Chatting with Suicidologist Dr Nikki Jamieson: Grief, Moral Injury, and a life dedicated to Suicide Prevention.

Content Warning: 

This episode discusses suicide and suicide prevention. 
Listener discretion is advised. 

In this ep Mark chats with Dr Nikki Jameson—social worker, suicidologist, and founder of Moral Injury Australia—to unpack how a mother’s loss of her son Daniel to suicide ignited a national push for reform, shaped a Royal Commission, and gave people a new way to understand suffering that doesn’t fit neatly under PTSD.

Nikki shares Daniel’s story—his loyalty, humour, and service—and the different weight of suicide grief. From there, we explore what moral injury is: the enduring psychological and spiritual harm that follows a violation of one’s core values or moral code, whether from orders that feel wrong, systemic betrayal, or a moment where you couldn’t act. We talk about how treatment approaches based on compassion, forgiveness, meaning-making, and body-based practices like breathwork, movement, and even laughter can help people heal. We also tackle misconceptions about suicide, the difference between ideation and intent, and why belonging and reasons to live are powerful protective factors.

This is a story of systems and change. Nikki walks us through key Royal Commission recommendations, including the explicit call to prevent and treat moral injury, and explains why families and cross-agency coordination are vital. 

If you work in defence, health, education, justice, or any role where hard choices meet human values, this conversation offers language, tools, and hope.

If this conversation resonated with you, please share it with a friend or colleague, and subscribe for more thoughtful insights on mental health and suicide prevention, and leave a review so others can find the show. Your voice helps this message reach the people who need it most.

Thanks for listening. 

To follow the work Nikki is doing: 

https://www.linkedin.com/in/dr-nikki-jamieson-658835154/

https://moralinjuryaustralia.com.au/

Website: www.thelaughterclinic.com.au

Youtube: https://www.youtube.com/@thelaughterclinicAus

"If you or someone you know needs support, please contact one of these Australian mental health services. In an emergency, always call 000."

Lifeline Australia
Phone: 13 11 14 (24/7)
Web: lifeline.org.au

Suicide Call Back Service
Phone: 1300 659 467 (24/7)
Web: suicidecallbackservice.org.au

Beyond Blue
Phone: 1300 22 4636 (24/7)
Web: beyondblue.org.au

Kids Helpline (for people aged 5-25)
Phone: 1800 55 1800 (24/7)
Web: kidshelpline.com.au

MensLine Australia
Phone: 1300 78 99 78 (24/7)
Web: mensline.org.au

SANE Australia (complex mental health issues)
Phone: 1800 18 7263
Web: sane.org

QLife (LGBTIQ+ support)
Phone: 1800 184 527
Web: qlife.org.au

Open Arms (Veterans & Families Counselling)
Phone: 1800 011 046 (24/7)
Web: openarms.gov.au

1800RESPECT (sexual assault, domestic violence)
Phone: 1800 737 732 (24/7)
Web: 1800respect.org.au

Headspace (youth mental health, ages 12-25)
Phone: 1800 650 890
Web: headspace.org.au

13YARN (Aboriginal & Torres Strait Islander crisis support)
Phone: 13 92 76 (13YARN) (24/7)
Web: 13yarn.org.au

Music by Hayden Smith
https://www.haydensmith.com

Chapters

• 0:00 Opening, Context, And Content Warning
• 2:12 Introducing Dr Nikki Jameson
• 4:20 Laughter As Medicine
• 7:15 Daniel’s Story And Values
• 11:20 Suicide Bereavement And Moral Injury
• 16:20 Royal Commission: Mothers Driving Change
• 20:10 Key Recommendations And Families’ Role
• 24:05 International Comparisons In Defence Care
• 26:15 What Moral Injury Is
• 31:00 Moral Injury vs PTSD: Treatment Implications
• 36:40 Organisational Betrayal And Psychosocial Risks
• 42:20 Who Else Is Affected: Beyond First Responders
• 45:10 Founding Moral Injury Australia
• 48:30 DSM Update And Why It Matters
• 53:30 Personal Costs, Purpose, And Learning
• 57:40 Stats, Access Barriers, And System Gaps
• 1:01:10 Humour, Body-Based Healing, And Research Gaps
• 1:05:40 Community-Level Prevention And Connection
• 1:09:10 Misconceptions: Mental Illness, Selfishness, Ideation
• 1:14:20 Reasons To Live And Protective Factors
• 1:19:20 Where To Learn More And Upcoming Events
• 1:22:30 Feel-Good Five: Dogs, Love, And Italy

Transcript

SPEAKER_00: 0:01

Welcome to the Laughter Clinic Podcast with comedian and psycho psychologist Mark McConville. Bringing you practical, evidence-based self-care strategies, the latest research in mental health, along with conversations that inspire, educate, and entertain. This is the Laughter Clinic Podcast with your host, Mark McConville.

SPEAKER_02: 0:35

Hi my friends, welcome to this episode of the Laughter Clinic Podcast. Thank you very much for joining me, and I hope you are well wherever it is that you are listening. And uh as you know, this is comedy meets mental health and suicide prevention strategies, and pretty much that's what we're diving into today with my guest, Dr. Nikki Jameson. So this episode does actually come with a content warning before I before we get into it. So uh pretty much the entire discussion that I have today with Nikki, we discuss topics of suicide, suicide prevention, and suicidality. So I understand that some listeners may find this content distressing, confronting, and and difficult to listen to. Therefore, I do advise listener discretion on this episode as it may not be for you, and you know what, that is totally okay. It's just one of those topics that obviously work in the field of suicide prevention, so I'm gonna have these guests on every now and then. Should you wish to proceed, however, and I th I you know if you're interested in mental health and suicide prevention, this is a pretty interesting chat. You're going to meet a uh an amazing woman and hear an incredible story, and and Nikki has done inspirational things in the field of mental health and suicide prevention, especially when it comes to defence force members and and all everything around moral injury. So, as always, there is a list of a comprehensive list of support services included in the show notes, should you need uh to reach out after the episode. So who's who is my guest today, Dr. Nikki Jameson? Well, in 2014, Nikki lost her 21-year-old son, Daniel, to suicide while he was serving in the Australian Defence Force. Uh now, since Daniel's death, Nikki has dedicated her life to defence and veteran suicide prevention. And she was also actively involved in the advocacy and a push for a Royal Commission into Defence and Veteran Suicide here in Australia, which actually ended up happening. So Nikki is a suicidologist, she's an academic researcher, social worker, she's also the founder of Moral Injury Australia. And Nikki has a PhD in moral injury and veteran suicide, and interestingly, she is now a specialist advisor to the Australian government in the field of defence and veteran suicide prevention. So, yeah, she's achieved a lot in the time that she's been in this space. And above all else, she is a mother. She is a mother. So, my friends, if you do stick around, you're gonna hear a fantastic story about an with an inspirational woman who's got a lot of knowledge in the field of mental health, suicide prevention, and and specifically around moral injury and the defense force. So yep. Listen to discretion advised, it's been put out there. So, my friends, please join me in welcoming my guest for today, Dr. Nikki Jameson. Please welcome to the Laughter Clinic podcast, the lovely and incredibly knowledgeable Nikki Jameson. Nikki, thank you very much for joining me today. How are you?

SPEAKER_01: 3:58

Thank you. I'm not sure about incredibly knowledgeable, but I'll give it my best shot today.

SPEAKER_02: 4:02

Well, I tell you what, we'll see by the end of our chat. People are going, he was right, he was right right at the start. She's pretty knowledgeable. Thank you so much for for joining me today. It's it's you've been a guest that I've wanted to have on since I very first decided to do this podcast. So very appreciative of your time. Now, as is the case with all of my guests being the Laughter Clinic podcast, first of all, we start by talking about the saying laughter is the best medicine. This is a saying that has been around for over 3,000 years, and now we have modern day research supporting both the physical benefits of laughter and the psychological benefits of using your sense of humor as a coping mechanism. So when you hear the term laughter is the best medicine, what does that conjure up for you?

SPEAKER_01: 4:51

The first couple of words that spring to mind when I think of that statement is contentment and longevity.

