Victoria’s priorities for
mental health reform
2013–15
Victoria’s priorities for mental
health reform 2013–15
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© Copyright, State of Victoria, Department of Health, 2013
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in accordance with the provisions of the Copyright Act 1968.
Authorised and published by Victorian Government, 50 Lonsdale Street, Melbourne.
December 2013 (1211034)
Minister’s foreword
The Victorian Government is putting individuals and families at the centre of mental health services
and investing in new ideas to improve the lives of people with mental illness.
Victoria’s priorities for mental health reform 2013–15 outlines the government’s agenda for change.
The change priorities focus on ensuring people who need mental health treatment and support
can access high-quality and responsive care when they need it. People with a mental illness and
their families should be able to actively participate in decisions related to their care and have
a range of choices about the types of support they need to achieve optimal wellbeing.
Preventing mental illness where possible, providing help early and working with individuals
and their families to meet their own recovery goals is central to the government’s approach.
Together with people with a mental illness, carers, families and services, the Victorian Government
is building a stronger system in which long-term recovery and support for overall health and
wellbeing, social connectedness and economic participation are paramount.
The Victorian Government currently invests record funding of more than $1.2 billion in mental
health services each year. With an additional $273 million committed to specific mental health
improvements, the government is building momentum for real and lasting change.
Victoria’s priorities for mental health reform 2013–15 highlights the concrete actions to be taken
over the next three years to:
• reform Victoria’s mental health legislation
• strengthen clinical mental health services
• reform community mental health support services
• connect mental health services with other health and human services
• broaden prevention and promotion activities
• develop a stronger, more capable and sustainable specialist mental health workforce.
Achieving this reform agenda involves service redesign, innovation, new mental health legislation
and workforce development across both acute and community mental health support services.
Victoria has a diverse and vibrant mental health sector spanning the public, community-managed
and private sectors. Yet the way this sector is configured, funded and integrated into the broader
health and human services systems needs significant reform, important aspects of which are
now underway.
State-funded mental health services will be a more integral and connected part of Victoria’s
broader health and human services system, with community-based treatment and care at the
centre. This is critical to reducing the potentially devastating impacts associated with mental
illness, including enduring disability, unemployment, homelessness and social exclusion.
Developments in mental health service delivery under this plan will play an important role
in progressing many of the key directions for the overall health system set out in the Victorian
Health Priorities Framework 2012–2022.
Improving access to mental health is also key part of reform in the human services system, where
care and support for vulnerable Victorians and their families is being streamlined and integrated
through the Services Connect integrated service model.
iii
Victoria’s priorities for mental health reform 2013–15 provides the basis for further discussion with
stakeholders and will be complemented by a range of more detailed plans. I look forward to working
with you on the next steps in mental health reform to deliver better outcomes for Victorians with
a mental illness and their families.
Hon. Mary Wooldridge MP
Minister for Mental Health
iv
Contents
Minister’s foreword
iii
Improving the lives of people with a mental illness
1
Part A: The case for change
3
People’s experiences of services
3
Growing demand for crisis care
5
A system under sustained pressure
6
Increasing use of involuntary treatment orders
7
Complexity of need
8
Part B: Policy context
9
The Victorian context
9
Health reform
10
The national context
11
Part C: The way forward
12
Reform objectives
12
New investment
13
Part D: Strategic priorities for reform
15
Strategic priority 1: Reform Victoria’s mental health legislation
16
Strategic priority 2: Strengthen clinical mental health services
19
Strategic priority 3: Reform community mental health support services
21
Strategic priority 4: Connect services to improve people’s lives
25
Strategic priority 5: Prevent mental health problems and promote positive mental health
29
Strategic priority 6: Build better practice and a stronger workforce
32
Part E: Working together to take action
34
v
vi
Improving the lives of people
with a mental illness
The Victorian Government is taking action to make a real difference to the way people and their
families are supported to cope with mental health problems and to achieve optimal mental health and
wellbeing. These reform directions, how they will be achieved and our expectations of the service
system are described in Figure 1.
Figure 1: Victoria’s mental health reform priorities
Outcome
What will be different
Strategic priority for reform
The best health outcomes
possible for people with
a mental illness
Environments which encourage better health
and wellbeing
Strategic priority 1
Minimised risk of long-term
disability and maximum
participation in the community
A better service experience for people and
their carers and families, with greater choice,
respect and more meaningful participation
in decision making
Strategic priority 2
People are managing their
own mental health better
Easier and earlier access to treatment and
tailored support of the right intensity and
duration for people of all ages, stages and
complexity of need
Strategic priority 3
People have the best
treatment and support
possible, tailored
to their individual needs
Individualised support with an increased
focus on self-management and improving and
maintaining health, independent living, social
connectedness and economic participation
Strategic priority 4
Mental health services are
consistently high quality and
readily accessible
Reduced use and duration of compulsory
treatment and restrictive interventions
Strategic priority 5
The mental health service
system is highly productive,
cost-effective and sustainable
Better connected care planning and delivery
across clinical, psychosocial rehabilitation and
primary mental healthcare services
Strategic priority 6
Specialist mental health
and broader health and
community services provide
a joined-up response to
people with a mental illness
and their families
Improved coordination and collaboration of
mental health services with the wider health,
human services and justice systems
Reform Victoria’s mental
health legislation
Strengthen clinical mental
health services
Reform mental health
community support services
Connect services to improve
people’s lives
Prevent mental health
problems and promote
positive mental health
Build better practice and
a stronger workforce
Increased focus on the needs of people’s
families and dependent children, particularly
vulnerable children and families
A stronger, more competent, capable and
sustainable workforce
Increased accountability and transparency
with a more explicit focus on achieving positive
outcomes for people
Sustainability through higher quality services
and improved efficiency and effectiveness
1
2
Part A: The case for change
People with a mental illness, their carers, their families and service providers agree that Victoria
needs a greater focus on prevention and early intervention, long-term recovery, wellbeing and social
participation and a whole-of-system approach to achieving better mental health outcomes for people
with a mental illness.
More than 19 per cent of Victorians – or about one million people – are affected by a mental health
problem in any given year. It is estimated that 63 per cent of these people have mild to moderate
problems; 21 per cent have moderate to severe illness and 16 per cent have severe mental illness.
Stakeholders have been of the view that, despite the vibrancy and strengths of the Victorian service
system, change was needed to consistently deliver the right services to the right people at the right time.
Much has been done over the past three years to address mental health demands. However,
more still needs to be done. Despite some excellent work by skilled and dedicated providers and
practitioners, many of the same problems continue to beset the system, and in some cases have
become more entrenched.
A strong case for reforming mental health services has been made nationally and in Victoria,
with consistent calls to target a wider range of people and conditions and offer intervention
where most benefit can be achieved by shifting focus from a crisis-oriented approach to a greater
emphasis on earlier intervention and community-based care.
People’s experiences of services
Access to services
Too many people who require mental health services do not receive timely or appropriate care.
In some cases, people reach a point of crisis before they seek or are able to receive services.
In other cases, even when people reach an acute stage of illness, they may not receive a timely
service due to high demand on the public mental health system. Some people with multiple
or complex issues or needs may struggle to seek care. Services may not be available where
people live, or the available services may not be suitable for their particular needs.
