sometimes life doesn't go like that. I would be actually relieved because I like them. I should look them up to say I see them. Very mixed bag is what I'm saying. Cilantro was strong with this one. Welcome to my January wrap-up, the first wrap-up of 2023. I have a lot of books and this stack is very precarious. Oh I forgot to put in my stuff. I have two DNFs for the year. I might have to go get those, but anyway I don't count those toward my reading goal. Anyway, so red books. I have 15 books. Holy moly. This is also the first time I'm using a new camera to film a video so I'm really hoping this is going well. I'm going to be assuming if you're hearing me say these words it went well, but if not then editing me, hi this didn't go well and you're gonna have to rerecord this. But yeah okay cool. I'm mostly just thinking about my camera right now to be perfectly honest, but I have things to tell you about books. Oh and also year of game is still happening. I have scripted my neverware review and I keep hoping to like film it, but I haven't had time to do that. I'm very fairly, these only confident. There's a very next video after this one that I post will be my neverware review. I have yet to record it, but I have it scripted. I just need to pull. There's some quotes I still need to pull and then I'll be ready to film it and post it. So that's coming. I wanted to post it in January. I wanted to post each game and book in the month that I'm reading it, but sometimes life doesn't go like that. January wrap up. Yes let's do it. I will go get my DNFs. It occurs to me that my child, my furry baby, is locked in the bedroom so that she won't mess with my new camera and my DNFs are in there. So instead please enjoy these graphics that I have pulled from the internet. So I believe the first book that I DNFed was Age of Myth by Michael J Sullivan and Jashana if you're watching this I would just like you to know that I have valued our friendship and I'm very sorry to lose that relationship. It's meant a lot to me so I'm sorry that this has to be where we part. But yeah Age of Myth is a my Michael J Sullivan story. The first Michael J Sullivan book I ever bought was Age of Myth because I saw the cover and this was like pre-booktube or very early booktube. Anyway so I got Age of Myth and then after getting it I learned that it was a prequel to the Ryuria Chronicles. So I was like oh shoot so then I went and bought all of the Ryuria Chronicles and then I found out that the Ryuria Chronicles are actually prequels for the Ryuria Revelations. So I was like okay so I bought all of the Ryuria Revelations and I've read the Ryuria Revelations. I did not love them but I also own all of the Age of Legends. Age of Legends? Is that what it's called? It's not called that. Legends of the First Empire I believe. That's what Age of Myth is the first book in. I own all of those in hard cover. They're so beautiful. Honestly such nice cover art. Like not just for the first book all the books. Anyway um yeah I didn't love Revelations but it was the first thing he had written like chronologically speaking or like publication order speaking chronologically speaking. Age of Myth is first. Joshana and Jesse and I think other people also had expressed that while they liked the Ryuria books they thought that the Legends of the First Empire is like his best. It's just like a lot lot better than the Ryuria stuff and I was like well the Ryuria stuff wasn't bad. It was like far from my favorite but like it was it had some good stuff in there and maybe what I didn't like about it was just kind of like him being an amateur. Like that was the first thing he wrote. In Age of Myth I started reading it and I was like this is the same. This is no better no different. In fact it's slightly worse than Ryuria Revelations. Especially because it's supposed to be taking place like thousands of years before Ryuria Revelations and the world and the tone and the like time period feel no different. And Ryuria already feels slightly modern and it's like kind of jokey and bantery and quippy in a very modern casual like window pane prose kind of way. Which is like it's not my preferred but like I can like a book that's like that. And it works better for me in Ryuria Revelations because Hadrian and Royce are kind of this like buddy cop heisting duo. So like that they have this like bantery, jokey relationship it's like it's fine. I actually started liking the series less and less because it kind of got more and more epic and I just didn't think it was handling it well because it was kind of keeping that jokey tone but like also trying to be epic and I was like I just don't really take any of this seriously and the world building's not that good. So thousands of years before this the tone is the same. Hadrian and Royce could like show up at any point and it would feel entirely appropriate. I would be actually relieved because I like them. And that's the thing too. Everybody that praises Legend of the First Empire is like oh it's the characters. I love the characters. Well in fairness I did DNF the book but like so far I was not impressed with the characters. I was like I just I don't think this is gonna be for me. I could keep reading this and maybe it gets a bit better but I'm just like I don't think this is gonna be for me. And I was keeping all of those books all my Michael J Sullivan books because I was like well my year ago was fine but like man I'm so looking forward to Legend of the First Empire and once I become a huge fan of that I will want to have a complete like full Michael J Sullivan election and I don't. I don't like Legend of the First Empire and I don't feel any kind of attachment to Royeria. So I think I'm unhauling. 15 books? 16 books? Something like that because I'm gonna get rid of all of it. So anyway that was my first DNF of the year and the other DNF was like way faster. I gave Age of Myth a bit of a chance because I own all of them. But the other one um I really I didn't even think I would like it but I, Alcrae was doing these like Lord of the Rings inspired little ceramic bowls and at Christmas like they had a big sale of like merch that had been in boxes where you could just buy the merch. So I had bought the three that they had which were like Rivendell, Erebor and the Shire. Now after that and you could not buy it separately they're like I think they're January box or the December box or whatever. The whole box that comes with a book and like other merch in it they did the fourth and final bowl which is Gondor. And I looked online to see if people were reselling it um because I was like I just want the bowl that's all I want. And I did find some people reselling the bowl but they were asking like the almost exact same amount as it is to just buy the box. And they did still have the box it wasn't like sold out because if it had been sold out I'd be like well I guess I'm paying a box amount for a bowl. They still had lots I don't know if they have lots but they still had in stock the whole box. So I was like well I could pay this amount and just get the bowl or I could pay this amount and like guess what I should have too including a book that I might like. So I got the box and I love the bowl the bowl's amazing the Gondor one's my favorite. But so the book that was in the box was The Luminaries by Susan Dennard and I tried reading the The Witchlands series because Bethany loves it so much before and I did own like several of them and I did not like that series it was not for me. But The Luminaries is like years later now and it's like supposed to be quite different it's not part of The Witchlands at all. I was like I mean sure like I probably wouldn't have bought this myself but like it came in this box. So I was like sure let's let's give it a go. I quickly enough I was like oh yeah no this is not for me I know immediately it was like even more YA in tone than The Witchlands ever had been and it was just more amateurish than The Witchlands was and it felt so YA and so derivative and so like quippy in the way that it felt like a CW show but a CW show that gets canceled. Because like I can I watch CW shows I admit that freely. Riverdale is one of my all-time favorite shows of all time ever. I have no shame about that. I watched like the first four seasons I think of The Vampire Diaries. What else is on the CW? There's probably others. I don't know. Point being like just because something is on the CW just because it's like you know kind of campy and over the top and derivative and quippy and I tend to prefer that on screen then in books because on screen it's easier to convey camp but I mean yeah I can like a book that's like kind of that way like something reminding you of a CW show it's not necessarily gonna be a turn off for me but yeah this is like what a CW show that like gets immediately canceled. So yeah I very quickly did that after that. I was like yeah no. So anyway um those are my DNFs. Let's talk about the books that I actually read like finished in January. The first book that I read and finished um was The Lincoln Highlight by Amor Tolles. I think I put this on my DVR if I didn't. Yeah I did right because this was my uh December uh book of the month club box um this and my other ones in there as well. So I always try to read it in the following month and the only reason I got this was because at the end of the year if you've like finished the reading challenge then actually I think maybe everyone gets to. I'm not sure if you have to be the really reading challenge or not but you get to pick one of the year's finalists for like best book of the year for free and the finalists I had already for all of them I had already gotten it or I wasn't interested in it at all. The only one that I had not gotten and was mildly interested in was this one. So I was like okay Lincoln Highlight and I really loved it. I need to like really like force myself to not pick the speculative books from book of the month because those are never good. But they always are the ones most appeal to me the cover and the like synopsis and never good. The only times I've loved book of the month club books is when they're like lit fake or thriller or things like that. So once again lit fake to save the day. I really really really loved this. It kind of reminded me of the movie Oh Brother Where Are Thou which um is a favorite movie. I really like that movie. Anyone looking to pick this up I don't want to give you a false impression. It's not exactly like that movie. That movie is a lot more like stylistic and over the top and campy and just more out there. But this does kind of like bring the like the sense of like a Greek Odyssey or Greek stories or just like kind of old myth and legend and brings it in a kind of like very I don't know significant way to a story that's just in America that's about Americans, a young man and his brother and some other people. There's a lot. It's a very character driven story. We're actually not on the Lincoln Highway that much in it. But yeah it's just a people story from multiple perspectives how they connect and intertwine and you get to see this kind of like mosaic portrait of some pockets of America at a certain time. But yeah I mean the main character or I guess it is an ensemble but I would say there's a main character or at least slightly more main character than the others.  