Panel on the practical aspects of NDIS transition
This panel session will provide information on the transitions process to NDIS and perspectives on experiences from the trial sites. Audeince members will have the opportunity to ask questions and participate in this interactive session.
- Arthur Rogers - Special Adviser NDIA reform, Department of Premier and Cabinet
- Simon Viereck - Chief Executive, Mental Health Community Coalition ACT
- Janette Korolew - Peer Carer Consultant, MI Fellowship
- James McLure - Peer Support Worker, Pathways
- Branka Carter - Region Manager North Victoria, National Disability Insurance Agency
- Deborah Roberts - Director Mental Healht, National Disability Insurance Agency
Reachout nextstep: co-designing an online help-seeking tool for young people.
While one in four young people in Australia experience mental health problems, only 35% seek professional help. Known barriers to help-seeking include lack of access to appropriate care, not recognising mental health issues, being unsure of where to get help and negative attitudes towards seeking help.
In response to this, ReachOut ‘NextStep’ is an online tool designed to facilitate help-seeking for mental health difficulties in young people aged 18-25. Co-designed in partnership with end-users, the tool helps users navigate the mental health system and empowers them to feel confident to seek help. The tool was designed using a mobile first approach, ensuring a positive user experience for a growing number of young people using smartphones as their primary device for accessing the internet (particularly outside major cities).
This presentation will use insights from a Randomised Controlled Trial (RCT) of an early release of the product, as well as analytics data from the live product in order to demonstrate:
- The effectiveness of an online tool to facilitate help-seeking among young Australians
- Benefits of co-designing with young people
- Benefits of partnering with academics and service providers to ensure reliable, evidence based outcomes.
‘ReachOut NextStep’ showcases how technology can be used to reach vulnerable young people that have unmet support needs and are disengaged from the mental health system. Young people report the benefits of the tool as anonymity, validation, reassurance and providing them with a sense of autonomy and confidence.
Victoria Blake - Research Organiser, ReachOut Australia
Victoria Blake joined ReachOut’s Research and Policy team in 2012. She has fostered specialist skills in Participatory Design and User Experience research methodologies in the context of online program development and has considerable experience working with young people from diverse communities and life experiences across Australia.
Participation and engagement in youth mental health.
The involvement of young people in mental health services and organisations is essential to ensure the quality and relevance of the work undertaken. At Orygen, The National Centre of Excellence in Youth Mental Health one of our key strategic aims is to put young people and their families at the forefront of everything that we do. In line with this goal, a Youth Engagement and Participation strategy is currently being rolled out across our clinical, research, teaching and policy divisions. This multimedia presentation will describe a number of initiatives underway that focus on the involvement of young people throughout Orygen, using interviews with young people and other staff members to engage and inform the audience.
Youth Advisory Council (YAC; All Divisions)
The YAC drives youth partnerships across Orygen’s four divisions and contributes to the implementation of the Youth Engagement and Participation Strategy.
Youth Research Council (YRC; Research Division)
The YRC plays a more research specific role, and members are tasked with contributing to the undertakings of the Research Division. The YRC is a key partner in the Research Division and contributes to the overall direction of research at Orygen, including what we research, the way in which we conduct research and how we disseminate these findings.
Youth Advisory Groups (YAGs; Clinical Division)
Run at each of the Orygen-led four headspace sites in north western Melbourne, the headspace YAGs provide anyone aged 16-25 with the opportunity to be heard and to take action to improve the health and well-being of young people. Activities include: creating, developing and leading local projects; website and social media consultation and development; research and evaluation; resource development; peer support and mentoring; and speaking with the media.
Summer Intern Program (Across Divisions)
Orygen’s Summer Intern Program provides a four week placement (three days a week) providing access to research teams, key policy and advocacy staff, clinical specialists and workforce trainers that have extensive experience working in the field of youth mental health. The Program gives young people an opportunity to increase their knowledge and understanding of the youth mental health sector in Australia, with an emphasis on workforce development, research, policy and communications. Interns are supported to develop leadership skills in order to contribute to improving the mental health and wellbeing of young Australians.
Youth Engagement Training Initiative (YETI; Across Australia)
YETI is an online tool designed to provide a social and learning platform for young people interested in having a voice around youth mental health. YETI is a space for young people from all over Australia to communicate and share information and provides an opportunity to discuss upcoming projects, events and receive updates on how to get involved in activities and programs offered by Orygen. There are also a number of Pathways and Steps that young people can take to learn about a range of issues related to youth mental health.
Christine Abdelmalek - Research Fellow and Youth Partnerships in Research Coordinator, Orygen
Christine Abdelmalek is an inaugural member of the Youth Research Council at Orygen, the National Centre of Excellence in Youth Mental Health. Based in Melbourne, Christine is passionate about youth involvement in mental health services and research and is currently studying a Bachelor of Psychological Sciences at Deakin University. She dreams of becoming a psychologist working in a multi-disciplinary team within a hospital, of teaching psychology and influencing change at a government level. Christine is also passionate about working with teenagers and young people to bring about a positive change to their mental health and wellbeing. She currently fulfils this passion by actively volunteering in the field. Other volunteer roles have included Youth Ambassador (ReachOut), Peer Mentor Leader (Deakin University) and volunteer (Alfred Hospital).
