Brisbane North Safe Space Reportnorthbrisbane.pirinitiative.com.au/wp-content/uploads/... · 2018-10-09 · ] v E } Z ^ ( ^ E Á } l W } i Z } } i X ] v E } Z ^ ( ^ E Á } l W } i

Safe Spaces Network for Brisbane North Project Report.

Brisbane North Safe Spaces Network Project Report

2 | P a g e W e s l e y M i s s i o n Q u e e n s l a n d f o r N o r t h B r i s b a n e P i R .

Safe spaces network for Brisbane North Region: Progress report Wesley Mission Queensland for North Brisbane Partners in Recovery November 2017



Table of contents

1. Introduction .............................................................................................................................. 5

1.1 Background ............................................................................................................................. 5

1.2 Methodology ........................................................................................................................... 5

2. A regional safe spaces strategy ................................................................................................. 6

3. Themes, challenges and opportunities ...................................................................................... 8

3.1 A guiding framework ............................................................................................................... 8

3.2 A community-based movement rather than a service delivery response .............................. 9

3.3 From crisis to prevention: the spectrum of safety planning ................................................. 10

3.4 Skilled assessments ............................................................................................................... 12

3.5 Goal setting and clarifying responses when frequent hospital presentations are a factor. . 13

3.6 The support needed to make community spaces work: community centres ...................... 13

3.7 Volunteers and the community: it takes a village ................................................................ 14

3.8 Expanding the role of trained peer workers ......................................................................... 15

3.9 A typology of safe spaces ...................................................................................................... 15

3.10 Guidelines for safe spaces ..................................................................................................... 16

3.11 Sensory methods .................................................................................................................. 19

3.12 Housing responses as part of safe spaces planning .............................................................. 19

3.13 Mutuality between participating organisations: warm referral pathways ........................... 20

3.14 Structuring the safe spaces network response ..................................................................... 20

3.15 A symbol and logo: branding the safe spaces network ........................................................ 22

3.16 Is the boundary limited to Brisbane north? .......................................................................... 22

3.17 Evaluation ............................................................................................................................. 23

3.18 After-hours options ............................................................................................................... 23

3.19 The risk of confusion about language ................................................................................... 23

3.20 Iterative approaches, and starting small .............................................................................. 23

3.21 Other spaces, opting in and other innovations..................................................................... 23

4. Brand ...................................................................................................................................... 25

5. Recommendations .................................................................................................................. 26

Appendix 1: Examples of safety plans with a focus on suicide prevention ..................................... 29

Appendix 2: Safe spaces brand .................................................................................................... 30

Appendix 3: Evaluation ................................................................................................................ 33

Appendix 4: Safe space options ................................................................................................... 42



Acknowledgements

This project would particularly like to acknowledge these contributions to the progress of this project.

North Brisbane Partners in Recovery Collaboration in Mind Group Formal working group of CIM:

Aftercare Communify Footprints MIFQ NEAMI International Open Minds WMQ Emma Davidson

Frank Winters from Six String Designs for assisting with logo and brand development All participants from all workshops for their input and guidance.



1. Introduction 1.1 Background In 2016, North Brisbane Partners in Recovery (PIR) funded an investigation into safe space alternatives responding to the needs of people who frequently present to hospital emergency departments because of distress. Wesley Mission Queensland conducted this research involving a literature review and extensive engagement with key stakeholders. This process identified that there is not a single service delivery model that can respond to every need and that safe space needs are shaped by the uniqueness of individuals.

The project reached the conclusion that rather than a single safe space model there is a need for a regional strategy that harnesses existing infrastructure, resources, services and skills and builds on this with specific interventions aimed at addressing system gaps. The following is a quote from the project report reflecting these findings:

The need for safe-space alternatives to emergency departments in North Brisbane reflects the full diversity of human experience. Having choices and options depending on circumstances, preferences and geography emerges as a critical factor in concluding the need for a Brisbane North Regional Safe Space Strategy rather than a single preferred model or service.

North Brisbane Partners in Recovery worked with the Collaboration in Mind Group (CiM) to see the Brisbane North Safe Space Strategy become part of their work program for 2017. This resulted in Brisbane North PiR committing some additional funds towards progressing two main elements of the proposed Safe Space Strategy:

Increase individual, coordinated safety plans as part of key worker support Identify and harness existing safe space options.

This progress report harnesses subsequent engagement and directions for a safe space network and individualised safe spaces planning. It provides some directions and actions for further project consolidation.

1.2 Methodology This project took into account information and research from the initial report and also input from a Safe Space Symposium held in December 2016. It built on this material through:

Input from a working group of people from the CIM group Interviews and discussions with community centres, specialist mental health agencies,

consumers, libraries, Local Government, churches, a community choir, and clinicians Input from the PiR network (one meeting and one teleconference) Two workshops seeking input at key milestones Research to evolve ideas for tools and resources to assist with implementation (including a

safe spaces planning tool and guidelines for safe spaces in the network).

The project also engaged an artist to work on concepts for a brand and logo based on the research, project video and art work from the project conducted through 2016. Logo concepts were generated and a short list has been identified for further consideration by key stakeholders.



2. A regional safe spaces strategy The suggested Brisbane North Safe Spaces Strategy identified multiple elements intended to be mutually reinforcing.

The following diagram shows the different elements of the suggested strategy. Those elements that relate to this current project are highlighted in blue:

Figure 1: Overview of a Brisbane North Regional Safe Spaces Strategy

The strategy recognises that when a person experiences significant vulnerability and where perhaps frequent presentations to emergency departments are already taking place, that a support guarantee is very important. Similarly, the project identified the need for after-hours hubs where people can visit and from where outreach can take place.

Regional safe space

strategy

Harness robust multi-sector governance and

leadership

Increase individual, coordinated safety plans as part of key

worker support

Identify and harness existing safe-space

options/facilities and resources

Initiate sub-regional safe-space hubs using existing buildings and achieve capacity for after-hours staffing.

Include outreach capacity.

