Embed Size (px)
Citation preview
Department of Developmental Disability Neuropsychiatry
Never Stand Still UNSW Medicine School of Psychiatry
Strategic Plan2013 to 2015
1
ForewordWe need to develop a new set of thinking about how we make support available, to accommodate the reality that people cannot be described by a diagnosis, or even a collection of diagnoses, but have an infinite variety of needs, wishes, aspirations and social circumstances.
The NSW Mental Health Commission in March 2014 will present to Government its recommendations for change to how support is provided for people who experience mental illness. The Commission, which is an independent statutory agency, has been charged with leading reform not just within the health portfolio, but across the whole of government including housing, justice, education, employment and community services – any of which may have a profound effect on the lives of people who experience mental illness.
We need to listen to people themselves, and their families and carers, to make sure the support we offer is aligned to individual needs, not diagnostic categories. That is doubly true when mental illness occurs alongside another complex condition, such as intellectual disability.
I commend 3DN’s Strategic Plan 2013 to 2015, which provides a powerful intellectual and professional framework on which a person-centred approach to support can be built.
It is heartening to see the emphasis on collection of epidemiological data that records the actual experience of people with mental illness and intellectual disability, rather than making assumptions about them. I welcome also the acknowledgement that much more sophisticated training will be required to meet the specialised needs of these people, and that clinicians must collaborate across agency boundaries if they are to secure the best support for their clients.
I am especially delighted to see this Plan recognise the need for health professionals to involve themselves actively in policy development, advocacy and lobbying. All of our voices will be needed to make a meaningful difference in the lives of people with mental illness and intellectual disability.
John Feneley NSW Mental Health Commissioner
A mental illness diagnosis may channel people through to the supports and services they need, qualify them for funding, affirm their experience, and bring recognition and understanding from health professionals and the wider community.
Conversely, a diagnostic label may become a sort of shorthand that thwarts more creative thinking about the situation of an individual person and triggers instead a cascade of standardised medication regimens and care protocols.
When people with an intellectual disability develop a mental illness – which they do at rates of up to four times those of others in the community – this double bind is further amplified.
First, it is very likely that the illness will not be promptly or adequately recognised. When psychological distress manifests primarily through behaviour, particularly in someone whose ability to communicate verbally may be limited, it may be misattributed as a facet of the intellectual disability.
Then, if the person is diagnosed with a mental illness, it is probable that much of the thinking that informs their care will be derived from studies conducted with people whose experience is not complicated by intellectual disability. Health professionals may also find there is little or no institutional provision for them to involve other services supporting the person in their other health and social needs.
What should we do to break down these diagnostic silos, which can cause so much damage to people by leaving them in unnecessary distress?
DisabilityCare, the renamed National Disability Insurance Scheme, offers a promising template. It frames qualification for assistance around a person’s level of need, not their diagnosis. Even so, the services from which individual support and care packages will be drawn are based generally on old models which view mental illnesses and intellectual disabilities as discrete entities, and may not flexibly respond to someone’s complex, overlapping or unusual difficulties.
2
Message from the Chair
The rich sharing of these stories with our
staff in clinical, educational, research and
social settings tells of major barriers to
access to mental health services, and
of substantial unmet need. These lived
experiences underscore the urgency of
our vision, and maintain our hope that our
work will be of direct benefit to the lives of
people with an intellectual or developmental
disability.
We look forward to continuing to refine our
strategy, as we work towards improving
mental health policy and practice for people
with an intellectual or developmental
disability. I hope you enjoy reading this Plan
and stay in touch with our work. You can find
us at our Facebook page or at –
www.3dn.unsw.edu.au
Associate Professor Julian Trollor
Chair, Intellectual Disability Mental Health
Head, Department of Developmental
Disability Neuropsychiatry, UNSW
The Department of Developmental
Disability Neuropsychiatry (3DN) has
grown rapidly since it was established by
the Chair of Intellectual Disability Mental
Health in 2009. From the start, 3DN has
been fortunate to have a passionate and
dedicated staff, who have worked hard
to improve the mental health and quality
of life of people with an intellectual or
developmental disability. The team’s
dedication has now resulted in our first
Strategic Plan, which will guide our work
over the next three years.
The breadth of our work to date has been
substantial, and a clear vision and plan for
future work has emerged from our initial
efforts. In the context of national disability
reform, this Strategic Plan will assist us to
maintain our focus in a rapidly changing
environment. It will guide our contribution
towards the attainment of the highest
possible standard of mental health and
wellbeing for people with an intellectual or
developmental disability.