Magenta Simmons - Research Fellow - Orygen
Magenta Simmons is a Research Fellow in Evidence-Based Clinical Decision Making and the Youth Partnerships in Research Coordinator at Orygen, the National Centre of Excellence in Youth Mental Health in Melbourne, Australia. As the Youth Partnerships in Research Coordinator, Magenta works with the Orygen Youth Research Council to promote youth participation across Orygen's Research Division; putting young people at the centre of what research we undertake, the way in which conduct this research and our strategies for dissemination and translation. Her work focuses on how young people can be meaningfully involved as collaborators in research projects, as consumers in clinical decision making about their own care, and as peer workers supporting other consumers. Magenta has developed a number of online tools to support young people to make decisions about treatment for mental ill health.
INTEGRATION, COORDINATION & COMPLEXITY
Mental illness and long term homelessness: bringing together clinical and community services.
The Mental health and Homelessness Program aims to break the cycle of long term homelessness for people experiencing severe and enduring mental illness, significant co-morbidities and high and complex support needs. The program supports up to 25 individuals aged sixteen years and older at any one time. It is a partnership between the lead agency Mentis Assist (community mental health), Peninsula Health (clinical mental health) and the Salvation Army (housing service). The Program is delivered by a multi-agency, multi-disciplinary team and is unique in its setting within a clinical mental health service.
The partnership model allows streamlined access to vital psychosocial, housing, health and psychiatric care which are often overlooked or inaccessible for this population. The program is based on the Assertive Community Treatment Model and works flexibly with participants for up to three years. Central to delivering this type of program is a team based approach, low caseloads and the flexibility to offer a stepped care approach, the ability to adapt the service delivery’s intensity, frequency and type of service over time as the participants’ needs change.
The partnership in service delivery and governance has core elements which allow the successful delivery of such a program. The key elements are the commitment of all partners in reaching and providing innovative responses to a group of participants who are traditionally hard to engage or maintain engagement in services. Trust and respect of the diverse experiences and expertise each agency and staff member bring to the program, along with transparency across all levels from direct service delivery to the support of higher management from all agencies and staff delivering the program, assist in developing a shared understanding across staff and agencies about participants’ needs, program objectives and service delivery.
Like the agencies, participants come from a range of backgrounds, cultures and all have a unique story, understanding and journey of recovery. Michael, a participant and Barb, a practitioner’s journey in recovery and supporting this process demonstrates the intricacies and parallels for staff and participants in navigating systems and inspiring hope, belief and the importance of meaningful connection and purpose in the recovery journey.
Michelle Francis - Program Manager Mental health and Homelessness Program , Mentis Assist
Julie Hartley - Senior Clinician
Barbara Wyatt - Mental Health Practitioner
The staff in the program bring to it a range of experiences ranging from clinical and community mental health in Australia, the UK and New Zealand, in such settings as inpatient and community, and programs designed to support the needs of clients experiencing high and complex support needs and long term homelessness.
Developing an evidence base for public policy advocacy.
Governments are under increasing pressure to demonstrate the effectiveness of social service investments through rigorous and independent research. This presentation will outline one of Australia’s most robust research projects for an evidence base on how to end long-term homelessness: Sacred Heart Mission’s Journey to Social Inclusion (J2SI) project.
J2SI was originally conceptualised in 2006. The program was piloted from 2009-2011 and evaluated using a longitudinal Randomised Control Trial. For the pilot, a total of 80 clients were randomised assigned to one of two groups -- the intervention (group J) and control (group E forexisting services). The longitudinal study followed the participants for six years: a survey was conducted every six months during the three years of the service response, as well as at the fourth and sixth year marks.
The independent evaluation found that several outcomes measures improved among J2SI participants:
- Health service use:
- 80% decline in emergency hospital services use (compared to 21% increase in control group)
- 80% decline in average number of days hospitalised (compared to 33% reduction in control group)
- Psychiatric service use: over 66% decline in usage rates for both emergency presentations and admission to psychiatric units
- Self-reported health: J2SI participants reporting no bodily pain increased from 27% to 45%
- Mortality rates: J2SI participant rates were half (2) those of control group (4)
This presentation will speak to the benefits regarding the rigor of evidence demonstrating the effectiveness of innovative practice as well as the way that the evidence is interpreted within government and used to influence public debate. This includes the use of a cost-benefit analysis showing that it is more cost effective to provide people with accommodation and support than to leave them to progress to prison, psych units or other emergency services.
It will also speak briefly to some practical aspects of the RCT and evaluation including the way in which hope and recovery is a key part of the service model and research.
Angela Merriam - Public Policy & Advocacy Advisor, Sacred Heart Mission
Angela Merriam holds a BS in Economics and MA in Public Policy, with professional experience ranging from government, academia and the non-profit sector. She is currently Public Policy & Advocacy Advisor at Sacred Heart Mission, a role which she has held for just over one year.
Way2home: a creative response to ending homelessness.
Managing an assertive outreach service that works with people sleeping rough in the city of Sydney demands a creative response. The Neami Way2Home service has been working closely with government, non-government agencies, health services and community housing providers to meet the ever growing numbers of people sleeping rough in the city of Sydney. Neami Way2Home is funded through the NSW Government - Family and Community Services and the City of Sydney Council.
To maximize our ability to respond appropriately to the complex needs of this vulnerable group we maintain very close partnerships with St Vincent’s Homeless Health outreach team along with mental health clinicians, drug and alcohol workers, and other allied health workers. In one area we noticed an increase in people sleeping rough, with 350 people cycling through the space since March 2015 and January 2016. Through a collective impact response 64 people have successfully entered into a housing pathway. These outcomes would not have been possible without a coordinated response by the 19 organisations that committed to working together with the goal of improving outcomes for those experiencing homelessness.
