Allied Health Podcast Series 1 Episode 19

Protecting your Mental Health in Your Graduate Years – Claire Ebstein

In Episode 19 Danielle talks with Claire Ebstein, a passionate Health and Safety Professional with background in Physiotherapy. They discuss the importance of work life balance, mental health in the workplace, managing stress in your graduate years and the importance of setting boundaries and asking for help if you need it.

Speaker You’re listening to Allied Health Podcast, talking all things Allied Health with your hosts, Danielle Weedon, physiotherapist, and Clare Jones, occupational therapist.

Clare Jones In this episode of Allied Health Podcast, Danielle talks with Clare Epstein, a passionate health and safety professional with a background in physiotherapy. Clare is particularly interested in the role that culture and leadership play in creating a healthy and productive workplace, and strongly believes that organisations need to address both mental and physical health in the workplace to support their employees, and achieve sustainable outcomes. Clare and Danielle discuss the importance of work-life balance, mental health in the workplace, managing stress in your graduate years, and the importance of setting boundaries and asking for help when you need it. Enjoy.

Danielle Weedon So today I’m joined by Clare Epstein, a passionate health and safety professional and physiotherapist by background. Thank you for taking the time today, Clare.

Clare Epstein That’s a pleasure, Danielle.

Danielle Weedon So we met in 1999 when I was a fourth year physio on a clinical placement, and you were grade one in your first year of practice. That was a long time ago now. How could we forget?

Clare Epstein Oh, I know, back in the lymphedema clinic.

Danielle Weedon That’s right. That’s right. So we’ve interviewed several grads in this first season of the podcast, and each has mentioned the challenges of work-life balance in their first year after graduation, and managing mental health and the steep learning curve and adjustment to practice that it is after university. So of course, I thought about you, to get your expert advice on workplace wellness, mental and physical. And you know, the fact that you’ve experienced being a grad physio and you’ve had other roles that, you know, work to billables and under pressure. So I just wanna have a chat with you, really? Do you to tell us a little bit about yourself?

Clare Epstein Yeah, thank you. So I graduated a long time ago, although it doesn’t feel it in in some ways, and I practiced clinical physiotherapy for only about five years. Some of that was in the UK, and then I came back and started working in occ rehab and health and safety. So I moved out of occ rehab after a couple of years, and that’s where I worked under that billable hours structured predominantly. And in the last few years that I’ve been working … I spent quite a bit of time doing OHS, or WHS as it’s known now. And now I focus more on the H in workplace health and safety rather than the S. So the job I have now is really all about workplace wellbeing and workplace health, whether that’s from ergonomics and manual handling through to mental health.

Danielle Weedon Excellent. And have you got some advice on, to grads really, and early career therapists on managing their mental health in an allied health environment?

Clare Epstein Yeah, I mean, it’s a big question, isn’t it, because there’s so many different factors that affect our mental health, and if I think back to when I was a new grad, I think one of the things that probably I think I experienced the most is probably imposter syndrome. I felt having come from university where it was, you know, quite a bit, I’m going to say nurturing, but it was quite a sort of a protected environment at university. And I remember my first day at St Vincent’s Hospital and saying to the grade two physio who sort of said, All right, well, this is your ward and this is what you’re doing. I was sort of hang on, isn’t anyone coming with me? Isn’t anyone going to watch what I’m doing? Yeah. And I was really quite shocked at thinking, wow, they trust me to just do this on my own and do I really know what I’m doing and that really freaked me out. And I think I felt that immense responsibility and pressure to be amazing at my job and to know everything. And I think certainly I put a lot of pressure on myself to know everything, and I really felt that I should. I was graduated, had graduated and I should know it all. So I think my first bit of advice is to to cut yourself some slack. You’re not meant to know everything when you first graduate, so just because you’ve got the degree does not mean you know, that you know it all. And I think you don’t need to pretend that you do. And so I think that, you know, if I could go back now and say, Hey, Clare, just chill out a little bit. You don’t have to be everything to everyone and know it all. That would be my first thing. I think there is a lot of pressure when you enter the work environment. And I think the other thing I now look back and reflect upon is that I probably thought that everyone I was working with had everything together. So all the seniors, grade twos, grade threes. They obviously had their shit together and knew exactly what they were doing. And as I look back and think, you know, some of them were not that older than me and maybe didn’t have that much more experience and they wouldn’t have either. So that reminder that everyone, everyone, we’re all human and we’re all going through that. Suffering is universal and stress is. And so we think that we’re sort of going through something unique, but in fact, we’re not everyone is going through a variation of the same thing.

