#49. Understanding Co-occurring Alcohol and Mental Health Problems - Dr. Jo-Anne Puddephatt

Dr. Jo-Anne Puddephatt of Edge Hill University is a mixed-methods researcher in the field of mental health, alcohol use, and co-occurring problems. She combines her experience of working in psychiatric intensive care units with her expertise using datasets to explore the patterns of drinking across individuals experiencing different mental health problems. Jo-Anne also conducts qualitative research and works with patient involvement groups to explore the mechanisms of co-occurring alcohol and mental health problems.

Chapters

• 0:00 Jo-Anne's Journey into Research
• 6:35 Understanding Mixed-methods Research
• 10:14 Importance of Patient and Public Involvement
• 14:26 Balancing Research with Personal Attachment
• 18:01 Literature Backing up Observational Evidence in Co-Occurring Mental health issues
• 21:51 Exploring Co-Occurring Problems in Mental Health
• 24:35 Impact of Co-Occurring Problems and Treatment
• 27:35 Personal Reflections on Alcohol and Research
• 32:13 Isolation and Drinking Behaviour
• 35:04 Understanding Context in Alcohol and Mental Health
• 37:13 Addressing Disadvantages in Mental Health Support
• 43:32 Balancing work with mental health
• 51:31 Engaging with Communities and Cultural Sensitivity

Transcript

0:03

Were there any questions you had, Joanne, before we got started? No, I don't really know what to expect. I'm growing in to just a bit blind. That's good. That's the best way to go into it. So is Jeremy. Jeremy has no clue either. All right. So yeah, let's get started. Welcome everybody to the Smooth Brain Society. After being interviewed myself, I'm back in the hosting chair again. Jeremy's here again as a co-host. And again, I'll just remind people the format of the podcast where me and a co-host who has no clue about the topic, Jeremy over here, learn about research topic from our wrinkly brain expert who is today Dr. Joanne Pudevat. Joanne is a senior lecturer in psychology at Edge Hill University. She is a mixed methods researcher in the field of metaphysics. So what that means is essentially she has experience in using. large data sets, as well as conducting qualitative research to explore different mechanisms. She mainly works with mental health, alcohol use and co-occurring problems. So welcome to the podcast, John. Thank you for having me. All right. So let's just start with where we start with every guest, What got you interested in your field and a little bit about your journey so we can understand how you got to where you are at Edgewell University? Yeah, it's a good question. I suppose, I don't know, it's a little bit of a kind of windy path. So I've always been interested in understanding sort of mental health problems. Primarily, that was something that I was really interested in it as an undergraduate student. Liverpool John Moores University. And then after doing the education, going down the educational route for a few years with, you know, A-levels undergraduate, took a break and traveled for a little while. And I thought I didn't want to be doing any kind of academic work or research or anything like that. And then during my travels and doing some like you know, jobs to get me by, I realised actually I'd quite want to do something that I'm really interested in, that might make somewhat of a difference. So then I decided to come back home to the UK and do my Masters in Health Psychology. And then because that was only two days a week, I wanted to get some clinical experience again. I thought I wanted to be a clinical psychologist. So I worked in a psychiatric intensive care unit in Manchester. which was probably one of the most pivotal experiences for me in determining where I am now. Sort of seeing the problems that people experience when they end up on a ward like that where they are detained under the Mental Health Act and just seeing their circumstances. I loved working with the patients, I got quite frustrated about. what I could do as part of my job at the time. And I also realized I didn't want to be a clinical psychologist. So I had to go back to the drawing board and I actually liked the sort of research side of it. And I was really interested, became really interested in how, you know, sort of people's social environments and how that can... you know, contribute towards the problems that they end up experiencing, particularly around their mental health. And also the how that enables them or doesn't enable them to cope with their situation. And so we would often see people on the ward who had substance use problems and really struggled to access support, particularly if they, I found if it's not empirical research, but an observation I made was that, you know, a lot of the people coming onto the world were really quite from quite disadvantaged backgrounds, didn't have much family or friends support, and they seem to be coming back through the system quite a lot. Whereas you would sometimes get someone from a more affluent background, had a lot of support, and it might be that the medication has stopped working or whatever and then go away and you wouldn't necessarily see them again. So it was just a bit of an observation that I'd made and then there was an opportunity to do some research at the University of Liverpool as a research assistant and that was actually focusing on alcohol, an alcohol intervention for veterans and then it kind of snowballed from there and I was then able to get a PhD which I wrote with sort of my supervisor at the time, which was then