On Thursday 2 September, the Mental Health and Wellbeing Division hosted the online event Overview: Mental Health and Wellbeing Reform.
This live online presentation provided an update on key mental health and wellbeing reform activities following the final report of the Royal Commission. More than 170 stakeholders from non-government organisations and community health services attended the event.
- 01 October 2021
- Duration: 56:42
- Size: 16.89 MB
Katherine Whetton: Good afternoon everyone and welcome to our event this afternoon.
I'd like to start by acknowledging the first peoples and traditional custodians of the lands on which we all meet today. For me, that’s the people of the Wurundjeri people of the Kulin Nation. I pay my respects to Elders past and present, representatives of the world’s longest continuing culture.
I’d also like to recognise all people with a lived experience of trauma, neurodiversity, mental ill health, and substance use or addiction, and their families, carers and supporters. This recognition extends to the clinical and non-clinical workforces who work to support those with lived experience.
Thanks very much for making the time to be here today. I appreciate everyone is very, very busy with changes to COVID-19 related restrictions and just generally life is very busy at the moment.
For those I haven’t met before, my name is Katherine Whetton. I’m the Deputy Secretary of Mental Health and Wellbeing in the Department of Health. I’m keen to acknowledge the increasing demand that the mental health system is facing right now, and the significant pressure that this is placing on yourselves and also your colleagues. I really appreciate and want to thank you for your leadership, and the efforts that I know you and your staff go to every single day to provide treatment, care and support to people experiencing mental health and wellbeing challenges.
I’m going to run briefly through our agenda today for the time that we have together. So you can see the agenda on the slides there. I’m joined by some of my colleagues. Matthew Hercus, the Executive Director of Mental Health and AOD System Management, and also Megan Boland, Director of State-wide Programs and Implementation. So you can see there, Matthew, Megan and I are planning to present for about 45 minutes so we can provide lots of information, and then we’d be really pleased to take some questions towards the end.
The focus of today’s session is really to provide an update and an overview of key mental health reform initiatives that the Department currently has underway since the May budget. I’m keen to reinforce the importance of our NGO sector as we do undertake this work. And there’s a lot of it, as we know. We’ll also touch on how we’re proposing to engage, involve and inform the NGO sector providers, workforces and communities.
For those of you not familiar with a Teams live event, you can submit your questions at any time using the Ask Question function in the top right of your screens, and at the end we will respond to as many questions as we can. For any questions we can’t get to today, or those that perhaps are subject to probity considerations, we’ll provide responses to these after the session, and we’ll publish these with the slides and a recording of the event on the Department of Health website. We are really committed to providing you with as much meaningful information as we can, and we hope that you do find today’s event to be valuable.
As many of us know, this year’s State Budget invested a record $3.8 billion over the next four years in mental health. This investment marks a really big turning point in how we support better mental health and wellbeing for all Victorians, and it is important to note that we are just starting out on an ambitious, 10 year reform agenda, so not everything from the Royal Commission recommendations was funded in this first year.
Since the Royal Commission Final Report was tabled, one of our really big priorities has been working through the sequencing of reforms so that we can understand what needs to be scaled now, what needs more codesign, and what can be scheduled for funding in later budgets.
And as we do start out on this journey, I’m keen to emphasise the Department’s commitment to collaborating with the sector, people with lived experience, and the Victorian community in a way that is genuine and productive. It will take all of us working together in new and innovative ways to bring about the level of system change that’s needed to achieve better outcomes for Victorians. And really, the leadership and insights from the NGO sector and across community health will be an important part of this collaboration.
The information on this slide here will be familiar to many of you already, but I did want to do a really quick recap on the key areas as part of the investment so far from the Budget, and that investment into Victoria’s mental health system. So the Royal Commission gave a really thorough analysis of what’s needed in a reformed mental health system, and it was across 7 themes, and you can see them there on the slide, and they’re grouped under 4 broad priorities.
Firstly, a redesigned system, the foundational pieces and reconfiguring how services are delivered to move from a crisis-driven model to a community-based one. So for example through the establishment of new Local Adult and Older Adult Mental Health and Wellbeing Services, we’ll link in with existing Area Mental Health and Wellbeing Services, and Megan and Matthew are going to talk further about these initiatives later in our presentation today.
Secondly, strengthening mental health and wellbeing promotion and suicide prevention efforts through collaboration, promoting inclusion, and addressing inequities, for example through establishment of new Healing Centres for Aboriginal people, and an aftercare service for LGBTIQ+ people. Also about ensuring the system’s new foundations are supported and enabled by lived experience leadership, strengthened workforce, and evidence. And of course, redesigning and expanding the infrastructure that we need to be able to meet current and future demands of the system.
We do have a significant and complex reform journey ahead of us. The work program is genuinely expansive, and while there is a lot of work underway, we really are at the beginning of this big journey.
