28 November 2019, Victoria – batyr welcomes the Royal Commission’s interim report into Victoria’s Mental Health System, and it’s encouraging to see that the Victorian government has already committed to adopting all of the recommendations.
batyr firstly wants to acknowledge that behind the recommendations, the data, the numbers are real people and communities affected by mental ill-health, who need the support of the whole nation.
We agree with the Commissioners’ view that stigma and discrimination can act as a barrier for people to access and receive appropriate care, not only deterring them from reaching out but also contributing to some of the shortfalls in the current design and resourcing of Victoria’s mental health system.
The commission heard from a number of people with stories of their personal mental health journey in Victoria, including young people like batyr speaker Nic Juniper.
“We all deserve to feel supported, cared for and listened to, and I hope that the Royal Commission will show Australia that we are in desperate need of systemic change, so we can all live to our fullest potential,” Nic said.
batyr CEO Nic Brown added that there was room for improvement in Victoria’s mental health system.
“This interim report, and the Commissioners’ efforts to consult people with lived experience from all walks of life, is a positive step in the right direction to make substantial, effective and long-lasting change,” he said.
“The types of evidence and witness statements presented in the interim report, particularly from individuals with lived experience, is reassuring because it means change will be driven by those directly accessing the system.”
batyr welcomes all nine recommendations to:
- Develop a Victorian Collaborative Centre for Mental Health and Wellbeing to bring together expertise in lived experience, research and clinical and non-clinical care. Part of its work will be to demystify perceptions that perpetuate the stigma and discrimination that people living with mental illness continue to experience.
- Provide funding to expand targeted acute mental health services, specifically, 170 additional youth and adult acute mental health beds to help address critical demand pressures.
- Expand follow-up care and support for people after a suicide attempt by funding all area mental health services to offer the Hospital Outreach Post-suicidal Engagement (HOPE) program, which is a core component of Victoria’s Suicide Prevention Framework 2016– 2025.
- In particular, batyr supports the recommendation to deliver the first phase of youth-focused assertive outreach and follow-up service to support children and young people, and having the voices of children and young people, their families and carers inform the design of this new service.
- Create an Aboriginal Social and Emotional Wellbeing Centre to support the recommended expansion of social and wellbeing teams throughout Victoria.
- Develop the first residential mental health service designed and delivered by people with lived experience, which will provide short-term treatment, care and support in a residential community setting as an alternative to acute hospital-based care.
- Expand consumer (individuals accessing support from the Victorian mental health system) and family-carer lived experience workforces, co-produced with people with lived experience and representatives of lived experience workforces.
- Developing educational and training pathways and recruitment strategies to drive mental health workforce reform and address workforce shortages.
- Introduce a new tax or levy to increase mental health funding in Victoria, which will allow for historical underinvestment to be addressed in an area where every single Australian has an interest – we all have mental health and around 1 in 5 of us will experience mental ill-health at some point in our lives.
- Appoint people with lived experience in senior positions within the proposed Mental Health Implementation Office, which is tasked with implementing the Commission’s recommendations.
These recommendations are promising in that they reflect batyr’s submission to the Royal Commission where we called for the amplification of people with lived experience to help shape service provision and overall policy reform in Victoria.
Victorian Collaborative Centre for Mental Health and Wellbeing
The Collaborative Centre will bring people with lived experience together with researchers and experts in multidisciplinary clinical and non-clinical care to develop and provide adult mental health services, conduct research and disseminate knowledge with the aim of delivering the best possible outcomes for people living with mental illness. The centre will work within a network of partners including service and research organisations in rural and regional areas.
The link between stigma and service provision and investment
There was evidence presented to the Commission which suggested that the community’s attitudes towards people experiencing mental illness not only deter people from reaching out for help but reduces the willingness of policymakers to invest in mental health.
Dr Chris Groot, a lecturer in the Melbourne School of Psychological Sciences at the University of Melbourne, informed the Commission that the distribution of government funding across the Australian and Victorian mental health systems was a result of ‘unintentional structural stigma’. (Witness Statement of Dr Chris Groot, 4 September 2019, para. 16.)
In addition, Dr Michelle Blanchard, Deputy CEO of SANE Australia and Founding Director of the Anne Deveson Research Centre, outlined that structural stigma refers to the ‘societal level conditions, cultural norms, and institutional practices that constrain the opportunities, resources and wellbeing for stigmatised populations’. (Witness Statement of Dr Michelle Blanchard, 27 June 2019, para. 46 citing Hatzenbuehler and Link.)
Of course, addressing structural stigma alone will not make long-lasting cultural change. All forms of stigma must be challenged, including self-stigma, perceived stigma and public stigma.
Additional government-subsidised psychology sessions
There was no specific recommendation to introduce more government-subsidised services but the Commission stated that it would “continue to consider the role of the Better Access initiative and primary care services more broadly”.
Currently, Commonwealth’s Better Access scheme offers a person up to 10 government-subsidised sessions with a psychologist, psychiatrist, GP or eligible social worker or occupational therapist each year.
The Commission was repeatedly told that the maximum length of treatment available (the 10 sessions) is inadequate for many people.
Since November 2019, people with eating disorders can access up to 40 psychological sessions and 20 dietetic sessions each year.
The Productivity Commission also recommended improving the flexibility of the Better Access scheme (up to 20 sessions), recognising that there is a proportion of users who would benefit from more sessions (Productivity Commission, Draft Report on Mental Health: Volume 1, pp. 20–21.)
