Mental health disorders and child development with Dr Tanya Hanstock

In this episode, Dr Tanya Hanstock and I discuss key issues in mental health for children and young people, using bipolar disorder as an example. Tanya also offers practical tips for how to balance research and practice.

Dr. Jasmine B. MacDonald (00:00):
In this episode, Tanya talks about her book called 'Who's who of the brain'. The book is really cool, but I'll leave it with Tanya to explain more in this episode. What I do wanna do though, is give a shout out to Jessica Kingsley Publishers for sponsoring this episode. They're providing two copies of 'Who's who of the brain' for a special giveaway. To find out more about how to enter the draw to win a copy of Tanya's book, please check out the Psych Attack social media accounts on either Twitter or Facebook. The handle is @psychattackcast. I hope you enjoy this episode.

Dr. Jasmine B. MacDonald (00:39):
Hello and welcome to this episode of Psych Attack. I'm Dr. Jasmine B. MacDonald. Today Dr. Tanya Hanstock and I explore mental health disorders and child development. I hope you're going well and have settled in with a warm cup of tea.

Dr. Jasmine B. MacDonald (00:59):
Hey there, Tanya. Thanks for joining me today.

Dr. Tanya Hanstock (01:02):
No worries. I'm really looking forward to it.

Dr. Jasmine B. MacDonald (01:05):
Let's start with a random icebreaker question. And what I have for you today is, if you could travel anywhere and take anyone with you, where would you go and why?

Dr. Tanya Hanstock (01:17):
Well I have a goal of when the travel can commence again, international travel. So I would go to Disneyland cuz it's always been a childhood dream and I have a three and a half year old son and he's just starting to get the concept of Mickey Mouse and Pluto and Mini Mouse and all that. And he actually asks to watch on YouTube videos of people walking through Disneyland and they current, they're up to date ones with people with mask and they have them filmed during the day and night. And they're just showing all the different attractions and the parade and the rides. And so, yeah, he talks about going to Disneyland and I would like to go to Disneyland too.

Dr. Jasmine B. MacDonald (01:53):
I love that answer. I think it was just last week I was watching on Disney+ behind the attraction and in the, the very first one they show the footage from the day Disneyland was opened and how they were just recording people walking around and enjoying all the attractions. So I love that it's like they've come full loop to do that now because of COVID, that's really funny.

Dr. Tanya Hanstock (02:15):
It is funny to see how current they are and see the mask and what that looks like. And I think there's something really special showing children things from your childhood or what you wanted to do as a child. Like I've taken my son on a few different holiday destinations where I have been as a child on holidays. And it's like reliving part of your childhood and sharing the, the special parts and there's something really beautiful about that. And like I said, I haven't been to Disneyland, but I, I think it's pretty special to go with him and, and I love all the child stuff. Like I'm a child psychologist, I love games and playing and all that sense of magic. It's a nice way to stay in touch with the inner child to have a child and try and see things through their eyes. It brings it back much easier.

Dr. Jasmine B. MacDonald (03:04):
Oh absolutely. Yeah. Well, I look forward to hearing about that trip when you do, um, eventually have it, that's amazing.

Dr. Tanya Hanstock (03:11):
Oh it'll be plastered all over Facebook. Yeah. You're gonna see it.

Dr. Jasmine B. MacDonald (03:15):
And so it, so it should be. I am really excited to have a chat to you today on the show, because I was thinking back to me as an undergrad student and you being one of the first clinical psychs that I had actually ever met outside of the university context, you know, like a real person, not a lecturer.

Dr. Tanya Hanstock (03:35):
It's lovely that you remember that time. It doesn't say like a long time ago, but I am thinking it was quite a while ago.

Dr. Jasmine B. MacDonald (03:45):
We sat in that cafe and we had a conversation about your psychology pathway and you know, what postgrad study is like, and that's my segue into asking you to introduce yourself to listeners and your background.

Dr. Tanya Hanstock (03:59):
I went to uni straight after high school, and I always wanted to work in the helping professions and something, uh, health related. And I had thought psychology looked really interesting. I think we all think that at various times, and I always got along with people, I always chatted to strangers on the bus and people would talk to me about quite sensitive information and stuff like that. And I didn't get too stressed in an emergency or crisis. So I came from a, an area in the North Coast that it was quite diverse in socioeconomic status. You know, I went to public schools. Yeah. So I was surrounded by lots of different people. I saw lots to things that I kind of feel has helped, um, me understand and probably engage clients a bit more easily. I did a Bachelor of Arts. So I actually had to do some other courses as well as psychology. So I did sociology and linguistics. And I think like most people you go into psychology first year in undergrad thinking you're going to do pretty much what you end up doing in postgrad. So seeing clients and learning how to work with people and being a bit surprised, uh, that it was quite theoretical and very research focused and a lot of statistics, which luckily for me, I was not a bad mathematician, particularly I loved stats in high school. So found that reasonably easy. Thank goodness, cuz it was a big part of getting through that, that undergraduate degree. Yeah. So I really enjoyed my time at University of New England and living in college and the whole college life. And I had, you know, friends from where I came from, which was from, uh, Lismore Goonellabah area on the North Coast. And in those early years I really actually really liked sociology and linguistics and especially the development of language, so the child development stuff. But as psychology went on in second and third year, uh, it became a bit more interesting. There's certain courses that I really enjoyed, like child development, uh, psychopathology like abnormal psychology, which is a bit more about mental health disorders and substance use. And um, so things that are a bit more, uh, clinical psychology based. So I stuck with it and became more interested as time went on and I could see glimpses of what you know was coming that I could actually do more practical clinical work. And, um, I had an awesome honours supervisor and my honours thesis was on acne and the psychological effects of that. And it was also looking at things like, uh, mild form of body dysmorphic disorder. And it was quite an interesting subject and a lot of my subjects were people in the college system as well and undergraduate students.