Danielle Weedon Yeah, a lot of the grads that we talk to as well are looking at, and are working in roles at the moment, in community NDIS, and I think the overwhelming feedback is how broad the clinical case load across community disability is. And as a graduate, even as a five year out therapist, it’s rare that you would know everything about a caseload that you’re given. So I think even just that concept that you, you can say to a client, I don’t know, I don’t know about this and seek help from somebody senior. But absolutely just knowing that you don’t, you’re not meant to know everything, especially in your grad year.

Clare Epstein Yeah, but you still, absolutely, you still know a huge amount. So give yourself credit for what you do know and your ability to research and your ability to find the answers. And it’s okay to ask questions. So I think I sometimes felt like I had to put on a, you know, this sort of mask of, well, I’m supposed to. I’ve graduated now, so I’m supposed to know the answers and I think I personally have found it… obviously, everyone has their own style, but it’s OK to show some vulnerability and to ask for help. And it’s actually a lot better to do that and to, you know, question. Oh, well I haven’t have had a lot of experience in this area, so I would love it if you could help me out. Ask the people around you. And there’s a reason why there’s a structure in in in health professionals in terms of the grading, because it’s there for exactly that reason, for providing supervision and support and your ability, you know you’re gaining knowledge along the way.

Danielle Weedon Yeah, that’s right. And what about if you got any advice on establishing boundaries in work and life when you first graduate because it is such a steep learning curve?

Clare Epstein Yeah, I mean, gosh, I wish I had the answer to that even now, because I mean, honestly, setting boundaries is become, as you know, many…I’m working from home. I appreciate that a lot of clinicians are not able to work from home, but the whole way we’re living, life has become so blurry in terms of, in terms of work and life. I think when you’re working in a clinical role, you know you can be exposed to some stuff that that really touches you and really gets to you at times and finding ways to acknowledge that, but also find ways to leave that at work is really, really important. So, you know, whether or not it’s little rituals that at the end of the day, a certain songs in the car or certain things that sort of create a boundary between work and home. S Setting rules with family or friends or partners about how long you talk about some of that, the work stuff, because you do take it home and you do need to actually sometimes process that and debrief about it. But there’s a line at which that then can become unhealthy if it pervades too much of your home life because you can’t bear all of those issues. I think also, you know, finding what what is important to you as an outlet like what, what your values are and then making sure that outside of work, you know, work is so important for us. It gives us purpose and meaning, and it’s incredibly important in our life, but also not losing sight of what is important outside of work. So whether that is staying fit and healthy, connecting with friends and family. You know, I still studied Italian in my early years of when I graduated and I would do a language class or you know, whatever it is. Playing in a netball team, making sure you don’t lose sight of those things. And I know it’s been really difficult in the pandemic to keep all of those things going. But making sure that you, you have that outlet, whatever it is and it’s different for everyone, and that is a really big priority in your life. So you schedule it in and you commit to it and you, you keep that balance. And I don’t say that flippantly. I know it’s easier said than done sometimes to to stick to those things, but it is incredibly important. The other thing I would say is knowing when things really are too much and when you maybe do need to go to the next step of talking to someone professionally, so recognising when what you’re going through is, is is actually sort of more than the day to day fluctuations in mental health. So when we talk about mental health, we always talk about it as a continuum. So it’s really normal that we all move up and down that continuum. We have good days and bad days, and we at one end of that continuum is where we have enough bad days and enough signs and symptoms that we would actually satisfy a diagnosis of a mental illness. And sometimes when you are moving down that end of the continuum, it can be quite hard to see it for yourself. It takes quite a lot of self-awareness and I guess that sort of introspection to to see it. And when you are aren’t that great, often it’s the people around you that will see it before you. Yeah, I know for me, when I’m not great, the thing that goes is my sleep. So I think everyone has a different thing, whether they’re particularly snappy or they’re aggressive or they’re really defensive, or they don’t want to do the things that are, you know, loss of interest and pleasure, the things that we normally enjoy doing is a sign. So I think it’s really important to familiarise yourself, what are the signs that maybe I’m not doing so great? And what are the signs in others so that you’re also looking out for each other and you recognise that in your friends and your colleagues and you say, Oh, you know, you never want to go for a walk anymore, we always used to go for a walk or you don’t want to play tennis or whatever it is. And knowing that about yourself, so that’s it for me. It’s my sleep when I find I stop and when I start to find myself really struggling to get to sleep, I know that I’m probably working too much stress and not, I don’t have the right balance. It takes time to learn those things. You might have learnt them through exams and through finishing up at school. But sometimes I think, you know, generally, physios are high achieving individuals and it’s got a good mark at school and they’ve done really well to to get to that degree. Hats off to you and me again, we did it too. And but you know, that means by the very nature of that cohort of people is that we can tend to ignore some of those signs because we think we should be able to do this.