This reminds me of Oh Brother Where Are Thou. The younger brother is very much into like classics and he keeps like relating things in their lives to classics which is what reminds me of Oh Brother Where Are Thou. So yeah I really really enjoyed this and it's inspired me to want to pick up more by any more tolls. I should look up how to say his name. I still don't know. I think I gave it four stars not five because the ending like didn't like fully come together for me at the way that I would have wanted it to but it was really really good. Next up was a reread and that was Kingdoms of Death by Christopher Rockio because book five in the senator which is next was coming out and or had just come out and Alex and I were doing a live show to chat about it and um if you don't know Kingdoms of Death and Ashes of Man those two books were originally one book that got split into two and it had been a long time. I mean I read this when it came out so not that long but I read this when it came out and the more when we were talking about it in my discord I was like did I even read that book? I don't remember anything about it. One I don't remember enough and two this is basically like the first half of this same book so more so than before I would like to read it like kind of back to back. So I reread this and I'm glad I did because I liked it more the second time. The issues I had with the pacing and whatnot just like I don't know maybe because I knew to expect them they didn't bother me as much so I enjoyed it more the second time and then like immediately thereafter I dove into Ashes of Man by Chris Veracchio and I did have slightly more issues with this in terms of the tone of certain positions of the author becoming a parent. Alex and I will have our live show when this is going up like two days from today from when you're seeing this so I'm sure we'll talk about it um but yeah there were some I mean I'm vaguely aware of Chris Veracchio's personal beliefs and leanings and like positioning on some things and I don't think we like fully see eye to eye on things and for the most part in the senator series it's not like so much a part of it that like it's like you know a deal-breaker for me or that like it ruins the story for me but there are times especially in the like short stories and like extra world material that it becomes quite apparent what his views are. Again most of the time either it's not affecting the story or when I do notice it it's it's not such a huge part of the story to where it ruins it I'm more just like observing it occurring in the story and I'm like I know why this is here um but moving on like I kind of note it and I'm like I don't agree but then I move on because like it's not integral to like the infrastructure of this story but it was a little bit more so a little more prominent um a little harder to ignore in Ashes of Man but that said I still give this five stars because I really really enjoyed it and where it's going I'm very intrigued I'm concerned about where it's going not because there's been any bad signs or well there's been a little bit. If ultimately where we go with this like the answer to like the big mysteries that have been building throughout these books if the answer to those questions the answer to those mysteries is hugely leaning into his personal views and personal beliefs well then that will kind of retroactively kill the series for me but so far it's just been kind of like it's like that one seasoning in a dish that you wish wasn't in it but it's still a yummy meal it's it's like me in cilantro I love Mexican food I eat Mexican food all the time and they always put cilantro in everything and I hate cilantro tastes like soap but I still eat Mexican food and I'm just like that bite was a little bit soapy moving on so that's kind of me and the like the parts of this that I'm like I don't think I agree with the author about I read it and I'm like there was the cilantro but moving on so like if the ending is just a big ol' pile of cilantro we're gonna have a problem but so so far it's apparent but like it doesn't bother me yet I look forward to chatting with Alex about this book next up is another book that you will see me chatting about soon and that is The Forgetting Moon by Brian Lee Derpy the first book in the Five Warrior Angels which I am doing a buddy read read along with Aaron from Books at Busy and the live show for this will be soon I don't think I know the date right now um any who sees this book is massively long and this did have some problems for me I think I gave it three stars because the things that it did badly it did quite bother me but the things that it did well were well enough for me to like that's how much it was able to balance it out because the good stuff was quite good so like it averages out to a three like that's how good the good stuff was if that makes sense so what it does badly I think is representations of females and exposition those things I think it does extremely extremely poorly um I as a fantasy reader I read a lot of books that handle those two things in particular quite badly and so the reason that I'm still quite excited to read the next book is what I've heard about where this goes what I've heard about like what happens and and where some of these things how they some of these things get subverted and and complicated in the next book so I'm very excited to see that but yeah so like with exposition in particular um basically if you're info dumping stuff to me I will never like that you're info dumping stuff to me or if you're having like really expository dialogue where it's like two characters or like this thing that you of course have heard of oh yes this thing that I have heard of that's a thing that does xyz isn't that so yes and don't forget it also does this thing and you're like no one talks like this like you're saying this because the reader will learn what this is or like literal just paragraphs that are just like telling you like we're just like pausing the story to tell you stuff like I will hate that always I would much rather be confused about what's going on in this scene than how you pause the scene to tell me what's going on that's just me as a reader I will I will never like it if you info dump to me or have a painfully unnatural sounding expository dialogue I will never like that have you do it a lot because like some books you know like you know you get that out of the way because it kind of like caught you up on the situation and then off we go I'll be like okay well I promise you could have delivered that more organically but fine we did it we got the info dumped we're doing the story now like just got through that moving on if your book is like a ton of info dumping all of the time there's never a point where we've caught up where we are continuing to constantly dump more and more information that I better think your information is interesting that's the only thing that can save it most of the time I don't most real building out there it's not that interesting it's pretty derivative or the author like that's you like now I'm thinking about the author and tell you info dump something to me or you can see the author's hand in it that's when you're aware that the author is speaking to you is when something is being info dumped and so then I'm also thinking about the author now and I'm thinking about how this author thinks they're so clever and I will always be annoyed by that so that's just like you're calling attention to yourself and to your real building and most of the time you're real building it's like not nearly as clever as you think it is so basically if you're info dumping information to me I better be really into it I better really love the world that you're telling me about where I'm able to forgive that you're dumping it to me like this and like to be perfectly honest the wolf by leo caru and all three of those books but particularly the wolf he does info dump a lot y'all know how much I love the wolf I've read it seven times and I will read it seven more times and I would give it six out of five stars I fucking love the wolf and it info dump so I'm saying like it is possible for me to not just forgive it but like give it a complete pass if I love what you're telling me and I'm not saying that I this isn't a new wolf I would have given it five stars not three but what I'm saying is I did think it was interesting I do think the world building is decently interesting I do think that the history of this world is decently interesting I do think that the mysteries it's setting up are decently interesting enough for me to go I don't like how you're telling me this and I don't like what you're doing with your female characters but I am interested I am I will keep reading I mean I have to keep reading because we're the read along but like even if there was no read along I would read the next book despite his flaws I am interested it is pretty good the world building and like the mystery of what's going on and and where we're gonna go with that so very mixed bag is what I'm saying next up is one of the biggest disappointments of the year for me and that is hell bent by Lee Bardugo I wrote a pretty scathing review on Goodreads I did give this three stars but it was more like a 2.5 rounded up and most of that 2.5 is just like cashing out the goodwill that it earned from me for 9th house so this if you don't know this is the sequel to 9th house 9th house was already like a shaky start but like a promising one in my opinion I thought you know it was it was it was hard getting into it I identified some pacing issues that I thought would have like structuring the story differently would have helped you to like be more immediately invested in it but like by the end of 9th house I was like okay but I do want to see where this goes you have me now you have me quite hooked and hell bent is like doing everything that 9th house did badly but even more so and then doing some new things like some fresh bad stuff that like 9th house didn't even do the world building is all over the place with this the pacing is terrible the plot is like I mostly compare this I don't think I did in my Goodreads review but I've like when I've spoken to people about it the most this most reminds me of Rise of Skywalker the Star Wars movie in the way that it's just like it's like non-stop fetch quests and just like we got to find them a guffin do the magic thing here's a ritual here's a scroll here's a book we got to find it we got to look at it we got to do it we got to get out of it like just constantly and a bit of that sure that's a bit of adventure that's that's what your plot is ostensibly that's how you learn real building but it's just like this complete grab bag of nonsense we're a building so that we can constantly be going from thing to thing to thing because God forbid we stop for a moment to like actually deal with the ramifications and the emotional fallout of the stuff that's supposedly happening to our characters which is weighty like it's not nothing that's happening to these characters there's some pretty intense stuff that's happening these characters but I feel nothing about it because we're just like this thing was super intense and I'll probably never be the same again anyway on to the next fetch quest like and that's not what I read books for personally I'm a character driven reader I would much rather have like you know 90% less fetch quests just have the one really significant one and like spend the book building up to this little ritual we need to do and slowly gather what we need for and figuring it out and really like sitting with the feelings and emotions and relationships that are affected by it that's what I'd like to read not whatever this is and like to be perfectly frank to like the macabre imagery of it was at times kind of ridiculous where it was like more funny than horrifying to me I was like are you seeing those right now this cover is like so cool and so sinister reminds me of the cover for what moves the dead what moves the dead is creepy as fuck that is sinister this is also like a cw show but a bad one next up is my other book of the month club book and that was the circus train by amita perique and this was not good this was very surface level almost offensively so because it's dealing with like so many different things and I feel like the author didn't have the space or time to really do justice to any of those things and then ended up telling like a schlocky hallmark channel kind of story instead because