Fully funded

On Saturday, I launched a fund raiser to help me undertake Mental Health First Aid instructor training. I’m so pleased to announce it has been fully funded! Thank you for your generous support, both donations and sharing my post far and wide. I appreciate the trust you’ve placed in me, and I’ll share updates as I undertake that journey so you can follow along. Much love, Daniel.

Graphic image of a ribbon saying Thank You

Thank you

— Ann Deslandes — Anthony Davis — Anthony MacAli — Ash Keeling — Bernadette Reeders — Bill Jesdale — Brigette Sharp — Bronwyn Donaghey — Daphanie Teo — Dorothy Broom — Elizabeth Humphrys — En KW — Ern Reeders — Euan Troup — Ginevra Martin — Helen Marshall — Jan Tully — Jarvis Chen — Jason Appleby — Jenny Walsh — Jerard Ng — Jo Szczepanska — Julie Miller — Kat Snow — Kathleen Neal — Kenton Miller — Lynne Gunn — Mark Bahnisch — Mary Gardiner — Natalie Hendry — Paul Kidd — Philip Saggers — Pria Holmes — Roj Amedi — Ruth Sayers — Sarah Kennedy — Stacy Smith — Stephanie Russo — Tim Vernum — Trent Yarwood — Zoe Bowman —

Help me take the next step

I’d like your help to take the next step in my mental health journey.

I’ve been writing and tweeting about mental health for years. Always from a mixed perspective, partly from my training in health promotion and partly as a person living with mental illness.

Sometimes, I talk about the self-care strategies that have worked for me; other times, how stigmatising discourses and service gaps limit the life chances of people with mental illness. But I’ve never made any move to formalise my status in the mental health advocacy ‘space.’ Until now, I was never sure how I could make a meaningful contribution.

I think I’ve found that role.

In my travels (and travails) as a postgraduate student, I meet academics and research training staff who feel very uncertain supporting students who may be facing mental health issues.

I see a lot of effort put into promoting mental wellbeing — particularly self-care and stress reduction — leaving mental illness as the elephant in the room. Simply listing the number for Lifeline, or the student counselling service, isn’t enough.

This is personal. During the second year of my PhD, I self-referred for an assessment that revealed a serious and permanent mental health condition.

That was a painful revelation, because I’d been living with that condition for sixteen years. Just white-knuckling my way through life. There were many opportunities for diagnosis along the way, but I missed out—despite being highly motivated and health literate.

That’s where Mental Health First Aid comes in.

I did the Mental Health First Aid training in 2012 as part of my work in HIV prevention. It empowers people to follow up on the signs that someone is experiencing distress, and provides the knowledge and skills needed to make an effective referral. Sometimes, it takes another person to spot that you’re in deep waters and to throw you a lifeline.

With your support, I will complete the Mental Health First Aid instructor training in 2021, which will enable me to deliver MHFA training myself.

My goal is to empower people who support postgraduate students to recognise the signs that stress and distress may have tipped over into something requiring expert assistance.

The program costs $3,750 and takes five days face-to-face. Instructors must then deliver at least two training programs per year. I’m seeking donations via PayPal to undertake the training and offer my first two training programs for free. This will allow me to gain experience and to undertake consultation on the specific needs of HDR supervisors and research training staff.

Your donation will help me find my voice as an advocate and enable me to empower others to support postgrad students doing it tough.

Update Mon 15 Feb ’21

With your incredibly kind support, I have hit my target and donations are now closed. Thank you for your generosity and the trust you’ve placed in me. Over the coming weeks I’ll post updates as I start on that journey.

With much love and gratitude,

Uncle Jack

once upon a time someone felt your loneliness. find ancestors. become their living memorial. — Alok Vaid-Menon

Before I left for Montréal, Jack was insistent that I visit him. He’d been crook for a couple of years, by then, suffering neurological episodes and ongoing problems with his memory and balance. When I visited, he was in good spirits, hopeful that a recovery was on the cards. He felt that Vitamin B12 deficiency was the most likely explanation for his condition, and I think he saw that as easily reversible. Whenever we spoke, I emphasised that you can learn to live a meaningful and happy life with brain injury. And he was, last we spoke, finally beginning to understand his time working for the Kirby Institute in the past tense, with sadness rather than an ongoing sense of injury.

On Jan 8th, 2019, I woke in the silence of a heavy snow day to a message saying Jack had died after a heavy fall, at home, with his beloved terrier Copa by his side.

For a few months after that, I was numb. I wanted to write about Jack. I was also resisting that with all my might. When I write, I tend to lose the living memory of the subject matter, instead remembering the words I wrote, which are inevitably inadequate. When writing about trauma, that’s helpful. For grief, it can feel like losing a loved one all over again.