As well as being expansive there is a breadth of work that will emerge from our reform program and the budget outcomes, and this ranges from laying the early foundations through planning and design, to providing direct support for organisations for service and workforce expansion, then to systemic reform in the way the system is governed and operated.
So there are considerable efforts underway to structure how this work will be delivered, and this includes organising how the Mental Health and Wellbeing Division in the Department is resourced, structured, and operates. And implantation is certainly underway. The recommendations from the Interim Report of the Royal Commission are well progressed, and the early foundational work from the Final Report is beginning, including establishing the first 6 sites of the new Local Adult and Older Adult Mental Health and Wellbeing services and developing a new state-wide workforce strategy, as well as a new Mental Health and Wellbeing Act.
So I’m keen to give a brief update on the progress of some of those core areas of work, and I’ll turn now to our new Mental Health and Wellbeing Act.
So the Royal Commission recommended repealing the current Act and enacting the new one in 2022 to provide the legislative framework for the redesigned system. Building on the Royal Commission’s very extensive consultation, the Department is engaging with people in a number of ways to translate the recommendations of the Royal Commission into the new Act.
So for example, we invited feedback on specific policy proposals through the Engage Victoria website, which was open between June and August. This engagement, importantly it didn’t replicate the work of the Royal Commission, but it focussed on policy issues where the Royal Commission gave either this high level direction, or where further information was needed to be able to translate the Royal Commission’s vision into legislation, and so some of the topics that were included were objectives and principles of the new Act; non-legal advocacy; supported decision-making; information sharing; compulsory assessment and treatment; restrictive interventions including chemical restraint; and governance and oversight including complaints management.
We sincerely appreciate and thank everyone who has taken the time to provide input to the work so far. The response from across the sector really has displayed everyone’s commitment to this reform journey. We received hundreds of submissions through the Engage Victoria process. Feedback came from a wide variety of people and organisations, including individuals with lived experience, consumers, carers, First Nations representatives, clinicians, service providers, academics and peak advocacy groups. And that’s just to name a few.
We’ve also as a Department attended targeted sessions with a range of groups to allow for deeper conversations about some of the key policy issues, and we really thank everyone who’s taken the time to provide that input.
We are continuing to work through our advisory structure, including our dedicated new Act Expert Advisory Group, which brings together quite a diverse range of expertise in order to incorporate public feedback and further refine the policy for drafting of the new Act.
Following incorporation of the public feedback and submissions we’ll provide an update about what’s happening next for the development of the new Act, and over the coming months the Bill will go through government approval processes to enable consideration by Parliament in 2022.
As you can see though from the slide here, the process does not end there. There will be other opportunities to contribute once we proceed to implementation of the new Act and the guidelines and processes that support it, and I do want to underscore that there is a lot of work for us to do, and working with our key partners on that implementation.
And then, as recommended by the Royal Commission, a review of the Act will be undertaken within five to 7 years. And this will be codesigned with consumers, families, carers, supporters, workers and providers.
We’ll continue to update the sector on the development of the new Act as the work progresses. We do know that the timelines set by the Royal Commission are very ambitious. We also know that these timelines are important to achieve because they set the legal foundations that create the architecture to support the new system envisaged by the Royal Commission. These legal foundations will mean that Victorians can achieve the highest attainable standard of good mental health and wellbeing through access to culturally appropriate and safe mental health and wellbeing services.
I’ll now touch on the work that is underway to develop the workforce strategy. I think we might have gone forward one slide too many. Okay, I’ll talk about the strategy. So the workforce strategy to be delivered in late 2021 will provide direction, guidance and advice around Victoria’s mental health workforce needs at a systemic, state-wide level. Our early focus has very much been on engagement. We have formed a Mental Health Workforce Technical Advisory Group with broad representation, including representation from Victoria’s NGO sector.
And we also, as you can see on the slide here, we held a mental health workforce forum in late July, which was attended by more than 140 people including representation from clinical services, mental health bodies and community service partners across both metro and regional locations so that we could be sure we benefitted from the breadth of expertise. And the forum did surface critical challenges, and it did identify some very important opportunities for us to consider.
So participants spoke about the critical workforce shortages in the current system and identified opportunities to be explored further, including expanding recruitment pathways, investing in workplace culture, and expanding the scope of practice to improve job satisfaction.
Participants identified trauma-informed care as a necessary capability. They’re seeking support to build capabilities to meet the needs of consumers and carers, and innovation that ensures the right disciplines are included in models of care.
We also talked a lot about rural and regional workforces, and talked about them in some detail. Participants highlighted the need for a comprehensive incentive scheme that considers working conditions, financial incentives, cultural and social supports, and coordinated undergrad training and placement programs.
And participants also identified opportunities to improve workforce wellbeing by building links between metropolitan and regional workforces, and improving supervision and professional supports.