Dr. Tanya Hanstock (06:33):
So yeah, so I had a really lovely time in fourth year and enjoyed research and that was quite practically applied clinical sort of based research, got a reasonable honours grade and passed the interview to get into the clinical program and started and loved it and remember thinking, "this is what I signed up for all those years ago. This is what I thought I was signing up for in psychology in undergrad". And it's taken me, you know, four years and this is my fifth year now of study. And, um, I was really quite behind in, well in life experience and, and clinical experience, but just soaking it all up like a sponge. I didn't have to unlearn things cuz I hadn't learned it to begin with. So I was just learning what they told me and learning it like how they wanted me to learn it. And then my first actual job when I graduated was at a child and adolescent mental health inpatient unit. It's still there, Nexus in John Hunter hospital in Newcastle and wow, what an amazing job that was to be exposed to so many young people, children and adolescents, severe and mental health issues or developmental issues and um, you know, associated health issues that are affecting their mental health issues. And it was the first inpatient unit for children and adolescents in New South Wales, outside of Sydney. Yeah. I loved it actually loved working with acute, uh, mental health issues, felt very privileged to help people at that really distressing time in their lives, um, and to provide some form of comfort and help to them and their families. So I was there for a few years and then I had a, really enjoyed working in the area of mood disorders, particularly bipolar disorder. Cause we were seeing a lot of young people around 15 to 19 really is the, the average age of onset. It's hard to diagnose cause it can look like many other things. So seeing clients and watching the onset and trying to get the diagnosis and the treatment sorted out as quick as possible to alleviate as much trauma and stress and suffering. And yeah, so then we developed a, uh, outpatient program in the community called The Bipolar Program and we were located with an early psychosis service and seeing a lot of clients and doing a lot of therapy. And then I did an outpatient outreach clinic to Singleton. From there I went to Wagga and that's where I worked as a youth mental health worker working with Community Mental Health team, the adult team and the CAMHS [Child and Adolescent Mental Health Service] team. And then they nicely lent me one day a week to Riverina Headspace where I worked with that amazing team and working with young people and doing assessments and therapy work.

Dr. Tanya Hanstock (08:59):
When I was doing the doctorate, I did a lot of tutes and a lot of marking. So I did a lot of learning some academic skills that way. And then when I was in Wagga the same, I was doing lectures and workshops and doing some online courses and things like that. So I've kind of tried to keep my feet over both sides of the fence of academia and clinical work because I really feel they both help each other. Like I really love teaching, uh, young psychologists and clinical psychologists and um, I always like doing research. So I've always been publishing during that time as well. Sometimes case studies, um, sometimes actual bigger projects. Yeah. So that's probably me in a nutshell, it's probably pretty long. I probably missed a little bit in there cause I actually went from Wagga back to work back at University of New England running the clinical and health psychology program that I had been a student in, which was surreal.

Dr. Jasmine B. MacDonald (09:49):
That's pretty cool.

Dr. Tanya Hanstock (09:50):
So I actually ran that program for a few years and then I came back to Newcastle and worked in child and family health team, which is now called the Child Development Clinic. And that is where I did more pure focus on child development, which was typical and then like developmental issues and like, you know, I had done ASD [Autism spectrum disorder] assessments and things like that, but I did a lot more on, um, diagnosing ADHD [attention deficit hyperactivity disorder] and really early age, you know, IQ assessments and getting kids ready for their starting of their education, working with a very big multidis [multidisciplinary] team with pediatricians and OTs [occupational therapists] and speech therapists and social workers and neuropsychs and child and educational psychologists. And yeah, it was, it was really cool actually. Um, it was great. And then I got the job here at The University of Newcastle, the convener of the clinical psychology program and the doctor of philosophy clinical psychology program. So I always say to people, I have been a full-time clinician and a part-time academic and other times I've been a full-time academic part-time clinician and I just balance them out a bit, but I definitely feel like that's a good fit for my skill set. I really kind of describe myself as a Jack of all trades, master of none. I really can do lots of different things. I like that diversity. And um, like I said, I feel like it helps me be a better clinician when I'm doing active research and also having all those clinical skills and clinical knowledge helps me think about what research is really needed. And what's, you know, of the best way of doing things with participants and uh, making it as applied and translational as possible.

Dr. Jasmine B. MacDonald (11:24):
The key model that we work with in psychology is a scientist practitioner model. And everything that you've just described is, um, this beautiful example of taking both really seriously and integrating them. You know, most of us that have trained in psychology have been really interested in that, but it's really hard to pull off.

Dr. Tanya Hanstock (11:41):
It is. It's not easy and you have to kind of live two lives in the one. You know, you really are working at two careers in the time you can do one. So sometimes you don't look that great in one versus the other. So it's an interesting concept. And I always just be mindful when people are comparing my publication rate, which isn't too bad, but it can look like if you're a pure academic, it might be like, oh, that's okay. But you know, but then as a clinician, you go, oh wow. That's like quite good. So you just kind of put it in context. I had a, a win in publishing my, from my honour thesis many years ago. So I published two papers from my honours thesis that first one I remember accepted straight away and had quite positive feedback. And there was a few things we had to change from both reviewers, but my supervisors say, said to me, you know, you've had a really easy run this first go and you you'll think it's easy, but it's not this easy normally, you normally get rejected and then you have to reformat it to another journal. And, um, it can deter you.

