Newsletter No. 22

Firstly, an apology from the new Editor. The Newsletter for November, 2009, was unable to be produced by the new Editor as he had broken his wrist. Several items have been held over and are presented below. A new segment has been introduced: History Corner.

AUSTRALIAN OF THE YEAR, 2010

MHYFVic congratulates Professor Pat McGorry for the recognition of his work with older adolescents in prevention and treatment of psychosis. Among his many contributions have been the bringing of attention to the issues and the gaining of resources for the field.

AICAFMHA & COPMI Conference

The October, 2009, Adelaide conference of the Australian Infant, Child, Adolescent and family Mental Health Association was combined with the first International Conference of COPMI, the program for children of parents who have a mental illness. MHYF Vic members Suzie Dean, Suzanne Robson, Paul Tribe, and Jo Grimwade were all involved in presentations, and in both the AICAFMHA and COPMI parts of the conference.

Papers presented were:

Together in voice: collaborative advocacy for enhanced mental health of the young and their families (Symposium: Suzanne Dean and Paul Tribe)

Paper on a parent’s view of CAMHS service (Suzanne Robson)

Paper on traversing the CAMHS system from consumer to provider (Paul Tribe)

Who or what is a parent? Voice, need, and responsibility in child mental health consultations (Jo Grimwade)

Who can listen to the child of a parent with mental illness: need, voice, and opportunity (Jo Grimwade)

A pernicious retreat: clinician-focussed intervention in child and adolescent mental health (Jo Grimwade)

IACAPAP Conference

Following the successful meetings in Melbourne and Istanbul, the International Association for Child & Adolescent Psychiatry and Allied professions will be holding its next Conference in Beijing, from 2 to 6 June, 2010.
Suzie Dean, has submitted two conference symposium abstracts on behalf of MHYF Vic with titles: Towards advocacy action in striving to improve child and adolescent mental health: Pathways to aims and arguments (presented by MHYF Vic and Children’s Hospital Boston, Massachusetts)

And: Expanding public and professional awareness: Professionals, consumers and families cooperating to improve mental health in the community (presented by MHYF Vic and Austin CAMHS Individual members have submitted abstracts through the MHYF Vic Project Groups (see below)

Winston S Rickards Memorial Oration

The inaugural Winston Rickards Memorial Oration will be delivered by Professor Bruce Tonge on Wednesday, 24 March, 2010, at 7:15pm at the Junior Common Room, Queen’s College, University of Melbourne (Queen’s was home to Winston’s “salad days”).

The title of the address is: Promoting recovery from youth mental illness.

Winston Rickards’ contribution to the formation of AICAFMHA and to child and adolescent mental health services in Australia and internationally were noted by Phil Robinson in his opening address to the recent conference.

Website update

Website grandmaster Ron Ingram has presented a new look website that has much available on the activities of MHYF Vic. Have a look at www.mhyfvic.org and find out about us, who we are and what we stand for, our aims and objectives. Examine our policies and constitution. Find out about our project groups. Join us and have your say online. Read our newsletters and keep up with events. We want to hear from you.

Report on Fourth National Mental Health Plan (NMHP) Stakeholder Forum held at Rydges, Melbourne on 29 April 2009 (J Luntz)

Background to the Forum
Planning for the 4th NMHP began in July 2008. The final version is due to be presented to the Health Ministers’ meeting on 29 July 2009.

Participation in the Process
a. The Working Group
Ruth Vine, Chief Psychiatrist in the Victorian Department of Health, chaired the Working Group. From the list of those on the Working Group, only Gill Callister, Executive Director of Mental Health and Drug
Division and previously Director of the Office of Children in the Victorian Department of Health, was the only one with the expertise to represent CAMHS issues be represented on this NMHP.

b. The Reference Group
The Reference Group had no CAMHS representation as far as I could ascertain. There were a number of adult consumer and carer representatives from all States and Territories.

c. Participants at the Forum
About 140 people were present, most appeared to be consumers and carers of adult mental health services (AMHS) from across the country; several NGO were represented by professionals from psychiatric services, and alcohol/drug field; some PACFA members; psychiatrists in private practice and a few from the public mental health field; one psychiatrist represented Aged Care; Pat McGorry and Peter Birleson from CAMHS; I represented AICAFMHA and MHYF Vic.
The day was chaired by Norman Swan.

Structure of the Day
After the introductory remarks, Joy Murphy welcomed us to Country. The historical context of the NMHP was set by a federal bureaucrat. Ruth Vine spoke briefly describing the Plan as being for “…the broad spectrum of those with mental health problems across the life span” and stressed that the intent is to build on what already exists and that mental health problems are a “…whole of government responsibility”.