SPEAKER_02: 5:02

Yeah, well, yeah, definitely content because you are pretty content when you're having a good laugh at something, aren't you?

SPEAKER_01: 5:08

Exactly. And it leads to that, you know, that's that just feeling of satisfaction, being connected to people, connected to your body, you know. I can't remember the last time I had a really good belly laugh, but that whole body experience when you get into something that really, really gives you that somatic experience of a belly laugh. And that, you know, we know clinically and diagnostically that all of these hormones and that you know, the research will tell us all of these wonderful, happy hormones will surge through the body when we laugh, similar to when we cry and we're upset. That's got a whole range of hormones that does all sorts of things to our body, and laughing can help to mitigate some of the damage some of those stresses can do, which adds to the longevity of life, hopefully.

SPEAKER_02: 5:58

Yeah, absolutely. Yeah, that's right. Well, I you said that you can't remember the last time you had a good hard laugh at something. So hopefully, Nikki, that's not going to be too far away for you. Have you got any big catch-up with friends or in? Because that's usually when it happens, when you've got a big catch-up with friends or something happening.

SPEAKER_01: 6:17

Correct. Well, it's been a while since I've been to one of your comedy club events, so maybe I need to schedule that in again because I had a belly laugh there last time.

SPEAKER_02: 6:25

Oh, nice work. Oh, good plug. I like it. I like it. I've got some shows coming up. I'll let you know about that later on. Wonderful, Nikki. Okay, so let's start by your journey into this field of mental health and and and suicide prevention in particular. So I've mentioned what your situation is in relation to how it is that you came into this right in in the introduction. So if you wouldn't mind, just fill in the gaps and and tell us tell us about Daniel and and and who he was.

SPEAKER_01: 7:00

So Daniel was one of those cheeky chappies. He was full of jokes, he was a prankster, he was known as the class clown on his school reports, and he was that kid who, you know, could really put himself to do something if only he'd concentrate and stop being a clown. That was generally his school reports. So, you know, he was social, he had a really good, close-knit group of friends, and he was one of those, he really valued loyalty. That was something in our family that was really strong. We really valued, you know, honesty and loyalty and trust, and you really had each other's back.

SPEAKER_02: 7:37

That master made you very proud as a mother.

SPEAKER_01: 7:39

Absolutely, you know, and that's what it was like with his friends as well. You know, if you were in his circle, you were in for life. Like he was the most loyal person, loyal friend anybody, you know, was lucky enough to have around. He really was. He dedicated, you know, himself constantly. I sometimes look back and think he would have been much better as, you know, maybe a youth worker or you know, in the nursing or you know, health professions, just because he gave so much of himself.

SPEAKER_03: 8:08

Yeah.

SPEAKER_01: 8:08

Um, you know, that was probably one of the driving forces. Well, it was a driving force why he wanted to go into the army, because he wanted to be something, you know, bigger and better for his daughter. He wanted, you know, for her to have something to be proud of and for him to be able to do something, you know, to make her proud. So the army for him also gave him that comradery, that, you know, that brotherhood, that mateship, all values that he was really strongly aligned to and that loyalty and you know, that courage and integrity, all the, you know, the the values that we have in the the defence force around courage, respect, integrity, excellence, and service. For him, they were, you know, his core moral values as well.

SPEAKER_02: 8:53

Yeah. Yeah. Yeah, that must it, like I said, it must make you incredibly proud. And and that's a reflection on you, Nikki. You know, really, that's a reflection on you as a mother, bringing him up in with holding those values dear to his heart. You know, that is that is something that, you know, is is a direct reflection on you, I believe. Parents are, you know, how their kids turn out is how they're brought up.

SPEAKER_01: 9:21

Thank you. I definitely think, you know, it's helpful and useful, and you know, and thank you for those lovely comments. I also think there's a flip side to that, because from that, you know, that strong sense of you know, honour and loyalty, and we've got each other's back no matter what. When somebody, you know, dies by suicide, it's almost like, well, this is where the moral injury was for me. It's like we had a pact. How could you do that? You've betrayed me, you've kind of dishonored our vow, you've been disloyal to our pact. And that was a lot of the, I guess, the moral injury that I was really struggling to cope with on top of losing somebody to suicide, and those that have lost and are bereaved by suicide, more most often than not, and I've spoken to a lot of people who who are bereaved by suicide, it's a very, very different kind of grief. And bearing in mind, I'm not a stranger to grief. So I've lost my parents, my siblings, both of my children. So I have no surviving children anymore. My whole entire family is now happily parting away on the other side, depending on what your beliefs are. So I'm no stranger to grief, but Daniel's loss was something above and beyond those experiences of grief, and just there was something about it that was very different, and that is what led to this whole journey into what is suicide? What is this thing we call suicide? And that's how I ended up doing the masters, but it was much deeper than that for me, and you know, I certainly don't recommend this as a coping mechanism for anybody, but I ended up doing a master's and a PhD at the same time. I do not recommend that line at all, but for me, that's what I needed to get me out of that really dark place, which I found myself in many a times when Daniel died. So, and it was there I found moral injury, and that's kind of where a lot of things fell into place for me. Not just my moral injury, but Daniel's moral injury, what he experienced in service as well, given he had such strong, you know, alignment to loyalty and trust and honour, when that was betrayed, and it really, really was during his tenure, that in my opinion contributed to his death. Suicide is incredibly complex, as we know. It's never a one plus one equals two, but that was definitely a contributing factor, knowing what I know about him, his values, and knowing what I know now about moral injury and suicide. And we see it now in the research and evidence in what happens, particularly with our veterans and military members, which is actually where the whole moral injury research started. Now it's much broader than that, obviously.

SPEAKER_02: 12:17

Yeah. Yeah, well, you know, so much to unpack there, but just on the on the grief side of things, you know, you and I both know because we were taught about the grief side of things as we did the we both did the same masters in in the suicidology there, and and that complicated grief, you know, that's what I try and explain to people is the grief associated with losing someone to suicide is is so complicated and so different. You know, you lose someone, an elderly family member or someone in an accident or they die from a they've got an illness or a disease or something. The grieving process is pretty clear, cut, and straightforward, as horrible as what it is, but a lot of the time the grieving process associated with losing someone to suicide is quite protracted, isn't it?

SPEAKER_01: 13:05

Yeah, it's very different. And that's certainly not minimizing or diluting the grief experience for anybody. Of course. You know, having lost my daughter years before Daniel to pneumonia, you know, losing a child is absolutely devastating. Losing a child to suicide is world shattering, it is catastrophic. You know, there's no words in the English dictionary that I can think of to describe the amount of destruction and devastation that attaches itself to a suicide. And people, you know, in our society, we're not very good at death in our eastern, in our western society. The eastern societies and cultures tend to do it much better. But there's almost this expectation, well, you know what, it's been a year now, you know, pick yourself up, you'll be right, get on with it, or whatever timeline society puts on you. That's not always the case. You know, I'm 10 years on, like it will be 11 years next month, and I still have those really crappy days, really crappy weeks, sometimes really crappy months. It doesn't just go away. You are constantly walking around with this hollow that you're endlessly searching to do things to fill. You know, part of that for me was doing a master's and a PhD, was really getting stuck into the advocating and pushing for a royal commission. It was really getting involved, you know, in the research in moral injury and being a leader in this space because I didn't want what was happening to me to happen to anybody else, uh anybody else. Now we call that in suicidology, as you would know, post-traumatic growth. Yeah. And there's certainly, you know, a lot of research that talks to the benefit and usefulness of post-traumatic growth, but it doesn't detract from the fact that, you know, some days are good and some days are not so good, and that's okay.

SPEAKER_02: 15:04

Yeah, and that that drive that you had to not only undertake those two full-on fields of study, but to be so heavily involved in pushing for that raw commission into defence and veteran suicide in Australia. So, what was it like for you to see it come to fruition and then to actually be because I think you were like one of the first people to to actually give evidence and give and give a lived experience account and be able to tell Daniel's story. So how how was that for you to see all of that play out?

