Dear  ,

From the editor's desk

Dear esteemed colleagues,

wish to acknowledge the Aboriginal and Torres Strait Islander peoples as the Traditional Owners, Custodians and First Nations of Australia, and Māori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand.

This end-of-year 15th edition brings together rich reflections from psychiatrists and registrars across Aotearoa New Zealand and Australia, each offering a window into the evolving realities of our profession.

Dr John Jacques describes the complex police–mental health interface reforms underway in NZ, highlighting both the anxieties clinicians feel and the opportunities emerging through more collaborative, less custodial approaches.

Dr Rebecca Pierrot from Queensland and Dr Caleb Armstrong from New Zealand share personal accounts of private practice, one detailing the emotional challenges of leadership, trust and boundaries, and the other exploring the entrepreneurial spirit that shaped the growth of Anteris and their shift toward system-level thinking.

We also hear from A/Prof Vikas Garg, whose work demonstrates how a determined clinician can build a thriving research culture in regional services, and from Dr Tharshanan Peiris, who reflects with humility and depth on the cultural, relational and structural realities of working with Indigenous communities in rural NSW.

Dr Thomas Clarke, a stage 2 registrar, examines the discharge summary as a crucial, but often underestimated safety tool, urging a shift toward relational handover and more meaningful KPIs in Queensland’s maturing digital ecosystem. Dr Samit Roy offers a contemplative exploration of mindfulness, reminding us that beyond its therapeutic applications lies a profound inquiry into awareness, impermanence and the nature of the observer.

Together, these contributions illustrate the diversity of our landscapes, from research to rural communities, from private practice to contemplative practice and the shared commitment to care that binds our bi-national faculty. In our regular columns, we note that NZ, WA, NSW and Queensland are progressing work to upskill GPs in ADHD assessment and treatment, while the College continues to strongly advocate for rigorous assessments and diagnostic formulations before interventions are initiated. Our Chair, Dr Motamarri’s Insights from the Chair, outlines key bi-national priorities for 2026, reinforcing our collective direction for the coming year.

As we close 2025, I extend warm thanks to all contributors and express special gratitude to Dianne Gregson for her impeccable formatting and the timely publication of each newsletter. Wishing all faculty members a restorative holiday season and ongoing fulfilment in the year ahead.

Kind regards,

Dr Muthur Anand

Insights from the Chair - Bi-national Faculty of Adult Psychiatry

As we look ahead to 2026, our Faculty’s priorities remain focused, strategic, and outward-looking. A key area of work in the coming year will be strengthening our international engagement, beginning with communication and collaboration with the Faculty of Adult Psychiatry in the UK. This relationship will support shared learning, alignment on emerging clinical themes, and the exchange of ideas across service systems facing similar pressures. In parallel, we are organising a formal meeting with the President of the Indian Psychiatric Society to further enhance our faculty’s global presence. Both partnerships reflect our commitment to positioning the Bi-national Faculty of Adult Psychiatry as an active and respected contributor to international psychiatric discourse.

Another major initiative is exploring the feasibility of holding a future FADLP Bi-national conference overseas to broaden participation, increase visibility, and create new opportunities for cross-cultural and cross-system dialogue. An international venue would allow us to engage a wider audience, attract global experts, and strengthen ties with international faculty counterparts—further enriching the academic and professional experience of our members.

At the same time, we remain firmly committed to the continued prioritisation and promotion of the Certificate in Adult Psychiatry. This credential remains central to supporting excellence in advanced practice, and we will work to ensure its accessibility, relevance, and recognition across both countries. The Certificate is not just a training pathway—it is an investment in the quality and future of adult mental health care.

As the year draws to a close, I extend my warmest wishes to all members for a peaceful, restorative holiday season. Thank you for your dedication and engagement, and I look forward to continuing our Faculty’s meaningful work with renewed energy in 2026.

“All Change Please”: The police and mental health change process

You sometimes hear, or maybe you used to hear the conductor on a train saying “All change please, all change” when the train has to make an unplanned stop or change route. It is inconvenient, it is stressful and it will usually add time to the journey, but you have no choice. You just sigh and have to get on with it, but you know that you will get to the destination and it will ultimately be ok. Change in health care sometimes feels like that. 

