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Rehabilitation, mental health & addiction programs trump prisons any day, says veteran crime writer John Silvester. theage.com.au/victoria/law-a…
If housing was considered in inflation data (a key cost-of-living gauge), the rate would be "significantly higher".… twitter.com/i/web/status/8…
Good health underpins everyone’s ability to live a good life, free of the distress and discomfort of disease and the costs of treating illness. Good health means people can make the most of their lives – maximising their capabilities to work, learn, play, socialise, volunteer and care for loved ones. A healthier community is not only more productive, but is happier, more cohesive and offers people a better quality of life.
Promoting good health for everyone, regardless of their social or economic situation, means utilising the social determinants of health approach. This focuses on creating living and working conditions conducive to good health, and supporting people with poor health and chronic disease. Reducing health system barriers that lead to poor health, and providing equitable access to income, education, employment and secure housing, helps build healthier communities.
Structural barriers prevent equal access to health services and can cause or compound health inequities. Barriers include fees and healthcare costs, low health literacy, poor access to health information, and lack of timely and quality services, especially in rural and regional areas.
The Victorian health system faces other challenges and changes. These include the rollout of the NDIS and the transfer of home and community care services to the federal ‘My Aged Care’ system. The Commonwealth government is also rearranging health service procurement by creating Primary Health Networks (PHNs).
There are also changing demographics and growing demand for services. For example, rapid population growth in outer metropolitan corridors puts pressure on Melbourne health services. Rural and regional health services face workforce and sustainability challenges. The Victorian government can strategically respond to the community’s health needs, prioritising prevention and early intervention, and making sure all Victorians have equitable access to timely and affordable healthcare.
The Victorian government can empower people to manage and recover from mental illness by retaining funding responsibility for community-based mental health rehabilitation services.
Victoria’s community-based mental health sector has long provided treatment, support and rehabilitation services for people with serious mental illness, to help them manage their illness and build life skills.
However with the move to the NDIS, Victoria has transferred all its community-based mental health services funding over to the NDIS. Victoria is the only state to do this. This means it is unclear who will provide people with mental health rehabilitation services, as rehabilitation is deemed outside the scope of the NDIS.
State-funded clinical mental health services will continue to provide treatment services outside the NDIS. However they are not well-placed to provide rehabilitation services, because they are subject to legal frameworks for involuntary treatment. Community-based mental health services are best-placed to deliver rehabilitation services, because they respond to people coming to them voluntarily for these services.
Victoria’s community-based mental health services need to be funded independently of the NDIS, alongside clinical and acute mental health treatment services. The community-based mental health sector estimates $80-$100 million is needed to maintain the existing system.
Many people living with mental illness will also be ineligible for the NDIS altogether. People with mental illness must be classed as having a ‘permanent’ psychosocial disability to be eligible for an NDIS package. Requiring people to identify as having a ‘permanent’ disability or condition contradicts recovery models of mental illness rehabilitation. It creates stigma, distress and a sense of hopelessness, and presents a barrier for younger people without a diagnosis, and for all people with moderate mental health needs, who are likely to recover if given appropriate support. GPs and psychiatrists also face difficulty giving people permanent diagnoses due to the episodic nature of mental illness.
Community health centres and Aboriginal community-controlled health organisations (ACCHOs) are the health system gateway for many people experiencing poverty and disadvantage.
The government has given assurances that people ineligible for the NDIS will receive assistance, but there is little detail or funding linked to this assurance.
“Twenty per cent of existing community managed mental health system clients… are clearly ineligible for the NDIS and NDIS status remains unclear to the agencies for another 11 per cent of consumers”.
The Victorian government can help people maintain good health and strengthen their access to local community health services, by investing in infrastructure and facilities.
Community health centres and Aboriginal community-controlled health organisations (ACCHOs) are the health system gateway for many people experiencing poverty and disadvantage. They help people manage chronic conditions and stay healthy in the community, and are more cost-effective than acute care. The community’s demand for services is growing. For example, the Victorian Aboriginal population increased 41 per cent between 2006 and 2011, putting pressure on ACCHOs. A study in 2012 indicated (ACCHO) infrastructure needs of around $120m.
Many community health and Aboriginal community-controlled health services’ facilities are ageing, too small, or not fit-for-purpose. ACCHOs and community health services report being unable to start new programs or provide extra services to meet demand due to inadequate facilities. Recent investment in community health infrastructure has been erratic, with a sharp decline since 2010.
The Victorian government can prevent unnecessary hospitalisations and illness by investing in prevention and health promotion. Chronic diseases are significant contributors to illness, disability and premature death, causing nine out of 10 Australian deaths. Disadvantaged communities face higher risks of poor health and chronic disease, including people living on low incomes and in rural and remote areas.
