people's questions so apologies if your question doesn't get answered but we have taken note of all of them and Valsa quite a lot of the questions were around ASD and anxiety so that's really helpful having your expertise. Welcome. So just a few ground rules. Just remember that in the chat box everybody can see what's happening so just remember that it is a public forum so behave as if it was a face to face activity. Please feel welcome to post your comments and questions for the panellists into the general chat box. If you find it too distracting you can click the small down arrow at the top of the chat box and there's a little highlight there for you now and that will make the chat box go away. If you do enjoy it you're very welcome to chat with each other and depending on how busy we are the panellists might also be involved with that chat box so please have fun with it if you'd like to and your feedback is really important to us so please complete the short exit survey which will appear as a pop-up when you exit the webinar. So and what will happen is that our panellists will each give their particular disciplinary response to the case study and then we'll facilitate a question and answer session and try and bring in the questions from the audience as well. So these are our learning outcomes so we're going to explore anxiety in students and using our case study. So looking at how to engage with young people to assess anxiety, looking at the key principles of providing an integrated approach in the early identification of young people at risk of suicide or self-harm due to stress and anxiety from the end of school studies and identify challenges, tips and strategies for how we can provide a collaborative response together. So you've already read the case and in the interest of time I'm not going to go over it again but just to remind you that our discussion is going to focus around Jessica who's a 17-year-old completing year 12 and experiencing various life complexities including in her family. So I'd first of all like to welcome Craig from the perspective of I guess both the GP and the mindfulness practitioner as to how you might respond to Jessica's story. And just to acknowledge Craig's had to use the handset on his phone which is perhaps a little uncomfortable but it was just to improve the quality of our sound. Thanks Craig. Good, well thank you very much. There are some things just to note on the history that Jessica's got a stable home situation is very good at least from what we've seen. Conscientious but like many conscientious students they're very vulnerable to anxiety perhaps because they're a little bit too so. Conscientious social isolation which seemed to be there as well. Although the work is having a positive effect grumpy and emotional and it's not always easy to tell is this just normal adolescence or what point is it actually part of a mental health problem because moodiness and so on can be very common. It's not always easy to tell for other family members. Irregular sleep which is a concern would be is she online at night and I'll come back to sleep later on. And she seems to be reluctant to see the doctor but she wants to be a dentist but is it her motivation or a parent and that wasn't 100% clear from the story and have to tease that out what's really driving her motivation to achieve. And a GP refers Jessica to a psychologist so the question really about what can a GP offer some GPs are very experienced in managing mental health problems and maybe the primary care in other situations would be very appropriate to refer depends on the individual GP and obviously what they negotiate. And also noted her tendency to worry or ruminate a lot and we'll come back to that in relation to mindfulness. Now from a holistic perspective or GP perspective an open and non-confrontational consulting style so just important to be curious and inquiring rather than sort of a top-down approach or in any way telling or instructing or pushing her so it's really she's essentially an adult and non-confrontational style and it's really important to find out what's her agenda and what's she interested in, what are her issues rather than perhaps how it might be framed by somebody else. Family or doctor as well to really inquiring to her agenda. Would probably not prescribe medications not convinced about the evidence necessarily for adolescents and children although getting into adulthood I mean if prescribing antidepressants could be appropriate and probably more in severe depression but certainly wouldn't be inclined to prescribe myself and what I'd like to put a lot of emphasis on is a lot of the other things that can be really helpful in this kind of situation in preventing or managing mental health problems and I'm just going to touch on a few things here mindfulness, sleep, exercise, diet, spirituality and self-compassion and it's very important perhaps to consider all of these areas because the aim is really to empower Jessica not impose treatments on her so to let her know there's a whole range of things she can do. Now I apologise in advance because I've got a number of slides here but I just wanted to present examples of evidence for the various things I'm going to be speaking about just very briefly but this is one among dozens of studies now on depression and there are review papers in many, many journals but just to illustrate the point 160 people, multiple episodes of depression before given mindfulness based cognitive therapy plus treatment as usual or treatment as usual and the red line's the relapse rate for the mindfulness group so very few people or far fewer people relapse into depression if they have mindfulness training along with whatever other treatments they're receiving. The blue line is just treatment as usual mostly just the prescribing of antidepressants without other psychological therapies and by 12 months more than half have had their next episode of depression compared to the red line where relapse was much less common and of course is it appropriate for adolescents and then studies started to look at younger age groups so mindfulness based stress reduction again similar to adults, less anxiety, depression, somatic distress increased self-esteem and sleep quality. The self-esteem is not about trying from a mindfulness perspective trying to think positive things about themselves it's just not constantly feeding a negative self-talk that might be very common so that rumination how mindfulness can help to switch off that default mode rumination is very, very important. There are also programs in schools and this is one review of 24 studies recently and it's pretty clear that it improves resilience and ability to cope with stress and mental and emotional health but also seems to improve performance at school as well because poor mental health can seriously impair academic performance. And this is a study that we did with Origin Youth Health and we looked at an in-depth qualitative study and in very short space of time adolescents learning mindfulness skills really develop a lot more self-awareness awareness of their own minds and bodies and how to work with that