On the fifth anniversary of the Mental Health Commission of NSW's establishment in July 2012, we reflect back on our achievements in the following areas:
- Supporting innovation and knowledge sharing
- Making data accessible and interactive
- Supporting recovery from eating disorders
- Growing peer work
- Mapping mental health services
- Changing the conversation about medication
- Building community resilience and wellbeing
- Supporting Aboriginal people's social and emotional wellbeing
- Monitoring and reporting on progress towards change
See a map of Commission visits as at August 2017.
When it comes to improving the mental health system in NSW, we do not need start from scratch. All over Australia and the world, there are leaders who have had great successes – and learnings – in how to improve an individual’s or a population’s wellbeing. Leaders in NSW have innovations that can benefit the rest of the world, too. The goal is to share this knowledge across organisations and countries so that we can help people with mental illness and their families more quickly and effectively.
The Commission and the NSW Ministry of Health co-hosted the 2017 International Initiative in Mental Health Leadership (IIMHL) Exchange, bringing nearly 300 leaders in mental health from around the globe to Australia for five days. The Exchange is held every 16 months and brings mental health leaders together to solve problems, to share innovations and to make connections with those working on the other side of the world. The 2017 Exchange was the first one to be based in Sydney, enabling many NSW leaders to attend and adding significant value to Australian policy and practice.
Over five days, the Commission offered in depth-meetings (‘matches’) on existing and emerging themes, including how urban planning can support mental health; e-mental health; what wellbeing is and how we can build it; and the importance of safety and quality in mental health care. Conference sessions developed by the Commission also explored new topics including learnings from the Royal Commission into Institutional Responses to Child Sexual Abuse about how to assist people who have experienced childhood trauma; how the New Zealand organisation Le Va has helped Pasifika families and communities seek help on the traditionally taboo subject of mental illness; and how the members of international movement Zero Suicide are working to achieve its goal.
Of the 270 delegates who attended the Exchange, 127 were Australian, including young and emerging leaders from disciplines including psychiatry, occupational therapy and peer work. The Commission had previously trained this cohort in the Mental Health Commission of Canada’s SPARK (Supporting the Promotion of Activated Research and Knowledge) knowledge exchange methodology.
More than 2200 tweets were sent with the #IIMHLSydney2017 hashtag, sharing event content with the world and ‘trending’ in Australia. The Commission enlisted Blendology e-conference tags to ensure attendees were able to continue to share their contact information with each other - and continue their knowledge exchange - once they got home. It was the first time the technology has been used in Australia and more than 5816 unique connections were made. Finally, the Commission captured much of the event in summary papers and on video, so professionals, consumers and families from all over the world can participate in the knowledge exchange too.
Events and initiatives such as IIMHL that focus on knowledge exchange mean established and emerging leaders from NSW get to learn about innovations in mental health care from around the world, and use them to resolve local issues.
Reliable, accessible data are essential to understanding the state of the population’s mental health, how support services are responding to people in need, and whether changes we make to the mental health system are having a positive impact on people’s lives. Policy and decision makers in government are not the only people who need mental health data; consumers, families, researchers and more also need to be able to access and understand this information if we are to have a transparent and accountable mental health system.
We worked with the NSW Government, the Australian Bureau of Statistics and universities to build a suite of interactive data presentations and snapshots that make NSW mental health-related data more accessible to everyone. Topics that users can explore include: access to mental health services; patterns of treatment; use of mental health services and medications; disadvantage and stress; psychological distress and health; and suicide. The Commission will add interactive presentations and snapshots on other topics over time.
These tools democratise mental health knowledge and provide an opportunity for everyone with a personal or professional interest in mental health care to make evidence-based decisions and discussions.
Only about 20 per cent of people with eating disorders engage with treatment or support services, and many report their illness is received with impatience, lack of understanding and even fear. Clinicians, too, have a documented lack of confidence in how to help people who are living with these serious mental illnesses, and research about what personal recovery from an eating disorder is like is hard to find. We need to increase the understanding of those working in primary health care in particular of how serious eating disorders are, what recovery involves, and how they can help people move down that recovery path.
