A smile

It all felt a bit odd. Definitely not the way we would do this stuff in Australia. But I went along without comment, which is not unusual.

I’ve been working with a GP and a Psychiatrist, both Balinese men practising in Ubud. The psychiatrist only comes here every couple of weeks or so. His schedule is a mystery to me, but I lose lots in translation so there may be a logic to it. His main practice is in Denpasar, twenty kilometres south. I have visited the day centre, Rumah Berdaya, that he started and runs through a ‘Yayasan’ or charitable status organisation. Most of the users are younger people with schizophrenia, and it’s a great place; full of pride in their achievements; getting severe mental illness out there into the heart of a busy city street.

The GP is an amazing guy, much admired by the ex-pat and local communities alike around Ubud. He seems to work endlessly, and while I’m sure he makes a good income from the ex-pats, his main driver is his Hindu religion. He just doesn’t seem to be able to turn his back on suffering, which is a recipe for burn-out that would deter most health professionals. A couple of years ago, he and I got talking about the almost complete lack of community services for people with severe mental illness in Bali.

Progress has been slow I think, but that may be my view of time, not necessarily shared by Balinese people. The hardest part has been finding people with mental illness in the local community. Attitudes are much like those in most countries where public health and welfare systems are still incomplete and/or inaccessible; where they just aren’t a reliable alternative to traditional medicine and doing your best to hide the problem in the family. ‘Coming out’ is a very big deal, so persuading families and individuals to seek western medicine takes great patience.

A couple of months ago I went with the psychiatrist and the GP practice manager to talk to two people whose families had asked for help. The first was in a beautiful family compound in one of the most prosperous streets in nearby Peliatan, which is world-famous for its dancing troupe. About fifteen people were grouped in a circle around the bale, the raised sitting area which is the outdoor focal point for many family activities. The psychiatrist and I sat apart on the bale, and two family members led a woman out of her room and motioned her to sit between us.

She is in her early forties, and is described by the family as being ‘possessed’ since she was about seventeen. She often talks loudly to herself, laughs for no apparent reason, and tries to leave the family compound, which they do not allow. She has ‘escaped’ several times, but was quickly found and returned.
She was visibly frightened of both of us, and sat in an almost foetal position, scratching at her upper body fiercely, sometimes giggling. In a family who were all well turned out, she was shabbily dressed, with lank hair, and extremely long fingernails.

So, there we were, perhaps twenty people in all, surrounding someone in obvious distress, all waiting to see what the psychiatrist would do. He began by asking what treatment the family had tried to find for her in the past twenty-five years. The answers, coming from many people, sometimes talking over each other, were all about faith healing, exorcisms and continual offerings at the temples. She had never met a doctor before. Like me, he doesn’t judge them harshly for this—they haven’t had much choice. Almost all GPs will not touch mental illness; just refuse to see it as their business. So, unless the family chooses to take her to the much-feared mental hospital in Bangli, the options have been non-existent. I make no judgement on Bangli—I haven’t been there–but it’s what these people believe that matters.

Because the discussion veered between Indonesian and Balinese, I only got the general gist. My Indonesian is passable but I know almost no Balinese. The psychiatrist’s brief summations in Indonesian, aimed at the family and me, helped me keep up to speed. Now the family, particularly the woman’s sister, were asking what could be done to help.

Rather than answer them, he turned to the woman, and made eye contact, by gently raising her chin. He said hello very quietly, re-setting the scene as a conversation between the two of them. The family members, ranging from babies to people who were most likely great-grand-parents, went quiet also, and most sat or squatted on the ground to watch.

He took her hand, and talked about her long brown fingernails, asking her if he could cut them for her. She seemed puzzled, started to pull her hand away, but he kept stroking it until she relaxed. Then he asked the family for some nail clippers. Excited chatter and a teenager dispatched produced them in seconds.
She flinched, looked worriedly into his eyes. He said (I think) ‘Let’s just do one and see how it looks.’ She nodded; looked intently at the clippers as if they were about to pounce on her. Mutters in the crowd intensified. Her sister said (I got this bit) ‘Just let the doctor do his work.’

One by one, with exquisite gentleness, the psychiatrist cut her nails, all the time talking quietly in Balinese. I saw her gaze shift from her fingers to his face, listening, apparently absorbed. He told me later he was explaining about the help she might get from an anti-psychotic medication. The first hand finished, he held it up for her approval. When she nodded and smiled, the whole family murmured support, and I sensed some excitement.

Without him asking, she put her other hand in his, smiling a little. Her body had relaxed now, her scratching stopped. Never hurrying, he cared for her nails one by one. The job done, he held up both her hands in his, and the family applauded. I wondered if this may have been for the first time in many years.

Throughout this process he had been asking for her consent to an injection, which was one that could be given once a month. When he now showed her the glass phial, she tensed up. Several family members jumped up, ready to restrain her. She began to panic immediately, but he held her hands and asked everyone just to sit where they were. He showed her the place, at the top of her buttocks, just below the belt-line of her skirt, where the injection would be, and she looked upset, but nodded for him to do it. I’ve often heard that Balinese people hate injections. If that’s true, she was brave, and his ability to gain her trust was outstanding.

It was over in seconds, and her frown turned to a smile, echoing many on the faces of the family. The toddlers I must say had looked horrified throughout, as soon as the needle appeared. I don’t know what they thought was going on, but theirs were the only frowns as we prepared to leave.

I felt I was in the presence of a special set of skills and insights. This young man, graduating only a couple of years ago, found ways to treat everyone involved with great respect, and to achieve an outcome with potential to change a woman’s life. She continues to have all the safety of the Balinese family and community system, which is now for the first time accepting that she has an illness for which there is treatment.

Post script
Yesterday I visited the same woman with a community nurse, for her third monthly injection. This time, only a handful of family members sat around as the procedure went ahead with no drama. But the big changes were in her appearance and demeanour. She was wearing newer and brighter clothes, her hair was clean and shiny, and she greeted us with a smile. The toddlers watched the injection closely, still frowning.

Because she only speaks in Balinese, I asked her sister how she was doing. ‘Happier, healthier, sleeping well now, not scratching’ was the gist of it. Does she still talk to herself? ‘A little Pak, but not like before.’ Then she asked who I was. I explained briefly, and she thanked me for coming. I shook hands with her and the woman we were visiting, who seemed unsure about the ritual. I don’t think she had shaken hands before.

This whole episode leaves me with mixed feelings; stuff to think about. Our western approaches rarely involve the whole family and a visiting retired mental health administrator sitting in on a consultation. While I don’t blame the family, it confronts me that they have effectively kept her a prisoner for her whole adult life. And I know that medication is only the first step to getting a life back, to becoming a full-functioning member of this community. She has so far to go on that journey, and there are no support services, government or private, to help.

It’s a start, a tiny shift in community acceptance of mental illness, and one person’s life given a little better chance to succeed. There are a few others in our project now getting similar help for the first time. I know there must be hundreds more out there in this district of half a million people. There has to be more I can do, but it’s not clear what that is. That woman’s smile is a much-needed energy booster.

Achievement

Today I am waiting nervously, excitedly, for my first working meeting with an editor. Only three hours away. Krista comes well recommended by people who have taken the time to write to tell me how much she helped them. Step one has been for her to read the first 50 pages of my novel. I’ve given her the sixth draft. I got to here with only one brief input from someone else a couple of months ago.

Now my eighty-seven-thousand-word baby is out there, in the purview of an expert at finding jewels in the dross; of wrangling a readable whole from my first attempt at fiction in any form. Actually, I’m not nervous; I’m exhilarated. This is exactly where I want to be; on the writer’s journey. I’ve always known I wouldn’t get it done on my own. I’m eager to get professional advice on how to polish what I’ve got so far; and as I’m sure will be necessary, to re-write, re-organise, make additions, and delete bits.