in a self-compassionate kind of way. Now, I won't say too much about default brain but rumination and worry as I said with depression anxiety forms of default mode and it's pretty much the mode of mind we go into and we're not mindful. So studies show that mindfulness switches off the default mode so as soon as the attention re-engages with the present moment through the senses then the brain becomes quiet again and switches out of rumination mode but there's not time to go into that more depth. I'll just skip on from that. Just talking about sleep chronic insomnia is a major factor for depression. A lot of kids these days are getting depressed because they're online at night and sleeping poorly and for many people with depression they actually need to learn to sleep better and a major, a very significant majority will have their depression resolved when sleep problems are a part of depression and I just wanted to mention that it's as common that depression is a product of poor sleep as a product of depression. Exercise and mental health, particularly aerobic exercise has a range of mental health benefits including anxiety and depression and obviously if it's engaged with other people as well and there's ways of being active that she enjoys then that could also be an important part of the therapy as well. I just wanted to mention about nutrition. Deakin University have done a lot of work in this and just to draw your attention to this study there was over 7,000 Australian adolescents and Q1 that's the 20% who had the healthiest diet but Q5 the 20% with the poorest quality diet they were nearly twice as likely to get mental health problems like depression and nutrition is almost totally forgotten as being a mental health intervention particularly for kids who are not getting any whole food in their diet much more likely to have mental health problems. The other thing to mention as well about spirituality and I don't necessarily mean that to be religious although that's the way in which most of the studies look at it but this is one review of studies on nearly 100,000 people. Two things I want to draw my attention to is one I think that the search for meaning is an important human need but this just draws attention this study to the fact that an intrinsic sort of religious or spiritual dimension to a person's life is associated with better mental health when it's just an external show extrinsic then it's not associated with better mental health. The other thing is if a person's got a very negative coping style so that feeling the problems in life are all about being punished and so on rather than actually having a sense of a compassionate and caring sort of connection to the universe like Einstein said believe the universe was a benevolent place so if a person has a very negative view of religion as a coping then it's associated with poorer mental health. So anyway I just make the point that where does she find meaning in life? What gives her life purpose? What's going to enrich her? And self-compassion is perhaps the last thing I'll mention but if a young person has self-compassion rather than self-criticism this is very important. Not only for making amends for failing in a study and a test for example of making errors in life but if a person meets those kinds of problems with intense self-criticism and self-judgment then that's associated with much poorer outcomes and there's quite a literature now that developing an attitude of self-compassion is not complacency but an ability just to give ourselves a bit of latitude to be human and to be a little bit kind to ourselves. So that's perhaps all I wanted to say for now and we may return to a few of those issues and unpack them a bit more later on so thank you very much. Thanks a lot Craig. If anyone wants to look at the slides for the presentation now and the documents box then obviously you can access that after the webinar as well. Craig it was great to have that discussion for our discussion in that really holistic approach. Now I'd like next to welcome Paul Jameson who's a school social worker. Hi Paul. Hi Mary. Hi everyone. Yeah thank you Craig for your comprehensive presentation and I guess my perspective as a school social worker is really coming from a perspective of education. In the case study it didn't really talk a lot about what was happening at school so I guess it lead it open to inquire as to what might be happening and how we can intervene to help Jessica. Now one of the things that I would be very interested in is how she's going at school. The case study notes that she's a very conscientious student but it doesn't say anything about what sort of grade she's getting or is she passing VCE or is she behind and what contribution that might be having towards stress and mental health so that was definitely something I'd want to find out from her teachers and her coordinators and speak to them and depending on how she's going to look at exploring any other options for completing Year 12 and in fact if she does even have to complete Year 12 and do the exams and get an ATAR score or is a Year 12 pass sufficient for her in terms of what pathway she wants to go so schools can do a lot with students around that and it would really depend on where she's at and talking with Jessica as well. The other questions I have around school is her level of engagement and are there any concerns around disengagement, any non-attendance or school refusal issues and again that's not clear in the case study but I would be inquiring with her coordinators around that but then any things we can do to improve her level of school engagement is definitely a protective factor for Jessica we don't know what her level of engagement is at school how well connected she is what sort of social network she might have at school what sort of relationship she has with her teachers and anything we can do to improve that and get her more connected will help Jessica's overall mental health. There's also in school referrals or in school support and schools have a lot of options for this and often it's an easier way for students to access help at school so often schools will have a psychologist or a social worker a lot of schools have chaplains a lot of schools have adolescent health nurses and other school counselors and well-being staff so generally a lot of high schools are well equipped to support students needing extra help so it would really depend on the nature of the difficulty she's experiencing and presenting her in a family with options the other thing I'd be interested in is there any safety concerns for her and is there a need to do some safety planning at school and I'll talk about that more in a minute the other area I'd be interested in because she's doing year 12 and coming up to her end of schooling and proceeding to tertiary education is really what kind of pathway Jessica wants now the case that you talked about interest in dentistry we don't know why that is or what's inspired that interest or motivated it or she's explored other pathway options and career options there is a lot of support out there schools are very good at helping students with this