Introduction by Croakey: In its 2021 final report, the landmark Royal Commission into Victoria’s Mental Health System condemned systemic failures that had inflicted a “profound human, societal and economic toll”.
One of its 65 recommendations was the creation of up to 60 Mental Health and Wellbeing Locals in a variety of settings and models across Victoria.
One has now opened in the culturally rich but socio-economically disadvantaged Brimbank local government area in Melbourne’s west, seeking to transform mental healthcare through lived experience, community engagement, and upended power relationships.
This article is published in collaboration with cohealth, a not-for-profit community health organisation, as part of their Health Equity Champion membership of the Croakey Health Media funding consortium.
Marie McInerney writes:
As the sole carer of two children with severe autism, ‘Lucy’ has faced challenges that were at times overwhelming.
Lucy, who asked that we not use her real name to protect her children’s privacy, took a long time to understand their health issues and to find the right diagnosis and treatment plan. And it took even longer before she found there was support available for her own wellbeing in a demanding caring role.
“I was not like I am now,” Lucy told Croakey, describing the comfort she now gets from meeting up with other carers over dinner, at the movies, out walking, meeting in groups in the Brimbank area in Melbourne’s west, which spans the traditional lands of the Wurundjeri and Bunurong peoples.
For years, she said, she had struggled by herself. “You want to ‘fix’ the problem, you cry, you feel alone, you feel no-one understands, you’re too busy, you forget you have to look after yourself.”
When invited to contribute to consultations for a new model of mental health service in her community, she had no hesitation sharing her experience and the need for carers to be linked into supports much sooner than she had been.
Lucy is among hundreds of local people in Brimbank who were consulted ahead of the formal opening last month of the new Brimbank Local Mental Health and Wellbeing Service.
The Brimbank service is led by Australia’s largest community health provider, cohealth, in partnership with mental health service provider Clarity Health Care and the University of Melbourne.
It is one of 60 new local mental health models being opened across Victoria by the State Government that are required to be free, easy to access with no referral required and delivered on a philosophy of ‘how can we help?’ and a ‘no wrong door’ approach.
Their formal mission is to help create a responsive and integrated mental health and wellbeing system, in which people receive most services locally and in the community, close to their families, carers, supporters and networks.
The Locals are among flagship reforms recommended by the Royal Commission into Victoria’s Mental Health System.
Delivering its final report in 2021, the Commission did not hold back on the size of the problem facing mental health in Victoria, detailing “catastrophic failures” and urging “transformation of the system.
Once in a generation shift
Psychologist Suzanne Dick, who has worked for more than 20 years across the mental health sector in Victoria, last year closed down her own private business to accept a lead role with cohealth at the new service.
Her title, Director of Mental Health Transformation, “says it all” about the ambition of the new service and the excitement she feels about the potential for real change, she told Croakey.
“It’s a once in a generation chance to be part of something so big,” she says. “I can’t imagine in my working life being part of something this big again, something that has such power to influence people’s lives for the better.”
The Brimbank model aims to be led by and created with community, with a peer workforce and lived experience as first point of contact for consumers and at every level of decision-making, to the point that all meetings must meet a quorum of lived experience before they can go ahead.
As a community health service, cohealth can offer a genuine health hub and strong focus on the social determinants of health, with GPs, nurses, a psychologist, psychiatrist, social workers and wrap around services such as recovery coaching, alcohol and other drugs, and family violence support at the one site.
The partnership with Melbourne University provides a conjoint psychiatrist appointment and the provision of clinical training, supervision and support. That includes establishing community psychiatry internships, part of a ten-year strategy to build a new local mental health workforce pipeline of trainees, medical students and graduates, through mentoring for local university students, raising awareness of health careers in Brimbank schools, tertiary scholarships and student placement.
As well as providing valuable job opportunities, the aim is to have a much more diversified mental health workforce, with a greater number of clinicians, community engagement workers and leaders who reflect the communities that they are supporting.
Research will also be an important component. With Brimbank home to nearly 160 nationalities, Melbourne University will also explore non-Western understanding of healing and wellbeing by working with cohealth to establish a Centre of Excellence in Culturally and Linguistically Diverse Mental Health as part of the project.
What did the community want?
As the local Council declares, Brimbank prides itself on its cultural diversity.
But structural disadvantage is a major issue: it has high socioeconomic disadvantage, lower rates of mental health and wellbeing relative to the state average, more than double the average number of people born in non-English speaking countries, triple the average number of refugees, and the highest use of specialist homelessness services in Victoria.
cohealth already has quite a strong presence in western Melbourne, but the organisation wanted to make sure it didn’t just hear from those it knew, or from the most vocal and most engaged, but from people who wouldn’t historically access a mental health service and those who with bad mental healthcare experiences, who kept away.
