Cohealth

Thanks again for taking the time to chat. For those who aren't familiar with Cohealth's work, maybe you could start by telling us about your mission?

Cohealth is a community health organisation with about 1,000 staff providing services to marginalised people across the North and West of Melbourne.

We have about 50,000 clients, and we focus on groups with high needs, people who wouldn't normally engage with mainstream services. Refugee health and public housing towers are a huge focus for us. There’s a lot of case management, and really helping people around their health and wellbeing.

What separates Cohealth or their approach from other health organisations?

I think there's a couple of things. This is my first time working in community health after a career in primary care, but the real difference with community health is the social care model.

It's not just about curing your illness, it's looking at the broad range of needs that people have around wellbeing, housing, and of course, mental and physical health.

But it’s also about connection to community. We're really looking at the broad social determinants of health, which is really how you fit within society. We also do a lot of work around poverty and income support, including advocacy to governments.

Social connection is definitely an issue that's getting more prominence in our current context. How do you see social connection and health playing together?

It's one of those things that I would say community health organisations, and the Aboriginal community-controlled health sector have been doing for a long time. Everyone else is just catching up.

For a few years, the UK has had a ‘Minister for Loneliness’, Australia is yet to see anything like that on a political level, but it’s certainly happening locally.

People get together and tell their stories, that’s the importance of community.

I heard something fantastic yesterday about how the coronavirus has community transmission, but the health information is also transmitted through the community.

Community connections are where people get messaging from. They're not sitting around watching Dan Andrews’ press conference every day. It's through your peers and your networks, those connections are how we communicate health messages.

Community connection is a real focus for our work as one of the things we are worried about is the impact of coronavirus on the arts, music and other creative outlets.

We're trying to support a lot of that online, but when we can actually get back to getting people together in groups around their common interests, we'll be very happy about that.

Tell me about how your approach has changed or how you've adapted during COVID.

Firstly, we've been distributing technology, phones, smartphones, and iPads to our homeless clients so they can stay connected with us.

It’s resulted in some of our homeless clients getting together and developing a newsletter on providing advice to people who are newly homeless.

Advice like, where do you get services? Where are the good toilets? Where are the showers? Where do you get food? The real basics and how to stay safe. Where to sleep, what to look for, what to be aware of.

What’s also been great is that some of the homeless people involved have said it's given them an interest in writing now. Doing something like that online has really helped people gain some skills while giving them a vision for a future, which I think is lovely.

Another example has been our focus on engaging the community around the virus. We've hired 160 people from high rise towers to be health concierges and provide education around the pandemic to their community.

Most of the people we’ve hired have never worked in Australia. We're able to provide support with all the forms and questions that come with having a job in Australia, things that people who work in offices take for granted.

We see this work as a real opportunity. That's 160 people who now have experience within the Australian health system. That's a tiny silver lining around the kind of work that we do, that we've managed to engage the community.

You mentioned before that community health has been doing this kind of social connection work for a long time, and it's only just starting to emerge into the mainstream consciousness. What could other industries or other sectors learn from what you guys have already been doing?

We've been thinking about it recently... and again, coming back to the pandemic, in the North and West of Melbourne, we were the hotspot. The housing towers went through the hard lockdown first—and then we reached zero cases across the whole of Melbourne.

What has been successful is our understanding of our community. We understand them innately. We understand how to put them in charge, how to get them making the decisions.

We have community advisory committees, they're part of our governance, they're part of our program. I think that's an investment over a long history of trust. It seems like we were able to move really quickly, but it's based on 10 years of building relationships. We just didn't fly in and try to do that work.

We actively reach out to our clients. We have a relationship with them, which isn't just about them walking in the door. When we had 3,000 people locked down in the Flemington and North Melbourne high rise towers, we quickly realised about a third of those people were already our clients.

Behind the scenes, we engaged whoever knew that client, so it might have been our dentist, and our dentist would give them a call and ask, "Do you understand what's going on? Are you okay? What do you need?" Just checking in, being that familiar voice on the phone during a very stressful time.

Again, it's built on a platform of trust and understanding. I hate to say it's philosophical, but it is. That's our mission, to work for the community and to have them involved in decision making.

What could organisations do to help build that trust and those relationships with the communities affected by their services?

While we have a range of GPs, nurses and allied health professionals that provide care, they're coupled with our community engagement workers—our bicultural workers— who are that link between our service and the many specific language communities or cultural communities.

Over the last five years, there's been hesitation from the government to invest in community engagement because it's not seen as healthcare. I think if the pandemic is teaching something to governments and society more broadly, it's that those things actually matter.