and again there's careers counselors you can get through schools there's also career exposits many students attend and that provide a lot of help for students and there's online careers course help also lastly I want to talk about risk assessment and safety planning again the case study doesn't make it clear what risk factors there are what are if there are any real safety concerns there's certainly risk factors present for Jessica and Craig touched on a lot of those the social isolation is one the her real sense of dedication and wanting to do well at school and how much pressure she puts under herself is could be a concern it's also a strength as well we don't know if there's been any history of suicidality and that's something I'd want to explore with her and well for it to be part of the assessment has there been any history of suicidality with Jessica history of suicidal thoughts current or previous plans previous attempts has there been a history of self-harming behavior if she's engaging in self-harming behaviors again we don't know that and we can talk directly to Jessica but the teachers may also be able to offer insights for that as well so what's the level of self-care the current level there's concerns around sleep Craig raised issues around diet we don't know what's happening for her in those areas online behavior it's also something I wonder that with the isolation and the being up late does she engage in online behavior media is that a risk for her is it a potentially a protective factor for her what her habits and what's her behavior like online we know with a lot of young people it can be very protective for them but it can also cause them to be very vulnerable as well is there any substance misuse issues for her is certainly something you can explore with young people and any other risk behaviors I've put some links in the additional resources in terms of risk assessment and safety planning there is quite a bit of support out there there's some good tools you can use to developing safety plans there's also a safe minds package which has been developed for schools and it's been specifically developed for Victoria but other people from other states can access it as a guest and I've also put that in the resources page as well thank you very much Mary I'm going to finish on that and I'm happy to answer other questions later thank you so much Paul and it's great to hear that there's so many possibilities in the school and we'll be exploring it more in our discussion later I'd now like to welcome Jodi as a psychologist and how you might think about supporting Jessica thanks Mary I think Craig and Paul have done a pretty good introduction I think the first thing that we do that I do definitely when I meet someone who's studying and appears quite anxious and depressed do a comprehensive biopsychosocial assessment of what's happening I think in terms of year 12 students and anxiety and depressive symptoms you want to work pretty quickly just because there tends to be a lot of kind of drama surrounding everything falling apart at the last moment definitely agree with what Craig said eating, sleeping and breathing being the kind of three key things that we start to look at to try and stabilise a young person the idea that an animal in distress is a person who's not eating is not sleeping and is not breathing properly so if those key factors aren't stable everything else is going to be quite wobbly around the edges and then looking at problem solving so this is where schools come in really well and working closely with school support I find tends to manage a lot of the stress and anxiety really quickly so getting straight on to the school educating the parents about how to talk to the school to get some pathway planning in trying to get some specialised school support around how to get out of exams or get extensions for assignments just to get a bit of breathing space so everything can calm down and move forward as quickly as possible but it also gives that sense of support and then validates the next step of therapy it's almost like it shows that things can change quickly because what we want to do is kind of begin to change someone's perception about a hopeless situation because often by the time you get to the stage where you're this withdrawn and this anxious and this depressed kind of holding that together and changing that kind of bunker down point of view is one of the most important things so sorry, I've changed my slides so something that I definitely look at in terms of psychological treatment developmental stage the person's at we're talking about a year 12 person that situation is quite different from a year 11 student which is different from a year 10 which is again different from a year 9 or the perfectionism and stress and anxiety that we might see in a year 8 student so just noticing that through this teenage years and anyone that works in schools or a lot with specifically this age group you know that the differences in emotional maturity from one end to the other end is quite extreme so you need to work within firstly the kind of age range you're talking about but also I think looking at the degree of separation from parents some 14 year olds are quite emotionally mature and independent whereas some 17 year olds aren't so being able to gauge that's also quite good just to see where that ability to self-regulate sits at so in terms of choosing a treatment style for people I think it comes down to the individual, the stage but then also even like a multimodal approach is quite important I agree with Craig mindfulness is just fantastic particularly for an anxious mind it comes it down and it focuses it really quickly and it's something that can be used in school and at home but I'd also say some of the act diffusive techniques we get really good feedback on those like learning how not to respond to a thought I'd say that but I think that's the key particularly works well once that stress and anxiety has been removed from the picture if you try and rationalise with a particularly anxious school student that whole cognitive debate that needs to happen tends to fall apart pretty quickly and they don't seem to engage quite so well when they're at a heightened level of distress so I'd be considering that in my treatment options I'd also definitely be looking at some existential therapy and everybody has raised the big elephant in the room and that is why are you doing dentistry it's a hard one I think if she had said she wanted to be a doctor we might not question it as much but there's something about dentistry that makes everyone say why are you doing dentistry so I'd be looking to see where the pressures are coming from them is it because she had the idea when she was seven that she liked to be a dentist is that because it's not quite medicine is it because she has a passion for oral health there's going to be something amongst that for some reason and if that loses meaning then the motivation is going to drop back something I would say though if we're talking about shifting somebody's perception of a situation to try and get them around to challenging it and changing it