Aotearoa New Zealand’s mental health services and police force have been working through a national change process over the past year that sees the police stepping back from our requests as mental health clinicians to assist with many activities. We all know that change processes bring challenges, and stress at all levels of the organisation, and we, as medics, have even been described as being “particularly resistant to change” for various reasons (1).  

We have found the change process challenging because we worry about the safety of our patients, their families and our colleagues, and being held responsible for adverse events that might be out of our control, and some of us do not have a clear understanding of our role and responsibility as clinicians. We also have longer-term concerns for the risk of further inequity and poorer outcomes for Māori and other communities. All of this change runs alongside and through a workforce that has its own long-standing challenges with recruitment and retention; a society and government that is keen to see the police fight crime, and a community that has perhaps become increasingly intolerant of the homeless population and those who are marginalised. 

The police and mental health change process has been staggered across four stages with implementation that began in November 2024. The police and mental health services have collaborated at the national level with representation from those with lived experience as well as cultural experts.  A new governance structure has been developed in each health district and there are working groups, workshops and training that supports this process. 

There have been some positive outcomes and opportunities, for example, from our experience in central Auckland, far fewer individuals with mental health difficulties are being held in police custody, and there have been opportunities to collaborate and think more laterally with managing and assisting individuals with repeated presentations, antisocial behaviour and social problems. The development and roll out of a police and mental health Co-Response Team, though not a panacea, will further enhance how we work with the police. 

We have been fortunate in central Auckland to have a collegial relationship with our local police leadership and police liaison team. The relationship has been helped by having regular face to face contact, and spending time in each other’s work-places to understand how we work, what we do (and what we can’t do). This has complemented our governance and operational meetings that run on a regular basis where we discuss situations that have not gone well and identify areas that we need to improve. However, we also acknowledge situations that have gone well, we celebrate good practice and outcomes, and we recognise that both of our organisations have resourcing challenges and competing demands.    

The final stage of the change process will be implemented next year. We will see changes in how police respond to requests for welfare checks in the community, and further changes to the handover process of patients in emergency departments, with the police leaving patients after 15 minutes if there are no immediate safety concerns. Our current process for asking the police to check on the welfare of people that we are worried about is well established and provides reassurance to families and clinicians, and enables us to assess, engage and support people that are otherwise hard or unsafe to reach. The proposed changes in emergency department handover will also be challenging to implement and may require us to change how we work. 

Perhaps medics do struggle with change, but as psychiatrists and as mental health clinicians, we have an advantage over some of our colleagues. In clinical practice, we are nearly always trying to support our patients to change, and therefore, we understand change and how to overcome barriers or resistance to change far better than most. We are all familiar with the cycle of change and fostering motivation, and as psychiatrists, we are skilled at communicating clearly with consistency, we are skilled at engaging in discussion, listening to both sides of the story, and being open minded. Above all, we value trust and the importance of relationships when working with other people. These values sit well with an inclusive and collaborative approach to change and leadership that is associated with better organisational performance (2), and we need to have faith in our skills and resilience to work in a system that is always changing and keep the patient at the centre of everything we do. 

1. Callaly T, Arya D. Organizational Change Management in Mental Health. Australasian Psychiatry. 2005;13(2):120-123. doi:10.1080/j.1440-1665.2005.02173.x

2. Konteh FH, Mannion R, Jacobs R (2023), "Changing leadership, management and culture in mental health trusts". Mental Health Review Journal, Vol. 28 No. 1 pp. 1–18, doi: https://doi.org/10.1108/MHRJ-03-2022-0018

Some Very Hard Lessons Were Learned

When asked to write a comment on my experience opening my own private practice, the first thing that came to mind was, that some very hard lessons were learned. In January of 2024, I opened a small and humble little practice, with myself as the only psychiatrist and I leased the other two rooms to allied health professionals. The hard lessons I have taken from this time were not the expected ones. I honestly expected I would have to learn a lot about business, finances, legalities, insurances…. And I certainly did. These lessons were time consuming and I’m sure aligned with the experiences of everyone else in the same position. The emotional lessons were a little more complex. 