Danielle Weedon We should be able to do them, yeah. And I think, I think that these are skills for life, I think we’ll be working on this from…you know, well it’s important to work on it your whole life.

Clare Epstein Yeah, yeah. And it grows over time. You know, you get to know yourself so much better and you realise, Oh, why did I? Why did I worry about that? And you know, that all comes with experience and perspective. But, you know, I think discovering it along the way and sort of taking the time to self-reflect is really important.

Danielle Weedon Yeah, agreed. And what about, have you got any advice on communicating assertively when you need assistance? I think it’s easy, you touched on that concept of, you know, health professionals having, you know, potentially imposter syndrome when they’re grads and feeling like they need to know everything. Have you got any advice on how to communicate assertively?

Clare Epstein Well, I think, you know, one of the best bits of advice that has been given to me is in terms of if you can communicate how something makes you feel, because that’s hard to argue with. So it’s if you know, I feel out of my depth when I’m asked to do this task or when I’m allocated this patient or, you know, communicating that, it’s sort of hard to argue with. So rather than it becoming, you know, a sort of a he said, she said, or getting into sort of a confrontational discussion, usually when you can communicate “his is how I feel when this happens”, you’re owning it. But also the person that you’re communicating can’t necessarily say, Well, don’t worry, you’ll be fine. You know, if you’re you be fine, you’ve learnt this, or I want you to have a go. If you’re letting them know what this is, how it makes me feel, or this is, you know, that is harder to sort of come back to. So I think owning that and acknowledging that a certain situation or scenario or whatever it might be makes you feel anxious or stressed or out of your depth or and you can find the words that make you feel most comfortable. So you may not want to use “anxious”, so you know, but “stressed” might make you feel, it might feel a safer word to use or letting someone know, you know, I’ve found I’ve been worrying a lot about this, and I think, I think the benefit now, is that we’re so much more comfortable talking about mental health problems, so if I said, you know, I’ve really been having trouble sleeping since we started this project, you know the workload – I just think the expectations are unrealistic. If I said that to the people that I work with, everyone would be like, OK, all right, what do we do? Let’s realign that. Let’s restructure how we’re doing it. So I think the world is a kinder place, I like to think, and that these conversations should be a lot easier to have. I also think if you can’t have those conversations with the people around you, then ultimately that may not be the best people you know, to be working with or to be friends with. You know, if the people around you can’t show compassion and care, then it’s maybe not the best environment. And that’s also a lesson that we have all learnt along the way about, you know, the people we work and the environments we work in. Sometimes it’s not you. It is, it is the people around you or the environment. And the best thing to do is maybe find an alternative.

Danielle Weedon Yeah. And we do talk a lot to any, any therapist that we sort of, that are looking for work, but especially graduates as sort of ascertaining what the workplace culture would be in a new job that you’re looking at and what sort of questions. I don’t know if you’ve got any advice, but what sort of questions that therapists might be able to ask an interview to get a sense of what support would be available in their workplace?

Clare Epstein I often ask. I mean, I often when I’m interviewing. I talk about the culture of the organisation. So I think that’s a really important question to ask: what is the culture of the organisation? Do people have fun at work? You know, I want to laugh with the people I work with. I genuinely like the people I work with, and if if there’s no laughter and there’s no fun, that’s not a place I want to be. So I think asking about culture, if the person interviewing me says, oh well and doesn’t can’t really answer that. If someone ask me instantly, I would say, you know, we have a lot of laughs and we like socialising when we can, you know, we genuinely like each other; they’re really important aspects of work. So I think culture is important. You can ask about how employee wellbeing is supported at work. You can ask about flexibility. I think they’re all really important aspects to, you know, what contributes to the well-being of people. It’s not whether or not you run wellbeing programmes and whether or not you, you know, it’s… I mean, we know that some of the things that impact well-being the most at work are the structure of work, the way work is designed, people’s work load, the hours that people work, role clarity. All of those psychosocial risk factors are so important, far more important than whether or not you’re doing a [?] challenging. And I say that as someone you know, I’m in the business of health and wellbeing services for clients, but I recognise that they are not the fundamental influences on well-being at work. So I’d definitely ask about culture and how work is, how wellbeing is supported.

