Inside the Mind of the President at Royal Australian and New Zealand College of Psychiatrists (RANZCP) / Ex -Deputy Chief Psychiatrist – Interview with Dr Vinay Lakra

COULD YOU GIVE OUR HUBSTERS A BRIEF BACKGROUND ABOUT YOURSELF AND YOUR JOURNEY TO AUSTRALIA?

I completed my medical and psychiatry training in India before I migrated to Australia in 2004. I initially wanted to be a Surgeon, but then an opportunity arose to be a Psychiatrist.

I thought hard about it, consulted a few people including my teachers and decided to go ahead being a Psychiatrist, and I have loved every moment of it.

I came to Australia to have some additional experience and see the landscape, but 14 years later I am still here primarily because of the opportunities I have had in my career.

YOU INITIALLY WANTED TO BECOME A SURGEON AND THEN WENT ON TO DO PSYCHIATRY? HOW DID YOU MAKE THAT CHANGE?

Exposure to psychiatry in medical school is very limited, but somehow when I got the opportunity to train in Psychiatry, it was an easy decision. I liked the fact that every individual I saw had a different story to tell. I have always had an interest in human stories.

WHAT ADVICE WOULD YOU GIVE MEDICAL STUDENTS ABOUT THE ATTRACTIVE ASPECTS OF PSYCHIATRY AND WHY THEY SHOULD CONSIDER PSYCHIATRY AS A POTENTIAL CAREER OPTION?

I have always advised the medical students to keep their mind open to various specialities.

It is more important to talk to them about psychiatry, as their exposure to psychiatry is still quite limited compared to many other clinical specialities. We always try and make sure that their experience during the psychiatry rotations is positive. One can then build on it.

There are many positives to choosing Psychiatry as a career – it’s a clinical speciality which maintains interest in the individual as a whole rather than focuses on disease only.

The interface with social issues makes it real, the kind of support we offer to trainees, the expertise they will develop which is unique given the tools we use to assess and treat people and last but not least the variety it offers in the professional life.

And most importantly the satisfaction you get from seeing the outcomes you get. Not only seeing people get better but saving lives and making a difference.

COULD YOU DECONSTRUCT THE ROLE OF A DEPUTY CHIEF PSYCHIATRIST FOR THE READERS?

I have always preferred to try different things every 3-4 years in my professional life.

It gives you opportunities to learn new skills and in my opinion, helps reduce burnout. So currently I have a few roles, Consultant Psychiatrist, Clinical Director of a mental health service, and President of RANZCP.

The role of deputy chief psychiatrist although seems daunting, but it is primarily focused on the safety and quality of mental health service delivery in the public system and statutory responsibilities under the Mental Health Act.

There are lots of different things I do in that role ranging from providing advice and guidance to services about complex issues to the development of guidelines, forums on specific topics and providing advice to the mental health branch and a range of other stakeholders.

All in all the work is quite interesting, and I enjoy the leadership aspect of it.

WHAT DOES A DAY IN THE LIFE OF A DEPUTY CHIEF PSYCHIATRIST LOOK LIKE?

Fun, busy, interesting, challenging and being honest, occasionally boring and stressful.

My roles include a review of reportable deaths, which can be challenging while simultaneously reassuring given the majority of times it is evident that clinicians go to extreme efforts to ensure they deliver good quality care. Apart from that and some of our long term work on guidelines, no day is the same. I like that aspect of my job. I enjoy the variability the day brings to you.

You can go in thinking ‘I will do this today’, and everything takes a back seat as something else is happening which needs immediate attention.

A phone call from the minister’s office – ‘one of their constituents contacted them about something related to mental health’, or a phone call from a distressed family member or a patient about access issues, or from the service about the challenges they are facing.

I can give some interesting examples, but privacy issues stop me talking about them.

There are always questions about the interpretation or application of the Mental Health Act.

There is a lot of interaction with other people in the health department and outside to address complex issues. Every possible contact with the Office can lead to multiple phone calls.

Sometimes you get an immediate great feeling as you have addressed something challenging with a good outcome and sometimes you have to wait to see the fruit of your involvement.

And then there are days when it is quiet, and you can focus on some planned tasks, only till the phone rings at 4.30 pm especially on a Friday.

YOU HAVE A SPECIAL INTEREST IN HELPING ADVANCED TRAINEES TRANSITION TO CONSULTANT PSYCHIATRIST ROLES. WHAT ADVICE WOULD YOU GIVE ADVANCED TRAINEES?

I have an interest in leadership right from my medical school days. As doctors, we have important roles to play given the skills we have and the trust the community places in us.

I had the fortunate experience of being supported in my journey, and I continue to do that now.

Besides supporting advanced trainees in transition to a Consultant role, I also support Psychiatrists who take on a leadership role, and I am supporting a few currently.

For advanced trainees, it is essential to recognise that sooner or later they will be in a Consultant role. Besides their clinical knowledge, they will be expected to lead a team and work with others.

That can be challenging without proper support and training. I encourage our advance trainees to work somewhat independently and take on leadership roles.

I also advise them to work in a range of settings. This helps them develop their skills and manage complex issues.

