Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697645414274.pdf (Australia)
Submission to the Select Committee on Mental Health and Suicide Prevention March 2021 NMHCCF submission to the Select Committee_March 2021 1 Mental Health and Suicide PreventionSubmission 71 Mental Health and Suicide PreventionSubmission 71 Mental Health and Suicide PreventionSubmission 71 Mental Health and Suicide PreventionSubmission 71 Mental Health and Suicide PreventionSubmission 71 • Ensure that the consumer and carer peak bodies are established using co- production and co-design approaches • Ensure that the needs of mental health carers and families are specifically identified and not just adapted from work that was developed for mental health consumers or for general carers • Ensure that State and Territory governments fund the establishment and ongoing operation of consumer and carer peak bodies in their jurisdictions to support system- wide lived experience workforce development • Ensure that the annual report on the state of systemic advocacy in mental health in Australia at a State, Territory and national level captures the perspective of people with lived experience and not just the perspectives of NGOs or other organisations that represent consumers, carers and families • Ensure that the combined voice has representation from all jurisdictions and diverse population groups such as Aboriginal and Torres Strait Islanders and Culturally and Linguistically Diverse and reach into the communities they represent.
The NMHCCF submissions to the Productivity Commission and the Australian Government’s Department of Health relating to the Productivity Commission’s Inquiry into Mental Health can be found at: https://nmhccf.org.au/resources/publications 2.

Royal Commission into Victoria’s Mental Health System Final Report The NMHCCF is focused primarily on national reforms across the mental health sector.
However, the Royal Commission into Victoria’s Mental Health System Final Report has many valuable findings and makes numerous recommendations which are relevant in the national arena and particularly relevant to the issues identified by mental health consumers, carers and families.

The members of the NMHCCF identify with many of the key themes described within the Final Report, in particular the following themes: • Community-based services are undersupplied.
• The system has become imbalanced, with an over-reliance on medication.

• There is a ‘missing middle’.

• Getting help is difficult.

• Access to services is not equitable.

• There is a patchwork of services that do not reflect local needs.

• Services are poorly integrated.

• The perspectives and experiences of people with lived experience of mental illness or psychological distress are overlooked.

• Families, carers and supporters are left out.

• Trauma is unseen.
• Trauma is unseen.

• The focus on personal recovery needs to be strengthened • Culturally safe services are not always available to Aboriginal communities in Victoria.

• Mental illness can be compounded by housing instability.

• People in the criminal justice system do not get the support they need.

NMHCCF submission to the Select Committee_March 2021 6 Mental Health and Suicide PreventionSubmission 71 • The experience of poor mental health and wellbeing is different in rural and regional areas.
• Stigma and discrimination are ever present.

• Dignity is often disregarded and human rights are breached • The value of lived experience work is starting to be recognised, but faces challenges.4 These themes are not isolated to Victoria and would be repeated consistently across the states and territories of Australia.

Further these themes are not new and yet the solutions to address these issues have not yet been implemented.
The NMHCCF acknowledges the range and breadth of recommendations outlined in the Final Report.
The recommendations which support the issues already identified by the NMHCCF in this submission are listed below: • Recommendation 3: Establishing a responsive and integrated mental health and wellbeing system • Recommendation 6: Helping people find and access treatment, care and support • Recommendation 7: Identifying needs and providing initial support in mental health and wellbeing services • Recommendation 24: A new approach to addressing trauma • Recommendation 28: Developing system-wide roles for the full and effective participation of people with lived experience of mental illness or psychological distress • Recommendation 29: A new agency led by people with lived experience of mental illness or psychological distress • Recommendation 30: Developing system‑wide involvement of family members and carers • Recommendation 31: Supporting families, carers and supporters and Recommendation 32: Supporting young carers • Recommendation 33: Supporting Aboriginal social and emotional wellbeing and Recommendation 34: Working in partnership with and improving accessibility for diverse communities • Recommendation 35: Improving outcomes for people living with mental illness and substance use or addiction • Recommendation 37: Supporting the mental health and wellbeing of people in contact with, or at risk of coming into contact with, the criminal and youth justice systems • Recommendation 41: Addressing stigma and discrimination • Recommendation 53: Strong oversight of the quality and safety of mental health and wellbeing services • Recommendation 54: Towards the elimination of seclusion and restraint • Recommendation 56: Supporting consumers to exercise their rights 4Final Report, pp 15 - 25, Royal Commission into Victoria’s Mental Health System - Home (rcvmhs.vic.gov.au) NMHCCF submission to the Select Committee_March 2021 7 Mental Health and Suicide PreventionSubmission 71 The NMHCCF supports the focus on addressing the needs of mental health consumers, carers and families both specifically and through several recommendations such as those relating to trauma, social interventions, and quality and safety.
3.

