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Walking the talk on mental health: an exercise in #NavigatingHealth

When a sizeable crowd gathered to walk and talk about mental health in Melbourne, participants shared a real life exercise in the importance of social connections for health and wellbeing.

The report below on the recent #NavigatingHealth #CroakeyGO event, sponsored by the North Western Melbourne Primary Health Network, provides an overview of the formal and informal discussions, as well as a compilation of the tweets, snaps and selfies. (NB: We are updating this post with additional photos, tweets and links).


Marie McInerney writes:

The Victorian Aboriginal Health Service (VAHS) provided a powerful starting point for the #NavigatingHealth #CroakeyGO, a walking journalism event that traced some of the journeys people make through mental health services. It was held on Wurundjeri land in Narm/Melbourne on August 1.

Like other key services along the inner city walking route walking route, VAHS was set up to address a specific community’s lack of access to safe mainstream health services, which too often cause them trauma and harm.

The social and cultural approach to health that is promoted by VAHS was another powerful message for an event that highlighted at every stop the need for holistic, connected, community-based mental health responses that address poverty, discrimination and the “epidemic of loneliness”, just as much as they do clinical issues.

#NavigatingHealth was the 11th CroakeyGO event (since our first one in Sydney in mid-2017) and our biggest to date, taking nearly 100 participants behind the doors of services provided in hospital, general practice and community settings in inner city Fitzroy and Carlton.

The event was sponsored by North Western Melbourne Primary Health Network, and will be used to inform its Regional Plan for Mental Health for the 1.7 million people in its catchment.

#NavigatingHealth walked the streets (and through the beautiful Carlton Gardens) for three hours, sharing insights, interviews and discussions among participants, with selected services, and across social media, with the hashtags trending nationally on Twitter.

Following the #CroakeyGO tradition, quick vox pops with many of the #NavigatingHealth participants at the start of the event revealed a range of interests and concerns that had brought them there, including autism, gambling, LGBTIQ health, the portrayal of mental health in the media, and inequitable access to healthcare.

Among the participants were many NWMPHN staffers wanting to look at the mental health care available at different entry points in the system and to learn how to improve access, experiences and outcomes.

As one staffer said, the motivation was: “to have challenging and thought provoking conversations with people I don’t sit next to at work”.

And we had some special guests – including two beautiful Labradors, Zella and Harpo, former seeing eye dog “trainees”, who highlighted the therapeutic relationships many of us enjoy with our pets, as well as Violet, aged six months, who is the newest addition to both the Amy Coopes clan and Croakey team.

Below is an overview of the day and associated Twitter action. We will report in a forthcoming story on one of our site visits, St Vincent’s Hospital’s Safe Haven Café, which is improving health and wellbeing and reducing Emergency Department presentations.

Introductions

#NavigatingHealth began with a Welcome to Country on behalf of the Wurundjeri people of the Kulin nation from Elder Uncle Colin Hunter whose grandmother was born at Coranderrk, home to one of the many remarkable stories of self-determination and protest in Australia.

The development of Aboriginal controlled health services is of course another of these stories, and former VAHS CEO and chair Alan Brown, who is still involved with the organisation after more than three decades, talked about the origins of VAHS in the 1970s in inner city Melbourne.

“A group of Aboriginal people decided that, even though they were two kilometres from St Vincent’s Hospital, the mainstream services might as well have been on the moon in terms of access and equity for Aboriginal people,” he said.

“People were literally dying rather than going to seek help.”

Now the big message to community is: “Don’t come here only when you’re sick”, said Lionel Austin, Manager of the VAHS Preventative Health Unit.

He outlined the holistic approach that has made Aboriginal community controlled health organisations a model for many mainstream services with their focus on physical, mental, social, emotional, spiritual and family wellbeing.

That includes financial health, Austin said, with clients helped to manage fines, Centrelink issues, and risks of having essential services cut off.

“We don’t believe in Closing the Gap here in VAHS, we’re about increasing the quality of the person’s life and the family’s life,” he said.

Social determinants highlighted

The impact of poverty, disadvantage, racism, stigma and isolation on mental and physical health were big themes right along the #NavigatingHealth route.

Yet as we walked, Prime Minister Scott Morrison, who has championed massive tax cuts for the most wealthy in our midst, emphatically ruled out lifting the $40-a-day rate of Newstart.

Ryan Sheales from the Victorian Council  of Social Service (VCOSS) told us that increasing Newstart is the “low-hanging fruit” of reform. The paltry payment is not a springboard to work but a “poverty trap”, he said, that can only work against the Federal Government’s declared commitments on mental health and suicide prevention.

“When we discuss mental health, we need to also discuss poverty and disadvantage and vice versa. We can’t look at either of them in isolation,” Sheales said.

Neither can we look past stigma. We heard a call for greater understanding, including in the media, of people affected by Autism Spectrum Disorder (ASD) – just as News Limited columnist Andrew Bolt came under fire for cruelly mocking teen climate change campaigner Greta Thunberg, who has Asperger’s.