Offer a support guarantee to

emergency department frequent presenters

Develop workforce capacity and capability to contribute to safe-

space solutions

Include scope for new innovations

Ensure rigorous evaluation



The proposed strategy also recognises that wellness, recovery and wellbeing depend on a deeper and wider set of opportunities to link more with people and places that contribute to a better life. This tool kit focusses on a positive and preventative view of the future and is intended to support people in a way of working towards recovery that is unique to them and linked to a set of universal opportunities to connect and contribute.

A Safe Spaces Network is aimed at responding to the needs of people with diverse experiences including:

people who seek out safety by visiting emergency departments of hospitals people who have other needs for safe space as part of wellness and recovery and who may or may

not yet have some strategies they use that reflect their uniqueness and interests.

It is possible to locate a safe spaces network in a broader framework of interventions acknowledging the specialist role of mental health services in a way that is complementary to other contributions. This intervention pyramid highlights specialist and non-specialist supports as well as stronger community and family supports. The pyramid also acknowledges the role of advocacy in a broader sense to improve access to a range of options. The arrows indicate where individualised safe space planning and a network of safe spaces might fit in.

Figure 2: Intervention pyramid



3. Themes, challenges and opportunities This section outlines themes, challenges and opportunities that emerged in the process of doing research and consultation about safe spaces.

3.1 A guiding framework Recovery principles and practices are currently embedded in mental health service delivery models. Engagement in this project continued to affirm this as a core framework to guide the implementation of the Brisbane North Regional Safe Spaces Project. Working with people towards individualised safe spaces plans combined with working at the community level to increase the options and choices available is highly consistent with core recovery principles such as:

the uniqueness of the person providing real choices listening to people about their preferences and hopes for the future partnership with the person and a respect for human dignity.

Australian Government Department of Health, 2016

Yet the processes of working to develop a safe spaces network are fundamentally based on community development methods of working. Bringing diverse stakeholders together in ways that increase collaboration, improve dialogue, enhance learning and achieves an exchange of strengths and skills are all essential to this project and to how a community-based partnership will be achieved and sustained into the future.

The project spoke to community and neighbourhood centres where the guiding framework is often described as community development. With the involvement of community centres and community development workers, there is capacity to recognise and embrace community development methods as essential to building the network and achieving a sustained exchange of strengths and capacities involving the mental health system, universal community services, broader community, peers and volunteers. The processes of building, consolidating and expanding the network will require community development methods and skills to be effective. It should be acknowledged that community development approaches seek to maximise participation, and change power dynamics. It aims to build both relationships and structures that support people to work together in their own communities to impact the issues and opportunities they identify and prioritise.

The original Project Report (The Clarion Call) also suggested that a model describing First Home, Second Home and Third Home is relevant. This model highlights the scope for wellbeing exists across the domains of:

Our selves (first home) The house or dwelling that we live in (second home) The broader community (third home).

Kraybill, 2012

Thinking about individualised safe spaces planning, people might identify goals and actions across one or more of these domains. There is scope for change involving personal actions designed to positively impact thoughts and feelings. There is also scope for broader community linkages and connections that are welcoming, supportive and encouraging.

Taking into account the previous report and the engagement towards this stage of the project, an integrated framework that draws on the following three frameworks is suggested:



3. Recovery 4. First home, second home and third home 5. Community development.

These three guiding frameworks are highly consistent and complementary and open up the scope for a safe spaces strategy to be guided in the following ways:

Figure 3: A unifying framework to guide the implementation of a regional safe spaces strategy

3.2 A community-based movement rather than a service delivery response While the importance of service delivery is clearly established, this strategy is more focussed on engaging non-mental health specialists in supporting wellbeing and recovery. As the safe spaces strategy is advanced, it is important that it is seen as a community based movement rather than a single service delivery response. To support this, it is essential to build on the role of the CIM in holding a multi-agency, region-wide approach that strives to work collaboratively to achieve choices and options for consumers of services rather than a single, concentrated service delivery relationship with one or even a few specialist agencies. While individual agencies may take on certain responsibilities, maintaining CIM leadership and oversight and working to engage as many agencies as possible is critical, combined with the involvement of community centres, gardens, libraries etc. thus deepening the community’s overall response. Agencies that take on specific and even funded roles in the safe space project will need exemplary capacities for collaboration and partnership building and be capable of working within a community development framework that galvanises a broader/deeper community response.

Community development

methods: the process for change

First home

second home

third home: the scope for

change

Recovery principles and

practices: the purpose for change

and a foundation



3.3 From crisis to prevention: the spectrum of safety planning Discussion with mental health services about the idea and practice of universal safety planning highlighted that:

Diverse practices are in place There were different views about the role and function of individualised safety plans being

somewhat focussed on crisis management most often associated with suicide prevention or something more long term and characterised by an earlier intervention approach

Networks such as the PiR network don’t necessarily adopt or share the same assessment and planning tools and this is not something that is mandated by their funding program.

Figure 6 highlights a possible spectrum of safety and safe spaces planning:

Figure 4: Spectrum of safety and wellness planning

Crisis management---------------------------------------------------------------Wellness planning (Such as WRAP)

Suicide prevention plans------------------------------------------------------------------------------Safe spaces plans

While some stakeholders saw the idea of a safety plan as being about suicide prevention, others took the view that safe spaces planning was a broader approach potentially relevant to a wider cohort of people while also being helpful to people with a history of suicidal ideas and attempts.

The project investigated various safety planning tools and these were nearly always focussed on suicide prevention. Some of those identified are provided in appendix 1. This material shows a selection of suicide prevention planning tools to indicate there is reasonable consistency across different tools about what domains and fields to use as planning prompts.

Given that suicide prevention is a region-wide priority, there is perhaps scope to consider the adoption of a common suicide prevention planning tool and some have emerged based on rigorous research, and have associated tools such as websites, online planning tools and an app (such as in the case of Beyond Blue). The ones outlined in appendix 1 all share an elegant simplicity which provided some guidance to consideration of a safe spaces planning tool.

For the purposes of this project however there is support for a prevention/early intervention tool that may be suitable for a broader cohort of people who seek safe space solutions or who may benefit from safe space solutions based on identified concerns and challenges such as isolation and a lack of things to do. For the purposes of delineating this approach from other readily available safety plans, it is referred to in this report as an Individual Safe Spaces Plan1.

