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Victorian Mental Health Carer Strategy: Proposed Objectives

This outline of aims and objectives has been prepared as a basis for

the Victorian Mental Health Carers’ Strategy.

It informs stakeholders of a proposed outline of the Strategy.

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Contents

Preamble ..................................................................................................................................................... 3

Introduction ............................................................................................................................................................ 5

The Policy and Legislation context ............................................................................................................... 8

Carer Involvement .................................................................................................................................................. 8

Objective 1: Carers to be equal partners in the Care Team .......................................................................... 8

Objective 2: Mental Health staff to be trained in Family Inclusive Practice ................................................. 9

Objective 3: Accountability provisions developed to ensure family involvement ........................................ 9

Objective 4: Services to have processes to identify and engage carers ...................................................... 10

Carer Support ....................................................................................................................................................... 11

Objective 1: An Individual Mental Health Carer Advocacy Service be established ..................................... 11

Objective 2: Carers to experience ease of access to services and consistency of services .......................... 11

Objective 3: Maintaining and improving customized support services ...................................................... 12

Carer Participation ................................................................................................................................................ 13

Objective 1: Carer participation in policy, system service development and service improvement ........... 13

Objective 2: A framework for representation based on national standards is developed so that carers are represented at local, state and national levels .......................................................................................... 14

Objective 3: Carers receive the information, education and training they require to be effective in their participation .............................................................................................................................................. 14

Objective 4: Carer participation to be appropriately funded and resourced .............................................. 15

Objective 5: Implementation and effectiveness of carer participation objectives be monitored and evaluated. ................................................................................................................................................. 15

Carer Peer Workforce ........................................................................................................................................... 16

Objective 1: Strengthen and grow the mental health carer peer workforce .............................................. 17

Objective 2: Commit to research towards a better understanding of efficacy and outcomes of carer peer work. ......................................................................................................................................................... 18

Objective 3: The establishment of an Institute for Mental Health Workforce Development and Innovation .................................................................................................................................................................. 18

References ............................................................................................................................................................ 19

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Preamble

Currently Victoria does not have a mental health carer strategy, even despite the introduction of the

Carer Recognition Act 2012 and a plethora of policy documents emphasising the rights of carers and

the needs for carer inclusion, acknowledgement and support.

A presentation laying out what such a strategy might include was made to Minister Foley in his

capacity as the Victorian Minister for Mental Health at the July 2015 Carer Partnership Dialogue, as

part of the consultation process for the next 10-year mental health strategy being developed by the

Department of Health & Human Services (DHHS).

The Carer Partnership Dialogues are hosted by DHHS and by Tandem, the peak body for mental

health carers in Victoria. The purpose of the Carer Partnership Dialogues is to engage, inform,

influence and interact with government to ensure the views and interests of carers influence

government policy and service development. Carer Partnership Dialogues are attended by members

of the carer workforce. Participants are primarily carers employed in carer support or carer

consultant roles in clinical and community mental health services. The presentation in July

addressed the key priority areas identified and endorsed by Carer Partnership Dialogues

participants.

Carer Partnership participants agree that the aims of a Victorian Mental Health Carer Strategy must

be to ensure that:

Carers1 are involved in care planning and decision making. (Carer Involvement)

Carers are provided with the support they need (Carer Support)

Carers are provided with ample opportunities to effectively participate in policy, service and

system design and evaluation (Carer Participation)

The Carer Peer Workforce is appropriately developed and expanded in both clinical and

community mental health services. (Carer Peer Workforce)

Building on this presentation, a working group was then formed to develop this document2.

1 The term ‘carer/s’ refers to any persons providing unpaid support/care to a family member or other person who is experiencing mental illness. This includes children and young people with caring responsibilities who may or may not wish to be defined as young carers. A person experiencing mental illness is likely to have more than one carer. 2 Members of this working group, who have contributed to the development of this document are: Lindy Alcorn, Michael Bastin, Cate Bourke, Katrina Clarke, Kathy Collet, Karen Fraser, Jan Korolew, Julien McDonald, Peter McKenzie, Frances Sanders, Amber Scanlon, Michelle Swann

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Summary of Proposed Strategy Objectives

Carer Involvement

Objective 1: Carers to be equal partners in the Care Team

Objective 2: Mental Health staff to be trained in Family Inclusive Practice

Objective 3: Accountabiity provisions developed to ensure family involvement.

Objective 4: Services to have processes to identify and engage carers.

Carer Support

Objective 1: An Individual Mental Health Carer Advocacy Service be established

Objective 2: Carers to experience ease of access to services and consistency of services

Objective 3: Services to develop, maintain and improve customized support services

Carer Participation

Objective 1: Carer participation in policy, system and service development

Objective 2: A framework for representation based on national standards is developed so that carers are represented at local, state and national levels

Objective 3: Carers receive the information, education and training they require to be effective in their participation

Objective 4: Carer participation to be appropriately funded and resourced.