The use of emergency departments as a pathway to care is growing, and this trend highlights
the difficulties people experience in accessing timely mental health care in the community,
particularly in times of acute illness.
Access for people in rural and regional areas
People in rural or regional areas of Victoria face particular challenges in accessing services due
to distance and limited service offerings. A sustainable approach to service system development
needs to recognise the significant differences between metropolitan and rural Victoria.
As highlighted in Victorian Health Priorities Framework 2012–2022: Rural and Regional Health Plan,
mental health service utilisation is higher in rural areas, but services face many challenges in terms
of accessibility and workforce availability.
3
Fragmented and inflexible services
Service users and service providers agree that the mental health service system is fragmented,
complex and difficult to navigate. This complexity is a result of a system that has developed in an ad
hoc way. Over time, State and Commonwealth investments have added new funding streams with
their own access and accountability requirements. While new investment is welcome, this has led
to a fractured experience of care for many people.
Another result of this historical development is a system that can be siloed, program-focused
and prescriptive. Work in recent years to create more flexible individualised funding and care
coordination capacity, particularly for people with high-level disability and complex care needs,
shows that a more flexible approach can make a real difference in people’s experience of services
and in their long-term outcomes.
Addressing these systemic issues is a major challenge but it is critical if the mental health system
is to be able to respond efficiently and with agility to a growing number of people with increasingly
complex needs.
4
Growing demand for crisis care
As Figure 2 shows, the demand for mental health services – particularly acute services – has increased
significantly over recent years.
Consistently high bed-occupancy levels, high caseloads and blockages in moving people
through services reflect these pressures, making it hard for many people to access timely care.
In addition due to these demand pressures services tend to focus predominantly on a person’s
immediate presenting problems – on achieving stabilisation and risk reduction – rather than
on long-term holistic recovery.
The proportion of people who present to emergency departments needing a bed has been rising
sharply. This reflects a great number of people experiencing acute illness or crisis and a growing use
of emergency departments as a pathway to care. This is occurring despite efforts to provide earlier
intervention and community-based care – for example, a statewide network of subacute mental
health facilities for adults and young people – to reduce the need for emergency care
and hospitalisation.
Figure 2: Mental health admissions
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
2007–08
2008–09
2009–10
MH admissions
2010–11
2011–12
2012–13
MH admissions from ED
5
A system under sustained pressure
Acute inpatient mental health services (especially those for adults) are experiencing sustained
pressure with consistently higher occupancy levels than are considered appropriate for this type
of service (Figure 3). While this suggests that services are maximising their use of available capacity,
it raises concerns about sustainability and timeliness of access. Persistently high acute inpatient
bed-occupancy rates indicate a system under sustained pressure despite a steady expansion
of acute mental health beds through capital developments across the state.
Work in recent years to divert people from acute services – for example, hospital diversion and
substitution initiatives for older people and adults with a severe mental illness and high-risk
behaviours – show promise in freeing up capacity, but more needs to be done and reform work
must build on these and other approaches.
Figure 3: Percentage of acute mental health services with greater than 90 per cent occupancy
80%
70%
60%
50%
40%
30%
20%
10%
0%
2007–08
2008–09
2009–10
Metro
6
2010–11
Rural
2011–12
Statewide
2012–13
Increasing use of involuntary treatment orders
The system now uses involuntary treatment orders extensively, with some 2,700 inpatients and
4,000 community patients on orders at any one time. Over a year nearly 6,000 individuals are placed
on community treatment orders and over 7,500 on both community and inpatient orders (Figure 4).
While there are many factors contributing to this trend, and as involuntary treatment is increasingly
seen as a last resort, we would expect a decrease rather than an increase in these numbers.
Figure 4: People on involuntary and community treatment orders each year*
8,000
7,500
7,000
6,500
6,000
5,500
5,000
4,500
4,000
2007–08
2008–09
Service users on confirmed
involuntary orders
2009–10
2010–11
2011–12
2012–13
Service users on community
treatment orders
* People are counted if activity relating to that person is recorded during that financial year (for example, if a person has a
community treatment order that commences in 2007–08 and finishes in 2009–10, then the person is counted in 2007–08,
2008–09 and 2009–10).
7
Complexity of need
A significant proportion of people with mental illness will have multiple needs, some of which can
be very complex.
Data from 2010-11 indicated that around 1 in every 100 Victorians were clients of clinical mental
health services. Cross checking this data with the Department of Human Services client base
indicates that among those clients the rate of engagement with clinical mental health services was
four times higher.
Of this DHS client group the incidence of young people who were clients of clinical mental health
services as well as of the justice and child protection service system was more than 1 in 8.
A similar pattern was evident across Victorian Government funded drug treatment services,
where 1 in 8 clients who received treatment over 2010–11 were also clinical mental health service
clients over that period.
This demonstrates a complexity of need amongst our client group, which challenges and tests the
adequacy of our overall service response. A lack of coordination between service systems means
that people that present with a range of needs must navigate across multiple programs to have all
their needs met, having to satisfy different eligibility criteria along the way.
While this can mean people’s needs may go unaddressed, it can also mean having to revisit
traumatic circumstances in telling their story to a range of services.
8
Part B: Policy context
To achieve long-term positive outcomes for people who use mental health services, reform efforts
must embrace opportunities for better connections and collaboration with many other sectors as
those other sectors undergo important change processes. This includes current reforms at state and
national levels in health, education and early childhood services, social housing and homelessness
support, child protection, aged care, Aboriginal health, policing and the justice system.
The Victorian context
Reform is underway on many fronts, providing significant opportunities to link mental health issues
and services with the broader health and human services system.
Reforms to Victoria’s community and human services
Through Services Connect – the new model for integrated services for vulnerable people
– the Victorian Government is changing the way human services are delivered to achieve a more
coordinated, person-centred response to vulnerable and disadvantaged people, no matter how
complex their needs.
The reforms involve a move away from a program focus to an integrated service model that will
result in people being connected to the services and supports they need, when they need them.
Improving the coordination of human services, integrated case management and streamlined
service pathways form the basis of this reform program.
This integrated approach will play an important role in identifying people in the human services
system who have a mental illness, or people at risk of acquiring a mental illness, and connecting them
to timely, appropriate treatment and support. This joined-up approach will proactively support the
needs of dependent children whose parents have mental health and/or drug and alcohol problems.
At the centre of this model is a focus on the whole person, not just their presenting issues,
and on life outcomes, not just crisis response and stabilisation. This new approach will put the
individual and family at the centre of care planning, in partnership with services. This is also
central to the way mental health services think about providing care.
This approach is consistent with work the Coalition Government has commenced on broader
community sector reform. In a recent report, Service Sector Reform: a roadmap for community
and human services reform, Professor Peter Shergold recommended a range of reforms designed
to foster a service system that improves outcomes for vulnerable Victorians by placing the recipient
of services at the centre of the system. The Government has welcomed this report and has begun
work on delivering on Professor Shergold’s key recommendations.
