Commissioner John Feneley began his presentation by acknowledging that most people in the room had waited a long time to see real change and improvement in mental health services, and to see a system focused on prevention and early intervention that keeps people well in the community with a lesser focus on hospitals. Mental health often does badly because hospitals receive preferential funding over community-based mental health services.
The Commissioner identified a number of contextual issues including significant increases in psychosocial disability, a lack of clarity between Commonwealth and state governments, the need for a focus on intervening early with children and extending care to support older people, and unsustainable health budget, the NDIS roll out and shift to self-directed funding, decisions around funding for NGOs, activity based funding and accountability structures. Somewhere in amongst all of these changes, workers and services have to cope and there are real issues about resiliency. The Commissioner did emphasise however that NSW can and should be proud of what it has done in mental health, with people working in both government and NGO sectors who are passionate, brilliant, innovative and who still have hope for change. He posed the question: “How can we tap into this resilience?”
So, what will change look like? The vision is for a person-led, recovery-focused, trauma informed, whole of life and intergenerational approach where true engagement occurs with consumers, carers and families in treatment and service planning and delivery. The focus of care will move away from hospitals to developing community based care, with a commitment to prevention and early intervention, consideration of physical and mental health wellbeing, a trained and supported professional peer workforce, and an extension of mental health literacy into educational institutions.
The centrality of trauma in mental illness and its implications for service provision and for the workforce providing those services must be acknowledged and accepted. There is a move towards leadership and services that are trauma informed in all aspects of care and practice, with a focus on recovery. Although not a complete answer in itself, adopting the recovery framework in service provision is intrinsically linked to addressing trauma for both patients and staff.
Commissioner Feneley outlined a number of workforce challenges associated with this including the need for acceptance that working at the front line is challenging with real risk of exposure to trauma both directly and indirectly. Supporting people to be mentally well requires a well trained and skilled workforce including peers in public and NGO services. It is important that NGOs have the capacity to assess whether they can provide services to a particular client, and also need to look at building clinical governance models and putting them in place. Supporting the workforce means ensuring they themselves are mentally healthy. The workforce resource is scarce and exploration is needed around ways to support it.
In terms of the future, there must be a focus on the training requirements of workers including in recovery and trauma informed practices, and in de-escalation as a move away from seclusion and restraint. The integration of a peer workforce into teams is critical to reduce the distance between the team and consumers, and also to reduce potential stigma. Finally, alternatives to hospitals must be built and improved designs of physical environments within hospitals must be considered (‘clinical’ is not that same as ‘safe’).
The Commissioner concluded by saying that this issue isn’t about beds, it is about what we do with people, how we talk with them and how we walk with them on their recovery journey.