Marie McInerney writes:
The importance of tackling the upstream determinants of mental health and wellbeing, and of promoting recovery and choices for people with mental health needs are among key priorities to have emerged from a recent conference in Victoria.
The VICSERV Towards Recovery conference also highlighted some major challenges for the system at a time of huge change.
In particular, there were calls for the impending roll-out of the National Disability Insurance Scheme (NDIS) to incorporate feedback from trials, and to address the needs of particular groups, especially Aboriginal and Torres Strait Islander people.
Our final Croakey Conference News Service report on the conference includes reflections from some participants about the critical issues facing the sector and health reform more broadly.
It comes as the Australian Health Care Reform Alliance (AHCRA) calls for an election focus on mental health, warning that “Australia’s approach to mental health has become fractured and piecemeal with unacceptable risks for people with a mental illness and their families”, and that the experience of mental health care now “varies wildly” depending on where you live.
An AHCRA statement says: “Huge problems remain in access to care, particularly for some key groups such as those under 25 years, the elderly, Aboriginal and Torres Strait Islander people and multicultural communities.”
Politicians should be asked the questions below, suggests AHCRA.
The AHCRA statement underscores concerns raised in our conference coverage about some storm clouds over mental health, particularly around the implications of the NDIS, and what it means for people with mental health issues.
The two international keynote speakers Dr Simon Duffy and Professor Mark Salzer put big ideas upfront – about where the welfare state has gone wrong, on citizenship, choice and control, and the barriers to community inclusion and participation – challenging the sector itself about its motivations and responses.
[divide style=”dots” width=”medium”]
Key reflections
As our Q and A below reveals, there was clearly an appetite for such big thinking.
Q1. What is your main takeaway/reflection from the conference?
Dr Lisa Brophy, Senior Research Fellow, The Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne and Director of Research, Mind Australia
I think the importance of addressing the social determinants associated with peoples’ experience of psychosocial disability were raised in so many different ways at the conference. It was so refreshing to talk about stigma, participation, loneliness, poverty, friends and love and focusing on supporting people to gain a good life – and the possibilities that personalisation and self-directed care might offer to address these issues.
Noeleen Tunny, VACCHO Senior Policy Officer
That there remains a worrying lack of clarity still about how the NDIS will cater for Aboriginal people with psychosocial disability whose needs are not being met currently by the disability service system. My worry is: if you’re putting all your efforts into transitioning existing service provision which is failing to connect with Aboriginal people, you’re going to just re-create the under-utilisation in a new environment. My biggest fear is Aboriginal people will again become a footnote: “NDIS worked well for the majority of people*” (*except Aboriginal people).
Mary Sayers, Deputy CEO, Victorian Council of Social Services (VCOSS)
The future social services will be completely different from the past, with a focus on facilitating community inclusion, enabling deep choice and control for service users and “deinstitutionalising” the service offering.
Bron Parks, mental health clinician
From the conference the biggest point I noticed was how important peer workers are to the industry and to how they connect workers and consumers in a hospital setting for the process to not be so clinical, scary, and informal.
Alan Murnane, General Manager, Primary and Mental Health, Inner South Community Health
The conference left me needing to rethink our models of service delivery within mental health. How effectively do we (the whole community, not services) use allocated resources to the best interest of people with mental illness? How well do we understand what will be the best use of allocated resources?
Russ Wood, Head Honcho, Bedrock Social Co
That it is OK to seriously question what it is we have built up over the last few decades in terms of the welfare state.
That a true and driven focus on the individual, their needs and aspirations is both morally right but also the best way we can currently see of empowering them to live their lives to its fullest.
Kim Koop, CEO VICSERV
My main takeaway: that the NDIS is only a small part of the mental health conversation we need to have in Victoria. The role of the state government in ensuring contemporary mental health services including rehabilitation needs to be our main focus.
Q2. What were the standout presentations and why?
Dr Lisa Brophy, The Centre for Mental Health, University of Melbourne
Both Simon Duffy and Mark Salzer were great and complementary keynote speakers. Simon’s story about the babies being thrown into the river was so memorable just because it makes so much sense – we need to find out why and how to stop the babies being thrown into the river as well as rescuing them! But so often all our efforts are too downstream. I also liked Mark’s urgent challenge about addressing poverty, transportation, rights, access to services and stigma and discrimination.
Noeleen Tunny, VACCHO Senior Policy Officer
A fantastic and inspiring case study presented about the Wadamba Wilam program about the way assertive outreach can be life changing. It too worried me though about whether the kind of wrap around care provided collaboratively by the services involved in the program will be supported by the NDIS when block funding makes way effectively for fee-for-service.
Mary Sayers, Deputy CEO, Victorian Council of Social Services (VCOSS)
cohealth and ERMHA’S presentations on preparing for the NDIS. Both presentations highlighted the opportunities of new ways of thinking about the opportunity of the NDIS in promoting greater control for people with disability and mental health needs.
I loved the analogy ERMHA made of ensuring you have right both the “poetry – staying mission driven” and the “plumbing – having the right business practices and organisational training and support”.
