MENTAL HEALTH AND THE JUSTICE SYSTEMcmha.org.au/wp-content/uploads/2017/06/2011Newparadigm... · 2017-07-13 · 4 newparadigm Autumn 2011 Psychiatric Disability Services 04 of Victoria

THE AUSTRALIAN JOURNAL ON PSYCHOSOCIAL REHABILITATION Autumn 2011

MENTAL HEALTH AND THE JUSTICE SYSTEM

CONTENTS

EDITORIAL Wendy Smith 04

MENTAL HEALTH AND THE JUSTICE SYSTEM Policing for positive mental health outcomes Elizabeth Crowther 06

Peace of mind: implementing the Victoria Police Mental Health StrategyEva Perez 10

Mental health and transition from prison to the community Paul Atkinson 13

Lighting the match: consumer participation at Forensicare Julie Dempsey 16

Bundji Bundji – supporting Indigenous young people in the justice system Freda Haylett 20

Prisons and the perpetuation of disadvantage Sam Biondo and David Taylor 23

The ARC List Carrie O’Shea 26

Penal solutions to social problems Indiana Bridges 29

Neighbourhood justice Caroline Ottinger 32

Smart Justice: responding to mental illness the smart way Michelle McDonnell 35

Inter-Church Criminal Justice Taskforce Antony McMullen 36

Mental health law reform - the Mental Health Bill Exposure Draft and beyond...Catherine Leslie 37

is published by

Psychiatric Disability Services of Victoria (VICSERV) Level 2, 22 Horne Street, Elsternwick Victoria 3185 Australia T 03 9519 7000, F 03 9519 7022 [email protected] www.vicserv.org.au

Editorial Team Wendy Smith, Editor Kristie Pate, Editorial Assistant Anthea Tsismetsi, Content Advisor

newparadigm Editorial Advisory Group Joan Clarke, Allan Pinches, Chris McNamara, Ellie Fossey.

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The power of peers MariaKatsonis 41

RESEARCHI’ve done my time, now what? The case for living skills interventions for people with mental health issues at risk of, and beyond, custodial sentences MurielCumminsandLouiseFarnworth 46

Violence against people with cognitive impairments: a study by the Office of the Public Advocate MagdalenaMcGuire 52

Co-designing mental health services – providers, consumers and carers working together KarenFairhurstandWayneWeavell 54

YOUR SAY…Opinion piece Strengths… time for a rethink? MaggieMaguire 60

Member profile Australian Community Support Organisation (ACSO)RobbRitchens 62

Expression session 64

Book review 66

New to the Resource Centre 67

Coming up in newparadigm 67

ABOUT US… 68

4newparadigm Autumn2011

Psychiatric Disability Services ofVictoria(VICSERV)04newparadigm Autumn2011

Psychiatric Disability Services ofVictoria(VICSERV)

Wendy Smith, PolicyandResearchManagerandEditor,newparadigm

EdItORIAl

WelcometotheAutumneditionofnewparadigm.Thethemeismentalhealthandthejusticesystem.ThiswasalsothethemeatVICSERV’smostrecentmembers’forum.Atthatevent,VICSERVPresidentandMentalIllnessFellowshipVictoriaCEO,LizCrowther,spokeabouthowcriticalanunderstandingofmentalillnessisateverypointwhereanindividualmightcomeintocontactwiththejusticesystem.LizhasworkedwiththegovernmentandVictoriaPoliceoveranumberofyearstoensurethatbetterunderstandingsareinplacethroughoutthesystem.Weareveryproud,therefore,tohaveherwritetheleadarticle.

ThearticlesthatwerecommissionedforthiseditionrangeintopicfromkeepingyoungKoorimalesoutofprison,throughtotheworktwoVICSERVmembersaredoingwithpeoplewhohaveamentalillnesspost-releasefromprison.AnoverviewoftheVictoria Police Mental Health Strategyisprefacedwithsomestarkstatisticsshowingtheamountofday-to-daycontactthepolicehavewithpeoplewhoarementallyill.Severalarticlesdescribeservicesthatareprovidedtopeoplewhoareincarcerated.VICSERV’scolleaguesattheMentalHealthLegalCentreInc.haveprovidedanotherexampleoftheirinnovativeworkwithprisoners.JulieDempseyisaConsumerConsultantatForensicareandofferswhatmightberegardedasasurprisinginsightintotheopportunitiesforclientparticipationinsecurefacilities.ThiseditionisroundedoutbyatopicalarticleontheMental Health Bill Exposure Draftandanarticleonawonderfulpeer-runmentalhealthprogramintheVictorianPublicService.

Thenewlyintroducedresearchsectionhasbeenpopularamongstreaders.Itisgreattohaveanarticleaboutsomesectorresearchwithajusticesystemfocus.TheVictorian

MentalHealthCarersNetwork(VMHCN)andtheVictorianMentalIllnessAwarenessCouncil(VMIAC)havewrittenanarticleonworkingtogetherwithstaffinaPDRSservicetoimprovequalityinservicedelivery.ThemodeltheyuseisthelatestinalongtraditioninVictoriaofparticipatoryandcollaborativeconsumerresearchinmentalhealth.Itisgreattocapturethiscurrentexampletoaddtotherecord.

TheauthorofourOpinionPiecestatesthatherattitudetooneofthedominantapproachesusedincommunitymanagedmentalhealthservicesis‘different’.Wethinkitwillpromotesomeinterestingdiscussionamongstourreaders.Wewelcomeallsortsofperspectivesandarehappytopublishreplies.

VICSERVhasrecentlysignedanMOUwiththeDaxCentretoreproduceartworkfromtheircollectionbypeoplewithamentalillness.TheExpressionSessionfeaturesthefirstoftheseworksanditisstunning.SpecialthanksareduetoCharlotteChristiefromtheDaxCentreforherassistancewiththisedition.

MENtAl HEAltHANd tHE JUStICE SYStEM



MentalIllnessFellowshipVictoriahasrecentlyratifiedapolicythatsetstheframeworkforouradvocacytoimprovetheexperienceofpeoplewithamentalillnesscomingintocontactwiththejusticesysteminVictoria.Improvingthecapacityofpolicetounderstandandmanagethechallengingneedsofapersonwithamentalillnessinappropriateways,withouttheuseoflethalforce,isoneofourkeyadvocacypriorities.

Policetrainingandpartnershipswithmentalhealthservicesareneededtoreducetheriskofharmduringpoliceinteractionswithpeoplewithmentalillness,andtocontributetomorepositiveoutcomesforpeoplewithmentalillness,police,andthewidercommunity.

Foralmostadecadenow,MentalIllnessFellowshipVictoriahascampaignedformoreandbetterpolicetraining,notonlytoprotectthehealth,safetyandhumanrightsofpeoplewithmentalillness,butalsotobetterprotectthesafetyofpoliceofficers,and,justasimportantly,toreducethecriminalisationofmentalillness,whichfeedscommunityfearsandprejudices.Thesefearsandprejudicesrunintwodirections:fromuninformedmembersofthepublictowardspeoplewithmentalillness,andfromfamiliesandfriendsofpeoplewithmentalillnesstowardsthepoliceforce.

Mostpeoplewithmentalillnessdon’tcommitcrimes,butwhenpeoplewithamentalillnessdocomeintocontactwiththepolice,itisfrequentlyinthefollowingcircumstances:

•policearecalledinacrisissituationwherefamilyorcarersarenolongerabletocontainasituationthemselves

•policearecalledifmembersofthepublicinterpretthesymptomsofmentalillnessasbeingdangerous

•mentalhealthservicesrequestpoliceassistanceiftheyarehavingdifficultydealingwithapersonincrisis

•apersonistakenintocustodyforcommittingaminorinfringementormisdemeanour.

Elizabeth Crowther, CEO,MentalIllnessFellowshipVictoria

Policing for positive mental health outcomes

Manyindividualswhocomeintocontactwithpolicedosobecausetheyhaven’thadaccesstotimelytreatment,communitysupport,housing,educationoremployment.Thereisaconcerningregularitytopoliceinterventioneventuatinginplaceofothersupports,andasaresult,toomanypeoplewithmentalillnessarecomingintocontactwiththejusticesystem.

ResearchcarriedoutthroughacollaborationbetweenMonashUniversity’sCentreforForensicBehaviouralScience,ForensicareandVictoriaPolicefoundthatinasampleof613peopletakenintopolicecustody,morethanhalfhadsomecontactwiththementalhealthsystem.Thepsychosisratewithinthissamplewas6.2percentcomparedwith0.7percentinthegeneralcommunityinVictoria.1

Thesefindingsarepartofabroaderresearchproject,fundedbytheAustralianResearchCouncilandledbyProfessorJamesOlgoff,toexaminethenature,purposeandoutcomeofpolicecontactswithpeoplewhoarementallyill,andincludesinterviewswithpolicetoexploretheirexperienceswithmentallyillpeople.Thefindingswillbeusedtodevelopabestpracticemodelfordiscussion.Thisgenuineattempttoimproveunderstandingbetweenmentalhealthpractitioners,consumersandthepolicegivesmecausetohopethatwewillbeabletobuildpartnershipsinordertobetterrespondtotheneedsofpeoplewithmentalillness.

the need for improved police training is well established

Followingthefatalshootingofa15-year-oldboyinaMelbourneskateparkin2008,theVictorianPoliceCorporateManagementRiskDivisioncommissionedanexaminationofpoliceshootingcriticalincidents,whichhadoccurredbetweenJuly2005andDecember2008.Oftheelevenpoliceshootingsthatoccurred

duringthattime,ineverycase,mentalimpairment,mentalillness,anddrugsoralcohol,wasprevalent.2

In2010,researchersintheCentreforForensicBehaviouralScienceatMonashUniversity,foundthatofthe48fatalpoliceshootingsinVictoriabetween1982and2007,87percentofvictimshadschizophreniaandotherseverementalillnesses.3

ThreeyearsbeforethedeathofTylerCassidyinMelbourne,theOfficeofPoliceIntegrity(OPI)hadrecommendedthatVictorianpoliceofficersbebettertrainedtoidentifyandmanagepeopledemonstratingsignsofmentalillness,throughmethodsotherthantheuseofforce.4In2009,theOPIfoundthatlittlehadbeendonetoaddressthisrecommendation,reportinginitskeyfindings:

Since June 2006, Operational Safety Tactics training has not focused on mental health issues or making sure police have the crucial skills required by police to identify and take appropriate action when someone may have a mental health problem.5

Inits2006reporttotheVictorianGovernment,theBostonConsultingGroupalsoidentifiedaneedforpolicetobeprovidedwithspecificmentalhealthrelatedtrainingtoimprovetheircapacitytorespondtopsychiatriccrisesanddivertpeopleintomentalhealthcareratherthanrespondingwitharrests.6

Mental Illness Fellowship Victoria justice policy

MentalIllnessFellowshipVictoriahasrecentlyratifiedapolicythatsetstheframeworkforouradvocacytoimprovetheexperienceofpeoplewithamentalillnesscomingintocontactwiththejusticesysteminVictoria.Improvingthecapacityofpolicetounderstandandmanagethechallengingneedsofapersonwithamentalillnessinappropriateways,withouttheuseoflethalforce,isoneofourkeyadvocacypriorities.



Improvingpolicetrainingisnotsimplyacaseofincreasingthehoursoftraining.Thetrainingmustprovidepoliceofficerswiththereal-lifeexperience,skillsandconfidencetocommunicatewithpeoplewhoaredistressedandvulnerable,resolveconflict,recognisesymptomsofmentalillnessandreferpeopleintoappropriatecare.

Consumers,carersandfamiliesneedtobepartofthistraining,andpoliceofficersshouldbegiventhechancetomeetwithpeoplewithmentalillnessduringtimesotherthancrises.Basictrainingshouldbeundertakenbyallpolice,withadditionaltop-uptrainingforsenioroperationalpolice.

Atthesametime,partnershipsareneededbetweenpoliceandotherservicesandcommunitysupports,toprovidepoliceofficerswithpathwaystocareforpeoplewithmentalillness,otherthanthroughthecriminaljusticesystem.TherelationshipbetweenCrisisAssessmentandTreatmentTeams(CATTs)andthepolicealsoneedstobestrengthenedsothatthespecialistknowledgeofCATTscanbeaccessedwhennecessary.

Ourpolicypositionalsocallsforareviewofpoliceprotocolsinrelationtoon-the-groundpolicingwhenpoliceareincontactwithpeoplewithmentalillness.

the Memphis CIt model

AfewyearsagoIwasfortunateenoughtospendsometimewiththeMemphisPoliceCrisisInterventionTeam(CIT).Themodelofpolicetraining,staffingandcrisisresponsedevelopedwithinthisteamisnowrecognisedinternationallyashighlysuccessfulandhasbeenreplicatedinothercities,includingSydney,whichhasreplicatedavarianceofthemodel.Between15and20percentoftheentireMemphisPolicePatrolDivisionistrainedtoworkwithpeoplewithmentalillnessincrisissituations.Thesetrainedofficersassumetheleadershiproleincrisisevents.Thefundamentalelementsofthetrainingundergonebytheseofficersinvolveshelpingpolicetounderstandtheeffectthattheirbehaviourcanhaveonescalatingorde-escalatingthebehaviourofapersonwithamentalillness,stressingtheinterconnectednessbetweenconsumersafetyandpoliceofficersafety,andprovidingreal-lifeexchangesbetweenpoliceandpeoplewithmentalillness.

Aspartoftheirtraining,theMemphisofficersvisitpsychiatrichospitalsandthehomesofpeoplewithmentalillness,and

undertakeninehoursofroleplaying.Mentalhealthworkersaretakenoutinpolicecarstoimprovetheirappreciationoftheenvironmentinwhichpoliceofficersareoperating.

TheCITmodelhasresultedinfastercrisisresponsetimes,ahighernumberofreferralstoemergencyhealthcareoutsidethecriminaljusticesystem,decreasedofficerinjuryrates,andincreasedpoliceofficerconfidenceinrespondingtomentalhealthemergencies7.Achangetoemergencydepartmentsinmanagingpsychiatriccriseshasbeenanimportantpartofthesedevelopments.

Joining up mental health and justice services

InVictoria,thereisagrowingrecognitionoftheneedforthementalhealthsector,governmentagencies,andthepolicetoworktogethertodivertpeoplewithmentalillnessfromthecriminaljusticesystemintoappropriatecare,andalsotoimprovethementalhealthcareofpeopleinprisonanduponreleasefromprison.

TheVictorianGovernment’sJusticeMentalHealthPartnershipGroupincludeswiderepresentationfromthejusticeandmentalhealthsystems,includingPoliceOfficers,Magistrates,Judges,representativesofchildprotectionservicesandrepresentativesofmentalhealthservices,agenciesandforensicfacilities.Thegroupisworkingondevelopinghigh-level,coordinatedprocessesinordertoimprovethehealthoutcomesofpeoplewithmentalillnessinprisonsorwithaforensichistory.ThisisapriorityoftheVictorianGovernment’sVictorian Mental Health Reform Strategy 2009-20198.

Indeed,24-houraccesstomentalhealthcarefacilitiesandpartnershipswithsupportservices,havebeenidentifiedaskeytothesuccessoftheMemphisCITmodel.

Investing in community-based services

Whenpeoplewithmentalillnessbecomepartofthecriminaljusticesystem,itis,toalargeextent,evidenceoftheunder-resourcingofcommunity-basedandcasemanagementservicesforpeoplewithmentalillness.

Greaterinvestmentisneededatthecommunityleveltohelpavoidthehugeresourcesthatareexpendedduringtimesofcrisis.Weneedgreaterinvestmentinhousing,employmentservicesandrecovery-focussedservices.Peoplewithmental

Policing for positive mental health outcomesbyElizabethCrowther

Positiveinteractionsbetweenpoliceandpeoplewithmentalillnessleadtobettermentalhealthoutcomesandcontributetocommunitysafety.Poorinteractionsleadtomistrust,fear,anxiety,andstoriesthatpeoplerememberandtellforyears,perpetuatingthefearandmistrust,eventhoughpoliceapproachesmighthavechangedsignificantlysincetheinitialexperience.

illnesslive90percentoftheirlivesintheircommunities.Investmenttosecurecommunitytenureisessentialtoimprovementalhealthoutcomes.

Despitethis,therecontinuestobeamajordeficitatthefrontendofthementalhealthsystem.Manypeoplewithmentalillnessgowithoutdiagnosisorwithoutaccesstoservices,ortheyareunabletomaintaintheirtreatmentduetolackofstableandsuitableaccommodation.Whenpeopledropoutoftreatment,orbecomeacutelyill,theyareatgreaterriskofcomingintocontactwiththepoliceandthecriminaljusticesystem.

Positive police intervention

Positiveinteractionsbetweenpoliceandpeoplewithmentalillnessleadtobettermentalhealthoutcomesandcontributetocommunitysafety.Poorinteractionsleadtomistrust,fear,anxiety,andstoriesthatpeoplerememberandtellforyears,perpetuatingthefearandmistrust,eventhoughpoliceapproachesmighthavechangedsignificantlysincetheinitialexperience.

Wherefamilieshavehadnegativeinteractionswithpolice,theyaremorelikelytodelaycallingforpoliceattendanceuntilacrisishasreachedapointofdanger.Earlierpoliceintervention,ontheotherhand,occurswhenpeoplehavetheconfidenceandthetrusttorequestpoliceassistance.Earlierinterventionchangestheenvironmentofpolicepresencefromoneofterrorandanxiety,toamanagedintervention,increasingtheconfidenceofpolicetobeable

todeliverbetterresults,andthelikelihoodofmoretimelycallsforassistanceinthefuture.

Policehaveacrucialroletoplayinthetaskofprotectingthecommunityduringmentalhealthcrises.Throughtrainingandpartnershipswithmentalhealthserviceproviders,theycanalsoplayacrucialroleintheequallyimportanttaskofgettingpeopleintothecaretheyneedandontheroadtorecovery.

References

1 VictorianInstituteofForensicMentalHealth,(2009-10) Ninth Annual Research Report to Council,p11

2 ReportedinOfficeofPoliceIntegrity(July2009)ReviewoftheuseofforcebyandagainstVictorianpolice,p24

3 Kesic,D.,ThomasSDM,OgloffJRP(2010)‘MentalillnessamongpolicefatalitiesinVictoria1982-2007:caselinkagestudy’,Australian and New Zealand Journal of Psychiatry,44,pp436-468

4 OfficeofPoliceIntegrity(2005)ReviewoffatalshootingsbyVictoriaPolice

5 OfficeofPoliceIntegrity(July2009)ReviewoftheuseofforcebyandagainstVictorianpolice,p14

6 BostonConsultingGroup(2006)ImprovingmentalhealthoutcomesinVictoria,p67

7 Dupont,R.,andCochran,S.(2000)‘Policeresponsetomentalhealthemergencies–barrierstochange’,Journal of the American Academy of Psychiatry and the Law28,338-44,p340

8 VictorianDepartmentofHumanServices(February2009)Victorian Mental Health Reform Strategy,p97



Thefollowingstatisticsindicatetherelevanceofmentalhealthissuesforpoliceservicedelivery:

•fifty-threepercentofpeopledetainedinpolicecellshaveapublicmentalhealthrecord

•onaverage,policerefer500peopleincrisistomentalhealthserviceseachmonth

•aroundsixty-sixpercentofpeopletakenbypolicetoemergencydepartmentsarementalhealthpatients

•aroundhalfofmissingpersonshaveamentalillnessandaround20percentofthemarereportedmissingfromamentalhealthservice

•atleastelevenpercentoffamilyviolencereportsidentifymentalhealthriskfactorsaspresentinoneofthepartiesinvolved

• internationalresearchshowsthatpeoplewithamentaldisorderareover-representedasvictimsofviolentcrime,sexualassaultandpersonaltheft

•policeundertakearound500coronialinvestigationseachyearintosuspectedsuicides.

Respondingtomentalhealthneedsthereforeformspartoftheprevention,earlyintervention,crisisintervention,lawenforcement,publicsafetyandsupportofotheragencies’rolesthatpoliceperform.Thisdiversityofinteractionspresentsbothchallengesandopportunitiesforpolice.Thechallengesinclude:

•respondingtounpredictableandoftenviolentbehaviour

•maintainingsafetyinsituationsinvolvingmultiplerisks,suchasamentalhealthcrises,drugoralcoholuse,andthepresenceofaweapon

• avoidingtheinappropriateuseof:» policemembers,e.g.conductingwelfarechecks

ordetainingapersonforprolongedperiodswhileawaitingassessment

» policevehicles,e.g.usingdivisionalvanstotransportapersoninamentalhealthcrisistohospitalwheretherearenosafetyconcerns

» policefacilities,e.g.usingcellsorinterviewroomstodetainapersonawaitingassessmentwheretherearenosafetyconcerns

Policeseetheeffectsofmentalillnessonindividualsandcommunitieseverydayandknowthattheycanimpactgreatlyonhowsafe,supportedandincludedpeoplefeel.Policeroutinelyinteractwithpeoplewhohaveamentalillnessorwithpeoplewhoarevictims,witnesses,suspects,orinneedofassistance.

Eva Perez, MentalHealthStrategyproject,OperationsCoordinationDepartment,VictoriaPolice

Peace of mind: implementing the Victoria Police Mental Health Strategy

•havingtomakecriticaldecisionswithoutaccesstoavailableinformationandexpertise

• identifyingtheappropriatereferralagencywithinacomplexservicesystem

•accessingservicesthathavelimitedhoursofoperation,limitedgeographiccoverage,highthresholdsforaccesstoservice,orlengthyresponsetimestopolicereferrals.

Theopportunitiesinclude:

• interveningtopreventapersoninamentalhealthcrisisfromharming(orfurtherharming)themselvesorothers

•linkingpeoplewhohaveundiagnosed,untreatedorunsupportedmentalhealthneedswithappropriateservices

• identifyingpeoplewhosementalhealthissuesarecontributingto,orbeingexacerbatedby,otherproblemssuchastheirsubstanceuse

•contributingpoliceexperienceandexpertiseinmanagingrisk.

VictoriaPolicehaspolicies,proceduresandpartnershipsinplacetoenabletheseinteractionsandcontinuestobuildonthemthroughitsimplementationoftheVictoria Police Mental Health Strategy.

VictoriaPoliceproduceditsStrategyinApril2007followingextensiveconsultationwithpoliceacrossthestate,aswellascommunitygroups,serviceproviders,partneragencies,consumersandcarers.TheStrategyencompassespeoplewith,oraffectedby,mentalillness,intellectualdisability,acquiredbraininjury,personalitydisorderandneurologicaldisorder,asitfocusesonbehavioursratherthandiagnoses.

TheStrategyincludes60directionsforimprovingpoliceknowledgeandinformation,strengtheninginternalandexternalpartnerships,andupdatingpolicetraining.Implementationisalmostcompleteandkeyinitiativesimplementedunderthesedirectionsare:

Improving knowledge and information

•CreatedandmaintainedaMentalHealthandDisabilityKnowledgeBankontheVictoriaPoliceintranettoprovidepolicewithacentralhubforinformationonstateandlocalprotocols,localinitiatives,accessingspecialisedservices,practiceguidesandanswerstofrequentlyaskedquestions,statisticsandresearch.

•Createdaflagformentaldisorderonthecentralpolicedatabase(LEAP)thatprovidesauthorisedpoliceandthe000-calldispatcherswithlimitedinformationonaperson’striggersandtypicalbehaviours,effectivecommunicationstrategies,knownrisks,contactperson,othermentaldisorder-relatedinformation(e.g.treatmentorders)andthesourceoftheinformation.Inresponsetorequestsfromanumberofconsumersandcarers,VictoriaPolicepolicynowenablesaconsumer,theirparentortheirguardiantovolunteerinformationforaflagtoassistwithanyfuturepoliceresponse.

• IntroducedaMentalDisorderTransferFormtofacilitatethereferralbypoliceofpeopletomentalhealthanddisabilitysupportservices.Policedocumentonthisformhowthepersonpresentedwhileincrisis,inordertoinformtheclinicalassessmentandanyfuturepoliceresponse.

•RevisedthepoliciesandproceduresintheVictoriaPoliceManualandtheDepartmentofHealthandVictoriaPoliceProtocolforMentalHealthtomakecleartheroles,responsibilitiesandresponsesofeachemergencyservicewhenassistingpeopleinneed.VictoriaPoliceiscurrentlyworkingwiththeDepartmentofHumanServicesonthefirstProtocolforDisabilityServices.

•Revisedtheproceduresforinvestigatingmissingpersonreportssothatmentaldisorderispartoftheriskassessmentchecklist.



Strengthening partnerships

•EstablishedanExpertAdvisoryPanelofseniorrepresentativesfromVictoriaPolice,partneragencies,communityservicesandconsumersthatmeetsquarterlytoendorseinitiativesdevelopedundertheStrategy,provideadviceonimprovingpolicingservicesandnotifyVictoriaPoliceofopportunitiestoworkwithothers.

•Createdanetworkof120MentalHealthandDisabilityLiaisonOfficersacrossthestateasanidentifiablelocalcontactforotherpoliceandpeopleinthecommunity,toprovideinformationandadviceonpolicingresponsestomentalhealthissues.

•Establishedregularreportingbetweenthe21localliaisoncommitteesandthestatewideInter-DepartmentalLiaisonCommitteeonservicedeliveryissuesandimprovements.Bothlevelsofcommitteecomprisepolice,mentalhealth,hospital,ambulance,consumerandcarerrepresentatives.

•Triallingdifferentwaysofrespondingtomentalhealthissuesinthecommunity.Forexample,thereisatrialinasouthernmetropolitanpolicedivisionofaPolice,AmbulanceandClinicalEarlyResponse(PACER)model.Themodelinvolvesavehiclestaffedwithapolicememberandamentalhealthclinicianrespondingtosituationswherefrontlinepoliceorambulanceparamedicsbelievementalhealthissuesarepresent.ThePACERunitprovidespromptonsiteclinicalassessments,referstoabroadrangeofservices,developsmulti-agencyinterventionplansforfrequentpresenters,avoidsunnecessarytransporttohospital,andadvisesonde-escalationtechniquesandoptionsforresponse.ThetrialendsinAugust2011andisbeingindependentlyevaluated.