Objective 5: Implementation and effectiveness of carer participation objectives be monitored and evaluated.

Carer Peer Workforce

Objective 1: Strengthen and grow the mental health carer peer workforce

Objective 2: Commit to research towards a better understanding of efficacy and outcomes of carer peer work

Objective 3: The establishment of an Institute for Mental Health Workforce Development and Innovation

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Introduction

In the 1980s, Victoria closed its mental illness institutions. The ultimate success of this

deinstitutionalization of mental health care depended upon treatment and care being available in

the community. It required mental health community services to be developed and resourced,

staffed by an appropriately qualified, skilled and experienced workforce. But above all, it required

that the state and community commit to adequately resourcing and supporting the people actually

caring around the clock for people with a mental illness.

In 1993, the Not for Service report from the Mental Health Council of Australia3 revealed clearly this

had not happened. Subsequent publications, including the 2010 VICSERV conference Unfinished

Business4, have documented further evidence of the failure of the state to provide a strong mental

health community support system. The system continues to be crisis driven with a high reliance on

emergency department interventions and clinical care. The burden of care and support

predominantly falls on carers.

Because the mental health community support service system (MHCSS) is under-resourced,

fragmented and hard to navigate, carers spend a lot of time and energy endeavouring to ensure the

person they care for does get access to treatment and care. Carers want the person they are caring

for to be able to access the treatment that is required early in the illness, early in the episode and

early in life. But, because of the absence of early intervention services and the lack of community

support services, carers have to struggle alone until there is a crisis before they are able to access

any clinical or psychosocial support services. The effect on carers of this crisis driven approach is

huge, especially when intervention by police, emergency services and/or the CAT team is required.

When things have escalated to this point, the intervention experiences are usually traumatic for

both the person with the illness, their carer and family. If the urgently needed improvements in the

system were implemented, not only would it have a huge impact on consumers themselves, those

improvements will also make life better for carers.

3 Not For Service A report of the consultations by the Mental Health Council of Australia and the Brain and Mind Research Institute in association with the Human Rights and Equal Opportunity Commission https://www.humanrights.gov.au/sites/default/files/content/disability_rights/notforservice/documents/NFS_Finaldoc.pdf 4 See the associated publication Unfinished Business: pathways to Social Inclusion, New Paradigm, The Australian Journal of Psychosocial Rehabilitation, Summer 2009/2010 http://www.vicserv.org.au/uploads/newparadigm/VICSERV%20NewParadigm%20Summer2010.pdf which prefaced the concerns of the conference.

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Although Victoria has had twenty years of world-leading mental health policy and plans and a large

amount of research evidence and advocacy, mental health services do not yet have full involvement

of families and carers in their service delivery system. The mental health system does continues to

exclude families/carers despite a plethora of policies which require family inclusive service provision.

Caring is a 24/7 responsibility.

Carers worry about how they will cope on a day to day basis and in the long term. Who will care for

their family member when they can no longer do so is a huge concern for many. Carers experience

the joy associated with recovery, but too often the presence of mental illness in a family member

jeopardizes the physical health and wellbeing of carers. Carers often do not sufficiently understand

the mental illness and how to provide the most positive support to the person they are caring for.

They can be fearful and anxious about what to do for the best when the person becomes unwell.

What can they do or say that will be helpful when someone is threatening to self-harm or attempt to

end their life? How should they respond when the person is describing frightening hallucinations or

paranoid fears?

These issues are difficult for all carers, but are exacerbated where language is a barrier, where

cultural beliefs and/or stigma are particularly strong, if the person has an intellectual disability, if

alcohol and/or drugs are involved, or if the carer is a child or young person under the age of 18.

In the absence of assistance and respite, carers become exhausted by the demands, anxiety and

fears associated with their caring role. Stigma contributes to this and often the family/carer and the

person being cared for become isolated and shunned by the community. Closure of many mutual

self-help and activity groups and centres over the past year has added to these pressures.

Who cares for the carer?

The contribution carers make in terms of prevention of mental ill-health and supporting the person

they care for to live in the community cannot be overestimated. According to the most recent report

commissioned by Carers Australia, released in September 2015, the annual value of the care

provided nationally by unpaid carers of all kinds equates to approximately $60.3 billion.5 Providing

support for carers is not only humane, it is a good investment.

What supports do carers need to carry out their caring responsibilities, maintain their own health

and wellbeing and live a contributing life themselves?