We work within a trauma informed framework, foster strong partnerships between housing and support services, and provide non-duplication of services with other specialist homelessness services. One of the remarkable themes that is constantly realised is the resilience of those we work with and that each person holds a story with individual hopes and dreams for their future. To hear the positive difference support and a home has made to a person’s sense of worth is astounding, as we found when interviewing past and current consumers of our service.
In order to challenge past processes and attitudes in responding to primary homelessness our service has actively lead and participated in key initiatives. The only way to maintain our work toward innovative solutions and positivity is to strengthen service coordination, use methods of data collection that at the very least identify the range of needs and vulnerability in order to better advocate and inform funding bodies. Opportunities to think outside the box will continue to improve our responses to homelessness while providing key information to inform policy and system change to ultimately end Homelessness in Sydney.
In December 2015 Registry Week was conducted using the Vulnerability Index-Service Prioritisation Decision Assistance Tool (VI SPADAT). It involved surveying 516 participants who were currently sleeping rough, residing in temporary accommodation or crisis accommodation. The data collected will be used to prioritise and triage an appropriate response for the people surveyed. The data released in the City of Sydney Registry Week 2015 Report showed 53% reporting a mental health issue, of those 64% reported have both a substance abuse and mental health issues. The information gained from this is also being used to inform both housing and support services relative to the needs of those experiencing homelessness and difficulties in accessing stable accommodation.
Tamara Sequeira - Way2Home Service Manager, Neami National
Tamara Sequeira is currently the Way2Home service manager for Neami National. Tamara has over 16 years’ experience in a range of welfare, health, training and management roles, in government and non-government agencies. Her academic qualifications are in Social Health, Health Science (Nursing) and Community Welfare. Tamara’s life work has been focused on working with our community’s most vulnerable and to seek to influence change in how the welfare and health sector respond to those needs that will see long-term effective solutions particularly to those who find themselves homeless.
INTEGRATION, COORDINATION & COMPLEXITY
Presentation one - symposium
Trauma informed care and practice - pathways to service improvement.
The majority of people accessing mental health services have experienced some form of trauma. The link between trauma as a contributing or causal factor in developing mental illness has been well established. Trauma Informed Care and Practice (TICP) aims to introduce care that minimises re-traumatisation, increases safety and communicates an understanding about the profound effects that trauma can have on a person.
In this symposium we will present current research findings that examine how mental health services respond to consumers who are survivors of trauma. In particular the focus will be on the findings of a PhD project that investigated how the Australian mental health and social service system responds to individuals who experience voice hearing and have past experiences of sexual assault or abuse. A picture of current mental heath and social service system responses will be outlined as well as the consumer identified impacts of these responses. Key themes emerging from interviews with consumers and practice wisdom from mental health professionals will be discussed leading to new ideas about TICP for voice hearers and other mental health consumers.
We will then discuss some of the complexities of implementing TICP. While TICP frameworks, toolkits and training packages provide excellent direction, ongoing implementation can be challenging. We will take a look at Australian and international documents and examples of implementation of TICP. We will then discuss how one Psychiatric Inpatient Unit (Northern Area Mental Health Service) tries to balance the challenges of acute psychiatric care with implementing TICP.
Now in its third year, the TIC Reflective Practice Group continues to be adapted to suit the needs of staff on rosters and an ever changing staff group. While the Reflective Practice Group is part of a broader focus on TICP, it is where ‘real-life’ conundrums and challenges are discussed. Emerging themes are worked with in order to continuously address staff development needs to support TICP implementation. An Action Research Framework provides opportunity for staff to contribute in review processes to contribute towards continuous review and feedback processes aimed at bringing theory and practice together.
Whilst inspiring work occurs across Community and Clinical Mental Health Services, the need for better trauma informed services in Victoria remains. TICP can be a connector between different types of mental health services, unifying systems that are often ‘siloed’ and work from different paradigms.
Formation of a Victorian Trauma Informed Care and Practice Network could join professionals, consumers, researchers and carers to work together to support the implementation of trauma informed practice throughout the state. This symposium will conclude with a discussion around the potential for forming such a network.
Kath Sellick - PhD candidate, University of Melbourne
Kath Sellick is a PhD Candidate in the Department of Social Work at the University of Melbourne. Her PhD project investigates how the Australian mental health system is responding to voice hearers who have experienced sexual abuse. This project has involved interviews with consumers about their experiences using services as well as an in depth survey of mental health professionals who work with voice hearers. Kath has spent seven years working in the community mental health sector as both a support worker and a team leader. She is passionate about mental health and social justice, and deeply committed to working towards a better mental health system that responds to trauma in a holistic, consumer informed way.
Dr Sabin Fernbacher - Northern Area Mental Health Service
Dr Sabin Fernbacher works at the Northern Area Mental Health Service in a service development role across Aboriginal and Women’s mental health and Families where a Parent has a Mental Illness. She is passionate about working collaboratively on systemic change to increase gender sensitivity and safety and cultural safety for Aboriginal people in mental health care. Her work has focused on trauma (family violence, sexual abuse) and mental illness for many years. She continues to work with community agencies, clinical mental health services, academia and state government on addressing trauma within and across different sectors and contexts.
Working with refugees: incorporating a relational approach to service delivery.
The Syrian refugee crisis has highlighted how the public and political responses to the plight of refugees are often polarised. The tragedy is that these responses reinforce the themes that already dominate the trauma narratives of refugees, that is, vulnerability, disconnection, discrimination, disempowerment and being devalued. Concomitantly, health and welfare sectors in countries of re-settlement struggle to engage and meet the complex set of psychiatric and psychosocial needs that refugees present with.
