The Interim Report
In November 2019, the Commission delivered an Interim Report outlining a number of priority recommendations that addressed immediate needs and laid the foundations for a new approach to mental health.
The Interim Report took stock on what the Commission had heard to date, and made several interim recommendations. Some of these recommendations were aimed at specific, immediate deficiencies in Victoria’s mental health and wellbeing system. Others laid the groundwork for more fundamental structural changes needed to transform the state’s mental health system.
In summary, the Commission recommended:
- Establishing a new entity, the Victorian Collaborative Centre for Mental Health and Wellbeing;
- Expanding youth and adult acute mental health beds to relieve critical demand pressures;
- Expanding follow-up support for people after a suicide attempt by recurrently funding all area mental health services to offer the Hospital Outreach Post-suicidal after Engagement (HOPE) program;
- Expanding social and emotional wellbeing teams through Victoria and that these teams be supported by a new Aboriginal Social and Emotional Wellbeing Centre;
- Establishing a residential mental health service facilitated through the Mental Health Implementation Office. This service will provide short-term treatment, care and support in a residential community setting, as an alternative to acute treatment in hospitals;
- Expanding consumer and family-carer lived experience workforces and enhancing workplace supports for their practice;
- Preparing a workforce reform and addressing workforce shortages by developing educational and training pathways;
- Developing a new approach to mental health investment such as a levy or tax or a dedicated capital investment fund for the mental health system; and
- Establishing a Mental Health Implementation Office to implement the Commission’s recommendations as set out in the Interim Report.
The Final Report
The Final Report builds on the key reforms tabled in the Interim Report. It explains system-wide changes that will create a mental health and wellbeing system that is contemporary and adaptable. The Final Report is made up of five volumes:
- Volume 1: A new approach to mental health and wellbeing in Victoria
- Volume 2: Collaboration to support good mental health and wellbeing
- Volume 3: Promoting inclusion and addressing inequities
- Volume 4: The fundamentals for enduring reform
- Volume 5: Transforming the system – innovation and implementation
Through these volumes, the Final Report makes 65 recommendations to improve Victoria’s mental health system. The Commission developed a path for reform using seven guiding principles upon which it based its recommendations. These were:
- The inherent dignity of people living with mental illness or psychological distress is respected, and necessary holistic support is provided to ensure their full and effective participation in society.
- Family members, carers and supports of people living with mental illness or psychological distress have their contributions recognised and supported.
- Comprehensive mental health treatment, care and support services are provided on an equitable basis to those who need them and as close as possible to people’s own communities – including in rural areas.
- Collaboration and communication occur between services within and beyond the mental health and wellbeing system and at all levels of government.
- Responsive, high-quality, mental health and wellbeing services attract a skilled and diverse workforce.
- People with lived experience of mental illness or psychological distress, family members, carers and supporters, as well as local communities, are central to the planning and delivery of mental health treatment, care and support services.
- Mental health and wellbeing services use continuing research, evaluation and innovation to respond to community needs now and into the future.
The Commission’s recommendations are centred on transformational reform. The major reform areas can broadly be grouped around four key features of the future mental health and wellbeing system.
A responsive and integrated system with community at its heart
The future mental health and wellbeing system will be restructured around a community based model of care. This means that people will be able to access treatment, care and support close to their homes and in their communities. Two parallel systems will be established. One system will be for infants, children and young people, and the other; adults and older adults.
A six tiered system has been developed, where the top level is aimed at the largest number of people and the lowest level – statewide services – the fewest. These levels will operate with a progressive level of specialisation. Broad reforms to New Adult and Older Adult Local Mental Health and Wellbeing Services are intended to create a “Broad Front Door” so more people can access such services than is currently the case.
A system attuned to promoting inclusion and addressing inequities
The new system would be designed to be particularly responsive to people and populations in Victoria with the greatest need. The Commission envisaged that this reform would require looking beyond the system to examine the social determinants of health, such as where people are born, grow, work live and age. This reform raises the possibility that stigma and discrimination will be diminished in the new mental health and wellbeing system, which in turn will create a sound foundation to support good mental health and wellbeing.
Re-established confidence through prioritisation and collaboration
The reforms will further encourage effective leadership, governance and oversight, accountability and collaboration across governments and communities, and ensuring that people with lived experience of mental illness or psychological distress are leading and partnering with others in reform efforts.
A new independent and statutory Mental Health and Wellbeing Commission will be established by the new reforms to hold the Victorian Government to account for the performance of the mental health and wellbeing system. A Chief Officer for Mental Health and Wellbeing will also lead a Mental Health and Wellbeing Division in the Department of Health. Importantly, the new Mental Health and Wellbeing Commission will include Commissioners with lived experience of mental illness or psychological distress and lived experience as a family member or carer. The Commission’s reimagined reforms will be enshrined in legislation in a new Mental Health and Wellbeing Act.
Contemporary and adaptable services
The Commission acknowledged that its reimagined mental health and wellbeing system would require a fundamentally different approach: the new system will need to adapt to changing expectations, trends and emerging challenges. Specifically, the new system will need to place a paramount importance on respecting consumers’ human rights every step of the way. This includes greatly reducing the use of seclusion and restraint and substantially reducing the use of compulsory treatment so that it is only used as a last resort.
Service providers will also be required to implement a minimum level of digital functionality to ensure continuity of care and navigation and to improve system access. Further, providers of mental health and wellbeing programs will need to agree to evaluation as part of funding arrangements. This will assist the system to continue to evolve and respond to the expectations of people engaged with the system.
Recommendations
Key recommendations of the Commission included:
- Ensuring that people have access to services that are compassionate and responsive to their needs and are based on their rights and preferences;
- Focussing on ensuring that treatment and care is available for all Victorians, no matter their background or need;
- Redesigning services and moving from a crisis driven model to a community support and clinical services model that delivers better outcomes;
- Setting up programs of support for families and carers that support them in their own right;
- Foundational changes focused on creating new structures that support the sustainable mental health and wellbeing system;
- Building a workforce that is diverse, large enough and with the right skills and experience;
- Pioneering initiatives in Victoria that are led by Victorians who have lived experience; and
- Looking beyond the traditional mental health system to create new ways to support mental health in the community and to make sure that people are well supported in the first place.
There is much more detail in the Report than can be included in a short summary such as this. The Victorian Government has committed to implementing all of the recommendations.
Russell Kennedy will continue to monitor the progress of the Government response and provide further information as it becomes available.
How we can help
If you require further information, please contact Michael Gorton, Solomon Miller, Jonathan Teh or Emma Turner.
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