I learned a hard lesson about being a boss. There is a surprisingly vast difference between supervising a junior doctor, managing wards, dynamics and teams and being an employer. I initially approached having staff the way I had managed teams, as a colleague, a support. With empathy, accommodation and understanding. The difference in this dynamic was that my business, my livelihood was now at risk from my overly accommodating approach. Letting a staff member go was a significant challenge, necessary from a business perspective, though not something I thought I would have to face so early in the journey. I believed with enough support, that my little team would thrive, though the lesson I learned was that I could not be or do everything. I could not cover for all the failings of others. 

I learned a hard lesson about trust. I have found the private sector surprisingly isolating, despite how many colleagues I actually have in the same position. I tried to work on establishing firm relationships with other professionals, for support, clinical advice, and simply the company. I approached these relationships with the same openness, trust and humility that I always have. I tried to support in turn and learned that I offered too much of myself and my capability and was burnt in the process. I had to learn to listen and support without giving anything of myself, without expecting anything of others. I burned myself out being the image of what I always viewed the consultant psychiatrist to be, the pillar of calm capable support and wisdom. 

Finally, I learned a hard lesson about boundaries. I actually am not certain I have learned this lesson well yet, but the dot points are certainly written in my psychological journal. I accepted so many referrals. I took more and more complex patients, with pleading referral letters seeking support, with escalating risks and at times seemingly hopeless trajectories. Again, on theme for me, I burned myself out working longer hours, doing more, seeing more. It impacted my own mood, my confidence in my abilities (hard to hold when your caseload seems increasingly hopeless) and my family. I had to learn to say no. I cannot possibly see everyone. 

The lesson I took away from the last two years, boiled down to the very core, was that I forgot to put on my own damn oxygen mask first. 

Promoting Research Culture in Regional Mental Health Services

Associate Professor Vikas Garg, Senior Staff Specialist in the Mental Health Department at Darling Downs Health, has been awarded the 2025 Darling Downs Health (DDH) Research Award in recognition of his extensive contributions to building a strong research culture in regional services.

Research activity in the department has grown significantly, with several key areas of focus. Over the past nine years, Dr Garg has mentored numerous trainees through their scholarly projects, including ongoing systematic reviews on ADHD and psychostimulant use. One project evaluating Mental Health Act regulations identified recurring procedural errors; following an educational intervention, the team demonstrated a significant reduction in both the number and frequency of these errors. Another project surveyed staff attitudes toward smoking bans in mental health facilities, showing increased support over time. A further scholarly project produced a published systematic review and meta-analysis on subclinical hypothyroidism and psychiatric illness (Aung TT et al., Australasian Psychiatry, 2024). Several additional scholarly projects are in development.

Dr Garg also supervises a PhD project examining the association between depression and chronic physical health disease across urban, regional, and rural populations. This work has led to multiple publications and conference presentations, with the thesis recently submitted to the University of Queensland. “Rainbow Minds,” a collaborative initiative with UniSQ and DDHHS, forms another component of this research, developing group programs for LGBTIQ adolescents and adults.

The department has recently become a collaborating site for multicentre clinical trials funded by NHMRC and MRFF, including a study on cannabidiol augmentation in clozapine-treated schizophrenia. It has also commenced its first pharmaceutical-sponsored trial—a double-blind randomised controlled trial assessing a novel antidepressant—with Dr Garg participating in the promotional teletrial video.

Collaboration remains central to sustaining research growth. Partnerships have been strengthened with the University of Queensland, Rural Clinical School, University of Southern Queensland, and Griffith University, with additional cross-departmental projects being developed. As a member of the DDH Research Advisory Committee, Dr Garg continues to advocate for embedding research across the organisation.

In conclusion, Ready, Set, Research remains the guiding motto of DDH. Dr Garg’s philosophy—One idea, one clinician, one year, one paper—encapsulates his commitment to fostering a thriving research environment in regional mental health services.

Working with Indigenous Communities in Rural NSW: Reflections from a Psychiatrist

For the past five years, I’ve been working as a psychiatrist in a rural mental health service in New South Wales. I also live in the same community I serve, and that has shaped my experience in ways I didn’t expect when I first arrived. Over time, I’ve come to see the people I work with not just as patients, but as neighbours, familiar faces, and part of the broader story of the town.