For its community consultations, cohealth avoided stakeholder style meetings and instead went out across the community, to people’s homes, family gatherings, community dinners and events, in libraries and shopping malls, to ask wide-ranging questions.
The responses they gathered are shaping the literal foundations of the service, from locations, fittings and furniture through to its whole approach to mental health and wellbeing.
People said they wanted a service that could reach across the council area, that didn’t duplicate but connected up existing services, that provided a hub and a network, was not limited to one location and had options for those reliant on cars and public transport. It had to be safe, for staff and consumers.
The consultations confirmed the need for better navigation of health services, proactive outreach, and different approaches and language around mental health and wellbeing for different cultural and faith groups.
They heard from groups who are not getting the support they need, including due to shame and stigma. Some talked about needing support with housing and work and managing stress in their lives and surroundings, on the need for lived experience support, for safe spaces and connection.
Dick admits it was an “incredibly challenging” to get to the stage of opening the doors at the first site in Sunshine in March, to stay the course on codesign with peer workers and community consultation.
But the process has delivered major benefits for those involved so far, and delivered a “beautiful space that people love, that is functional and fit for purpose and safe, but still is human and homely and provides the things that people wanted”, she said.
Now those consultations are driving the selection and scope of a second site, and a new way of operating in mental health, that is all about “supporting the transfer of power from mental health professionals and experts to consumers and their families and the community”, Dick says.
It’s a power shift that requires her to constantly check her own bias, she says, laughing that peer workers on the team will let her know that she’s “thinking like a clinician again”.
Lived experience career pathway
Strongly welcoming the shift, David Pedlar, cohealth’s Lived Experience Practice Excellence Coach, says the Royal Commission has made it very clear now that lived experience is “really a key part of the recovery journey for people, and also a key part for prevention and early intervention”.
Pedlar has no doubt that peer support was the most significant factor in his own mental health recovery.
“Even though everyone’s story is unique, not being judged or stigmatised, having people who could understand what I was going through, providing empathy and support…I felt I was part of a community again,” he said.
“I needed that safety net before I felt about to connect with a bigger world.”
He too is excited and confident that the Brimbank service will be “fundamentally different to what’s happened in the past”, with lived experience “present at every stage of this service, from the frontline worker right up to governance”.
Most importantly, he says, it will have “a real iterated career pathway for the Lived Experience workforce”. That’s a big step forward, he says, reflecting on his own “quite frustrating” journey as a peer worker, where there were “no promotional opportunities, no senior roles”.
“I am now in a leadership/management role which is commensurate with my skills, experience and qualifications,” he said.
Before speaking to Croakey, Pedlar had spent the day at local libraries in Brimbank, looking at what local facilities, services and networks can do to make sure that people don’t exit mental health supports into a vacuum.
“That’s why the community factor is so integral to the (Brimbank) model. There is plenty of research that people are able to maintain and sustain recovery if they’re connected, if they’re part of community, so that’s a key part of the journey (for the new centre), bringing the community along with us,” he said.
“We could have the best mental health service in the world but if it’s not the right one for this community, it’s not going to work.”
Community report card
Determining how well the service is working will be the next phases in the Brimbank Local’s development.
Maria Budimir, the Local’s Transformation and Impact Lead, says that in the short-term cohealth will “collect feedback on how well we are doing” through client surveys that measure how easy it was for clients to get the required help and whether it met their needs.
“Our longer-term vision is to build outcomes and evaluation questions with our community for our community, and report to community,” she said.
As well as reporting to the State Government, the Local will report to the Brimbank Local Mental Health Client and Carer Committee and its Community Advisory Committee. It also plans to publish a quarterly ‘community report card’ for the Brimbank community, focused on care and outcomes delivered and key metrics that consultations show are most important to the local community.
She adds that the long-term evaluation of the Mental Health and Wellbeing Locals that are being rolled out across Victoria will need to be collaboratively agreed.
“It is likely that key outcomes will include both positive measures (such as increased subjective wellbeing) as well as indirect impacts, such as reducing rates of unplanned hospital admissions for mental health related conditions and reduced rates of avoidable harm due to mental health (including self-harm and suicide),” she said.
This article is published in collaboration with cohealth as part of their Health Equity Champion membership of the Croakey Health Media funding consortium. cohealth had input into the selection of the topic of the article; Croakey maintained editorial control over the research, writing and publication of the article.
See Croakey’s archive of articles on mental health matters