The core strengths of our plan include
its solid grounding in a human rights
framework, and its collaborative,
interdisciplinary and consumer focus.
Our work is shaped by the experiences
of individuals with an intellectual or
developmental disability, their carers,
families and advocates.
3
VisionThe highest attainable standard of mental
health and wellbeing for people with an
intellectual or developmental disability.
MissionTo improve mental health policy and
practice for people with an intellectual or
developmental disability.
Guiding PrinciplesThe principles that guide the work of our
Department are:
• Human rights
People with an intellectual or
developmental disability have the right to
the highest attainable standard of health
and mental health care.
• Equity in mental health care
People with an intellectual or
developmental disability have the right
to equitable access to mental health
services, delivered by an appropriately
skilled workforce.
• Excellence and academic leadership
As a centre of expertise, we provide high
quality advice and promote excellence in
clinical practice, research, education and
policy.
• Innovation in health services
We translate research into practical
benefit at the level of health systems
and workforce capacity. We encourage
the use of sound evidence in the
implementation of new ideas.
• Collaboration
We value the multidisciplinary context
of our work. We actively engage
stakeholders to share expertise and
promote integrated systems in health
and disability. We actively seek the
participation of people with an intellectual
or developmental disability. We value
our collaborations with carers and family
members.
• Ethical conduct
We act in accordance with professional
and industry codes of conduct and
practice, the human rights of people with
an intellectual or developmental disability,
and the Guiding Principles in this Plan.
4
IntroductionThe Department of Developmental
Disability Neuropsychiatry (3DN) was
established by the Chair of Intellectual
Disability Mental Health in 2009. The
Chair is funded by Ageing, Disability and
Home Care, Department of Family and
Community Services NSW.
3DN is part of the School of Psychiatry
within UNSW Medicine. We champion
the right of people with an intellectual
or developmental disability to the same
level of health and mental health care as
the rest of the population. We promote a
standard of excellence in clinical practice,
research, workforce development, education
and policy in the field of intellectual and
developmental disability mental health.
Context for the Strategic PlanThere are an estimated 300,000 to
400,000 people with an intellectual
disability in Australia, and many more
with developmental disabilities. Despite
experiencing a higher rate of mental
illness compared with the general
population, people with an intellectual
or developmental disability are far less
likely to access appropriate mental health
services compared to those without an
intellectual or developmental disability.
Mental health and disability service
systems do not generally work well
together, and there is little professional
expertise in area of intellectual and
developmental disability mental health.
Many of the underlying causes of the poor
health status of people with an intellectual
or developmental disability derive from
the social environment in which they live,
including health care systems. Recognition
of these social determinants of health
provides a strong impetus for actions to
improve the quality and accessibility of
mental health services for people with an
intellectual or developmental disability.
In 2008, Australia ratified the United Nations
Convention on the Rights of Persons with
Disabilities, outlining its commitment to
achieving the highest standard of health
care attainable for people with a disability.
Realising this right to health care, and
responding to health inequities, requires
concerted action and investment in
research, policy, services and workforce
development.
Now more than ever, health care providers
must be able to respond to people’s
individual needs, and collaborate across
sectors. This level of response is called
for at a national level, with major reform in
the disability service system resulting in an
increased emphasis on the individual needs
and choices of people with a disability.
Against this backdrop, 3DN has evolved as
a leading academic department in the area
of intellectual and developmental disability
mental health in adults. This plan sets
out our strategic approach to significantly
improve mental health policy and practice for
people with an intellectual or developmental
disability.
Our Strategic Plan shows our activity in the
areas of consultancy, building capacity and
research. These three areas are mapped
against the level of impact of our work
(people, the workforce, systems and policy).
5
POLICY
SYSTEMS
WO
RKFORCE
PEOPLE
R
ES
EARCH
CONSULTA
NC
Y BUILDING CAPACIT
Y
3DN’s Activity
6
Objectives:
1.1 Deliver interventions and education to people with an
intellectual or developmental disability and their carers.
1.2 Deliver clinical consultations.
1.3 Produce diagnostic tools.
1.4 Document the experience of people with an intellectual or
developmental disability and their carers.
1.5 Develop clinical services.
1.6 Deliver mental health promotion and prevention
initiatives.
1.7 Build an epidemiological profile of people with an
intellectual or developmental disability and mental health
issues, including more accurate prevalence statistics.
1.8 Investigate specific neuropsychiatric disorders in people
with an intellectual or developmental disability.
