Songs about rainbows

As I come to the end of my presidency, it’s inevitably a time for reflection, for review and questioning. Being president of a medical college affords an amazing perspective of the work of the college as a whole, and of its fellows.

And, as I realise this is the last time I’ll be on this stage for the College ceremony, I know this is one of the most pleasurable moments of being president: the absolute privilege to present awards and shake hands with all the new fellows of our college – the future of our profession. It’s hard not to get emotional in sharing and celebrating your achievements.

However great your passion for psychiatry, training or the pathway to fellowship, can sometimes seem like an endless stream of challenges. But to quote Dorothy in The Wizard of Oz: ‘Somewhere over the rainbow skies are blue; and the dreams that you dare to dream really do come true’. ¹

Kermit the Frog once asked, ‘Why are there so many songs about rainbows?’ ² The rainbow is a wonderful natural phenomenon – of refraction, reflection and dispersion of light. The rainbow’s appearance at the end of the storm has been a source of wonder since ancient times and appears in mythology across the world. In the Old Testament, in the book of Genesis, God sends a rainbow to Noah at the end of the flood – a sign of hope.

In ancient Greece, Iris is the personified goddess of the rainbow, a messenger of the gods, bringing messages of peace and good fortune, and she is credited with filling the golden jug with holy water for Zeus. The Irish believe that there is a pot of gold guarded by leprechauns at the end of the rainbow. Buddhists believe that the rainbow represents a higher state that is achievable before attaining nirvana.

The Rainbow Serpent is an important image in Aboriginal culture, and has a variety of different meanings – including the connection between the cycle of the seasons and the significance of water; or the source of life and fertility.

The College strongly advocates for all Indigenous peoples across both our nations to have access to culturally safe mental health and psychiatric care. We want to close the gap in mental health inequality between Indigenous and non-Indigenous Australians and New Zealanders.

The RANZCP Reconciliation Action Plan ³ has driven a range of College activities aimed at promoting reconciliation and enhancing our engagement with the Aboriginal and Torres Strait Islander communities. The Aboriginal and Torres Strait Islander Mental Health Committee, together with Te Kaunihera, are currently considering the next iteration of the College’s Indigenous mental health strategies.

Important in the College’s efforts to improve recruitment of Indigenous medical students and junior doctors into the psychiatry profession are the Aboriginal and Torres Strait Islander Congress grants. I warmly welcome four grant recipients to this Congress, which, pleasingly, the College partnered with the Australian Indigenous Doctors’ Association to jointly support.

Just as important is the College’s work in developing a strategy to embed cultural safety in the training curriculum and in professional development, which was furthered by Dr Siva Bala and my participation in the Leaders in Indigenous Medical Education Network’s Specialist Medical Colleges Workshop recently.

Last year, I was incredibly honoured to represent our College at the Pacific Region Indigenous Doctors Congress in Hawaii. Native Hawaiians have over 2000 words for rain and 42 words for clouds – so important are the elements to their sense of identity and understanding of a collective self. This is a reminder to us of the important connections between the natural environment and health, particularly mental health.

Māori mythology has a god of rainbows too, called Kahukura: it is believed that the rainbow is the celestial embodiment of Kahukura in the sky. In mid-2018 the College convened a wānanga meeting in Whangarei, New Zealand. The hui (gathering) provided a focused time for discussion and reflection, and a culturally safe environment for critical conversations about issues central to Māori psychiatrists.

Perhaps one of the most familiar rainbows in recent times is the rainbow flag – the symbol of the LGBTIQ+ community, commissioned by Harvey Milk, the gay icon and political activist, and designed by Gilbert Baker as a symbol for the San Francisco Gay Freedom Day Parade in 1978. It’s incredible how much this flag has come to symbolise in the way of unity, acceptance and celebration of diversity.

A disproportionate number of Australia and New Zealand’s LGBTIQ+ populations experience mental illness and psychological distress, and have increased risk of suicidality. The College is committed to action to enhance the mental health sector’s responsiveness to the needs of LGBTIQ+ people, as outlined in our position statement on recognising and addressing the mental health needs of the LGBTIQ+ population. ⁴ The College strongly supported marriage equality, recognising the positive link between improved mental health outcomes and legislative change for LBGTIQ+ people and their children.

However, the colours in the rainbow flag, representing togetherness and diversity, are transferable concepts that are so important in so many aspects of psychiatry and mental health care. We look after diverse populations; many are vulnerable by virtue of their mental illness and many have additional vulnerabilities.

Professor Julian Trollor, the winner of the RANZCP Senior Research Award, is giving his keynote address, ‘Improving the mental health and wellbeing of people with intellectual disability’, on Thursday. This is an area of mental health where we, as psychiatrists, can and need to do so much more. As a College, we can start by ensuring our trainees gain competence in the mental health of intellectual disability and I hope it’s not too long before we have (a much overdue) Faculty of Psychiatry of Intellectual and Developmental Disabilities.

