Progress Report on the Implementation of Living Well: A

Progress Report on the implementation of Living Well: A Strategic Plan for Mental Health in NSW 2014 - 2024 Preferred citation: Mental Health Commission of NSW (2015), One year on: Progress Report on the Implementation of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024 © 2015 State of New South Wales ISBN: 978-0-9945046-0-9 Acknowledgements

In presenting this report the Commission thanks all the NSW Government agencies, community-managed organisations and individuals that contributed to its development. In particular, we acknowledge NSW Health, the Department of Family and Community Services, the Department of Education and the Department of Justice. We acknowledge the lived experience of those with mental illness. To you we say: your preferences, wishes, needs and aspirations are at the heart of all the work we do, your perspective is essential to defining and achieving our goals and your courage continues to inspire and drive the work of the Commission. We acknowledge the families and carers of all people with a lived experience of mental illness. We recognise your commitment and the vital contribution of your role in supporting people who experience mental illness to live well on the terms they choose. Your knowledge and experience of mental health systems and services are among our most important sources of information and help guide our understanding of the change that needs to come. We acknowledge the dedication and continued effort of those working within the mental health system who strive for the change needed to create opportunities for better lives for those of us who live with mental illness. And we acknowledge and express our respect to the Wallumedegal people of the Eora Nation, the traditional owners of the land on which the offices of the NSW Mental Health Commission stand. We pay tribute to the resilience of Aboriginal people and communities, and their enduring cultures. The Commission would also like to thank the 744 people who completed our online Ready for Change survey and contributed to our understanding of how the community understands the opportunities and challenges of mental health reform over this first year.

Cover images, clockwise from top: • Celebrating Mental Health Month at Parliament House, with the NSW Minister for Mental Health Hon. Pru Goward MP, Fay Jackson, Deputy Mental Health Commissioner, Premier of NSW the Hon. Mike Baird MP, Chair of NSW Parliamentary Friends of Mental Health, Scott Farlow MLC, John Feneley, NSW Mental Health Commissioner • Main street in Broken Hill, from the Commission’s visit in May 2015 • Release of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024 on 15 December 2015, at Wayside Chapel, showing the Hon. Jai Rowell MP (former NSW Minister for Mental Health), Professor David Richmond AO, Rev. Graham Long AM, Dr Elizabeth Scott, Senior Psychiatrist, St Vincents Hospital, John Feneley, NSW Mental Health Commissioner, Professor Ian Hickie AM (at back) • Guunumba sit-down circle with Galambila Aboriginal Health Service, Coffs Harbour, June 2015 • Judy Parr, Broken Hill City Council, Catherine Lourey and Samantha Gray, NSW Mental Health Commission, Broken Hill visit June 2015 • Deputy Mental Health Commissioners Dr Robyn Shields AM and Bradley Foxlewin, 2014 • Central image: detail of cover of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024 which features artwork by Rosemary Dugan 4 Contents

To the Minister...... 6 One year on – achievements and essential action...... 8 Achieving the vision...... 9 Findings and recommendations...... 10 1. A clear whole-of-government communication strategy is overdue...... 10 2. Government must be more transparent and accountable via public reporting on mental health and wellbeing...... 11 3. Reporting on funding of mental health reform must be transparent ...... 12 4. Planning needs to be improved to realise a better system...... 13 5. Justice and policy reform requires more progress...... 15 Achievements in the first 12 months...... 16 Government action...... 16 Agency action...... 19 State initiatives that complement Living Well...... 21 Local Initiatives to support reform ...... 22 Commonwealth initiatives that align with Living Well ...... 24 The Commission’s work...... 26 Monitoring and reporting...... 28 Getting the best information...... 28 Issues of concern...... 28 Whole of community impacts...... 29 The Commission’s reporting framework...... 30 Monitoring and reporting over 10 years...... 31 Living Well indicators – at a glance...... 33 Living Well indicators...... 34 The community perspective – at a glance...... 51 The community perspective...... 52 Implications for the next 12 months...... 59 Appendix 1 – Local Health District projects...... 60 Appendix 2 – Research program in support of mental health reform...... 63 References ...... 66 Sources – Living Well indicator graphs...... 69 This report is accompanied by series of online supporting papers. These are available at nsw.mentalhealthcommission.com.au and include: • government agencies’ advice to the Commission about their progress • the work of the Mental Health Reform Implementation Taskforce • baseline analysis of the 10 Living Well indicators • findings of the Commission’s Ready for Change community survey • examples of reform initiatives and innovative practice across NSW • an overview of policy changes affecting mental health since the launch ofLiving Well in December 2014. 6 To the Minister

It is now a year since the launch urges the Government and I look forward to further funding of in December 2014 of Living Well: agencies to focus their efforts on reform activities across additional A Strategic Plan for Mental Health these foundational steps in 2016. Government agencies to fully in NSW 2014-2024. The Premier implement Living Well. I am pleased the Government committed the Government at has established a Mental Health The Commission highlighted in that time to adopt and implement Reform Implementation Taskforce Living Well the importance of all its actions and directions, and with senior representation from enabling local action and design announced a $115 million funding key government agencies, chaired of services across Commonwealth package to kick-start reform. by the Secretary of Health. The and state-funded agencies. In Living Well articulates a whole- Taskforce will report annually to NSW this has been advanced with of-government, whole-of-life and the Minister for Mental Health. the devolution of more planning whole-of-community vision for and operational responsibility The Premier’s commitment to the mental health in NSW to better to LHDs and alignment between preliminary $115 million funding support people by strengthening these and Department of Family package was most welcome, and community based responses to and Community Services (FaCS) these funds have begun to seed mental health needs and to shift districts. The Commission is important activities in the first our system from acute crises pleased that the Commonwealth months of implementation. First towards prevention and earlier Government has now contributed initiatives include Pathways to intervention. to this local capacity with the Community Living, under which announcement in November that The focus now has to be on long-stay patients in psychiatric funding for specific mental health effective implementation, which facilities will transition to live in programs will be devolved to the the Commission, under the terms the community with appropriate new Primary Health Networks of its establishment legislation, support. An Innovation Fund to (PHNs). may assess at any time in a report support reform has also been to Parliament. This is the first of announced, as have a number of Realisation of the potential for those reports. other new or expanded programs. good local planning and service It is also heartening to see some design will now largely depend Living Well’s launch was followed Local Health Districts (LHDs) on the capacity of leaders in LHDs by the NSW election in March explicitly aligning their mental and PHNs to develop collaborative 2015, and an unavoidable hiatus health plans to Living Well. relationships with each other in government business. This and with other relevant agencies slowed activity, and the $115 However the effectiveness of and community-managed million reform package – for work this additional funding will organisations. Community to be undertaken by the Ministry largely depend on transparent responses to a survey conducted of Health - was not approved and appropriate expenditure of by the Commission in September until September 2015, followed the recurrent $1.7 billion annual 2015 also highlight the need for by an implementation plan and mental health budget. The Hansard greater leadership to develop monitoring framework in October record shows that this issue was a culture in which people are 2015. central to the establishment of the authorised to respond to reform Commission, and the Commission There have nevertheless been and engage with others in raised specific concerns about this notable achievements in this advancing the priorities of Living in Chapter 9 of Living Well, but to first year. This report identifies Well. date has seen no tangible evidence progress, and focuses on the that these are being addressed. I acknowledge the remarkable preparations agencies are making efforts of professionals working in for the bigger changes ahead. Action within other agencies, the mental health system, and of Some actions and directions which powerfully aligns with the the community-managed sector, of Living Well are particularly vision and directions of Living in innovatively meeting people’s important because they have the Well, includes the Department of mental health and social support potential to maintain confidence, Education’s Wellbeing Framework needs. I must also acknowledge build capacity and help produce for Schools and its associated $167 the energy of NSW public servants change in future. The Commission million funding package. in driving implementation of the profiled in this report.) Now it is social and emotional wellbeing National Disability Insurance time to harness this energy and approach to mental health issues, Scheme (NDIS), with its the commitment of the Premier will be essential guides on the commitment to person-centred and Ministers to progress the next journey. funding and individual choice. stage of reform, and to energise I hope this report will help the Their work is fundamental to the the sector and the community people of NSW understand what creation of a better mental health to be active participants in that the Government has done so far system. process. towards meeting its commitment The Commission has seen many People were at the heart of the to Living Well. I commend it to you examples of real collaboration and development of the Living Well and recommend it be made public innovation that are pointers for reform strategy and I believe they immediately. future success in mental health are central to its implementation. reform in NSW. (Some of these are Aboriginal communities, and their

JOHN FENELEY NSW MENTAL HEALTH COMMISSIONER

11 December 2015

Images, left to right: • John Feneley speaking at Broken Hill on one of the Commission’s visits to regional NSW in May 2015 • Audience at the Commission’s ‘No Offence’ comedy night, Cell Block Theatre, Sydney, June 2015 • Guunumba sit-down circle with Beth Wriggly, Circle Facilitator and Auntie Bea Ballangarry, Circle Holder, Galambila Aboriginal Health Service, Coffs Harbour, June 2015 8

One year on

ACTION ACHIEVED IN 2015 ACTION ESSENTIAL IN 2016

Living Well – NSW Ministry of Health Comprehensive approach to Living Well • $115 million in new Ministry of Health money to begin • Development of a Living Well Government implementation of Living Well announced December communication strategy for the government and 2014 community sectors • Cabinet approval in September 2015 of the $115 million • Mobilising Ministry of Health and other agency and implementation plan budgets beyond the initial three year $115 million funding package • Mental Health Reform Implementation Taskforce established to oversee implementation of Living Well • Ministry of Health to address the governance and accountability actions in Living Well Chapter 9 • Planning commenced on the transition of long stay regarding obstacles to effective mental health service patients to community accommodation, with initial delivery focus on aged care • Development of datasets addressing information • Local Health Districts (LHDs) and communities reshaping gaps in the mental health service system, including their services in line with Living Well community-managed services and the peer workforce. • Integrated Care Strategy initiated across NSW Health Better data collection for stigma and discrimination, community participation and forensic indicators • Mental Health and Drug and Alcohol networks initiated within the Agency for Clinical Innovation Empower leadership at the local level • Implementation of the NSW Service Plan for People with • Adoption by Ministry of Health of the National Mental Eating Disorders 2013-2018 Health Services Planning Framework to guide LHD Aligned reform across Government resource planning and community-based care • Transparent annual reporting on mental health system • NSW Wellbeing Framework for Schools implemented data, funding and resources (staffing and vacancies, with $167 million in new investment program mix, service mix, beds and detailed budgets) • Release of Department of Premier and Cabinet Social Impact Investment Policy Integrated planning and infrastructure • The Collective NSW – community collective impact development initiative. Active in four Department of Family and • Development of a NSW mental health workforce Community Services districts plan, including for community-managed and private • National Disability Insurance Scheme (NDIS) rollout with services funded by the Ministry of Health detailed engagement by NSW human services agencies • Completion of the Framework for the NSW Public Wider sector reform alignment Mental Health Consumer Workforce with guidance to LHDs on staff ratios • Innovative programs and collaborations across the • Integration of Partnerships for Health and other community-managed sector that complement Living community-managed and private sector Ministry Well, such as the Young People’s Outreach Program of Health reforms with all planning processes for and components of the Synergy Ecosystem e-mental community-based mental health care. health pilot, as well as a groundswell of local Partners in Recovery and NDIS-related initiatives. • Clarity on the governance and maintenance of specialist clinical capacity for complex needs under the fully implemented NDIS, after the closure of Ageing Disability and Home Care • Development of demonstration models that facilitate better interaction between community mental health services and prisons, as per Action 6.6.1. Achieving the vision

A Mental Health Reform Implementation Taskforce has been established to achieve the Government’s Living Well vision for NSW, with senior representation from key government agencies. The Commission’s role is to monitor progress towards Living Well and to report on its findings to Parliament.

GETTING THERE VISION Living Well Mental Health Reform Better mental health NSW Government’s Implementation and wellbeing plan for reform Taskforce for everyone in NSW

Figure 1: Achieving the Living Well vision 10 Findings and recommendations

During 2015 the Commission has spoken with people with lived experience of mental illness, families and carers, consulted clinicians, professionals and workers in the mental health sector, gathered and analysed data, surveyed the community about reform and obtained information from government agencies. Through these means it has gathered evidence about how the Government is implementing Living Well – and whilst good things are happening there are some shortcomings in implementation, which must be addressed in the coming year.