National Mental Health Workforce Strategy The NMHCCF supports the development of the National Mental Health Workforce Strategy (NMHWS, the Strategy) to identify key workforce challenges and actions to support the effective provision of mental health services across Australia.

The Australian Government’s Department of Health has engaged consumers and carers with lived experience of mental ill health as members of the NMHWS Taskforce.
Further, consumers and carers have participated in working groups across the following mental health workforce priority areas: 1.

Rural and Remote 2.

Aboriginal and Torres Strait Islander Communities 3.

Peer Workforce and Lived Experience 4.

Education and Training 5.

Interjurisdictional and Intergovernmental strategies and policies.

The NMHCCF is generally supportive of the actions being proposed in the NMHWS.
The NMHCCF is particularly keen to see significant improvements in the consumer and carer peer workforce as a priority matter and has raised these matters in the submission to the Australian Government in response to the Productivity Commission’s Final Report.
This submission is available at: https://nmhccf.org.au/publication/submission-australian- government-department-health-response-productivity-commission We note that no state or national workforce strategy has yet integrated the findings of ‘the notable report The Economic Value of Informal Caring in Australia’5 which found the number of (unpaid, usually family members) mental health carers was equivalent to 173,198 full-time equivalent (FTE) formal support workers and $13.2 billion in replacement costs, The NMHCCF supports the inclusion of the findings of this report in state and national workforce strategies and funding treatment and support services.
5 Diminic S, Hielscher E, Lee YY, Harris M, Schess J, Kealton J & Whiteford H. The economic value of informal mental health caring in Australia: technical report.

Brisbane: The University of Queensland, 2017.

NMHCCF submission to the Select Committee_March 2021 8 Mental Health and Suicide PreventionSubmission 71 4.

Bushfires and mental ill health Some members of the NMHCCF have been impacted by bushfires and others work with community agencies to support people affected by bushfires.
The NMHCCF understands that the mental health impacts from bushfires are evident in different ways, at different times for people.

The NMHCCF has identified the following issues and ideas that need to be considered in relation to the mental health and wellbeing of people impacted by bushfires: • • the importance of involving a range of health care experts in responses to national disasters, including those with expertise in mental health policy and service planning and delivery.
the need to consider the immediate, short term and longer-term needs of communities and individuals involved in a natural disaster.

For example, people experiencing trauma require different services and supports in the immediate time of the incident compared with the issues raised as time goes on.

• greater integration of primary care providers and Primary Health Networks in natural disaster preparedness, response and recovery is required.
Primary care services have a ‘whole of community’ approach in their work, they know the needs of their local communities and are well placed to plan and implement integrated regional responses.

• the integration of primary care responses needs to be broader than just the health care system, and include services provided by local councils, non-government agencies and social services agencies.
This would ensure that the knowledge and skills held by primary care providers is shared with those agencies and staff not usually involved in helping people prepare for a recover from natural disasters which could result in the issues around loss and grief could be better managed by all involved.

For example, below is some feedback received from people affected by the 2019/20 bushfires.
o It is suggested all staff in all agencies and organisations both those dealing with public and those behind the scenes making the decisions, need basic grief and loss mental health training to be empathetic and validate the meaning of loss people experience not put their own bias and judgements on the impacts of loss on individuals emotionally not just economically.
• the involvement of community agencies, such as Red Cross and Vinnies, in primary care responses can provide ‘real people’, not Hotlines, to walk with individuals affected by natural disasters to assist them in tasks such as insurance claims, obtaining support for housing and the like.
• Primary care services can also assist the broader community in planning and preparing for natural disasters through the development of guidance/principles and implementation of training (such as Mental Health First Aid and Suicide Prevention) for staff in government agencies and businesses such as Councils, Services NMHCCF submission to the Select Committee_March 2021 9 Mental Health and Suicide PreventionSubmission 71 Australia, Insurance companies and other organisations.
The development of systems and training will further support the staff in understanding the needs of their communities, particularly their mental health needs, when dealing with them after a natural disaster.

The staff will be skilled in working with people and not just rely on inflexible systems in supporting people affected by natural disasters.
• During the response and recovery phases of a natural disaster the demand on psychological services is expected to be high and expected to impact on the capacity of the primary care team, especially the psychological mental health workforce.