1.9 Analyse the impact of ageing and dementia in people
with an intellectual or developmental disability and
identify predictors of healthy ageing.
STRATEGIC PRIORITY 1SP1. Improve mental health outcomes for people with an intellectual or developmental disability.
7
Objectives:
2.1 Develop a competency framework for the mental health
workforce.
2.2 Encourage the recruitment of appropriately skilled
professionals in health and disability services.
2.3 Create authoritative, good quality, accessible education
and training resources.
2.4 Engage in teaching in intellectual and developmental
disability mental health at the undergraduate,
postgraduate and community levels.
2.5 Analyse the training needs of the health and mental
health workforce.
STRATEGIC PRIORITY 2SP2. Increase the knowledge, skills and
confidence of the health workforce to deliver quality care and support to people with an
intellectual or developmental disability.
8
STRATEGIC PRIORITY 3SP3. Promote greater integration between disability and mental health systems and
improve access for people with an intellectual or developmental disability.
Objectives:
3.1 Analyse current support systems.
3.2 Develop pathways to mental health care.
3.3 Develop frameworks to guide service delivery.
3.4 Foster collaboration and build relationships between
agencies.
3.5 Raise awareness of the barriers to mental health service
access for people with an intellectual or developmental
disability.
3.6 Investigate the health and mental health service needs of
people with an intellectual or developmental disability.
3.7 Investigate the health and mental health service use of
carers.
9
STRATEGIC PRIORITY 4
SP4. Highlight the importance of intellectual and developmental disability mental health initiatives
and funding.
Objectives:
4.1 Develop policy and legislative advice and
recommendations.
4.2 Advocate the implementation of relevant policies and
frameworks.
4.3 Enhance lobbying success using the improved evidence
base resulting from our research activity.
4.4 Increase awareness of the health and mental health
needs of people with an intellectual or developmental
disability.
4.5 Build the evidence base in the field of intellectual and
developmental disability mental health, including the
collection and collation of accurate epidemiological data
and the publication of high quality work in peer-reviewed
journals.
10
Scho
ol o
f Psy
chia
try
Stra
tegi
c Pr
iorit
y Le
vel o
f im
pact
Obj
ectiv
es
Cons
ulta
ncy
Build
ing
capa
city
Re
sear
ch
SP1.
Impr
ove
men
tal h
ealth
ou
tcom
es fo
r peo
ple
with
an
inte
llect
ual o
r dev
elop
men
tal
disa
bilit
y.
Pe
ople
1.1
Del
iver
inte
rven
tions
and
ed
ucat
ion
to p
eopl
e w
ith a
n in
telle
ctua
l dis
abilit
y or
de
velo
pmen
tal d
isab
ility
and
th
eir c
arer
s.
1.
2 D
eliv
er c
linic
al c
onsu
ltatio
ns.
1.3
Pro
duce
dia
gnos
tic to
ols.
1.4
Doc
umen
t the
exp
erie
nce
of
peop
le w
ith a
n in
telle
ctua
l or
deve
lopm
enta
l dis
abili
ty a
nd
thei
r car
ers.
1.5
Dev
elop
clin
ical
ser
vice
s.
1.
6 D
eliv
er m
enta
l hea
lth
prom
otio
n an
d pr
even
tion
initi
ativ
es.
1.7
Bui
ld a
n ep
idem
iolo
gica
l pro
file
of p
eopl
e w
ith a
n in
telle
ctua
l or
deve
lopm
enta
l dis
abili
ty a
nd
men
tal h
ealth
issu
es, i
nclu
ding
m
ore
accu
rate
pre
vale
nce
stat
istic
s.
1.
8 In
vest
igat
e sp
ecifi
c ne
urop
sych
iatri
c di
sord
ers
in
peop
le w
ith a
n in
telle
ctua
l or
deve
lopm
enta
l dis
abili
ty.
1.
9 A
naly
se th
e im
pact
of a
gein
g an
d de
men
tia in
peo
ple
with
an
inte
llect
ual d
isab
ility
and
id
entif
y pr
edic
tors
of h
ealth
y ag
eing
.
SP2.
Incr
ease
the
know
ledg
e,
skill
s an
d co
nfid
ence
of t
he
heal
th w
orkf
orce
to d
eliv
er
qual
ity c
are
and
supp
ort t
o pe
ople
with
an
inte
llect
ual o
r de
velo
pmen
tal d
isab
ility
.
