REFRAMING MENTAL HEALTH: A NEW STATE OF MIND€¦ · REFRAMING MENTAL HEALTH: A NEW STATE OFmergers MIND It is a taster for those of you attending the conference and an opportunity

THE AUSTRALIAN JOURNAL ON PSYCHOSOCIAL REHABILITATION Autumn 2012

REFRAMING MENTAL HEALTH: A NEW STATE OF MIND

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PsychiatricDisabilityServicesofVictoria(VICSERV) Level2,22HorneStreet,ElsternwickVictoria3185Australia T0395197000,F0395197022 [email protected] www.vicserv.org.au

Editorial Team WendySmith,Editor KristiePate,EditorialAssistant AntheaTsismetsi,ContentAdvisor

newparadigm Editorial Advisory Group JoanClarke,AllanPinches,ChrisMcNamara,EllieFossey.

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PsychiatricDisabilityServicesofVictoria(VICSERV)hasaneditorialpolicytopubliciseresearchandinformationonprojectsrelevanttopsychiatricdisabilitysupport,psychosocialrehabilitationandmentalhealthissues.Wedonoteitherformallyapproveordisapproveofthecontent,conductormethodologyoftheprojectspublishedinnewparadigm.

ContributorsWeverymuchwelcomecontributionstonewparadigmonissuesrelevanttopsychiatricdisabilitysupport,psychosocialrehabilitationandmentalhealthissues,buttheeditorretainstherighttoeditorrejectcontributions.

CONTENTS

EDITORIAL WendySmith 04

REFRAMING MENTAL HEALTH: A NEW STATE OF MIND A message from the Minister for Mental Health HonMaryWooldridgeMP 06

A new story for a new leadership MaryO’Hagan 08

Reframing community managed mental health KimKoopandWendySmith 11

Managing a merger ArthurPapakotsias 14

RESEARCH National psychosis survey: mapping use of services ProfessorVeraA.Morgan 30

YOUR SAY… Member profile PrahranMissionUnitingCare 38

Expression Session 41

Book Review 45

ABOUT US… 46

Peer support: an integral part of mental health services AnneWickingandFrancesSanders 18

Doorway: creating a home, building lives EmmaLadd 21

Recovery orientation: effective implementation through the use of coaching IanOliverandAlexCouley 24

Q&A: Equal pay for community sector workers LaurenMatthews 27

04newparadigm Autumn 2012

Psychiatric Disability Services ofVictoria(VICSERV)

Wendy Smith, PolicyandResearchmanager

EDITORIAL

WelcometotheVICSERVReframingMentalHealth pre-conferenceeditionofnewparadigm.

REFRAMING MENTAL HEALTH: A NEW STATE OF MIND

Itisatasterforthoseofyouattendingtheconferenceandanopportunitytoengagewiththeleadingedgethinkingthatwill beonshowforthoseofyouwhocan’tmakeit.WearedelightedtohaveasourleadarticleamessagefromtheVictorianMinisterforMentalHealth,theHonMaryWooldridgeMP.Initsheoutlinesthegovernment’snewreformframeworkforthecommunitymanagedmentalhealthsector.MinisterWooldridgewillmakeanaddresstotheconferenceabout thereframingofmentalhealthtobettermeettheneedsofindividualswithcomplexneeds,theirfamiliesandcarers.

Althoughshecan’tbewithusinperson,oneofVICSERV’sfavouritethoughtleaders,MaryO’HaganfromNewZealandagreedtowriteforthisedition.Herpiececallsonustoreframetheold‘fadinglifechances’storyofmentalillness thatshewasgivenasayoungwomantoastorythatframesmadnessasaprofoundlyhumancrisisofbeingfromwhich wecanderivevalueandmeaning.Sheasks,’howdowegenerateanewstoryofmadnessthatmostpeoplesignup to?’Theanswersareinspiring.

VICSERVCEOKimKoopandIhaveco-authoredanaccountofthedevelopmentofapaperthatrecommendsaprogramofreformforthecommunitymanagedmentalhealthservicesinVictoria.TheAgenda for the futureisVICSERV’Smajorstrategicandadvocacypolicy.Itwasdevelopedwithandonbehalfofourmembers.ItwillguideourworkforthenextthreetofiveyearsandinformourresponsetotheVictorianGovernment’sPsychiatric Disability Rehabilitation and Support Services Reform Framework.

NeamiCEOArthurPapakotsiashaswrittenanaccountof therecentmergerbetweenNeamiandanothercommunitymanagedmentalhealthservice.Itprovidesgreatinsightinto theprocessthatwasinvolvedandthelessonsthatwere learnt.ArthurandMindAustraliaCEOGerryNaughtinwillbe

presentingattheconferenceontheirexperiencewithsuccessfulmergersandthebenefitsforconsumers,carersandstaff.

Oneoftheconferencesub-themesisconsumerleadershipandwillfeatureadiverserangeofspeakersoninspirationaltopics.TwoCEOsfromtheMutualSupportandSelfHelpNetwork,AnneWickingandFrancesSandersmakeacompellingcaseinthiseditionfortheroleandimportanceofpeersupportinthereformprocess.Housingandhomelessnessisanotherconferencesub-themeandEmmaLaddfromtheMentalIllnessFellowshipofVictoriaintroducesanexcitinginnovationinprovidinghousingandsupporttopeoplewithamentalillness.TheDoorwayprogramwillbeshowcasedattheconference.DouttaGallaCommunityHealthServiceisoneofanumberoforganisationsthatareusingtheCollaborativeRecoveryModel(CRM).Readhowtheyhaveincorporatedthemodelintostaffcoaching.

Theequalpaycaseforcommunityworkershasgeneratedgreatinterestforthosewhowillreceivethepayriseandforthosewhowillfundit.WearepleasedtohaveananalysisfromVCOSSonhowitcameaboutandwhatitmeansforthecommunitysector.

Oneofthemostsignificantpiecesofmentalhealthresearch inrecentyearsisthe2010Survey of high impact psychosis. Itis10yearssincethelastsurveyandwhiletherehavebeenimpressiveimprovementsinsomekeydomainsofeverydaylife;inequalityandsocialexclusionisstillafeatureofthelives ofpeoplewithapsychoticillness.ProfessorVeraMorganpresentssomeofthesurveyresultsinourresearchsection.

Asalways,Iamextremelygratefultoallthecontributors whomakeupthisedition.newparadigmprovidesarecord ofachievementandaspirationswhichisespeciallyvaluable asthesectorentersaperiodofmajorreform.



An Agenda for Change – reforming Victoria’s Psychiatric Disability Rehabilitation Support Services

TheVictorianCoalitionGovernment’sreleaseofamajorconsultationpapertodrivereformofstate-fundedPsychiatricDisabilityRehabilitationSupportServicesmarksthefirststageof anexcitingandchallengingperiodofchangedesignedtodeliverbetteroutcomesandmoretargetedandaccessibleservicesforpeoplewithseverementalillnessandtheircarersacrossVictoria.

Victoriahasadiverseandvibrantcommunity-basedmentalhealthsectorandtheVictorianCoalitionGovernmentseestheseservicesasavitalpartofthementalhealthsystem.

Morethantwodecadesfollowingthede-institutionalisation ofpeoplewithamentalillness,moreandmoreVictorians withamentalillnessarebeingsupportedtoliveinthecommunity.Thischangehasseencommunitiesdevelopagreaterunderstandingofandresponsibilityformentalhealth.

Asgovernmentswitnessthepositiveoutcomesofde-institutionalisationandcommunitybasedmentalhealthcarethereisalwaysaneedtocontinuetoimproveandevolve.

Inmanyways,de-institutionalisationwassuccessfuldueto thestrengthandfundamentalroleofVictoria’scommunitybasedmentalhealthservices,ormoreformally,thePsychiatricDisabilityRehabilitationSupportServices(PDRSS).WithoutthededicationandcommitmentofourPDRSSsector,mentalhealthcareinVictoriawouldbeinaverydifferentplace.

TheStategovernmentspendsmorethan$100million eachyeartosupportmorethan14,000Victoriansthataresupportedbyover100communitybasedmentalhealthservices.Thissupportcanalsobeintheformoflinkingpeopleintohousing,employment,educationandfamilysupport– allofwhichcontributeinabigwaytoassistingsomeone intheirpathofrecoveryandre-buildingtheirlives.

Asourrelianceonourcommunitybasedmentalhealth sectorcontinuestogrow,governmentsmustcontinuetocreateopportunitiesforinnovation,growthanddevelopment.Individuals,familiesandcarerswanthigherqualityservices thataremoreflexible,individuallytailoredandresponsive.

TheCoalitionGovernmentwantstoworkinpartnershipwithVictoria’sPDRSSsectortoreformandbuildsustainableandstrongcommunitymentalhealthservicesforthefuture.

EmbarkingonacomprehensivereformagendaacrossasectoraslargeanddiverseasthePDRSSisnotsomethingthatwedo

The Hon Mary Wooldridge MP, MinisterforMentalHealth

lightly.Weareconfidentthatthesectorisresilientandreadytoembracethechallengeandbecomestrongerasaresult.

Itisoftenwhenaparticularservicesectorhasreacheda criticalpointinitsgrowthandsuccessthatreformismostneededandthattheopportunitiesforbenefitaregreatest.ThatisnowthecasewithourPDRSSsector.

TheCoalitionGovernment’sconsultationpaperPsychiatric Disability Rehabilitation and Support Services Reform Framework seeksyourviewsonhowwecanachieveourvisioninreshapingcommunitybasedmentalhealthservices toensurebetteroutcomesforpeoplewithamentalillness.

Adhocinvestmentbygovernmentsovertimehascreatedanunsustainablesituationwithmanyagenciesunabletoprovideadequatechoiceandflexibilityforindividualsandfamilies.

Attheheartofourreformagendaistheneedtooffera moreconsistent,flexible,tailoredsetofsupportsthatmeet theneedsofindividualsandfamilies.Thismustincludeasharperfocusonbothindividualgoalsandkeyaspectsof socialandeconomicparticipation.

Inordertoachievethis,thereformprogramwillworksimultaneouslyonthreelevels.

First,wewillworktoenhancethecapacityoforganisations sotheyarestrongerandmoresustainable.ThismeansinvestinginthePDRSSworkforce,deliveringbettergovernanceandimprovingaccountabilityaroundoutcomes ofclientsaccessingservices.

Second,wewillremodelprogramssothattheyareflexibleandencourageinnovationandchoiceforpeopleaccessingservices.Wewantprogramsandservicesthatareeffective,

workinacoordinatedwaywiththefullrangeofotherhealthandsocialservicesandareresponsivetotheindividualneedsofapersonwithamentalillness.

Finally,wewillstreamlineservicessothattheyareofahigherquality,accessibleandmoreefficient.Weneedtoinvestinbuildingasystemthatisabletomeetthegrowingnumberofpeoplewhowillaccesscommunitybasedmentalhealthcare.

Thisisnotanagendathatgovernmentcanorshould pursuealone.Theoutcomesweseekwillonlybeachievedthroughclosepartnershipwithdeliveryagenciesandotherstakeholders.Iverymuchlookforwardtoworkingwithawiderangeofparticipantsinthissector.Iamparticularly keentohearfromserviceusers,theirfamiliesandcarers aswereshapethewaycommunitybasedmentalhealth carelookslikeinVictoria.

OurpartnershipwithVICSERViscriticaltothisagenda. IcongratulateVICSERVfortherecentreleaseofitsowndiscussionpaperonthechallengesforthecommunity-managedmentalhealthsector.Thatpapersharesmanyconclusionsofthegovernment’spaper.Thisbroadconsensus ondirectionsetsasoundbasefortheworkahead.

Thiskindofreformisnoteasy.TheCoalitionGovernmentiscommittedtoanopen,transparentandconsultativeapproachateachstage.Iamconfidentthattogetherwecanachieveanevenbetter,strongersystemofcommunity-mentalhealthsupportservices.

08

Theleadershipofpeoplewithlivedexperiencein theirownrecovery,inservicedeliveryandinthewidersystemisjustaside-show,whilethedarkdramaofadisempoweringandhope-sappingmentalhealthsystemplaysontofullhousesofcaptiveconsumersyearafteryear.

The old story

WhenIusedmentalhealthservicesasayoungwoman Iwasgivena‘pillsandpillows’serviceanda‘fadinglifechances’story;theideathatpeoplelikemecouldleadin anysenseofthewordwasasunimaginableasgaymarriage ordownloadingamovie.Mostofmypaidhelperswere goodpeoplewhotriedtohelpmebutfailedbecausetheyapproachedmewithadepletingblendofpessimismandpaternalism.Theyviewedmeaschronicallydisabled byachemicalimbalanceinmybrain.Noneofthemacknowledgedmystrengthsortheskillsandwisdom mylivedexperiencegaveme.Noneofthemevertoldme Icouldgoontoliveafulllife.Myonlyrolemodelswerepeoplelikemewhoseliveswereconsumedwithcrisesandhospitaladmissions.Idon’trecallanymentalhealthworkersopenlyacknowledgingtheirlivedexperience.Idon’trememberanymentalhealthworkersaskingmeifserviceshelpedme.Itdidn’toccurtomethatpeoplewithlivedexperiencecouldruntheirownservicesorsupportnetworks.

Howthingshavechangedinthelast20or30years.Wenowhaverecovery,peersupport,consumer-runorganisations,consumerparticipationpolicy,andconsumersworkinginmanagement,research,trainingandpolicy.There’sacatchthough–thesedevelopmentshaveaffectedveryfewconsumers’lives.Manydon’tknowaboutrecoveryortheirrighttoparticipation.Veryfewhaveaccesstopeersupportorhaveheardoftheconsumermovement.Manyarestilldisempowered,miredinan‘illness’identity,stuckinservices,andmarginalisedinthecommunity.

Theexplanationforthisisobvious:theleadershipofpeoplewithlivedexperienceintheirownrecovery–inservicedeliveryandinthewidersystem–isjustaside-show,whilethedarkdramaofadisempoweringandhope-sappingmentalhealthsystemplaysontofullhousesofcaptiveconsumersyearafteryear.Peoplewithlivedexperience,thementalhealthsystemandwidersocietyneedtoco-directanewplayforthemainstageinwhichpeoplewithlivedexperiencearetheprotagonistswiththemostquotedlines,ratherthanthevictimsorthevillainslurkingoff-stage.

Mary O’Hagan, Internationalconsultantinmentalhealthandrecovery

A new story for a new leadership

A new story

Atthemostfundamentallevel,thenewproductionneeds totellastoryaboutmadnessthatreleasesprofessionalsfromthe‘fadinglifechances’story,andcommunitiesfromtheirprejudiceandfear.Ithastobeastorythatframesmadness asaprofoundlyhumancrisisofbeingfromwhichwecanderivevalueandmeaning.Thereisanarchetypaltemplate forthistypeofstorywhichthemythologistJosephCampbellcalledthe hero’s journey.Hefoundthat,inthestoriesofmanycultures,theheroesdepartfromtheworldtheyknowandbecomelostinaperilousplacewheretheyfacemanyteststhatstretchtheirresourcestothelimit.Theyeventually findtheirwayoutofperilwithwoundsbutalsowithnewknowledgeandskills,thenmakethearduousreturnjourney totheknownworld,wheretheyusetheirlearningtomake anewcontribution.Theheroleadstheirownjourneybutsomeonewhohasbeensubjectedtothefadinglifechancesstoryhasnothingtolead.Aheroneedsempowermentandresourceswhereassomeonewithfadinglifechancemerelyneeds‘maintenance’supportsor‘palliative’care.It’seasytoseethatthestorywetellaboutmadnesshashugeimplications forthewaywerespondtoit.