•Participatinginafive-yearresearchcollaborationwithForensicareandMonashUniversity(ProjectPRIMeD)onaspectsofpolicingandmentaldisorder.The13studiesunderwayareexaminingthesymptomsofpeopledetainedinpolicecells,policeknowledgeof,andattitudesto,mentalillnessandtheuseofforceanddataanalysisfromtheMentalDisorderTransferForm.VictoriaPoliceisusingthefindingsfromtheresearchtoreviseitspolicies,proceduresandtraining.

•Contributingtosystemicinitiatives,suchasthedevelopmentandimplementationoftheVictorian Mental Health Reform Strategyandthere-writeoftheMental Health Act 1986.

Updating training

•RecommendedchangestothecontentanddeliveryoftheDiplomaofPublicSafety(Policing)forrecruits,updatedtheReferenceGuideandcoursenotes,andintroducedarequirementforprobationaryconstablestodemonstratetheirskillsinreferringapersonincrisistomentalhealthservicesaspartoftheirmandatoryqualifyingtasks.

•CreatedanewmentalhealthmodulefortheOperationalTacticsandSafetyrefreshertrainingthatallfrontlinepolicemustundertakeeachsixmonths.Thisfour-hourmodulecomprisedscenarios,presentationsbyexperts,role-playing,adviceoncommunicationstrategiesandsourcesofinformationandwasdeliveredfromJanuarytoJune2010.TheJulytoDecember2010cyclebuiltonthismodulewithasessiononacutebehaviouraldisturbance.Planningisunderwayformodulesonotheraspectsofpolicingresponsestomentalhealthissuesforfuturecycles.

•RevisedthemoduleonrecognisingandrespondingtocognitiveimpairmentdeliveredtodetectivesaspartoftheSexualOffencesandChildAbuseInvestigationTeamcourse.

•Accreditedtenemployeestodeliverthetwo-dayMentalHealthFirstAidcourseonrecognisingandunderstandingdifferentformsofmentalillness.Todate,84courseshavebeenrunacrossthestatetomorethan1220employeeswhovolunteertoattend.WorkisunderwaytorunjointcourseswiththeMetropolitanFireBrigadeandAmbulanceServicesVictoria.

•FundedAppliedSuicideInterventionSkillsTrainingfor120police,peersupportofficersandanumberofotherpolicemembersacrossthestate.

•TrialledanonlineprogramonSuicideAwareness,SubstanceUseandMentalHealthinpartnershipwithatertiaryeducationprovider.

VictoriaPoliceiscommittedtocontinuallyreviewingandupdatingitspolicy,practiceandtraining,andwelcomesanyfeedbackoradviceonareasrequiringattention.

Peace of mind: implementing the Victoria Police Mental Health StrategybyEvaPerez



In2000,theVictorianAssociationfortheCareandResettlementofOffenders(VACRO)publishedanarticlebyGrantCurranabouttransitionfromprison.Grantcalledit‘PostPrisonMadness’.Drawingonhispersonalexperience,Grantexplainedthesocialandemotionalprocessofgettingoutofprison.1

Hislistofchallengesincludedisolation,dislocation,fearandparanoia.Hetalkedaboutthe‘overwhelmingsenseofnotbelonging’andthestrongdesireto‘lockyourselfawayinyourhouse,flatorroom,becauseitiswhatyouareusedto’.Healsowroteaboutburstingintotearsatrandomandthetroubledistinguishingtherealfromtheunreal.Grantalsoposed,rhetorically,thequestionfacingmanyex-prisoners:‘howdoyouexplaintoadoctororcounselloraboutanadultwhosesurvivalskillsareonlyappropriatetoalifeinprison?’

Grantexplainedthat‘youarenot,andneverwillbe,thesamepersonwhowenttoprison’,andtalkedoftheramificationsthishasontheex-prisoner’srelationships.Healsotalkedabouttheunrealisticexpectationsprisonershaveoftheirpartnersaswellasthedifficultytheyfacereturninghometoanewsetofresponsibilities,orthechaosofchildren’stoysandnoise.

VACROprovidesarangeofservicesforpeopleleavingprison.Weworkintwoconsortiatoprovidecase-managedtransitionalsupportformenandwomenleavingprisonandhaveanothersupportprogramforseriousandpersistentoffenders.VACROalsoprovidesanumberofothersmallprogramsthatassistpeopleinprison,suchasourprisonerpropertyandbankingservice.Womenexitingprisonareabletojoinavolunteermentoringprogramthatsupportsthemastheyreintegrateintothecommunity.Weworkwithfamiliesofoffenders,acknowledgingthedifficultiesassociatedwithhavingalovedoneincarceratedandtheimportantrolefamiliesinvariablyplayuponreleasefromprison.

OurapproachtoworkingwithprisonersisinformedbythestoriesofpeoplelikeGrantCurranandnearly140yearsofworkinginVictoria’sprisonsystem.Weassistourclientsbyprovidingintensivesupportprogramsandmanagingissuesassociatedwithmentalhealthaspartofaclusterofoften,interconnectedissuesfacingprisonersonrelease.Poormentalhealth,homelessness,drugandalcoholdependence,acquiredbraininjuries,gambling,poverty,lowlevelsofeducationandlimitedworkhistoriesaresomeofthemanyissuesfacingprisonersandallhavethepotentialtoimpactsubstantiallyonpost-prisonoutcomes.

Weassistourclientsbyprovidingintensivesupportprogramsandmanagingissuesassociatedwithmentalhealth,aspartofaclusterof,often,interconnectedissuesfacingprisonersonrelease.Poormentalhealth,homelessness,drugandalcoholdependence,acquiredbraininjuries,gambling,poverty,lowlevelsofeducationandlimitedworkhistoriesaresomeofthemanyissuesfacingprisonersandallhavethepotentialtoimpactsubstantiallyonpost-prisonoutcomes.

Mental health and transition from prison to the community

Paul Atkinson, SeniorProjectOfficer,VictorianAssociationfortheCareandResettlementofOffenders(VACRO)



Beyondourintensivesupportprograms,wealsoworkwithcurrentandformerprisoners,suchasSilvio*,whoiscurrentlyparticipatinginSecondChanceCycles,aVACRO-runbicycleworkshop.Heisoneofseveralprisonersparticipatingindayleavefromprison–anopportunityopentoinmatesattheendoftheirsentence.WhenIfirstmetSilvio,hewaselbowdeepingrease,replacingthederailleuronanoldroadbike.Riggeduponastand,thebike,stolenandunclaimed,hadspentthelastfewyearsrustingawayinacontaineratapolicedepot,amongstanassortmentofothermakesandmodels.

VACRO’sprogramssuchasSecondChanceCyclesprovideopportunitiesforpeopletoengageinasharedactivitywithothers,supportingthemtoconnectwithpeopleinasafespacewhilelearningnewskills.Clientsareabletofollowthroughwithaccreditedtrainingandworkplacements.

Silviohasgainedconfidenceandworkplacecompetenceatthebikeworkshopsurprisinglyquickly,transferringskillshepickedupwhilstworkingintheprisonindustry.Likemostprisonershowever,theproficiencieshehasaccumulatedfromhistimeinprisonremainunaccreditedandhisresuméisdauntinglysparse.Statisticsshowthatin2010,nearlyninety-fivepercentofprisonershadnotcompletedsecondaryschool.2Thereareonlyahandfulofprisonerswithtertiaryqualifications(noteventwopercentin2010)andevenlesswithtradequalifications:betweenoneandsixpeopleineachofthelastfiveyears.

Inafewweeks,SilvioisdueforreleaseonParoleandwillre-enteracommunityhehasknownonlyinfitsandstartsasanadultandonethatchangesrapidly.Heislongpasttheagewhereindiscretionscanbepassedoffasyouthfuland,likemanyprisoners,hispost-prisonprospectsarelimited.HewillfacestrictParoleconditionsandharshsanctionsforanybreachesonaccountofhishistory.Itisfortuitousthathenowhasageonhisside,beingolder,moreexperiencedandcalmer.

Likemanyprisoners,Silviohasason,nowelevenyearsold,whoiswaitingforhimashetransitionsfromprison.A2001studyputthefigureofchildrenofprisonersatover38,000Australiawide,3anumberpresumablyrisingwiththeAustralia-wideexpansionofprisoncapacity.Incontrasttothemajorityoftheotherfathersinprison,Silvioislikelytoresumetheroleofprimarycarerofhisson,somethinghetookonafterhispartnerpassedawayin2005.

VACROhasheldalong-standingconcernforthechildrenofimprisonedparents.4AlthoughthisissuehasbeendiscussedforatleastthirtyyearsinAustralia,5theresponsetothese‘invisiblevictims’ofcrimerequiresfurtherdevelopment.

DuringSilvio’srecentstintinprison,hissister-in-lawassumedresponsibilityforhisson.Thefamilyisnowfacingyetanothercriticalpointoftransition.VACROhasachildren’scounsellorwhoisassistingSilviowithhisparentingrole.Silviohasbeenabletodevelopandenactafamilyreintegrationplaninasafespacewherehecanexploreandmanagehisanxietyandfear.

Childrenwithimprisonedparentsarereportedtoexperienceelevatedlevelsofanxiety,shame,grief,isolationandguilt,havelowerself-esteemandreporthavingpoorerrelationshipswiththeirpeers.6Althoughsomeofthisrelatestopre-existingdisadvantage,therearecrediblesuggestionsthatparentalimprisonmenthassuchasevereimpactonchilddevelopmentthatitcandamagementalandphysicalhealth.7

Havingachildisadouble-edgedswordforprisoners.Itcanbeablendofburden,anxiety,motivationandhopethatisdifficulttosynthesise.Prisonersoftenseetheirreleaseasaperfecttimetosetthingsstraightandmakeamendsforfailedrelationships.Somespendyearsinisolationimagininghowthingscouldbeandmentallyplayingoutareturnthatmaynothappenwithinafamilythathaslongsincemovedon.

Silvioisundernoillusionsaboutgettingoutandgettingbacktohisfamily,perhapsbecausehehasbeenthroughittoomanytimesbefore.Heisfortunatetohavebeengivenanopportunitytogothroughatransitionalprocess,whichincludesgraduallyincreasingdayreleases.Althoughhehasmissedsomeimportantyearsinhisson’slife,duringanagewhenchildrenrapidlychangetheirfriendsandinterestsandunderstanding,heisapproachingthesituationwithacautiousoptimismthatappearstobeworking.

AccordingtoGrantCurran,afteralong-termimprisonment,‘thelastthingyouwantpeopletodoistellyouthatwhatyouarefeelingis“normal”becauseitdoesn’tfeelnormal.Whatyoudoneedispre-releaseandpost-releaseprogramsdirectedtowardsprisonersandtheirfamiliesandfocusedonrelationships,developingcopingandsurvivalskillsandensuringtheprisonerhaseverychanceofremainingin,andfeelingpartof,thecommunity’.

Mental health and transition from prison to the communitybyPaulAtkinson

Prisonersareaheterogeneousgroupwithdifferentinterestsandgoalsandconnectingex-prisonerstotheircommunityisfarfromstraightforward.VACROdeliversacase-managementmodelthatassistspeopletodevelopapre-releaseplan,startinguptothreemonthsbeforerelease.Casemanagersarethenabletoprovidethenecessarylinksandresourcespostrelease,fortheplanstobesuccessfullyimplemented.AtSecondChanceCyclesweworkwithpeoplelikeSilviotodevelopanddemonstrateaskillofvaluetothemandthecommunity.SilvioiscurrentlyworkingthroughasetofmoduleswithtrainedbikemechanicsthatwehopewillleadtohimenrollingintheCertificateIIinBicycleMechanics.Hehasalsorestoredanumberofbikesthathavebeendonatedtothecommunity.

Understandingtheprevalenceofmentalhealthinprisoniscomplicated.Wedoknowthatpeoplewithmentalhealthissues—diagnosedandprobablyundiagnosedaswell—areoverrepresentedatallstagesofcontactwiththecriminaljusticesystem,includingpolice,courts,prisonsandcommunitycorrections.Wheresubstanceabusecommonlyoccurswithmentalillness,itisnotsurprisingthatconflictwiththelawcaneasilyfollow.Peoplewithmultipleandcomplexneedsmayhavelimitedaccesstomainstreamhealthandsocialsupportstomaintainstabilityinthecommunity.Theresultingcyclesofunstablebehaviourattractstheattentionofthecriminaljusticesystem.

TheVictorianDepartmentofJusticehasacknowledgedtheneedtoaddressthe‘significantnumberofpeople’withmentalhealthconditionswho‘cyclethroughprisons’withthereleaseofthe Justice Mental Health Strategyin2010.

VACRO’sapproachfocusesonpeople’ssocialandemotionalwellbeingandrelationships.Weprovidesupportaroundbasicneedsformaterialaidandhousing,aswellaslinkstospecialistservicestailoredtomeettheneedsoftheindividual.Beyondthat,ourholisticapproachmeansthatweworktocreateopportunitiesforpeopletorebuildimportantfamilyandsocialconnectionsandengageinrecreationandmeaningfulvocationalpathways.Workinginparallelwithspecialists,suchasmentalhealthprovidersanddrugandalcoholclinicians,weworktodeliveraholisticresponsetosupporteachperson’saccesstotheservicesandrelationshipstheyneedforstabilityinthecommunity.

References

*Namesandcertaindetailsalteredtoprotectidentity.

1Curran,G.(2000)‘PostPrisonMadness’,VACRO,Melbourne

2Allprisonstatistics,unlessotherwisespecified,comefromtheDepartmentofJustice,Statistical Profile of the Victorian Prison System 2005 – 06 to 2009 –10,availableat:www.justice.vic.gov.au

3SimonQuilty,MichaelH.,Levy,KirstenHoward,AlexBarratt,TonyButler(2004)‘Childrenofprisoners:agrowingpublichealthproblem’,Australian and New Zealand Journal of Public Health,Volume28,Issue4,pp339–343

4Seeforexample,DoingitHard(2000)Children Unintended Victims of Legal Process (2006) Court Based Family Support Project(2009)allavailableonVACRO’swebsite:http://www.vacro.org.au/

5Hounslow,B.,Stephenson,A.,Stewart,J.&Crancher,J.(1982)Children of Imprisoned Parents,NewSouthWalesDepartmentofYouthandCommunityServices,Sydney

6JusticeStrategyDivision,AttorneyGeneral’sDepartment(2005)Children of Prisoners Project,p18,Adelaide,accessedat:http://www.justice.sa.gov.au/publications/pdf/Children_of_Prisoners_Report.pdf

7OliverRobertson(2007)The impact of parental imprisonment on children,QuakerUnitedNationsOffice,Geneva

‘SecondChanceCycles’,VACRO’scommunitybikeworkshop.PhotoscourtesyofINCF.



TheVictorianInstituteofForensicMentalHealth,commonlyknownasForensicare,isthekeyproviderandcoordinatorofadultforensicmentalhealthserviceswithinVictoria.ThisincludesprovidingservicesatThomasEmblingHospital(TEH),Community-BasedForensicMentalHealthServices(CFMHS),andinvolvementinPrisonServicesincludingtheAcuteAssessmentUnitatMelbourneAssessmentPrisonandMarrmakUnitforwomenattheDamePhyllisFrostCentre.Forensicareemploysfourconsumerconsultantstocoverthisbroadumbrellaofprograms,howeverIwillbeconcentratingonconsumerparticipationatTEHasthisismymainareaoffocus.

ThomasEmblingHospitalisa116-bedsecurefacilitycateringgenerallyforthreetypesofpatientgroups:

•Security patientscomeacrossfromprisoninneedofacutecarefortheirmentalhealthissues

•Forensic patientsaredeemednotguiltyduetomentalimpairment,butinneedoftreatmentandrehabilitationinacustodialsetting

• Involuntary patients,detainedunderSection12ofThe Mental Health Act1986,areinneedofasecureforensicsettingtosafelymanagetheirmentalillness.

AtfirstglanceonemaythinkthatTEHwouldbemorerestrictivethanAreaMentalHealthServiceswhenitcomestoenablingconsumerparticipation.Onthecontrary,thereisanextensiveconsumerparticipationprograminplacefacilitatedbytwopart-timeconsumerconsultants,andsupportedwellbyotherdisciplines,particularlyAlliedHealth,andaprogressiveManagementTeam.

ForensicareacknowledgestheprinciplethatpatientshaveafundamentalrighttobeinvolvedintheirtreatmentandcareasstatedbytheWorldHealthOrganisation:‘Peoplehavetherightanddutytoparticipateindividuallyandcollectivelyinthe

Julie dempsey, ForensicareConsumerConsultant,ThomasEmblingHospital

lighting the match: consumer participation at Forensicare

Itistheresponsibilityofstafftoencourageandsupportconsumerparticipationsothatitbecomesadynamicexchange,resultinginincreasedgrowthandunderstandingforallparties.

planningandimplementationoftheirhealthcare’(WHO,1978).IwillgiveexampleslaterhowForensicaredoesthisonbothanorganisationalandindividuallevel.

Theabovequoteassumesawillingnessandabilitytoparticipateintreatment.Inmentalhealth,treatmentcanbegiveninvoluntarilyandoftenworksontheassumptionthatthepatientcannot,atleastinitially,participateconstructivelyintheirowntreatment.Symptomssuchaslackofinsight,impairedjudgement,diminishedcapacity,separationfromreality,withdrawal,reducedmotivationetc.canresultinthejustificationofinvoluntarytreatment.

Itisbecauseofthisclashofviewsastowhatconstitutesrealityandsocietalviewsofacceptablebehaviour,thatconsumerinputisnotonlycriticalinimprovingservicedeliverybutisaveryemotiveandpassionateareatobeinvolvedin.Sotheprocessneedstobecollaborative,respectful,andengagingforallparties.Itis‘aprocessofqualityimprovementforservicedeliverythatincreasesconsumersatisfactionthroughconsumershavingtheopportunitytobeinfluentialinthedecisionmakingprocessacrosspolicyanddevelopment,includingtrainingandevaluation’(DHS,1996),withtheaimofinvestigating‘improvementactivitiesthatconsiderclinical,social,emotionalandculturalaspectsofcareandservice’(TheVictorianQualityCouncil,2003).

Itistheresponsibilityofstafftoencourageandsupportconsumerparticipationsothatitbecomesadynamicexchange,resultinginincreasedgrowthandunderstandingforallparties.

‘Real consumer participation is not just inviting the match to sit beside the matchbox; it’s getting the match and matchbox to interact so they will make something new: fire’ (MaryO’Hagan,1994).

Thedangersofbeingtokenisticandjusttickingtheboxescanhavenegativeconsequencessuchasineffectiveservice

deliveryanddeteriorationinconsumerparticipants’mentalhealthandwillingnesstoengage.Atypicalexampleofthisiswhenaconsumerisinvitedtobeonaworkinggrouporcommitteebutisnotgiventheopportunitytoexpresshis/herviews.Consumersshouldbeencouragedtospeakupandaskeddirectlywhattheirthoughtsareonwhatisbeingdiscussed.

Inthesesituations,theconsumerisofteninaroomfullofstaff,whichcanbeintimidatingasitisnotalwayseasyforconsumerstospeakuporforstafftohearwhattheyaresaying.Ipersonallythinkthatifaconsumerisinvolvedinameeting,itistheresponsibilityofthechairofthatmeetingtocheckinwiththeconsumerafterwardstoseehowtheyaretravelling.Thisprocessneedstoberespectfulandstaffalsoneedtoberemindedthattheconsumercanbecomingfromavulnerableposition.

Consumerconsultantscanalsosupportpatientsinmeetingsorthroughdebriefingsessionsaftermeetingsifnecessary.IttakescourageforpatientstoputthemselvesoutthereandfortunatelyatForensicare,inmyexperience,staffencouragepatientstobeactiveinpartsoftheirtreatmentandchallengetheminapositivewaytogrowwithinthesystem,eventothepointofchangingthesystem.

Forexample,oneoftheOccupationalTherapistsorganisedagroupYouAreWhatYouEattobeplanned,deliveredandco-facilitatedbypatientsontheunit.Theendresultwasthatbyhavingpatientinputintothedevelopmentofthegroupandco-facilitating,therewasamoreconsistentandenthusiasticattendance.Asweightgainisanimportantissueformentalhealthpatients,thiswasaninclusivewayofgettingthemtolookathowfoodandexercisecandeterminetheirphysicalwellbeing.



Althoughitmayhavebeenconfrontingatfirstforthepatientco-facilitators,theresultingself-esteem,senseofachievement,confidence,andinclusionintherapywasagoodreward.RelatingtoMaryO’Hagan’squoteon‘makingfire’,theoutcomewassopositivethattheoccupationaltherapistisnowworkingwithpatientsandtheconsumerconsultantstodevelopatrainingmanualsothatotherscanreplicatetheirsuccessinotherpartsofthehospital.

Partofbeinglookedafterinhospitalistheunsaidsurrenderofyourusualautonomyandself-determination.Rulescanbeputinplaceasnecessaryriskmanagementandprotectionofpeopleandproperty.However,somepatientsmayseethesesamerulesascontrollinganddehumanising.Whatstaffmayperceiveasatherapeuticrelationshipcan,totheconsumer,feellikeapower,orlackthereof,setupintheeyesofthepatient.

Asworkinmentalhealthoftencomesfromakindheart,itisunfortunatethatreceivingtreatmentcansometimesresultinaperceivedlossofdignityforpatients.Byencouragingconsumerinput,someofthestingofbeinginarestrictiveenvironmentistakenoutsothatpatientscanfocusonpositivesandstrengths,thusbecomingmorepivotalintheirownrecovery.

OneexampleofconsumersbecomingmoreinvolvedintheirowntreatmentandworkingcollaborativelywithstaffisapilotprojectinoneoftheacuteunitsatTEH.Theprojectinvolvedpatients,clinicalstaff,theNurseUnitManager,theQualityManager,andwaspartlyfacilitatedbyaconsumerconsultant.Asaresult,certainpatientswillnowbeinvitedtoattendpartoftheirclinicalreview.Thisconcepthasbeenviewedpositivelybybothstaffandpatientsinitsimplementation.

Theresulthasbeentheopportunityformoredirectcommunicationbybothpartiesinpatients’treatment,workingtogethertoovercomepresentdifficultiesandgrowthofmutualrespect,allleadingtobettertherapeuticrelationshipsandcooperativeoutcomes.Thiscanevenflowontomeanamoresettledunit,duetofewerdisgruntledpatientsandtheabsenceofthe‘usandthem’mentalitytranslatingintolessaggressionandincidents.

Individually,consumerconsultantscanalsoactasmentorsandleadbyexampletootherconsumersthatadiagnosisofmentalillnessdoesnothavetomeantheendoftheworldandlifeasyouhaveknownit.Consumerconsultantsalsosupportother

consumerstotakeanactiveroleintheirtreatmentandconditionswhilstbuildingdignityandhope.Arecentexamplewaschangesbeingintroducedtothepropertypatientswhoweretobeallowedintheirrooms.

ThroughtheConsumerAdvisoryGroup(CAG)andfollow-upsbytheconsumerconsultants,acompromisewasreachedregardingthefinalformulationofthePatientPropertyPolicy.Althoughthepatientsdidnotgeteverythingtheywanted,they,atleast,feltconsultedandheardontheissuesandwerehappierwiththefinaloutcome.

Whennavigatingthesometimesturbulentwatersbetweenconsumersandstaff,theconsumerconsultantscangototheCAG,managementandtheConsumerParticipationReferenceGroupforconsultation.TheConsumerParticipationReferenceGroupisanessentialpartofourframework,providinganopportunitytomeetwithmanagerstodiscussissues,initiativesandprovidefeedbackaboutourwork.Tome,thisreflectshowsupportive,committedandrespectfulForensicareisaboutconsumerparticipation.

OurCAGismadeupofonepatientrepresentativefromeachofthesevenunitsatTEH,rangingfromAcuteUnits,ContinuingCareUnits,totheRehabilitationUnits.Thereisalsoasustainabilityrepresentativetoencouragearesponsibleenvironmentfocusaroundthehospital,afoodrepresentative,andatransitionrepresentativewhoattendsboththeCommunityForensicMentalHealthService,theCAGandTEHCAG.Thetransitionrepresentativepositionwascreatedtobuildbetterbridgesbetweentheservices,particularlyhighlightingobstaclesfacedbypatientsreintegratingbackintothecommunityaftermanyyearsatTEH.

WhiletheCAGisfacilitatedbytheconsumerconsultants,partofbeingarepresentativeonCAGcomeswithcertainresponsibilities:Tobeanapproachablepointofcontactforconsumers,talktofellowconsumerstoascertainviews,representtheseviewsimpartiallyattheCAGmeetings,forums,andcommitteeswhererequired,attendcommunitymeetingsforstaffandpatients,raiseissueswiththeNurseUnitManagerwhereappropriate,offerpossiblesolutionstoissuesraisedinimprovingservicedelivery,andprovidefeedbacktoconsumersontheCAG’sactivities.Consumersarereimbursedfortheirtimeandcommitment.

Lighting the match: consumer participation at ForensicarebyJulieDempsey

Alotofconsumerresponsescanbeviewedaspurelyreactiveandthisisanimportantpartofourwork.However,wearealsocommittedtoprogressiveactionsuchascapacitybuildingandprojectinitiatives,e.g.consumerrepresentativesontheObesityCommitteeandSpecialEventsCommittee,developmentoftheMedicationQuestionsBrochuretoassistpatientswhentalkingtostaffabouttheirtreatment,andtheWaterCoolersSubmissiontoencourageconsumptionofwaterinunitsinsteadofcoffeeandsoftdrinks.

TheCAGalsoholdscollaborativeforumsforstaffandpatientstoattendtogethertodiscussissuesinanopenenvironment.In2010,guestspeakersspokeonfaithandspiritualitytobreakdownbarriersandbroadenknowledgeonChristianity,IslamandBuddhismreligions.TheChiefPsychiatrist,DrRuthVine,alsodeliveredasessionontheRoleoftheChiefPsychiatrist’sOffice.