Dr. Jasmine B. MacDonald (12:41):
That's good supervision. That's setting realistic expectations. .

Dr. Tanya Hanstock (12:45):
Yeah he was trying to tell me that, you know, this isn't what always happens and you've been a bit lucky and uh, you know, so, but it did create this interest of mine in publishing. And so I always kept up my publishing even when I worked full time in clinical settings where research wasn't really a requirement, but I luckily worked with people that were quite academic minded and also always, you know, encouraging great evidence based practice and educational programs within our teams, like, you know, journal clubs. We had this thing at Nexus called the Brain Breakfast where we would have two talks once a week. One being quite the theoretical research component of an issue, say self harm, like why people may engage in self harm and what's happening at a biological level and what's reinforcing about that. And then the next person would present on, okay, so now we know the theoretical side, what's the practical application of how we manage it. And um, so we might have, you know, a, a clinician talk about how we could find other ways for people to learn to regulate their stress and, you know, emotions and, and how to self sooth and things like that. And we actually went to conferences as a team and we would put in abstracts and present on different research. I would apply for ethics and do some research on various things that was happening in our unit. And it just lent itself well, cause we were seeing some quite severely unwell young people that you might have read about in textbooks, but to see, and actually work with people and then see what works and you wanna help, um, other people learn the easier way and not the hard way. And you know, when things didn't go so well, I teach people about that as well. So they avoid similar mistakes. And that's when I started publishing case studies, uh, which is one of my areas of interest as well. Cause I think that's a very practical applied, uh, form of research. I find those ones, I get the most requests for reprints and full text prints. Um, and I often get emails as soon as they're published from countries where people wanna read about case studies. So I use them in my training with the students and I also help them with writing up tricky cases. And so kind of helping them as a clinician, but also help guide them as future researchers as well. And, and a lot of my clients would really enjoy being asked to be part of a study and, um, that people were learning from them and or if they were being written up as case study, I would talk to them about that and get their permission and, and they would feel quite, I, mostly people would say yes and be quite happy to, um, it'd be de-identified details.

Dr. Tanya Hanstock (15:16):
So they wouldn't be, we wouldn't breach confidentiality, but they were feeling quite honored that you know, that they were chosen and, you know, they were helping other people, um, learn more about say bipolar disorder or whatever issue they had that we were, uh, helping treat them for. And then I would go to conferences and then I would come back and I'd talk to my clients about things I'd learned and what was happening in the field. And, and I guess I'm just, always want my clients just like my students to be the best they can be. And to know as much as they can. I think knowledge is power and it reduces anxiety and misinterpretation, things like that. So the more they know the more empowered they are and the more choices they can make and the more assertive and articulate they can be towards their treating team, which won't always be me. They, you know, they have to, sometimes in different services I've worked in, they've gotten to an age where they have to be transferred to an adult mental health service, for example. And you know, they have to then form rapport with their new treating team and then they have to articulate themselves and we have to work collaboratively with our clients and that they're part of the treating team. And they're very important part of that treating team. So empowering them to speak up when they're having side effects that are really hard to live with and being able to tell us when they're not going well. And to be able to disagree with the clinician and say why and feel safe to do that.

Dr. Jasmine B. MacDonald (16:37):
Yeah. Great examples of how to incorporate practice into research and research into practice. And I really wanna be part of a brain breakfast. That sounds amazing.

Dr. Tanya Hanstock (16:45):
we used to actually have breakfast too. It was early in the morning and we would have nutrition like nutritional breakfast with the dieticians would be, you know, have to be okay with it as well. We used to get quite a few regular people from the community and who worked in mental health particularly, and we'd get people who worked within the hospital as well. And, uh, and we would ask some of our external colleagues to present at times as well. So it became a bit of a community educational program. The psychiatrist who ran Nexus at the time, professor Ken Nunn, he had a model, he used to call it the Brain by Personality and he personified different parts of the brain. And he would try to help people understand complicated neurobiology and neuroanatomy and neurochemistry by giving these parts of the brain human names and that linked in with, their character linked in with the function of that brain. So he kind of set it in like a town that was, and like the frontal lobe was the mayor of the town and it told the rest of the brain what to do. And, um, it was a thinker and, um, it was a big part of personality. And if something went wrong with it, then you know, like the rest of the brain, wasn't quite sure what to do. And so he had a few characters and so through the brain breakfast, he started presenting some of them. And then he asked me to help him develop a bit of a series on the brain, in the areas we, that hadn't been developed. And I suggested, well, why don't we make it into a book? And each chapter being part of, you know, the character and then the facts really about that brain area. So we worked and we worked very part-time on it with another psychiatrist who was over in England, Bryan Lask. It's called 'Who's who of the brain'. And again, it's set in this town and the brain's the town. And, um, each part of the brain is a prominent character in this town. So each chapter starts by introducing that character. And we actually got an illustrator to draw a picture of what that person would look like. So there's a little story about them and what they do well in the town and who they relate to the best. And then also what they do when they going well. And what happens when they're not going so well and who helps them out. And, and then rest of the chapter was what we know about that brain area and, and some case studies linking to when people have had those issues in that area of the brain. So that's was most of the book and at the end, they're all together at this function, a social function and things were going well. And then eventually things, suddenly it sets on fire and everyone's running around and who's struggling the most. And then what everyone does in when they're not working, when they're distressed and then how they all come together, one by one to help each other and then function again.