something that I see quite regularly is if we jump straight in and start talking about things that they can do to fix their cognitions they tend to shut down pretty quickly it's almost like we're blaming them for the way they see the world and that's not very helpful whatsoever so I think firstly trying to jiggle their perspective into looking after their health showing that things can be done to change the situation at school and then turning in and starting to look at the beliefs and values and the thoughts that are influencing their really strong emotions tends to kind of make things far easier so the specifics to this case I think there'd likely be a lot of catastrophic thinking involved such as you know what are we going to do you're going to drop out of school she's going to fail, she's not going to get to uni so calming that down as quickly as possible would be my first focus and everyone's noted as well the relationship with mum and now I'd be looking at that relationship first so there's obviously some perceived pressure there mum wants me to do this, mum wants me to do that so I'd be looking at trying to work out if that's really the case or is that a faulty cognition is that just a perception because mum really wants me to but does mum really want me to or is she just happy with me doing what makes me happy so getting those two talking even though mum says that they're a happy family they get along well together and also have evidence that she's been hiding in her room for the past two years studying so I would be wondering why so is it perfectionism or is it to escape the family lounge room so looking at the family dynamics and what's going on there will show a lot of the underlying tensions that often fuel so everyone in year 12 is stressed well not everybody that's an exaggeration so most people are quite stressed particularly if they're going for a high rank and it's the line where someone crosses from typically stressed or slightly anxious to depressed and so anxious that I can't complete any work it generally has to do with something else in their life so either there's a lot of external pressure pushing down from school, from home or from friends even so a lot of competitiveness amongst friends or it's a lack of support so I'd be looking for that to resolve that pretty quickly I'd also do work on parents about educating them about how to talk to the school often parents don't understand that they can advocate for their child at the school and also find that career pathways now are so confusing even for me that and I talk about it all the time I'm still not clear so I know that there are rank systems to get into university but I know that they don't really count I think I need one rank to get in but it's likely that with another rank I'll slip in somewhere so I think that that creates even more anxiety for young people because you can't adequately plan your future if you don't know what you need to get there I'd also say that this is likely to be a crisis of her developmental stage so Jessica if she has had a stay at home mum and if there has been any investment there we know she doesn't have a wide circle social circle we know that she's just had this job taken on this job that she really enjoys that she's temperamentally kind of quite likely to be conscientious and shy is she going through like a normal kind of process of individuation where she's trying to separate from her family but can't isn't able to acknowledge that or voice that or do that in a healthy way that would be one of my thoughts so I'd definitely be talking about her existential crisis in some degree like what do you want to do what gives you meaning and talking with her about living a life without joy or a lack of human connection because those are both really key things that I think are missing and can I just look at those questionings of those beliefs and values and being able to support those in a healthy way rather than just saying that's it I'm out Finally I've got a few questions that I'd probably ask about what was happening so asking where someone's most comfortable or least comfortable is a really good question to ask because it shows the place in which someone feels most accepted or emotionally safe so if they say at work that's quite indicative okay I found this place that I fit so that's likely to make me question my future because this is where I feel belonging if it's at school that someone feels most comfortable you know why not home what is it about school if someone feels comfortable at home then that's a good thing I'd also ask about what Jessica wants from her parents so what would be useful for them what do you need to hear from them to make this easier for you and I'd be talking with parents about the ways that they can support Jessica rather than just pressure and badger another question I'd also like to ask is asking somebody about their day so really clearly saying tell me about your day yesterday it's stolen from Irvine Yalom who's a psychiatrist in the States and it always gives a really accurate picture of what a day looks like for someone and I'll probably get more data from that than I do for most other questions just because you get a sense you're getting to really talk through everything in the day are they talking to anyone or are they talking to everyone I found out that someone got to think help from like three or four different sources just from asking that question so I think I should finish there because I know Valsa's going to speak now and she's going to actually talk more about the assessment so I hope that's covered everything I just tried to get everything in there Thank you and we did sort of talk on the dentistry question earlier and I'm sure we'll come back to a lot of it and so thank you for that probably being the psychiatrist Valsa you might be the person who met Jessica after some of the others had and so I'd really like to hear how you would think about this situation Thank you very much it's probably a good thing that I'm going last because most things have been covered but I'm going to assume that by the time they come to see a psychiatrist a child psychiatrist either it's because it's more severe or there are other issues also going on so I'm going to probably take that extreme end for a minute to describe what might happen in that space definitely in the assessment situation you'd be considering the severity the duration and also how long has it been going on sometimes you don't realize when it really started you might think that it started three months ago that may have been symptoms from before there may have been a past history of few symptoms here and there for a period of time so those kind of things will need to be carefully explored and if you think that there is a severe anxiety together with some depressive symptoms then you need to consider the urgency of treatment and again in an HSE student are we talking six weeks from trials on what kind of treatment would you suggest in that situation might be slightly different if you saw them at a different point in time so that's kind of very important to gauge when you're assessing within the