Danielle Weedon Yeah, yep. And jumping back a little bit. You touched, I touched on it. And then you mentioned when you worked in occ rehab, you worked to billable hours. We’re finding that, I keep saying graduates, but any therapist really working in private practice an/or in community NDIS, as well as occupational rehab at the moment are targeted to billable hours. I think I think some graduates are finding that really hard. Some employers are doing sort of stepped, you know, less billable for the first six months of their employment, which then, you know, eases them into it. But in terms of billable targets, are you able to comment on how you, if you remember how you manage them or meeting the demands of them?

Clare Epstein Um, I think in a weird way, I think one of the fundamental things with billable hours is being really organised. And I actually didn’t mind them that much because I was okay at working to a sort of a task and a target. So if you’re that, if you’re motivated that way, then it’s actually probably not a really big ask because I sort of found I was quite motivated to get the work done and therefore the billable hours just followed. So interestingly, in hindsight, maybe I thought more about just what I had to get done than obsessing over the billable hours. Because that comes when you focus on later tasks, complete a task and the hours will follow. And so yes, it was always sort of there hanging over. And I mean, it’s not my favourite model, and it’s not how I work now, but it is quite common and it’s common in lots of industries, not just in sort of occupational rehab in NDIS, but I wonder if there’s a way to reframe it and thinking about what do I have to achieve and sort of focussing on the work and the tasks rather than this sort of, you know, hanging over your head. I’ve got to meet the hours. Because they should,it should solve itself if the work is being done, yeah, that’s right. I don’t know if that’s a good answer, but that’s sort of how I think I looked at it.

Danielle Weedon Yeah, but it’s it is interesting, isn’t it? Because I have not worked to billables in my working life, but I do talk to grads, obviously, you know, billable hours are in place for an employer to be able to bill for their therapy services, but they’re also in place for an employer to know that you’re managing your workload efficiently and effectively. So yeah, you’re absolutely right. If you’re managing your workload, caseload, effectively and efficiently, the billable hours should follow with the work that you’re completing anyway.

Clare Epstein Yeah. And to be fair, I didn’t do that role when I was a new grad. Yeah, so that was the role that I’d done after about five years. So perhaps I I felt more comfortable at that point to sort of own what it is that I was doing. And yeah, and maybe, that maybe that made a difference. But I also kind of I think I relished in the change that I had moved from clinical roles then to that type of work, so I kind of was enjoying the difference in work. But I think, yeah, I mean, it’s a tough ask of a new grad; not only are you getting used to working in a new environment and just working, but feeling the pressure of needing to achieve those hours is another thing. And I think it’s a employers that perhaps have that stepped approach as a more reasonable way to look at it.

Danielle Weedon Yeah, yeah. And do you know much about EAP Clare?

Clare Epstein A little bit. Yeah. So we’re not an EAP service, but a lot of our clients have EAP. And so that’s a service that’s funded by the employer. It’s a free counselling service. So usually the service is available to employees and to family members as well, in many cases, to the employee’s family members. And there’s usually, every employer is different in terms of what they fund, but usually it’s a number of telephone counselling sessions, so it might be three, might be five, might be two, but it’s a really very underutilised service for whatever reason. But we absolutely advocate for it when we’re running training for employers. So it basically, it’s a service that you can call to, it’s completely confidential, so I suspect that is why it is sometimes underutilised because there’s a mistrust there. But I can absolutely vouch for the fact that it is confidential. You can call them basically about anything. You can call them to talk about an interpersonal issue that you’re having with your employer. You can call them about a huge fight you’ve had with your boyfriend, like it is there for any sorts of issues and incredibly valuable. You know, psychological therapy is expensive and it can take a while to access. So to do that through your own GP and to then to go down that on your own path can take time. Whereas actually having two or three sessions chatting on the phone with someone might be all you need to sort of resolve an issue and work through something. So saying things out loud and talking through what it is that you’re experiencing can be incredibly helpful in resolving that. Likewise, writing things down is also an incredibly beneficial way of working through a particular problem. So if your new grads have got access to an EAP service, I would highly recommend they utilise it. It’s again, I think often there’s a sense of people feeling like there’s weakness in asking for help, but it’s the complete opposite. It’s absolute strength to be able to say I’m not right and I’m going to talk to someone about it. Yeah, yeah, and not let it get any worse. So if you always think about that continuum, your opportunity to sort of intervene. And like anything, whether it’s a physical injury or a psychological issue, the earlier you intervene, the far better, you know, the faster you can resolve it and get back to feeling like you again.