Working with Indigenous patients and families has been one of the most meaningful parts of this journey. It is both rewarding and challenging. The work is rich in complexity — I often see the deep interplay between culture, intergenerational trauma, and mental illness. No two stories are ever the same, yet many are connected by a history of loss and resilience that continues to shape people’s lives today.

I’ve learned that building trust is the absolute foundation. For many of my Indigenous patients, engagement doesn’t happen quickly. It takes time, consistency, and respect. Sometimes, it’s the quiet moments — sitting together, listening more than speaking — that build the strongest connections. When trust is established, progress follows in ways that are more genuine and lasting.

Family involvement is another essential part of care. Decisions are rarely made by individuals alone, and I’ve found that involving extended family not only enriches understanding but strengthens the healing process itself. It reminds me that recovery is not just a medical process but a collective journey.

Coming from a culturally diverse background myself, I often notice similarities in values — respect for elders, connection to land and family, and the importance of community. These shared values have helped me relate more naturally and approach my work with humility. I’ve realised that being culturally sensitive isn’t just about training or frameworks; it’s about being curious, respectful, and human.

Of course, there are challenges that make this work harder than it should be. Access to Aboriginal Liaison Officers is limited — in our hospital, there are only a few supporting the entire service. Their role is invaluable, yet it’s not always possible to have them available for reviews or care planning. Continuity of care is another struggle. Like many rural areas, we’ve been affected by the shortage of permanent psychiatrists in NSW, which can disrupt therapeutic relationships and trust.

In a small town, there are also unique challenges — staff and patients often know each other outside the hospital, which can blur boundaries and create ethical dilemmas. And despite strong community will, Indigenous-specific rehabilitation and recovery services are still limited. This can make it difficult to sustain progress once a patient leaves our care.

Still, despite these constraints, the work continues to feel purposeful. Moments of connection — when a patient starts to open up, when families express gratitude, or when small steps forward happen after long setbacks — are deeply rewarding. These moments remind me that psychiatry, especially in rural and Indigenous settings, is about people first.

Working here has changed the way I understand mental health and community. It has taught me that cultural safety grows from relationships, and that healing often starts with being seen, heard, and respected.

Entrepreneurship in Psychiatry: Lessons from Building Anteris

In 2019, weary of a lack of control of my working conditions and Auckland, I decided to start my own private practice in Tauranga. I called it Anteris, which means “support” or “buttress” in Latin—a name that felt right because I wanted patients to feel reassured and professionals to feel backed up.

Before we even finished renovations on the office, COVID hit, and telemedicine was the only option. That turned out to be a skill I still rely on today, convenient and flexible as it is. At the time, I had almost no business experience, so I consumed a lot of books on the topic of entrepreneurialism.

It was daunting that there was an emphasis on failure being the greatest teacher, but it also made sense.

One of the biggest wins early on was hiring an amazing practice manager who has grown with and now beyond the company we have built up from scratch. Workforce challenges are constant in psychiatry, prompting me to rethink how we deliver care. Five years later, I’m making the shift from working in the business to working on it. For a clinician, that’s a tough mindset change, but it’s key to better outcomes, both for the business and a greatly increased number of patients.

Unlike public mental health roles tied up in bureaucracy, I’ve had the freedom to pivot quickly and explore new treatments—like oral ketamine therapy, which I’ve provided to hundreds of patients. I’ve also learned what makes partnerships work (or not) and grown a lot personally along the way.

Clinicians need support so they can focus on patients. Tasks that may seem peripheral such as documentation should be made as easy and painless as possible. That means automating processes to keep things running smoothly. Early on, I invested in a custom patient management system—expensive, yes, but worth it for the flexibility. It’s also given me a new appreciation for my entrepreneur patients.

One thing I’m proud of: doctors can review referrals before seeing patients, so they’re not seeing their neighbour or working outside their scope or with a client group where they may lack the skills. Rather, they have an opportunity to work within their “zone of genius”, where their skillsets and interests intersect.

Being an entrepreneur isn’t for everyone, but it turns out, it is for me. I’m grateful for this journey and excited about what’s next: launching my new venture, Validus, which ought to sound bold, strong, and healthy. Stay tuned!