The World Health Organisation estimates at least 80 per cent of all heart disease, stroke and diabetes is preventable, as are 40 per cent of all cancers. The Commonwealth government’s 2014 termination of the National Partnership Agreement on Preventive Health has led to fewer Victorian preventative health programs operating. The community health sector reports Victorian government health promotion and prevention funding has not grown in recent years.
The Victorian government can help more people overcome problem drug and alcohol use and reduce drug-related harm by making it easier for people in growth corridors and rural and regional Victoria to receive alcohol and drug treatment.
Alcohol and drug treatment helps people regain control of their lives and reengage with work, education, family and community. It can reduce hospital costs, drug-related harm, violence and welfare costs.
Alcohol and drug rehabilitation services in Victoria cannot meet demand and have long waiting lists. Alcohol and drug services report particularly high demand in regional Victoria, and in Melbourne’s growth corridors.
In last year’s state budget the government funded a new residential rehabilitation facility in the Grampians region. While this welcome funding helps meet demand in western Victoria, extra beds and facilities are still needed elsewhere.
The Victorian government can reduce the spread of blood-borne viruses among injecting drug users by expanding access to needle and syringe programs.
Needle and syringe programs provide clean injecting equipment, education and information about health, wellbeing and drug-related harm, and are often injecting drug users’ first contact point with the health system. They prevent the spread of diseases, including HIV and hepatitis C.
“Between 2000 and 2009 it is estimated that 96,667 hepatitis C and 32,050 HIV infections were averted through the provision of sterile injecting equipment.”
International evidence shows needle and syringe programs do not encourage drug use or increase numbers of discarded syringes in public places.
Equitable local access to needle and syringe programs means operating outside business hours. The Victorian government can build on its recent Ice Action Plan investment in 20 needle and syringe program sites, by funding out-of-hours services and installing dispensing machines to all needle and syringe program sites in Victoria, including in rural and regional Victoria.
The Victorian government can support healthy, culturally strong and resilient Aboriginal communities by adequately resourcing the Aboriginal Health, Wellbeing and Safety Strategic Plan and building on the successes of past plans.
VCOSS welcomed the introduction of the Victorian government’s Koolin Balit Aboriginal Health Strategy 2012-22, and the development of statewide and regional action plans, governance structures, an evaluation strategy and workforce development plan. The momentum, successes and investment so far acheived by Koolin Balit and the Human Services Framework can be carried into developing the new Aboriginal strategic plan.
The previous state government invested $61.7 million over four years to 2017 for Koolin Balit. Extra resources can support the new plan’s expanded scope, including housing, disability and family violence.
The Victorian government can help people access dental care earlier and prevent problems worsening by expanding the public dental scheme. Poor dental health causes pain, discomfort, embarrassment and difficulty participating in work and social activities. Many people cannot afford dental care, with out-of-pocket costs accounting for 60 per cent of Australian dental care spending.
The public dental system is under-resourced. Average general dental care waiting times have grown from less than 12 months in the June quarter of 2015 to more than 15 months a year later.
The Commonwealth government proposed closing the Child Dental Benefits Scheme (CDBS) and reducing spending on dental health in its 2016-17 budget. Under the CDBS, eligible children are offered private or public dental services including general check-ups, x-rays, fillings, cleaning and other preventative services. There is no waiting list for this scheme. Community health services warn the proposed replacement scheme risks moving children back onto the general waiting list, further increasing waiting times.
The Victorian government can promote good health by developing a comprehensive, statewide sexual and reproductive health strategy.
Good sexual and reproductive health supports people’s enjoyment of social relationships and their general physical and mental wellbeing. It is more than the absence of disease or dysfunction, and includes positive and respectful approaches to sexuality, the ability to have a responsible, safe and satisfying sex life, the capability to reproduce and the freedom to decide if, when and how to do so.
Victoria does not have a statewide sexual and reproductive health strategy or overarching evidence-based framework for research, policy and program development and delivery. In the absence of this, responses to sexual and reproductive health risk being siloed or primarily focused on treating disease and behaviour change.
The Victorian government can help people with drug and alcohol problems by progressing the recommendations of the recent review of the alcohol and other drug (AOD) treatment system.
In 2015 the Victorian government commissioned an independent review of the new alcohol and drug treatment arrangements, arising from the 2014 recommissioning process. The review found some elements of the recommissioned AOD system present barriers to people accessing the system, including catchment-based intake and assessment.
The review recommended assessment be devolved to treatment services, and a comprehensive review be undertaken of the drug treatment funding model. At the time of writing, the Victorian government has released an exposure draft of proposed new alcohol and other drug program guidelines.
