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Early steps towards a mental health system that works

THE Royal Commission into Victoria’s Mental Health System’s interim report makes for important and sobering reading.

It provides Victorians with an early look at the Commission’s thinking and while we want more on housing in the final report, VCOSS believes the Royal Commission is on track to deliver a big, bold and long-term plan to fix our mental health system.

The report made nine recommendations, which we go through below.

Impressively, the report puts people with lived experience where they belong: at the centre of the system, with key roles designing and delivering services and building the peer workforce. It also encourages innovative models, like the provision of acute, comprehensive care in people’s homes, instead of only in hospitals.

Building a system that works will require adequate investment and a skilled and qualified workforce. A new levy, as recommended by the Commission, is one way to drive this investment. A key challenge will be making sure the levy is imposed fairly, and VCOSS has already called for it to be means tested like Medicare.

The benefits of this new revenue must also flow directly to the low-income and disadvantaged Victorians who most need it.

But a levy is just be one part of the solution.  It can’t be a “get out of jail card” for the government to reduce existing spending, and it doesn’t replace the need for immediate investments—including in the 2020 Victorian Budget.

 

The recommendations

  Establishing the Victorian Collaborative Centre for Mental Health and Wellbeing

The Royal Commission concluded that Victoria lacks an overarching approach to mental health research, including the evaluation of programs and services, and how best to improve them.

To drive change, the interim report recommends the establishment of a new entity, the Victorian Collaborative Centre for Mental Health, in a new purpose-built facility in Melbourne.

For the first time, The Collaborative Centre will bring people with lived experience together with researchers and experts in clinical and non-clinical care to develop and provide adult mental health services, conduct and share research.

The Collaborative Centre will:

  • Drive best practice in inclusion of people with lived experience in the mental health system
  • Conduct research into new treatment and models of care
  • Develop and train the workforce.

The recommendation draws on comprehensive cancer centres, including the Victorian Comprehensive Cancer Centre.

 

 Expanding acute services in targeted areas

The interim report recognises that Victoria’s public clinical mental health services are operating in a state of crisis because of underinvestment and growing demand.

The Commission notes that the demand for acute inpatient beds will continue to be unsustainable if there is not a much stronger investment in early intervention and community-based mental health services to support people before they become critically unwell.

The interim report recommends funding 170 extra youth and adult acute mental health beds to address urgent demand. These include:

  • 135 acute public mental health beds provided to Barwon Health and Melbourne Health (in partnership with Western and Northern Health), to service pent-up, unmet demand in the inner-west, mid-west, northern and north-western regions of metropolitan Melbourne. Beds will be allocated on the basis of population growth, availability of services and socio-economic need.
  • 35 extra acute mental health beds for a private provider to deliver care to public patients. This is intended to drive competition and innovative model design.

Some of the funding for additional beds should be for treatment and care to people with mental illness in their own home, as an alternative to an inpatient stay.

 

  Increasing investment in suicide prevention

Some area mental health services provide adults with follow-up care after a suicide attempt through the Hospital Outreach Post-suicidal Engagement (HOPE) program. There are no other programs that offer this type of support, and HOPE services are not available state-wide or to children and young people under 18.

The interim report recommends that the program be expanded to ensure availability throughout the state, including in rural and regional areas.

In parallel, the interim report recommends developing a broader position on preventing suicide. A Towards Zero approach will be supported in consultation with people with lived experience, academic institutions, research institutes, multiple agencies and government departments, as well as with community organisations.

 

  Expanding Aboriginal social and emotional wellbeing services

The interim report says Aboriginal communities continue to live with the effects of trauma wrought by colonisation and post-invasion government activity. Aboriginal leaders and organisations told the Commission that communities have been calling for self-determined social and emotional wellbeing models of care for decades.

It recommends establishment of a new Aboriginal Social and Emotional Wellbeing Centre (housed at VACCHO in partnership with others), scholarships for Aboriginal social and emotional wellbeing workers to obtain clinical qualifications and dedicated, recurrent funding for Aboriginal Community Controlled Health Services (ACCHOs) to establish and expand multidisciplinary social and emotional wellbeing teams.

 

  Designing and delivering Victoria’s first lived experienced–led service

The interim report recognises that the current suite of Victorian mental health services designed, led and delivered by people with lived experience is very narrow.