Anewstorywouldenableustotakeonnewrolesandidentities.Itwouldgivepermissiontopeoplewithlivedexperiencetoleadtheirownrecovery–tobeactiveagents intheirlivesratherthanpassiverecipientsoftreatments,servicesandpoorprognoses.Itwouldtakementalhealthworkersoutofthedriver’sseatwheretheyhabituallysteer,controlanddothingsforpeople,intothepassengerseatwheretheyhavetolearntosimplynavigateandsupport. Attheindividuallevel,mentalhealthworkerswouldgiveprioritytoearningtrustanddevelopingcollaborativerelationshipswithconsumersratherthanignoringtheirhumanity,erecting‘professionalboundaries’,orhabituallyresortingtocoercion.

Anewstoryalsowouldhavehugeimplicationsforthedistributionofpoweratalllevels–awayfromdecisions andresourcesdominatedbyprofessionalsandmanagerstowardsthepeoplemakingthehero’sjourney,whoneed alltheempowermenttheycangettocompleteit.

Attheserviceorsystemlevelahero’sjourneystory wouldshowustheimportanceofdemocratisingour servicesandsystemssothatpeoplewithlivedexperiencewouldhaveagenuinevoiceindecisionmakingand resourceallocation.Anewstorybasedonthehero’s journeywouldencouragethementalhealthsystemto employmanymorepeoplewithlivedexperiencein allkindsofroles–aspeerworkersandasbureaucrats,managers,academicsandprofessionals.

Anewstorywouldgivethementalhealthsysteman urgentincentivetoofferarangeofservicesthatenable peopletoleadtheirownrecoveryandmakeprogress withtheirhero’sjourney.Theseincludepeersupport,recoveryeducation,supportineducation,jobsandhousing andhumaneoptionsinacrisis.

Finally,anewstorywouldmakestigmaanddiscriminationagainstmadpeopleasuntenableasitisagainstotherpeoplewhomakehero’sjourneysintotheunknown,suchassoldiers,mountaineers,firefighters,artistsandmonks.

Howdowegenerateanewstoryofmadnessthatmostpeoplesignupto?Thestoryneedstotransformeverythingwefeel,thinkanddo.Thestoryalsoneedstoinformeverylevelofthementalhealthsystemandeverycommunicationwemakewithourcommunities.Oneofthemostdirectwaystotransmitthenewstoryisthrougheducation. Peoplewithlivedexperience,theirfamilies,mentalhealthworkersandcommunitymembersallneedre-education togivethemnewawarenessandskillsattheindividuallevel andwhenworkingattheserviceorsystemlevel.

New competencies to support individuals

Allthemajorstakeholdergroupsneedanewsetofcompetenciestosupportindividualstoleadtheirownrecovery.Manyofthesecompetenciesneededbypeoplewithlivedexperience,theirfamiliesandfriends,mentalhealthworkersandcommunitymembersaresimilar.

People with lived experience

Toleadtheirownrecovery,individualswithlivedexperience needtobecomecompetentatbelievinginthemselves,managingtheirlivesandtheirrelationships,andusingtheresourcesthatareusefultothem.Forinstance,theyneedto:

•makesenseoftheirexperienceinarecoveryframework•resolveinternalisedstigma•recognisetheirownstrengthsandexpertise•acquireskillsinself-management•knowaboutserviceoptions,treatmentsandrights•knowhowtogetthemostoutofservicesand

communityresources•havepositivecommunicationandassertivenessskills•havenegotiationandcollaborationskills.

Families and friends

Familiesandfriendsalsoneedtobecomecompetent atsustaininghopeforthepersonwithmentaldistress,supportingtheirrecoveryandunderstandingthatthey maybeontheirownseparaterecoveryjourney.They needasimilarsetofcompetenciestopeoplewithlivedexperienceaswellastheabilityto:

newparadigm Autumn 2012


Theendofthefirstdecadeofthe21stCenturysawthedawn ofaneweraformentalhealthinAustralia.Improvingmentalhealthandassistingpeoplewithmentalillnesswashighon theagendaofgovernmentsatalllevelsandofallpersuasions.

Kim Koop, CEO and Wendy Smith, PolicyandResearchManagerVICSERV

Reframing community managed mental health

10

•resolvethegrief,shameorangertheymayfeel abouttheirrelative

•supportthepersontoleadtheirownrecovery• leadtheirownrecoveryasafamilymember.

Mental health workers

Mentalhealthworkersneedtobecollaborative, flexible,respectful,andempowering.Inadditionto directlydevelopingthecompetenciesofpeoplewith livedexperiencetoleadtheirownrecoverytheyneedto:

•showrespectforthemadnessexperience•knowandapplyrecoveryprinciplesintheirwork•understandpeopleinthecontextoftheirwholelives•developpartnershipswithpeople,theirfamiliesand

otherservicesandcommunityresources•preventandprovidealternativestocompulsory

orcoercivepractices•havepositivecommunicationandassertivenessskills•havenegotiationandcollaborationskills.

Community members

Individualmembersofthecommunitywhodonot havelivedexperienceorfamilyexperienceneedto:

•understandmadnessaspartofthehumancondition•knowhowtorespondinanempoweringwayto

peopleindeepdistress•haveexposuretopositivestoriesaboutmadness•havepositivecontactwithpeoplewithlivedexperience•knowthatdiscriminationagainstpeoplewithlived

experienceisnottolerated•welcomediversityintheircommunity.

New competencies to work at a service or systemic level

Someofusinthestakeholdergroupsdoworkforthecollectivegoodattheserviceorsystemlevelinmany differentroles.Weneedalltheindividuallevelcompetenciesaswellascompetenciesrelatedtoourparticularroles;we alsoneedadditionalprofessionalcompetenciestosupport thenewstoryofmadnessandtheleadershipofpeoplewithlivedexperience.

People with lived experience and their families

Peoplewithlivedexperienceandfamiliesmayparticipate intheplanning,development,deliveryandevaluationofservicesandsystemsasvolunteersoremployeesinawidevarietyofroles.Theyneedtodevelopcompetenciestoenablethemtoamplifythevoiceandadvancetheinterests oftheirstakeholdergroup.Forinstancetheyneeddevelopmentinthefollowingareas:

Personal •understandandlearnfromtheirownor

theirfamilymember’sdistressandrecovery•acquireskillsinself-careinlifeandatwork•possessself-awarenessandskillsinreflectivepractice.

Knowledge •understandthevaluesoftheconsumermovement

and/orfamilymovement•understandrecoveryprinciplesandpractice•knowabouthelpingsystems•knowaboutcriticalperspectivesinmentalhealth.

Skills•knowhowtouseself-disclosureforthebenefitofothers•encourageotherstousetheirstrengthsandresources•enableconsensusorautonomousdecision-making• relateasequalstodiversegroupsofconsumersandfamilies.

Mental health professionals and managers

Mentalhealthworkersalsoneednewcompetenciesforanewleadership.Theyneedmanyofthesamecompetenciesaspeoplewithlivedexperienceandtheirfamilieswhoworkattheserviceorsystemlevelaswellastheabilitytopassonthesecompetenciestoserviceusersandfamilies.Inadditiontheyalsoneedto:

•knowandrespect‘livedexperience’perspectives andexpertise

•workinpartnershipandwithaccountabilitytoclients andtheirfamilies

•practisezerotoleranceofdiscriminationandabuse withinservices

• ‘comeout’asapersonwithlivedexperienceifthis ispartoftheirlifestory.

Community leaders

Communityleadersincludepoliticians,mediacommentatorsandopinionleaders.Theyarticulatecommunityviews onmentalhealthissues.Theseleadersneedto:

•understandmentalhealthissuesfromhumanrights andsocialjusticeperspectives

•practisezerotoleranceofdiscrimination•makesupportivepublicstatements• ‘comeout’asapersonwithlivedexperienceifthisis

partoftheirlifestory.

To finish...

Developingthesecompetenciesthrougheducationwillallowustoditchtheoldscriptandstagedirectionsandgiveusnewones.Ourperformanceswilldemonstratesupportivebeliefsaboutmadness,modelnewidentitiesandroles,equalisepowerdynamics,valueanddevelopaworkforcewithlivedexperience,andopenthewaytoabroaderrangeofservices.Onlythenwilltheleadershipofpeoplewithlivedexperiencecomeontothemainstage.



A new story for a new leadership ByMaryO’Hagan

Thiswasreflectedinsupportivepolicyandsignificantfundingcommitments.ConsumersandcareradvocateswereenthusiasticaboutpsychiatricdisabilitybeingincludedinaproposedNationalDisabilityInsuranceScheme(NDIS). Inamongstitall,theuniquecontributionandphilosophy ofcommunitymanagedmentalhealthwasbeingrecognised. Inajointstatement,FederalMPsNicolaRoxon,Jenny MacklinandMarkButlerstated:

As important as clinical treatment is, other services and support in the community are also critical for the recovery of people with mental illness – to participate in social and community life, get and keep a job, improve relationships with family and friends and help manage the tasks of everyday life. The budget includes substantial additional funding for community-based mental health support including Personal Helpers and Mentors and essential respite support.1

InVictoriatheLiberalNationalsCoalitionreleasedamentalhealthpolicystatementwhichsaid:

Victoria has developed a good PDRSS* sector, but further investment is needed to build capacity of organisations

providing services to young people, adults and older Victorians. A stronger PDRSS sector will be effective in supporting people and their carers in their homes to manage and recover from mental illness, and in so doing, reducing the demand for acute services.2

ItwasinthispositiveenvironmentthattheVICSERVBoarddecidedthatitwastimetoreframethediscourseaboutcommunitymanagedmentalhealthinVictoria.Thestrategicintentwastopositiontheservicesystemtotakeadvantageofwhatwerehistoricopportunitiesforgrowthanddevelopmentthatwouldleadtosignificantlyimprovedoutcomesforconsumersandtheircarers.Beingproactiveensuredthatmomentumforreformcouldbemaintainedandconstructiverelationshipswithgovernmentsandotherstakeholderswould bebuiltupon.

AStrategicDirectionsSubcommitteewasestablishedtooverseethedevelopmentofaconsultationpaper.TheVICSERVAgenda for the future3(thepaper)wasreleased inFebruarythisyearandaperiodofextensiveconsultationconcludedinApril.



12Reframing community managed mental health ByKimKoopandWendySmith

InreframingtheCMMHservicesystem,thepaperlooked tothefuture.Threekeytrendswereevident:

• fundingformentalhealthservicesprovidedinthecommunityisexpectedtosignificantlyincreaseover thenextfewyearsdue,inalargepart,totheFederalGovernment’sAustralianMentalHealthInitiativeand theintroductionofanNDIS

• theshifttowardsindividualisedandtailoredserviceofferingswhichhadcommencedwiththeintroductionofHomeBasedOutreachService(HBOS)issettocontinueand befullyrealisedundertheproposedNDISmodel

•consumersandcarerswillhaveincreasingcontrolofhowtheirfundingdollarsarespentandwillbedemandingvalueformoney,choice,flexibility,qualityandaccountability. Thiswillleadtoamoremarket-basedapproachtoservicedelivery.Blockprogramgrantswilllargelybereplaced byindividualpaymentsandcompetitivepricing.New andfor-profitprovidersmayenterthemarket.

ItisinthiscontextthatthepapercallsontheVictorianStateGovernmenttodevelopanewprogramandfundingstructure.Existingprogramguidelineshavegenerallynotbeenreviewedformanyyearsand,aswillbediscussedfurther,fundingallocationshavetypicallybeenmadeonahistoricalandad hocbasisratherthanaplannedandrationalapproach.Thepaperputsforwardahigh-levelprogramframeworkdesignedtoassistthetransitiontothefullyindividualisedserviceenvironmentofthefuture.

DuringconsultationsonthepapermanyparticipantsconfirmedthatthestakeswereincrediblyhighforCMMHnowandintothefuture.Greaterchoiceandcontrolforconsumerswasconsistentwiththesector’sphilosophyandmajorfundinginvestmentsinprogramswerewelcome.However,manyhadexperiencedwhathappenedinothersectorswhennewfundingandservicedeliverymodelswereintroducedbasedontheseandsimilartrends.Agencieslostfunding,somewereforcedtoclose.Ofgreatestconcernwasthatpeopleinneedreceivedareductioninhoursofserviceormissedoutentirely.Thisledtosomeanxietyandcreatedasenseofurgencythattheextentandtimingofreformneededtobesufficienttominimisetheserisksoravoid

themalltogether.Thepaper’srecommendationforastategovernmentfundedtrialofindividualpackagingwaswellsupported.

ThescanofthepolicyandfundingenvironmentandoffuturetrendslikelytoimpactontheCMMHservicesystemconcludedthatagenciesofthefuturewouldneedtobecapableof:

•providingabroadrangeofservicestailoredtoindividual andchangingneeds

•usingbudgetsflexiblytodeliveranumberofservicetypes aspartofanintegratedsuiteand/or

•providingaspecialistornicheservicebasedonadefinedrecoveryorientatedlogic

•operatingplanning,financialmanagement,ICTandreportingsystemsthatareabletomeettherequirements ofmanydifferentfundingstreams

•developingbusinessmodelstooperateefficientlyinacompetitivemarketplace

•developingstrongpartnershipswithmultiplestakeholders•recruitingandretainingaworkforcewithappropriateskills

andknowledge.

Inordertoencourageagenciestoreframetheirbusinessandstrategicplanninginlinewithfuturedemandsthepaperputforwardaself-assessmentframeworktocapturetheseandothercapabilities.Chiefamongstthesewasthefinancialbottomline.Futurecapabilitydependsonarobustbalancesheetandmultiplerevenuestreams.

OneofthemajorfindingsfromtheresearchandanalysisundertakenforthepaperwasthatmostCMMHagencies, bothsmallandlarge,receiveonlysmallamountsofstategovernmentmentalhealthfunding.Figure1(nextpage)showsthedetails.Ofthe130agenciesaccessingPDRSSfunding, 73receivelessthan$500,000and33receivelessthan$100,000.Thepaperdrewnospecificconclusionsregardingeitherthedesirablesizeofagenciesorthesizeoftheirbudget.Thequestionwasreframedinthecontextofcapability.VICSERVhasrecommendedthattheDepartmentofHealthfundittoworkwithagenciestoincreasetheircapabilityandcapacitytothriveinthefuture.

PDRSS Allocation Tiny Very small Small Medium Large Very large Total

Orgsize <$100k $100k-$500k

$500k-$1m

$1m-$3m

$3m-$10m

>$10m

Small <$6m 5 17 8 7 0 0 37

Large >$6m 15 19 11 8 11 1 65

Aboriginal All 13 4 0 1 0 0 18

120

Figure 1: PDRSS funding distribution

Thefuturetrendsidentifiedabovepointtotheneednotonlyforagenciestobecapablebutthattheyareconfiguredaspartofarationalservicesystemdeliveringthefullrangeofservicesthatconsumersandcarersrequirewhereandwhentheyareneeded.Consumers,carersandworkershaveconsistentlyreportedthecomplexitiesofnavigatingthecurrentCMMHservicesystem.Partofthedifficultyisthathistoricfundingpatternshaveledtoanunevenspreadofserviceofferingsacrossgeographicareasandprogramtypes.ThishasbeenfurthercomplicatedbyallocationsofCommonwealthfundsoftennotbeingmadeonthebasisoflocalneedorcapacity.