OurlatestaccomplishmenthasbeenextensiveconsumerinvolvementinmakingtheDVD:Introduction to Thomas Embling Hospital,targetedatfuturepatients,newstaff,familiesandcarers.TheideasbehindtheDVDweretoallayfearsofpeoplenewtothehospitalaboutany‘OneFlewOvertheCuckoo’sNest’typepreconceptionstheymighthave,andattempttotakethestressoutofatransferfromprisontoanunknownplace.

Summing up

Whenstaffarewelcomingandrespectful,consumerscanreallythriveinanenvironmentthatmightotherwisebeintimidating.

Consultingwithconsumerstapsintoawealthofexperienceandon-the-groundknowledgeregardingtheservicetheyare

involvedin.Theirrolecanchangefrommerelybeingarecipientoftheservice,tothatofanactiveparticipant,resultingin:empowermentoftheindividual,aregainedsenseofrespectforthemselvesandworkers,andanoutlookofbeingactivelyengagedintheirowntreatment.

Thismeansmorethanjustcompliance.Itisaboutseeinglifeandthecurrentsituationasworthwhileandwithongoingpurpose.Itoffershope.Withhopecomesmotivation,whichcanbehardtomusterattimes.Consumerparticipationisaprocess,notjustanendproduct.

Fortheservicetohaveeffectiveinformedservicedelivery,continuedacknowledgementanduseofconsumerinputacrosstheserviceisvital.Consumersarerealpeople,withrealinsightsandrealfeelings.IbelieveForensicare’scomprehensiveConsumerParticipationProgramaddressesthiswellwithinitsworkingparametersandisalwaysreviewinghowtobestmeettheneedsofthoseinitscare.

References

WorldHealthOrganisation(1978)Article 4: Declaration of Alma – Ata,InternationalConferenceonPrimaryHealthCare,Alma–Ata,USSR

DepartmentofHumanServices(1996)Victoria’s Mental Health Services Working with Consumers: Guidelines for Consumer Participation,Aged,Community&MentalHealthDivision,VictorianGovernmentDepartmentofHumanServices

TheVictorianQualityCouncil(2003)Enabling the consumer role in clinical governance – A guide for health services(supplementarypapertotheVQCdocumentBetter Quality, Better Health Care)

O’Hagan,M.(1994)The removal and return of competence and power to consumers,TheMHSConference:SurvivingMentalIllness,Melbourne

TheConsumerParticipationReferenceGroupisanessentialpartofourframework,providinganopportunitytomeetwithmanagerstodiscussissues,initiativesandprovidefeedbackaboutourwork.Tome,thisreflectshowsupportive,committedandrespectfulForensicareisaboutconsumerparticipation.



Freda Haylett, EvaluationOfficer,WhitelionCommunityCare

Bundji Bundji – supporting Indigenous young people in the justice system

Background

BundjiBundjiisapartnershipbetweenWhitelionandNaranaCommunityCare.ThepartnershipwasformedinMay2006inresponsetotheoverrepresentationofIndigenousyoungpeopleintheyouthjusticesystem.ThereisastrongbeliefintheIndigenouscommunitythatthejusticesystemisnotworkingforKooriyoungpeople,butratherprivilegesthemainstream.Therefore,itistheaimofBundjiBundjitoprovidesupporttoIndigenousyoungpeoplewhoaremarginalisedbyhavingtheuniquelydifficultchallengeoffacingthejusticesystem.

UndertheumbrellaofBundjiBundjiaretwosubsequentprograms:theNorthernBundjiBundjiProject,avoluntaryoutreachserviceforyoungIndigenousmenthatbeganin2006andtherecentlyformedTiddasProgramthatprovidessimilarsupportforIndigenousyoungwomen.

TheBundjiBundjiProgramobjectivesareto:

•assistKooriyoungpeopletostayinschooloremploymentandtoreconnectwithcommunity

• linktheyoungpeopleintolocalservices•promotehealthy,positivelifestylechoicesthroughrecreational

programssuchasculturalcampsandartprograms•utilisetheleadershipofEldersandyoungpeoplewho

canactasrolemodelstoguideat-riskyoungpeople•reducetheextentandincidenceofantisocialandcriminal

behaviorinyoungpeoplethroughdiversionsthatprovidemeaningfulalternativestooffending.

Thefactremainsthatthestructureofthehealthsystemcanbeextremelyintimidatingtotheyoungpeopleandrunstheriskofexacerbatingcurrentmentalhealthissuesifnotdealtwithinaculturallysensitiveway.BundjiBundjihasfoundthatprovidinganAboriginalfacilitatortoassisttheyoungpeopleinnavigatingthementalhealthsystemcanleadtomoresuccessfuloutcomes.

Mental health

MentalhealthisnotformallydealtwithbyBundjiBundji,butisasignificantunderlyingissue.Factorssuchassubstanceabuse,familybreakdown,griefandloss,intergenerationaltraumaanddiscrimination—particularlyintheeducationsystem—haveresultedinalossofclarityanddirectionforalotoftheyoungpeopleBundjiBundjisupports.Intergenerationalfactorsareparticularlycrucialinunderstandingthechallengesfacedbytheseyoungpeople.Researchsupportsthisassertion,revealingthatIndigenouschildrenwhosemotherswereforciblyseparatedfromtheirnaturalfamiliesaretwoandahalftimesmorelikelytobeatriskof‘clinicallysignificantemotionalorbehaviouraldifficulties’i.

BundjiBundjisupportsclientswhosesuspectedmentalhealthconcernshavebeenalleviatedbytakingamoreholistic,culturallysensitiveapproachtotheclient’srecovery,ratherthanjustrelyingonclinicalpractitionersastheprimarymethodoftreatment.Simple,practicalsolutionsthatreducethecomplexitiesintheyoungpeople’slivescan,attimes,provemosteffectiveinreducingstressandanxiety.Forexample,BundjiBundji’syoungclientssometimesreceiverequestsforinformationfromservicesthataskthemtoprovidemeansofidentificationsuchasabirthcertificateoraMedicarecard.Unsurprisingly,duetothechaosmanyoftheyoungpeopleexperienceintheirdailylives,abirthcertificatemighthavebeenmisplacedsometimeago.BundjiBundjicanprovidetheyoungpeoplewithanewbirthcertificate;asmallgestureofsupport,butitneverthelesssimplifiesanaspectoftheyoungperson’slife.Sortingthroughsomeofthemoreminorcomplicationshasallowedanumberoftheyoungpeopletogettoaplacewheretheyfeelmorecapableofreceivingclinicalhelpifneeded.

InthecaseswhereamedicalinterventionhasbeendeemedappropriateforaBundjiBundjiclient,thereareinstanceswherereferringtheyoungpersonwithmentalhealthconcernstoaclinicalpractitionerwithoutaculturallyappropriatemediatorinplacecanbecounterproductive.A2008reviewofthesocialandemotionalwellbeingofIndigenousAustralianspublishedintheAustralian Indigenous Health Bulletin,foundthattherewas‘alackofculturallyappropriateservices,andalackofIndigenousstaffwithinavailableservices’iiconsequentlyhavinganadverseimpactonIndigenouspeopleaccessingsupportservices.Thefactremainsthatthestructureofthehealthsystemcanbeextremelyintimidatingtotheyoungpeopleandrunstheriskofexacerbatingcurrentmentalhealthissuesifnotdealtwithinaculturallysensitiveway.BundjiBundjihasfoundthatprovidinganAboriginalfacilitatortoassisttheyoungpeopleinnavigatingthementalhealthsystemcanleadtomoresuccessfuloutcomes.

BundjiBundji’soutreachworkersofteninvolvethefamiliesofclientsinthesupporttheyprovide.ThisapproachhasbeenidentifiedasaneffectivecomponentinassistingyoungpeoplewithamentalillnessinthereportWorking Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice.Thereportstatesthatworkingwiththefamiliesasateamandprovidingpracticaladvicetofamilymembersareamongthemanythingsthatworkerscandotoenableagreaterunderstandingofmentalillnessamongstfamiliesinthecommunity.iiiBundjiBundjiOutreachWorkerUncleLesterGreentookawhole-of-familyapproachthatreallyresonatedwiththeyoungpeopleandthiswasevidentinanevaluationoftheprogram.OneyoungpersonrecalledthatUncleLester‘toldhim[thefather]mysideofthestory’,whichhadbeenasignificantmomentinthatparticularyoungperson’sabilitytoreconnectwiththeirdad.



Furthermore,BundjiBundjihasseenpositiveresultsfromtakingamoreholistic,spiritualapproachtomentalhealth.AfewofBundjiBundji’sclientshavebeenreferredtoculturalhealingcentresinMelbourneandEchuca.Asaresultoflong-termculturallyappropriateplacementsthatbuildtrust,theyoungmenhavecommencedclinicalassistancetoaddresslong-termgriefandlossissuesthathavehadenormousimpactontheirlivesandplayedamajorpartintheirongoinginvolvementwiththecriminaljusticesystem.

Case study

Josh*isan18-year-oldclientofBundjiBundjiwhohasbeeninvolvedwiththeBundjiBundjiProgramformorethanthreeyears.HeinitiallyaccessedtheprogramthroughBundjiBundjiElderUncleLesterGreenwhoprovidedadvocacyforJoshinthejusticesystem.Joshwasusingsubstances,mostlycannabisandalcohol,whichledtoinvolvementincrime.Theprogramprovidedculturallyappropriatesupportandadvocacywithinthejusticesystem,andworkedwithJoshtoaddressissuessuchasincomesupport,fines,trainingandemploymentandreconnectiontocommunitythroughsport.TheprogramalsousesthestoriesoftheworkersandElderstoconnectwithyoungpeopleandcontinuestosupportyoungpeopleinapositiveregard,aslongastheycontinuetowantthesupportoftheprogram.

Joshcontinuedtohaveissuesaroundgriefandlossanddealingwithfamilyconcernsaroundsubstanceuseandviolence.Whenhewasabletosortouttheissuesinhislife,thelargerissues

werecomingtotheforefront,wherehecouldtacklethemheadon.Joshmadeadecisiontoplacehimselfinadetoxfacilityandthenintoalong-termrehabilitationfacility.Hecontinuestoresideatthefacility,iscommittedtothefour-monthprogramandhassecuredapositioninlandscapingwhenhefinisheshisrehabilitation.Heisinvolvedincounsellingandhasbeenabletomoveawayfromfamilyandfriendswhoencouragedruguse.HefeelsthatworkingwithAboriginalsupportworkersinaprogramthatisculturallyawarehasmadeasignificantdifferencetohiscircumstances.Theabilitytobeinvolvedindecisionmakingwithintheprogramandbeatthecentreofanydiscussionsordecisionsthatinvolvehim,havemadeadifferencetohisabilitytomakedecisionsforhimself.

*Namehasbeenchanged.

References

i Silbern,S.R.,Zubrick,S.R.,Lawrence,D.M.,Mitrou,F.G.,DeMaio,J.A.,Blair,E.,Cox,A.,Dalby,R.B.,Griffin,J.A.,Pearson,G.&Hayward,C.(2006)‘TheIntergenerationalEffectsofForcedSeparationontheSocialandEmotionalWellbeingofAboriginalChildrenandYoungPeople’,Australian Institute of Family Studies – Family Matters,No.75,p16

ii GarveyD.(2008)AreviewofthesocialandemotionalwellbeingofIndigenousAustralianpeoples–considerations,challengesandopportunities,Australian Indigenous Health Bulletin8,(3)Originalarticleaccessedat:http://healthbulletin.org.au/a_review_of_the_social_and_emotional_wellbeing_of_Indigenous_Australian_peoples,on30July2010

iii Purdie,Dudgeon&Walker(2010)‘WorkingTogether:AboriginalandTorresStraitIslanderMentalHealthandWellbeingPrinciplesandPractice’,AustralianGovernmentDepartmentofHealthandAgeing

Bundji Bundji – supporting Indigenous young people in the justice systembyFredaHaylett

Intergenerationalfactorsareparticularlycrucialinunderstandingthechallengesfacedbytheseyoungpeople.Researchsupportsthisassertion,revealingthatIndigenouschildren,whosemotherswereforciblyseparatedfromtheirnaturalfamilies,aretwoandahalftimesmorelikelytobeatriskof‘clinicallysignificantemotionalorbehaviouraldifficulties’.



ThisarticlediscussesthecostsofimprisonmentinAustraliaandthecollateralharmwhichitcreates.Itoutlinessomeofthefactsandfiguresrelatedtoimprisonmentaswellassomeoftheharmsderivedfromthis.Thisarticledoesnothavethescopetoprovidenuancedpoliciesinresponsetothefailuresofthejusticesystem,butwilloutlineawayforwardtorespondingtocrimeandthesocialdeterminants,whichareoftendeepseatedcausativefactors.

TheAustralianprisonpopulationisasmall,diverseandisolatedcohort,characterisedbyhighlevelsofdisadvantageacrossarangeofissuessuchashighlevelsofmentalillness,victimisation(includingfamilyviolence),substanceuseanddependenceissues,unemployment,limitededucation,limitedaccesstohousingandpoorhealth.Prisoners,byvirtueoftheseadversesocialdeterminantsandthesocialisolationtheyendure,bothinprisonsandinthecommunitygenerallyfinditdifficulttoself-advocateandhavelimitedaccesstoavenuesofpublicdiscourse.Interestingly,muchoftheresearchinformingthegeneraloperationandevaluationofAustralianprisonsandthosewhofrequenttheprisonsystem,doesnotrelatetothelivedexperienceofthoselikelytoendurehighlevelsof

disadvantage,butratherreferstoprogramoutputssuchasprogramcompletion,recidivism,escapes,deathsincustody,hoursoutsideofcell,assaultsincustodyandprisoneremploymentandeducation.Thisapproachtolookingatprisonsandtheirinmates,inpart,drivespenalpolicyandpractice.Infact,thisapproachdeterminestheideologicalbasisofprisoneridentitytothepointthat:‘ratherthanclientsinneedofsupport,theyareseenasrisksthatmustbemanaged’,(Garland,2001).

the financial burden of running prisons

CrimecoststheAustraliangovernmentupto$19billionperannum;ofthis,$10billionischannelledintothedevelopmentofprisonsandpolicing.ThedailyaveragenumberofprisonersinAustraliainmid-2010wasapproximately28,843.Itisofgreatconcernthattherateofreoffendingwithinthefirsttwoyearsofreleasehasgraduallyincreasedoverthepastfiveyearsto39.3percent.Astoundingly,twooutofeverythreeprisonershaspreviouslybeenincarcerated.Despitethesefailures,approximately$2.8billionofpublicmoneyisspenteachyearonmaintainingandexpandingtheAustralianprison

Prisons and the perpetuation of disadvantage

Sam Biondo,ExecutiveOfficer

david taylor,PolicyOfficer,VictorianAlcoholandDrugAssociation(VAADA)

Thereisastrongyeterroneousperceptionthatthecrimerateisconstantlyrisingaswellasanexaggeratednotionoftheprevalenceofviolentcrime.Thereislittlespaceinthemainstreampublicdiscourseforissuesrelatingtodisadvantageandtheroleprisonsplayinperpetuatingthecycleofdisadvantageorthetypeandextentofrehabilitativeserviceslinkedtoprisons.Ingeneral,thissilenceperpetuatesmanynegativeandingrainedproblemsassociatedwithprisons.



system.Yetthisexpenditure,irrespectiveofthelong-termoutcomes,drawslittlecommentorqueryfromeitherpoliticiansorthepublic.Prisons,policeandlawandorderpoliciesappeartobeviewedasanembeddednecessitybythegeneralcommunityandlargelybeyondreproach.Prisonersareportrayedas‘theother’andseenasundeserving,wicked,violentandintractable.Thereisastrongyeterroneousperceptionthatthecrimerateisconstantlyrisingaswellasanexaggeratednotionoftheprevalenceofviolentcrime.Thereislittlespaceinthemainstreampublicdiscourseforissuesrelatingtodisadvantageandtheroleprisonsplayinperpetuatingthecycleofdisadvantageorthetypeandextentofrehabilitativeserviceslinkedtoprisons.Ingeneral,thissilenceperpetuatesmanynegativeandingrainedproblemsassociatedwithprisons.Withinthementalhealthenvironmentmanysimilaritiescouldbedrawntothenatureandimpactofinstitutionalisedmentalhealthservicedelivery,whichfortunately,inrecentdecades,hasgraduallytakenonaseriesoftransformativechanges.

A health and welfare diagnosis of prisoners in Australia

Australia’sgeneralprisonpopulationischaracterisedbyacomplexamalgamofsocialandhealthissues.Asaninsightintoourprisonsystemconsidersomeofthefollowingfacts:

•75percenthavecompletedonlyuptoyeartenofschooling

•betweensevenandeightpercentofmalesandelevenpercentofwomenwerehomelesspriortotheirimprisonment

•AboriginalandTorresStraitIslanderpeoplesaresignificantlyoverrepresentedinprisonsandgenerallyexperiencemoreexacerbatedadversesocialdeterminantsthanotherprisoners.Forexample,theyare13timesmorelikelytobeimprisonedthanothercommunitymembers

•37percentreportthattheyhavehadamentalhealthdisorderatsomestageintheirlivesand18percentarecurrentlyonmedicationformentalhealthrelatedconditions

•35percenthaveHepatitisC(withhigherratesforthosewhoareinjectingdrugusers).

Furthermore:

•prisonersareheavyconsumersofbothlicitandillicitdrugswith81percentbeingcurrentsmokers(comparedwith16.6percentofthegeneralpopulation)

•52percentofprisonersreportedthattheydrinkalcoholatharmfullevels,comparedwith20.4percentofthegeneralpopulation

•71percentofprisonershadusedillicitdrugsinthepast12months,comparedwith13percentinthegeneralcommunity.

Finally,prisonersarelikelytoalsobevictimsofcrime.Thisisparticularlysalientforfemaleprisoners,whohaveoftensurvivedfamilyviolenceandsexualassault.Thesewomenfaceawidearrayofchallenges,whichisuniquetotheirdemographicandbeyondthescopeofthispapertocoverindetail.ManyofthesechallengesarediscussedintheDrugsandCrimePreventionCommittee’sInterimReport.

Evidence that prisons exacerbate existing harm

» SuicideSuicideisasignificantissuefacingprisonersandex-prisoners.Thesuiciderateamongstex-prisonerswithinthefirstsixmonthsfollowingreleaseisthreetimeshigherthanthegeneralcommunity.Likelytobecontributingtothisincreaseistheincreasedlikelihoodofheroinoverdoseforthosewhouseafteraperiodofabstinence.

» Family breakdownImprisonmentoftencontributestothebreakdownoffamilies,inparticularwhensinglemothersareincarcerated;approximately80percentofwomeninVictorianprisonshavechildrenwiththemajorityofthembeingsoleparents.Thesewomenmayfinditdifficulttobereunitedwiththeirchildrenassuitableaccommodationisoftenafactorindeterminingthesecases.Thesecircumstancesoftenleadtoafurtherspiralofdangerousbehavioursandself-harm.

» HousingThereareinherentchallengesfacingex-prisoners,ascriminalrecordsoftencreatechallengesinobtainingprivaterental,duetogapsinrentalhistory.Thehousingsectoralsocreatesbarrierstoex-prisonersobtainingpublichousing,whichresultsinthembeingforcedtoresideininappropriateandharmfulabodessuchasroominghousesandhostels,wheretheyareoftenexposedtovariouselementsthatcatalysetheirlikelihoodofreoffendingandundoanypositivegains,whichmayhavebeenachievedthroughvariousrehabilitation,treatmentandsupportprogramsandactivities.

» Poor education and healthThereisagrowingbodyofevidence,whichhighlightsarelationshipbetweeneducationandhealth,notingthatthosewithpoorhealthtendtohavelimitededucationandviceversa.Researchindicatesthataddressingthedeficitineducationwillresultinagreaterlevelofawarenessingoodhealthpracticesandwillalsohaveasubsidiarypositiveeffectonemploymentand,inturn,animpactonincome,resultinginbetteraccesstoaccommodation.

Prisons and the perpetuation of disadvantagebySamBiondoandDavidTaylor

» The need for systemic changeThelikelihoodofreturningtoCourtisgreaterforthosewhohavemorepriorCourtappearances.ThisisnottosaythatCourtsareanti-therapeuticorcausecrime,butratherthatthesystemasawholeisnotmeetingtheneedsofthosewhofrequenttheCourts.Formanypeoplewhoareexperiencingthemyriadadversesocialdeterminantsdetailedabove,thecriminaljusticesystemprovidesthefirstcomprehensiveinterventionandresponsetotheirchallenges.Other,moretherapeutic,interventionsmustbeavailabletothiscohortatanearlierstage.DirectorofNSWBureauofCrimeStatisticsandResearchDrDonWeatherburnnotesthatthosewhostartearlyincrimetendtoremaininvolvedandcommitmoreseriousoffencesastheygetolder.

AsWeatherburnasserts,individualswhooffendregularlyoveralongperiodoftime,aremorelikelytocomefromlowincomefamilies(withsiblingswhohavealsoengagedwiththejusticesystem),havealowerIQthanaverageaswellasmentalhealthproblems.Theyarealsomorelikelytouselicitandillicitsubstancesatharmfullevels.Developingandimplementingevidence-basedapproachestoaddresscrimewouldlikelyhavetheadditionalbenefitofpositivelyimpactinguponthoseotherharmfulsignifiersofdisadvantage.

Solutions to address the causes rather than symptoms of crime

Thefirststeptobetakenistoprovideapublicspaceforsensibleandreasoneddiscussiononevidence-basedresponsestolawandorderissuesandtorealisethatadversesocialdeterminantshaveastructuralfoundation,whichmustbeacknowledgedandcannotbeaddressedthroughindividualsectorsworkinginisolation.Thereisaneedtoquestionthemores,whichprovidethefoundationsthatembedspecificinstitutionsintothesocialandpoliticalfabricofcontemporaryAustralia,suchasprisons.Thisneedstobeundertakenwithaviewtorevealingtheiriatrogenicandcounter-productiveaspects.Forinstance,anevaluationintotheutilityofprisonas

asuitableenvironmentforthoseexperiencingadversehealthconditions,suchasdrugandalcoholaddictionormentalillness,isaworthwhileendeavour.Thisevaluationwoulddemandacomprehensiveexaminationofthepurposesofaprisonandmeasurethosepurposesandpracticesagainsttheirachievements.Akeyfunctionofthisexaminationistheneedtoreviewthefunctionandformofwhatprisonsareexpectedtodeliverorcapableofdelivering.Currentpoliciesofenlargingtheprisonsystemonthesamebasisasthepast,aremisdirectedandcontrarytoreducingoveralldisadvantageinthelongterm.Itisvitalthatwere-examinecommunity-basedapproachesorwhethermoretherapeuticapproachesareinfactpossiblewithintheexistingprisonsystem.

Theprioritiesgoverningthedailyoperationsofprisonstypicallyruncontrarytotheevidence-basedapproachesadoptedbythemanywelfaresectorswhichprovidesupportandassistancetoindividualswhoexperienceadversesocialdeterminantsthatarecommonamongstprisoners.Whetherdeliberateorotherwise,thesenseofheighteneddangerandthreatassociatedwithprisoners,protectstheideologicalstructuresthatmaintainthestatusquoofprisonsandcontinuetoperpetuatetheprioritisationandemphasisofsecurityaboveallotherwelfarematters.Thisalsocontributestoprotectingprisonsfrommeaningfulreviewandevaluation.Itiscrucialthatthesebarriersarebrokendownandthatreviewandevaluationbeundertakenwithdueconsiderationgiventothecharacteristicsandadversesocialdeterminantsevidentintheprisonpopulation.Accessto,andinvolvementof,relevantwelfareorganisationsmustbegivenprimacyinprisonoperationsandplanningandinthebroaderdiscoursesonrespondingtothesymptomsofdisadvantage,whichoftenmanifestaslawandorderissues.

VICSERVcanprovidethisarticlewithitsfulllistofreferences.Torequestacopy,[email protected]

[I]ndividualswhooffendregularlyoveralongperiodoftime,aremorelikelytocomefromlowincomefamilies(withsiblingswhohavealsoengagedwiththejusticesystem),havealowerIQthanaverageaswellasmentalhealthproblems.Theyarealsomorelikelytouselicitandillicitsubstancesatharmfullevels.Developingandimplementingevidence-basedapproachestoaddresscrimewouldlikelyhavetheadditionalbenefitofpositivelyimpactinguponthoseotherharmfulsignifiersofdisadvantage.



Editor’s note

TheAssessmentandReferralCourtList(theList)isaspecialistcourtlistdevelopedbytheDepartmentofJusticeandtheMagistrates’CourtofVictoriatomeettheneedsofaccusedpersonswhohaveamentalillnessand/oracognitiveimpairment.

TheListislocatedatMelbourneMagistrates’CourtandworkscollaborativelywiththeCourtIntegratedServicesProgram(CISP),whichprovidescasemanagementtoparticipants.Casemanagementmayincludepsychologicalassessment,referraltowelfare,health,mentalhealth,disability,and/orhousingservicesand/ordrugandalcoholtreatment.

This description has been reproduced from the following webpage: http://www.magistratescourt.vic.gov.au/wps/wcm/connect/justlib/magistrates+court/home/court+support+services/magistrates+-+assessment+and+ referral+court+list (2010), State of Victoria, via the Magistrates’ Court of Victoria’s website.

IntroductionTheAssessmentandReferralCourt(ARC)ListcommencedsittingattheMelbourneMagistrates’Courton21April2010.AstheCoordinatoroftheVictoriaLegalAid(VLA)workingwithintheListIhavebeenactivelyinvolvedwiththecourtsinceitsinception.Nearlyayearintothepilotthecourt’spracticesandproceduresarenowfirmlyestablishedandanumberofclient’shavefinalisedtheirepisodesintheList.Itis,therefore,agoodtimetoreflectonhowtheListisoperating.

the role of VlA in the list VictoriaLegalAidprovidesadutylawyerservicespecificallyforthecourt.VLAlawyersarepresentateachListsittingandhavedevelopedstrongrelationshipswithcourtstaff.TheyhavealsocompletedtrainingtolearnaboutissuesfacingtheListclientgroup.HavingtheserelationshipsandexpertiseensuresVLAlawyersareinagoodpositiontorepresentclientsandexplaintothemhowtheListoperates.Thededicatedservicealsoensuresthattheclientseesthesamelawyereverytimetheycometocourt.

