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Deinstitutionalised, underfunded, disconnected and overshadowed by stigma, the mental health system in Victoria has limped on for decades. What was so badly missing for so long were the voices of the people the system was supposed to serve.
On Tuesday of this week the Royal Commission into Victoria’s Mental Health System tabled its final report at a joint seating of Parliament. The report, all 3,500 pages, is huge even by the standards of other similar inquiries and is indicative of the Commissioners’ perspective on the size and scope of the problem.
From the outset, Premier Daniel Andrews committed to implementing all the Commission’s recommendations. In announcing the final report, Premier Andrews said:
"We're facing a watershed moment in Victoria's history. This report will change lives, and it'll save lives. The thousands of Victorians who have so bravely and so generously shared their personal stories deserve our full, undivided attention - and they deserve our help."
The Commissioners heard many voices indeed - 12,500 individuals and organisations made witness statements or contributed to various forums.
Storytelling in mental health is often traumatic. Healing comes not just with recognition, but also through genuine action. We are optimistic that this truly is a ‘watershed moment’ and that meaningful and sweeping reform will follow. As the Premier said, this is the time to get it done.
We offer deep respect and gratitude to people with a lived experience, including First Step clients and their family members, who contributed to the Royal Commission. It was crucial that your voices were heard because each one of you has uniquely relevant insights, and also because each one of you represents thousands of others who didn’t, or couldn’t, have that chance to speak.
We would also like to thank the Chair of the Royal Commission, Penny Armytage AM, along with Commissioners Professor Allan Fels AO, Dr Alex Cockram and Professor Bernadette McSherry for their sincerity, respect, compassion and generosity with their time, including visiting First Step to hear from our clinicians and clients.
In this special edition newsletter we will outline some of the key observations of the final report, share First Step’s featured case study, hear from Mary Pershall (author and advocate) and outline how we think, at this early stage, the recommendations may affect our crucial work.
Chief Executive Officer
Major themes identified by the Commission
It is important to acknowledge that the Commission’s work and report is extremely broad. The document itself offers many ways to view the information including summaries, info sheets, plain language recommendations, major reform areas, hundreds of infographics and much, much more. These are all accessible at https://rcvmhs.vic.gov.au/. However, most of us don’t have a spare month to read it, so we’ve packaged together some of what we think the crucial information is at this stage.
The Commission identified the following major themes - perhaps as you read them, reflect on whether they ‘line up’ with your own experience and understanding. All the themes are relevant to First Step’s work, but those in red are of greatest immediate relevance.
Demand has overtaken capacity
Community-based services are undersupplied
There is a ‘missing middle’ (‘not sick enough’ for more support)
Suicide is far-reaching
Access to services is not equitable (esp. Poverty)
The system is driven by crisis
The system has become imbalanced, with an over-reliance on medication.
Getting help is difficult
The system is antiquated
There is not enough focus on the promotion of good mental health and wellbeing
Trauma is unseen
The experience of poor mental health and wellbeing is different in rural and regional areas
Communities and places (e.g. work, school) do not adequately support good mental health and wellbeing
Limited focus on early years
Value of lived experience work is starting to be recognised, but faces challenges
Emergency departments are used as entry points
The system’s foundations need reform
Culturally safe services are not always available to Aboriginal communities
The workforce is under-resourced
Services are poorly integrated
Younger people are adversely affected
There is a substantial service gap for older people
The focus on personal recovery needs to be strengthened
Some groups face further barriers. (e.g. LGBTIQ+ people, refugees, CALD)
Mental illness can be compounded by housing instability
Stigma and discrimination are ever present
People in the criminal justice system do not get the support they need
Good mental health is not given priority
Dignity is often disregarded, and human rights breached
Four key features of the future mental health and wellbeing system
The Commission has a vision of a balanced system with more services delivered in community settings, extending beyond a health response to a more holistic approach to good mental health and wellbeing.
74 recommendations have been made and the Victorian Government has committed to implementing all of them. The major reform areas are grouped around four key features:
A responsive and integrated system with community at its heart where people access treatment, care and support close to their homes and their communities.
• Rigid catchments, where people can only receive specialist services based on where they live, will be dismantled.
• Services will be delivered based on a philosophy of ‘how can we help?’ to enable people to be supported from their first to their last contact.
• Tertiary-level (hospital) high-intensity and complex support responses will utilize multidisciplinary teams, responding to crisis calls 24/7 and offering an alternative to police and ambulance callouts and visits to emergency departments.
