Georgie Harman: The woman behind Beyond Blue

Q. The Productivity Commission recently issued its draft report following the inquiry into mental health, why is it important to look at how we as a nation deal with mental health struggles?

I think as the Productivity Commission has sort of highlighted, the cost of doing nothing is actually bigger than the cost of further investment in the mental health of our nation. We’re about human beings, we’re about people, but actually as a country we can’t afford not to act, because as the Productivity Commission has determined the cost of mental ill health, suicide, reduced life expectancy and the health impact on the economy are conservatively estimated to be around $180 billion a year. So, it’s a huge number.

I think what we’re excited about, with the Productivity Commission inquiry, is the fact that they are looking at this through not only a sort of social lens and a human lens, but also an economic and productivity lens. They’ve been licensed to look across the different parts of the system that are funded by different parts of government, to look outside of the health system, into things like housing and employment and education, which are all fundamental enablers of good mental health ... And obviously to look, as the Productivity Commission does, at fundamental system and financing reform.

Are we actually placing the right financing incentives in the right place, so that we’re able to push better outcomes forward, rather than just pick people up when they’re really unwell? Where can we invest downstream? So that we can actually prevent a lot of mental distress, a lot of illness and we can actually get in earlier in the communities using different types of models of support, we can actually get people recovering far quicker and help people to maintain good mental health when they do recover.

Really, I think it’s about rebalancing the system from being one that is heavily weighted towards the crisis end. And don’t get me wrong, we need enough hospital beds, we need enough crisis services, but currently our balance of investment is skewed heavily towards the crisis end, which is very expensive and it’s where we actually don’t want people to get to.

So, this is fundamentally about people, but it’s also about productivity and economics and actually building the kinds of services and supports in the community and in systems that actually allow people to thrive and allow people to have their best possible mental health.

I think one of the biggest barriers we’ve still got is the fact that we still don’t think about mental health and mental ill health or mental illness, in the same way that we think about physical health and poor physical health and physical illnesses. We’re still held back by stigma, self-stigma in particular. We somehow think that this is different, when in fact we’re all born with mental health just as we’re all born with physical health. We need to look after that physical and mental health, and treat that as parts of our whole selves, as opposed to thinking of these things individually.

Our brain is the most complex organ we have. It is very different to our heart and to our lungs. And sometimes it goes a bit wobbly, sometimes it’s wired differently, sometimes things happen to us in our lives that affect our thinking and our ability to cope and our psychological wellbeing.

Somehow, we think about people as being different when that does happen. But in fact, all of us, one in five of us will experience a mental health condition in any given year and 45 per cent of us in our lifetime. If it’s not you, it’s your family, it’s your colleague, it’s your boss, it’s your supplier, it’s your customer.

Q. You recently said that with half of all mental health issues emerging by the age of 14, you support the commission’s view that we must be doing more to support children, young people and their families. Tell us more about that?

Look, half of all adult mental health conditions actually emerge by the age of 14, we know that we can, at a population level, if we really focus on the early years and supporting families in particular, we can really change the trajectory of our mental health as a nation.

As I said, before people get to that early adolescence or their teenage years, a lot of the brain development is formed and a lot of distress is embedded.

There is really solid research, over many decades by extremely talented people, that has shown that the first 1,000 days of life are actually really important to healthy development and healthy adulthood, not just physically but also mentally.

So, if a child is born into a world and a family environment that is highly traumatic, they’re more likely to develop more slowly, behaviourally. They’re less likely to play well with other kids for example, they’re less likely to develop the resiliency that stands them in really good stead for the inevitable ups and downs of life.

Childhood trauma, in particular childhood adversity, is incredibly forming and really sets a lot of the pathways that we then travel down as teenagers and adults.

So if we can get in early, and if we can support parents and families who are facing adversity, if we can support the educators, our fantastic early childhood workers and teachers to actually be equipped and know the signs and symptoms when kids are starting to struggle, and know how to work with their families and support those kids to get the services they need, then we can turn things around for families and young people.

This isn’t about medicalising kids. Go back to that first principle that says that just as we’re born with physical health or challenges, we’re also born with mental health. Sometimes, those early formative years damage our mental health or don’t give us the opportunities to really build up the mental health of our youngest so that they can be resilient. And this is scientifically proven.

If a two or three-year-old is starting to exhibit signs of actual trauma and lack of resiliency and behavioural difficulties, we get very scared about that, but that’s when it happens and it is happening in those really early days and years. Why shouldn’t we be thinking “That family and that kid needs things like speech therapy to help them connect and play better, the family may need some support around dealing with some of the adversity they’re facing”? But somehow, we stigmatise it ourselves and we think no, we can’t do that, because that’s about kids having depression or anxiety.