The objective here is not to get a pat on the back. It is to make my book the best book it can be. And for that to be a work that I know is well-written, well structured and compelling to at least some readers. If that means several more months work, I’m up for it. The great beauty of not having to work to live the good life is that I have all the time I need.

I’ve done enough in the last two years to know I have so much joy to come from the writing ahead. Being completely absorbed in an activity, whether it be chairing a meeting, selling an idea, arts and crafts, sport; whatever you find rewarding; those are the times when life is full. Learning new skills, gaining new knowledge, using the skills you have to the maximum, and above all, basking in the sense of achievement as you lift your game.

Like everyone else, I often go on about living every day as if it was the last and so on. Like everyone else I don’t. But these days, when I write, I know I haven’t wasted a second; I haven’t missed a thing that matters; there’s nowhere else I’d prefer to be.

So, on with this writing life. The writers’ groups, the courses and the retreats, the research, the structuring of plot that challenges my big-picture abilities, the flashes of insight about where my fictional character is likely to go next, the worrying at a sentence or paragraph until it is as concise and pleasurable to read as I can make it. I love it all.

Energy

I sat in the lounge re-reading Elizabeth Pisani’s amazing ‘Indonesia Etc’ today. What an enchanting combination of true adventure and poetic writing. A French accent interrupted me.

’Ello’

There was a tall woman, super-glamorous, to my eyes the ilk of Naomi Campbell or Halle Berry.

‘Can you tell me please where I can go for yoga?’

I wish I could write the accent and the husky tone in words, but use your imagination.

I ran through the three best known options, Radiantly Alive, The Yoga Barn and Intuitive Flow—the names alone keep me at a distance—and she chose The Yoga Barn.

‘Oh yes, I ‘ave ‘erd of it’

I asked if it was her first time in Bali.

‘Yes, and tomorrow I ‘ave to return to Paris. Paris is good, but ‘ere there is a great energy. I feel it as soon as I got off the plane. People tell me this, but now I know for myself. I am so sad to leave.’

At which point she cried, clasping her hands to her face—embarrassment, emphasis, I’m not sure.

‘I don’t want to go; it ‘urts in here. (indicates heart) Is Bali in your ‘art?’

‘Yes, it is. The people, the culture, the physical beauty of Bali all call me back again and again.’

‘It is too much. I must go to yoga now. Goodbye.’

And with quick wipe of the tears, and a flourish of her long scarf over her minimalist crochet top, she was gone.

This sort of thing rarely happens for me in Adelaide. Am I just looking in the wrong places, or don’t these people come there?

Tonight, I am off to a movie at a friend’s house. They host anything up to thirty people, and we must all bring a plate to make a collective feast. Last week I sat with a woman in her eighties who speaks six languages–Russian, German, French, Italian English, and Indonesian—and likes to read in all of them except Indonesian.

‘I confess I am not fluent enough to read Indonesian without a dictionary.’

Ah, not so smart then.

‘And are your languages useful to you, apart from reading?’

‘Reading is wonderful, especially in Russian which I like the best, but it is very good to keep up correspondence with people who exhibit my textiles in many cities. Most speak a little English, but you can’t carry on a proper discussion about the nature of art, and properly describe what you are making right now, in a language you don’t speak well.’

Oh, very smart, actually.

Maybe I’ll sit with Anne-Marie again, or maybe some other exotic, gifted and wildly experienced person, traveling through or living here, will engage me in conversation. Or one of the hosts will. Dave is an energetic, voluble local, originally from Texas. He’s keen to talk politics, especially his visceral dislike of Trump and the Republican Party in general. He’s also a keen environmentalist, who has dived most of the best locations in the Archipelago.

Pong, who comes from Thailand, is a soft-spoken, warm woman who exudes almost saintly calm and gentility in the best possible way. She works the room, greeting everybody like her best friend. A couple of minutes talking with Pong has as much impact on your grounded well-being as many two-hour mindfulness workshops. In terms of social skills, Pong is a rock star.

And apart from my morning two-hour ride on my own through all manner of Balinese settings, and getting my butt kicked at pool by my friend Barry this afternoon, that will be one day in Ubud.

She is right. The energy here is palpable. Call it sacred, mystical or just, as I do, a perfect blend of people and place making each day feel slightly out of this world. And I do feel it right after I get out of the airport.

Stuck in Bali

Stuck for writing ideas is what I’m referring to. Hard to imagine the feeling stuck because you’re desperate to leave Bali. For me at least.

I do meet ex-pats living here who get like that every few months. They use words and phrases like ‘feeling trapped’, ‘gotta get out of here soon’, ‘Bali fever’. Some are more specific, such as;
‘I need to go somewhere organised for a while, where the traffic is predictable, where the infrastructure works all the time, where the water is safe to drink.’
Or;
‘Just because I live here doesn’t mean I want to travel less.’

The result is that most ex-pats are always just back from somewhere or already planning the next trip. Which for me can be a bit tedious; essentially it feels like I haven’t left home, where the conversations constantly turn to the same topic.

Of course, there is more focussed travel. A common necessity is the ‘visa run’, where people who haven’t got through the bureaucratic miasma of obtaining longer-term residency have to leave the country for a day and come back. The cheapest option is usually Singapore, although some go to KL or East Timor and spend a few days there. One gay couple I know went to Europe to get married, because to do it here is illegal and could result in major visa problems.

Another is medical check-ups and procedures. Bali has some good options for surgery and dentistry, but Thailand is much more favoured. Medical travel is a huge industry there, and the reports about price and quality are glowing. Vietnam is well thought-of, but it’s a bit more expensive to get to.

Finally, the need for face-to-face contact with family and friends rarely goes away completely. Given my demographic, it’s ageing parents and new grand-children that are mentioned most, along with important events, especially marriages, or major family get-togethers. Grand-children can be game-changers. I know couples who are leaving permanently, or for the majority of the year, to be closer to them while they can. The women in particular don’t want to miss the opportunity to be involved, and to support their children with their babies.

I have met people who have no-one left outside Bali, or no desire to stay close. I read the phrase ‘the whiff of burning bridges’ somewhere recently, and that’s not an uncommon part of the back-story here. They have either no contact, or leave it at occasional emails or skype calls. Somebody told me they had chosen Bali because ‘it is as far away as possible from my family’.

The ones who have no desire to travel fall into two groups; the fully settled and the poor. The first are resolved; ‘I’m staying here till I die and that’s that. If anyone needs to spend time with me, they can come here, because I’m staying put.’ One woman, in her nineties, almost blind, has refused all efforts by her family in Europe to go home and be cared for. She was born in Indonesia, lived away for nearly seventy years, and feels completely at home in Bali.

The poor, and there are many of them, have just enough money to rent accommodation, eat and socialise a bit. They know the restaurants that still offer lunch for $2, Travel is an out-of-the-question luxury, except the occasional visa run. It used to be possible to ‘buy’ that entry stamp on your passport, and might still be, but the consensus is that it’s too dangerous now. Some hide away for years without a visa.

I knew a man who got away with it for more than a decade, living with a local family in a tiny, remote village. He worked for a well-known Ubud restaurant without pay, instead getting as much food and alcohol as he wanted. He tried so hard not to create any record of himself, but somebody noticed. Tipped off in time, he hung himself just before ‘Imigrasi’ arrived to deport him.

Finally, there are the wanderers, always moving around the world, but staying in each place for long periods. They may have good insight about that, and not put down deep roots, or keep hoping against the evidence that this is it, the place to call home for ever. Turkey, Costa Rica, Thailand and Mexico are all mentioned often. I do miss one woman, who was the life of the party here for ten years. She moved to Mexico a few month ago, ‘because it’s time for my next adventure’. She is about to turn ninety-one. From there she had already visited Antartica, and is currently in London.