The contemporary and crucial question, therefore, given the current political and economic climate, is how do practitioners and services respond humanely and effectively to the needs of refugees, either directly or indirectly? The aim of this presentation is to explore how Cognitive Analytic Therapy (CAT, Ryle & Kerr, 2002) principles can inform a relational approach to working with refugees. This presentation takes a CAT relational lens and maps it onto an existing trauma framework (Silove, 1999; VFST, 1998). In doing so it provides a relational ‘mirror’, which highlights the dominant relational patterns in the refugee experience. The narratives of survivors, practitioners and services are drawn upon to illustrate these relationship patterns. There is real potential for a relational approach to be of value in supporting existing frameworks and services in better understanding, assessing, engaging and supporting refugees in a manner that enhances engagement and the recovery process. We also argue that a relational framework is valuable not only as a therapeutic framework but also as a conceptual framework for indirect work with practitioners and services and has potential as a tool for advocacy.
Jennifer O'Brien - Program Leader for Professional and Organizational Development, Foundation House
Jennifer O’Brien is the Program Leader for Professional and Organizational Development program at Foundation House which aims to support individuals and organisations to work more effectively with refugees and asylum seekers. She has over 14 years experience working within the health and community service sector specifically with youth, trauma and general mental health. She has an interest in utilising relational approaches to therapeutic work in order to support health, community professionals and organisations to reflect on and improve their therapeutic engagement. With experience in clinical mental health counseling, training and organizational development Jennifer is passionate about supporting the mental health sector to engage more effectively with refugees and asylum seekers.
Fritha Melville - Clinical Psychologist, Orygen
Fritha Melville is a senior clinical psychologist with Orygen Youth Health, a public mental health service, which works with young people aged 15 to 24 years with a serious mental illness. Fritha has over 15 years of experience working with young people in the health and community sectors, including homelessness, drug and alcohol and refugee specific services and also has training and service development experience Fritha’s conceptual approach to mental health is based on a holistic framework, which advocates the integration of individual and community based interventions as well as community and service development and research. Fritha has been involved in advocating for the needs of people from refugee background both through research and clinical work for over 15 years.
Research project - questioning the service response to those with borderline personality disorder in the hume.
Participants will be exposed to an innovative systems change project including research and key ideas of empowerment, hope and how we can transform systems working to achieve a better future for people withBorderline Personality Disorder (BPD). To improve system response and effect systems change we needed to first scrutinise what we are currently doing. Our project objective is to provide a review into service access and response to people diagnosed with BPD within the HUME region.
Part of the project outcome is to inform and engage the service system, carers and consumers about the experience of consumers and provide an informed pathway to work together to achieve better service responses and outcomes for people with mental illness. Participants will have the opportunity to explore how the research project has linked with other projects, St Luke’s Project Mindful and MPHN project Family Connections.
These projects share a steering committee with representation from key stakeholders including clinical services, carers and consumers addressing key sector issues of service integration and coordination. This project came about due to PIR in the Hume region experiencing a high number of participants who have a diagnosis of BPD;anecdotal evidence suggests that people are not receiving adequate care from services, and that service system responses are disjointed and inconsistent.
This raised questions including; Why does their appear to be no consistency in responses from services in dealing with people with BPD? Do services and consumers think there is a system issue? Do they think change needs to happen and what would they like to see? We aim to inspire others to explore service responses, we want participants to consider consumers experiences in the mental health system and to hold hope in the development of our services, inspiring innovation for change and improving systems.
Maryanne Donnellan - Support Facilitator, Gateway Health and Hume PIR
Maryanne Donnellan has worked in government and community services for the past 20 years, starting her career in child protection and then moving to working in programs for children and families experiencing separation. Maryanne has worked in regional and remote areas including Cobar, Bourke and Whyalla. Maryanne currently works in Wodonga as a Support Facilitator in the Partners in recovery Program at Gateway Health, working with participants that have severe and complex mental health issues.
Alana Pund has worked in mental health for the past 12 years, starting in a youth residential rehabilitation service. Alana has worked with young parents and homelessness through to people with a severe and persistent mental illness in the Partners in Recovery program as a Support facilitator. Alana is originally from the Local area and spent her 20’s in Melbourne. Living in the regional town of Beechworth meant that Alana grew up around May Day Hills and through de-institutionalisation, always being aware of the stigmatisation of people with a mental illness. Alana has had experience in presenting and project work and held roles in group facilitation, case management and currently is a team leader in community health centre.
MENTAL HEALTH REFORM
Implications for family carers when people with psychosocial disability have individualised funding packages.
This literature review examined the impact of individualised funding on family carers of people with psychosocial disability. It was conducted in the context of the National Disability Insurance Scheme (NDIS) being rolled out across Australia as individualised funding is becoming the dominant funding mechanism in disability and aged services. The presentation will provide an overview of the key themes and findings. It is vital for consumers and carers to have up to date information as we progress to an NDIS.
The overall findings from the literature were that individualised funding programs resulted in better outcomes compared to traditional block funded service provision for carers and participants and had no adverse effects when conditions were conducive. That is, there was adequate funding and assistance. However, they presented challenges to family carers when carers had to ͚fill in the gaps͛ and provide support when funding was inadequate or when they were expected to shoulder the burden of managing administrative responsibilities without adequate support.
Funding for family carers
Individualised funding programs typically assess a person’s needs and this assessment determines their allocated funding. It was found that assessments of carer need, in practice were rarely taken up. The reasons for this appear to be a combination of staff not being aware of carers͛ needs, family carers either refusing the offer or not asserting their rights and asking for an assessment, and carers not knowing this opportunity existed. Family carers need education about assessment processes and planning meetings so that they can use these processes effectively for the benefit of their family member and themselves.