The NMHCCF recommends the involvement of mental health peer support workers and additional mental health teams to support the local workforce and to support the community.
• The NMHCCF also supports the involvement of mental health consumers and carers in planning measures and responses to mitigate the psychological trauma to those impacted by natural disasters.
• there is a need for the implementation of training, such as Mental Health First Aid and Suicide Prevention, for government and businesses such as Local Councils, Services Australia, Insurance companies and the like to enable them to better understand the trauma being experienced by their community and assist the primary care providers in responses to natural disasters.
• A significant issue for primary care services and providers is the recognition of the mental health and wellbeing support required by their community for many years to come following a natural disaster.

The research into grief and loss speaks of the important markers being 1 month, 6 months and 12 months, so approaches that support primary care providers to continue to meet the needs of their communities over an extended period is required.
• Over the longer term the introduction of mental health peer workers within the community would be a valuable resource for those experiencing the trauma resulting from natural disasters.

Peer workers could work with the community to identify their issues from a mental health and wellbeing perspective and ensure support is available within the community.
For example, the mental health and wellbeing needs of local Indigenous community members may vary from those of a farmer or a person operating a business within the local town.

It is challenging for health services to ensure they offer programs to meet the very broad needs of a community.
• There is a need to ensure that any research into the mental health impacts of natural disasters considers both the immediate impacts and the long-term effects of these disasters on people’s mental health, physical health, relationships, family dynamics, employment, educational achievements and the like.

The NMHCCF has identified several priority areas for research regarding the health impacts of natural disasters.
These areas are: o The impact for the people involved, first responders and firefighters of trauma and subsequent re-trauma from natural disasters o Mental health impacts on people with a mental illness, their carers, and the broader community.

NMHCCF submission to the Select Committee_March 2021 10 Mental Health and Suicide PreventionSubmission 71 o The impact of vicarious re-trauma when similar events in other locations within Australia or elsewhere in the world are reported.
For example, news footage of forest fires in Canada or the United States can re-traumatise people in Australia affected by bushfires.

o The overall impact on health and wellbeing of children and young people – their education, mental health and wellbeing, relationships etc.

o Ongoing evaluative measures applied across the community measuring trauma, loss, grief, social determinants of health.

5.
5.

Covid-19 Pandemic The NMHCCF has focused its response below on systems and structures that were established in response to the pandemic to assist people with mental ill health and/or psychosocial disability.

It should be noted that people with psychosocial disability and their family and carers were significantly impacted by the pandemic with minimal government income support.
Further details can be obtained at http://www.caringfairly.org.au/resources/covid-19-carer-survey- results Telehealth services The implementation of telehealth services was an issue that the NMHCCF reviewed closely in order to provide feedback to all governments.

Issues that were identified by members included: • Although well known, access to telehealth is not achievable for some.
Approximately 10-15% of our population do not have a phone, nor internet services, and if they do, they may not have sufficient data or a phone plan to have their calls.

While we might believe this is a rural and/ or remote issue, it isn't only that- our metro area people, and for people sleeping rough, it is a reality they do not and cannot access these services.
• While a video option is one to consider- there are many who live with a degree of concern and paranoia about cameras/ videos which needs to be taken into consideration.

• Some people are very uncomfortable with undertaking telehealth, particularly those who have not accessed services before.
It is a challenge establishing a new relationship with a MH worker, because a consumer is being asked to discuss intimate details, and telehealth services are not a great way to establish (let alone continue with) quality therapeutic relationships.

• Bulk billing for telehealth items for GP, psychology etc appointments is fantastic.

Reduces the financial burden as well as reducing travel time, allows for physical distancing etc.
Possibly something for the DoH to consider long term, particularly for people based far away from their preferred services (both metro and rural) or with difficulty travelling etc.

• Many consumers, particularly those engaged in public mental health services, do not have access to smart phones or computers.

Additionally, many consumers don't answer calls from an unknown number (most public services) and this has been an ongoing issue in the public sector for years.
Need processes in place where the NMHCCF submission to the Select Committee_March 2021 11 Mental Health and Suicide PreventionSubmission 71 consumer is aware they will be receiving a call from an unknown number at a certain time.

Some general health services use texting to confirm appointments.

This may or may not be appropriate in the mental health space and should be agreed to by the consumer.

Some services, such as youth mental health, use texting quite well for engagement as standard practice.
• Some services have limitations on the amount of secure video links they have access to for sessions with consumers (some have no access at all).

These links were traditionally used for one off assessments etc.

rather than ongoing support.

Increasing capacity for publicly funded services to provide support via video link would be helpful.

• Changes in service access has varied across regions.

Some community teams stopped providing support face to face.
Services, including peer workers, adapted work practices where they could continue to provide support.