So onto the next stages of the workforce strategy. The next stage will be targeted engagement. So the work that we’re doing now, we’ve got about 150 representatives across 76 organisations who’ve come together to form 4 specialised targeted engagement groups providing insight, innovation, and the implementation advice we need to shape the strategy.
The groups are advising us on four key themes, so supply, capability, worker wellbeing, and rural and regional issues. They’re also going to guide us on the process of engagement that would be important and necessary after the release of the strategy, to make sure we are still working collaboratively to achieve the vision.
The Royal Commission specified that the workforce strategy must be delivered by the end of 2021. The timelines of the development of this first strategy are tight, but I do want to emphasise that it is a first step in what will be an iterative process over a number of years. While the first strategy will not solve all of our workforce challenges it will be an important first step in laying the foundations to build the workforce in the ways envisaged by the Royal Commission.
The strategy is also being developed by incorporating all of the very robust consultation that was undertaken to inform the Royal Commission, the Final Report, and also integrating content from relevant existing and previous work. It will be through implementation of the strategy that we’ll have the opportunity to engage in even more targeted and detailed work, and we really do welcome and encourage your involvement throughout this process.
Now I’m keen to give an update about some regional governance and regions. The regional governance and commissioning arrangements recommended by the Royal Commission are a significant shift from the current centralised model where the Department is the system steward, and governs and commissions the Area services. I’m very aware that understanding how these interim regional bodies and, later, the legislated Regional Boards will work is definitely of high interest.
As a priority we’re currently working through options for both the alignment of the eight regions and the establishment of the inter-regional bodies, and those bodies will be the precursor to future legislated Regional Mental Health and Wellbeing Boards. And as this work progresses we do absolutely intend to work closely with our key stakeholders.
Each interim regional body will include a chair and five members, including a person with lived experience of mental illness or psychological distress, and a person with lived experience as a carer. The members and the chairs in particular will play a critical role in advising the Department and engaging with the services in those regions. Local knowledge and engagement will be critical functions of the interim regional bodies.
And as I said, the interim regional bodies are at the first step in a longer term journey of decentralised governance reform, and you can see the steps on the slide there that will be undertaken over time. And ultimately each region will have a legislated Regional Mental Health and Wellbeing Board, and it will take time for us to get there.
We are getting started with the appointment process for chairs of the interim regional bodies. We’re hoping to commence our public merit-based process in coming days, and we’ll able to share some more information soon.
I’m going to hand now to Matthew Hercus, who is going to give us an overview of the Area Mental Health and Wellbeing Services reform. Over to you, Matthew.
Matthew Hercus: With many thanks, Katherine, and many thanks to all those on the call that have made time, effort and energy to be here today. It’s terrific to be amongst old friends, and I use the word ‘old’ in the sense of the time we’ve worked together and acknowledge that.
I’ll spend a few moments, if that’s okay folks, on the Area Mental Health and Wellbeing services. The context for this conversation is to reframe for ourselves the Royal Commission directions that have specified that the services formerly known as Area Mental Health Services, AMHS, be they child services, adolescent services, adult or age services, are all undergoing significant reforms on the back of recommendations from the Royal Commission and becoming Area Mental Health and Wellbeing Services is a deliberate intention that has deliberate effort and deliberate outcomes that we are seeking.
What we’re showing here is a representation visually of the reform system that the Royal Commission has proposed, and specifically the tiered effort in the staged care system which set the context for where we are heading.
Area Mental Health and Wellbeing Services will receive a significant uplift in capacity in order to meet demand. The Royal Commission has asked for Area Mental Health and Wellbeing Services to see more of Victorians, and see more of those Victorians who they do see.
The Area Mental and Wellbeing Services will also shift in focus. They will provide services to those with the highest levels of need, whilst doing so in the context of expanding wellbeing supports, drug and alcohol capacity, and also expanding urgent and crisis care needs. In addition, state-wide specialist services will be reformed, and they will also have a presence, importantly, in delivering services across both Locals and Area services.
Katherine has referenced the Regional Boards and the function of the Regional Boards in the future. We’ll look to these Board to assess demand and needs within each of the eight regions, and focus on the capacity, the functions, the delivery of Area Mental Health and Wellbeing Services, Local Mental Health and Wellbeing Services, and the state-wide specialist services in the Victorian context.
Of course Area Mental Health Services cannot do this work and undertake their reforms without engagement with the Local Mental Health and Wellbeing Services and primary, secondary and other community-based services currently in existence.
The Royal Commission has called out, in addition to the staged care, a very significant shift to the demographics of the system, producing consistency across all parts of Victoria. Importantly to note, two key age-based streams, noting the slide represents three, but the two of course is 0-25 and 26 plus, with the added additional detail in 0-25, I’ve focused deliberately on 0-11, with children, family support needs; 12-25 taking into account the demographic characteristics of the cohort; and 26 plus, noting that 26 plus is not all-inclusive. There will still be need and will continue to be a focus on older adult persons and their needs.