A range of benefits was identified for family carers involved with individualised funding when outcomes were compared to traditional service provision: Carers benefitted when individualised funding provided more choice, control and flexibility with services and supports. Carers often benefited when their family member’s quality of life improved. For example, they gained respite when their family member had activities or a holiday, and when they shared the same residence and domestic assistance was provided. In addition, carers had ͚flow-on͛ benefits when their family member had improved outcomes such as spending less time as a psychiatric inpatient, having fewer criminal justice contacts, being less stressed, gaining confidence and getting a job.
Studies identified that many carers and participants found the administrative responsibilities onerous when they were required to recruit and direct support workers, manage taxation and insurance requirements, find services and activities and acquit financial accounts. This discouraged some carers from promoting self-managed programs or the use of individualised funding to their family when they were optional. Coupled with this concern was that of not having sufficient funds. This resulted in people being unable to purchase necessary supports and services or purchase administrative assistance when required. Austerity measures in some countries have cut people’s budgets and left them with insufficient funds to purchase necessary supports. These cuts are particularly concerning in individualised funding programs because there are no disability services with block funding available to support people in times of crisis.
Dr Carmel Laragy - Research Fellow, The Centre for Mental Health, University of Melbourne
Dr Carmel Laragy is a Research Fellow for The Centre for Mental Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne. Carmel for the past 15 years has studied the introduction of individualised funding programs in disability and aged care services. She has published internationally reports of her studies and observations of individualised funding programs – these include a focus on program design and supports offered, strategies staff and service users adopted to transition to this new service design, the outcomes achieved and the challenges faced. Carmel drew on her extensive background experience to research and write a literature review on the implications for family carers when people with psychosocial disability have individualised funding packages.
Frances Sanders - mind Australia
Dr Lisa Brophy - University of Melbourne
Living independently and being included in the community – the ndis and advocating for human rights.
Under section 15 of the Guardianship and Administration Act 1986, one of the functions of the Public Advocate is to “promote, facilitate and encourage the provision, development and co-ordination of services and facilities provided by government, community and voluntary organisations for persons with a disability with a view to promoting the development of the ability and capacity of persons with a disability to act independently”.
The Public Advocate has a strong interest in the state of community mental health support services (CMHSS) and is gravely concerned about the future of these services as Victoria moves towards the full implementation of the NDIS. We have already seen the impact on CMHSS consumers in the trial site and the inaccessibility of the NDIS for many mental health consumers.
VICSERV and its partners have called for urgent action to continue to support people with a mental illness, saying that “without the articulation of a clear vision and commitment to implementing a policy framework and process for retaining the most comprehensive mental health system in Australia, Victorians living with a mental illness, their families and services, are facing a future of serious risk”.
The Public Advocate’s position is that the State Government must take on an integral role as systems manager for community mental health services, monitoring the impact of the transfer of responsibility for community mental health service provision to the NDIA. We have argued for no net loss of services for mental health consumers in the transition to the NDIS. Fundamental to this position is that, without access to rehabilitation services in the community, many people with serious mental illness will struggle to live independently and participate in the life of the community.
Many consumers, carers, agencies and services are undertaking advocacy on this issue. The United Nations Convention on the Rights of Persons with Disabilities is a tool can help to support this systemic advocacy. Elsewhere in the disability landscape, Article 12 has had a significant impact on the supported decision-making movement. Could advocates in the Community Mental Health arena utilise Article 19, “Living independently and being included in the community” to strengthen advocacy efforts around community mental health services? In this paper, I will talk about the relevance of the rights articulated in Article 19, which include having a choice of where to live, access to personal care, residential and other community support services necessary to support living and inclusion in the community.
Liz Dearn - Coordinator Policy and Research Unit, Office of the Public Advocate
Liz Dearn started working life in residential rehabilitation services in the early days of deinstitutionalisation and has maintained a strong interested in mental health services throughout their working life. Since working at the Office of the Public Advocate, Liz has had portfolio responsibility in the mental health area. This has entailed systemic advocacy in all areas of mental health reform including legislative and policy reform in Victoria. Liz was instrumental in the ͚long stay patient project͛, a Community Visitors initiative, that raised the issue of consumers in mental health secure extended care units, who had spent up to twenty years of their lives in these facilities due to a lack of suitable accommodation and support being available in the community. Liz is currently working on a position paper for the Public Advocate to inform OPA͛s position on mental illness, human rights and the NDIS.
Human support groups - lets embrace them!: re surrecting a fundamental necessity in the mental health system.
The mental health reform framework of 2013 to 2014 which saw Psychiatric Disability Rehabilitation & Support Services (PDRSS) become Mental Health Community Support Services (MHCSS) also saw the demise of many group activities that consumers participated in.
Time limited, closed groups have continued with a focus on psycho education, I do not wish to take away from these groups as they provide a needed and beneficial service. Yet the overwhelming response through surveys, forums and in speaking with individuals across all areas of the mental health system is the need to have open, ongoing groups with no fixed agenda.
Mentis Assist saw the value in groups and made a commitment to continue facilitating two groups, being the Peer Support Group and Hearing Voices Group. This was achieved by partnering with the local Community House which provided the space to run the groups at a very low cost. Mentis Assist Peer Services Coordinator facilitates the groups and the Community House takes responsibility for managing the groups.
The benefits to those who attend these groups is that the relationship between members is based on equality, reciprocity and mutuality. In Sheri Meade’s words:
“essentially the relationship is as equal as it can be and both parties learn from each other in a process of mutual learning and growth based on shared expertise and a departure from the re-enactment of past roles.”