Dr. Jasmine B. MacDonald (19:19):
I need to read this book.

Dr. Tanya Hanstock (19:20):
It's a great, like, you know, I feel biased by saying it's a great book, but it helped me understand the brain because they're quite complicated names to remember, you know, and it's, so we all have, and it'd be good if we all knew about it. And I found it a popular book with neurologists explaining to clients when they had impairments in various parts of their brain. I used it teaching students about the brain and trying to help them understand as a clinician, you still need to know about human biology and neurobiology, particularly with mental health issues and development. And yeah, it was great. It was great fun, but I guess that's my style. And, and I've learned that from others is how do you make it personable? So the person's interested and how do you make it easy to remember and understand. Yeah. And how do you engage the listen, you know, the listener and make it memorable. Different people have read different chapters and like said, oh, you know, my relative had a stroke in that area. And, and it gave them a bit more understanding of that brain area and why they do what they do now. And it wasn't my original idea. So I have to thank Ken. He had that great creative brain himself to come up those ideas. And, uh, I had, I guess I had the energy and the interest in writing and, um, researching.

Dr. Jasmine B. MacDonald (20:37):
But it sounds like the trend of the things you've done in your career, where it is very team focused rather than trying to just pursue things alone.

Dr. Tanya Hanstock (20:46):
Yeah. Because that would never work even clinically. Um, you have to work within the team and you often work, uh, in co-therapy. I find, you know, you become part of this treating team for clients. And it's really a powerful experience when you're working with team members and a client's getting better, and clients might not know this, or, you know, you, you still think about them and you, you have this one way relationship with them where they, you know about them and they don't know much about you. And, um, and then you finish that relationship, you know, when they no longer need you and you know, they've gotten better and that's, that's a sort of sign of a good therapist. You make yourself redundant, you know, you teach 'em as much skills and give as much help that they get better and, and you give them a good experience so that they will try other psychologists in the future if they need to. Yeah. So it's really nice when I see a client and see that they're doing well, I run into one of their family members. It's such a nice thing to hear like the good news stories and the progress, how they're going, and to think that you could helped them, you know, yeah. I tell my, um, my students that, cause I think they get worried, they're gonna do harm. And they they're worried about chronicity of mental health issues. And they're worried about clients attempting suicide or completing suicide. And, you know, it's, it could be very risky patient population. And so I think they need to hear the good news stories and that, um, that people can get better and do really well. And to tell your other clients about great outcomes for others.

Dr. Jasmine B. MacDonald (22:13):
That's a great point.

Dr. Tanya Hanstock (22:14):
You know, they, they wanna hear that. You've seen other people who have the same issue as them who got better and went on and did what they had wanted to do before.

Dr. Jasmine B. MacDonald (22:24):
So Tanya, your area of expertise is practice and research in mental health disorders and child development. So I was wondering if you could talk broadly for those non-clinicians or people who might not know a lot about psychology.

Dr. Tanya Hanstock (22:40):
I think it's a really important area and time. And, and I guess I'm also passionate really about early development and early intervention, and how to help someone's trajectory. So getting in early when mental health symptoms first appear, and sometimes what they first look like is very different than what they eventually end up having as well. So we see a lot of young kids looking like they have ADHD symptoms, for example, and that may go on to develop, to be a lifelong ADHD picture. But for some, it may change to more of a mood disorder or some may go on to a pathway that eventually, you know, they might have down the track, more psychotic disorder. So, and whether they've continued to have comorbid ADHD or if that's just how it looked at the beginning, or yeah. I find that the concept of the developmental changes of presentation over time really interesting. So basically I treat and, and research in any area that's sort of in the DSM–5. So that's our diagnostic and statistical manual on mental health disorders. So I'm kind of really interested in yeah, assessment, picking up symptoms early and then also researching what is the best treatment from a psychologist in that area. And some of the work I do is looking at things like we might use a traditional model of CBT [Cognitive behavioral therapy] for a client, but we might have added a few extra components like mindfulness or some aspects of ACT [acceptance and commitment therapy], and then seeing how that goes. I do have a very specific interest in bipolar disorder. And that, as I said, came from working with a lot of young people at Nexus. And I find what I'm interested with that disorder is because it's such a varied presentation. So if you had bipolar disorder and you present in an unwell episode often, um, that would for most people, it's presenting in the depressed phase. So they alternate in mood. So most of us, you know, would be in a mood that we would call euthymic, which is sort of more middle ground means you can have some slight ups and downs as life gives you stressors and great things. And when people with bipolar, they have these episodes where they can have euthymia, but they can also have these really low periods. They can have mild or major, um, depression, and then they have some high elements so that their moods elated. And that is like, hypermania, it's not so severe. And then full blown mania, which is quite profound to see in someone where they're not sleeping and they're even not eating and they're just goal focused and they might be doing more risk taking behavior than normal. And they might be much, a bit more talkative and they might spend more money and might just do things that just as I said, is outta character to them.

Dr. Tanya Hanstock (25:18):
So I guess it depends on when you see the person, that's why you've gotta really see them over time to see the changes. Because if you just see them in a snapshot, you could make a diagnosis that's incorrect. You could just, so you see them when they're depressed and you think, oh, they, you know, they've got depression and they've got a unipolar depression, and then antidepressant medication may elevate them to an elevated mood. So sometimes you don't realize someone's got bipolar until you see them treated for depression. And then it's set off this hypermania or mania and then continues and hasn't sort of settled. And then there's this cyclic pattern between those mood states. And some people in their mania can get so quite high and elevated they end up with psychotic features as well. And then you can have a mixed mood where you have both depressed and hypermanic or manic at the same time. And that's a really dangerous mood. So when people are quite depressed, they have more, more likely to have suicidal thoughts, but if they're depressed, sometimes they don't have the energy to, and motivation to plan, uh, how they would go through with those thoughts. But if you have the high energy and the depressive thoughts, it's a really difficult combination cause you do then have the energy and, um, the goal directed behavior to pursue that. So...