But it’s not. It’s actually about making sure every kid has the best possible start in life and that includes their mental health. 

Q. Australia has a national mental health strategy, but how much time and energy does the government actually invest in promoting the mental health of Australians and preventing the development of mental disorders?

We’ve had a series of strategies and our strategies are fantastic, we lead the world in a lot of areas. Some of the challenges have been that we haven’t necessarily had a specific plan underneath that strategy that says these are the things we’re going to invest in to this level.

Over the years, there has been significant new investments in mental health, we have to acknowledge that. We’re one of the only countries in the world where you can go to your GP and get subsidised mental health treatment. We see a huge amount of investment in mental health services, like Headspace and other great initiatives, and we’re exporting a lot of our innovation.

We are seen as a great leader in our thinking and our research, and our research translation into great new programs and services.

But what we’ve tended to find is that much of that investment hasn’t gone into early intervention and prevention. I think the latest figures I saw was that less than 1 per cent of the health budget is actually invested in prevention. Why don’t we do that like we do with dentistry or looking after our skin, preventing skin cancers? We know what the solutions are, we just need to actually turn the dial slightly so that we are all playing a role in the community, as well as in services around prevention.

Q. Moving on to workplace bullying, one in two Australians experience workplace bullying. How do we deal with these shocking findings? Would you recommend that each workplace undergo special anti-bullying training?

I think training is a really important aspect in both preventing and managing workplace bullying. But really the best way to deal with it, as well as having an educated and trained and supported workforce, is to take steps to prevent bullying and harassment from happening in the first place and to respond very quickly when it does.

So, if you look at the whole approach, workplaces should be identifying and addressing what drives bullying behaviour in the first place, setting the standard of workplace behaviour through a code of conduct or a workplace bullying policy.

And as leaders we need to be exemplars of that. We need to be talking openly about the fact that we don’t tolerate bullying and harassment, and encouraging people to report poor behaviour or instances of bullying.

Workplaces should also be aware of the financial implications of workplace bullying and the benefits of preventing it, and the disbenefits of not doing anything about it.

Be aware of your legal obligations. I am legally responsible for providing a psychologically safe workplace for my staff, as well as a physically safe workplace for my staff.

One of the things we know works really well is to include your staff in the development of policies and procedures, not just on bullying, but actually more generally. Ask them what a mentally healthy work place looks like for them. Quite often they will come with really great, simple, inexpensive, easy to implement solutions, that we would never have thought of.

You want to create a culture where people actually do put their hand up if they’re being bullied and without fear. Ensure that those workplace policies, and your position on this, are clearly communicated, they’re succinct and easy to understand. Actually talk about how you report bullying. Quite often that is the missing piece. People think we have a bullying policy, but I wouldn’t have the first clue where to go and who to go to if I did observe something or if I was subject to bullying behaviour myself.

Q. As for HR departments, do you believe that HR professionals should be professionally trained to deal with mental health issues in the workplace and to assist employees suffering from bullying or other forms of hardship?

I think yes, but not just HR. I am known for saying, and in saying this I upset HR people who I have a huge amount of respect for, but mental health at work is not just an HR issue. It is a business improvement issue and the whole business needs to be involved in driving the solutions.

If something is given to HR, it quite often, rightly or wrongly, gets perceived as an issue that has reached a point that requires risk management. I think that leads us to think about mental health and people who have mental health conditions as risks, when in fact that is a really unhealthy and unhelpful way to be thinking about this. One in five employed Australians live every year and work every year with a mental health condition.

So, it’s not just about HR. HR is absolutely at the table, but all of us need to be at the table, every part of the business. And train up other people across your workplace.

Mental health first aiders, peer champions, people across the business that you know are influential, that people go to, they trust, they’re seen as one of them and can often be the first gateway into someone who is struggling.

So, train a cross section of your business in mental health first aid, and educate them in mental health and suicide prevention as well.

Q. Recently, Wellness Daily published a blog about how and when employees should disclose mental health issues to their employers. The author had quite a few comments from people telling him they were either fired or feared being fired if they were to disclose their stresses. This suggests that the issues surrounding mental health are still very much stigmatised, how do we deal with this?

I think that is really true unfortunately in too many cases. But I honestly believe that things are improving. I’ve been working in this space at Beyond Blue, working with a lot of businesses and a lot of workplaces, and I’ve seen quite a considerable shift in the last five years in particular. So, I think we have cause to be hopeful, but we are not there yet. I absolutely acknowledge that.

But disclosure is a really difficult thing and it’s a highly personal thing. You are not legally obliged to disclose that you have a mental health condition diagnosis to anyone, unless that either puts you or others at risk. If you’re able to continue to work and perform the duties of your role, you’re not obliged legally to let your employer know.