Victoriaisnotaloneinhavingafragmentedsystemandsignificantattemptshavebeenmadetoaddresstheissue.However,changehasnotbeenachievedonthescale thatisrequiredfortheindividualisedandmarket-basedenvironmentofthefuture.VICSERVhasrecommended thattheDepartmentofHealthinitsroleofsystems manager,commissionalocalareaplanningproject.

CMMHagenciesthathavemadeathoroughassessment oftheircapabilityandareawareoftheirstrengthsandanyweaknesseswillbeinastrongpositiontoparticipateinlocal areaplanning.Oncethecurrentandfutureneedsofan areahavebeenestablishedthepaperoutlinesanumber ofpathwaystocreateamorerationalservicesystem thatiseasyforconsumers,carersandotherstonavigate. Thismightinvolvesharingbackofhousefunctions, co-locations,poolingresources,alliancesandpotentially,mergers.

VICSERVconsidersthatamorerationalapproachto areabasedplanningisakeybuildingblockforthefuture. Itrecognisesthediversityofagenciesandauspicesinvolvedandthecomplexityofreachingagreementaboutthe requiredplanningandauthorisingprocesses.ItwillrequireactiveengagementfromBoardsandtheDepartmentof Healthasthefundingbody.

Atthetimeofwriting,thestategovernmentisabouttoreleaseamentalhealthstrategyandPDRSSreformframework.Thesedocumentshavebeenmuchanticipated.VICSERVhasworked

collaborativelywiththeVictorianDepartmentofHealth overthelastfewyearsinmentalhealthreformandpartnershipgroupsandprojects.Itsownreformpaper hasbeenenrichedandinformedbythesecollaborations anddiscussions.Tocontinuethemomentumandmaintain thedialogue,VICSERVrecommendstheappointmentof anAmbassadorforCommunityManagedMentalHealth. ItalsorecommendsthatthetermPDRSSisnolongerused torefertotheservicesystemcollectively.Itisthenameof afundingstreamanddoesnotreflectthedistinctiveroleandpurposeofagenciesthataremanagedbyvoluntaryBoards toproviderecovery-basedservicesinpeople’shomesor closetowheretheylive.

TheprogramofreformoutlinedintheVICSERV Agenda for the future willassistwithreframingtheperceptionofCMMHfromabitplayerinthespecialistmentalhealthservicesystemtoanindustryinitsownrightthrivinginaradicallyalteredenvironment.Thekeydriverforchangeistocapitaliseontheopportunitiesthatwillarisetosignificantlyimprovethelivesofconsumersandcarers.

References

1 NationalMentalHealthReform(2011)Statement by the Hon Nicola Roxon MP, the Hon Jenny Macklin MP, the Hon Mark Butler MP

2 TheVictorianLiberalPartyandNationalsParty(2010)The Victorian Liberal Nationals Coalition Plan for Mental Health,p.3

3 http://www.vicserv.org.au/feature-menu/an-agenda-for-the-future-consultation-paper.html

* WherePDRSSisusedinthisreportitistoidentifythespecificfinancialcontribution madetocommunitymanagedmentalhealthagenciesbytheVictorianStateGovernment.PDRSSfundedprogramsinclude:MutualSupportandSelfHelp(MSSH),HomeBasedOutreachSupport(HBOS)andIntensiveHBOS,PlannedRespite,PsychosocialDayPrograms,ResidentialRehabilitation,SupportedAccommodationandPreventionandRecoveryCare(PARC)services.

Oneofthemajorfindingsfromtheresearchandanalysis wasthatmostCMMHagencies,bothsmallandlarge,receiveonlysmallamountsofstategovernmentmentalhealthfunding. Ofthe130agencies,accessingPDRSSfunding,73receive lessthan$500,000and33receivelessthan$100,000.



14

FromtheperspectiveofstaffandBoardDirectorsofbothorganisations,themergerhasbeenhighlysuccessfuland wassteeredbyagoodprocess.Anecdotalfeedbackfromstaffworkingdailywithconsumersandcarershasbeenequallypositive,althoughitmaybeusefulinthenearfuturetoformallyevaluatetheconsumerandcarerexperienceregardingthischangeprocessaswellasanyeffectonthequalityofservice.

ThisarticleprovidesanarrativeaccountoftherecentmergeroftheInnerEastMentalHealthServiceAssociation(IEMHSA),agovernment-fundednot-for-profitorganisationprovidingpsycho-socialrehabilitationservicesinfourmunicipalitiesinMelbourne’sinnereasternsuburbs,withNeami,anon-governmentmentalhealthorganisationprovidingrehabilitationandrecoverysupportat26branchesacrossnorth-easternMelbourne,NewSouthWales,SouthAustralia,QueenslandandWesternAustralia.

InApril2012,wecelebratedthefirstanniversaryofthesuccessfulmergerandaprocesswhichhasprovideda valuableandpositivelearningexperience.

Ihopethisarticlefacilitatesusefuldiscussionandreflectionsabouttherelativemeritsofmergersaswellassomeoftheuniquechallenges.Itaimsalsotofosteranunderstandingofthesuccessfulprocessweundertook,whilstacknowledgingthat‘onesizedoesnotfitall’.

The beginnings

IreturnedtoMelbourneinmid-2009afterlivinginSydneyfortwoyearstooverseethedevelopmentofNeami’sHousingandAccommodationSupportInitiative(HASI).Afterearlyconsultationswithdepartmentalstaff,localclinicalleadersandsisternon-governmentorganisations,itbecameevidentthat

therewereconcernsatveryseniorlevelswithintheDepartmentofHealthregardingtheviabilityofthePsychiatricDisabilityRehabilitationandSupportServices(PDRSS)sector, inparticularforanumberofsmalleragencies.Itappearedthathistoricorganicgrowthinthesectorhadcomeunderscrutiny,withaviewemergingthat,inordertodevelopthesector,agencieshadtooperateatalargerscale,possessgreaterinfrastructureandhaveincreasedcapacitytoaddressthegrowingqualityimprovementrequirementsandcontractcomplianceresponsibilities.

OneofthemeetingsduringthistimewaswiththeCEOofInnerEastMentalHealthServicesAssociation(IEMHSA),anorganisationwithwhichNeamihadenjoyedalong-term,professionalrelationship.Oftendiscussingtrendsinthementalhealthsector,webegantorealisethesharedvaluesevidentineachorganisation.

DiscussioncontinuedwhenthenewlydevelopedIEMHSAStrategicDirectionswerereleased,expressingissuesofviabilityandthesubsequentneedforimprovedpartnershipsandtobuildcapacity.Webegantocanvassthequestion:whatwouldapartnershiporalliancebetweenNeamiandIEMHSAlooklike?

Afterdetaileddiscussion,theIEMHSABoardagreedthatfurtherexplorationofthisissueshouldoccurandtherelativemeritsofapartnershipwerepostulatedatanumberofformal

Arthur Papakotsias, CEONeamiLtd

Managing a merger

andinformalmeetings.Itwasduringoneofthesethattheword‘merger’wasused.ThenextstepwastotaketheissuetotheNeamiBoardtoconfirmwhetherDirectorswished toexplorethedesirabilityandfeasibilityofamergerwithIEMHSA.Theresultwaspositive.

The process

WithsupportfrombothBoards,amutually-agreedexternalconsultantwasappointedandaskedtofacilitateaworkshopbetweenseniormanagersandBoardDirectorsfrombothIEMHSAandNeamitoalloweachorganisationtoputtheir‘cardsonthetable’:thatis,declaretheir‘negotiables’and‘non-negotiables’,clarifyandhopefullyagreeona‘valueproposition’and,ifallpartieswerestillhappytoproceed, mapoutaprocessincludingtasksandtimelines.

Theworkshopturnedouttobeamilestoneeventin assistingthemergerprocess.Asalarger,nationalorganisation, Neamimadeitclearthatour‘non-negotiable’wasthatIEMHSAwouldbecomeapartofNeamiandthatIEMHSA, asitwasknown,wouldceasetoexist.Theotheroptionexplored–thatofmergingthetwoorganisationstogether toformanewone–wasrejectedbytheNeamiBoard.

Itbecameclearthat,withanoperatingbudgetofaround $3million,IEMHSAstruggledwithinadequateinfrastructure

andoperationalcapacitytoachievetheorganisationalimprovementsitdesired.IEMHSAalsoacknowledgedthattheEasternandInnerEasternsuburbsofMelbournewereaverycrowdedPDRSSspacethatwashighlycompetitive–growthopportunitieswerelimited.IEMHSAindicateditsdesiretobepartofanationalorganisationandhaveaccesstostafftraining,includinginanevidence-basedservicemodelofrecovery,suchastheCollaborativeRecoveryModel(CRM)whichNeamiutilises.

Inlate2010,Neamihadanoperatingbudgetofaround $30million,aswellasnationalcoverage.Thismeantithad thecapacitytodiversifyitsfundingsourceswhilstmaintaining aclearfocusonworkingwithpeoplewithaseriousmentalillness,providingitwithrelativelygoodgrowthprospects.

Themutuallyagreed‘valueproposition’wastoprovide thebestpossibleoutcomestopeoplewithamentalillnesslivingintheeasternsuburbs.AsuccessfulmergerthereforewouldaddresssomeoftheconcernsaboutcapacityandinfrastructureraisedbytheIEMHSABoardandseniormanagement.ButwhataboutthebenefitsforNeami?ReflectiononNeami’smissionof‘Improvingmentalhealth andwellbeinginlocalcommunities’andgenuinebeliefthatconsumersofIEMHSAwouldbenefitfromNeami’smodel ofservicedelivery(CRM)andintegratedapproachtoservicedelivery(seebreakout),wasenoughtosatisfythevalueproposition.



16Managing a merger ByArthurPapakotsias

Approaches to service delivery

Neami’sintegratedapproachtoservicedeliverymeansthat,whenreceivingmultifunctionfundingforarange ofprograms,multifunctionteamsarecreatedtomanagethesedifferentservices.Forexample,grouprehabilitationandhome-basedoutreachsupportsareprovidedbythesamestaffmemberwithinateamapproach.ThereisthereforenoneedtoemployseparateGroupRehabilitationworkersandHome-BasedOutreachstaff.

Thisapproachwhichhasbeenprovenovertheyearstoprovidebetteraccessforconsumerswhooftenrequire arangeofservices.Neamihasalsoadoptedamodelofsupportwhereallgrouprehabilitationprogramsarerunincommunitysettings,notattheservicesitewhereourstaffarebased.ThishasbeenNeami’swayofassistingconsumerstoconnecttotheircommunityofchoiceforover10yearsandhassuccessfullypromotedsocialinclusion.Inshort,Neamidoesnotoperatedrop-incentres,hasnotdonesoforyearsanddoesnotintendtodosointhefuture.

IEMHSAhadexperiencedvariabilityinthisapproach; inworkingtowardsthemerger,itcouldseethebenefitsoftransitioningtothismodelandwasencouragedbyNeami’seagernesstointroduceaconsistentapproach inlinewithitsotherservices.Itshouldalsobeacknowledgedthattheadditionalgrowthcreatedby themergerwouldaddcapacityforNeamitoimprove itsabilitytotrainstaff,conductresearchandevaluateprogramsinamoreeffectivemanner,therebybetterresourcingstaffandimprovingoutcomesforconsumers.

Oncethevaluepropositionandnon-negotiableswere agreed,adetailedassessmentofeachorganisation’s serviceswascarriedouttodetermineifthemerger processshouldcontinue.Thiswasacriticalstepand involvedameticulousprocess,whichwasoverseenby aProjectLeadershipGroupconsistingofseveralseniormanagersandDirectorsfromeachorganisation,meetingregularlytoguideandassessworkundertaken.

Thefirstissuetoresolvewastoseeifthefunding bodieswerereceptivetothepossibilityofamerger. Fundersatbothstateandfederallevelsresponded positively,witheachtierofgovernmentgivingstrong signalstoproceed.

Theothertwocriticalissueswere:theneedtoundertake afinancialandlegalduediligenceexerciseaswellasanexplorationoftherespectiveculturesofeachservice. Thefinancialandlegalissueswereresolvedfairlyeasily,notwithstandingsomecapacityissuesindedicating resourcesandtimetotheseissueswhilststilloperating aserviceatfullcapacity.Similarly,theculturalfitwasassessedasexcellent,analmostperfectmatchinbothorganisations;directcarestaffvisitedeachother’srespectiveservicestoseehowservicesoperated,howstaffinteractedwitheachotherandwithconsumers.Staffwerekeentotrynewwaysofdeliveringservicesandwereverycommittedtoconsumer-directedservices.

The decisions

InFebruary2011,bothBoardsmadeindependentdecisionsthatthemergershouldproceed.ItwasagreedthatIEMHSAwouldbecomeapartofNeami,thatallIEMHSAstaffmanagingandprovidingservicesweretobeofferedongoingemploymentwithNeamiand,thatIEMHSAwouldbewoundupasalegalentity.(Justpriortothatwindingup,anIEMHSABoardDirectorwasappointedtoNeami’sBoard.)

ThreeIEMHSAheadofficestaff,includingtheIEMHSA CEO,werenotofferedongoingpositions,astheseroleswouldnotberequiredinthemergedorganisation.Suchdecisionscanbeverydifficultforallpartiesinvolved, howevereachofthethreemanagersdemonstrated integrity,honestyandahighrespectforconsumers,andit ispleasingtoseesomeofthemcontinuingtoplayvitalroles intheVictorianmentalhealthsector.

Afterthemergerdecisionsweremade,acommunicationstrategywasimplementedtoensureaclearandconsistentmessagewasprovidedtoconsumersandcarers,staff, clinical,housingandotherpartners,andfundingbodies.

CommunicationwithstaffattheIEMHSAwasmostcritical inconveyingwhatwouldchange,overwhattime,andhow.Wehadahighdegreeofclarityandplannedthetransitionprocessverythoroughly.Animportanttimingfactorwas thefundingbodies’abilitytotransferIEMHSAcontracts andfundingtoNeami.FromNeami’sperspectiveaquick transitionwasmuchbetterthanalengthyone.

The merger

On1April2011NeamiassumedmanagementofIEMHSA.TheIEMHSABoardcontinuedtomaintainoverallgovernanceresponsibilitiesuntilthetransferoffundingcontractswascomplete,howeverNeamiputinplaceamanagementstructuretoensureservicescontinuedandstaffwere

supported.Overthistime,consumers,staffandmanagementmettoclarifywhatNeamiintheeasternsuburbswouldlooklike,howtheserviceswouldoperateinadifferentmanner, toorganiseastafftrainingscheduleandtolayoutatimeline totransferleaseagreementsandassets.

AtJuly1,allIEMHSAstaffbecameNeamistaff,allcontracts,fundingandassetsweretransferredtoNeami,andstaffhadalreadybeguntraininginCRM,StaffSupervision,Coaching,MotivationalInterviewingandthelike.

ReassessingthemajorityofEasternclientstoprioritisewhichservicetheyshouldreceivewastheveryimportantnextphaseandwasaplannedandwelldocumentedprocess.Itwasidentifiedthatasignificantnumberofclients,aboveandbeyondthefundedtarget,wereregisteredwiththeservice.Manyweresocialparticipantswhohadlittleornocontact withtheagencyforextendedperiodsoftimeandanumberdidnotrespondtophonecalls,mailorotherattemptstocontactthemtoreassesstheirneedforservice.Afurthersignificantnumberdecidedtoexittheservicefollowingacomprehensiveassessment.Feedbackshowedthatmany oftheseindividualsdecidedthat,withoutadrop-incentreapproachtoservicedelivery,theydidnotwishtocontinuewiththeprogram.Itshouldbestressedthattheofferforservicedeliveryremainedavailabletoallindividuals.