5 The economic value of informal carer in Australia in 2015, Deloitte Access Economics, June 2015. Commissioned by Carers Australia. http://www.carersaustralia.com.au/storage/Access%20Economics%20Report.pdf

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Carers have the lowest health and well-being of any cohort measured to date according to the

Wellbeing of Australia Index Reports. 6 There are approximately 750,000 informal carers in Victoria,

including around 194,000 primary carers.7 Who cares for these carers when there is very little

support available to them?

Children and Young People

The voices of children and young people within families where an adult has a mental illness are often

invisible. When living within families where a parent has a mental illness, there may be specific

significant impacts for children and young people. The support requirements of these children and

the taking on of additional caring roles and responsibilities need to be considered within the

framework of this strategy. Some children/young people may have their own significant mental

health issues within the family, and as a result, have increased support needs from within their

family. Carers of people with a mental illness may also have caring responsibilities for children, and

this may contribute to the burden of care and the complexity of support requirements for the family.

Identification of children and young people who may have caring responsibilities is critical if their

wellbeing is to be optimised. A preventative, family focussed approach needs to be inclusive of

children in families, not just adults or young carers in order to allow engagement with a broader

system response. This would allow for earlier screening and better engagement with parents.

Relevant strategic relationships that would assist with this improved service response includes the

Victorian State Government funded initiative FaPMI (Families where a parent has a mental illness) 8

For carers to be effectively supported, a Victorian Mental Health Carer strategy is urgently needed,

with an accompanying implementation plan.

6 What makes us happy? 2014 3rd Edition of the Wellbeing of Australians Index, (http://www.australianunity.com.au/about-us/news-and-views/what-makes-us-happy) including an update of The Wellbeing of Australians – Carer Health and Wellbeing, R.A. Cummins et al, 2007 Australian Centre on Quality of Life Deakin University, Carers Australia, Australian Unity Report 17.1 executive Summary page vi http://www.carersaustralia.com.au/storage/Wellbeing-Index-Special-Report-October-2007.pdf

7 The Australian Bureau of Statistics indicates that in 2007, 3.2 million Australians had a mental health disorder of at least 12 months duration (2007 National Survey of Mental Health and Wellbeing: Summary of Results 7). Of these people, approximately three million have contact with family or friends. As Victoria has 25% of the nation’s population, potentially there are 750,000 mental health carers and close family. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0 8 FaPMI is a service development initiative which works across 11 Area Mental Health Services and partner organisations to improve the capacity and responses of the workforce when considering the needs of families where a parent has a mental illness. A significant component of the work of the FaPMI Coordinators has been to give voice to the needs of the entire family system which includes children, young people, and carers. FaPMI Coordinators are well-placed to assist with the implementation of some of the recommendations made within this document. See Families where a parent has a mental illness: A Service Development Strategy (2007), http://www.health.vic.gov.au/search.htm?q=FaPMI+strategy

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The Policy and Legislation context

Caring together, an action plan for carer involvement in Victorian public mental health services, was

published in 2004.9 It was intended to guide action from 2003 – 2008. Sadly, the plan has only been

partially implemented. The plan is now outdated in many aspects. A new strategy is required with

clear accountability provisions tied to funding and service agreements. The National Mental Health

Standards10, the Fourth National Mental Health Plan11, the National Carer Recognition Act 201012,

Because mental health matters13, the Carers Recognition Act (Vic.) 201214, the Victorian Charter

Supporting People in Care Relationships 201215 and the Victorian Mental Health Act 2014 all

commit to the importance of family inclusion, including dependent children.

With this regulatory and policy framework in place, a strategy is required to ensure that the carer

relevant sections of the above guiding documents are implemented.

Carer Involvement

The involvement of carers in the treatment, care and discharge of the person they care for should be

embedded as a core practice of services, tied to funding and service agreements and supported by

accountability provisions.

Objective 1: Carers to be equal partners in the Care Team

9 Caring together - An action plan for carer involvement in Victorian public mental health services Mental Health Branch, Department of Health 2004 http://tandemcarers.org.au/images/Resources/State%20Gov/Caring_Together.pdf 10http://www.health.gov.au/internet/main/publishing.nsf/content/CFA833CB8C1AA178CA257BF0001E7520/$File/servst10v2.pdf 11https://www.health.gov.au/internet/main/publishing.nsf/content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf 12 https://www.comlaw.gov.au/Details/C2010A00123 13 Because Mental Health Matters - Victorian Mental Health Reform Strategy 2009 - 2019 https://www2.health.vic.gov.au/getfile/?sc_itemid=%7BBBDAB24E-CD8C-4880-A3A8-3732327A9849%7D&title=Because%20Mental%20Health%20Matters%20-%20Victorian%20Mental%20Health%20Reform%20Strategy%202009%20-%202019 14 http://www.dhs.vic.gov.au/about-the-department/documents-and-resources/policies,-guidelines-and-legislation/carers-recognition-act-2012 15 http://www.dhs.vic.gov.au/__data/assets/pdf_file/0010/738667/91-The-Victorian-charter-supporting-people-in-care-relationships.pdf

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Processes to be established to ensure that carers are identified early so that they are not

invisible to staff and are involved at all stages of their family member’s/friend’s involvement

with services.

