Transcript Victorian Mental Health Service System

Victorian Mental Health
Service System
Sue Brennan
Acting Director Mental Health
9 July 2007
Department of Human Services
Mental health – broad brush
• Growing community awareness and expectations re
mental health,mental illness and services
• 19% of Victorians (1 in 5) experience some form of
mental illness over lifetime (~ 3% severe;~4%
moderate)
• 23% of those on C/y based orders & Combined C’y &
Treat’t order with MH problems; 26%+ of prison
population
• Mental illness is often combined with other factors
which adds to complexity eg AOD, housing issues;
child protection, ABI, offending/justice
Service system broad brush
• Commonwealth & State contribute (COAG)
• Promotion/prevention focus & activities – Vichealth;
public health; local government; other universal
services eg schools
• Primary mental health – GPs, community health;
Maternal & Child Health
• ‘Tier’ 2/secondary level services – private
psychologists, AOD, homelessness services
• Specialist MH services – state funded clinical and
PDRS (NGO); private psychiatrists
• Commonwealth funded services across the spectrum
– system increasingly complex with risk of further
fragmentation
State funded specialist
system
Clinical (CAMHS, adult,
aged)
• Inpatient beds
• PARC beds
• Secure Extended Care
beds
• Community Care Units
• Forensic beds
• Community mental
health teams (CAT, MST,
CCT, PMHTs)
PDRSS – psychiatric dis’y
rehab & support
services (non govt)
• Residential rehabilitation
• Supported
accommodation
• Home Based Outreach
at 2 levels
• IRRCS
• Day Programs
• Mutual Self Help &
Support
• Koori program
Legislative framework
• 1986 Mental Health Act – increased transparency &
accountability for patients predominantly in
institutional settings
• Statutory ‘watchdogs’ – Mental Health Review Board,
Public Advocate; Chief Psychiatrist, Community
Visitors, Ombudsman, Health Services Commissioner
• Sentencing Act 1991 – restricted involuntary
treatment orders & hospital security orders
• Crimes (Mental Impairment & Unfitness to be Tried)
Act 1997 – custodial & non custodial supervision
• 2007 – Charter of Human Rights & Responsibilities –
increasing community expectations on respect for
rights; MHA + MHB policies & procedures being
examined
Issues
• Access – 50% of nominal client group being seen
(60,000 clients per year)
• High demand on beds – long waits in EDs (ALOS – 11
days)
• High levels of complexity – dual diagnosis; other comorbidities; growing proportion of involuntary (71%
of admitted group)
• Workforce shortages & maldistribution
• Beyond health – housing, employment, social
connection
• Accommodating community safety as well as
personal autonomy & rehabilitation/recovery
Recent service developments
• Build the core and develop new service
models
• PARC
• Youth early psychosis
• CAMHS & Schools Early Action (conduct
disorder)
• Families where parents have a mental illness
(FaPMI) strategy
• Aged intensive community treatment (bed
substitution)
New mental health strategy
• Whole of government approach – IDC with
Vicpol, DoJ, Education, Office for Children,
Housing, Primary Health etc
• Key areas under consideration – early
intervention; access and responsiveness of
system including for people in crisis, and
system gaps for particular groups; family
support; MH/AOD interface; justice interface;
community participation
Justice system interfaces and
issues
• Diversion– relevant programs include
- court liaison services – (DHS 1994) court
based, provided by Forensicare in 4 metro &
5 rural courts – assessment; links to services
- court integrated services program (DoJ2006
assistance; case man’t; pathways to service;
joint DoJ/MHB project examining program
• Neighbourhood Justice Centre – 2006; court;
on site services; work with local community
• All aiming to divert; achieve access to right
care; reduce re-offending
Other developments
• Community Corrections Protocol –
under development; aims for a
systematised approach for people in
corrections system with MH problems or
in need of crisis care Prisoner pathways
and discharge plans
• MH/Juvenile Justice & Community
Corrections/COATs protocols are in
place
Areas for further development
• Diversion programs
• Attention to pre and post release – risk
of relapse & reoffending at transition –
how can services work better & achieve
continuity of care?
• Core MH specialist service system
resources and skills (clinical & PDRSS)
• Required focus on the forensic group