[Intro music]

Caroline West: Hello and welcome, I’m Dr Caroline West and I’m delighted to host, what will be, I’m sure, a very lively discussion on a subject that I believe that all of us are very passionate about: The future of better health.

So now I’d like to introduce though our panel, first to the stage is somebody that would be familiar to all of you if you have a bit of a DIY gene in you. He’s a leading Australian designer, he’s on The Living Room, aren’t you, come up Barry Du Bois.

He’s also going to be sharing his story, very generously with us, his story of living with a mental health condition and also his journey with cancer.

Now Sally (Dr Sally Phillips) can I welcome you back to the stage.

She’s the General Manager of Health Services for TAL of course.

Can I welcome to the stage Professor Michael Boyer, the Chief Clinical Officer at the Chris O’Brien Lifehouse, and you’re also a member of TAL’s specialist Advisory Team.

Now our next guest, you might recognise her, she has spent more time in the pool than probably any of us have done put together and basically Libby (Trickett) was a gold medallist at multiple Olympics, 2004, 2008 and 2012, and the World Record holder.

Libby Trickett: Feels like a lifetime ago now but thank you!

Caroline: But the other hat that you wear, apart from being a legendary swimmer, is that you’ve become a very passionate advocate for living with mental health conditions and hopefully tonight you’ll share your story as well.

And finally I’d like to introduce you to Professor Nick Glozier, who is a professor of psychological medicine at the University of Sydney. You do see patients and I understand that, really, to be a great psychiatrist you have to be a great listener as well as being highly empathetic?

Nick Glozier: What did you say?

[laughs]

Caroline: So thank you very much for being on our panel. 

The next chapter of health is going to be a particularly exciting one. I used to work on a program a years ago called Beyond 2000 and we always were trying out new gadgets and gizmos and I think the next 5 years we’re going to see a lot of interesting innovations come to the forefront of medicine.
And really excitingly though we’re moving into an era of personalised medicine. Now, I know Michael you hate that word “personalised medicine”…

Michael Boyer: I do. I mean all medicine is personalised but when we use that word we’re really talking about identifying characteristics of individual people and actually tailoring, very precisely, the treatment that they need – in my case for cancer, but in fact it applies in other areas of medicine as well – and making sure that we get, if you like, the maximum benefit because we’ve used the correct treatment.

Caroline: We’re not only redesigning our systems to be very personalised, but we’re redesigning spaces and that includes hospitals?

Michael: Yeah and I think that if you’re going to build a hospital, and I was lucky enough to be involved in building a hospital from scratch – and actually I should point out that it is exactly 10 years to the day that Chris O’Brien died – but if you’re lucky enough to build a hospital from scratch you can design it in a way that takes account of what people need. 

And I’m not talking about what nice little bits of oxygen you have coming out of the wall and what tubing you need. But I’m talking about an environment that actually helps healing.

Architects talk about “patient-led design” having spaces that are light, that are easy to navigate, that don’t feel like a hospital, actually helps in the healing process.

Caroline: The new systems design is not just around the physicality of the delivery of health, it’s all about putting the patient as the central player of that team and it’s all around patient-led care isn’t it.

Michael: It actually takes a team to treat any disease and the patient needs to be at the centre of that team, with all the people they need to help them, to get better ranged around them.

Barry Du Bois: From a design point of view, as someone who’s spent a lot of time in those spaces, hospitals are not somewhere I’d go. The Chris O’Brien Lifehouse, The Black Dog Institute, these places embrace you, give you a sense of security and belonging and that is a medicine in itself for me.

Caroline: Can I come to you Barry and you’ve unfortunately spent more time in those sorts of places than you would have preferred to spend over the last few years. Can you take us through your story and perhaps share it with us?

Barry: Yeah, nevertheless I haven’t spent a second longer than I’ve had to, I hate the places but they are evolving and it’s amazing. It’s very interesting to listen to Brett (Brett Clark, Group CEO and Managing Director, TAL) talk and say how the Life Insurance industry wants to understand the health model a lot better and that’s been more or less my life for the last couple of decades.

I got cancer at 52 the first time and I wasn’t given a great outcome – I was only given a couple of months to live back then – and I said, well I was a husband and I had an amazing life, a gifted life, we weren’t able to have children so I thought “I’m not jumping on the conveyor belt, I’m going to go to the alternatives”. 

And I took it on – I started to personalise my own treatment – I went on for another seven years and a couple of people in the room saw me announce about 18 months ago on my TV show that my cancer had come back.