ForclientswhosuccessfullycompleteanepisodeintheARCListthebenefitsareclear.Achievementscanrangefrommaintainingabstinencefromdrugsandalcoholtoreconnectingwithfamilymembersorfindingstableaccommodation.Clientswhohaveachievedsuchgoalsspeakofbeinggivena‘secondchance’andareextremelygratefultothecourtforhavingbeengiventheopportunitytoparticipate.

Carrie O’Shea, AssessmentandReferralCourt(ARC)ListCoordinator,VictoriaLegalAid

the ARC list

Referrals ReferralstotheListhavecomefromvarioussourcesincludinglegalrepresentatives,prosecutors,Magistratesand,inasmallnumberofcases,serviceproviderswithinthecommunity(forexampleDisabilityClientServices).Experiencehasshownitisimportantthatreferralsaretargetedatappropriatecandidates.BecausetheListisvoluntary,itisnotappropriateforpeoplewhodonotwantassistanceordonotbelievetheyhaveissuesthatneedtobeaddressed.Further,someclientsfindattendingcourtinherentlystressfulandthisstressovershadowsanybenefittheListmayoffer.Thisisparticularlythecasewheretheoffendingisminorandtheclientisnotfacingatermofimprisonmentorotheroneroussentencingdisposition.InsuchcasesclientshaveeithernotparticipatedandbeenexitedfromARC,orchosentohavetheirmattermovedtomainstreamcourt.

At court – client experiencesIntheARCList,hearingstakeplacewithallparties,includingtheMagistrateandclinicalstaffsittingaroundanovaltable.Clientssitbesidetheirlawyer,alongwiththeirsupportworkerorfamilymember/s.HearingsbeginwiththeMagistrateintroducinghimorherselfandtheothercourtstafftotheclientandexplainingtheirrespectiveroles.Indiscussingtheclient’ssituation,goalsandprogress,allpartiesareencouragedtocontributeandexpresstheiropinions.Clientstraditionallyassociatecomingtocourtwithpunishmentand,often,jail.Speakingopenlyaboutthemselvescanbedifficult.Asaresult,itcantakeanumberofappearancesincourtbeforeclientsfeelcomfortablewiththeprocess.Thetopicsthatarediscussedaremanyandvaried.Theyrangefromemploymentandfamilyrelationshipstomoreunusualtopicssuchasfootballteamsandpets.Becausetheconversationsareledbytheclient,theygenerallyfocusonthingsthataremostimportanttotheindividual.

TheoperationoftheARCListisinmarkedcontrasttoclients’previousexperiencesofcourt,wheretheyareoftenthesubjectofdiscussion,butrarelyaparticipant.ThroughtheARCListprocess,clientsgofromhavingsolutionsimposedonthembythecourttobeingtheonesdrivingthediscussion.Havingthisleveloftrustandresponsibilitybestoweduponthemcanbeempoweringforclientsandagreatmotivatortosucceed.

TheimpacttheListishavingonthelivesofclientsbecomesclearwhencasescomebackbeforetheMagistrateforreview.Whenaclient’spositiveprogressisdiscussedtheyoftenexpresshowproudtheyareoftheirachievements.Similarly,ifthingshavenotbeengoingwell,clientsspeakaboutnotwantingtolettheMagistratedownandhopingtogetbackontrack.Clientshaveeventakentobringingphotographs,artworkandcertificatestocourttoshowtheMagistratewhattheyareachieving.

lawyers’ experiences in court Inmainstreamcriminalmatters,lawyersactasafilterforclients.Theytrytoensurethattheirclientispresentedinthemostfavourablelight.BecauseclientsintheARCListspeakdirectlytotheMagistrate,issuesthatwouldnormallybeconsideredtaboofordefencepractitioners,suchastherecentuseofillicitsubstances,arecommonlydiscussed.Theunpredictabilityofthisscenariocanbeuncomfortableforlawyers.Theprocessnecessitatesachangeofapproachfromthetraditionaladversarialroleofadvocatetoamoreopenandcollaborateapproach.

Benefits of the list for lawyers Whenpreparingmattersforcourt,criminallawyersspendaconsiderableamountoftimelinkingtheirclientsinwithsupportservices.Successfulengagementwithsuchservicescanbetakenintoaccountbythecourtwhendetermining



whatsentencetoimpose.Manyclientsinthecriminaljusticesystemhavemultipleandcomplexneeds.Thismayrequirereferralstovariousservices,forexample,drugandalcoholcounsellingorpsychologicaltreatment.Forlawyers,whoareoftentimepoorandnottrainedinthisarea,thiscanbeachallenginganddifficulttask.ConsolidatingonandextendingtheworkalreadyundertakenbytheCISPprogram,theARCcourtfacilitatesthesereferrals.Formorecomplexclientsthiscanactuallymeanareductionintheworkloadoflawyers,despitetheincreasednumberofappearancesbeforethecourt.Theinterventionofexpertsalsoensuresthatreferralstoservicesaretargetedandappropriate.

Benefits of the list for support workers TheListhasseenanincreasedparticipationofsupportworkersinthecourtprocess.Insomeinstances,serviceshavebeenconcernedthattheirclient’sparticipationintheListmayresultinthembeingover-serviced.However,courtstaffconsultingwithservicespriortoandduringthecourtprocesshasensuredthatrolesareclearlydelineatedandservicesarenotduplicated.Further,havingworkersbeinginvolvedinthecourtprocesshasledtoagreatermutualunderstandingbetweentheparties.Lawyerscometounderstandthetreatmentgoalsandcaseworkers,theforensicissuesatplay.Thisenablespartiestoworktogethertoachievebetteroutcomesforclients.

Outcomes ForclientswhosuccessfullycompleteanepisodeintheARCList,thebenefitsareclear.Achievementscanrangefrommaintainingabstinencefromdrugsandalcoholtoreconnectingwithfamilymembers,orfindingstableaccommodation.Clientswhohaveachievedsuchgoalsspeakofbeinggivena‘secondchance’andareextremelygratefultothecourtforhavingbeengiventheopportunitytoparticipate.Toseethechangeintheseclientsisincrediblyrewarding.Forsomeclients,however,the

achievementsmaybemoremodest.TherehavebeencaseswhereclientshaverelapsedintodruguseandoffendingbehaviourandbeenexitedfromtheList.However,eveninthesecases,theListhasusuallymadesomepositiveimpact.Clientsmayhavemadethefirstattempttostopusingdrugsorreducedthefrequencyoftheircontactwithpoliceandemergencyservices.Insuchcases,itisimportanttorecognisethatevensmallachievementsaresignificantandmaybepartofanincrementalprocessofchange.Importantly,thoseclientswhodonotsuccessfullycompleteanepisodeintheARCListarenotpunishedforthis.Magistratesareprohibitedfromtakingtheclient’sfailuretocompletetheARCprogramwhendeterminingasentence.

Conclusion PracticingasalawyerintheAssessmentandReferralCourt(ARC)Listisachallengingandrewardingexperience.TheListworksbestwhenclientsaremotivatedtoaddresstheirissuesandcourtstaff,supportworkersandlawyersworktogetherwiththeclienttogetthebestoutcome.Therehavebeenvaryingdegreesofsuccessfortheclientswhohaveparticipatedtodate.Forsome,theListhasprovidedawaytobreakthecycleofoffending,whichhasledtodramaticbenefitsforthemandthecommunity.However,eventhosewhohavenotsuccessfullycompletedtheprogramhavemadesomepositivechanges.Allpartiesinvolvedhavegainedabetterunderstandingoftherolesandfunctionsofotherparticipants.Thishasledtoamorecollaborativeapproachtothepassageofmattersthroughcourt.Itiscertainthatfortheremainingtwoyearsofthepilot,newexperiencesandchallengeswillcontinuetoarise.

The ARC ListbyCarrieO’Shea

Forsome,theListhasprovidedawaytobreakthecycleofoffending,whichhasledtodramaticbenefitsforthemandthecommunity.However,eventhosewhohavenotsuccessfullycompletedtheprogramhavemadesomepositivechanges.Allpartiesinvolvedhavegainedabetterunderstandingoftherolesandfunctionsofotherparticipants.Thishasledtoamorecollaborativeapproachtothepassageofmattersthroughcourt.



ThereisabroadconsensusamongsttheAustraliancommunity,policymakersandgovernmentthatpeoplelivingwithmentalillnessmay‘slipthroughthecracks’inexistinghealthandsocialsupportsystems.Consequently,peoplelivingwithmentalillnessaremorelikelytoencountersocialdisadvantage,whichmayleadtocompoundingproblemsintheirlives.Althoughlivingwithmentalillnessisexperienceddifferentlybydifferentpeople,oftenitisassociatedwithmanycomplexandinteractingsocial,economicandculturalproblems.Withoutdetractingfromthecomplexitiesoflivingwithmentalillnessinamodernsociety,itpresentsparticularchallengesforthosewhoendupinthecriminaljusticesystem.Thisisparticularlyso,whenapersonisfirstdiagnosedwithamentalillnessfollowingtheirincarceration123.

Inside AccessInsideAccessisaninnovativeprisoneradvocacy/legalservice,whichwasfirstpilotedbytheMentalHealthLegalCentre(MHLC)in2008.Itisanon-governmentfundedproject,whichdeliverstherapeuticjusticetoincarceratedpersonsinVictorianprisons,withtheassistanceofatalentedteamofpro-bonolawyersfromDLAPhillipsFoxandBlakeDawson,aswellasasignificantcontributionfromadedicatedteamofvolunteersfrommanyofVictoria’slawschools.

Theprojectwasdevelopedinresponsetothealarmingover-representationofpeoplewithmentalillnessinthecriminaljusticesystemandtheinherentdifficultiesofaccessingjusticewhilstincarcerated.Theservicescurrentlyprovidedbytheprojectinclude:

Asparticipantsinthecriminaljusticesystemwhoarelivingwithmentalillness,oftentheyhaveexperiencedalienationfromthelegalsystem.Thismaybetheresultofavarietyoffactors,includinganinabilitytounderstandlegaljargon,nothavingcourtprocessesproperlyexplained,beingmentallyunwell,nothavingalegaladvocatewhohassomebackgroundknowledgeofmentalillness,oraMagistratewhodoesnotfollowingthepreceptsoftherapeuticjurisprudence.

Indiana Bridges,LawyerandCoordinatoroftheInsideAccessproject,MentalHealthLegalCentreInc.

Penal solutions to social problems



• legaladviceandassociatedadvocacy,supportandreferralservicesforincarceratedpersonswhendealingwithalegalneed

• legaleducationforincarceratedpersonsabouttheirlegalrightsandpromotionaroundunderstandingthelegalandmentalhealthsystems

•communityeducation,trainingandresourcestogroups,professionals,workersandindividualstoincreaseawarenessofmentalhealthlegalissuesandassociatedmatters

•evaluatingandmonitoringofexistinglaws,legalandmentalhealthservicestandards,policiesandprocedures,workingtowardsreforminareasofrelevancetothoselivingwithmentalillnessinthecriminaljusticesystem,andadvocatingtowardssystemicchangewherenecessary

•deliveryofalegalclinicattheDamePhyllisFrostCentre,MelbourneAssessmentPrisonandThomasEmblingHospital.Theaimsoftheprojectaretodeliveraspecialisedlegalserviceforclientstoaddresstheirimmediatelegalneeds.Whenaclientpresentswithamatterthatisbeyondourresourcesorexpertise,wewillactivelyseektoreferthatclienttoanotherlegalpractitionerorotherserviceprovider,whichisbetterequippedandwillingtoassist.

Ourongoingnetworkingandcollaborationwithotherserviceproviders,hasensuredthattheInsideAccessprojectincreasesunderstandingofthelegalprofession,governmentandcommunitysectorintheissuesaffectingpeoplewithmentalillnessinprison.

Overthepast15months,theprojecthaswrittenanumberoflawreformsubmissionsrelatingtomentalhealthandcriminaljustice.ThisincludedsubmissionstotheVictoriangovernmentontheDiversion and support of offenders with a mental illness – Guidelines for best practiceconsultationdraftinFebruary2010,andthediscussionpaperTransforming VCATinJune2010,(bothincollaborationwiththeMentalHealthLegalCentre),andpresentingoralandwrittensubmissionstotheDrugandCrimePreventionCommitteeparliamentaryinquiryintotheImpact of Drug-Related Offending on Female Prisoner NumbersinJune2010.

the impact of Inside Access on advocacy and legal servicesTheimpactoftheInsideAccesslegalclinicshasbeenmeasurablethroughtheoverwhelminglypositiveresponseofclients,stakeholders,andthroughourpartners.Weprovidea

specialisedservice,aportalforclientstoaccessinformationandreferralpathwaysthatmayotherwisebedifficultforanincarceratedpersontoinitiateoraccess.Inaddition,ourpartnersandpro-bonolawyersareprovidedwithanopportunitytogainexperienceandgreaterexposuretothesocialaspectofthelawbydirectlyassistingclientswhoarelivingwithamentalillness.Lawstudents(whomayhavedegreesinpsychology,socialwelfareorcriminallegalstudies),areabletoworkdirectlywithclients,underthesupervisionoflawyers,todeveloptheirpracticallegalskills.

Examplesofourworkinassistingpeopleinclude:

• fosteringhumanrights–accesstomedicalrecordsandphysiciantreatmentplansforthepurposeofrepresentingclientsatForensicLeavePanelhearings

• facilitatinginterpreterserviceswithlawyersandclients,wherethereislittleornospokenEnglish

•providingadvocacy–legalrepresentationatVCAThearingsandMagistrateCourthearings

•communicatingwithclients’triallawyerstoassistclients’informationpathways

•assistingclientstoseekameritsreviewonappealoftheirsentence

• liaisingwithDepartmentofHousingrepresentativestoassistwithtenancyissues

• liaisingwithfamilymembersinrelationtoculturalneeds.

Weworktogetherwithcourtsandotherlegalserviceproviderstoensureourclientshavethebestsupportnecessary.Forexample,clientswishingtochallengeanAdministrationOrderarereferredtoafinancialcounsellorfromGoodShepherd,whowillattendtheprisontoassesstheclient.Ononerecentoccasion,aclientwishingtochallengeherAdministrationOrdersoughtourlegalassistance.Shehadbeendiagnosedwithanacquiredbraininjuryandwassoontobeleavingprison.InsideAccessfacilitatedaone-to-onesessionwithafinancialcounsellorfromGoodShepherd,whoattendedprisonandprovidedaletterinsupporttotheTribunal.TheVCATMembermadereferencetotheletterandwas,inturn,satisfiedwiththeletterofopinionprovidedbythefinancialcounsellor,whichstatedthattheclientwassufficientlywelltomanageherownfunds.Inthatcase,theAdministrationOrderwasrevoked.

Penal solutions to social problemsbyIndianaBridges

Frequently,InsideAccessworkswithclientstoensuretheiroutstandingdebtsdonotescalatewhilsttheyareincarceratedandunabletopay.Oneclientwrites:

I write just a short letter offering your firm my deepest heartfelt appreciation in your supporting both my partner and myself in our request to suspend our loan repayments.

Anotherclientwrites:

Inside Access provide a vital, invaluable support and advocacy resource for female prisoners, and we feel it is important this organisation receive continued funding.

Profiles of prison inmatesThereisaparticularemphasisonlivedexperiencesofclientsoftheservice.Therecentpastofmanywhogotojail,showsthattheywerelikelytohavebeenalienatedfromsocietyinsomeway,eitherthroughsocialexclusion,lowerlevelsofeducation,unstableaccommodationandhomelessness,substanceabuse,domesticviolenceleadingtomaritalandfamilybreakdown,unemployment,sufferingthroughundiagnosedmentalillness,gamblingduetostressarounddebtissues,stealinggoodsandcars,drivingundertheinfluenceofalcohol,defaultingonfines,violatingaparoleorder(orrevokingtheirownparoleinfearthattheymayre-offend),abusingfamilymembers,(whichmaybeattributedtofailureintakingmedication)and/ordefyingcontrolorders.

Asparticipantsinthecriminaljusticesystemwhoarelivingwithmentalillness,oftentheyhaveexperiencedalienationfromthelegalsystem4.Thismaybetheresultofavarietyoffactors,includinganinabilitytounderstandlegaljargon,nothavingcourtprocessesproperlyexplained,beingmentallyunwell,nothavingalegaladvocatewhohassomebackgroundknowledgeofmentalillness,oraMagistratewhodoesnotfollowthepreceptsoftherapeuticjurisprudence.Forotherswholivewithmentalillness,theymaybereluctanttopathologisetheirbehaviourandwouldprefertakingresponsibilityfortheiractionswhereitmayfeelmoreappropriatetodoso.Someclientsfeelstigmatisedandareinfearofbeingdiscriminatedagainstifitisrevealedthattheyhaveamentalillness.However,itisevidentthatpunitivesanctionsalonedonotleadtoasafercommunity–theavailableresearchdoesnotsupporttheeffectivenessofimprisonmentasaspecificdeterrenttore-offendingand,infact,suggeststhatitmayindeedincreaserecidivism5.

InsideAccessaimstobeoneofmanypreventativemechanismsthathelpdivertpeoplewithmentalillnessoutofthecriminaljusticesystem.Byfocusingonpreventionthroughaccesstolegalrightsandeducation,InsideAccesscanempowerpeopletoenforcetheirlegalrightsandtoaccessappropriatesupports.

However,inordertoprovideanintegratedandpreventativeresponse,diversionoutofthecriminaljusticesystemforpeoplewithmentalillnessisvital.Forexample,mentalhealthprofessionalscanplayasignificantroleindiffusingasituationbeforeitdevelopsintoacrisis.Similarly,policehavethediscretionnottochargeapersonsuspectedofcommittinganoffence,anddivertthemawayfromthecriminaljusticesystem,intoappropriatecareandtreatment.6

Diversionandsupportprogramscanfacilitateaperson’shumanrights,includingrightsundertheUnitedNations’Convention on the Rights of Persons with Disabilities,whichincludesrightsto:equalrecognitionbeforethelaw(article12),accesstojustice(article13),independentlivingandsupport(article19),healthcare(article25)andrehabilitation(article26).Theserightscanbeimpairedifmentalillnessgoesundetectedorisnottakenintoaccountbythecriminaljusticesystem.

Legalserviceprovidersneedtodeliverstrongandeffectiveadvocacyandensurethatdecisionmakersunderstandtheimpactofaperson’smentalillnessaswellasothercircumstances.ThisisoneofthefundamentalrolesoftheInsideAccessproject.

References

1 SeeMentalHealthLegalCentreReport(2010)Experiences of the Criminal Justice System – the perspectives of people living with mental illness

2 The National Survey of Mental Health and Wellbeing 2007foundthatamongpeoplewhohavepreviouslybeenincarcerated,41percentreportedamentalillnessinthepast12months,doubletherateofpeoplewithoutahistoryofincarceration,AustralianBureauofStatistics(ABS)(2008c),National Survey of Mental Health and Wellbeing 2007: Summary of results,ABS,Canberra

3 Researchhasshownthatoffendershavehigherratesofmentalillnessthanthegeneralcommunity.Continuedattentionisrequiredtobefocusedonunderstandingthereasonsforthedisproportionateprevalenceofmentallyillpeopleinthecriminaljusticesystem

4 SeeChapter4,MentalHealthLegalCentreReport(2010)‘Participants’experienceofthecourtritualsandenvironment’,Experiences of the Criminal Justice System – the perspectives of people living with mental illness,availableat:http://www.communitylaw.org.au/mentalhealth/cb_pages/images/Experiences%20of%20the%20Criminal%20Justice%20System%20Report.pdf

5 Weatherburn,D.,Vignaendra,S.,andMcGrath,A.(2009)‘Thespecificdeterrenteffectofcustodialpenaltiesonjuvenilere-offending’,AustralianInstituteofCriminologyReports,TechnicalandBackgroundPaper33

6 SeeMentalHealthLegalCentreReport,n4



Thefollowingcasestudydescribestheinvolvementofarecentclient(knownasDS)withtheClientServicesTeamandMagistrates’CourtoftheNJCinCollingwood.Itisintendedtodemonstratetheimpactofcomprehensive,multi-disciplinarytreatmentandsupportservicesontheclient’sabilitytorehabilitate,includingtoceaseoffending,successfullycompletehiscourtorder,gainemploymentandaddresspersonalandtreatmentgoals.

BackgroundDSwasa32-year-oldsingle,unemployedmanwhowasawaitingthehearingofaseriesofoffences(propertyandsubstance-related)listedattheNJCinCollingwood.DShadalong-standinghistoryofinvolvementwiththecriminaljusticesystem,havingpreviouslybeensubjecttoaseriesofcommunitybasedorders(CBOs),repeatedperiodsofimprisonmentandwas,atthetimeofreferral,subjecttoaSuspendedSentence.

DSdescribedalonghistoryofbehaviouraldifficulties,anddepictedhischildhoodandadolescenceinpredominantlynegativeterms.Hedescribedencounteringdifficultyinmaintainingappropriatepatternsandstandardsofbehaviourduringchildhoodandadolescence.DSleftschoolatage14duetoincreaseddifficultyconcentratingandfailuretokeepupwithhispeer’seducationalachievements.

DSdescribedusingsubstancesduringhisearlychildhoodandreportedcommencementofillicitsubstanceuseduringhisadolescence.DSidentifiedpreviousengagementinoffendingbehaviours,bothtosupporthissubstanceuseandinresponsetochildhoodindoctrinationintooffendingbehaviourswithinhisfamily.

Duringhispre-sentenceinvolvementwiththeNeighbourhoodJusticeCentre(NJC),DS’sprogressandcompliancewithtreatmentgoalswassubjecttojudicialmonitoringviaaseriesofcourtreturndates.Duringthecourseofthesecourtappearances,hismaintenanceofanoffence-freelifestyleandhisattendanceatregularcasemanagementandtreatmentappointmentswerediscussedwiththepresidingMagistrate.DSwasalsosuccessfulinsecuringconstructionworkemploymentduringthisperiod.

Caroline Ottinger, CommunicationsManager,NeighbourhoodJusticeCentre(NJC)

Neighbourhood justice

treatment and support services at the NJCUponattendanceattheNJCMagistrates’Court,andenteringofapleaofGuilty,DSwasreferredtothegeneralistcounsellorprovidedbytheNorthYarraCommunityHealthCentreforpre-sentenceassessment.Hiscourtmattersweresubsequentlyadjournedforaperiodoftimetoallowforthisassessmenttotakeplace.Attheinitialassessment,DSidentifiedaseriesofpersonalandtreatmentgoalsinvolvingmaintenanceofadrug-freelifestyle,securinggainfulemployment,andinterventioninrelationtounmetmentalhealthneeds(depressionandanxiety).

Followingtheinitialassessment,DSwasreferredtoanumberofservicesbasedattheNJCandwasengagedincasemanagementprovidedbytheNJC’sClientServicesTeam.DSwasreferredtotheemploymentpathwaysworker(providedbytheBrotherhoodofStLaurence)forvocationalassessment,andtothementalhealthclinician(providedbyStVincent’sMentalHealthService)forfurtherassessmentandidentificationofunmetmentalhealthneeds.HewasalsoreferredforanAlcoholandOtherDrugassessment(providedbyOdysseyHouseVictoria).

Vocational assessmentidentifiedthatDShadahistoryofemploymentincludingsuccessfulcompletionofatradeApprenticeshipandwashighlymotivatedtowardreturningtogainfulemployment.TheemploymentpathwaysworkerprovidedDSwithinformationregardingrelevanttrainingcoursesinhisidentifiedareaofemploymentinterestandprovidedfurtherappointmentstosupporthiminre-enteringtheworkforce.

Alcohol and Other drug assessmentidentifiedthatDS’scurrenttreatmentprogramwassuccessfullyassistinghimtomaintainasubstance-freelifestyle,andthatthecounsellingandsupportserviceshehadengagedwithattheNJCweresupportinghimtocomplywithtreatmentandattainmentof

treatmentgoals.DSwasnotsubsequentlyreferredforfurthertreatmentofhisAlcoholandOtherDrugneeds.However,theAlcoholandOtherDrugassessmentrolewasaccessedduringDS’sinvolvementwiththeNJC,toprovidesecondaryconsultationandadviceinrelationtoDS’scasemanagementandtreatment.

DSwasreferredforamentalhealthassessmentinresponsetohisself-reportedhistoryofdepressionandanxiety.Hedescribedahistoryofinvolvementwithpublicmentalhealthserviceshavingpreviouslybeensubjecttoinvoluntaryinpatientpsychiatricadmissionasaconsequenceofperiodsofincreasedruminationonsuicidalthoughtsandengagementinsuicideattemptsandself-harmingbehaviours.DSalsodescribedafamilyhistoryofseriousmentalillness.Duringthecourseofassessment,DSrelatedahistoryofgrosslydisorderedbehaviour,impairedcognitivefunctioning(mostpronouncedintheareaofhisexecutivefunctioning)andexperienceofdifficultyinsustaininghisconcentrationandrespondingtocompeting/changingpersonaldemands/needs.DSalsodescribedahistoryofexperienceofdepressivesymptoms,andwhilstthesewereidentifiedashavingasignificantimpactuponhispersonalfunctioning,hewasambivalentaboutengagingintreatment.Atthetimeofassessment,DSreportedhavingpreviouslybeenprescribedantidepressanttreatment,whichhefailedtotakeasprescribed.Hewasambivalentaboutfurtherinvolvementintreatment.