we wanted to have like happy endings and good good vibes but we're dealing with like horrifying parts of actual history as well as like really serious things that affect and have affected real people there's not really any circus in this if you're expecting like it'll be like the night circus it'll be like I don't know what's another work with a circus in it I don't know there's another one isn't there the people I don't know but if you're expecting circus vibes like nope not a lot of that the disability rep in it is um would have bothered me anyway and then when I saw so what people had to say about it people who are disabled and how we're like um no we're not we don't like this but it even it's just kind of like put words to a vibe but that I had or I was like something I something about this like I don't I don't know why I don't like this I don't like what this is doing this doesn't this feels off to me and I wouldn't have been able to tell you why but like yeah seeing reviews from people who are disabled saying this is why this is not okay I was like okay yeah yeah that's that was why the vibes were off so yeah and it like losses over the holocaust in a way that it's like it's like the hallmark channel version of the holocaust which is like out of that you know you don't have to write about the holocaust you know you don't if you don't want to write a story that's gonna like handle it with the weight and gravity that it deserves that just maybe don't touch it you know maybe possibly so yeah like I get what the author was trying to do and I did like there was an interview with the author as well that I like I just like I get what she was going for and I know why she was going for those different things and what she thought she was doing but like this wasn't it like so there's another book that I did not care for that was the winter king by Bernard Cornwall which was my well technically my first Bernard Cornwall book that I have finished but I have started like reading some other Cornwall books which is good because those other Cornwall books are like a lot better whereas if I had just read this and not touched anything else I probably would have never tried it again but like concurrently I was like picking up a bunch of different Cornwalls and this was one that I like had to read for this month so I finished it the other two I don't have to have read in January so I was like I'll finish y'all at another time winter king I was like this was the worst by far of the ones that I'm like reading at the same time I have a review on goodreads for it but basically like what is this it's like if if Harry Potter was told by Seamus Finnegan by which I mean the main character the the character that's telling you the story has like no is like hardly important to the story and not really present for a lot of important things so it's like why is he telling the story like I feel no investment in this and I'm also not getting very interesting information about it because he like wasn't there he wasn't in the room where it happened it's like this like 30 000 foot overview of stuff we kind of breeze by stuff the like action and battle stuff kind of happens off screen the stuff it's doing with the like characters from the Arthur myth is not terribly interesting maybe it's very interesting and subverted I have heard that it does get interesting and subverted in the following books but not in this one the one that it does subvert in this one is Lancelot in a way that I don't like not really I mean I don't really personally like feel any kind of way about Lancelot where I'm like Lancelot's my favorite character how dare you like I don't care honestly about the Arthur story that much I just think it's really uninteresting and annoying and unbelievable it was done with Lancelot I was like well don't like that and like Arthur is like kind of too perfect so like I would prefer an Arthurian story that's like subverting stuff to like make him unlikable because he is already the heroic like mythic figure like you know what I'm saying like okay this book confirms Arthur was a special dude like great cool and then like there's so much um sexual violence in this book to the point and it's not handled with care and it feels gratuitous and unnecessary and it feels like half the scenes the author was like hmm the scene needs something hmm need something to spice it up a little bit hmm I don't rape oh it's just exhausting after a while it's not even that I'm reading it being like horrified and upset I'm just like for real again and the the way that it depicts pagans again I don't find it personally offensive I'm just like I pagans weren't just like doing like wild banana stuff for no reason it's like the Arthur things because this is the Dark Ages and because they were pagans it can just write any all kind of wild nonsense that occurs to him and it's like no that's not how that works so yeah no I don't like this I own the other two so I might read them but I definitely will read more Cornwell because I could I've seen him do a lot better this is I don't get why people hype this at all well it's not for me next up I have Nine Liars by Maureen Johnson and I was really excited for this because I really like the truly devious books this is another truly devious like in the world of truly devious like the the truly devious mystery was already solved in that three book arc but there's other books with the same character so Box in the Woods came out last year I think it was okay and this is another story with the same characters that are from truly devious I was so pumped for this because well one the cover is orange and covered with fall leaves and it's like I mean yes and then it takes place in like an old house in England it's like an isolated closed circle mystery at least that's how it's pitched and I was like knives out in England yes but it actually really doesn't it's not so much an isolated closed circle mystery in a cool old house vibe like they are briefly in the house it's more about the characters and like their problems and the mystery kind of takes a backseat to that and I'm mostly interested in the mystery or like that's what I would come to this book for with some like fun character vibes on the side and yeah the character stuff is kind of getting old because it feels like these are the same problems they've been having for all of the books and it's like you know let's resolve it or move on or something like and then the the quippy bantry stuff like sometimes was funny like that's why these books why I generally like them because the humor does generally work for me but like yeah this just like wasn't that interesting or that good or that compelling and I'm just kind of getting sick of it and it wasn't a fun isolated closed circle mystery like I wanted and the character stuff yeah like I said it's just kind of getting old and also I've listened to this on audiobook this takes place in England and our main character and her friends they're not English they're the same kids from the truly devious but where they everyone they're who's involved in the mystery this new mystery they're all English they're all from England and there's lots of flashbacks for their mystery that are like just them there's like lots of people that are supposed to have British accents and the the narrator cannot do an English accent to save her life it was so painful to listen to this so that certainly did not help matters but I don't think I would have given this book like five stars if I'd read it physically instead of on audio but like reader be warned the audiobook like if you are tuned to accents at all and that will bother you it's bad it's really bad so anyway this was pretty loud cluster and disappointing and I don't know if I'll read any more truly devious books if she publishes more I mean the way the character stuff went I'm assuming she does want to publish more truly devious stories because it is not resolved what our character stuff and I just I just don't care anymore I don't think next up I have the last wish which is the short story collection before the other short story collection before the main witcher series because on chapter 3 podcast we were doing a read-along for the witcher series so we did have our live show talking about the last wish if you missed it I'll leave a link down below which was a great conversation and our bonus content for patrons of the podcast was to do with fairy tales and fairytale retellings and how fairy tales function in our collective consciousness because of fairly obvious reasons if you have read the last wish so anyway um this was a reroute for me I was also a reroute for Bethany the rest will be new for her rereads for me I really really love rereading this I kind of miss being in the world of the witcher the way the series ends kind of left a little bit of a bad taste in my mouth because I didn't love the way the series ends the main books um I don't hate it I have generally fond feelings towards witcher but like it kind of fizzled for me a bit I did not feel very enthusiastic about it by the end so being back where it started where I was giving these five stars because I loved it the first time I read it and I definitely love that again so it's nice just kind of being in the world with Geralt doing some monsters and some moral conundrums and just kind of vibing in the world of the witcher I had a great time great time chatting and I'm very excited to read Sword of Destiny in February next up is Neverwear by Neil Gaiman this is my third time reading it and I will have a review for it I will it's scripted I have it I just need to like do it this has never been a favorite for me for many reasons and having read it three times I think I've come to a more like firm understanding of why that is I can't wait to tell you about that in the review that is coming I promise but yeah uh Neverwear by Neil Gaiman is a book that I've read three times that I will tell you more about shortly next up is Let in the Mist by Hope Merilis and this was the blades and bodice rippers book club pick my pick and me and the ladies all dressed up as Fay for the live show for it so if you missed it I'll leave that link down below so you can see us all in costume chatting about this book this was a unicorn in the sense that none of us hated it me and Bethany really loved it Mara quite liked it and Amanda was fine with it no one hated it so yay I really really really enjoyed this like I said we had our live show talking about it for an hour or more but um yeah I think this is a really interesting strange um sweetly sinister little book and I'm really glad that we read it well I mean I I picked it so like thanks to me thank you to self for choosing it but yeah I had a really great time reading this so yeah if you missed the live show link down below next up is the book that my patrons chose for me to read on vlog for them which of course I did and that was Children of Time by Adrienne Tchaikovsky which is a long book and I had very mixed feelings about it I've never read a book before where I'm like there is neither characters that I care about nor a plot that isn't grossing but I still feel entertained and interested by this so I mean I talked about it at length in the vlog for my patrons but yeah to suffice to say I did not love this but I kind of get why it's so well known I think it did some things quite brilliantly but like the overall package isn't that great in my opinion I think it has a lot of weak points and a lot of flaws a lot of things that I think would improve it so like I wanted to love it and I think it could be brilliant but it's a long way from being my favorite and next up is a reread for me and that was Norther Lights by Philip Pullman also known as the Golden Compass we're doing a read-along for these books on my patreon and um I think we're all having a good time because we're gonna have our chat about it for the filming of this video that's