Comments were then made by a carer representative (Judy Bentley), a consumer representative (Isobel Collins) and an NGO representative (Kim Koop) all three of whom were on the Reference Group. Comments made by these three included:
• Mental health issues differ across the life span and responses need to be tailored to these differences;
Services need to tailor their responses appropriately to cultural issues brought by consumers and carers coming from Koori and CALD families;
Best practice workforce should include enlarging the numbers of consumers and carers employed. Consumers and carers need to be provided with training and ongoing supervision in order to carry out their roles effectively;
• The NGO sector provide a much greater component of service provision than is true in other comparable countries, and they need to be adequately resourced to provide adequate service;
Norman sought general comments from the audience. Highlights of these included:
• The Federal Government should take responsibility for establishing one Mental Health Act for the whole of Australia;
• Emphasis should be on prevention, wellness and recovery as much as service provision for those who are actually ill;
• Service delivery should be evidence based;
• Service cultures should focus on “care of patients” not current practice fads;
• Accountability is not just data collection. It should be carried out by an independent body which is both transparent and inclusive;
• Currently services provided outside hospitals can more appropriately be described as outpatient, they should be reconfigured into community services;
• The process of deinstitutionalization in Australia remains incomplete and the 4th NMHP needs to remedy this;
• The draft Plan is not currently sufficiently concrete and needs to include “action based” goals;
• There needs to be a commitment to goals that can be measured. At present the focus is only on numbers, which can be crunched. The focus should be on quality improvement of clinical practice and the extent to which the
service provided leads to improved
mental health in the patient;
• In Australia, governments are very good at developing policy but hopeless at implementing it. The rest of the day was spent by participants asking questions and making comments, positive and negative, about the priority areas for the next five years for the NMHP:
Social inclusion and recovery
Prevention and early intervention
Service access, co-ordination and continuity of care
Quality improvement and innovation
Accountability, monitoring, reporting and evaluation.

Highlights in discussions of each of the five priority areas included the following:

Social Inclusion and Recovery

• The need for more emphasis on mental health promotion;
• The document in its current form is “patronising” and socially exclusive rather than socially inclusive;
• There should be an emphasis on qualitative measures which focus on how clients feel about whether the service has or hasn’t helped them;
• Stigma exists in the services set up to assist consumers as well as in Health Insurance companies, pharmacies providing the medication and Centre-link offices. This stigmatising of consumers is a barrier to people who are trying to recover from a illness episode;
• A large number of consumers and carers of AMHS were present but there appeared not to be people who had received/were receiving services from CAMHS;
• It was important for carers to receive assistance during the recovery phase of the consumer’s illness. If they don’t, the
consumer’s recovery might be short lived.
Assistance also needed to be provided to COPMI and to siblings of young people recovering from the mental illness.

Prevention and Early Intervention

• Prevention and Early Intervention (P&EI) is almost non-existent because most P&EI should be occurring among 0-18 year olds. CAMHS have been chronically underfunded in spite of the fact that 50% of mental disorders occur before age 14, and yet CAMHS currently receives 8% of mental health funding (Peter Birleson); He stressed that schools and GPs need to be better equipped to recognise incipient mental health problems and have the skills to deal with them;
• Funding needs to be invested in training for workers in all universal services to recognise and treat incipient mental health problems so they know when they can provide assistance themselves and when they need to refer them on to specialist services;
• Service distribution is currently “metro-centric”. P&EI services in the regional and rural areas (especially to address such issues as suicide prevention) is very limited;
• There is a need to build evidence in the link between risk factors which exist outside the mental health system, which can cause mental health problems eg family violence; divorce, child abuse;
• There is a need to ensure that people who have recovered from a mental illness can re-refer if their symptoms start re-emerging. Being refused services because they were not “sufficiently ill” is very destructive to someone trying to keep well:
• Transferring young people from CAMHS to AMHS is rarely smooth. Mechanisms to improve this transition need to be built into the system;
There needs to be funding for P& EI across the life span not only for children and young people.

C. Service Access, Co-ordination and Continuity of Care

• This is a key area to be developed in order to drive change;
• Community based services need to be increased;
• Types of service delivery that work need to be spread across the System;
The System needs to be consumer focussed if not consumer led.

Quality Improvement and Innovation

• As long as mental health care remains a State responsibility it will be impossible to change many structures and processes which impede improvement in service delivery and innovation;
Is this document really a Plan? It appears more like a Framework!
• All sectors of the Mental Health Field need a substantial increase in the funding for both universal and specialist services. This is particularly true in both CAMHS and Aged Care;
Neither quality improvement nor innovation is possible without an increase of the workforce and other resources.

Accountability, Monitoring, Reporting and Evaluation

• Targets need to be realistic;
Measures need to be meaningful; • Evaluation needs to be qualitative as well as quantitative;
To be accountable, an external body without the possibility of a conflict of interests, needs to oversee the monitoring, reporting and evaluation;

Results of monitoring, reporting and evaluation must be available to consumers, carers and the community at large.