Bron Parks, mental health clinician
The stand out presentations were both by ACSO (Australian Community Support Organisation) – one on dual diagnosis and the other on group work: PUMP (Participate Understand Motivate Persevere). They both showed innovation in arguably one of the most important areas in mental health: the presence of dual diagnosis as an expectation, not an exception, with 75-80 per cent of consumers having symptoms of mental health concerns and concerning substance use. Not only was this problem area identified, effective and empirically based solutions were suggested.
Alan Murnane, General Manager, Primary and Mental Health, Inner South Community Health
Simon Duffy’s keynote on ‘Being a True Equal…Citizenship’ was my standout presentation. Simon is a philosopher and delivered his presentation from that perspective, challenging traditional notions of mental health service delivery. Simon quoted research showing that income redistribution (UK or USA) is only about 2 per cent of Gross Domestic Product (GDP).
Instead of using the tax and income support systems to ensure everybody has adequate income, funds are put into services. ‘We spend most of the money on stuff that is not very good or does not change the situation.’ He also presented research showing the distribution of services to women. It showed that the women with the greatest needs received the least services.
Russ Wood, Head Honcho, Bedrock Social Co
Simon Duffy keynote: First time I have heard in Australia that our ‘welfare’ system is perversely feeding ill-health and disadvantage and that if the ‘welfare state’ isn’t supporting the most in need and the most complex, what good is it!
Stories of Recovery (Eating Disorders Victoria) and Sane Australia (who with University of New England looked at how to safely present the experiences of people who have attempted suicide via different media to help reduce stigma). At the other end of the scale from the high-level, philosophical debate about purpose, funding and policy investment were two presentations that reminded me of the power of the individuals’ stories. While we can all get caught up in programs, recommissioning, reform, elections etc, it all comes to nought unless we are best able to support the people we work with. Both presentations were very powerful reminders of this.
Paul Ramcharan: Paul’s presentation (about the It’s My Choice program) followed Simon’s and he really brought together theory and research in terms of the role that promoting and supporting ‘risk-taking’ plays in recovery. An excellent presentation.
Kim Koop, CEO VICSERV
Simon Duffy and the session following that with Prof Paul Ramcharam – together they explored the importance of giving CONTROL to individuals and unpacked the things that get in the way of choice. This shows the complexity of the environment we are in and the exciting opportunities and also risks we are working with.
Q3. Any standout quotes, evidence, or tweets?
Dr Lisa Brophy, Centre for Mental Health, University of Melbourne and Director of Research, Mind Australia
“We must move from a ‘professional gift’ model towards a ‘citizenship model’” – Simon Duffy
Noeleen Tunny, VACCHO Senior Policy Officer
Simon Duffy in his plenary speech about the need to place control, not just some choices, in the hands of the person with the need. That really resonates for me as a worker in an Aboriginal community controlled health service where at the moment we are engaged very explicitly in discussions around self-determination and what it means.
Mary Sayers, Deputy CEO, Victorian Council of Social Services (VCOSS)|
“Seeing the person and not the diagnosis is the key to community inclusion” – Mark Salzer
Bron Parks, mental health clinician
I remember my tweets more than anything as I aimed to quote information that I thought was important and stood out. The two would be:
Schizophrenia recovery has better outcomes in developing countries due to social inclusion – Simon Duffy
Wellbeing is a presence of a positive, not absence of a negative – Dr Lindsay Oades
They both focus more on positives and recovery in a strength based and community model.
Russ Wood, Head Honcho, Bedrock Social Co
The ‘dignity of risk’ – Paul Ramcharan.
“Morally, what’s at stake here is freedom” – Simon Duffy
“Too often we do the right thing, but not the effective thing” – Simon Duffy
Kim Koop, CEO VICSERV
Favourite moment: when Victoria’s Public Advocate Colleen Pearce asked everyone connected to VICSERV in the auditorium to stand up. How great to see our work in such a tangible way.
The Office of Public Advocate award will give the VICSERV team lots of courage to step up and speak out in the year ahead.
Q4. What are the urgent priorities to be addressed on mental health in the federal election campaign?
Dr Lisa Brophy, Centre for Mental Health, University of Melbourne
The Federal Government has an important opportunity to respond to the feedback about the NDIS from the trial sites – it is such a fantastic development for Australia with so many good intentions but the architecture of the scheme needs to be addressed to ensure it fulfils its promise.
People with psychosocial disability need access to evidence based support and interventions – including developing their opportunities for informal support – that are going to enable economic participation and social inclusion. So many people just don’t get a chance and remain stuck in cycle of unsatisfactory treatments and marginalisation.
Noeleen Tunny, VACCHO Senior Policy Officer
A willingness to commit to long-term flexible funding that allows community controlled organisations to address the needs of communities in the way they know will work. No more strategies without funding, no more 10-year plans with 12 months of funding, and the flexibility to focus on outcomes rather than activity.