clinical features it's also very important that anxiety can sometimes be the front runner and maybe there is depression and related symptoms hiding behind so it is very important that we try to unpack that a bit mostly going into the specifics of what are the kind of anxiety for working situations is it more social, is it more general is it about everything is it only about assignments or the whole life in general and again with depressive symptoms you might want to go a little bit into the sleep and appetite it can be either more or less either of it can be a symptom and also you will be looking at everything has become an effort are they very tired and there is a lot of psychomotor retardation and that kind of thing would also give you a glimpse that it's kind of really probably a little bit more silly than what originally was seeming to be of course you might also look into whether there are any bipolar type of symptoms or psychotic symptoms especially if a young person has been kind of drawing themselves and what else is happening would be very important to look into sometimes somatic symptoms like headache maybe or abdominal pain or nausea vomiting that may be the symptom that is the main concern for the person but it may be resulting from anxiety which is underlying those somatic or physical symptoms once that presentation of that is clarified you would then need to look at where is it coming from what are the things is there any families of course what we heard is that it's all well in the family we are happy and all that but sometimes a family history may not come out in the first instance and you may need to fully ask about what kind of a person is each one and are they really joyful bubbly their take on life is more negative so those kind of things would be very important even if there is no major mental health issues exploring what kind of personalities they have relationship issues would be extremely important both at school and at home sometimes friendships or either not fitting in or sometimes an acute breakdown in a relationship may be what's presenting the severity or the to the forefront at this point in time so interpersonal conflicts both at home or generally friendship relationships would be something that you would want to really understand in a person presenting with anxiety and probably depressive symptoms as well also you need to dig a little bit into what happened at the time when they relate to us the start of the symptomatology was there any bullying was there the pressure of wanting to get the grades to be a dentist became head on at the start of year 12 is it the high expectations that the person has put on herself or is it coming from the parents or others sometimes they have internalized it so much that they think it's their own but it may be coming from others sometimes they may be projecting it onto others and thinking that we want me to do but it's actually their own high expectations and their own agenda so we do need to understand a bit more of that and being perfectionist is a great thing at times but can also get things undone especially when you're working under time pressures with assignments one after the other coming on that probably would really be a huge stress on a person who is wanting to get everything right there so risk assessment would also be something that has already been covered and so I will just give the risk assessment part I would also look at whether there are any other diagnostic considerations I said about the bipolar disruptive mood dysregulation disorder is a new category that DSM file brought in mainly for persistent irritability anger outburst in a person but not really it's not bipolar premenstrual dysphoria disorder is again a common thing maybe that's super imposed on and underlying anxiety and that can really bring things to a head but the temper relationship with the menstrual cycle would give you the clue if substance misuse or any other medication or something else induced mood change due to your medical condition particularly in a thyroid issues vitamin deficiency now when you are treating your goals of treatment would be to relieve the symptoms reducing the functional impairment that's very important then how can we improve the person coping adapting and being functional is a key thing as a goal for your treatment along with improving quality of life and again you have to have the patient on both they think that you can have the best treatment but if they don't come on board then that's not going to be any good so engaging the person it's a patient centric perspective collaborative approach that is very important for treatment adherence and again failing if they are failing to engage at all or failing to engage in kind of sessions where they have to come and talk to someone internet based interventions can be sometimes useful for the person to get some help if they are not willing to come and engage with the person again school and family support would be important too so the medication would be reserved when it is very severe extreme panic, extreme distress as I said before hopelessness, guilt, suicidality or psychomotor retardation severe obsessive compulsive symptoms you would need to also look at comorbidities because autism or ADHD complicate both the presentation and your management substance misuse and personality traits would also be a consideration I will sum up with this slide many of the things on the end with the lifestyle factors have been covered I would also think that the psychological, psychosocial support issues have been covered the medication when you do use it it's only for moderate to severe and for very specific markers that you would think about carefully before you start medication or think about medication but having the patient on board and the family on board is extremely critical for that so it would be a biopsychosocial lifestyle model is probably what would be worth going in with thank you I'm going to open this up to the question and answer session and I'd like to start by inviting Craig back in now Craig as a GP I know that you spoke about engaging with Jessica herself who's nearly an adult as a GP you often see the family well how would you approach it if Mum for example had an obvious anxiety disorder of her own which was impacting on Jessica but Jessica you know but the problem is people are trying to locate the problem in Jessica these are the sort of questions that have come up a lot from the audience as well so how do we think about the family oh look I think that's a really relevant question there may not be a problem with Jessica at all I don't think we're assuming that in this situation but sometimes parents are worried and it's their own anxiety they project very often parents who have a very anxious way in their own life will teach their children from an early age to be anxious I was quote one study I do a lot of work with schools and I was looking at 5 year old children and their level of maths anxiety and maths performance and how that correlated with their parents maths anxiety and performance and they found there was a strong correlation but only if the parents regularly