I now suffer with multiple myeloma, I think the long term look for that is about 5 years they reckon you’re going to last, but now I have twins, seven-year-old twins. There’s no way I saw life as “ok it’s a good life, I’m happy to go” no way in the world.

I don’t want to go anywhere, I want to last as long and as strong as possible. I was very lucky to get involved with the Chris O’Brien Lifehouse as well as St Vincent’s and I just spread my treatment out across what the medical industry told me or what I know I can do for my brain, my respiratory and my nutrition, so it’s a really broad thing for me.

Caroline: I guess your experience would be one that would be shared by many Australians. If we live long enough I think the reality is many of us will be living with a chronic condition.

Michael: So in terms of your comment about how many people get cancer, in NSW – and actually it’s true for the whole of Australia – if you live to the age of 85, one in two of us will develop cancer of some sort. That’s the bad news.

There’s good news behind that though as well. And the good news is that while we think of cancer as a death sentence, and I wouldn’t want to pretend that it’s something light hearted, the fact is that in the last 40 years survival at five years, after a diagnosis of cancer, has increased from 48% to 68%.

And I don’t think we’ve even seen the impact of some of the really big advances that have come in the last 10 years or so. So I think that it’s really likely that in their lifetime, everyone in this room, we will see cancer going from a disease that you have, and you have to have some treatment and maybe you beat it and maybe you don’t, to something that you live with for very very many years. Along the lines of diabetes, or blood pressure, or high cholesterol or something along that line.

Caroline: I know that I’ve was talking to you before Barry and talking about the mental health impact that that had on you, and I know that’s something that’s close to the heart of many people on the panel, including you Libby, I guess that if we’re looking, as Sally was mentioning before, about the whole person and we’re really looking at that physical, mental and financial wellbeing model, Libby you had to live through a chapter yourself which was also a chronic condition that you’re managing. Could you talk us through what that’s been like?

Libby: Yeah definitely. So just to give a little bit of background with my experiences with mental illness, I first experienced depression when I retired from swimming in 2009. I was about 24 at the time and very ready to take on the real world and see what it had in store for me and see what new great opportunities were there and unfortunately the reality of what I faced was very different to what I imagined and fell quite quickly into a depressive state. 

I had no purpose, I had all of my social connections, who were involved in swimming, and I was living in Sydney at the time, away from my family as well, so there were a lot of elements that sort of drove me to a place where I became incredibly depressed and struggled to get out of bed every single day and it became a very dark place for me and certainly had implications on my relationship with my husband – we actually separated for six months in that time because I was not a very nice person to be around to be perfectly honest – and for me the only way that I could see myself come out of that was to return to swimming.

It gave me a sense of purpose, it gave me an understanding of what I was working towards – a goal that was very tangible and very real to go to a third Olympics – and more than anything it was my comfort zone. I was back in my comfort zone again and that really helped me course-correct and allowed me to come out of that very dark place that I had come to in that position.

And second time around in retirement, I’m happy to say, was slightly better transition but then I think the biggest challenge to my mental health has definitely been the transition into parenthood. So I experienced post-natal depression after the birth of my first daughter and combined that with the feeling that I just wasn’t doing anything right. I thought that if I just loved her enough, if I was just enough for her she would sleep, and that led to what I can only describe as a break in my mental state and that was the first moment where I realised that I desperately needed to get help, for my safety and also my daughter’s safety.

Caroline: Nick, if I can bring you in there, you’re nodding your head at the other end. Now you’re a mental health expert, how does that resonate with you, Libby’s story?

Nick: The thing that we’re hearing from both our people with lived-experience here, is this concept of these different aspect of your life – the pillars that TAL are trying to get to at the moment – and it’s not just about being happy, it’s around having engagement, relationships, meaning and achievement. Those are the five pillars of flourishing that Seligman talks about, and I think that forms the core of our approaches now and you talk about innovation, and I think those things are innovating – the that we actually approach mental health now. 

It’s not just about being happy and getting a happy drug, it’s about all these other aspects of our life that are really important to a meaningful life.

Caroline: And what’s the evidence on sleep?

Nick: I work in sleep and mental health and I think one of the key things is not just to focus on sleep, it’s about sleep and circadian rhythms.

And we talked about design, and that’s fundamental. I too was involved in a hospital, and we’re now designing hospitals to allow more natural light which enables people to keep sustained circadian rhythms. 