For further information about Services Connect visit <www.dhs.vic.gov.au/about-the-department/
plans,-programs-and-projects/projects-and-initiatives/cross-departmental-projects-and-initiatives/
services-connect>. For a copy of Professor Shergold’s report visit http://www.dhs.vic.gov.au/aboutthe-department/documents-and-resources/reports-publications/service-sector-reform-a-roadmapfor-community-and-human-service
Strengthening our response to vulnerable children
Another vital government priority in which mental health is being strongly incorporated is Victoria’s
Vulnerable Children Strategy, developed in response to the Protecting Victoria’s Vulnerable Children
Inquiry (October 2012).
9
Reform of mental health service delivery will strengthen the role of specialist mental health services
in identifying the needs and focusing on the wellbeing of dependent children of people receiving
treatment and ensuring that parents are better supported in their parenting role.
For more information about the strategy visit <www.dhs.vic.gov.au/about-the-department/plans,programs-and-projects/projects-and-initiatives/children,-youth-and-family-services/victoriasvulnerable-children>.
Health reform
Key developments in mental health will be guided by the Victorian Health Priorities Framework
2012–2022 – both the metropolitan and rural and regional health plans – and the Victorian Public
Health and Wellbeing Plan 2011–15.
These plans focus on strengthening the integration of mental health service delivery within the
hospital and primary health systems to closely coordinate mental and physical healthcare.
Exciting changes in the way care is delivered, through initiatives such as telemedicine (for example,
psychiatric consultation by video) and personally controlled health records, hold particular potential
to advance mental health care. These must be developed in ways that recognise the specific
challenges faced in working with people experiencing mental illness and their families.
For more information about the Victorian Health Priorities Framework 2012–2022 visit
<www.health.vic.gov.au/healthplan2022>.
For more information about the Victorian Public Health and Wellbeing plan 2011–15 visit
<www.health.vic.gov.au/prevention/vphwplan>.
Capital and infrastructure
Mental health must also be central to Victoria’s health capital and infrastructure developments.
This means planning mental health facilities that are well matched to changing population needs
as part of wider health service projects. It also means building on Victoria’s well-established
community-based and clinical mental health service delivery capacity, to join up with new models
of integrated healthcare in the community such as health precincts.
Reducing the alcohol and drug toll
An important contribution to reducing mental health problems will also be provided through Victoria’s
whole-of-government alcohol and drug strategy Reducing the alcohol and drug toll: Victoria’s
plan 2013–17 and major reforms to the alcohol and drug treatment system as described in New
directions for alcohol and drug treatment services: a roadmap (June 2012). More effective treatment
of alcohol and drug dependency, combined with stronger approaches to prevention, will contribute
to addressing the complex links between mental illness and alcohol and drug misuse.
For more information on Reducing the alcohol and drug toll visit <www.health.vic.gov.au/aod/strategy>.
For more information on drug and alcohol treatment system reform visit <www.health.vic.gov.au/
aod/sectorreform.htm>.
10
The national context
National mental health reform
Victoria’s mental health system is undergoing significant development stemming from national health
reform agreements. This includes activity-based funding for services delivered through the hospital
system, Medicare Locals as a focal point for local planning and service coordination and crucial
health workforce reforms.
The Victorian Government is keen to fully benefit from the national mental health reform program.
This program includes the Council of Australian Governments (COAG) Roadmap for national
mental health reform 2012–22, the National Mental Health Commission and additional
Commonwealth investment.
A strong Victorian agenda for reform can influence the shape of national programs and ensure
that Commonwealth funding initiatives are aligned to local delivery systems.
In particular, Victoria is keen to participate in and influence a number of major national initiatives,
for example, the significant expansion of Early Psychosis Prevention Centres for young people and
continuing the National Perinatal Depression Initiative.
Victoria will deliver four agreed projects under the National Partnership for Mental Health Reform,
with an overall investment of $38 million over five years. These initiatives aim to improve support
for people who are at risk of homelessness and have complex care needs and reduce the need for
emergency department responses.
Victoria will work with the Commonwealth on planning and implementing Partners in Recovery
to provide care coordination support for people with a severe, enduring mental illness. This plan
includes a number of actions designed to better join up with key national initiatives being rolled out.
These include the headspace youth mental health centres, the KidsMatter school-based mental
health promotion program and major primary mental health programs, including Better Access and
Access to Allied Psychological Services. At the same time the National Mental Health Commission’s
review of national mental health services will also provide valuable insights into current service
delivery in Victoria and other jurisdictions.
Disability reform
Victoria’s mental health system must prepare for very significant change and expansion under the
National Disability Insurance Scheme. The Victorian Government is taking a lead role in driving the
establishment of the National Disability Insurance Scheme and is hosting one of the five launch sites
in Barwon. Victoria has committed $2.5 billion per annum to the full rollout of the National Disability
Insurance Scheme in Victoria by 2019–20.
Victoria has advocated strongly for the inclusion of psychiatric disability support in this initiative
to ensure that eligible people with a psychiatric disability, their families and carers have the lifetime
support they need. The reform of community mental health support services will support Victoria’s
long-term transition to the National Disability Insurance Scheme.
The Victorian Government will continue to work proactively with the mental health service sector
and the Commonwealth Government in preparing for the rollout to ensure appropriate responses,
supports and measures are established under the National Disability Insurance Scheme.
More information about the National Disability Insurance Scheme is available at <www.ndis.gov.au>.
11
Part C: The way forward
Improving people’s overall health and wellbeing and maximising opportunities for those affected
by mental illness to live satisfying lives in the community is central to the Victorian Government’s
efforts in mental health.
Reform objectives
The mental health service system needs to consistently provide the most effective treatment and
care possible at the right time for an individual. This care must prevent harm but also support the
person’s long-term recovery goals.
Together, government and mental health services need to build stronger foundations for good
mental health in the community, prevent problems escalating into serious illness and disability where
possible and support those affected to maintain the best possible social and emotional wellbeing.
Over the next few years the Victorian Government will work with service providers, service users and
their families and key partner agencies to achieve the following objectives:
• environments which encourage better health and wellbeing
• a better service experience for people and their carers and families, with greater choice,
respect and more meaningful participation in decision making
• easier and earlier access to treatment and tailored support of the right intensity and duration
for people of all ages, stages and complexity of need
• individualised support with an increased focus on self-management and improving and
maintaining health, independent living, social connectedness and economic participation
• reduced use and duration of compulsory treatment and restrictive interventions
• better connected care planning and delivery across services supporting people with mental illness
• improved coordination and collaboration of mental health services with the wider health,
human services and justice systems
• increased focus on the needs of people’s families and dependent children, particularly vulnerable
children and families.
In order to achieve these objectives, the government will work with funded services to create:
• a stronger, more competent, capable and sustainable workforce
• increased accountability and transparency, with a more explicit focus on achieving outcomes
for people
• sustainability through higher quality services and improved efficiency and effectiveness.
Close attention will be paid to the diverse needs of Victorians, recognising that social, cultural and
economic factors impact on a person’s experience of mental health.
Particular focus will be placed on: the needs of people with mental health problems who face
disadvantage, disability or homelessness; those who have experienced trauma and abuse;
Aboriginal and Torres Strait Islander communities; migrant groups; people living in rural areas;
people involved in the justice system; young people and others who are at risk of discrimination.
