Lyndy | Clinical Leader
Lyndy is a consultant adult Psychiatrist and has held numerous leadership positions throughout her career, including a decade working within Maori Mental Health services. She is passionate about reducing inequity and improving access to mental health services for those that need it; it is this that has driven her engagement in medico-political roles. Lyndy is a true advocate for those whose voice is not being heard and it was a pleasure hearing her story.
I was a British military kid and I remember growing up thinking that life was so much better for men! I recall being asked when I was young by benign but slightly patronising adults what I wanted to do when I grew up when it seemed like the right answer was to arrange flowers and marry a military man. And then I was admitted to hospital at the age of nine with a burst appendix. I was there for ten days; they even sewed the eye back onto my bunny! I watched the nurses, the junior doctors, the consultants and I just thought it was fantastic. From then onwards, I wanted to be a doctor. I didn’t really have a clue as to what it actually involved, there were no doctors in my family, but I was determined.
As I got older, it became pretty obvious my better subjects were English and history and I was hopeless at maths! But I kept at the sciences and got my offers for medical school. I trained at the Royal Free in London and loved it, I felt that I was finally doing what I had always wanted. I ended up doing SHO jobs on the Liver Unit and Emergency Medicine and Intensive Care. During this time, I met and married a Kiwi; I was young, only 24. I was working one in two, nights and weekends, which was exhausting. I felt I had no chance to actually build therapeutic relationships with patients. It wasn’t why I went into medicine. Eventually I decided I was over the hierarchy, the hours and I left to pursue my other childhood dream – to be a journalist – when I had idolised Kate Adie (a BBC war correspondent). I realised emulating her was unrealistic and I got a job at the British Medical Association writing for the BMA News Review. I learned how to write (and to type) and had a fantastic mentor in the editor; covering the Labour and Conservative Party Conferences and interviewing eminent colleagues. However, I soon realised how difficult it was to get people to speak to you frankly as a journalist. I had always been struck by how being a doctor instilled trust in people; journalists have the opposite effect! Around that point, we decided to come to New Zealand to spend time in my husband’s country and I decided to come back to medicine.
I had always been struck by how being a doctor instilled trust in people
I started out with an SHO job in psychiatry followed by a run in geriatrics and came out wanting to specialise in psychiatry. This was unexpected as, since my undergraduate runs, I had viewed psychiatrists as a slightly suspect breed! But I began training and loved the fact the work was about hearing and understanding people’s stories. Psychiatry was on the ‘edge’ of medicine in many ways but it was also experiencing a surge in research and new knowledge. I took time to have two babies along the way and qualified in 2001.
My journey to leadership
I was offered a great opportunity in my final year as a senior registrar to shadow the Clinical Director for Mental Health Services in Waitemata. I agreed to do it because I figured if I was going to be working in this system, I should understand how it worked. I had hung on to a fantasy that somewhere, many levels above me, somebody had a plan and I was quite keen to get a look at it! The reality though was rather different. There were so many players. Clinical knowledge and experience had to be lobbied for. The political and financial dimensions of health service provision became clearer. I became particularly impatient with people having visions seemingly on a whim that did not necessarily translate to improved services on the frontline but which sucked up precious energy and attention. I must admit I developed some fairly strong opinions about how we should be delivering mental health services and mental health care. Essentially, I became politicised without really intending to!
I figured if I was going to be working in this system, I should understand how it worked
Once I became a consultant, I became the clinical lead for a high-needs population in South Auckland. There was a lot of change happening in the sector at the time and it was a vertical learning curve for me, learning to manage myself and teams. I had learned the words to use with management to be heard. Something that was so helpful yet something we were never taught. I used some of my CPD money to do business school short courses. The most memorable was strategic negotiation, which proved to be the best parenting tool ever!
During this time, I separated from my husband and we parented week on/week off. I really threw myself into work. After two years I became exhausted, feeling I had nothing much left in the tank. A colleague of mine at the time was trying to persuade me to go and work in the Waikato for a Kaupapa Maori organization. I was very reticent – what were they going to think of a middle-aged white woman with a British accent?! He told me ‘all you need to be is a good psychiatrist’. They were offering a stable part-time role, so I eventually decided to go for it. I ended up working there for seven years and it allowed me to be around much more for my children growing up. I was working in a service where as a non Maori clinician I was absolutely in the minority and I received supervision from a Tohunga. I learned so much and the psychiatry was fantastic. Colleagues cottoned on to the fact I was only working a few days a week and I was asked to join the NZ committee of the College of Psychiatrists. I ended up becoming the chair of the New Zealand National Committee and then representing New Zealand on the board of the binational college. This all sounds grand, but it wasn’t difficult to get these positions if you were keen, outspoken and didn’t habitually or intentionally get people offside!
I learned the words to use with management to be heard
The roles opened doors to many other interesting opportunities. One was working with John Kirwan (now Sir John) on a national MH campaign to destigmatise mental illness and produce an online resource for managing depression and anxiety. I learned how grateful people in other sectors are for specialist advice and how fun as well as effective it was to combine my professional expertise with that of others; in this instance filmmakers, ad men and IT experts.