Wor
kfor
ce
2.1
Dev
elop
a c
ompe
tenc
y fra
mew
ork
for t
he m
enta
l hea
lth
wor
kfor
ce.
2.2
Enc
oura
ge th
e re
crui
tmen
t of
appr
opria
tely
ski
lled
prof
essi
onal
s in
hea
lth a
nd d
isab
ility
ser
vice
s.
2.3
Cre
ate
auth
orita
tive,
goo
d qu
ality
, acc
essi
ble
educ
atio
n an
d tra
inin
g re
sour
ces.
2.4
Eng
age
in te
achi
ng in
in
telle
ctua
l and
dev
elop
men
tal
disa
bilit
y m
enta
l hea
lth a
t the
un
derg
radu
ate,
pos
tgra
duat
e an
d co
mm
unity
leve
ls.
2.5
Ana
lyse
the
train
ing
need
s of
th
e he
alth
and
men
tal h
ealth
w
orkf
orce
.
Stra
tegi
c Prio
ritie
s
11
12
Stra
tegi
c Pr
iorit
y Le
vel o
f im
pact
Obj
ectiv
es
Cons
ulta
ncy
Build
ing
capa
city
Re
sear
ch
SP3.
Pro
mot
e gr
eate
r int
egra
tion
betw
een
disa
bilit
y an
d m
enta
l he
alth
ser
vice
s an
d im
prov
e ac
cess
for p
eopl
e w
ith a
n in
telle
ctua
l or d
evel
opm
enta
l di
sabi
lity.
Syst
ems
3.1
Ana
lyse
cur
rent
sup
port
syst
ems.
3.
2 D
evel
op p
athw
ays
to m
enta
l he
alth
car
e.
3.3
Dev
elop
fram
ewor
ks to
gui
de
serv
ice
deliv
ery.
3.
4 Fo
ster
col
labo
ratio
n an
d bu
ild
rela
tions
hips
bet
wee
n ag
enci
es.
3.5
Rai
se a
war
enes
s of
the
barr
iers
to m
enta
l hea
lth s
ervi
ce
acce
ss fo
r peo
ple
with
an
inte
llect
ual o
r dev
elop
men
tal
disa
bilit
y.
3.6
Inve
stig
ate
the
heal
th a
nd
men
tal h
ealth
ser
vice
nee
ds o
f pe
ople
with
an
inte
llect
ual o
r de
velo
pmen
tal d
isab
ility
3.7
Inve
stig
ate
heal
th a
nd m
enta
l he
alth
ser
vice
use
of c
arer
s.
SP4.
Hig
hlig
ht th
e im
port
ance
of
inte
llect
ual d
isab
ility
men
tal
heal
th in
itiat
ives
and
fund
ing.
Po
licy
4.1
Dev
elop
pol
icy
and
legi
slat
ive
advi
ce a
nd re
com
men
datio
ns.
4.2
Adv
ocat
e th
e im
plem
enta
tion
of re
leva
nt p
olic
ies
and
fram
ewor
ks.
4.3
Enh
ance
lobb
ying
suc
cess
us
ing
the
impr
oved
evi
denc
e ba
se
resu
lting
from
our
rese
arch
ac
tivity
.
4.4
Incr
ease
aw
aren
ess
of th
e he
alth
and
men
tal h
ealth
nee
ds o
f pe
ople
with
an
inte
llect
ual o
r de
velo
pmen
tal d
isab
ility
.
4.5
Bui
ld th
e ev
iden
ce b
ase
in th
e fie
ld o
f int
elle
ctua
l and
de
velo
pmen
tal d
isab
ility
men
tal
heal
th, i
nclu
ding
the
colle
ctio
n an
d co
llatio
n of
acc
urat
e ep
idem
iolo
gica
l dat
a an
d th
e pu
blic
atio
n of
hig
h qu
ality
wor
k in
pe
er-r
evie
wed
jour
nals
.
12
Definitions
• ‘Consultancy’
includes clinical work, delivering
interventions, sharing expertise, giving
advice, advocacy and collaborations.
• ‘Building capacity’
includes teaching, training, aspects
of health promotion, development
of educational resources and other
professional development activities.
• ‘Research’
includes studies and data analysis, or the
development of policies, frameworks and
tools.
• ‘People’
refers to people with an intellectual or
developmental disability and their carers
and family members.
• ‘Workforce’
includes the mental health, health and
disability workforces.
• ‘Systems’
includes disability and mental health
services and others that these have an
interface with.
• ‘Policy’
refers to the frameworks which outline
how systems should work and how
services should be delivered.