And Jack was a loved one. I call him my gay uncle, a member of my queer family. When I first met Jack, he was the quiet, polite research assistant of a social researcher I knew. Which is to say, I hadn’t really met Jack at all, yet. Around 2008, everyone in the HIV sector simultaneously joined Facebook and friended each other. Jack took to Facey like a duck to water, using frequent status updates to tell stories and spark up conversations that could pivot in a second from ribald to reflective and back again. He shared soulful pics of Copa, his constant companion, and near daily #JMOGs, ‘moments of gratitude’ that often featured the sun setting over his balcony, hammock and frangipanis. Alongside Copa, and his work at the Kirby Institute, Jack’s great loves were his friend and former colleague Brigette, and her son Aiden – and he delighted in their adventures together to Uluru and Italy.

Back to the uncle bit. When I moved to Sydney in 2017 for PhD fieldwork, shit went sideways, I barely knew anyone in Sydney, and Jack was there for me. But he’d been there for years before that: when I was living with treatment-resistant depression and social anxiety, Jack was there on Facebook, always willing to have a chat. It’s always been pretty clear that, if I’m not on the spectrum, I live near the on-ramps, and he never, ever took any notice of that. Being loved for who you are is a life-sustaining gift.

I will remember two things about Jack. His politeness, and his fierceness. He was proud that he never blocked anyone on Facebook, never made his posts private, always tackled disagreement with implacably stubborn Southern politeness. And the fierceness with which he loved life, a drink, a joke, a sexy bloke, his work, his adopted family and his friends. Even as his memory and his balance got a bit wobbly, nothing could change that about him. I miss him every day.

Posse of bullies

Content warning: vivid description of transphobic assault, discussion of bullying, PTSD and suicide.

This weekend the SMH ran an anonymous piece that claims to be written by a mother whose child is preparing to affirm a different gender, worried that the process makes it too easy. Then Chris Uhlmann, federal political news director for Nine, which includes Fairfax, tweeted an entirely predictable attempt to stir up Day Two controversy, referring to trans folk who objected to the piece as a ‘hysterical posse of bullies.’ It’s cynical as fuck.

Chris, let me tell you what a posse of bullies looks like.

Tonight, I was sitting at a bus stop in Newtown by the station, on my way home from work, waiting for a bus that threads its way through Marrickville. A spray of phlegm lands on me. I look up and there’s a chubby kid on a scooter, maybe 14 years old, and he’s glaring at my coloured nails. He scoots around the bench and stands right behind me. I stand up. I’m ready to put him on blast. But I can see he’s with four mates and they’re already arcing up. Shaken, I turn and walk up the road to the next stop.

I came out as nonbinary in 2017 and I came out publicly as trans last week. Smart friends of mine define trans as identifying with a gender other than whatever you were assigned at birth. Even though I understood that definition at an abstract level, it took me a really long time to identify as trans myself, because I don’t experience the kind of daily hostility and outright violence many trans people live with – particularly trans women. I’ve always sought to be careful not to claim to speak for experiences I don’t share.

But when I faced that question, I could recall a never-ending torrent of micro-aggressions, dating back to early childhood and coming from women and men alike, intended to correct my performance of masculinity. Nothing will ever match the relief I felt when I ‘declared bankruptcy’ on masculinity. Not all the aggression was micro, either — I was bullied so severely at school I wound up with PTSD. Many trans and gender diverse (TGD) kids don’t make it through: this group has the highest rates of self-harm and suicide of any sub-population. The increased risk shrinks dramatically when kids are supported to affirm their gender.

So when Chris Uhlmann talks about trans people and allies tweeting their disagreement as a ‘hysterical posse of bullies,’ I’d like to draw the conversation back to the ugly fact of actual posses of bullies and the damage they can cause. As that anonymous article demonstrates, the parents of trans kids can sometimes be their worst bullies — insisting their life should be made harder just in case it’s possible to coerce them back onto the straight and narrow.

Denin Lawley on Unsplash

Nobody at Fairfax seems to have stopped and thought, if your child is trans, that’s a sickening thing to write about them. Responding to some firm but reasonable tweets, editor of The Age, Gay Alcorn, took the article off that masthead’s online presence, acknowledging it was insensitive to publish it in the same week as writer Bridget Flack has died.

However, as my own experience might demonstrate, trans and gender diverse kids are always under attack — initially for ‘failing’ at their assigned gender, and when they affirm a different gender. When is it ever okay to tell the parents of vulnerable children that it’s okay to doubt them, okay to dream of making their path more difficult?

Coping without change

A few years back I was diagnosed with a serious mental illness. I couldn’t metabolise the first medication I tried and its toxicity caused a mild brain injury. I was half-way through a PhD and I should have taken a leave of absence, but I kept going, even though I was not getting much work done. Instead, for about 12 months, I was just getting through the days, waiting for change and unable to get much done. I’m seeing my friends in Melbourne suffering from something similar as the outbreak and lockdown grind slowly onwards. Our federal Deputy CMO was asked this week for tips on maintaining mental health during the crisis, and, caught on the hop, he recommended making the bed every morning. I wanted to share some notes from my own experience and an engaged Buddhist perspective on coping when a painful situation does not let up. 

