The Royal Commission into Victoria’s Mental Health System final report is detailed, ambitious and significant. It’s a roadmap for a real, positive change.

And it puts people who have lived with mental illness at the centre of service design and delivery.

As the Royal Commission says:

“There is much cause for hope that this time, effective and lasting reform will be implemented. All partners in delivering profound change must rise to the challenge. The Commission’s inquiry is over; the time for decisive and deliberate action is now.”

Many of the recommendations are technical and complicated, and deal with system design, service delivery, governance and workforce challenges.

Social service bodies and community organisations will play a vital role getting the implementation right. We will bring you more analysis of these recommendations in coming days and weeks, as will other peak bodies and experts.

But on initial inspection, the principles underpinning the final report’s recommendations are strong, ambitious and a cause for genuine excitement.

Reorienting the mental health system to care in the community will keep people out of hospital, and make sure they have a choice about the type of care they need, when they need it, where they need it.

The report also puts welcome focus on the needs of children and young people, intervening early to prevent worsening illness that can change a child’s life trajectory.

A new agency will be established, led by people with lived experience of mental illness, to support the development of organisations and services that are led by and for people with lived experience of mental illness.
The report also recommends an overhaul of the way services are delivered in the community.

The new system (see diagram below) will be designed around eight regions. New regional governance structures, which will be known as Regional Mental Health and Wellbeing Boards, will be phased in over time.

Within these regions, new ways of commissioning and contracting will also be used to encourage more integrated and innovation.

50-60 new Adult and Older Adult Local Mental Health and Wellbeing Services will be created as a ‘broad front door’ so more people can access services in the community. They will deliver treatments, therapies and psychosocial supports. They will be delivered by a range of different services, and include comprehensive, coordinated multidisciplinary teams.

VCOSS looks forward to working with the Government to make sure these services build on the strengths and relationships of the community sector, including existing community managed mental health services.
22 Area Mental Health and Wellbeing Services will be delivered through a partnership between a public health service or hospital and a community organisation that provides psychosocial supports.
Area Mental Health and Wellbeing Services will operate with extended hours, and also respond to crisis calls from anyone in the community, 24 hours a day, seven days a week.

The six levels of the new system

New services will be developed for young people, infants and children, and community perinatal teams will support new parents. A new state-wide service for people living with mental illness and addictions will be established, as will Aboriginal healing centres.

The link between stable housing and good mental health was recognised. The report ensures that the 2000 houses for people with mental illness announced as part of the Big Housing Build will be delivered as supported housing.

Other important recommendations include:

• Carer-led centres will be established to support carers and families and respond to their needs
• Development of a Mental Health and Wellbeing Outcomes Framework to drive collective responsibility and accountability across government
• Addressing gender-based violence in mental health facilities
• Promotion of healthy workplaces and schools
• Expanding supports for young carers and children of parents with a mental illness
• A new Mental Health and Wellbeing Commission to guide implementation, maintain accountability, and address stigma around mental illness.

VCOSS looks forward to working with the Victorian Government and the community sector to implement the ambitious plan put forward in the report.

We will continue to update the community sector as we work through the detail.

Briefing for sector stakeholders

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By Connie Jones

This story is part of the My Corona series. We’re publishing personal stories about the pandemic, life in and after lockdown, and Victorians’ hopes and fears for the future. We have changed Connie’s name at her request. 

For a lot of people what’s gotten them through lockdown is knowing that it will end. But for some of us, this is life and it does not end.

I’ve had chronic illness for a long time. When I look back I can’t identify a point in my life when I didn’t have pain and fatigue, although it wasn’t until I was in my late twenties that I realised being in pain all the time wasn’t actually normal.

I’ve got a beautiful wife, Sara – we’ve been together since we were 21 – and we have a little kid, Alex, who’s eight. They’re my reason for everything, my reason to get up in the morning.

I’ve been a teacher for most of my professional life, although my health has interfered with that a lot. I used to be a secondary teacher but I had to take some time away from it, although I was still writing educational resources and creating educational videos.

For the last two years I’ve been doing my masters of primary teaching. I’m really passionate about education, but I have a lot of anxiety about whether I’m going to be able to physically do what’s required of me to pursue that career. Teaching is a job that takes all of you, and all of me is not enough sometimes, with all of the health stuff that goes along with it.

When you’re sick all the time and in pain all the time, it’s really hard to not be depressed and anxious all the time. The thing I find the most challenging is the mental health side of dealing with chronic physical illness.

It’s not linear. Some days I’m at peace with it and other days I’m really mad about it.

All of that emotional stuff, I think a lot of people were feeling that in the pandemic. People were realising Oh, I can’t do my job, I don’t have the things in my life that give me purpose and my sense of identity and my sense of connection with the world.

All of those things that make us human – a lot of people have found how depersonalising and anxiety-creating it is to not have that stuff.

I’m hoping that having been in lockdown will give people a bit of personal experience, a way to understand what it’s like for people with disabilities – how we live all the time. And that for some people it will create empathy. That’s what I’m hoping and what other people I know who are either disabled or love someone who’s disabled are hoping.