So, the crowd is never settled here, always in flux. There are downsides, like the frustrations of my choirmaster, who just can’t find a date for a performance when enough singers will be here at the same time. After tearing his hair out about it last week, he announced that he was going away for two months directly after our next concert.

But it works for most people. Last week I chatted with George at croquet. He has been coming to Ubud for thirty-five years, with his late wife until twenty years ago. He stays in the same Homestay for two months every year, June and July, paying the same price since 2000–$15 Australian a night. He strolled into croquet, said ‘Hi folks, I’m back.’; picked up a mallet and played. That’s just how I slip in and out of Bali. Works for me.

Turning point

I’ve been asking myself why I’ve been writing every week, several days a week for most of 2018, and not just writing, but being driven to get it out there on my blog site as soon as each piece is complete. Charmaine says I seem to stay on edge until I post, which I usually won’t do until she has read it and commented. I nag at her to read what I’ve just finished; and she’s right; it’s a sort of release, a completion of some process, when I hit ‘publish now’.

So why write? Because I have ever since I learned to read and write, in one form or another. I’ve usually enjoyed it, and now in retirement I have this chance to spend large chunks of time on just about anything I choose. I’ve always said to myself I would grab the opportunity to attempt well-crafted, meatier pieces of writing, and get into processes of feedback that would help me find out if I have what it takes to make work that people want to read.

And there’s the clue. I don’t just want to create good stuff; I want people to enjoy it. I have the urges of a performing writer, looking for applause, or at least for a reaction that isn’t too critical of my use of words and sentences. I guess people have been examining those motives in art-making forever, and debating what art means, if anything, until it has been viewed. I’m sure a therapist, or any keen observer could hone in on the life-long needs in me that this is all about, but it doesn’t feel important for me to know. Writing as well as I can, and wanting to see if people like reading what I produce, doesn’t sound too pathological, as long as that need for applause is somewhat under my control. I worked in arts education for a while, and I wouldn’t want to turn into the sort of self-absorbed, attention-craving, frequently anxious artists that fret their needy ways through a constant search for validation. So far at least, this exploration of writing doesn’t feel like that. (Charmaine has just suggested that it may be too late; I may already have strayed off the reservation. I guess only time will tell.)

A close friend of many years has said he is worried about me putting so much personal information in the blog. At least, not so far, but he thinks I might be about to reveal more than I should in public, because I’ve finished most of my work history. That’s not going to happen, and not because Trevor is concerned; I simply have no urge to go there. I’m not especially driven by the need for anyone to know about my life, beyond general interest. Just because I do want an audience, and the material so far is my life, doesn’t lead to that conclusion.

I started writing a partial memoir, not as a therapeutic exercise, but simply because I’m what I know best. I’m the topic I have to research least. It was the easiest way I could think of to get cracking. I’ve pushed and shoved and shuffled around most of what I think is worthy of potential readers’ interests in my life into some sort of first draft. I’ll go on with the tasks that people who know this stuff tell me to, and see if it has a future as a short memoir of about 60,000 words. (A memoirella?) But I think my next writing content and genre will take a sharp turn towards fiction. I’m done with my history, at least as far as autobiography goes.

My hunch is that this is when the hard work starts. Everything I read and hear about fiction tells me it is going to take a ton of trial and error to manage the basic conventions, while I try to find a distinctive voice with topics and settings that I haven’t even started to think about in any detail. I’m going to need a lot of help. I’ve just signed up for a one-week retreat in April, and I will start searching for groups for would-be writers that meet near where I live as soon as the Christmas holidays are over.

This probably means a very different relationship with blogging. Up till now, I’ve put most of what will form my memoir up on justwrittenonline.com as soon as it was written. If I set out to write a novel, posting something once a week or more would mean writing different material at the same time, unless I tried the Charles Dicken’s model of weekly instalments. That’s not likely, so I guess the next postings might be short pieces on the issues of the day, or something about recent travels to lovely places. So many opportunities for more writing!

Bad job choice

I knew it was time to leave the Helpmann Academy, but the job offers for me in my preferred fields of health and welfare services just weren’t there. Late in 1997, the Liberal Party was back in power, and the Minister of Health was my nemesis from the Hillcrest Hospital dramas of five years before. I probably should have stuck it out in the Academy until something good came up, but my personal life was in chaos right at that moment, so when I was offered a job reviewing public subsidies for arts institutions, I grabbed it without really checking out what I was supposed to achieve. By the time I did, it was too late to turn back.

The new CEO of the Arts Department was an economic conservative, who had assured his Minister that substantial budget cuts were possible without much political risk. In our first discussion, he made several key points; viz;

• Most of the senior people in the State Theatre, the Festival Centre, State Opera, Art Galley of SA, etc, etc, were ‘socialist types’ who were too used to the easy life of government funding without much accountability for results;
• They weren’t trying nearly hard enough to raise funds from the private sector and the public; if this was the USA they would have to find most of their income from foundations and the like;
• It was time for a shake-up of people, so some amalgamations or other forms of re-structuring were needed to create opportunities to make the ‘fat cats’ apply for their own jobs;
• My job included finding substantial savings, beginning with at least a few hundred thousand dollars in the next financial year.

I was very uncomfortable. I had a sinking feeling that this guy would only get more strident and opinionated as we went along, and in other circumstances I would have walked away. But I had just separated from my wife, and I had to prioritise holding on to my public sector executive rank and salary, so that she and my kids would be OK financially. I’d already left the Helpmann Academy a few days before, and there was no going back. This time I had to take a job I didn’t want, the only time I can remember doing that. I asked how long I had to complete what was really a consultancy, and he suggested six months. I agreed and we shook hands.

It was near Christmas, so I had a couple of weeks off, time spent mainly finding somewhere to live, before I had to begin learning how the top end of the subsidised arts world worked. After moving into a friend’s house in Semaphore, it was back to the office. Within a short time, I had the walls covered in organisation charts, showing the people and the dollars, which were much less than I had imagined. I think there was less than $20 million in total for the twelve major organisations; and this was in South Australia, which prided itself on being the ‘Festival State’ because of events including the Adelaide Festival of Arts, the Fringe Festival and the world music event ‘WOMAD’, which were, and still are, much celebrated in Australia.

There had been several other reviews in the couple of years before this, both of individual organisations and of arts funding in general. I had to read them all, and there was little there to support the government’s current down-sizing objectives. I don’t know for sure if this had anything to do with it, but during that consultancy, the Arts Minister was the only member of the Liberal Government I ever saw at an arts event of any type, except for one performance of ‘The Pirates of Penzance’, where I met the Minister of Health. The arts just wasn’t their scene, although I must say the Arts Minister was and still is a stalwart supporter of many art forms, so I think the fiscal pressure was coming from other Cabinet colleagues, most likely the Treasurer. My guess is she was a lonely voice in that Cabinet, not least because she was the only woman.

For about three months I prepared an overall summary of where the money was, how it was being spent, and how that all looked in comparison to other parts of Australia. It soon became obvious that South Australia was not providing any more public funds than anyone else, but the proportion of income raised from other sources was low compared to New South Wales and Victoria. One woman, a rich arts donor, told me our problem was that ‘Adelaide doesn’t have enough wealthy Jews. In Sydney, and especially in Melbourne, they are the backbone of the arts.’ Whatever the truth of that, I knew from my time in the Helpmann Academy that getting large donations and bequests for the arts was rare in Adelaide. I had so nearly proved otherwise with the Helpmann fortune, but nearly changes nothing. It was all very well to say the local subsidised bodies weren’t trying hard enough, but their Boards were stacked with conservative rich people, many appointed by the current government, and they didn’t seem to have the answers.

