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Victoria’s Mental Health Royal Commission promises to transform “failed system”

The Royal Commission into Victoria’s Mental Health System delivered its final report on Tuesday, describing “catastrophic failings” in the system including over-reliance on medication, compulsory treatment and acute care, and where too many people are  turned away from supports and services, “often in their darkest hour”.

Urging transformation of the system — a new road versus filling in the potholes — the Royal Commission delivered 65 recommendations in a massive 3,000 page, five-volume report that reportedly weighed 13 kilograms as a hard copy.

You can access it all here, including a summary document, recommendations, videos, fact sheets, and a briefing event. Here’s a summary video.

While many in the sector (and at Croakey) were still working their way through its pages late in the day, the report has won early support from many stakeholder groups for strongly embedding the voice of people with lived experience in design and delivery of services and reorienting the system towards community-based treatment and away from hospitals and acute care.

Some of its key reforms include establishing a new Mental Health Act, a new Chief Officer for Mental Health and Wellbeing in the Department of Health, and a new agency and services led by people with lived experience to support the development of organisations and services led by and for consumers.

Other recommendations include two on-Country healing centres for Aboriginal people, the rollout of up to 60 new local mental health and wellbeing services in community, new family and carer-led centres across the state, and an independent Mental Health and Wellbeing Commission to hold the Victorian Government to account.


Shocked by evidence

Delayed by the pandemic last year and again by the latest COVID-19 lockdown in Victoria last month, the Royal Commission report was finally tabled at a joint sitting of the Victorian Parliament, meeting at Melbourne’s Royal Exhibition Building to ensure all MPs, witnesses and participants could attend, adhering to COVID-safe rules.

Royal Commission Chair Penny Armytage told the joint sitting she had been personally shocked by what she had seen and heard during the course of the Royal Commission, which was launched in 2019 by Premier Daniel Andrews, who declared the system “broken”.

“The system wasn’t compromised in part, its foundations were broken,” Armytage said, declaring the Royal Commission has sought through its recommendations to establish a new system built on compassion and where, “for those in crisis, police and ambulance call-outs and emergency departments will no longer be the only options.”

She said:

For too long, the profound human societal and economic toll of a failed system has been ignored. We know that a collection of discrete reforms to an antiquated system is not viable. We have recommended a fundamental redesign.”

We have moved beyond filling in the potholes, we have created an entirely new road.”

Here are some key takeaways from the report and event.

1. Catastrophic failings steeped in stigma and discrimination

Armytage declared Victoria’s mental health system had “catastrophically failed to live up to expectations and is woefully unprepared for current and future challenges”.

The 2019-20 severe bushfire season and COVID-19 pandemic had “shone further light on the pressures on the system”, which had been failing people for decades, she said, quoting the lived experience of mental health advocate Honor Eastly:

“It wasn’t until I started working in advocacy that I started to understand that a big part of what I was struggling with was a broken and traumatic system. I had up until that point thought that what was happening was because I was a broken and ill person.”

Armytage described an utterly under-resourced system, where the average mental health service hours are estimated to be just two hours per person per year, meaning typically that the system “offers too little too late” and last year responded to less than one-third of estimated demand for community-based services.

“Again and again we heard from people and their families, at times in harrowing detail, about the negative impact of being told that they were not sick enough or not suicidal enough to access services and the sometimes tragic consequences of this,” she said, describing also “appalling” abandonment of carers, especially young family members.

Importantly, Armytage said the failings of our community to demand a mental health system as strong as the rest of our health systems “is much about the stigma and discrimination against people living with mental illness”, which explained why “complacency and meagre expectations have stifled reform and why the mental health system has been relegated to the shadows”.

2. Big commitment to reform….so far

Unlike the Federal Government’s approach so far to the Royal Commission into Aged Care, holding off from any announcements on what recommendations it will support, the Victorian Government promised from the outset, and reaffirmed on Tuesday, that it would implement every recommendation from Victoria’s Mental Health Royal Commission.