If you go into a hospital you’re in grey-zone light for hours and hours and hours. Your circadian rhythms just disappear and we realise that you need active, strong circadian rhythms for your mental health, your physical health, it changes the way we metabolise things, it changes our whole metabolism, it changes the way our drugs work in many areas as well, so we realise that sleep and circadian rhythms are fundamental to our health.

Michael: This idea that you have rhythms of light and dark, that you can see what’s happening, makes an enormous difference to the wellbeing of people, to how rapidly they recover and to how happy the people are around them.

Nick: A grey room. A neon-lit grey room that we all work in has 1 thousandth of the light intensity that a cold grey rainy day in Sydney, outside, so if you can get out, just of your offices for a short period of time, you are doing a phenomenal thing for your health and we are doing a great thing for our patients.

Caroline: What we are really dealing with, with modern health, is really the surge of chronic conditions. So, conditions that we are all living with for a very long period of time, is not the condition that we suddenly get today and die of tomorrow, it’s something that we’re often having to manage year after year and that’s where partnerships become so important as a new collaborative model of health.

Sally Phillips: And I think it’s also important to think about it post-claim as well. So it’s not just about paying the claim and supporting somebody. Once they’ve got better and they’ve returned to the best health they can be, it’s how do we continue to help with tertiary prevention, or even secondary prevention. As Barry said he’s had one cancer but then another, so how do we keep supporting on that journey?

Barry: I say all the time, “I don’t know why I got cancer”, but whatever I was doing has probably contributed to it. So I can’t just get treated and go back to exactly what I was doing. I’ve learnt. I’ve always meditated but mindfulness meditation has really enhanced my life therefore I will be prepared better if something comes up next time, again. 

Caroline: What do we know about cancer and its causes Michael? What do we know?

Michael: Well we know some things that definitely cause cancer, and fortunately we’ve done things about that. We know that cigarette smoking is dreadful and it is probably the number one preventable cause of cancer. We also know that sun exposure, both in terms of skin cancer but also in terms of other cancers, is a bad thing. We know that good diet and exercise prevent cancer, so it’s not the cause but it is part of the solution.

So we know a fair bit about what causes cancer across populations. What’s much much harder of course is to say “what caused the cancer in an individual person” and it’s nearly impossible to do that.

I should also say that we talk a lot about genetic cancers, they are real and there are genetic abnormalities that can be passed on from generation to generation. But that’s the minority of cancers and that may be 5%, 10%, that kind of number.

Caroline: If we are really looking at the mental health area I guess there’s a lot of interest in that and we’ve touched upon that, what’s the story with social media and mental health. Is it really bad for us? Is checking our Instagram and doing selfies and flipping through Facebook bad for our mental health?

Nick: So there’s actually a burgeoning field of research on this at the moment. There’s a “when” you do your social media, which is bad. So you shouldn’t be doing your social media about 12 o’clock at night, one o’clock in the morning, that’s probably not too good for you, probably because it stuffs your sleep up more than anything.

There is a recent paper that’s just come out from Oxford actually showing that the number of young adults, teenagers, who are severely affected by social media and their mental health is actually remarkably small. So it is true, it does exist but it is actually really small. 

I think it’s become one of the shibboleths, the modern demons of our time that gives people of my age something to beat up my kids about, and I probably do that too much.

So yes, there is a danger, and there are also real positives around social media as well. The idea that we have online forums for support groups, you have people who reach out and actually find what has worked for other people, and yes we can provide evidence as doctors and professionals but actually people gain a lot of autonomy, of competence, in managing their own lives through the use of social media and social media-enhanced platforms.

So yes, I think there are goods and bads, as there are with everything in life really, and we shouldn’t just demonise it for one aspect.

Barry: I’m a part of RUOK Day which is just all about talking and asking the question “are you OK?” but have a belief that somehow, someone is going through something that you’ve got through and they’re okay. It’s a great relief for yourself.

My kids ask me how cancer was and why do I have it. They don’t understand what it is, they can’t understand mortality, and they’re 7 years old. I said, “Well, some people get really busy, they don’t get to eat as well as they should, they don’t get to sleep as well as they should, and they don’t get enough exercise and the better we do those things the less likelihood that we’re going to be sick”.

And it’s interesting that 7 year olds understand that really well, and yet a lot of people in this room – no disrespect – don’t so we’re imbalanced. We probably will be doing emails tonight at 12 o’clock.