Carers should be able to talk directly to staff and contribute to treatment, care planning and

decision making, including discharge planning, and have their concerns taken into account

Carer expertise is recognised and valued in understanding consumer’s early warning signs

and understanding consumer’s behaviour

Carers are valued as an ally of holistic, effective recovery.

Carer involvement is valued as part of the clinician-consumer relationship i.e. clinicians

should encourage consumers to value carer roles.

Carers to be provided with education and opportunities such as understanding illness/es,

coping strategies, available services, grief and loss, self-care.

Young carers should be identified and offered appropriate opportunities to be involved in

the care and treatment journey of their family member

Information and training for carers needs to be provided in languages other than English,

and include provision for people with hearing and vision impairment and in appropriate

formats.

Objective 2: Mental Health staff to be trained in Family Inclusive Practice

Family inclusive practice to be part of induction for all new staff.

Mental Health professionals & services to acknowledge and value the information and

expertise of carers and refrain from judging and/or pathologizing carers.

Family inclusive practice to be part of required competencies in position descriptions for

staff.

The diversity of carers is to be incorporated in Family Inclusive Practice training – this must

include age differences (as well as children and young people), economic factors and cultural

and gender diversity.

Children and young people who may have caring responsibilities have access to age specific

information and support

Objective 3: Accountability provisions developed to ensure family involvement

Develop and implement outcome measurements in service delivery at the individual staff

level and at service level.

Experience of Care surveys to be conducted to explore carers’ experience of involvement

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Carer involvement to be embedded in health service practice guidelines, e.g. carers

involvement recorded and audited.

Employers to be accountable for embedding carer involvement in staff roles and

responsibilities e.g. audits, regular assessment/annual review

Employers ensure workforce is appropriately trained with up to date, evidence based best

practice training through ongoing assessment of staff needs and provision of professional

development opportunities in relation to supporting family involvement.

Develop appropriate, easy to use forms for recording carer information and user friendly

processes for responding to carer concerns.

Objective 4: Services to have processes to identify and engage carers

At present, many carers remain invisible to the mental health sector.

Mental Health professionals to be trained in how to identify carers and conduct carer needs

assessments. Carers need to be identified and -supported at first contact, or as soon as

possible thereafter. On admission, services need to ensure that they learn how

families/carers would like to be engaged with the services and to assess their immediate

needs. Then a more thorough assessment using the detailed Family/Carer Needs

Assessment Form should be conducted. Best practice guidelines should be developed for

ensuring that the assessment is thorough and is embedded in routine practice.

Mental Health professionals to be trained in how to continue this throughout the

assessment process, treatment, recovery plan development/implementation and reviews.

GPs, who can offer early pathways to family and carer support services, as well as providing

the referrals to clinical and community mental health services for the consumer, can identify

carers In order for carers to be assessed and provided with services in their own right and to

address their own carer related needs.

Services need to practice carer engagement strategies e.g. training people in identifying

carers, conversation starters and “welcome” letter from the service, specifically addressing

families.

Particular attention needs to be paid to identifying and supporting children and young

people as early as possible

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Carer Support

Objective 1: An Individual Mental Health Carer Advocacy Service be established

Carer Advocacy - An independent mental health specific individual carer advocacy service

must be provided for carers of people with a mental illness. This has been identified as the

number one priority for carer support by many carer groups and Tandem has reported

receiving an increasing number of requests for individual advocacy, many of which are from

very distressed carers. This service was funded as a pilot by ARAFEMI Victoria in 200916. The

report produced by ARAFEMI at the conclusion of the pilot demonstrated the effectiveness

of the service and the resultant improvement in carer well-being. It is vital that provision is

made for this.

Objective 2: Carers to experience ease of access to services and consistency of services

Support systems and services must be flexible and evidence based, utilizing outcome

measures.

Support systems and services must ensuring that carers of people with a mental illness

receive appropriate information and support interventions relative to their position in the

caring journey, their life stage and their relationship to the person with the mental illness.

For example, a carer who has just had their family member diagnosed may need

information on all aspects of the mental health system, the different mental illness

diagnoses, treatment and management of symptoms, support systems. A carer further

along the journey may require regular respite due to the ongoing illness and accumulation

of stress.

