CENTRAL Victorian agencies are feeling the strain of flaws in the state's mental health system.
Submissions to Victoria's Royal Commission into Mental Health from organisations based in our region detail a range of challenges, from funding to staffing to support for carers.
But there's a common thread: a desire to better service the needs of some of the community's most vulnerable members.
Lifeline calls for help
Lifeline Central Victoria and Mallee has used a submission to Victoria's Royal Commission into Mental Health to make the case for increased funding.
Chief executive Rebecca Cornish wrote in her submission that the centre was at risk of closing its doors, with an annual deficit of $200,000 and only $140,000 a year from the state government.
"Volunteers are being taken off phones and from doing their lifesaving work to raise funds," the submission stated.
The region's Lifeline centre called for the community's help in 2016 to maintain its level of service.
But its Royal Commission submission, prepared earlier this year, spoke to a more urgent need.
"If Lifeline Central Victoria and Mallee does not receive more financial support from the state government there is a significant likelihood it will need to close its doors. This would be a significant loss for our community and none of us want to see that," the submission stated.
Ms Cornish yesterday said Lifeline Central Victoria and Mallee had no intention of closing and she did not want the community to be alarmed.
"We're a resilient organisation that's stood the test of time despite limited funding, and we have been working hard to build up our other program areas to help respond to that deficit, in particular building up the training unit of our business," she said.
She told the Bendigo Advertiser the centre's annual deficit was closer to $120,000. Ms Cornish said the centre's budget had been finalised since the statement was prepared.
"We're very appreciative of the state government funding we do receive but it's just not enough to cover all our costs," she said.
Lifeline Central Victoria and Mallee's submission said state government funding was "under a third of what would be reasonable".
It said the Lifeline centre was on skeleton staffing with three employees, only one of which was full time.
"Our operational budget which includes salaries, rent, insurances, payroll and all other business-related costs is conservatively $340,00," the statement said.
Ms Cornish yesterday said the centre had enough staff to respond to operational expectations, though it was not as much support as it would like.
She said the centre managed its deficit through the goodwill of the community, fundraising and donations, and building up the training unit of its business.
"Even with current restraints, Lifeline Central Victoria and Mallee does an amazing job," Ms Cornish said.
She wrote in her submission that the centre responded to about 14,000 calls from distressed community members every year.
"We've scaled back on fundraising because I don't want to take people off the phones," Ms Cornish said.
She said the centre would like to provide more early intervention services and was working with other community providers in terms of building up its suite of programs.
Story continues below Lifeline Central Victoria and Mallee's Royal Commission submission
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Ms Cornish told the Royal Commission that operating a Lifeline centre was very expensive.
"It costs approximately $3500 to train just one volunteer. Lifeline Central Victoria and Mallee runs two semesters of training each year with up to 30 volunteers in each round," the submission stated.
It went on to state the centre's financial situation was "not feasible".
"We are at risk of closing our doors and have the potential to continue our great work and increase our reach into smaller rural towns who are desperately wanting our service. We need funding to do what we do," the submission said.
Ms Cornish said Lifeline Central Victoria and Mallee wanted to do more in the space of mental health training, but was restricted by the "highly limited funding" it received.
The submission also suggested rural Lifeline centres receive funding to establish satellite centres into other regional areas.
"I have had significant numbers of requests from towns in our region wanting a local Lifeline centre," Ms Cornish wrote.
She emphasised the importance of investing in services in rural centres.
"Small rural communities simply lack the resourcing and education the larger centres have," the statement said.
"Often rural areas experience high levels of risk factors that are going unaddressed. There is often increased stigma in smaller communities and Lifeline centers seem to be the one organisation that people off the land will relate more too as the core premise of a Lifeline center is it's mates helping mates who are doing it tough - it is everyday people who want to be there for each other.
"Greater investment in small rural centers have the potential to work with the community in a preventative way that many others will not due to the unique nature of what we do and the respect people have for our service."
Ms Cornish wrote that Lifeline centres were an essential part of the fabric of communities and needed to be properly supported and funded so they could continue.
She made a distinction in her statement about the funding local Victorian centres received.
"Lifeline is advertised regularly throughout all media, however local centres lack the funds and support to meet the increasing need," the submission stated.
"Given the significant advertising it would be likely the community would believe that the Victorian Lifeline centers are well funded and would be incredibly surprised to see the limitations of this."