happening tomorrow I will have already happened or is happening when you're seeing this I loved it gave it five stars it was so nice being back in this world kind of with Witcher where like the series kind of fizzles for me so like going back to the beginning again was really nice to be like oh yeah I did really love the beginning though so yeah I love Lyra so much um and I just like being in this world I think it's very clever and um and yeah I'm very happy to be rereading these books and I can't wait to chat about it with my patrons next up is the other ongoing read-along with my patreon and that is book of the new sun we read shadow of the torturer and this was my my second time reading it these re-reads for me up until um citadel of the autark and while I was reading I was like why didn't I give this five stars the first time because I I saw on goodreads as four stars I was like this is so brilliant I mean I remember liking it but this is amazing truly the pros like it's there's moments of writing that are just like I'm in awe I was like why didn't I give this five stars and then we got to like all the like questionable depictions of females that are like in quick succession and I was like there it is and it's like one or two of those and I would be like I'll still give it five stars but there's too many that's what I was thinking to myself at first when I was starting to get that I was like oh okay this might have been why but you know I think I could still give it five and then I was like and there's oh there's more well maybe I could nope there's oh god there's even more no no so yeah that's not great but other things the good stuff is so good so I'm excited to keep reading this and I do think it's brilliant I really do I just wish we would didn't do so much of like the naked sexual art of ladies I don't like that anyway I'm excited to chat about this with my patrons and the last book that I squeezed into January which I'll be chatting with without chatting about with Alex we chatting about with Alex is queen of mid ashes by Christopher Rock you which is a short story collection that includes queen of mid ashes I only give this three stars user did I say in the world of the senator if I didn't this isn't the world of the senator that's why we're talking about it with ashes of man I did not like most of these stories and this more so than ashes of man I was like there's some stuff in there I'm like there's lots of cilantro this this book is like mostly cilantro so I was like I don't know I don't know there's still some decent stuff yeah that's why three stars like I like being in the world there's some interesting stuff interesting expansion of stuff we've heard about there were some characters we haven't seen that much in the main series we got to see more of here and it was interesting to get that contact but like the cilantro was strong with this one I'm excited to talk about it with Alex see what he thought see if he tasted all the cilantro that I did those are all the books that I read slash gnf'd in January let me know your thoughts in the comments down below did have you read these books do you want to read these books do you feel the same way as I do about these books whatever you want to let me know I post videos on saturdays at the random house well don't be saturday so like and subscribe join my patreon if you feel so inclined I'll see you when I see you


The webinar tonight is Perinatal Mental Health, working better, working together. This webinar is presented by MHPN. The panel tonight are Dr. Morton Rowland, Professor Breanne Barnett, Professor Jeanette Nogrum, and Ms. Stacey Noble. Morton is a GP. Brianna is a psychiatrist. Jeanette is a psychologist, and Stacey is a consumer. I'm your facilitator, Markle Murray. This webinar is hosted by MHPN. It is a Commonwealth-funded project supporting the development of sustainable interdisciplinary collaboration in the local primary mental health sector across Australia. We currently support over 450 local interdisciplinary mental health networks. For more information, go to MHPN.org.au. The learning objectives tonight. At the end of this session, participants will be able to better recognize the early warning signs of perinatal mental health issues, better recognize the core principles of and pathways to effective treatment and management of perinatal mental health issues, better understand the merits, challenges, and opportunities in providing collaborative care to people experiencing perinatal mental health issues. To find out more about your discipline, CPD, recognition, please visit MHPN.org.au. The webinar is comprised of two parts. We will have a facilitated interdisciplinary panel discussion and a question and answer session. Feel it from the audience. So please feel free to put questions up in the message box on the right-hand side and we will keep an eye on those and present them to your panel during the evening. So the grand rules are that I will moderate the panel discussion and field questions from the audience. You can also submit questions for the panel by typing them in the message box. You can also minimize that message box if you're finding it distracting. Use any arrows. And if your specific questions are not addressed or if you want to continue the discussion, feel free to participate in a post-webinar online forum on MHPN online. If you require technical support during the evening, please call 1-800-733-416. Ensure that the sound is on and the volume turned up on your home computers for all participants. This does not apply to the panel. If you're experiencing problems with sound, dial that number. Dial that number, dial that number, dial that number. If you're having bandwidth issues, sound or internet lagging or dropping out, you can minimize this by clicking on the presenters' web cams and pressing the pause button under the video screen. You will still be able to hear the presenters when you pause their web cams. Webinar recording and PowerPoint slides will be posted on MHPN's website within 40 hours of the live activity. Again, for technical support, call 1-800-733-416. Now, we're going to hear from our consumer rep, Stacey Noble. Stacey will present her presentation now. Thank you, Stacey. Thanks, Michael. Hi, everyone, and thank you for joining myself and the other panel members this evening. I hope that you enjoy the session and get a lot out of it. Anti-natal depression, which is, as you're probably all aware, depression during the pregnancy period from conception through to birth and approximately 10% of pregnant women in Australia experience anti-natal depression. And postnatal depression, which is the period from birth following the birth of the baby, has almost 16% of women in Australia experiencing postnatal depression. And I actually fell into both of those categories with my second child, basically suffering anti-natal depression from conception through to postnatal depression, which lasted for approximately three months following the birth of my baby. Perinatal depression does not discriminate. It can, and it does affect women and their families across different cultures, age groups, and from different social, professional, and financial positions. Through my own experience and through my work as a counsellor with the postnatal depression association, I've seen the impact of Perinatal mental health on not only the affected woman, but her partner, other children in the family, family and friends. Quite often a woman will present by saying that she knows that there's something wrong, but she just can't work out what it is. She doesn't feel herself. Likewise, I often hear from the partners of these women that they can't do a thing right. Everything that they try to do is wrong and they really have no knowledge or they don't have the skills to be able to identify that there's actually a problem. What ends up happening is that they put it down to a lack of sleep and it's simply the demands of being a new mum. Quite often this can reach a crisis point and at this point it throws the whole family into turmoil. This is often the family's first point of contact in regards to the woman's decline in health, which quite possibly has been beginning to happen over a long period of time. And at this point, when it does reach a crisis point, there's quite often a need for the woman to be admitted as an inpatient. Many times the partner is struggling with his own transition to parenthood and he often feels quite low himself and then he finds himself in the unlikely position of having to support his wife emotionally and quite often the other children that may be in the family also. Michael. Thanks very much, Stacey. That was a lovely presentation and it's a really good introduction to our work tonight. Morton, I'd like you to start your presentation now if you may. Thanks, Michael. Welcome, everybody. It's great to be here. Morton, may I just ask you just to move the microphone a little bit closer? Thank you. Maybe speak up a little bit. Is that any better? That's much better. Thank you. Great. Thanks, everybody. It's great to be with you. This is a really important issue in mental health. As Stacey said, a very large percentage of women do suffer from perinatal depression and I think it's absolutely important for us to recognize that it actually does start from conception and then you've also got the postnatal perspective which in sort of traditional terms the postnatal depression was the one that most of us were taught about but it's actually much bigger than that. There is a spectrum of severity. Certainly in my years of general practice, I think most mothers will have a degree of anxiety and the pregnancy blues. Most are mild but like any of these problems there is a great spectrum of the severity to the very severe where people are thinking and contemplating of suicide and more particularly harming their children as well. And those are the sort of things that we're aiming to try and prevent obviously. One of the problems with perinatal and postnatal depression is that it often, in my experience, presents a little bit late. Often with the person very much feeling guilty, why is this happening to me? It all should be perfect. Well, life isn't always like that and it's important for us to recognize that we need to be very supportive. The approaches that are important are that we need to move people to discuss their problems and certainly listening empathetically, not sympathetically only, but listening and actually hearing what people are saying is really important. Open-ended questions which are important and in actual fact don't increase the time of your consultation markedly. If you look at the research, are really helpful in this case and you'll actually usually get more information with open-ended questions. I think it's really important in this situation that we remember that there's quite often some social isolation occurring here as well. Whether it's because mom and bubba are at home or whether the process, particularly with the first baby, not enough help around and it's important to remember that that's something that you can actually work on to help. I can't emphasize strongly enough that suicide can occur so it is not something to be taken lightly and acknowledging that the person isn't feeling good about themselves and they are having problems is really an important thing and not just to say they're there, it'll be okay. From the general practice perspective, some of the things that can be done by the GP apart from actually listening and recognizing that there's a problem and potentially helping that person to get to the other health professionals within our network to help them specifically but actually to help that person to goal set. Small cues and small wins each day are often really helpful and giving them some tasks that they've agreed are helpful is often a very important thing. Contracts with the patient, particularly in the more severe forms I always find is really helpful. If you're feeling like this, you can contact me or the crisis team in your state or contact your mother or it needs to be worked out with the patient but it's a safety net. I've also found that often almost more important than some of the things that are actually said are the non-verbal cues. How mom actually comes into the room, how they're dressed, how mom and baby are interacting and also how the family unit is acting with the partner or mother-in-law or mother, whoever's coming with mom and Bob. It's important to get that vibe if you can. And I think the other thing that I've learned over the years that's really important here is to remember that the mother and baby are a coupled group and sometimes some of the things that you would perhaps suggest to somebody who has a depression or an anxiety not associated with the perinatal and postnatal period. In other words, leave what's stressing you and go out and have a night with your partner having a dinner or something may not be actually possible with young babies and you have to be realistic in helping mom with your counseling. So I might leave it there and hand over to Mike again. Thank you very much, Morton. That was a very, very good presentation. We're now just going to move on to Breanne Barnett's presentation. She's requested that we, before we put her slides up, she just speaks to the audience first. Thank you, Breanne. Thank you very much and thank you Morton. I think we have to have you cloned immediately. Trevor, now let's just begin. I haven't had the opportunity yet to discuss her story with Stacey, so I'm taking up the position of the psychiatrist who is her first contact when she calls the hospital after Jake's arrival.   