I think that's been a big lesson that we want to make sure is maintained beyond the pandemic, because that investment is the platform for your entire service. It's so important.

What strikes me about the community health approach is the systems-thinking and interconnectedness, whereas some more reductionist ways of thinking might try to silo off those things.

I think it's interesting because our funding is definitely provided in a silo. It's our challenge—as the organisation on the ground with hundreds of different funding streams—to figure out how to wrap those around our clients.

Just the other day I was invited to a meeting with the local council, and they were asking, "Well, what's our role in the recovery and in healthcare?"

We were discussing their ability to bring people together around activities, because they have gardens, sporting grounds, swimming pools and events. Hearing them wanting to lean in and recognise their role in connecting the community is wonderful because if they do more of that, that really complements everyone's wellbeing.

It's how we come together as different people, and different cultures, different attitudes around music, a food festival or a theatre experience, whatever it is. So, I think councils are seeing the value through a health and wellbeing lens, not just a vibrant community lens.

This series is really about talking about people's different definitions and understanding of what community is. What does community mean to you?

I think it's the people you interact with each day. My community isn’t just my friends and my family, but the woman who walks past with her dog, who I have a chat with while patting her dog. All those daily interactions, where I walk and where I move my body around the neighbourhood.

But then I also have online communities that centre around specific interests, whether it's the live music scene and sharing stories from the past, or bands that we've seen, or whatever. Those are people I've never met, but they remind me of the collective experiences that we've had.

I think that's probably my other sense of community, which I think this is something we struggle with as Cohealth, like what is our community? Is it a place? Is it people in a place? Or, is it people who share experiences? That's very much where we have both. I think we try to cater for both. It's a big word, isn't it? Community.

Sometimes we use community as this blanket term, but hearing you talk about the services and how you're engaging different groups, it sounds like there's a whole bunch of different communities that overlap and intersect.

If we think about Melbourne, some of the things that we just spoke about was the homeless community. There's a shared experience there, and it's a unique experience. They have intelligence and insights to share with each other. I would say from our point of view, that's a community that we want to tap into and support and be part of.

There's also our refugee community, people with a shared and potentially traumatic experience—spanning very different cultures and very different backgrounds.

That experience of being a refugee is something that unites them. But thinking about our bicultural workers, they work within language groups. People who have a specific way of communicating have specific Facebook groups as an informal way of staying connected.

There's also place as a community. You live in West Melbourne, and there's a certain identity to that. There's place, there's language, there's experience, and I think that's how we've pivoted a lot of our services. I think it comes from need, and a community who are identifying that need.

Something else I've been thinking about lately is the role of place in community and it seems to me—and I don't really have data to back this up necessarily—that we're becoming less connected to place, as we go forward. Is that something that resonates with you at all?

I think that we may have been moving that way before we had our five-kilometre limit. I mean, this is purely anecdotal, but we’re hearing that our CBD is quiet.

People are not going to the CBD. But some of those little shopping strips in the suburbs are quite vibrant, because all of a sudden, people are working from home, and they're going for walks. Petrol sales were at an all-time low, so people were staying within their neighbourhoods. There's been this vibrancy and this invigoration of the place where you live, and the importance of it.

People who don't have amenities nearby, they just live near other houses, and there aren't any shops or parks, I think those are the people who were struggling the most, because you need that within your neighbourhood.

The five kilometre limit has taken us back to the 1800s, hasn't it? Where your place and your nearby areas are so important. What will be interesting is whether that's maintained later, but I personally feel like I’m staying in my suburb. I live in Richmond and the dog park is full.

It's a great joy just to walk past and see my neighbours and see the dogs of the area. While I’ve been staying at home, that sense of place has strengthened much more compared to when I was always going into the CBD and getting on the tram.

It's so true. I live and work in Fitzroy, so I have no reason to leave five kilometres anyway, but since this has started, I feel like I've got such a bigger connection to my neighbours and the green spaces, especially.

I just want to pick up on a couple of other things that have been coming up. You mentioned stories and the importance of sharing stories and community. Can you talk a little bit about that?

I'll say in our community, particularly the people in the housing towers, storytelling is a key part of recovering from the hard lockdown when people couldn't leave their apartments. It was very traumatic.

Storytelling is being able to share what they've been through and what it meant to them. How nervous they were when they saw police assemble around their buildings and how that felt, but also the story of how they got on top of it, of sharing their success and caring for each other.