Lifeline Central Victoria and Mallee chief executive Rebecca Cornish said people could help by:
- Donating directly to the centre at: lifelinecvm.org.au/donate-today/
- Volunteering their time to assist with fundraising by calling 5443 1330 or emailing email@example.com
System under strain
HOSPITALS are having to discharge mentally unwell patients earlier than they'd like to manage demand for inpatient services, according to Bendigo Health.
The health care group's submission to Victoria's Royal Commission into Mental Health details the burden of decades of "systematic shortfalls" in funding, infrastructure and workforce capabilities, combined with increasing demand for services.
Bendigo Health said the average length of stay for patient in mental health inpatient units was constantly decreasing.
Patients "deemed to be the least unwell" were being discharged "to 'create' capacity to admit those more acutely unwell".
The submission said occupancy rates were "well and consistently above the national recommended levels" in order to support patient flow.
Other strategies included "the utilisation of other psychiatry units, as well as at times general wards as an interim solution until an appropriate bed is available".
Examples included admitting an adult patient into an aged psychiatric bed.
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Bendigo Health wrote of extended wait times in emergency departments - an environment, it noted, was "acknowledged to be clinically inappropriate for safe and effective treatment of mental health patients".
"Across Victoria, mental health patients have been the most represented patient cohort when wait times in emergency departments have exceeded 24 hours," the submission stated.
The health care group warned of the harms associated with implementing such strategies, though they helped manage throughput short-term.
"The flow-on effects to patient care, family/carer burden and staff morale and resourcing are evident," Bendigo Health wrote.
More important, it said, were the long-term effects.
"The adverse impact and burden of a work environment that persistently requires clinicians to implement treatment decisions based on demand rather than best practice is not to be underestimated," Bendigo Health wrote.
It suggested a number of ways in which the Royal Commission into Mental Health could improve the situation.
The 26-page submission contained 17 recommendations.
Five recommendations related specifically to workforce.
Other key issues included access and funding equity; service provision; therapeutic environment; occupational health, safety and wellbeing; and informatics and statutory reporting.
Story continues below Bendigo Health's Royal Commission submission
Bendigo Health highlighted flaws in the way a number of elements of services it provided were funded.
They included the health care group's role supporting smaller hospitals and health services that did not have mental health beds or clinicians.
Bendigo Health assists 23 services within its catchment area with mental health care.
"A 'one size fit all' approach does not ensure equity and appropriate allocation in relation to funding," its submission said.
"Rather, it often results in services being required to re-direct core and/or growth funding to address these shortfalls and gaps."
It called on the Royal Commission to assess the management of mental health responses to emergency departments.
Bendigo Health also highlighted the need for a review of specialist statewide services.
"Whilst there are a reasonable range of statewide specialist services within the mental health system, many of these are based in Melbourne," the submission said.
"As a result, these services, including Eating Disorder, Forensic, Borderline Personality Disorder, Neuropsychiatry and [children's] inpatient beds, are often in high demand resulting in delayed access and a limited ability to provide early intervention."
Bendigo Health recommended the broad and consistent range of specialist services be provided in all regions.
"To the extent that this is not possible, increased assistance is required to assist patients from rural and remote regions, as well as their family/carer to travel from their community and be appropriately accommodated within Melbourne where these essential services are located," it wrote.
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It stressed that resource levels and funding for care of people experiencing serious mental ill-health should extend beyond crisis treatment, to achieve long-term recovery and wellbeing.
"For an effective and responsive mental health service, sufficient capacity across both inpatient and community services is essential," Bendigo Health said.
The health care group's mental health beds almost doubled with the opening of the new hospital in January 2017.
In its submission, Bendigo Health identified staffing as a major challenge it had to overcome to make the facilities available.
"Bendigo Health has effectively managed, and continues to manage, these challenges to ensure quality care is provided," it wrote.
"How these workforce challenges will be confronted and managed at a broader level needs to be addressed as a key adjunct in planning increase in services and bed numbers".
Agencies call for changes
"BRING back the programs and support services that worked well prior to NDIS," a central Victorian organisation has urged Victoria's Royal Commission into Mental Health.
The Loddon Mallee Mental Health Carers Network wrote in a submission that two major changes in the way support was provided - the roll-out of the NDIS and the impending transition to the Integrated Carer Support System - had been 'fundamentally negative' for service participants and their carers.