focusing on co-occurring alcohol and mental health problems. But I suppose what I do now for research, it's always really important for me to think back to those different experiences that I've sort of been exposed to and thinking about, you know, what is the point in what I'm doing? Like, what is it actually, what difference is it actually going to make? So I've always got that. forefront of my mind when it comes to any research that I'm doing or I'm involved in is thinking about those people that I have seen and how I can sort of work more closely with them within the research environment to make sure that what we're doing has potential to help people. It's not always possible. There's only so much sort of, you know, research. researchers can do sometimes, but I like to think that always guides what I do. So yeah, so that's kind of my long and windy road into research and where I'm at the moment at Edge Hill. No, nice. No, that's really, that's really nice that you then have a little bit of clinical experience as well to go on, because I guess in my intro, I just said mixed methods. And when I said mixed methods, they're talking about the statistics side and a little bit of when you say qualitative research, people usually just think interviews, maybe a little bit more than that. But yeah, if you could elaborate on So first of all, now when you say mixed methods, you're actually like, completely mixed methods, you have experience with clinical stuff as well. How has that sort of influenced the way you approached your qualitative work? And I think I guess the question half a step back is, when you talk about qualitative work, what are you talking about in your field when you do it? I suppose So in terms of what I see as qualitative work is more from like a research or an academic perspective. So you know interviewing people who have co-occurring problems who are from different backgrounds you know whatever the focus of the research is on it's sort of interviewing or doing focus groups with those groups of people but I've also learned a lot from interviewing staff who work in services and sort of learning about the different perspectives from those different groups of people and what I found is that you can find some very similar issues but then some very different assumptions or perspectives from those different sides so I actually quite like interviewing different people who are potentially exposed to the same thing, but coming at it from a different angle. I think it's always interesting to get those different perspectives. So that's why I would class it sort of, for me, is as a researcher, it's the qualitative research. I suppose a separate thing that I do a lot of is sort of patient and public involvement work. I suppose I don't really consider it as much as qualitative research, because I don't see. working with the patients or the people who have lived experience with, say, for example, co-occurring problems, I don't see them as participants in the work. I see them as contributing equally, if not more in some ways, because they've gone down the path that I'm interested in and learning from their experiences. understanding what is needed from me or members of a project team to sort of address or better understand the issues that they're going through. So I suppose I see that different to qualitative research because I suppose I'm not trying to, I'm trying to understand both of those different groups of people for example but in a different way. And that's where I sort of come at it. I can't remember your first question though, I'm really sorry. No, you answered it. You answered it pretty well, so don't worry. Sorry, I was just waiting, Jeremy, I wanted to say anything. Just listening and learning, honestly. It's fascinating. I really, really like how you've mentioned that you kind of work with these people as opposed to treating them as subjects, which I think is a really interesting point. Yeah, I think it's just, it's a, I really value it. It's something that I really try and do my best to incorporate in the research. I mean, I feel like, you know, you always learn something new and learn how you could do better for future work. I don't feel like I ever get it 100% right with research or with patient and public involvement work, I feel. there's always some ways that you can improve and you know that sometimes unexpected things come up that you've never come across before and so at the time you're just dealing with things as they come and dealing with it as best as you can and then trying to learn from that going forwards when it comes to the next project but I do try and have you know though the people at the heart of the research it's tricky, it can be really hard to balance and you know the time scales with research is very different to what other people might be expecting, particularly if they've not been involved in research or patient and public involvement before. It can be quite a bit slower than people would like it to be, but I've learnt to try and help address that through like managing expectations, just being very clear with them. what they can expect and when they can expect for things to be done. Yeah, it's something I'm really quite passionate about, the patient and public involvement side. It's for me, it's not, it is research, but it's the power dynamics are a bit different than, you know, interviewing someone or getting them to fill in some questionnaires. I think that they have a lot of value. And like I say, it was really from actually the clinical experience that really got me