SPEAKER_01: 15:43

So I was the first person to give a submission at the Royal Commission, and I was the first person to mention the term moral injury, because I was one of the first to do a private hearing as well. So I like to think that once I put it out there, you know, we had over 4,000 mentions of moral injury throughout the Royal Commission, which is massive. How much of that is, you know, contributed to the work I did, who knows? But you know, I'm happy that we got a recommendation out of it. So recommendation 78. But what the whole Royal Commission process really highlighted for me was the power of mothers. So I wasn't an island in this one. This actually, Julianne Finney, who lost her son David, she was very much the face at the media front when she lost her son a few years after Daniel. And from there, you know, Karen Byrd, who lost her son Jesse, who was very much in the media as well, plus my son Daniel, plus another few mothers, all came together. And we quite literally stormed, you know, Scott Morrison's office, and we weren't moving until we had a role commission under our belts. Certainly helped by 500,000, you know, people signing the petition. Yeah, and I'd been involved in the petition since 2014 when Daniel died. So it took a few years to get the role commission, but we did finally get there. What I only found out a few years ago when I took my granddaughter down to the Anzac Square commemorations at Martin's Place at St. Martin's Place in Sydney was that the Anzac Day event actually started from a grieving mother. She was at St. Martin's Place in Sydney, she was grieving the loss of her veteran son who had died in service. And you know, she was seen, and that was basically a snowball for all of the Anzac Day events that we see today. So that was a mother. So it's the power of the mother's, you know, the mother's loss and the mother's grief, and the mother's wanting that change to stop potentially other families experiencing that. So it's really, really powerful, and again, really highlighted that post-traumatic growth. I certainly wish we didn't need a role commission. I certainly wish none of us have to experience these things and these events that lead us to that. But when we do, it provides a comfort that, you know, you're not on your own. And Daniel wasn't on his own. You know, we've heard all of the testimonies and submissions, and you know, things are certainly working towards positive change, which is really lovely to see and really lovely to be a part of.

SPEAKER_02: 18:30

Oh, you should be incredibly should be incredibly proud, Nikki, of everything that you've done and achieved in this space. And so going back to the the recommendations, you were saying that because there's over a hundred how hundred and twenty-two. 122, that's right. Recommendation number 78. Run us through what that one is specifically.

SPEAKER_01: 18:51

So that's about preventing, treating, and minimizing moral injury.

SPEAKER_02: 18:55

Right.

SPEAKER_01: 18:56

That specifically calls it out.

SPEAKER_02: 18:58

Yeah. So was there like out of that 122 recommendations, obviously that one is quite significant because it actually calls out and and names lor moral injury as a specific driver. And are there are there other recommendations like you know that are quite significant in amongst that massive amount of protocols that they've said that they believe should be initiated?

SPEAKER_01: 19:23

Yeah, absolutely. I mean, all 122 are you know incredibly important. In fact, the 122nd is the establishment of the independent entity, which is currently underway now. So that's really exciting to see who you know gets into the hot seat and can really drive the implementation of those recommendations and evaluate it, which is super important. But the important ones for me, you know, as well as moral injury, of course, were about the families. Families often get left out of the conversation and left behind. So it's really good to see that inclusion of families and that systems-based response to suicide prevention. So systems being, you know, bringing in DVA, bringing in other government departments, really working in an integrated and a coordinated fashion. So those recommendations are super important. And also the ones around, you know, those risk and protective factors and you know, the military sexual trauma space as well. So really highlighting some of those core contributing factors, which we know, you know, military sexual trauma in my research was the number one contributing factor of moral injury, particularly for female veterans. So being able to really target those risk and protective factors like military sexual trauma, like moral injury, like the deployment and transition space are just super, super important. So I'm really hopeful that they will be implemented in full and the way that they're meant to. And we'll start to see some of those successes and benefits from that.

SPEAKER_02: 21:00

Is there an expected timeline, Nikki, for for these implementations to start to come through to fruition? Because I know that, you know, previous Royal Commissions in the past that have been done in Australia have, you know, cop some slack because nothing's changed and years down the track, you know, half of the implementations have still gone unattended and that sort of stuff. So have they actually put forward a timeline where they want to actually get these things happening?

SPEAKER_01: 21:27

Yeah, they have. There's a whole suite of recommendations in there that, you know, some may have 12 months that they need to be implemented in, some are more longer term. The establishment of the independent entity that also had its own timelines that it had to adhere to. And for that purpose, we need something or someone to be able to drive the implementation of those recommendations and make sure that defence and DVA are doing what they've actually said and agreed to doing as well. So those recommendations that they have agreed to, that they're actually doing it, you know, in the way that it's intended. But you know, I've worked across many large government departments, health, education, commissions, DVA and defence. These are massive machines and these take a long time because you you want to do it right. So there's a lot of planning in there, there's a lot of, you know, making sure that implementation is good, there's a lot of scoping on how the recommendations will look and apply and how they can be contextualized. And all of that stuff takes time. So, you know, when we think, oh, nothing's happening, I'm not seeing anything, it's because a lot of that work is happening in the background to try and make sure it is the best possible implementation of the recommendation for that particular area.

SPEAKER_02: 22:46

Talking about doing it right, are the are you aware of any do any countries actually do it right or do a better job than others in relation to looking after their their, you know, current and and past Defense Force personnel? Are there any countries that, you know, when you were doing all of your research, anyone that stood out that went, you know, they do a pretty good job there?

SPEAKER_01: 23:09

Yeah, look, all militaries similar to ours, so Canada, New Zealand, the UK, the US to some extent, but their model is uh quite different to ours.

SPEAKER_02: 23:23

They've got quite a problem with they've got quite a problem with defence suicide, I don't know.

SPEAKER_01: 23:27

They do, they do, but theirs is not a voluntary like I mean it is voluntary, but there's a lot of benefits associated with being in defence. So their their model is slightly different to ours, so it's difficult to compare them with us. The closest to us is Canada and New Zealand. No military gets it right, every military has its problems, but I'd probably say Canada is the closest to being the best, from what I've seen. And they're actually really open and really progressive, and particularly in the moral injury space as well. They've really grasped that with both hands, and they're really working towards changes in service over there. Hopefully, we can kind of draw and leverage from their research to see what's been working for them. And the UK, of course, they've got you know a really good, very, very well-established military system, you know, for millennia, but it's it still has its problems.

SPEAKER_02: 24:27

Yeah. So you've spoken a bit about the term moral injury. So for those that will be listening who may not be aware of what moral injury actually is, as as a editor, you're you're absolutely the best person for me to ask this, you know, Nikki. So so for our listeners that may be unaware of what moral injury actually is, can you can you just take us through what that actually looks like?

SPEAKER_01: 24:54

Yeah, so moral injury. So think about a time when you or your listeners may have done something or not done something or witnessed something that has really stuck with you. It's hit you in the belly or it's hit you in the heart as just not feeling right. You've not felt good about it. You, you know, whether you've actually done it or you've witnessed something, you've not been able to stop it or make that change, you've just not felt good. It's just felt a bit icky, like it wasn't in alignment with you know your personal truth, your value.

SPEAKER_02: 25:31

Your moral compass.

SPEAKER_01: 25:33

Yeah. That's where we start to see the symptoms of moral injury. So that initial, oh, that didn't feel right. I'm that I'm terrible. I should have done X, Y, and Z. That can be the moral distress. If we have a few of those, that can lead to moral injury, which is basically that long enduring psychological and spiritual damage resulting from something that was morally wrong to us. Now, my moral framework could be different to your moral framework. So, what may be morally injurious to me may not be morally injurious to you because we're all unique. We all have, you know, different family upbringings, different cultural experiences, different education, different societal experiences. That all helps to shape and create our moral beliefs and values over time. So, moral injury can also be considered being on a continuum. So, as I mentioned, you know, you might walk past the street and not put a dollar in a homeless person's cup, and that might be fine. You don't think about it. For somebody else, that might be a bit of a moral bruise. Like, oh, I should have put a dollar in. I'm about to go spend, you know, seven, eight, nine, ten dollars on my chocka, moco, loco, latte, cappuccino on frappe on ice, whatever, you know, costs a fortune, and I couldn't even put a dollar in, you know, some person's cup. That may be a bit of a moral bruise, but we can actually brush that off quite quickly. That's oh, that wasn't a good thing to do. Maybe next time I'll do something different. When we see a few of those bruises or those bruises stick for longer and we experience moral distress, that's when we start to get those feelings of shame, of those feelings of guilt. I should have, I could have, I would have, I didn't, I, you know, I mustn't. It's the difference between what is and what ought to. That's where moral injury tends to fester. When those symptoms become, you know, get to a point where they're really starting to impact our function. So there's really deep feelings and senses of guilt, shame, self-condemning beliefs. I'm a terrible person, I don't deserve to be loved, I'm unworthy, I'm a burden to everybody. That's where we start to see the, you know, the suicidal distress. And sadly, that's where we start to see the increase in risk of suicide. So moral injury has a strong relationship with suicide.