12
Building the workforce – mental health specialists as well as those in other sectors who identify
and respond to mental health issues – is key to achieving a more coordinated system and better,
sustainable outcomes for people.
The actions outlined in this statement will play a major part in addressing these challenges.
They comprise a mix of service redesign and innovation, major legislative reform, workforce
development, cultural change and investment in new capacity, including capital infrastructure.
While primarily focused on action by the Victorian Government and its funded agencies,
these reform priorities also provide a basis for collaborating with the Commonwealth Government
and the many stakeholders who share responsibility for achieving better mental health outcomes
for the Victorian community.
New investment
The Victorian Government will invest a record $1.2 billion in 2013–14 to meet the needs of people
struggling with mental ill-health within the Victorian community. This represents an increase in the
mental health budget of almost 20 per cent in three years.
Our investment in mental health services has been targeted to all sections and sectors of the
community in order to bring to life our vision of a person-centred and strengths-based approach
to service delivery.
For people with acute mental illness
• 430 new or replacement mental health beds are being provided in a range of settings right across
the state, including 95 new beds at the Dandenong Hospital and Austin Health, 25 new beds at the
Werribee Mercy Hospital and four new four-bed short stay psychiatric assessment and planning
units in various locations around the state.
For people needing support within their communities
• The Government recognises the critical role that community-based mental health plays
in mental wellbeing through its expansion of mental health community support services,
funding for capital improvements in community-based facilities and additional investment
in home-based outreach services.
For young people
• The specific needs of young people are being addressed by increasing our investment
in youth mental health services, additional funding for eating disorders programs, strengthening
youth suicide prevention and increasing our support for the work of service providers such
as headspace.
For women
• Women experiencing mental illness are being supported through the establishment of three new
mother baby units in regional Victoria and significant improvements to women’s safety in inpatient
settings throughout large and small inpatient facilities right across the state.
13
For refugees
• Counselling advocacy and interpreter services for record numbers of refugee arrivals in Victoria
are being expanded through specific, targeted funding to the Victorian Foundation for Survivors
of Torture (Foundation House).
To advance mental health treatment
• The Government has established a $10 million Mental Illness Research Fund in order to maintain
Victoria’s position and reputation as a national leader in the field of mental health care. Evidence
generated through funded projects will be actively promoted and disseminated to the sector such
that tangible improvements in treatment and recovery outcomes for people with a mental illness
can occur.
This funding complements the significant reforms this Government is making to support Victorians
with a mental illness. These reforms, currently underway, are intended to make mental health
services safer, more focused on the needs of services users and their carers/families and better
connected to other parts of the service system.
14
Part D: Strategic priorities
for reform
Six strategic priorities have been set to consolidate reforms already underway and to meet emerging
challenges, policy gaps and stakeholder concerns. Where appropriate, the priorities will link with
Commonwealth investments and national mental health reforms to maximise the benefits for Victorians.
Strategic priority 1: Reform Victoria’s mental health legislation
A contemporary legislative framework for mental health service delivery will minimise the use
and duration of compulsory treatment and support people to have meaningful involvement
in decision making. Legislative reform will be complemented by a supported decision-making model
of treatment and care and associated practice and cultural change across the service system.
Strategic priority 2: Strengthen clinical mental health services
Specialist mental health services will be streamlined to improve the effectiveness and experience
of care for people needing specialist mental health treatment. Actions will focus on streamlining
access and better managing service pathways, with more options for acute, subacute and
community-based treatment for people of all ages.
Strategic priority 3: Reform community mental health support services
Community mental health support services will be redesigned and recommissioned to achieve
the best possible recovery for people with enduring mental illness.
Strategic priority 4: Connect services to improve people’s lives
The mental health service system will link to health and human services, education and employment
and work smarter with police, corrections services and the court system to connect people to the
services they need, actively support people to participate in community life and increase social
connectedness and economic participation for people with a mental illness.
Strategic priority 5: Prevent mental health problems and promote positive
mental health
Embedding mental health promotion and resilience-building more widely in education, workplace
and other community settings will promote positive mental health and prevent mental health
problems for individuals, families and communities at risk.
Strategic priority 6: Build better practice and a stronger workforce
Action will be taken to ensure quality service provision, including supporting workforce development,
enhancing research efforts, fostering a culture of evaluation and greater use of evidence-based
practice to deliver better care.
15
Strategic priority 1: Reform Victoria’s mental health legislation
A contemporary legislative framework for mental health service delivery will
minimise the use and duration of compulsory treatment and support people to have
meaningful involvement in decision making. Legislative reform will be complemented
by a supported decision-making model of treatment and care and associated practice
and cultural change across the service system.
Significant progress is being made towards a new Mental Health Act for Victoria. The Victorian
Government has released a summary of the proposed legislative reforms that are the basis for
a Bill to go before the Parliament of Victoria, with implementation in 2014. Implementation planning
is underway, with the provision of information to, and consultation with, consumers, carers,
clinicians, health services and other key stakeholders.
The new Victorian Mental Health Act will reflect and drive modern approaches to recovery-based
treatment and care for people experiencing a severe mental illness.
People with a severe mental illness will have better treatment experiences as a result of more active
involvement in decision making related to their care. The use and duration of compulsory treatment
and restrictive practices will also be minimised.
The new legislative framework will safeguard the rights, dignity and wellbeing of people subject
to compulsory treatment consistent with the aims of the Charter of Human Rights and
Responsibilities Act 2006.
The new mental health legislation will:
• empower and support people and their families and carers to make decisions about their
treatment and exercise their rights
• recognise the importance, value and challenges of the role undertaken by carers and families,
and encourage greater opportunities for partnerships among carers, service users and clinicians
• minimise the use and duration of compulsory treatment in both inpatient and community settings,
and ensure that the least restrictive compulsory treatment possible is used for the circumstances
• establish a Mental Health Complaints Commissioner to receive, investigate and resolve complaints
about mental health services
• create a new Mental Health Tribunal to replace the Mental Health Review Board and the
Psychosurgery Review Board
• improve safeguards for use of electro convulsive therapy (ECT) and minimise use of restrictive
interventions such as seclusion and restraint
• be the platform for an extensive program of service improvement, practice and cultural change
in the delivery of mental health treatment.
A summary of the legislative reforms is shown in Figure 5.