• Multidisciplinary care for bed-based services will be delivered in a range of settings, including a person’s home and fit-for-purpose community and hospital environments.
• The role of families, carers and supports will be recognised as central with the establishment of family- and carer-led centers.
• A statewide trauma centre will deliver best possible mental health outcomes for people who have experienced trauma.
• A statewide service for people living with mental illness and substance use or addiction will be established to provide integrated treatment, care and support.
A system attuned to promoting inclusion and addressing inequities so that all Victorians may enjoy optimal mental health and wellbeing.
• Investment in the leadership, coordination and delivery of a statewide approach to prevention and promotion activities.
• Partnerships with Victoria’s diverse communities to set new expectations of services.
• ‘Community collectives’ will bring together community leaders and members to promote social connection and inclusion.
• More mental health workers in rural and regional communities.
• Anti-stigma programs developed, implemented and evaluated.
• Improved access to legal protection from mental health discrimination.
Re-established confidence through prioritisation and collaboration across governments and communities and ensuring people with lived experience are leading reform efforts.
• An independent and statutory Mental Health and Wellbeing Commission which will include Commissioners with lived experience and a Mental Health and Wellbeing Division within the Department of Health.
• Services will be commissioned in new ways to respond to the preferences and expectation of people living with mental illness, families, carers and supporters.
• A new Suicide Prevention and Response Office.
• The Commission’s reimagined mental health and wellbeing system will be enshrined in a new legislation – a new Mental Health and Wellbeing Act.
Contemporary and adaptable services that respond to changing expectations, trends and emerging challenges
• Workforce reforms to build a workforce that is diverse, large enough and with the right skills and experience.
• Changes and shifts to practices and cultures, ensuring consumers human rights are upheld.
• A new approach to information management to help collect, use and share information effectively, safely and efficiently.
• Innovation in treatment, care and support through a dedicated mental health and wellbeing innovation fund, with a strong focus on translational research.
• All new programs will need to agree to evaluation as part of funding arrangements.
This is a comprehensive program of reform with new, well-funded governance bodies to ensure that the reform is enacted and that the results are satisfactory. If we do this, Victoria will be a world leader, and our most vulnerable Victorians will reap the benefits.
To learn more and read the Final Report visit https://rcvmhs.vic.gov.au/
First Step featured in the Final Report
First Step contributed in many ways to the Royal Commission over the journey:
- Commissioners Penny Armytage and Dr Alex Cockram attended a 2.5 hour Zoom ‘visit’ to First Step where they heard from senior staff, a First Step client and the family member of a client.
- Several First Step clients took place in a face-to-face lived-experience forum
- Senior managers of First Step (Joe Fishburn – Mental Health Services, and Tania Wolff – First Step Legal, Patrick Lawrence - CEO) took part in forums on community services, health justice partnerships and trauma-informed care.
- CEO Patrick Lawrence and First Step Legal each submitted comprehensive Witness Statements to the Royal Commission
It was crucial that First Step’s unique perspective was heard by the Commissioners and it is important that our insights appear in many sections throughout the final report, particularly in Volume 2 (Collaboration to support good mental health and wellbeing) and Volume 3 (Promoting inclusion and addressing inequalities). Our clients are quoted several times throughout the document, as are our expert opinions on trauma, stigma,
Of greatest significance is the chapter 22(volume 3) Integrated approach to treatment, care and support for people living with mental illness and substance use or addiction. This chapter outline three models of care, one or more of which must be adhered to by any organisation seeking funding. The first of these models, the most integrated example, is ‘multi-disciplinary teams.’ And First Step is the one example given:
“An example of care provided by multidisciplinary teams is that delivered by First Step (mentioned throughout this chapter). First Step’s model of care involves multidisciplinary practitioners and clinicians working together to deliver care in a single setting. The team includes GPs, an addiction specialist physician, nurses (including mental health nurses), lawyers, clinical and counselling psychologists and a psychiatrist.”
The document also quotes the World Health Organization stating that ‘[t]ruly integrated care involves more than co‑locating health workers with diverse specialties into the same building.’ First Step has a decade of experience in this area, and we can clearly explain to the new regional commissioning bodies and Mental Health Reform Victoria, just exactly what is involved in developing that ecosystem of whole-person care. It is crucial that First Step’s unique voice continues to be heard on these issues, and this report will greatly aid in our advocacy for the most vulnerable people in the community.
Mary Pershall’s interview with First Step
Mary Pershall provided a witness statement and gave evidence to the Commission, describing her experiences as the mother of a daughter, Anna, who used crisis services frequently before being jailed for killing her housemate.