SPEAKER_02: 28:10

And and talking about relationships, what's the what's the relationship between moral injury and PTSD? Because you both you're going to see both of those in, you know, a defense force personnel and and first responders as well, I dare say.

SPEAKER_01: 28:25

Yeah, absolutely. So moral injury and PTSD. So I guess it's two similar but different constructs. So moral injury is a distinct construct, but it quite happily spends time in bed with PTSD and shares a lot of the symptoms. So things like um nightmares, anger, depression, those kind of things, they can be PTSD or they can be moral injury. What isn't that often shared is some of those feelings of betrayal, that significant distrust, that you know, that grief element that we've spoken about. What becomes tricky is as a clinician when you're trying to tease the two apart because they're so interlinked, it is very difficult to gently tease the two apart. However, there has been research in Canada again where they've started to do a treatment approach where it treats the moral injury first or the symptoms of moral injury first. And what has been really impressive is the symptoms of PTSD have drastically reduced by treating the moral injury. So that's really that a lot of the treatment approaches, and this is because PTSD is in the diagnostic statistical manual, which is the Bible that clinicians use to make a diagnosis and treatment process. PTSD is in the DSM. So moral injury was in the DSM in the 1980s. And then PTSD came along and sideswiped it out of the way. Well, people, moral injuries back in town.

SPEAKER_02: 30:07

Back in it, isn't it? Yeah, definitely. Definitely. Well, we'll we will get to that very shortly because that's quite a significant development, having that come back and be included, not pushing PTSD out of the way to be included as its own standalone thing. So just getting back to the treatment protocol, so uh so given that research that's come out of Canada, so is are you saying that a lot of the treatment protocols for PTSD and moral injury are very similar in in the way that they've put forward to the client, to the to the patient?

SPEAKER_01: 30:43

So if we think about PTSD as that physical threat to safety, it's a fear-based response. So often it's a fear-based therapeutic approach. So things like prolonged exposure, imaginal exposure, exposure therapies, those sort of things to take people back into the experience. Moral injury, on the other hand, is a relational, it's an existential threat to safety. So it's the threat to the relationship. Moral injury is grounded and founded in relationships, relationships with others, the society it's involved in, the systems it's involved in, and that relationship with ourselves, when that's disconnected, that's when we start to see suicide. So a lot of the treatment approaches that are being typically used for moral injury over the past, you know, 10 years or so were actually developed for PTSD. So there's a few that are coming out to play now that have been wholly and solely developed for moral injury, and they're really founded in relationships: acceptance, forgiveness, compassion, self-understanding, being able to draw the experience through multimodal avenues such as narrative, music, dance, those body-based therapies, breath work, you know, meditation. Yeah, laughter, absolutely, those body-based responses. So there is a difference, but again, you have to kind of know whether moral injury is a factor before you start just doing you know willy-nilly treatments everywhere. One of, I guess, the downsides at the moment is, and it's certainly not, you know, the fault of anyone, this is just the situation we're in at the moment. If somebody has what I call purest moral injury, so no PTSD, nothing, you know, PTSD related that created the moral injury or you know, is symptomatic, symptomatic of PTSD, it's pure moral injury. The worst thing we can do for a client who presents with that is treat them with the gold standard PTSD treatment approaches because that will actually do more harm. The last thing we really want to do is be sending people back into their experience. It's really about helping them understand their part in that experience, their role, and working with, you know, self-forgiveness, forgiveness of others, compassion, acceptance, validation, and building meaning and purpose again. So, you know, a bit different to what we do with PTSD.

SPEAKER_02: 33:18

Trauma is so complicated, isn't it? You know, like we've you're about the trauma of first responders or defense personnel, you know, seeing or being exposed to a traumatic event and what that brings up for them and what they relive. But you know, I've been chatting to a few first responders over the last couple of years who are on the receiving end of organizational trauma.

SPEAKER_01: 33:45

Ah, it's that organizational betrayal by any very significant contributing factor to moral injury because moral injury is multi-layered, it can be interpersonal. So an injury that occurs between two or more people about that relationship, and that might be you've been ordered to do something that's against your moral framework, or you know, you've done something that, you know, for whatever reason just wasn't the right thing to do off your own back. So it's either by omission or commission. Um but there's also the intrapersonal, so and that's that I did something and I feel really terrible about this. I'm an awful, I'm a bad person. And then there's the systemic, which includes the organizational um factors as well. So the system has done something, and we heard a lot about this throughout the role commission with the DJA system and veterans, you know, refusing their claims or leaving them penniless and their mental health spiralling, those sorts of things that can be an organizational moral injury as well.

SPEAKER_02: 34:51

Yeah, I remember thinking at the time that, you know, we hear that term duty of care, you know, a lot. And as you know, I do a lot of work with the first responders that are dealing with the the PTSD and and and moral injury. And I remember thinking when the Royal Commission was coming out that, you know, we we entrust these individuals to look after our communities and our countries and to put themselves in harm's way. And it just we constantly seem to be hearing stories about the organizations that are there that these people are working for being neglectful in their duty of care in relation to the personnel that they're entrusting to look after our communities and our countries, you know. And at the end of the day, it is duty of care.

SPEAKER_01: 35:44

It is, and you know, right there is the moral injury. We see in the workers' compensation system where people are made to feel like a criminal because they're trying to claim something for what they're entitled to because of what the organization may or may not have done, or somebody in the organization may or may not have done is you know associated with their job. And a piece of work I'm involved in at the moment and will be publishing publishing on it later this year, is the psychosocial landscape and moral injury. So we all in Australia work under you know the Safe Work Australia guidelines. We're all you know obligated to try and ensure that our workplace has a level of psychosocial safety, and we need to look out for people in our workplace so we don't intentionally or unintentionally create psychosocial risks and hazards that can then go on and increase the risk of mental health problems for a person. And there's 17 different elements of the psychosocial landscape in Australia, and these include things like bullying, harassment, poor change management, poor job control, lack of reward, poor justice. The majority of those will absolutely 100% increase the risk of a moral injury happening. So I'm working on a paper at the moment that looks at moral injury as a psychosocial risk, but also puts a framework for organizations around that to help them mitigate that risk as well. And that's for mainly public safety personnel. So our first responders, healthcare, our you know, military personnel and veterans as well.

SPEAKER_02: 37:30

Yeah, it's pretty disturbing when I've heard horror stories over the last couple of years where first responders have had to go to court to actually prove that their PTSD or their moral injury has been a direct result of the situation that they found themselves in the course of their duties. And yet the organization has had, you know, has fronted up with lawyers and a legal team to say, oh no, well, you had this happening in your personal life and you had this happening in your personal life to try and diminish their level of responsibility and accountability. And I just I'd hear that stuff and I'm just amazed that that shit goes on.

SPEAKER_01: 38:15

We actually have a lived experience. I'll say we, my husband was in a used to be a coal miner before he became a psychologist. So now he specializes in moral injury, and that was born from his lived experience of being in a coal mine when the coal mine collapsed.

SPEAKER_03: 38:30

Really?

SPEAKER_01: 38:31

And he was literally seconds, him and his crew were seconds away from dying, like the whole thing collapsed in on them. Luckily, they escaped with minimal injuries, but they were all pretty much just blamed and told to get back to work literally on the next shift after that major coal mine collapse. And it was kind of like business as usual. So when they tried to put in claims to take some time off work, it was the same thing. Oh, well, you know, you've got this going on in your life, or this is happening. It's you know, PTSD is nothing to do with the coal mine, it's just that, yeah, haven't paid your electricity bill this month or something. It was ridiculous. And that was under Campbell Newman's changes in the policy and legislation, which meant that these people didn't get enough points to be able to claim for PTSD. It was disgusting.