So my only recourse was to look at achieving some administrative savings by reducing the number of separate arts organisations. I had observed before what I think of as the iron law of separateness—organisations will tend to want to remain separate, unless there is a major incentive to change, or force is applied. CEOs and Board members work in their little corner of the world because they love it, and there needs to be a very good reason for them to lurch into the unknown. As I got to know all the CEOs of these arts agencies, I could see no signs of an appetite for new arrangements, except for those few who told me ‘strictly between you and me’ that they would be happy to absorb one or more of the others as long as they retained the lead role.

I bargained with my boss. How much did we actually have to save in the 1998/99 financial year? We eventually settled on $200,000, and I started devising scenarios that would achieve this. Was anything definitely off the table? The answer was ‘No, but you’d be crazy to touch organisation X, or Y, or Z.’ With few options left, I proposed two major amalgamations, both leaving one of the untouchables in charge and enlarged, which would yield $200,000 (Based on experience, I actually meant ‘Just might yield $200,000, with exceptional luck and steady management’, but consultants don’t say that sort of thing).

My boss was impressed, and surprised. What I suggested was ‘do-able’ (his term) as long as we kept it a secret until the Minister was on-side. I was to write it all up, prepare a one-page summary for the Minister, and say nothing to anyone else in the Department. I could then wind up my consultancy, and make my own arrangements to find other employment. Within a week, I delivered, and waited to be called to the Minister’s office, the usual next step in these things.

I’d done what was asked of me. I knew these changes would need very adroit political manoeuvring to have any chance, especially given some of the heavy-hitters on the Boards of the organisations who would think of themselves as losers. I intended to say that to the Minister when I saw her, and offer to assist. I liked her, and I didn’t want to see her get further marginalised among her conservative and minimally-arts-loving colleagues. But the call never came.

Somebody must have leaked. The Minister was confronted by journalists asking if it was true that a secret report existed; one that proposed to cut funding to iconic arts organisations. I thought she had received my briefing, because the Arts Department CEO had told me he handed it over personally. In retrospect, it’s just possible she was blindsided. She said the usual things, such as ‘We are always looking closely at how tax-payers’ dollars are spent, but no decisions have been made about any cuts of the type you describe.’ The journalists, obviously holding a copy of my report, pressed harder, but she managed to fend them off. I would be surprised if phone calls from irate Board members didn’t come in thick and fast.

I knew none of this. It happened a couple of weeks after I had finished that job, and I was just beginning a new role in the Health Department. Today’s constant newsfeed on the smart-phone didn’t exist then, and the interview had missed the evening news. It wasn’t till the day after the Minister’s run-in with journalists that I read in the paper what had happened in the Legislative Council the night before. The Minister told the Council that she had just been made aware of ‘The Meldrum Report’, which ‘contained some rather radical ideas about re-structuring the main arts bodies’. ‘But’, she went on, ‘it is certainly not my intention to implement any of these proposals.’

Which dropped me right in it. My first call was to the Arts Department CEO, but he never, and I mean never, got back to me. I wrote to the Minister, and got no reply. I was very stirred up, worried that my name would be mud in the arts world from now on. And it was, at least with people who didn’t know me well. Within a week, one Board I was on asked me to leave the room, while they discussed a vote of no confidence in me. This was brought on by a fellow Board member who happened to be CEO of one of the arts agencies I had recommended should be amalgamated with another. The vote was upheld; I returned to the meeting to be informed so; frostily thanked by the chairman, and asked to go. I gave a little speech, to a sea of thin lips, thanking them for the opportunity to support their work, and left in as dignified a manner as I could dredge up. The next few days were very hard for me.

Although I kept quiet, lots of people guessed correctly what had happened, and I didn’t lose any good friends. Ironically, because the arts world is so marginal to most peoples’ interests, almost nobody in the health/welfare world had even noticed. Which was great, because I didn’t want to deal with a reputation as a victim or a loser. As usual, I preferred to move on, even though I did feel wounded for a while. Some enmities persisted. The CEO of one arts company refused to speak with me ever again, whisking past me in the street or at events with exuberant disdain. But I could live with that. I was just doing my job; I was told funding cuts had to happen, and the proposals I made were the least damaging ones I could come up with. As for the Arts Minister, the CEO had told her significant savings were feasible without much political risk. He was wrong. So be it.

Recently Charmaine and I went to a fascinating talk on Japanese art from the 17th century. And there was the Arts Minister concerned, now long retired. We chatted easily, and I enjoyed her company for a few minutes. Those events in 1998 all seemed so unimportant now. We were just actors in a process of a type that goes on constantly. I know I did my best, and It’s likely she feels the same way about herself.

Being brave

The defining issue for me in 1966 was the Vietnam war, partly because that year I turned 20. All 20-year-old men were in a lottery whether they liked it or not, to see if a marble with their birth date on it came up. If it did, you were conscripted into the army for two years’ service, with a high likelihood of being sent to Vietnam.

As a university student studying liberal arts, I was almost naturally against the war. Only a few brave souls in my psychology and history classes supported it openly. To get a real debate going you needed to pit economics or engineering students against us long-hairs. Outside the university, I was in a very different zone, whether at one of my factory jobs or having dinner with my girlfriend’s parents. Her dad was a WW11 veteran who believed we had to stop the commies in Vietnam the same way he did with the Japanese in New Guinea in 1943. Any other view was stupid and possibly traitorous. Most of the time I shut up, but we did get into a few heated arguments that ended with both of us red-faced, sullen and unpopular with the rest of the family.

Australia went ‘All the way with LBJ’ immediately after the USA got involved in the war, and within a few months in 1966 I think about 200 Australian soldiers were killed and many more wounded. On campus, we talked about it every day, and many of us took part in the first of the ‘Vietnam Moratorium’ marches that went on until Australia announced its withdrawal in 1972.

As my ballot came closer, I started to read up on the causes of the current conflict, and about the experiences of conscientious objectors in recent wars. In 1966, saying no would mean two years in jail, and it sounded as if that would be a hostile environment for people branded as cowards. I was beginning to realise that it was only the truly brave ones who went down that route.

In those last few weeks I withdrew into myself on this issue, torn about what to do if my number came up. Part of me was attracted to the adventure of traveling to Asia to test myself in challenging situations. I never wanted to kill anyone, so I romanticised about being selected for intelligence work, anticipating the plans of the enemy, and working out how to ‘win the hearts and minds’ of the Vietnamese people. But I couldn’t even fool myself with that line, knowing that whatever part you play in a war, in the end it’s about who wins lethal combat, and about the hapless civilians whose lives are lost or ruined in the process.

The night before, I sat at my study desk for a couple of hours, supposedly trying to write an essay, but completely distracted. Was I prepared to go to jail? Was I completely sure that I knew what I was talking about in opposing this war? Why should other young men risk their lives if I wasn’t prepared to? Could this be the biggest experience of my life, one that I would be a fool to miss? I believed I had to have this sorted before I found out about my marble, so around midnight I made a decision. I would go quietly if I was conscripted, because I didn’t want to go to jail.

That moment was a shocking one for me. All my commitment to the anti-Vietnam movement seemed hollow and pretentious now; I had shied away at the first hurdle. I felt pretty sure I was making the right decision, but I didn’t know what it would be like to live with the consequences. I thought I might come to see myself as a coward for not sticking to my principles. I went to bed clear about my decision, but too tense to sleep. By the next morning, looking in the bathroom mirror I saw a worried stranger, someone who had arrived at this place without any clarity about why.

I went to lunch in the university refectory, and then walked with three of my friends to the building in Currie Street where the marbles were rolled around in a glass sphere. We were all jittery and a bit loud, feeling quite powerless. I didn’t talk about my decision of the night before, still too confused to say anything coherent about it.

My date didn’t come up, but my best friend’s did. We went to have a beer nearby, and he talked non-stop, rattled about how to finish his studies, finish renovating his beloved MGTC, tell his girlfriend and tell his parents. He went on to be selected for officer training (largely because he was an ‘old boy’ from an exclusive college) and went to Vietnam. He stayed in the army, retiring twenty years later as a Major.