Mary told the Commission that the mental health system failed to recognise the severity and escalation of Anna’s mental illness and distress because they treated each crisis event in isolation and failed to engage with people who could have told them about Anna’s history.
In her witness statement, Mary asks:
“Why couldn’t the authorities have taken a team approach and consulted people who actually knew this young woman? They could have talked to Dr D who had spent hundreds of hours with Anna. They could have consulted John and Katie and me, who had loved and cared for her for 26 years.”
In a series of short interviews with First Step, Mary shares her reflections on a broken system and provides insight into how a future mental health and wellbeing system can support Anna, once she is released from prison.
Here is the first interview:
Make sure you follow us on Facebook, so you don’t miss hearing Mary’s story over the coming weeks.
About two weeks into Melbourne’s first lockdown, I was chatting with a client out the front of the building, and she said something I’ll never forget: “So, I’m stuck alone at home, I’ve got no reason to get out of bed in the morning, and people look at me like I’m contagious. Same old same old.” What an insight!
This year has been like that - full of contradictions, full of learnings, and we’ve had to take our humour where we could find it.
This is our first newsletter - we promise not to spam you! But we do want to keep in touch and keep you updated on our work. Please click on the links below to hear from our staff and clients.
Have a restful and rejuvenating end of year break, and please look after each other.
Chief Executive Officer
ResetLife goes online
“My life was pretty grim before I started ResetLife, having barely a thread of hope. Since starting and completing the ResetLife Program, it has restored that hope and confidence that I can recover from my addictions and made me feel like I deserve to as well.”
First Step is committed to the philosophy of harm minimisation and is proud to include the ResetLife treatment program for those ready to extend their treatment goals. ResetLife is an abstinence-based 16-week program that includes individual, group and family education sessions, and is supported by qualified therapists and peer workers.
When COVID-19 restrictions began, it impacted our service delivery model and ResetLife was moved online. We were really concerned about our clients staying engaged and committed to the program, but as the weeks unfolded, we were pleasantly surprised.
We found that client engagement increased and attendance rates in groups were consistently high. Our clients were keen for contact with their peers (people with a lived experience of addiction) and workers, especially those clients who lived alone or had little other contacts. And for many, it was easier to attend as they could just turn on the computer rather than navigate traffic or public transport.
The other unexpected benefit of being online, was that it made it easier and more convenient for family members to attend the Family Education sessions. Having families connecting became the norm, even from interstate and overseas
ResetLife has a ‘rolling admission’, which means clients can enter the program at any stage. Because of this, they develop strong support networks through the sharing of mutual experiences. Peers often hold hope for those new clients to look towards, when they cannot hold it for themselves.
Eleven clients have completed the program since COVID-19 started. And for most of them, we have not met in person! This really is a testament to their personal drive and determination to turn their lives around.
We look forward to celebrating their graduation in the new year when we can all be together face to face.
Supporting our clients through COVID
Keeping our community healthy and safe has been our top priority during this period of COVID-19.
As you will remember, one of the four reasons people could leave home during lockdown, was to get the medical care they needed, and we certainly encouraged our clients to do just that.
In the most part, we transitioned to phone or video consultations. And for those that couldn’t, whether they were too unwell, or simply did not have access to a telephone, we continued to see them face to face.
In the first three months of lockdown, we were busier than ever, providing 3,329 consultations – all whilst adapting to a new way of working virtually overnight.
We implemented a COVID Practice Plan from the first day of lockdown. Any clients coming to 42 Carlisle Street had their temperature taken and were asked the standard questions we all got used to this year – have you travelled overseas? Have you been in contact with anyone who is unwell? Do you have any flu-like symptoms? Anyone who answered ‘yes’ was seen in the portable POD we have at the side of the building, with staff in full personal protective equipment and using disposable equipment.
We made sure that we still helped people as much as possible. And we made sure we looked after each other as well. We are committed to keeping our community healthy.
And remember, stay healthy by washing your hands, distancing yourself from others by 1.5m and take care of your mental health.
New opportunities for First Step Legal
“The whole premise of me getting mental health support, addiction support and legal support all under the same umbrella is incredibly beneficial and it’s changed my life. I’m really so grateful for my experience with First Step Legal. My actual vision for myself has never been more clear. I feel like it’s doable. I’m not just clutching at straws; I feel like I can achieve it.”
