Department of Human Services

Victorian Mental Health Victorian Mental Health Service SystemService System

Sue BrennanActing Director Mental Health

9 July 2007

Mental health – broad brushMental health – broad brush• Growing community awareness and expectations re

mental health,mental illness and services• 19% of Victorians (1 in 5) experience some form of

mental illness over lifetime (~ 3% severe;~4% moderate)

• 23% of those on C/y based orders & Combined C’y & Treat’t order with MH problems; 26%+ of prison population

• Mental illness is often combined with other factors which adds to complexity eg AOD, housing issues; child protection, ABI, offending/justice

Service system broad brushService system broad brush• Commonwealth & State contribute (COAG)• Promotion/prevention focus & activities – Vichealth;

public health; local government; other universal services eg schools

• Primary mental health – GPs, community health; Maternal & Child Health

• ‘Tier’ 2/secondary level services – private psychologists, AOD, homelessness services

• Specialist MH services – state funded clinical and PDRS (NGO); private psychiatrists

• Commonwealth funded services across the spectrum – system increasingly complex with risk of further fragmentation

State funded specialist State funded specialist systemsystemClinical (CAMHS, adult,

aged)• Inpatient beds• PARC beds• Secure Extended Care

beds• Community Care Units• Forensic beds• Community mental

health teams (CAT, MST, CCT, PMHTs)

PDRSS – psychiatric dis’y rehab & support services (non govt)

• Residential rehabilitation• Supported

accommodation• Home Based Outreach at

2 levels• IRRCS• Day Programs• Mutual Self Help &

Support• Koori program

Legislative frameworkLegislative framework• 1986 Mental Health Act – increased transparency &

accountability for patients predominantly in institutional settings

• Statutory ‘watchdogs’ – Mental Health Review Board, Public Advocate; Chief Psychiatrist, Community Visitors, Ombudsman, Health Services Commissioner

• Sentencing Act 1991 – restricted involuntary treatment orders & hospital security orders

• Crimes (Mental Impairment & Unfitness to be Tried) Act 1997 – custodial & non custodial supervision

• 2007 – Charter of Human Rights & Responsibilities – increasing community expectations on respect for rights; MHA + MHB policies & procedures being examined

IssuesIssues• Access – 50% of nominal client group being seen

(60,000 clients per year)• High demand on beds – long waits in EDs (ALOS – 11

days)• High levels of complexity – dual diagnosis; other co-

morbidities; growing proportion of involuntary (71% of admitted group)

• Workforce shortages & maldistribution• Beyond health – housing, employment, social

connection• Accommodating community safety as well as

personal autonomy & rehabilitation/recovery

Recent service developmentsRecent service developments

• Build the core and develop new service models

• PARC• Youth early psychosis• CAMHS & Schools Early Action (conduct

disorder)• Families where parents have a mental illness

(FaPMI) strategy• Aged intensive community treatment (bed

substitution)

New mental health strategyNew mental health strategy

• Whole of government approach – IDC with Vicpol, DoJ, Education, Office for Children, Housing, Primary Health etc

• Key areas under consideration – early intervention; access and responsiveness of system including for people in crisis, and system gaps for particular groups; family support; MH/AOD interface; justice interface; community participation

Justice system interfaces and Justice system interfaces and issuesissues• Diversion– relevant programs include

- court liaison services – (DHS 1994) court based, provided by Forensicare in 4 metro & 5 rural courts – assessment; links to services- court integrated services program (DoJ2006 assistance; case man’t; pathways to service; joint DoJ/MHB project examining program

• Neighbourhood Justice Centre – 2006; court; on site services; work with local community

• All aiming to divert; achieve access to right care; reduce re-offending

Other developmentsOther developments

• Community Corrections Protocol – under development; aims for a systematised approach for people in corrections system with MH problems or in need of crisis care Prisoner pathways and discharge plans

• MH/Juvenile Justice & Community Corrections/COATs protocols are in place

Areas for further developmentAreas for further development

• Diversion programs• Attention to pre and post release – risk

of relapse & reoffending at transition – how can services work better & achieve continuity of care?

• Core MH specialist service system resources and skills (clinical & PDRSS)

• Required focus on the forensic group