Mental Health Community Coalition ACT Inc.

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1 Mental Health Community Coalition ACT Inc. e-bulletin March 2014 MHCC ACT is the peak body representing the not-for-profit Community Mental Health sector in the Australian Capital Territory. This e-bulletin is compiled on a monthly basis for members to promote local sector news and events. Contributions in plain text format are welcome. Please [email protected]. You can contact us on or visit our web site

2 1. From Ian Rentsch, Executive Officer NDIS Preparedness NDIS continues to dominate our consciousness. Last week s Australian newspaper headlines read, NDIS body struggling to cope. Anecdotal reports from the trial sites would indicate that this is largely true. The National Disability Insurance Agency (NDIA) has been laboring under very tight timeframes and lack of uniformity in operational policy. We recognise the latter issue may be part of a deliberate decision to trial processes before evaluating and deciding on best practice, but it does cause confusion for those applying for packages and staff serving them. Mental Health Council of Australia launches a framework for providing psychosocial disability support through NDIS The proposal, Providing Psychosocial Disability Support Through NDIS, is aimed at ensuring that people with psychosocial disabilities are not disadvantaged vis-à-vis the broader population of people with disabilities, particularly in the transition phase. In short, the proposal seeks to quarantine the spending on psychosocial disability within the NDIS and ensure some continuity in programs like PHaMS and others that deliver services to people who may not qualify for a full NDIS support package, while some more work is done to get the scheme s design right. It is important to realise that the NDIA itself invited MHCA to submit a proposal as to how some of these issues might be overcome. MHCA also has had the opportunity to put these proposals directly to Minister Mitch Fifield who has responsibility for the NDIS within government. MHCA is now inviting responses to the proposal from its members. Please see the attached document for further information. You can send your feedback directly to MHCA but we at MHCC ACT would also like to collate feedback so that we can give it through the coming MHCA Members Forum and CONGO to be held 9 & 10 April here in Canberra.

3 ACT Community Sector Reform ACT Sector Reform, including the Human Services Blueprint proposal, is gearing up to deliver five modules in the coming year for community sector leaders. These include Sustainability and Risk, Governance and Financial Management (delivery commenced in 2013 and a further tranche will be provided in association with the NDIS readiness [see below]), Collaboration and Strategic Alliances, Working with Government, and Tendering and Procurement. I encourage MHCC ACT member organisations to take advantage of the learning opportunities that these modules offer. The information provided immediately below comes from the NDIS Taskforce. If member organisations have not yet taken advantage of the Governance and Financial Reform Packages Monday 31 March is your chance to learn more about them. NDIS Governance and Financial Reform Packages When: 4-5pm. Monday 31 March 2014 Where: Ballarn Rooms, Ground Floor, Nature Conservation House, 153 Emu Bank, Belconnen RSVP: 24 March 2014 via [email protected] Who is this forum for? This forum is for executive officers and members of the board of management of ACT community providers of disability (including psycho-social disability) services which are currently funded by the ACT Government for that purpose. What is available? From the NDIS Sector Development Fund negotiated with the Commonwealth, the ACT Government is making available a range of assistance to local providers in anticipation of the phased introduction of the National Disability Insurance Scheme (NDIS) from July. This investment includes access for 60 providers to the National Disability Services NDIS Self Assessment Toolkit, workshop and support ( Further assistance will be announced shortly. NDIS Governance and Financial Management Reform Packages - $20,000 Packages are capped at $20,000 per provider. They can include tailored assessment and advice on the organisation s financial management, governance arrangements and business planning in the NDIS context, from a consultant with extensive relevant expertise and understanding of the ACT community sector. These packages are an extension of the Governance and Financial Management Initiative delivered to the ACT sector in as a part of the Community Sector Reform Program. Organisations which have accessed those packages previously will not be eligible to apply. Who provides the advice? The panel of consultants comprises Deloitte Touche Tohmatsu, Third Horizon Consulting Partners and RSM Bird Cameron Accreditation Workbook for Mental Health Services The Australian Commission on Safety and Quality in Health Care has developed an Accreditation Workbook for Mental Health Services. The workbook is designed to guide services through the NSQHS Standards, which also link to the National Standards for Mental Health Services, which community managed mental health services across the ACT will be reporting against from this year.