SPEAKER_02: 39:20

That's abhorrent behaviour, isn't it? I mean, seriously, you talk about organizational trauma, seriously, right there. You know, to have the organization actually go out of their way to not only try and dismiss what you've been going through, but to try and blame you and shift the shift the it's just yeah, I'm just in awe.

SPEAKER_01: 39:59

We saw it with people who've experienced mil military sexual trauma and their cases were not even investigated, or they've been brushed under the carpet, or you know, it's all in your head. It's that second assault from the organization again, contributing to those moral injuries. Because we go into a workplace expecting a level of safety. We expect our bosses and our colleagues, you know, to have our backs. It's just part of being in that workplace. We're all here to do, you know, what we share that we're going to do in that workplace. So we expect some shared loyalty and values, and when that doesn't happen, that's when we start to see, you know, either moral distress or if it's more deep moral injury.

SPEAKER_02: 40:44

So I I was fascinated. You you and I have chatted about this numerous times over the last couple of years, in relation to the extent of professions that could experience moral injury, which is something that I've found absolutely fascinating whenever you've written about this, in relation to, you know, the the most common we would talk about would be defense personnel and first responders, because obviously there's a lot of similarities there in relation to what they go through. But talk us through some of the other professions that you've you've found that are exposed to this.

SPEAKER_01: 41:22

So this is widespread. Moral injury is one of those, I guess, things that once you know what it is, it deeply resonates with people. So there aren't many professions now that haven't said to me, Oh no, we don't have anything like that to worry about. The majority is that, ah, yeah, I get it. And I'm talking lawyers, teachers, social workers, funeral directors, veterinary staff, so animals when you know they have to euthanase, or people working in shelters for animals, or homeless shelters, DFV, so domestic and family violence areas, corrections, journalism. It's you know, any any profession that exposes us to make a decision that may impinge on our moral beliefs, they're vulnerable to a moral injury. You know, that's fundamentally all the professions that we have. Because we face moral dilemmas every day. That's part of being human, that's a human condition. When those moral dilemmas really get stuck and we can't seem to shift the feelings with the decision around that moral dilemma, that's when we start to see moral distress and moral injury. And that can happen to anyone, anywhere. It's not how much money you've got, it's not, you know, what class you consider yourself to be, it's not what occupation you're in. This is you as a human and your moral values.

SPEAKER_02: 42:53

Yeah, those the uh unacknowledged workforce that are exposed to this, like something was said to me uh by a fire and rescue guy a couple of years ago, and we were talking about who you know, you and I both know that firies these days are hardly putting out fires. Unfortunately, they're pulling people out of car accidents and that sort of stuff. And and he was saying to me, he said, you know, the people that I feel sorry for are the tow truck drivers. You know, he said, because here is an entire workforce of people that they are exposed to the same stuff that we're exposed to, but they're not trained for it in the way that we're trained, they're just tow truck drivers.

SPEAKER_03: 43:44

Yeah.

SPEAKER_02: 43:44

You know. So, you know, a big acknowledgement to the tow truck drivers out there.

SPEAKER_01: 43:50

100%. Yeah, it's those forgotten and those people, you know, even those people who are trained, you know, we see more and more instances of moral injury in our peer workforces now. And that can be, you know, maybe because of an organizational issue and that non-acceptance of a peer workforce, particularly in a clinical setting, or it could be peer workforce, you know, drug and alcohol space, family violence space, and for them having to sit with somebody who may or may not align with their moral framework, but them having to be professional and not having the training like we do as social workers or like we do as psychologists, that can be really morally distressing for people as well. And those people having to do investigations who don't have any mental health education, and they're the ones having to pull this information together, reading it, being immersed in this information, and then having to digest it and take that home without having appropriate training in how not to take that home, that could be morally injurious.

SPEAKER_02: 45:02

Oh, police prosecutors, I mean, seriously, that's got to be a tough and I that's gonna be a tough job being exposed to that day. And is this where Moral Injury Australia came about, Nikki? Was you were thinking that there needs to be specific training for people in this space? Correct. No, you're you're the founder of Moral Injury Australia, so talk us through that and and what your vision is for this leading foot going forward.

SPEAKER_01: 45:28

So I actually founded Moral Injury Australia quite a few years ago now and just kind of had it sat there for a while because I thought, oh, nobody's going to be interested in moral injury. It's just, you know, a nicky thing, I'll do a little bit of research and see where it lands. Boy, was I wrong. So I have presented all over the world, all over Australia. You know, I've done hundreds, if not thousands, of talks and presentations on moral injury. And what has become evident is that people are really thirsty for the information. People actually want to try and, you know, mitigate and stop moral injury as far as they possibly can, but don't know how to do it. The other side of that is people want to be able to treat and support people with moral injury as well, and they don't know how to do it. So a lot of my presentations have been around this is moral injury, these are some of the symptoms, and giving that kind of that first response to moral injury. Here are the things you need to look out for, and here are some tools. Over the past, you know, four or five years, that's now developed into something much more, I guess, intensive. People really want to know about the mitigation space and the treatment space. So I've done a lot of presentations on both of those spaces. So I've combined the two and created training on those and kind of put it all together and tied it up in a pretty package, and I deliver those all over the place. So Moral Injury Australia, you know, the website and the program was basically just a place to hold everything together because, you know, I've written books, I've developed an app for first responders and families, I've done all sorts of training, I've been published all over, I've got lots of publications, but I didn't have anywhere to contain it. So I developed the website, and it's been lots of back and forth over the years with the website, and you know, it's it's actually been quite an arduous experience. I mean, let down a few times with the whole process, but now it's finally going through its last suite of changes, so should be live, you know, any any day soon.

SPEAKER_02: 47:38

Oh, that's exciting, Nikki. I didn't realise it was so close to because I I I hear you when I was putting together the laughter clinic website, so many people and and even myself trying to get the whole comedian, suicidologist, suicide prevention, putting it all together and packaging in in a suite. It's it's something it's so overwhelming. And and you need to find someone who you trust to put this together and and put it together in a way that is what you want to have outward facing for the world. So I'm so glad that you've able to find someone, obviously, that you've been able to trust and and and bring this so close. It's it's very exciting. It's very exciting to to put that together. And and so one of the questions that I wanted to ask you about this is you know, what do you what do you think is something that you would really want people to know about moral injury?

SPEAKER_01: 48:35

What would I want people to know? Know that moral injury is a language now. You can take that and use that as a language with your treating therapist, with your clinician, or on Google and do your own homework as to what it is. So knowing that moral injury exists is a starting point for you to be able to go to whatever step is next for you. So know that you are not alone, and this is a lot more common than we ever imagined. And the more people who know what moral injury is, the more people have that aha moment and that, you know, penny dropping moment. Like, goodness gracious, that is what I'm dealing with. It's not, you know, burnout or it's not PTSD or it's not vicarious trauma, it's moral injury. And that's not to say that moral injury can't happily be, you know, side by side with vicarious trauma, burnout, and all the compassion fatigue, and all of those others, but moral injury is a distinct construct. So it's knowing it's distinct, having that language, and then knowing that there are tools available and there are treatment options available.

SPEAKER_02: 49:47

So that is a beautiful lead into circling back to it being included now in, I think it was September this year, wasn't it? It's it's gone back into the DSM 5. So for those of you that don't know, the uh Diagnostic Statistic Manual for Mental Disorders is the like the gold standard, it's the Bible when it comes to uh to mental illness. And so having moral injury come back in, what do you think that actually means in like in in real world terms in relation to you know diagnosis and treatment? Like how significant because it sounds significant, it sounds very significant.