Through research and engagement with stakeholders, the following framework emerged and is presented for further discussion:

1 Safety planning is a recognised term in responding to domestic violence as well as suicide prevention.



Table 1: DRAFT Individual Safe Spaces Plan

Proposed Individual Safe Spaces Plan Question/prompt Now In the future What can I do to make the place I live somewhere that is more safe for me?

Examples: Create a calm corner Listen to music Do stretching

What can I do in the wider community so that I feel more connected and/or safe? Where can I go?

Visit coffee shop Join a choir Go to a community

meal at my local community centre

What things do I like doing that I could do myself or with others?

Craft Sport Watching my favourite

TV show

What help do I need to make these things happen?

Someone to go with me the first few times

Transport Money to cover costs

Who can help me make it happen?

Support worker Someone I know

Who can help me celebrate my progress?

Family member Friend Neighbour Someone I know at

the shops Support worker

Summary of actions: Actions Who needs to help

make this happen? How and/or where?

Contacts for people who can help: Name Phone number 1 Phone number 2

People I have shared this plan with: Name Phone number 1 Phone number 2



3.4 Skilled assessments The consultation often highlighted the role that skilled assessments play in identifying the scope for working to address wellness goals. It is important that risk assessments are part of identifying when a safe spaces plan might be helpful and when other associated types of planning are important and essential including suicide prevention or safety planning.

The consultation also highlighted that different services have different approaches to assessing the number of hospital presentations that occur for example. This may or may not be known by a support worker or care facilitator and therefore the question of when safe spaces planning might be prompted emerged. How do support workers and support facilitators know when a safe spaces plan might be helpful? How can this be prompted or suggested based on an assessment of need?

It was raised that workers and consumers already engage in many assessments and are required to provide/collect a lot of data. The scope for some shared data collection at the point of assessment is one that needs more discussion as workers are concerned about:

The time that more questions at the point of assessment will take The challenge to integrate more data collection and new fields into existing data systems because

of time constraints and also that systems are diverse across agencies and changes can be costly.

It would be helpful to evaluation outcomes if data collection did identify people who perhaps frequently present at emergency departments, GPs or other services with unmet psychosocial needs. Yet this does need further discussion at least initially with the PiR agencies to identify ways to achieve:

An appropriate assessment of when a safe spaces planning process would be helpful and is warranted

A way of tracking clients/consumers who have safe spaces plans as a basis for evaluation.

To assist in identifying when a safe spaces plan might be helpful, the following might be taken into account:

The person indicates they don’t have enough things to do The person mentions things they like to do but experiences barriers to making those things part

of their life (such as confidence, cost, distance etc.) The person spends most or all of their time at home or in a limited number of places The person has few or no broader community or social connections or their social connections are

concentrated among specialist services and/or few or one family/friendship link The person has a known history of frequently presenting to hospital, GP or other specialist services

related to unmet psychosocial needs.

In one or more of these situations, it may be helpful to explore having a Safe Spaces Plan. If a person is identified as experiencing more serious risks such as the risk of self-harm or suicide, then it is important to assess whether suicide prevention planning is a more appropriate approach. An individualised assessment of needs might result in one or both types of planning being used to focus on an immediate crisis and future prevention.

Some ongoing workforce development might include continued exploration of:

Differentiating the need for a safety plan and a safe spaces plan Assessment skills and questions that help to identify when a safe spaces plan might be helpful.



3.5 Goal setting and clarifying responses when frequent hospital presentations are a factor.

Some discussion during the engagement raised questions about whether people should be discouraged from going to hospital. The idea of safe spaces planning is not intended to involve active discouragement from hospital presentations but rather an additional option where support workers or care facilitators can explore with people future options and possibilities within a plan. This type of safe spaces planning should focus on diverse options and the support needed to achieve those options rather than provide active discouragement from any existing options of patterns. It is imagined that the process of change will be incremental rather than a sudden change from existing patterns of behaviour and places – an approach that might raise risk.

3.6 The support needed to make community spaces work: community centres as a case study The project has significant positive feedback about the scope for participation in a pilot project of networked safe spaces linking with mental health services. Community centres were particularly supportive highlighting that the scope of their activities includes many spaces, events, services and activities that people who experience mental health difficulties already access.

Community centres as an important part of a network highlighted the ongoing challenge of low levels of resourcing. They often are an access point for people seeking many types of help and experience significant gaps in service delivery.

A number of resource gaps were identified:

The need for visiting/outreach mental health services The need for more community development resources to support outreach and access to diverse

population groups The need for centre-based community development capacity to support networking, linking and

welcoming activities including through leveraging the role of volunteers as much as possible Support for volunteers including training and other capacity building as many volunteers interface

with visitors to the centres.

There is a need to continue dialogue about how community centres can be better supported to offer access and support to people when they visit. Community centre coordinators saw this as an active and very present role, that when people visit, they are well-supported and make contact with people who can help them link with others and with things they can do.

This raised a number of important possibilities:

That future projects to secure resources for safe spaces includes some resource capacity for community centres to actively welcome people who visit and link them with programs, services and activities

That mental health specialist agencies consider the scope for providing visiting services to community centres to help facilitate contact and referral with people who need more mental health assistance

That mental health specialist agencies enter into protocols with community centres about being a line of contact, assistance, referral and advice – in many examples this is often the case but in some locations this needs to be enhanced or may not yet be in place.



That resources, tools and training are offered to community centres and in particular to volunteers who are trained inter-regionally to explore and build capacity for confidence and responsiveness to people visiting who may have mental health difficulties

That the scope for paid peer roles in community centres is explored.

3.7 Volunteers and the community: it takes a village The safe spaces project raises options for greater involvement of citizens and community members in mental health responses that are led and owned locally. Group 61 is already a model of identifying and supporting volunteers to become involved in actively supporting people with their goals around social, recreational and community connections. As community centres and other locations such as choirs, community gardens, social enterprise coffee shops and other community drop in places all have volunteers and some of them are in significant numbers. There is an opportunity to enhance the capacity of these volunteers about deliberately and mindfully responding to mental health challenges in the community. There is significant appetite for relevant volunteer training across agencies and regions to build the sense of a movement and an identity for people working and responding in this way. This could be an important way that mental health specialist agencies can offer practical assistance to a broader community response. Agencies identified significant difficulties in paying for volunteer training for example so some resources contributed towards training opportunities would be helpful.