I am not going to recommend mindfulness. Under those conditions, if you can concentrate at all, mindfulness meditation is just going to make you vividly aware of how terrible it feels in your body right now. Instead, I suggest the heart practices, including metta meditation. Now, metta gets a bad rap. The translation of metta as ‘lovingkindness’ makes it sound like New Age positive thinking. People misunderstand it as sending out good vibes to all living beings, rather than finding inner warmth. The commonly-used guided meditation starts with finding warmth towards yourself, which is, for me, the hardest thing of all. So this is an awkward recommendation to begin with, but this practice will make you feel better. Start with Tara Brach here.

Next up: self-compassion, but make it practical. This thing is not only disrupting your life, it’s disrupting the coping strategies you normally use as well. For me, I’d normally watch intense long-form dramas to distract myself, but in 2017, I was struggling to follow the plot. I discovered it’s easy to get even more distressed, feeling like now you’re failing at coping. I had to change it up, watching comedy series with short episodes that I would never normally be into. I had to grieve the loss of rituals that normally brought me peace, like baking and cooking. Until I did that, I’d buy heaps of groceries, let them rot in the fridge and feel guilty about it. It took some work before I could let myself order frozen meals for delivery, even though I knew this was more practical than UberEats. Self-compassion isn’t letting yourself go because life is hard; it’s letting yourself feel what you’re feeling and keep going.

Speaking of the body… it needs movement. I learned to do as much as I could do. Some days that’s a walk around the block. Some days I made it to the gym, and I thought about what I did there in terms of stretching out and limbering up, rather than burning and building (metaphors…). Getting sun and air on your face, oxygen deep in your lungs, getting a little flush on, getting rained on — they’re all ways of bringing you out of rumination and back into your body in the present moment. There’s a podcast called The New Psychology of Depression by Mark Penman and Danny Williams, arguing rumination is obsessive, discrepancy-focused thinking, often stuck in the past or worrying about what might happen. Trigger warning: their solution is mindfulness meditation. But the concentration practices are not the only way of getting out of your head and back into the present. 

Lastly, make appointments earlier than you think you’ll need them. Make a regular appointment and keep it. There is no virtue in pushing on through the pain. Waiting until you’re really in trouble can complicate your condition and make recovery much harder. (I know this first-hand.) If you have reservations about diagnosis and medication, that’s understandable. As anyone in the mental health community can tell you, people can get stuck in (or on) these things. If your GP listens to your experience and suggests there’s some depression, it can be helpful to take a short emotional holiday with a ‘beginner SSRI’ such as Lexapro, which is known for numbing people out a little. Emphasis on short: months not years. The goal as I see it isn’t ‘treating a disorder’ — there is nothing disordered about feeling depression under these circumstances — so much as giving you a circuit-breaker on painful and ingrained patterns of thinking/feeling. 

Heads up: when you start an anti-depressant, particularly an SSRI, there’s a small but well-known risk of tipping into agitated distress that is a known risk factor for suicide. If this happens, you go to A&E immediately for a Valium and stop taking the medication. I would always recommend telling someone who knows you well that you’re starting new meds so they can check in on you occasionally. I owe my ‘Aunties’ Zoe and Sam huge love for doing this for me, when I was titrating slowwwly up to an effective dose of the anti-depressant that is the backbone of my medication combination.

In my last post I wrote about how we define disability. I copped some flak for my suggestion that people with disability can make coalitions with people who are disabled by other forms of social discrimination, particularly racism and queerphobia. One guy huffed that abled people can’t possibly understand, but if that’s the case, I wonder, why are we constantly telling them our stories? My sense is that many people under lockdown in Melbourne are experiencing a depression familiar to many people with disability, realising either that our lives have changed for good, or that we are trapped within society’s expectations of and plans for us. And I’m offering these suggestions as a form of encouragement. Not all problems are fixable, but if we are lucky, we live through until our possibilities open up again.

What is disability?

I was talking today with a friend about our shared reluctance to access disability services as people living with mental illness. There is both internalised and anticipated stigma attached to the label ‘disabled,’ and it takes considerable identity work to process how identifying as disabled may change both how we see ourselves and how others will as well. This is part of a broader category of disability work which includes participating in various assessments in order to access reasonable adjustments and supports; managing those supports and coordinating your care; representing people with your condition when it becomes salient; and managing stigma and enacting disclosure, among other forms of labour required when you identify as chronically ill or disabled.

So I completely understand someone thinking ‘oh, fuck, I can’t face all that right now.’ That was me for a long time. In case it helps other people on the same journey, I want to say a bit about what disability means. 

Quick overview: I’ll briefly cover the basics – medical versus social models of disability – before I bring in notions of assets/deficits and needs. It may come as a surprise to some advocates that I favour a needs-based definition, but I’ll explain what this means and distinguish this from a deficit model. I introduce the notion of vulnerability as a key concern, while acknowledging the language is not ideal. Keep in mind these are all different ways of thinking (and talking) and none of them captures the full variety of needs, identities and experiences that exist among people with disability (PWD). As well, I’m writing in a relatively abstract and introductory mode, and there’s a risk this may disguise the way my perspective is partial, situated and in many ways privileged.