help their children with their maths homework if a parent was anxious about maths but didn't help their child with their maths homework their child was fine with maths and they weren't anxious about it I guess it just illustrates the point that very often parents aren't teaching their children what they think are they're teaching them how to be anxious so you would want to have a conversation with the parents if Jessica was happy to have a conversation with them both together of course having a conversation with Jessica by herself but it's going to be a family issue in how they cope but also in what the parents are projecting onto absolutely it's a really important point Thanks Craig and now I wonder Paul if this is really about collaboration so how would you feel if for example Craig as a GP or Chats Jody as a psychologist rang you as a contact person in the school what are the sort of nuts and bolts around how those conversations go Yeah good question Mary look it is really critical the collaboration from a school's perspective and we're school based or certainly my role is school based so we need to collaborate with external professionals and specialists so I would be very welcoming of being to collaborate with someone like Jody or Craig it's probably trying to work not overlap and not duplicate what we're doing so really having a discussion around what kinds of things we can help with at school from the school perspective and also what you'd be looking for an external service provider to be able to do I guess the other really important thing is ensuring we've got proper consent and ability to share information but just making sure that we're communicating and we're both talking about what we're doing so if the school's already having discussions around career planning and pathway planning then it may not be necessary for someone like Jody to explore that in as much depth and similarly if the school's already had the discussion around doing something in terms of the course and her studies and possibly reducing her study load or lengthening the time period that she's going to complete a VCE over then it wouldn't be necessary for external people to look at that so I'd be really keen to get the good communication happening so we're not duplicating and not causing more confusion for Jessica and her family. And I think you had a question for Jody in particular around the family I'm not sure whether you'd like to frame that one. Yeah I would and look it was I guess it was similar to the question you put to Craig but Jody what would you suggest or recommend to support the family with mental health issues in the family and challenging preconceived expectations and gender roles? I think in terms of supporting the family something we do here it depends it depends on what's going on if there are dynamics within the family suggesting that parents get their own support and knowing those people in the community so having good working relationships with different services so the mum or the father or both in a few times and you know that they're going to get good care and everything's going to go well and smoothly and there's not a big waiting list for example. That's one thing in terms of agenda issues that goes down to that beliefs and values side of things so we know that mum's education has a direct influence on how likely Jessica is to go to university so that research is out there so we know that mum's expectations might be hard but being able to support Jessica to do that might be difficult so the gender roles that maybe Jess sees replicated in her house aren't necessarily the ones that are being explained to her or put onto her but her beliefs and values will be a really tense complicated version of both of them put together so I definitely speak to her about those just so she can at least understand where that tension comes from. Thanks Jodi. And thank you Paul. I'd like to just I was interested in Valsa's slide at the end with the biopsychosocial perspective and that lifestyle things included things like exercise and nutrition whereas Craig had raised the idea that they were in fact biological treatment so I think I'd like to just invite Valsa and Craig perhaps Craig if you start just around exercise I guess as a biological treatment. Yes it's there's quite a large literature on this particularly aerobic exercise just by itself is therapeutic for depression and anxiety but it's not just the physical activity I believe I think it's also that when a person's doing something they love or something that really engages their attention they're actually being mindful at that time as well so the mind's unhooked from its usual remediation that person's had a break from that for a while so the person feels a bit more clear headed and a bit more relaxed energized and so on but the other thing to add too in exercise particularly if it involves other people being active with your friends and it you know wants to be a form of activity that she enjoys but you've got the social interaction as well and the nutrition side of things there's quite a literature on this as well and I don't think it's recognized enough in mental health areas that if the body's not got the right nutrition coming in then the body can't make all the neurotransmitters and everything else it needs to make it can have a pro-inflammatory effect which is unhelpful as well and if there are specific deficiencies vitamin D, folate for example if those deficiencies are not affected then you don't get the same therapeutic outcome and there's quite a literature growing up around this now as well it's not like if a person's got a normal vitamin D or it's got healthy levels of folate if you give them more they're going to get you know happier it's just that if the person's got a deficiency you get a much poorer therapeutic outcome unless you correct that deficiency and so in the total management of mental health problems we need to be thinking from all sorts of different perspectives because when you put all of these things together you have a much more powerful therapeutic outcome than if you just direct your interest and attention at one avenue for therapy Thanks Craig and I would like to bring Valsa and I noticed that Valsa also you also spoke about the biopsychosocial approach and exactly what Craig was just saying about considering all those things I guess would this be an unfair question to spring on you but would there be a message that you would like to convey to general practitioners around using SSRIs and young people? Yeah I would say that if you carefully select the ones that you would want to put on the medication that would be very rewarding especially if you have got someone who is having significant panic symptoms your ability to get them to do any psychological work with you or even the lifestyle modifications might be extremely difficult so if you have got severe panic symptoms, if you have got severe psychomotor retardation everything is an effort there is no motivation effort, lack of interest those kind of patients you probably would be wanting to keep the medication with all the biopsychosocial lifestyle bits the reason why I