It called on the Royal Commission to ensure people who had not transitioned into the NDIS had easy and fast access to treatment and support services.
The organisation said there had been uncertainty around future supports for mental health carers within the new NDIS environment.
Loddon Mallee Mental Health Carers Network said funding for a mental health respite program was the second-highest funded carer support service in 2015-16. That funding was committed to the NDIS.
The submission said carers were becoming burnt-out because "carer support has dwindled to zero" and "there is no longer anywhere to turn for assistance".
"There is no longer the compassion or understanding for carers or for the many thousands of people with a mental illness who didn't transition into the NDIS, it's cold and it's ugly," it stated.
The Loddon Mallee Mental Health Carers Network represents people living in about a quarter of the state.
It encompasses 10 local government areas: Greater Bendigo, Mount Alexander, Macedon Ranges, Central Goldfields, Loddon Gannawarra, Buloke, Campaspe, Swan Hill and Mildura.
"It is contended that this region of Victoria is the most poorly serviced for mental health," the organisation's submission stated.
The region is home to 16.5 registered mental health clients per 1,000 people - about five per cent more than the state average.
"The vast distances, low population densities and extensive pockets of low socio-economic disadvantaged communities all combine to form considerable challenges in accessing mental health supports and services," the submission stated.
Loddon Mallee Mental Health Carers Network was among a number of central Victorian agencies that highlighted how critical mental health carers were to the system.
The organisation also detailed what it believed was needed to better support carers in their roles.
"The value of this caring role effort outstrips the actual expenditure on mental health by government each year by a considerable margin," its submission stated.
"Without continuity of care and seamless transitions between the various parts of our current mental health system, care recipients continue to cycle in, out and around the system.
"The bulk of care is still being provided by families and carers who despair at this repeated cycling, particularly as it does not offer much hope of genuine recovery."
The submission said carers were paying the price for a lack of government funding, at a very high cost to their own health and wellbeing.
"All too often services refer people on because they are 'too complex' or 'too risky', yet carers are expected to cope regardless," it said.
Story continues below Loddon Mallee Mental Health Carers Network's Royal Commission submission
A lack of appropriate accommodation for their loved ones was by far the biggest issue facing carers, Loddon Mallee Mental Health Carers Network said.
"This is a persistent and pervasive issue which needs critical and immediate action. Without it, many carers are forced to house their loved one, regardless of the toll it takes," the submission stated.
It was also next to impossible for someone to manage chronic mental health issues without a roof over their head, Loddon Mallee Mental Health Carers Network said.
"Yet there is no pathway to obtaining that secure, appropriate housing."
The submission made the case for carers to receive support in their school, study and work environments and for the role they were performing for a loved one experiencing mental illness.
More than a third of the Loddon Mallee carers surveyed in 2016 could not access mental health services, in-patient hospital beds, a psychiatrist, a GP or psychologist within a year of their loved one becoming unwell.
More than half were travelling more than 100 kilometres for specialist mental health services. Almost 20 per cent were travelling more than 200 kilometres.
Seventy per cent of respondents were caring for a person who had a condition or disorder additional to their mental health issue.
About a third of carers were themselves experiencing mental health issues as a result of their roles.
Loddon Mallee Mental Health Carers Network said services needed to be responsive to the additional needs of carers in rural and regional Victoria.
A number of central Victorian organisations raised issues specific to rural and regional areas.
Several also identified the need for culturally sensitive services for Indigenous central Victorians.
Bendigo and District Aboriginal Co-operative called for more funding for mental health workers within Aboriginal Community Controlled Organisations.
The organisation's submission highlighted the importance of culturally-safe settings in which Aboriginal people could access services and support.
"Many Aboriginal men feel shame and reluctance to talk about their mental health issues. Programs that allow Aboriginal men to feel safe in acknowledging and raising their mental health is imperative," it stated.
"Aboriginal women also need culturally safe places to raise their needs, experiences and issues."
BDAC said there was an opportunity to improve the service system for Aboriginal people and support self-determination by creating service and community hubs that understood and worked within Aboriginal understandings of health and wellbeing, connecting people with culture and with kin and community.
"Access to treatment is a significant issue for our BDAC community - there are very long wait times," the submission said.
"ACCO-based psychologists are very much needed."
Racism, intergenerational trauma caused by colonisation and disconnection from culture were among the key reasons BDAC identified for poorer mental health outcomes among Aboriginal Victorians.
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