DuetoDS’scomplicatedpersonalandmentalhealthhistory,hewasprovidedwithassessmentoveraseriesofsessionsduringwhichheagreedtoareferraltotheAcquiredBrainInjuryAssessmentUnitforcognitiveassessmentandaprivatepsychiatristforfurtherassessmentofhismentalhealthneedsandtreatmentrecommendations.



LongitudinalmentalhealthassessmentidentifiedDSasdemonstratingresidualsymptomsofachildhoodpervasivedevelopmentaldisorder(AttentionDeficitHyperactivityDisorder(ADHD)).Hecommencedacourseofappropriatetreatment.ThementalhealthclinicianhelpedDSdevelopcopingstrategiestocompensateforandaddresstheimpactofthesesymptomsonhisdailyfunctioningandbasicproblemsolving.

Pre-sentence judicial monitoringDuringhispre-sentenceinvolvementwiththeNJC,DS’sprogressandcompliancewithtreatmentgoalswassubjecttojudicialmonitoringviaaseriesofcourtreturndates.Duringthecourseofthesecourtappearances,hismaintenanceofanoffence-freelifestyleandhisattendanceatregularcasemanagementandtreatmentappointmentswerediscussedwiththepresidingMagistrate.DSwasalsosuccessfulinsecuringconstructionworkemploymentduringthisperiod.

SentencingUponfinalisationofDS’smattershewasdeemedtohavedemonstratedExceptionalCircumstancesasevidencedbyidentificationofapre-existingdiagnosisofADHD,demonstrationofongoingsymptomsofthisdisorder,andproductiveengagementintreatmentandcasemanagement(bothofwhichweresignificantdeparturesfromhisprevioushistoryofverypoorengagementwithtreatment/services).DSwasthensentencedtoatwo-yearCommunityBasedOrderandcontemporarySuspendedSentence.

Community Correctional Services and the Court Review processAftersentencing,casemanagementofDSwastransferredtoCommunityCorrectionalServices(CCS)basedattheNJC.TheClientServicesTeamgaveallrelevanttreatmentandsupportinformationtoCCS.

DuringthecourseofDS’sCBO,hewassubjecttoaregularcalendarofcourtreviews,asisstandardpracticeattheNJC,andwasproactivelyengagedwithcasemanagementprovidedbyCCS,withspecialistinputprovidedbytheClientServicesTeamasrequired.DSalsomaintainedregularcontactwiththesupportservices(bothinternalandexternaltotheNJC)engagedduringhispre-sentenceperiodwiththeNJC.

InadditiontomonitoringhiscompliancewithtreatmentandotherprogramconditionsattachedtotheCBO,hisCCScasemanagerassistedDStoidentifyhowhismentalhealth,substanceabuseandupbringingdirectlycontributedtohisoffendingbehaviour,andtodevelopstrongrelapsepreventionstrategiestoreducehisriskoffutureoffending.

TheCBOCourtReviewprocessfacilitateddiscussionbetweenDS,theMagistrateandrelevantsupportagenciesofhisprogresstowardthecompletionofthisorderandachievementoftreatmentgoals.ThisprocessofreviewsfoundthatDShadsuccessfullycompletedallrelevantconditionsoftheorderandhadbeensuccessfulinaddressingtheidentifiedunderpinningfactorsassociatedwithhispreviousoffending.Inconsiderationofthis,andthelengthyperiodoftimethatDShadbeensubjecttothisCBO,theMagistratesuggestedthathemakeanapplicationforconfirmationoftheorderpriortoitstermination.DSmadesuchanapplicationthatresultedinhisorderbeingconfirmedandsubsequentlyterminatedearly.DSremainedsubjecttoaSuspendedSentence,whichcouldprovideanexpedientresponsetoanyfurtheroffending.

AtthetimeofcompletionofhisSuspendedSentence,DShadcontinuedtomaintainadrug-andoffence-freelifestyleandwasproductivelyengagedinthegainfulemploymentthathehadsecuredpriortosentencing.Hewasalsopursuingaccommodationintheprivaterentalmarket,havingresidedwithhisimmediatefamilymembersduringthecourseofhisinvolvementwiththeNJC.

Neighbourhood justicebyCarolineOttinger



SmartJustice,acoalitionofcommunityorganisations,isledbytheFederationofCommunityLegalCentres(Victoria)Inc.,whichisthepeakbodyforVictoria’s50communitylegalcentresincludingtheMentalHealthLegalCentre.TheaimofSmartJusticeistoenhancethesafetyofallVictoriansbypromotingunderstandingofcriminaljusticepoliciesthatareeffective,evidence-basedandhumanrightscompliant.Theprojectisbuiltonajointcommitmenttoagreaterfocusoncrimepreventionandcost-effectivecrimepreventionstrategies.Weadvocateforgreaterresourcestoaddressthecausesofcrimebytacklingunderlyingfactorsthatcontributetooffending,throughincreasedinvestmentinchildprotection,familysupport,housing,employment,education,mentalhealthanddrugandalcoholprograms.

TheorganisationsinvolvedinSmartJusticehaveavastarrayofexperienceworkinginthecriminaljusticesystem.Weknowfromourworkwithclientsthatweneedtosubstantiallyincreaseinvestmentinearlyinterventioncommunitymentalhealthcare.Thisisbecausethereisaseriousover-representationofpeoplewithmentalhealthproblemsinprison.Forexample,85percentofwomeninprisoninVictoriahaveamentaldisorder.Prisonisfarmoreexpensivethancommunitymentalhealthcare;itfailstorehabilitatepeopleandcanactuallyexacerbatementalillness.

AnencouragingnewinitiativetoreducethenumberofpeoplewhoendupinprisonistheAssessmentandReferralCourtpilotprogramattheMelbourneMagistrates’Court.Theprogramprovidesspecialistsupportforpeoplewithamentalillnessand/oracognitiveimpairmentincludingclinicalassessment,welfareandmentalhealthreferralanddrugandalcoholtreatment.Whiletheprogramhasnotyetbeenevaluatedandisonly

availabletopeoplewhopleadguilty,itaimstoreducethenumberofpeoplewithmentalimpairmentinprison.

Anotherimpactofourunder-resourcedcommunitymentalhealthcaresystemisthattimelysupportforapersonwithamentalhealthproblemisnotalwaysavailable.Unfortunately,anuntreatedproblemcanescalateintoamentalhealthcrisistowhicharmedpolicearecalledtorespond,sometimeswithfatalconsequences.FromourworkandresearchweknowthatpeoplewithmentalillnessareoverrepresentedinfatalpoliceshootingsinVictoria.Partofthesolutionisbetterpolicetraininginidentifyingandrespondingtopeopleexperiencingmentalhealthcrises,includingbettercommunicationandnegotiationskills.AspromisedbythenewcoalitionStateGovernment,wewanttoseeVictoriaPoliceworkingalongsidementalhealthexpertstodevelopspecialisedmentalillnesstrainingforallpoliceofficersaswellasthe940newprotectiveserviceofficers.

OurnewStateGovernmenthasmadesomeencouragingpolicystatementsinrelationtoearlyinterventionprogramsandgreaterresourcesforthementalhealthsystem.SmartJusticewillbemonitoringthosepoliciesastheyaredeveloped,andwillthenbeevaluatingtheireffectivenesswhentheyareimplemented.

FINDOUTMORE:TheSmartJusticeprojectnowinvolves21leadingcommunityandlegalagenciesandtheyarealwayskeentogetmorepartnersinvolved.Youcanfindoutmoreinformationabouttheprojectat:www.smartjustice.org.au.

Michelle Mcdonnell,SmartJusticePolicyOfficer,FederationofCommunityLegalCentres,(Victoria)Inc.

Smart Justice: responding to mental illness the smart way



the taskforceTheInter-ChurchCriminalJusticeTaskforceispartoftheVictorianCouncilofChurches(VCC).Itsupportsarestorative,rehabilitativeandcommunity-basedjusticesystemtoreduceoffendingandre-offending,withimprisonmentasthelastresort.

Observations about mental health and the justice systemAnareaofinteresttotheTaskforceismentalhealth.TheincreaseofpeoplewithmentalhealthproblemsinVictorianprisonsreflectsanincreasingprevalenceofmentalillness,afailureofhealthservicestointervenebeforetheillnesscausessocialharm,andinadequatepreventionorearlyinterventionwithinthejusticesector.ThefollowingdamningobservationsaredrawnfromthereportofthepreviousVictorianGovernment,Because mental health matters: Victorian mental health reform strategy 2009 – 2019.i

Victorianprisonsheldapproximately1150peoplewithadiagnosedmentalillness(28percentofprisoners).Ofthese,500hadpsychosisand700haddepressiveconditions.Theprevalenceofpsychiatricillnessesisdisturbinglyhigherintheprisonpopulation(threetofivetimesmorecommonamongprisoners)comparedtosamplestudiesofthegeneralcommunity.

The‘deinstitutionalisation’ofmentalhealthfacilitiesinVictoriahaspossiblyresultedinanincreaseinthenumberofpeopleinprisonidentifiedassufferingfromamentalillness.Thereisuncertaintyastowhetherincreasedprevalence,orincreasingreporting,isthemaincauseofthispurportedswellincasesii.Despitethis,thereremainsadesperateneedforeffectivehealthservicesforprisonersandex-prisoners.Currenttreatmentservicesareverylimitedandoftenineffectual.Governmentandcommunitysupportisrequiredtostemrecidivismofmentallyilloffenders.

Post-releasesupportprogramsaddressingaprisoner’sholisticneeds,includingtheirmentalhealthneeds,havebeenfoundtobehighlyeffectiveinreducingrecidivismrates(upto70percentreduction).Whenitisconsideredthatprisonbedscostthepublicmorethan$100,000eachyear,itmakessensetoallocatefundsforcareratherthanpunishment.

TheTaskforcewelcomessupportandinvolvementfromthereligiousandnon-religiousalike.

FINDOUTMORE.YoucancontacttheauthoratDFitzgerald@css.org.au.Thefollowinglistsfurtherreadingonthetopicofthisarticle:

A safer Victoria:AnopenLettertoVictorianParliamentariansandelectioncandidateshttp://cofcaustralia.org/cofc-cms/images/stories/CofCVicTas/headsofchurchesletterforwebsite6august20101.pdf

Church leaders call for less focus on locking up criminalshttp://www.heraldsun.com.au/news/victoria/church-leaders-call-for-less-focus-on-locking-up-criminals/story-e6frf7kx-1225903176736

Crime, prisons and community: A Christian approach

http://www.css.org.au/documents/Cc_brochuresA4b_FINALtoPRINT_smallress.pdf

References

i StateGovernmentofVictoria(2009)Because mental health matters: Victorian mental health reform strategy 2009 – 2019,VictorianGovernmentPublishingService,Melbourne

ii Prisons: mental health institutions of the 21st century?White,PaulandWhiteford,Harvey(2006)MJA,185(6),302-303,accessedat:http://www.mja.com.au/public/issues/185_06_180906/whi10502_fm.html

Antony McMullen, SocialJusticeOfficer,JusticeandInternationalMission,UnitingChurchinAustralia

Inter-Church Criminal Justice taskforce



Of all the tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive... [for] those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.

SoremarkedCSLewis,andsoquotedMaryO’Hagan,psychiatricsurvivor,internationallyrenownedconsumereducatorandformerNewZealandMentalHealthCommissioner,inherpresentationentitled‘Compulsorytreatment–riskybusiness’,duringhervisittoMelbourneinSeptember2010.

Thequotationservesasapoignantreminderofhowinsidiouspaternalismandso-calledbeneficencecanbe.Althoughnoteveryonewillnecessarilyidentifywiththelanguageof‘oppressor’and‘victim’,thepowerimbalanceitinvokesisalltookeenlyfeltbypeoplelivingwithmentalillnesswhofindthemselvessubjectedtoforcedpsychiatrictreatmentand

detentionundertheMental Health Act 1986.TheVictorianGovernment’sReview of the Mental Health Act 1986—itsfirstwholescalereviewinnearly20years—hasbroughtpausetochallengethisdynamicandthecultureofserviceprovisionandprovidealternativesinlaw,whichfurthertherightsof,andempowerpeoplewith,mentalillnessinVictoria.

Afterthewavesofhope,scepticismandcriticisminthegovernment’scommunityconsultationprocess,adraftofwhatanewActmightlooklike(calledtheMental Health Bill Exposure Draft 2010)wasreleasedforpubliccommentinOctober2010.At400-oddpages,justreadingthroughtheDraftBillis,initself,anachievement.ItisanotherthingagaintonavigatethroughthedetailandthedensityoftheproposedDraftLawstotrytodetermineitsimpactonthepeople‘about’whomand‘for’whomitiswritten:mentalhealthconsumers.

Consumersattheforumwerescepticalthatchangestothetreatmentplanning,whichwouldrequirethetreatingteamtoadopta‘collaborative’approach(withtheperson,theirnominatedpersonandacarerorfamilymemberwiththeconsumer’sconsent),wouldbeasconstructiveandbeneficialastheycouldbe.Somuchotherwisedependsupontherelationshipapersonhaswiththeirtreatingteam.

Catherine leslie,LawyerandPolicyOfficer,MentalHealthLegalCentreInc.

Mental health law reform – the Mental Health Bill Exposure Draft and beyond...



Promptedbythecomplexityand,insomecases,ambiguityoftheDraftLawsandthedesiretofindoutdirectlyhowmentalhealthconsumersfeltabouttheproposednewlaws,theMentalHealthLegalCentre(MHLC),inFebruary2011,heldaconsumerdiscussionforumonkeytopics.Asastatewidespecialistcommunitylegalcentreprovidinglegalservicestopeoplewithorlabelledashavingamentalillness,theMHLCundertakeseducation,policyandlawreformactivities,whichaimtofurthertherightsofmentalhealthconsumers.Itwasfittingthereforethatthediscussions,viewsandexperiencessharedbyconsumersattheforum,entitled‘Whatmentalhealthconsumerswantfrommentalhealthlaws’,feddirectlyintotheMHLC’ssubmissiontotheDraftBill.

ManypeoplewillalreadyhaveperusedtheExplanatoryGuide,whichthegovernmentproducedtoaccompanytheDraftBill.Withinitstatesthattheproposednewlawsreflecta‘rights-basedapproach’tolawsgoverningtheprovisionofpublicmentalhealthservices,which,asweknow,havetraditionallyfocusedonregulationofinvoluntarytreatmentanddetention,basedondefinedcriteria.Consumerparticipantsattheforumhowever,remainedscepticalaboutwhetherthecultureofmentalhealthserviceprovision,sofocussedoncoercivetreatment,wouldshifttoan‘empoweringandparticipatory’frameworkwherevoluntarytreatmentreallyisthefocusofcare.

Asonepersonremarked:

Is there anything in this Act that’s going to change what happens now? ‘Cos you can... get attended to at a clinic if you are made “involuntary”. Everyone talks about voluntary patients but [try] showing up saying, “I’m in distress” and you won’t get in if they don’t see you’re serious enough... [as a voluntary patient] you’ll be the first one kicked out.

Suchattendantproblemsinpeopleaccessingservicestheydesire,consistentlywiththeirexpressedneeds,reinforcesthefindingsofthegovernment-commissionedreportbytheBostonConsultingGroupin2006.Evenwhenpeopleareinacutedistressormentalhealthcrises,theirneedsarenotprioritisedandrather,itisotherconcernsthatdeterminetheactionsofservices,includingstaffattitudesandpressuresaroundlackoftrainingandresources.

Consumerscontinuetoclamourtohavetheirvoicesheardandtheirconcernsandviewsseriouslytakenintoaccountandacted

uponbyclinicalservices.AsapartytotheConventionontheRightsofPersonswithDisabilities(CRPD),AustraliahasanobligationunderArticle4toensureandpromotethefullrealisationofallhumanrightsandfundamentalfreedomswithoutdiscriminationofanykindonthebasisofdisability,includingmentalillness.Thisincludesadoptingallappropriatelegislativeandadministrativemeasuresforimplementationoftheserightsandensuringpublicauthoritiesactconsistentlywithhumanrights.ThePreamblerightlyrecognisesthat:

Persons with disabilities continue to face barriers in their participation as equal members of society and violations of their human rights in all parts of the world.

Supported decision-making

Reformofthelawshouldstartfromthepremisethatallpeople,regardlessofdiagnosisofdisabilityorotherwise,haveequalrightstoexercisecontrolover,andparticipatein,theirowndecisionmaking,andtherighttohaveaccesstoappropriatesupportstofacilitatethis.Ifthereistobeaseparatementalhealthlawatall—aquestionwhichisbeyondanydoubtintheGovernment’sReview—itmustfacilitatetherealityofsupporteddecisionmakingforpeopleconsistentwithArticle12oftheCRPD.Thatis,thelawmustprovidemechanismsforapersontomakedecisionsforthemselves,forexamplewhentheyarewell,inadvanceofacrisis,andtobeprovidedwithsupportindoingso.

Inthisrespect,consumersattheforumwereresoundinglyinfavouroftheintroductionintheDraftBillofmeasurestoenablethemselvestoappointalegally-recognisedsupportperson(‘nominatedperson’)andtodrafttheirwishesandpreferencesinalegally-recogniseddocument(‘advancedirective’).Nevertheless,whattheproposedlawsprovideisnotnecessarilycommensuratewithwhatconsumerswantsuchmeasurestoachieve.

Peopleattheconsumerforumweregenerallyinsupportofthenominatedpersonscheme,which,tosome,wastheonlybenefittheycouldseeinthecompulsorytreatmentandtreatmentplanningprovisionsintheDraftBill.Itwasconsistentlyfelt,however,thatthescheme,asenvisagedundertheproposedlaws,wastoorestrictive.Whyshouldapersonbelimitedtonominatingonlyonesupportpersontobeinformedof,andconsultedabout,everyaspectofcareandtreatment?Whyshouldn’tthepersondeterminewhatandhowmuchinformation

Mental health law reform – the Mental Health Bill Exposure Draft and beyond...byCatherineLeslie

Reformofthelawshouldstartfromthepremisethatallpeople,regardlessofdiagnosisofdisabilityorotherwise,haveequalrightstoexercisecontrolover,andparticipatein,theirowndecisionmaking,andtherighttohaveaccesstoappropriatesupportstofacilitatethis.Ifthereistobeaseparatementalhealthlawatall—aquestionwhichisbeyondanydoubtintheGovernment’sReview—itmustfacilitatetherealityofsupporteddecisionmakingforpeopleconsistentwithArticle12oftheConventionontheRightsofPersonswithDisabilities.

shouldbesharedandwithwhom?Whyshouldthenominatedperson’srolenotincludethepowertomakedecisionsinthesamewayamedicalpowerofattorneycan?

Similarly,consumersgenerallywelcomedthefactthatrecognitionofanadvancestatementtooutlinewishesandpreferencesfortreatmentwouldencouragemorepeopletoformallyexecutesuchadocument.However,whilstgenerallysupportiveoftherequirementtoreportanypotentialdecisioninconsistentwiththeperson’sadvancestatementtothenewlyestablishedmentalhealthcommissioner,theweightandenforceabilityofthedocumentsneededtobestrengthenedconsiderably.Advancedirectives,ifgivengreaterweightinthelaw,wereseenasakeymeansofoperationalisingsupporteddecisionmaking.But,asmanyconsumersremarked:

We really dislike the language… We want it to be stronger. We want it to say that “[the advance statement] must be followed unless there are compelling reasons not to”, rather than they “must have regard to” because that’s wishy washy and we want it to be more “person first”.

Whenitcomestorefusalofspecifictreatments,includingelectroconvulsivetherapy(ECT),onegroupofconsumersstatedemphatically:

What do we want the law to do? Advance directives that override everything else, i.e. if I say I don’t want ECT or a certain medication in my advance directive when I’m capable, that should be respected even if I’m made involuntary. It shouldn’t be able to be overridden.

Safeguards and external review of compulsory treatment orders

Whereapersonissubjectedtoinvoluntarytreatment,robustlegislativesafeguardsincludingindependentreviewsandappealmechanismsarecriticaltoensurethataperson’srightsarenotdisproportionatelyinfringed,consistentwiththeVictorian Charter of Human Rights.Keyrightsinthisrespect,aretherightstobefreefrommedicaltreatmentwithoutconsent,tobefreefromcruel,inhumananddegradingtreatment,toprivacyandbodilyintegrityandtohumanetreatmentwhendeprivedofliberty.

IntheDraftBill,despitethemovetoastagedsystemofinvoluntarytreatmentorders(nownamedCompulsoryTreatmentOrders,orCTOs),sometighteningofthe‘fivecriteria’forcompulsorytreatment,andashiftintheprocesstooneofpriorMentalHealthTribunal(Tribunal)authorisation,beforethemakingofextendedcompulsoryorders,manypeopleattheconsumerforumclearlyfelttherewasunlikelyto



beanyreallysignificantchangeinthecompulsorytreatmentregimeasawhole.Someproposedchangesmightevenbedescribedastakingonestepforward,onlytothentaketwostepsbackward.Forexample,whiletheDraftBill’slimitingofan‘initial’CTOtothree-monthswasseenasanimprovementonthecurrent12-month(maximum)length,thefactthatbeyondthat,anorderwouldbelonger–upto18months–wasroundlycriticised.ItiswellknownthatVictoriahasthehighestuseofforcedcommunityoutpatienttreatmentofanywhereelseintheworldwhere,asPsychiatristDrGunventPateldescribes,mentalhealthclinicianshave‘activelyengagedintheirusewithanalmostreligious,unquestioningzeal’.

Consumersattheforumwerescepticalthatchangestothetreatmentplanning,whichwouldrequirethetreatingteamtoadopta‘collaborative’approach(withtheperson,theirnominatedpersonandacarerorfamilymemberwiththeconsumer’sconsent),wouldbeasconstructiveandbeneficialastheycouldbe.Somuchotherwisedependsupontherelationshipapersonhaswiththeirtreatingteam.Asoneconsumerexplained:

[The treatment plan] should be looked at, at least weekly and [the person] should have explanations given to them as to what decisions are being proposed and why they’re being proposed so they are then in a position to give informed consent. It’s very hard to give informed consent if you do not know and have not had… explained to you the reasons… why the decisions are being made.

Overall,theexternalreviewandoversightofcompulsoryordersbytheTribunal—totheextentthatthisisseenasasufficientlyindependentbody—appeartobeweakenedintheDraftBill.Theintroductionofanewpositionofreviewofficerstoconductaninitial‘proceduralcheck’onordersandproviderightsadvicewasproblematic,notleastofallbecauseoftheirlackofindependenceoftheDepartmentanddecision-makingpower.Itwasclearthatareviewofficercouldnotbesaidtobeactingonbehalfofandforthebenefitoftheperson,rathertheyappearedtobeacheckandbalanceforclinicalservices.Oneconsumersaidattheforum:

…You wouldn’t need a review officer if everyone’s doing their job! Why’s the person there in the first place?

ConsumersareunderstandablygravelyconcernedthatapersonmaybesubjectedtoinvoluntarytreatmentinthecommunityforuptothreeorfourmonthswithoutaTribunalhearingtoreviewthevalidityoftheorder,andforinpatients,uptoaroundsevenweeks,whichrepresentsnomeaningfulimprovementonthecurrentAct’seight-weekinitialreview–astatutoryreviewperiod,whichwasroundlycriticisedduringtheReview’scommunityconsultation,asfartoolongandwhichviolatesaperson’srights.

OneaspectoftheTribunal’sadditionalpowersintheDraftBillofwhichconsumerswereoverwhelminglyinfavour,isanewsystemrequiringpriorTribunalauthorisationofECTbeforeitcanbeperformed–thefirsttimethatVictoriahashadsuchasystem.

Conclusion

Mentalhealthconsumers,advocates,lawyersandthecommunityatlargekeenlyawaittheoutcomeofthereformofmentalhealthlawsthroughboththegovernment’sReview,aswellastheVictorianLawReformCommission’sreviewofguardianshiplaws.TheCommissionisalsoconsideringsimilarissuessuchassupporteddecisionmakingandtheinteractionbetweenguardianshipandmentalhealthlawsandisduetoreportlaterintheyear.

GenuinemeaningfulreformtopromotetherightsofconsumersconsistentlywiththeCRPDisdesperatelyneeded.AsTinaMinkowitz,psychiatricsurvivorandlawyer,commentedinanearlierissueofthisveryjournal:

If reform cannot deliver any real improvement, it does not serve the purpose of social justice and instead functions as a junk substitute that deflects the energy of a movement and limits people’s imaginations.


Mental health law reform – the Mental Health Bill Exposure Draft and beyond...byCatherineLeslie



‘Fromlittlethings,bigthingsgrow’,sangPaulKelly.TheselyricsequallydescribethefirstyearofOpenMinds,avolunteerpeer-directedgroupforVictorianPublicService(VPS)employeeswhohaveamentalillness,orarecaringforsomeonewithmentalillness.Establishedin2010,OpenMindsprovidesarangeofprogramsformentalhealthconsumers,carersandpeoplewithaninterestinmentalhealthissues.Itisthefirstwhole-of-VPSprogramtospecificallytargetmentalhealthissuesintheworkplace.

Sinceitsinception,OpenMindshasbeenshapedanddrivenbyitstwoco-convenorsandtheirownlivedexperienceofmentalillnessandcaring.InestablishingOpenMinds,theco-convenorsdrewheavilyontheconceptsofpeersupport.Peersupportissocialandemotionalsupport(thatismutuallyofferedorprovidedbypeoplewithamentalhealthcondition,orwhocareforsomeonewithamentalhealthcondition),tootherssharingasimilarconditionorsituation.Ithasbeendescribedas‘asystemofgivingandreceivinghelpfoundedonkeyprinciplesofrespect,sharedresponsibility,andmutualagreementofwhatishelpful’(Mead,Hilton,andCurtis2001).

Theliteratureonpeersupporthighlightsarangeofbenefits.

•Acceptance, empathy, and respect SallyClay(2005)describesthisempathyforpeoplewithamentalillnessasfollows:Since we have been crazy ourselves, we feel compassion for the confusion of others rather than fear of their madness, and we strive to offer unconditional respect to those who are ‘in the same boat’ as we are.