She's been a patient here before after the birth of Madison and she wants help again now. So we arrange for her husband to bring her and Jake to the hospital and leave Madison with Stacey's mother. Here is the story as I might have seen it at the time and I'm pondering about it. Stacey is a 36 year old woman at this stage. She's been married for eight years to Wayne and they have two children, a girl aged three or four, Madison, and a baby boy aged five weeks, Jake. The latter was a planned pregnancy but she felt unwell throughout and his being a boy was a problem. He slept poorly, had severe reflux and has a strong personality. Though I think this is a distressed baby but I'm glad to say he hasn't given up hope of getting the help he needs. Assisted, I hope, by reading the notes from her previous admission, I now want to know from both of them what their current difficulties are. Despite help from Wayne and her mother, Stacey is obviously going under and prolonged sleeplessness is certainly a major health hazard. I need exact details about the insomnia and I need to know about her mood over the course of the day and her anxiety and panic attacks. What is she worried about? Does she have any intrusive thoughts about harm to herself, her partner or the baby? And I want to know about her weight and appetite and so on. Also, it is important to discover whether there are any signs of loss of touch with reality. In other words, is this a psychotic illness? I also want to know about the pregnancy and the delivery and how her health has been physically since then. Her pride for help alone is enough to make me think I'd like her to be in hospital for observation at least over the next short time. So admission of mother and baby are arranged and Wayne will visit daily with medicine as appropriate and the staff are instructed to ensure that mother and baby are fed and tucked into bed with sedation for Stacey if required. Over the following days, I need a lot more information from Stacey and I needed some stage to talk in depth to Wayne and to her mother because they may also need help. For example, is Wayne managing or is he also depressed and anxious? Did his own mother perhaps have similar problems and he found it hard to deal with them? Stacey's mother certainly had similar problems and I need to give her a chance to talk about them. I will also need to make sure little Madison is supported as I do not want in another 20 years to find another anxious, potentially depressed woman in this family. This comprehensive plan will require collaboration and no one person can provide all that's required to help Stacey and her family. I will be pulling in many teeth members. Now could we have the first slide? Thank you. So some of the missing information, what and why, and there are lots and lots of questions that I will need to have answered before I can possibly put together a plan to help Stacey and the family. The second slide, the previous hospital admission, what was the diagnosis? And it followed an extended period of sleep deprivation. What exactly did that involve and what else happened over that period of time? Was she repeatedly perhaps at her GP worried about the baby's health or something else of this nature? What was the diagnosis? Postnatal depression is a pretty useless diagnosis. It can cover such a lot of different things. What was the treatment? I suppose we have to say it was helpful because Stacey has applied to the same hospital again. But what's the diagnosis adequate and what's the treatment adequate is what I'm wondering. And of course, where the couple warned to obtain help early in her next pregnancy because an illness serious enough to have the mother in hospital is likely to recur in the next pregnancy. And I would imagine that someone tried to tell them about this and how they could deal with that. Next slide. After discharge, what was offered to Stacey and the family to enhance their resilience?  We could, if we intervene now, help her to become more resilient in the future. We can offer her ongoing therapy for herself. We can offer couple therapy. We can offer mother-infant relationship work. And all of this, I would expect our mental health nurses or psychologists to take on. I want to know if medication and other treatments were offered and were they acceptable to Stacey? What side effects did she have and what did she find useful? Next slide. Other things that I'm thinking about at this time before I've even seen Stacey is how is it that she wasn't identified and helped during either pregnancy? Given that in the public system at least, we have mandatory sets of psychosocial questions and depression and anxiety screening and so on, all of which goes on anti-natally. How is it that Stacey slipped through the net? How is it that she doesn't seem to be able to tell health professionals when she's not well? Has she always had to solve her own problems? Is it that she needs approval from people and she tries to be a perfectionist and therefore when things are going wrong, she feels bad about herself and feels it's all her fault? But this is a problem that many women have. And I'm wondering the next slide, please. What else is going on here? When Stacey herself was born, was her mother depressed and anxious? Was her mother very ill when her sister was born? Because Stacey's been anxious, she says, since around the age of four, which I would have thought was around the time her sister was arriving. And I need details of what happened in adolescence when she got depressed. And I wonder why her father and sister are not mentioned for any grandparent. She notes that Jake has a very strong personality and I'm wondering whether her sister is a bit like this or perhaps her father. And she says, and this is clearly something that's very important for her, someone's hungry and I'm wondering who's hungry, hungry for what and what do they want from whom? There clearly are a lot of bits of information that I will need to be able to put together a package that will help Stacey and her family. Thank you very much, Brian. That was a very good presentation. And you certainly raised some questions which many of us would have thought about, but some which we wouldn't have. Thank you very much. That was very nice. Now we'll hear from Jeanette Milgram, our psychologist. Thank you very much. And I'm really pleased to be here and with an audience out there and also with my colleagues, Brian and Morton. It's great to be talking in this multi-disciplinary way. And Stacey, thank you so much for sharing your story. I'm a clinical psychologist. I was asked to react to your story with some thoughts from a psychology perspective. And so what I've done is covering some thoughts that come both from my knowledge in the field from my decades of research in the area as well as from my clinical work and how I would be thinking about what's happened to you, Stacey. Of course, as Brian says, it's a very short snippet and there would be many more questions. I too would like to know, but I've done my best with information I have. So as I started reading your story, Stacey, I started thinking, well, it might be helpful to think about what led to disease and depression. And we find that a very useful way of thinking about what triggers depression is a bi-psychosocial model. And our best understanding is that a combination of biological, psychological, social and historical factors combine in an individual often to tip the balance into postnatal depression. And we can understand from Tracy's brief story that there are some vulnerabilities that have been identified as very important predisposing factors. So Stacey talks about her mother's history of anxiety and her own personal history of depression and anxiety. And the big five of risk factors, and it doesn't mean that that's the only one, are previous history of depression. And particularly also, I'm wondering whether there were any hints in pregnancy with Madison even because anti-natal depression and anxiety can predispose women. So when I encourage people to start looking in pregnancy, not just wait till the birth, major life events, lack of support or low partner support, that didn't seem to be an issue in Stacey's story. And previous depression histories, the other of the big five. So there were two of the big five there in the snippet. And so Stacey, what was quite striking was that Stacey did not seem to have received treatment from a psychologist for previous episodes of depression that she had had or anxiety since the age of four, which might have helped to develop coping skills and perhaps deal in future when she noticed these symptoms recurring. I could have the next slide, thanks. Like Brianne, I was quite interested that Stacey did not disclose her anxiety and panic attack after the birth of Madison. But we know that's not at all unusual. That is a very, very common story. And so professionals such as yourselves working in the field need to be very aware of reasons behind this to best support and encourage women in the perinagal period. They imagine more than when women come to your general practice, they may present with other things rather than directly with how they're feeling. And we know that there are many reasons why women find it difficult to disclose, living up to other people's expectations to your stigma and many others. However, when we're talking about risk factors and difficulties, we also, when we work with individuals, take a good look at one of the strengths and protective factors. And from the story, I can see that Stacey has obviously achieved a lot. She's a school teacher. She's managed to be productive. She's got a confidence even when she was having difficulties with Madison and her strategies. She has thought help. It obviously was faster after Jake, but that's a terrific strength and has a supportive partner. But despite this, it wasn't until Madison was five months that Stacey felt she needed an admission. And so I guess that we're now working very much with our multidisciplinary colleagues who might see pregnant and postnatal women before they come to a psychologist to engage in screening exercises because many women do not make it very obvious that