1. A CLEAR WHOLE-OF-GOVERNMENT COMMUNICATION STRATEGY IS OVERDUE

Twelve months after its launch reform, but lacked confidence that Western Sydney LHD, which has of Living Well, the Government the Government and the mental developed a new mental health released in December 2015 an health sector would put real efforts service plan guided by the Living information package on the first into producing genuine change. Well directions. steps, funding and priorities More work is now required by In parallel, public sector agencies it has taken to implement the Government at central and local need to discuss the elements of strategy.1 The long absence of levels to clearly communicate Living Well and assess whether communication by Government left that Living Well reforms are their service planning and delivery many in the community unaware government policy and as such, enable them to meet the needs of any action and therefore lacking are to be adopted in local plans, of people who experience mental confidence that things will change. actions and approaches. In turn, health issues and their families This view was reported frequently these steps need to be conveyed and carers. to the Commission through its to communities, service networks community survey (see page and stakeholders. Early evidence 51) where the 744 respondents of translation into local practice indicated that Living Well had includes the work of South identified the right directions for

For 2016 the Commission recommends: 1. A comprehensive Living Well communication strategy to be developed and implemented by Government 2. GOVERNMENT MUST BE MORE TRANSPARENT AND ACCOUNTABLE VIA PUBLIC REPORTING ON MENTAL HEALTH AND WELLBEING

The Government committed working with LHDs to resolve these a platform for monitoring and under Living Well to increasing issues. reporting over the remaining nine local data availability, reporting years. During 2015 the Mental Health regularly to the community on Reform Implementation Taskforce In preparing this first progress its mental health and wellbeing, developed an implementation report the Commission and improving transparency in plan and monitoring framework. encountered difficulties in gaining the reporting of mental health Information about these should access to relevant NSW Health spending. In this first year little now be made publicly available data, which has affected the level progress has been seen in this to inform the sector and the of detail included. The Commission regard. Work was commenced by community about the actions and will propose a memorandum of the Bureau of Health Information processes Government has put in understanding with NSW Health to publish an annual report on place. The Taskforce should also to support the Commission in its mental health performance, but report specific and new efforts reporting responsibilities under the Commission has been advised against each of the 141 actions of the Mental Health Commission Act by the Ministry of Health that this Living Well. 2012. did not progress due to concerns regarding data integrity and More fundamentally, work remains standards. The Commission was to establish a robust baseline further advised that the Ministry is and data-set that will serve as

For 2016 the Commission recommends: 2. Publication of the Taskforce’s Mental Health Reform Implementation Plan and information reported through the Government’s monitoring and reporting framework, via the Ministry of Health’s website 3. Public reporting of data against each of the 141 actions and 10 indicators inLiving Well 4. Improved public reporting of mental health system and population mental health data as proposed in Living Well 12

3. REPORTING ON FUNDING OF MENTAL HEALTH REFORM MUST BE TRANSPARENT

Local Health District (LHD) mental action by the Ministry of Health of mental health expenditure, health funding and accountability to improve governance of and including allocations both to the accountability for existing mental public (inpatient and specialist There has been a recognition of health funding (see Chapter 9 of clinical outreach in the community) the need for a staged increased Living Well). and community-managed investment over the decade to organisation (CMO) sectors and the 2024, with a focus on enhancing The adequacy of LHD mental acquittal of that money. services in the community. The health budgets, and whether the Government’s $115 million mental funds are fully spent on mental One way to strengthen local health reform package in the health services, remain among accountability is for LHD Directors first phase to 2016-2017, with the most frequent concerns raised of Mental Health to report directly $75 million per year promised with the Commission. This was an to the LHD Chief Executive and thereafter, is a modest but issue central to the establishment to ensure that Directors have well-targeted investment when of the Commission as is evident delegated authority over how their considered alongside NSW Health’s from the second reading speech. mental health budget is spent. A annual $1.7 billion recurrent Lack of accountability has the number of LHDs already have this funding for mental health, and in potential to undermine the reform arrangement. Additionally, the the context of the requirements initiatives and to compromise Commission urges LHD Boards to of a 10 year reform plan. the impact of the additional support the Living Well reforms Consequently it remains critical funding. The Commission will by putting in place mechanisms that the core budget is spent continue discussions with the for Mental Health Directors to effectively. The Commission is Ministry of Health about improving regularly and directly report at concerned at the lack of observed accountability for and transparency Board meetings.

For 2016 the Commission recommends: 5. LHD Directors of Mental Health should report directly to Chief Executives and have delegated authority over their budget, where they currently do not 6. LHD Directors of Mental Health should be given formal opportunity to address LHD Board meetings to regularly advise on progress with reform and local issues of concern

Future funding million for enhancing community Well and must be provided, funded living supports, there needs to be and planned alongside strong, The Commission is not confident a strong and ongoing commitment contemporary and recovery- that adequate resources will by the Government over the oriented inpatient services. be allocated to support the following seven years. This is full implementation of mental Over the forward years of the essential to accelerate investment health reform. The initial $115 reform to 2024, investment in in under-funded community-based million funding, for NSW Health community mental health services mental health services both in alone, is for the first three years may be threatened by lower terms of specialist clinical outreach of the reform process. There is growth in Commonwealth hospital from LHDs and community- no evidence that a longer term funding from 2017, announced managed organisations providing funding strategy has been put in in the 2015 federal budget, psychosocial supports. NSW falls place to meet the requirements of which places NSW mental health behind Victoria, Queensland, South a 10 year reform plan. reform within a period of fiscal Australia and Western Australia restraint.3 This is all the more The Commission is concerned that in its per capita investment in urgent because activity based after the initial funding of $45 community mental health care funding (ABF) under the current million for specialist mental health services.2 Community mental national classification in effect services in the community and $47 health is a cornerstone of Living until 2017 may inhibit planning for community or residential mental (CMO) sector also have business planning. The Commission health activities by providing implications for the provision of is aware that work is underway by growth funding for inpatient community-based mental health the Ministry, but it has yet to see service activity only. The Ministry services. The National Disability definitive action. of Health has some capacity to Insurance Scheme (NDIS) and The Taskforce and Government counteract this effect in its service Commonwealth pooled funding should therefore consider agreements with LHDs and in how of mental health programs to undertaking 10 year economic it chooses to apply ABF from 2017 Primary Health Networks make modelling of the Living onwards. The Commission awaits fundamental changes to how the Well reforms, to inform the advice about how NSW Health will CMO sector will be resourced and development of a long-term exercise its purchasing power to contracted. In NSW the apparent investment strategy. Given the provide community mental health lack of a strategy for funding, promising developments in local and inpatient services in line with partnering and contracting with planning and collaboration, this patients’ needs and contemporary the CMO sector within an overall should include investigation of models. financing approach contributes pooled budgeting strategies. to instability and insecurity for Changes that affect the the sector in terms of service and community-managed organisation

For 2016 the Commission recommends: 7. A long-term investment strategy to fund mental health reform in NSW, including 10-year economic modelling of the Living Well reforms 8. Investigation of pooled budgeting strategies to support local collaboration

4. PLANNING NEEDS TO BE IMPROVED TO REALISE A BETTER SYSTEM

The National Mental Health states such as Western Australia Well, and now repeats this call. Service Planning Framework as the basis for its 10 year mental The service benchmarks defined health and drug and alcohol plan, in the Framework are especially The Commonwealth Government was developed through extensive important for district managers funded the development of a national consultation and built in service design and redesign National Mental Health Service upon a set of contemporary efforts and in the commissioning of Planning Framework to support models of care. NSW Health is yet services, drawing upon evidence to the identification of future to approve its use by Local Health determine skill mix requirements requirements for public mental Districts. The Commission called for different service types. health services and supports. The for its public release in Living Framework, being used by other

For 2016 the Commission recommends: 9. NSW Health release the National Mental Health Service Planning Framework to guide LHD planning 14

NSW Mental Health Workforce managed, private sector and peer The Ministry has identified this Plan mental health workers. This is work as a priority,4 but it now an essential foundational reform needs to turn this into real action Living Well relies on the early activity and the establishment of in 2016. development of a NSW Mental a high-level steering committee to Health Workforce Plan that start this work is now overdue. includes public, community-

For 2016 the Commission recommends: 10. Development of a NSW Mental Health Workforce Plan is immediately commenced

Peer workforce plans Group). Since then the Ministry Consumer Workforce – as outlined of Health has undertaken further in Living Well (Action 8.2.1). In this Prior to the launch of Living Well consultations but to date the status process the Commission urges the significant work to develop a peer of this work is unclear. Ministry to recognise the work workforce framework had been already done by the Mental Health undertaken within NSW Health Central leadership from the Consumer Workers Committee and by the Mental Health Consumer Ministry of Health is now urgently Being. Workers Committee and Being required to develop a Framework (formerly NSW Consumer Advisory for the NSW Public Mental Health

For 2016 the Commission recommends: 11. That a Framework for the NSW Public Mental Health Consumer Workforce be urgently progressed and completed 5. JUSTICE AND POLICY REFORM REQUIRES MORE PROGRESS

People who experience mental impairments in the criminal justice The Commission also remains illness and the criminal justice system which addressed, amongst concerned about the forensic system other things, issues including early mental health system’s capacity intervention and court diversion. to adequately meet the needs of Living Well called for mental forensic patients. This particularly health services to be integrated However, no legislative reform relates to the ability to transition with interventions to reduce has begun, and the Government them to appropriate step down criminal behaviour. It called for has not finalised its response to care as their condition improves the development of models that these reports. The Commission and the impact this has on the facilitate interaction between is concerned at the delay to this Forensic Hospital’s capacity to community mental health services work given the vulnerability of accept new patients being referred and prisons, with concerted efforts this population and the expected from the courts, resulting in to meet the needs of Aboriginal growth in the prison population patients waiting in prisons for prisoners (Action 6.6.1). In mid- to 2021, indicating an increase a bed to become available. The 2014 the Commission understood to between 11,200 and 12,700 Commission requested information that the Government intended inmates – up from 10,578 in 2014.5 from NSW Health about this issue to implement recommendations Given that three quarters of NSW and will further pursue the matter made by the NSW Law Reform prisoners have been told they have in the coming year. Commission in two reports a mental illness at some point in concerning the needs of people their lives, these trends underline with cognitive and mental health the urgent need for action.

For 2016 the Commission recommends: 12. Government makes an immediate start on the Living Well Action 6.6.1 to develop demonstration models that facilitate better interaction between community mental health services and prisons

Policy and legislative review carrying out their functions.6 This are being addressed, yet this is includes that people who have a foundational to establishing a Living Well called for government mental illness should be supported consistent mental health reform agencies to review existing to participate fully in community framework for all activities of polices and legislation to ensure life and lead meaningful lives, Government. consistency with its reform via an integrated pathway across directions. This action is consistent Living Well flagged this would be government and other service with the direction under the an area for the Commission to providers.7 Mental Health Commission Act review in the third year of reform 2012 that requires agencies to To date, no agency has provided implementation and accordingly, have regard to the same principles the Commission with information concentrated effort is now that guide the Commission when that indicates these matters required in 2016.

For 2016 the Commission recommends: 13. Government agencies, as a priority in 2016, review existing polices and legislation to ensure consistency with the reform directions set out inLiving Well 16 Achievements in the first 12 months

This chapter reports on progress made by NSW Government agencies tasked with actions under Living Well. The Ministry of Health, and the Departments of Education, Family and Community Services, Justice and Premier and Cabinet have responsibilities in relation to mental health reform, as does the Commission.

In 2015 the Commission looked for evidence of ‘reform readiness’ activities designed to prepare the ground for fundamental change. GOVERNMENT ACTION

The Commission wrote to NSW These responses form the basis • a commitment to culture Government agencies in August of the information reported in change, including internal 2015 requesting information this chapter. Copies of all agency communications to educate staff about their activities and plans responses can be found on the and collaborators on the reform for implementing Living Well. The Commission’s website. priorities and what this means Commission also wrote to the locally, and training of staff to Chair of the Mental Health Reform What reform readiness respond appropriately to people Implementation Taskforce and to means who experience mental illness the Public Service Commission. The mental health and social • devolution of authorisation The agencies were asked questions support system needs to have six and accountability of staff based on sections of Living Well building blocks in place in order to to regional, local and service where preparatory action would successfully implement reform: delivery levels, empowering be necessary for the major reform them to drive reform directions to succeed. They were • strong leadership to translate also asked about other activities the directions of Living Well into • collaboration between signifying reform readiness. local and regional programs of NSW agencies and with activity Commonwealth, community- Responses were received from managed and private sector the Ministry of Health, and the • agency accountability for organisations, including data Departments of Justice, Education, progress, maintaining fidelity sharing where appropriate and and Family and Community with Living Well while aligning local and regional planning. Services. Short letters were with other reform activity across received from the Department the NSW public service of Premier and Cabinet and • a commitment to learning from the Public Service Commission successes and failures to build advising the Commission to refer a platform for change. The to the Implementation Taskforce’s Agency for Clinical Innovation, response. However, the Taskforce’s the Health Education and response did not detail specific Training Institute, the Clinical activities undertaken by those Excellence Commission and the agencies. Bureau of Health Information each have important roles and responsibilities in mental health reform EDUCATION

FAMILY AND COMMUNITY SERVICES

MINISTER LIVING WELL PREMIER IMPLEMENTATION FOR MENTAL PARLIAMENT NSW Government’s AND CABINET TASKFORCE HEALTH plan for reform

m n o o n i JUSTICE t i t a o t r n in e g HEALTH m , e re l v p ie im w of Government agencies ing s a res and community-managed nd r rog organisations work together eporting on p to implement reform MENTAL HEALTH COMMISSION OF NSW