16
Figure 5: Summary of Victoria’s mental health legislation reform
Reform objective
Recovery
framework
Establish a recoveryoriented framework
for treatment and
embed supported
decision making
Reform actions
Presumption of capacity
Advocates
Advance statement
Nominated person
Recognition of the role of carers
Compulsory
Treatment
Minimise the duration
of compulsory
treatment
New criteria for compulsory
assessment and treatment
New compulsory treatment orders
Mental Health Tribunal to make
Treatment Orders
Reform outcomes
Outcomes
• Patients are informed and treatment
preferences are respected
• Patients are involved and supported to make
treatment decisions
• Patients understand and exercise their rights
• Carers are involved in supporting patient
decision making
• Improved patient, family and carer
experience of compulsory treatment
Outcomes
• Duration of compulsory treatment
is minimised
• Use of compulsory treatment is minimised
• The least restrictive and least intrusive
treatment possible in the circumstances
is used
Orders of shorter duration
to protect young people
Safeguards
Increase safeguards
to protect the rights
and dignity of people
with mental illness
Independent hearings
and determinations by the
Mental Health Tribunal
Mental Health Tribunal
authorises ECT
Outcomes
• Reduction in the duration and use
of restraint and seclusion
• Increased patient autonomy and
self‑determined recovery
• Patients understand and exercise their rights
Greater regulation of restrictive
interventions
Second psychiatric opinion
Oversight
and service
improvement
Enhance oversight
and encourage service
improvement
New role for Chief Psychiatrist
Establish a Mental Health
Complaints Commissioner
Community visitors
Outcomes
• Timely and responsive resolution
of complaints
• Improved quality of service delivery
• Improved communication between
clinicians, patients, families and carers
Introduce codes of practice
Clarify information sharing
17
Building on existing good practice and innovation
As part of its reform of the Mental Health Act, the Victorian Government has established the
Reducing Restrictive Interventions (RRI) project to reduce, and where possible eliminate,
restrictive interventions in mental health services and emergency departments across Victoria.
This initiative is being undertaken in partnership with clinical mental health services and
emergency department clinicians, carers and consumers. An early action of the project is to
reduce the statewide seclusion rate in the government’s agreement with hospital-based mental
health services (from 20 seclusions per 1,000 bed days to 15 seclusions per 1,000 bed days)
to reflect the progress made in reducing seclusion in recent years.
Key actions
1.1 Introduce new mental health legislation into the Parliament of Victoria to govern the
assessment and treatment of people with a serious mental illness.
1.2 Establish a range of new statutory bodies and mechanisms – including a Mental Health
Complaints Commissioner and a new Mental Health Tribunal – to make and review
treatment orders, better manage complaints about mental health services and facilitate
supported decision making for people subject to compulsory treatment.
1.3 Assist mental health services across the state to reduce and where possible eliminate the
use of restrictive interventions.
1.4 Build the capacity of mental health services to implement the new legislation by
facilitating practice and culture change and readying the workforce.
1.5 Fund independent advocates to assist and support people with a mental illness
to understand and exercise their rights and make decisions about their treatment.
1.6 Work with other sectors to prepare for the commencement of the legislation,
including police, ambulance, general practitioners and courts.
18
Strategic priority 2: Strengthen clinical mental health services
Specialist mental health services will be streamlined to improve the effectiveness
and experience of care for people needing specialist mental health treatment. Actions
will focus on streamlining access and better managing service pathways, with more
options for acute, subacute and community-based treatment for people of all ages.
Victoria’s area mental health services have provided a good basis for organising service delivery
for nearly two decades. However, there is a strong case that some reconfiguration of service
catchments and health service responsibilities for area mental health services is required to provide
the most accessible, integrated care possible for people with a severe mental illness and ensure
sustainability of the system.
Public mental health services will have more flexibility, capacity and capability to meet the treatment
and care needs of people with a severe mental illness, improve their experience of care and achieve
long-term recovery outcomes in partnership with them, their families and carers.
The system will put community-based care at its centre while providing access to hospital beds
when needed. Mental and physical healthcare will be better integrated to address high levels of poor
health experienced by many people with a serious mental illness.
Better mental health treatment will depend on continuing service innovation, including use of new
technology such as telemedicine and e-health and a capital program to provide necessary facilities,
both inpatient and community-based.
Reform must encompass all age groups. Treatment options for older adults and children require
attention, as do youth and adult services. The system will also strengthen its focus on the needs
of vulnerable children and the families of people using services.
To achieve this the government will work with services to:
• make it easier for people with a severe mental illness, their carers and families to access and
navigate services by streamlining and better connecting pathways into and across the different
elements of the mental health service system
• involve people using services, their carers and families in decisions and take a stronger recovery
approach
• build capacity for earlier intervention in illness to reduce preventable crises and more effectively
support people with acute needs
• extend community-based treatment services, including diversion and substitution services,
to avoid unnecessary admissions and reduce long bed-stays (where appropriate) while improving
options for acute and subacute treatment
• strengthen the continuum of care for service users by improving coordination and collaboration
between services supporting people with mental illness
• improve access to refugee mental health services
• respond to the mental health needs of prisoners and strengthen services for people who
are involved in the justice system and based in the community through the Forensic Mental Health
services planning project and targeted work with the Department of Justice on the new 1,000 bed
Ravenhall development, which includes 75 dedicated mental health beds.
19
Building on existing good practice and innovation
Improving women’s safety in inpatient facilities
In the last two years the Victorian Government has provided more than $4 million to upgrade
existing mental health inpatient facilities to improve women’s safety – this has supported
47 projects so far. Additional staffing will also be allocated for evening and night rostering.
This will improve women’s safety when they are at their most vulnerable. The Victorian
Government has also funded the development of Gender Sensitivity Training Resources that
can be used by services to improve gender safety.
Key actions
2.1 Work with area mental health services, emergency departments, police and ambulance
services to improve the front end of the mental health system, especially for people
in crisis, by streamlining service pathways, improving community-based crisis responses
and centrally supporting access to mental health beds.
2.2 Reconfigure catchments and individual health services’ responsibilities for area mental
health services to support integrated, streamlined care and better access for people
seeking services.
2.3 Broaden the redesign of specialist mental health services for children and young people
aged 0–25 years across the state to provide earlier, more integrated care for a wider range
of conditions, including increased effort in perinatal and youth early intervention services.
2.4 Create alternatives to inpatient care and presentation to emergency departments
by investing in the Prevention and Recovery Care program and the Mental Health Hospital
Admission Reduction program, and by building four new psychiatric assessment and
planning units (16 beds).
2.5 Work with mental health services to review how community clinical resources, including
community care units, are best organised and how people are supported to achieve the
most effective outcomes.
2.7 Develop a plan in consultation with relevant stakeholders including residential aged care
services to improve care pathways, options and outcomes for older people experiencing
a severe mental illness.
20
Strategic priority 3: Reform community mental health
support services
Community mental health support services will be redesigned and recommissioned
to achieve the best possible recovery for people with enduring mental illness.
The Victorian Government invests more than $100 million annually in mental health community
support services (previously known as Psychiatric Disability Rehabilitation and Support Services)
and is undertaking large-scale reform of these services to better support adults with a severe mental
illness and psychiatric disability to live independently, maintain the best possible social and emotional
wellbeing and live satisfying lives in the community.
Reforming community support services for people with a mental illness, released in July 2013,
provides the framework for reform that will result in client-centred, personalised support that delivers
outcomes that really matter to the individual and the carers and family who support them.
The reform work comprises three interrelated components that will:
• build organisational and system capability for quality service provision, with a focus on workforce
development, streamlined intake assessment processes, strengthened cross-sector planning and
coordination and improved client information management systems
• remodel programs and funding streams to create more flexible, outcome-oriented and person and
family-centred approaches
• streamline the configuration of the current service system to achieve improved access, efficiency
and clear area-based delivery responsibilities, in collaboration with providers from a range of sectors.