thinking about, you know, I wouldn't have known some of the things that came up during my time there, had I not gone and worked in those environments, like, you know, the traditional routes, I think it's very hard to capture that until you're actually in that environment and see, you know, how sort of individual level but also system level processes, just how things work in a system, particularly in healthcare and what sort of impact that has. And for me as like working in the hospital, I was also tied with what I could give them or what I could do to support them because I wasn't allowed to do certain things, so I wasn't qualified to do certain things. So I learned a lot from that type of experience and from just being with patients, you know, for long hours, you know, 13-hour shifts. And you get to know them very, very well when they're on the ward. And you get to know lots of different pieces about their life. And it's really through that that... I don't think it's very difficult to get that from, from other ways of like doing research. And that's why I like the patient public involvement stuff, because I feel like you can kind of tap into that, not as much of like a sort of closer level because you're not with them 30 hours a day, for example, but you certainly get to have a bit more of an insight. And it's a bit more flexible than if you've got like an interview schedule where you've got set questions that you want to ask them. that you're asking of everyone. And there's not so much you can do with that. Does that present any further challenges? I know you mentioned working with them, sort of the challenge there is managing their expectations on timelines and ways you can help. Does the, because I imagine you would get emotionally attached to some of these people and some of the things that they're going through. Does that ever... I don't know if the phrase muddy the water is the right one to use, but does that ever present challenges for you personally and for the research? Not so much. I mean, it's about just sort of maintaining the boundaries and also acknowledging that there's only so much I can do for them. I mean, you do kind of, you get to know them quite well. I mean, with sort of patient and public involvement work, it kind of depends how involved. they are and how many times you're meeting with them a lot. That really depends on funding, for example, so being able to reimburse them for their time to actually come to meetings and stuff. I suppose, if anything, it makes me more... aware of the different things that they've got going on and then thinking, okay, they've raised these issues, what, is there anything in the evidence, in like the academic research field that can, you know, point us to, you know, trying to bring together that, their actual lived experience along with what we know in the literature or what we don't know. And I think for me, it's just about maintaining those boundaries. So it's never really muddy the waters as such in terms of, you know, things that they might tell me or things like that. I think it's more... there's maybe just a bit more pressure to try and keep the ball going with it. Because, you know, with research a lot, the majority of it's contingent on getting the funding. And, you know, I can't promise that will lead to funding because I don't know. If it could, it'd be great, but we don't know that. And so I try and sort of manage that by making it clear to them and also be a bit... more gentle to myself, I guess that, you know, these are the things that I can control and, you know, I can apply for certain things or try and collaborate with people to do certain things to keep that momentum going with, you know, the lived experience member, for example, but also just being really clear with them that, you know, thank you for being involved and, you know, we're doing what we can to keep this work going. But obviously, the nature of the game is that you need the funding to allow that to happen. And so that for me is the tricky bit because they're dedicating their time that they don't need to and sharing some very personal experiences at times. And, you know, it just feels, for me, I just feel more responsible to make sure that I'm handling that in the right way and that it hopefully leads to something more meaningful. But within my own control, there's only so much you can do. A lot of it's out of our control as researchers, unfortunately. Yeah, um, we, we can, one thing which you mentioned when you spoke about your clinical work was you saw a bit of anecdotal evidence as you said, observational evidence, which you set off, meeting certain people, more people from certain backgrounds a bit more. And you say you look at back look back at what you do now qualitative PPI work with what you find in what do you say in academia or like in the literature? Have you have you found stuff which has substantiated your sort of observational? Or yeah, what you what you saw observationally? Kind of. It's something that I'd like to try and do a bit more of, to be honest. So As part of one aspect of my PhD was looking at the role of social support and neighbourhood disadvantage among people who have a mental health problem and looking at whether that moderated the associations with their levels of drinking. So whether they were a non-drinker or drank at levels that were harmful to their health. In terms of, and so what we found, so that was using an existing data set of the national survey of people living in England. And what we saw was that people from living in sort of the more