SPEAKER_01: 50:28

It's massive. So moral injury is not a diagnosis, even though it's in the DSM, it's under a Z code, which is a supplementary code to allow clinicians to garner additional information on something. So it's not actually a diagnosis per se, it is the connection to you know the bit between what's happened to a person and the diagnosis. So we're all kind of working in the background to have moral injury firmly established as a distinct criteria to go in the DSM. So, like PTSD is a distinct criteria, we're working very hard to have moral injury as a solid distinct criteria as well. In the meantime, we've got this placeholder, which is called moral problems. Now, that wasn't my choice of words, to be honest. I cannot stand the term moral problem. I find it minimizes and reduces it, but it gives us a placeholder to work from whilst we work on the distinct criteria and have it fully established. What that means is if it's in the DSM, even as a supplementary Z code, it means more opportunities for research, more opportunities for people to collect data, more opportunities for evaluation, more opportunity for knowledge building, awareness, education, and training and treatments. So this is a really important step forward in being able to identify moral problems and the you know resultant moral injury from that. So it's massive and it's been in the works for a while.

SPEAKER_02: 52:03

How often do they do edits to the DSM?

SPEAKER_01: 52:08

Oh goodness, the DSM is such a slow process. I think it's like every 10 years or something. So ideally, in my magic wand moment, if I could change anything, the DSM 6, whenever that comes out, which I suspect should be in the next few years, I would like to see moral injury as a fully formed, distinct criteria. And we have that. We've got the criteria we want to, you know, have established the team that's working on that, it's there, it's ready to go. We're just kind of trimming around the edges and making sure it's fit for the DSM. Hopefully the DSM six.

SPEAKER_02: 52:44

Wow. That's a task, isn't it? Like that sounds, it just seems like an enormous task. Like it, because it's it's already so thick, that book. Like, I mean, I was, you know, if you actually get the hard copy, it's a pretty big book.

SPEAKER_01: 53:00

And you know, there are tensions, and this was a bit of a moral conflict for me as well, because I didn't want moral injury to be pathologized and end up like PTSD. It's just a clinical diagnosis. Here you go, have some tablets, you know, have a treatment and off you go. Moral injury, very similar to suicide, is incredibly complex. It is multidimensional and multifaceted. So it impacts us biologically, psychologically, socially, spiritually, environmentally. So it needs a multidimensional response, but getting it in the DSM as a supplementary Z code is that stepping stone that we need to make sure it's addressed in the way that it needs to be addressed.

SPEAKER_02: 53:43

I'm sure it will be, Nikki. I have no doubts that it will it will be. So in all the years that you've undertaken so much of this research and and have traveled the world speaking at different conferences on moral injury and suicide, how is how has this changed your outlook on life personally? Has it changed it? Do you think?

SPEAKER_01: 54:12

I get a lot less sleep.

SPEAKER_02: 54:15

Well, that's because you're either reading something or writing something for someone else to read. That's that's what that is.

SPEAKER_01: 54:22

Yeah, exactly. Um it's certainly it's given me a drive and a purpose that wasn't there before, I guess. So that would be some of the biggest changes. It's also introduced me to a wide range of people, events that I wouldn't have, you know, crossed paths with prior to to you know, Daniel's death and my research on moral injury. So, and you know, like anything, there are pros and cons. It does give you meaning and purpose, but there's also there's also the sacrifice that goes with that as well. You know, the time element and the fatigue and the writing and you know, all of that stuff, which is wonderful, but and you know, going through, I think I'm on my fourth different website company because all of the others just uh let me down, or you know, took the money and run and I didn't really get anything for it, you know, all of those things that really take the toll.

SPEAKER_02: 55:23

Yeah. So with with everything that you've learned, right, because I know when I was studying the masters in suicidology, I went to that as you know, not having an undergrad degree and and being thrown in the deep end kind of thing. And so it was really very steep learning curve for me. And there were times where, and even now, as I try and keep up to date with everything that's happening in the world of you know, suicide prevention around the world, there are there are days where I think to myself, I'm really glad I know that information. And then there are other days where you'll find out something and you go, Oh man, I wish I didn't know that. Because it's something that you can't put out of your head. You know, do you find that? Do you find that with because you know you're traveling around the world and speaking at all of these conferences, there must be certain things that you go, I'm glad I know this, but man, I wish I didn't know that.

SPEAKER_01: 56:18

Yeah, I think the biggest one for me when Daniel died, and this is part of the grieving process as well, was when I did the masters in suicidology, like yourself, it was that understanding and comfort that it wasn't my fault. That suicide is so complex, so multidimensional, it is never one factor. There's often a range of distal and proximal factors that kind of come together at a point in a person's life, and that's what ends up, you know, ending, leading to the end of their life. Knowing that was worth the whole amount that we paid for the masters, but also knowing that my own suicidal journey after Daniel died wasn't just me and that other people have walked those shoes and also, you know, are still living and breathing to share their stories as well. So it does give you that sense of comfort that, you know, regardless that you know you lose family. And I'm not just talking about in death, death brings out the best and worst in people. I don't know about others' experience, but certainly in mine, family kind of fell to the wayside, friends, they disappeared. You really are left alone, apart from maybe one or two people who stick around, and they're like your core nucleus friends. So it really is a lonely and isolating time. So knowing that you're not alone and people have shared similar experiences is you know, as much as you don't want it to happen to people, it's quite comforting that you know it's not just you.

SPEAKER_02: 57:54

Yeah, absolutely. Yeah, I I totally agree. And the the side of it that I find sometimes a little bit hard to get my head around is you know, statistics when can because as you know, you read so much and you just and and it's all numbers on paper, you're constantly reading statistics and the percentages, and sometimes just sitting back and reminding yourself that these aren't just numbers on a piece of paper. These are actual people who have taken their own life, and you and I both know the extended ripple effect of that, the hundred and thirty-five plus people that are affected by that one incident. And it can sometimes just like I know when it comes to any time that I spend in talking about youth suicide and and the youth mental health situation that we have in Australia at the moment, and then traveling around to regional country towns and seeing people that are struggling for mental health services. And you know, I I I read something recently out of the 2024 Mental Health Commission report where they're saying like one in four, one in six Australians is are not seeking mental health help because uh of cost of living pressures. You know, that's why they're not going and seeing a psychologist or a psychiatrist, you know. And you just think to yourself, man, I you know, some some things just go, we're really hard up against it, aren't we?

SPEAKER_01: 59:24

We are, and the PHNs for those clients who, you know, are not able to afford a psychologist, as my husband works with a lot of PHN clients as well. There's at least a six month waiting list. Well, as we know in the suicide space, there's you know, six months is a hell of a long time for people who are struggling with their mental health, and you know, suicide thoughts and b behaviours tend to fluctuate. So it's really difficult. Our system, our mental health system, is not designed for those upstream. helps and protections. It's not, it's it's always in the pointy end, in the crisis end. And even that, you know, there's still people who fall through the gaps, as we know. Because unfortunately they end up in the statistics, which is the ones that we end up reading. And it just kicks you in the guts every time you hear of another.

SPEAKER_02: 1:00:18

Yep. Yeah. And that's I I gotta tell you, it's pr pretty rewarding traveling around and actually working in what I call like, you know, the early intervention space, keeping the population healthy in the first place and and really focusing on self-enhancing humor, you know, that sense of humour that we use as a coping mechanism to help us deal with negative life events as they come up. In in all of your research into into moral injury and PTSD, has there been any any overlap in relation to using because one of my big things has been having increased sense of in increased use of self-enhancing humor being included and recognized as a protective factor.

SPEAKER_03: 1:01:01

Mm-hmm.

SPEAKER_02: 1:01:02

You know, in the list of protective factors against suicidality. So with all of these people that you spoke to like your book Darkest Before Dawn that you wrote as part of your PhD or to come out of your PhD where you interviewed all of these Defense Force personnel, I like it was so full on and I can't help but think that you know I talk to military people and first responders and a lot of them talk about how it's their sense of humor that has really helped them get through some pretty dark times.

SPEAKER_01: 1:01:38

Absolutely it's that you know they'll either call it a dark humor or a black humour. And we used to have it in social work as well. You know you'd be dealing with some pretty confronting cases particularly in the child safety space and the domestic and family violence space. And you would use dark humor or black humour depending on what term you use to help alleviate some of that trauma. And you know we know that anything that gets the body going somatically so laughter or movement or breath work can really help in processing that trauma. For those may have read who may have read Stephen Bandercock's book The Body Keeps a Score, I believe that's what happens with moral injury as well. It gets stuck in there. So laughter and movement would be a fabulous way of helping to shift some of that and basically see what happened through a different lens as well. I think that's incredibly important.