Dr. Jasmine B. MacDonald (26:28):
Right.

Dr. Tanya Hanstock (26:28):
It's a very difficult mood state for a lot of people. I like doing research in, in that area because the majority of people with bipolar disorder, it's normally like a 10 year delay in correct diagnosis because it is such a difficult presentation and it's so varied. So they can get diagnosed with other disorders like personality disorder, borderline personality disorder, or people may presume that they're taking substances when they're not, their high mood can look like someone under the influence of substances. So yeah, usually around 10 year delay in diagnosis, so that persons missed quite a lot of their life being unwell. And we know the more time unwell is the more damaging to the brain. So if you have untreated episodes of mania, it's really quite detrimental. You don't, you want to limit the amount of untreated episodes as much as possible. I think that helps with engagement with health services as well. Like if they can actually get the right diagnosis early on and then get the right treatment. And the other area I've been doing more research in more recently, and which is the focus of my PhD, is looking at physical lifestyle behaviors and healthy lifestyle behaviors and how to help clients monitor it more because they also, not only do that impact on their physical health, but their lifestyle behaviors impact on their mental health. So bipolar disorder, as I said, is, uh, it's quite sensitive to the environment. So if someone has bipolar, they have to be really mindful of keeping their sleep routine and also activity levels and stimulation and cause they're so sensitive to changes like that. So if they became sleep deprived, they're more likely to have a manic episode. They have to be a bit more careful than the average person in their lifestyle routines going to sleep at the same time, waking up the same time, get, making sure they get enough sleep. You know, the healthy amount of sleep each night. We know that drugs and alcohol affects them as it does for most people, but it can really affect them and make them relapse into the, the two poles of different moods states. So they have to be very mindful of recreational drugs, they also can get triggered into relapse by stress.

Dr. Tanya Hanstock (28:29):
So they need to also learn some coping skills and be aware when they're not going so well. And they might need to see their psychologists or psychiatrists outside the scheduled appointment times they might need some extra different medication or they might need an inpatient stay for a little while. Lifestyle factors are really important in people with bipolar, but also, um, we know that people with bipolar disorder can live 12 to 20 years, less than someone without bipolar disorder. And the majority, the main reason for that is due to the effects of preventable health disorders. So we know that people with bipolar disorder are more likely to have a lifestyle that is also associated with health complications, like diabetes and cardiovascular disease, cancer and things like that. So that's the other aspect of my research is helping people monitor their, their healthy lifestyle, be aware of the effects of it on their mental health disorder, but also their health long term and their lifespan long term. Cause you know, 20 years is a lot of life to miss for them and their, their loved ones and combine that with the 10 years of diagnostic delay. And they may have self medicated during that time. You know, we're talking now 30 years of affected time and, and that's saying if they just get the diagnosis correct. And you know, and their treatment works and...

Dr. Jasmine B. MacDonald (29:41):
Right.

Dr. Tanya Hanstock (29:41):
they may not realize the effects of their lifestyle behaviors on their mental health disorder, but also their quality of life long term. So some of the work I've been doing is looking at things like having participants with bipolar disorder, wearing Fitbits and getting them to monitor their sleep and the quality of sleep and also things like activity level. So if we're looking at our sleep and we are looking at activity levels, we're more likely to be mindful of that and to make sure we get more sleep and we do more steps and things like that. We were using that for a year. So a bit of a longitudinal study with adults with bipolar disorder to see if they could actually, if these sort of objective data was helping predict signs of relapse, early signs of relapse and how early we could pick that up so that people with bipolar disorder could actually start monitoring themselves easier. And also getting that instant feedback, you know, getting that graph and getting that reminder and getting the rewards for how many steps they take and reaching a certain threshold of, of that. I think when people are on, get on well, can be hard for them to trust other people's feedback. So I think the objective measure showing them this real life data would hopefully be more believable. They don't trust, you know, if it's part of their illness, that they might be starting to be paranoid about what people are saying, or people have other motivations to tell them stuff, they would see their own data and, you know, know objectively and believe that, and then ask for help or change some of their lifestyle behaviors themselves. So empower them more again and, and improve their self efficacy. Yeah, that's, that's the area that I've sort of more recently been moving into with my research.

Dr. Jasmine B. MacDonald (31:16):
Super interesting, the delay between people seeking treatment and also that delay in diagnosis, as well as that mortality gap that you talk about in your research. These things really blew my mind when I was reading your work and got me kind of instantly interested and paying attention of this is something that needs the focus that you're putting into it. One of the things I did wanna ask was around it was in the chapter that you had written about bipolar, and you were saying that pregnancy is a trigger for onset of bipolar symptoms and also a trigger for relapse and listening to you it sounds like that's likely because of the stress that might come along with pregnancy. Is that the case or is there something else there?

Dr. Tanya Hanstock (31:56):
Yeah, there's a, there's a number of risk factors. So one's hormones. So for women, we know that some of the risky time for onset is puberty. Uh, hence the 15 to 19 age range we often would see. So, uh, we see a lot of adolescent girls developing bipolar disorder, particularly around that time. Pregnancy again, another hormone related time and menopause.