4 The Accreditation Workbook for Mental Health Services is available online at: MHCC ACT Board Decides At the February meeting the MHCC ACT Board endorsed a proposal to establish a network of workplace NDIS promoters (we had used the word advocates, but it has been suggested that advocates are outside the scope of NDIS). MHCC ACT will be asking each community managed mental health service provider to nominate a workplace promoter to be part of the network. Not only will these promoters help their colleagues and service users to be more informed about NDIS, they will be trained to support clients, who may be eligible for an NDIS support package. They will also network with clinicians and staff of the public mental health system. In the coming weeks MHCC ACT will be contacting each of our members and encouraging them to nominate workplace promoters. (I promise to come up with a better title as soon as possible!) MHCC Conference: Changing the community mental health service delivery landscape of the ACT MHCC ACT will host a conference for the community managed mental health sector, 4 and 5 June this year, to coincide with the launch of NDIS in the ACT. Please lock these dates in your diaries. The theme is: Changing the community mental health service delivery landscape of the ACT Choice, Control and Possibilities for Consumers Carers and Service Providers Sub-themes Recovery Co-design & Collaboration National Disability Insurance Scheme Peer Work Sector Leadership E-health and Online Mental Health Supports Purpose The purpose of the conference is to raise sector awareness and understanding of imminent changes in ACT community mental health service delivery and provide practical tools to prepare for these changes. We aim to achieve this through offering a platform for people with firsthand experience of significant change to relate their journeys of Recovery. Most importantly, this conference will explore ways in which people with a lived experience, their families and carers, can collaborate with mental health service providers to design and manage services that will make possible the contributing life. MHCC ACT recognises that changes in service delivery will ensure the person with a lived experience of a mental illness has the power to choose and design their own service package. In light of this, the MHCC ACT remains committed to delivering a consumer-centred conference and strongly encourages submissions from people with lived experience of mental illness, and their families and carers.

5 MHCC ACT Member Visits In the February e-bulletin I indicated a willingness to meet with our members Boards and Senior Staff to discuss the likely impact of these sector wide transformations. That offer still stands and I will be writing to our members and arranging times to meet. Obviously, I will be asking our members to also nominate a workplace promoter in relation to NDIS readiness (see above). National Mental Health Review Community Mental Health Australia (CMHA) is the national peak body for state/territory peaks, like MHCC ACT, across Australia. It has prepared a submission to the National Mental Health Commission s National Mental Health Review, which I have included here in full. The Commission has now called for public submissions by 14 April. We would appreciate any feedback or information from our members so that MHCC ACT itself can prepare a submission on behalf of the sector here in the ACT. Ian Rentsch 2. MHCC ACT News Update Quarterly Community Forum The first Quarterly Community Forum of 2014 was held in March with the theme PTSD, Peers and the Workforce. PTSD Awareness and Education Program Samantha Davidson Fuller, recently appointed Executive Officer of MIEACT, presented on the new MIEACT PTSD Awareness and Education Program to be launched later this year; Preliminary delivery to Community Sector and Clinicians planned for June 2014, with full program launch planned November Samantha confirmed she had been leading the program until her recent new appointment and the new program manager would be: Ray Simpson; [email protected] The PTSD Program is being developed in partnership with the University of Melbourne and the Australian Centre for Post-traumatic Mental Health (ACPMH). There has been an intensive and ongoing consultation process, MIEACT have looked for consultation beyond their own consumer membership to ensure consumers are truly at the heart of the development of this program. The program is being designed to be adaptable to its audience acknowledging this could be; community sector, clinicians, GPs, Government, workplace or schools. The PowerPoint presentation is available on our website:

6 Peers ACT Keith Mahar and David Jenkins introduced Peers ACT as an organisation that looks to support and develop Peer Workers within the sector. David offered a moving person story example of how and why Peer Work is so important and effective. Keith identified the need for developing strategies for; Self- Care, improved employment options, training and development, resilience to sector changes and providing access to supports via a Peer Support Network. The presentation discussed the potential risks and possibilities for Peer Work with planned sector developments such as the NDIS. Finally Keith introduced a Caucus Peer Work Project in development that will look at the establishment of Peers ACT organisationally and the creation of a Peers ACT education project that can be rolled out to the sector. Caucus update Caucus Co-Chair Chris Van Reyk provided a brief update on Caucus events and planning for the year. As a result of the resignation of the Caucus facilitator in January 2014, members decided to move forward nominating member based Co-Chairs and Deputy Co-Chairs to lead Caucus. As an internal project Caucus is now developing an updated Meeting Ground Rules agreement to assist the Co- Chairs in managing the meetings. Caucus is developing 2 external sector projects; The previously mentioned Peers ACT Project and an NDIS Working Group Project, in partnership with the NDIS Taskforce. For more information or if you have any questions or comments or to request Caucus updates please contact Caucus; [email protected] Consumer & Carer Caucus Caucus update: A word from Co-Chair, Chris van Reyk We re very grateful to Kat and Rachel for the completion of the Caucus brochure which gives us an attractive medium to promote ourselves and increase our engagement with the wider community of Carers and Consumers. To complement this wider engagement we are looking to establish meaningful links with peak bodies from youth, CALD and Indigenous groups, and the elderly. This is intended to ensure the sharing and eliciting of information and comments from the complete MH community; thereby providing a comprehensively informed and united voice in relation to MH matters. This linking will commence with an invitation to the Youth Coalition to attend our next meeting. Caucus members will distribute the brochure to the various agencies. Caucus is also looking to review and (if needed) update the relationship with the MHCC ACT board. This is regarded as needed due to the potential for the recent revival of interest in Caucus to generate some significant initiatives that will involve resources, budget etc Next Caucus meeting When: Friday 11 th April 12pm 1.45pm Where: MHCC ACT meeting room, level 1, Griffin Centre, 20 Genge Street, Canberra City, 2601 To RSVP or if you have any questions regarding Caucus or to be included on our Caucus mailing list please contact Caucus at [email protected] or on;

7 3. CMHA Submission to the National Mental Health Review Introduction The CMHA applauds the government review of the mental health system, recognising that there is a need to improve the effectiveness of a system that continues to miss the mark in the delivery of good mental health outcomes for the Australian population. Indeed, improvements in the planning, organisation and integration of relevant services and support are required at federal, state and territory levels of government. During the past decade a proliferation of government reports including the Framework of National Indicators and Targets for Mental Health Reform by the COAG Expert Reference Group on Mental Health Reform (Expert Reference Group on Mental Health Reform 2013), have identified a number of priorities for mental health system reform that can / will / are being set as the basis for enduring positive change in the sector. Despite all the best intentions and the many mental health plans by both Commonwealth and state governments, mental health remains underfunded, continues to be focused on hospital and clinical care, and mental health services across the country are fragmented and driven largely by providers rather than by the priorities of consumers and carers. While the Framework itself sets targets and indicators that will support consumers to achieving a contributing life, much of the reform rhetoric remains aspirational, without any clear direction on how change can be achieved. A recent report, Obsessive Hope Disorder, highlights the challenge of implementing reform and the inability, despite numerous pockets of excellent practice, to achieve a coherent, integrated, sustainable and client-friendly system. The authors advocate the need for fundamental realignment of governance and funding models at national, state and local level in order to achieve consistency in accessibility to services across Australia (Mendoza et al. 2013). The CMHA believes that it is imperative that in seeking to reform mental health service provision in Australia, and make it more efficient, the government does not resort to the false economy of significant disinvestment in mental health services. This would deliver a reduction of immediate budget pressure at the cost of a ballooning cost due to ongoing burden of disease, and economic exclusion of consumers in leading to larger economic burden in long term. More concerning would be the resulting negative impact on people experiencing mental distress and illness, as well as their carers and families. Careful and diverse investment in mental health services, which include proven, innovative practice, for example step up and step down models of care, can save public money and improved service quality at the same time but most importantly, change the lives of mental health consumers and their carers and families for the better. The CMHA publication, Taking Our Place, refers to examples of Australian services that do just that, including The Centre of Excellence in Peer Support which provides a centralised specialist clearinghouse and online resource centre for mental health peer support (Community Mental Health Australia 2012). In this difficult economic climate, with significant reductions in public spending in real terms set to become the norm for many years, such careful and considered investment is required more than ever. In the first instance, government needs to acknowledge that effective implementation of a reform agenda requires greater collaboration between public service agencies and CSOs, underpinned by a shared sense of the need to place the best interests of the individual, family or community first. Whilst the current fiscal environment is tough, nevertheless there remains a historical underspend in mental health both nationally and in each state relative to the illness burden of 13%. Combined with balance of investment ie overinvestment in bed-based acute care versus community care this is major source of problems. In the long term governments cannot solve fundamental problems that consumers and families continue to raise, without solving underinvestment and balance issues.