Conclusions

Norman Swan closed the day by complimenting the quality of contributions made by the carers and consumers. He regularly chairs health forums eg for cancer, heart conditions and diabetes. None of these other forums have involved consumers and carers as articulate, thoughtful and well informed as those attending this Forum. Consumer and carer involvement in the mental health area is the benchmark for the Health Care Field.
Note from the editor: These sorts of forums are attended by MHYFVic on several occasions throughout the year. If a reader has notes from similar such events we would be pleased to receive and publish.
Project groups Quality in early childhood education and care: Children’s development and rights: Sarina Smale has submitted an abstract to the IACAPAP conference entitled: Early childhood advocacy for and with children Consumer and parent/carer participation in child and adolescent services Suzanne Robson has submitted an abstract to the IACAPAP conference entitled: Stigma experienced by young people with a mental illness Jacinta Bleeser has submitted an abstract to the IACAPAP conference entitled: Children and families as central in Child and Adolescent Mental Health Services: How can this be made a reality? Lynne Ruggiero and Paul Tribe have submitted an abstract to the IACAPAP conference entitled: From consumer to carer to mental health worker: Translating the experience into practice
The process of beginning contact with child and adolescent services: th An abstract for the upcoming 27 International Conference of Applied Psychology, 11 July, 2010, Melbourne, has been submitted by Jo Grimwade with title: Beginning is the common factor: a new direction for psychotherapy research.
Access of community to child and adolescent mental health services (incorporating development of arguments for cost benefits of such services):
An abstract from the working group has been submitted for the upcoming IACAPAP conference, entitled: Focus on funding: How can economic arguments support human rights and humanitarian advocacy for child and adolescent mental health?
Chris Smale has submitted an abstract to IACAPAP entitled: Engaging with governments to improve policy and resources for mental health: Challenges and possible solutions
Other project groups:
Advocacy for early childhood services and their benefits The need for young people to have a voice in planning adolescent mental health services.
The shape of mental health services in Victoria for indigenous families. The impact of stigma associated with mental health services and how this can be challenged

HISTORY CORNER: 1909

Welcome to a new feature of the MHYF Vic newsletters. Workers in our field often do not know about its origins. We hope that through this column and the choice of particular dates, we can all become a little more aware of our roots.
The AICAFMHA conference was held on the centenary of a number of important events in social and political history in the USA and Australia.
In the USA between mid-January to 17 February the following events occurred:
• Death of GeronimoClifford Beers launched the National Committee for Mental Hygiene (NCMH) and published his account of his hospitalisation and treatment, A mind that found itself , First White House Conference on Childhood
Healy’s studies of the delinquent began
The National Association for the Advancement of Colored People (NAACP) was founded In Australia the following events occurred:
Aged and Invalid pension
NSW Aborigines Protection Act
School Medical inspections, Victoria • Women’s Service Guilds of Western Australia
League of Women Voters of South Australia
Congress of Workers among Dependent Children (see image of cover, below; obtainable at:
http://www.archive.org/details/dependentchild00inte

Topics of discussion at the Congress:
Infant mortality
Alcoholism
Parental disease
Maternal employment
Environmental causes
Institutions as unsuitable
Parental education
Constraint
• Delinquent children and parental control
Uniformity of legislation
Interstate movement of families
Payment for carers
Disabilities of illegitimate children
Age of consent
Responsibilities of State to Half-Castes
Medical inspections of schools
Teaching hygiene in schools.

JOIN US. IN ADVOCACY

Much is happening within MHYF Vic and we need more to happen. Advocacy needs advocates. Please circulate this Newsletter to other interested parties and invite others to participate with online correspondence or by providing news about what is being done in the various workplaces where child and adolescent mental health issues are being confronted.
The papers listed above will be available on our website and could be the subject for a professional development session at your workplace. Please contact the presenter and invite participation. We would enjoy the opportunity to take our work in advocacy, research, and consumer participation to workplaces, funding bodies, and conferences.
MHYF Vic has a growing membership with new members each year, and some who do not continue with their membership. To do the things we do we need our supporters to:
Maintain membership
Participate in our events (like the coming Winston Rickards Oration)
Participate in our projects
Join the organizing committee (We have one important vacancy at the moment, that of Secretary).

Other Committee members are as follows:

President, Allan Mawdsley
Vice-President, Jenny Luntz
Treasurer and Parent Consumer, Lillian Tribe
Projects Coordinator (and Acting Secretary), Suzie Dean
WebMaster, Ron Ingram
Newsletter Editor, Jo Grimwade
Youth Consumer, Paul Tribe
Members without portfolio, Rita Gordon and David Mushin

FEEDBACK

Please let us know what is needed in the MHYF Vic Newsletter by emailing grimwade@bigpond.net.au You may like to know of events or want to see certain things reported. You may see how this medium can be improved. You might have a note for the History Corner. Alternatively, provide us with feedback through the website.

CALENDAR OF EVENTS

24 March Winston Rickards memorial Oration
2-6 June IACAPAP conference, Beijing
25 August MHYF Vic AGM