The development or extension of peer-run warm lines (phone lines) has occurred in some organisations which was a great initiative.
• The NDIS stated that participants could use core funding for purchase of devices for therapy, if they do not already have such devices and require ongoing therapy, however this does not solve the issue of a lack of affordability of data or wifi, and people with disability are more likely to be living in poverty than the general population.
It also appears that for those that do not have support coordination within their plans, they can use some of their core funding for this purpose, and then support coordinators can assist with budgeting, researching wifi options, etc., however it is often difficult to find a good support coordinator.

• Prisoners are continuing to miss out, for example, because Medicare is not able to be accessed in prison.

However, the IT capability and equipment within correctional services is often poor.
There are a significant amount of people in prison who have disabilities, but these have not yet been identified, which is concerning given that this population also has very poorly addressed physical health issues, leading to a reduced life expectancy.

Case studies Service provider perspective I think we are all learning some lessons for the future and the current situation is providing opportunities to explore some different options for service provision.
For example, our family/carer peer support workers have been working from home using telehealth with great success.
This has been great during the pandemic – we need health professionals to be able to work like this out of hours following COVID 19 Access to telehealth from a Consumer perspective: It is better as they are not having to deal with a range of external factors like finding parking, wait times when clinicians are running late, overcoming anxieties or finding the motivation to get to appointments, making sure they have the financial resources to attend appointments etc.
This person finds it easier to do the appointment via the telephone, rather than video, as as they are not having to face the clinician to speak about issues.

The consumer is an aware that the clinician may have preferred a face- to-face so they can better assess the person and would be willing to participate via a platform like Zoom that is secure if the technology were available.
NMHCCF submission to the Select Committee_March 2021 12 Mental Health and Suicide PreventionSubmission 71 Access to telehealth from a Carer perspective: It has taken a lot of stress off us as a family from the carer point of view as we don't have to leave the house to get to appointments and don't have the long waiting times.
It is also easier on the relationship as we are not having to walk through all of the expressions of anxiety or depression in relation to getting to appointments from those we are caring for.

So, there are definite positives from the changes.

The only negative I see as a carer is that the consumer is more able to mask their choices in relation to medication or physical health compliance, as they are less accountable without a face to face meeting.
This could become an issue in the long run, but post COVID-19 I would be keen for there to be the option for public community services to continue to offer a mix of telehealth and face-to-face appointments as I believe it would take some of the pressure off both the consumer/carers and clinicians caseloads work.
Further, the carer is less involved as a member of the care team in telehealth sessions Digital mental health services • People accessing any mental health services need to have control and choice on the services they access and the modality of services they use.
• While the NMHCCF supports the availability of digital mental health services it is a flaw to start from the premise that the provision of mental health services through a digital mechanism is the panacea that will ‘fix’ the issues of access, equity, and good mental health care.

Digital mental health should be one of a number of strategies – not a cookie cutter one size fits all.
• The role of face to face services in the development of therapeutic relationships and providing trauma-informed care should be emphasised.

While digital offerings are cheaper they may not be the best response for consumers and carers.

• The NMHCCF members believe that there is a need to use evidence to determine what services are most effective when provided in a face-to-face (in person) modality and what services are effective when delivered digitally.

This may also be blended.

ie.


an initial assessment in person (where possible0 then ongoing use of digital services, then at least once a year access to in-person services.

• Issues of ‘digital safety’ such as safety of the service user in their environment where they are receiving the services is a crucial area for consideration.
Accessing services at a public place (such as a library, may enhance access to technology but may preclude anyone receiving a mental health consultation that requires privacy).

This may be more of an issue during Covid-19 as many people are in an environment together and for longer periods, such as working/studying from home.

• Digital capacity to support use of digital services in areas with poorer internet, lower SES, affordability of access also needs to be considered.
• The NMHCCF strongly supports the development of clinical governance frameworks and processes for all mental health services, including those provided digitally.

The clinical governance framework needs to utilise the newly released National Digital Mental Health Standards from the ACSQHC.

NMHCCF submission to the Select Committee_March 2021 13 Mental Health and Suicide PreventionSubmission 71 A clinical governance framework is critical to ensuring that safe, effective and efficient services are provided.
For example, such a framework would describe: o o o the mechanisms that are in place to monitor deterioration in service users, even those using online services the mandatory reporting that is in place or required.

For example, the framework would link to standards on acute deterioration.

the framework would need to include some information about the requirements for follow-up of certain service users.
NMHCCF submission to the Select Committee_March 2021 14 Mental Health and Suicide PreventionSubmission 71