The medical model of disability is the one most of us have in our heads when we first come to disability — our own or that of someone close to us. Quite bluntly, this suggests there is something wrong with the person. To establish that, medicine establishes an idea of the ‘normal’ body and specifies standards that a ‘normal’ body can meet. If you can’t meet those standards, there are two possible responses: one is to train you to meet them (‘discipline’) and the other is to deem you abnormal (‘deviance’). If that sounds moralising, it really is; the ‘good’ disabled person never misses their physiotherapy, complies cheerfully with psychometric testing, etc. 

For example, for many years, children with autism were put through rigorous training in the conventions of non-autistic social interaction (‘ABA’). There was outrage when autistic people demanded respect for the value of autistic ways of thinking and being in the world from people they cheekily deemed ‘neurotypical.’ Adherents of the medical model saw this as celebrating abnormality, which is the hallmark of deviance. So the medical model of disability appears objective but it has little patience for human diversity and shades instantly into moralising.

The social model of disability has respect for diversity at its core. It acknowledges we are all born different in a society built around the idea that only some bodies are normal. The social model holds that disability only arises when society disables us. For example, a person who cannot walk is only disabled if they can’t access a wheelchair or mobility aids, and again if buildings don’t offer wheelchair access. These are just two examples of many ways in which society disables people who can get around just fine without walking. 

The social model of disability lies at the heart of the 2006 UN Convention on the Rights of Persons with Disability (CRPD) as well as Australia’s Disability Discrimination Act 1992 (Cth). The Act provides PWD with the right to request reasonable adjustments that would enable our participation in public life. It places the onus on the PWD to request the adjustment — hello, disability work. It also provides a lot of leeway for an educator or employer (for example) to refuse the request, for example because it’s too much work. And the onus then lies on the PWD to pursue resolution via the Australian Human Rights Commission. This puts legal dispute resolution at the heart of a social change model and, to be quite frank, it doesn’t fucking work. 

There are also social programs that offer supports that enable PWD to participate in public life, such as the Commonwealth Disability Employment Services program, or indeed the National Disability Insurance Scheme. The challenge here is that PWD are seen as needing charitably-minded public assistance to achieve the same ‘level of function’ as non-disabled people. This way of thinking is endemic in disability service provision and it is just as disempowering as the medical model. The scholar of community work John McKnight called this a deficit model — seeing people as lacking, rather than seeing their capabilities (an ‘asset’ model).

So here’s a conundrum: the social model of disability acknowledges that society needs to change in many ways to avoid disabling people; but when we provide services, adjustments and supports, we slip easily into ways of thinking that focus on what’s missing rather than how people are already capable. And it’s going to sound odd, but I think a more nuanced conception of needs can help, here. Need sounds awful – it sounds, well, needy. But the UK National Institute for Clinical Excellence (NICE) defines need as the capacity to benefit. You don’t have to be deficient, undisciplined or deviant to benefit from services, adjustments, supports and social change. We just have to take seriously the social democratic impulse to make life better than it was for previous generations, and to see participation in public life as essential for human dignity – an impulse and a vision we routinely deny in a neoliberal era.

So here’s my definition of disability:

Disability means you can benefit from adjustments, supports and social change that enable participation in public life and the attainment of personal goals.

But Daniel, doesn’t that mean we’re all disabled!?? Well, yeah. Haven’t you been paying attention? Go read Kate Manne on the invisible ‘shock collar’ worn by women and femme people, or Kimberlé Crenshaw on the interlocking systems of oppression that apply to disable the participation of Black women in public life. We are all disabled by society in different ways. People we currently understand as disabled may benefit from more specific and concrete kinds of supports and adjustments. But if we stop at that, we neglect the kind of social and cultural change that need to happen to overcome the discrimination that prevents us from public participation and achieving personal goals. 

For me, the value of this definition is the very queer kind of coalitionality it suggests we can find, with people who face other, or further, systemic forms of oppression. If we scratch the surface of anti-Black racism, we find a dense writhing mass of privileged beliefs about bodies and capabilities. Similarly, so much misogyny consists of constructing perfectly ordinary bodily experiences of people who menstruate, experience PCOS and endometriosis and dyspareunia and infertility and menopause, as deviant, undisciplined, deficient, and, yes, disabled. If we only attend to the capacity to benefit from specific and concrete supports and adjustments, we miss out on these connections with social justice.

A research hero of mine is the U de Montréal Professor Kate Frohlich, who developed (with Prof Louise Potvin) the ‘vulnerable populations framework’ (VPF, Frohlich & Potvin 2003). (Yes, okay, I’m going there.) I’ve just finished a few weeks of pro bono consulting on an engagement strategy for Covid-19 in an Australian state, and the whole writing group united hating the term ‘vulnerable,’ which triggers notions of deficiency and affective-relational needs for pity and charitable care.