As mentioned we’re looking for absolute consistency across the state in this stream-based model. We’re also noting that in addition to the Area Mental Health Service being streamed, there will be streams of Local Services, for the local wellbeing services, mental health and wellbeing services that will differ across the streams.
Noting for zero to 11, younger people, the importance of children’s services, family services, and other critical paediatric community health services as local partners. For 12-25, using the headspace platform and leveraging the outcome of the local primary staged care system that that service provides. And importantly in the 26 years plus cohort, the new Local Adult and Older Adult Mental Health and Wellbeing services.
We are looking for treatment, care and support that is developmentally appropriate, and that there’s equity of access regardless of where in Victoria people are, and regardless of age. We’re also looking to expand hours of operation to increase accessibility, whilst ensuring there’s flexibility between the age stages, and the transitions, but not being exclusive, and enabling consumer and family choice that’s central to the timing of any transition between and across services.
Specifically to the Area Mental Health and Wellbeing Services reforms, we’ve used the phrase ‘expanding’ and ‘modernisation’. There will be an expanded range of treatments and therapies and wellbeing supports, which are currently known as psychosocial supports. We need to improve care planning and coordination. We need to improve day to day practical assistance and connections to other community services with a special focus on housing in particular.
Victorians need help to find and access treatment, care and support, and a comprehensive, 24-hour a day response, 7 days a week, to that access. The word ‘wellbeing’ is a deliberate decision made by the Royal Commission in place of the word ‘psychosocial’. ‘Psychosocial’ as a term is relatively technical, in fact highly technical, some would say, and has limited meaning in plain English. It’s also heavily associated with disability-based language of the National Disability Insurance Scheme. So instead rather ‘wellbeing supports’ is the preferred term, and that wellbeing support will encompass a broad range of support-building, community connection, social wellbeing, practical life assistance, and also enabling consumer agency.
Currently wellbeing supports in Areas, as an example, are the Early Intervention Psychosocial Support Response Program. Areas will continue to deliver integrated clinical, mental health and wellbeing supports. It’s a functional and foundational role of the Areas that the clinical specialist end of the system will remain.
There is, however, a deliberate decision to move the system away from bed-based care towards community-based services. As Katherine mentioned, the bulk of investment in 2021 that has been referenced, has been made in community mental health services. It’s expected this will continue, and additional work on activity-based funding model development has been recommended by the Royal Commission, and will support this framing. The community focus recognises the importance of stability and functioning to recovery, and Areas will now deliver in the community context, integrated clinical or wellbeing services.
It's also recommended that a service partnership between the public health service or public hospital and a non-government organisation that provides wellbeing supports is established in each area for infant, child and youth, and Adult and Older Adult Area services. These partnerships are critical to realising the ambition of the Commission for a system that offers holistic responses Victorians need, recognising and supporting the relationship between social factors and a person’s mental health and wellbeing, and the partnerships will see public health services and non-government organisations work in a coordinated way, ensuring the access to a high quality and safe treatment, care and support that is deserved.
I’ll now throw to Megan Boland, who will give us a brief update on the Local Adult and Older Adult Mental Health and Wellbeing Services. Thanks, Megan.
Megan Boland: Thanks Matthew. Hi everyone, I’m Megan Boland, the Director of State-wide Programs and Implementation, and I’m here to talk to you about one of the flagship reforms of the Royal Commission, the Local Adult and Older Adult Mental Health and Wellbeing Services, as my team is responsible for the implementation.
Local Services are a significant part of our system reform, and these services, alongside the Area services uplift, will provide much needed capacity in both treatment and wellbeing support, as Matthew has just said. Access to local community mental health and wellbeing services is the foundation of the Commission’s reforms, and Locals are the front door for mental health services, and where most people receive mental health treatment, care and support in the reformed system.
You would have seen the six tiers, as per Matthew’s presentation, but just to remind you, the Locals sit at the fourth tier between primary and secondary mental health and Area services, and Locals are arranged in age groups. Infants and children, starting with three new hubs to seed the model, scaling up over time to state-wide. Young people, using the existing headspace network. Adults and older adults, up to 60 new services delivered by the end of 2026.
Today I’m focusing on the Adult and older Adult Local Mental Health and Wellbeing Services, which is a very big mouthful, and it’s known as ‘Locals’.
We have an ambitious timeframe for the delivery of Locals of up to 60 across Victoria by the end of 2026. They’ll be for people 26 and over experiencing a mental illness or psychological distress, whose needs are too intensive for primary and secondary mental healthcare alone, but do not require intensive care from the tertiary Area Mental Health and Wellbeing Services. Locals will also care for people with coexisting or co-occurring alcohol and other drug issues.
