A note on reform in mental health
Reform is about achieving significant change by rapidly altering the status quo to deliver improved mental health and wellbeing outcomes. Underpinning any reform effort is the recognition that the same ways of working in the past are not going to get us where we want to go. Reform means improvement, innovation, a cultural shift and rapid change, beyond any usual quality improvement activities.
Reform in the mental health sector is mostly driven by new or different investment and programs, culture change and innovation to deliver services which are proven to make a positive difference to people with a lived experience of mental health issues and caring, families and kinship groups. The Mental Health Commission of NSW drives this process by providing strategic direction, advocacy, and ensures accountability by monitoring and reporting publicly on mental health reform and innovation across NSW.
1. Making it local
NSW is a state with exceptional cultural, economic and geographical diversity. Three quarters of us live in big cities but we live very differently, depending on our location, our community and our culture. The experiences of mental illness and wellbeing echo this diversity. This means that the help we need for our own journey to recovery will not be the same for another person. In the past, services in NSW have been traditionally centralised with planning and policy responses developed in head offices in Sydney.
Making it local means that services are designed, driven and planned locally to meet the needs of communities, and are accessible where and when people need them (including online, in their community activities, or in their workplace).
2. Getting in earlier
Having a safe, healthy family life and building resilience in early childhood is fundamental to maintaining good mental health and being able to adapt to life’s challenges in adulthood. Schools, workplaces and communities have the opportunity to build resilience as people transition through life. This needs to start in childhood and in the first, foundational years of life.
Getting in early to prevent distress becoming an ongoing mental health issue means promoting the protective factors that foster good mental health and wellbeing for us all. This includes secure housing, employment, having something meaningful to do and maintaining a healthy lifestyle. Workplaces and schools can be supportive of good mental health, but also be a place where someone can get help and support at the earliest signs of distress through peer support or access to professional help. Getting in earlier also includes improved services to prevent relapse and provide alternative support to a recurring cycle of hospitalisation.
3. Putting people first
People and their recovery journeys should guide all facets of designing and evaluating mental health programs, services and supports. Planning and priorities should be made in collaboration with people with a lived experience of mental health issues and caring, families and kinship groups. The needs of carers must be a key part of planning for any mental health or community service.
Putting people first means recognising that people are the experts in their own mental health and the services they need. Full participation means that people with a lived experience of mental health issues and caring, families and kinship groups are involved in all aspects of design and service review. Different communities have different needs and goals. Putting people first means collaboration with people from diverse backgrounds, including and not limited to, Aboriginal people, LGBTIQ+ people, and people from culturally and linguistically diverse backgrounds, the young, elderly and people living in rural and remote areas.
4. Providing the right type of care
Hospital care must always be available for those that need it, particularly when people are very unwell. However, evidence shows that people recover more quickly in their community of choice and at home, surrounded by their family and friends. For too long, NSW has been overly reliant on hospitals in the delivery of clinical mental health care. Increasing mental health care, treatment options and support in the community remains a major reform priority. As more treatment options become available in the community, we hope that more people will be able to access care and support before they become unwell and have shorter admissions when they do relapse.
An effective community-based system wraps support around the person and their carers where and when they need it. This includes mobile treatment, crisis response teams, residential respite, peer support and access to psychiatrists and other mental health professionals outside of hospital, without long waiting periods. It means that people of all ages have access to alternatives to inpatient admission or places to provide community based supports after a period of acute illness. The right type of care is less reliant on hospital beds and supports social inclusion and participation and opportunities for learning, employment and developing social relationships.
5. Better responses
Mental illness does not happen in isolation. People experiencing mental health issues often have other difficulties impacting their life. They may experience physical health problems, drug and alcohol addiction, poverty and homelessness and other co-existing conditions. A high number of individuals with mental health issues will have had contact with the justice system. Often these systems are not integrated and the person has to shop around to have all their needs met.
Integrated care within aspects of the health system and across government not only provides the optimum opportunity to offer the person the best chance of getting the help they need, when they need it, but also can improve efficiency across government.
6. Care for all
We know that some people living in NSW are more likely to experience mental health issues than others. The ability to access mental health support depends on where you live, or what services you can afford. Care for all takes into account these inequalities and proposes tailoring services to meet peoples’ needs. We know that LGBTIQ+ people experience a higher rate of mental illness than heterosexual people. We need to know more about culturally and linguistically diverse communities, and the language barriers and cultural sensitivities that affect their access to services.
Care for all means that no matter what your mental health issue, whether you have a mental illness and a co-existing condition or whether you have a diagnosed condition such as end eating disorder or bipolar disorder, that you will be able to access the same quality and level of care as for any other medical problem. Through appropriate care, treatment and support in the community, we can re-direct people away from hospitals to recover and remain well in the community.
7. Enablers supporting reform
An “enabler” is something that supports reform or assists the development of a new program or initiative. This could mean workforce policies, new recruitment strategies, technological advances, research or co-commissioning models.
The workforce is the heart and soul of delivering quality services and supports to people in distress in NSW. To support people who experience mental health issues and their carers, we need a workforce that has the right values and is the right size with the right capabilities to meet the needs of people, in the community, in hospitals and in public mental health settings. Employing people with lived experience of mental health issues in peer worker roles to support others is shown to have a range of important benefits and outcomes at all levels, including peer support, research, policy development and culture change.
For people who experience mental health issues, access to support online can make a real difference, particularly for people in rural and remote areas and young people who may be more comfortable accessing help online. There is good evidence that new technologies can improve mental health and wellbeing. In addition, better information systems can improve care quality and open up new ways of sharing information and data to support integrated care.
Research and knowledge exchange
Building the evidence base on what works will help guide investment, program design, health planning new policies and emerging treatments and therapies to support reform.
Partnerships, shared care and new funding models
Co-ordinated and comprehensive local partnerships need are critical for reform. A community-managed organisation might have a range of activities and funding sources including from local health districts, primary health networks as well as Commonwealth funding, social-enterprise activities, and support from local businesses. Service providers need to know how to better position their role to meet the needs of local communities in collaboration with existing services, and relationships and agreements should reflect outcomes for people rather than process.