Parenting is often challenging - particularly for us as mental health-interested GPs - as we know full well how important it is to get it right with attachment. Thank goodness for Winnicott’s “good enough mother” idea to get us through those sleepless nights!
Latency (thanks Erikson) gives us a few years of relief when things go underground, and then issues burst out again in adolescence where we get a chance to pick off the scab and have another go.
We know that early intervention is key to successful passage through adolescence. Do you know about “A second chance in the second decade”? It’s a comprehensive report from the World Health Organisation looking at adolescent health and wellbeing and underlining the need for action at every level to improve the health of this vulnerable cohort.
Working with adolescents
You certainly don’t have to be cool or speak the current lingo to work effectively with young people at headspace or anywhere else for that matter (thankfully), but it helps if you are interested in, and passionate about what makes this period of life so special.
Young people often wander into primary care very tentatively - putting them at ease, opening a conversation about wellbeing and offering support can be one of the greatest gifts you can give someone. The chance to feel cared for and to know that the system is on their side can be a life saver.
When my son was a snarly disaffected youth, he’d often ask me when we caught up at the end of the day “Did you save any lives today mum?” –Tuesday at headspace I could sometimes answer yes!
Working at headspace
So what does a day at headspace look like? For me these days it’s full of challenges. When I started the general practice at headspace in Bondi 4 years ago, I was there 4 hours a week and flat chat with patients. Now, with the unwavering support of my wonderful colleagues (from the practice manager, clinical lead, centre manager right up to clinical director, PHN and the board of directors), we have 40 hours of GP coverage per week.
I supervise a registrar and act as “GP clinical lead” ensuring the other 40 odd clinicians understand the breadth and depth of skills we have as GPs. I help to enhance the management of complexity in the service. Yes, it’s supposed to be a service for people with “mild to moderate” conditions but we know that headspace attracts young people of varied levels of morbidity and we do our best to find them all care. GPs are really well placed to “hold” young people waiting for therapy, liaise with other services and specialists, see someone until we work out what’s really going on, help determine stepped care and collaborate with colleagues when young people have complex multi-morbidity.
Where is the joy?
Who are some of my most interesting young people? It’s hard to say. It’s always satisfying to see someone successfully tackle an eating disorder - like the young woman who about 18 months after I’d started seeing her admitted her veganism was in truth a front for her disorder, or a medical student with anorexia who got better really quickly once well supported by a multidisciplinary team and who was able to jump in to her next clinical attachment feeling enthused about the role of GPs.
I love it when young people send their friends or siblings in because they feel listened to and cared for and I like being on the spot to help out colleagues - helping a terrified psychologist manage panic attacks in one of her patients and winning a friend for life!
Teaching at headspace is always fun – there are registrars who are passionate and stay on when fellowed, and medical students who can go back to the hospital able to do a good HEADS assessment.
I also find myself advocating for role of GPs in youth mental health at local and national level and I advocate for good communication with other GPs in the community - running CPD events and connecting professionals.
Is it the same everywhere at Headspace?
You need to know that every headspace is different - I went to the national conference last year convinced my local headspace centre was the best and most innovative. I was so delighted to see a room filled with posters from maybe 50 other centres which were all responding to local needs and had their own unique identities.
There are over 100 headspace centres nationally now and each one could do with more GPs.
There are different models of remuneration ranging from salaried to 100% bulk billings to mixed. They are different in terms of type of practice - sitting alone in a consulting room to even GPs running the place, integrated into the team or busy and communicating only as needed. If you’re interested in this kind of work, please contact me and I’d be happy to link you with the appropriate people.
Karen Spielman firstname.lastname@example.org
And don’t forget to check out the e-headspace website for a range of adolescent friendly online resources https://headspace.org.au/eheadspace/