Figure 2: The Government’s implementation and reporting governance

Mental Health Reform The NSW Mental Health • NSW Department of Premier Implementation Taskforce Commission separately and and Cabinet independently reports to the • NSW Department of Education The Mental Health Reform Minister for Mental Health and and Communities Implementation Taskforce was Parliament on progress towards established to oversee the implementation of the Living • NSW Department of Family and implementation of Living Well. The Well reforms. The Commission Community Services Taskforce also has performance also supports the reform work of • NSW Treasury and monitoring functions to initiate other agencies and organisations and sustain whole-systems change. by being a catalyst for innovation • NSW Department of Justice. It reports to the Minister for and change; assists in cross-sector The Commission attends Taskforce Mental Health. development; identifies areas for meetings as an observer. ongoing and future action and Government agencies, including The roles of the Taskforce are to research; and contributes to public the Ministry of Health and the oversee the implementation of debate. Departments of Premier and Living Well and the associated Cabinet, Justice, Education and The Taskforce first met on Ministry of Health budget of Family and Community Services, 10 November 2014, and is $115 million, and to provide are individually responsible for chaired by the Secretary of the Government with reports on completing particular actions in Ministry of Health. Membership implementation. It has met five Living Well. In addition they are comprises senior executives times, from November 2014 to members of the Taskforce. from the agencies which have December 2015. responsibilities to implement actions under Living Well: 18

Achievements in 2015 opportunity for both documents to be publicly released in full. • Managed the development The Commission was provided of the financial business case with a copy of an implementation for the $115 million reform schedule and was disappointed funds, which was approved in that it included only the $115 September 2015. million of NSW Health initiatives • Prepared an implementation previously announced and a set schedule for funded initiatives. of activities already under way • Prepared a cross-agency prior to development of Living monitoring framework through Well. While these are important, which the overall impact and the Commission expected the outcomes of mental health implementation plan would reform will be evaluated and include cross-agency responses will inform the Taskforce’s against each of the 141 actions annual report to government in Living Well, especially as on progress. The monitoring some of these did not require framework was approved in specific funding. Without this, October 2015. there can be no assessment of completion of the actions and • Released online a fact therefore no opportunity for public sheet in December 2015 accountability. providing updates on reform implementation: The Commission will continue to request a more detailed - NSW Mental Health Reform implementation schedule from the 2014-2024: 12 months on Taskforce which addresses each action and prioritises foundational Progress in 2015 actions such as the Workforce Development Plan. Throughout the year the Commission consulted with people The Commission looks forward with mental health problems and in 2016 to the Taskforce’s first their carers and families, spoke report to government and to with mental health organisations that information being publicly and met with agencies. It heard a available. consistent message that there was little knowledge or understanding of the Government’s mental health reform plans. With little public information available until December 2015 when a series of fact sheets was released, there was little advice to assist agencies to interpret their responsibilities or to help the community – including consumers and carers – understand what people should expect. The Commission has been often told that there has not been any substantial communication to frontline or district staff on the implications of reform for their work. The Government’s approval of the implementation plan and the monitoring framework, offers an AGENCY ACTION The Government departments and agencies that sit on the Taskforce are responsible for providing the conditions and resources to enable the fulfilment of Living Well.

NSW Health health services, as the Government market with the new contracting Achievements in 2015 committed to do in Chapter 5 of framework. The Commission Living Well. does not have a clear picture There has been significant activity Specialist and community mental about the future funding of regarding the announced $115 health teams mental health CMOs, any plans million of programs and initiatives. in relation to future purchasing Many have already begun rolling A number of specialist mental of CMO programs and services, out and the remaining are health teams across NSW are to or of the approaches adopted scheduled to begin in 2016. be funded or have their funding by the Ministry in coordinating Hospital to community options for extended (Action 5.1.1) including: Partnerships for Health with LHDs long-stay patients adult assertive care; specialist so as to support the overall aim of services for older people; Living Well to shift services to the The My Choice: Pathways to specialist services for children and community. Community Living Initiative adolescents; services for mothers Mental health and drug and (Actions 5.2.1 to 5.2.3) is to with complex conditions; whole- alcohol clinical networks support the transition of 380 of-family teams addressing mental long stay patients in mental health, drug and alcohol and In 2015 the NSW Agency health units into community parenting; community integration for Clinical Innovation (ACI) living. Work is under way to support for young people leaving established two new clinical assess these people by June 2016 custody; and telehealth access networks for mental health and to determine their individual to mental health services for the for drug and alcohol. (Action requirements for community Northern NSW regional hub. 6.1.3) These networks are to accommodation. This initial support clinicians in partnership The continuation or expansion progress and the development of with consumers and managers to of a number of community- project management supports and effect change and improve health managed programs (Action 5.1.1) protocols is encouraging for the service delivery and outcomes has included expanded adult future success of this program. at a state-wide level through the and youth community living development of evidence based However it is not yet clear how supports, continuation of the clinical guidelines and models of NSW Health will respond to the Housing and Accommodation care. The ACI has held two fora for needs of people in long-stay Support Initiative Plus program, the Mental Health Network and hospital units who will not be which provides clinical and social while formative work continues, part of the initial cohort of 380 support along with housing, and there is also an opportunity for long stay patients, but who are funded scholarships for consumers these two ACI networks to align also likely to experience better studying for Certificate IV in Peer and better integrate. outcomes from wrap-around Work. community service provision. Partnerships for Health The Commission urges the Ministry The Partnerships for Health to advance this work and provide initiative is intended to deliver a clarity regarding the development range of reforms in funding and of new models of care to divert purchasing with the community- people away from a pathway of managed organisation (CMO) long-stay inpatient treatment and sector as part of implementing about how savings from reducing Living Well (Action 8.3.1). At the reliance upon long-stay the time of writing this report, hospital care will be reinvested the initiative had yet to go to in enhanced community mental 20

Department of Education new support for public schools NSW Police and Achievements in 2015 across NSW over five years. The Transport NSW investment includes $80.7 million The Wellbeing Framework for to employ 236 additional school Achievements in 2015 Schools counsellors, in addition to existing Mental health and suicide The NSW Wellbeing Framework expertise provided by more than prevention training for front-line for Schools is, to date, the most 4000 specialist staff, including personnel counsellors and specialists in comprehensive response aligned The NSW Police Force and learning and behaviour, and more with Living Well. The Framework Transport for NSW have led the than 100 specialist tutorial centres provides a mandatory structure way in equipping their front-line and special schools for students and guidance to NSW public personnel to respond appropriately whose social skills or behaviour schools on enhancing their to suicidal behaviour (Action mean they cannot be appropriately responsiveness to student and 3.4.7). The NSW Police Force now educated at mainstream schools. teacher wellbeing. Importantly, mandates a one-day mental health In 2015 the Wellbeing Framework this work commenced ahead workshop for all sworn officers. was embedded in the School of Living Well, underlining how Also in the last year, Sydney Trains Excellence Framework, which the Department of Education and NSW TrainLink have rolled out establishes wellbeing as a core prioritised the issue, which was one-day suicide awareness training component of each school’s then taken up in Living Well. to their front-line employees, strategic planning and evaluation (Action 3.1.4) developed in conjunction with processes. The Wellbeing Framework TrackSAFE Australia and the Black package of $167.2 million provides Dog Institute. (Action 3.4.7) STATE INITIATIVES THAT COMPLEMENT LIVING WELL A number of initiatives progressed in 2015 by government agencies, while not specified as actions under Living Well, they have embodied its reform principles.

Ministry of Health Department of Family and through mechanisms such as social impact bonds. The Ministry of Mental Health Innovation Fund Community Services Health advises that this work will The Mental Health Innovation Fund The Collective NSW progress in 2016.10 (Living Well of $4 million was announced by The Collective NSW is a social Topic 5.1 Shift to Community). the Minister for Mental Health the impact project under which local Legal Aid NSW Hon. Pru Goward MP on community processes direct the 13 November 2015. The first path towards resolution of complex Justice-related initiatives round of tenders, which close social problems. This collective Legal Aid has championed Health on 5 February 2016, seeks approach allows for a joint Justice Partnerships, bringing proposals from service providers response from the community, together representatives from to collaborate with Government to multiple tiers of government, public sector agencies including provide innovative ways to deliver and business, big and small. The NSW Health, FaCS, and the service and supports to people program expanded strongly in 2015 Departments of Premier and with mental illness and their carers with four FaCS Districts – Northern Cabinet and Justice with the in the community. This tender Sydney, Illawarra, Western Sydney private sector and community process is anticipated to seed and Murrumbidgee – adopting legal centres into a Community of improvements in state agency and this model and undertaking Practice. The purpose of the group, community sector collaboration, initiatives and projects focused co-chaired by the Commission, and is on track to provide local on community-led social impact is to explore opportunities for district and CMO consortia with activities. FaCS is now transitioning collaboration to improve health, $1.5 million by June 2016 and The Collective NSW to become wellbeing and legal outcomes of another $2.5 million by June 2017. a non-government, community- people who live in disadvantaged (Living Well Topic 8.5 Research and managed organisation. (Living communities. knowledge exchange). Well Topic 3.1 Building Community LikeMinds Resilience and Wellbeing). Legal Aid also created a new position to help its staff to LikeMinds services provide Treasury deliver effective legal services to consumers and their families Social Impact Bonds people living with mental illness with a one-stop shop, where and to collaborate with other they can access an array of On 15 February 2015 NSW agencies providing supports to mental health services, including Treasury in conjunction with NSW the individual. (Living Well Topics access to professionals such as Health held a market sounding 6.5 Bringing a holistic therapeutic psychologists and psychiatrists, on social impact investment approach to youth justice, 6.6 and to community-based service opportunities to bring about Improving access to services for providers involved in their support. change in long-stay mental health adults in custody). In 2015 services were opened at hospital admissions.9 This initiative Penrith and Seven Hills, with two aligns with the action under Living more in planning.8 (Living Well Well to support the development Topic 6.1 Integrated care). of innovative community-based alternatives to hospital admissions 22

LOCAL INITIATIVES TO SUPPORT REFORM As a whole-of-government, whole-of-person and whole-of-community reform strategy, Living Well initiatives instigated at the local level are fundamental to reform.

During 2015 the Commission response to needs identified by and aspirations to develop the met with directors and managers local communities. plan’.11 The consumer is an active of services and visited local co-author of their own individual For example, Northern Sydney communities across the state who recovery plan. An evaluation found FaCS district has implemented expressed the consistent view that consumer involvement increased initiatives such as the Northern a centrally co-ordinated response dramatically after the project was Beaches Project and the Greenway to Living Well was absent. At implemented, with 67 per cent of Estate Wellbeing Centre which the local level some workers felt consumers having a co-authored are detailed in the FaCS response unsupported and under-resourced care plan, up from 5 per cent letter, published online to to commence such ambitious previously. accompany this report on the change. But nonetheless strong Commission website. reform leadership was seen within Partnerships between individual program streams and in Local agency collaboration community-managed local communities. to achieve common goals organisations and The Commission learned of local for local communities Local Health Districts initiatives that demonstrated in expanding early cross-agency and cross-sector The North Coast Primary Health collaboration, exemplified Network (PHN) and Northern intervention innovative practice or embedded NSW Local Health District worked Community-managed organisation the Living Well philosophy. intensively with stakeholders to RichmondPRA’s Young People’s Some examples are highlighted develop the Northern NSW Mental Outreach Program (YPOP), here, with a fuller account in a Health Integration Plan 2015- developed in partnership with supporting paper available on the 2018. The plan outlines the shared Western Sydney Local Health Commission’s website. intent of agencies involved in District, supports young people mental health to work closely with to build their skills, learn about Government realigning CMOs, consumer and carer groups, self-management of mental administrative boundaries government agencies, and mental health issues, and pursue an to improve interagency health professionals, to ensure that education or get a job. The YPOP local health services are integrated, collaboration model has been adopted as the person-centred, seamless, effective NSW Government’s new Youth The Department of Family and and efficient. The Integration Plan Community Support Service, Community Services (FaCS) is available on the North Coast PHN diverting young people away has moved to a regionalised website ncphn.org.au. from a trajectory of chronic management structure, which Improved co-design in illness, unemployment and social has created new opportunities to isolation. provide integrated, holistic service consumer care planning delivery for people with mental The Sydney Local Health District’s Aboriginal holistic health problems. Since 2013 when Collaborative Care Planning Project approaches to social and FaCS boundaries were re-aligned establishes a process for nurses emotional wellbeing to those of the NSW Health Local and consumers to co-develop Health Districts, new collaborative recovery-focused care plans during Tharawal Aboriginal Corporation relationships between local acute mental health inpatient in Sydney’s Macarthur region representatives of the two admissions. Operating at the Royal provides holistic health care agencies have removed many Prince Alfred Hospital’s Professor focused on prevention for service barriers that previously Marie Bashir Centre, ‘the project members of the local Aboriginal had to be escalated to decision considers the consumer’s unique community, and works through makers outside the local area. This background and circumstances and strong agency partnerships. It runs has enabled local reforms in direct uses the consumer’s own goals several Close the Gap programs, including chronic disease of Premier and Cabinet is co- across an extended rural region. All prevention, tobacco control, ordinating the evaluation of this the Council’s senior managers have maternal and infant health, and work, which is being undertaken by undertaken Mental Health First a Community Garden for people Western Sydney University. Aid training and they encourage to learn skills in growing fruit and openness about mental health vegetables. Tharawal provides a Living Well resonating in issues, improving the service parenting program to strengthen Commonwealth funded offered by front counter staff as parenting skills and address programs well as reducing stigma around mental health issues early in life. mental illness within the Council A Social and Emotional Wellbeing Partners in Recovery in South itself. team provides a range of mental Western Sydney has developed the health services with integrated No Wrong Door initiative to foster: case management, while general • collaboration and integration counselling services, specialist across mental health health workers, GPs and specialist organisations in the region clinicians work alongside an allied • coordination of services to health team. ensure people living with Tharawal has strong partnerships mental illness do not experience with local services, including barriers to accessing services Campbelltown Community Mental and are not turned away Health Centre and Partners in • improved means of providing Recovery South Western Sydney, quick and accessible information and community-managed for people to be able to navigate organisations such as Odyssey the service system. House, a drug addiction treatment centre. By December 2015, 21 organisations in South Western Co-design with consumers Sydney had signed the No Wrong and carers and across Door Charter, and were developing agencies action plans. Western Sydney Local Health Local council leading District (WSLHD) and Western community resilience Sydney FaCS District are partnered programs in a co-design initiative and are working closely with relevant Bega Valley Shire Council identifies stakeholders, including consumers children’s and young people’s and carers, to redesign mental services, leisure and recreation health service provision in Western infrastructure, and community Sydney for children and young leadership in suicide prevention as people from infancy to 24 years. At its priorities in supporting mental the centre of the design process is health reform. It works to ensure the consumer’s voice, providing a people have spaces, such as halls, better understanding of people’s libraries and sport facilities, to experiences with mental health pursue activities that enhance services and what they want wellbeing as well as promoting improved. more formal conversations about mental health, reaching out to Multi-stakeholder workshops groups such as young people identify potential solutions and whose needs are often not well design prototypes to be tested served. It has helped to establish a and retested with consumers and mobile Police Citizens Youth Club workers, to inform the design for and sees mobile mental health better provision of care through and wellbeing services as critical a coordinated and integrated to providing community support service system. The Department 24