Locals will be formally networked to other parts of the system including Area services, to ensure smooth transition as needs and acuity changes. Area services will provide primary and secondary consultation and shared care with locals, allowing people with higher needs and complexity to continue to be cared for in Locals where appropriate, rather than stepping up to Area services. Locals could potentially be used as a delivery platform for elements of Area services or state-wide services where it makes sense and enhances local integration.
Locals represent a significant expansion of the mental health system in Victoria, and together with Area service expansion, will address the ‘missing middle’. As Matthew and Katherine have stated, Locals will eventually be managed and commissioned by the Regional Boards.
This slide helps to understand the Royal Commission’s conceptualisation of the consumer streams, and what part of the system is responsible. You can see that Locals fall into the moderate to severe intensity levels, and that they will be delivering primary care with extra support stream, which is defined as treatment, care and support from primary and secondary mental health and related services, and also short-term treatment, care and support stream, which is defined by the Royal Commission as short-term treatment, care and support from Locals and Areas. So not really much of a definition. So for short term treatment, care and support stream there will be some overlap with Areas, Consumers of these with these needs.
Locals will be delivered on a philosophy of, ‘How can we help?’ with no referral required. Locals will do engagement, screening and assessment. There will be a seamless pathway between Locals and Areas for those stepping up or down on the care continuum. Locals will provide integrated clinical treatment. They will provide individualised wellbeing supports to address psychosocial stressors such as homelessness, unemployment, gambling and family violence; peer support and self-help; client-lead care planning and care coordination, and Area services will provide primary and secondary consultation to Locals.
We will be having a phased implementation of Locals, up to 60 services to be progressively operationalised by the end of 2026. This allows the workforce to grow and the model to mature and adapt to local contexts across Victoria. Six locations by the end of 2022, which was already announced by Minister Merlino to be Benalla, Brimbank, Frankston, Greater Geelong, Latrobe Valley and Whittlesea. Providers to be identified through an open tender process to commence mid to late October. Eligible providers are public health services, public hospitals, and non-government organisations and private providers. A market briefing will occur following the release of the tender, and phasing of the remaining locations will be progressive over the years until 2026-27, and a schedule for that is being developed now.
Engagement is underway to help us understand how people would like to experience services at the Locals, and place-based consultations will occur in the first six site locations following the release of the tender. Our engagement is limited to how consumers, their carers, families and supporters, service providers and other key stakeholders would like to experience Locals. The Royal Commission was quite specific in its recommendation about the service model for Locals, so consultation is limited to experiential feedback.
I’d like to alert you to the consultation via the Engage Victoria website. You can participate in a survey now. There is a stream for individuals and organisations, and we encourage you to share this with your networks. We understand there’s a lot of interest in contributing to Local services. If your organisation has an existing group or groups that meet regularly that you think may be interested in hosting their own discussion about Local services, we can provide a conversation toolkit that can help guide the conversation and collect valuable insights on how people want to experience the Locals. If you’d like more information about this opportunity, we can provide contact information for Capire, who are managing these consultations on behalf of the Department.
We’re undertaking targeted consultations with people with lived experience and their families, carers and supporters from diverse communities.
The addition of Locals to our system will make an enormous difference to our capacity to respond to the huge pressures that have been faced over the past several decades, and I look forward to working with you all over the next several years to make this happen.
Thanks Katherine, back to you.
Katherine Whetton: Thanks very much Megan, and thanks Matthew too for your presentations. So we do have a couple of questions that we’ll start with, and I’ll answer some, and I’m going to ask Matthew and Megan to help as well. So first question I’ve got is, ‘How will the regional bodies align with PHNs?’ I’ll have a first go, Matthew, if you wanted to add that would be fantastic.
It is important to say that the Royal Commission was really clear about seeking to have regional governance so that the planning and decision-making is made at much more localised levels, and really thinking about that move to more community-based care, but we also want to be really careful not to recreate the wheel and not be duplicating things. So we’re very conscious that PHNs do play a role already in local areas.
And so there’s the interim regional bodies that will be established in the near future, and we are thinking at the moment about how we can involve PHNs in that. There’s also then the work that we’ll need to undertake on the future legislated Regional Mental Health and Wellbeing Boards, and that’s something that is very much work in progress and for future work as well, so there’s all sorts of things that we’re keen for feedback on about how we can best do that.
Matthew, did you want to add to that one?
Matthew Hercus: Yes, thanks. Thanks Katherine and thank you questioner. Also important to note the Royal Commission provided the Department the capacity to make decisions about the Areas and the regions that we set up, and it recommended eight of them, so automatically there’s a misalignment between eight and six. Also important to note that the Royal Commission has been very clear and directed that the areas, and the regions, are not boundaries or catchments. They are in no way to define service delivery or service access in the ways historically the system has understood the way we’ve designed the system. They are areas for planning and for distribution.