Some ways of actively supporting volunteers helping to provide safe space include:

Supporting volunteers in helping to provide safe space options

1 Recruit volunteers with an interest in responding to mental health challenges.

2 Provide orientation and training to support volunteers to understand mental health.

3 Provide orientation and training to support volunteers to understand ways of working and relating to people that builds community and belonging.

4 Create role descriptions for volunteers that involve a mindfulness about creating welcoming spaces (physical elements and relational elements).

5 Involve volunteers in maintaining welcoming space (reducing clutter, making improvements, making suggestions about improvements)

5 Provide volunteers with someone they can reflect with and talk to about what they are learning and experiencing.

6 Ensure volunteers have a worker they can connect with if they are concerned about someone who may need more assistance.

7 Provide written materials to support volunteers’ learning about mental health.

8 Celebrate the contribution of volunteers.

9 Develop leaders and champions among volunteers who take particular care to support and promote safe space solutions.

10 Involve volunteers in planning for the future and in reflecting on how things can be better.



3.8 Expanding the role of trained peer workers The engagement processes continued to affirm the importance of potential peer roles in decentralised safe spaces. There is scope to consider how these roles might be identified and engaged. Given the work done by PHN and PiR to develop and strengthen peer worker roles and peer input to policy and service delivery, some continued dialogue about the role and value of peers in a safe spaces network is important.

There was an idea to involve people doing Certificate IV in peer work doing their placements in the provision of safe spaces. There may be other scope to include students from different backgrounds as well.

3.9 A typology of safe spaces Many key stakeholders have identified safe space alternatives that include existing services and buildings as well as universal access points such as community centres, community gardens, libraries and coffee shops. It was suggested that a typology of safe spaces is considered to reflect a way of managing expectations when people visit safe spaces that are part of a network. Stakeholders were careful to suggest that safe spaces needed to offer a clear understanding of the level of support, access and assistance that is available. The following is a suggested (draft) typology aimed at helping to clearly identify how safe spaces may contrast and also complement one another.

Table 2: Suggested tiers for safe spaces

A service that offers mental health specific programs

May be a multi-service or program agency offering various types of assistance based on eligibility criteria

People may visit for formal and informal activities or groups or drop in for contact with people or just to use space for a visit

People can request support and other mental health specific assistance if they need it and be referred internally.

Includes specialist mental health services or programs within the organisation

A universal service that offers different programs

Is connected to referral pathways into mental health services and can offer referral support

People can visit for formal or informal activities or groups and drop in for contact or to just use space and relax

People can request support and other mental health specific assistance if they need it and be referred externally.

A universal community service such as a community centre

A universal space or venue where everyone is welcome

Maybe includes optional experiences or activities

Can be used in active or passive ways to spend time, be active, rest or relax.

A universal space or venue such as a garden, coffee shop or library.



3.10 Guidelines for safe spaces Some stakeholders suggested that there could be guidelines for safe spaces that help emerging safe spaces in the network to build capacity and responsiveness. These types of guidelines could also be used in training. Some possible safe spaces guidelines are indicated below and focus on a set of six themes:

Leadership and governance Partnerships and collaboration Welcoming space People and skills Mental health support Reflection and improving

Table 3: Safe Space Guidelines to support community services to become same spaces

Ref Safe Space Characteristics How Next steps 1 Leadership and Governance 1.1 Your board or management committee

actively supports the organisation’s involvement in offering safe space.

1.2 There is evidence of this commitment in organisational plans and other documents such as brochures.

1.3 The CEO and senior managers know about and are committed to the organisation making a safe space contribution and support other staff to help make it happen (such as through supervision).

1.4 There is a safe-space champion identified as a point of contact and to take special responsibility for implementation.

1.5 Your organisation links with other community leaders and shares information about the safe-spaces strategy.

2 Partnerships and collaboration 2.1 Your organisation actively links to other

safe-spaces in your region.

2.2 Your organisation seeks to respectfully collaborate with diverse organisations towards achieving varied safe space solutions.

2.3 Your organisation participates in an MOU with other organisations about offering safe space and supporting other safe space contributions.

2.4 Your organisation participates in the Safe Spaces Strategy regional cluster meetings.



Ref Safe Space Characteristics How Next steps 2.5 Your organisation links with the

Collaboration in Mind Group’s work to develop, resource and enhance the Safe Spaces Strategy.

3 Welcoming space 3.1 There is a space or spaces where people

can visit or gather for informal contact.

3.2 There are activities that people can join and participate in if they want to.

3.3 Spaces are designed to be calming and welcoming.

3.4 There is space where people can sit quietly if they need to.

3.5 There are people who provide a welcome point of contact.

4 People and skills 4.1 Staff are aware of and committed to

participation in providing a safe space.

4.2 Staff have access to training to support them in understanding and responding to mental health.

4.3 Staff are offered an orientation about safe space responses.

4.4 Volunteers are supported and trained to contribute to safe space solutions.

4.5 Peers are involved in supporting your agency to provide safe space solutions.

5 Mental health support 5.1 There are active referral pathways into

mental health specialist support when needed (either internally or to other agencies/partners).

5.2 Mental health services brochures are clearly on display and readily available.

5.3 Information about mental health is available (such as brochures, posters).

5.4 Your organisation displays the safe space logo.

6 Reflecting and improving 6.1 Your organisation uses team meetings,

supervision and group discussions to reflect on how safe space is provided.

6.2 Your organisation seeks feedback from safe space users and how safe spaces could be better.

6.3 Your organisation works with partners to seek feedback about current strengths and ways of improving.



Ref Safe Space Characteristics How Next steps 6.4 Your organisation reports to

stakeholders about the delivery of safe space solutions.