SPEAKER_02: 1:02:37

So in answer to your question no there hasn't been any research done that I'm aware of but you could always be the first always oh look yes that has been suggested to me Nikki but in all honesty I'm not an academic like I can't I can't begin to tell you how much I admire people like yourself that are able to do that research and and and get in and publish all of those papers it's just incredibly important for for that research to be out there in the world and yeah I just you know I just feel as though I'm I'm a I'm a people guy you know I like to be out there comedian making people laugh having you know doing my thing and but yeah you never know I'll never say never Nikki never say never. Hey so talking about going out there and talking to people like as you've have you've traveled around the globe there must have been instances where you know people have come up to you after a keynote that you've given or something like that where they've shared with you a personal story as to you know what they've been through. Did does something stand out for you like someone coming up to you after one of your keynotes and and just talking about what they've gone through and what your work has meant to them?

SPEAKER_01: 1:03:53

It's one of the greatest privileges and honors of doing what I do. So often when I deliver a keynote or a presentation I literally have a queue of people waiting to talk to me afterwards to ask me questions or talk about their experience. And one of the I guess big ones that has really stuck with me all of these years is it was kind of in my earlier days of research in this space when I was talking about some of the fundamentals of moral injury I had a really prominent person from the military come up after who had listened into the presentation and he was crying and he said I've had a diagnosis of PTSD for over 25 years. You are the only person who's ever been able to tell me what it is that's been going on for me. And he took that back to his treating clinician and said I don't think it's PTSD at all. I want you to have a look at this and his life has changed you know radically so that was huge. And I get a lot of those people those types of stories coming up a lot of the more common ones are around it's not just a penny dropping moment it's a whole rainfall of pennies that have just come down on me after listening to your presentation and that really fills me with you know honour and you know humility and and pride that we are getting the message out there and it's really making a difference to people.

SPEAKER_02: 1:05:26

Yeah it fills your cup doesn't it when when that happens and it and it reminds you of anyone that speaks publicly in this space like we do on week in week out it it's a constant reminder of you never know who's in your audience and and what they're going through and what impact you will have had on them.

SPEAKER_01: 1:05:49

Absolutely you just you really don't know you know the amount of people who've come up to me absolutely crying you know and can't thank me enough for actually giving them a language something they've known was there but didn't know what it was called they knew something was off or they had a diagnosis of something but just didn't feel it was that until I've spoken about moral injury and it was literally a massive light bulb moment for them. And that sense of relief and release you can actually see it in people like that oh my goodness this is it it's almost like winning the lottery for them I've got this magic tool now that I can actually use that will help me now and that's not priceless it's invaluable.

SPEAKER_02: 1:06:37

Yeah for sure and it it just it's a it's a reminder for us about how much knowledge sharing is still needed in this space. In the moral injury space in the suicide prevention space there still needs you know like we're doing a good job of getting the word out there you know you've got the lifeline and the beyond blue and are you okay and all of these things which are all good and well and it's clear to me that you know we can't look towards the big powers that be the governments to you know solve the mental health crisis overnight and prevent suicide. It happens at a community level with like you said people coming up to you after a talk and just going thank you now I've kind of got some direction you've answered you know just in the case in the course of you doing what you're doing you've shed a light on something that they've been struggling with for a long time and that to me I'm constantly telling people that's where suicide prevention occurs at a community level community engagement you know because it really highlights for me there's still so many gaps in education around around suicide and suicide prevention.

SPEAKER_01: 1:08:00

I agree a hundred percent it's it really is that that multi-layered it's that individual connection it's that societal it's that community it all comes down to relationships and you know we we live in the most connected world that we've ever lived in but yet loneliness and isolation through the roof statistically you know we've never been lonelier than what we are now yet we're the most connected I guess civilization at this point in time that now we've become that connected we're actually lonely. You know we don't do the whole I'm just gonna pop around for a cup of tea anymore. It's all you know messages or you know on Facebook on social media oh look she's doing this or doing that. You know back in the day we'd just pop over to the neighbor's house and have a bit of a vent about Mr. Jones up the road not taking his rubbish out and you know he have a cup of tea or whatever. That just doesn't happen anymore. You know we've got our houses there's big fences all around we don't connect if you speak to somebody randomly in a cafe or a supermarket you get looked at like you've got two heads yeah so what do you think is do you think there's a common misconception people have about suicide? Yeah I think the biggest one for me is that people need to be mentally ill to be suicidal and that's not the case at all. Sometimes mental health can can be quite poor and that may be through financial stress or relationship stress but it doesn't make them unwell. In fact there are people out there who die by suicide who have perfect mental health and not struggling with poor mental health but they have incredibly rational they have decided that that decision is better for them with a very rational mind. So that is probably one of the I guess the main ones for me in that you don't have to be mentally unwell to experience suicide you know dial distress. I get annoyed when I still hear people refer to it as being selfish yes or and a coward as well the amount of friends I have lost I don't call them friends anymore when Daniel died and saying oh well that was so cowardly how could he do that to you I think I pretty much redlined because to lose somebody by suicide is far from selfish or cowardice that it can possibly be when all of these things are fighting intrinsically inside you to stop that happening. It's yeah and a lot of that comes you know predominantly from where we stood with religious views for many many years when it came to suicide and how suicide is a sin. You know that's why we some people talk about committing suicide or committed suicide which we don't talk about in that way anymore because it isn't that at all. We've moved well away from that and it's more about understanding the person in their environment and how we can support them in making a choice to stay with us because you know it is a choice I choose to live and this is coming from somebody who lives with suicide ideation every single day. So for those people who are listening I live with suicide ideation every single day. It doesn't make me suicidal it means that I have these fleeting thoughts and often you know they're quite passive thoughts just like I think about what I'm gonna have for dinner that night or where I'm gonna walk the dogs because I'm so immersed in suicide prevention every single day. Of course I'm gonna think about suicide that's my whole world but it does not make me suicidal so I guess it's that misconception as well that for somebody to experience suicidal ideation automatically makes them suicidal. And it's really helping us to unpack what that means now we know so much more about suicide that we didn't know you know 10, 20, 30, 40 years ago. So I guess our jobs as suicidologists is to help people understand the complexity and navigate suicidology.

SPEAKER_02: 1:12:19

Yeah it's incredible how when I mentioned to people that I did a master's degree in suicidology people go is that a thing sometimes they think I'm making it up.

SPEAKER_01: 1:12:28

Yeah I had that as well like yeah it is like it is great.

SPEAKER_02: 1:12:32

Really that's a thing just what you're saying there about the the living with the suicide ideation it really brings home the importance of where we talk about reasons to live. Yeah you know that balance of you've got a lot to live for Nikki.

SPEAKER_01: 1:12:48

And this is a thing and again it's a bit of a misconception but it's actually really empowering for people who experience suicide ideation to know and understand that there is always that choice. So for me knowing that you know if I decided I wanted to end my life that choice was there for me and that's actually a very strong protective factor for people who experience suicide ideation. And that's in the research and the evidence as well. What we intend to do when we're working with people is keep them grounded you know keep that choice being here with us with their family with their friends with their dogs with whatever has meaning and purpose for them knowing that we all have a choice but let's make that choice to stay with us and what does that look like for you?

SPEAKER_02: 1:13:38

Yeah yeah I know when I'm doing the laughter clinics I talk about the you know the three biggest warning signs you know hopelessness and isolation and and that burdensomeness you know that driving that burdensomeness being the big driver for suicidality and and that you know when you explain it to be it what I find really interesting is recently I had someone come up to me afterwards and say that they had shifted their thoughts towards suicide because they'd they'd for a long time thought it was selfish. And then after having someone explain to them about the burdensomeness and the thought of someone getting to the point where they feel as though people would actually be better off if they weren't around and and no one would miss them it was it was one of those fill your cut moments where someone comes up to you and goes you know what mate you've changed the way I totally think about this and wholly and solely because I had no idea about that I didn't even know the word burdensomeness existed.