deprived areas, that kind of, so people who were from lower socioeconomic backgrounds, who have a mental health problem, lived in sort of more deprived areas, they were more likely to drink at levels harmful to their health. The social support one was a little bit trickier to sort of understand and so I think that needs a bit more of unpicking. There is quite a bit of literature around social support, sort of like the qualitative side, but that's something that I would like to look more into because as I say there's different levels of support, there's different types of support. Someone could have lots of family and friends for example but actually you know the nature of those relationships might not be the most positive. Someone might have might want support might see support in terms of financial support as one way of getting support another might be emotional support. So there's like different types of support, which there are questionnaires and measures out there that look at that, but it seems a little bit messy. So I think something that I'd like to do is sort of try to untangle that a little bit because I think it would be interesting to see, particularly for people with co-occurring problems or people who have co-occurring problems, but also live in... come from different levels of advantage or disadvantage, what that type of support looks like and how that sort of impacts them. But I think there needs to be a bit more in that line of work really. I'm not sure that there are some measures out there, but I'd need to look into them more really before I could say much more on that. No, that's really nice. What I was thinking while you were saying that was about some of the current work which you're doing because you mentioned co-occurring problems over there in that sentence. Could you explain what you mean by co-occurring problems? Yes, co-occurring problems, I think, for what I do is really people who have both a mental health condition and an alcohol problem at the same time. They can, the way in which they co-occur could differ. So someone might have a mental health problem first and then they potentially have limited resources to sort of cope with that. condition that they're dealing with. And so they might use alcohol as a way of managing their mental health condition. And what happens is that might become a bit of a cycle, a maladaptive cycle, where they start drinking at levels that aren't good for their mental, physical health. And they might also become quite socially isolated through that. There is also the other way where, you know, someone might have a problem with drinking. And then because of their problems with alcohol, they might have experienced, you know, sort of negative consequences from their drinking and that might then worsen their mental health and then it becomes a cycle. Or it could be that they both occur at the same time. We know that there are sort of potential genetic factors that might be common for both alcohol and mental health conditions. which means that someone's more susceptible to that. I mean, when you look at the evidence, there's more, so when research has followed people up for a longer period of time and seen, tried to test, you know, which comes first, is it alcohol problems or mental health conditions that come first? They've generally found more support for the view that the mental health condition comes first, and then... alcohol is used as a way of potentially as a way of coping and that creates that cycle. So that's what I mean by co-occurring problems is you've got two conditions but it can be a bit messy as to which comes first. That's still quite a bit of a debate in literature. Um, do you think that which comes first plays a role in how you sort of deal with it or treat it in that sort of way? Um, yes. It's a bit tricky though. Because if you have both an alcohol and a mental health condition, what we know is that it can be very tricky for them to get support for either of those problems which ever came first. So, for example, if someone first had a mental health condition and then the alcohol problems came later, struggle to get access to support for their mental health condition because they do drink alcohol so some services won't see them until they've stopped drinking and that's really tricky because if that is the one of the only things that's helping them at that time then you're taking away that one thing that is helping them before they've been able to even access that. mental health support to address that first issue. And, you know, it might be that even before that condition came about, they might have had sort of quite traumatic experiences. You know, there might be a lot of different factors that have contributed and potentially that have led to them developing a mental health condition. So although I do think it we should be thinking about which has come first. I think it's also about making sure that they have access to support for both of those conditions at the same time, even if it's delivered by different services, because otherwise you run the risk of physical harm if they're drinking at really heavy levels and they stop drinking all of a sudden just to get access to a service. then that's really risky for their physical health. But also, there's then nothing, we know that there's quite big delays of people accessing both alcohol and mental health services, let alone if they need, say, more trauma informed support, for example. We know that there's big delays in that. And so it's very difficult. To tackle those like one problem