The feedback

FromtheperspectiveofstaffandBoardDirectorsofbothorganisations,themergerhasbeenhighlysuccessfulandwassteeredbyagoodprocess.Anecdotalfeedbackfromstaffworkingdailywithconsumersandcarershasbeenequallypositive,althoughitmaybeusefulinthenearfuturetoformallyevaluatetheconsumerandcarerexperienceregardingthischangeprocessaswellasanyeffectonthequalityofservice.

Inpersonaldiscussions,anumberofstaff,inparticularservicemanagersinvolvedinthetransition,offeredtheviewthatthe

mergercouldhavehappenedevenfaster.Thisobservationseemedtoreflectmoreanxietyassociatedin‘notknowing’,thanactuallychangingpractices.

Wereceivedsomecomplaintsfromasmallnumberofconsumersandqueriesfromothers,whichinmostcasesweredirectlyreferredtome.Investigationshowedthat, inmostofthesecases,therehadnotbeenadequatecommunication.Amuchsmallernumberopposedthe lossofa‘drop-incentre’styleofservice.

The lessons

Itisnowmorethan12monthssincethemergertookeffect andithasbeenatremendouslysuccessfulventure.Ihave fiveimportantreflectionsabouttheprocessandresult.

Firstly,theterm‘merger’:formanypeople,thistermsignifiesthecomingtogetherofequalsandthedevelopmentofsomethingnewwhichappearsmoreequitable.Thiswas notthecasehereand,ineffect,theprocesswasmoreof anacquisitionthanamerger.

Secondly,clarityaboutwhocanmakewhatdecisions andwhoisinvolvedintheprocessiscritical.

Thirdly,consistentandagreedcommunicationbetween thetwoorganisations,bothinternalandexternal,isvital toconveyaccurateinformationandwillminimiserumours,gossipandconstantspeculation.

Fourth,thesupportoffundingbodiesiscriticalandultimatelydetermineswhethermergerscanproceed,givenallfundingcontractsneedtobetransferredfromtheexistingorganisationtothemergedentity.InNeami’scase,theDepartmentofHealthstronglysupportedthemerger.

Finally,agreeingupfrontonwhatisandwhatisnotnegotiablecansaveallpartiesalotoftime,resourcesandheartache.

ItappearedthathistoricorganicgrowthinthePDRSSsectorhadcomeunderscrutiny,withaviewemergingthat...agencieshadtooperateatalargerscale,possessgreaterinfrastructureandhaveincreasedcapacitytoaddressthegrowingqualityimprovementrequirementsandcontractcomplianceresponsibilities.



18

‘The Victorian Government has stated in its strategic priorities its commitment to ensuring people with a mental illness receive help earlier, and that the treatment and support they receive effectively reduces the often devastating health, social and economic impacts of mental illness. The 2007 National Mental Health and Wellbeing Survey found that one in five Victorians aged between 16 and 85 years suffer from a mental illness at some stage in their lives. An estimated 4.6 per cent of the Victorian population – just over 250,000 people – experienced a severe mental illness or substance use disorder each year. A further 16 per cent experienced a moderate or mild mental health problem.’– (Department of Health, The Victorian Mental Illness Research Fund, p4)

InVictoria,thereismuchdiscussiononthereframingofthementalhealthsector,withtheStateGovernmentrecognisingthemagnitudeofsupportthatisneeded.Morethaneverbefore,weneedamentalhealthservicessystemthat:

• catersforadiverserangeofmentalhealthillnessesandissues•meetsadiverserangeofneed•adoptsearlyinterventionstrategies(bothearlyinlife

andearlyinepisode)forbothconsumersandcarers•providesawell-resourcedandintegratedcontinuum

ofcarethatfocusesonaclient-centeredapproach torecovery,includingthedevelopmentofself- managementandinclusivepractice.

Anne Wicking, CEO,TheCompassionateFriendsVictoriaInc.and Frances Sanders, ExecutiveDirector,ARAFEMI

Peer support: an integral part of mental health services

Intermsofearlyinterventionandprevention,peersupportprovidesunequalledaccesstosupport,knowledgeandreferralinawaythatrespectsandupholdstheknowledgeoftheindividual.Inreducingtheisolationandstigmaassociatedwiththeexperienceofmentalillness,itprovidesapowerfullysalientmodel,increasingasenseofmutuality,personalempowermentandcommunityconnection.

Withinthenewmentalhealthframework,peersupportneedstobeconsideredasavitalpathwaytorecoverythatsupportssocialinclusionandwellbeing.ThisarticleexaminesthecurrentpolicyframeworkformentalhealthrecoveryinVictoria,and therolepeersupportshouldplayinthatenvironment.

Mental health framework

In2011theVictorianDepartmentofHealthreleasedtheFramework for Recovery Orientated Practicewhichfocusedattentionontheuniquejourneyandinvolvementoftheindividualinrecoveryservices,definingitspurposeinthefollowingway:

‘In the paradigm of mental health, the concept of recovery is understood to refer to a unique personal experience, process or journey that is defined and led by each person in relation to their wellbeing. While recovery is owned by and unique to each individual, mental health services have a role in creating an environment that supports, and does not interfere with, people’s recovery efforts. To this end, the Framework for Recovery Oriented Practice explicitly identifies the principles, capabilities, practices and leadership that should underpin the work of the Victorian specialist mental health workforce.’

Withinthisframework,theLiteratureReviewidentifiedimportantcomponentsofrecovery-orientedpractices inorganisations.Theseincluded:

•apeersupportworkforce• involvementofpeoplewithlivedexperienceand

theirsignificantothersinprocessessuchasrecruitment,education,traininganddevelopment,andquality-improvementactivities

• responsivenesstopeople’sfeedback;forexample, throughusingoutcome-measures,surveys,quality audits,complaints,serviceplanningandevaluation activitiesandtrainingledbypeoplewithlivedexperience.

(VictorianDepartmentofHealth,2011,Framework forrecovery-orientedpracticep1,p4)

Addressingtheseneeds,andofparticularimportanceinanyreform,ispeersupport.Itdeliversaclientcentredapproachtorecovery,embracesself-directionandmanagement,providesarangeofchoices,encouragesfamilyinclusivepracticeandhasafocusonbuildingcapacity–individuallyandwithincommunities.

Role of peer support

PeersupportiswelldescribedbyBorkman(1976,p446)as:“Experiential knowledge is truth learned from personal experience with a phenomenon rather than truth acquired by discursive reasoning, observation, or reflection on information provided by others.”

Itisinthisdescriptionthatwefindtheessenceof‘livedexperience’andthevalueitcanaddinmentalhealthrecovery.Fortoolongthevalueoftheindividuals’experiencesinguidingtheirownrecoveryandwellbeinghasbeenundervaluedand,insomecases,discounted.Infact,wehavetoooftendeferredto‘discursive reasoning, observation or reflection on information provided by others’toinformpractice.

Peersupportserviceshavegrown,inVictoriaandelsewhere,overtheyearsbecausetheyhavefilledanimportantgapintheservicestructure.Manypeersupport(orMutualSupportandSelfHelp)groupswereformedasaresultofthelackofaccesstomentalhealthservices.Intermsofearlyinterventionandprevention,theyprovideunequalledaccesstosupport,knowledgeandreferralinawaythatrespectsandupholds theknowledgeoftheindividual.Inreducingtheisolationandstigmaassociatedwiththeexperienceofmentalillness,peersupportprovidesapowerfullysalientmodel,increasingasenseofmutuality,personalempowermentandcommunityconnection.

Theneedforpeer-basedinterventionsisbothanoutcome-basedandeconomicimperative.Studiessuggestthattheuseofpeersupportcanhelpreducetheoverallneedforanduseofmentalhealthservicesovertime(Chinman,etal,2001;Klein,Cnaan,&Whitecraft,1998;Simpson&House,2002).Theuseofapeersupportspecialistaspartoftreatmenthasbeenshowntodeliverarangeoffavourableresults(Daniels,2010),whileinformationprovidedbypeersisoftenseentobemorecrediblethanthatprovidedbymentalhealthprofessionals(Woodhouse&Vincent,2006).

Inothermodernmentalhealthsystems,avisionforthefuturehasengagedconsumersandcarersastheexpertsintheirownservicesandrecovery.TheSurgeonGeneralReport(1999)demonstratedthattherewerewelldocumentedevidencebasedtreatmentsinmentalhealth,andarangeoftreatmentsexistsformostmentaldisorders.Thereportalsopresentedfindingsthatself-helpandmutualsupport,fromwhichpeersupportserviceshaveevolved,wasthefastestgrowingservice



20Peer support: an integral part of mental health services ByAnneWickingandFrancesSanders

forpeopleinrecovery.Victoriahasformanyyearsled Australiainitsaspirationalprogresstowardspeerled supportsandinterventions.

Thevaluablerolethatpeersupportplaysintherecovery andwellbeingofindividualsisshownintherecentincrease infundingtopeersupportgroupsforpeopleexperiencingchronicphysicalillnessinVictoriaandtheexpansioninternationallyofpeersupportfunding.Withinthenew mentalhealthframeworkforVictoria,peersupportneedsto beconsiderednotonlyasa‘growth’servicebuta‘foundation’ tosupportpeoplewithmentalhealthillnessandissues.

Peer support advocacy

ThelaunchoftheCentreofPeerSupportandAdvocacy(MentalHealth)andreleaseoftheCharterofPeerSupportin2011wereimportantstepsinadvocacyfortheinclusionofpeersupportinserviceprovisionbygovernmentandnot-for-profitprovidersinthementalhealthsectorinVictoria.Writtenbyconsumersandcarersandnowendorsedbyarangeofmentalhealthservices,theCharterarticulatestheimportancethatconsumersandcarersplaceonthelivedexperience,throughsevenpillarsofpeersupport:

1.Opportunitiestobenefitfromcollectivewisdom2.Opportunitiestounderstandanddestigmatise

mentalhealthissues3.Arenewedsenseofself-respect,understandingand

belongingthroughbeingpartofacircleofacaringcommunity

4.Opportunitiesforpeopletore-discoverandactivatetheirownpersonal,hiddenresources

5.Opportunitiestoreceivehope,inspirationandempowermentforrecovery/healing

6.Opportunitiestogivehelptoothers,asequal-to-equal7.Auniquepathwaytohelp.

MostofVictoria’sspecialistPDRSSmentalhealthservices wereestablishedbypeoplewithlivedexperiencewhocouldnotfindthehelptheyneededelsewhere.Thesehavebeenprovidingsupportfor30yearsormoreforarangeofmentalhealthissuesthatconfrontconsumersandtheircarers.Peersupportaseitherastand-aloneorpartofacontinuumofcareisanintegralgatewayandpathwayforVictorianswhoexperiencementalhealthissuesandtheirfamiliesandcarers.

References

BorkmanT,1976,‘Experientialknowledge:Anewconceptfortheanalysisofself-helpgroups’,Social Service Review,50(3),p446.

ChinmanMJ,WeingartenR,StaynerD,andDavidsonL,2001,‘Chronicityreconsidered:Improvingperson-environmentfitthroughaconsumerrunservice’,Community Mental Health Journal,37(3)pp215-229.

DanielsA,GrantE,FilsonB,PowellI,FricksL,&GoodaleL(Eds),2010,Pillars of Peer Support: Transforming Mental Health Systems of Care Through Peer Support Services,availableat www.pillarsofpeersupport.org,p9.

DavidsonL,ChinmanM,Kloos,B,WeingartenR,StaynerD&TebesJK,1999,‘Peersupportamongindividualswithseverementalillness:Areviewoftheevidence’,Clinical Psychology: Science and Practice,6(2),pp165-187.

KlienAR,CnaanRA&WhitecraftJ,1998,‘Significanceofpeersocialsupportwithduallydiagnosedclients:Findingsfromapilotstudy’,Research on Social Work Practice,8(5),pp529-551.

Simpson,EL&HouseAO,2002,‘Involvingusersinthedeliveryandevaluationofmentalhealthservices:systematicreview’,British Medical Journal, 325,pp1-5.

The Charter of Peer Support, 2011,availableatwww.peersupportvic.org.

U.S.DepartmentofHealthandHumanServices,1999,Mental Health: A Report of the Surgeon General—Executive Summary, Rockville,MD:U.S.DepartmentofHealthand HumanServices,SubstanceAbuseandMentalHealthServicesAdministration,CenterforMentalHealthServices,NationalInstitutesofHealth,NationalInstituteofMentalHealth.

VictorianDepartmentofHealth,2011,Framework for recovery-oriented practice, StateofVictoria,p1,p4.

VictorianDepartmentofHealth,2012,The Victorian Mental Illness Research Fund, StateofVictoria,p4.

Woodhouse,A&VincentA,2006,Mental health delivery plan – development of peerspecialist roles: A literature scoping exercise, ScottishRecoveryNetworkand theScottishDevelopmentCentreforMentalHealth,Edinburgh.

ThelaunchoftheCentreofExcellenceinPeer Support(MentalHealth)andreleaseoftheCharter ofPeerSupportin2011wereimportantstepsin advocacyfortheinclusionofpeersupportinserviceprovisionbygovernmentandnot-for-profitproviders inthementalhealthsector.





One can have a place to live, but that place may not be one’s home. In a sense, one can become part of a group that is best described as the sheltered homeless if the place one lives is not a “real home” (Kendrick, 2008).

Workingalongsidepeoplewithseriousmentalillnesswho arehomelessoratriskofbecominghomeless,Doorwayis aninnovativehousingandsupportprogramdeliveredbyMentalIllnessFellowshipVictoriainpartnershipwiththeVictorianGovernment,clinicalmentalhealthservicesandtheRealEstateInstituteofVictoria(REIV).Overthenextthreeyears,Doorwaywillassist50Victorianstofindandcreatehomeswithintheprivaterentalmarketandtodevelopthesupportsandresourcestosustaintheirtenancies.

The model

Havingarealhomeprovidesaspaceforpeopletoconnectwithfriendsandfamily,findwork,improvehealthandwell-beingandbuildalife.DoorwaybuildsonthesuccessfulHousingFirstmodel,whichhasdemonstratedthatpeoplewithmentalillnesswhohavebeenhomelessareabletomaintaintenancieswhenprovidedwithhousingandpersonalisedsupport(Gulcuretal,2003;2007).Ithasalsodemonstratedthattimelyaccesstohousingreducesincidencesofhospitalisationandtheneedforacutetreatment(Sadowskietal,2009).However,themodelhasalsoattractedcriticism:Yanosetal(2007)reportedthatpeopleinterviewedfromaHousingFirstprogramwereinstablehousingbutappeared tolive‘liveswithoutanyinvolvingpursuitsorsetofmeaningful

Emma Ladd, RegionalManagerforQualityandServiceDevelopment, MentalIllnessFellowshipofVictoria

Doorway: creating a home, building lives

Doorwaysupportsparticipantstoidentifywhat‘home’isfor them–whetherthismeanshavingadog,livingwithapartner orchildren,orbeingclosetoasportsclub.Beingableto choosetheirownplacemeanspeoplefeelmoreconnected toandinvestedintheirhome,increasingthelikelihoodthat thetenancywillbesustainable.