COMMONWEALTH INITIATIVES THAT ALIGN WITH LIVING WELL

The National Disability through the complex issues. For to work collaboratively with the Insurance Scheme (NDIS) many LHDs the NDIS presents an Commonwealth and Primary opportunity to expand services Health Networks to advance On 16 September 2015, the NSW to support people with disability common priorities while and Commonwealth Governments with associated revenue, and implementing Living Well. signed an agreement to roll out the better connect those support NDIS in NSW between 1 July 2016 arrangements with the person’s New roles for Primary and 30 June 2018. The Ministry health care needs. Health Networks in mental of Health and FaCS will need There are also broader health to ensure current services and opportunities for NSW Health. psychosocial supports available On July 1 2015, 10 Primary Aligning with the NSW Living Well to people living with a mental Health Networks (PHNs) were reform agenda, NSW Health could illness and their families and carers established in NSW, with a remit strengthen its future capability will not be eroded during the to focus on outcomes, improve to get meaningful outcomes implementation of the NDIS. frontline services and provide for people with mental illness clearer pathways between hospital NSW will need to maintain by recognising the strengths of and primary care especially for appropriate governance the community-based operating people with chronic or complex mechanisms following full model currently used by ADHC, conditions. The PHNs have six implementation of the NDIS and augmenting the residual role work priorities of which one is and the cessation in 2018 of of FaCS within the NSW Health mental health. In November the Ageing, Disability and Home structure to drive a culture of 2015 the Commonwealth Care (ADHC) branch of FaCS, to integrated care. To achieve this, announced PHNs would become ensure a seamless provision of consideration should be given to commissioning agents for pooled services for those who require retaining the skills and knowledge Commonwealth-funded mental supports from both the State developed within the disability health services, commencing from and the NDIS. This is particularly sector in designing and delivering 2016-17.12 These pooled funds important for individuals who person-centred care and early are to be sourced from Access to have a psychosocial disability with intervention approaches, and Psychological Services (ATAPS); additional health or social issues, embedding those skills in the NSW Early Psychosis Prevention & and those who come into contact public sector. Intervention Centres (EPPIC); with the criminal justice system. National Review of Mental Headspace; the Mental Health The Commission understands that Nurse Incentive Program; the ADHC and the National Disability Health Programmes and Mental Health Services in Rural Insurance Agency will trial special Services and Remote Areas program; models of care in the Hunter NDIS and various suicide prevention The Commonwealth Government’s trial site to address complex needs, programs. and this will inform the service response to the 2014 National system scheme. Concern remains Review of Mental Health The implications for NSW, and the about the maintenance and Programmes and Services was effect on planning and delivery ongoing development of specialist released on 26 November 2015. of local publicly funded mental clinical services currently funded or It supported a series of reforms health services, will need to be supported by ADHC. that closely align with those of monitored carefully. However, the Living Well: consumer-focused care Commission considers this move LHDs will need to decide in 2016 models, better local responses to away from a top-down approach whether to become registered communities, the development of is a vital step. If leaders of PHNs providers with the NDIS. The the peer workforce, provision of and LHDs collaborate with other Commission understands that stepped-care models, the provision government and community currently no LHDs are registered, of psychosocial supports and the agencies, this creates the potential and as such cannot charge for the role of the NDIS, the needs of for a more rational service design disability-related supports they people with complex and chronic that responds to actual local need. might provide to NDIS participants conditions, and Aboriginal mental as part of their support plans. health and suicide prevention. It understands the Ministry of This affords NSW an opportunity Health is assisting them to work Intentionally left blank 26 The Commission’s work

Following the launch of Living Well in December 2014 the Commission distributed copies widely to agencies, Local Health District (LHD) board members, community groups and partners such as universities and the mental health community- managed organisation (CMO) sector, to promote awareness of its principles and directions.

In 2015 the Commission visited opportunities to learn first-hand of partnered with government and the communities of Bega, Broken local experiences, challenges and community-managed agencies, Hill, Coffs Harbour, Kempsey, action and the Commission thanks provided seed funding for activities Goulburn, Griffith, Wagga Wagga the people in those towns who in LHDs, and targeted research and Queanbeyan to talk about organised the visits and made time activities to enhance local skills, Living Well with local agencies, to showcase their services and knowledge and tools. This reform community-managed organisations share their experiences. readiness work is outlined in this and consumers and carers. chapter. In 2015 the Commission also These visits provided valuable LOCAL PROJECTS TO SUPPORT LOCAL READINESS

In March 2015 the Commission diversity, reflecting variability of prerequisites for the LHD to called for applications from local needs and confirming that commence its reform process. LHDs for grants up to $30,000 to reform readiness is different within These projects are all completed, organise and undertake activities each community. However there and in some instances have to support local reform readiness. were also common priorities – to germinated further collaborative Fourteen LHDs submitted investigate local collaborative local work. Details of the funded proposals which were all funded partnerships, local planning projects are summarised in for a total of $376,750 in 2014-15. processes to support mental Appendix 1. These projects demonstrated great health reform or to identify the RESEARCH PROJECTS TO ACCELERATE REFORM

In January 2015 the Commission Research Council Centre for fund the Black Dog Institute, the funded nine research projects Research Excellence in Suicide lead agency in CRESP, to conduct to provide system support and Prevention (CRESP) to develop a this work. The Commission expects tools to support reform. These framework for suicide prevention to hold the first meeting of a projects focussed on specific topics in NSW based on the international NSW Suicide Prevention Forum including suicide prevention, evidence of the benefits of (Action 3.4.1) in early 2016 which wellbeing, recovery, service taking a systems approach that will contribute advice to the mapping and planning frameworks implements proven interventions implementation process of the (Appendix 2). They are funded simultaneously in an integrated Framework trial in NSW. over the financial years 2014-15 program (Action 3.4.2). CRESP to 2015-16 and are intended to and the Commission launched iBobbly provide additional resources, the Framework in August 2015. Originally developed for the understanding and evidence to An implementation proposal, Kimberley region in Western support change and innovation. developed for the Commission, Australia, iBobbly is a smartphone recommended an initial trial of NSW Suicide Prevention app designed to reduce suicidality four sites across NSW over six among Aboriginal young people. Framework years at cost of approximately The Commission funded the Black The Commission funded the $14.7 million. The Paul Ramsay Dog Institute to enhance and National Health and Medical Foundation generously chose to extend iBobbly for NSW users in consultation with local Aboriginal examine tools for wellbeing involved in the recruitment and communities. This work was measurement and evaluation with retention of a peer workforce, completed in November 2015 a view to identifying the contexts the Commission contracted Craze and will form part of the national in which these tools might be Lateral Solutions to develop a Peer extension of the app. useful, and how they could be used Work Guide. Informed by existing collaboratively across agencies. state, national and international Integrated Mental Health work, and a series of strategic Atlas of Far West NSW Pathways to Mental Health consultations, the Guide provides Care in Western NSW The Commission funded the practical advice on developing a University of Sydney to map all ReachOut.com was funded to pilot peer workforce including roles services for people experiencing a program in the Western NSW and functions, training and mental illness and their families in Local Health District that integrated competencies, organisational far west NSW. The project classifies technology-based services with supports, and policies and services according to their main primary health care providers and procedures. The Guide will be care structure or activity, as traditional clinical services within developed into an online resource well as their availability and a stepped-care framework (Action and is expected to go live in 2016. utilisation. It provided the region’s 8.4.7). This project demonstrated Insights into Recovery first inventory of mental health the effectiveness and acceptability services, from which it will be of a stepped care approach to The Commission has funded the possible to derive benchmarks and integrate a continuum of care Butterfly Foundation to translate comparisons with other regions. options from online self-care to knowledge from lived experience specialist mental health services. of people with an eating disorder This work has been adopted by The results will be fed into the into a framework of recovery- other LHDs in NSW with Atlases broader Synergy project. oriented practice. Drawing on for Western Sydney and South the National Framework for Eastern Sydney LHDs completed Synergy Pilot Recovery-Oriented Mental Health in 2015 and most metropolitan services, this project will include LHDs committed to the project. The Commission has partnered with the Young and Well the development of guidelines for Discussions are under way on how professionals working with people to complete this work across NSW. Cooperative Research Centre (CRC) to run a NSW trial of Synergy, with eating disorders suitable The Atlas comes at a particularly a central gateway that allows for use in policy and professional important time with the young people to use a single login development. The project is due Commonwealth’s recent to engage with online mental for completion in 2016. commitment to focusing on the health services. Synergy is being Clinical Alliance and regional planning of services via developed by the Young and Research in ECT (CARE) Primary Health Networks (PHNs) Well CRC with funding from the using flexible funding pools in Commonwealth Government. The Commission has provided seed order to meet local needs. The NSW trial will customise and funding to the University of NSW Wellbeing Collaborative integrate e-mental health tools and for the CARE project which aims services into the Synergy system. to improve clinical ECT (electro The Wellbeing Collaborative was It has engaged young people convulsive therapy) services by launched in June 2015 (Action in greater Western Sydney, the recommending a set of outcome 3.1.1) and brings together Central Coast and Far West NSW to measures, and providing training representatives from a range of co-design the look and feel of the in their use in centres across NSW. government and community- site. This work, to be completed in The project has been developed managed agencies to provide June 2016, will be complemented after wide consultation with leadership and promote awareness by an education and training experts across Australia by leading across government and the program to promote the uptake of psychiatrists with both clinical community that wellbeing is e-mental health support by young and research expertise in ECT. ‘everybody’s business’. Key people. The Commission is interested in activities in 2015 included the project’s capacity to collect a providing training in Mental Peer Work Guide common dataset which can then Wellbeing Impact Assessment and To assist government and be used for benchmarking directed consultation around wellbeing community-managed organisations towards service improvement. language and definitions. Experts to understand the value of mental This phase of the project will be have also come together to health peer workers and what is completed in 2016. 28 Monitoring and reporting

The NSW Mental Health Commission has an ongoing, legislated function to provide progress reports to Parliament on whole-of-government implementation of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024.