at a time, if one is helping. the other, even if it's not helping that person, but for that person at that time, it's what's working-ish for them, even if it's potentially causing more harm. Hopefully that makes sense. You sort of touch on the fact that it feeds into different places in this cycle, right? There's, it's kind of like a chicken and egg situation. And I'm wondering if your perception or your relationship to alcohol has changed since sort of, as you've sort of under undergone this research. That's a really good question. It has actually, to be honest, it's made me think a lot more about my how I drink alcohol and what it's done for me. I mean, it's hard as well because I've got older, so you know, I can't handle a drink like I used to. But yeah, it has made me think a lot more and I think it's also made me look at the people around me is drinking, like relationship with alcohol. So for example, my granddad, he has, he's always had like a bottle of whiskey next to his, next to his chair in the living room, right? And that was just, what was the other one? I can't think what it is. It's gone from him. Basically, he'd always have a bottle of of alcohol next to him. Not that he'd be drinking it all the time, but it was always there. And then it gets to a certain time in the day and you'd have it, you'd have a glass of it. And like he was just night and flight falling asleep with a glass of whiskey on his belly, you know, resting on his belly. And that would never ever tip. Like he'd be asleep and it would never tip. And I never thought anything of it. Truly never thought anything of it because that was just something that I grew up with. until I started working down this in this area and then I was like hmm that's not great you know like and I would know I wouldn't broach that with him personally but it was it's through the research where I've started looking at my own and other people's drinking where I'm like oh okay maybe like some of this is a bit interesting to look at and I'd never you know I wouldn't personally go out and say anything to them because I don't think I'm qualified or that's my place to say it. But it certainly made me look at my relationship with alcohol, when I use alcohol, how alcohol actually makes me feel when I do drink, but also that of the people around me because I'd never thought that was a bit weird and potentially problematic that my granddad would do that. And then it was only when I started working and I was like having like, you know, half a bottle of whisky, you know, most nights is not, you know, we would turn that as like something that's not good for your health and you know, potentially a problem. And it's only through doing the research where it's like where I just started to question that, I suppose. Yeah. Oh, Ozzy White, that was the drink. Ozzy White is a bottle of Just came to my mind that I've got to give a shout out to Ozzy why that's his drink. And swears that it makes him feel better. Or he swears that it's given him good health because he never has a hangover the next day. Take notes, Jeremy. Hangover purposes. Yeah. No, yeah. Yeah. I mean, I'm not sure how much I believe in with that, but you know. not going to question the 90 year old man to be honest at this point. No, my granddad passed away at 93 94 and he and his rule was never drink alone. And that's it. And I was like, don't question don't question the man. No. It's interesting, isn't it? Like, you know, you've got like, there's certain people and you see in like the research that I do, where they don't question would never question certain people, you know, particularly the elders, I guess, with what they say and then, you know, you start, I don't know, working in that line or whatever and then you're like, actually, I'm not quite sure that what you're saying is right but I'm also probably not going to try and even address that with you at this point in your life. One thing which you brought up with that story is a story of my own or observations which I've seen myself of friends, family members who started drinking more when they felt more isolated. So when they were unemployed, for example, another time was when the work one of my cousins was and had no friends and it was a real tiny town. So I started drinking a lot more than, and then now when they're back in a big city with the kind of, with they grew up in, or like with they grew up in, don't nearly drink as much. So is that, one, it touches back to some of your previous answers on isolation, but, and also to how behaviors sort of change and how you realize it when you start researching or working in the field. Yeah, definitely. And I see that with like lots of people that I've interviewed in the past. Like that's why I like the qualitative works. I definitely value like lots of the quantitative work and what you can get from big secondary data sets. But when you're talking to people, or even, you know, maybe not as part of research, but just through those observations, you start to notice, you know, certain things. And, you know, how sort of when the patterns change, because it's, you know, it's common for any behaviour to sort of change over time. It kind of reflects lots of different things going on in your life. That might not be, you know, poor mental health. It might not be that you're necessarily going through a tough time. It might be that you're just getting older and you can't hack it like you used to and, you know, or you've got like certain responsibilities that you, you know, you can't engage in certain behaviours. But