•Sharing what works, strategies for recovery and fostering hope…Bytellingtheirownstoriesofrecovery,peerscanprovideencouragementandactasarolemodeltoshowthatrecoveryispossible(Clay,2005).

•Empowerment and affirmationPeersupportpromotesacultureofhealthandabilityratherthanoneofillnessanddisability(Meadetal,2001).

SinceitwasestablishedinFebruary2010,OpenMindshasundertakenanambitiousprogramofactivities.Thishasincludedseminars,forums,outdoorexerciseevents,informationprovisionandcommissioningbeyondbluetodeliveraworkshopdesignedspecificallyfortheVictorianPublic

CriticaltothesuccessofOpenMinds,isthefactthattheprogramanditsactivitieshavebeenmanagedandrunbypeoplewhohavefirst-handexperiencewithmentalhealthissues.ThispeerbasehasgiventheprogramalevelofcredibilityandauthenticityintheeyesofOpenMind’sintendedtargetgroups.

Maria Katsonis,VictorianPublicServantintheDepartmentofPremierandCabinet,andCo-ConvenorofOpenMinds

the power of peers



Servicetoincreasemanagers’competenciesandcapabilitiesinmanagingstaffwithmentalhealthissues.WhileOpenMindsreceivesamodestamountofprogramfunding,allprogramsaredeliveredwithinavolunteerorganisationalbase.

Table1showsthelevelofprogramactivitydeliveredin2010.

Level of program activity delivered in 2010

Numberofseminars 5

OpenMindsseminarsattendees 650

Numberofmanagerstrainingworkshops 5

Managerstrainingparticipants 108

NumberofMentalHealthFirstAidcourses 1

Mentalhealthfirstaidattendees 27

MentalHealthWeekFestivalevents 10

Exerciseyourmoodwalk/runevents 2

Exerciseyourmoodwalk/runparticipants 220

SubscriberstotheOpenMindse-Newsletter 800

OpenMindsHealthyMindsbookmarksdistributed

7,000

Table 1: Quantitative overview of Open Minds

TherapidgrowthofOpenMindshasbeeninresponsetothedemandfromconsumers,carersandmanagerswhoarelookingtodomorethansimplysendstafftoemployeeassistanceprograms.InordertobetterunderstandthedemanddriversandtheimpactofOpenMindsprograms,OpenMindscommissionedTheNousGrouptoconductanevaluation.Theevaluationwaspartlyfundedbybeyondblue

whowereinterestedinexploringtheworkplaceeffectivenessandadvantagesofapeer-directedmodelinengagingtheworkplaceaboutmentalhealth.TheevaluationfoundthatOpenMindshadapositiveimpactontheattitudes,behaviourandwellbeingofmanyVPSemployees,withanambitiousprogramofactivitiesthathastargetedthreefairlydistinctgroupsofemployees:

1.consumersofmentalhealthservices

2.peoplewhocareforapersonwithmentalhealthissues

3.managersandcolleaguesofpeopleaffectedbymentalhealthissues.

Programparticipantscitedgreaterunderstandingandawarenessasthemostcommonimpacts.Figure1(below)graphicallyrepresentsthemostcommonofthe448responsestotheonlinesurveyquestion‘whathaveyoupersonallygainedfromparticipatinginOpenMinds?’

Figure 1: Textual analysis of survey responses

OpenMindshasbeenhighlysuccessfulatraisingawarenessofmentalhealthissuesamongtheVPSemployeeswhohaveactivelychosentoparticipateintheprogram.Themajorityofmanagersandcolleagueswhohavebeeninvolvedwiththeprogramidentifiedchangesintheirownknowledge,attitudesandbehavioursinceattendinganOpenMindsactivity.

The power of peersbyMariaKatsonis

ThereisconsiderablescopeforOpenMindstopositivelyimpactsignificantlymorepeopleintheVictorianPublicService.ThechallengeforOpenMindsinmovingforwardistoextendthereachofitsprogramactivities,whilepreservingtheelementsoftheprogram–particularlypeer-directedsupport–thathavemadeitsuccessful.

Change in behaviour Percentage

Betterunderstandingofwhatitisliketoexperienceamentalillnessorcareforsomeonewhodoes

90%

Greaterunderstandingofhowmentalillnessmayaffectthatpersonintheworkplace

90%

Feltmorecomfortabletalkingwiththeircolleaguesaboutmentalhealthissues

82%

Talkedwithcolleaguesabouthowtheirworkplacecanbettersupportcolleagueswithamentalillness,orcolleaguescaringforsomeonewithamentalillness

59%

Table 2: Affirmative responses to the question ‘Since you attended an Open Minds activity, have you:’ (n=164)

TheresultsinTable2indicatethatthemajorityofparticipantshaveactivelychangedtheirbehaviourbyengaginginactivitiessuchasconversingwithcolleaguesaffectedbymentalhealthissues.

Additionally,OpenMindshasenabledasubstantialnumberofprogramparticipantstotalkmoreconfidentlyandopenlywiththeircolleaguesabouttheirmentalhealthissues.Participantsalsoreportedfeelinglessisolatedafterbecomingbetterconnectedtotheirpeersandsuitablesupportservices.FormanyVPSemployees,OpenMindshasprovidedtheirfirstopportunitytotalkaboutmentalhealthintheworkplaceandseekassistance.

I have never previously received any information or support around mental health issues directly from a government agency; all the information and advice I have received has been through Open Minds.

OpenMindshasalsoprovidedprogramparticipantswiththeopportunitytomeetandconnectwithotherpeopleaffectedbymentalhealthissuesforthefirsttime.Buildingthesenewcommunitieshasresultedinaconsiderablenumberofpeoplefeelinglessisolatedandalone.

I feel less alone because I know that there are others across the VPS who are experiencing similar things to what I have experienced.

OthersurveyrespondentsandfocusgroupparticipantstalkedabouthowOpenMindshasempoweredthemtodiscussmentalhealthissuesintheirworkplace.



[I have gained] the personal courage to speak more openly about my own experience, a learning from others in Open Minds.

[I have gained] more confidence in dealing with my own mental health issues. Discussing it as something that exists in the world helps to objectify it, reducing the sense that it is an intractable problem that is intrinsic to myself.

TheOpenMindswebsitehasalsoprovidedachannelforsomeVPSemployeestopubliclyspeakforthefirsttimeabouttheirexperiencethroughguestcontributionstotheblogandtheOurStoriespage.

Figure 2: Screen shot of the Our Stories webpage

CriticaltothesuccessofOpenMindsisthefactthattheprogramanditsactivitieshavebeenmanagedandrunbypeoplewhohavefirst-handexperiencewithmentalhealthissues.ThispeerbasehasgiventheprogramalevelofcredibilityandauthenticityintheeyesofOpenMind’sintendedtargetgroups.

[Open Minds] better understands the issues from a user perspective rather than an often ill-informed expert point of view that further isolates.

BecauseOpenMindsisnotaffiliatedwithaparticulardepartment,itisseenascommunityowned.Thishascreatedasenseofinclusionandownershipamongtheparticipants.

Open Minds is VPS staff driven and this creates a safe, trusted environment for discussions on these topics.

ThereisconsiderablescopeforOpenMindstopositivelyimpactsignificantlymorepeopleintheVPS.ThechallengeforOpenMindsinmovingforwardistoextendthereachofitsprogramactivities,whilepreservingtheelementsoftheprogram—particularlypeer-directedsupport—thathavemadeitsuccessful.

References

Clay,S.(2005)On our own together: peer programs for people with mental illness, VanderbiltUniversityPress,USA

MeadS.,Hilton,D.,andCurtis,L.(2001)Peer support: a theoretical perspective, Plainfield,USATheNousGroup(2011)OpenMindsProgramEvaluation,availableat:www.vpsopenminds.com

The power of peersbyMariaKatsonis

RESEARCH



IntroductionStrongevidenceunderpinsthefactthatpeoplewithmentalhealthissuesareover-representedinthecriminaljusticesystem.Researchalsoreportsthatprolongedincarcerationimpactsthementalhealthandlivingskillsnecessaryforsurviving‘ontheouter’.ThePsychiatricDisabilityRehabilitationandSupportService(PDRSS)sector,andthebroadercommunitymentalhealthsector,workwithsignificantnumbersofclientswhohavespenttimeinprison,andsupportthemastheyfacethemanychallengesinvolvedinthetransitionbacktothecommunity.Thispaperdescribesonestudywhereparticipantswithmentalhealthissuesinprisonidentifiedtheacquisitionoflivingskillsasimportanttothem.Theprocessofsupportingpeoplewithmentalhealthissuestomaintainanddeveloplivingskills,sotakenasintegraltoeverydaypracticeinmentalhealthservices,can,inreality,bechallenging.Thefindingsofthisresearchhighlightthecaseforbuildingworkforcecapacitytoaddresslivingskills,andexplainwhythisisanimportantcomponentofthePDRSSsector’sforensiccapacitytoworkwiththiscomplexandvulnerablegroup.

the literaturePrevalence of mental health issues in prison Internationalliteratureindicatesthatindividualswithamentalillnessaresignificantlyover-representedwithinprisonpopulations(Applebaumetal.,2001;Steadman,Osher,Robbins,Case&Samuels,2009;WHO,2001).Australianstatisticsdescribingthenumberofpeoplewithmentalhealthissuesinthecriminaljusticesystemareequallyalarming.Whileapproximately20percentofthegeneralpopulationinAustraliawillhavehadamentalillnesswithintheprevious12months,thosewhohavebeenincarceratedhavetwicethisprevalence,atarateof41percent(AustralianBureauofStatistics[ABS],2007).Whencomparedtothegeneralpopulation,Australianswhohavebeenincarceratedhavealmostfivetimestheprevalenceofsubstanceusedisorders,threetimestheprevalenceofaffectivedisordersandtwicetheprevalenceofanxietydisorders(ABS,2007).Ofthoseinpolicecustody,30percenthavehistoriesofpsychiatrictreatmentand30percentofnewlyremandedoffendershavementalhealthissues(VictorianDepartmentofHealth,2008).

Protectivefactorsthatreducetheriskofre-offendingincludestablementalhealth,stablehousing,reducedsubstanceuseandmeaningfuloccupation.ThePDRSSsectorwillneedtostepuptoleadershiprolesinthedevelopmentofpartnershipsthatcanfacilitatemakingthe‘wraparoundsupport’conceptareality.

Muriel Cummins, ProgramManager,CommunityMentalHealth,WesternRegionHealthCentre

louise Farnworth, AssociateProfessorandHeadofDepartmentofOccupationalTherapy,MonashUniversity

‘I’ve done my time, now what?’ the case for living skills interventions for people with mental health issues at risk of, and beyond, custodial sentences

Ifthereare29,317individualsinAustralianprisons(ABS,2009),itcanbeestimatedthenthat41percent,or12,019incarceratedindividualsareexperiencingsomeformofmentalillnesseveryday.Ogloffetal.(2007)claimedthatin2001,ofthe15,000peoplewithmajormentalillnessesinAustralianinstitutions,onethirdofthosewereinprisons.Theexactfigureisunclear,butithasbeenwellreportedthatindividualsinthecriminaljusticesystemhavedisproportionatelyhigherratesofmentalillness,andofmajormentalillnesssuchasschizophrenia,thanthegeneralpopulation(Henderson,2007;Ogloff,Davis,Rivers,&Ross,2007;Wilson,2008).Armstrong(2005)arguesthatthisislikelytobeasecondaryconsequenceofaninadequatelyresourcedandoverstretchedcommunitymentalhealthsector.AsHenderson(2007)explains,whilethereisnoinherentlinkbetweenmentalillnessandcrime,thereisastrongcausallinkbetweenmentalillnessandincarceration.

the impact of the prison environment: mental health and living skillsSpendingtimeinacustodialenvironmentcanseriouslyimpactmentalhealth(Hills,2003;WHO2001).Deprivationoffreedom,byitsnature,isnotconducivetorecoveryorpositivementalhealthoutcomes(WHO,2001).Factorsthatcancontributetoadeclineinmentalhealthfollowingincarcerationincludelossofsocialsupportfromfamilyandfriends,lackofcontrolovertheimmediateenvironment,lackofchoice,isolation,andlonghoursinlockdown(Hills,2003).Nurse,WoodcockandOrmsby(2003)investigatedtheenvironmentalfactorsthatinfluencementalhealthwithinaprisonenvironment,andfoundthatlongperiodsofisolation,combinedwithlimitedactivitychoice,contributedtopoormentalhealth,andinsomecases,increasedlevelsofanger,frustrationandanxiety.Thisstudyalsosuggestedlinksbetweenthelackofmentalstimulation,adeclineinmentalhealth,andincreaseddrugabusewithinprison.Furtherstudies

indicatethatanabsenceofmeaningfulandpurposefulactivityandroleinacustodialenvironmentincreasesfluctuatingemotionalstates,stress-relatedmedicalproblemsanddisciplinaryincidents(Applebaumetal.,2001).

MolineuxandWhiteford(1999)suggestedthatthelackofaccesstoroutineactivitiesofdailyliving,suchasdoingpersonallaundryandmealpreparation,canleadtolonger-termlossoflivingskillsandabilitytoresumeliferoles.Engagementinactivitiesthatlackchallenge,overextendedperiods,canpotentiallyleadtolossofskillsanddecreasedpersonalsatisfactionandself-esteem(Farnworth,2000;Whiteford1995).WittmanandVelde(2001)warnedthatthestructureofsecurityintheprisonsettingcanleadtosensorydeprivation.AsportrayedsoaptlybyGoffman(1961),thereareanumberofreasonsforhighlevelsofstructure,routineandsameness,mainlytoensurethesmoothrunningoftheinstitution,butinthecaseofthecorrectionalfacility,theunderlyingassumptionisthatpreviousroles,habitsandroutinesarelinkedtooffendingbehaviourandaretherefore‘maladaptive’.Thechallengeofcopingwithamentalhealthissueinprisoncanbeoverwhelmingandisoftenaccompaniedbyadeteriorationinsocial,occupationalandlivingskillfunction(O’Connell,Farnworth&Hansen,2010;Muñoz,Farnworth,Hamilton,etal,2011;Applebaumetal.,2001).

transition to the communityResumingliferolespostreleasecanbechallenging.Thereisevidencetosuggestthatcrosssectorcollaboration,providing‘wraparound’supportisoptimalforapersonwithmentalhealthissuestransitioningbacktothecommunity(DepartmentofHealth,2008).Thereisevidencetosuggestthatlivingskillsupportandtrainingcanbekeystoasuccessfultransitiontocommunityliving,whichcanbecompromisedasreducedabilitytoperformlivingskillsonrelease,potentiallyleadingtoincreasedrecidivism(Hills,2003).



Whileaccesstoaffordablehousingisanissuepostrelease(VictorianDepartmentofHealth,2008),maintaininghousingcanbeanevengreaterobstacleforsome(Livingstone&Miller,2006).Reducedlivingskillproficiencyhasbeenidentifiedasoneoftheriskfactorsfortenancyfailure(Jonesetal,2004;WesternRegionHealthCentre,Guide to Living Skills Assessment and Intervention,2008).Theinclusionoflivingskillstrainingresultsingreatersuccesswithobtainingandmaintaininghousing(Morseetal,1992).Whilesomelivingskills,suchascooking,aretaughtingroupprogramsincommunitysettings,ithasbeenarguedthatprogramsthatprovideoneinterventionforallparticipantsmayfailtomeettheindividualneedsofparticipants(Mairs&Bradshaw,2002)andthatpeoplewithcognitiveimpairmentandpeoplewithhistoriesofhomelessnessandcomplexneedsoftenrequireapersonalisedprogramtolearnlivingskills(Helfrich&Fogg,2007).Itissuggestedthatsuchaprogramforthesegroupsallowforskill-practiceandongoingcoaching(Helfrich&Fogg,2007).Studieshaveshownlivingskillstrainingimproveskillsinpeoplewithseriousmentalhealthissues(Brownetal2002,Wongetal1988).

the studyThestudywasconductedwithinaprisonenvironmentinVictoria,Australia,andaimedtoexploretheself-perceiveddailylivingskillsofparticipantsacrossadefinedsetofskills.TheOccupational Self Assessment(OSA),(Baronetal.,2006)wasutilisedasanoutcomemeasureforthisstudyandthefullresultsareavailableelsewhere(Cummins&Farnworth,2008).EthicalapprovalwasgrantedbytheVictorianDepartmentofJustice,andallparticipantswereissuedaparticipantinformationstatementandsignedaconsentpriortointerview.

TheOSAiswidelyusedasanassessmentandoutcomemeasureinthedisciplineofoccupationaltherapy.Aswellasmeasuringtheself-perceivedskill-levelin‘occupationalfunctioning’(Gordeetal.,2004),thatis,thefunctionallivingskillsindailylife,italsomeasureshowimportant,orvaluable,eachskillistotheperson.Foreachfunctionallivingskill,theclientfirstlyassesseshow difficulttheskillistoperformonafour-pointratingscale.Secondly,theclientrateseachfunctionallivingskillintermsofhow importanttheskillistothem.Bycombiningtheseratingsfordifficultyandimportance,client-identifiedprioritiesforskilldevelopmentcanbeestablished.QualitativecommentsinresponsetotheOSAwerealsocapturedandrecordedonthequestionnairebytheresearcher.

TheOSAquestionnairewascompletedininterviewformatwith35randomlychosenparticipantswithmentalhealthissues,representingapproximately50percentofthetotalpopulationof69prisonerswithmentalhealthissuesincarceratedatthisprisonatthetimeofthestudy.Theaverageageofparticipantswas32years,rangingfrom18-54years.Allparticipantsweremale.Twenty-sixwereAustralia-born,andtheotherninewerefromarangeofcountriesasfollows:NewZealand(2),HornofAfrica(3),Cambodia(1),Vietnam(1),Croatia(1),andGreece(1).OneparticipantidentifiedhimselfasbeingAboriginal.Theaveragelengthofincarcerationforthegroupinthisprisonenvironmentwasthreemonths,rangingfromonetoelevenmonths.Twentyoftheparticipantswereonremand,and15weresentenced.Forelevenparticipants,thiswastheirfirstperiodofincarceration.Thepreviousnumberofincarcerationsforthegrouprangedfromoneto12,withanaverageofthreepreviousperiodsofincarceration.

Intermsofaself-reporteddiagnosedmentalhealthissue,12participantsindicatedthattheydidnotknowtheirdiagnosis.Ofthosewhoreportedadiagnosis,12reportedhavingschizophrenia,withanadditionalsixreportingschizophreniapluseitherbipolardisorder,depressionoranxiety.Tworeportedbipolardisorderastheirmaindiagnosis;onereporteddepressionandtworeportedanxietyastheirmainmentalhealthissue.

Datafromthe35OSAquestionnaireswerecompiledtoformapriorityprofileoflivingskills.Descriptivestatisticswereusedtoobtainfrequencycountsonskillsperceivedaschallengingbytheprisonergroup,andwhichskillswereperceivedtobemostimportant.Theresearcherswereinapositiontoexaminethetrendsintermsofprioritiesforskilldevelopment,andhencetoestablishtheprofileofskill-developmentpriorityfortheparticipants.TheseskilldevelopmentprioritiesarepresentedinTable1.Overwhelmingly,theskillof‘workingtowardsmygoals’wastheitemmostfrequentlyidentifiedasmostimportantbutmostdifficulttoperform.Thesignificanceoflivingskillsisqualitativelysupportedbycommentsfromparticipants.Forexample,theseincluded:

The last time I got out, I said to myself ‘I’ve done my time, now what?’ This time, I won’t know where to start either.

I’m no good with money, that’s my problem.

I thought I was on top of things, got my housing organised... but I didn’t look after the place... now I’m back in here.

‘I’ve done my time, now what?’ byMurielCumminsandLouiseFarnworth

Skill priority list based on ratings of 35 participants

OSA: Living skill

1 Workingtowardsmygoals

2 GettingdonewhatIneedtodo(dailyroutine)

2 Managingmyfinances

3 DoingactivitiesIenjoy

3 Effectivelyusingmyabilities

3 AccomplishingwhatIsetouttodo

4 Takingcareofmyself

4 Expressingmyselftoothers

5 Managingmybasicneeds(food,medicine)

6 TakingcareoftheplacewhereIlive(e.g.house-keeping)

6 Concentratingondailytasks

7 MakingimportantdecisionsbasedonwhatIthinkisimportant

8 PhysicallydoingwhatIsetouttodo

9 Handlingmyresponsibilities

10 TakingcareofothersforwhomIamresponsible(e.g.family)

11 Beinginvolvedasastudent,worker,volunteer,and/orfamilymember

12 GettingwhereIneedtogo(e.g.appointments,programs)

Table 1 – Skill priority list ratings

discussionOn the Inside: the case for pre-release preparationAllparticipantsengagedindiscussiononthevalueoflivingskillsinre-establishingalifebeyondprison.Settingmeaningfulgoalswasidentifiedbyparticipantsofthisstudyasthemostimportantskilltoacquireinpreparingforthistransitionbut,inturn,participantsidentifiedalackofopportunitiesofferedtodevelopskillsincompetentgoal-settingorproactivechoice-making.Forexample,participantscommentedthat:

Making goals, that’s easy. Abiding to them is a different story.

I never stick to my plans, something always gets in the way.

Yetsocietyexpectschangeinbehaviourfromthoseincarceratedontheirreturntothecommunity.Thisrevealsaninterestingpicture:participantsidentifyingtheneedforchangeandlearningopportunities,societyexpectingchangedbehaviour,andaprisonsystemthat,bydesign,holdsitsinternsinastatusquo.

Manyinternationalcorrectionalsystemsadvocatemovingfromthetraditionalapproachofsafe-custodytooneofrehabilitation(Howells&Day,1999;Howellsetal.,2004).CurrentdebateinAustraliafocusesonhowtobestincorporaterehabilitationprinciplesintothejusticesystem,andintocustodialoperationalphilosophies(Howellsetal.,2004).Thisincludesaddressingtheneedsofvulnerablegroups,suchaspeoplewithmentalhealthissuesinprison(VictorianDepartmentofHealth,2009).Forthisgroup,theabilitytomakechoices,learnnewskillsanddevelopself-awarenessofpersonalvalues,strengthsandweaknesses,areparamounttooptimaltransitiontothecommunityandreducingriskofrecidivism.

Furthermore,itisnoteworthythatover33percentofparticipantsinthisstudywereunawarewhatdiagnosistheyhadbeengiven.Successfultransitiontothecommunityrequiresthepersontosetrealisticgoals,incorporatingaclearunderstandingoftheirmentalhealth,theirtriggers,patternsandearlywarningsigns.Understandingdiagnosisisclearlyanaspectofself-managementofmentalhealth.Stablementalhealthisaprotectivefactorthatreducestheriskofre-offending(VictorianDepartmentofHealth,2008).

Resultsofthisstudysuggestthecaseforpre-releaserehabilitationwithdueemphasisonlivingskills,particularlytheskillofgoal-setting,isessential,asistheopportunitytolearnmentalhealthself-managementstrategies.Theparticipantsinthisstudyappeartoconcurwiththisposition.



On the outer: the case for ‘wrap-around’ supportInlinewithpreviousresearchwiththispopulation(Hendersen,2007),participantsinthisstudyexplainedjusthowchallengingthetransitiontothecommunitycanbe.Commentsincluded:

In this place, there’s a set routine, and a lot’s done for you… three meals a day handed to you. Then you get out and you’re doing it all yourself.

Inside, it’s easy to say what I should do better. Out there, it’s hard, there’s too much chaos and too much going on in my head.

Thepersoncanbefacedwiththereal-lifechallengesoftransition,compoundedbyaservicesystemthatstrugglestorespondtotheirneeds.ThecurrentVictorianMental Health Reform Strategy(VictorianDepartmentofHealth,2009)identifiestheneedtobuildcommunity-basedforensiccapacity.PartnershipsbetweenthePDRSSandtheclinicalmentalhealthsectorwillneedtodevelopsharedstrategiestoworkwithpeoplewithforensichistories(VictorianDepartmentofHealth2008),andalsostrengthencollaborationtoachievebetteroutcomes,particularlyforclientswithchallengingbehaviours.Serviceprovidersneedtoensurethatforensichistories,orhistoricalriskfactorsrelatingtoaggression,donotbecomebarrierstoaccessingmentalhealthserviceswhenthereisaneed.Post-releasesupportsthataddressthebroadrangeofneeds,includinghealth,housingandemployment,haveproveneffectiveinreducingriskofrecidivismbyupto70percent,andarehighlycosteffectivebycomparisontoimprisonment(DepartmentofHealth,2008).

Protectivefactorsthatreducetheriskofre-offendingincludestablementalhealth,stablehousing,reducedsubstanceuseandmeaningfuloccupation.ThePDRSSsectorwillneedtostepuptoleadershiprolesinthedevelopmentofpartnershipsthatcanfacilitatemakingthe‘wrap-aroundsupport’conceptareality.

ThePDRSSsectorisplacingemphasisonbuildingworkforcecapacitytoworkwithpeopleatriskofoffending.Anecdotally,thisincludescapacityinidentifyingandmanagingriskandchallengingbehaviour,aswellascapacitytocoordinatemanagementandpreventionplans.Thefindingsofthisstudysuggesttheneedforthesectortobuildcapacitytoaddress

livingskills,asthisisarealandcurrentneedforourclientswithforensichistoriesandthoseatriskofcomingintocontactwiththecriminaljusticesystem.TheexperienceofWesternRegionHealthCentre(WRHC)inbuildingthecapacityofstaffinaddressingskills,andthepotentialoflearningstobesharedacrossthesector,isexplainedbelow.

Building the capacity of the PdRSS sector to address living skills Acoreelementofpsychosocialrehabilitationisworkingalongsideconsumerstowardsmeaningfulgoals.Frequently,thesegoalsfocusonaspectsoftheperson’slivingskills.

I can think of a few living skills I’d need help with, to get me on my feet when I get out of this place: cooking, for sure. I don’t look after myself well.

