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The path to a stronger mental health system

VCOSS submission to the Royal Commission into Victoria’s Mental Health System

FULL SUBMISSION (PDF)

Executive Summary

Almost half of the community will experience a mental illness in their lifetime.[1] It might affect their ability to work, study, connect with family and friends and contribute to community life. Most people will have a network of people who will worry about them or care for them during their illness. In turn, this can impact their own mental health and wellbeing.

Mental health and disadvantage are closely linked. Poverty is a major driver of mental ill-health as both a cause and consequence. Around one-third of people living with a serious mental illness live in poverty. Homelessness, drug and alcohol use and histories of abuse and trauma all contribute to a person’s mental health. Many of the challenges people with mental illness face are a result of the environment they live in and community attitudes and expectations towards them.

To prevent mental illness and build healthy and well communities we need to target these risk factors, of poverty, homelessness and social isolation. A whole-of-government approach is needed that recognises mental health is everybody’s business; we all have a role to play.

Right now the mental health system is failing many Victorians living with mental illness, their families and carers. Emergency department presentations are increasing, and the proportion of people getting help is decreasing. Victoria’s investment in mental health has dropped to the lowest per capita in the country.[2] Fragmented responsibility for planning, commissioning and monitoring system performance has led to gaps, failings and under-performance.

This Royal Commission is a once in a generation opportunity to reform a system in crisis. Sustained, large-scale investment in clinical and community managed services are needed to enable the system to meet demand. Psychosocial rehabilitation and support must be recognised as a vital component of the mental health system, alongside clinical care and disability support.

But it’s not just funding. Without system oversight and monitoring, service gaps will again emerge. A Mental Health and Wellbeing Commission could provide system oversight, accountability and stewardship. It could guide investment, coordinate research and provide long-term leadership and vision for the promotion of mental health and prevention of illness.

The mental health system encompasses more than just health services and beds. Community service organisations are an important part of the support system that help people living with mental illness every day. Community service organisations are well-connected with some of the most vulnerable members of our community. They maintain strong connections to their communities and relationships with people who access them and are well-placed to identify and act on the early warning signs of mental illness before a person reaches crisis point.

Addressing mental illness requires a strong, sustainable, well-funded community sector, with capacity to intervene early, providing wrap-around and integrated support to people and their families. Integrated housing and support options are needed. Without stable and secure housing, it is very difficult for people to get their other needs met. Access to timely and affordable legal assistance, inclusive education and supportive early childhood and family violence services help people live good lives.

Delivering high quality, timely services requires a skilled workforce. Growing demand across the community services industry and mental health system is leading to acute workforce shortages. Community service organisations face recruitment challenges including short-term contracts, insecure work, poor pay and conditions and a lack of knowledge about mental health services. Strategies are needed to make sure mental health services and the community services industry generally is an industry of choice, providing rewarding career pathways, secure employment and good pay conditions and support to staff.

The foundations are there for a strong mental health system; Victoria has a history of providing nation-leading community-managed psychosocial support services and embedding leadership of people with lived experience in its services. We look to the Royal Commission to set out an ambitious long-term plan that builds on the strengths of the current system, and provides a blueprint for a system that delivers real and meaningful change for people living with mental illness in Victoria.


Recommendations

Build a well-funded, well-governed and accountable system

  • Clarify the roles and responsibilities of the Victorian Government in system planning and market stewardship
  • Establish a Mental Health and Wellbeing Commission
  • Develop a Mental Health Services and Infrastructure Plan with clear targets, milestones, outcome measures
  • Build the evidence base for effective mental health interventions
  • Value psychosocial support as a key part of the mental health system
  • Scale up psychosocial support programs for people not eligible for the NDIS
  • Identify strategies to attract workers to the mental health sector
  • Coordinate workforce strategies with the 10-Year Community Services Industry Plan
  • Implement the recommendations of the Victorian Auditor-General’s Child and youth mental health report
  • Provide carers with access to emergency and planned respite
  • Provide clearer timelines and a comprehensive engagement plan for the implementation of the Carer Strategy