22Doorway: creating a home, building lives ByEmmaLadd

connections’.Padgett(2007)likewisenotesthat‘othercoreelementsofpsychiatricrecoverysuchashopeforthefuture,havingajob,enjoyingthecompanyandsupportofothers, andbeinginvolvedinsociety...haveonlybeenpartiallyattained’.Tobuildonthegainsthatnonethelessaremadewhenstablehousingisattained,theDoorwayprogramisdesignedtoincreaseconfidenceandself-efficacyforparticipantsandtopromotegenuineandsustainablesocialinclusion.

AkeydifferenceundertheDoorwayprogramfromthetraditionalHousingFirstapproachliesinworkingwithpeople tonegotiatetheprivaterentalmarketaspartoffindingahome.Developingasolidtenancyhistoryenablespeople toavoidthepotentiallimitsoflivinginsocialorsupportedhousing,andbroadenstheiroptionsforcreatingreal homesnowandinthefuture.Goingthroughtheprocess ofidentifyingpreferencesandapplyingforpropertiescan alsobuildconfidenceinpeoplewhomayhavehadlittle ornochoiceorcontroloverpasthousingenvironments.Doorwaysupportsparticipantstoidentifywhat‘home’is forthem–whetherthismeanshavingadog,livingwithapartnerorchildren,orbeingclosetoasportsclub.Being abletochoosetheirownplacemeanspeoplefeelmoreconnectedtoandinvestedintheirhome,increasingthelikelihoodthatthetenancywillbesustainable.

Today’srentalmarketcanbehighlycompetitiveand manyoftheparticipantsinDoorwayhavestruggledtobeconsideredforprivaterentalhousingduetostigmaandtherequirementforprospectivetenantstodemonstrateastablerentalandemploymenthistory.Doorwayaimstodeveloppartnershipswithrealestateagenciesandlandlordstoaddresssomeoftheprivaterentalbarriersthatpeoplewithamentalillnessface.TheRealEstateInstituteofVictoria(REIV)hasbeenanenthusiasticsupporterofDoorway,detailingthebenefitsoftheprogramtoitsmembersandtolandlords. Anumberofrealestateagenciesarenowactivelyinvolved insupportingandpromotingtheprogramandhavereallyhelpedlandlordstounderstandtheprogram.Onceanagency isonboard,individualagentslearnaboutDoorwayandalso gettoknowparticipantsastheyattendinspectionsandapply forproperties.Agentsareabletoanswerquestionsthat landlordsmayhaveabouttheprogram,andevenadvocate forpeople.Inseveralinstances,thissupporthasmadethedifferenceinalandlorddecidingtooffertheirpropertyto aDoorwayparticipantoverotherapplicants.

Key components

Aswellasbuildingstrongrelationshipswithrealestate agenciesandlandlords,theDoorwayprogrammakessomeotherimportantadaptationstotheHousingFirstmodeltoassistparticipantstoincreasetheirlevelsofsocialinclusion.Theseinclude:

Increased choice

Eachpersonissupportedtoexploreandidentifyhousingpreferencesandtomatchthesewithavailableresourcesandproperties,sothataperson’s‘senseofwhatisadesirableandidealhomeisincorporatedintohowthathomeisformedandshaped’(Kendrick,2008).Oncetheysecureasuitablehome,aselectionoffurnishingsisprovidedsotheycandesigntheirhomeenvironmentandinviteinputfromfamilyandfriends.

Themovementtowardperson-centredserviceschallengesproviderstocontinuallygofurtheringivingpeoplechoice andcontrol,includingthepowertoco-designtheservices thatwillbestsupporttheirneedsandrecoverygoals. InDoorway,eachpersonisinvolvedinthe‘design’of anintegratedsupportteamfromaservicemenuthat hasbothcoreandflexibleelements,includingpeersupport,employmentconsultants,familyservicesandotherhealthprofessionals.Assessment,planningandreviewarealldesignedtobeledbytheparticipant.

Focus on social inclusion

Lonelinessandsocialisolationcontinuetobesignificantissuesforpeopleevenoncestablehousingisachieved(Franklin&Tranter,2011).Gettinginvolvedinemployment,educationandtrainingisakeymarkerofsuccessinrecoveryformanypeopleanddirectlyaddressesthesocialexclusionexperiencedbypeoplewithamentalillness.Doorwaywillcombinehousingandtenancysupportwithafocusonassistingpeopletoconnectwithfriends,neighboursandthe‘interlockingsocialorganisationsofpeoplethatmakeupcommunities’(David &Baron,2010).

Naturalsupportnetworksaretherelationshipsthatoccurineverydaylife,andusuallyinvolvefamily,friends,neighbours,co-workersandcasualacquaintances.Theserelationships tendtobereciprocalandarevitalinhelpingtodevelopasenseofbelonging.DoorwaydrawsontheCirclesofSupportapproach:asocialsupportinterventionthatprovidesguidelines

andstructuredinterventionsinthedevelopmentofa person’snaturalsupportnetwork.TheCirclesofSupportmodelhasalsoshownsomepromiseasanadjuncttoSupportedEmploymentservicesinassistingpeoplewithpsychiatricdisabilitiestogetandkeepajob(Spagnoloet al,2011;Robertsetal,2010).

Sustaining tenancy through employment

Peoplewithamentalillnesscanbecometrappedina stressfulcycleofdebtandpoverty,whichisaffectedby andaffectstheircapacitytobecomesuccessfultenants.Participantswillbeabletoaccess–whentheyareready–appropriate,tailoredsupporttogainemploymentand toimprovetheirfinancialsituation.

DoorwayparticipantswillhaveaccesstoemploymentconsultantswhousetheIndividualPlacementandSupportmodel.IPShasresultedinpaidemploymentformostparticipants,atafarhigherratethanpeoplewithaseriousmentalillnessenrolledinmainstreamvocationalsupport. AstudybyBond&Drake(2008)demonstratedthat43.6percentofIPSparticipantsworked20hoursormoreperweek,comparedto14.2percentofpeoplewhoreceivedtreatmentasusual.Gettingajobisawell-establishedmarkerofrecoveryandwillincreasepeople’sabilitytoreducetheirrentalsubsidy,ensuringthattenanciesaresustainablewhenpeoplemoveonfromDoorway.

Summary

Housingisunderstoodtobeabasichumanright,andmanyservicesforpeoplewithmentalillnessdoworktoensurethatpeoplehavesecureandstableaccommodation.InDoorway,theconceptofhomeissupportedbytheprinciplesofchoice,

socialinclusionandsustainability.Workingwithpeopletocreatebothahomeandalifemeansensuringthateachperson’sidentity,valuesandpreferencesareconsideredinshapingboththeirlivingenvironmentandtheservicesandpartnershipsthatsupporttheperson.

References

BondG&DrakeR,2008,‘Predictorsofcompetitiveemploymentamongpatients withschizophrenia’,Current Opinion in Psychiatry,21,4,pp362-369.

DavidJ&RichardB,2010,IntotheThickofThings:ConnectingConsumerstoCommunityLife–ACompendiumofCommunityInclusionInitiativesForPeoplewithPsychiatricDisabilitiesAtConsumer-RunPrograms’,TempleUniversityCollaborativeonCommunityInclusionofIndividualswithPsychiatricDisabilities.

FranklinA&TranterB,2011,Housing, loneliness and health,AHURIFinalReportNo.164,AustralianHousingandUrbanResearchInstitute,Melbourne.

GulcurL,TsemberisS,StefancicA&FischerS,2003,‘Housing,hospitalisation,andcostoutcomesforhomelessindividualswithpsychiatricdisabilitiesparticipatingincontinuum ofcareandHousingFirstprogrammes’,Journal of Community & Applied Social Psychology, 13,pp171-186.

GulcurL,TsemberisS,StefancicA&GreenwoodR,2007,‘Communityintegration ofadultswithpsychiatricdisabilitiesandhistoriesofhomelessness’,Community Mental Health Journal, 43,pp211-228.

KendrickM,2008,‘Howgenuinelysupportivepersons,agenciesandsystemscan enablepeopletohaverealhomesoftheirown’,Crucial Times,40,pp13-15.

PadgettDK,2007,‘There’snoplacelike(a)home:ontologicalsecurityamongpersonswithseriousmentalillnessintheUnitedStates’, Social Science and Medicine,64,pp1925-1936.

RobertsM,MurphyA,DolceJ,SpagnoloA,GillK,LuW&LibreraL,2010,‘Astudyoftheimpactofsocialsupportdevelopmentonjobacquisitionandretentionamongstpeoplewithpsychiatricdisabilities’,Journal of Vocational Rehabilitation, 33,3,pp203-207.

SpagnoloA,DolceJ,RobertsM,MurphyA,GillK,LibreraL,LuW,2011,‘AstudyoftheperceivedbarrierstotheimplementationofCirclesofSupport’,Psychiatric Rehabilitation Journal, 34,3,Winter,pp233-42.

SadowskiLS,KeeRA,VanderWeeleTJ&BuchananD,2009,‘Effectofahousingandcasemanagementprogramonemergencydepartmentvisitsandhospitalisationsamongchronicallyillhomelessadults:arandomisedtrial’, Journal of the American Medical Association,301, pp1771-1778.

YanosPT,FeltonBJ,TsemberisS&FryeVF,2007,‘Exploringtheroleofhousingtype,neighbourhoodcharacteristics,andlifestylefactorsinthecommunityintegrationofformerlyhomelesspersonsdiagnosedwithmentalillness’,Journal of Mental Health, 16,pp703-717.

TheRealEstateInstituteofVictoriahasbeenanenthusiasticsupporterofDoorway,detailingthebenefitsoftheprogramtoitsmembersandtolandlords...AnumberofrealestateagenciesarenowactivelyinvolvedinsupportingandpromotingDoorway,andhavebeenhugelyhelpfulinhelpinglandlordsunderstandtheprogram.



24

Acoachismorethanaproblem-solver;heorsheisapartnerworkingwiththeindividualtohelpthembethebesttheycanbe.Crucially,acoachgeneratesanenvironmentinwhichthepersoncoachedisabletofeelstretchedandchallengedinasupportivemanner.

Whenwetalkaboutrecoveryinthementalhealthfieldmanyofusthinkofthejourneysdescribedbyconsumersofmentalhealthservices.Inrecoveryliterature,anumberofcommonthemesemerge(Slade,2009).Oneistalkof’someonewhobelievedinme’asacentraltenetoftherecoveryjourney. Thiscanbetranslatedassomeonewhocarriedhopefortheindividualwhentheyhadlittleornohopeforthemselves.

Overthelasttenyearsorsomanyservicesworldwide haverenamedthemselvesas‘recoveryorientated’or‘recoveryfocused’butveryfewhavesystematicallytrainedtheirstaffinthelatestevidence-basedrecoveryinterventions,muchlesscreatedsystemicchangestosupportthistraining. Theevidenceisclearfromallindustry,includinghealth andwelfare,thatverylittletrainingexpenditureisevertranslatedintopractice.

Thepotentialthusexistsfortherenamingofaserviceas‘recoveryoriented’tobeseenasmerelyanexpressionofpoliticalcorrectness.Indeeditcouldbearguedthatthiswillonlyreinforcetheargumentposedbythe‘recoveryskeptics’.

Howthencanworkersinrecoveryorientatedservicescarryhopeforpeopleiftheyhavenotbeengiventheskillsnecessarytoassistinthejourney?Oriftraininghasbeenprovided,butnotinternalisedandmadepartoftheworker’sday-to-daypractice?

Thispaperarguesthatmentalhealthservicescanlooktootherservice-basedindustriesforgoodmodelsforchangeandinnovation,andthatcoachinginparticularholdsgreatpromiseandpurpose.

Wesuggestthat,foraservicetobetrulyrecoveryorientated,theorganisationasawholemustfirstembracetheconceptandpracticesofrecovery(Slade,2009).Furthermore,thisrecoveryorientationshouldconsistofseveralparallelprocesses:theemergenceoftheserviceasanewlydefinedentity,theredefinitionbystaffmembersoftheirrole,andtheemergenceofapreferredidentityforconsumers.

Inconjunctionwiththis,thestaffmustpossesstheknowledge,valuebase,skillsetanddesiretomakerecoveryareality.Inessenceitisnotwhatyoucallyourselfbutwhatyouactuallydo,thatwilldefineyouintheeyesofothers.

Ian Oliver,ManagerPrevention&RecoveryCareProgramProjects ManagerRecovery-OrientedServicesDouttaGallaCommunityHealthand Alex Couley, BusinessCoachandVisitingFellow,AustralianInstituteofBusinessWellbeing

Recovery orientation: effective implementation through the use of coaching

Health care innovation

Manyauthorsandresearchersspeakaboutinnovationinhealthcare,howeververylittleappliesdirectlytomentalhealthserviceproviders.Muchoftheexistingresearchhasfocusedonimprovingthedeliveryofservicestoclientsinlargehealthcaresettings.NotablyPorterandTeisberg(2006)arguestronglythatthewaytoinnovateinhealthcareisthroughtherealignmentofahealthcareprovider’sservicedeliverywiththevalueitprovidestopatients.Thisseemsanattractiveandrationalargumentatfirstglance.

However,oneofthechallengesthehealthcaresectorbroadly, andmentalhealthsectorspecifically,hasfacedisinseeingitself asdifferentwhen,infact,manyofthesameorganisationaldynamicsexistwithinotherservice-basedindustries.Ifweacceptthatmentalhealthserviceprovidersrespondtothesameorganisationaldynamicsasotherservicetypes,thentherecouldbemuchtolearnfromthosenon-mentalhealthorganisationsthathaveflourished,whilesciencessuchasPositiveOrganisationalScholarship(Caza&Cameron,2008)teachmuchaboutwhatworkswellingeneratinginnovation.Thesametechniquesthathavehelpedtodeveloptheseindustrieswouldbenefitthehealthcaresector.

Wewillconcentrateinthisarticleupononeofthesecoretechniques:coaching.

Coaching: how to define?

Therearemanyandvarieddescriptionsofcoaching.Tocompoundthedifficultyinfindingacatch-alldefinition,therearealsonumerous‘models’ofcoaching(Passmore,2007).

Thatsaid,therearesomeagreedpracticesthatappearwithinalldefinitionsandmodels.Itisreasonablethereforetostatethat,throughaprocessofastructureddialogue,coachingofferstheopportunityforanindividualandtheirorganisation topursuetheirunrealisedpotential.Furthermore,through the art of effective questioning and reflection, coaches help individuals articulate their current situation clearly, leading to a greater vision of what they would like their future to look like. Acoachismorethanaproblem-solver;heorsheisapartnerworkingwiththeindividualtohelpthembethebesttheycanbe.Crucially,acoachgeneratesanenvironmentinwhichthepersoncoachedisabletofeelstretchedandchallengedinasupportivemanner.

Asyoulookatcoachingmoreclosely,theparallelswiththeessenceofrecoveryorientationbecomeapparent.TheUnitedKingdom’sInstituteofPsychiatry(2011)talksaboutcoachingas:assumingthepersonisorwillbecompetenttomanagetheirlife;learningtolivewithmentalillness;strengtheningtheperson’sexistingrelationships;andbothparticipantsplayinganactivepartinordertomakethiswork.

The role of coaching

Theevidenceisoverwhelminginwiderindustryforcoachingasthe‘goldstandard’fordevelopingstaffandenhancingtheuptakeofnewskillsets.Researchhasdemonstratedbenefitinallareasoforganisationalandindividualperformance,andledtoannualspendingoncoachingintheUnitedStatesofnowmorethan$1billion.Outsidethehealthcaresector,coachingisrapidlybeingacceptedinternationallyasacoremethodologyandsignificantgrowthisevidentinAustralia(Grant&Zackon,2004).Indeed,Bianco-Mathisetal(2008)makethepointthat‘organisations(which)arehopingtoraisethebarandcreatehigh-performanceculturesaremakingcoachingpartofthewaytheydobusiness’.