Now, having said that, if we really think about this as trying to create a shift in the way we act around mental health at work, we want to be getting to a stage where disclosing that you have depression is no different to disclosing that you have diabetes or heart disease, or you’ve been diagnosed with cancer and you need to undergo treatment.

We want to get to that point where people don’t even blink, which we don’t with cancer, we just go “Oh, I’m so terribly sorry to hear that, what can we do to support you?” And that person is not thought of as any less capable at their job than they were the day before disclosing their cancer diagnosis. That’s where we want to get to.

But, unfortunately, people are very fearful of doing that, but I think it is changing. One of the things that we’ve got on the Beyond Blue Heads Up website is a disclosure tool, that anyone can use. It is completely free and it helps a person consider a whole range of context [and] environmental issues. What kind of manager have they got, have they got trust in that person, is it really necessary to disclose, or if in fact disclosing would be helpful to that individual?

Hiding something is actually incredibly stressful and takes a lot of energy, especially if you’re not well. So sometimes, disclosure is actually incredibly helpful for the person, because it opens up a conversation with your employer.

Ultimately, we want to get to a point where this is not even a question. When someone becomes unwell, they say “Hey, I’m struggling a bit” and they’re not discriminated against, they don’t lose their jobs and they don’t get overlooked for promotions or be seen as less competent as a result of something that is incredibly common.

Q. Let’s turn to mental health and small business. Running your own business often leads to psychological distress. How can we support our small business owners, particularly ones based in a country setting where the elements amplify the struggle?

We’ve been doing a lot of work with small business and a lot of other organisations are too, because they’re not only employing millions of Australians, but also, they don’t have HR departments.

They are facing exactly the same issues as a business of any size and quite often their situations are very unique and they’re under a lot of pressure. As you say, in drought affected areas there is an incredible amount of stress for individuals. We need to really cater our support, and advice, and the kind of services that we give small business.

So, we’ve actually created a guide, Supporting small business owners to improve their mental health and wellbeing at work, and we’ve done that very deliberately because if a small business owner’s mental health is not good, then the whole business suffers. It’s a bit like putting your oxygen mask on first. As a person around whom your whole business is built, if you’re not good, yourself as the owner, everything else will start to be affected.

So, really, the guide is not even targeted at small business owners themselves, it’s actually about creating that support structure around that person. So, it’s for people who are in constant contact with small business owners, their friends and family, business advisers, accountants, bookkeepers, tax agents, industry associations. How do we get them to equip themselves to look out for the person who is running a small business?

How do those advisers provide that support without obviously being a trained counsellor or a clinician? That guide includes practical tips on how to provide immediate support, how to recognise poor mental health, how to have a good conversation with someone you’re concerned about.

Q. And lastly, are you OK? Doing this sort of work, I am sure you are often exposed to stories of hardship and grief. How do you separate work from your personal life/emotions? 

It’s a really lovely question to get asked. And people do ask it of me. It’s something I have really recently thought particularly about, because I am very passionate about what I do, I love my job, I get a lot enrichment and joy out of my job.

People often say to me, “How do you do your job, it must be very sad?” And yes it is, of course I hear and I talk to and I am constantly exposed to stories of great hardship and tragedy, but also I am exposed to and I hear about and I connect with people who have got the most incredible stories of recovery.

It’s about hope. Quite often, their recovery and coming back from a very dark place has started with contact with Beyond Blue. Reaching out, even if it’s just coming to our website and just realising that the feelings they’ve got are not normal, but they’re really common and treatable, and then finding their way through to support via us to a GP or online therapy or by calling our support services and speaking to one of our counsellors.

For me, every one of those people that I have had the privilege of hearing, of having them share their stories with me, is an incredible privilege. For all of those people it started with a conversation whether that was with an online counsellor, or a GP, or a mate or a loved one, or a teacher, or a complete stranger on the end of a phone. And their journey to recovery started with recognising that something wasn’t quite right, realising that they weren’t alone and getting connected to support and services.

I think of Beyond Blue as a big blue door. Millions of Australians contact us. Millions of Australians know about us and that comes with a great responsibility, but also a great privilege.

And when I thought about whether or not I wanted to apply for this job, I asked a few people and they said, “Georgie, of all the people we’ve met over the years, Beyond Blue is often the organisation that they say ‘I wouldn’t be here if it wasn’t for Beyond Blue’”. And I’ve found that to be true every day of every year I’ve worked in this place. But look, there are days when I need to be careful and I need to look after myself. I have got good people around me, good networks around me. I’ve had my own experiences with depression and this job has made me even more conscious of the things I need to look out for in myself. How to deal with stress, for example. Physical exercise is a very important part of keeping myself well.

I’ve learnt a lot in the job as well about myself. I am not immune, just like none of us are.

Thank you for asking that question.