Living Well – Putting people at the centre of mental health reform

146 Pages·2014·4.06 MB·English

LIVING WELL
PUTTING PEOPLE AT THE CENTRE OF MENTAL HEALTH
REFORM IN NSW: A REPORT
OCTOBER 2014
© 2014 State of New South Wales

You may copy, distribute, display, download and
otherwise freely deal with this work for any purpose,
provided that you atribute the Mental Health
Commission of NSW as the owner. However, you must
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This Report is available on our website:
www.nswmentalhealthcommission.com.au

ISBN 978-0-9923065-3-3
This Report may be cited as:
NSW Mental Health Commission (2014). Living Well:
Putng people at the centre of mental health reform in
NSW. Sydney, NSW Mental Health Commission.
Publicaton of this Report:
In accordance with Secton 17(2) of the Mental Health
Commission Act 2012 the Mental Health Commission
of NSW recommends that this Report be made public
immediately.
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Cover image by Anthony Mannix:
The Beast of the Unconscious is Vivid
Inside details from other works by Anthony Mannix
Anthony Mannix’s art works are created mainly on
paper using inks, oils, watercolours, tea and ballpoint
pen. They have been widely exhibited in Australia and
are part of collectons in the US and Europe.
Mannix spent tme medicated and under involuntary
treatment in psychiatric hospitals, including the old
Gladesville psychiatric hospital where the NSW Mental
Health Commission ofces are now housed. His works
are confrontng yet compelling, and ofen humorous.
They express his experiences of mental illness and
insttutonalisaton, and also of exhilaraton and
joyfulness.
Anthony Mannix’s story is featured on page 11
of this Report.
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A LETTER FROM
THE COMMISSIONER
This Report tells the story of mental health in NSW
from the perspectve of people who live here.
This includes people who live with mental illness
and pursue their recovery through work, art or
connectons to their communites – and those who
are striving to change our systems of mental health
support, so that they respond more efectvely and
more proportonately to people in distress. This
includes Aboriginal people, people who live in the
country and the inner city, children and adults, and
people from diverse cultures who bring all manner of
life experiences to this document.
Some people speak directly, through the personal
stories presented here. These stories are testmony
to the extraordinary resourcefulness and resilience of
the human spirit, and to the strength and generosity
of families and communites.
The voices of thousands more are embedded in the words on every page.
During 2013 the Commission undertook what we believe is the most extensive mental health consultaton
conducted in NSW. We travelled the state, holding public meetngs and barbecues in small and large towns
and Aboriginal communites. We held meetngs in Sydney to hear the concerns of people from diverse cultural
backgrounds.
We established working groups, based on common mental health experiences at diferent tmes of life, in
which people with expertse gained from living with mental illness joined academics and service providers to
get to the heart of how our system responds now and to develop ideas for how we could improve it.
Those people were joined by hundreds of others who partcipated online in the reform planning project,
contributng their views and commentng on drafs.
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The pages that follow present a powerful and at tmes emotonal case for a new generaton
of mental health reform in NSW – one that puts people frmly at the centre. I am confdent
that this Report contains is a faithful artculaton of the ideas and experiences shared with the
Commission during our long and deep conversaton with the community, which will contnue as
we drive reform forward.
People have been let down in the past. Three decades ago, Australia began in earnest to reform
mental health care, recognising that isolatng unwell people in secure hospitals could not be
justfed in a humane society. We began to close the asylums; the subsequent history in which
we failed adequately to support people in the community is well known.
We live with the consequences of that failure every day. Our state of mind is the bedrock of our
whole life – afectng personal relatonships and family roles, interactons in our community,
the work or occupatons we pursue, and the fundamental ways we view ourselves and our
abilites and aspiratons. The whole of society loses out when we squander human potental,
when we limit the capacity of people to be our friends, colleagues or leaders because we do
not ofer them the right assistance when they need it.
This Report is a companion document to the Strategic Plan for Mental Health in NSW, in which
the Commission has developed what we heard about people’s experiences, needs, wishes
and priorites for mental health support and community wellbeing into specifc advice for
government.
Together, the Report and the Plan set an ambitous but achievable agenda for mental health
reform in NSW.
The Commission exists to promote change, and to guide and monitor it. But the Commission
cannot make change happen. Positve reform that really benefts people who live with mental
illness is everyone’s responsibility.
I look forward to working with the Government, the mental health sector and the people and
communites of NSW to ensure that this tme round we fulfl the promise of reform.
JOHN FENELEY
NSW MENTAL HEALTH COMMISSIONER
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A NOTE ON LANGUAGE
Language is how we express the ideas in our minds, and is therefore a most powerful
agent that can reinforce separaton, stgma and discriminaton or, instead, work to
overcome our diferences and emphasise the things we have in common.
The Commission has atempted Some insttutons, programs and mental illness and people who
in this Report to ensure the models of care were known by live with mental illness are
language used refects and names we would now consider used interchangeably. The term
respects the experience of people stgmatsing and undignifed. consumers may imply that people
who live with mental illness, and consume or use mental health
In this Report we have updated
