September 2013

Profile: Emeritus Professor Ian Webster AO

Community health pioneer and supporter of the diverse workforce providing needle and syringe programs, Emeritus Professor Ian Webster AO is spending his golden years healing the poor, trying to reduce suicide rates and improve mental health policy.

While some of his peers may have retired to the golf course, Professor Webster prefers to work at the coalface with under-privileged and highly vulnerable people.

Not only does he find that work humbling and rewarding, he also says there is a lot to learn from people who have led remarkable lives.

“I often want to tell stories about the people I see,” he told the Bulletin.

“I also like being a doctor and enjoy having some practical skills to offer. I have knowledge and skills which I’ve gained and I don’t want them to atrophy and go away.”

Professor Webster grew up in Kyabram, in country Victoria, whose all-too-apparent poverty formed his famed commitment to helping the down-and-out. “The kids I played with in the streets, not many of them made it,” Professor Webster said.

He recalled watching a homeless wanderer trying to mow his next-door neighbour’s lawn with a decrepit machine. It was a boiling hot summer day and the swagman struggled with the blunt brute of a mower, almost certainly for a pittance. The young Ian Webster looked over the fence and was struck by the man’s desperate situation. That image stayed with him.

“One of my passions is about injustice and poverty. It’s… about wanting to see things done fairly, feeling anger at injustice… and at exploitation of people. I want to stand on the side of the people who have led difficult lives… and who nevertheless demonstrate resilience in the face of those adversities.”

The nexus between trauma, mental health and substance misuse was under-recognised at the societal level, but familiar to frontline workers, he said.

My experience is that there is a very high proportion of childhood neglect – actual trauma: physical, mental and sexual – amongst people who run into substantial and significant problems in the drug and alcohol field.

Emeritus Professor Ian Webster AO

“My experience is that there is a very high proportion of childhood neglect – actual trauma: physical, mental and sexual – amongst people who run into substantial and significant problems in the drug and alcohol field.

“A huge proportion of them have had very traumatic childhoods, in terms of being physically abused… and certainly, amongst those who are homeless, the stories of institutional abuse are very high. The number who would have been through state homes or boys’ homes of some kind sticks high in my memory.”

Professor Webster says that decency, respect, having conversations and learning about the clients can go a long way for NSP workers engaging with traumatised clients who have accumulated vulnerabilities.

“I would say that the first task… is to treat them decently and respectfully, and to metaphorically shake their hand and greet them as equal people. I’ve seen the way staff are decent, are non-judgmental and have a caring way of speaking to the people who are coming to get the needles. It’s quite remarkable.

“Secondly, if they are able to pursue conversations – and there is not always time – then I’d be asking questions in a very general way, like ‘how are you managing?’, or ‘how are you getting on?’

“To me, one of the most significant things about engaging with other people is… to be able to hear their story. It’s all very well to be able to respond to an immediate episode or event… but in helping people or in responding to people’s needs, understanding where they have come from and why they have reached this point is absolutely fundamental.”

Professor Webster remains committed to the concept of ‘chain of care’, which he picked up in Norway as part of his suicide prevention leadership. In a chain of care, even the hospital receptionist handing out sterile injecting equipment was a vital link in the broader health system.

“The idea of a chain of care is a fundamental and a very important idea. It means that you might intervene, exchange a needle or provide immediate advice to a person; but in the end the real outcomes are determined by the links in the chain. What will happen next?

“It’s all very well for me or a doctor in an emergency department to resuscitate a person from an overdose, or to help someone who has presented with an attempted suicide, or indeed to present with anything – particularly a mental health problem. [But] the job can only be done if there is a link in the chain to the next point.

“Unless we establish follow-up and linkage, we really haven’t done our job. To me, the chain of care is a fundamental idea, and in relation to NSPs, it’s about those initial engagements: responding decently to the person and then being sensitive to the fact that people ought to be included in the chain of care and linked to the drug and alcohol service, or the mental health service, or the homeless persons service, or their housing or, might I say, to Centrelink so that they can get their appropriate benefits.”