SPEAKER_01: 1:14:37

Yeah and you know Thomas joyners we know talks about the belongingness the burdensomeness and then acquired capability as being you know part of that suicide triangle I guess for want of the best and you know that sense of belongingness takes us back to that isolation piece and that loneliness piece and with the moral injury space often what happens is we tend to withdraw and isolate because we don't feel worthy. We we feel like we're a burden we don't feel like we belong because how could we were terrible people we did this awful thing that we may or may not have done or may or may not have happened you know in the way that it should have happened or shouldn't have happened depending on what it is. But yeah and then obviously having the acquired capability which Luke Bailey's done a whole heap of research that looks at that as well and what that means in a suicide space and he's done some brilliant work on that suicide ideation to action piece and framework. So for those who are interested I'd really suggest you have a look at his work as well and that's getting really deep into what it means for somebody to be experiencing you know suicidal distress and how we can start to really uncover those layers that have been covered for so long now we're starting to understand it much more and that that'll mean that we can develop some really good treatments and supports for people.

SPEAKER_02: 1:16:05

Yeah yep yeah there's so many impressive people around the world doing great work in this space and you are one of them. So speaking of which if uh if anybody listening to this is you know stuck with us for the journey and they've they're fascinated by this moral injury space and the work that uh you're doing Nikki where is the best place do you think for people to go and suss suss out some of your work and and and get a little bit more educated around the moral injury space?

SPEAKER_01: 1:16:36

So at the moment while my moral injury website is still going through its final refinements Google me and then you'll find a whole heap of resources and bits and pieces on moral injury but in the meantime hold tight a website is underway so keep an eye out for Moral Injury Australia and of course reach out to me directly if anybody wants further information my information again is easily accessible on all sorts of different platforms.

SPEAKER_02: 1:17:03

LinkedIn I I would suggest people you've got a wonderful LinkedIn profile Nikki and and you're always sharing quite informative stuff. That's how I found out about the DSM actually sharing that news and I was like oh look at that that's interesting so Moral Injury Australia the website coming soon will it be a dot com or will it be a dot com dot AU?com.au right okay so I will put the link to that in the show notes and it will hopefully be live soon so Nikki I'm I'm so proud to know you and and you should be so incredibly proud of the work that you do because you've clearly you've clearly done Daniel proud.

SPEAKER_01: 1:17:50

Thank you.

SPEAKER_02: 1:17:51

You know and and I know that you've saved lives it's one of those things that our mutual friend Jacinta said to me a couple of years ago she goes you'll never know you'll never know how many lives you've saved through the work that you're doing Nikki all you need to know is what you're doing is fantastic and just keep doing it.

SPEAKER_01: 1:18:10

Thank you and same to you and same to your work as well.

SPEAKER_02: 1:18:14

Oh that's very so that being said all things be it fair and equal we like to finish our uh our laughter clinic chat unless there's something else that you you want to share with us before we go I don't think so one of the question one of the questions that I was actually going to say before we get to the feel good five is and you've you you you kind of answered it and that's one of the things that what do you think what do you what you would you like what do you want people to know about suicide that they're not alone that they are loved we want them here and thank you for keep for keeping being here with us. I know it's hard at times but we really thank you for your strength and your courage and you are very much loved and wanted as are you Nikki Jameson as are you and everything that you bring to the world so that being said let's wind it up by what we like to call the feel good five the feel good five okay so five questions your answers can be as short or as long as you like it's totally up to you there are no rules so the first one is what makes you happy my dogs oh dogs what sort of dogs are we talking to love dogs I've got golden retrievers and cavalier King Charles oh beautiful how old are they I've got so youngest to oldest 11 months four years old one who's seven and one who's 10 you've got four how have you got four yeah well two of them are training to be therapy dogs so oh really isn't that cool I've got to tell you how cool is the canine therapy amazing yeah absolutely isn't it just yeah yeah in fact that's probably my next role if I move out of this space I'd like to train therapy dogs.

SPEAKER_01: 1:20:11

I've seen um I've seen I've been amazed by the canine therapy and the equine therapy yes yeah yeah I'm not a big horse person but because I don't like animals that are bigger than me but dogs all day long. Yeah dogs all day long I'm with you I'm totally with you I love dogs I'm I'm I I agree I don't trust horses but anyway okay beautiful dogs make you happy love it what are you grateful for my husband he's just an amazing person he's my absolute rock and lifesaver and yeah he just takes my crap a lot the time when most people wouldn't so was was he uh going to study being because he's recently become a psychologist hasn't he yeah he's kind of always wanted to be a psychologist but life threw him into being a Sparky and then he got the opportunity to study to be a psych and yeah that's what he did and that's what he does now and he actually specializes with veterans and first responders and does work in the moral injury space now as well so we make quite a nice little team yeah absolutely fantastic I love that love that what's happening what are you looking forward to a holiday so excellent when's that happening have you got it planned well no I I'd really love to go to Italy. It's one of the places in Europe um that I didn't really have an opportunity to visit so ideally sometime next year I've got to go back to England next year so I might just tag it on to the England trip. Oh my god Nikki you have to go to the Amalfi coast yes so I keep hearing the Amalfi Coast Sorrento oh you'll fall in love with it yeah yeah I bet it just looks beautiful and I love Italian boots.

SPEAKER_02: 1:21:56

Avoid Naples oh okay yeah Naples is overrated but the Amalfi Coast if you can spend a week on the Amalfi coast it'll change your life perfect done love it look forward to seeing the photos what's your me time when you want to switch off from the world and have some time just for you gosh look this is something that I struggle with.

SPEAKER_01: 1:22:17

I I preach to people about self-care but I just don't do it at all. So if anything it's probably just sitting around my pool on my property and watching my dogs having fun in the water.

SPEAKER_02: 1:22:31

Yeah well that's pretty good me time.

SPEAKER_01: 1:22:34

Yeah so that's nice doesn't happen often unfortunately but when it does happen it's nice.

SPEAKER_02: 1:22:38

Yeah I think any time spent in the company of your dog is me time. Yes yes and I really do um okay so self-care is on the to-do list for you my dear yeah and okay so last one what's made you laugh recently doing this podcast doing this podcast maybe jokes we've had some giggles other than that my dog especially the youngest she's a tripod dog so she's only got three fully working legs really and then she gets up to like absolute antics she's hilarious so she makes me laugh a lot awesome oh well that's a beautiful that's a beautiful kind of laugh that's gonna come from hanging out with your dogs me time laughing with the dogs love it absolutely love it well Nikki I'm sure that I'm sure that so much is going to happen in this space in the future that we will have this opportunity to chat again I'd I hope down the track and and I wish you well as you go forward and and continue to do incredible work in this space and and safe travels as you trip around the world and and do everything. I know you've got the Moral Injury conference coming up in when is that next year in Tasmania in May.

SPEAKER_01: 1:23:58

So that would be awesome I'm a keynote and a presenter at that so if anybody wants lots of information on moral injury that is definitely the place to be or if you want to submit an abstract um go ahead and submit. So it'd be great to see you and I hope you're gonna be there as well.

SPEAKER_02: 1:24:13

I actually was going I was right up until the point I was just about to because I've got an abstract written that I was going to submit to it and then I've got a two day corporate MC that I've got an MC and it's right in the middle of it and I'm like I can't I can't be in two places at once and I've got bills and I know that's a horrible excuse but because I wanted to try and go to your conference and the spa conference as well.

SPEAKER_01: 1:24:38

Yeah I'll be at the spa once are you going to go to the spa conference?

SPEAKER_02: 1:24:40

Yeah okay cool that's suicide prevention Australia for those listening anyway Nikki Jameson thank you so much it's an absolute treat to chat with you and I love your work you're you're an absolute gem.

SPEAKER_01: 1:24:53

Thank you unto you and I'll see you around the traps.

SPEAKER_00: 1:24:58

Absolutely all right cheers Nikki thank you for listening the information contained in this podcast is for educational and entertainment purposes it is not intended nor should it ever replace advice received from a physician or mental health professional. Want more info? Visit thelasterclinic.com dot you enjoyed the episode please share and subscribe thanks again for listening to the Laughterclinic podcast with your host