This creates a space that is welcoming and accepting, it reduces isolation and is an environment in which a person can safely explore their experiences and explore new ways of being that may enhance their recovery.
Studies have shown that this type of social support:
- Increases a sense of control and ability to bring about change in one’s life
- Increases a sense of hope
- Increases self-esteem and self-efficacy
- Increases the ability to engage in treatment
- Increases positive feelings towards oneself and one’s family/friends
- Increases a sense of community and belonging
- Decreases hospital admissions and use of emergency services
- Decreases symptoms of mental illness including symptoms of psychosis.
When we look at not holding social support groups, we see a large population of those experiencing mental distress living with increased isolation and the opposite to the benefits as tabled above.
The group members of the Peer Support Group and the Hearing Voices Group assist each other in areas that previously a Mental Health Outreach Worker would fulfil, they provide a space for people to be heard, a space to learn, a space to laugh and a space to grow. It is a human space that allows the discovery of meaning in one’s life beyond the symptoms of mental distress.
The Peer Support Group is now in the process of forming a Music Group and an Art Group, both will encompass all the benefits of peer support with the added opportunity to utilise skills and impart knowledge in these areas to others.
Sherie Stiefler - Peer Services Co-ordinator, Mentis Assist
Sherie Stiefler is the Peer Services Coordinator for Mentis Assist, MHCSS. Sherie commenced with Mentis Assist (previously Peninsula Support Services) as a volunteer in 2011 supporting the outreach team. In 2012 Sherie moved to a paid position within the Rehabilitation Team and became Team Leader in 2014 until the recommissioning saw the closure of that program.
Sherie then moved to the outreach program as a Mental Health Practitioner before her current role of Peer Services Coordinator. Sherie has a lived experience of mental illness and service engagement and is currently involved in assisting to educate those entering the mental health field. She is one of 30 people Australia wide who qualified as a Champion of Mental Health Peer Work and is trained to deliver the Cert IV in Mental Health Peer Work.
Sherie is currently on the Victorian Mental Illness Awareness Council (VMIAC) Committee of Management and a passionate advocate for social justice and human rights within the mental health system. Sherie is also a qualified Reiki Master and Level 2 Reconnective Therapist.
Recovery co-design and peer workforce development in clinical services.
Part 1 - My Recovery Story: A youth peer perspective on recovery from Schizophrenia
In this presentation a co-design and co-delivery approach will be shared both in the narrative shared and who tells the story – whose voice is given primacy. A young person of Vietnamese/Chinese heritage in active recovery from Schizophrenia would like to take this opportunity to, with a clinician chosen by the consumer to join her, discuss aspects of importance in recovery.
This consumer has elected to consider themes in the recovery journey so far: strengths to be drawn upon – both personal and in the environment – and challenges and barriers to be noted, considered, explored, and worked with. Issues of cultural sensitivity will be considered. Issues of developmental age and life stage, and competing needs to be emotionally held by family and yet also independent in choice and preference, will be considered. This is a reflection that includes physical health challenges, social anxiety challenges, and challenges in acquiring new skills around managing budgets, home duties and responsibilities. This is a reflection that includes a renewed appreciation of personal skills such as being friendly, good at mathematics, reliable and competitive. This is a reflection on what it means to a person, and what impact stays with a person, as the result of multiple inpatient admissions across 7 years, between the ages of 14 and 21.
Part 2 - Peer workforce development in the acute inpatient setting
The National Standards for Mental Health Services highlights that delivery of care should take an overall recovery-oriented approach and include the involvement of consumers in development, delivery and evaluation of services. Practices and principles for specialist mental health services have been further defined by the Department of Health in the Framework for recovery-oriented practice, identifying the importance of incorporating recovery values and a peer support workforce. St Vincent’s Hospital (Melbourne) is thus currently implementing recovery-oriented practice and development of a Peer Workforce. We would like to talk about how an initiative was established in the acute inpatient setting: Reducing Restrictive Interventions– using a Peer Worker role as central to the innovation.
Reducing Restrictive Interventions
In 2013 preparations were made at St Vincent’s Hospital (Melbourne) to reduce seclusion rates in the form of a pilot study looking at admission data and seclusion rates. It was found that half of people who were admitted via the emergency department (ED) were first time admissions and half of those people experienced seclusion. For many it was within the first four hours of admission. Stemming from this the Pre Admission Liaison (PAL) team, comprising of a peer worker and a mental health nurse, was developed whereby this team would visit people in the ED once they had been assessed. These visits aimed to explain the process of transferring to the Acute In-Patient Service (AIS), to introduce a peer worker and a nurse so they would have familiar faces, offer sensory modulation to make them more comfortable and more connected to reality, and to have a conversation to help the person feel safe and supported. It was suggested that by the time they did come to the ward they would be less agitated and hopefully would not require seclusion. Consumer feedback must be considered, and thus this study is based on surveys conducted by the peer worker and completed by those experiencing a transfer from the emergency department.
Dr Melissa Petrakis - Senior Research Fellow, Mental Health, St Vincent’s Hospital (Melbourne) and Senior Lecturer, Department of Social Work, Faculty of Medicine, Nursing & Health Sciences, Monash University
Copresenters part 1
Gloria Banh, consumer
Meagan McNamara, RPN Educator, Mental Health Acute Inpatient Service, St Vincent's Hospital (Melbourne)
Copresenters part 2
Liam Buckley, Peer Worker/Consumer Researcher, St Vincent's Hospital (Melbourne)
The mental health act peer support worker: exploring legislation through the lense of lived experience.
