Amongst all the talk about mental health reform and health reform more broadly, we haven’t heard much about the role of the community mental health sector.
But the sector is facing profound challenges as a result not only of national health reform, but also disability sector reforms, suggests a recent paper from VICSERV, which represents the Victorian sector.
The consultation paper, Community Managed Mental Health: an Agenda for the Future (PDF alert), says the sector is fragmented (reflecting historic funding patterns), and needs to become more flexible, accountable and easier for clients to navigate.
The paper says the proposed National Disability Insurance Scheme would change the policy, service system and organisational context of mental health significantly, as well as almost doubling fundings for community managed mental health services in Victoria.
The paper also urges the community mental health sector to contribute to the development of Medicare Locals. “Organisations focussed on working with people who face serious mental health issues need to recognise the broad mandate that Medicare Locals appear to have. The original framing as new primary care infrastructure has perhaps led to some organisations regarding the new bodies as less relevant than the current evidence suggests,” it says.
The paper notes that Victorian Government funding for the sector has fallen from 10.62% of the state mental health budget in 2002–03 to the current 8.88% in 2011–12. It says Aboriginal Community Controlled Organisations in particular need more support.
It notes that community managed mental services focus on people with serious mental illnesses and those facing significant social and economic disadvantage, and provide support to people in managing their mental illness and building their skills for life in the ways they choose. “It is the part of the mental health service system where there is the strongest evidence of commitment to a recovery approach and of the building of skills and systems that underpin effective practice,” says the paper.
More detail on the paper is provided in the article below, from Kim Koop, CEO of VICSERV, and and Elizabeth Crowther, President, VICSERV and CEO of the Mental Illness Fellowship Victoria.
Community mental health services shape up for bigger role
Kim Koop and Elizabeth Crowther write:
Victoria’s community managed mental health sector has recently released an extensive reform agenda which is seeking major change in the way Victorians use mental health support services.
Made up of 130 individual agencies of varying size across Victoria, the community managed mental health (CMMH) sector delivers support services to 20,000 Victorians a year who have severe mental health issues.
People with a serious mental illness can and do recover. Often life isn’t as it was before but it can be a good life. Drugs and psychological therapies can play an important role in reducing symptoms of illnesses such as schizophrenia and bipolar disorder.
However, there is more to recovery than this. People affected by mental illness have aspirations to resume disrupted education and careers, to find stable and secure accommodation, to be physically fit and healthy and to have strong bonds with family, friends and the community. Sometimes achieving these goals requires some extra support. This is the work of community managed mental health services.
In Victoria and elsewhere throughout Australia, community managed mental health services work with people who experience severe and persistent mental health issues to reduce the associated disability and disadvantage. Victoria’s service system has been built up over the 30 years or so since large institutions were closed down in favour of independent living in the community.
Many of the 130 services that currently make up the sector were started by family and friends of people with a mental illness. These committed individuals worked tirelessly to gain government and other funding to provide day programs, short and medium-term residential care, housing, skills development programs for day to day living and respite services.
Funding to the sector has historically been piecemeal and unevenly distributed among services and across the state. The state government provides funding to a variety of service types, including stand-alone services, programs that are integrated with primary health care services, and those that are part of welfare and housing agencies.
In recent years community managed mental health services have been able to access Australian government funding for programs such as the Personal Helpers and Mentors Scheme (PHaMS) and Day-to-Day-Living in the Community (D2DL) and respite services. A significant portion of funding to the sector is allocated in small amounts, with more than half the agencies in the sector receiving funding of less than $500,000 a year.
Governments at all levels have recently begun to recognise the unique contribution of community-based services to people’s recovery journey and to their ability to make choices about community participation.
It is expected that over the next five to ten years funding for community managed mental health services will nearly double.
At the same time governments, consumers, families and carers are advocating for a move towards fully individualised service offerings. The introduction of a National Disability Insurance Scheme (NDIS) as part of this shift will fundamentally change the way community mental health services do business.
The sector knows it delivers services that change lives, but it also knows that the current service delivery system has systemic weaknesses that need to be addressed. Changes are needed to create a more rational, less fragmented service system responsive to the current and future needs of individuals and local communities.
VICSERV, the industry body that represents the sector, has developed a reform agenda to prepare the community mental health system for its growing role. An agenda for the future sets out an achievable strategy for the development of the community managed mental health service system over the next five years.
The proposed reforms would see local area planning identify the correct configuration of services required in a given area. Some rationalisation of the service system would also occur.
VICSERV considers that there are a number of pathways to reform that need to be considered as part of a rationalisation debate: some of the outcomes will be driven by organisational choice and circumstance while others will be linked to area planning.
Attention must also be paid to building the capability and sustainability of community managed mental health services to meet the challenges of a new environment, including meeting new performance reporting requirements and the introduction of new assessment and efficient pricing mechanisms.
VICSERV is also proposing the appointment of an Ambassador for Community Managed Mental Health to drive the agenda for change and to position community managed mental health services as key players in the mental health system of the future.
The reforms will make services easier to navigate for consumers, carers and health professionals. Efficiency will be increased across the sector, more individualised support packages will be delivered and increased government funding will be secured.
Most importantly, more people affected by mental illness will be able to achieve their goals and live meaningful and productive lives in the community.