Work has begun on redeveloping and recommissioning Victoria’s psychiatric disability rehabilitation
support services. To better describe the services that will be provided in the future they have been
renamed Mental Health Community Support Services (MHCSS).
People with a severe mental illness or psychiatric disability will find it easier to access and navigate
a simplified service system. They will receive high-quality services through person-centred support
packages that can be tailored to their personal needs.
Minimising the risk of long-term disability or helping people to better manage their own mental health
and achieve their recovery goals in partnership with services, families and carers is a priority.
Community mental health support services will have stronger links to clinical services and the
wider health and human services system and a sharpened focus on supporting people to achieve
maximum wellbeing and participate in community life.
21
National Disability Insurance Scheme
These reforms align with the broad directions of the National Disability Insurance Scheme.
They represent the first step towards a person-directed service model and funding approach
for community mental health support services. They give all involved the chance to adapt to the
packaged support model, an increased focus on accountability for outcomes, and much greater
involvement of service users, their carers and families in shaping the services they need.
The Victorian Government is taking a lead role in driving the establishment of the National Disability
Insurance Scheme and is hosting one of the five launch sites.
Features of the new MHCSS
The new MHCSS comprises the following components:
• new catchment-based intake units to streamline access and ensure consistent targeting
• recovery-oriented support packages tailored to the needs of the individual
• strengthened accountability for achieving client outcomes.
People will receive an individualised support package based on their recovery plan that will help
them to:
• improve their daily living, self-care and social and relationship skills, as appropriate
• achieve their broader quality-of-life needs regarding physical health, social connectedness,
housing, education and employment
• coordinate access to, and engagement with, the range of health and community services
they need.
Figure 6 shows how a person will experience mental health community support services as a result
of the planned reforms.
Importantly, these reforms align closely to those being progressed through Services Connect and
community sector reform. MHCSS providers will continue to be important participants in the work
of re-shaping our service system for the benefit of vulnerable Victorians.
22
Figure 6: An overview of a person’s pathway in the reformed system
Access and identify
How will I
experience a
mental health
community
support service?
Intake point
I can be referred
a number of
ways such as:
• Self or carer
referral
• Clinical mental
health
• Health
services
• Services
Connect
Access to services
• Easy to find and access
• Initial need identified and
assessed
• Improved service at first contact
• Appropriate, meaningful referral
• Engagement while waiting for
mental health support service
(if required)
Assess and plan
Service response
Comprehensive needs
assessment and recovery
plan developed
Provision of service to help
the person improve their
quality of life
• Person-centered assessment
• One record for each person
• Brief screening for significant
others in their caring role
• Level and intensity of support
identified based on need
• recovery plan developed with
the person and their family
• Individualised support
• Focus on improving daily living
skills, capacity for mental health
self-management and social
connectedness
• Support to access health
and human services required
I have an urgent need
I will immediately be put in touch
with an emergency service
I have discussed my needs
and aspirations
I have a psychiatric disability
I will be put in touch with a mental
health community support service
I do not have a psychiatric
disability but I have other
support needs
I will be put in touch with someone
who can assist me, for example,
through Services Connect
I have discussed my needs and
aspirations in partnership with
a mental health professional
I have directed decisions related
to my needs
My carers/family have been
actively involved in the
assessment of my needs
I receive individualised
support based on my needs
I work in partnership with my key
worker, who provides support
and helps me coordinate access
to other health and human
services I need
I work with my key worker to
monitor my needs and adjust the
support I need if my needs change
My carers/family are supported
in their caring role
I do not need support
anymore but I know I can
re-engage if I need to
23
Building on existing good practice and innovation
The Doorway: Joining up housing and mental health services
The Victorian Government has provided $3.22 million over three years from 2011–12 for
The Doorway project, which is operated by Mental Illness Fellowship, a community mental
health support service. Every year The Doorway helps 50 people with a mental illness and their
families who are homeless or at risk of homelessness to secure housing in the private rental
market through partnerships with local real estate agents. Mental Illness Fellowship provides
support for people to access employment opportunities, develop daily living skills and sustain
their housing tenancy.
Early evaluation of The Doorway (April 2013) has found that those who have participated
in the program have improved their day-to-day living skills in areas such as financial planning
and maintaining their housing and have experienced greater connection to their community.
Their use of mental health inpatient services has also reduced. The early findings highlight the
critical importance of ongoing employment as a way of breaking the cycle of disadvantage.
Key actions
3.1 Implement Reforming community support services for people with a mental illness over
the next 18 months.
3.2 Build system capacity and capability through:
• demand modelling to inform equitable provision of services
• a new area-based community intake assessment and referral function
• a new funding model
• a performance management framework
• a workforce development program
• improved capacity to manage people’s information
• a review of state-funded Mutual Support and Self-Help and Planned Respite programs
• working with the Aboriginal and Torres Strait Islander community to identify how
community mental health support services and Aboriginal community-controlled
organisations can jointly address the mental health recovery needs of Aboriginal and
Torres Strait Islander people.
3.3 Prepare for the incorporation of psychiatric disability support into the National Disability
Insurance Scheme, including participation in the Victorian launch site in Barwon.
3.4 Work with the Commonwealth to align investment in community-managed mental health
support services, including the new care coordination program Partners in Recovery.
24
Strategic priority 4: Connect services to improve people’s lives
The mental health service system will link to health and human services,
education and employment and work in a more integrated way with police,
corrections services and the court system. This will connect people to the services
they need, actively support people to participate in community life and increase
social connectedness and economic participation for people with a mental illness.
An integrated approach
Addressing capacity demands requires more integration and better coordination both between and
across service systems.
The key task is to develop more clearly defined, streamlined but flexible structures that enable
a multifaceted system to function smoothly and work in partnership with other health and
human services.
Public mental health services must be managed as an integral part of health services, with
community-based care at the centre. There should be greater joint local planning and delivery
between specialist clinical mental health services, community support, primary health services
and broader human services.
The non-government and private sectors have an important role in this system and must increasingly
be part of planning and service development processes.
A wide range of services – alcohol and drug treatment, child and family services, youth services,
aged care, homelessness and housing support agencies, disability support services, education and
early childhood services, Aboriginal community-controlled organisations, employment support, police,
corrections services and the courts system – have a crucial role to play in identifying and supporting
people with a mental illness.
An integrated approach requires all service partners to work together in the interests
of people with a mental illness and their families (Figure 7).
25
Figure 7: Integrated approach to mental health
Primary health
Corrections
Police
Problem gambling
Child protection
Youth justice
Youth services
Maternal and
child health
Alcohol and
drug treatment
Victorian
Government
Health promotion
Area mental
health services
People, their
families and
communities
Commonwealth
Government
Schools and
vocational training
Mental health
community
support services
Employment
services
Housing
Homelessness
services
Disability services
Public and private
hospitals
Private specialists
Income support
Family violence
services
Connecting people to opportunities for economic and social participation
Reducing homelessness, unemployment, family breakdown and involvement with the justice system
experienced by many people with severe and enduring mental illness will be a priority focus.
This will involve helping people to connect and remain engaged with social, educational and
employment opportunities in the community wherever possible. It will also involve improved
cross-sector planning and service coordination to achieve a more joined-up response to their needs.