The Victorian government can reduce health inequities by making it easier for people to access mental health support and alcohol and drug treatment, especially people experiencing homelessness, Aboriginal and Torres Strait Islander people and other marginalised groups. Services with established relationships with these groups are well placed to provide ‘soft entry points’ to the system.
Community mental health AOD service reforms have made it more difficult for people experiencing homelessness to enter the system, as they are less likely to access the new formal central intake assessment system. For example, one survey reported services had difficulty engaging Aboriginal, culturally diverse and LGBTI people because of system inflexibility, cultural inappropriateness and ‘reduced front doors’.
Data from the Barwon NDIS trial site shows people in unstable housing are overrepresented among people with mental illness found to be ineligible for the NDIS. The NDIS structure makes it more difficult for organisations to reach out to help marginalised groups.
Peer education involves knowledge sharing between people of similar age, background or experience. The peer workforce employs people with lived experience, for example as mental health consumers or carers, or as injecting drug users.
Peers can be a trusted and credible source of information, and can be more approachable than traditional health services, making people feel their experiences are valued and understood. This can reduce social isolation, combat stigma and improve service access. Peer education can change attitudes and behaviours, and help link people with health and other support services.
More can be done to support the growth of innovative peer education models, and some programs are under threat. For example, the Commonwealth government recently defunded YEAH, an organisation delivering youth-led sexual health education to young people.
The Victorian government can reduce health inequities experienced by people living in rural and regional areas by reducing barriers to accessing healthcare.
Victorians living in rural and regional areas experience higher rates of socioeconomic disadvantage and have poorer overall health status than other Victorians, including lower life expectancy and cancer survival rates.
One way of improving health outcomes for rural and regional Victorians is by ensuring they can reliably access health services when they need them. Many people have to travel to regional centres or metropolitan areas to see specialists or get the care they need.
An NCOSS study of access to community transport for people with chronic illness found that 77 per cent of respondents in dialysis units, and 81 per cent of respondents in cancer centres reported that their patients experienced some level of difficulty accessing transport to and from treatment. The greatest burden of unmet non-emergency transport needs was borne by older people, people on low incomes, people living in rural and regional areas, people with a disability, Aboriginal and Torres Strait Islander people and people from culturally diverse backgrounds.
Transport barriers continue to adversely affect people’s timely access to services. People in rural and regional Victoria are highly dependent on cars for their travel. With fewer public or alternative transport options, most people feel their only option is to drive a car. More accessible, affordable and coordinated public transport would help reduce health inequities among rural and regional Victorians. Alternative forms of transport, including community transport and health transport services can also be further explored.
Emerging technologies may provide opportunities for improving regional Victorians’ access to health services and greater opportunities for person-centred care. It is not, however, a replacement for other, face-to-face forms of service delivery. The digital divide means some people have more limited access and technology-related skills than others.
 VICSERV, Learn and Build in Barwon, June 2015, p. 15.
 Ibid, p. 11.
 Australian Bureau of Statistics, Estimates of Aboriginal and Torres Strait Islander Australians, June 2006 and June 2011.
 VACCHO and Aboriginal Housing Victoria, Submission to All things considered; Exploring options for Victoria’s 30 year Infrastructure Strategy, 2016.
 Victorian Healthcare Association, Futureproofing Victoria’s health system, 2016, p. 37.
 Australian Institute of Health and Welfare, Australia’s Health 2014, 2014, p. 94.
 World Health Organisation, Prevention chronic disease: a vital investment, 2005.
 Department of Health, Australian Government, Needle and Syringe Program, accessed September 2016.
 Victorian Council of Social Service, Aboriginal Health and Wellbeing Plan Submission, 2016.
 Australian Institute of Health and Welfare, Oral health and dental care in Australia, Key facts and figures 2015, 2015, p. vii.
 Department of Health and Human Services, Average time to treatment for general dental care – Quarterly data, 1 April 2015 – 30 June 2016.
 Women’s Health Association of Victoria, Proposal for Victorian Sexual and Reproductive Health Strategy, 2013.
 Aspex Consulting, Independent review of new arrangements for the delivery of mental health community support and alcohol and drug treatment services; Final Report, September 2015.
 Victorian Alcohol and Drug Association, Challenges and opportunities: Key findings from VAADA’s Alcohol and other drug sector recommissioning survey, August 2015.
 VICSERV, Learn and Build in Barwon: The impact of the NDIS scheme on the provision of mental health services in the Barwon launch site,
June 2015, p. 6.
 NCOSS and Community Transport Organisation, Staying Alive: Transport to treatment for people living with a chronic disease, 2015.