The Mental Health Reform The Commission in its own service funding will affect the Implementation Taskforce, under reporting will look to evidence state’s capacity to provide the auspices of the Ministry of and system-wide measures for the services, and the introduction of Health, oversees the government’s far-reaching reforms envisaged the National Disability Insurance implementation of Living Well by Living Well, which emphasise Scheme (NDIS) will directly and is expected to provide an mental health within a context affect some individuals who annual report to Government of broad community wellbeing, require ongoing support in the on progress against agreed supported by responsive, community. As far as possible, agency performance measures. individualised services across a full the Commission’s reporting will The Commission was advised in spectrum of government activity. It acknowledge and reflect the the Taskforce’s letter that it will will endeavour to not duplicate the context in which NSW mental identify progress against the intent reporting of the Taskforce. health services are provided. of the 141 actions in Living Well, The Commission is also acutely With these things in mind, the not against each action. This will aware that external factors may Commission will concentrate its not afford a line of sight to how impact strongly upon NSW and its reporting program in the areas each action is being progressed, people. Changes in Commonwealth discussed below. and will be a point for future arrangements for mental health discussion with the Taskforce. GETTING THE BEST INFORMATION

The Commission will use system contribute their views through an to Parliament. The government will information, quantitative data online survey. Details and findings also need to reappraise its own and qualitative information, and from this survey are presented in a data sets to work collaboratively will triangulate these to measure following chapter. with the Commission to establish progress towards the vision of meaningful and transparent data The Commission will work with Living Well. Central to this is and reporting, and to work with NSW Health, the Bureau of Health listening to experiences of care agencies to provide relevant Information (BHI) and others to from people who use services, baseline data and information identify sources of information and the Commission will seek systems to support their to improve the completeness to strengthen its data collection responsibilities in reporting to of reporting and monitoring to in this area. In this first progress government and the community. inform the Commission’s reports report it invited people to

ISSUES AND CHALLENGES TO REFORM

The Commission will also look to mental health reform survey for the Commission monitors progress opportunities to ‘spotlight’ issues example, held in September 2015, over the years to 2024, it will adapt of concern regarding progress with identified concerns regarding poor its reporting approach to ensure it implementation of Living Well, to resourcing, inadequate leadership remains meaningful and relevant highlight good practice or poor and lack of contemporary models to the changing environment. performance regarding system of care as barriers to successfully reform. Its Ready for Change rolling out the reform program. As WHOLE OF COMMUNITY IMPACTS

Living Well offers the potential to ‘Social impact’ is the net effect to address cross-agency and deliver positive impacts across the of action on the wellbeing cross-community progress. whole of the community. of individuals, families and The Department of Family and communities. For positive social Community Services is already Complex social problems cannot be impact to be achieved, social well advanced in developing this resolved by a single organisation or outcomes measurement needs approach for its services, and program. Collective approaches are to be an integrated and inter- its work offers a good example needed to produce lasting large- dependent part of strategy and on which to base a model for scale change. Mental health and day-to-day operations. measuring social impact across wellbeing challenges are especially the full spectrum of mental health strongly associated with social This will depend on the reform. disadvantage, so community-level development of a methodology collective approaches are critical. which goes beyond monitoring the work of individual agencies

COMMUNITY

SOCIAL ISSUE

DEFINE OUTCOMES

COLLABORATIVE & PARTICIPATIVE APPROACHES

FOSTER & SCALE SOCIAL INNOVATION EFFECTIVE MEASURING FUNDING OF OUTCOMES OUTCOMES

SOCIAL OUTCOMES ECOSYSTEM

GREAT GOVERNANCE LEADERSHIP & MANAGEMENT

EFFECTIVE IMPLEMENTATION

SOCIAL IMPACT

Figure 3: The elements of change (Based upon the work of Hanlybrown F, Kania J, and Kramer 201113 online source) 30

THE COMMISSION’S REPORTING FRAMEWORK

The Commission has adopted a framework that underpins monitoring and reporting across three domains in achieving the vision of Living Well: individual, population and system.

POPULATION SYSTEM

VISION Better mental health and wellbeing Improved health and Driving best value from for all in NSW equity for all groups collective resources

INDIVIDUAL

Improved quality, safety and experience of care

Figure 4: Framework to support the reform vision

Within these three domains the Commission expects to see measurable change over the next 10 years: Individual – Improved quality, safety and experience of care Increase in the use of interventions and supports that are evidence based and higher positive reporting by people with lived experience of mental illness and their carers so that they have the opportunity to actively participate in their treatment and have a voice in system reform. Population – Improved wellbeing and equity for everyone Improvements across measures including increased life expectancy, reduced discrimination, and improved outcomes across the domains of a person’s life, arising from activities across the mental health and human services system as a whole. System – Driving the best value from collective resources Every dollar of investment demonstrably used to full value by providing efficient services based upon best available evidence, through resource allocation and service and system design focused on maximising outcomes for people and government. MONITORING AND REPORTING OVER 10 YEARS

The Ministry of Health has Given these tollgate reviews across take into account the findings and advised the Commission that the the 10 year reform program, the outcomes of the tollgate reviews Government’s state-wide reform Commission considers there are to inform its ongoing advice to agenda for NSW includes major three distinct phases for mental Government. The Commission will ‘tollgate reviews’ at two points, health reform. Its reporting review this approach from time to in 2016-17 and in 2020-21. Such will take into account both the time, and adjust it if appropriate. review points are part of the NSW opportunities to provide advice Treasury’s budget review strategy. at these tollgate points and to

VISION Set targets Drive reform and Embed outcomes and priorities monitor priorities and system change Better mental health 2014-2017 2018-2020 2021-2024 and wellbeing for all in NSW

• Establish governance • Rebalance investment • Measure progress • Set budgets • Measure progress • Review progress and identify • Confirm agreed indicators • Reinvest efficiencies generational change goals • Set foundations for reform into community support • Embed outcomes and and service priorities learnings across relevant systems and sectors • Establish ongoing public monitoring to prevent system regression

Figure 5: The phases of NSW mental health reform to 2024 32

Intentionally left blank Living Well indicators at a glance

CONCERNED: PLEASED: The proportion of young people who are happy The proportion of people reporting high levels of with life as a whole has fallen since 2011. psychological distress has been decreasing.

NO DATA AVAILABLE: NO DATA AVAILABLE: To indicate if people with a mental illness are To assess if the rates of community participation experiencing less discrimination and stigma. of people with a mental illness are improving.

CONCERNED: PLEASED: Consumer workers have decreased as a The majority of consumers rate their care as very proportion of the mental health workforce. good or excellent. However, the proportion of carer workers has increased.

CONCERNED: CONCERNED: The suicide rate has not improved over the past The proportion of spending allocated to decade. community-based services has decreased.

CONCERNED: PLEASED: Community treatment order rates are steady, but The number of diversions from court to involuntary hospital admissions are increasing. treatment is increasing for both adults and adolescents. 34 Living Well indicators

This chapter establishes the status of the 10 indicators described in Living Well, that are intended to track the success of mental health reform over the next decade. The indicators were selected because of their potential to highlight change in the mental health system, and the Commission will advocate for the availability of data to report against them in cases where none exists, or for improved data quality where current collections are unreliable.

1. Increase the proportion of the community that reports positive mental health and wellbeing

Information about individual However, a series of longitudinal was not evident in the previous mental wellbeing is not currently studies of three separate groups survey group of 1998, and so collected in a consistent manner of young people in NSW aged 15 indicates that this is unlikely to useful for monitoring at a to 25, surveyed in 2003, 2006 and be an age-related occurrence. As population level. The Commission 2009 and then followed over time, young people are most vulnerable is seeking to include questions shows the proportion reporting to developing mental illness, the about mental health and wellbeing that they are happy with life as a decline in their wellbeing and in future collections of the NSW whole has dropped substantially happiness is of concern. Population Health Survey. since 2011 from 97 per cent to 90 per cent in 2014.14 15 16 17 This trend NEW DATA

100 1998 Cohort

98 2003 Cohort

96 2006 Cohort

2009 Cohort % Happy with life as a whole 92

90 2000 2002 2004 2006 2008 2010 2012 2014

Graph 1: Life satisfaction for people aged 15 to 25, NSW, 2000-2014 18 19 20 21 9

Moderate or good mental health 8

7 Poor mental health

6 Average life satisfaction out of 10

5 2001 2003 2005 2007 2009 2011 2013

Graph 2: Average satisfaction with life (out of 10) for people in poor or moderate to good mental health, NSW, 2001-2013

Life satisfaction has been found The Commission will urge NSW to be lower for people who are Health to establish a whole of in poor mental health, when population measure in order to compared to people in moderate more reliably understand levels of to good mental health, and this positive wellbeing across the whole gap has stayed consistent for more of the community. than a decade. 36

2. Decrease the rate of psychological distress in the community

Detailed and up-to-date estimated 9.8 per cent of the NSW cent.23 Scores in the ‘high’ and information on the rate of population reported high or very ‘very high’ range on this measure psychological distress in the high psychological distress, down indicate that a person is likely to community is important to from 12.2 per cent in 200322. This be experiencing a mental illness. understand whether enough is proportion was slightly higher in The overall proportion of the NSW being done to tackle mental ill females (11.1 per cent) than males adult non-Aboriginal population health. (8.5 per cent). and of Aboriginal people within these two highest categories is The rate of high or very high Of major concern is the particularly presented in the graph below. psychological distress among elevated rate of high or very high NSW adults has declined over the psychological distress among years 2003 to 2013. In 2013, an Aboriginal people at 16.3 per

20 Aboriginal

% High or very high distress Non-Aboriginal 10

5 2003 2005 2007 2009 2011 2013

Graph 3: Percentage of non-Aboriginal and Aboriginal people reporting high or very high levels of distress, NSW, 2003-2013 Childhood is a critical period for for an estimate of the proportion notably higher than that for girls shaping life outcomes. While there of children in NSW with a likely (5.3 per cent) in 2013-14. is no self-report data24 regarding mental illness.25 This proportion psychological distress in children, has not changed substantially over the Population Health Survey the decade prior to 2013-14. The (PHS) includes data that allows rate for boys (11.2 per cent) was

10 Males

% At substantial risk Females 6

4 2003-04 2005-06 2007-08 2009-10 2011-12 2013-14

Graph 4: Percentage of children at substantial risk of developing a behavioural problem, 2003-2014 38

3. Reduce the proportion of people with a mental illness experiencing discrimination and stigma

Community attitudes may be of people living with a mental discrimination in health care changing but there is still a health difficulty also encounter settings. However, this will only significant problem in the way discrimination, and again this can provide an insight to discrimination people with mental health be a barrier to seeking assistance. experienced when in a hospital. problems are seen and treated by As such, a survey to measure this In the absence of a nationally others. However the Commission indicator is imperative. consistent measure, the has been unable to identify any The Commission is pleased that Commission engaged the timely and ongoing data collections Bureau of Health Information University of Melbourne to provide regarding the experience of has recently included questions a report for NSW based on its discrimination among people with on discrimination in the Adult National Survey of Discrimination mental illness. Without this data it Admitted Patient Survey. While and Positive Treatment. There is difficult to understand the scale these questions do not explicitly is evidence from this work that of the challenge or what works in mention mental illness, the people who scored highly on a tackling it. Commission hopes that over time measure of psychological distress, Discrimination is known to be a this survey will include enough or who reported having had a barrier to people seeking help respondents with lived experience mental health problem in the and accessing health care and (self-identified via responses to previous 12 months, indicated supports, as well as job seeking or ‘[do you have a] mental health that by and large they were staying engaged in employment or condition?’) that it will be possible treated more positively due to social activities. Families and carers to examine their experience of their illness.26 Of the 399 people

Spouse or partner Positive Friends

Other family members Avoided

Health professional Discriminated

Education

People in the workplace

People in the community or neighbourhood

Other people

Looking for work

0 10 20 30 40 50 60 % Agreeing

Graph 5: Percentage of people with mental illness experiencing discrimination, avoidance and positive responses, NSW from NSW in this survey, more respondents reporting being than half (58.2 per cent) reported treated more positively. In being treated more positively by addition, 11.4 per cent reported their spouse or partner due to being avoided in the workplace. their illness, compared to 35 per Respondents also reported being cent per cent who reported being treated more positively by health discriminated against or avoided professionals – 44.9 percent, due to their illness. This pattern compared to 10.8 per cent who was repeated for friends and reported being discriminated other family members, with whom against. Similar results were found positive experiences were far more for education, with 37.1 per cent common than discrimination and of respondents reported being avoidance. treated more positively, compared In all 24.4 per cent of respondents to 8.9 per cent reporting being reported being treated more discriminated against. positively by people in the These findings are generally workplace due to their illness, heartening, but in the absence compared to 12.5 per cent of an ongoing population-based reporting being discriminated survey it is challenging to track against. In contrast, 10.6 per cent changes in people’s experiences of reported being discriminated discrimination due to their illness. against while looking for work, compared to 3.1 per cent of 40

4. Increase the rate of community participation among people with a mental illness

Participation in work, education Outcomes and Classification questionnaire, and has advised and social and community life is Network (AMHOCN) has developed that it is expected to be ready for integral to living a fulfilling and the Living in the Community implementation in March 2016.27 contributing life. At this time Questionnaire which aims to do Population surveys show however, there is no current data source this. It includes questions on social that people experiencing high which directly asks people with activities, education, employment, psychological distress are less likely a mental illness for their own voluntary and unpaid work, to participate in social activities assessment of their level of employment seeking, and living such as visiting neighbours or being community participation. However, circumstances. AMHOCN has a member of a local organisation.28 the Australian Mental Health undertaken a series of trials of the

Able to ask for neighbourhood help Low to to care for a child moderate distress Ran into friends and acquaintances when shopping in local area

Visited neighbours High in the last week distress

Would feel sad to leave their neighbourhood NEW Active member of DATA a local organisation, church or club

0 10 20 30 40 50 60 70 80 % Agreeing

Graph 6: Percentage of people experiencing social inclusion activities, NSW, 2013

People living with a mental health without these problems (65.2 problems are less likely to be problem in NSW also participate per cent compared to 78.7 per employed and/or enrolled for in employment and education at cent).29 People with a psychological study in a formal secondary or lower rates than the rest of the or psychiatric primary medical tertiary qualification than those community. People with mental condition make up 31.5 per cent without such problems (80.8 per or behavioural problems are less of NSW recipients of the Disability cent compared to 93.2 per cent).31 likely to be in the labour force than Support Pension, up from 22 per people without these problems cent in 2001.30 Importantly, in (69.5 per cent compared to 81.5 terms of establishing life skills and NEW per cent). They are also less likely opportunities, young people aged DATA to be employed than people 16-30 with mental or behavioural 5. Increase the proportion of the workforce in mental health services who are peer workers

Peer workers use their lived on employees categorised as workforce outside of the public experience of mental illness in carer or consumer workers within mental health system. There is no professional roles to support and the National Mental Health centralised collection quantifying work with others with a mental Establishments Database, and this workforce. illness. As of 2013-14, across the definition of these categories NSW there were 26.5 full-time- has changed over the reporting equivalent consumer peer workers period. As such the data may and 7.7 full-time-equivalent carer underestimate the true number of peer workers reported to work peer workers in the public mental in the public specialised mental health system, for example where health sector.32 a peer worker is employed under a different staffing categorisation. Care should be taken in regard to In addition, the Commission is these estimates. The peer worker aware that there is a sizeable peer data is derived from information