We funded the Butterfly Foundation to conduct research with more than 100 Australians who had experienced an eating disorder about what helped and hindered their recovery, and turn these findings into a resource for health professionals. The resulting resource, called Insights in Recovery: A consumer-informed guide for health practitioners working with people with eating disorders, was released in November 2016 and has been downloaded more than 1500 times. It identifies for health professionals key things they can do to support people to recover, namely: discuss with clients what recovery entails; help them to feel safe, and make safe choices; help them to talk about their eating disorder; use mindful language; discover who they are beyond the eating disorder; connect them with healthy supports in everyday life; and be open to learning about eating disorders with them.
By using the person-centred, recovery-oriented practices in the Guide, health professionals can reduce the stigma and discrimination people with eating disorders face, and support and motivate them to engage in treatment. Because the Guide is for all health professionals – not just eating disorder specialists – it will help bridge knowledge and confidence gaps, especially among professionals such as GPs who work beyond the mental health sector. Individuals and families can use the Guide to advocate for their needs, and researchers and policy makers can use it as a model of how to capture consumers’ experiences and put them at the heart of treatment and services.
Employing people with lived experience of mental illness in peer worker roles brings a tremendous range of benefits, including providing hope and evidence of recovery for people experiencing mental health issues. Yet while peer workers have been employed in the public mental health sector for 20 years, they have not always been welcomed or accepted and their numbers remain low within many services. NSW needs formal resources and policies that demonstrate the value of establishing and growing a peer workforce, and how to go about it.
We developed the Peer Work Hub, an online resource that provides employers with the tools they need to establish and grow a peer workforce. The site includes a business case for peer work, a toolkit of resources such as template position descriptions, and two language guides that explain key terms and concepts. The Hub also includes case studies of NSW employers and peer workers that show how peer work can be put into practice. The site had 3000 users in its first year.
The Peer Work Hub collates vital evidence-based information about peer work into one, free, online space, helping spread awareness of what peer work is and its benefits. The Hub is suitable for both public and private employers to use, including those beyond the mental health sector such as the Department of Family and Community Services. It contributes to more supportive and fair conditions for peer workers in NSW by providing template policies and procedures that reject discriminatory practices such as underpayment, and the business case addresses stigmatising attitudes and incorrect beliefs. Peer workers can use these to better advocate for themselves. Finally, it supports people with lived experience of mental illness to participate in the workforce, which we know can help people lead more connected, contributing lives.
We know that access to mental health support is not equitable across NSW. Where people live, their background and language, and the complexity and quantity of their needs can all mean some people do not have the same access to services as others. These disparities need to be identified and addressed so we can strive for equal access and service quality for everyone.
We funded the University of Sydney to map all the services for people experiencing mental illness and their families in Far West NSW. The project classified services according to their main activity or type of care, their level of availability and how much they were used. It was NSW’s first complete list of available mental health services for a region.
The Integrated Mental Health Atlas of Far West NSW enables policymakers and service planners to clearly see what services do and do not exist in the area, and compare this to other regions in NSW, so future services and resources are allocated where they are most needed. For example, the Far West Atlas revealed that region had a lack of mental health services for older people, a lack of some types of care such as day programs and long term accommodation, and not enough skilled and qualified workers including psychiatrists to meet the community’s needs. The Atlas has been used by the Far West Local Health District and Western NSW Primary Health Network, which provide mental health services to the area.
The pioneering concept has now been adopted by other regions in NSW and Australia. For example, metropolitan Sydney was due to be fully mapped by July 2017, and atlases are also under development in the ACT, Victoria, Queensland and Western Australia. The more areas we have mapped, the more decision makers will be able to see gaps and inequities, and the more they will be able to address them.
While psychological and social interventions are available for people experiencing mental illness, too often the first-line treatment is medication. Our interactive data portal shows half of people in NSW using the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) programs for mental health receive medication only, while just 21 per cent receive both medication and other non-pharmalogical forms of mental health support together. We need a mental health system that provides holistic care, recognising that while medication can offer enormous benefits and opportunities, it is just one treatment option.
