SUB.0002.0030.0061 Submission to the Royal Commission into Victoria’s Mental Health System NorthWestern Mental Health A division of Melbourne Health 1 SUB.0002.0030.0061_0002 Table of Contents Executive Summary ................................................................................................................................................ 4 Top Recommendations ....................................................................................................................................... 4 Background: About NorthWestern Mental Health ................................................................................................. 7 1 Improving understanding of mental illness and reducing stigma and discrimination: What we know from our consumers .............................................................................................................................................. 10 WHAT IS WORKING WELL? ............................................................................................................................... 10 ISSUES ............................................................................................................................................................... 10 RECOMMENDATIONS ....................................................................................................................................... 11 2 Prevention and early intervention: What is already working well and what can be done better to prevent mental illness and support people to get early treatment and support ...................................................... 13 WHAT IS WORKING WELL? ............................................................................................................................... 13 ISSUES ............................................................................................................................................................... 14 RECOMMENDATIONS ....................................................................................................................................... 14 3 Preventing suicide: What is already working well and what can be done better ....................................... 16 WHAT IS WORKING WELL? ............................................................................................................................... 16 ISSUES ............................................................................................................................................................... 17 RECOMMENDATIONS ....................................................................................................................................... 18 4 Accessibility and navigating the mental health system: Improving people’s access to and experience of mental health treatment and support, and how services link with each other ........................................... 19 WHAT IS WORKING WELL? ............................................................................................................................... 19 ISSUES – For Inpatient Units and Emergency Departments .............................................................................. 19 RECOMMENDATIONS ....................................................................................................................................... 24 ISSUES – for community .................................................................................................................................... 26 RECOMMENDATIONS ....................................................................................................................................... 32 5 Improving mental health outcomes: The drivers behind some communities experiencing poorer mental health outcomes and what needs to be done to address this ..................................................................... 36 WHAT IS WORKING WELL? ............................................................................................................................... 36 ISSUES ............................................................................................................................................................... 38 RECOMMENDATIONS ....................................................................................................................................... 39 6 The needs of family members and carers: What we know from our families/carers and what can be done to support them better ..................................................................................................................................... 40 WHAT IS WORKING WELL? ............................................................................................................................... 40 ISSUES ............................................................................................................................................................... 40 RECOMMENDATIONS ....................................................................................................................................... 41 7 Attracting, retaining and better supporting the mental health workforce .................................................. 42 WHAT IS WORKING WELL? ............................................................................................................................... 42 2 SUB.0002.0030.0061_0003 ISSUES ............................................................................................................................................................... 43 RECOMMENDATIONS ....................................................................................................................................... 45 8 Improving social and economic participation for people living with mental illness: Opportunities and what needs to be done to realise them ................................................................................................................. 48 WHAT IS WORKING WELL? ............................................................................................................................... 48 ISSUES ............................................................................................................................................................... 49 RECOMMENDATIONS ....................................................................................................................................... 49 9 Priorities for change: areas and ideas for reform to improve Victoria’s mental health system .................. 50 Top Recommendations ..................................................................................................................................... 50 10 Preparing for change: What can be done now and what will support improvements to last ..................... 54 References ............................................................................................................................................................ 56 Glossary ................................................................................................................................................................ 57 Appendix 1 ............................................................................................................................................................ 58 Appendix 2 – NorthWestern Mental Health Service Data .................................................................................... 60 Summary table of key issues and recommendations ........................................................................................... 73 3 SUB.0002.0030.0061_0004 Executive Summary Melbourne Health welcomes the Royal Commission into Victoria’s mental health system, and is pleased to have the opportunity to provide feedback, thoughts and recommendations for change via the formal submission process. Melbourne Health provides publicly-funded clinical mental health services through NorthWestern Mental Health (NWMH), one of our clinical Divisions. We are the largest mental health service provider in Victoria. Contributions to this submission have been made by a broad cross section of staff working within our mental health services. It is written from the perspective of our specific role within in the Victorian mental health service system. There is no doubt that Victoria’s mental health system is now in a state of crisis. Rising demand and low growth in resourcing have led to an inability of the system to provide services to the population who need them, and inpatient units and emergency departments are under enormous pressure. The report into mental health services by the Victorian Auditor General (March, 2019) provides a clear account of how the system has failed. This submission begins with our top recommendations to improve mental health services in Victoria. Background information about NWMH is presented to provide some context around the perspective from which this submission is written. A response is then provided across each of the 10 questions asked by the Royal Commission. In response to each question, we have provided some background information, a description of what we believe is currently working well and what issues are faced by our services, and our recommendations for change. Appendix 2 contains data about NWMH demand, access, safety and capacity. Top Recommendations 1. Change funding models: Implement equitable population based funding models that incorporate complex social factors and take