35 NEW DATA 30

25 Consumer

20 Carer

FTE peer workers/ 15

10,000 mental health care staff 10

5 2009-10 2010-11 2011-12 2012-13 2013-14

Graph 7: Peer workers as a proportion of mental health workforce, NSW, 2003-04 to 2013-14 42

6. Increase the proportion of consumers with a positive experience of service delivery

A positive experience of service felt respected, safe, and listened September 2015, inpatient return delivery indicates that services to, and to rate their experience of rates increased from 14.8 per cent address the needs and priorities service. to 19.9 per cent, while return rates of consumers. In order to from people who used out-patient NSW Health has adopted the YES develop a standardised national or community-based services questionnaire and commenced approach to the measurement of increased from 1.0 per cent to implementation in March 2015. It consumers’ experience of care, 2.0 per cent.33 While this data is pleasing that YES is now available the Commonwealth Department is preliminary, it is encouraging to all LHDs, and regular reporting of Health funded the National that most respondents rated to LHDs has commenced. The Consumer Experiences of Care their overall experience of service Commission has been provided project. This project was led by the as very good or excellent. The with data for this initial period. Department of Health and Human Commission also looks forward The number of completed surveys Services Victoria, and resulted in to the roll-out of the Carer as a proportion of people eligible the Your Experience of Service Experiences of Care Project being to complete the YES is low at this questionnaire (YES). YES includes developed by AMHOCN. early stage, but it is heartening questions on whether consumers that from April-June to July- NEW DATA Poor Fair Good Very Good Excellent

Inpatient

Ambulatory

0 20 40 60 80 100

Graph 8: Experience of service overall satisfaction rates, NSW, April to September 2015

In addition to the above, the the care they received. These (community-based or out-patient) Bureau of Health Information results found that for 2010 and respondents rated the care and has published the results of two 2011 combined, 39 per cent of services they received as overall consumer surveys of people who inpatient respondents rated the “Excellent” or “Very good”. used inpatient and community counselling or treatment they These are valuable sources of mental health services across NSW received as ‘Excellent’ or ‘Very information, although they are at during February 2010 and February good’. Similarly, 45 per cent of a single point in time rather than 2011.34 inpatient respondents rated the ongoing. care they received at hospital In these two surveys consumers as overall ‘Excellent’ or ‘Very were asked how they would rate good’. 53 per cent of ambulatory 7. Decrease the rate of suicide and suicidal behaviour

Reducing suicide and suicidal The suicide rate for males in 2013, during the months of March, behaviour is a priority given the at 13.2 per 100,000 population, June, September and December devastating loss of life and distress was higher than for females at 4.8 2013, NSW ambulances attended experienced by the person and the per 100,000 population. For the 2,020 suicide attempts and 3,614 effect of suicide on carers, families period 2009-13, the rate of suicide instances of suicidal ideation and the community. Suicide rates among Aboriginal people was 12.5 where the person did not attempt can also be a reflection of the per 100,000 people, compared suicide.37 This is equivalent to more mental health and wellbeing of the to 8.9 per 100,000 people among than 16 suicide attempts and 29 community. non-Aboriginal people. The rate for cases of suicidal ideation per day Aboriginal males was particularly in NSW. Indeed, the authors of the In 2013, the most recent year for high, at 20.4 per 100,000 report note that these numbers which there is data, there were 674 population compared to 13.6 for are likely to be underestimates. deaths by suicide in NSW.35 This non-Aboriginal males.36 is equivalent to an average of just under two people dying by suicide In addition to these completed every day in 2013, or a rate of 8.9 suicides, a report released by per 100,000 population. Turning Point indicates that

10.5 10.0 9.5 9.0

Suicides per 8.5 100,000 population 8.0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Graph 9: Suicides per 100,000 population, NSW, 2004 - 2015 44

In 2013-14, the most recent year population. The rate for people As can be seen below, the self- for which there is data, there were aged 15-24 at was more than harm hospitalisation rate has 10,256 hospital admissions related double that average at 335.8 per remained steady. It is not possible to intentional self-harm in NSW. 100,000 population. The self-harm to know from these statistics the This is equivalent to an average of hospitalisation rate for females proportion of episodes of self- 28 hospital admissions per day. – 181.5 per 100,000 population – harm that were actually suicide was higher than for males at 105.3 attempts. The self-harm hospitalisation rate per 100,000 population.38 in 2013-14 was 142.7 per 100,000

200

Females 175

150

125

per 100,000 population Males Self - harm hospitalisations 100

75 2001-02 2003-04 2005-06 2007-08 2009-10 2011-12 2013-14

Graph 10: Self-harm hospitalisations per 100,000 population, NSW, 2001-02 to 2013-14

8. Increase the proportion of NSW mental health spending allocated to community- based alternatives to hospital services

The development of community- mental health service expenditure A further $491.8 million based alternatives to hospital in allocated to community-based (34.1 per cent of total expenditure) the delivery of mental health care services than the Australian was allocated to ambulatory and support services is a critical average. While the Australian services, including community- element in rebalancing the NSW average has trended slightly based and out-patient services. mental health system. NSW has the upwards, the NSW proportion has Non-government organisations lowest per capita funding allocated stayed stable.39 received $76.1 million (5.3 per cent to community-based services of of total expenditure). As can be In 2012-13, NSW total expenditure any state or territory. Living Well seen below, NSW has the lowest on inpatient mental health sets out an intention to transform proportion of funding directed care was $807.4 million (56 per NSW from the lowest spending to towards community-based care of cent of total mental health care the highest spending Australian all Australian states and territories. expenditure). This expenditure jurisdiction on community mental included $216.2 million in funding health by 2017. for public psychiatric hospitals As can be seen in the graph below, (15 per cent of total expenditure) NSW has a substantially lower and $591.1 million on public acute proportion of total recurrent hospitals (41 per cent). 55 Australia

50 of total recurrent

% 45

NSW mental health service expenditure allocated to community-based services

40 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Graph 11: Percentage of recurrent funding allocated to community-based mental health service, NSW and National, 2005-06 to 2012-13

Community Non-government residential Ambulatory organisations Indirect

NSW

VIC

QLD

TAS

ACT

AUS 0 10 20 30 40 50 60 70 80 % of total recurrent mental health service expenditure allocated to community-based services

Graph 12: Percentage of recurrent funding allocated to community-based services, all States, 2012-13 46

9. Decrease the rate of involuntary treatment orders (inpatient and community) issued

A high rate of involuntary Treatment Orders (CTOs) and facility under the provisions of treatment orders, whether in Involuntary Patient Orders (IPOs) the Mental Health Act. The data hospital or in the community, is a for involuntary stays of three days is derived from direct reports marker of a system which is not or more. As can be seen below, the from services to the MHRT, but is intervening early or effectively in rate of CTOs40 issued per 100,000 likely an underestimate of the true the course of a person’s mental population has stayed relatively number of involuntary admissions. distress or increasing illness. stable since 2008-09,41 while the In 2014-15, there were 19,551 rate of IPOs has nearly doubled involuntary admissions in NSW, The Mental Health Review due to procedural changes.42 or a rate of 257.7 per 100,000 Tribunal (MHRT) reports annually population. This rate has been on outcomes of its proceedings. MHRT also reports on the number trending upwards since 2010-11. This includes data on Community of people taken to a mental health

Community 70 Treatment Order

60 Involuntary Patient Order Rate of orders issued per 100,000 population 50

40 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Graph 13: Rates of community treatment or counselling orders and involuntary patient orders per 100,000 population, NSW 2008-09 to 2014-15

Effective mental health health services as part of standard improve its completeness and services should minimise the National Minimum Data Sets. The reliability and to develop an use of involuntary treatment Commission has been provided indicator. The Commission urges by improving early access to with data related to involuntary NSW Health to undertake this community-based care and status on admission, but the data development and testing work as a working with individuals and varies in its completeness, limiting matter of urgency. families. The Commission wishes any conclusions regarding trends to ensure that NSW mental health in involuntary treatment. This data services report on their rates of has not previously been used for use of involuntary care. Data on reporting, and NSW Health advises legal status is collected by mental that further work is required to 260

250

240

230

220 per 100,000 population Rate of involuntary admissions 210

200 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Graph 14: Rate of involuntary admissions per 100,000 population, NSW 2008-09 to 2014-15 48

10. Reduce the proportion of people in the prison population who have a previous experience of mental illness

People with a mental illness are cent), ADD/ADHD (10.1 per cent), can be seen in the graph below, disproportionately represented bipolar disorder (9.2 per cent), or this number has increased over in custody, with three quarters of schizophrenia (8.8 per cent).43 time. In particular, the number of prison entrants in 2015 reporting adolescents diverted from court The Bureau of Crime Statistics and having ever been told they have into treatment more than doubled Research (BOCSAR) projects an a mental health disorder. In 2009, between 2007-08 and 2014-15. increase in the prison nearly half (48.6 per cent) of While the use of such programs population,44 which presents a NSW inmates reported having is rising, we do not know what risk that the number of people received assessment or treatment proportion of cases involving a incarcerated with a mental illness by a psychiatrist or doctor for an mental illness are managed this will also increase. Diversion ‘emotional or mental problem’. Of way, or their impact upon reducing programs can prevent people with these people, one in three (35.4 the proportion of people in prison mental illness entering custody per cent) reported a diagnosis with a mental illness. by diverting them from court of depression, one in four (24.6 into mental health treatment. per cent) reported a diagnosis of In 2014-15, 2051 adults and anxiety, and approximately one 554 adolescents were diverted in ten reported a diagnosis of a from court into treatment. As personality disorder (10.2 per

2500

2000 Adults

1500

1000

Number of diversions Adolescents 500

0 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Graph 15: Number of diversions from custody NSW 2007-08 to 2014-15 Intentionally left blank 50

Intentionally left blank The community perspective at a glance* SIGNS OF REFORM READINESS GAPS IN REFORM READINESS Knowledge of Living Well • Around 80 per cent of survey respondents had • Overall the results indicate that further effort is heard about Living Well and over half said they required in 2016 to communicate Living Well and its understood its purpose enough, well or completely. reform priorities. Attitudes to Living Well priorities and their implementation • 88 per cent agreed that they were keen to help • The findings indicate that further effort is required implement Living Well, with 68 per cent indicating to mobilise all sectors in the implementation of that their organisation was keen to implement Living Well, in order to support the participation of Living Well. those most affected in that process. • 75 per cent supported all key reform priorities. • While support for reform was high, respondents showed a lack of confidence that the reforms would happen. • Confidence can be improved by agencies demonstrating their commitment to reform. Implementation of Living Well • Over 50 per cent said their organisation ‘was • Over 50 per cent said the most common action was engaging in activities related to Living Well’. ‘informal conversations between colleagues’ and that they had ‘no knowledge of what is happening locally about the Plan’. • This indicates that agencies at both state and district levels need to disseminate information on reform readiness and implementation activities, as well as engage frontline workers, consumers and carers in reform processes. • Feedback on experiences of implementing Living • Barriers and challenges were also reported (66%), Well noted successes (36 per cent), with successes with barriers and challenges reported in the reported in the areas of: models of care (55 per areas of: resources (68 per cent of respondents), cent); leadership (44 per cent); attitudes (12 per leadership (49 per cent); models of care (41 per cent); education (9 per cent); communication (6 per cent); education (13 per cent); communication (10 cent); and resources (5 per cent). per cent); and attitudes (6 per cent). • Leadership was seen as integral to the successes. • This indicates that agencies need to address barriers to reform within and across sectors and promote positive practices and successes. • Leadership needs to be mobilised at all levels to support reform readiness, including the identification and engagement of reform champions. • Approaches need to be developed to strategically reform models of care across the government, community-managed and private sectors, so that they incorporate evidence-based, consumer-driven and integrated practice.