I think it's very interesting to... to think about the wider context within which drinking happens, but also particularly with people with co-occurring alcohol mental health problems, I think it's always important to look at the wider setting that they sit within, because I think ultimately that really can contribute towards what they're going through. And we know there's a lot of research to show that. lot of like the public patient public involvement work is highlighted you know how important things like housing, social isolation, employment, finances, you know how important they all kind of a role they all kind of have played and still do play in sort of staying well or you know potentially declining. So yeah I think it's for me it's always important to think about that wider context. I think if you lock up things too much in isolation, I think it's very difficult to get a real understanding of what's going on without looking at that. This is very funny because literally the last podcast was about isolating particular things and doing animal research. Then we expanded back out and we like, but it's very important to not isolate things. I suppose it depends what you're looking at, right? Exactly. There are some, you know, in some ways you do have to look things in isolation, particularly in certain lines of research. I think... to really understand, you know, it depends on what your question is, right? Depends on what it is that you're in, that you're looking at and what you're interested in. I just find that there's a lot of contributing factors from all the work that I've done or read. It's there's so many contributing factors. It's very hard to even say which one is contributing the most, for example, without potentially looking at genetics and And even then, you've so then got to account for, you've got to look at all of the other factors and trying to think of what the other factors could be. But yeah, I just, just based on a lot of the work that I've done, it's kind of, you have to understand the wider circumstance to get a bit more to grips with, particularly if you look at people with co-occurring alcohol, mental health problems. So I want to use the next part of the podcast to talk about, yeah, next step. So if suppose we're talking about your work is about understanding the contexts and people's circumstances and co-working problems and so on. But the thing which you had mentioned at the very start is wanting to make a change and people's lives. So what sort of outcomes are you trying to achieve currently with your work? Or what do these sort of outcomes look like? How would a PPI process sort of lead to change? I guess is my question. So I think for me, I think there still needs to be a lot more work around understanding co-occurring problems with specific groups of people who we know are more likely to experience disadvantage so a lot of the work that I've been doing over the last few couple of years has been really focused on people from diverse ethnic and religious backgrounds so we know that they have poor health outcomes. we know that they are less likely to engage with sort of, you know, formal mental health or alcohol services. And firstly, just trying to understand more about what they need to access that support or to even seek that type of support. And then, which I think we're doing quite a bit of work on that and both the patient and public involvement work where we've been working very closely with people who have a mental health condition and come from different ethnic and religious backgrounds. That's been really useful to think about what systems are in place, where do they get referred to, where are they accessing support and what are the issues that they've had so far. has really helped to understand what is needed going forward. And so I suppose for me, the next steps are to work out how do we try to implement those changes? And it's quite a complex one because on the one hand, it's sort of trying to do it in a way which is addressing the needs of the... the people that we're interested in, so people with occurring alcohol mental health problems, making sure that they're accessing or are nowhere to access support and can access it in different ways. Some people might not want to go to certain services, they might prefer to go to a community or mutual aid service. So that's on the one side for that individual, but then it's also for staff and services that are available in different areas to know what their service users are looking for and to also know what the different places of support that they could signpost people to. So trying to sort of make the change from both ends, not just for helping the individual, but also helping staff and services who are already very busy. very much under resourced. I'm doing it in a way where we're not trying to get them to do loads more work. So that's like a very tricky balance. And so I suppose for future work that I'm trying to do is work out, is to work more closely with both of those groups to see how we can. either not necessarily develop systems because I'm not sure that I could do that as just a lone researcher, but working out how can we work with what we've got to make sure that we're, or adapt things in a way that becomes more inclusive for people from different ethnic religious backgrounds, from different levels of disadvantage who might not live in an area where they can actually. easily walk to or get go and attend a mental health service, for example. So that's sort of where I'm sort of at the moment. I think there's still