In 2014, with guidance from our expert Pharmacotherapy Advisory Group, we commenced a community consultation to hear people’s experiences of medication for mental illness and to better understand the issues they face. We received more than 200 submissions. People told us about the side effects and costs of medication, the availability and communication of other treatment options, and the pressures on prescribing clinicians. The findings were captured in a Perspectives paper released in December 2015 that highlights both good practice and practices that need changing to ensure medications are used in a safe, recovery-oriented way. To complement the paper the Commission produced a series of videos about the use of medication for mental illness that can be used in education and advocacy settings, and a postcard-size discussion guide that people can use when talking to their healthcare professionals. The postcards were disseminated in early 2017 to 2000 pharmacies and neighbourhood centres across NSW. The paper has now been downloaded or requested in hard copy by more than 1000 people and services, while video views are close to 4000.
This project elevated the importance of people’s personal experiences of medication for mental illness so it could sit equally alongside the experiences of clinicians and researchers. It drove home the need for everyone to consider evidence-based treatments and interventions beyond medication, and to know the physical health impacts of medications, especially antipsychotics. The paper, videos and postcard support people and families who are considering or using medication to better advocate for themselves in discussions with their healthcare professionals, and give clinicians insights and discussion points that can assist them to be more recovery-focused in their prescribing. Finally, the paper illustrates for policy makers the pressures in the mental health system that can lead to unsafe prescribing, and why these need to be addressed.
To really improve mental health in NSW, we must concentrate not just on acute, crisis care but also on fostering our individual and collective wellbeing. When our wellbeing is high, we feel connected, supported and safe, have good physical health and a sense of purpose. We are more likely to be able to cope with life’s difficult events, and are less vulnerable to mental health issues. We need leaders across government and non-government services to prioritise wellbeing.
In 2015 we launched the NSW Wellbeing Collaborative, a group of government and community-managed organisations that regularly come together to share, support and promote wellbeing initiatives. The Commission supports the Collaborative’s activities which have included the piloting of Mental Wellbeing Impact Assessments (MWIA) in NSW, enabling organisations to measure how their work impacts on people’s wellbeing. It is also training organisations and communities in the principles of the Wheel of Wellbeing. Most recently the Commission has supported the Wellbeing Collaborative in its development of three resources that will support increased awareness and action on wellbeing: a Wellbeing Language and Definitions Guide, A Case for Change and Principles for Action.
We adapted and brought to Australia a US-developed model of promoting mental wellbeing, called Check-Up from the Neck-Up. The model involves offering free, evidence-based wellbeing assessments to community members passing by busy locales, to increase awareness of wellbeing and its importance. Over 2016-17 the Commission staged three ‘Check Up’ events, reaching people in Sydney’s CBD and multicultural suburbs as well as regional and rural visitors to Sydney’s Royal Easter Show. National media coverage and promotional materials spread the initiative’s wellbeing message well beyond the 300-plus community members who had an individual ‘check-up’. Commission staff were supported at the events by clinicians and peer workers from Local Health Districts and non-government organisations, putting into practice Living Well’s focus on co-ordinated, person-centred care.
Each year we hold a free community event to spread positive messages about mental health and break down the stigma and discrimination that surrounds mental illness. From comedians sharing their lived experience of mental illness at 2015’s No Offence, to experts advising on how to keep children and young people safe and well at 2017’s Growing Up Digital, the events have focused on practical, positive ways people can support their own wellbeing and that of their loved ones. The Commission has captured each event on video so people from all over NSW can benefit from the advice shared.
Increasing individual and collective wellbeing is an important part of living well, and of preventing and protecting against mental illness. Having a diverse leadership group who understand and believe in the importance of promoting wellbeing, helps seed and grow the message across NSW that wellbeing is everyone’s business.
Aboriginal people experience poorer mental health, and higher rates of suicide, than non-Aboriginal people. The path to turn this trend around must be determined by Aboriginal people and communities, in recognition that we are all experts in our own lives and healing. However, the NSW Government and mental health system has a role to play in supporting this healing, especially by working alongside Aboriginal people to create and implement initiatives that effectively build their social and emotional wellbeing.