And I might just, if I can be bold Katherine, the question 3 around NDIS fit with local regions and supports, again I’ll have a go and then throw to Megan on that one. The question for me speaks to the slide around the tiers and the stages where the NDIS are clearly part of the staged system, and it would be a function of the regional bodies and ultimately Regional Boards to understand the system in their area in their entirety. But Megan may have a comment about No.3.
Megan Boland: Probably just to add to No.3, Locals and Areas will provide services that are complementary to NDIS supports, so if it is that people also require support from other Areas or Locals, they will be provided with that support, noting that we’re not wanting to duplicate what’s already provided through the NDIS.
Matthew Hercus: And that’s part of that regional area focus, which the Royal Commission has called out and Katherine introduced; that local responsiveness, local understanding of a system, and consumers, carers particularly locally having understanding about how they can input into improvements.
Katherine, I might go back to Question 2 if that’s all right? The question for me – is that okay?
Katherine Whetton: It is, but just perhaps read it out because I think that not everyone can see them.
Matthew Hercus: Sure. Indeed.
Katherine Whetton: It’s all good.
Matthew Hercus: So Question 3 was, ‘How does the NDIS fit within your local regions and support?’
So playing backwards again, Question 2: ‘Do wellbeing supports also include primary preventive services?’ A great question. ‘Primary preventive’ for me sits in the local type service delivery in the first instance, where a helpful response is provided as early as possible in someone’s presentation to a service seeking supports.
Let’s not forget the importance of secondary preventive services, however, and you know this on the call, in providing the support services you do through prevention and recovery services and EIPSR models. Really critical that Area mental health and wellbeing components focus on the secondary preventive. So I would be so bold as to suggest wellbeing supports include both primary and secondary preventive.
I’d also point to the Royal Commission direction around prevention and wellbeing as a really important construct. In fact, the name of our Division is now the Mental Health and Wellbeing Division. And we will have as part of our structure, chief officer to guide us in that prevention and wellbeing – in those wellbeing directions. Megan, do you have any thoughts on primary preventive?
Megan Boland: Just that the Locals, yes, will definitely do early intervention to improve mental health outcomes for people and trying to avoid presentation to Areas and EDs is probably the aim.
Katherine Whetton: Thanks very much, Megan and Matthew. Are there any other questions that anyone wants to ask us? See how quickly you can type into the chat. Okay, we do have another question. So, ‘COVID-19 is clearly putting additional stress on services and workforce. Has the pandemic impacted Royal Commission work, and if so what changes are being made?’
I’ll have a go at that one. It’s a really challenging time, and I think it is absolutely fair to say that the ongoing restrictions are having an impact on our community, and absolutely on our workforce as well, and on services. And so there are – the Royal Commission set out a very good blueprint for a 10 year reform agenda, and we are getting along with those reforms because we think they are the right things to be doing, and they will be of great assistance and support for Victorians over time.
But we are conscious too that in the short-term, that there are things that we’re needing to put into place and additional measures, and people will be aware that there have been measures over time and additional funding provided to services to be able to provide that additional treatment, care and support, and we are also thinking about what additional measures we can put into place at the moment.
So I think we really do need to keep an eye on the medium to long term, because they are the things that we need to do. I talked earlier about the workforce strategy that we’re developing and really, really critical that we’re thinking about the existing workforce and the support that we’re providing there for the wellbeing of workforce, but also then thinking about how we can build the supply for future workforce as well. So yes, very, very conscious and think we do need to keep an eye on that medium to long term as well thinking about what immediate measures we might be able to put in place to support as well.
Thank you for that question. We’ve got another one. ‘How are we planning to ensure more peer-led providers are embedded from the outset as was intended by the Royal Commission recommendations?’ Matthew, do you want to handle this one?
Matthew Hercus: Yes, thank you, Katherine, and thanks questioner for raising this. The Royal Commission very clearly has called for all of us to respond and acknowledge the lived experience in whatever form that takes, and again we extend acknowledgments.
There’s a second question in thinking about the answer to the question, there’s peer-led providers, and there’s also peer workers and the peer workforce as well, which will continue as they do within the current service providers.
The better from the outset, of course one of the reasons for the call is to note that the Engage website has gone live, and we absolutely would welcome all Victorians with lived experience of caring, working with and having a lived experience of mental health and other support needs across life to participate in that at the individual level, and also some tailored conversations are coming.
We will be looking of course in the commissioning process to the capacity of service providers to articulate partnerships with peer-led providing organisations, and also to articulate their approach and their direction towards peer workforce. Megan, your thoughts?