*Findings from the Ready for Change survey conducted in September 2015 52 The community perspective

The vision of Living Well is to which 744 people completed. The representing another quarter of enable the people of NSW to have aim of the survey was to gain an respondents. Other members of the best opportunity for good understanding of the community’s the community accounted for the mental health and wellbeing and knowledge of Living Well in remainder.45 to live well in the community and order to better understand how Among survey respondents, 4.7 on their own terms. This vision successful its dissemination has per cent identified as Aboriginal, embodies a recovery perspective, been and whether its priorities which is a very positive response as and Living Well’s reform priorities are supported. The survey also Aboriginal people comprise 2.9 per are designed to support the provided perspectives on people’s cent of the NSW population. This development of a recovery- confidence in the Government comparatively higher response rate oriented mental health and human achieving the stated outcomes of of Aboriginal people means their services system. The perspectives Living Well, and in the steps taken voice can be more clearly heard, of the community and individuals during 2015 – with implications which is integral to mental health are therefore essential to an for how agencies approach the reform in NSW. informed understanding of how implementation of Living Well reform has progressed. during 2016. For a more detailed report on the survey methodology, respondent This chapter presents the The single largest group of profile, analysis and findings, perspectives of consumers, respondents was people with a please refer to the technical report families and carers, and people lived experience of mental health on the Commission’s website. working in the sector about early issues, who comprised one third preparations and progress towards of all respondents. A quarter of reform, drawn from a survey – respondents were mental health Ready for Change – conducted practitioners/clinicians, with carers from 2 to 16 September 2015, of people with lived experience

COMMUNITY PERSPECTIVES ON REFORM READINESS Shared understandings of Living Well

The community, the mental health its purpose enough, well or in the not-for-profit/community- sector and the mental health completely. managed sectors and 51 per cent workforce need to understand the of private sector respondents. Of Just over a quarter of people with intent and directions of Living Well the 115 people who identified lived experience of mental health so that they can participate in the as having board, executive or issues who completed the survey process of reform. manager roles, 83 per cent said reported they had not heard of their understanding of the Plan The Ready for Change survey asked Living Well, and had a lower level was ‘enough’ or better. people about their knowledge of of understanding of it than those Living Well, in order to understand without lived experience. Overall the results indicate that how well its vision and directions further effort is required in 2016 The Government sector had the have been communicated by the to communicate Living Well and highest level of understanding of Government and the Commission. its reform priorities, in order to Living Well; 65 per cent of those Overall, just under 80 per cent support its implementation and working in government said they of respondents had heard the participation of those most understood it enough or better, about Living Well and just over affected in that process. compared to 54 per cent of people half indicated they understood Five reform priorities of Living Well addressed in the survey 1. More consumer and carer involvement in decisions about care and service delivery 2. Shift towards more care and support in the community 3. Increased focus on prevention and early intervention 4. Different organisations and services needing to work together better (including health, mental health, justice, housing, employment, education, community services and local government sectors) 5. All organisations considering and including mental health issues in their policies, decision making and services

Willingness to participate in reform and confidence in its implementation

The appetite for reform is support in the community’. There to respondents from the not- strong. Eighty-eight per cent of were no differences in responses for-profit/community-managed respondents agreed that they were between those who identified as sectors, respondents from the ‘keen to help implement the Plan’, having lived experience and those Government sector were less with 75 per cent of all respondents who did not. supportive of reform and less supporting all five reform priorities confident it would happen. Graph 16 compares the level surveyed. The level of support of support for the priorities These findings have particular ranged from 97 per cent for ‘All with confidence in their implications for agencies which organisations should consider and implementation. Just over provide front-line services and include mental health issues in half of respondents believed supports to people with mental their policies, decision making and ‘organisations working together’ illness. services’ to 85 per cent support would occur. When compared for a ‘shift towards more care and

Organisations considering mental health issues

Organisations working together

% Respondents More consumer and carer involvement who support

Prevention and early intervention % Respondents who are con dent Shift towards community

0 20 40 60 80 100

Graph 16: The gap between support for key priority areas of reform and confidence in their implementation 54

Reform readiness

The survey asked participants how those working in the government working, with appropriate planning prepared their organisation was to (71 to 77 per cent) and private for the involvement of people implement Living Well reforms. sectors (44 to 54 per cent). with lived experience of mental illness, their families and carers, in Of government respondents 63 per In terms of respondents’ overall decision making that affects them. cent endorsed ‘my organisation feedback on their organisations’ has the knowledge, skills, people reform readiness: It is important to note that most and resources to implement the survey respondents worked within • 68 per cent indicated that Plan’, compared with 73 per cent the government sector (45 per their organisation was keen to of those from the not-for-profit/ cent), followed by the not-for- implement Living Well community-managed sectors. profit or community-managed • 59 per cent agreed that ‘my (35 per cent) and private sectors In terms of respondents’ feedback organisation has the knowledge, (9 per cent). However 12 per cent on their organisation’s support for skills, people and resources to of respondents identified as not the key priority areas for reform, implement [Living Well]’ being currently employed. Of the organisations overall were seen to 630 respondents who provided endorse the key areas of reform • 46 per cent agreed that information on their areas of work, – ‘more consumer and carer ‘organisations in my local the most common were Mental involvement in decisions about area have the knowledge, health (70.2 per cent), Community- care and service delivery’ skills, people and resources to based (30.6 per cent), Health (70 per cent), an ‘increased implement [Living Well]’. (19.8 per cent), Drug and alcohol focus on prevention and early In order to fully seed local action (17.6 per cent), and Education intervention’ (70 per cent) and and collaboration, these figures and/or training (17 per cent) a ‘shift towards more care and need to be improved. There needs areas. Note that respondents were support in the community’ to be a higher level of engagement able to choose multiple areas of (68 per cent). Respondents from with the mental health reform work to best reflect their role or the not-for-profit/community- agenda. Agencies need to clearly organisation. managed sector consistently demonstrate they are responding demonstrated the highest levels of internally to its challenges in endorsement of these statements terms of their governance, staffing (84 to 86 per cent), followed by capacity and skills, and ways of What is happening locally?

The first year of the across the three sectors was for of organisations, reporting that implementation of Living Well is ’informal conversations between ‘organisations/my organisation will an important time to empower colleagues have taken place in not change’. communities to develop local my organisation about [Living Graph 17 indicates the range of action plans. Well]’ (51 per cent). This indicates responses to Living Well across either a low level of specific Half of the 744 respondents (51 the government, not-for-profit/ actions by organisations, or poor per cent) to Ready for Change community-managed) and private communication of what they are agreed that they had ‘no sectors. doing. knowledge of what is happening locally about [Living Well]’, while Government sector respondents 52 per cent of the organisations were more likely to report that where people worked were their organisations were taking noted as ‘engaging in activities specific actions, while private related to [Living Well]’. Overall, sector respondents were the least the proportion of respondents likely to report this. It is interesting reporting specific local actions to note that 10.2 per cent of was generally below 50 per cent. respondents reported having Of the options that illustrated ‘already seen signs of change’. A specific local actions, the small fraction of responses (5 per highest level of endorsement cent) showed low expectations Government No knowledge of what is happening locally

No activities Community- Managed Organisations Informal conversations

Formal internal meetings Private

Local planning meetings

Planning to implement actions

Actions implemented

Local organisations taking steps

0 10 20 30 40 50 60

Graph 17: Percentage of respondents across sectors reporting responses to Living Well

Respondents were also asked ‘how was three to five years reform would come earlier than long do you think it would take to (38 per cent). However, there was other respondents. The private see changes in local organisations variation by sector as noted in sector endorsed ‘organisations/my (or your organisation) as a result Graph 18. Respondents from the organisation will not change’ more of carrying out [Living Well]?’ The not-for-profit/community-managed than the other two sectors. most frequently chosen response sector tended to believe that 56

Government I have already seen signs of change

Community- Managed Organisations 1-2 years

3-5 years Private

5-10 years

10+ years

Organisations/ my organisation will not change

0 10 20 30 40

Graph 18: How long will it take to see changes as a result of implementing Living Well?

Further action is needed

Survey respondents were asked Barriers and challenges The issues they raised included: to provide feedback on the Respondents nominated • uncertainty of funding challenges and successes they ‘resources’ as the largest have experienced in relation to • competitive processes for barrier to reform (68 per cent implementing Living Well. Of the funding of respondents), followed by: 744 survey respondents, 359 (48 leadership (49 per cent); models • limited funding per cent) provided this feedback. of care (41 per cent); education Of these, 66 per cent provided • short funding cycles (13 per cent); communication written feedback under the broad (10 per cent); and attitudes • funding cuts themes of ‘barriers and challenges’ (6 per cent).47 • closure of services while 36 per cent provided written feedback under the broad theme The resources challenge related to • gaps in services of ‘successes’.46 Additional themes current funding practices (noted • duplication of services also emerged which are included by 38 per cent of those who in the technical report findings nominated resources as a barrier), • cost shifting. which were seen to undermine of the Commission’s community The next most frequently collaboration and good practice mental health reform survey on mentioned resource challenges and to be inconsistent with reform. the Commission’s website. related to: • the need for additional funding Leadership was nominated by The next most frequently to implement reform nearly half of respondents as mentioned leadership challenges (32 per cent) a barrier to reform. Workplace included the need for: culture was noted by 41 per cent of • staffing issues (31 per cent) • greater communication and those who nominated leadership collaboration within and across • accessibility of services as a barrier, including: sectors (24 per cent) (21 per cent) • negative attitudes and behaviour • executives to consult and • workforce capacity to address towards consumers, especially collaborate more with staff complex needs (14 per cent). towards people with severe about implementation (16 per mental illness Respondents also advocated for cent) additional support for reform, • resistance to change • strategic development of models including enhanced leadership and • fear of change related to the of community care across all change management practices shift towards more care and sectors (15 per cent). (10 per cent). support in the community.

THE PERSPECTIVE OF THE MENTAL HEALTH CO-ORDINATING COUNCIL (MHCC)* ‘The past 12 months have seen community-managed organisations searching for an overall perspective on the proposed changes to the mental health sector. While there have been discussions and communications in regards to major reform related to the Partnerships for Health programs, the National Disability Insurance Scheme, the transition of Medicare Locals to Primary Healthcare Networks and the potential for more clients to move from inpatient care within state funded institutions to the community, it has been left for each component of the mental health sector and beyond to piece this together as to what role each organisation plays in this reform picture. This has led to many organisations reflecting on what their contribution may entail, and how to prepare for this change in focus. ‘Leadership is a key issue across the sector, as many ideas of how organisations will function both as a stand- alone entity and as part of the system are challenged. It is likely that training to increase leadership skills and seek and resource leaders of the future will be required, as well as key requirements in how to negotiate with others through potential regional engagement and responsibilities, lead teams to increased focus on consumer-centred care and performance improvement, and be transparent in accountabilities and outcomes. ‘There are opportunities to forge stronger and innovative partnerships, that can support optimised consumer and family care, and the path to these outcomes is likely to require resilience, focus and the ability to hold strong to a shared vision.’ *MHCC is the peak body for non-government organisations working for mental health, providing leadership and representation on current issues.

Respondents also noted the Other issues included: tokenistic (noted by 54 per cent of those who importance of improving and inadequate consumer and nominated models of care as a leadership to mobilise reform at carer representation; low staff barrier). This included: national, state and local levels. morale and burnout; organisational • over-reliance on the medical Some commented on a lack of bullying; and workplace model of mental illness guidance from their central agency, stigmatisation of staff experiencing while others called for more work mental health issues. • a focus on inpatient and crisis to emphasise the relevance of interventions, rather than having In terms of models of care, the Living Well to organisations outside a balanced system that includes most frequently mentioned the mental health sector, saying it these options as well as a range concern was that ‘old, out-dated was perceived by some as ‘mental of community options models of care and service health business’ only. delivery’ were a barrier to reform • paternalism 58

• traumatic practices such as Education was identified as a A lack of communication about seclusion and restraint significant reform issue by a Living Well was seen as a number of respondents, who significant challenge for reform, • referral criteria that limited noted the need for a range of along with a lack of awareness of collaborative efforts across the education and training initiatives local developments in relation to sectors, and resulted in poor addressing issues such as: person- its implementation. experiences and outcomes of centred care; trauma-informed care Respondents noted that attitudes care; evidence-based care; such as stigma and resistance • fragmented and siloed care, with recovery; dual diagnosis; and to change also posed significant a need for greater coordination mental health training for non– barriers that could prevent people and collaboration within and mental health workers. with lived experience of mental across services and sectors. health issues from living well in the community.

Smallest barrier Smallest success

ATTITUDES RESOURCES COMMUNICATION COMMUNICATION EDUCATION EDUCATION MODELS OF CARE ATTITUDES LEADERSHIP LEADERSHIP RESOURCES MODELS OF CARE

Biggest barrier Biggest success

Figure 6: Identified barriers to and successes for reform

Successes

In terms of successes, Ready for care as a success). Other responses reform, 44 per cent of respondents Change respondents reported identified as successes included: who wrote about successes activities undertaken in response reflected leadership as integral to • integration of services to Living Well, as well as pre- those successes. These included existing initiatives that aligned with • increased consumer the role of management in leading its priorities. participation in governance organisational responses to Living processes Well, including the incorporation of Six main areas of success were its reform directions in local plans noted: models of care (55 per • greater focus on recovery and and implementation of pre-existing cent); leadership (44 per cent); collaborative care planning initiatives which aligned with Living attitudes (12 per cent); education • employment of peer workers Well. (9 per cent); communication (6 per and Aboriginal mental health 48 cent) and resources (5 per cent). workers Successful examples under attitudes included a keenness The most frequently mentioned • increased focus on promotion, to employ more consumer and successes under models of prevention and early peer workers and to engage in care related to collaboration intervention. prevention and early intervention and communication with other activities. Responses also cited organisations within and across Notwithstanding respondents’ support for increased consumer sectors (noted by 38 per cent of nomination of inadequate and carer participation, as well those who nominated models of leadership as a major barrier to as support of Living Well and its for peer workers, consumers Examples of success related to implementation. and carers; and more consumer- resources included the hiring of focused information. Increased additional staff, including peer Education successes included media attention to mental health workers. One respondent noted activities such as Mental Health issues, and its contribution to that their organisation provided First Aid and other mental health greater openness and awareness, small innovation grants internally training; staff education about was considered an example of to help implementation of Living recovery and person-centred communication success. Well. care; increased education options IMPLICATIONS FOR THE NEXT 12 MONTHS

Respondents to the Ready for of agencies in a way that can • Developing approaches to Change survey indicated their be translated into local action strategically reform models of overwhelming support for the plans. Confidence can also be care across the government, implementation of Living Well. improved by demonstrating not-for-profit/community- However, the feedback they actions to address barriers managed and private sectors, so provided also highlighted areas to reform within and across that they incorporate evidence- where further work needs to be sectors, promoting positive based, consumer-driven and done: practices and successes, as well integrated practice. as engaging frontline workers, • A comprehensive The Mental Health Commission of consumers and carers in reform communication strategy NSW thanks all respondents to its processes. needs to be developed and inaugural Ready for Change survey implemented. • Mobilising leadership at state, about mental health reform in district and service levels to NSW. • Improving confidence that support reform readiness, reform in mental health will including the identification be realised, by improving the and engagement of reform dissemination of information on champions. the actions and commitments 60 Appendix 1

Local Health District reform readiness projects funded by the NSW Mental Health Commission in 2014-15

Local Health District Project focus Description Budget South Western Sydney Implementation of Strengths South Western Sydney Local Health District engaged $28,800 Model a consultant to develop materials to support the implementation of the Strengths Model to develop a recovery-oriented approach to service provision. The consultancy delivered an implementation plan, a Strengths Model Training Manual and advice in relation to evaluation tools to be used to assess the take-up and effectiveness of the model, including measures of model fidelity and recovery orientation.