includes the whole community in services, when not everyone who
our use of language wherever
shared ideas of mental health and struggles with their mental health
practcal, to emphasise a more
wellbeing. does so.
progressive understanding of
But we know that some terms mental illness and to reassert the Client is used only to refer to
are contested, and may carry contnuing worth and capacity clients of partcular services, such
diferent meanings for diferent of people who experience it. as housing. Patent is sometmes
people. People who experience Occasionally, we have needed to used to refer to people who are
mental illness have diferent retain historical language to allow undertaking treatment, especially
perspectves from those of their readers to understand precisely the if this is in hospital.
families and carers. Doctors issues we discuss, and to seek out
Mental health support is our
may see things diferently from further references if they wish to.
preferred term both for clinical
nurses, social workers or health
This will not please everyone all and medical interventon and for
system administrators. Aboriginal
the tme, but we hope readers social support ofered to people
people’s understandings of
will accept our good faith in the with mental illness. It carries
psychological and social wellbeing
choices we have made. the noton that a person is stll
may diverge from those of other
responsible for their own life and
people born in NSW, or of migrant Some of our consideratons in
choices. Care is used sometmes,
communites. making these choices are set out
and refers to people who are
here:
Those nuances may be contained currently unwell. We have tried to
in a single word or phrase. Mental illness is the term we have avoid treatment because it may
typically used. Some people prefer imply a paternalistc relatonship,
This is partcularly problematc
mental ill-health because they usually with a doctor, in which the
when we encounter the language
consider it implies a less medical person is a passive recipient.
of the past, when people with
perspectve. We have generally
mental illness were marginalised We refer to drug and alcohol
avoided mental health disorders
and not expected to be actve use, drug and alcohol misuse
or conditons, unless the instance
partcipants in their own support. and drug and alcohol problems,
refers to a partcular report or study
depending on the circumstances.
in which these terms were used.
We avoid the terms abuse or
Mental health consumers (or addicton, which are imprecise
just consumers), people with and stgmatse people.
lived experience of mental
We have moved away from the
illness, people who experience
term non-government organisaton
(NGO) in favour of community-
managed organisaton (CMO)
though both appear in this Report.
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VALUES
In developing the directons for change described in this report, the
Commission has been guided by a set of core principles. These apply at all
stages of life, across all cultures, and for all communites in NSW.
gni g d e l w o n k c A e h t l a u q e e u l a v f o yr e v e n a m u h e f i l d l u o h s n i p r e d n u
Respect gnih t y r e v e e w o d o t t r o p p u s d n a e t o m o r p l a t n e m h t l a e h d n a
wellbeing. In partcular, we must ensure that government, community-
managed and private services always assure the autonomy, dignity and
yti l a u d i v i d n i f o e l p o e p o h w e c n e i r e p x e l a t n e m .s s e n l l i
e s o h T f o s u o h w e v i l h t i wl a t s n s e e m n l le i v a h e h t t h g i r o t t c e p x e o t d a e l
Recovery fulflling lives, and to pursue our own choices about how we live and
about the support we accept, regardless of whether are experiencing
.smo t pmy s sihT dluohs osla eb os ro f ruo seilima f dna .s re ra c
Strong connectons among people are the foundaton of mental
Community health and wellbeing and resilience for individuals, families and our
wider society. These connectons nurture social inclusion and respect
for diversity and are partcularly important for people who experience
lat nem senli dna ro f rieht seilima f dna .s re ra c
In partnership with consumers, mental health professionals, service
Quality planners and policy-makers must ensure supports and services meet
contemporary standards and are efectve.
elpoe P ohw evil htiw la t nem senli dluohs tcepx e o t eb de tropus
Equity equally in their recovery, regardless of their age, gender, culture,
sexual or gender identty, where they live or any other health
smelbo rp y eht .ev ah
ytilibisnopse R ro f laudividni dna ytinumo c la t nem htlaeh dna
Citizenship wellbeing is shared across our society. All of us, whether or not we
experience mental illness, should expect to contribute to that shared
mental health and wellbeing, and to be able get support when we
den .ti
e W dluohs e t ae rc na t nemno riv ne e rehw elpoep esohw se vil e ra
H O P E afected by mental illness can experience the benefts of positve
change and be optmistc for a beter future.
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CONTENTS
A LETTER FROM THE COMMISSIONER 2
A NOTE ON LANGUAGE 4
VALUES 5
CONTENTS 6
A LETTER FROM FAY JACKSON 9
ANTHONY MANNIX 10
WHAT WE KNOW 12
A NEW APPROACH TO ACUTE CARE 19
ELAINE 20
THE REFORM STORY 22
A LETTER FROM ALAN ROSEN 27
RESPONDING TO PEOPLE’S TRAUMA 29
SUPPORTING REFORM 30
A LETTER FROM ROBYN SHIELDS 33
USING CULTURE TO IMPROVE CARE 35
JASON 36
ABORIGINAL WELLBEING 38
A GROWING CONCERN 46
BEYOND THE CITIES 48
ANNA 52
A QUESTION OF DIVERSITY 54
SEXUALITY AND IDENTITY 56
HEALTHY BODY AND MIND 58
MAIA 60
INTELLECTUAL DISABILITY 62
TRAVELLING TOGETHER 65
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A MATTER OF JUSTICE 66
DRUGS AND ALCOHOL 70
WHAT WE NED 72
THE JOURNEYS
WHAT WE DID 78
READY TO LAUNCH 81
JOURNEY 1 – BUILDING COMMUNITY RESILIENCE AND WELLBEING 82
THE EARLY YEARS 87
JOURNEY 2 – THE BEST START 88
JOURNEY 3 – TROUBLED KIDS 92
GROWING UP STRONG 97
JOURNEY 4 – HEALTHY TRANSITIONS 98
MARK’S STORY 103
JOURNEY 5 – TOWARDS A BETTER LIFE 104
FREEDOM, HOPE, RENEWAL 109
JOURNEY 6 – BREAKING THE CYCLE 110
PAT’S STORY 115
JOURNEY 7 – BODY AND SOUL 116
ALL DUE RESPECT 121
JOURNEY 8 – LIVING LONG AND STRONG 122
IN CONCLUSION 126
ARE WE GETTING THERE? 128
A LETTER FROM BRADLEY FOXLEWIN 133
ACKNOWLEDGEMENTS 134
REFERENCES 138
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