As for me, I felt a huge anti-climax. I’d made my decision, I had to live with what I would have done, but nobody knew about the process I’d gone through. I was lucky enough to have one good conversation about that with my father a few days later. He thought it was uncannily like his own experience in WW11, where his pacifism proved very shallow when several of his best friends went off to fight, a couple never to return. He tried to enlist, but because of his scientific work, he was deemed to be in ‘essential services’ that had to be maintained. He said; ‘You’re lucky to be out of it, so just leave it at that.’

It wasn’t that simple. I think those days defined me as a middle of the road type on most issues. I found myself watching passionate people exhorting the rest of us to action, and reserving my judgement about whether they really knew what they were talking about. I became much more likely to think ‘Let’s see what they actually do rather than accepting what they say’. I’m happy to watch and wait before I’m a bit clearer what it is people believe in strongly enough to back themselves. I hope that makes me sceptical, but not cynical. It wasn’t a bad outcome overall. Over time I came to accept that my process around the conscription issue was OK, a productive bit of growing up. I think even now it helps explain why I go with the flow most of the time, but when I make decisions, I stick to them, even if it means being a bit lonely.

Fifteen years later, I worked with a man who decided he would say no, and when his marble did come up, he went to jail for two years. He had a bad time there, with most guards and fellow prisoners treating him as a coward who had let his country down. Now, as a family social worker, he was quiet, kind and widely respected. No matter how challenging our clients might be, and some were real heart-breakers for us, lurching from one terrible decision to the next, Phil stuck with them. He taught me the meaning of ‘walking alongside’, when your clients have even given up on themselves. I guess we all go on different routes to find our strengths. Phil and I went opposite ways on one decision. Was he braver than me? I thought so at the time, and maybe I still do, sometimes at least, when I’m not too impressed with myself. But you can be tested anytime, and I try to hold on to the memories of when I know I did the brave thing. Everybody’s got some.

A bad reputation

If adolescence marks the beginning of a clearer sense of who you are, and who you do and don’t want to be, I hit it at 12 years old when a girl told me I had a bad reputation.

For the previous three or four years I had been a very naughty boy—not all the time of course, but often enough to be a worry to my parents. And they didn’t know half of the things I got up to, often with my younger brother as a willing accomplice. Shoplifting was my debut, after a friend in school told me he had grabbed some fireworks from the news-agency. I had the perfect accessory; a double-breasted overcoat with big inside pockets, so it was easy to lean over an item and slip it in without appearing to put your hands near your pockets.

I was spotted first time. The next day my dad confronted me, telling me I had been seen hovering near some toys, and now they were missing. I confessed immediately, knowing I had no choice, and dad returned the toys. Apart from being grounded and losing my pocket-money for a month or so, I can’t recall any other punishments hurting much. Dad rarely hit us, but I was worried about the school principal finding out, because he was very free with the cane. That didn’t happen, and I wouldn’t understand why until years later.

After maybe a year of limiting my risky impulses to standard boys’ stuff like destroying ants’ nests, stone-throwing fights and scaring the neighbour’s cows, my next crime was putting objects on the railway line near our house. At first it was just pennies and small metal toys, with pleasing results. But I wanted to see what would happen if we put a large thing in front of the huge steam train that came through late most evenings, filling the valley with noise and smoke. We found just the right choice near the tracks; an empty, rusty 44-gallon drum. As soon it was dark, we snuck out of the house and put the barrel on the track.

My brother and I shared a bedroom, and we peered out into the darkness when we heard the long, mournful train whistle. Suddenly I was terrified, realising this was going way too far, and an awful accident might be about to happen. I just hoped the barrel would be crunched flat, and wouldn’t cause a derailment or worse. But that night the train slowed right down, coming to a stop at the station, and simply bunted the barrel to the side. The next morning, we couldn’t find the barrel, and for a long time afterwards I feared the knock on the door asking if we boys, who were often seen playing near the tracks, were responsible for a very serious crime. In fact, no-one seemed to know about the barrel; nobody said anything; so we just swore a vow of silence on the whole matter.

Over the next few years, among other exploits my brother and I vandalised street-lights, made guns out of pipes and firecrackers and stole money and cigarettes from our parents. The most dangerous was partly an accident. My dad and my brothers, along with his friend Ian and two of his sons, went camping next to the River Murray. While dad and Ian went into town to get drunk as usual, I looked in Ian’s car and found a rifle. I played with it for a while, pointing at birds in trees and imaginary rabbits in the grass. I stopped to speak to my brother, holding the gun in front of me, and for some reason pulled the trigger. There was a sharp crack, and a hole appeared in Ian’s car door. He had left it loaded and cocked, which doesn’t make it his fault, but was a very stupid thing for an experienced shooter to do.

Unsurprisingly, the other boys distanced themselves from my problem immediately. I opened the door and found no hole on the other side. The bullet must have been inside, probably sitting at the bottom of the door. The car was very untidy, and mud-spattered, so I decided to try disguising the hole by throwing new mud along the side, after plugging the hole with more mud. It looked quite convincing, but I knew it would dry out, and then most likely fall out at the first big bump on the rough dirt tracks. My chances seemed slim. The other boys kept the secret, Ian’s sons probably because of his famous temper, and my brothers through loyalty.

Again, there were no consequences. While I waited for the axe to fall, Ian drove that car around Mount Barker for months afterwards with the mud untouched. He often came to our house, and parked right in front of where we would sit and eat from the family barbecue, with the door facing us. About a year later, I saw him driving a new car. I never knew when or if Ian or the new owner discovered that bullet hole, or if Ian ever harbored any suspicions.

When I turned 12, my best present was a pocket knife. Typing now, I can still see the scar on my knuckle where I accidentally closed it on my index finger. Of course, I tried cutting everything I could find; plants, ropes, wood and so on; but I still don’t understand what I was thinking when I took to the hoses on my neighbour’s milking machine. I can see them now; red rubber that my knife whipped through so easily. The next evening, having forgotten about the hoses completely, I felt no fear when I answered the door to the local police sergeant. There was no-one else at home, but that didn’t stop him questioning me. I was a pushover.

‘Hello there; David isn’t it? Tell me David, have you got a sharp pocket knife?’

I couldn’t wait to pull it out of my pocket to show him.

‘A very smart little number. So what would you know about the rubber hoses on the milking machine next door—the ones that I reckon have been cut by a knife just like yours?’

I was dumbstruck, and very afraid. He pressed on.

‘It was you wasn’t it David? I think we need to have a talk with your father about what to do. Your neighbour is pressing me to take legal action on this.’

My silent tears were my confession. Perhaps at that moment he realised he was overstepping the mark, questioning a 12-year-old alone at night, because he said ‘I’ll be talking to your father about this in the morning. And I’ll have that knife now please.’ Leaving me alone in a state of panic.

Yet again I got off lightly, at least in the short term. I was taken by my dad to give a shame-faced apology to a furious neighbour, dad paid for the hoses to be replaced, and no charges were laid. Dad told me to say nothing about the matter to anyone, and I didn’t. But dad did say to me that he had great difficulty in talking our neighbour out of legal action, and he just hoped other people in our little town didn’t find out. I was never afraid of my dad, but his obvious disappointment cut me deeply. Completely self-absorbed, it never occurred to me how much this and my previous shoplifting might have cost him in his social standing. As one of the big bosses in Mount Barker, he could call in favours, but this one must have hurt.

I might have gone on to more juvenile crime, but for two things. The first was when a boy in my class, from one of the poorest families in the district, was sent to a reform school for a year, for stealing some money from a neighbour. I stopped to think about a couple of others who had gone before him. It hit me that I only got off because my dad was well-off and influential. It just didn’t feel right. But the cruncher was all about a girl. She lived not far from our place, and I had a crush on her, with absolutely no way to express that. One day I saw her walking home in front of me, and I joined her, offering to carry her bag.