lots of work that needs to be done. I think in terms of better understanding, I think that the needs depend on particular groups of people, people with from different areas with different characteristics. I mean, a lot of the sort of work that I've been doing around ethnicity and religion has really just sort of highlighted how you know, the very different groups within that. And I don't think, I'm not sure that the current guidance and research necessarily acknowledges that to its full extent. There's sometimes, you know, sort of, not necessarily generalizations, but there's certainly like in the big data sets, people tend, people from certain ethnicities will tend to be grouped as one ethnicity, for example. You know, you might have an Asian population within a big sample size, but that is a very big, broad group that doesn't really speak to all of the sort of nuances within that. And if you're using that data to inform anything, it's a bit risky because you don't know what's underneath that. And it's really through the qualitative work and the patient public involvement work wave. really start to understand a bit more about the intricacies within that and how that actually impacts where people want to get support, whether they'll access support, whether they'll actually engage with it and stay engaged with it. I feel like I've gone on a bit of a tangent there but like I think there's a lot more that still needs to be done to really get to grips with what both the individual needs. but also what staff and services need and maybe assume the individual needs and sort of marrying them together to work out how they can better access that support when they need it and regardless of if they've got both an alcohol and a mental health problem that shouldn't necessarily always stand in the way. A lot of this stuff has, obviously it sounds very heavy, like it is, it's a very heavy topic, I think, and you're clearly immersed in this world quite a lot. So I guess one of the last burning questions from me would be twofold. It's sort of, again, a look at you personally, but also sort of wider advice to the audience. which is sort of how do you manage your mental health while dealing with all of this stuff? What are the sort of the good practices that you put into place to ensure that your mental health is well, I guess. I don't think it caught the second question, but in terms of managing my mental health, I do little things. So I don't have my work emails on my phone. So I do not see my emails unless I'm on my laptop or a computer. I put that in place fairly quickly after coming into academia when I was on a part-time contract. So I was working three days a week as a research system. And what I was finding was that on my days off, I was still checking emails. And then it felt like I had never had a break by the time I'd come back to doing the work again. So I ever since then and continue as a lecturer, which is somewhat of a controversial thing, but I stand by it is I won't have my emails on my phone. There is never usually anything too important that needs to be addressed at midnight. or on a weekend. I break that promise by checking emails if say I've got like a big deadline that I know like needs to get sorted. That is the only time I'll do it and I'll do what I might do work is an evening but it's kind of on my terms. It's not with emails. I find them just really distracting from actually doing any kind of work. You know, you can spend like, find I spend about a good hour of the morning. addressing emails. So if I was to do that all the time, I'd just get burnt out. What else do I do? I just surround myself with different people. And I actually, I'm one of my family and friends, sort of close family and friends. I'm like the only person that works in academia and research. So, which I actually quite like. I mean, it was a bit lonely as a PhD student when, you know. your family and friends don't quite understand just how, you know, what PhD really involves. Or, you know, for me, like sorting out a piece of syntax was like gold. I was just made up for like the entire week and you've got like your partner or like your mum going, okay, great. You know, like the underappreciation of sort of getting that syntax code going on M plus or something like that. But yeah, I quite like that I don't, you know, I obviously have friends and, you know, good friends in the sector and stuff, but I quite like that when I go home, it's completely separate to what I do at work. It gives me, that's, it's just making sure that I have time for those breaks, otherwise you just get burnt out. I mean, there are times I definitely struggle when you've got loads of deadlines. I particularly found going from being a researcher, only a researcher, to a lecturer managing the teaching, you know, a bit of a challenge initially. But actually I quite like that, you know, some days I just do teaching and that's really quite nice because I'm just with students and that's that. And then I also get dedicated, I just dedicate days to research where it's really nice to just dip back into what I actually really like. Um, I didn't catch the second part of your question. Sorry. It was, it was just me rephrasing the question a little bit. Just, yeah, no, you answered it perfectly. And yeah, really interesting. Thank you. Um, I was gonna say lucky you for that because my mom did a PhD and not only did she do it, she did it in my field. Oh, in your field as well? Well, she did more genetics, I did it more psycho, more psychology. So she would rip apart everything