Embed respect, choice and lived experience in the mental health system

  • Develop a statewide approach to growing the peer workforce
  • Provide opportunities for the growth of consumer-operated services
  • Provide funding to improve workforce understanding and expertise in trauma-informed practice
  • Expand Safe Haven models
  • Build knowledge among mental health services about the importance of advance care planning and substitute decision-making

Approach mental health in the context of people’s lives

  • Address mental health over the life course
  • Examine how risk and protective factors affect mental health
  • Advocate to the Commonwealth to increase Newstart and related payments and remove unfair restrictions on access to the Disability Support Pension
  • Provide funding for an additional 90 financial counsellors across Victoria
  • Consider how predatory or irresponsible lending practices impact on people’s mental health
  • Ensure services have flexible funding so that they can provide holistic support for people experiencing poverty
  • Empower communities to design and deliver place based-responses
  • Provide communities with funding for “backbone support” to manage, coordinate and deliver place-based responses

Take a whole-of-government approach to improving population mental health

  • Develop a whole-of-government approach to improving population wellbeing and reducing health inequities using evaluated models from Australian and international jurisdictions
  • Develop an extensive range of health and wellbeing indicators to guide policy making and investment
  • Use wellbeing indicators to inform budget allocations across all levels of government
  • Establish a Mental Health and Wellbeing Commission with responsibility for providing a long-term vision for prevention of mental illness and promotion of mental health, including research, coordination of investment, implementation, monitoring and reporting
  • Make a long term commitment to building the evidence base for mental health promotion and mental illness prevention
  • Ensure that mental health expenditure is allocated across the mental health intervention spectrum
  • Invest in evidence-based promotion and prevention initiatives, and provide pilot funding for untested initiatives

Ensure the community sector can respond to mental health needs

Upskill community and universal service workers to intervene early

  • Invest in workforce development programs that help community service workers intervene early to identify and respond to mental illness

 

 Provide community service organisations with secure and sustainable funding

  • Pursue funding models for community service organisations that are sustainable, flexible and reduce burdensome reporting requirements
  • Provide community service organisations with a responsive funding indexation formula, that reflects the real costs of service delivery

 

Provide for outreach and soft entry points

  • Ensure funding includes capacity for case coordination and outreach

 

Help people find safe and secure homes

  • Invest in social housing
  • Scale up integrated housing programs
  • Consider a housing and mental health agreement
  • Require no exits into homelessness

 

Improve access to and interfaces with the National Disability Insurance Scheme (NDIS)

  • Deliver a robust and clear NDIS bilateral agreement
  • Continue to fund programs that improve access to the NDIS
  • Fund advocacy services to help people with psychosocial disability

 

Support the mental health of people in prison

  • Fund longer-term transition support programs for people leaving prison
  • Encourage NDIA discharge planning earlier in prison terms

 

Provide people with access to legal assistance

  • Increase funding to legal assistance services to respond to civil legal problems
  • Provide ongoing funding for health-community partnerships

 

Equip schools, early childhood and family services to intervene early

  • Expand the Mental Health in Schools program to government primary schools
  • Review whether the Mental Health in Schools program has sufficient capacity to meet demand and evaluate its impact
  • Continue to invest in Early Parenting Centres to ensure vulnerable children and families get the right support
  • Equip schools, early childhood services and family services to intervene early

 

Address co-morbid alcohol and drug use

  • Fund dual diagnosis capacity building programs in mental health and alcohol and other drug treatment services

 

Partner in developing integrated community hubs

  • Work with the Commonwealth to embed community mental health service hubs in local communities

 

[1] Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, Cat No. 4326.0, 2007.

[2] Mental Health Victoria, Saving lives. Savings money: the case for better investment in Victorian mental health, June 2018.

 

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