8 1. Needs of consumers and families What consumers and their carers need, at the most fundamental level, is a coordinated and integrated approach across all levels of government and the private and non government sectors, including in the areas of health, housing, employment, education and justice. In short: access to what they need, where they need it and when they need it. To be effective, this must be provided in communication and collaboration with consumers, their family and carers and service providers. Commonwealth and state government plans over recent years have all confirmed this position and yet people with severe mental illness still have to, according to a Medibank Private report on system review, deal with fragmented and uncoordinated systems [and] despite previous attempts at reform and investment by governments, too many people with severe and debilitating mental illness are still not getting the support they need, don t know where to find it, and are falling through the cracks in the system. The families and people who care for them struggle with a system which often causes them frustration and even despair (Australian Government 2011). There is also a lack of connection between research and service provision, resulting in good work not being taken up by the system despite achieving positive outcomes. For example, research recently completed by Carol Harvey demonstrates that family interventions are effective in reducing relapse for people suffering from schizophrenia and reducing distress for family members, and yet they are rarely provided in routine care in public mental health services (Harvey & O Hanlon 2013). It is critical that consumer and carer participation in the system both as individuals and as a sector is part of any reform. There is significant evidence of the benefits of this consumers themselves benefit hugely, and the service users too, but there is also a beneficial impact well beyond the direct interactions. For example, research shows that the teams in which peer support workers are employed achieve better results in terms of their recovery-focus, and this positive impact is also felt through the wider community. On the whole, engaging consumers and carers has been proven to enhance the provision of a quality mental health sector. Consumers and carers can and should assist in the provision of: Staff training Community education and information Consumer and Carer advocacy Peer support services Input to service development and evaluation Input to policy development 2. Inefficiency At the moment a key driver in mental health is not what works but who pays, an unhelpful legacy of the confused governance arrangements between the states and the Federal governments. This confusion also leads to patch protection behaviour which limits access, innovation and diversity of service models. Another key task to be undertaken by the Productivity Commission therefore must be to examine funding models and options for mental health in Australia, including consideration of alternatives internationally (Mendoza et al. 2013). There is no doubt that there are a number of factors contributing to the inefficiency of the mental health system Australia-wide. To begin with, up till now there have not been targets relevant to the contributing life in place around Australia and we are yet to see these targets fully adopted and reporting against them begin. Other factors include: Lack of clear role delineation leading to duplication there are mixed and overlapping responsibilities for funding mental health services, including both state and Commonwealth funding of community service sector programs.