These are high-density environments, it’s very hard to maintain any kind of social distance, there’s shared foyers, shared laundries, a lot of shared space. And yet, that community has managed to do that. I think they need to come out and celebrate that, it's a good story about the success of that community.

I think that storytelling—from an individual level—helps you identify common ground with others, doesn't it? It's what we have in common and what shared experience we have.

I was talking to someone about the advocacy work that we do around public housing. I grew up in public housing, and through that conversation realised that some of my colleagues did too. That's our shared story. We would never have been able to look at each other and say, "Oh yeah, you grew up in public housing" but we had this shared story about what that meant to our parents. For me it meant my mum could go to university and become a teacher, being the first in her family to do that.

That's why I think storytelling is so important. It gives you space to get to know each other.

Another theme that was coming up a lot was art and creativity as a way to connect. What is it about being creative that helps people connect?

For some people, it's almost the difference between breathing and not breathing. It's part of who they are.

I’ve been learning about the injecting drug user community, because of some work we're doing. It’s highlighted the importance of group art activities, and how highly sought after they are by that group of marginalised, vulnerable people.

When you announce that you're having an art class, it will be completely oversubscribed. That ability to express yourself when you feel powerless or you may not be good at communicating through writing or in conversation can be really healing for people.

There's also just when we're in highly logical environments for work, you know you're relaxing when you're doing something creative. That's certainly how I feel. It just activates different parts of the brain. But again, it's about a different type of community. If you don't have your hobbies and your interests, then you just really have work and television.

There's a reason that we as a community health centre have an arts generator, and talk about the importance of the arts, and it does have science to it. People often don't think about that, but there is a lot of science in this around brain development, the way you use your brain and the way that we connect with other people at that pointy end.

I think this might be a good one to end on, but how have approaches to community and health changed over the years, and where do you see it going?

We talked about the place-based approach. That was a real imperative last millennium, at the advent of community health. When that started, there was a very broad approach to healthcare, it was very place-based, and the community was involved, which was seen as critically important.

I think over the last 10, 20, 30 years, the way that community health is funded is more clinical. They're much more interested in funding doctors, nurses, allied health, or psychologists, which can be transactional sometimes. It relies on the client coming in and seeking care, having that autonomy over their lives and being able to have a regular relationship with a healthcare provider.

And now, just over the last six months, we’ve recognised the importance of place-based approaches, but after the pandemic, are we going to go back to being highly clinical?

That business mindset has been brought to a lot of our caring industries and that's difficult when we have complex clients with complex needs, that transactional care doesn't work for them. It doesn't work for us. It makes it hard to add up, one plus one plus one is not three, it's actually seven. Because of everything that goes on in between those specific clinical appointments.

I think that's what's changed, bringing a business mindset to the caring industries, including aged care. And that's what we’ve seen in the aged care Royal Commission: "This is how much you get for your food each day, and this is how much you get for your nursing." But it doesn't matter about how unwell you are, or how much money you have.

We're trying to retain the old style of care, with the focus on community and the focus on the whole of the person, while we're being pushed into this transactional mode. Which is old business.

Modern businesses understand service design and understand client engagement. I don't think they're particularly transactional, they want to have a relationship with you. So business has caught up to the relationship, but I don't think governments have yet.

Are you hopeful for the future changing that? Where do you see us going?

If coronavirus has taught us anything, it's about the social determinants of health. The people who have been involved in Melbourne's second wave understand why it's so difficult.

People in vulnerable work, people who work in abattoirs, people who work in aged care, people who work in the security industry, in Ubers, in taxis, and who are very self-propelling, all rely on being well and being able to go to work. They don’t have many work protections, and they're not highly paid, so a combined lack of job security and overcrowded housing has really contributed to the coronavirus.

I hope we retain our lesson of looking at the person as a whole. Our challenge is how do we maintain that, or do we just go back to being dog eat dog and ‘every man for themselves?’ We've had people with coronavirus who are being pressured to go to work by their employers and don't feel that they can stay at home.

Even with a $1,500 payment—which is a blessing—but what if you lose your job? We haven't put the employment protections in place, and we also haven't talked to employers about changing their attitudes. If you are threatening to sack someone who won't come to work because they have a contagious disease, there's something wrong, isn't there? We haven't quite got to that discussion, but I certainly feel that will come in the wash-up.

The lessons will be around those vulnerable groups who feel that they don't have choices, and how do we give them choices as a society? Because those are society rules, when you can hire and fire and whether you get sick leave and those kinds of things. I hope that's what's changed.