“No matter how long you’re in government, you only get a handful of days to do something that is truly profound, something that will change lives and save lives,” said Premier Daniel Andrews. But he warned that change won’t be “easy and quick” and said the final report would serve “as our blueprint for the biggest social reform in a generation”.

While the proof will be in the pudding — people working in the family violence sector have complained that implementation of some of Victoria’s Family Violence Royal Commission recommendations were ‘tick a box’ exercises, Premier Andrews said Victorians had declared they would “pay the price of failure [in mental health] no longer”.

Andrews said the Royal Commission report had been “shaped profoundly” by those who know our mental health system best – “the people who have turned to it, the people who have worked in it, the people who have been failed by it”.

Their courage and commitment had “laid the foundation for this once-in-a-generation reform,” he said, promising significant announcements in the May Budget on implementation.

3. Shocking breaches of human rights

Chair Armytage said under-resourcing of Victoria’s mental health system has led to an over-reliance on medication and too little offered by way of therapeutic and recovery-oriented services, meaning that many people who access services are not treated with dignity and respect and had their distress and trauma “compounded” by the system.

Echoing the shocking findings of the Aged Care and Disability Royal Commissions, she said “sadly, inpatient units too often feel frightening and unsafe”, with an “entrenched and unacceptable” prevalence of interpersonal and sexual violence particularly towards women.

Mental health consumers also had their human rights breached through the use of compulsory treatment, seclusion and restraint, and not as last resort, she said, again quoting a person with lived experience.

I reflect on three compulsory admissions with sadness. I wonder how my mental health trajectory would have been different if the GP I had seen in the lead-up to my first admission had organised an urgent psychiatric referral and I’d been supported to sleep . . . If the crisis assessment and treatment team had come the first time I called them and helped prevent my second admission . . . If the private hospital had treated me adequately rather than discharging me and prevented my third episode.”

4. Workforce in “moral injury/distress”

Armytage, leading mental health expert Professor Patrick McGorry, who headed the Royal Commission’s expert advisory committee, and Premier Andrews each highlighted the pressures on the mental health care workforce, who face “moral distress” — a desire and knowledge to do the right thing but in a system of constraints that “makes it impossible to do so”.

5. Social determinants on the agenda

Unlike the recent Productivity Commission inquiry into mental health, the Victorian Royal Commission reforms look beyond the mental health system, “recognising that other social services such as housing and education, the justice system and the places we live, work, learn and connect in, shape our mental health and wellbeing”.

The Royal Commission says stable housing is a key pillar to overcoming inequities and that  it has ensured that people living with mental illness “will be recognised as a priority population for housing”.

It also understood that while poor mental health “does not discriminate”, some people, including from Aboriginal, LGBTQ+, refugee, CALD and disability communities experience additional barriers.

In recommending a holistic approach, Armytage said the Royal Commission had drawn on the knowledge long held by Aboriginal people and other diverse communities that “connection to land, culture, spirituality, family and community all influence mental health and wellbeing”.

In specific and wide-ranging recommendations  (p131) for Aboriginal people, the Royal Commission has called for the delivery of two on-Country healing centres, which were among recommendations made by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) in its Balit Durn Durn report, developed to support the Final Report.

“For too long Aboriginal people have fallen through the cracks of a fragmented and culturally unsafe mental health system,” VACCHO CEO Jill Gallagher said. “These two new centres will support resilience, healing, and trauma recovery through fostering connections to Country, kinship, and culture.”


Responses from key stakeholder groups

Below are responses from key stakeholder groups. We will add more as they are published.

See also this Twitter thread from mental health survivor researcher Indigo Daya.


VACCHO: welcomes healing centres, child supports

As well as the two on-Country healing centres (see above), the Victorian Community Controlled Health Organisation (VACCHO) welcomed recommendations from the Final Report for further investments for VACCHO to lead and establish appropriate family-oriented services for infants and children who require intensive social and emotional supports.

CEO Jill Gallagher sa