9 Lack in continuity and consistency of service, resulting in a breakdown of support and often, rehospitalisation, a far from efficient outcome. International research identifies lack of community support including step-up and down facilities, rather than a person s illness symptoms, as a main factor in readmission (Davidson et al. 2001). Care co-ordination alone is insufficient and not necessarily uniformly implemented. Too much reliance on the acute, hospital sector when it has been proven that services provided in the community have far better outcomes and hospital beds cost far more than most community supports. There are a number of programs that have been trialled and evaluated both here and overseas and these represent good models for system reform but, more often than not, the opportunities for positive change that they represent are not pursued. There are many examples where community supports deliver better outcomes with regards to contributing life for consumers and a direct reduction in demand for acute and crisis care. Efficiency and effectiveness gains, as highlighted in the CMHA publication Taking our Place (Community Mental Health Australia 2012), can be made by providing more resourcing to the mental health community service sector A good example of this is the South Australian IPRSS program which involves NGO providers and government MHS working in partnership with other key stakeholders including housing to provide structured, goal focused and individually tailored services at a level of intensity and duration appropriate to consumers needs. An important component of individual psychosocial rehabilitation is community capacity building. Service types include: services delivered to assist the consumer engagement in meaningful daytime activity and employment; services delivering combined housing and support programs provided the service is not facility based; services delivered in community settings intended to promote community engagement and social connectedness; independent living skills support and training to enable day to day living in the community; and transition from facility based services to home and community living (SA Health Evaluation of the Individual Psychosocial Rehabilitation & Support Services (IPRSS) Program Final Report 2011). The independent evaluation of the program in 2011 demonstrated that IPRSS is effective in supporting individuals to build a better life in the community and reduce the need for unplanned admissions to bedbased services. The evaluation showed reduced incidence of hospitalisation for mental health reasons by 40% and reduced average length of stay by 16%. For every 54 people supported during the period of the study, there was a reduced demand for hospital services by the equivalent of one hospital bed per year. Another example of a community based program is the Queensland s Housing and Support Program (HASP), was established in 2006 to support individuals with psychiatric disability leaving acute and extended treatment mental health facilities. In the 2010 evaluation of this program, the authors compared the costs of an Acute Inpatient Unit, $244,550 pa. ($670 per day) with HASP (with one acute admission), $66,663 pa ($183 per day) and HASP (no admission), $54,000 pa. ($148 per day). In 2010 the Commonwealth Department of Health estimated that the average cost of a public hospital acute care bed for mental health problems is $1,000 per day (Australian Department of Health 2010). Whatever the true cost of hospitalisation, it is clearly significantly more than the cost of supporting consumers to live in the community. NDIS The concept of the NDIS has been universally welcomed by the mental health sector; however there is still some cause for caution and concern. These include: The risk of NDIS being the primary mental health initiative, which will mean that the majority of mental health consumers who are ineligible for NDIS support will miss out on critical services. Gaps in support because there are currently areas that need investment to provide for the needs of people with severe psychosocial disability including supported accommodation. The predetermined pricing of NDIS may drive many service providers out of the market,

10 potentially putting at risk the current provision of targeted well-designed programs. This market failure may reduce the range and quality of services, particularly to clients in rural and remote regions. The danger that the quality of staffing will suffer with price pressures, increasing casualisation, erosion of skills and a qualifications base and the compromising of workforce supply, development and capacity into the future. Further to this is the poorly targeted investment in workforce development to date which has done little to develop the emerging community workforce, or recognise the depth of skill present in the community sector. It is also envisioned that some clients will struggle as the services and supports they are used to change shape and evolve and that there will be clients who are functionally more able or better supported than others to navigate these changes. Those with severe mental health problems may not fare as well. Workforce Workforce capacity is one of the great challenges facing the mental health sector in Australia. Strategies and mechanisms are required to support comprehensive workforce development and expansion. A core reform priority for government is to reorient the focus of the mental health service from hospitalbased care to strong community-based options. Workforce shortages exist across all professional disciplines and are exacerbated by the ageing of the workforce. A recent report notes that Despite increases in the size of the mental health workforce over recent years, many public, private and NGO mental health services are experiencing shortages in workforce supply, and difficulties with recruitment, distribution and retention (The National mental Health Workforce Strategy and Plan 2011). There are three other significant issues that impact on the provision of services from the community sector and these are: The underestimation and underutilisation of skills in the community sector where there are staff available and qualified to undertake clinical work. Lack of balance in training funding which overwhelmingly favours clinical training and is not targeted to community mental health service provision. There has been a great deal of work done to benchmark qualification standards in clinic-based professional training but this benchmarking is not being replicated in the community-managed mental health sector. A number of commentators have advocated for a national workforce plan to address workforce issues in the sector which include the need to train current and future mental health staff in the following areas: whole of life supports service coordination skills competency based training recovery-oriented, person-centred practice e-health worker roles peer worker roles Conclusion There is compelling evidence for the economic benefits of government investment in community-based interventions for mental illness, including psychosis. Currently governments across Australia are moving to the provision of many mental health services in the community with increased commitment to investing in community services. However, there is still a long way to go in resourcing the community programs needed to provide the best outcomes for consumers and their carers. There is a clear