Mary Sayers, Deputy CEO, Victorian Council of Social Services (VCOSS)
Ensuring there are no gaps for mental health funding and that we do not lose service for people in the transition to the NDIS – especially for those with episodic disability.
Bron Parks, mental health clinician
100 per cent it needs to be early on intervention and prevention, which includes suicide prevention. As Simon Duffy said, it’s time to stop the ‘babies’ being thrown in the river, rather than to keep on fishing them out.
Russ Wood, Head Honcho, Bedrock Social Co
Focusing on those in the community with the most complex needs by re-setting policy incentives to encourage, not discourage, integration and client-focused services.
Making sure that all government programs have an evaluation element built-in.
Building the focus on peer support programs across mental health (and other areas).
Kim Koop, CEO VICSERV
Federal election urgent issues – the trend towards reducing mental health investment. Mental health needs to come back on the table as an important issue for the health of our whole community.
Q5. What change/challenge will most occupy your work in mental health this year?
Dr Lisa Brophy, Centre for Mental Health, University of Melbourne
I will be doing lots of evaluation of innovative services types – like Recovery Colleges and Prevention and Recovery Services. I will also be continuing to work in partnership with consumers and their supporters regarding how we can reduce coercive interventions and promote people’s human rights, particularly through supported decision-making. I will be focusing on hearing from people about what makes a difference for them, what they need, what they think works for them, where the gaps are and thinking about how to fill those gaps.
Noeleen Tunny, VACCHO Senior Policy Officer
My focus is on the NDIS, so my urgent priority is to make sure it does not re-create the old disability service sector environment, which clearly has not served the needs of Aboriginal people.
Mary Sayers, Deputy CEO, Victorian Council of Social Services (VCOSS)
Continuing to work towards building sector capability to respond to the changes and capitalise on the opportunities of consumer directed care in partnership with Ageing, Disability and Mental Health Collaborative Panel.
Bron Parks, mental health clinician
The Q&A part of Simon Duffy’s opening presentation created a lot of doubt on NDIS, which should be a fantastic person-centred model. This year will be focussing on understanding the NDIS roll out, the impact it’s going to have on mental health programs in the community, and making sure no one is ‘lost in the gaps’.
Alan Murnane, General Manager, Primary and Mental Health, Inner South Community Health
Access to quality psychosocial rehabilitation in the community sector with the implementation of the NDIS will be a major challenge in Victoria. All current Victorian Mental Health Community Support Service funding is rolling into NDIS, and the NDIS clearly excludes rehabilitation. We will remain very focused on this issue as the rollout develops in Victoria.
Russ Wood, Head Honcho, Bedrock Social Co
Supporting innovative organisations to find, and then sustain, service models that allow us to provide integrated, ‘wrap-around’ support for the most vulnerable – cohorts like the chronic homeless and those with a dual diagnosis. There are many agencies trying to work around the current support system to get things done for clients – which seems entirely perverse.
Kim Koop, CEO VICSERV
The impact of the transition of community managed mental health services in Victoria to the NDIs and the looming gaps between disability support and the treatment services: Who will be responsible for rehabilitation? The Bilateral agreement says “States”: Will the Victorian Government step up the challenge and fund services that build citizenship and social inclusion?
[divide style=”dots” width=”medium”]
Kudos and tips for future conferences
Conference organiser VICSERV, the peak body of Victoria’s community-managed mental health services, was presented with Victoria’s Public Advocate’s Award 2016 for its long-standing work with services, their consumers, families and carers.
“In particular, it has showed courage over the last few years in advocating for Victorians with mental illness to access supports under the National Disability Insurance Scheme, and continuing supports for those who may not be eligible,” Public Advocate Colleen Pearce said.
Missing voices
The closing session also heard some criticism of the conference. One delegate said some of the presentations around peer work had been “troubling” because they were not discussed by the peers undertaking the work. “I think you need to be more mindful of that when looking at abstracts,” he said.
He was also disappointed there had not been a keynote speech from a mental health consumer, such as US psychologist and researcher Patricia Deegan who had addressed one in the past. “That was wonderful to hear,” he said.
He added: “Otherwise, it was a great conference.”
Another delegate felt that issues relating to people with mental illness who were caught up in the forensic system, and those who hear voices that are distressing, were missing from the conference this year.
[divide style=”dots” width=”medium”]
How do we move to recovery? Messages from posters
[divide style=”dots” width=”medium”]
Tweets and Selfies
[divide style=”dots” width=”medium”]
Twitter Analytics
There were more than 8 million Twitter impressions for #TowardsRecovery from 17 – 30 May, and 478 participants. Read the Twitter transcript here.
Warm thanks from Croakey to all who participated in sharing the news on Twitter, and a special shout out to Aram Hosie for covering the conference for @WePublicHealth.
[divide style=”dots” width=”medium”]
• Marie McInerney covered the #TowardsRecovery conference for the Croakey Conference News Service. Disclaimer: Marie McInerney works as a sub-editor for VICSERV’s newparadigm magazine.
• This is our final report from the conference – see previous coverage at this link.