Caroline: It’s interesting that we’ve talked about the different aspects of health that can really impact on our health destiny and we’ve talked about physical side of things, we’ve also got the social side of things and that includes our purpose – you talked about flourishing before Nick – and that sense of purpose and meaning, and I think Sally you talked about career advice, or a career service that helps people transition. Can you tell us about how that’s important to somebody’s future better health?

Sally: Well it’s really trying to get people back into society, so, for example, if you’re a painter and you’ve injured a limb it might be difficult to go up and down a stepladder again, but it doesn’t mean you should be written off from a society perspective. So how do we work with that person to find out what interests them, and how they can get back to feel productive in life? 

And so it’s working at career coaching.

Caroline: Libby, you’ve been an elite athlete and I think for a lot of us, who aspire to be elite athletes, we’re really curious to know how you manage that transition?

Libby: The transition, I think, into what I always call “the real world”, is challenging in lots of different ways and it was challenging to me because I didn’t know how to value myself outside of being an athlete, and I thought there were different elements to me, but when push came to shove in retirement, one of the biggest things for me was accepting the fact that I couldn’t replace it. That was not something that I was going to be able to replace.

Swimming in your peak physical condition on the world stage is not something that you’re going to be able to replicate in normal life. But what we can replicate are the highs of life. And there are lots of little highs in life every single day and I’ve started to slow down, learn to appreciate those moments in whatever they look like – and they’re not always perfect and they’re not always pretty – but there are beautiful moments in every single day.

Caroline: You touched on that point of health literacy and I think that’s really at the core of patient empowerment. It’s really about having the language to be able to enter into the conversation and increasing your health literacy. Michael, what do you find with that in terms of people coming forward, and being more confident in being a clear stakeholder in what they should be – which is their own health.

Michael: To understand your health, to understand what determines your health, all of the things we’ve talked about actually is enormously empowering as a patient, or as a person not as a patient, it’s actually the thing that stops you becoming a patient in many ways. 

Barry talked about him steering his own ship and it’s really having an understanding of what matters, what do you need to do to stay well, if something does happen to you, how do you navigate the system in a way that results in the best possible outcome.

And I think there’s a fair bit of research that shows that despite the improvements, the health literacy of the Australian population is still not good. And there’s a lot of work that needs to be done about it.

Nick: There were 1,500 apps out there for treating depression that you could get. That you could access on Google Store and the App Store.

Caroline: 1,500!? 

Nick: 1,500. So we said, OK let’s have a look, do they work? There is evidence for 32 of them, this is two years ago. Of those 32, one of them actually was negative, it made you worse! And several of them have absolutely no effect whatsoever.

We need to have a literacy across a whole range of the population around how we actually access the ones that work and provide the evidence and access to the ones that really do work.

Barry: I think if I could improve anything in the world is that we could communicate what we’re going through to people that are also going through it. 

I know just in my own world, I talk to so many people and, listening to you (Sally Phillips) earlier talk about the fact that you offer knowledge and information to your customers from life stories, that’s empowering.

Caroline: We’re just going to wrap up but if I could just get a quick final word from each of our panellists about what they would like to see happen with the future of better health. Barry?

Barry: More collaborative thinking, especially from groups like this, because you’re going to change the world we live in. Punters like me have very little effect, big groups like you, if you can be more collaborative and innovate further I think we’ll head to a better space, or at least I hope we do.
Caroline: Sally, what would you like to see happen?

Sally: I would love for us as life insurers and our partners to be an integral part of the health system and a tool in patients’ tool bag to make them feel better.

Caroline: Michael?

Michael: I’d like to really see a recognition that good health and wellbeing is something that’s actually under our control. And I don’t mean the medical profession, I mean all of us. And if we do the right things we can actually improve our health, our wellbeing and, ultimately, our longevity.
Caroline: Libby?

Libby: From my perspective, following on from what Michael just said, I think we are in control of our health and our mental health and I would encourage everyone on an individual level, here, to take stock of where they are at in their lives and if, perhaps you may not be exactly where you want to be, create a mental health plan.

It’s about being proactive about your mental health. Do the things that nourish you as a person, outside of work, outside of family, outside of every responsibility that we have in our lives and go back to those things that really nourish us as people because that is going to allow us to perform, be productive, be effective in our work, be good people and great as parents, brothers, sisters, friends.

Caroline: Well thank you so much to all of our panellists and thank you once again, I’m Caroline West.

Outro voice over: TAL is not a health insurer, if you need someone to talk to, or have concerns about your mental health, seek help immediately by calling Lifeline on 13 11 14. Or Beyond Blue on 1300 22 46 36.