6.5 Your organisation incudes safe space in formal evaluation processes when they occur.

It is acknowledged that some safe spaces are less formal and require a simpler framework of guidelines. These may be universal spaces that may or may not be staffed by people for example. These may be used by users and other stakeholders to describe and promote a space as somewhere to visit.

Table 4: Safe space guidelines for universal gathering places.

Ref Safe Space Characteristics How Next steps 1 The most senior people are committed to

contributing to safe space solutions.

2 Your organisation links with other community leaders and safe spaces for support and an exchange of ideas.

3 There is a space or spaces where people can visit or gather for informal contact.

4 There are activities that people can join and participate in if they want to.

5 Spaces are calming and welcoming.

6 There is space where people can sit quietly if they need to.

7 There are people who provide a welcome point of contact.

8 Staff (when present) are offered an orientation about safe space responses.

9 There are links with mental health services for extra support.

10 Your organisation seeks to learn and reflect on ways of improving.



These types of guidelines exist in other sectors such as guidelines to help agencies and services be more responsive to people living with a disability and guidelines to support the inclusion of LGBTI communities.

It is imagined that a set of guidelines will be refined and evolved through experimentation. It is suggested that these guidelines are workshopped further by initial safe space networks and then regularly reviewed and refined based on what is being learned. In this sense the process needs to be iterative and continuously open to dialogue about improvements at every stage.

3.11 Sensory methods The role of sensory methods was identified as relevant to home-based and community space options. There are examples of sensory methods being used in community spaces such as libraries and community centres. It is suggested that support to create sensory options in more universal spaces is explored. There is considerable thinking and practice emerging about the value of sensory methods that have been applied in clinical settings, institutions, community and other spaces.

3.12 Housing responses as part of safe spaces planning Some stakeholders highlighted that people’s choice to visit emergency departments can sometimes be driven by inadequate housing or homelessness. Homelessness or insecurity of tenure can be a factor in people seeking out safe space alternatives. Again, this assessment is important as are linkages to options that perhaps help mental health specialists to link people with appropriate housing solutions. There are a number of direct referral agencies and also care coordination networks operating throughout the north Brisbane region that may be helpful as part of the Brisbane North Region Safe Spaces strategy.

Many organisations include a housing assessment as part of a broader assessment. It can be helpful to ensure an understanding of the person’s current housing and housing history. It is important to be certain wherever possible whether housing conditions or homelessness are factors in a person seeking safe alternatives such as by going to hospital.

Questions might include:

What is your current housing situation? How is that going? Is there anything about your housing you need help with or would like to change? Where have you lived in the past and how did that go? What kind of support will help you keep your housing?

Sometimes people may be living in a situation that represents a degree of homelessness (rough sleeping, couch surfing or living in insecure or shared premises). This can be a factor in people seeking out alternative spaces including later in the day and into the night. A careful housing assessment can help to identify where housing is a factor in people feeling unsafe where they live or are staying. This assessment is a basis for:

Assessing housing needs Assessing housing history Understanding whether there is a history of sustaining housing or if a person has cycled in and out

of housing options and homelessness Identifying housing goals Identifying all factors and domains that impact on the sustainability of current and future housing



Identifying support arrangements (type, intensity, time frame) that will help achieve sustainable housing solutions into the future

Working as quickly as possible to address housing needs and achieve a sustainable, longer term option.

3.13 Mutuality between participating organisations: warm referral pathways and active engagement and support

There is concern among agencies such as community centres that people referred to safe spaces will be loosely referred without adequate support. Some of the concerns were about the lack of resources in community centres should this take place ‘at volume’. It was seen as important by consumers and by agencies that people are not just the subject of cold referrals or ‘dropped at the door’ without introductions and active support to make links and relationships.

Some mental health services cited concerns about lack of time in actively referring people by going with people to new locations. Some agencies also didn’t see this as part of their key role. This element needs further discussion to identify a ‘practice’ of linking people to safe spaces. It shouldn’t be a passive approach to referral but rather an active, relationship building approach with the goal of consolidating new connections as much as possible.

Community centres are keen to strengthen referral pathways and there are some very positive examples of how some existing referral pathways involving mental health specialist agencies are working well. It is important that structurally there are ways of making sure that ongoing implementation challenges can be spoken about in a spirit of open dialogue.

3.14 Structuring the safe spaces network response Brisbane North Region is expansive, taking in diverse locations including the inner city, outer suburbs, and regional towns and cities. In a number of discussion, it was explored how a regional safe spaces network could be structured.

It emerged that the central role of the CIM and a CIM working group is valued and critical to success. It was agreed that the continuation of a CIM working group is important to the future of the project. In addition to this, the idea of sub-regional safe space clusters emerged where there is scope to meet a couple of times a year and also the facility to communicate through forums and other web-based options as something of a community of practice.

Brisbane North Safe Spaces Strategy requires consideration of structures that support leadership and direction at the same time as sub-regions are able to respond on unique ways harnessing local strengths and opportunities. A key feature of a Safe Spaces Strategy is that it provides opportunities for decentralised and localised responses while being more broadly connected to a regional approach supported by key leaders.

The structural arrangements suggested to support the implementation of the strategy includes:

Leadership and governance by the Collaboration in Mind Group, inclusive of key PiR agencies and other key mental health stakeholder agencies

Building sub-regional clusters inclusive of: o Specialist mental health services such as Partners in Recovery and Personal Helpers and

Mentors Programs o Community Centres o Libraries o Coffee shops (where identified)



o Group 61 volunteers (where available). Sub-regional structures/groups would meet at least two times each year to plan together and

exchange ideas, experiences and shared solutions to common challenges. One option if for each sub-regional group to come together once a year as well for learning opportunities and knowledge exchange.

Sub-regional structures would be helpful in: o Brisbane inner north o Brisbane middle and outer north o Redcliffe o Caboolture o Pine Rivers.

Each sub-region might benefit from a yearly action plan that guides implementation. This might address:

A purpose / aim Two or three goals A few specific actions to support those goals Responsibilities and time lines Key roles such as a sub-regional champion and organisational champions/leaders Ways of meeting (when, where, how (such as through technology) Terms of reference for the cluster group. Ways of evaluating success.