In pre-Incan times in the Amazon, people believed that you should close your mouth when you see a rainbow to avoid disease, and the Karen people in Burma believe that the rainbow is a dangerous demon that eats children – a reminder that we can never assume the perception of another person or the meaning of an event is the same as our own: this is never more important than in our multicultural societies of Australia and New Zealand.

In addressing the mental health needs of culturally and linguistically diverse people, whether they have chosen to migrate or have arrived as refugees, there are many practical and ethical issues to consider. Our College has a position statement on the provision of mental health services for asylum seekers and refugees, ⁵ and professional practice guidance for psychiatrists working in Australian immigration detention centres. ⁶ The College is also establishing an Asylum Seeker and Refugee Mental Health Network to bring together those of us with an interest in improved mental health outcomes for refugees and asylum seekers.

The College has been involved in the Migrant and Refugee Women’s Health Partnership: a partnership of health professionals and community leaders to address systemic health barriers and to enhance health care for migrants and refugees. In February this Partnership launched a new Competency Standards Framework for Clinicians called Culturally responsive clinical practice: Working with people from migrant and refugee backgrounds. ⁷ This groundbreaking work provides a much-needed resource to support clinicians in embedding culturally appropriate practice in clinical education and health care.

Many a child has pointed in amazement at the sight of a rainbow, and many of us here will have helped a child grieve over the loss of a beloved pet by invoking the concept of the rainbow bridge as a pathway to pet heaven. But despite research strongly indicating that the most cost-effective way to prevent the development of mental health problems and promote mental wellbeing is to target childhood and adolescence, including the perinatal period, child and adolescent psychiatry is under-resourced and we have significant workforce shortages across both our nations.

Meanwhile children who are subject to abuse, family violence and neglect are particularly vulnerable, including children surviving experiences as refugees, or forced migration, torture and trauma. Our profession has an important contribution to make to improve the capacity of mental health services to respond to family violence and, in the future, we need greater emphasis on the importance of trauma-informed care.

Caring for the carers, including ourselves, is an ongoing area of work at the College. We are committed to creating resources, removing barriers and providing support services to address the physical and mental wellbeing of psychiatrists and trainees. This year’s Congress has a number of sessions about doctors’ mental health, including Associate Professor Sam Harvey’s keynote address, ‘The mental health of junior doctors’.

We also anticipate greater involvement in addressing the mental health needs of first responders and emergency service workers. The College believes there are significant opportunities to improve the management of mental health in first responder, emergency service worker and volunteer organisations.

The work of our Military and Veterans’ Mental Health Network continues. Resources are being developed to provide psychiatrists with guidelines when working in this specialised field: two military and veterans’ mental health symposia are being held at Congress.

This is a time of unprecedented advocacy for the College. Historically there have been many challenges in getting the College’s voice heard, but stakeholders are listening to us and, increasingly, we are consulted and asked for our opinions in the media as well as providing expert advice to governments.

In the lead-up to the forthcoming Australian Federal election, the College has called for a shift in the design and investment of the mental health system to a recovery-oriented model, where people with mental illness are supported in the community and by intensive services when needed. It is important for us to establish and maintain relationships with MPs in both major political parties, as well as independents.

In both Australia and New Zealand we are in the midst of a number of major inquiries and commissions. The College has made significant submissions to the Australian Productivity Commission Inquiry into Mental Health, and the Royal Commissions into Institutional Responses to Childhood Sexual Abuse, and into Aged Care Quality and Safety, as well as the New Zealand Government Inquiry into Mental Health and Addiction.

I firmly believe that to be effective in advocacy, it is essential to join with other key stakeholders in mental health. We should be proud of the strong relationships we have with organisations nationally and internationally.

But the most important partnership we can develop is with the consumers of mental health services: our patients and their carers. The Private Mental Health Consumer Carer Network is now offering an award each year for Best Practice in Consumer and Carer Inclusion for the best reflective piece submitted by a trainee after completing the College’s online modules for Collaboration, Communication and Cooperation between Health Professionals. I quote the words of inaugural award winner Dr Katherine Moss: ‘I have been challenged to seek out more genuinely and consistently, information and insight from consumers and carers … to see the consumer as an individual person – with hopes, aspirations and plans for their life – above and beyond a diagnosis or illness’.

Just as all the colours in the rainbow coexist and complement each other, rainbows can be diverse in shape and form and can even be double – so, just as Peggy Lee did, it is possible to ‘sing a rainbow’. ⁸

Rainbows are also symbolic of transition – and as all the new fellows who are here with us this evening move from one phase to the next, I thank you for listening.

And I thank our fellowship for entrusting me with the role of president for the past two years. I wish you well.

So next time you hear Kermit the Frog ask, ‘Why are there so many songs about rainbows?’, there’s no need to answer – or even do what we psychiatrists do and wonder why the question was asked. Just take your fellowship, take your expertise in psychiatry and, as individuals and as a College, continue to contribute to improving the mental health of our patients and communities in whatever way possible and just create many more songs about rainbows.