This approach recognises that addressing social and economic disadvantage will lead to improvements
in a person’s health and wellbeing and is integral to the process of recovery.
Supporting family relationships and parenting roles of people with a mental illness, and the impact
on vulnerable children in particular, will be a more explicit part of care planning and coordination
among service providers.
Work in these areas will complement the sharpened focus on social and economic participation
that will be achieved through reform to mental health community support services, and build on
opportunities created by Services Connect.
People should experience increased connectedness, a reduction in discrimination as a result of their
mental illness, and an improvement in their overall wellbeing.
26
Particular focus will be placed on:
• supporting people with a severe mental illness and complex needs to live in the community
by improving pathways to stable and affordable long-term housing
• improving workforce participation rates by addressing barriers preventing open employment
and access to education and vocational training opportunities
• better supporting families of people with a mental illness, particularly dependent children, in order
to reduce the impact of mental illness on the wellbeing of both the individual and the family
• reducing offending and reoffending behaviour by people with mental health problems, focusing
on early intervention and diversion
• increasing collaboration and planning with human services to ensure that the full range of people’s
needs are identified and planned for
• ensuring that the particular social and cultural issues faced by Aboriginal and Torres Strait Islander
people experiencing mental health problems are better handled throughout the system.
Progress in this area will be achieved by developing new partnerships at the national, state and local
levels, sharing responsibilities across sectors and through a range of targeted initiatives.
Building on existing good practice and innovation
Pathways to Economic Participation
The Victorian Government has introduced Pathways to Economic Participation, a new
program that provides access to employment and education for people using mental health
services. Over a period of two years, employment and education officers are being trialled
in two sites – Eastern Health and Bendigo Health. These officers are part of multidisciplinary
continuing care teams that get people quickly into work or education and support them
to maintain their employment or training. The program works with the Improved Housing
Access service in both areas.
Joint casework and planning with Services Connect
The Victorian Government is trialling Services Connect in Dandenong, Geelong, and the
Southwest Coast and is being expanded to Shepparton and Preston. This includes finding
better ways to integrate mental health services into the Services Connect model operating at
the Dandenong demonstration site. Joint case planning is identifying issues for families involved
in Services Connect and the systemic barriers that are preventing them from accessing the
services they need. Joint casework is also contributing to the development of more holistic
approaches to addressing entrenched disadvantage. The Services Connect project team has
held several learning workshops with community-based mental health specialists to talk about
how Services Connect is changing service delivery and how to link in mental health services.
27
Key actions
4.1 Ensure that mental health needs are properly identified and assessed, and service
linkages effectively managed, as an integral part of Services Connect.
4.2 Develop an integrated Victorian mental health employment participation plan to support
people with a mental illness to participate in education, training and employment.
Workforce participation will be improved by:
• supporting people with a mental illness who wish to return to education and training
• improved coordination with the Commonwealth Government, acknowledging their lead
role in employment services, to expand on current opportunities and create greater
links between employment services and mental health support services and agencies
• working with national employer groups to promote opportunities for employing people
with mental illness
• making WorkSafe, in partnership with employer and industry bodies and health
organisations, a key partner in the Plan.
4.3 Create Mental Health Employer of the Year and Mental Health Educator of the Year
awards to profile and promote exemplar activity in these areas.
4.4 Facilitate access to a wider range of long-term housing options for people with a severe
and enduring mental illness who have a history of homelessness or insecure housing,
through new local partnerships and tailored individual supports.
4.5 Better equip both mental health and child and family support services to identify and
respond effectively to vulnerable family members, including providing family therapy
as an integral part of treatment where appropriate.
4.6 Identify further joint opportunities between the Department of Health and the Department
of Justice to reduce offending and reoffending behaviour, and continue to identify
diversion opportunities.
4.7 Work more effectively with people with mental health problems who are in prison
or involved with the courts or police.
4.8 Work with the Victorian Aboriginal Health Service and the Victorian Aboriginal Community
Controlled Health Organisation to improve access to mental health treatment and
psychosocial rehabilitation support for Aboriginal people, with a focus on early intervention.
4.9 Continue to develop and evaluate the broad range of initiatives already underway, from
prevention to long-term support, that are engaging allied health, human services and
justice partners through local networks.
28
Strategic priority 5: Prevent mental health problems and promote
positive mental health
Embedding mental health promotion and resilience-building more widely in education,
workplace and other community settings will promote positive mental health and
prevent mental health problems in individuals, families and communities at risk.
Mental health services will support Victorians to maintain positive mental health and wellbeing
and reduce preventable mental health problems by addressing key risks that contribute to,
or trigger, mental illness. These include trauma, abuse, family violence, social discrimination,
isolation/exclusion and alcohol and drug misuse.
With the right knowledge and supportive environments, the resilience of individuals and the
knowledge and understanding of the broader community can be fostered, and risk and protective
factors better addressed.
Victoria has long been a leader in mental health promotion. It is now time to strengthen promotion
efforts in a more coordinated way across a broader range of settings, with a particular focus on early
childhood, schools, aged care settings and workplaces.
Mental health promotion cannot be isolated from broader promotion of good health and wellbeing.
Wherever possible, efforts to build mental health literacy and resilience should be built into programs
that empower individuals, families and local communities. Particular risk factors in rural populations
and Aboriginal and Torres Strait Islander communities need to be better recognised.
Closer partnerships will be developed with key non-government agencies and statutory bodies that
play lead roles at both a statewide and local community level in mental health promotion.
Action under this priority area will:
• improve mental health literacy and help-seeking behaviour of Victorians, particularly those
exposed to abuse, trauma and other risks
• build resilience and wellbeing in children and young people by supporting the environments that
encourage the development of good mental health for children and young people by working with
schools, local government and youth and family services
• promote supportive and inclusive communities that do not tolerate discrimination, bullying or other
harmful behaviours that impact on emotional and mental wellbeing
• reduce the incidence of suicide, focusing particularly on vulnerable groups
• reduce workplace stress by supporting the development of workplaces and cultures that promote
good mental health.
29
Building on existing good practice and innovation
Youth suicide prevention in Casey and Cardinia
The Victorian Government has invested nearly $1 million over two years in the School Support
Casey/Cardinia Community Initiative – an innovative approach to tackling youth suicide
in Melbourne’s south-east growth corridor.
Youth mental health service headspace is providing screening and wellbeing assessments,
intensive support, early intervention and resilience programs for students and their families,
as well as training for school staff in up to 12 secondary schools and TAFEs in Casey and
Cardinia that have been significantly affected by youth suicide in recent years.
In addition, a dedicated coordinator for local suicide prevention activity in Casey and Cardinia
works closely with youth counsellors and Monash Health clinicians to enhance resilience
among young people and school communities. The learning from this initiative will lead to the
development of tools for other communities affected by suicide in the future.
30
Key actions
5.1 Encourage and support schools and early childhood settings to incorporate effective
mental health promotion activities and resources in their curricula and programs
and through student health and welfare functions, in line with government-endorsed
benchmarks and policies (including the Victorian Prevention and Health Promotion
Achievement Program’s mental health and wellbeing benchmarks).