The role of technology in mental health education and suicide prevention
It’s encouraging to read that the Commission will examine the role of new technologies as part of its design of a reformed mental health system.
Technology and online platforms are increasingly providing support for, and advice to people who are unable to get help from traditional mental health services. (Witness Statement of Scientia Professor Helen Christensen AO, 18 July 2019, para. 49)
Children and young people can be reluctant to seek help in person, and many prefer to access support and information online. A survey conducted for the Commission found that, while older people are more likely to visit their GP about mental health concerns, young people are more likely to use the websites of specific mental health support services (RCVMHS, Community Sentiment Survey – Key Findings, November 2019.)
Another survey, cited by Lifeline, reported that ‘over 59 per cent of young people prefer to contact crisis services via short-form messaging such as text (25.3 per cent), online chat (18.7 per cent) and social networking (15 per cent)’ (Lifeline Australia, Submission to Productivity Commission Inquiry into Mental Health, April 2019, p. 20.)
batyr is currently developing a digital platform that will allow young Australians to access and hear positive stories about mental health from their peers anytime, anywhere, in a safe, relatable and engaging online environment.
We are also trialing a peer-to-peer digital support tool, aimed at improving the inpatient experience for young people in mental health units.
Prevention and recovery centres
A common theme throughout the Commission’s community consultations, evidence presented and submissions was the value of prevention and recovery care centres.
Consumers, families and carers provided positive feedback on some models of care for young people. For example, headspace was raised as an example of a service that was working well to support consumers by providing a range of services and supports from across different parts of the system. (RCVMHS, Geelong Community Consultation – April 2019; RCVMHS, Warragul Community Consultation – May 2019)
Some young consumers also reported valuing headspace centres because they felt it was a less clinical environment. (RCVMHS, Mildura Community Consultation – May 2019.)
The economic case for mental health reform
Like the Productivity Commission draft report, the Commissioners point to the economic benefits of adequately pursuing better mental health outcomes in Australia. The estimated cost of poor mental health in Victoria is $14.2 billion a year (See Appendix C of interim report for methodology).
According to the Commissioners, a well-functioning mental health system goes to the heart of an inclusive and fair society so economic investment in mental health is of great concern and benefit to everyone.
Positive experiences and the power of peer groups
Although affirming experiences within the Victorian mental health system were the exception in the interim report, the Commission gave air time to some positive experiences.
Central to these positive stories were services that “recognise and respond to individual needs, services provided in therapeutic homelike settings and services delivered by the same individual or team of workers”.
In their witness submission, one individual spoke of the importance of peer groups in creating safe spaces to share stories:
“Peer groups are a really fantastic way for participants to communicate with each other. You get to talk to a spectrum of people—there are shared stories; the groups do different things such as cooking […] gym […] Within those groups, I’m able to do things I wouldn’t feel confident to do in any ordinary community setting. People understand what you’re going through. It’s a safe space.” (RCVMHS, Sale Community Consultation – May 2019.)
This is very much the goal of our own Being Herd workshops so it was great to see the Commission providing a platform for these real experiences from individual Victorians to be shared.
Another individual described their experience of accessing a youth service:
‘I have a GP, a psychologist, a psychiatrist, and a case manager—all in the one place. I still have the same case manager from when I first started […] She has worked very hard to understand my trauma history and my [borderline personality disorder], and together we have developed ways of understanding my illness that make sense to me. Without my case manager and doctors […] persisting with me even when things were very severe, I would not be alive.’ (Witness Statement of Erica Williams, 1 July 2019, para. 45.)
Positive stories like this foster hope in individuals who need support but have been hesitant to reach out. We believe the Victorian Collaborative Centre for Mental Health and Wellbeing is a positive step in having people with lived experience involved in service design.
However, investing in the delivery of engaging and positive conversations for people from all walks of life is essential to changing negative perceptions of mental health and increasing help-seeking rates (Research and the elimination of the stigma of mental illness, Patrick Corrigan, 2012). batyr would like to see the Victorian Government invest specifically in positive storytelling.
Rural communities represented
The Commission made a specific call to improve services in regional and rural Victorian communities.
Just over half of the 61 community consultation sessions were held in rural and regional Victoria.
The high level of stigma in rural communities and the difficulty in accessing services were highlighted as major challenges.
It’s great to see as part of its suicide prevention recommendation that the Commission has also called for additional clinical outreach services networked to a regional health service HOPE program, to provide support for people living in rural and regional areas.
Collaboration needed for system reform
batyr support the Commissioners’ view the changes needed for the mental health system cannot be achieved by government alone and will require a “collective effort” from all tiers of government, service providers and the mental health workforce, the media, the education system, other health and social sectors, as well as individuals, families and communities.
“Most importantly, people with lived experience of mental illness must have an opportunity to lead positive reforms to the mental health system. Working together in new and coordinated ways at all levels is vital for responding to the multiple varying factors that affect mental health,” the Commissioners stated.
The recommendations put forward by the Commission at this point are not designed to resolve all the problems but provide the foundation to begin delivering better mental health outcomes in Victoria.
Again, batyr strongly supports the Commission’s view that in redesigning and strengthening the current system, people with lived experience will play an “invaluable contribution”.
The majority of the Commission’s recommendations for change will appear in the final report in October 2020.
If you would like to learn how to share your lived experience with mental ill-health, please register your interest to attend a ‘Being Herd’ workshop.