Support systems must be consistent across metro, regional, rural and remote locations.

Support systems must be well promoted, easy to access and easy to use, e.g. perhaps

consideration of a one-stop shop model where a broad range of integrated services (i.e.

information, helpline, counselling, respite, support groups, education etc.) could be offered

and accessed at a single location.

Support systems should be accessible by carers in their own right – in the community sector,

for instance, services don’t have to be linked to consumer based services.

16 The Victorian Carer Advocate Program, ARAFEMI Victoria 2009. The Executive Summary of the final report of the pilot is found at http://tandemcarers.org.au/images/Other_Organizations/ExecutiveSummaryArafemi.pdf

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There needs to be increased cooperation between clinical and community-based services to

promote and strengthen available supports and involvement in relation to family and carers.

There should be age and developmentally appropriate services for children and young

people who have caring responsibilities. Preventative, whole-of-family approaches are

needed. 17

Objective 3: Maintaining and improving customized support services

To sustain the carer role, carers need a broad range of individualized support responses/options. As

carers begin to realize the likely lengthy duration of their need to engage with the sector, they in

turn recognize their own need for support. Including:

Support from professionals and clinicians - this includes professional counselling

Peer and other face-to-face supports -support from skilled peers includes support groups,

education, counselling/emotional support and workshops – with recognition that

customized/individualized service responses often produce the best outcomes by meeting

the real needs of families. Multicultural and ATSI families require culturally appropriate and

competent support services tailored to their needs.

Customized programs – including peer support for children and young people who live in

families where a parent has a mental illness

Carer Education and training - highly valued, these resources build confidence and

resilience, and empower carers to undertake their role to maximum effect. Formal and

informal carer education opportunities need to be offered on a regular and continuous basis

including Well Ways18, Mental Health First Aid19, Skills Bank20 and peer support.

Carer Respite - Respite should be a very flexible concept and include a wide range of options

to give carers a break and reduce stress. It can be both direct to the carer e.g. trips away,

day outings with other carers, and indirect via supports to the consumer which give the

carer a break e.g. consumer camps, regular social outings etc. There needs to be whole of

family-oriented respite options that address the needs of all family members rather than just

17 Unfinished Business: Public policy and children in families with a person with a disability or mental

illness Carers Victoria (2014), DISCUSSION PAPER 18 Well Ways – Peer Education http://www.mifellowship.org/content/well-ways 19 Mental Health First Aid - https://mhfa.com.au/ 20 Carer SkillsBank – Tandem training http://tandemcarers.org.au/carer-skillsbank-training.php

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a focus on the primary carer. There is currently a general lack of respite options that address

the needs of parents and carers of children and young people, particularly options that

provide trained mental health support to the child or young person as a respite activity.

New technology and telephone helplines - Increased access to E-learning and support and

reliable and well-resourced telephone helplines are important. However technology and

helplines must be regarded as a complement, never a replacement for the face to face

supports listed above. Many carers are elderly and either do not have or are unable to use a

computer.

Material Carer Support Programs - Financial assistance for carers is available through

Commonwealth respite funding and through the state funded Carer Support Fund which

provides practical financial assistance to carers of people registered with a public mental

health service. The availability and flexibility of this fund is highly valued by carers and

services.

Carer Participation

The strongest motivation for improving the mental health system rests with those most affected

by it – people experiencing mental illness and their carers, hence the importance and value of

consumer and carer participation. Carer participation refers to participation of carers in policy,

system and service development and improvement. Systemic carer participation should be

embedded as core practice of services, tied to funding and service agreements and supported by

accountability provisions including outcome measures and key performance indicators. Services

must be held accountable for implementing carer participation by having systems, processes and

practice guidelines that are clear and transparent.

Objective 1: Carer participation in policy, system service development and service improvement

Carer participation should be understood and valued by staff at all levels and in all services

Carer participation is embedded as core business throughout the mental health service system

at all levels within all organizations, government and non-government.

Every project and program incorporates carer participation in all facets of design of policy,

system and service development.

Carer participation plans to be developed and implemented in all services. These plans must

include key performance indicators, outcome measures and accountability provisions

Accountability provisions to be developed and implemented

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Recruitment for carer participation roles be expanded and promoted

Carer participation pathways and opportunities are provided through well supported and

resourced carer peer support groups and volunteer activities

Clearly defined carer participation roles with participation opportunities are available at all

levels of services

Carer Advisory and support groups to develop succession planning to ensure sustainability of

carer participation

The voices of carers from minority groups multicultural/ATSI/GLBTI must be strengthened

through equitable participation opportunities being provided.

Carers who have different roles – siblings, partners, and children/young people – need to be

included in the development of the carer peer workforce.