Safe space clusters in sub-regional areas may look like networks with different organisations and locations offering diverse space and activities. Sub-regional safe space champions could be a contact point within the sub-region and also facilitate contact between the regions for the purposes of learning and exchange.

With a sub-regional focus, safe space options could be gradually added so that there is more diversity suited to individualised needs.



3.15 A symbol and logo: branding the safe spaces network An artist was engaged to develop some safe space network logos and these were reviewed by the CIM, CIM Working Group and workshop participants. The design brief provided key words and all of the project reports and art work from the previous project. While some slight preferences emerged, the advice of the workshop was to retain the umbrella image and integrate the idea that safe spaces options can almost be mapped like a constellation. The initial options for safe space logos are attached and the assessment of different options is included in appendix 2.

There was advice that:

The font needed to be friendly, informal and accessible The look needed to avoid a corporate look and be very community friendly The image should be able to work alone and also with words. It would be good to have:

o Just an image o An image with the words Brisbane North Safe Spaces Network o An image with the words Safe Spaces Network.

3.16 Is the boundary limited to Brisbane north? In the processes of engagement, people identified other safe spaces options in other parts of Brisbane for example. There is acknowledgement that a safe spaces network could be broader than north Brisbane and that there is scope to scale this type of approach.

Champion role

Safe space cluster

safe space

Safe space

Safe space cluster

safe space

Safe space

Safe space cluster

safe space

Safe space



3.17 Evaluation The project sought input from an evaluation specialist who provided a framework of tools and approaches to assist. These need to be further examined and explored by the CIM Working Group and sub-regional networks. The framework includes:

Stages for process, impact and longer term outcomes evaluation Suggested questions and tools to measure perceptions and practices and the take up of tools.

This framework is currently being simplified into a one-page summary to support early implementation of sub-regional clusters including use of the safe spaces planning tool suggested earlier. The approach to evaluation is elaborated on in appendix 3. It should be noted that the question of evaluation was raised in the first report about safe space alternatives and a literature review highlighted the lack of robust evaluations of safe space and emergency department alternatives. Building in an evaluation framework early into implementation creates opportunities for measuring early processes as a basis for continuous improvements and having the data longer term to measure impact and outcomes. There is a need for further discussion about how this would be implemented and how data capture could take place. There are concerns about the time it takes to collect extra data so further discussions are needed to reach agreement about the scope of data and evaluation as part of this initiative.

3.18 After-hours options The need for after-hours safe spaces continues to emerge and some PiR agencies and community centres were seen as an option to consider a trial of some after-hours options leveraging from existing activities. This was seen as a very limited trial but one that could be further explored as part of early implementation. Two PiR agencies indicated a willingness to see if existing partnerships with community centres could be slightly expanded to include an after-hours trial of activities even if this was only one night a week.

3.19 The risk of confusion about language The consultation raised the issue that the language of ‘safe space’ has been used with and identified with safety from violence. There is also a ‘safe place’ network using a rainbow or pink triangle symbol providing support to LGBTI communities. It was suggested that next steps might include some engagement with each of those sectors to clarify any issues with language and assess the risk that language might cause confusion about what people can expect at spaces identified as part of this network.

3.20 Iterative approaches, and starting small There was advice that while many elements may need refining and further definition that an approach to catalysing this initiative is to start soon, start small and then engage in iterative learning, planning and implementation. In this mode, it was seen that developmental progress could be made that results in more resources, tools, willingness and options. Some of the issues and concerns in some ways can only be dealt with through practical actions where there is structural support to resolve any challenges and realise opportunities through meaningful dialogue.

3.21 Other spaces, opting in and other innovations A range of ideas and opportunities were identified in the project including the following for further consideration in subsequent phases:



There is considerable work going on to strengthen community meals in various places and it was suggested that a network of meals is included

There should be application processes where new safe spaces can assess themselves and opt to join. Ways for joining should be clear and accessible.

The project spoke to one app developer about the scope for an app to help locate regional safe spaces. There is an existing service delivery app that could be built on for this purpose and could be included in a subsequent phase at a reasonable cost

In some ways safe spaces are like a community of practice and they need ways to exchange learning and knowledge

The guidelines could become more formal like the Rainbow Tick system and a type of accreditation – perhaps in co-design with the first wave of participants

The project spoke to the College of Psychiatrists and a retired psychiatrist about mentoring a safe spaces network. While currently practicing psychiatrists may not have the structures for participating directly it was suggested by one clinician that a call out through the College of Psychiatrists journal might discover some people willing to volunteer in this way

Finding a high profile community champion could help promote and expand safe spaces.



4. Brand A process of reviewing several brand options was undertaken (see appendix 2). The brand is intended to identify a network a safe space options and unite agencies and people participating. After a layered process of prioritisation and selection, the following two images will be used:

2

2 The Safe Space Project acknowledges the contributions of Frank Winters from Six String Designs for developing the logo concepts.



5. Recommendations

Governance and leadership 1. That the CIM remains the governance group overseeing the implementation of the Safe Space

Regional Strategy. 2. That a CIM sub-committee is formalised to work more operationally to support the safe spaces

regional strategy implementation. The role of the sub-committee would also be to inform and report to the CIM about progress and milestones. This sub-committee should adopt formal terms of reference.

Guiding framework 3. That a guiding framework is adopted that synergises recovery, first second and third homes

and community development. Community development is important to the process of building and maintaining a network of safe spaces.

Structural arrangements 4. That the project now works to develop sub-regional safe space clusters bringing together an

initial network of safe spaces identified in this project. 5. That each cluster has a safe space champion and that safe space champions link with each

other to exchange ideas and to help trouble-shoot challenges. The safe space champion role could be further augmented by engaging and connecting retired clinicians in regional locations.

6. That consideration is given to each safe space participating organisation identifying a champion or key contact person to facilitate engagement between and across agencies and regions.

7. That an initial statement of commitment is signed by participating agencies who agree to use safe space guidelines.

Training and capacity building 8. That training is provided for volunteers across regions and agencies as a capacity building

measure to support continued and enhanced engagement with people who visit safe spaces. 9. That an orientation to using safe space tools and guidelines is provided to participating

agencies.