Thereisalsomountingevidencethatthecoreelements ofarecoveryorientationcanbebestachievedthroughacoachingdialogue.MikeSlade(2009)saysthat‘staffcansupportrecoveryby,whereverpossible,usingcoachingskills’andnotesthatcoachingisacoretenetofinnovativeworkbeingdoneintheUnitedKingdom.Indiscussingthepromotionofrecoveryincommunitymentalhealthservices,theUK’sInstituteofPsychiatry(2011)identifiescoachingas ‘aspecificinterpersonalstylewhichsupportsrecovery’.Ithasdevelopeditsowncoachingframeworkwithfivecorestages:Reflection,Exploration,AgreedOutcomes,ActionandHoldingtoAccount.

Despiteallthis,thereislittleevidencetosuggestthatmentalhealthserviceprovidersaresystematicallyintegratingcoachingintotheirpractices,eitherinAustraliaorelsewhere.

The Doutta Galla experience

DouttaGallaCommunityHealth(DGCH)isanexample ofaCMMHserviceusingcoachingmethodologytoaddress itsaimofbecomingtrulyrecoveryorientated.

DGCHprovidesarangeofprimaryhealthandcommunityservicesinMelbournetotheCitiesofMelbourneand MooneeValley.Servicesincludealliedhealth,healthpromotion,medical,dentalandmentalhealthprograms. Theconfigurationofitsmentalhealthprogramsisrepresentativeofthenon-government,not-for-profitsector inVictoria.Theseinclude:

•Home-basedOutreach•PreventionandRecoveryCareProgram(PARC)in

partnershipwithMelbourneHealth•SocialInclusionPrograms(formerlycalledDayPrograms)•AdultResidentialRehabilitation•YouthResidentialRehabilitation•CareCoordination&IntensiveHomeBasedSupportInitiative.



26 27newparadigm Autumn 2012


Recovery orientation: effective implementation through the use of coaching ByIanOliverandAlexCouley

DGCHhasprovidedmentalhealthprogramssinceitsmergerwithMacaulayCommunitySupportAssociationin2000.LikemostPDRSSservices,thecurrentconfigurationofprogramshasevolvedextensivelysinceMacaulaywasoriginallyestablishedasasmalloutreachprogramwiththreestaffin1987.Theevolutioncanbechartedthroughanamalgam ofdriversandimperatives,includinginnovation,necessity,expansion,mergers,innovationgrants,opportunismandgrowthandinkeepingwithgovernmentpolicyinitiativesatbothstateandfederallevels.

Introduction of a CRM model

In2010DGCHintroducedtheCollaborativeRecoveryModel(CRM),astrengths-basedcoachingmodel,asitsoverarchingservicedeliverymodelacrossallmentalhealthprograms. TheCRMhasbeenwelldocumentedelsewhereandthereforewillnotbeexploredatlengthinthisarticle.Butat itsheartliesacoachingrelationshipwhichaimstogenerate anenvironmentwherethepersonbeingcoachedarticulatessolutionstotheirdesiredgoals(Oadesetal,2005).Thisis nottherapybutaprocessthatbuildsuponstrengthsand valuestogenerateameaningfullife.Inturnthisleadstothere-establishmentofhopefulnessandapreferredidentity.

ThereasonsbehindtheintroductionofCRMweremultiple,includingtheneedto:

• formallyadoptarecoveryorientation•pursueevidence-basedpractice•ensurequalityandconsistency•continuallyimproveconsumerinvolvement•providestaffwiththetraining,support,supervisionandtools

toperformtheirroles•embracecontemporaryknowledgeanddirectionsinmental

health(ledbybothgovernmentandconsumer).

CentraltoitsintroductionatDGCHwasthedecisiontoevolvetheroleoftheworkerfromsupportgivertorecoverycoach.Itwasthereforeamajorinitiativefortheserviceinvolvingextensiveconsultationandplanningwithstaffandconsumers,thetrainingofallmentalhealthstaff,andtheintroductionofformalcoachingtosupportandembedCRMtrainingintoeverydaypractice.Theapplicationofskillslearnt attrainingintotheworkplaceisreferredtoas‘transferoftraining’(Uppaletal,2008);amongstitsmanyotherbenefits,coachinghasbeenproventosignificantlyimprovetransfer oftraining(Deaneetal,2006).

DGCHworkersnowdelivertheCRMdirectlytoconsumersoftheservice.Theyare,inturn,coachedbyateamofinternalcoacheswhoaresupportedbyanexternalcoach.Plansareinplacetodevelopasmallteamofleadcoacheswhowilltakeoverthisexternalrole.

Results

Recentlytheorganisationconductedamulti-faceted reviewoftheimpactoftheCRMandcoachingprograms. Thisincludedtheuseofforums,anonlinesurvey,and one-on-oneinterviews.Anumberofthemesemerged:

1.Peoplespokeofthegrowththatcoachinghadbrought forthemasworkersandthosetheywerecoaching. Theparallelprocessinaction

2.Theyalsospokeofthe‘aha’momentswithincoaching;pointswheretheirpracticedevelopmentmovedthroughinternalrealisations

3.Mostpeopledescribeddevelopingadeeperunderstandingofthemodel(CRM).Thisisakeydriverinensuringfidelitytoanevidence-basedmodel

4.Significantlyenjoyingthecoachingitselfappearedtosupporttheprocessofengagingwithoverallframework.Havingfunhasbeenemphasisedasfundamentaltoeffectiveengagement.

Comments

Therearedemonstrablyclearparallelsbetweentheaimsoftherecoverymovementandthatofacoachingintervention.Leadersintherecoverymovementhaveidentifiedcoachingasamethodofenhancingrelationshipsandcommunicationinrecovery-orientedservices.Itissurprisingthenthatthementalhealthsectorhasnotwidelyadoptedcoachingasanorganisationaldevelopmentstrategy,despitethesuccessfulimplementationofcoachingthroughoutthebroaderbusinesssector.Wesuggestthenaturalalignmentbetweencoachingandrecoveryprovidesonemethodologyforassistingservicesinbecomingtrulyrecoveryoriented.

References

Bianco-MathisV,RomanC&Nabors,L,2008,Organizational Coaching: Building relationships and programs that drive results, AmericanSocietyforTraining&Development,UnitedStatesofAmerica.

BonfieldH,2003,‘Executivecoachingisnotjustforbigcompanies’,British Journal of Administrative Management, Summer,pp18-19.

CazaA&CameronK,2008,Handbook of Macro-Organizational Behaviour, Sage,NewYork.

DeaneF,CroweT,Kavanagh,D,&OadesL,2006,‘Challengesinimplementingevidence- basedpracticeintomentalhealthservices’,Australian Health Review, 30,pp305-309.

GrantAM&ZackonR,2004,‘Executive,workplaceandlifecoaching:findingsfromalarge-scalesurveyofinternationalcoachfederationmembers’,International Journal of Evidence Based Coaching and Mentoring,2,2,Autumn,pp1-15.

InstituteofPsychiatry,2011,Refocus: Promoting recovery in community mental health services,Rethink.org,UnitedKingdom.

OadesLG,DeaneFP,CroweTP,LambertWG,LloydC&KavanaghD,2005, ‘Collaborative recovery: An integrative model for working with individuals who experience chronic or recurring mental illness’, Australasian Psychiatry, 13(3),pp279–284.

Passmore J (ed), 2007, Excellence in coaching: the industry guide, KoganPage, LondonandPhiladelphia.

PorterM&TiesbergO,2006,Redefining health care: creating value based competition on results, HarvardBusinessSchoolPress,Boston.

Uppal,S,Oades,LG,CroweTP&DeaneFP,2010,‘BarrierstotransferofcollaborativerecoverytrainingintoAustralianmentalhealthservices:implicationsforthedevelopment ofevidence-basedservices’,Journal of Evaluation in Clinical Practice, 16,3,pp451–455.

SladeM,2009,Personal recovery and mental illness: a guide for mental health professionals, CambridgeUniversityPress,Cambridge.

SladeM,2009,100 ways to support recovery, a guide for mental health professionals, Rethink.org,UnitedKingdom.



This year saw a landmark ruling on equal pay for the community sector. How did this case begin?

ThepredominantlyfemaleSocialandCommunityServices(SACS)workforceendured,overmanydecades,anincreasingwagesgapwiththoseworkingincomparableindustries.Thisgap,anditslinktothegenderundervaluationofSACSwork,wasthecatalystforAustralianServicesUnion’s(ASU)equalpaycase.ThefirstcasewasruninQueenslandand,afteritssuccess,thedecisionwasmadetorunanationalcase,callingforsimilarsalaryincreasesaswereachievedinQueensland.

ThecasebeganinMarch2011whentheASU,alongwithotherunions,lodgedanapplicationforanEqualRemunerationOrderundertheFair Work Act 2009.Thiscasewasthefirst ofitskindundertheAct.

What were Fair Work Australia’s initial findings?

Afternearlyayearofhearings,sitevisitsandsubmissions, onMay16,2011,FairWorkAustraliahandeddownitspreliminarydecisionthatcommunitysectorworkersdonotreceiveequalremunerationforworkofequalorcomparablevalue.Theyalsoruledthatgenderwasanimportantcontributortothewagegap.

FairWorkAustraliathencalledonallinterestedpartiestomakefurthersubmissionsandprovideadditionalevidence totheextentthatgendercontributedtothewagesgapin

thesector.Fromthere,therewereanother10monthsofadditionalhearingsandevidence,includingajointsubmissionfromtheASUandFederalGovernmentthatagreedona wayforward,takingustoFebruary2012whenthefulldecisionwashandeddownbyFairWorkAustralia.

What was the decision and what does it mean?

It’snotoftenwegettobepartofmakinghistory,butwe didwiththedecisionwhichacknowledgedthehistoricalundervaluationoftheworkofthecommunitysector’spredominantlyfemaleworkforce.Thiswasprobablythemostexcitingpartofthedecision(apartfromthefinancialbenefitsfortensofthousandsofworkers,ofcourse)–therecognitionoftherolethatgenderplayedininhibitingwagesgrowthin thesector,whereabout80percentofworkersarewomen.

Thedecisionhas,ofcourse,widespreadandlong-termimplicationsforoursector.AsourCEOCathSmithsaid tothemediaontheday:‘This decision is a turning point for the future of the community sector. From today, when people are thinking about their careers, the community sector will now be seen as a rewarding and fairly paid career option for all Australians.’

What did FWA order, and is it what was expected/hoped?

Salaryratesinthesector,forthosewhoarepaidundertheSocialCommunityHomeCareandDisabilitiesServicesAward

Lauren Matthews, SectorSustainabilityPolicyAnalyst,VictorianCouncilofSocialService

Q&A: Equal pay for community sector workers

Wesaythatthecommunitysectordeliversservices ontheGovernment’sbehalfsoithasanobligation toensurethatwearefullyfundedtoprovidethese servicesandsupportstothemostvulnerableVictorians.

2010(SCHCDS),willincreasefrombetween19-41percent(Level2:19percent,Level3:22percent,Level4:28percent,Level5:33percent,Level6:36percent,Level7:38percent,Level8:41percent,).Ontopofthiswillbe4percentloading(paidoverthephase-inperiod),alongwithannualminimumwageincreases.

ThesearetheincreasesthattheAustralianServicesUnion(ASU)andthesectorhadcampaignedforandwhatweexpected(hoped!)tobedelivered,astheyreflectthosepreviouslygrantedtoQueenslandsectorworkers.The eightyearphase-inperiod,withnineequalinstallments, from1December2012islongerthanwehadhoped(theASUandtheCommonwealthGovernment’ssubmissionsrecommendedasixyearphase-in)howeverthistiming willhopefullyensurethatthereisnobarrierforfunders, bothgovernmentandnon-government,tofullyfundthe newwagerates.

So is everything done and dusted now – the pay rises will come automatically now?

No,actuallynowthehardworkhasbegunforthesector. InVictoria,wehavebegunworkingonmodelingwithgovernmentandnon-governmentsourcesoffunding– theDepartmentofHumanServices,employerorganisations, peakbodiesandourmembers–makingsurethesectorispreparedforthetransitiontotheSocial, Community, Home Care and Disability Services (SCHADS) Industry Award 2010 (commonlyknownastheModernAward)on1July2012 andthenfortheimplementationofthefairpaydecision on1December2012.

WearealsostillwaitingonthefinalEqualRemunerationOrder(ERO)tobehandeddownbyFairWorkAustraliaregardingtherelationshipbetweenthetransitiontotheModernAwardandthemethodologybeingusedtocalculatethesalaryincreasesthroughouttheimplementationperiod.

Haven’t both federal and state governments already committed to doing that?

TheCommonwealthhasbut,atthetimeofpublication,Victoriahasonlycommittedtofunding$200millionover 4years,pendingthefinalisationofthecase.WewillbeworkingcloselywiththeVictorianGovernmenttoensure thattheoutcomesofthecasearefullyfunded.

TheStateGovernment(andothersourcesoffundingto thesector)mayarguethattheydon’thaveenoughmoney tofundtheincreases.WesaythatthecommunitysectordeliversservicesontheGovernment’sbehalfsoithasanobligationtoensurethatwearefullyfundedtoprovide theseservicesandsupportstothemostvulnerableVictorians.Wearealsopointingoutthatallourresearch,includingthat oftheProductivityCommissionontheproductivityofthenot-for-profitsectorandresearchcommissionedbyVCOSSfromAllen’sConsultingGroup,hasshownthatnomore

efficienciescanbegainedfromthecommunitysector withoutcuttingintoservicedelivery.

VCOSS’ media release said, ‘The COSS network will be analysing the decision on implementation to ensure it won’t undermine service effectiveness over time.’ What does that mean?

Likewithanydecisiontobeimplementedoveralongperiodoftime,therewillbechangesintheenvironmentandshiftingcostsandrelativitiestotakeintoconsideration.Asasector weneedtoensurethatweanalyseourworkpracticesandorganisationalviabilitytoensurethatanysalaryincreases haveapositiveimpactonourworkersandourclients.

Alotofotherissueshavebeenonholdtoo,waitingforthedecision.Nowwecanopenthedoorondiscussionsaroundfundingforthesector,ratesforpriceindexationofservices,andbuildingastrongerworkforce,particularlylookingattherealchallengeswefaceontraining,recruitmentandretention.

What was it like getting such an outcome after such a long fought campaign?

Itwasamazingtobepartofsuchanhistoricwin.Thiscouldn’thavehappenedwithoutthechangestotheFair Work Act enactedbytheRuddandGillardGovernments,thesupport oftheCommonwealthindevelopingajointsubmissionwith theASU,theinvolvementofpeakbodiesandthesectorand,aboveall,theleadershipanddeterminationdemonstrated bytheASUandtheirmembers.Wewereupagainstsomeprettystrongopponents,includingbroaderindustryandemployergroups,andthere’sstillsomeriskthatthe decisioncouldbeappealed.

WecongratulatetheASUanditsmembersforrunningasuccessfulcaseoverthelasttwoyears.VCOSSalsowants tothankitsmembersfortheirlong-runningsupport,inparticularthosethatprovidedadditionalfundingforustocampaignonpayequity.

What’s the next step in advancing the sector’s sustainability?