News From ADHD Network

Government initiatives to allow GP led assessment and treatment of ADHD is on the way at WA, QLD and NSW. More jurisdictions are anticipated to join this initiative in future. Improving access to ADHD assessment and treatment is necessary to meet the unmet needs of the individuals with undiagnosed ADHD. From ADHD Network Committee’s perspective, access to care reform needs a carefully considered approach with balancing quality of care with equity and government’s investment in supporting a national approach in professional training and a staged approach.  

Registrar Perspective
From Paperwork to Patient Safety: Rethinking Discharge Summaries in Queensland Psychiatry 

The period surrounding discharge is one of the most vulnerable times for people receiving psychiatric care. The weeks following discharge carry disproportionate rates of self-harm, suicide, and unplanned readmission. This risk underpins Australia’s long standing seven-day post discharge follow up key performance indicator (KPI). In Queensland, this metric is monitored through the Mental Health Alcohol and Other Drugs Branch (MHAODB) as part of statewide performance and accountability reporting. 

Yet, the seven-day KPI measures the contact, not the handover that makes follow up safe or effective. This is where the discharge summary (DS) becomes pivotal. The DS is more than an administrative task, it is the formal handover of risk formulation, treatment plan, and recovery direction between inpatient and community care. When delayed or incomplete, it leaves community teams and GPs without the information needed to maintain safety or continuity of treatment. 

Metro South Health’s Digital Health Strategy 2023-2028 highlights the importance of discharge information as part of an integrated digital ecosystem, treating each discharge summary as a communication event within real-time data systems rather than a static document, to ensure the right information reaches the right clinician at the right time. 

Queensland Health’s Communicating for Safety Standard (Action 6.11) and Criteria Led Discharge Guideline both emphasise timely and structured transfer of information. The Chief Psychiatrist’s Policy on Treatment and Care further requires that discharge documentation be available to the consumer, GP, and treating team, and that it includes medication changes, outstanding risks, and follow up arrangements. 

Learning Points for Registrars 

For psychiatry registrars, the discharge summary is both a clinical tool and a professional learning opportunity. RANZCP training outcomes emphasise communication, systems-based practice, and collaboration. Writing a thoughtful discharge summary reinforces skills in clinical formulation, risk communication, and multidisciplinary liaison. Registrars should consider each summary as a brief case formulation, articulating the meaning of the admission, the risk narrative, and the plan for maintaining safety and recovery in the community. Attention to this process can prevent the repetition of maladaptive patterns seen in “revolving door” admissions and supports reflective, patient centred practice. 

Future Directions 

The next challenge for Queensland’s mental health system is to make KPIs more meaningful, shifting from counting activity to evaluating value. The Queensland Mental Health Commission’s Shifting Minds Strategy and the MHAODB Quality Improvement Data Portal encourage integration of safety, outcomes, and consumer experience into performance reporting. Queensland Health is incorporating consumer-reported experience measures, such as the national Your Experience of Service (YES) survey and associated Carer and Family surveys, into inpatient and community mental-health services. These tools capture patient perceptions of safety, communication and preparedness for discharge, domains that directly align with the quality of discharge summaries and transition planning. 

There is also movement toward linked and relational indicators that capture clinician to clinician handover or reference of the DS in follow up documentation. Such measures highlight that quality in mental health care is relational, not transactional. 

Ultimately, meaningful KPIs in psychiatry will connect process, safety, and person-centred outcomes. In Queensland, with its maturing digital systems and recovery-oriented policy, the opportunity now is to evolve from “form completed” to “information transferred, understood, and acted upon.” 

• Queensland Health. Chief Psychiatrist Policy: Treatment and Care under the Mental Health Act 2016 (2024).
• Australian Commission on Safety and Quality in Health Care. NSQHS Communicating for Safety Standard. 
• Queensland Mental Health Commission. Shifting Minds: Queensland Mental Health, Alcohol and Other Drugs Strategic Plan 2018–2028.
• Royal Australian and New Zealand College of Psychiatrists. Fellowship Competency Framework (2020): Domains of Communication, Systems of Care, and Professionalism.