they're depressed. They may present looking from the outside okay. And so I guess I'm asking the question, where along the line and which professionals did Stacey come into contact with? With screening for depression and anxiety could have helped earlier. And there we usually turn to maternal and child health nurses and GPs who can play such an important role. And I have the next slide, thanks. So who can screen for depression? Anybody can and I guess that we're also moving not just from looking at professionals who come into contact with women around in the perinatal period, but families who become aware of what the symptoms of depression are. And many of you probably heard of the Edinburgh Postnatal Depression Scale which is being used as a very user friendly almost icebreaker 10 question which raises the profile of distress when it's there. And in that context, anyone who gets a hint that there are symptoms of depression and anxiety needs to also consider what else should I be asking? What else do I need to understand about this woman who is telling me that she has some signs of distress? So they're much broader assessment areas that one needs to cover obviously to get the full perspective of Stacey's story as Brian so elegantly covered. And the Beyond Blue Clinical Practice Guidelines provides a very nice guideline on that. And there's also a very nice online training program that we've been involved with in developing on the website for learning how to screen and recognize signs of depression and anxiety and anxiety right on the Beyond Blue website. But I guess that I would expect all professionals working in this area to be very familiar with the symptoms of depression such as DSM4 criteria. So that's right off as Brian was saying, I'd like to know more about how she's been feeling, whether she's had depressed mood, loss of interest, weight appetite, sleep, psychomotor, fatigue, worthless feelings of worthlessness, guilt, indecision and importantly, we always, as Morton said, want to be very aware of the possibility of suicidal ideation and to immediately engage in a risk assessment process if that seems to be the case. Can I have the next slide, thanks? So, even Stacey's experience with Madison, like Brian, I wondered about what what psycho prevented support she was given in her second pregnancy. Was anyone alerted to the fact that she had had a difficult period with Madison and therefore with Jake, she was likely to have some difficulty? Was Stacey's ambivalence over giving birth to a board related to her self-efficacy and anxiety? I'm starting to raise questions that might be relevant to some of the directions that we might engage in if we decide to go down the line of psychological treatment and like Brian, I would have liked to have seen that the initial efforts and the good gains that Stacey no doubt had by being in the mother-baby unit were followed by post-discharge help and Stacey may have found psychological treatment very helpful both to deal with historical problems and also her current issues. So, it would break that Stacey acted quickly in seeking help with Jake and sought another mother-baby unit admission, but what would help her after discharge? And if I could have my last slide. Well, I guess that's what comes to my mind is that the pressure symptoms and underlying anxiety have been long standing for Stacey. And so, that would be a very strong focus, not only to deal with the current episodes, but to look forward and to see how one could help to develop coping skills by perhaps cognitive behavioral strategies if she was wanting to work in that way so that focus psychological strategies are very important and there certainly is a lot of evidence that CBT, cognitive behavioral therapy and interpersonal psychotherapy are very effective for new mothers. I think that as I do in my own work and in my clinic it needs to be have a tailored to new months like you can't have a mother doing relaxation for 20 minutes, three times a day when you've got a toddler and a baby. And so, for instance, what we do is we teach relaxation on the run.  As Brian said, we need to mobilize the family and partner support that is just so important as well as giving the partner support as Stacey and Brian said that it's a family issue and everybody gets affected. Mother baby issues may also arise. It doesn't with all women, but when it does, it's very distressing for both mothers and babies where the depression has gotten in the road of a joyful interaction. And what's so rewarding is that intervention results in the ability to reconnect and reestablish relationships when depression has occurred, but these need to be targeted in their own right. So these are just some thoughts about where to go and what I thought when I read your story, Stacey. Thank you very much. Thank you very much, Shannette. That was a very, very interesting presentation and it's raised many issues and many of our participants throughout Australia have commented before and during your presentation on many of those same points. But as we're all consumer orientated, I think we should hear again from Stacey. Stacey, would you be willing to add in some perspectives on what you've heard tonight and your experiences as well during your pregnancy and postnatally? Yeah, absolutely, Michael. I just wish that Jeanette and Brian had have been around for me when I was experiencing this because what you two ladies have mentioned this evening would have made such an incredible difference to my whole experience and even just hearing it without being actively involved in your treatment and care. I know that I would have benefited hugely. So to wrap up and basically to look at the care that I received in comparison to the treatments that you ladies would have provided was that I basically had no screening from my GP. My initial consultation with my GP was to confirm my pregnancy and my next consultation with anyone at all was some 12 to 14 weeks later when I had my first obstetrician appointment and it was during this period that I was at my absolute worst, suffering nausea, completely isolating myself and basically reaching crisis point where I was contemplating termination and I was also considering what I could do to myself as a way of releasing myself from this situation. I think that had I been screened at that initial GP appointment where there were in fact details and a past history of my experience of being in a mother and baby unit with Madison and also a history of my mental health but this question was never asked. So that period for me was particularly difficult and by the time I actually had my obstetrician appointment I was probably through the worst but and being at that point in time the fact that I had improved slightly meant that that prevented me from them saying anything because I felt that the worst was over despite going on to have a very unwell and extremely emotionally draining remainder of the pregnancy. You know, as I said, having been assessed I think, I really think it should be routine that with any woman who presents to her GP to confirm a pregnancy, to check whether she's pregnant I think that there should be a routine mental health history completed regardless of whether the GP feels that, you know, this might upset the woman or is intrusive. I really think that this intervention and this question needs to be asked very early on in the piece. I truly believe that if I had had intervention at that point as the ladies have said that I would have been able to get through that pregnancy and I think that when my baby was born I would have had a much more beautiful experience and perhaps not experienced the postnatal depression that I did. I think for me when I did reach the point of entering the mother and baby unit I was extremely lucky that I responded well to the medication as you probably have all read from my story. I was actually discharged from the mother and baby unit in perhaps a worse position than I was when I was admitted. My Edinburgh postnatal depression score was in fact higher upon discharge than it was upon admission and so I actually left the hospital in quite an anxious state. I was just fortunate enough that I managed to bump into my psychiatrist who was in fact a registrar at the time so was very dedicated and very interested in what was going on for me and she responded in the only way that she could because my bed had already been filled. She increased my medication and she ordered my husband to take care of his leave and she presented that option to him as basically being non-negotiable. So at that point on that particular day she really made a big difference. I went home, I had my husband with me for that week which got me through possibly the tender stage where I was still waiting for that medication to kick in and I think by the time he'd returned to work within perhaps a week or so the medication had reached its full potential and there really was a 360-degree turnaround and I think that medication actually treated the anxiety and the depression that I in fact lived with my whole life. So I think, you know, in hindsight and in looking back on my situation it was extremely fortunate that I did respond so well to the medication because the follow-up care and the treatment and the options that were provided for me were really non-existent and I think the important thing to note too is that when a mum is extremely unwell it was impossible for me to access any resources or any information that I was provided with. I literally needed the hospital or medical professionals to make those links for me, to make the phone calls for me, to basically to do everything I wasn't capable of being given information and being able to respond to that. So I look at myself as being one of the lucky ones but I really think that there was a huge gap in the care that I received and the possible outcome and the links that my illness could have gone on for. So I always have, you know, fully supported the absolute need for early intervention. That hits crucial. Thank you. Thank you, Stacey. That was, as somebody has commented, that was a very courageous presentation and we, as practitioners, we very much appreciate your input tonight. Thank you. Morton, I believe you have a question for Jeanette around collaboration between GPs and psychologists. Yeah, thanks, Michael. One of the things that I'd like to talk with Jeanette about is what sort of psychological approaches would be of benefit and how can we better collaborate with our psychology and mental health nurse colleagues to help in this situation? Thanks, Morton. I think it's a great question and the very question itself, sort of that openness of thinking, well, how can we all, you know, use the resources that exist in the community, GPs, nurses, psychologists, psychiatrists and bring them together? And I think talking to each other is terribly important.  