But the VPF calls for public health to use social science to identify and address the processes that put some people at greater risk of risks. If need is the capacity to benefit, vulnerability is the capacity to be harmed. Meeting needs does not cancel out vulnerability; if anything, people with disability are most vulnerable to harm by their so-called carers and other close relationships, such as partners, family members, employers and research supervisors. As we develop schemes to promote public participation it is not optional to focus on reducing vulnerability as well. 

Drawing this all together, disability does not mean you are deficient, deviant or undisciplined. It means you can benefit from a service that would enable your participation in public life and the attainment of personal goals. It doesn’t turn you into a completely different kind of person: if anything, it means you have common purpose with many, many others fighting for social justice. And if you’re reading this and you don’t need much support or social change to participate in public life, I would ask you to join our fight for social change and to reduce vulnerability for PWD.

If you would like to support the work I am doing, a small donation would be gratefully accepted — but sharing this post would be equally awesome!

Donations will be used to support this blog and reliable, independent health promotion initiatives like RinseNRepeat.info.

The app we should have had

Early this year the federal government announced it was buying in a contact tracing app that hadn’t worked in Singapore. The ‘CovidSafe’ app uses a wireless protocol to connect with nearby phones that are also running the app, to record an encrypted ID for each person the phone’s owner had contact with. The government refused to wait until Apple and Google had released an update that solved key problems, such as the way iOS shuts down apps that aren’t in use, particularly when the phone is locked. It claimed the app would allow us to exit lockdown and return to public life, so long as at least 60% of the population downloaded and installed it on their phones. However, total downloads stalled around 25-30% of the population, with the public perhaps remembering the privacy fiasco over the MyHealthRecord. The state governments that actually do the contact tracing reported it was of no use, and it was quietly dropped.

The app was meant to compensate for a human flaw — the difficulty of remembering where we’ve been and who we’ve met, going back up to fourteen days from exposure through to viraemia and finally immunity. Indeed, we don’t know who we’ve met on public transport, or in the queue for the supermarket. The design aims to take the human agent out of the picture altogether, instead relying on cool, hard technology to capture encounters with machinic precision. Yet the design and implementation embed and reflect the all-too-human vices of hubris and impatience, and what Evgeny Morozov called ‘solutionism.’ 

The problem that needs solving

It was also a gigantic missed opportunity to design an app that could have solved a long-lasting problem for citizens and governments alike. Imagine, instead of assuming humans are incapable, we designed something that could support and enhance our capability. We are deluged with information about the outbreak and limited in the time and effort we can devote to processing it. Reflect for one second on how you get your information about the outbreak: daily press conferences top the list, followed by media coverage of them and social media conversations about them. The situation is dynamic and right now, restrictions are changing almost daily. The amount of information that we need to process and respond to can be overwhelming, even for English speakers —and as far as I’m aware, no government translates them into other languages. 

I want to single out one issue: indications and requirements for testing. Each day, governments release a list of locations and times. If you were at the Apollo Restaurant in Potts Point on August 28th between 11AM and 9PM, please… go straight into quarantine? Seek testing? And then what — stay home until you get a negative result, or go about your day-to-day life? Misunderstandings about these requirements have become a matter of national scandal, fuelled by governments shifting blame for the outbreak onto ‘individuals doing the wrong thing.’ But their communication is haphazard. I just got a swab at a respiratory clinic and received no instruction to isolate until I got a result. And apart from the difficulty of remembering when you were there, this approach relies on people catching a momentary reference to the restaurant in media coverage. 

’If you were on the 8.12am service departing Central to Sydenham, please seek testing…’ Was I on that service? I caught a morning train at Museum, who knows what time it departed Central. Nah, probably not.

What the app should do instead

A few years back I was a bit startled, but basically pleased* to discover the Google Maps app had been tracking every trip I made, every day. (* This is pretty creepy but quite useful if you’re an ethnographer like me.)

Screen captures for my Sunday adventure from the Google Maps app

So just do that: remember where I’ve been, for me. In the second image, Google Maps is asking if I was at my usual morning café Warren & Holt.

If NSW Health announces there’s a case or cluster associated with that location, the app should notify me. If I take a long train journey and NSW Health later discovers one of the other passengers was a case, they can publish that information in a machine-readable format. The app checks that information for updates and if it matches my own data, it can notify me. In this vision, the app would not ‘phone home’ and notify anyone else. This is an approach to contact tracing that empowers the user, providing a precious resource — tailored information — and trusting them to act on it.

Edit 6 Aug — writing late at night, I sometimes forget to mention my main point. In this case: if I am traced as a contact or I get a positive test result, I can use the app to remember and relate details of my travels and encounters. I don’t need to send any data to the contact tracers other than by having a conversation with them, which allows the contact tracer themselves to use their own practice wisdom and personal intuition to ask questions an app could never answer.