Mindfulness Corner

The soft buzz of the bedside alarm wakes ‘me’ up.

‘Me’? Maybe better conceptualised as the ‘body mind complex’ called Samit.

It was 4 am on the 11th of November 2025 and it was time to get ready for my meditation session.

While I sat sipping my cup of hot tea, I glanced through the morning news channel and a blaring headline announced that there has been a terror attack in New Delhi, and many have been killed. 

As this news seeped through my consciousness, I was aware that this mind and this body was suffused with a lot of dark thoughts and unhelpful emotions.

I overcame my inner resistance and sat down for the meditation and watched and watched and watched as those thoughts, memories, sensations and feelings which had initially appeared to be all consuming, gradually settle and then totally cease, and I could again appreciate openness, space and peace.

So, what is mindfulness?

In today’s world many people see mindfulness as a relaxation exercise or practice mindfulness in therapeutic form to reduce anxiety and depression and we also hear about how we can enjoy ourselves more by practicing mindfulness. For example, by eating mindfully, getting a massage mindfully or walking mindfully.

But that is like purchasing a Lamborghini to just drive to the newsagents next door!!

Because mindfulness goes much much deeper and encourages us to go on a journey into the very centre of the mystery of our existence.

The roots of mindfulness goes way back in time, and its origination was in the dusty plains of India about 2500 years ago from a being called The Buddha

Mindfulness or Sati in Pali is a core practice in Buddhism that involves cultivating continuous, alert and non-judgmental awareness of the present moment. 

The Buddha had said in one of his discourses that this practice is quite simple, just mindful one breathes in, mindful one breathes out, and this awareness of breath cuts through the complexities of discursive thinking, pulling us back from mental meandering and anchoring the mind securely in the present. 

The Buddha's most detailed teaching on the practice of mindfulness is found in the famed Satipatana Sutta. The Discourse on Foundations of Mindfulness. 

The Buddha had said that mindfulness is to be established in four ways. We must establish mindfulness of the body, mindfulness of the feelings, mindfulness of the mind, and mindfulness of the Dharma—the laws and relations that govern life. He had continued, “Mindfulness leads to healing and the end of sorrow and grief. Mindfulness brings liberation.”

Mindfulness is the means by which we can bring our full caring presence to the world. With balance and understanding we can experience gain and loss, pleasure and pain, war and peace, the joys and sorrows that make up human life, and see everything as fleeting or impermanent.

The open and compassionate attention of mindfulness liberates us from reacting to and being caught by all things in the world. Instead, we offer the world our peaceful heart. We respond with care and courage, and in doing so we embody the presence and liberation we wish for all.

Mindfulness (Sati) is not passive relaxation but the watching of the mind -The watchdog is constantly alert to what your mind and by extension the body is doing.

It is also not just about being in the present moment. 

There are 2 other crucial elements. 

1) Being aware that everything is fleeting or impermanent, and 

2) Deeply contemplating the fact that if a body, sensations, perceptions, thoughts, memories, emotions is being witnessed then who is the ‘witness’?

The mind immediately jumps in and says, “I am the witnesser”. But then when we look deeper, we realise that the thought or feeling of ‘I’ is also an object and is being witnessed. 

Witnessed by whom we ask again?

There is no answer …. just Silence 

There lies the deepest mystery of existence which some people call God.

Bi-national Faculty of Adult Psychiatry Committee

A/Prof Balaji Motamarri – Chair
Dr Muthur Anand – NZ Jurisdictional Member
Dr Suneel Chamoli – ACT Jurisdictional Member
Dr David Chapman – NT Jurisdictional Member
Dr Dharshanie Gunaratne - Chair, SATAP
Dr Karuppiah Jagadheesan – VIC Jurisdictional Member
Dr Peter Melvill-Smith - WA Jurisdictional Member
Prof Nagesh Pai – NSW Jurisdictional Member
Dr Suman Sinha - NZ Jurisdictional Member
Dr Surabhi Sinha - Trainee Delegate
Dr Georgina Weir – SA Jurisdictional Member
Dr Ashlea White - QLD Jurisdictional Member

A/Prof Balaji Motamarri
Chair, Bi-national Faculty of Adult Psychiatry Committee