First Step Legal is a community legal centre embedded within First Step. We provide pro bono legal advice and representation to some of the most disadvantaged and disenfranchised members of our community, ensuring that the stress of dealing with a legal matter does not derail their rehabilitation efforts.
COVID-19 demanded a radical shift in the way we operate and support our clients. We increased phone contact for many as they experienced distress from the economic, social, and medical implications of the pandemic. We engaged with their families, navigated various service closures and tried to find alternatives, and managed a new online system for court appearances.
For the first time since our inception, we received confirmation of our eligibility to receive Community Legal Centre funding from the state government to partially fund our legal practice. This wonderful news allowed us to start busily scoping two new health justice partnership pilots – one with St Kilda Road Clinic Community Mental Health, and the other with Star Health Family Violence.
We also added a criminal lawyer and family lawyer to our team, and a new legal administrator. This means we can support even more clients struggling with legal issues, in a more meaningful way than ever before.
Overwhelmingly, we continue to deal with criminal law and family violence matters, driving offences, dishonesty offenses and drug related offending. Over the last year we assisted 151 clients with 188 legal matters.
As part of our ongoing commitment to clients, we keep in regular contact once their matter is resolved. Of the clients surveyed this year, 95% had not committed any further offences and 100% felt more hopeful and positive than before working with us.
It’s remains an enormous privilege to be able to do this work and to use whatever capacities we have to help make a difference in the lives of our clients whose courage and determination to overcome overwhelming obstacles in their owns lives, continues to inspire us.
39 Greeves Street: space to grow
Sometimes, opportunities arise even in the middle of a crisis.
First Step has been providing mental health and addiction services to our local community from 42 Carlisle Street for 20 years. Over those years, we have continued to grow and adapt to meet the needs of the community. Our programs and our staff increased, but we remained at the one increasingly busy site.
It was getting tight. And we knew that our capacity to support more clients was limited by space.
Literally over the back fence, on Greeves St, was a beautiful old red brick building which became available for rent just when we needed it. Well, that fence is now gone, and we have two buildings on one ‘campus’, with a courtyard in between.
The new building will house ResetLife and First Step Legal, which have both significantly expanded during lockdown, as well as our executive and philanthropy team.
ResetLife has grown from five clients earlier this year, to over 40, with a waiting list. 39 Greeves Street has a major conference room to run family education sessions from, as well as smaller counselling rooms, and generous amenities.
And First Step Legal have room for an expanding team of staff and volunteers as well as a virtual courtroom.
The ‘new’ building is full of character and history. We believe that it was used as a boarding house for many years; and used to count money from the local parking meters – the walls and doors were fortified steel! We repainted the deep red walls, restored the ornate features on the high ceilings, and reconfigured some of the rooms. We even sourced furniture from a local institution, Big Mouth, which sadly closed due to COVID-19, with our staff carrying tables along Barkly Street!
This is the first time we have physically expanded, and I expect both buildings will be full before too long. We remain dedicated to supporting our clients, and to encouraging the community health sector and government to embrace multi-disciplinary hubs and whole-person care.
Our reception, mental health services, GPs, psychologists and psychiatrist remain at 42 Carlisle Street so you know exactly where to find us if you need us.
Have a restful and rejuvenating end of year break, and please look after each other.
A couple of months ago a small group of community CEOs in Melbourne’s inner south east sat down around what would be their last communal coffee for a long time. COVID was coming in fast, and we were all discussing the current and likely future challenges. Every organisation had a different story to tell, but they all contained elements of the following:
- How can we continue to support the people we exist to serve?
- How can we protect our staff and volunteers?
- How can we maintain financial sustainability/income/fundraising?
- How can we keep morale high?
- How can we learn and come out of this even stronger?
Some organisations, like Lord Somers Camp, knew that their business model as they new it (running life-affirming camps for people of all ages, cultures and abilities) was going to be totally disrupted. Others, like Ready Set, could possibly keep preparing people for re-entering the workforce, but had a lot of elderly volunteers who were of course extra vulnerable. Some, like First Step, simply could not close their doors because they had ongoing therapeutic relationships (GPs, addiction treatment) with clients that simply couldn’t be mothballed.