Carer Champions to be identified, strategically positioned and supported in the workplace

Objective 2: A framework for representation based on national standards is developed so that carers are represented at local, state and national levels

Links with national bodies including the National Mental Health Commission, Mental Health

Australia and the National Mental Health Consumer Carer forum (NMHCCF), Private Mental

Health Consumer & Carer Network (PMHCCN), Carers Australia and National ARAFMI are

strengthened

Carer Advisory Groups to be established to work with management, staff and consumers at all

levels of service delivery and evaluation.

Carer peak bodies are appropriately resourced to convey the diverse voices of carers to

politicians, government departments at state and national levels and to service providers.

Carers have opportunities to contribute in a variety of ways including representative roles

Carer surveys to be developed to extend opportunities for participation.

Objective 3: Carers receive the information, education and training they require to be effective in their participation

To be effective and avoid tokenism, carers require skills, experience, education and support. They

need to be sufficiently linked in to carer networks to bring a broad perspective, in addition to their

own personal experience, to their participation.

Carers to be educated about the opportunities to participate in policy, systems and service

development activities

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Carers to be oriented to their role and provided with the information and education they need

to participate effectively

Carers to be provided with adequate support noting that often the carer is the sole carer

representative on committees or working groups which can be very daunting and intimidating

for carers. Many do not have prior experience of working in this environment.

Carers to receive regular supervision and/or mentoring by a staff member with carer experience

Leadership training opportunities to be developed for carers, particularly for young people who

have caring responsibilities

Carer participation to provide pathways for employment opportunities

Annual carer forums to be provided as opportunities for educational and expression of views

and concerns

Opportunities to be created to enable carers to attend conferences, socialize and network

Objective 4: Carer participation to be appropriately funded and resourced

Carer participation is developed in a consistent way across Victoria inclusive of rural, social and

economic disadvantage

Carers to be equitably remunerated for time, expertise and costs associated with their

participation

Services to have carer participation as a budget line item with dedicated resourcing to support

Carer Advisory groups and volunteers

Objective 5: Implementation and effectiveness of carer participation objectives be monitored and evaluated.

DHHS to collaborate with carer representatives to co-design an evaluation process to

evaluate implementation of carer participation in services

Ensure evaluation process is inclusive of diversity

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Carer Peer Workforce

The Victorian government strategy document (2010 – 2020), Because Mental Health Matters, listed

a key area of reform as creating consumer and carer peer worker roles across area mental health and

PDRS services as a mechanism towards addressing carer needs in relation to their caring role21

Currently there are more than 65 carer peer workers in the mental health system in Victoria, nearly

triple the original number since the inception of this workforce in the late 1990s.22 Thirty percent of

these workers are fully funded by community services. They are predominantly part-time. There has

been no increase in workforce size or systematic monitoring of these roles within the clinical sector

in the last 10 years. Yet there are 60,000 consumers actively using Victorian clinical mental health

services, and the figure continues to increase.

The target number required would be to have at least 125 people in the Victorian mental health

carer peer workforce by 2025, and this workforce is entitled to position security and a career

pathway. Carer peer worker roles and responsibilities must be clearly defined and reflected in

realistic position descriptions with appropriate supervision, training, evaluation and accountability

provisions.

Who is this workforce?

The carer peer workforce provides support to carers of people who are active clients of a Victorian

Area Mental Health Service or a Mental Health Community Support Service (MHCSS). The mental

health carer workforce comprises those carers who are employed specifically for their expertise

developed from lived experience as a carer (National Mental Health Consumer & Carer Forum,

201123). The workforce is diverse and includes parents, partners, siblings, grandparents, daughters

and sons. The carer peer workforce is well placed to contribute to development and supported

change in services, to identify carer needs and work with service providers in meeting these needs.

21 Because Mental Health matters, op cit, .106

22 Victoria led the development of a carer peer workforce from the late 1990s. By 2005 the Adult Mental

Health Services had 20 part-time carer peer workers funded by the Department of Health, Mental Health

Division. However, there were no state funded roles in the then Psychiatric Disability Support sector, nor the

Child & Adolescent or the Aged Persons Mental Health Services. (CCNV, 2012)

23 National Mental Health Consumer & Carer Forum 2011 Position Statement - Supporting and developing the

mental health consumer and carer identified workforce - a strategic approach to recovery

http://nmhccf.org.au/publication/position-statement-supporting-and-developing-mental-health-consumer-and-carer-identified

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The carer peer workforce complements other parts of the mental health workforce - both clinical

and MHCSS. Integration into multi-disciplinary teams enables carer peer roles to assist the wider

workforce. The challenge is to ensure that the needs of the carer peer workforce are met. They are

people who often, after working all day with other mental health carers, return home to care for a

family member with a mental illness.