Wearefacingaperiodofbigchange.Inthenext18monthswewilltransitiontotheModernAward,renegotiateratesofpriceindexationforVictorianGovernmentfundedservices,seetheintroductionofaNationalCharitiesRegulator,receivetheGovernment’sresponsetotheProtecting Victoria’s Vulnerable Children Inquiry, undergoVictorianandnationalnot-for-profitlawreform,andseethecommencementoftheNationalDisabilityInsuranceScheme(amongstanarrayofothersub-sectorreforms,CommonwealthofAustralianGovernmentinitiatives,etc).

VCOSSwillbeworkingwithpeakbodiesandthesector,commissioningresearch,developmentsectorviabilitymanagementtoolsanddeliveringtraining,supportandresourcestoensurethatthesectoriskeptinformedandrepresentedoneachandalloftheseissuesandinitiatives.

RESEARCH

28Q&A: Equal pay for community sector workers ByLaurenMatthews



30

Surveyparticipantswereaskedtoidentifythemostimportantchallengesfortheminthecomingyear.Thetopthreechallengeswerenothealth-related.Theywerefinancialproblems(43percent),lonelinessandsocialisolation(37percent)andlackofemployment(35percent).

Section 1. Overview and findings

The2010SurveyofHighImpactPsychosis(SHIP)isAustralia’ssecondnationalpsychosissurvey.Thesurveycovered1.5millionpeopleaged18-64years,approximately10percentper centofAustraliansinthisagegroup.Atwo-phasedesign wasused.InPhase1,screeningforpsychosistookplaceinpublicspecialisedmentalhealthservices(publicinpatient andambulatory/communitymentalhealthservices)andnon-governmentorganisationssupportingpeoplewithmentalillness.InPhase2,1,825peoplewhowerescreen-positiveforpsychosiswererandomlyselected,stratifiedbyagegroup(18-34years;35-64years)andinterviewed.Thedatacollectionincludedsymptomatology,substanceuse,functioning,serviceutilisation,medicationuse,education,employmentandhousing,aswellasacomprehensiveassessmentofphysicalhealthincludingaphysicalexaminationandthecollectionoffastingbloodsamples.

Theone-monthtreatedprevalenceofpsychosiswas3.5casesper1,000population.Themajority(63percentpercent)ofparticipantsmettheWorldHealthOrganisation’sInternationalClassificationofDiseases(ICD-10)criteriaforschizophrenia orschizoaffectivedisorderand17.5percentmetcriteriaforbipolaraffectivedisorder.Symptomsreportedovera12monthperiodincluded:delusions(61percent),hallucinations(56percent),elevatedorirritablemood(23.5percent),anxiety(60percent)anddepression(54.5percent).Themajority(92percent)wereusingpsychotropicmedication.Polypharmacywascommon:63percentwereonmore thanoneclassofmedicationand27percentofthoseonantipsychoticswereusingtwoormore.

Halfofthesamplemetcriteriaformetabolicsyndrome,acombinationofmedicaldisordersthatincreasestheriskofdevelopingcardiovasculardiseaseanddiabetes.Ratesforotherphysicalhealthconditionsweremarkedlyhigherin

Professor Vera A. Morgan, Chair:SurveyofHighImpactPsychosisTechnicalAdvisoryGroupandHead: NeuropsychiatricEpidemiologyResearchUnit,SchoolofPsychiatryandClinicalNeurosciences,UniversityofWesternAustralia

National psychosis survey: mapping use of services

peoplewithpsychosiscomparedtothegeneralpopulation.Theproportioncurrentlysmokingwas66percent.Halfhad alifetimehistoryofalcoholabuse/dependenceand54percenthadalifetimehistoryofillicitdrugabuse/dependence.Two-thirdswereimpairedintheircapacitytosocialiseover thepreviousyearandone-thirdhadimpairedabilitytocare forthemselvesoverthepreviousfourweeks.Educationalachievementwaslowandonly33percenthadanypaidemploymentinthepastyear.Nonetheless,regardlessof thedifficultiesfacingthem,72percentofpeoplewithpsychosiswereveryorsomewhatsatisfiedwiththeirlevel ofindependenceand77percentbelievedtheircircumstanceswouldimproveovertheforthcomingyear.

Thisisthefirstnationalepidemiologicalsurveytomeasure theprevalenceofpsychosisinnon-governmentorganisationsfundedtosupportpeoplewithamentalillnessandtolookatthecharacteristicsofpeoplewithseverementalillnessusingthissector.Wepresentthedatacollectedfortwogroupsofusersofnon-governmentservices:

1.Peoplesolelyusingnon-governmentorganisationsin thecensusmonth(March2010)andnotreceivingpublicspecialisedmentalhealthservicesoverthesameperiod.ThissmallergroupisdescribedinSection2below.

2.Peopleusingnon-governmentorganisationsina12-monthperiodeithersolelyorinconjunctionwithpublicspecialisedmentalhealthservices.ThislargergroupisdescribedinSection3.

Therestofthisreportsummarisesmentalhealth serviceprovisioninthenon-governmentsectorandisextractedfromthemainreportofthesurvey(Morgan etal,2011).Thefullreportmaybedownloadedat: www.health.gov.au/mentalhealth.

Section 2. People solely in contact with non-government mental health services in the census month

One-month prevalence estimate

Theestimatednationalone-monthprevalenceofICD-10psychoticdisordersinpeoplesolelyreceivingmentalhealthservicesthroughnon-governmentorganisationswas0.4casesper1,000populationaged18-64years,atotalnumberof6,204persons.Theratewashigherformalesthanfemales, at0.6and0.3casesper1,000populationrespectively.

Key characteristics

Oneinten(11percent)participantswasonlyincontactwithnon-governmentorganisationsfundedtosupportpeoplewithamentalillnessinthecensusmonthandnotincontactwithpublicspecialisedmentalhealthservicesoverthesameperiod.

Theseparticipantsdifferedfromthoseusingpublicspecialisedmentalhealthservicesonafewkeyvariables.Theyweremorelikelytobeolder,withthreequarters(74percent)aged35-64years(comparedto60percent).Theywerelesslikelytobeemployed,eithercurrentlyorinthepastyear.

Althoughtheywerelesslikelytohaveadiagnosisofschizophreniaorschizoaffectivedisorder,peoplereceivingmentalhealthservicessolelythroughnon-governmentorganisationswereamoredisabledgroupwithmarkedlypoorerfunctioning.

Despiteonlyusingnon-governmentmentalhealthservicesinthecensusmonth,manyhadusedotherhealthserviceseitherinthe11monthspriortocensusorbetweencensusandinterview.However,theyweremuchlesslikelytohaveusedpublichealthservicesformentalhealthtreatmentandalittlemorelikelytohaveusedpublichealthservicesforphysicalhealthreasonsoverthepastyear(Table1).Theywerealso alittlemorelikelytousegeneralpractitionerservices.





Proportion (%)

Using non-government organisations only in census month

Using public specialised mental health services in census month

Using public specialised mental health services in 11 months prior to census

Males 60.5 60.0 57.7

Olderagegroup(35-64years) 69.3 57.4 52.6

CompletedYear12education 30.7 31.2 32.5

Formalstudiesinpast12months 27.8 19.0 22.5

Inpaidemployment(pastyear) 24.9 30.5 43.0

Inpaidemployment(past7days) 16.6 19.2 30.6

ICD-10schizophreniaor schizoaffectivedisorder

46.3 67.2 58.9

Service use

Anyinpatientadmission(pastyear) •Mentalhealthrelated •Physicalhealthrelated

32.7 19.5 17.1

45.6 37.6 12.6

43.5 34.5 13.7

Involuntaryadmission(pastyear) 7.8 22.7 21.0

Anyemergencydepartment attendance(pastyear) •Mentalhealthrelated •Physicalhealthrelated

31.7 13.7 22.0

43.0 29.0 21.6

39.9 25.2 20.0

Anyoutpatientcontact(pastyear) •Mentalhealthrelated •Physicalhealthrelated

65.9 54.1 29.3

92.8 90.5 22.4

77.3 71.9 22.7

Mentalhealthrehabilitation program(pastyear)

74.1 36.8 16.6

Casemanager(pastyear) 67.8 78.1 43.3

Consultationwithgeneral practitioner(pastyear)

91.2 87.8 88.0

Chroniccourseofillness 32.2 33.0 22.0

Globalindependentfunctioning:moderately,significantly,extremely ortotallydisabled(pastfourweeks)

60.0 52.3 39.4

Proportion (%)

Public specialised mental health services

Non-government organisations

Attendedcommunityrehabilitationprogram* 14.5 22.4

For those accessing a community rehabilitation program

Typeofprogram •Group •Individual •Combinationofboth •Notknown Total

13.6 72.0 13.3 1.1 100.0

46.5 29.1 24.4 - 100.0

Usefulnessofprogram •Veryhelpful •Somewhathelpful

54.9 32.6

62.6 27.4

Table 1. Key characteristics of people solely in contact with non-government organisations in the census month compared to those in contact with public specialised mental health services

Table 2. Community rehabilitation programs in past year by sector

* Some participants used rehabilitation programs in both sectors

Section 3. People using non-government mental health services in the past year

Manyparticipantswereincontactwithbothnon- governmentandthepublicspecialisedmentalhealthservices,withoneinthree(30percent)participantsoverallusingmentalhealthservicesprovidedbythenon-governmentsectorinthepastyear.Thissectiondescribesthetypesofprogramsandkindofsupportthattheseparticipantswerereceivingfromtheseagencies.

Rehabilitation programs

Justoveronethird(36.5percent)ofpeoplehadparticipatedincommunityrehabilitationordayprogramswithinpublic

mentalhealthservicesand/ornon-governmentorganisationsinthepastyear(Table2).Moreparticipantswereinvolvedinrehabilitationprogramsinthenongovernmentsector(22percent)thaninthepublicmentalhealthsector(14.5percent).

Themajorityofparticipantsusingtheseprogramsfoundtheprogramuseful,with87.5percentofthoseusingpublicspecialisedmentalhealthservicesand90.0percentusingnongovernmentcommunityrehabilitationprogramsreportingthattheyweresomewhatorverysatisfied.

Thepercentagewithanindividualrehabilitationorrecoveryplanwas29percent.

Thisisthefirstnationalepidemiologicalsurveytomeasuretheprevalenceofpsychosisinnon-governmentorganisationsfunded tosupportpeoplewithamentalillnessandtolookatthecharacteristicsofpeoplewithseverementalillnessusingthissector.

National psychosis survey: mapping use of services ByProfessorVeraA.Morgan



Figure 1. Non-government organisation group-based rehabilitation programs

Figure 2. Non-government organisation one-to-one support

Group-based rehabilitation programs

Non-governmentorganisationsarekeyprovidersofrehabilitationprogramstopeoplewithpsychoticillnesses, withonequarter(22percent)ofallparticipantsattendingnon-government-runprogramsinthissectorand90per centofthemreportingthattheprogramswereveryorsomewhathelpful(Table2).

Themostcommonlyattendedprogramswereindependentdailylivingskillsprograms(33percent),healthylivingandfitnessprograms(30percent)andcreativeactivities(28percent).Thesewerefollowedbyprogramstargetinganxiety andstress(23percent),communicationandsocialskills(22percent),moodmanagement(17percent)andsymptommanagement(13percent).Smallerproportionsofpeople hadattendedalcoholanddrugmanagementprograms(7.5percent)andantismokingprograms(3.5percent)(Figure1).

One-to-one support

Aswellasrunninggroup-basedrehabilitationprograms,non-governmentorganisationsalsoprovidedone-to-onesupportandassistance.Two-thirdsofparticipantssupported bynongovernmentorganisations(69percent)hadreceivedcounsellingoremotionalsupport,whilemanyhadreceived helptoaccessotherservices,includingcommunityservices (45percent)andmentalhealthservices(37percent).Just overtwo-fifthshadreceivedinformationonmentalillness (44percent)orrecoveryplanning(41percent).Onethird hadbeengivenpracticalassistanceintheformofhomehelp (32percent)andsubsidisedmeals(32percent),andonequarterhadreceivedhousingassistance(25percent). Almostonequarterhadreceivedvocationalorskillstraining (23percent)orhelpwithpaidorunpaidemployment(22 percent)(Figure2).

Proportion (%)

0 10 20 30 40 50 60 8070

Help to access education

Counselling or emotional support 68.6

Help to access other community services 45.4

Information about mental illness 43.8

Information on recovery planning 41.4Support to link with mental health services 36.6

Free or cheap meals 32

Accommodation or help to find accommodation 24.6Vocational training/employment skills/experience 23Help to find or keepa job or volunteer work 22.4Financial assistance/material aid or help to access financial assistance/material aid 19.3

Home help 32.2

Proportion (%)

Public mental health services

Non-government organisation

Casemanager* 61.6 20.2

For those with a case manager

Contactwithcasemanagerisasoftenaspreferred Frequencyofcontact •Onceaweekormore •Lessthanonceaweek,butatleastonceevery4weeks Satisfactionwithcasemanager •Verysatisfied •Somewhatsatisfied

76.5 28.1 54.4 62.2 22.8

77.8 64.0 30.4 69.6 19.8

Table 3. Case management by sector if case managed in past year

*Some participants had case managers in both sectors over the past year

Case management and home visits

Sevenoutoftenparticipantsreportedhavingacasemanagerinthepastyear:62percentofthetotalsamplehadacasemanagerprovidedbypublicspecialisedmentalhealthservicesand20percenthadoneprovidedbyanon-governmentorganisation,with13percenthavingoneprovidedbyeachsectoratsomestageoverthepastyear(Table3).

Satisfactionwithcasemanagementfrombothsectorswashigh,with85percentofparticipantswithpublicspecialised

mentalhealthservicecasemanagersand89percent ofthosewithnongovernmentcasemanagersbeing veryorsomewhatsatisfied.

Three-quartersofparticipantsreportedbeinghappywith thefrequencyofcontactwiththeircasemanager.Mostof theremainderwouldhavepreferredmorecontact:13.5 percentofpeoplewithacasemanagerprovidedbypublicspecialisedmentalhealthservicesand16percentofpeoplewithoneprovidedbyanon-governmentorganisation.

Aroundhalf(53percent)hadhadoneormorehomevisitsinthepastyearbysomeonefromanon-governmentorganisation.




Proportion of those with a personal helper (%)

Providedparticipantwithsupporttomanagedailyactivities

64.0

Referredparticipant tootherrelevantservices

49.3

Accompaniedparticipant toappointments

45.3

Actedasanadvocate 45.3

Providedsupportwith physicalactivities

34.2

Supportedparticipant’s familyorcarer

21.3

Total respondents 225

Table 4. Type of support provided by personal helper in past year Personal Helpers and Mentors Services

ThePersonalHelpersandMentorsServices(PHaMS)is anAustralianGovernmentinitiativedeliveredthrough non-governmentorganisationstosupportpeoplewith aseverementalillnesstomanagetheirdailyactivitiesand liveindependentlyinthecommunitywithcoordinated, integratedaccesstocommunityservices.Thefirst demonstrationsiteswerefundedin2007.

Inall,12percentofparticipantshadapersonalhelper overthepastyear.Manyhadusedtheserviceforalong time.Themajorityofthoseusingtheservice(60percent) hadhadapersonalhelperforayearorlonger,andover aquarter(28percent)hadhadonefortwoyearsormore.

Twothirds(64percent)ofthoseparticipantswithapersonalhelperreceivedsupporttomanagedailyactivities.Personalhelpersalsoassistedbyreferringparticipantstootherservices (49percent),accompanyingparticipantstoappointments (45percent),andactingasanadvocate(45percent).Serviceshadalsoprovidedsupportwithphysicalactivitiestoone-third ofparticipants(34percent)andsupporttoonefifthofparticipants’familiesandothercarers(21percent).SeeTable4.