Theprocessofdevelopinglivingskillscanbecomplexanduniquetotheneedsoftheindividual.Theindividualmayhavemultipleissues,suchassubstanceuse,acquiredbraininjuryorintellectualdisability,inadditiontotheirmentalhealthissues.Inrecognitionofthiscomplexity,WRHCdevelopedaLivingSkillstrainingpackagethatbuildstheskillsandunderstandingofstaffinworkingwithclientstoaddresstheirlivingskills.TheLivingSkillspackageincorporatesacomprehensiveGuide to Living Skills Assessment and Intervention,andLivingSkillstrainingdeliveredviaaninteractiveworkshop.TheLivingSkillsGuidewasdevelopedin2008inresponsetoasurveyofPDRSSandassertiveoutreachstaff,whichindicatedthatthemajorityofstaffassessandsupportclientswiththeirlivingskillsandbelievetheywouldbenefitfromeducationinthisarea(GuidetoLivingSkillsAssessmentandIntervention,2008).Thepackageaimstoprovideworkerswithsystematicwaysofassessinglivingskills,andprovidinginterventionstargetinglivingskilldevelopment.

Theassessmentcomponentofthepackageenablestheworkertoidentifywhatskillsrequireattention.Inthisway,thetrainingcanbetailoredtoindividualneeds,increasingtheperson’sparticipationandmotivation(Nemecetal,1992;WRHCGuidetoLivingSkillsAssessmentandIntervention2008).TheinterventionstrategiescomponentoftheLivingSkillspackagedrawsonadultlearningprinciplesanddescribesarangeoftechniquesforusewithindividualclientssuchasenabling,verbalandwrittenprompting,andgrading.The

‘I’ve done my time, now what?’ byMurielCumminsandLouiseFarnworth

preferredlearningstyleofthepersonwillinfluencewhatstrategiesworkbestforanindividual,andrecognisingtheperson’slearningstyleisimportant(GuidetoLivingSkillsAssessmentandIntervention,2008).

TheLivingSkillstraininginteractiveworkshophasbeenrolledoutacrossWRHC’smentalhealthandassertiveoutreachprograms,withpositiveresultstodate.IthasalsobeenmadeavailabletothePDRSSsector,viaapartnershipwithVICSERV’straininganddevelopmentteam.Thetrainingisundergoingevaluationandisincludedinthe2011VICSERVtrainingcalendar.

Additionalstrategiestoenhancementalhealthworkforcecapacityinlivingskillsin2010,includedtheemploymentofanoccupationaltherapist,andtheprovisionofacreativegoal-settingworkshoptostaff.Theemploymentofanoccupationaltherapistwithexpertiseintheinteractionoftheperson,environmentandlivingskills,servedtodiversifythe

skill-setoftheworkforceandenhancethelivingskillfocus.Thecreativegoal-settingworkshopprovidedaforumtoexplorethechallengesinherentinmeaningfulgoal-settingwithclients,andofferedarangeofcreativestrategiestoconsiderwhenapproachingthistask.

Inconclusion,theresponseto‘I’vedonemytime,nowwhat?’ispotentiallyaquestionthatthePDRSSsector,incollaborationwithpartners,willanswerwithincreasedconfidenceandcapacity.


Serviceprovidersneedtoensurethatforensichistories,orhistoricalriskfactorsrelatingtoaggression,donotbecomebarrierstoaccessingmentalhealthserviceswhenthereisaneed.Post-releasesupportsthataddressthebroadrangeofneeds,includinghealth,housingandemployment,haveproveneffectiveinreducingriskofrecidivismbyupto70percent,andarehighlycosteffectivebycomparisontoimprisonment.



Throughitsadvocacyandguardianshipwork,theOfficeofthePublicAdvocate(OPA)isfrequentlyinvolvedwithpeoplewithcognitiveimpairmentswhoexperienceviolence.Inresponsetothisissue,JanineDillon,anAdvocate/GuardianatOPA,undertookaprojectthatinvestigatedthecircumstancesofOPAclientswhoexperienceviolence,andexploredtheresponsesofserviceproviderstotheseincidentsofviolence.Thisarticleoffersanoverviewofthereport,andhighlightstheimpactofthereporttodate.

OPA’smissionistopromotetherightsandinterestsofpeoplewithdisabilities,andtoworktowardsenablingpeoplewithdisabilitiestolivelivesfreeofabuse,neglectandexploitation.ThismissionismetthroughworkconductedbyOPAinarangeofareas,includingsystemicadvocacyandresearch,acommunityinformationservice,threevolunteerprogramsandtheAdvocate/GuardianProgram.

Inlate2009,JanineDilloncommencedaprojectthatexploredtheincidenceofviolenceagainstpeoplewithcognitiveimpairmentswhohadbeenclientsofOPA’sAdvocate/GuardianProgram.Janine’sprojectwasexploratoryinnatureandwasundertakenovera12-weekperiod.ThetighttimeframeoftheprojectprecludedacomprehensiveanalysisofallOPA’srecordsrelatingtoviolence.Instead,Advocate/Guardianswereaskedtovolunteerinformationaboutcasesinwhichtheyhadrepresentedapersonwhowasavictimofviolence.Inresponsetothisrequest,14Advocate/Guardiansprovidedinformationabout86casesinvolvingpeoplewhohadexperiencedviolence.Anallegationofviolencewassufficienttoenableacasetobecollectedaspartofthisresearch;therewasnorequirementthattheincidentofviolencebesubstantiated(which,inpart,isareflectionofthedifficultiesthatcanexistinprovingthatviolenceagainstapersonwithadisabilityhasoccurred).

Consistentwiththebroaderresearchonfamilyviolence,themajorityofthesecasesrelatedtoviolenceagainstwomen(66cases).Abroadrangeofcognitiveimpairmentsarerepresentedwithinthecasestudies,withintellectualdisabilitybeingthemostcommonprimarydiagnosis(41cases).Insomecases,itwasnotedthattheviolenceresultedinthepersonsustainingadditionalimpairment/s,suchasatraumaticbraininjuryoramentalillness.

Magdalena McGuire, LegalPolicyandResearchOfficer,OfficeofthePublicAdvocate

Violence against people with cognitive impairments: a study by the Office of the Public Advocate

Thedatafromthe86casesformsthebasisofthereport,Violence against People with Cognitive Impairments: Report from the Advocacy/Guardianship Program at the Office of the Public Advocate, Victoria.Thisreportexplorescasestudiesinvolvingviolenceagainstpeoplewithdisabilitiesaged16to100+.Consistentwiththebroaderresearchonfamilyviolence,themajorityofthesecasesrelatedtoviolenceagainstwomen(66cases).Abroadrangeofcognitiveimpairmentsarerepresentedwithinthecasestudies,withintellectualdisabilitybeingthemostcommonprimarydiagnosis(41cases).Insomecases,itwasnotedthattheviolenceresultedinthepersonsustainingadditionalimpairment/s,suchasatraumaticbraininjuryoramentalillness.

Advocate/Guardiansinvolvedinthisresearchreportedthattheirclientshadbeensubjectedtoarangeofviolentandabusiveacts,includingphysicalandsexualviolence,emotionalandpsychologicalabuse(suchasseclusionandisolation),impairment-relatedabuse(suchasdenyingapersontheirmobilityaid),financialabuse,andneglect.Mostclientshadbeensubjectedtomorethanoneformofabuse(50cases).Fifty-twooftheclientsinvolvedinthecasestudieswerereportedtohaveexperiencedphysicalviolence.Womenclients,inparticular,reportedahighrateofsexualviolence(thiswasreportedin30ofthe66casesinvolvingwomen).

Perpetratorcategoriesincludedtheclient’sparentorparent’spartner,sibling,adultchild,otherrelative,partner,neighbour,staff,co-resident,andstranger.Overall,therewere64casesinwhichperpetratorswerecategorisedasrelativesandpartners,meaningthattheiractionsmaybeclassifiedasfamily/domesticviolencewithinthedefinitionsoftheFamily Violence Protection Act 2008 (Victoria).Inspiteofthis,theratesofinvolvementoffamilyviolenceserviceswerereportedtobelow.Likewise,Advocate/Guardiansreportedcasesofpeoplewithdisabilitiesdisclosingabuseandnotreceivinganappropriateresponseinrelationtothecriminal,socialandemotionalaspectsofthedisclosure.Withinthecasesstudied,itwasalsoevidentthat,forsomepeople,riskfactorsforexperiencingfurtherviolencehadbeenidentifiedbutwerenotactedupon.Forexample,therewereseveralexampleswithinthecasesstudiedofclientsoftheDepartmentofHumanServiceswhoremainedininappropriatehousingand,consequentially,experiencedfurtherviolenceand/orcontinuedtoexhibitbehavioursofconcern.

Overall,thecasesstudiedinthereportindicatethatthereneedstobegreatercoordinationbetweendisabilityandlegalservicesinordertoachievebetteroutcomesforpeoplewithdisabilitiesexperiencingviolence.Inresponsetotheissuesraisedinthereport,OPAhassoughtthefollowingchanges:

•greatersupportforpeoplewithcognitivedisabilitiestomakecomplaintsofviolence,andensuretheircomplaintsareappropriatelydealtwithbythecriminaljusticesystem

•moreresponsiveservicesthatofferimmediateprotection,includingprovisionofalternativeaccommodation,whenviolenceagainstapersonwithacognitiveimpairmentisdisclosedorsuspected

• improvedpreventioninitiatives,includingbetterpubliceducation,improvedreportingofinappropriateordangerousbehaviour,andmorerisk-conscioushousingdecisions.1

ThereportondisabilityandviolencedemonstratesthatconcretedataonviolenceagainstpeoplewithdisabilitiescanhaveasignificantimpactontheVictorianpoliticalandsocialmilieu.Thereleaseofthereportresultedinconsiderablemediaattention,includinganarticleonthefrontpageofThe Age,astrongAgeeditorial,andfollow-upinterviewsonABCradio.ThenewMinisterforMentalHealth,Women’sAffairsandCommunityServicesrespondedveryfavourablytothereport,withacommitmenttoanindustryreforminAprilandaparliamentaryinquiryintothecontactthatpeoplewithintellectualdisabilityhavewiththecriminaljusticesystem.2

Itisclear,however,thatmuchworkstillneedstobedonetoensurethatpeoplewithdisabilitiesareabletoachieveandenjoytheirhumanrights.SincethepublicationofthereportinAugustlastyear,OPAhasreceivedtennotificationsofsexualassaultorseriousviolenceagainstapersonwithadisability.Likewise,OPA’sIndependentThirdPersonProgramstatisticsshowthat272victimsofsexualassaultattendedapoliceinterviewwithanIndependentThirdPersoninthelastfinancialyear–twicethatofadecadeago.ViolenceagainstpeoplewithdisabilitiesisapriorityareathroughoutallOPAprograms.StaffandvolunteersatOPAcontinuetopromotetherightofpeoplewithdisabilitiestolivelivesfreeofviolence,andwelookforwardtosomerealchangeforvulnerableVictoriansasaresult.

References

1 OfficeofthePublicAdvocate,Violence against People with Disability: Public Advocate Calls for a Major Change,[mediarelease](28January2011)

2 TheHon.MaryWooldridgeMP,Coalition Welcomes Public Advocate Report,[mediarelease](28January2011)

FINDOUTMORE.Toviewthefullreportondisabilityandviolence,visittheOPAwebsiteat:http://www.publicadvocate.vic.gov.au/research/255/



IntroductionInvolvementinmentalhealthserviceplanning,implementationandevaluationisakeyfeatureofconsumerandcarerparticipationpolicy.ThisprinciplewashighlightedbytheVictorianDepartmentofHumanServices(2002),whichpublished,asoneofitscoreprinciples,thefollowingstatement:

The Government is strongly committed to consumer and carer participation in the development and review of mental health services, and the involvement of consumers and carers as active partners in individual treatment and care planning.

MentalHealthExperienceCo-Design(MHECO)implementsaresearchmethodologythatappliesthetheoryandpracticeofExperience-BasedDesign(EBD)(BateandRobert,2007),

inhealthservicequalityimprovement.TheprimarygoaloftheEBDapproachistoengageconsumers,carersandserviceprovidersinactivelyworkingtogethertoco-designfeaturesofservicedelivery.InMHECO,thesefeaturesareidentifiedthroughananalysisofcarerandconsumerexperiencequestionnairesadministeredwithintheparticipatingmentalhealthservice,semi-structuredinterviewsandfocusgroups.

development MHECOisamethodofservicequalityimprovementthathasdevelopedfromtheConsumerandCarerExperienceofCareandSupportpilotproject(C&CExperience).Thepilotprojectwasinitiatedin2006bytheVictorianDepartmentofHealth-DOH(formerlytheDepartmentofHumanServices-DHS)asameansofimprovingthelowparticipationandresponse

Karen Fairhurst,ProjectOfficer,CarerResearchandEvaluationUnit,VictorianMentalHealthCarersNetwork(VMHCN)

Wayne Weavell, ProjectOfficer,ConsumerResearchandEvaluationUnit,VictorianMentalIllnessAwarenessCouncil(VMIAC)

Co-designing mental health services – providers, consumers and carers working together

Byprovidingasystematicandeffectivemechanismforgainingconsumerandcarerexperiencesofservicedelivery,theConsumerandCarerExperiencepilothighlightedservice‘touchpoints’.Touchpointsaredefinedasthoseaspectsoftheservicethatconsumersandcarersidentifyasbeingthemostortheleastpositiveaspectsoftheirexperiencewiththeservice.Thehighlighted‘touchpoints’fromtheConsumerandCarerExperiencesurveyswerethenusedtoinformtheMentalHealthExperienceCo-Designprocess.

ratesofmentalhealthconsumersandcarerstosatisfaction-basedsurveys.TheC&CExperiencepilotprojecttrialledanew,mixedresearchdesign,inanumberofclinicalandPDRSmentalhealthservices,aimedatgatheringdataonconsumers’andcarers’experiencesofcareandparticipation.ThedatafortheC&CExperiencepilotwascapturedthroughstructuredquestionnairesusingComputerAssistedTelephoneInterviews(CATI),face-to-face,semi-structuredinterviewsandfocusgroups.

Identifying touch points Byprovidingasystematicandeffectivemechanismforgainingconsumerandcarerexperiencesofservicedelivery,theC&CExperiencepilothighlightedservice‘touchpoints’.Touchpointsaredefinedasthoseaspectsoftheservicethatconsumersandcarersidentifyasbeingthemostortheleastpositiveaspectsoftheirexperiencewiththeservice.Thehighlighted‘touchpoints’fromtheConsumerandCarerExperiencesurveyswerethenusedtoinformtheMHECOprocess.

Inpractice,thethreemostpositivelyratedandthethreeleastpositivelyratedserviceaspectsfromtheC&CExperiencedataanalysisprocesswereidentifiedforexamination.AsDouttaGallaCommunityHealthwasoneoftheservicesparticipatingintheC&CExperience,theMHECOproject,undertakenatDouttaGalla,utilisedtheC&CExperiencedatatodeterminethetouchpointsusedtoinformservicequalityimprovementprocesses.

MH ECO project stakeholdersMHECOatDouttaGallaCommunityHealth,involvedthefollowingstakeholders:

•DouttaGallaCommunityHealth,MentalHealthandComplexNeedsPrograms

•DouttaGallaCommunityHealth•VictorianMentalIllnessAwarenessCouncil(VMIAC)•VictorianMentalHealthCarersNetwork(VMHCN)• theMentalHealthandDrugsDivisionoftheDHS•clientsofCommonGroundDayProgramandRocketYouth

ResidentialProgramatDouttaGalla•carersofclientsofCommonGroundDayProgramand

RocketYouthResidentialProgramatDouttaGalla.

Theengagementofrelevantchampionsandsupportfromseniorexecutivesthatlinksbacktothenormalmanagementprocesseswithintheorganisation(BateandRobert,2007),werekeyfactorstotheoverallsuccessoftheproject.

Project objectivesTheprimaryaimoftheDouttaGallaMHECOprojectwastodevelopcapacityinDouttaGalla’sMentalHealthservicesforincorporatingexperiencebasedco-designprocessesintoorganisationalqualityimprovementpractice.Specificqualityimprovementobjectives(1,2and3listedbelow)werederivedfromthetouchpointsidentifiedintheC&CExperiencepilotproject(DouttaGallaServiceReport,2008)withobjectives4and5beingaddedattheprojectplanningstagebytheprojectLiaisonGroup,whichwasestablishedatthestartoftheMHECOproject.

the MH ECO project objectives were as follows:1.Tore-designthewayinwhichconsumersandcarersare

informedaboutwhattheycanexpectfromparticipatinginthepsychiatricdisabilityrehabilitationandsupportservicesattheCommonGroundDayProgramatDouttaGalla.

2.Tore-designthewayinwhichconsumersandcarersareinformedaboutthefeedbackandcomplaintsmanagementprocessintheCommonGroundDayProgramatDouttaGalla.

3.Tore-designthewayinwhichcarerscanbesupportedintheirrole,whichmayincludeabetterunderstandingofthechallengesfacedbypeoplewithmentalillness,betterfulfillingoftheircarerrole,andmakingdecisionsregardingtheroletheywishtotakeinsupportingtheirlovedonewithmentalillnessattheDouttaGallaRocketYouthResidentialProgram.

4.ToevaluatetheeffectivenessoftheMHECOmethodologyinachievingimprovementsinprogramspecificservicedelivery(asdescribedabove).

5.Toincreasethecollaborationandservicere-designskillsofstaff,consumers,andcarerswhoareinvolvedintheproject.

TheprimarycriteriaforthefirstthreeobjectiveswerethattheservicefeaturestoberedesignedhadscoredalowpositiveresponserateontheC&CExperienceCATIquestionnaire,and,hadalsofiguredprominentlyininterviewandfocusgroupthematicanalyses.ThefourthobjectivewasbuiltintotheprojectbriefinordertoevaluatetheMHECOmethodologyinaprogramspecificsetting.ThefifthobjectivewasviewedbyboththeProjectTeamsandtheDepartmentofHealth(DOH)asbeingimportantinbuildingcapacitywithintheparticipatingserviceorganisation,whichisafundamentalfeatureoftheMHECOmethodology.



the Role of the Project teamTheConsumerandCarerProjectTeamconsistedofprojectworkersfromboththeVMIACandVMHCNResearchandEvaluationUnits.Theteamsactedasanexternalresourcetotheserviceandprovidedon-the-groundsupportandmethodologicalassistancethroughouttheMHECOprocess.However,itisimportanttonotethattheresponsibilityforleadershipandoverallgovernanceoftheprojectrestedwithDouttaGallamanagementandnotwiththecombinedConsumerandCarer(MHECO)ProjectTeam.TheConsumerandCarerProjectTeamsassistedandsupportedtheDouttaGallaMHECOprojectinthefollowingmanner:

•promotedMHECOtotheserviceexecutivetoenlisttheirleadership

•promotedMHECOtoconsumers,carersandstaffmembersattheservice

• facilitatedastafffocusgroupinresponsetotheitemsthatwereidentifiedbyC&CExperience(pilotproject)

• involvementintheestablishmentoftheMHECOCollaborationGroup

•provisionoftrainingandsupportintheMHECOprocesstostaff,consumerandcarerrepresentativesthroughtwoeducationworkshopsheldattheservice

•beingsupportmembersoftheCollaborationandCo-designgroups

•supportingtheimplementationprocessofthenewdesigns•reportingofMHECOprojectprogresstotheDOH.

Throughthesesteps,theProjectTeamwasabletoestablishrelationshipswithkeystakeholdersandengagethemintheproject,whilesimultaneouslyenablingthestakeholderstomaintainownershipoftheco-designprocess.

Establishing collaborative practicePriortotheformationoftheMHECOCollaborationandCo-Designgroups,trainingsessionsfortheconsumers,carersandstaffoftheparticipatingservicewereconductedbymembersoftheresearchteams.Thetrainingeducationsessions(developedbytheresearchteams)aimedatenablingconsumers,carersandstafftofeelcomfortable,supportedandincludedasparticipatingmembersoftheCollaborationandCo-designgroups.

Co-designing mental health services – providers, consumers and carers working togetherbyKarenFairhurstandWayneWeavell

PriortotheformationoftheMentalHealthExperienceCo-DesignCollaborationandCo-Designgroups,trainingsessionsfortheconsumers,carersandstaffoftheparticipatingservicewereconductedbymembersoftheresearchteams.Thetrainingeducationsessions(developedbytheresearchteams)aimedatenablingconsumers,carersandstafftofeelcomfortable,supportedandincludedasparticipatingmembersoftheCollaborationandCo-designgroups.

Intheinitialtrainingsession,researchstafffromVMIACandVMHCNworkedwithconsumersandcarersonlyinordertosharetheirpriorexperiencesofgroupprocesses.Thetraininginvolved:

•adiscussionofgroupprocessandfunctionandanexplorationofhowparticipantsfeltwithrespecttoparticipatingwithstaffonanequalbasis,(giventhatpreviousexperiencesmayhaveinvolvedapowerdifferential,wherethestaffmemberwasperceivedastheexpert)

•assistingtheprospectiveparticipantsingainingsomebackgroundunderstandingoftheC&CExperiencephaseofMHECO,i.e.howinformationaboutDouttaGallawasgatheredandanalysed

•buildingparticipants’confidenceforparticipationintheupcomingCollaborationandCo-designgroupmeetings.

Anintendedoutcomeforthesecondcombinedsessionwasthebuildingofacollaborativeethosamongtheparticipants.Theachievementofthisoutcomewasevidencedbythefactthatconsumers,carersandstaffdidworktogetherinamutuallyrespectfulandproductivemannerinboththeCollaborationandCo-Designgroupsettings.Inthesecondtrainingsession,thefocuswasto:

•provideanexplanationoftheconstructsofCollaborationandCo-Designgroups

•modelworkingtogetherin‘hypothetical’CollaborationandCo-Designgroups

•organisethemembershipofthetwogroups•selectthemosteffectivetimesforparticipantstomeetin

thetwogroups.

Thesessionswereheldaweekapartataconvenienttimethatwasintendedtofacilitatetheattendanceofconsumers,carersandstaff.Thismeantthatthesessionswereheldattheserviceintheevening,whichdidresultinasufficientlylargenumberofpotentialparticipantsattending.Feedbackobtainedthroughanevaluationformfilledoutby14participantsattheendofthesecondsessionindicatedthatover90percentoftheparticipantsfeltthattheeducationandresourcesprovidedwereusefulandrelevanttotheirneeds.AttheendoftheCo-Designgroupprocess,participationinthetrainingsessionswashighlightedbymanyparticipantsasakeycomponentcontributingtothesuccessfulimplementationofMHECO.

MH ECO in actionThemajormilestonesoftheMHECOprojectatDouttaGallaservicewere:

• formationoftheLiaisongroup• establishmentoftheCollaborationgroup• formationoftheCo-Designgroups• inclusionofactionplanelementsintotheorganisation’s

qualityimprovementprocesses.

TheprojectLiaisongroupoversawtheprojectandmetmonthly.ThegroupconsistedoftheGeneralManagerofDouttaGalla’sMentalHealthPrograms,theProjectCo-ordinationOfficeratDouttaGalla,theQualityManager,aSeniorProjectOfficerfromtheDOH,andtheProjectManagersoftheconsumerandcarerProjectTeams.Inpractice,theLiaisongroupensuredfidelitytotheMHECOmethodology,monitoredprogressoftheprojectandassistedintheevaluationoftheproject.

Collaboration group TheinitialfunctionoftheCollaborationgroupwastoanalyseanddiscussthetouchpointsthathadarisenfromtheDouttaGallaC&CExperiencedata.Oncethiswascompleted,thesecondtaskwastoformulate,prioritiseandthenallocatetheobjectivestothreeCo-Designgroups(seenextsection).Thephilosophyusedinthedecision-makingprocesswasthattheobjectivesweretoberealistic,achievableandmeasurable.AttheendoftheCo-Designgroupprocess,(seenextsection),threeactionplanswererelayedbackuptotheCollaborationgroup,whichthenperformeditsthirdfunctionofco-ordinatingtheCo-Designgroupproposals,whichwerethenformulatedintocomprehensive,actionablequalityimprovementplans.

TheCollaborationgroupwascomprisedofrepresentativesofseniorDouttaGallastaff(includingastaffmemberappointedastheProjectCoordinatorfortheservice),consumers,carers,researchworkersandconsumerandcarerconsultantswhometatthestartandendoftheCo-Designprocessaswellasattwofollow-upmeetingsthreemonthsapart.Thefirstfollow-upmeetingassessedtheinitialoutcomesoftherecommendedqualityinitiativesandthesecondfollow-upmeetingwasorganisedtoprovidefeedbacktoparticipantsoftheprogressofthequalityimprovementactivities.Thefeedbackwasverypositiveandencouragingillustratingthevalueoftheprojecttotheorganisationanditsconsumersandcarers.



the Co-design groups ThreeCo-DesigngroupswereformedatDouttaGalla,eachofwhichhadthegoalofproducinganactionplanforthere-designobjectivethatithadbeenallocated.Thegroupsmetthreetimes,withmeetingsafortnightapartandconsistedofrepresentativesofstaff,consumers,carers,researchworkersand,consumerandcarerconsultants.ThemeetingsofeachCo-Designgroupfollowedaprogressivepatternofactivity.

Thefirstmeetingdiscussedandmappedthecurrentprocessesinvolvedintheserviceareathattheywereassignedtoredesign.Theprocessmappingexerciseoftenprovidednewandvaluableinsightsforparticipants,whowereabletobetterconceptualisetheserviceareathroughbeinginformedbythemultipleperspectivespresentedbygroupmembers.

ThesecondmeetingofeachCo-DesigngroupinvestigatedexamplesofgoodpracticethatweresourcedbytheresearchteamsandtheDouttaGallaMHECOProjectCoordinator.Inthethirdmeeting,theCo-Designgroupsdevelopedtheiractionplansbasedonthegroup’spreviousanalysisofcurrentserviceactivitiesandexamplesofgoodpractice.