I think for a lot of people what’s gotten them through lockdown is knowing that it will end. Knowing we just have to get to a certain number of cases or we just have to get to November and this will be over and it will be okay. That’s the only thing that’s been getting them through without going insane.

For some of us, this is life and it doesn’t end.

At the moment my health is declining and I’m not leaving the house very much, while other people are going back out into the world.

I’m feeling a little bit like I had all these people with me in lockdown – I had my family with me in a very literal sense, but I had my friends with me in a figurative sense. We were kind of all in it together for the first time ever. And now everyone’s going back to their lives and I’m feeling quite alone again in a way that’s adding another layer to the mental health challenges.

I’m quite comfortable with dissonant emotions coexisting. I’m really happy for my friends who run small businesses and for my kid who gets to go back to school. I’m genuinely one hundred per cent thrilled for them.

But sitting right next to that is that sense of being sad that I’m by myself again. And that I’m feeling left behind. I don’t think those two things are mutually exclusive.

I was talking to my wife about my health. She said I don’t seem physically worse to her, and I explained that’s because for the last few months I haven’t had to go anywhere – my life has been entirely at home, contained and controllable and manageable. I haven’t had to go to the supermarket, which sometimes is all I can manage in a three-day period. I haven’t had to go to campus for uni; I haven’t had to navigate moving through the world, and that’s a huge part of what makes my life hard.

She had a bit of an aha moment, she was like, Oh, oh I see. And it’s funny because she knows the intricacies of my health situation; she often knows what I need better than I do. I think it goes to show that when you’re living that embodied experience of disability, the world really does look so different to you. And it’s very hard to communicate that to other people.

sitting right next to that is that sense of being sad that I’m by myself again. And that I’m feeling left behind.

I’m sad that everyone had to experience lockdown. I know that there’ll be long-term mental health and anxiety issues that people will have to process, so I’m not happy that it happened.

But I hope that people can take those negative experiences and think, some people have to live like this all the time and I now have a greater insight into how hard that is. So the next time they vote, or read an opinion piece about the NDIS, or do anything related to people with disabilities, I hope they’ll have a new insight into what we might need. And the world might become a little bit more compassionate.

But they aren’t routine for many people in our community, particularly those struggling to find work against the backdrop of COVID-19 restrictions in Victoria.

Take for example Caryn Hearsch, who has been jobless since 2017 and hasn’t done a substantial supermarket food shop in around seven years.

“I get milk and bread occasionally. I have a friend that brings me sometimes a bit of other bits and pieces,” the 63-year-old explains.

“But to be able to like plan a shopping list and push a trolley around all the aisles – I wouldn’t know where to start now.”

Caryn was receiving JobSeeker payments until recently moving onto a disability pension. She received $1,100 a fortnight after the Coronavirus Supplement was added to the base JobSeeker payment but is now instead paid a disability pension of $944 fortnightly.

It’s a struggle for Caryn to pay the mortgage on her Hoppers Crossing home and buy food and medicine for various medical conditions, including depression and high blood pressure. The grandmother of two used to try to earn money by selling items at a trash and treasure market in Geelong but stopped when the pandemic hit, resorting to listing some of her possessions for sale online.

“I don’t have any other option, I have to rely on the pittance that the (federal) government gives me and just pray to God that I can keep paying my mortgage, which is my priority, and just try and keep up with the other bills as best I can,” she says.

“No one should have to be making choices between food and bills, medication and bills. But we are.

“I was brought up with (the idea) Australia’s the lucky country. Where has it gone?”

Caryn has applied for more than 700 jobs over the past eight years, after seriously injuring herself when she slipped on a freshly washed floor in 2012. She had to have reconstructive surgery on both shoulders after her accident.

“After my accident … my life just really ended,” she says.

Before her injury she worked as a medical secretary for 49 years at the Peter MacCallum Cancer Centre and the Melbourne Brain Centre at the Royal Melbourne Hospital.

A few years after her accident, Caryn retrained as a teaching assistant and managed to secure one six-month contract and one six-week stint at a school, but hasn’t worked since her last contract ended in 2017.

“I just feel I’m, I’m worthless. I am not contributing to the world, I’m not bringing an income in,” Caryn says.

“Life’s pretty crap at the moment to be honest, only because not working has had such a huge, huge impact on my mental health.”

“to be able to like plan a shopping list and push a trolley around all the aisles – I wouldn’t know where to start now.”

The pandemic has compounded Caryn’s mental health struggles and she recently contemplated taking her own life.

Caryn says her best friend Lynne, who lives in Queensland, is like a sister to her. She was hoping to try and visit Lynne this year but that plan is now off the agenda due to border closures and other COVID-19 restrictions.

Caryn stays in regular phone and video contact with her daughter Emma, who is based in Romsey, some 80 kilometres away, and her grandchildren – Aurora, who is nearly eight, and Cody, who turns six in August.

She says it’s heartbreaking not being able to see her family, particularly for Cody’s birthday, and she’s worried about whether she’ll be able to see them again at all.

“I’m here, she and the grandchildren are up there. The way this world is like, nobody knows what’s going to happen tomorrow.”

Next: ‘A bitter pill to swallow’: coping with racism and the virus

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