Section 4. Conclusion

Surveyparticipantswereaskedtoidentifythemostimportantchallengesfortheminthecomingyear.Thetopthreechallengeswerenothealth-related.Theywerefinancialproblems(43percent),lonelinessandsocialisolation(37percent)andlackofemployment(35percent).Health-relatedissueswererankednext,with27percentnamingphysicalhealthissuesand26percentnamingtheuncontrolledsymptomsofmentalillness.Housingwasrankedsixth,at 18percent.Amajorundertakingofthe2010SurveyofHighImpactPsychosis(SHIP)wastocollectkeyand,insomecases,uniquedataonthesechallengesandmanyotheraspectsofthelivesofpeoplewithseverementalillness,includingtheiruseofservicesprovidedbynon-governmentorganisations.Itishopedthatthedatacollectedwillinformpolicychangeandserviceprovisiontothebenefitofpeoplelivingwithpsychosis,theirfamily,carersandtheservicessupportingthem.

Reference

MorganVA,WaterreusA,JablenskyA,MackinnonA,McGrathJ,CarrV,BushR,CastleD, CohenM,HarveyC,GalletlyC,StainH,NeilA,McGorryP,HockingB,ShahS&SawS,2011,People living with psychotic illness 2010. Report on the second Australian national survey. Canberra,AustralianGovernmentDepartmentofHealthandAgeing.


YOUR SAY...



PrahranMissionUnitingCare(formerlyPrahranMethodistMission,thenlaterPrahranCityMission)wasestablishedin1946whenthepremisesat211ChapelStreetPrahranwerepurchasedfor30,000pounds.In1977theMissionbecamepartoftheNepeanPresbyteryoftheUnitingChurchinAustralia.In1982thefirstdayprogramforpeoplewithapsychiatricdisabilityinVictoriawasestablishedwithfundingfromtheCommonwealth-oneofonlytwoorganizations atthetimefundedforworkinthisareainVictoria.

PrahranMissioniscommittedtothewell-beingofthecommunitythroughitsmentalhealth,agedcare,employment,socialfirms,housingandresidentialservicesandcommunitydevelopmentactivities.Itprovideshighqualitysocialandprofessionalcommunityservicesandchallengesunjustsocialandeconomicstructures.PrahranMissionserves,assiststheempowermentof,andadvocatesalongsidepeoplewhohaveapsychiatricdisability,olderpeople,youth,thehomeless,peoplefromnon-Englishspeakingbackgrounds,diversecommunitiesandothereconomicallyandsociallydisadvantagedindividualsandgroups.

Ourmissionistopartnerwiththosewhohaveorhavehad amentalillnessorexperienceextremesocialandeconomicdisadvantageinordertofacilitateafullandmeaningfullife.PrahranMissionachievesthisthroughtheprovisionofservicesthataregroundedinourvaluesandbyeffectingbeneficialsocialchangethatcreatesopportunitiesformeaningfulparticipationinsociety.

During2010/11morethan3,500peoplewerehelpedbyPrahranMission.TheMission’sprofileandreputationwaslargelybuiltaroundprovidingasocialoutletandfood,clothingandmaterialaidtothefinanciallyandsociallydisadvantagedacrossMelbourne’sInnerSouth-Eastregion.Therealitynowhoweveristhatapproximately90%ofexpenditureandstafftimeisspentcaringforpeoplewithvaryingdegreesofmentalillness.Over600consumersaccesstheMission’sserviceseveryweek.

PrahranMission’sservicesextendacrosstheLocalGovernmentAreas(LGAs)oftheCitiesofStonnington, GlenEira,PortPhillip,Monash,Boorandara,Kingston, GreaterDandenong,YarraandBayside.

TherecentredevelopmentoftheChapelStreetsitehasallowedagrowthinservicessuchastrainingandjobplacementaswellasadditionalsocialsupportprograms andspaceforemergencyservicesforpeoplelivingwith mentalillnesstoincreasethecapacitytofeedandclothe,providefinancialreliefandassistinfindingahome.

PrahranMissionhassixdiscretesuitesofclientservicesprogramswhichare:Home Based Outreach Support (Mothers’SupportProgram,PHaMsBaysideandMonash,InnerSouthOutreach,KillaraAgedPDRSS);Day Rehabilitation (OpenHouse,SecondStory,EmergencyRelief,StablesArtStudio,VoicesVicandConnectEd)Employment, Education & Training(JobSupplyPersonnelEmploymentService). Aged Care (CommunityAgedCarePackages).Scottsdale Residential Service and Haven South Yarra (24hourResidentialbasedpsycho-socialrehabilitation)Retail Operations(OpportunityShops,Restaurant,Catering, Café,VolunteerSupportandHospitalityandRetailTraining).

OneofourmostimportantprogramsinthePDRSSHomeBasedOutreachareaistheMother Supportprogram.Thisprogramworkswithwomenwhoareaffectedbymentalillness,and whohavechildrenlivingintheircare.Thisprogramprovides apsycho-socialrehabilitationprogramtowomenwhohave anenduringmentalillness.Itisagoalorientedprogramwhichassistwomentoachieveimportantoutcomesinareassuchasparenting,housing,physicalwellbeingandsocialconnections.

AnotherimportantfocusoftheorganisationhasbeentoprovidesupporttopeopleintheOpenEmploymentarea.ThroughJobSupplyPersonnel,afederallyfundedEmploymentProgram, wehavebeenabletoassistover200peopleayearforthepast 18years.Thefocusonemploymentparticipationinallourstrengthbasedmentalhealthprogramshasbecomeincreasinglyimportant.

Member profile Prahran Mission Uniting Care

Mark Smith, GeneralManagerServices

VICSERV Conference Presentation:

PrahranMissionislookingtopresentandshowcaseanumberofareasinboththeVICSERVconferencethisyearandtheMHSconferencelaterintheyear.TheHavenSouthYarraResidentialRehabilitationprogramstaffwillpresentthebenefitsofworkingalongsidecarersinthisinnovativemodel.VOICESVIC,partofDayRehabilitation,willbepresentingontheenormousbenefitsandgrowthwhentrueparticipationisnurturedandencouragedwithinanorganisation.AsapartnerintheInnerSouthEastMentalHealthAlliance,Prahran Missionwillbepresentingwithothersontheartand practiceofcollaboration.

New Developments:

IntheearlydaysIthinkoursectorwasquitesignificantinprovidinganalternativetothemedicallybasedmentalhealthservicesandinfactitwasthis“volunteerparticipation”notionthatmanypeoplewereattractedto.Ibelievethatnowistheperfecttimeforsomenewthinkingaroundthewayservice isprovided.TheincreasedrecognitionbyparticipantsandgovernmentacrossAustraliaofthevalueofworkbythecommunitymanagedmentalhealthsectorwillleadto furtheropportunitiesforpartnershipsbetweenclinicalandcommunitymanagedservices.

Itisindeedexcitingtoseeparticipantsfindingtheirvoice acrossthesectorandhavingalotmoresayinplanning,developingandrunningofprograms.Ithasbecomingeasier toidentifythebuildingblocksofwhatconstitutesagoodprogram:empowerment;assumptionthattheuserisincontrol;dignity;meaningfulevaluationandvaluesthatarebasedonthebeliefthatrecoveryispossible.

TheareasIseeasdevelopingrapidlyinthenextfewyears willbethatcommunitymanagedagencieswillbeincreasinglylookingataccountabilityandhowtheycanmeasureaneffectiveoutcome,bothforparticipantsandforfundingbodies.Theabilityforagenciestoaccuratelyfullycosttheworktheydoinordertobeeffectiveandusethefundinginthemost

efficientmannerwillbecomemoreimportantasblockfundingchanges.Theimportanceofmeaningfulemploymentandphysicalhealthwillincreasinglyberecognisedasanimportantaidtorecovery.Theroleoffamiliesandcarersshouldbeutilisedmore,whereappropriate,toassistinthedevelopmentofrecoveryplans.

Organisationswillneedtobeinnovativearoundworkforcetraining,retentionandappropriaterecognitionasthesectorgrowsandrequirementsbecomemorestringent.

Onethinginourworkneverchanges–itisadeeplypersonalandchallengingrelationshipbetweentheorganisation,workerandparticipant.

Finally,asparticipantsoftenpointout,recoveryisadeeplypersonalandemotionalprocessyoudoyourself.Inrealityservicesarejustheretoassist,whenneeded.Ithasbeenmyimmensepleasuretobeabletoworkinanareawhereoneisconstantlyinspiredbythecourageanddeterminationofpeople.

About the author

Celebrating21yearsintheCommunityManagedMentalHealthSectorthisyear,MarkSmithhasbeenGeneralManagerofServicesatPrahranMissionUnitingCarefor almost9years.Hepreviouslyspent18monthsasa SeniorProjectOfficerintheMentalHealthBranchinthe DepartmentofHealthworkingonQualityImprovementProjectsandbeforethat12yearsinManagementinPDRSSHomeBasedOutreachandEmploymentprograms.Mark hasbeenadirectorontheVICSERVBoardofgovernance forthepastsixyears.

ExPRESSION SESSION



CallumMcfarlane

Thefollowingartworksinthisedition’sExpressionsession arebyparticipantsinNorthYarraCommunityHealth’sartprograms.NorthYarrawillbepresentingfurtherexamples ofcreativityattheReframingmentalhealthconference.



CallumMcfarlane

Expression Session



GulerAltunbas

Mentalillnessistroubling;troublingforthepersonwhohasitandtroublingfortheirlovedones.Oneinfivepeoplewillhaveamentalillnessinanytwelvemonthperiodandnearlyhalfwillexperienceitduringtheirlifetime.Willpower,loveandempathyareseldomenoughtomakethingsbetter.Whensomeone’sthoughtsaredisturbedanddisturbingortheirbehaviourisbizarrelyoutofcharacter,fewamongstusknowwhattodo. SobeginsthesearchforanswerswhichusuallystartswithseekingprofessionaladvicefromaGPormentalhealthpracticioner.

Somepeoplealsohavelatenightsessionswith‘DrGoogle’.Thereareexcellentwebsitesthatprovidefactsheetsandinformationaboutwheretogethelp.Readingmorewidelycanbehelpfulduringthejourneyfromdiagnosistorecoveryandbeyond.Manybookshavebeenwrittenaboutspecificillnesses,aboutlivingwithmentalillnessandaboutworkingwithpeopleaffectedbymentalillness.ArecentreleaseisUnderstanding troubled mindswhichisapracticalguidetomentalillnessanditstreatmentwrittenbyEmeritusProfessorSidneyBlochfromMelbourneUniversity.

Thebookbeginswithashortchapteronthehistoryofpsychiatrywhichhiglightsthesignificantadvancesthathave beenmadeinthelastfiftyyearsbythescientificcommunity andtheconsumermovement.Asenseofhopeandoptimismrunsthroughoutthebook.Theliberaluseofbriefcasestudies,insightsandimagesfromartistsandwritersrevealthecomplexity ofhumannature.Inchaptertwo:Making sense of a life,theauthorconsidersthelifeoftheartistVincentvanGoughusingthetwinperspectivesofunderstandingandexplanation.Themeaningbehindaseeminglyclear-cutcaseofmentalillness

ispresentedinthebroadcontextoffamilydynamics,culturalmoresandaparticularhistoricalmomentintime.ProfessorBlochusesthelifeofthisfamouslytroubledindividualtodemonstratethatunderstandingtheimpactofanillnessonapersonandtheirfamilyisthekeytoasuccessfultherapueticalliance.

Thebooklargelyconsistsofchaptersdescribingtheworkings ofthemindandspecificdisordersandtheirtreatment.There isasectiononchildrenandadolescents,oneonwomenandanotherontheelderly.Thebookdoesnotfocusonthesocialdeterminantsofmentalhealth.Nordoesitacknowledgetheroleofthecommunitymanagedmentalhealthservicesystem inworkingwithpeopletoassisttheirrecoveryandincrease theirsocialinclusion.Theconcludingchaptercontainsaveryinterestingdiscussionontheethicaldimensionsofthepractice ofpsychiatry.ProfessorBlochdescribesthemanydifferentethicalchallengesencounteredbypsychiatrists.Theseincludetheethicsofmakingadiagnosisandofvoluntaryandinvoluntarytreatment.Aframeworktodealwithethicalchallengesispresentedandisbasedonprinciciplismandcareethics.

Understanding troubled minds isveryreadable,informativeandthoughtprovoking.Iimagineitwouldbeparticularlyusefulforpeoplerecoveringfrom,orwhohaverecoveredfrommentalillnessandwhomightwishtospendsometimereflectingonhowitwastohaveatroubledmind.

Reviewedby Wendy Smith PolicyandResearchManager,newparadigmeditorVICSERV

Book reviewUnderstanding troubled minds: a guide to mental illness and its treatment (full revised second edition)

Professor Sidney Bloch, MelbourneUniversityPress,2011

Expression Session 45



ABOUT US

VICSERVisamembership-basedorganisationandthepeakbodyrepresentingcommunitymanagedmentalhealthservicesinVictoria.Theseservicesincludehousingsupport,home-basedoutreach,psychosocialandpre-vocationaldayprograms,residentialrehabilitation,mutualsupportandself-help,respitecareandPreventionandRecoveryCare(PARC)services.

ManyVICSERVmembers alsoprovideCommonwealth fundedmentalhealthprograms.

As the peak body for the community managed mental health sector in Victoria, we pursue the development and reform of mental health services.

We support members by:

•Promotingrecoveryorientedpractice•Buildinganddisseminatingknowledge•Providingleadership•Buildingpartnershipsandnetworks•Undertakingworkforcedevelopment,

trainingandcapacitybuilding•Promotingqualityinservicedelivery•Undertakingadvocacyandcommunityeducation

Our MissionOur Vision

Collaboration (Teamwork)

• Workingtogethertoachievesharedobjectives• Respectingtheknowledgeandskillsofothers• Puttingtheneedsoftheorganisationabove

individualinterests

Inclusiveness

• Listeningtoarangeofviews• Representingandembracingthediversityofthesector• Honouringtheconsumerandcarerexperience

Flexibility

• Proactivelyembracingchangeandnewopportunities• Steppingupandoutfromourrolesandperspectives

whenrequired

Courage

• Takingleadershipbyspeakinguponimportantissues• Encouragingandsupportinginnovation• Persistenceinthefaceofobstaclesanddelays

Integrity

• Doingwhatwesaywewilldoontimeandtothe bestofourability

• Listeningandrespondingtomembers• Havingarespectedvoiceandvisibilityinthesector,

broadersystemandingovernment•Beinganhonestbrokerofinformationandresources.

Our Values

VICSERV envisages a society where mental health and social wellbeing are a national priority and:

•Everyonehasaccesstotimelymentalhealth treatmentandsupport

•Mentalhealthservicesarerecoveryoriented•Peopleparticipateindecisionmakingabouttheir

ownlivesandtheircommunity•Peopleaffectedbymentalillnesshaveaccessto,and

afairshareof,communityresourcesandservices•Allpeopleareinvolvedasequals,withoutdiscrimination.

Psychiatric Disability Services ofVictoria(VICSERV) Level2,22HorneStreet, ElsternwickVictoria3185Australia T0395197000F0395197022 [email protected] www.vicserv.org.au

REFRAMING MENTAL HEALTH: A NEW STATE OF MIND€¦ · REFRAMING MENTAL HEALTH: A NEW STATE OFmergers MIND It is a taster for those of you attending the conference and an opportunity

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