I was chairing the College of Psychiatrists when the Christchurch earthquakes hit. I was very happy that we could quickly mobilise a useful response to support the people in Canterbury. Guidelines that normally took 15 months to compile and sign off were ratified in seven days. We learned a lot during that time, including how supportive international colleagues and experts could be in a crisis.
At around the same time, at a meeting of the Council of Medical Colleges I was unexpectedly nominated to be the next Chair. I ran down the road to the College of Psychiatrists in the break and asked whether I should do it. I was told ‘for heaven’s sake, just say yes!’. So, I did. And that was next level learning. I was suddenly in meetings with the Minister of Health, the unions, getting slapped about by the surgeons when they thought I might be encroaching on their patch! But I learned so much and we did some really interesting work on the back of employing an experienced director for the group.
These various roles gave me a fantastic view of healthcare through different lenses.
Clinically I moved back into DHB services, eventually becoming Clinical Director of Maori Mental Health and Addiction Services. I refused to take the title until it had gone through a proper Maori process, helpful learning from my time in the Waikato, but I then held the role for seven years.
These various roles gave me a fantastic view of healthcare through different lenses. Over time I realised that the thing that drives me is a passion for equity of access to good mental health care, support and advice. There is enormous opportunity to reduce the burden of preventable mental illness and this is an area I have become increasingly involved in. I persuaded Waitemata to give me a job working with primary care for two years after a decade in Maori mental health. A great GP gave me space in his practice to start running a clinic once a week on a ‘suck it and see’ basis. I took my findings and experiences back to the DHB providing insights into the reality of primary care and the MH need GPs were struggling to meet. We were eventually joined by enthusiastic addiction and child and adolescent clinicians. It was a very rewarding job because it provided early mental health input for people who otherwise wouldn’t have had access to secondary services. During this time, I also became the first lead psychiatrist for the National Telehealth Service which has provided another pathway for ordinary New Zealanders to access mental health support as and when they need it.
The Next Chapter
I met my partner David ten years ago (you can read his aviation medicine case-study here). We started travelling a lot due to his job and I joined him in Sydney for a couple of years. While there, I took a role at headspace, an early intervention service for those aged 12-25, priceless where 75% of adults with mental disorder are developing symptoms by age 14. I was the oldest person in the building by at least 25 years and it was inspiring to work with young people, many non-clinicians, with lived experience. I am now back in NZ working with the National telehealth service, doing some primary care liaison work and a little private practice. I feel the baton regarding access to better mental health services is being carried strongly by a new wave of leaders, including the people that use our services and their whanau. I am very happy to be working in continued support of them and their work and am lucky to have a newish role on the Board of Te Pou, the national MH&A workforce organization.
My experience of ‘going beyond’
When I decided I needed to leave medicine and try being a journalist, I went to see my grandfather. I felt very guilty having had a State-funded education and a coveted medical school place, to be turning my back on that. But I had the loveliest conversation with him. He expressed faith that I would remain true to my ideals whatever path I took. People often take you by surprise.
By contrast, when I took that non-clinical role in my final registrar year, consultant colleagues who were waiting for me to come on board were furious. I recollect several ripping into the Clinical Director for taking me away to do ‘management’ at the time. I am also aware that some of my colleagues may look at my career pathway with alarm; the longest I have stayed in a job is seven years; but I have a sense that everything I have had the privilege to get involved with is part of coherent whole. I suspect that I may have been discounted for some roles if perceived as lacking stickability. But senior colleagues seem to regard me as a person of integrity and a good clinician, and I am finding I am now returning more fully to my “roots” in clinical psychiatry with a sense of gratitude.
If someone wanted to pursue a similar role, how could they go about it?
Firstly, try to be clear about what fuels you. In psychiatry, I saw a group of people who were stigmatised and lacking a voice and that drove me.
Once you know your passion, there are many paths that can get you to similar places. Just grab a vehicle and hold on until it ceases to be useful! There is luck involved but I think that firstly being a sound clinician and colleague is a solid launchpad.
Try to be clear about what fuels you
You do need to learn how to get your point across without alienating people. I had mouthy thoughts for a long time when I didn’t know how to express them effectively. One thing that the Clinical Director taught me in my non-clinical year was to not leave the table. I had to suppress urges to flounce off and slam the door. And I won’t lie, I still get that urge sometimes! But if you are not at the table, you can’t change anything.
I am always keen to support younger colleagues who haven’t yet become cynical about change. We need people questioning how things are done, with a fresh perspective. I am regularly impressed with the younger people I meet.
If you could go back to your medical school graduation day and give yourself one piece of advice, what would it be?
It sounds crazy, but I think I'd say work harder. When I left medical school, I kind of thought, right, I'm done with studying. I did work hard clinically but I do wish I had put a bit more into the books once I left medical school!