TheMHECOProjectCoordinatorcollatedeachoftheCo-Designgroups’actionplansforpresentationtothesecondCollaborationgroupmeeting.ItwasthentheCollaborationgroup’stasktoanalyseandrecommendactionsforinclusionintotheorganisation’squalityimprovementframework.TheresearchteamsfromtheVMIACandtheVMHCNeachsuppliedaprojectworkertotheCollaborationandCo-Designgroupstoactasfacilitatorsandmentorsintheco-designprocess.TheprojectworkersplayedanintegralpartintheMHECOco-designprocessthroughtheirsupport,facilitationandexpertiseingroupdynamics.

ConclusionMHECOisaninnovativequalityimprovementmethodologybasedonutilisingtheexperiencesofconsumers,carersandservicestaff.AtDouttaGalla,theC&CExperiencepilotprojectidentifiedtheconsumerandcarerexperiencesfromwhichthetouchpointsfortheco-designprocesswereidentifiedandthesubsequentdevelopment(throughtheprocessofcollaborationandco-design)ledtothedevelopmentofdetailedactionplansthatresultedinrealisticandmeaningfulqualityimprovements.Theprojectalsointroducedtheco-designphilosophyintotheorganisationandresultedintheup-skillingofDouttaGallaservicestaffinthemethodology,therebybuildingcapacityforapplicationinfuturequalityimprovementactivities.

DouttaGallademonstratedahighlevelofcommitmenttobothleadershipandownershipthroughouttheprojectandinreturn,theMHECOprocessfulfilleditspotentialofenhancingserviceandultimatelyimprovingstakeholderexperiences.

References

Bate,P.&Robert,G.(2007)Bringing User Experience to Healthcare improvement, the concepts, methods and practices of experience-based design,Radcliffe,Oxford

DepartmentofHumanServices(2002)New Directions for Victoria’s Mental Health Services: The Next Five Years.MetropolitanHealthandAgedCareServicesDivision,VictorianGovernmentDepartmentofHumanServices,Melbourne,September2002,p13

C&CExperiencePilotProject(2008)Doutta Galla Service Report,VictorianGovernmentDepartmentofHumanServices,Melbourne

Co-designing mental health services – providers, consumers and carers working togetherbyKarenFairhurstandWayneWeavell

YOUR SAY...



InJuly2010theTasmanianCommissionerforChildren,PaulMason,raisedasmallredflagovertheubiquitousStrengthsPerspective.InhisReportontheroleoftheTasmanianChildServicesinatragicincidentofamotherprostitutingher12-year-olddaughter,CommissionerMasonsaid:

The title of the Report ‘She Will Do Anything To Make Sure She Keeps The Girls’ is a sentence from a list of strengths relied on to justify a recommendation that it was now safe to let a time-limited 12-month guardianship order lapse in October 2009. That strength was a weakness.1

CommissionerMasoncorrectlyidentifiedaseriousproblemwiththeuseofthestrengthsperspectivewhenworkingwithpeoplewithmentalhealthissues;thatstrengthsforpeoplewithmentalillnessoftenalsocontaintheseedsofsomeoftheworstaspectsoftheillness.

WhenIwasfirstinrehabilitationandwasaskedwhatmystrengthswere,Ihadgreatdifficultyansweringthequestionmainlybecause

whiletenacity,determinationandconfidenceweremymainstrengths,whenIwasilltheywerealsomygreatestweakness.Forexample,havingtenacitymeantthatIcouldholdontoseriouslydamagingdelusionsforsomesixyears.

Thesamecanbesaidformostmentalillnesses.Forinstance,ifyouaskedsomeonewithanorexiawhattheirmainstrengthsweretheywouldprobablylistself-discipline,self-controlanddetermination.However,wouldrealisingthatlistofstrengthsreallyhelpthatpersonrecover?Byaskingmentalhealthconsumerstodescribecharacteristicsasstrengthswithoutadmittingthepossibilitythattheyarealsoweaknesses,isn’ttheworkeratriskofreinforcingproblembehaviour?

Similarly,problemsmayarisebecausethestrengthsexperiencedwhenapersonisundergoingpsychosisforexample,arenotnecessarilyabletobetranslatedintoordinarylifewhentheyarerecovering.Anotherexamplemightbewhenacaseworkerisencouragingaclienttoperhapsgooutsidetheircomfortzone

Otherpeoplehavesaidthatmyattitudetothestrengthsperspectiveisdifferent,butifyouthinkaboutmostmentalillnesses,theactualmanifestationoftheillnessisnearlyalwayseither‘strengthsusedinexcess’or‘strengthsusedoutofcontext’.Learningtorecogniseandmoderatethoseexcessesandinappropriatebehavioursisperhapsthemostimportantpartofstayingwell.

Maggie Maguire,MentalHealthConsumer

Opinion piece Strengths… time for a rethink?

andusepublictransport,askingthemto‘tellmeaboutyourstrengthswhenyoujoinedtheForeignLegion.’Let’ssaytheclientidentifiedwiththestrength‘courage’whenusingpublictransport.Thepersonmayalsothink,‘yes,IwasverybravewhenIjoinedtheForeignLegion,butIwasalsoverybravewhenIstoodontheedgeofthatskyscraperimaginingIwasaleaf.’Thereforethegeneralfeelingmaybeoneofconfusion.

Generallyinmyexperience,aftersome30yearswithbipolarschizoidaffectivedisorderdisruptedbypsychoticevents,thereisnotthecontinuityofexperienceandemotionsthroughoutthelifespanthatwouldallowapersontodrawstrengthorempowermentfrompreviousevents.Infact,themainreasonIenvy‘normal’peopleisbecausetheyhaveacertaincontinuityofexperience.

However,forallpeople,allstrengthsusedinexcessareweaknesses.Amotherwholovesherchildtothedegreesheignoresdisciplineisexhibitingweakness.Aswellasthis,allstrengthsusedoutofcontextarealsoweaknesses.Forinstance,itisagreatstrengthtobeentertainingbutaweaknesstotap-danceinChurch.IfeelthattheratherformulaicwayinwhichtheStrengthsPerspectiveisusedinmentalhealthprogramsisreallyquiteinappropriateasitignoresimportantaspectsaboutstrengths.IwillgosofarastosaythattheStrengthsPerspectiveshouldnotbeusedatallwhenworkingwithpeoplewithmentalhealthissueswithoutconsiderablereferencetotheproblemsthatoccurwhenstrengthsareusedeitherinexcessoroutofcontext.However,asIamawarethatdiscussing‘problems’issomewhatoutofvogue,Ithereforeproposeaskills-basedalternative.

Ifsomeoneasksmewhatmyskillsare,noneoftheproblemsthatarisewiththeuseoftheword‘strengths’exist.Icanlistthemveryeasilyandwithoutanyconfusion:Icookwell,Icanknitandsew,Imakegreatconversation,Icanswimexpertly.

Strengthsarerathervague,andincludefeelingslikeoptimism,determinationandconsideration,whichsometimesIhaveinexcessandsometimesnotatall;sometimesthey’regoodtohave,sometimesthey’rebaddependingonthecontext.Skillsareconcreteandonceyouhavethemyoudon’tlosethemevenifyoubecomementallyill(Icanplaythepiano,Icansing,Icandance.)

Skillssuchastyping80wordsaminute,swimmingandpaintingarealsovalue-free,whereasstrengthsarevalue-loaded.Being‘considerate’maybesomethingapersonwithAspergersSyndromemaynevercontemplateasbeingagoodthing.‘Independence’is,culturally,avalue-loadedwordanddoesnotnecessarilymeanthesamethingtoallpeopleinallsocieties.Therearetimeswhenbeing‘independent’canbegoodandtimeswhenitcanbedamaging.

Peoplewhohaveaseriousmentalillnessoftenhaveextraordinaryskillsinotherareasoftheirlives.Thesespecialistskillscouldbeinareassuchasphotography,art,musicorthenaturalworld.Sometimesthedriverfortheseskillsisthatthereissomerelieffromtheconstantruminativethoughtsthatarisewithmentalillness.Theseskills(andtheprojectsthatderivefromthem)aremuchmoreimportanttopeoplewithseriousmentalillnessthanvaguestrengths,yetveryoftenskillsareignoredandneglectedinStrengthsPerspective-basedprograms.Peoplewiththeseskillsrequiresupporttocarrythemtothenextlevel.Oftenthissupportisreallyquiteinexpensiveandsimple,e.g.havingaccesstocomputers,theinternet,photocopiersandtelephonesandlinkingupwithmentorship.

Ihatetousetheterm‘rabbitingon’,butthecontinualemphasisonstrengthswhentheperspectivehastheproblemslistedaboveoftenleadstodisappointmentandfrustrationbytheconsumerswhomayhavethemostserioussymptomsofmentalillnessbutthemostfantasticskills.Iknowthatsomeconsumersextolthevirtuesofthestrengths-basedapproachandIthinkitdoeshavesomepositiveaspectsforpeoplesuchasyoungwomenwhosestrengthsmayhavetraditionallybeenrepressed.However,eveninthissituation,IthinktheStrengthsPerspectiveshouldbetranslatedintoskills.Perhapstheskillsassociatedwithtakingpublictransportsafely(e.g.self-defenseskills)couldbetaughtdirectlytothepersonratherthanhavingadeepandmeaningfuldiscussiononpersonalstrengths.Thiswaytheconceptisnotlostinavaguewashofwordsandthedisturbingintrospectionthatoftenresultswillnolongerbethecase.

Otherpeoplehavesaidthatmyattitudetothestrengthsperspectiveisdifferent,butifyouthinkaboutmostmentalillnesses,theactualmanifestationoftheillnessisnearlyalwayseither‘strengthsusedinexcess’or‘strengthsusedoutofcontext’.Learningtorecogniseandmoderatethoseexcessesandinappropriatebehavioursisperhapsthemostimportantpartofstayingwell.

Maggie Maguire is a mental health consumer of some 37 years. Having teacher training she is interested in the application of educational theory and research to psychosocial rehabilitation. She is currently studying to be a nutritionist and blogs on mental health issues on her website ‘Stop Thrashing Around’ at: www.stopthrashingaround.wordpress.com

References

1 She Will Do Anything To Make Sure She Keeps The Girls,(July2010)ReportbyPaulMason,Children’sCommissioner,Tasmania,availableat:http://www.dhhs.tas.gov.au/news_and_media/?a=63735



ACSOhavebeenassistingthedisadvantagedfor25years,connectingthemwiththesupportstheyneedtoimprovetheirlives.

For19years,SpecialistMentalHealthServices(SMHS)hasbeenservicingmenandwomenwithsubstantialpsychiatricissuesthatleadtomarginalisationandincarceration.SMHSconsumersexperienceisolation,substanceabuse,unstablementalhealthandhomelessness,allofwhichinfluencetheirbehaviourresultingincriminaljusticeinvolvement.

TheSMHSsuiteofprogramsassistsserviceuserstotransitionfromacustodialsettingbackintothegeneralcommunity.Ourprogramsarevoluntaryandattempttogivebacksomecontroltopeoplewhoareoftenunderseveralformsofmandatoryorders.

WetypicallyengagepeoplethroughthecorrectionalsystemandattendtheentireVictorianprisonsystemandassessandplanforasuccessfulreturntocommunitylife.Ourserviceuserstypicallyhavemultiplebarriersimpactingontheirabilitytoaccessandmaintainservicesincludingstablehousingandtreatmentoptions.Ourprogramsadoptaholisticapproach,whichrequiresourworkerstobeknowledgeableintheareasofmentalhealthpathology,treatment,housingandhomelessnessandthelegalsystem.

Programparticipationisvoluntaryandfocuseslargelyonwelfare.Theservicedeliverymodelincorporatesprisonin-reach,outreachandsupportedhousing.SMHSdeliversintensiveoutreachforwomenwithadiagnosisofborderlinepersonalitydisorderwhoaregenerallyunabletoestablishandmaintainpersonalandprofessionalrelationshipsand,typically,cannotaccessclinicalcasemanagement.

TheSpecialistMentalHealthServicesteamrecognisesthatdespiteourefforts,serviceusersoftenrelapse,resultinginoffendingandprison.Therefore,weviewourrelationshipasastop-overontheirjourney.Weprideourselvesonthedoor-always-openapproachandcontinuouslytakeonthesameclientmultipletimes,evenwhentheiroffendingissometimesaimedatus.

Robb Ritchens, SpecialistMentalHealthServicesManager,ACSO

Member profile Australian Community Support Organisation (ACSO)

SpecialistMentalHealthServicesoverview–keepingthedooropen

TocomplementoursupportmodelwehaverecentlygoneintopartnershipwithYarraCommunityHousingtoestablishYarraSpace,afully-staffedaccommodationfoyermodel.TheSMHSMcCormackworkerspromoteintegrationthroughonsitesupportandpsychosocialprogramsthatfostercommunityconnections,reduceisolationandbuildbetterrelationshipsbetweenresidentsandtheirlocalcommunity.

SMHShavealsolongrecognisedtheimportanceofsupportingthefamiliesthatareoftenleftdamagedfromtheconsequencesofmentalillnessandrelatedoffendingbehaviour.SMHS’sRestoreProgramisanewinitiativethatprovidessupporttosuchfamiliesandisoftenaparallelandcomplementaryservicetoourotherprograms,althoughitalsosupportsfamiliesthatdonothaveanotherfamilymemberinvolvedwithSMHS.

TheSMHSteamrecognisesthatdespiteourefforts,serviceusersoftenrelapseresultinginoffendingandprison.Therefore,weviewourrelationshipasastop-overontheirjourney.Weprideourselvesonthedoor-always-openapproachandcontinuouslytakeonthesameclientmultipletimes,evenwhentheiroffendingissometimesaimedatus.Thefollowingcasestudysaysitbest:

Twenty-two-year-oldJimmywasreferredtoSMHSpre-release.Hisundiagnosedmentalillnessesledtohimcommittingatragicallyviolentoffence.Overseveralchaoticyears,SMHSremainedJimmy’sonlysupport,despitehismaladaptiveandanti-socialbehavioursincludingdrugrelatedoffendingandnon-compliancy.

Jimmy’stendencytointegrateworkersintohisdelusions,especiallywhentheywereinitiatingcrisisservices,ledtoviolentoutburstsandpropertydamage.TheSMHSteamunderstoodthatJimmy’sbehavioursweresymptomsandhisnon-compliancewasdrivenbymanylossesanddenialofhisdiagnosisofschizophrenia.

ThekeytoJimmy’seventualsuccesswastrust,flexibility,commitmentandastrongcollaborativeapproachwithservicesincludingclinicalservices,AlcoholandOtherDrugsservices,mentalhealthandforensicservicesandcorrections.SMHSremainedconnectedusingtheSMHSout-of-hourscontactservice,assertivein-reachandoutreachwellbeyondtheusualgeographicalboundaries.

Eventually,JimmystabilisedandthroughACSO’sDisabilityEmploymentServicehegainedemploymentandSMHSsecurednominatedlong-termaccommodation.Jimmynowlivesafulllife,isinastablerelationshipandinhissparetimehehelpsothersthroughvolunteerwork.

Thisstudydemonstrateshowkeepingthedooropen,despitethebricksbeingprojectedthroughit,doesworkwhenassistinghighneedsclientswithmajorbarrierstosocialintegration.

ExPRESSION SESSION

Artist’s statement about this painting (opposite): ‘Muchofmyworkfeaturesfacesthatareambiguous,suggestiveofalossoflanguageandpersonalityintimesofillness.Thechainissymbolicofconstraintandthepillsrefertoonemeansofconstraint.’donna lawrence

See Beyond This2006oilandacryliconcanvas110x100cmCunninghamDaxCollection

AselectionofDonnaLawrence’sworkswillbeincludedintheupcomingexhibition:Melancholia,attheDaxCentre.Theexhibitionwillbeopenfrom21stApril2011untilOctober2011.Theexhibitionexploresthemesofdepressionandcreativity,thearthistoricaldiscourseofmelancholia,thevisuallanguageofmelancholia,andtheexperiencesoftheartistswithmelancholicinspiration.

Artist profileDonnaisanaward-winningpracticingartistwhohasexhibitedregularlyoverthepast15yearsandhasbeeninvolvedinawidevarietyofcommunityartsfestivalsandprojects.Donna’sworkreflectsthemesofcatharsis,isolation,prejudiceandlanguage.

Artist’s statement‘Ibelievevisualartworkcanbeaestheticallypleasingaswellaspoliticallymotivatedorintellectual.Iaimforbothoftheseelementsinmywork.

Ibelieveartworkcanbeempoweringinitssharedmeaningasopposedtosimplyitsaestheticqualities.Itcanallowsomepeopletofeelasignificantadherencetoagroupofsimilarminded/experiencedpeople,andleadotherstoexperienceempathyandgainknowledge,concerningtheoccurrencesofothers.Similarly,Ihopethatmyworkwillreachpeoplewhohaveexperiencedmentalillness,andpeoplewhohavenot.Itisultimatelyanissuethataffectsusall.’

About the Cunningham dax Collection TheCunninghamDaxCollection,amassedovera70-yearperiod,consistsofover15,000artworksincludingworksonpaper,photography,paintings,sculpturalwork,journals,digitalmediaandvideoscreatedbypeoplewithanexperienceofmentalillnessand/orpsychologicaltrauma.TheCunninghamDaxCollectionispartoftheDaxCentre.

The Dax Centre promotes mental health and wellbeing by fostering a greater understanding of the mind, mental illness and trauma through art and creativity.

FormoreinformationontheCunninghamDaxCollectionandtheDaxCentre,visit:www.daxcentre.org



This book proved to be excellent holiday reading for a policy wonk like me. Recent developments in outcome measurement (OM) from around the world are brought together in a single source. The fact that many of these developments have occurred in Australasia makes the book particularly relevant to local practitioners. Australia is regarded as a world leader in the field and it is fitting, therefore, that one of the chapters is written by VICSERV Board Member and Neami Victorian State Manager Glen Tobias on OM in NGOs.

Earlyinthebook,thepointismadethataccordingtonationaloutcomedata,inthemain,consumersincontactwithAustralianpublic-sectormentalhealthservicesgetbetter(p17).However,therestofthebooksuggeststhatthisisbynomeansasimpleclaim.Howareoutcomesinmentalhealthdefined?Whodefineswhata‘good’outcomeis?Canoutcomesbeattributedtoparticularinterventions?Whycollectoutcomedata?Howcanconsumers’perspectivesbeincorporated?Theseareallquestionsthatcountriesaroundtheworldhavegrappledwith.ThefirstsectionofthebookcontainsaccountsofOMinAustralia,NewZealand,Canada,Germany,Italy,Norway,theUnitedKingdomandtheUnitedStates.Fromreadingthesevariedapproaches,itseemsthatforOMtobesuccessful,itrequiresdistinctpolicyandlegislativedirection,adequateresourcingandstronglocalleadership.

ThesecondsectionofthebookisdevotedtoOMinspecificgroupsandsettings.Chapterscoverthevariousagegroups,privatehospitals,indigenoushealth,NGOsanddrugandalcoholsettings.GlenTobias’chapterhighlightsproblemswithintheAustralasiancommunitymanagedmentalhealthsectorwhoarenotmandatedtoreportondataandwhouse

severaldifferenttoolswhenitiscollected.Thisprecludesthepossibilityofbenchmarkingandservicesystemplanningonamacrolevel.Glengivessomepracticeexampleswheregoodthingsarehappeningatthelocallevel,especiallybetweenthecommunitymanagedmentalhealthsectorandtheclinicalsector.ObstaclestomoreroutineuseofOMinthesectorarealsodiscussed.ThechapterconcludeswithacallforstrongleadershiptodriveorganisationalchangeandforgovernmentfundingdepartmentstomandateauniformsystemforRoutineOutcomeMeasurement.

ThefinalsectionofthebookreviewsarangeofcurrentissuesinOM.Applicationsandutility,stakeholderperspectives,theassessmentofchange,workforceissues,therangeofavailableinstrumentsandtheeconomicaspectsofOMarecovered.

Theeditormakesthepointquiteclearlythatthisisabookpredominatelywrittenbycliniciansandacademicsforcliniciansandacademicsandthatiswhytherearenochaptersbyconsumers(p8).Ouch!Clearlythough,mostoftheauthorshadconsultedconsumersandcarersandalmostalladvocatefortheirinvolvementtoagreaterorlesserextentinOMdevelopmentandimplementation.Inanumberofaccounts,consumerswereallforOMbecauseitencouragedtheircliniciantostopandtalkwiththemabouttheirtreatmentandgoals.Reallyrathersimpleisn’tit?

Reviewedby

Wendy Smith PolicyandResearchManagerandnewparadigmEditor,VICSERV

Book reviewOutcome Measurement in Mental Health: theory and Practice

Edited by tom trauer,CambridgeUniversityPress,2010

Peoplewithaseriousmentalillnesssuchasschizophreniahaveanaveragelifeexpectancythatisatleast20yearslessthanothernon-indigenousAustralians.Inthiscontext,50to59yearsisequivalenttooldage.Thecausesaremanyandmostlypreventable.FortheupcomingWintereditionofnewparadigmweareseekingarticlesaboutthephysicalhealthstatusofpeoplewithmentalillnessandsuccessfulapproachestoimprovinghealthoutcomes.

Wewelcomesubmissionsfromworkersandconsumersinthementalhealthsector,GPs,physicians,academics,policymakersandanyoneelseinterestedinsharingtheirviewonthisissue.

Please note that the deadline for submissions is 1st June 2011.

Formoreinformationonnewparadigm,includingContributorGuidelinesandtheremainingschedulefor2011,pleasegotowww.vicserv.org.au

Coming up in newparadigm

Call for contributions

New to the Resource Centre

Mentalhealthlawsexistismanycountriestoregulatetheinvoluntarydetentionandtreatmentofindividualswithseriousmentalillnesses.‘Rights-basedlegalism’isatermusedtodescribementalhealthlawsthatrefertotherightsofindividualswithmentalillnessessomewhereintheirprovisions.

Thecollectionaddressessomeofthecurrentissuesandproblemsarisingfromrights-basedmentalhealthlaws.Thechaptershavebeengroupedinfivepartsasfollows:

•historicalfoundations• theInternational Human Rights Frameworkandthe

UnitedNations’Convention on the Rights of Persons with Disabilities

•gapsbetweenlawandpractice•reviewprocessesandtheroleoftribunals•accesstomentalhealthservices

Manyofthechaptersinthiscollectionemphasisetheimportanceofmovingawayfromthelimitationsofanegativerightsapproachtomentalhealthlawstowardsmorepositiverightsofsocialparticipation.Whilethelawmaynotalwaysbethebestwaythroughwhichtoalleviatesocialandpersonalpredicaments,legislationisparamountforthefunctioningofthementalhealthsystem.Theaimofthiscollectionistoencouragetheenactmentoflegalprovisionsgoverningtreatment,detentionandcarethatareworkableandconformtointernationalhumanrightsdocuments.

ThisbookisbasedonresearchfundedbyanAustralianResearchCouncilFederationFellowship.

PleasecontacttheResourcesCoordinatoratVICSERVon0395197000toborrowthisbook.

Rethinking rights-based mental health lawsEditedbyBernadetteMcSherryandPenelopeWeller,HartPublishing,Oxford,UK,2010

ABOUt US

VICSERVisamembership-basedorganisationandthepeakbodyrepresentingcommunitymanagedmentalhealthservicesinVictoria.Theseservicesincludehousingsupport,home-basedoutreach,psychosocialandpre-vocationaldayprograms,residentialrehabilitation,mutualsupportandself-help,respitecareandPreventionandRecoveryCare(PARC)services.

ManyVICSERVmembersalsoprovideCommonwealthfundedmentalhealthprograms.

Our Vision

VICSERV envisages a society where mental health and social wellbeing are a national priority and:

•Everyonehasaccesstotimelymentalhealthtreatmentandsupport

•Mentalhealthservicesarerecoveryoriented•Peopleparticipateindecisionmakingabouttheir

ownlivesandtheircommunity•Peopleaffectedbymentalillnesshaveaccessto,and

afairshareof,communityresourcesandservices•Allpeopleareinvolvedasequals,withoutdiscrimination.

As the peak body for the community managed mental health sector in Victoria, we pursue the development and reform of mental health services.

We support members by:

•Promotingrecoveryorientedpractice•Buildinganddisseminatingknowledge•Providingleadership•Buildingpartnershipsandnetworks•Undertakingworkforcedevelopment,

trainingandcapacitybuilding•Promotingqualityinservicedelivery•Undertakingadvocacyandcommunityeducation

Our Mission

Collaboration (Teamwork)

• Workingtogethertoachievesharedobjectives• Respectingtheknowledgeandskillsofothers• Puttingtheneedsoftheorganisationabove

individualinterests

Inclusiveness

• Listeningtoarangeofviews• Representingandembracingthediversityofthesector• Honouringtheconsumerandcarerexperience

Flexibility

• Proactivelyembracingchangeandnewopportunities• Steppingupandoutfromourrolesandperspectives

whenrequired

Courage

• Takingleadershipbyspeakinguponimportantissues• Encouragingandsupportinginnovation• Persistenceinthefaceofobstaclesanddelays

Integrity

• Doingwhatwesaywewilldoontimeandtothebestofourability

• Listeningandrespondingtomembers• Havingarespectedvoiceandvisibilityinthesector,

broadersystemandingovernment•Beinganhonestbrokerofinformationandresources.

Our Values

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Theabovenamedorganisation(orindividual)herebyappliesformembershipofPsychiatricDisabilityServicesofVictoria(VICSERV)Inc.andnominatestheabove-namedpersonasthecontactpersonforallcorrespondence.Uponacceptanceofthisapplication,PsychiatricDisabilityServicesofVictoria(VICSERV)Inc.isauthorisedtoinsertthenameofthisorganisation(orindividual)intheregisterofmembersoftheincorporatedassociation.WeherebyagreetoabidebytheRulesofPsychiatricDisabilityServicesofVictoria(VICSERV)Inc.

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Documents

MENTAL HEALTH AND THE JUSTICE SYSTEMcmha.org.au/wp-content/uploads/2017/06/2011Newparadigm... · 2017-07-13 · 4 newparadigm Autumn 2011 Psychiatric Disability Services 04 of Victoria