She looked at me, not unkindly, and said ‘I’m not allowed to talk to you David, because my parents say you have a bad reputation.’ I couldn’t think of anything useful to say, so we walked along in silence until we got to her gate.

‘Goodbye David.’

I went home in tears. The thought that other people, especially the girl I was swooning over, saw me like that was just about unbearable. How many people knew? Did mum and dad know people were talking? The girl never spoke to me again, and I tried to avoid her whenever possible. And from that day on, I have never stolen anything or vandalised property. I spent the rest of my adolescence fully aware of how close I went to ruining my life, which only added to my general lack of self-confidence. As an adult, I’ve found other ways to be thoughtless, to be careless about the rights of others and to take stupid risks. But my urge to do something destructive, just for the sake of it, went away when a girl taught me a little about the wages of sin.

My focus is mental illness

In 2004, I became a Board member of the Mental Illness Fellowship of Australia (MIFA). This is a national federation of community-based NGOs. The Presidents and their CEOs were a great bunch of people with a common objective—better services and community acceptance for people with mental illness anywhere in Australia. It had been more than 10 years since I was bundled out of leading mental health reforms in South Australia, but the juice still ran strongly in me on this one. It was unfinished business, and probably always will be.

In 2009 the national CEO of MIFA was rocked by the suicide of her son, who had finally given up the struggle against the ravages of schizophrenia. He had been remarkably well for a time, but the early warning signs were there; he knew another episode was on the way. It was too much to bear. He told her he loved her then went for a walk and jumped off a building. Margaret, working in the garden, stopped to think about the way he had spoken to her, suddenly realising it sounded like a farewell. He had mentioned the tall office block near her house before, so she hurried there. She found him, and cradled his broken body until the ambulance arrived. Although she handled the aftermath brilliantly, Margaret decided to take a back seat for a while, and resigned.

Which left MIFA looking for a CEO. Apart from MIFA and two other boards, I was busy earning a living with two jobs, one as CEO of a small privately-owned health company, and one working around Australia and New Zealand as a consultant. But I knew a day job at MIFA was the ideal place for me. It was a national role, and I had always wanted to work at that level. It was smack in the centre of my main passion, and I knew there was so much that could be achieved if I kept the job for a few years. It meant getting the best out of a consortium of partner organisations, the sort of work I had done several times before. And it involved a lot of traveling, which I have always loved. With Charmaine’s and my kids all largely independent; this was the time to take off to all parts of Australia; a chance to make a real difference.

There was a money problem; MIFA had a tiny budget. I offered to start on three days a week, at a very low rate, banking on continued consulting work for the rest of my income. With a partner who was a senior academic, and a small pension from my public servant days, we didn’t need much money anyway, which was a freedom to be enjoyed. The MIFA Board agreed within a few days, and I started in a role that turned out to be a perfect fit for me, better even than I had hoped for.

First I needed an off-sider. Susan had worked with me several times in the previous ten years, but she was currently based in Cairns. One phone call, and we were a team again, her also part-time but not fussed about it. She was a savant of information, and what she didn’t know she could dig up faster than anyone. A genius, who could digest a 200-page government report in a couple of hours, and give me the only things that mattered, in a dot-point summary that I could trust completely. And a no-nonsense woman with a sharp tongue who kept me grounded whenever I showed any signs of self-importance. Whatever I achieved in that job, she was half of it, but she absolutely refused to share the limelight. When it came time for her farewell a few years later, I asked her if she would make a little speech. She snapped back ‘I’d rather stick a fork in my eye.’ We worked so well together; I’m missing those days keenly as I write this.

Our job was to keep the impacts of severe mental health on the radar across Australia, and to influence policy and funding decisions wherever we could. Margaret had given me a legacy of many opened doors in Canberra, the national capital, and I worked hard to build on what she had started. I particularly liked the “Parliamentary Friends of Mental Illness’ that she had invented, and so did a couple of pharmaceutical companies who funded it generously. That became a vehicle to get people who were dealing with severe illnesses telling their story directly to politicians, their staff and bureaucrats. Choosing the best speakers there became our art form, because getting it right meant huge impact with the real decision-makers.

As for those top people, I just went for it. I had one-on-one meetings with all the relevant Ministers and heads of departments, and the other movers and shakers who lobbied them. They wanted one-page simplified summaries of issues, giving them a clear path to making a real difference that they could claim the credit for. There’s just no point in telling these people how awful it all is, if you can’t help them see a way to make a start on doing something useful. I also made sure I praised the good initiatives, and offered to work with them to make sure they were implemented well. Because our member organisations were all well-established, authentic voices of ‘lived experience’, I went to Canberra loaded with their service medals; accepted as an impartial, honest advisor, with good knowledge of the national picture, and with no axe to grind except helping people in desperate straits.

Not long after I started, the drug company that had been giving MIFA about $100,000 a year received legal advice that they were in breach of their industry code of conduct. By providing such a large proportion of our total income, they might be perceived to have undue influence. They reduced their grant to $10,000. Until that time, the member organisations had only been putting in small amounts, and MIFA now faced being wound up. I proposed they make a decision; either give a lot more, or give up the game of being a national advocate of any relevance. After very little debate, it was agreed that each member would give a percentage of their annual turnover to MIFA. That gave us a budget of nearly $250,000, which was more than I had suggested, partly because they wanted me to become full-time, at a better rate of pay. I was very happy to agree.

There were difficulties. Within a few months, one member organisation, as usual in these matters, the largest one, began grumbling about their share of the cost. They worried that they may have been hasty in not thinking through their capacity to lobby government on their own, without depending on a national body. In Australian federated bodies, these spats always seem to originate with tensions between the Victorian and the New South Wales people, and this one was no exception. With frequent visits to Board meetings in Melbourne and Sydney, I managed to keep both at the table for a year, but it was an increasing distraction from my core business of trying to make things better for people dealing with mental illness. When most of your debates are about internal politics, and not about your customers, any organisation is in big danger of losing its way. It was a bit bloody when the Victorians left, and it meant I had to spend more time finding other sources of funding, but I was actually relieved when they took their ball and went home. The other members were so pleased to see them go that they increased their contributions to MIFA to help close the funding gap. Their loyalty to each other, and support to me as CEO, was absolutely solid from then on.

The next couple of years were a buzz. I was invited to help the federal government design a new initiative that received about $500 million funding over four years. It laboured under the clumsy name ‘A federal program of coordinated care for people with severe and persistent mental illness’, which luckily morphed into ‘Partners in Recovery.’ That program has been an outstanding success, helping thousands of hard-to-reach people who can’t or won’t engage with what’s on offer. People living under bridges. People in jail. People hidden in family homes where parents consumed by shame had no idea what to do about their child’s relentless downward spiral. Partners in Recovery reached out to these people in ways that had never been possible before, and everyone from psychiatrists to General Practitioners and police loved it.

MIFA was also influential in the rapid expansion of other federal and state programs that supported families doing it tough with dads, mums, sons and daughters with severe mental illness. The Federal Minister at the time, Mark Butler, fully endorsed modern understandings of the types of supports needed, and I had excellent access to both he and his advisors. He made a number of visits to locations run by MIFA members in every state, organised through my office. He was happy to recognise us as the group with genuine grass-roots support across Australia.

These halcyon days never last, and the power cut that nearly switched out our lights came in the form of the National Disability Insurance Scheme. During 2012 I was a member of an Expert Advisory Committee, looking at how the proposed model could work for people with ‘psychosocial disability’ that resulted from severe mental illness. It seemed too good to be true—an extra $1.2 billion for our people each year from about 2016 onwards. How could we say no? I was warned by a colleague on the committee that ‘We aren’t really having any influence David. We’re just salad dressing on a meal being cooked up somewhere else.’ He was so right.