So collaborative keeping each other in the loop, working out collaborative management plans. I think that the GP plays a very important role in being there in a sense of the anchor of the base and being able to do some very good support of strategy and depending on their skill, more than that. And it's a question of using the other professionals as you need, like, oh, I wonder if I need more of an assessment on this or I think that it might be helpful to say, for example, to get some very focused help with behavioral techniques for her anxiety. So it's about making suggestions and keeping the lines of communication open and vice versa. Psychologists really need to give you very brief but constant feedback to their, to general practitioners and nurses so that everyone's in the loop and we are working together to support a woman, Stacey. Thank you very much, Janessa Morton. Stacey, I believe you had a question for Brian around medications. Yes, Brian, I was just wondering more so, I think from my experience, I had attempted to take medication previously but I always had side effects, headaches, you know, all of those sorts of things. So I gave up on medication and it wasn't until I was in the mother and baby unit that I found one that suited me. So I was wondering and through my work with Panda, I also find women that sort of have to change medications because they're either not working or they don't agree with them. So my question is what happens when a woman tries a number of medications or treatments with no success? Is there always an alternative or at some point, is there a time when a woman has to find alternative treatment other than medication? What medication were you on, Stacey? Initially, look, I tried a number. I tried Zoloft, I tried Cypramil, I tried a number of different ones. Arapax, I tried all of them and they all presented with the same side effects. So I dreadful head pressure and that sort of thing. So I just gave up on them because I would give them long enough to work, you know, a good two, three weeks but the side effects were really quite unbearable. And I'm currently on Lexapro, which is the one that I've been on since I had Jake and I've had no problems on that one. There is a newer version of one of the ones you had before, all of which are in the same group but in fact, just because one of them doesn't suit someone, doesn't mean one can't try another one. There are other medications that I might have tried but we need to be thinking here that your diagnosis is not just postnatal depression here, we've got an anxiety disorder so we definitely need something for the anxiety. Most antidepressants are also quite good for anxiety but a lot of women are a little intolerant of that particular group of medications which are called SSRI, selective serotonin reuptake inhibitors because they do provide nausea and headache and so on, especially to begin with and I think often people are not careful enough to start on a very small dose and let the woman get a little bit used to the medication before you increase to the standard dose. Now medication by itself is never enough, that's one of my hobby horses, so that if you offer or insist on medication before the woman trusts you and you have a therapeutic alliance with her, she's going to get side effects and it isn't going to work. I think it's very important to build up the relationship, use medication appropriately if you have to and to remember all the other things you need to put in place. It's not been my experience that people need several iterations of medication. Usually the first one seems to be all right so to some extent I think it's to do with the therapeutic alliance and what the woman is willing to try and I'm very conservative about medication if I can manage without it and just doing psychotherapy then that's what we do. Thank you. Morton, I get the feeling that you want to say something there. Yeah, look I would just like to echo what Brian was just saying there. I think the therapeutic relationship and the relationship between the patient and their doctor is really critical in these areas particularly around mental health. I certainly also had the same sort of experiences in that when you do know the patient well and there is a trust relationship, things certainly go much more smoothly and more I think comfortably for the patient than where you are looking at a more episodic emergency type relationship which can sometimes be very difficult both for the clinician and also for the patient to get the most out of that relationship. So I think it's important for us as clinicians and GPs particularly because we tend to have more of a long-term relationship with our patients to make sure that we do maintain that relationship through thick and thin. That is interesting actually. May I just jump in there? Sure. I'd just like to ask Brian a question. Some of our attendees have touched on this in their questions. It seems to me as if the person who's got the least time with Stacey has got the most contact with her as the GP. Brian, can you think of any way that we can all collaborate better in the care of Stacey? Well I suppose this is one of the things that is again a particular hobby horse of mine. I spend my life trying to get people to collaborate but one of the ways that I do it is by making sure that all the people we see have a GP referral and that I'm in close touch with the GP and it is important to remember as Morton said that long after they've finished seeing me patients will be going back to their general practitioner. A problem we have in some of the areas where I work is that unlike in Britain people don't have to have a GP allocated and stick with that person and they can often hop from GP to GP which means that nobody has the previous history of this person. I don't see that you can do a great deal in five to ten minutes unless you have got that history already at your fingertips and one of the advantages of general practice is that presumably you already know the patient and the family and if you don't then you saved me behind the eight ball but I don't see why in fact if a woman is pregnant the nurse in the practice can't ask her some questions and the way the midwife would do at the hospital and give her an Edinburgh perinatal depression scale to complete. Some of that can be done outside the GP's time and the GP and the nurse can have a look at the results if they wish. It occurred to me listening to Stacey that she'd possibly been a private patient. Yes, that's correct. Yes, and you see that is a hazard at the moment and we're only just beginning to get the system of doing the psychosocial assessment and depression into the private system. There have been rather far behind in this the public system it's happening in most places the private system it's only just beginning. Yes, there is. Mostly with a midwife but others don't. Yes, there is that peculiar dysfunction now, isn't it? Yes, but we are making a little progress. Good. Now Jeanette, I believe you had a question from Morton around about depression and postnatal depression tools for use in practice. Yes, and if I can just lead off from the discussion right now I think that another quite helpful tool that we sometimes when we refer to a woman who from a GP and then we assess her then we will create a little card that we call collaborative networking amongst health professionals where we write down the names of all the professionals and we ask her to bring that along to each professional appointment so everyone knows who everybody else is and there's some communication happening. What I was going to ask you Morton is in terms of GP practice what are the ways in which you find the most helpful way of identifying women with depression and I'm always curious about what is the best support that we can offer to GPs in the identification and screening of women because there are GPs like yourself who are very well versed in this and there are others who may not have as much experience. So I was just wondering about your thoughts about how you think GP's best go about identifying it as a routine exercise. Sure, thanks for the question. I think general practice has lots of challenges shall we say and one is having the right tools at our fingertips at the right times. One of the problems is that certainly making sure that we're teaching our GP registrars about using proper screening tools is really important. I freely admit that when I was trained no such thing existed for general practice and it was learning how to do it on the job. That's a little different now and we're certainly more aware of using various scales and the K10 is probably the most commonly used in general practice but not specific for perinatal and certainly many of us are also using the Edinburgh scale who have interests in and seeing lots of women with the perinatal period. The computerized technology that we now have allows us to have some drop-down menus and things like that which has made a big difference and then it's about educating GPs making sure that we're not staying back 10 years ago just as it is. Things change and we have to change with it. I think critically though it's important to make sure that you listen to your patient well and you can certainly do that in a 10 minute and acknowledge that if you have concerns bringing that patient back sooner rather than later certainly not leaving them hanging for 12 weeks until the obstetrician sees them is really important and certainly with most of my young mums and young ladies who are pregnant I make the point that I'm very happy to see them sooner rather than later and my girls in my practice know that they can get in at a priority if they so demand it. So it's about setting up your practice as well as having the right screening tools. Thank you very much, Jeanette Morton. Stacey I believe and you had a question for Jeanette about accessing or benefiting from psychological therapies when you feel that you may be too unwell to do so. Yes, which leads me back to my point when I was in fact admitted to the mother and baby unit in such a severe state that I really felt that I was incapable of engaging in any treatment because I was that unwell. So that was where my question came from that can psychological treatment be beneficial if that biological or that chemical imbalance is too far out of control? Thanks Stacey. There's a lot of questions packed in there about both the severity of how you're feeling and also what is causing it. But I think that we have psychologists who work both in mother-baby units and then on discharge and the sort of support that psychologists could give a mum would be different when she's in her most unwell state and it might be much more as Morton and Brian were talking about that forming support or relationship, engaging in a trusting relationship to try to help with feelings of fear and safety and not actually starting the very focused work that's only perhaps possible once you're feeling a little more in control. Because as I said before we understand and as Brian said that it's not just a biological event. There's things psychologically happening in your family and relationships and how you feel. The best approach is to always consider help at every level. So I think the short answer is that you wouldn't attempt an intensive psychological treatment of trying to teach someone cognitive strategies of how to challenge intrusive thoughts when you're very unwell but you could very much help with some supportive behavioural strategies and forming a relationship so that you would have had a good experience whilst in the inpatient unit of feeling supported and cared for and contained with the particular issues you're facing at that time. Thanks, Jeanette. Brian, would you like to comment on that? Well, I'm not sure that there's a lot I can add actually to what's been said. I think that if you're in the hospital you're sick enough probably to need medication and that the medication should be sorted out and the patient should have adequate rest before any other work is expected of her. And if in fact she hasn't been well enough to engage in any psychological treatments before she's discharged then I wonder why she's being discharged. I would like her to be attached to various services before she leaves the hospital. I want to know that all this has been set up for her and her family either she returns as an outpatient to our service or we've made contact with other services and linked her in and she should certainly not be going home feeling as bad as or even worse than when she was admitted to the hospital. We seem to, and this has come through from some of our attendees, we seem to have left out some important people in the care of antinatal and postnatal patients of obstetricians mid-wide. Would anybody like to comment on their role? I have already commented to some extent in that some obstetricians are very keen on psychosocial assessments and depression screening being done. They don't necessarily do it