say it is important to get the other bits in is when you are in stress whether it is panic it is fight, flight, reaction or otherwise you are using up a lot of your chemicals and it is only natural that the levels are going to go down and down and you put yourself in a very vicious cycle so there is only so much you can spend less and I always say that psychotherapy and other interventions supportive ones are about spending what you have got well so you can spend your chemicals well using all those strategies or boost up your chemicals by having the exercise and the diet and everything and sleep hygiene so it is a little bit of both when your levels are so low when you are really broke you do need a bank loan so you would use the medication in those kind of situations but that will not improve your situation unless you learn to spend it well and get your balance kind of in order so it is a bit of combination of the two and very carefully selecting those patients with severe anxiety very severe panic psychomotor retardation or urgency because of suicidality or hopelessness you can lift them to a level where other measures of intervention and teaching them how to spend because well and all those things can then come on board but then that initial phase it may be a very important thing for them to kind of lift themselves up a little bit to a position where they can then use the other methods of treatment And also Val, so there has been a lot of questions from the participants around any special considerations when people have ASD you know, trays or a full diagnosis obviously it's more complicated and you spoke about the importance of trying to assess what's what is there any particular considerations with regard to if you make a decision to prescribe medication and ASD Yeah, because you may not be able to engage the patient in a way that you would like to understand what's going on what's the severity etc you would be looking at external factors like is there any significant recent change they used to enjoy something or they used to do this but now they are not interested in that or when you see something which is very recent which is an important change and then you put the pieces together and the sleep and appetite the biological symptoms, vegetative symptoms can give you the clue that it is very severe it again even if they have got ASD symptoms they are trying to get the person on board and then together with that patient and the family you develop the kind of management plan and I think that just because somebody has got ASD especially this is a person attending school and functioning okay then it is possible to get them to at least engage with you on a particular symptom that they would like to get rid of sometimes they would say there is nothing wrong with me or there is no problem or don't want to engage but see where there is an issue where you can agree that there is a problem sometimes it's sleep or sometimes it's something that you kind of stumble upon from somewhere but you do need to find that little anchor point where you get the person to engage a little bit better and wouldn't that be good to do that and shall we give it a try and so it's very important to find that common ground somewhere even if it is a little bit of a sleep problem or it's a irritability that they recognize it's not good or inability to focus or things that they enjoy which they can't which is frustrating them that they can't do it anymore because they have become apathetic and so there was one young person who actually told me that the empathy was killing him I mean to come that from a a sea person I thought was kind of truly remarkable but it may be possible if you really kind of get them to explore with you what would be the one thing that you would want changed or agree on something where you kind of meet on the crossroads and then take them with you and then take them with you I should have said we have had 860 people we had 878 earlier we are approaching the end and as usual this discussion is never long enough but I would just I know that Jodi you had a question for Paul around when you as a psychologist become aware that the young person's hopes and expectations for themselves probably are not academically possible would you like to just address that to Paul? Yeah I was just wondering if Paul had this where someone is incredibly anxious and distressed because they are trying for a certain rank to get to university and then when you actually look at their marks or the feedback for me from the school is they are never going to get there so I have a problem as a clinician because I practice unconditional positive regard completely aligned with young person yeah you can do this to a certain degree but then when there is this crushing reality that this isn't going to happen but that isn't being conveyed directly by the school I was wondering if you had any ideas about how to approach that Thanks for the question Jodi look it is something that does come up and it is a difficult issue to manage it's not all that common but it is something that does need to be dealt with because for a young person they can put themselves under incredible stress and anxiety in trying to achieve something that just may be completely unrealistic for them so it's got to be a process and I think you do need to include the parents in the discussion with the young person but you would hope that that discussion could be had earlier with the young person so that you can be talking to them about what their goals are and I guess trying to steer them towards something that might be more realistic for them and helping to manage some of their goals and what they wanted to do and achieve and you can use certainly the careers councillors at school can help with that but also their coordinators can help as well and when they are in year 12 their coordinators do work quite intensely with the young people around their course and how they are going and how they are tracking with it and monitoring their stress there could be a role for the well-being, specialist well-being staff at school but it really depends on who she is linked in with externally so I guess my advice would be to try not to identify it early a collaborative approach is really important and the sooner you have the discussion the better with the young person and bringing other people to assist as well can be really helpful Thanks for that Paul now we are just we are going to just be finishing up so I think Jodi we might get you back on for a moment and I just wonder if there is just one final message that you would like to share with the panel and the participants before we close I think the big thing with year 12 stress particular it has been identified by lots of teachers that they all get sick of it so there is a percentage of everything that is happening in Jessica's life that is completely typical and normal and it is about isolating that and pushing it to the side and then problem solving from my perspective pretty quickly to help her push back those depressive symptoms as quickly as possible Thanks Jodi Craig we have not heard from you for a while and I am sure you have