Several months after the committee finished and reported, a senior bureaucrat in Canberra took me aside to tell me the exciting news. The NDIS was going ahead, the legislation would be in Parliament within weeks, and trial sites in two states would start within a few months. I asked how this would be paid for. The answer was’ No problems. We can put in about half the money by closing down current programs for people who need this most, and the rest of the money will come from an increase in the Medicare levy.’ I asked which programs would close down. It was all the services we had been building for the last ten years, including Partners in Recovery. I was gobsmacked.

‘But the NDIS is only for 65,000 people, the most severely and persistently and permanently disabled, right?’ What about the other 200,000 or more Australians only slightly less disabled, who can access all the current programs? They won’t get into the NDIS and their current services will disappear. We all agreed the NDIS would be great as an addition to the options available, but now you’re saying it’s an alternative, for about a quarter of them, and the rest get nothing?’

The answer was, ‘We don’t agree with those figures David. In any case, the other groups you mentioned shouldn’t have been in these programs anyway, and the states and territories will need to step up and meet their needs.’

And there you have it. That conversation was in March 2013, and the rationale was pure fiction; part of a mad scramble to find a way to prove that Australia could afford the NDIS. But it went ahead unchallenged, and five years later, individuals and families are finding doors closing that used to be open, staff are being sacked in large numbers, and state and federal governments are still not fully admitting they made a huge error of judgement in 2013. Belatedly agreeing to some extent, but too little and too late for so many people in need, and for the staff who wanted to walk alongside them.

From that time in 2013 to when I retired at the end of 2016, most of my job became trying to hold the line, persuading as many decision-makers and other people with a voice in the game to call it out: governments of all parties had no mandate to desert these people, and talking rubbish about Australia making great strides with mental health could not be excused just because a minority were going to get a better deal sometime soon. We made submissions to parliamentary committees, we spoke to newspapers, we presented papers at conferences, while all the time trying to cooperate constructively where the Scheme was slowly rolling out to provide new life opportunities to a small number of the right people. I and a few others on the case made some headway; delaying the Scheme by a couple of years at least, convincing the Federal Government to allocate much more ‘transition’ funding, and several states and territories to plug gaps as they showed up.

I never quite got over the feeling that we did far too little in 2013 when the problem emerged. Like most people, I couldn’t believe the Government was serious about closing down programs like Partners in Recovery; programs they had boldly announced and funded only two years before.; programs that were universally popular, and undoubtedly turned around many lives blighted by mental illness. While we dithered trying to understand how it might play out, the legislation went through, and then it was all too late. Having said that, from then on I decided to ‘give ‘em hell’ every chance I got, to keep on pointing out the truth and the possible ways out of the impasse that was approaching.

It’s hard to rail against the machine when governments of both major parties have decided to implement a $22 billion scheme. The PR was relentless, and it included painting critics like us as self-serving, and/or ignorant of the facts, and/or too risk-averse to see a wonderful opportunity ahead. But we knew we were fighting for the future of the people we cared about, so I had to learn some new behaviours. I’ve always wondered at the ability of legal, industrial and political professionals to keep on repeating the same arguments, in the same words, at every chance they get. I get so bored with the sound of my own voice repeating itself. I think that has something to do with my life-long pattern of changing jobs every few years. Anyway, it hit me that I had to accept the role of inflexible standard-bearer and do it very well; it was what they paid me for.

So for three years, I became a one-note warrior, turning up wherever I could to explain for the umpteenth time that the NDIS was a great concept for those few who would get into it, but everybody else dealing with serious mental illness had to join the fight to maintain vital services. I averaged 80 trips a year during that time, and there were days when I felt like George Clooney in the film ‘Up in the air’, when he’s asked by the passenger alongside where he lives. ‘Here’ says George, pointing to his seat in the plane. I started thinking about my pitch for the next speaking engagement when I was eating breakfast; I was still thinking about it watching TV that night, and then I even dreamed about it. Where was the clincher, the cut-through lines and pictures that would sway the NDIS zealots? Or at least get them to agree we needed a Plan B for people who would miss out on the NDIS?

It became achingly obvious to all of us that we could be absolutely right and still lose. I watched a senior bureaucrat talking rubbish about there being ‘no disadvantage to any existing clients’ to a Senate inquiry, rubbish that I demolished a few minutes later. I could see all the senators agreed with me, but nobody took any notice of their report. Over time though, as the number of influential people we persuaded grew, discussions did begin to change. Queensland and the Northern Territory lead the way with new funding for people not eligible for the NDIS, after several forums that we initiated were attended by all the key decision-makers. By 2016, only a few NDIS spin-merchants would have the hide thick enough to parrot the ‘no disadvantage’ clichés. The real debates were about how to find new funding to cover the looming gaps.

I had to retire sometime, and at 70 there were other adventures I didn’t want to miss out on. A year living in Bali beckoned to Charmaine and I, so at the end of 2016 I pulled the plug. In my last week on the job, I went to a forum in Canberra. I looked around the room at people from all over Australia that I knew now, colleagues I had such respect for, and listened to some B-grade bureaucrats giving a tired, largely fact-free analysis of why we were all needlessly worried about the NDIS. I finished with a flourish, telling them they were trying to re-write history, and that nobody believed a word of it. I confess, it was delicious fun, and the applause was nice. When it was over, I sat there feeling very sad, watching people planning their next trip, conference, newspaper interview etc, etc; hoping I had made the right decision. A woman I’d never met sat down beside me. She said ‘You’re the only one here today who talked sense. We’re going to miss you.’ It was a perfect ending.

It’s a couple of years since then, and my successor is doing a great job. He’s at all the ‘top tables’ and has the ear of key government Ministers of Health and Social Services. The ‘valley of death’ scenario, with new funding coming too late to keep existing staff and services going, has hit hard. Hundreds of mental health workers have been sacked, and the majority of the people they were helping have been left to fend for themselves. I think the worst is over, and I hear about new initiatives somewhere in Australia every week. The NDIS is being implemented with breathtaking clumsiness and constant delays, but a few thousand people around the country are getting the real ‘choice and control’ over the new and generously funded packages of care that they were promised.

I have a very minor role, as a member of three boards, and these days my thoughts are just as often with a project I’m involved with in Bali. Yes, it’s about helping people affected by serious mental illness. That hasn’t changed, and I doubt it ever will. There’s so much unmet need in the world; you can’t tackle all of it. Stay focused, and sometimes just a few people can make a difference My focus is mental illness.

Teeth at risk

In 1999 I did a short stint as CEO of the South Australian Community Housing Authority, while the agency’s future was being reviewed. The previous CEO had left under a bit of a cloud, so a ‘steady hand’ was needed for six months or so. It was fun, and the mission to deliver housing for low-income people certainly fitted my values, but a bigger challenge came along sooner that I expected.

Another CEO had fallen out with his Board of Directors and resigned, but this time the conservative Liberal Party government was talking about winding up an icon of progressive healthcare, the South Australian Dental Service—known to all as SADS. Private dentists had long argued that they could do all the dental work for school-age children and poor people with improved subsidies, and that there was no need for salaried dentists to be employed as public servants. The Australian Dental Association, really the private dentists’ lobby group, had the ear of the Health Minister. The end of SADS was nearly fait accompli, when the Human Services Department Chief Executive persuaded her Minister that installing a ‘trouble-shooter’ CEO for 12 months was worth a try. My name was put forward, and that nearly scuttled things, because the Health Minister and I had a chequered history, dating back to my role in closing a mental hospital.

