SUB.0002.0028.0259 Royal Commission into Victoria’s Mental Health System Public Submission from Mr Godwin Grech 4 July 2019 SUB.0002.0028.0259_0002 Contents Part I: Overview - Victorian Royal Commission - Personal Objectives - Methodology - Changing Behaviour and Culture: The Power of Storytelling and Leadership - Public vs Private Submission - Sources and Verification Part II: A Personal Case Study - The Lived Experience: A Personal Journey of Comorbid Physical and Mental Health Challenges (A) Physical Health Challenges - (i) Intestinal Deformity and Disease - (ii) Perforation, Intestinal Haemorrhage, Septic Shock and Organ Failure - (iii) Intestinal Disease Prognosis - (iv) Chronic Kidney Disease - (v) Metabolic Bone Disease (B) Mental Health Challenges - (i) Depression and Generalised Anxiety - (ii) Suicidal Ideation - (iii) Obsessive Compulsive Disorder (OCD) 2 | P a g e SUB.0002.0028.0259_0003 - (iv) Eating Disorder – Anorexia - (v) Borderline Personality Disorder (BPD) (C) Comorbid Physical and Mental Health Crisis: A Case Study of Workplace Aggravation (D) The Mental Health System: Personal Experiences - (i) Hospital Inpatient - (ii) Mental Health Practitioners - (iii) Rehabilitation Experience: Mental Treatment Programs - (iv) Rehabilitation Experience: Workers Compensation Schemes - (v) Rehabilitation Experience: Cost Barriers Part III: Recommendations / Possible Improvements (A) Prevention and Early Intervention - (i) Mandatory ‘Interactive’ Mental Health Strategies - (ii) Responsible Utilisation of Performance Management Systems - (iii) ‘Incentivising’ Good Mental Health through Performance Management Systems - (iv) Full Disclosure Statements of Duties and Responsibilities - (v) ‘Invested’ Organisational Management and Leadership - (vi) Responsible Human Resource Management: Sustainable Accountability - (vii) Executive Remuneration and Mental Health - (viii) Management Training and Recruitment: Emotional Intelligence and Output Maximisation - (ix) Mental Health Referrals: Proactive Medical Practitioners 3 | P a g e SUB.0002.0028.0259_0004 - (x) Mutual Obligation and Personal Responsibility (B) Treatment and Rehabilitation - (i) Accessing Cost Effective Therapies: A Possible Mental Health Contributions Scheme (MHCS) - (ii) Accessing Mental Health Services: Refining the Public Messaging - (iii) Accessing Sustainable Therapy: GP Proactivity - (iv) Improving Therapy Effectiveness: Client Input and Consultation - (v) Rehabilitation and Recovery: Non-Discriminatory Workplace Schemes Part IV: Conclusion 4 | P a g e SUB.0002.0028.0259_0005 PART I: Overview Royal Commission into Victoria’s Mental Health System It is pleasing that the complex and multifaceted issue of mental health has in recent years become a seemingly greater priority for Australian government’s at both the Commonwealth and State level and has also received attention from some prominent corporate and community leaders. While the additional funding and rhetorical support of various Australian government’s is welcome - as is the recognition of the need to seriously address mental health by elements of the corporate sector – it is hardly surprising that those who live with mental illness or who care for those living with mental illness quickly become sceptical about the degree to which our leaders and decision makers are seriously committed to addressing the issues – or are simply engaging in a rather cruel form of virtue signalling for their own ends. We can only hope that the professed desire to make things better is genuine and that those who can make a difference are prepared to play the long game because not only are there no quick fixes - but the risk of regression is real without a long term commitment to change. While it very much remains to be seen what the Commonwealth and others come up with, it is clear that the Victorian Government and in particular the Victorian Premier, Daniel Andrews, is genuinely committed to addressing the complex issues of mental health not only by following through on an election pledge to establish a fully resourced and highly qualified Royal Commission – but to effectively commit to adopt all of the Commission’s recommendations before the Commission has made any! For this the Victorian Government and Premier Andrews deserve to be commended with the expectation that they will indeed follow through and implement the final recommendations. The current Royal Commission therefore represents perhaps the most significant opportunity in more than a generation to make some genuine and lasting improvements in our understanding of mental health, the everyday challenges that those living with or who care for the mentally ill are struggling with, the failings and inadequacies of the mental health system in all of its dimensions, the critical role of the workplace in both the prevention, early identification and rehabilitation of those living with mental illness – and the sheer destructiveness and cruelty resulting from the ingrained stigma and discrimination towards the mentally ill be it in the wider community or the workplace. As many, if not all of the Commission’s findings will have relevance and applicability across all Australian jurisdictions, the Royal Commission presents an opportunity for Victoria to play a critical national leadership role in addressing mental health in partnership with the Commonwealth and other stake holders. 