been thinking a few things so I just like if there is any kind of final messages that you would like to give us all around just how we help someone like Jessica with exam stress in year 12 Well look I think so many wonderful points have been made by the whole panel and I think one of the things for somebody at this age to also consider is that at various times life can be very difficult I mean if I reflect on my own life there are some pretty challenging times year 12 university and so on and I think if a person can have a larger view at this time of life that having challenging times is certainly very uncomfortable but this is a real opportunity for growth and insight and if she learned to work with this in the right way find support from important people explore things that might be useful then she will come out a far better person than she was before so to turn adversity into advantage I think is a really important way to have an idea of growth and development as you go through your life so I think that is an important sort of underpinning attitude for the therapist and also for a young person such as Jessica Thanks Craig I know that question about growing through adversity did come through in the questions from the registrants at the beginning so that sometimes people need to make mistakes and learn from them and that's how we build resilience I'm really glad that you've raised that and I would like to invite Valsa back in just to give us some final points that you think are really important to leave us with I probably would want to stress that each and every person who is coming with an anxiety or depression or a different type of issue to do with mental health I think the first and foremost and the most important ingredient in any approach to help them would be that establishing that relationship and getting them to share the most difficult bits with you and that patient centric therapeutic alliance, no matter what your role is that probably would be the most important thing that you would be doing for that young person much more than probably your professional role which you do professionally the number one ingredient would be that relationship that you build with the person that's probably the one that you need to initially conflate most on so getting to understand the person the person thinking that you are there really for them their well-being is at the heart of what we are doing and until they take that on board whatever else we do it's a really important point that I like the way that Dan Siegel proposes a model of the mind stating that it's both embodied and relational and I think that's really come through tonight we've talked a lot about biological and body things and you've just really beautifully reminded us that all of us as people who work in schools or therapists or social workers GPs have this opportunity so I'm really grateful to you for bringing that in and last but definitely not least I'd like to just invite Paul to just sum up some final points for us Thanks Mary yeah look for me I guess the critical issue is around making sure communication is good between the school home and the external agencies involved with Jessica and that everyone is able to talk and there's a common understanding about what's going on for Jessica and both that school and at home the other thing that I think is really important is she's new 12 and she's coming up to finishing her schooling and we don't know how significant the engagement and attachment to the school has been but that's about to come to an end and thought needs to be given to that transition from schooling which might have been a real protective thing for her and a strong connection for her and there might be a lot of anxiety around her finishing starting at school a place where she's been for a long time and moving on to what she or about so there could be some work that could be done there to help her and assist her and also her family and I think that would be really important to look at as well. Thanks Paul that's a really critical point and I must say some of the young people I see with anxiety in Year 12 it's not about Year 12 it's all about the future and the unknown so really grateful to you for raising that as well now I can see that the participants have been really engaged and finding this a really valuable discussion tonight so I'd like to thank all our panelists participants if you just stay on for a couple more minutes it's really important for us to get your feedback at the end when you log out I'd like to thank Craig for just reminding us about having a really holistic approach thinking about exercise and nutrition and physical well-being, relational well-being and Paul has really opened our eyes up to the number of possible supports in the school which is probably a lot more than some of us knew were there and the flexibility that's possible and the importance of trying to engage with the school in problem solving which is I guess one of the things that Jodi emphasised is to actually quickly act to try and help solve problems which can help reduce stress and Jodi has also kept just thinking about the importance of the culture for the person which might be their actual cultural background or it might also be their family culture and how are they viewing the world and then Valsa has reminded us also about the value of medication sometimes in very severe symptoms but also beautifully at the end that no matter what your profession, what your background the therapeutic relationship with the young person is really the most important thing and I guess without it you know other things that can never be as effective and interestingly I am aware that that even includes medication so thanks so much everybody for participating tonight for the audience for being so lively in the chat box and for all our panellists for an excellent and interesting discussion now you'll notice there on the screen that there's another MHPN webinar on the 20th of June which will be equally interesting with young people so working together to support people who deliberately self-harm is a topic that often causes us great anxiety and I'm sure that the discussion will be really helpful for that please ensure that you complete your exit survey before you log out and it'll come up on the screen and you will get emailed to your certificate of attendance for this webinar within a couple of weeks and you'll also be sent a link to all the online resources associated within a week and if you are interested in joining one of the youth networks you can see the link there or any other local networks in fact it's really helpful to also meet face to face with people in your local area and those local networks help with creating collaborative care which is best practice and results and the best outcomes for clients and before I close I'd like to acknowledge the consumers and carers who have lived with mental illness in the past and those who continue to live with mental illness in the present and I'd like to thank everyone for your participation this evening and we look forward to seeing you at another webinar. Good night everybody. Thank you, good night.