Danielle Weedon And have you got any, are there any other ways mental health can be supported in the workplace?

Clare Epstein Yeah, I think there are, I think just being aware of what help is out there is really important. So, you know, the world is a different place now. You’re hard pressed to look at the news on any day and not see some story about well-being or mental health. So I think that’s really comforting knowing that’s really normal to talk about these issues and that whatever you’re experiencing, the people working around you, no matter how together they’ve got it, they’ve probably gone through exactly the same thing. So I think acknowledging that and being kind to yourself is really important, and then knowing where to get help. So whether that’s through EAP, whether that’s through going and talking to your GP. So that’s another really important person that we sometimes forget and we think we just go to the GP for sort of other medical issues. And we don’t think to go sometimes when we’re feeling down or we’re feeling not ourselves. So GP’s an incredibly important step. There’s also amazing websites, so BeyondBlue has a free counselling service. Lifeline for crisis situations. The Black Dog Institute… There’s amazing resources. There’s little quick quizzes that you can do with sort of a check in, whether it’s anxiety or whether it’s depression. There are, also there’s a website called This Way Up, which has some online courses that you can work through. I think they were all made free, have been made free during the pandemic. And there’s loads of different, incredible resources there. And I think also just the other important thing is to perhaps create a network, a peer support network with your fellow graduates checking in on each other and looking out for each other, because you know you’re used to being together at university all the time, and then everyone goes their separate ways and it can feel quite lonely at work. If you feel, I think in truth, you’re not alone, but I think in those early years it can feel a little bit like you’re alone. So whilst you may not be physically with the people that you studied and graduated with, I think if you can create a network with them and check in on each other, that’s incredibly valuable because you’re all going through the same experience.

Danielle Weedon Yeah, it’s so true. There’s lots of social media sort of graduate OT and physio hubs and yeah, definitely keeping in touch with your peers that you’ve gone through university with. But I also interviewed Leanne Kerr from the APA, just I think it only came out today, but she was talking about some of their student and graduate benefits for members, and they include sort of graduate hubs and support services.

Clare Epstein Great.

Danielle Weedon And I think Clare interviewed OTA as well, which comes out today, and they’re the same. So I think I think as a graduate in those early years, reaching out for your membership, your membership body as well, could be a good idea.

Clare Epstein Yep, yep, definitely. I think also, you know, I probably took work and have many times, too seriously. I think, you know, without a doubt, all of the grads that you work with Danielle, you’ve done an incredible job and to be out in the workforce, it is a big jump. And I think the number one lesson, I think we need to be kinder to ourselves and realise it’s one part of our life. I probably overthought things and worried about things too much that I think, gosh, if I could have that time back and just sort of be a bit kinder to myself, that would be the number one lesson because, you know, the experience that they’re gaining and the exposure that they’re getting. It’s all incredible life experiences and we put a lot of pressure on ourselves to kind of jump ahead and feel accomplished and everything, and it just doesn’t work like that. And I think accepting that is part of it.

Danielle Weedon Yep, yep, I agree. And have you got any advice to your younger self as a graduate physio? Or you’ve probably just did it, be kinder to yourself.

Clare Epstein I probably, yeah, be kinder and probably just relax a little bit. Do you know the other thing that I have thought, which is, this is, I’m sure there aren’t that many new grads with children. But once I had children, I realised that probably the grade twos and threes that I was working with that had small children were so sleep deprived and I now have a totally different perspective on what they were going through, but as a new grad and as a grade one, I never thought about that. I just thought, oh my gosh, they’re all over it and you know, they’re so good at their job. But I now look back and think, Gosh, I would have worked for so many people who were exhausted and had probably been up all night. And I never had that perspective. And I think, you know, it’s funny as you get older and you realise, gosh, the things that people are going – everyone is going through something at different phases in their life. I think just being aware of that. Yeah, I probably would have given me more comfort. Just like just the other thing is mostly no one’s really thinking about you. You’re thinking about you all the time, and everyone else is just getting on with it. And, you know, I think that also gives me some comfort.

Danielle Weedon Yeah, I couldn’t agree more. All right. Well, thanks for taking the time again to speak with us. I’ve got no doubt our grads will love to have a listen to this, and I always love chatting to you.

Clare Epstein Oh, I know we could chat all day. I think we’d lose some listeners on the way.

Danielle Weedon I’m sure we would. All right. Thanks again.

Clare Epstein Thanks Dan.

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