As we contemplated these challenges, we were certain of one thing: now was a time to come together, not pull apart. And from that fundamental urge for connection and community Rock Around the World was born. It is an extremely rare thing, a collaborative fundraiser. Who can think of another one? And it was purpose built for the current, extraordinary period, with certain goals in mind:
- To enhance community and connectedness (despite social isolation)
- To encourage physical exercise (despite social isolation)
- To empower people new and old to the community sector to raise funds for those organisations (despite social isolation)
- To have fun!! (you guessed it, despite social isolation)
Now, permit a little genuine promotion here please (just for one paragraph):
Several weeks later and we enter the home stretch. I myself am attempting a world record (most basketball free throws made by one person in a 24-hour period getting one’s own rebounds), hence the picture of Andrew Gaze who is generously getting behind my efforts. Others are cycling, rolling (wheel chair), walking, dancing. After all the training and fundraising, the event culminates on Sunday June 21st with the day of activity and a simultaneous Livestream full of music, interviews, activities, celebrities, Zoom Room and more. If you want to get involved please go to www.rockaroundtheworld.org.au and see the full list of organisations you can choose from to get behind. You can go to the Facebook page on the 21st and watch/join in the Liverstream too: https://www.facebook.com/rockaroundit/
Now, we’re raising some pretty good funds. But we’ve also forged bonds between our organisations that I believe will stand the test of time. And that is hugely important, and I’ll tell you why. The vast majority of the people our organisations exist to support are experiencing or did experience childhoods of significant trauma, and in many cases abuse and neglect. A great many of our people (in some cases like Mirabel ‘all’) grew up or are growing up in out-of-home care. Can you imagine moving through 20, 30 or even 40 group homes and foster families, but the age of 18? Never knowing someone who could honestly say or show that they loved you. And probably meeting some people on the journey who did the opposite.
It is fair to say that the overall feeling in Australia is that if someone’s parents are really struggling, say for instance they use illicit drugs, then . . . get the kids out of there! It will be better than living with those parents! But will it? Will 40 foster homes been better than a tumultuous home environment? Now is not the time to delve into that questions, hugely complex as it is, but it is crucial that as a society we develop a better and deeper understanding of the unbearable struggles of many young people. Folks, this is trauma, and it’s here in Australia.
Now, back to why the bonds between organisations are so important. Many of the people described above have a great many disempowering factors in the life: various states of homelessness, loneliness, lack of bonding, early school leaving, drug and alcohol use, joblessness, no real family etc. There really is only one way to tackle an almost intractable problem like this. And that is harness the amazing resilience of our people, and then to strive for incremental whole of life improvements; small, lasting wins across all areas of disadvantage, that reinforce each other and build towards a brighter future . . . maybe even the daily experience of happiness.
How do you achieve ‘incremental whole of life improvements’? The principle is actually pretty simple: provide ALL the support vulnerable people want and need. And if that can’t be provided in one place, by one team, then you better have some really fantastic collaboration and coordination going on. And that, fundamentally, is what we’re working on here. First Step’s vision, and every other organisation in this partnership expresses a similar sentiment using different words, is that everybody has every chance to turn their lives around. Achieving incremental whole of life improvements (mental health support, addiction treatment, housing, social connection, joyful experience, employment/training support, legal representation) is the way to give everybody every chance. And note that it is FAR more expensive to NOT do this work than to do it properly. There are literally no excuses.
So, please, go forth, collaborate. If you are not already involved in the community sector in some way . . . dare I say now is a good time to think about it.
Stay safe, look after each other, and build the kind of world you want to live in.
Chief Executive Officer
24 April 2020
I have a fabulous opportunity next Wednesday at 5.30pm to speak to hundreds of people about the live-saving work of First Step. I will be speaking (with 3 other CEOs of fantastic mental health not-for-profits) as a finalist in The Funding Networks first ever online event.
The previous, successful format was that you get 100+ interested parties in a room, each CEO gives a 6-minute pitch, and individuals and businesses pledge support in an upbeat bidding kind of process. By all accounts it’s a fun night and people get to feel good and connected about making a contribution.
Now, under COVID-19 social distancing restrictions, that is going online. It will be a great chance to get connected and get cracking on helping vulnerable Victorians. Still the ‘6-minutes of my best’, but all participants will be joining remotely. The one advantage is that there are no limitations on numbers at all; the more the merrier, so please sign up and tell your friends.
We are so lucky at First Step that we've been able to transition, almost seamlessly, to telehealth and phone health, with not a single client (of our 2,500) 'going missing.' Surprisingly, for some clients, telehealth is actually better than face-to-face, but I for one have had enough Zoom meetings to last a lifetime!
Below is the promotional video (I saw a few cheeky words at the end), the website for registering.
At First Step we believe that everybody deserves every chance to turn their lives around. If we do well on the night we can make that vision a reality for more people.
Chief Executive Officer