Showcasing: The Resolve Program
Nepean Blue Mountains
Flourish Australia, in partnership with Social Ventures Australia, Western New South Wales Local Health District, Nepean Blue Mountains Local Health District, NSW Health and the NSW Office of Social Impact Investment.
Living Well Domain
Providing the right type of care
The Resolve program is Australia’s first social impact investment for mental health. The innovative and flexible program employs peer workers to support people with lived experience of mental health issues who have spent between 40 and 270 days in hospital in the previous year to live within the community. Peer workers use their own lived experience of mental health issues to encourage recovery, optimism and inspire hope.
Resolve began in October 2017 and expects to support approximately 530 people over a seven-year period across two sites. The three elements of the Resolve program include differing ways to support the people on the program:
- access to a 24-hour phoneline for one on one support
- psychosocial outreach services that include links to other support services
- care coordination and case management
- access to periodic residential care with 24/7 peer support at the Resolve Centres in Orange and Cranebrook.
Resolve is funded through a $7 million social benefit bond. Investor returns are based upon the NSW Government paying for an improved social outcome that results in public sector saving. The NSW Government also pays an upfront standing charge to cover some of the program operating costs.
In this case, the public savings are measured through reduced hospital use for the Resolve participants compared to a control group, by supporting their mental health and physical health in the community and reducing their need to go to hospital. The program is targeting a 25% reduction in hospital use.
For some people with lived experience of mental health issues their life is punctuated by frequent and repeated admissions to mental health units, this separates them from family, social networks and opportunities to participate and engage in the community. The factors contributing to a pattern of readmissions include a lack of the range of supports across the domains of their life to keep them mentally and physically well to stay in the community.
The challenge to provide options to keep people well and supported in the community to avoid hospital admissions, is one angle, the other is to ensure that mental health funding is spent most effectively to get the biggest health gain for the community. Reliance on hospital services requires a considerable financial investment from the NSW Government, absorbing funding that could be otherwise redirected to community-based mental health services or more effectively used across a range of mental health interventions.
Participants are referred to the Resolve program by Local Health District staff, who provide ongoing clinical support and governance in collaboration with peer workers.
As part of the Resolve approach, there are residential homes in Orange and Cranebrook, run by peer workers and designed to support participants to recover in the community, while acting as a central hub for group activities and services.
Peer workers are at the heart of the approach and success of this program. People with lived experience of mental health issues and caring have co-designed and implemented the Resolve program with clinical staff from the two Local Health Districts. The program is based on international evidence on crisis intervention, best practice residential programs and outreach programs.
The Resolve program is supporting people with lived experience of mental health issues to access the care they need in the community and avoid unnecessary hospital admissions. Feedback from clinicians and participants points to the positive impact the program is having.
The Flourish team has been collecting data every three months to evaluate the program. Of the 167 people who were referred, 165 have actively engaged in the program. Eight out of ten participants have participated actively for more than 80% of the time they have been enrolled.
Over the year prior to their enrolment, program participants spent an average of 84 days in hospital, 79 of them for mental health reasons. While the preliminary results should be treated with caution because they only cover a short period and a small group of participants, they estimate a 35% reduction in hospital admissions and a 20% decrease in emergency department visits compared to a control group (Resolve Social Benefit Bond annual investor report, available here: https://www.socialventures.com.au/assets/Resolve_SBB_Annual_Investor_Report_2019_web.pdf).
Use of the Resolve centres for overnight stays has increased every quarter, while group activities aimed at developing participants’ life skills and enhancing their social connectedness have also been well attended.
“Being able to spend time at the house in Orange on two occasions has kept my wife out of hospital both times. Please continue this invaluable work.”
- Husband of participant
While formal evaluation results have yet to be released, it is hoped the program’s ongoing success will lead to it being replicated nationally.
For more information, visit https://www.flourishaustralia.org.au/.