Dr. Jasmine B. MacDonald (32:19):
Interesting.

Dr. Tanya Hanstock (32:19):
Um, we don't see a lot of bipolar in pre-pubertal children. There are cases and I, I have seen some cases in a very high genetic loaded family. It's quite controversial. And in my work over what now, 21 years working with children and adolescents, I definitely saw what the literature's saying, which is the 15 to 19 age of onset as being the majority, but also sleep deprivation. So we know that comes with pregnancies and having babies, you know, when you have newborns.

Dr. Jasmine B. MacDonald (32:49):
Right.

Dr. Tanya Hanstock (32:51):
Sometimes people even with like a overseas trip, you know, when you used to be able to fly overseas, different time zones and sleep deprivation. So that could be the trigger. Major life stressors. And we know that good stress and bad stress, the brain sort of it's still stress. And so even great positive things like getting a promotion or, uh, increase, like I think in that age range increase in exam stress as well. Um, things like that.

Dr. Jasmine B. MacDonald (33:16):
Right.

Dr. Tanya Hanstock (33:17):
I used to see also trigger with, you know, trauma, so sexual assault or physical assault, things like that. But also think about that age range in adolescents, like 15 to 19, there's a lot going on there. So we're talking about hormones, we're talking about what happens around that time, you know, that people can often experiment with substances and alcohol. So they may have had a genetic predisposition for bipolar disorder and not realized or have realized, but didn't realize that if they smoked marijuana or they took ecstasy, that it could trigger a bipolar disorder in them because they've got the genetics in there versus their friend who can take that and didn't have that outcome. That's another thing we see in that age range as well. And that's why we want to kind of help educate families and people that if you're having those open conversations in your home about adolescents going to parties and trying things that, okay, well, you know, we've got bipolar disorder our family. So if you experiment with substances and alcohol, you know, you may trigger this. So we need to be making sure you are safe as you can be. And if you do engage in that, that, you know, it's smaller amounts and oh, you might choose not to. And how do you have those skills to combat peer pressure? So some of my clients, we would develop strategies on how to manage at a party, you know, put non-alcoholic drink in alcoholic bottles and it looks like you're drinking and you're not drinking alcohol, you know, but no, one's there going, here's another drink, here's another drink. You know, I fine got mine. Or having, you know, one, a alcohol drink and then a non-alcoholic drink. And then also having a limit of how many drinks cuz it's, you know, people are on medication and it's very dangerous mixing the two at times. So it's an interesting thing. There's many risk factors and it's the combination of a few of them. That's the dangerous point, isn't it. And I think people just don't know that they don't know sometimes what's in their family, they might have had a relative that, you know, this is uncle such and such and we don't talk to him anymore. He was a bit strange and he's estranged from the rest of the family, you know, you know, people adopted or, and people, if they don't just, they don't wanna talk about things like that. It's really hard for people to make informed choices really.

Dr. Tanya Hanstock (35:19):
And the more we inform young people than, you know, and it's a hard time in life for them, even if they do know all the risk factors, having those open conversations and then also being aware of what services that young people can go to to get help. And I think we're in a much better time with, you know, Headspace centers. There's more of them and they're very youth focused. I think we've learned a lot more about the development of mental health disorders and the treatment of them. Years ago when I first started in this area in research and in clinical work, a lot of people would say to me at conferences, young people don't get bipolar disorder. Only adults did that somehow at 18, clock switched to midnight and you turned 18. Suddenly you could develop bipolar disorder. And it just did not make sense to me at a neurological neurochemical level. Why suddenly as an adult, you would what we call adult. Um, I guess suddenly...

Dr. Jasmine B. MacDonald (36:11):
Yeah , when Australian children turn into adults at 18.

Dr. Tanya Hanstock (36:15):
...then they could develop bipolar, but anyone under that age couldn't, and it just didn't make sense to me, especially my exposure to young people in the inpatient unit and also in community settings. That wasn't my experience. I think when people were hearing me talk about working with children and adolescents, they thought I was working with really young children and medicating and like that those young children with that label would get medicated for natural behavioral issues or ADHD behavior and things like that or trauma. There's a lot of people doing clinical work and research work in perinatal and postnatal period. Cause it's a pretty complicated time. People are on psychiatric medication. Some of them can be harmful to the fetus. They have to see psychiatrists and workout what's safe. And then also some people have to weigh up the pros and cons of being on medication in pregnancy and then postnatally with breastfeeding and whether not to breastfeed or there's a whole lot of people who specialize in that area and research in that area to help develop good guidelines on how we help women prenatally and postnatally and can be done. And it is often done, you know, and it, but it's just gotta be known. You know, someone's gotta be able to say I, you know, I have bipolar disorder and um, and then they've got a treating team that actually is helping them during that time. One of my most memorable cases was, uh, a young person who was in a early twenties who was actually her first pregnancy. Um, she wanted to go off medication during the majority of her pregnancy cause she was worried about effects of medication on the developing baby. She did so under a lot of help, you know, I saw her weekly in one service and then the psychiatrist saw her fortnightly to monthly and the other service, she became unwell at seven months. And I think this is a case study that's in my, um, chapter. And it was in the high dependency unit. And I had a clinical student on placement with me. We went over and saw my client and the only two women in high dependency unit in the mental health unit, one was prenatal and one was postnatal and they were the only clients in the high dependency unit.

Dr. Jasmine B. MacDonald (38:19):
Wow.