Capacity and resources 10. That an after-hours trial of some activities in community centres is conducted involving a

partnership with existing PiR agencies. This should leverage off existing activities and groups wherever possible and involve two trial sites initially.

11. That further resourcing for a Regional Safe Spaces Strategy includes consideration of enhanced resources for community centres in being able to support building-based and outreach activities that improve access and inclusion by people seeking safe space solutions. This could include some after- hours capacity to offer activities and access to safe spaces.

12. That a Brisbane North Region safe spaces community development role is identified and resourced to provide ongoing support to the development, consolidation and eventual expansion of a safe spaces network.



Tools and brand 13. That mental health support workers and care facilitators from PiR agencies trial using the

Individual Safe Spaces Planning tool for a period of four months and use this trial to review and refine content and processes of implementation.

14. That further discussion about the adoption of a common suicide prevention planning tool is undertaken within the PiR network.

15. That all tools and guidelines are trialled and refined after a period of four-six months in a co-design process.

16. That the chosen brand is distributed as door stickers and used to identify and unite a safe space network.

Communication and further engagement 17. That a regional gathering of all stakeholders is held to provide people with clear feedback

about the project findings and directions as well as next steps and ways to remain involved. 18. That consideration is given to developing a website to link people with safe space resources

and also an app that guides people to available safe space locations. 19. That a network of retired clinicians is identified and linked to the project to provide supportive

mentoring.



Appendix 1: Examples of safety plans with a focus on suicide prevention Beyond Blue WICHE Centre for

rural mental health (Colorado)

Youth Suicide Prevention Program

My warning signs

Warning signs What are the signs that a crisis is coming?

My warning signs Warning signs

My reasons to live

Make my environment safe

Making the environment safe

What can you do to remove risks from your environment? Who can help?

Things I will do by myself

Internal coping strategies

What coping strategies can you use first?

Personal coping strategies

Internal coping strategies

I will cope, calm and soothe myself by… I will tell myself…

Connect with people and places

Social contacts who may distract from crisis

Where can you go or who can you be with to distract yourself?

People to call. People and social settings that provide distraction

I will go to.

Friends and family I can talk to

Family members or friends who may offer help

Who are your support people who you can tell about the crisis and ask for help?

People whom I can ask for help.

I will call…

Professional support.

Professionals and agencies to contact for help

Who are your support people who you can tell about the crisis and ask for help? What are the available professional resources?

In an emergency

Appendix 2: Safe spaces brand Input on a preferred brand reflected the following results (referenced to the attached document on brand options).

Page 4 1

Page 5 1

Page 6 1

Page 7 1

Page 8 1

Page 9 1

Page 10 1



Page 14 1

Page 16 1

Page 18 1

Page 19 1

Page 12 2

Page 13 2

Page 15 5



At one workshop several people suggested the following logo mostly because of the umbrella concept perhaps integrated with an image of constellations. At a final workshop presenting results to participants, a review of logos was undertaken and the following two were selected to the be the brand. It is anticipated that participating agencies will display this logo so their involvement in the strategy is identifiable.



Appendix 3: Evaluation

Assumptions and conditions

1. This plan is to evaluate the implementation of a Safe Space Planning Tool + Safe Space Network (collaborative platform). This initiative is designed to ultimately reduce consumer need for hospitalisation and other acute health service use.

2. Data for this evaluation will come from multiple sources: o A survey of Safe Space Workers before and after implementation of the Safe Space

brand, planning tools and training (Safe Space Worker Survey) o A survey of eligible PiR consumers (with a recent history of hospital ED

presentation) before and after implementation of the Safe Space brand, planning tools and training (Safe Space Consumer Survey)

o PiR Client/Consumer Records o HHS Data on hospital admissions

3. Safe Space Worker surveys should ideally include all staff operating within the Safe Space

Network, including those employed by PiR and those working in Safe Space collaborating organisations.

4. It is recommended that both worker and consumer self-reported data for the purpose of service evaluation are collected by people who are independent of the providers of service being evaluated. Independence of data collection from service provision may be important for managing self-report (social desirability) bias in the self-reported data from consumers, and therefore the validity of findings associated with that data. If there is low feasibility of independent collection, participants can self-report and return their responses anonymously (or, for example, to PiR or other service providers in a sealed envelope or secure online survey).

5. This plan assumes that individual-level data for consumers who consent will be provided by PiR (from client records) for engagement in Safe Planning with consumers that have a history of ED presentation, PiR worker's use of SS Planning Tools and referrals to Safe Space Network.

6. This plan assumes that individual-level data for consumers who consent will be provided from the relevant HHS/Queensland Health for admissions, length of hospital stay and number of readmissions within 28 days of discharge. In addition, aggregate rates for each quarterly period will be supplied for total number of unique eligible patients admitted and discharged, with separate reporting of unplanned admissions only. See here for contacts for CIMHA data custodian if needed for negotiating data access: https://www.health.qld.gov.au/ohmr/documents/regu/data_custodian_list.pdf

7. This evaluation design is limited by lack of an independent non-exposed control group. Individuals who participate in the evaluation are acting as their own (historical) control participants (i.e., a one-sample within-group pre-post design) for many outcomes, and being compared to retrospective, aggregated population rates for others. This means that other initiatives which participating individuals are exposed to during the evaluation period



may account for any changes or differences detected. Such parallel initiatives should be monitored and recorded as part of any ongoing evaluation that lacks a valid control group, and use of a controlled design is recommended for evaluation beyond this pilot phase.

8. Assessment of different types of service use may also (i.e., in addition to evaluating effects on acute service use) be used to monitor potential unintended negative consequences (e.g. increased demands on other care providers/services, particularly community-based services).