This suggests a second function. I’m a reasonably educated guy, I can follow a complicated recipe, I’m literally a regulatory scholar, and I still find some of the advice on testing, isolation, and quarantine requirements confusing. The app should just tell me, here’s the nearest Covid-19 testing clinic. Here are their opening hours. Here’s a link to make an appointment. You should go home and stay home until you’ve had that test and got your result. If you need it, here’s a link to apply for a cash payment in case you have no income or paid leave. These details vary from one jurisdiction to another. The information should be supplied by governments in a format the app can parse and present to the user.

Finally, a third function. When regulations and services change, governments should be able to push out notifications to app users based on their location. This should be systematic but sparing, to avoid overwhelming app users. And — fucksake — governments should translate this information into languages other than English. If government is announcing new restrictions that can create criminal liability, it’s a matter of basic human rights that it translates the announcement into the languages in use in the whole community. It shouldn’t be left to communities of people trying to cope with the cops showing up and locking down their residential towers to make their own translations on the fly. The app should provide easy access to updates on the current situation in multiple languages, easily shareable via chat apps and social media. 

Who should do it?

Google, with input from Apple. The federal government dropped the ball. State and territory governments will take forever and develop their own separate apps with varying degrees of functionality. And none of these apps will have access to the location data Google already collects — the routes taken and the database of premises, transport routes, etc. Google should define the machine language and establish a secure API for accredited government users. It has existing expertise in interface design, user testing, security, hardware integration and regulatory compliance.

The key to this approach is that it coordinates the strengths of different actors: Google for apps and platforms, governments who determine regulations and provide information, and users, who almost always want to do the right thing if they are supported to do so. The last is a foundational principle for both adult education and social marketing — people see themselves as independent actors and respond best when you respect their agency and empower them to act.

If you would like to support the work I am doing, a small donation would be gratefully accepted — but sharing this post would be equally awesome!

Donations will be used to support this blog and reliable, independent health promotion initiatives like RinseNRepeat.info.

Covid-19 spreads like glitter

I’ve written a couple of pieces expressing evidence-based doubts about the value of general public mask mandates as an epidemic control strategy. In them, I acknowledge that we know masks work when Covid-19 is present, and encourage people to make and wear face coverings if that would make you feel safer. Let me add a third note: if government in your part of the world mandates wearing masks, I strongly encourage adherence. Epidemic control is not an opt-out endeavour.

My last piece expressed concern that debate over masks has been a distraction from the real drivers of the outbreak in Victoria — the networks of transmission among precarious workers and workplaces in aged care, child care, meatworks, fast food and freight. It’s very easy to focus on individual behaviours and whether people are doing the right thing, and much harder to think and talk about social structure and complex networks. Indeed, I have come to suspect Premier Dan keeps talking about individuals doing the wrong thing because it functions so well as a distraction from government failures. But I have been encouraged by the public conversation about precarity and the need for paid pandemic leave and other forms of job security. 

As I noted, mask advocates often claim that Covid-19 is airborne. The people who advocate masks are the same people who advocated ‘go hard, go fast’ on society-wide shutdowns. I am in two minds about how sincere they are, since there’s an important contradiction in their claims. If SARS-CoV-2 can be passed on via droplet nuclei, which are particles 1-5 microns in size that can hang in the air, then wearing a surgical mask or improvised face covering is not going to have any protective effect whatsoever. But there’s another effect in play, which I’ll call reverse reasoning. Let me give an example.

As a public health practitioner, I look carefully at the science on transmission routes, and then I consider what devices and practices could interrupt them. But members of the public don’t have the training or the time to engage in that kind of systematic consideration. I’m not an expert on the environment, for example. I encounter facts and recommendations in everyday life, and as a moderately curious person I try to work out the links between them. When my local council provides a recycling bin, with a detailed list of what can and can’t go inside it, I reason backwards from that to develop a mental model of recycling as an environmental practice. I assumed the contents of my recycling get sorted and returned to Australian packaging manufacturers. It was a big surprise to discover it gets shipped en masse to China and ends up as landfill.

Because the federal government made such a mess of explaining the rationale for its control recommendations early in the outbreak, many people have used reverse reasoning to fill in gaps in their understanding of Covid-19. The clearest example is the anxiety and rage people feel and express about momentary breaches of the recommendation to keep 1.5m physical separation in public. Reasoning backwards from this recommendation, they have concluded that Covid-19 must be easily transmitted via brief, casual contact in public places. We’ve known since early in the epidemic that this is not the case, but people don’t understand why not, leaving them open to competing explanations. The notion that Covid-19 is airborne is a perfect fit for that mental model.

In a crisis, a group of cranks can easily out-communicate a government. They have one issue and that affords them excellent message discipline, while the government has to communicate across a whole range of issues. They can just keep banging the drum, keeping their issue on the media agenda until the government gives in, precisely because it needs the airtime for other issues. A simple message will beat a messy, complex set of messages every time — just ask John Hewson or Bill Shorten. But we should ask why some people seem so determined to ‘beat’ government in the first place. The answers are not pretty. They include relevance deprivation syndrome, hunger for public profile, and feeling overlooked for a role in advising the government response. 