In October 2014, the Inner West Area Mental Health Service created a new and innovative role, "Mental Health Act Peer Support Worker", in response to the new legislation. It is a consumer peer support position that aims to inform and support both consumers and staff about the changes in the Act. The worker, Martin Janssen, uses his own lived experience to inform his practice. Martin hopes to present his role and the research gathered around it.
The MHA PSW has co-designed two groups for the John Cade Unit (psychiatric inpatient setting) with the local Mental Health Tribunal Co-ordinator, that continue to develop from participant's feedback. They are 'Knowing Your Rights' and 'Writing an Advance Statement and Choosing a Nominated Person'. The groups commenced December 2014 and run weekly with alternating topics. They will be the focus of this presentation - their purpose, structure and the feedback results (which have been overwhelmingly positive) will be covered.
The groups highlight to participants key rights they have that apply both to their current inpatient setting and post-discharge, and encourage self-empowerment to act upon them. The role resonates with Victoria's 10 year Mental Health Plan that has a 'a strong commitment to upholding the human rights and dignity of all people' (DoHS, 2015, pp 12), as well as the Roadmap for National Mental Health Reforms Priority 5: Improve access to high quality services and supports (CoAG, 2012, pp 26) by delivering information about Rights related services such as Victorian Legal Aid and the Mental Health Complaints Commissioner.
The inpatient groups are peer led by the MHA PSW, with the local occupational therapist providing additional assistance in recruitment, managing group dynamics and providing staff perspective. A key structural element throughout the groups is the MHA PSW providing contextual lived experience. This develops peer rapport and connection, first hand examples and hope. It opens up a (primarily) recovery focused peer space where people can reflect on their past, current situation and actions for the future.
The extension of the role will also be explained. The MHA PSW has also:
- Presented the group content at the Norfolk Terrace Community Care Unit and the ARION PARC.
- Provided individual support in the community, supporting consumers to complete Advance Statements.
- Delivered training to staff, and co-developed local MHA related material. Through this the MHA PSW has contributed to ensuring the ethos of the Act and its specific functions are embodied by the organisation.
- Liaised with external organisations such as Independence Mental Health Advocates, Department of Human Services and Co-Health.
It is IWAMHS' hope that other services consider implementing similar roles, such as facilitating their own Mental Health Act focused groups either in the inpatient or community, and incorporate Mental Health Act principles at all levels.
Martin Janssen - Consumer Peer Support Worker, Melbourne Health and Neami National
Martin Janssen is a consumer peer support worker at Inner West Area Mental Health Service and Neami Abbotsford. Martin leads an innovative role at IWAMHS, the Mental Health Act Peer Support worker, and also co-facilitates PeerZone there. At Neami Martin co-facilitates Flourish, and is the site consumer participation portfolio holder. Martin has been involved in a peer support pilot project and a peer led music group at Northern Area Mental Health Service, as well as a range of consumer consultation work at North West Mental Health. Martin’s consumer work spans over five years in a variety of community and inpatient settings. Martin is passionate about supporting consumers on their recovery journey, and draws upon his own lived experience to do this.
DOWNLOAD MARTIN'S PRESENTATION:
Expanding the peer workforce.
The introduction of the consumer workforce is the biggest change that has affected the mental health sector in recent years. There is abundant literature on the value of ͚lived experience͛ when delivering services within this area. There are, however, only a handful of local studies on experiences of recruiting and sustaining a thriving peer workforce.
Mind Australia recently lead a project ͚Expanding the peer workforce͛ to explore how it can sustain a thriving peer workforce. The project reviewed existing policies, procedures, and practices. Various mechanisms were used to evaluate practices such as surveys, organisation-wide workshops as well as targeted interviews in collaboration with external consultants.
This presentation will discuss the processes and findings from this project and cover:
- What are the key ingredients for attracting and retaining peer support workers?
- Are peer practitioners clear on their roles and responsibilities?
- What training do managers need in order to best support peer support workers?
- What have we already done and what do we need to do regularly to keep the peer workforce thriving?
- What does the organisation need to do to ensure sustainability and growth of key communication and initiatives across our peer workforces?
Erandathie Jayakody - Team Leader Consumer Engagement Unit, Mind Australia
Erandathie Jayakody is the Team Leader, Consumer Engagement Unit at Mind Australia. She provides peer supervision, including peer reflective practice, to peer support workers at Mind.
HEALTH AND WELLBEING
We don’t talk about it.
The mental health service utilisation of Arabic-speaking communities in Australia is much lower than in their English-speaking counterparts despite evidence that levels of psychological distress are higher. Differences in cultural language, or explanatory models of mental illness, between Westernised health professions and their multi-cultural clients, has been shown to create a gap in understanding that contributes to service under-utilisation.
The current study employed a social constructionist framework to explore the particular cultural language of mental illness of Arabic-speaking Australians. Semi-structured interviews with ten second-generation Arabic-speaking Australians were audio-recorded, transcribed verbatim and analysed for themes. The three themes demonstrated a powerful need to be perceived as normal, influenced by the experience of being a new migrant and the tenets of a collectivist culture. Situational explanations of mental illness, somatisation of symptoms and the role of religion as an explanation of cause and cure were ways to normalise the perceived abnormal experience of mental illness.
The findings of the current study speak to the need for mental health professionals working with Arabic-speaking Australians to be aware of the nature of the stigma associated with mental illness among this cohort. Mental health education for religious and community leaders with an emphasis on normalising mental illness could also encourage and facilitate help-seeking behaviours among Arabic-speaking Australians.