Conceptual Design

Safe Space Initiatives

• PROCESS EVALUATION• PiR workers' engagement in Safe Safe Planning with consumers that

have a history of ED presentation• PiR worker's use of SS Planning Tools for eligible consumers (reach,

adoption)• Consumer, PiR worker's and network staff's awareness of Safe Space

Network ('brand' awareness)

Proximal/Immediate effects

• IMPACT EVALUATION• PiR worker and Safe Space Support Network staff's confidence to

effectively support people in psychological distress• Consumer perceived change in Recovery• Consumer confidence to use Safe Spaces effectively (when to access,

how to access, appropriateness for need, etc.)• PiR workers' Referrals to safe space alternatives• Workers' more positive attitudes toward helping people with mental

illness (stigma)• Consumer use of Safe Space Network services• Consumer Subjective Units of Distress Tool and Outcomes Star

Distal/Longer term effects

• OUTCOME EVALUATION• Hospital admissions (number of admissions, length of stay and

readmission frequency) at consumer level; • Other acute health service use (Ambulance, Emergency Department)



Consumer Pre-Implementation Survey

Indicators Assessed:

Perceived change in Recovery Safe Space Network Brand Awareness Confidence to use Safe Spaces effectively (when to access, how to access, appropriateness

for need, etc.) Consumer use of Safe Space Network services Consumer Subjective Units of Distress Tool and Outcomes Star Heath service use Consent to data linkage

Instructions for administrator:

Include any consent procedures required at commencement of this entry survey. Must include some individual identifier for linkage with prospective data.



CONSUMESAFE SPACE SURVEY:

PRE-IMPLEMENTATION

UNIQUE IDENTIFIER:

What is this survey about? This survey asks you questions about your own experience as someone using PiR services. Your responses will be kept confidential and will be combined with the answers from other consumers to help us understand how well our services are meeting everyone’s needs.

1 Over the last 6 weeks, do you think that you…(tick one box only)

Have moved forward in your recovery journey? Have stayed pretty much the same? Have moved backwards in your recovery journey?

2 In the last 2 months, how often have you done each of the following for your mental health? (including stress, anxiety, depression, or dependence on alcohol or drugs) (Write the number of times in the box)

Number of times

Been admitted to hospital overnight (or for more than one night)

Visited a Hospital Emergency Department

Been attended to by Ambulance Services

Visited a GP

Visited a mental health worker (e.g., psychologist, psychiatrist, social worker)

Visited a community service

Self-help group or online forum

Please tick here So we can avoid asking you the same things more than once, please tick here if you consent to us linking your survey responses with other information you have provided.



Consumer Post-Implementation Survey

Administered by _________


Perceived change in Recovery Safe Space Network Brand Awareness Confidence to use Safe Spaces effectively (when to access, how to access, appropriateness

for need, etc.) Consumer use of Safe Space Network services Consumer Subjective Units of Distress Tool and Outcomes Star Heath service use Satisfaction with the Safe Space Network

Instructions for administrator:

Must include some individual identifier for linkage with previous data.



CONSUMER SAFE SPACE SURVEY: POST-IMPLEMENTATION

UNIQUE IDENTIFIER:

1 Over the last 6 weeks, do you think that you…(tick one box only)

Have moved forward in your recovery journey

Have stayed pretty much the same

Have moved backwards in your recovery journey

2 In the last 2 months, how often have you done each of the following for your mental

health? (including stress, anxiety, depression, or dependence on alcohol or drugs) (Write the number of times in the box)

Number of times

Been admitted to hospital overnight (or for more than one night)

Visited a Hospital Emergency Department

Been attended to by Ambulance Services

Visited a GP

Visited a mental health worker (e.g., psychologist, psychiatrist, social worker)

Visited a community service

Self-help group or online forum



3 Would you recommend the Safe Space Network to a friend? (Mark one box only)

NO YES

4 If you could change one thing about the Safe Space Network, what would it be? (Write your response on the lines below)

5 What was the most helpful thing about the Safe Space Network? (Write your response on the lines below)

Please complete your details below if you agree to us contacting you in the future to help us determine how well our service has met your needs. We will never pass on your details to anyone else.

First Name Surname Address Suburb Postcode



Worker Self-Report Data Collection Tools

Worker Pre-Implementation Survey Administered by __________________________


Prompted and unprompted awareness of the Safe Space Network Confidence to effectively support people in psychological distress Attitudes toward helping people with mental illness (stigma)

SAFE SPACE WORKER SURVEY: PRE-IMPLEMENTATION

UNIQUE IDENTIFIER:

2 How confident are you to…

1. Refer a person experiencing distress to a NON-ACUTE mental health support service/s 2. Engage and collaborate with mental health support service/s for people in distress 3. Assist a person with mental illness to EMPLOY SELF-MANAGEMENT STRATEGIES 4. Assist a person if they were experiencing a crisis or risk of self-harm

3. Stigma: Attitudes of health care providers towards people with mental illness (subscale from Kassam, 2012). Scoring of the attitudes of healthcare providers towards people with mental illness subscale

may range from 7 (least stigmatizing) to 35 (most stigmatizing).

Your views: Response options: 1 = Strongly disagree, 2 = Disagree, 3 = Neither agree nor disagree, 4 = Agree and 5 = Strongly agree.

1. I am more comfortable helping a person who has a physical illness than I am helping a person who

has a mental illness. 2. If a person with a mental illness complains of physical symptoms (e.g. nausea, back pain or

headache), I would likely attribute this to their mental illness. 3. Despite my professional beliefs, I have negative reactions towards people who have mental illness. 4. There is little I can do to help people with mental illness. 5. More than half of people with mental illness don’t try hard enough to get better. 6. Healthcare providers do not need to be advocates for people with mental illness. 7. I struggle to feel compassion for a person with a mental illness.



Appendix 4: Safe space options The following contacts have been explored during the course of the current project. The next step needs involve consolidating these contacts and formalising them.

Community centres

Encircle (Lawnton and Redcliffe)

Piccabeen

Woolloowin

Bowen Hills

Kelvin Grove

New Farm

Zillmere

Sandgate and Bracken Ridge

Nundah

Libraries

Moreton region

Community gardens

New Farm

Sandgate

Windsor

Coffee shops

Caboolture

New Farm

Nundah

Other spaces

Church Fortitude Valley

MIFQ Hub

Community meals

Choirs

Creativity Australia Choir in Brisbane City.

Documents

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