And as media reported allegations that Crown Casino’s efforts to attract Chinese high rollers to its Melbourne gaming rooms had seen it partner with people linked to organised crime, we heard at various points about the impact of gambling on mental health for many different groups in the community and the reluctance of governments to act on even minor reforms for “low rollers” who are targeted at so many levels by venues.

Victorian Independent Upper House MP Fiona Patten, who participated actively throughout the walk, said: “We know particularly for a socially isolated woman in her 50s or 60s, a pokies venue is a ‘safe place’, it doesn’t have the stigma of loneliness [to say], ‘I’m going to the club, where everyone knows my name’.”

Deep in conversation: Fiona Patten (R) with NWMPHN’s Mary Anne Toy and Christopher Carter

A long history of caring

Drummond street services was another #NavigatingHealth stop whose origins continue to inform the values and operation of the organisation today.

The service was set up in response to public outcry in 1887 at the death of a destitute itinerant worker in the back of a horse drawn cab because the city hospital was too full to take him, according to CEO Karen Field.

“It sets you up thinking about how you think about people walking in the door and also the people that don’t walk in the door and aren’t getting the services,” Field said.

As a result, drummond street has a history of working with people who don’t or can’t engage with mainstream services, particularly the LGBTIQ community, survivors of institutional child sexual abuse, and asylum seekers who can’t access Medicare.

Field hailed the PHN “bucket of funding” approach, which allows it to go beyond siloed allocations – specific funds for mental health, drug and alcohol or other ‘diagnoses’ – to factor in a spectrum of needs, including extreme economic disadvantage.

“[It] allows us to talk to [the PHN] about what we’re noticing, what our service data shows us about who is not walking through the door, who we’re not getting to early enough, who don’t find mainstream services sensitive to their needs,” she said.Our final stop was Carlton Family Medical, one of 500 general practices in the NWMPHN region, where a frustrated GP, Associate Professor Ralph Audehm, urged a “no wrong door” approach for mental health.

Audehm detailed the experiences of some of his patients: asylum seekers with no access to Medicare funded services, a new mother with post-natal issues and a history of mental illness who endured three months of “to-ing and fro-ing” between specialists over who would take on her care, and international students floundering with the pressure of study, no family support, and little access to culturally informed care.

Pointing to an absence of mental health leadership in Australia, he recalled being on the cover of Australian Doctor magazine 20 years ago, talking about failures in mental health care.

“And here I am now, and nothing has changed.”

Timely context

#NavigatingHealth was a timely event, particularly for Melbourne where most health and social organisations have been lodging submissions to the Royal Commission into Victoria’s Mental Health System, which just wrapped up four weeks of powerful public hearings.

Nationally the Productivity Commission is also conducting an inquiry into mental health, and it is expected that the Royal Commission into Aged Care will also closely examine mental health issues and treatment for older people across Australia.

As well, many health groups are planning to make submissions to the Senate inquiry, Adequacy of Newstart and related payments and alternative mechanisms to determine the level of income support payments in Australia.

Ahead of the event, Croakey asked: can the deceptively simple act of walking together create space for new types of conversations and connections, for disrupting world views and understanding?

From our perspective, #NavigatingHealth showed that walking journalism can democratise the process of investigating and communicating health information. It was an act of journalism, but the journalists weren’t the only ones asking the questions.

Navigating the mental health system is not of course the neatly mapped route we took along the streets of Melbourne.

As observed by MP Fiona Patten, “all too often it’s a maze”, not a pathway. And we were powerfully reminded by prominent consumers on Twitter ahead of the event that harm and trauma continues for people in many parts of the system behind closed doors.

But the event was also, as Croakey managing editor Dr Melissa Sweet observed in a final interview with NWMPHN CEO Adjunct Associate Professor Christopher Carter, a “brave act” for a PHN and the services that opened their doors to us in such a public and unscripted way.

It revealed the determined efforts by passionate and dedicated professionals, including peer workers, to make change – as well as the significant roadblocks in their way, including people’s own biases and professional silos, in addition to inflexible governmental and bureaucratic funding streams and processes.

• Croakey’s #NavigatingHealth team included Marie McInerney, Paula O’Connell, Melissa Sweet, Rebecca Thorpe and Mitchell Ward. Amy Coopes also participated, together with six-month-old Violet. We acknowledge and thank the NWMPHN team for outstanding support and engagement with the event, and all of the participants (IRL and online) and services that contributed.

Bookmark this link to follow our ongoing coverage: still to come are a story about the Safe Haven Cafe and a compilation of the video interviews


From Twitter

Sue Hedges, VAHS site manager


Take home messages

From Adjunct Assoc Prof Christopher Carter (guest tweeting at @WePublicHealth)

Snaps and selfies

Great to have our colleagues from The Conversation participating

Watch this interview with Dr Tess Ryan talking about her art.

Wider participation

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