Dr. Tanya Hanstock (38:20):
My client was really heavily pregnant. She was psychotic, she was manic and she, you know, she was taking her clothes off and she was, uh, verbally abusive to staff, which was out of, very outta character for her. And she also was refusing oral medication and they were having to sedate her. And it was a big conversation, a big team meeting about her having ECT [Electroconvulsive therapy]. And I luckily had this rapport with her and I'd been seeing her for so long. And I had to explain to the rest of the staff who just met her in this state, this is not how she normally is. She's very engaging, respectful to help. And she had said clearly to me, she said, you know, you won't recognize me when I'm unwell, it's that different. And she also said, please, whatever you do, don't let them give me ECT.

Dr. Jasmine B. MacDonald (39:04):
Mm-hmm.

Dr. Tanya Hanstock (39:05):
I had to have those conversations with her that if this continued her refusing her medication, then that would be the only option that the staff had. And just having that conversation gave her power to actually decide, to take the medication. And then with the medication she got better within a month and the end of her pregnancy, she was living at home and coming back as an outpatient and she actually got to have her baby in the hospital. She got to go to the maternity ward and she was, well, she was euthymic again, there was a stage where she was unwell and there was going to be a possibility that she delivered the baby and then came back to the psychiatric unit and the baby was left on maternity ward and she would get to visit the child, but she wasn't with it. And that was worst case scenario for all of us. And as you know, with attachment and her maternal health and the babies. So, and I luckily got to come visit her in the inpatient unit daily and work with staff and, and be part of the big treatment team discussions. And cause of course child protection was involved.

Dr. Jasmine B. MacDonald (40:04):
Right.

Dr. Tanya Hanstock (40:05):
And they were quite reassured when they, you know, we did a home visit, saw how she was preparing her house for baby's arrival. And it was such a good news story that she got to have her baby and they got to be together. And a, also that she was so well, and that was a lot of work with luckily the public health system and working together as a group of clinicians and services that we could monitor her so quickly. In fact, when she got unwell, it was so quick that she got into hospital. But I remember coming back to the, where I worked with with my student after we'd gone into first see her and we saw the, the lady who was psychotic postnatally and my client who was psychotic and manic prenatally and my team leader saying, what do you think now about having children? And we, our eyes were just wide open. We just hadn't realized how risky a time it was. I think to see it in, happening like that and how hard it is for some women. But it's nice to hear that, you know, you can help people in that really hard time and that things can go much better than what they were before. So...

Dr. Jasmine B. MacDonald (41:06):
Yeah.

Dr. Tanya Hanstock (41:06):
And um, from all accounts, I've heard that client went on and became, you know, lovely mom and the little baby grew up well, and yeah, so it was, it was great to be part of that.

Dr. Jasmine B. MacDonald (41:18):
It really speaks to the importance of having a plan with the client around when you're unwell, what's your preference for treatment? How do you want to be supported? What are the things that are gonna be useful for you? What are the things that are really not gonna be useful for you. For you to be able to use that and sit with her and have that conversation, that's pretty powerful, Tanya.

Dr. Tanya Hanstock (41:36):
Yeah. I was at the right place at the right time. And I think, cause we had had so many months of working together, I was kind of also having to remind staff that, you know, like it must be such a scary, confusing time and, and our staff you know, were great. They were used to working with clients with mental health issues, acute episodes. And it must be that scary to be psychotic where you can't trust what your senses are telling you, you know, you can't trust what your brain is telling you. If you have someone that you do trust that hasn't let you down or does tell you how it is and you know, is truthful. And uh, you have some faith in that. You know, I think that really helped. And to be able to have that conversation about that, she has a choice to determine where things changed to. You know, um, she had enough insight still to make the right decision that she wanted all along, which was not to have ECT. And, and in other cases I've had clients have ECT and they've been quite happy with the outcome and to have that for some people it's life saving.

Dr. Jasmine B. MacDonald (42:37):
Yeah.

Dr. Tanya Hanstock (42:37):
And some people there's just no choice but that. I think we had the time we had the relationship and, um, she was very insightful. And actually that case was the first time I ever met anyone who never had lows. She actually only had highs and psychotic highs when she had really quite large highs. And I got that confirmed by a previous psychiatrist of hers that she had actually, um, given me consent and permission to contact. And he had never seen her depressed either.

Dr. Jasmine B. MacDonald (43:05):
Mm.

Dr. Tanya Hanstock (43:05):
Yeah. It was a really interesting concept. In the previous DSM it was like bipolar disorder, not otherwise specified, but actually in the current one, she could actually be diagnosed as bipolar disorder based on that, just having the highs. So it was quite educational for me. And, you know, I didn't have a lot of experience with perinatal work myself cause I'd mainly worked with children and adolescents, but working in Headspace suddenly, you know, the age range was up to 25 and I often had young people who were pregnant and just had babies and had little toddlers. So it was actually such a great opportunity with Headspace to work across the age span of like, you know, 12 up to 25 cause so much can change. You know, I've had, you know, little kids that had anxiety. I had other kids who had school refusal. And then when I had, you know, adolescents had, you know, experienced bullying and various onset of mental health disorders. And then I had these young people that were married or having children and, you know, managing work and study.

Dr. Jasmine B. MacDonald (44:08):
Developmental psychologist's dream.

Dr. Tanya Hanstock (44:10):
yeah, it was, it was really, I felt like that was the a definite, um, good, good part. And it's very weird when I look back, cause I did a lot of my clinical degree clinical work with it, not having a child myself and now more recently having a child. And, and it's just interesting to look back on all the work and, you know, having empathy and helping clients, it, it's still not having that life experience myself. It's a very different, uh, aspect now having that life experience and...