I have always advised them to seek opportunities to develop their leadership skills through formal programs, coaching and mentoring, and be on the lookout for opportunities to put their skills to test.

If you prepare well, you can transition as a Consultant smoothly. Never hesitate to seek help.

TRAINEES AND NEW CONSULTANTS ARE DAUNTED BY THE WORD LEADERSHIP. WHAT IS THE IMPORTANCE OF DEVELOPING LEADERSHIP SKILLS AND HOW ONE CAN GO ABOUT IT?

The word leadership can be daunting, confusing or even mesmerising to people. As I mentioned, the community looks up to doctors as leaders, but bar a few who are natural leaders, most of us need to develop and nurture this skill.

As a leader one can contribute more to their role by influencing others.

Some of this starts early while we observe a range of leaders around us in many fields. There is a formal element to developing the leadership skills, and there is a range of programs to help one at different stages of their career.

Before delving into a formal program, I suggest receiving supervision and mentoring as a starting point. And then there are leadership programs, courses, workshops etc.

One has to work out their strengths and opportunities to develop. Having a good mentor can help you guide through the process.

AN IMPORTANT ASPECT OF LEADERSHIP IS MAKING DECISIONS? HOW DOES ONE DEVELOP THIS SKILL?

That is a great question. I have seen people in leadership positions struggle with decision making and then there have been others who excel in that, especially during crises.

I am sure your readers would relate to this from watching events from our daily life. I would also like to remind your readers that we make so many decisions every day without even thinking about it.

So a first step is to reflect on that and explore elements of that. And then there are things which one can learn. Decision making is one thing I have found the hardest to learn.

There are things one can do to improve this skill though. Improving what we call emotional intelligence, learning to manage uncertainty and trusting your instincts are key elements in my opinion to improve your decision-making skills.

Mind you, there are organisations that run workshops to help with this, so it is not easy to capture this in a few words.

WORKING AS A MANAGER AND LEADER MEANS LOOKING AT BIG PICTURE SITUATIONS WHICH OFTEN MEANS DEALING WITH PEOPLE FROM MULTIPLE DISCIPLINES? WHAT ARE THE KEY SKILLS IN MANAGING PEOPLE? WHAT ARE THE KEY PRINCIPLES IN MANAGING CONFLICT?

Although historically management and leadership skills were considered separate, there is greater recognition that they relate to each other.

Even the CanMEDS framework has recognised this and changed the name of one of their competencies from manager to leader. I refrain from using the term ‘managing people’ as I don’t do that.

I work collaboratively with others and engage them in the process to get the desired outcome.

Managing has a connotation that you are superior to others, which is a fallacy. A good leader recognises that the solution to the problem lies in others and not in them.

It is important to look after the people you work with and help them flourish, and they will make sure your workplace or business flourishes. Managing conflict is again a big topic, but my basic approach is to listen to people, find out where they are coming from and identify common ground.

WHAT ARE THE CHALLENGES IN WORKING WITH TRAINEES AND CONSULTANTS?

Trainees need time for training besides working. We try and make sure they are supported and identify any problems early on and address them.

Most of us face problems in personal life now and then and I, continuously see doctors struggling to perform when things are not right in their personal life. So we try and find out if they need help and support them at work.

Junior consultants have slightly different needs. They are in the process of transitioning from a registrar to consultant and need support for those issues.

I run a supervision program for our junior consultants, and I have a program to help them develop their leadership skills. One of the ways I do it is to tell them that I am always available if they need me. It reassures them and trust me; I don’t get calls all the time.

It gives me a lot of pleasure to see when people can address the challenges on their own. Although we want people to adhere to protocols, we also want them to think and bring their knowledge and skills to the issues.

COULD YOU GIVE US A PRACTICAL EXAMPLE OF THE INTERSECTION OF PSYCHIATRY WITH POLITICS AND HOW YOU MANAGED IT?

If you have noticed lately, everyone talks about mental health. Mental health in the workplace, mental health of doctors, mental health of kids, homeless people – you name it.

But unfortunately, we remain stigmatised and under-resourced. The ‘chatter’ about mental health has not translated into an improvement in the system, and we as a profession have to take some responsibility for it.

We have not been at the forefront of advocacy efforts. We also have not been able to demonstrate to the politicians and the public that mental illnesses respond to effective treatments. Take for example treatment for cancer.

So much has happened and one gets quick and comprehensive access to treatment with good ongoing follow up. So much so that there is a ‘pink test match’ to support breast cancer. I would love for the Boxing Day test match to be the ‘blue test – blue can refer to the blues of depression’. A lot more needs to be done in this space.

HOW WOULD YOU SIMPLIFY GOVERNANCE FOR TRAINEES AND NEW CONSULTANTS?

Governance refers to a framework of systems to govern. Clinical governance is the framework within which safe and quality health care is delivered.

There are some definitions about this, but mainly it refers to a system which provides safe, effective and person-centred care.

The key elements required for this include leadership and culture, workforce development and support, clinical practice systems including guidelines for evidence-based care, risk management and working in partnership with consumers, carers and families.

There is a need to monitor and evaluate how we are performing and make improvements as required. So every activity we engage in a health system contributes to the governance.