We provided funding to the Black Dog Institute to enhance and extend iBobbly, an app designed to reduce suicidal thinking among Aboriginal people aged 16-35. Our funding meant Black Dog was able to extend the app’s usability, so Aboriginal communities beyond the Kimberley region could use it; make it more user friendly, such as via a clearer navigational structure and more videos; and make it accessible on iDevices, in addition to its original Android design.
Since 2013 we have provided strategic support to the National Aboriginal and Torres Strait Islander Leadership in Mental Health (NATSILMH) group, which works to restore, maintain and promote Aboriginal social and emotional wellbeing. This included supporting NATSILMH’s development of the Gayaa Dhuwi (Proud Spirit) Declaration, which launched in August 2015 and calls for increased Indigenous leadership in Australia’s mental health system. NSW Deputy Mental Health Commissioner Robyn Shields is among NATSILMH’s members.
As part of the Commission’s annual community visits across NSW, we have been welcomed by Aboriginal communities who have shared insights about their emotional and social wellbeing and examples of Aboriginal leadership and healing. For example, in 2015 we visited the Maari Ma Health Aboriginal Corporation in far west NSW to learn about their healing program and its impact. Our findings are captured in a visit report and online video. We have also profiled the Guunumba Sit Down Circles (Yarning Circles) that run in Coffs Harbour and Durri Aboriginal Medical Service in Kempsey.
We’ve worked closely with the Aboriginal Health & Medical Research Council (AH&MRC) since our establishment, seeking its advice on all our major projects. Our commitment to working closely together has been formalised in two successive Memoranda of Understanding.
We worked with Tharawal Aboriginal Corporation to profile how they work to improve the social and emotional wellbeing of their clients in the Campbelltown area. The resulting three short videos (to be released August 2017) are intended to assist other mental health services in NSW to understand how they can better support Aboriginal clients.
Projects that support Aboriginal self-determination, and share best practice learnings from Aboriginal communities and organisations, have an enormous potential to improve social and emotional wellbeing for all Aboriginal people.
A big part of the Commission’s job is to monitor and report on the implementation of the 10 year strategic plan for mental health in NSW, Living Well. We also conduct other reviews and evaluations to see if services and programs that are meant to help people who have a mental illness actually do so. This monitoring and reporting aims to hold the NSW Government accountable to the commitment it made in December 2014 to implement Living Well and improve our collective wellbeing and mental health system.
We have published two papers on the progress of the Living Well agenda. The first, One Year On, was a comprehensive report on the achievements made during the first 12 months of the plan’s roll out. It also noted areas that required urgent action in the next year. The Commission gathered data from government departments and agencies, and via its own survey of 750 community and sector members, to compile the analysis. Our findings, tabled in the NSW Parliament, were summarised in 10 graphical Living Well indicators that we will continue to use in future reporting. Information to inform measurement of these indicators are derived from multiple sources and include data on: experiences of service for people receiving mental health care; prevalence and trends in population mental health and self-harm behaviour; stigma and discrimination; community participation of people with a lived experience of mental illness; mental health of the prison population; peer workforce; and involuntary treatment orders.
The second paper, Community perspectives of change (2016), captured more than 1500 people’s feedback about the changes they had – or had not – observed in mental health services. It conveyed what things were like ‘on the ground’ for people with mental health issues, their families, and mental health workers including clinicians. Most respondents reported was that things were the same (average of 37 per cent).
Other reviews and evaluations that that Commission has conducted or funded include a review of the NSW Institute of Psychiatry, which influenced its incorporation into the Health Education and Training Institute (HETI); a rapid review of the effectiveness of consumer-led services, which showed there is small but growing evidence that they are effective in supporting recovery; and most recently, a review of the transparency and accountability of mental health funding within NSW Health, to help everyone understand how mental health budgets are spent.
The Commission’s regular and transparent reporting on the progress of Living Well means the results are available in plain sight for all to see. If change is not on track, we have the evidence to demonstrate that is the case and request action.