5 | P a g e SUB.0002.0028.0259_0006 Victorian Royal Commission and Productivity Commission Inquiry into The Social and Economic Benefits of Improving Mental Health It is fortuitous that the Royal Commission is occurring simultaneously with a major Productivity Commission (PC) mental health inquiry that is seeking to address issues from a ‘participation and contribution perspective’ through the workplace and the broader community. It is to be hoped that the Royal Commission can usefully draw from the work of the PC because many of the issues that the PC has been tasked to explore are critical in addressing issues relating to intervention, rehabilitation and recovery in a way that is sustainable for the individual, the workplace and the broader community. It is also through meaningful ‘participation and contribution’ that we can hope to break down the barriers of discrimination, stigma and the inherent dehumanisation that is experienced routinely by those living with or trying to recover from mental illness. It is therefore welcome that the Terms of Reference for the Royal Commission – TOR IV (d) - asks that the Commission ‘have regard to the Productivity Commission’s Review into Mental Health’. The very personal submission I have chosen to make to this Royal Commission is almost identical to that which I recently made to the Productivity Commission Inquiry into the Social and Economic Benefits of Improving Mental Health. Having now spent a decade in the mental health system in Victoria and the ACT - including a 6 month stint as an inpatient in a mental health facility and as a consumer of numerous mental treatment programmes in Victoria and as a ‘client’ of 18 different mental health practitioners of varying quality and integrity - I believe that my experiences allow me to offer some insights which may be useful to the work of the Commission. Personal Objectives Although my submission seeks to address a broad spectrum of mental health issues ranging from causal and aggravation factors including domestic violence, childhood emotional abuse, the impacts of comorbidity particularly with respect to serious physical illness, workplace stress, bullying and harassment - as well as issues relating to early intervention, treatment and rehabilitation – particularly through the world of work and productive engagement – I appreciate that a key focus of the Royal Commission is the identification of systemic failures within the Victorian mental health system and possible remedies. My submission therefore seeks to identify some of the major deficiencies within the Victorian mental health system as I have experienced them – as well as offering some thoughts on possible remedies. The key deficiencies I have experienced and which represent a significant barrier to effective treatment and rehabilitation include: 6 | P a g e SUB.0002.0028.0259_0007 The financial cost of mental health services which are prohibitive especially for those dealing with complex and long-standing issues requiring long term therapy perhaps involving both a psychiatrist and a clinical psychologist; The surprising difficulty of finding competent and compatible therapists with life experience that compliments their clinical training and who are willing to commit to a long-term client-therapist relationship; The ‘production line’ business model that compromises the effectiveness of specialised programs designed to treat complex personality disorders and trauma related mental illness such as those offered by The Melbourne Clinic; and The failure of private health funds to offer value for money with respect to the accessibility of mental health services which is becoming worse thereby placing an even greater burden on the public system – despite the assistance the health funds derive from Government and taxpayers. I am also keen to provide some insights, albeit from a sample of one, on why those struggling with mental illness over many years not only go to great lengths to hide their torment - but are highly unlikely to ever seek treatment until it is either too late or only when their hand is forced – often at very significant cost. As