themselves although some of them do but they expect that when the woman books at the hospital she will be asked these questions and they will be told the result and they will make sure that referrals are made for support for this woman. Another of my mantras is that a well-trained midwife and similarly postnatally a child and family health nurse a well-trained midwife is an intervention. If the woman sees this midwife perhaps on several occasions trusts her and the midwife takes an interest in her that makes a huge change to the women's anxiety level and her confidence in what that midwife might suggest. And if the midwife says, look you had a bad time last time why don't we link you in with a psychiatrist now so that we have a plan that way we can avoid you getting sick again. By this stage hopefully the woman trusts the midwife well enough to say okay I'll see someone that you can recommend my GP. Thank you. Martin would you like to add anything to that? Yeah look I think Grant's absolutely right I think there are just as there are GPs with different interests within within general practice there are also obstetricians with different interests in their practice and I certainly know several obstetricians who if I have a lady who I am concerned about in terms of her mental health history or her mental health at the time I will be recommending who have really good abilities to talk and collaborate with other mental health professionals. There are several just as I'm sure there are GPs who Stacey probably wouldn't recommend you know I think it's important to if you're not getting the response that you want from your health professional to look for another opinion or sort of make that known to your professional so that some of those issues can be worked through. Thanks Morton. Just Jeanette may I just ask you a question many of our practitioners are from rural areas and regional areas where they may not have access to the luxury of a mother and baby unit. Do you have any take home messages for the practitioners attending tonight just sort of you know quick five or a quick ten or a quick six. Jeanette? Yes I could just add something in the previous question because we haven't talked enough about nurses. I think nurses are very privileged in Australia to have a very good maternal and child health nurse as we call them Victoria or similar in other states system and midwives also play a pivotal role and we certainly have found that not only are they important in contact with new mothers but we've trained nurses and found nurses to be able to provide poor mild to moderate personnel depression very effective care. So you know I think that there's another resource there in our primary care network and when we talk about the problems of rural areas of the extent if we've got a national perinatal depression initiative that wants to try and up the screening so all women are screened we need to find ways of reaching women without many resources. So that's your question about the rural and around about way I think that we have to use our primary care professionals that exist and train them up but also be aware of when it gets beyond their level of expertise we would refer to one of their colleagues so if there's a good knowledge of that I think we can use a broader range of professionals and we're certainly exploring other mediums for intervention as well as for example we are developing an online training program supported by telephone counseling. Good that's good and do you have any comments at all on that Stacey what you're hearing over the last five or ten minutes any comments? Yeah look I think particularly for rural women in the area that I work in which is in fact telephone counseling helpline what we're commonly presented with the fact that there appears to be a lack of resources or these women are unable to link in with appropriate resources so for these women we actually find that online support services are extremely useful and with a service such as Panda2 we're hopefully able to provide a link to these women with a database that we can provide so look I think overall basically what I'm hearing here is that there is what I would consider to be a limited network of professionals in this area when you look at the number of women that become pregnant versus the number of professionals dealing specifically or with a specific interest in perinatal depression you can certainly see where the gap is so the obvious question that I pose is how do women access the people such as Brian and such as Jeanette when people with such expertise and such a specific interest in this area are limited thank you now we're just unfortunately time always runs by too quickly when you're engaged Brian we allowed you not to ask any questions in this segment but I'm going to ask you to ask one of your fellow panelists one question that occurred to you during this webinar if you were allowed to make one change to our health system to assist women with perinatal depression and I insist perinatal anxiety what would that change be because from my point of view we no sooner train up lots of midwives who are excellent lots of child and family health nurses who are excellent and the numbers are cut back and they can't do all the things they're mandated to do and it seems to me that if these professionals are well trained they're a wonderful resource we need more of them Morton would you like to address that yeah look I mean I think that certainly from a general practice perspective I think it's about education reminding GPs of the importance of this area as we've said before this is only part of what a GP does so it's important to keep that in the front of their mind and that's probably the main thing that I'd suggest education and keeping them informed Jeanette I can give you 38 seconds to speak no I'd agree with everything that's been and I'd also like to say that families and supportive communities and social networks we haven't talked a lot about that but that's very very important and has been shown to reduce severity and reduce the time of suffering so I'd say yes let's train up as many people as we can and be creative in developing and researching a broader range of services that can be done more remotely and never forget that a group of women getting together is a wonderful resource excellent I'm glad somebody said that I think women getting together and I think people talking at their problems in their own settings is very useful therapy unfortunately we are coming to the end of this webinar nearly a thousand people apply to participate in the webinar and we have had 250 people log in I'd like to thank all of the attendees for logging in and I trust that you will continue to access the MHPN website for further conversation around this topic we didn't get a chance to talk about all of the therapists who can be engaged in this area particularly with mental health nurses and we probably didn't cover sufficiently with maternal and child nurses and I apologize for that I am a GP and I have learned a lot tonight I think it's a very important area it's probably our only biological function is to reproduce so we need to make sure that those who do the most work the mothers all our mothers and all our daughters get good care during this time and I would hope that this webinar will raise the issues that we've discussed tonight more broadly throughout Australia and throughout all the marvelous therapists who have attended tonight I feel very humbled Stacey having listened to your story and I cannot tell you how much we all appreciate how bravely you articulated that I'm going to leave the last word to you I normally have the last word Stacey because you can have the last word tonight I think again I push for early intervention and the opportunity to be given for women to be given permission to say that something's not right and to be listened to and heard I think there still is a stigma about women's mental health and particularly when it's such an experience that is anticipated and projected as meant to be a wonderful joyous time so I think that perhaps by just being given permission to say everything's not as good as what it should be I think would allow for that early intervention and so much work could be done to prevent the experience that I went through and on behalf of everybody I would like to thank all of our panelists I'd like to thank Brian and Morton and Jeanette and last but certainly not least Stacey for her articulation tonight I wish you all well and I trust that we will see you all again at some stage on one of our webinars from MHPN thank you all have a safe trip home good night everybody thank you


Hello, good afternoon, Emirates FA Cup. Sees Bournemouth enter away at second-bottom championship side. Queen's Park Rangers, today the expectation, always all on Bournemouth. And a proud day for David Brooks. He is also captaining the Terries, leading them out of the tunnel. Changed 31 places above Queen's Park Rangers in the lead pyramid. Sinistera and Billion player 1-2, and Billion with a left-footed shot, just past the right-hand post. Down this right-hand side, Armstrong again. This time he's up against Sinesse. He holds off Sinesse, and Armstrong into the penalty area, and Sinclair. Four minutes to go until half-time, and Aarons wants some help, and Dyches into the penalty area here. Coupier on the crest of a wave, and they've got two off. As Lindon Dyches right-footed shot, deflected off Max Aarons, and all of a sudden, in the space of a couple of minutes, the Terries Emirates FA Cup campaign is already hanging by a thread. And Bournemouth are going to have to come from a long way back here. And that is half-time, so the Terries at the moment are in danger of heading out of the cup. They're two-nil behind at Coupier. And Erola is at to turn to his bench at half-time. Ryan Christie and Justin Cliven are both on. As he works to Sinistera, left side of the penalty area for the Terries. Sinistera, left side of the six-yard box, he's cut back a couple of times. He wins a corner off Aarons drew on this near-side. The Bosque and Bucker, the net charm, rings out from behind that goal away to a left. It's a short forward to Billion, click back to the penalty spot, driven by Tavonier, and Bournemouth strike. This is the reaction what you show. And I think today you see the reaction what we show is the team spirit we have. And it's beautiful to come back like this. We just needed to do what we know, how to press. We know what he expects from us, you know. And first off we had some difficulties and we get some goals also. And just the second half our mindset was different. Me and Ryan came on and we just did everything to help the team to change the mindset and we did. It's going to be Alex Scott with the corner. The front of the two-tiered away in. Into the near post and into the back of the net. Off the glancing head of Kepa Moore. So, game on. This is about survival, these kind of competitions. And today we were really in danger. We were under pressure in the halftime, but it's good that we kept our mentality in the right place and we could attend the things. Numbers arriving at the back post and Justin Kyler puts Bournemouth in front. Those moments, I wait on those moments, you know. It feels quality. I know the ball arrived at me also. It's a massive away end. 3,000 FC Bournemouth fans there and they were in fine voice. Yeah, they have been amazing today. They have been amazing and I'm happy that they could enjoy at the end. No, because for sure we were in the events. We were suffering especially at halftime under a lot of pressure and I think they pushed us a lot. You know, when they created this momentum now and we were having the chances, we scored the first one and luckily for us now we could score the three goals. Bournemouth secure their passage through to the fourth round of the FA Cup. It finished here at Loftus Road, Queensborough Rangers 2, Bournemouth 3.