A new service will be designed that provides short-term treatment, care and support in a residential community setting as an alternative to acute hospital-based care, and be delivered and operationally managed by a workforce comprising a majority of people with lived experience, working across a range of disciplines. The Commission has drawn on the Piri Pono residential service in New Zealand.

The Commission recognises that one service designed and delivered by people with lived experience will not be enough to change existing power structures, but it will lay the groundwork for a future that elevates the voices of people with lived experience throughout all areas of the mental health system.

 

 Supporting lived experience workforces

The Commission envisages a system in which everyone can choose to have access to peer support workers and advocates, and services are shaped by lived experience educators, trainers, researchers and consultants.

But members of the lived experience workforce continue to experience challenges to their role, including lack of organisational support, limited supervision, unclear roles, isolation, stigma and inadequate remuneration.

The interim report recommends expanding the consumer and family-carer lived experience workforce, and enhance workplace supports for their practice. This includes:

  • Development of learning and education pathways and opportunities, including adding the Certificate IV in Mental Health Peer Work to the free TAFE course list
  • Coaching and supervision for lived experience workers
  • Delivery of a mandatory, organisational readiness and training program for senior leaders, and induction materials for new staff, that focus on building shared understanding of the value and expertise of lived experience workers.

 

 Ensuring workforce readiness for future reforms

A capable and skilled workforce is crucial to a reformed mental health system. The Commission will continue to carefully consider the attributes, skills and composition of the workforce, as well as the supports they will need to work in a future mental health system.

The interim report recommends:

  • More allied health and nursing graduate positions in public mental health services in areas of need, including in rural and regional locations
  • Postgraduate mental health nurse scholarships
  • Recruitment campaigns, including internationally
  • A mental health leadership network, with representation from across the state, disciplines and the lived experience workforce
  • Collection and publication of better data about the mental health workforce.

Workforce and industry planning should align with and complement the industry planning being undertaken by the broader community services industry.

 

 Establishing a new approach to mental health investment

Victoria’s mental health system is currently underfunded. The Commission recognises a new approach is needed. A substantial increase in investment will be needed to deliver the scale of reform set out by the Commission.

To support that investment, the interim report recommends the Victorian Government design and implement a new revenue mechanism (like a levy or a tax).

 

 Setting up a Mental Health Implementation Office to drive the initial effort.

The interim report recommends the Victorian government establish the Mental Health Implementation Office for two years to implement the interim report recommendations, while final governance arrangements for the mental health system are being considered.

Its CEO will be appointed by the Premier, and report directly to the Secretary of the Department of Health and Human Services. DHHS will remain responsible, through its existing structures, for the management and oversight of the mental health system.

 

So what’s next?

The Royal Commission are not inviting submissions on the interim report. They will be undertaking targeted consultation on areas where they need additional information and discussion. There will be additional hearings in April and May 2020.

The final report will be delivered by the end of October 2020.

VCOSS will continue advocating for additional work and recommendations related to:

 

  Adopting a wellbeing budget.

his year New Zealand delivered its first Wellbeing Budget, requiring all new spending to advance one of five wellbeing priorities, including improving mental health, reducing child poverty and combatting Indigenous disadvantage. Ministers must demonstrate the wellbeing impacts of budget proposals, and explain any trade-offs between environmental, social, human and financial capital. By adopting a Wellbeing Budget, Victoria would continue to lead the nation in social policy.

 

  Addressing housing and homelessness

Housing is a precondition for successful mental health care. Without stable and secure housing, it is very difficult for people to have their other needs met. Chronic public and social housing shortages need to be addressed, and a concrete plan put in place to assist more of the 82,000 people stuck on the public housing waiting list.

Programs that integrate housing and mental health support save money and reduce hospital admissions and length of stay. They also contribute to tenancy stability, improve people’s wellbeing, social connectedness and lead to improvements in involvement in education and work.

 

  Valuing psychosocial support services

Psychosocial rehabilitation and support must be recognised as a vital component of the mental health system, alongside clinical care and disability support. Psychosocial support can keep people out of hospital, help them recover at home and stay well. Victoria should be directing more funding to community based support, to reduce the need for hospital admissions and clinical inpatient care.

 

  Preventing mental illness

Australia has been directing most of its mental health money into clinical treatment and service delivery. Preventing mental illness requires us to take action to address disadvantage, and promote community wellbeing. The Royal Commission presents Victoria with the opportunity to look at whole-of-government models for promoting good mental health and preventing illness.

 

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