A Liberal party elder statesman was sent to see me, to suss me out. He was extremely blunt, telling me that he agreed with the private dentists, and that I’d have a hard job convincing him that ‘a pack of chardonnay socialist public servants’ could do a better job than private enterprise. He looked at my CV, we talked for quite a while, and he decided that it was worth a try, as long as he became a Board member, ‘to keep an eye on you’, and that I undertook to (a) get the budget back into balance within six months and (b) ‘Get the Australian Dental Association and that pain in the arse Professor of Dentistry from Adelaide University to both stop bothering the Minister and Premier with a string of complaints about SADS.’ I do like a clear brief, and I said I’d take on the job.

The Chair of the Board, a recent government appointment, was a private dentist, but he shared with me early on that he had real doubts about winding up SADS, because his best guess was that there was no way his colleagues could do the amount of dentistry required for the same cost. In other words, privatising this public service would most likely cost taxpayers more. But I knew from several politically sensitive previous jobs that the facts are weak in the face of ideology and party platforms, so this was going to be about really good information at my fingertips, a quick return to budget discipline and building solid relationships with the main complainers.

The honeymoon period in any change leadership job is extremely valuable, and I tried not to waste it. I shook a lot of hands, talked to many meetings of staff, and called up briefing papers on every topic that seemed related to SADS losing so much political capital that it had nearly been closed down. The Board, at least half of them Liberal Party stalwarts, several thriving on their role of disseminating damaging stories about SADS, were my first target for spreading the love. I had one-on-one meetings with all of them within the first couple of weeks. It was quickly obvious that a balanced budget would give me some breathing room to assemble more good news about SADS’ value, so that became the top priority.

It took several heated management meetings, and complete re-jigging of financial reporting, to clarify that we were heading for a deficit of about $2.5 million by the end of the financial year, less than nine months away. With a total annual spend of $35 million, most tied up in salaries and essential dental supplies, this was a scary assignment. Not one of my senior colleagues thought it could be done. But we did it, over six weeks of analysis, debate and difficult decisions. Workloads were increased, periods between scheduled dental check-ups were extended, stock-piling of dental supplies was refined to ‘just in time’, capital works projects were deferred or spread over more years, vacancies in non-essential areas were left unfilled, leases were re-negotiated and more dentistry was farmed out to private dentists willing to accept our low rates. No patient was going to miss out on urgent care, we sacked nobody, but we were going to break even. The Board were satisfied, and we had the temporary reprieve we needed to start working towards a better future.

I think my management team surprised themselves with this achievement. What they didn’t know was that I was amazed. This was the most serious bit of cost-cutting I had ever attempted, by far, and my confident demeanour in the first few weeks was more about hope than certainty. Patient, detailed, sometimes gruelling dissection of every spending line gradually yielded up a clear path to survival. It was exhilarating. We had come up with an austerity budget that hurt nobody.

While all this was underway, I was getting to know the ‘stakeholders’ of dentistry, or oral health as it was becoming known. The Australian Dental Association, which had a fearsome reputation as a lobby group, was quite easy to win over. My predecessor had stayed right away from them, but I asked for their help on several matters, especially finding dentists who would take on some of our work at our rates. They did this quickly and graciously, and seemed to thrive on being asked at last. Together with the Professor of Dentistry mentioned above, we worked out a scheme for private country dentists to provide placements for final year dental students. This had been on the back-burner for years, and country people were being denied the extra services that these young trainees delivered under supervision. It was so easy to arrange, and now the Board had the first of the good news stories that I thought might save SADS. The Liberal Party elder statesman, whose constituency was in the country, was delighted. The SADS whisperers in the corridors of power were starting to say the right things.

Dentists, and the dental therapists, hygienists, prosthetists and assistants who work with them, were an entirely new type of colleague for me. Their world was very narrow, focused on the number of ‘teeth at risk’—I kid you not, that was how they measured demand. Most of them had gone directly from high school into the teeth business, and it showed. Except for the specialist dentists, including orthodontists, endodontists, maxillo-facial surgeons and others, most were very shy outside of the oral health world, a bit defensive around medical doctors, and convinced that nobody else could understand their work. Although many were long-serving senior people, they had minimal networks in the bureaucracy and politics of government, which helps explain how they had failed to see the dangers I was brought in to deal with.

The dental therapists were an unusual lot in several ways. They had mostly been recruited about fifteen years before, in a scheme to bring dentistry to all primary school children at an affordable cost to the taxpayer. They were trained to a level where they could do inspection and cleaning of all teeth, and extractions and fillings on milk teeth in younger children. Along with fluoridation of water, the School Dental Scheme was credited with giving South Australian children the equal-lowest rate (along with Norway) of tooth decay in the world. Private dentists were apoplectic about this threat to their monopoly at the time, and they fought successfully against any further recruitment. They were still making scurrilous remarks about the incompetence of therapists when I came along.

The other unusual thing, besides this one cohort all being women and about the same age; 35 to 40 when I knew them; was that they all seemed to be very good-looking. Two of them had been ‘Miss South Australia’ around the time they came into the scheme. I found out later that one of my predecessors had managed the whole selection process, which was swamped with applicants, and he had used his power to fill his working world with beautiful women. I can only wonder how many talented people, men and women, might have come into that scheme if they’d had the chance.

And, like most of their oral health colleagues, all of them had perfect teeth. Before this job, I had never really noticed teeth much, although I was self-conscious that mine were a bit battered and small. Within a few months of being in SADS I was planning my own major upgrade, at considerable cost. Sitting in meetings where everybody had a Hollywood smile does that to you. A friend of mine was/is a very successful private dentist, and he had been telling me for some time that the up-front cost was trivial compared to a lifetime of comfortable eating and a confident smile. Now I was ready. He said ‘If you bought a new car, within a few months you would have forgotten how much it cost—it will be the same with this.’ I had the feeling it wasn’t my new car we were talking about, and I did see him in a brand-new Mercedes convertible soon afterwards. I probably paid for the leather seats.

Over the next year, SADS became the poster-child of the health system in many ways; reducing waiting lists, working pretty much harmoniously with private dentistry and their professional association, and, most importantly, not blowing its budget. We were given extra funding to reduce country waiting lists, and we delivered all of that through private dentists. I involved all of the staff who wanted to participate in a strategic planning process; focusing the priorities for the next few years. It was very satisfying, particularly as I watched jaded people start to get excited about their work.

A few remained grumpily uninvolved. There was a Professor of Dental Surgery who told me to ‘Keep out of my way unless you want me to withdraw my services.’ He ran a clinic in the Dental Hospital. People were told they had a morning appointment or an afternoon appointment. This meant waiting for hours, often to be told to come back tomorrow. I challenged him about it, and he said ‘These people would just be sitting at home watching daytime TV—they’re better off here.’ I stayed in his face until he compromised and divided the day into four sessions. I hate those attitudes to people doing it tough, and luckily he wasn’t typical of most SADS professionals.

With a new strategic plan, a budget that we all knew could work, and a supportive board, we had managed to get fully on-side with the Liberal Party-led Government, just in time to see them get kicked out of government in an election that brought Labor back into power. I found it ironic that this whole change-management process would most likely never have happened if Labor had been running things all along, but they were delighted to give us a small budget increase and take all the credit for saving the public dental service. All’s well that ends well, etc.

My tenure as CEO was short-lived. The new Minister of Health said to me privately that ‘We might use you for some other projects we have in mind.’ I wouldn’t have minded staying with SADS a bit longer, to see the new plan unfold, but it wasn’t to be. The nation’s best dental administrator, who was running the Victorian equivalent of SADS, wanted to come home, and he took over from me shortly after that chat with the Minister. My next ‘trouble-shooter CEO’ job was great, but I have some very happy memories from the time I ran the dental services.

For the first time in my life, most days I had felt fairly confident that I knew what I was doing; that the processes I was leading, and the understandings I could call on to back my judgements were generally about right. I’d learned to be patient, and to be a better listener, and it was working. And I still have those new teeth. As my dentist friend said at the time, ‘Only the best for the boss of SADS’.