Dr. Jasmine B. MacDonald (44:38):
Right.

Dr. Tanya Hanstock (44:39):
...watching, you know, being around, um, mothers groups and watching so many little kids and toddlers and seeing child development in such a large range, you know, I teach about, um, developmental milestones and when you should be worried and, but there's such a diverse range in children as well. Yeah. And just sort of sometimes waiting a bit to see if it is an issue versus something that they pick up eventually, but maybe just a bit, um, behind others and how we all develop at different stages. Like none of us develop all our areas at the same time. You know, we we've got strengths and we in various areas and things come on board a bit quicker than others.

Dr. Jasmine B. MacDonald (45:15):
A lot of really interesting points have been raised for me. And I especially appreciate the way you've highlighted for bipolar disorder, some of these really life stages or milestones that are normative, that are stressful for anybody to be able to look at bipolar as a reaction to an understandably stressful triggering event or period of time I think is really useful. And hopefully then we have less people who go "that is, you know, the eccentric or odd uncle that we don't talk to now". So I really appreciate that, Tanya.

Dr. Tanya Hanstock (45:49):
Yeah, I think the more, you know, the better and I think it explains sometimes some things that people get confused by and, um, having those conversations in family is really important. I've had even some peers, some colleagues, some friends get diagnosed with bipolar disorder over, over the years and look back at their family history. Cause they were the might have been the first person diagnosed, which is always the hardest and then like find other people in their family that, you know, been in an inpatient unit. But no one talked about why, or if there was a family history of suicide, for example, but never know, or label that as another thing, you know, reaction to drugs and alcohol or something like that.

Dr. Jasmine B. MacDonald (46:26):
Mm-hmm .

Dr. Tanya Hanstock (46:27):
And then like, think, well, maybe that could have been, maybe that person had that as well, like who knows? And then once someone gets diagnosed and treated and they're the first in the family, then the next person in the family that can be quicker for them. Cause there's already one person known, but it's often hard when people are trying to find, um, a family history. Um, if it's not talked about and, and look, I just think it's a different era now where we talk about my know health disorder and we have the ads and we know, you know, we're constantly reminded about, you know, Lifeline of Beyond Blue and Headspace and um, the public mental health system. And I think it's definitely more of a conversation and less stigma. And I think the more we talk about it and um, acknowledge it, less stigma there will be because it's actually the prevalence rates say that it's actually more common than we think like, so bipolar disorder is like 1 to 2% of the population here in Australia. Have it.

Dr. Jasmine B. MacDonald (47:23):
Right.

Dr. Tanya Hanstock (47:23):
And that's the ones who had been diagnosed. There's a lot of people who go undiagnosed or misdiagnosed. When I was in WGA, I used to do these school drama plays with the, you might remember that too Jaz . I'd go out and help, I'd run this drama festival and we'd go out and help the students write plays on mental health disorder. And one group of students was writing a play on schizophrenia and they read the stats. It was like 1% and they realized like in their year there was a hundred children in that year. I think it was year 11. And they thought, wait a minute. That means, you know, there's at least one person in our year that could have psychosis and eventually schizophrenia and putting it in those, that perspective is quite empowering that suddenly it's not this, oh, this, you know, won't have happen to someone we know it's actually, no, this is actually...

Dr. Jasmine B. MacDonald (48:12):
It's our community.

Dr. Tanya Hanstock (48:13):
Happens in...

Dr. Jasmine B. MacDonald (48:14):
Yeah.

Dr. Tanya Hanstock (48:14):
Yeah, yeah, definitely. And so that really brought it home for them. And then they were very motivated to do this amazing play and um, help inform other people about early signs of schizophrenia and how to get assessed and treated and get well. So, um, yeah, that's very good.

Dr. Jasmine B. MacDonald (48:31):
Yeah. That's awesome. If people wanna reach out to you or they wanna keep up to date with what you're working on, is there a place that we can point them to to do that?

Dr. Tanya Hanstock (48:40):
Yeah. So, um, so I'm a Senior Lecturer at the University of Newcastle and I have my staff profile page, which has a list of all my research outputs and has my email address, but yeah, tanya.hanstock@newcastle.edu.au. Yeah. Ask me any questions that might have come from this. And uh, yeah. And anyone who's listening, thinking about a career in mental health services and being a clinician. I, you know, I can't tell you enough how rewarding it is and I hope some of the things you've heard today inspires you to, uh, help others and learn more about mental health and development and how they interact and um, also how to be a clinician who's also a researcher. Yeah. So I hope you've enjoyed the conversation we've had today.

Dr. Jasmine B. MacDonald (49:27):
Tanya, thank you so much for your time today. It's been an absolute pleasure.

Dr. Tanya Hanstock (49:31):
Thank you so much. I really appreciate the, just the opportunity to reflect on my career and um, remind myself of the, some of the great cases and also why I do what I do. And I still love it. It's 21 years and I'm never gonna change my career. And I found my job for life. So I'm so glad.

Dr. Jasmine B. MacDonald (49:51):
For those of you at home, that's all for today. Show notes for the episode can be found at www.psychattack.com. If you've enjoyed listening to Psych Attack, please rate it on your favorite podcast platform and share this episode to help other people find the show. If you have questions or feedback, you can reach out on Twitter [or Facebook]: @psychattackcast. Thanks for listening and we'll catch up with you again next time.

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