Northern Sydney 10 year Mental Health Northern Sydney Local Health District commenced $30,000 Service Plan a ten year planning process and commissioned an external agency to develop a ‘Roadmap’ for a new Northern Sydney Mental Health Services Plan. The Roadmap developed two papers. The first paper sets out the broader environmental context in which the new plan will be built. The second paper details in priorities and processes identified by stakeholders.

Central Coast 3 development priorities: Central Coast Local Health District Mental Health $30,000 Building consumer and carer Service undertook consultations with consumers and workforce, recovery-oriented carers, government and community organisations practice and improving the to outline a service delivery restructure focused consumer journey on three key areas; building a skilled consumer and carer peer workforce, ensuring the service is recovery orientated and improving the consumer journey.

Mid North Coast Learning from the NZ Mid North Coast Local Health District brought out $29,000 experience and development two CEO’s from New Zealand, Robyn Shearer and of a 5 year plan Paul Ingle, who work in community mental health and addiction services, to conduct workshops on collaborative practice that will inform the Mid North Coast Mental Health Integrated Care Collaborative. Workshops involved leaders and champions across government, non-government, primary care, Aboriginal medical services, and carers and consumers.

Illawarra Shoalhaven Challenge and change the The Illawarra Shoalhaven Local Health District Mental $25,000 culture towards recovery- Health Service developed a sister organisation oriented practice: Learnings relationship with Barwon Mental Health Drug and from Barwon Alcohol Service in Victoria which is recognised as a leader in the development and implementation of recovery-oriented practice. Consumers, carers and clinicians from the Illawarra Shoalhaven visited Barwon to learn firsthand from the Barwon experience and are now working to develop a transformational culture change locally. Local Health District Project focus Description Budget South Eastern Sydney Integration Forums with GPs: South Eastern Sydney Local Health District Mental $19,000 Physical Health and Mental Health Service facilitated an Integration Forum to Health enhance existing relationships with GPs in a focused, purpose‐driven way. The forum was designed to lead to greater feedback, enhanced co-management of mental health consumers and more meaningful partnerships. GPs showed interest in referral pathways, the use of medications in treating mental health clients and how education courses offered by the South Eastern Sydney Recovery College could benefit their local communities.

Murrumbidgee Consultancy to develop a The Murrumbidgee Local Health District formed $20,000 collaborative framework a Murrumbidgee Mental Health and Drug and among key service partners Alcohol Alliance which was made possible as a result of a seeding grant from the Commission. Two consultation forums were held in the district and individual interviews conducted with Chief Executive Officers of all organisations who comprise the alliance. A Memorandum of Understanding (MOU) was developed which builds on existing relationships, initiatives and programs to provide the framework for a robust approach to priority setting, population- based planning and improving health outcomes for mental health and drug and alcohol consumers, families and carers.

Western NSW Service Transformation Western NSW Local Health District has used the $20,000 Project: Reconfiguration of seed funding to formalise a partnership with the the Mental Health and Drug Mid-Western Advisory Group (MWCAG) through and Alcohol Service a Service Level Agreement, to further progress engagement with consumers and carers. MWCAG is using the funds to work with the health service and community-managed organisations to develop the peer work force in the region, in particular through training in Certificate IV in Mental Health Peer Work; developing a network of peer workers; pathways for peer workers, volunteers and representatives on committees and assisting with cultural change within the Health service.

Northern NSW Reforming Models of Care Northern NSW Local Health District undertook a $20,683 and Redesign Steering range of consultations to increase their knowledge Committee and capacity to inform the mental health reform agenda. Key clinical and planning staff visited other LHDs demonstrating innovations in service delivery. Consumer and carer consultation sessions were conducted to test Models of Care and sessions with Community-managed organisations were conducted to further develop transition to care pathways. 62

Local Health District Project focus Description Budget Far West Partnership with Broken Hill Far West Local Health District facilitated a meeting $4658 Stakeholders - Collective with local mental health service providers to Impact Framework introduce the Strategic Plan for NSW and to learn about the Collective Impact Framework and how use of the Framework can build a shared agenda for the implementation of local mental health reforms.

Hunter New England The state of the nation Hunter New England Local Health District $29,000 report - a scoping project commissioned a report on bed management and patient flow evaluation to identify service gaps and inform their response to rising bed occupancy levels to create a more sustainable, safer and improved patient experience. The report provides thirteen evidence-based recommendations for action for ongoing change.

Nepean Blue Engage specialist services Nepean Blue Mountains Local Health District $30,000 Mountains to identify service provision conducted a review of their services for 12-18 year gaps for children and young olds to improve the system for vulnerable children people in the LHD and their families and identify more efficient alignment of services, age group trends, strategies to reduce / eliminate Emergency Department presentations, and, opportunities for care delivery innovation. The subsequent report identified a gap in service provision for 12 years and under, including perinatal, highlighting a need for further review and subsequent action.

St Vincent’s Health Development of an urban St Vincent’s Health Network is located in an area $30,000 Network partnership for integrated whose population is characterised by Australia’s care highest concentration of homelessness and social vulnerability. To work towards a model of integrated care St Vincent’s established an Urban Partnership for Integrated Inner City Healthcare and Wellbeing involving government and community organisations across the health and community services sectors.

Western Sydney Blacktown LGA Beacon Western Sydney Local Health District mapped the $20,000 Site for Acute Community final stages in establishment of an integrated acute Treatment community treatment service in collaboration with a local Primary Health Network and a community organisation. They developed a cross-sector operating protocol and conducted training and mentoring to facilitate collaborative working. A “Colloquium for Acute Community Mental Health Treatment” is planned for promotion and dissemination. Appendix 2

2014-15 and 2015-16 research program in support of mental reform readiness funded by the NSW Mental Health Commission. Project Title Description Service Provider Budget The Integrated Mental The project will map the services for people University of Sydney $177,722 Health Atlas of Far West experiencing ill-health and their families NSW providing care in Far West NSW. The research will result in a new decision-making tool for monitoring and improving mental health systems of care. Actions in Living Well under 5.3 Addressing inequalities and 5.1 Shift to Community.

Establishing a NSW Electro- The project will build a NSW network of ECT University of NSW $229,885 Convulsive Therapy (ECT) research hospitals, to collect a large clinical Research Network database that will provide information on clinical ECT service models and treatment effectiveness, and has the potential to influence ECT clinical practice and policy nationally and internationally. Actions in Living Well under 5.3 Addressing Inequalities.

Insights in Recovery A consumer participatory project translating Butterfly Foundation $100,000 knowledge from lived experience into a framework of recovery-oriented practice to support implementation of the Mental Health Recovery Framework for people with eating disorders. Actions in Living Well under 7.4 Eating Disorders, as well as the implementation of the current NSW Service Plan for People with Eating Disorders.

Lived Experience Framework The project will develop resources to support Craze Lateral Solutions $100,000 NSW organisations and agencies in growing and developing the peer workforce. Actions in Living Well under 4.2 Engaging consumer and carers in service design and 8.2 Peer Workforce.

System Approach to Suicide This project will detail costs associated with Black Dog Institute $131,179 Prevention the design, implementation and evaluation of a large-scale systems approach to suicide prevention across selective sites. Actions in Living Well under 3.4 Suicide Prevention. 64

Project Title Description Service Provider Budget iBobbly The project will pilot an app, iBobbly, which aims Black Dog Institute $161,934 to reduce suicidality among young Aboriginal and Torres Strait Islander people and to make it available on Apple devices. Actions in Living Well under 2.2 Aboriginal Communities and 3.4 Suicide Prevention.

NSW Wellbeing Collaborative A Wellbeing Capacity Building Program is being Maudsley International $200,000 implemented in 2015 • Training in Mental Wellbeing Impact Assessment (MWIA) facilitation. • Training in MWIA screening. • A Wheel of Wellbeing (WoW) Workshop where a series of resources for the promotion of positive mental health will be tested with NSW stakeholders and communities. Action in Living Well under 3.1.1 Establish a NSW Wellbeing Collaborative.

Pathways to Mental Health The project will pilot across Western NSW LHD ReachOut $301,140 Care a stepped-care program, designed to improve mental health and wellbeing and increase service access and use amongst vulnerable young people. ReachOut.com will target young people aged 14-25 years in the Western NSW LHD Actions in Living Well 8.4.7 under 8.4 Better Use of Technology.

NSW Synergy Pilot Spanning three locations in NSW, the project will Young and Well CRC $500,000 deliver and evaluate a pilot ‘proof of concept’, to provide clear indicators of the changes required to support schools, universities, workplaces and services in their use of technologies and to take the Synergy e-mental health ecosystem to scale. Actions in Living Well under 3.3 Prevention and early intervention for children and young people, 3.2 Promoting self-agency and 8.4 Better use of technology. Intentionally left blank 66 References

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39. HealthStats NSW, 2015, Intentional self-harm: hospitalisations http://www.healthstats.nsw.gov.au/Indicator/men_suihos/men_suihos (Accessed: 22/09/2015) 40. Australian Government Productivity Commission, 2015, Report on Government Services Table 12A.48, http://www.pc.gov.au/research/ongoing/report-on-government-services/2015/health/data/rogs-2015- volumee-chapter12-attachment.xlsx (Accessed: 06/10/2015) 41. A Community Counselling Order (CCO) may be made for a person who is likely to become mentally unwell in the next three months, while a CTO may be made for a person who is currently mental unwell. CCOs have now been phased out, but data is reported for both categories combined. 42. Mental Health Review Tribunal, 2015, Mental Health Review Tribunal Annual Report 2013-14 Table 9, http://www.mhrt.nsw.gov.au/assets/files/mhrt/pdf/AnnualReport201314.pdf (Accessed: 07/10/2015) 43. Mental Health Review Tribunal, 2009-2015, Mental Health Review Tribunal Annual Reports 2008-09 to 2013- 14 Table 3, http://www.mhrt.nsw.gov.au/annual-reports.html (Accessed: 07/10/2015) 44. D. Indig, L. Topp, B. Ross, H. Mamoon, B. Border, S. Kumar, M. McNamara (2010). 2009 NSW Inmate Health Survey: Key Findings Report. Justice Health. Sydney 45. The 2015 NSW prison population forecast. Neil Donnelly, Imogen Halstead, Simon Corben and Don Weatherburn. NSW Bureau of Crime Statistics and Research, Corrective Services NSW http://www.bocsar.nsw.gov.au/Documents/BB/BB105.pdf (Accessed 08/01/2016) 46. Respondents were able to choose multiple options, with the results indicating that a number of people identified multiple roles 47. Note that respondents often included multiple themes in their feedback 48. Findings reflect percentage of ‘barriers and challenges’ responses noting the identified theme Sources Living Well indicator graphs

Graph 1- The Longitudinal Survey of Australian Youth (LSAY) 1998 , 2003 , 2006 , and 2009 Graph 2 - Household, Income and Labour Dynamics in Australia Survey. Graph 3 - HealthStats NSW, 2014, Population Health Survey Graph 4 - HealthStats NSW, 2014, Population Health Survey Graph 5 - National Surveys of Mental Health Literacy and Stigma and National Survey of Discrimination and Positive Treatment: A report for the Mental Health Commission of NSW. 2015. Mental Health Commission of NSW, Sydney. Graph 6 - Mental Health Commission of NSW analysis of 2013 NSW Population Health Survey data Graph 7 - Supplied by NSW Ministry of Health on request Graph 8 - Supplied by NSW Ministry of Health on request Graph 9 - HealthStats NSW Graph 10 - HealthStats NSW Graph 11 - Report on Government Services 2015. Mental health management attachment Graph 12 - Report on Government Services 2015. Mental health management attachment Graph 13 - Mental Health Review Tribunal Annual Reports Graph 14 - Mental Health Review Tribunal Annual Reports Graph 15 - Supplied by Justice Health & Forensic Mental Health Network on request Data for Graphs 16, 17, 18 and Figure 6 are taken from the Ready for Change survey, conducted by the NSW Mental Health Commission in 2015. 70

Intentionally left blank Intentionally left blank Locked Bag 5013 T 02 9859 5200 E [email protected] Gladesville NSW 1675 F 02 9859 5251 W www.nswmentalhealthcommission.com.au