Objective 1: Strengthen and grow the mental health carer peer workforce

Provide a direct line of funding to support the stability of carer peer workforce roles in both

clinical and the community sector.

Provide for career structures to recognize seniority and skilled expertise, including

opportunities for career advancement.

Define & delineate systemic and peer support roles with key selection criteria relevant to

these roles, including relevant qualifications;

Ensure provision for supervision and support structures.24

Ensure access to consistent orientation and further training and professional development

Ensure and monitor access to supervision structures that are effective in supporting this

workforce.

Assist with the adoption of a minimum standards though the assisted completion of the

Certificate IV in Mental Health Peer Work (such as scholarships / bursaries)

Provide supportive and realistic work conditions. Currently, there is, on average, one carer

worker for every 300 adult mental health staff. A typical Victorian metropolitan adult mental

health service provides support to over 1,000 consumers at any one time. Most consumers

have at least two key family members or carers – often more in families where a parent has a

mental illness so that, at a typical adult mental health service, one carer worker has the

impossible task of supporting potentially up to 2,000 family carers. In addition, many carer peer

workers also have systemic duties as part of their role. We know that one Carer Peer Support

Service can support 500 family members or carers each year.25 However, this requires a clear

24 Utilising the framework of Implementing Recovery through Organizational Change (imROC) op cit to work

towards position clarity.

25 Bourke, C., Allchin, R., Sanders, B., Lentin, P. & Lang, S. (2015, July). Occupational shifts and valuing

carer peer support. 26th National Occupational Therapy Conference, July 1 – 3, 2015. Melbourne, Australia. http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12212_1/epdf

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delineation of peer support from systemic work and also requires clear and accessible

supervision and supports.

Support structures for carers include the volunteer workforce. All basic conditions and rights

afforded to the paid workforce, such as role clarity, supervision and general support, should be

made available to the volunteer workforce. However, the volunteer workforce should not, in any

way, replace the paid carer peer workforce. Families and carers are entitled to and require a

stable and appropriately remunerated carer peer workforce. It should be supported by highly

valued volunteers with lived experience. The volunteer carer workforce should also be expanded,

valued, supported and resourced.

Objective 2: Commit to research towards a better understanding of efficacy and outcomes of carer peer work.

Provide project funding to determine a baseline of competencies – so as to measure the

contribution of the carer peer workforce.

Provide project funding to better understand the efficacy of carer peer work26

Objective 3: The establishment of an Institute for Mental Health Workforce Development and Innovation

Explore the creation of an Institute for Mental Health Workforce Development and

Innovation to drive workforce development and cultural change. This body would

consolidate the work of separate specialist centres of excellence, define core competencies

and training needs, facilitate training rotations across sectors and lead adoption of evidence-

based practice.

The above Institute should consider some form of collaboration, partnership or integration

of the developing Centre of Excellence for Consumers and Carers. This could provide a focus

for consumer and carer-led research and workforce development While this has been partly

implemented through Victoria’s Centre of Excellence for Peer Support (Mind, 2015), further

collaborative development and integration would enable greater focus on the carer peer

workforce.

26 Work by Trachtenberg,m., Parsonage,M.,Shepherd, G & Boardman,J., (2013). Peer support in

mental health care: Is it good value for money? Centre for Mental Health. London. UK. indicate positive outcomes in general citing Re-analysis and aggregation of the data in these studies support a positive conclusion: the financial benefits of employing peer support workers do indeed exceed the costs, in some cases by a substantial margin however more research specifically in the care peer workforce is required.

19

References

ARAFEMI (2011) Best Models for Carer Workforce Development: Carer Peer Support Workers, Carer Consultants, Carer Advocates and Carer Advisors, ARAFEMI WA (Prepared by ARAFEMI Vic) Retrieved 28 July 2015 from http://www.mentalhealth.wa.gov.au/Libraries/pdf_docs/Best_Models_for_Carer_Peer_Workers_-_ARAFEMI_Nov_2011.sflb.ashx

Bourke, C., Allchin, R., Sanders, B., Lentin, P. & Lang, S. (2015, July). Occupational shifts and valuing carer peer support. 26th National Occupational Therapy Conference, July 1 – 3, 2015. Melbourne, Australia. http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12212_1/epdf

Bourke, C., Allchin, R., Lang, S., Sanders, B., & McKenzie, P. (2009). COPES: Carers offering peers early support. A decade of an evolving model of carer peer support within a clinical service. Ringwood, Victoria, Australia: Eastern Health Adult Mental Health Service:

Carer Consultants Network of Victoria (2012) Orientation Manual & Toolkit: Training for Carer Peer Workforce. Melbourne. Co-produced with The Victorian Mental Health Carers Network Inc (Now Tandem)

Carers Victoria Inc. (2010). Retrieved 23rd July 205 from http://www.carersvictoria.org.au/how-we-help/young-carers

Commonwealth of Australia. (2010). National Mental Health Standards. Canberra, Australia: http://www.health.gov.au/internet/main/publishing.nsf/content/CFA833CB8C1AA178CA257BF0001E7520/$File/servst10v2.pdf

Cummins, R., Hughes, J., Tomyn, A., Gibson, A., Woerner, J., & Lai, L. (2007). The Wellbeing of Australians: Carer Health and Wellbeing. Report 17.1 Geelong, Australia: Deakin University, Carers Australia & Australian Unity. http://www.carersaustralia.com.au/storage/Wellbeing-Index-Special-Report-October-2007.pdf

Edwards, B., Higgins, D.J., Gray, M.,Zmijewski, N. & Kingston, M. (2008) The nature and impact of caring for family members in Australia: Research report 16, Australian Institute of Family Studies, Melbourne. Retrieved September 7 2015 from https://aifs.gov.au/publications/nature-and-impact-caring-family-members-di

Leggatt, M. (2007). Minimising collateral damage: Family peer support and other strategies. [Consumer Perspectives]. Medical Journal of Australia, 187(7 Suppl), 61-63.

Mental Health and Drugs Division. (2009) Because Mental health matters; Victorian Mental Health Reform Strategy 2009 –2019. Department of Human Services, Melbourne.

MIND Vic (2015) Retrieved 10 September 2015 from http://www.peersupportvic.org/index.php and http://www.mindaustralia.org.au/resources/peer-work/ceps.html

National Mental Health Consumer & Carer Forum (NMHCCF) Advocacy Brief., Issue: The Peer Workforce, June 2011. Retrieved July 23 2015 from http://nmhccf.org.au/publication/peer-workforce

RARE: Reducing Avoidable Hospital Admissions Effectively. (2015) Institute for Clinical Systems Improvement, Minnesota Hospital Association & Stratis Health. Lake Superior Quality Innovation Network. Minnesota. Retrieved 4 September 2015 from http://www.rarereadmissions.org/areas/

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Repper, J., Aldridge, B., Gilfoyle,S., Gillard, S., Perkins. R. & Rennison, J. (2013) Peer Support Workers: a practical guide to implementation. Centre for Mental Health and Mental Health Network, NHS Confederation, London . Retrieved July 10 2015 from http://www.imroc.org/wp-content/uploads/7-Peer-Support-Workers-a-practical-guide-to-implementation.pdf

Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20(4), 392-411.

Robinson, V., Hill, M., Neef, D., Bourke, C., O’Boyle, S., Collet, K. & Brooks, I. (2014, August) A roadmap of collaborative family and carer peer support. Poster presented at the Cross Sector Collaboration Conference, Bouverie Centre, Victoria.

SANE. (2007, July). Family carers and mental illness. Research Bulletin 5: ISSN 1832-8385 Retrieved 10 July 2015 from, https://www.google.com/search?q=SANE.+%282007%2C+July%29.+Family+carers+and+mental+illness.+Research+Bulletin+5%3AISSN+1832-8385&ie=utf-8&oe=utf-8

Shah, A. J., Wadoo, O. & Latoo, J. (2010). Psychological distress in carers of people with mental disorders. British Journal of Medical Practitioners, 3(3), a327 . Retrieved September 7 2015 from http://www.bjmp.org/content/psychological-distress-carers-people-mental-disorders

Trachtenberg,m., Parsonage,M.,Shepherd, G & Boardman,J., (2013). Peer support in mental health care: Is it good value for money? Centre for Mental Health. London. UK.

Background documents:

Consumer, Carer and National Relations | Mental Health, DHHS. Carer Partnership Dialogue, World Cafe Discussion Summary, 2015, May. Melbourne http://tandemcarers.org.au/images/Carer%20Strategy%20May%20Carer%20Pship%20Dialogue%20World%20Cafe%20Summary%20May%202015.pdf

Tandem Summary Carer Strategy Session Carer Partnership Dialogue May 2015: Extracts re Carer

Peer workforce.

Tandem & CCNV. A Review of Victoria’s Carer Peer Workforce: A snapshot to support consolidation and development. Melbourne.

Tandem CCNV Joint position paper. The Mental Health Peer Workforce. June 2015

Victorian Government, Department of Human Services (2007), Families where a parent has a mental

illness: A Service Development Strategy

http://www.health.vic.gov.au/search.htm?q=FaPMI+strategy