(But enough about me.)

The truth is always messier than a message. In the remainder of this piece, I want to explain the difference between airborne and droplet transmission. When you understand the basics, then you develop literacy that allows you to make sense of the more complex and uncertain aspects of the bigger picture. My hope is that enough people will read it and become the seeds of a diaspora, becoming informal educators in a culture of care around Covid-19. 

By contrast with formal education, which follows a plan of topics and activities, informal education has no curriculum. It happens spontaneously, when you spot a fleeting moment of opportunity in a conversation on equal terms, and you know just the right thing to say to tweak how someone understands the issue. It can’t be planned-for, but you can be prepared. And metaphor can be a powerful (albeit unpredictable) strategy for informal education.

So here’s the metaphor: Covid-19 spreads like glitter.

Airborne transmission is sometimes explained as involving droplets of respiratory secretions less than 5 microns in size, which can hang in the air and travel on air currents more than 1.5 metres from their source — even after the infected person has left the room. Droplet transmission is said to involve larger droplets that fall onto nearby surfaces, or get caught in our hands when we smother a sneeze and then transferred to another person when we shake hands or hug each other. This size distinction has been criticised. And, to be honest, this doesn’t seem enough to explain the incredible contagiousness of the condition, right? Surely it’s airborne.

Here’s how comedian Demetri Martin describes glitter:

Glitter is the herpes of craft supplies. 😘👌

People often think airborne transmission includes direct spatter from coughs and sneezes, but it doesn’t — that falls under droplet transmission. Glitter can fly through the air when propelled by a glitter cannon, and it can go everywhere after that, but it doesn’t hang in the air. Covid-19 is the same. 

And it’s still plenty transmissible. No matter how careful you are, if you use glitter in your craft project, you are going to spread it all over the place — by touch alone. If you air-kiss someone wearing glitter make-up, you are going to get it on you. If you get it on your hands, cuffs, phone cover, wallet, face mask, then you are going to transmit glitter to other people you meet and touch. And you’ll do all of those things unconsciously, even if you make a real effort to keep it contained and vacuum your craft space. Covid-19 is the same.

The finest glitter particles are 200 microns in size. That’s way bigger than the droplets that we create when we cough or sneeze (or snot all over ourselves). And yet they are highly, highly transferable.

We do not need airborne transmission to explain why Covid-19 is contagious.

Metaphors only go so far. One big difference is that glitter is forever — plastic glitter will take a thousand years to break down — whereas particles of SARS-CoV-2 will break apart with soap and water or hand sanitiser, and will be inactivated fairly quickly when deposited on surfaces. Another big difference is that glitter spread ceases when its point source is exhausted, whereas Covid-19 can keep infecting new hosts and creating new sources. But you can use this metaphor to understand and explain the considerable potential for spread via particle deposition and transfer.

This is why social distancing is so important. We know from studies of infection control in hospitals that medical staff require significant training and monitoring to use personal protective equipment correctly. To avoid catching glitter, your best strategy is to avoid dance parties indoor social gatherings, stay home as much as you can, and limit visits by people who could track it into your house.

Bonus for reading this far: enjoy this gorgeous track by NZ artist, Benee.

If you would like to support the work I am doing, a small donation would be gratefully accepted — but sharing this post would be equally awesome!

Donations will be used to support this blog and reliable, independent health promotion initiatives like RinseNRepeat.info.

Shut the schools down

But the reason is not what you think

For the past 3 weeks I’ve been spending time on twitter, monitoring the emerging response to the Covid-19 epidemic and, as we learn more, translating scientific ‘signals’ and policy responses into plain language.

In the past week, that role has become controversial.

I wrote in my last post about how our Prime Minister has politicised the reliability of communications. The government has taken to late night press conferences where it announces a laundry list of restrictions with no clearly apparent underlying principle. Journalists and health promotion people are united in agony at this spectacle.

The government’s ongoing failure to show its workings has important implications for adherence with recommendations. As I’ve argued, people don’t adhere to recommendations they don’t understand. This includes people (of all ages) going to cafés and pubs, for example, breaking recommendations of physical separation and avoiding mass gatherings.

But reactance against poorly-understood recommendations can go in the opposite direction as well — people being hyper conscientious, and people being utterly convinced that current recommendations are totally inadequate.

The public debate over how we are responding to Covid-19 is increasingly focused on demands for school closures. People are quite rightly observing that kids can get the virus and pass it on. Intuitively, that makes sense, right? Kids are little grot monsters and childcare is a swap meet for bugs of all kinds — every head cold going, flu, gastro, nits, hand and mouth, you name it.

All the same, AHPPC says there’s no evidence kids play a major role in epidemic transmission and it does not recommend school closures. That looks like a huge contradiction, and the failure to explain it has left a lot of people feeling severely mistrustful of the response.