Megan Boland: Yes, and I think we’re all in agreement that we need to do better in the peer-led space, and we don’t perhaps have that many peer-led organisations that have the scale that we are requiring to complete our reforms. So it is acknowledged absolutely.
Katherine Whetton: Thanks Megan, and again I do apologise for my lighting. It’s a bit distracting. The next question we’ve got is, ‘How does the reform connect to or would be impacted by the National Mental Health and Suicide Prevention Agreement that’s under negotiation?’ It’s a really good question and something that we’ve been working the Commonwealth now for quite a few months. There’s both the National Agreement that we are negotiating, and there’s also then a series of bilateral agreements that each state and territory will negotiate with the Commonwealth as well.
We think there’s some really strong alignment between the Royal Commission into Victoria’s Mental Health System, and there’s also of course the Productivity Commission report as well that the Commonwealth is focused on. So we have been talking about different principles and priorities to reform. They do line up very, very well, and we’ve certainly had even the Premier and the Prime Minister have talked about the importance of the Royal Commission report. It was a Victorian report, but it does hold true for a number of jurisdictions as well, and the Commonwealth is very conscious that we’re very focused on implementing the Royal Commission’s recommendations. It’s very important to us. So if anything, it’s a strength that we’re building on.
I’m just going to see if there’s another question. So our next question is, ‘What will be put into place to ensure that all mainstream services are culturally safe for people to use, and particularly Aboriginal people?’ Matthew or Megan, I might ask you to touch on these ones.
Matthew Hercus: No, thank you, Katherine. So really important shifts and adjustments the Royal Commission has called out too for the Aboriginal community, with the prioritisation of Aboriginal social and emotional wellbeing programs as well as community-controlled organisation and community-led functions.
The Department of course has a focus and an objective towards self-determination of the Aboriginal community, and that is right, and the process of supporting the Aboriginal social and emotional wellbeing support services will happen within that frame. Mainstream services of course are all required through various service provision agreements and improvement frameworks and performance accountability, statements of priorities and so on if you’re a health service, to undertake and demonstrate cultural safety.
A clear priority for ourselves in the Mental Health and Wellbeing Division, across mental health and AOD services, is to broaden that focus, deepen that focus, and look at frameworks which will support. There’s national frameworks which we are able to afford access to, which is important. There’s been multiple initiatives over the last 12 or 18 months irrespective of COVID. We have put in front of us some models for improvement, so there’s certainly work to be done in there, and that will be part of our objective.
Katherine there’s another question about the locals for the Locals being selected. Megan, do you want to talk about that? Will I talk about that?
Megan Boland: Sure. Thanks, Matthew. So we’ve selected the first six locations via our methodology around reviewing data for ED presentations, suicide rates, a number of other sort of criteria. So the – sorry, I have to think of the words to use. Matthew, help me with the IRSID?
Matthew Hercus: Indices of advantage and disadvantage. SEIFA.
Megan Boland: Yes, thank you. And we have looked at the demand for hospital services across all of the LGAs and come up with a methodology about the most urgent LGAs requiring further services. So there was a number of criteria, as I said, that were involved in selecting the first six, and will be involved in selecting the other ones to come as well.
Matthew Hercus: Of course, if I can jump in Katherine?
Katherine Whetton: Yes.
Matthew Hercus: Noting that the recommendation is for between 50 and 60 Locals across the state of Victoria, so I think fair to assume that in whatever part of the state, a local service will be way more accessible than the current service system affords.
Katherine Whetton: Thanks Matthew, that’s a really good point. We do have a question, ‘Is there a preference for local board directors to be people with lived experience?’ And I think if we’re talking about the interim regional bodies that there’s really a mix of capabilities that we think we need for the chairs of those bodies, and so we are, as we develop our position description for those chairs, there’s a strong focus on people having governance experience, but also that they would have really good local knowledge of their region, but also that lived experience will absolutely be an important thing to be in that mix as well. So I think that we’ve got eight of the bodies to establish so that there will be that mix of capabilities we’re looking for across.
It's important to say that as well as the chairs there will be five members alongside - as part of those regional bodies, and that - we’ve been really clear on this – is that those regional bodies, the members will include a person with lived experience as a consumer and also as a carer. So that’s a really important aspect of making sure that we are really having that rounded out set of experiences and capability on the interim regional bodies.
Now I’ll just check if there’s one more question and then we might move to wrap up. So the question is, ‘How can we be involved in specific consultation for the first 6 local sites?’ Matthew or Megan, who wants to take that?
Megan Boland: I can take that. So the place-based consultation is going to occur after the tender is released, and the reason for that is so that potential service providers can attend those consultation sessions. They’re going to be with local communities and service providers in the local areas, local governments, advocacy groups, etc. and the idea of having prospective service providers in the room is so that they can hear the feedback from the community about how they want to experience Locals in their local communities. So that’s the reason we’re doing it post release of tender, and just so we can get a better insight into what is required in those particular areas, taking into consideration local nuance and what services are already in existence in those areas. Thanks.