I wrote. I was gonna say, what is that like? I mean, I suppose it's that I would assume there's some good things about it. There's good things about it, like Like the opposite of what you said, there's someone to converse with. Yes. At the same time I've got my supervisors to converse with. I don't need to come home to that. It's interesting isn't it? I mean like there were definitely some times where you get a bit frustrated and you're like, you don't appreciate what I have managed to do today or you know, you don't appreciate how big this deadline is. And but I think it also, you know, But then it's good to have someone that has some of that understanding. But I also think I just find it all very grounding. You know, you have like a day where, I don't know, you've like your paper got rejected and now you've got to find somewhere else for it to go. And then you go home and then you talk about something entirely different that's actually really, you know, personally quite important. And it just, you know. You know, it just humbles you a little. It just brings you back, brings everything back into perspective. I think I think my mom was pretty good with that. The first time I said, oh, I had a paper rejected. She was like, oh, I've had hundreds. Don't worry. It's fine. It's not used. It's all good. But what was it? There was one more thing which I wanted to say about that, which is equally funny. Yeah. The other problem is because my mom did wrote her thesis on a typewriter. She typed it out. Wow. So she's like for she's like, we have it way too easy with Google Scholaring, formatting information when she had to go to the library, order the Society of Human Genetics Journal from America and it would come and then they would read that paper and it was a whole process. Oh, and then if there was a typo in. thesis you needed to get go to a typewriter and type the whole page out again, and now I can just backspace You don't get much appreciation either Understand that I can understand that I think there's also like different pressures nowadays but I I'm not envious of your mom doing that. I mean even like now when I like what was it? I took go from my thesis the other day just to grab like a reference for something or I can't remember why there's a reason for it. And I saw like a typo and I was just like, and I've got it bound, you know, when you're just looking at it like, I can't, I need to quickly close this before I get really annoyed, let alone doing the typewriter, gosh. Awesome. So in interest of time, we'll start our wrapping up. Joanne, did you have? Oh, what can like sort of people expect if they wanted to sort of get involved with your work? Sorry. So what are the current projects you're doing? If anybody would be interested in getting involved or getting in touch with you? How would they be able to do that? Yeah, if you talk about that for a little bit. Yeah, so currently, we're working on developing some tools for mental health care professionals around sort of trying to enable and encourage having conversations around drinking, but with a particular focus on culturally sensitive conversations around drinking. So if you work in the mental health field or even sort of the community health field, or you are someone from a diverse ethnic, religious, cultural background, then you can find me on X. I normally say Twitter, but it's X now, isn't it? Otherwise, you can also email me. You can find my email on the Edge Hill University website. That's sort of the main work that I'm doing at the moment. But we also do quite a bit of work around sort of the different ways in which people with co-occurring our comments, health problems, access support. And then we've also got I'm on a project with a colleague at Edge Hill University looking at sort of recovery from alcohol problems and mutual aid groups. So if that's something that you're interested in being learning more about, then just get in touch with me either by email or Twitter, to usually the way that people find me. And Joanne will only reply during work hours, so. And I will only reply during work hours. I might see it, but I won't reply. straight if it's outside of work hours. Awesome. Joanne, any final thoughts? Other than this has been absolutely fascinating. No. No thanks. Awesome. All right Joanne, the final question we ask all our guests is if you had one piece of advice for people listening, what would it be? Like general piece of advice? General piece of advice. Oh my goodness, gosh. It's the toughest question actually. That is a, that's probably the toughest question on this podcast. Um, uh, it would be, you can only control what you control. So the, if you can't control it, then try not to worry too much about it. So much you can do. Awesome. Amazing advice. Try and stick with that. It doesn't always work, but you know, try and go with that mantra. Yeah. It's the thought that counts. Yeah, yeah, try it. See if it works. Follow up advice is the thought that counts. Awesome. No, thank you very much. And this was really fun. Thanks, Jeremy, again. Coming up. No worries. Thank you guys. And thank you, everyone, for listening. Yeah, just and yeah, just a reminder to follow our socials and all that, because I never say it, but looking at Jeremy, who's a so... who's a creative director and a social media president himself. Please, please like, subscribe, follow. Go visit smoo Patreon, Instagram, all of the things. Go follow, go and support because this is important stuff that the world needs to hear. Awesome. And yeah, thank you everyone and goodbye.