Along with a small crew of co-authors on a recent Conversation piece, I’ve been active on twitter trying to explain what Prof Tony Blakely calls the ‘missing rationale’ for Australia’s responses to the Covid-19 epidemic.

Some of the most bizarre inconsistencies, like weddings being capped at five people but fitness boot-camps being allowed ten, are a little easier to understand if you know that Covid-19 is most easily passed on via close, sustained contact. Sitting side-by-side in pews for 90 minutes affords a better chance of viral transmission than doing star jumps 2 metres apart, outside.

(Others, like allowing barbers to remain open, are just bizarre and inconsistent.)

So this past week on twitter I’ve been making the point that school closures are not supported by evidence… and encountering increasingly caustic responses.

Such as Amy Thunig saying ‘you’re not an expert, you’re not an epidemiologist, you’re just a health communications guy.’ Somehow overlooking the fact our epidemic response is currently paralysed by our government’s inability to communicate effectively, and there’s an emerging political crisis about that.

The demand for school closure fits the pattern I described in my post on panic. Processing complex messages is much harder in high energy emotional states like alarm, distress, anger and panic. People in those states reject emotionally dissonant messages, e.g. if the tone isn’t suitably urgent, the speaker is seen as untrustworthy and the message is discounted.

School closure is simple, urgent, and decisive.

Here’s the counter-argument:

  • The WHO Joint China investigation found that in China, which had one hundred thousand cases and aggressive tracing of contacts, children were much more likely to be infected by their parents than the other way around.

  • Other countries like Singapore have controlled the outbreak without closing schools, albeit with much higher collective adherence to social distancing (physical separation) recommendations;

  • In Australia, data on cases and contact tracing shows very few infections in young people — at the time of writing, in New South Wales, only 27 out of 818 total cases were under 19 years.

  • Modelling studies show that school closures won’t help, and a study published today from the University of Sydney shows they may lead to more children becoming infected via contact with higher risk adults.

But it seems nobody’s buying that. It is contradicted by the widespread belief that there is exponential community transmission that is not being picked up in our data.

These two beliefs — infectious kids, unobserved transmission — have formed what sociologist Erving Goffman called a strong discourse. Normally you validate a model against empirical data. In a strong discourse, if the empirical data doesn’t fit the model, it’s the data that is rejected.

We see that happening when we attempt to persuade anti-vaccination advocates and climate denialists with evidence. They reject empirical findings as logically inconsistent with prior beliefs, even though nothing about the universe obeys the laws of logic.

It’s happening now with Covid-19 control, and that is an extremely concerning development. It has the potential to compromise the ability of governments to communicate not just the rationale for action, if they ever felt like doing that, but what we need people to do.

It can also poison the political conversation.

We’ve spent a week on an increasingly heated argument about school closures. They have driven a split through the ‘national cabinet’ of state and territory and the Commonwealth governments, with Vic and NSW going their own way. And while that has dominated the news, we haven’t been talking about the devastating effects of the epidemic and control measures on people’s livelihoods.

This week we saw the modern-day equivalent of bread lines snaking around the block, as people tried to get their identity validated so they could complete online claims for social security payments. We have a huge population of temporary residents who are not eligible for those payments and therefore have to keep working, putting them at increased risk of exposure to SARS-CoV-2.

Some twitter users have argued the government, in trying to minimise restrictions and their impact on employment, is putting dollars before lives. Others have demanded the government tell us all it knows.

But there’s no big secret there.

The government is sitting on epi modelling that predicts tens of thousands of deaths as hospitals are overwhelmed. That isn’t a secret; it’s the premise for flattening the curve, which many people now recognise, if not understand precisely. It is also sitting on economic modelling that predicts millions jobless and multiple years of recession. And it is trying to negotiate a way forward with both of those things happening simultaneously, knowing those predictions could spark widespread panic.

We need to be talking about that. We need to talk through what that means.

So let’s close the schools and move on with the public conversation.

If you would like to support the work I am doing, a small donation would be gratefully accepted — but sharing this post would be equally awesome!

Donations will be used to support this blog and reliable, independent health promotion initiatives like RinseNRepeat.info.

In a crisis, promote reliability (Part II)

This is Part II of a three-part series about effective communication during crises like our current pandemic of Covid-19. In Part I argued To avoid panic, promote efficacy. This post looks at how we can craft reliable communications during times of crisis. A third post will take a longer view, looking at anticipating inequity in how we respond to crises.

I’m calling this model TAPPER.



And always (3.) Anticipate Inequity.

Don’t need the explanation?
Download a one-page tip sheet here.

I was initially concerned this post might be a bit technical, relevant only to experts and insiders. But reliability has become a major political issue over the past week of the online conversation about Covid-19 and Australia’s response to the outbreak. People have been making and circulating ‘home-brew’ graphs, many from engineers and IT guys. Without any modelling skills at all, and without any information on Australia’s outbreak other than infection numbers, they visualise doubling time and little else.

Continue reading “In a crisis, promote reliability (Part II)”