Katherine Whetton: Thanks, Megan, and I think we’ll go to our final question so that we can wrap, that, ‘How will workforce development be consistent across the regions?’ Matthew, can I hand that one to you?
Matthew Hercus: Yes, certainly Katherine. And so Katherine’s reference in the introductory presentation around the state-wide workforce plan is indeed a beginning, as was noted and referenced. And again, I think this is one of those opportunities but also the challenges the Royal Commission has put in front of us as a system, and collectively as a system of providers.
To ensure integrity and fidelity and local access through the regional-based approach requires that there is actually a consistency in workforce accessibility across regions. It would not be appropriate for us to be establishing a particular region with a stronger workforce base than another region, because of course that debases that idea of fidelity, integrity and consistency. So there will definitely be - in the streams of work for interim regional bodies for supporting the workforce plan, there will definitely be some work around workforce in the initial stages, and as the state-wide workforce plan rolls out, there will be continuous work around each region having workforce plans that are aligned to state-wide work.
In a similar theme, the Royal Commission has called for us to plan the system differently, undertake state-wide planning in a way which sets the state-wide view of services and replicate that state-wide planning and integrate at regional and at area levels.
Again there’s a question about the PHN interface there, because there’s lots of planning occurring with PHNs, and that planning will also include workforce considerations as well. Thanks, Katherine.
Katherine Whetton: Thanks, Matthew. Look, given we are running close to time let’s wrap up the questions there. But before we close I did want to just spend a couple of minutes talking about how we’re very committed to working with you and the workforce and organisations that can help deliver on this reform vision. We are very conscious this is an all of system and all of community reform, and that we really do need that everyone is playing their role in the reforms.
So this beautiful picture on the slide, hope what it illustrates is that our approach to engagement is an incremental one. So in May when the budget was released we held a series of budget briefing sessions to really be able to inform our stakeholders about the budget outcomes and what we would be seeking to implement with that investment. And since then we have been approached by many organisations and individuals asking to be kept in the loop with the way things are – the work is underway. Our stakeholder database has been growing ever since, and we have – this database is being shared across the Division in the Department, and that we do have plans that we can extend its use.
We’re also developing a series of resources to support the divisional staff in engagement efforts, and as I’ve touched on today, early reform efforts are underway, and people who are leading on each of those initiatives are undertaking engagement already, and I’m sure that a number of you have been involved in things along the way so far, and we will be doing much more of it as well. So we do continue to shape our efforts about our broader advisory structures as well, and this is quite a pivotal piece for us and the engagement strategy.
A really important part of the engagement is how we communicate with you, and we are doing some work on redesigning our website so that you do have access to the latest information about where we’re up to and opportunities for further engagement as well, and so looking at other ways that we can send out regular broadcasts or newsletters, whatever – at how it looks, so that can be user friendly as well.
We’re also keen that we’re shaping a culture that embeds engagement and continual learning so that we really are focused on that deep consultation, collaboration, and that it really is second nature to us in our work. We are in a state of transition as we move from our previous structures in the Department to our new Mental Health and Wellbeing Division. We went live with our new structure in late July, and we’ve got quite a bit of work to do to build up the resources in the Division, and if you’ve been having a look you might have seen, we have started recruitment to fill a number of executive roles and also non-executive roles as well. So we do think it is going to take a number of months to bring people on board so we can reach capacity.
I’m really keen that we bring staff into the Division with lived experience, both from a consumer and carer point of view, and that expertise and experience also from the mental health sector. So a bit of a plug for our recruitment drive, but please keep an eye out for any of those ads if you are keen for opportunities to work with us.
And many of the steps we take now and in the coming months, they will be incremental as we do build up our capacity and as momentum for the reform grows as well. We really do want to make sure that we’ve got genuine engagement, and I do appreciate just how much interest there is in getting involved in the work, and we look forward to keeping on sharing information, detail about next steps for that engagement.
And then finally, as we do come to a close today I wanted to take an opportunity to thank you for making the time today to attend this event. We hope that it has been informative for you. As I mentioned earlier, we’ll circulate a recording of today’s events, the slides that we’ve used, and also answers to submitted questions, and these will be put onto the Department of Health website shortly.
As Megan said, we are running an Engage Victoria process at the moment, so I really encourage you to go and visit that website to find out more about the consultation opportunities that are now available for the Local Adult and Older Adult Mental Health and Wellbeing Services. And there are some other links there on the screen where you can go for further information as well.
So with that I thank you very, very much for your attendance today. Thank you for the ongoing work that you do every day. I hope you have a good rest of the week and we’ll look forward to engaging again with you shortly.
Thanks, everyone. See you later.
Reviewed 06 October 2021