11 need to focus on the contributing life as articulated by the National Mental Health Commission in its 2013 report card as the goal of the mental health system, and to adopt targets that match contributing life related outcome. It is also important to address the chronic government underinvestment in mental health relative to illness burden and to balance of investment currently weighted towards expensive tertiary as opposed to less expensive, and more effective, community services. Paul Senior has reinforced the importance of the community-managed mental health sector as central to the development of quantity, quality and accessible services He goes on to note that: The sector has been, and continues to be, a leader in the development of person-centred, recovery orientated services promoting a narrative of care that is in opposition to that based on access to hospital beds. Historically, this is a sector that has received little of the public spend on mental health and yet there is compelling evidence that investment in this sector will increase access to timely, effective and responsive services.access will only be addressed by investment in a diversity of services that are relevant to the communities and target populations they seek to serve. Access will not be resolved with great investment in hospital-based beds. Developing a political and community understanding of mental health needs that is more sophisticated than a plea for more beds is a fundamental step in this direction (Senior 2013). The CMHA believes that this position represents the way forward for system change and that proposes that any review of the system take into account the issues raised in this submission. It also would like to stress that there is a clear need for a long-term perspective for those making funding decisions, and it is critical that they avoid short-term gain for longer-term gain. References Australian Department of Health 2010, Development of an alternate funding scheme for persons with recurrent or persistent psychotic disorders, < Australian Government 2011, Budget: National mental health reform, in the Case for Mental Health Reform in Australia: a review of Expenditure and System Design 2013, Medibank Private Limited and Nous Group, pp. 8 < mental-health-servicesystem>. Community Mental Health Australia 2012, taking Our Place Community Mental Health Australia: Working together to improve mental health in the community, CMHA, Sydney. Davidson, L, Stayner, DA, Nickou, C, Styron, TH, Rowe, M & Chinman, ML 2001, Simply to be let in: Inclusion as a basis for recovery Psychiatric Rehabilitation Journal, vol. 24, pp Harvey, C & O Hanlon, B 2013 Family psycho-education for people with schizophrenia and other psychotic disorders and their families, Aust N Z J Psychiatry. Mendoza, J, Bresnan, A, Rosenberg, S, Elson, A, Gilbert, Y, Long, P, Wilson, K & Hopkins, J 2013, Obsessive Hope Disorder: Reflections on 30 years of mental health reform in Australia and visions for the future, ConNetica, Caloundra, pp. 52. SA Health Evaluation of the Individual Psychosocial Rehabilitation & Support Services (IPRSS) Program 2011, Health Outcomes International, Kent Town, pp.1. Senior, P 2013, Looking beyond hospital beds for more flexible interventions, in Perspectives: Mental Health & Wellbeing in Australia, Mental Health Council of Australia, pp. 25. The National Mental Health Workforce Strategy and Plan 2011, for the Mental Health Workforce Advisory Committee, Victorian Department of Health, Melbourne, pp. 3.

12 Disclaimer This bulletin is a compilation of material submitted by individuals, organisations and government departments. The views expressed by contributors may not reflect those of the Mental Health Community Coalition ACT.