5.2 Develop and implement a new Victorian suicide prevention strategy in collaboration with
local communities, local government and non-government organisations. This will include
targeted suicide prevention initiatives, with an initial focus on same-sex attracted and
gender-questioning young people.
5.3 Implement key actions of Reducing the alcohol and drug toll: Victoria’s plan 2013–17
to prevent substance misuse and associated harms including:
• delivering a long-term cultural change program to promote healthier, more informed
attitudes to drinking (through VicHealth)
• promoting SayWhen – Victoria’s e-health initiative to support people online to reduce
risky drinking – to a wider range of health and community settings
• delivering better health promotion in Victorian schools through comprehensive
evidence-based alcohol and drug education
• working with community organisations to reduce stigma related to substance misuse
and to promote community attitudes supportive of recovery.
5.4 Develop and implement Victoria’s first eating disorder strategy, incorporating prevention
activities focused on body image and healthy eating behaviours.
5.5 Develop approaches to reduce workplace stress in partnership with organisations such
as beyondblue, VicHealth and WorkSafe Victoria. Workplaces will also be supported
to create environments that promote mental health through the National Partnership
Agreement on Preventive Health, Healthy Workers Initiative.
5.6 Support the uptake of best-practice mental health promotion in key settings within local
communities. This will include work with 14 selected communities under the National
Partnership Agreement on Preventive Health.
5.7 Support expansion of Mental Health First Aid training in a range of community settings.
31
Strategic priority 6: Build better practice and a stronger workforce
The Victorian Government will support workforce development, enhance research
effort and foster a culture of evaluation to underpin quality service provision and
greater use of evidence-based practice to deliver better care.
Workforce development is of crucial importance in driving change and supporting many central
aspects of the reform agenda. The mental health workforce strategy has been the subject of broad
sector input.
Quality of care will be improved across the system by supporting the continued development
of a highly skilled, adaptable mental health workforce and systematic use of evidence to drive best
practice and service model design.
This will require a competent, capable and sustainable workforce, both in the specialist mental health
service system and in a range of other sectors. It will involve rethinking roles and building individual
and team competencies to match new modes of service delivery. Leadership development and
a program of cultural change are critical.
Victoria’s considerable strengths in mental health research need to be focused and supported to
respond effectively to emerging opportunities and challenges.
Collaborative, large-scale research programs will emphasise translation of research into practice.
A comprehensive evaluation will be undertaken to assess the effectiveness and value of reform
effort for people with a mental illness, their carers and family, and the service system, building on an
established mental health outcomes framework.
Particular focus will be placed on:
• building a more flexible, skilled and responsive specialist mental health workforce, with greater
emphasis on interventions grounded on a strong evidence base
• developing a more effective frontline response to people with, or at risk of, mental health problems
by systematically improving capability across a range of health, education, community services
and justice workforces
• fostering innovation in treatment and practice through targeted evaluation and research.
32
Building on existing good practice and innovation
Victoria’s recovery-oriented practice framework
The Victorian Government released the Framework for recovery-oriented practice in August
2011. The framework encapsulates the government’s commitment to recovery-oriented
practice. It supports specialist mental health professionals to continue to develop and enhance
their practice in line with recovery principles. It is an opportunity to create more positive
experiences for people accessing services.
The framework clarifies the principles that should underpin practice and complements existing
professional standards and competency frameworks.
The framework is respected and commended by the mental health sector in Australia and
internationally. Organisations in the United Kingdom and other jurisdictions in Australia have
sought to adopt the framework to meet local need, and the Victorian framework was a key
informant to the Commonwealth’s development of a national recovery-oriented framework.
Gender-sensitive training
In 2011 the government released the Service guideline on gender sensitivity and safety:
promoting a holistic approach to wellbeing to support mental health services and practitioners
to consider the needs, wishes and experiences of people in relation to their gender and sexual
identity, and to ensure access to high-quality care based on dignity and respect.
The government funded the Women’s Mental Health Network Victoria (WMHNV) to develop
a gender-sensitive training resource based on the service guideline and the Centre for
Psychiatric Nursing is coordinating the targeted delivery of training to clinical mental health
services using the WMHNV training resource.
Key actions
6.1 Undertake a set of major collaborative research projects through the Victorian Mental
Illness Research Fund and develop a dissemination program to support the translation
of research into practice, in partnership with Neurosciences Victoria.
6.2 Initiate a rolling program of evaluations of key mental health service innovations and
reforms to determine their benefits for service users and the service system.
6.3 Finalise comprehensive workforce development frameworks and implementation plans
for the specialist clinical and community mental health support services workforces.
6.4 Trial a workforce initiative to improve the capability of clinical and community mental
health workforces to better assess, treat and manage people with a severe mental illness,
aggressive behaviours and patterns of offending behaviour.
6.5 Work across a range of government agencies to initiate mental health training for child
and family services, justice, alcohol and drug treatment, police and education sectors
to ensure these workforces can identify and support people with a mental health problem.
33
Part E: Working together to
take action
The priorities and actions outlined in this statement will be the basis for continuing discussion with
stakeholders as work progresses, and will be complemented by a range of more detailed plans.
Partnership, engagement and shared accountability will be fostered through:
• stakeholder forums and cross-sector roundtables – an ongoing series of opportunities will
directly contribute to government thinking and provide input into strategy development and
implementation from a service user, carer and family, service provider and community perspective.
This includes increased mental health involvement in the Human Services and Health Partnership
Implementation Committee (HSHPIC), along with the Community Sector Reform Council,
which has been established to advise government on the implementation of key reforms in the
community and human services sectors.
• consumer and carer engagement – new forums established by the government are providing
a regular opportunity for mental health service users and their families and carers to contribute
to developments and ideas for service improvement. In addition, both the Victorian Mental Illness
Awareness Council (VMIAC) and the Victorian Carers Network have both received funding
to help inform and support consumers and carers through reforms to the Mental Health Act
and recommissioning of mental health community support services
• Commonwealth–State collaboration – under the COAG Roadmap for national mental
health reform 2012–22, Victoria will renew and intensify collaboration with the Commonwealth
Government through a range of planning and coordination mechanisms including co-chairing
COAG’s mental health working group (the Victorian Government will also strengthen links with
the National Mental Health Commission)
• communication strategy – including a dedicated website, newsletters, ongoing presentations
to the sector and regular communiqués
• local partnerships – fostered through regional and local mechanisms, involving consumers
and carers, specialist mental health services, primary health including Medicare Locals,
community services, education, justice and other services where relevant.
In addition, consultative forums for specific population groups such as Aboriginal and Torres
Strait Islander communities will be conducted, building on established representative structures
wherever possible.
Service providers will also continue to be actively involved in the formulation and implementation
of the evaluation programs. Expert input will be sought to ensure that evaluation is rigorous
and contributes to understanding the strengths and weaknesses of the overall system and the
achievement of outcomes for people with a mental illness and their carers and families.
Anyone interested in Victoria’s mental health reforms is encouraged to keep up to date and view
more detailed material at <www.health.vic.gov.au/mentalhealth>.
For further information please email <[email protected]> or write to:
Manager, Service System Development and Reform
Mental Health and Drugs Division
Department of Health
50 Lonsdale Street
Melbourne VIC 3000
34