This presentation outlines the findings of this study which speak to several of the VICSERV 2016 concepts, in particular, that of Empowerment/Rights. Mental health services in Australia operate under the National Framework for Recovery-Oriented Practice that promotes the right of individuals to represent themselves and their experiences through their own individual understanding.
The framework emphasises the critical importance of the use of words and language in talking about mental health in the shaping of how people see themselves, describe themselves and make sense of their experiences. Without a willingness to bridge the cultural language gap between health practitioners and Arabic-speaking Australians it is difficult to achieve recovery-oriented practice.
The presentation of the findings of this study offer ways in which practitioners can better foster recovery-oriented practice with Arabic-speaking Australians.
Brooke Smith - Researcher, Charles Sturt University
Brooke Smith was the recipient of a Charles Sturt University Honours Scholarship and received first class Honours in psychology in 2015 for her research into how Arabic-speaking Australians perceive and understand mental illness. Brooke received her undergraduate degree (BPsych Sc) from the University of New England in 2013. For the past two years she has been a team leader with the Western Sydney Partners in Recovery Program, in a region with the highest CALD population in NSW, working with consumers with severe and persistent mental illness with complex needs. Previously Brooke worked as a regional coordinator for the Compeer Program, working to reduce social isolation for people with severe and persistent mental illness.
Engaging the chinese community to reduce stigma and support the recovery and empowerment of consumers and carers: processes and initial outcomes.
Stigma and misunderstanding of mental illness within the Chinese community is well documented and has been established in the culture over many hundreds of years. Entrenched attitudes can create significant barriers to those living with a mental illness with regard to seeking treatment. Such attitudes can discourage families from talking about illness, and families can be extremely reluctant to seek any form of mental health support for themselves or loved ones. K. F. Chung and M. C. Wong (2004), in Experience of stigma among Chinese mental health patients in Hong Kong concluded that:
“The most frequently reported coping method was maintaining secrecy about the illness”.
Working with the Chinese community, Mental Illness Fellowship has previously developed and delivered translated, culturally-specific versions of the award-winning peer-led WellWays Family Education programs for the Chinese community.
This presentation at VICSERV aims to share the establishment phase, processes and initial outcomes from an innovation project – with funded awarded through the Department of Health Partners in Recovery (PIR) initiative – to increase the social connectedness and engagement in community of Chinese consumers and carers, while reducing the stigma of mental illness within the Chinese community. The project is explicitly targeted toward people who are not engaged in the service system or their community. All activities engaged in are culturally relevant and have been determined through stakeholder input, are occurring in the community, and are being investigated pre and post with academic input to support a robust evaluation.
It is our pleasure to bring an instructive presentation on key challenges, how to overcome these, successes, initial outcomes and future plans at the mid-point of program delivery. We are especially excited – given the theme of this 30th anniversary conference – to bring a co-developed and co-delivered presentation with consumer, carer and Chinese community staff and participant input.
Justin McKenzie - Regional Manager, Inner East, MI Fellowship
Cory Haugh - Partners in Recovery Manager, MI Fellowship
Dr Melissa Petrakis - Senior Research Fellow, Mental Health, St Vincent’s Hospital (Melbourne) and Senior Lecturer, Department of Social Work, Faculty of Medicine, Nursing & Health Sciences, Monash University
Strengthening the consumer voice: the loddon campaspe southern mallee consumer participation group (cpg).
The CPG is a group that comprises of mental health consumers, along with clinical and community services staff, that works to build better mental health services together.
The CPG conducted a review of its function that was focused on strengthening the consumer voice, both internally within the CPG and also through external consumer networks.
The recommendations from this review were implemented in 2015, and made a significant difference in ensuring that consumer voices are heard. The learnings from this project would be beneficial for any organisation looking to create or enhance their consumer participation, especially in areas such as the implementation of the NDIS and mental health reform.
This presentation will focus on the CPG and inform participants on:
- An overview of the review of the CPG and the importance of focusing on strengthening the consumer voice.
- The structure of the group; how the group ensures that the voice of the mental health consumers is heard and valued with the clinical and community mental health services,
- The processes for co-design that the CPG has established for engagement with local clinical and community services, and how it has ensured that requests for consumer participation and consultation are meaningful and purposeful.
The model, developed by the CPG engages service providers to work alongside mental health consumers for the benefit of enhancing and improving their mental health service provision. 3 tiers of membership were implemented; full consumer members, associate consumer members and network members. The full members carry ultimate decision making authority, reflecting the importance of the consumer voice within the group.
A further innovative approach of the CPG is to include distinct consumer-only and also partnership time within the meeting structure to ensure that consumers are granted the opportunity to discuss matters amongst themselves and also to enable full discussion of relevant matters between service providers and consumers. The model has been recognized by Jackie Crowe, National Mental Health commissioner as "Innovative, collaborative, positive, respectful and fun ... a group that focuses on strengths and innovates to achieve outcomes".
Co-design & Peer Led
At the heart of the redesign of the CPG was the ambition to create a consultative group that was truly consumer led and driven, with the necessary partnerships to deliver change. The group aimed to support the development of best quality mental health service provision through partnerships and collaborations between consumers and service providers.
At all times the 'strengthening the consumer voice' project was consumer-led, from the formation of the concepts to the development and implementation of the model. Service provider partners were instrumental in supporting the consumer members to deliver the new CPG.
Participants from organisations that are looking to create, or enhance their consumer participation process, or consumer/carer groups wanting to strengthen their voice in their local area will gain valuable information about how to achieve this, along with the learnings that have come from this process.
Jodie Rasmussen - PIR Project Co-ordinator, Murray Primary Health Network