Newsletter No. 26

The MHYF Vic Annual General Meeting was conducted successfully on Wednesday 25 August 2010 at 7pm at Hot Honey in Middle Park. Over twenty members were in attendance to hear our annual reports and the address of Dr Sandra Radovini. Her topic was: Child & Youth Mental Health from the perspective of the Chief Child Psychiatrist- Challenges and Future Directions. A report of this and of the Presidential address appears in this Newsletter.

MHYF Vic President’s Report, 2010
At our last Annual General Meeting I reported several important developments in the Child & Adolescent Mental Health field. One of these was the appointment of the first Chief Psychiatrist for Child and Adolescent Psychiatry, Dr Sandra Radovini. We are most appreciative that she has agreed to be the speaker at tonight’s meeting, but I will speak more about that when the introduction is due. Other noteworthy items mentioned were:
* the launch of the revised Mental Health Policy after the consultative process based on the discussion paper called “Because Mental Health Matters” to which MHYF Vic contributed, and
* the separation of the Health Department from the Department of Human Services where it had been uncomfortably attached just a few years earlier.
I hope that Dr Radovini’s talk will bring us up to date on the impact of those changes as well as a range of other issues.
Members could hardly fail to be aware of the public debate around the Commonwealth Government’s limited contribution to Mental Health funding which has been highlighted by Australian- of-the-Year Professor Pat McGorry’s forthright criticisms. The Government must be reflecting upon the wisdom of their choice of this eminent advocate for their annual award, and I am confident in predicting that next year’s nominee will be much less vocal. However, we are very fortunate that Professor McGorry has been so outspoken because our field is rarely in the news unless there has been some kind of disaster, and it is wonderful to have some real discussion of the unmet needs.
Dr Jureidini’s criticism of Professor McGorry’s advocacy, saying that selective use of statistics was catastrophising the debate and de-emphasising the needs of large numbers of less seriously ill young people, produced some valuable responses. Professor Paul Fitzgerald from Monash University made the important point that Professor McGorry has been leading an important campaign to raise awareness of the need to improve a grossly under-funded system and that his focus on services for youth did not conflict with the enhancement of services for other children in need. Some other authorities, however, have felt that the advocacy did cause such a conflict. But McGorry, himself, made the best response in a letter to THE AGE which I will quote:
“Even young Australians with serious mental health problems have only a 50-50 chance of accessing care. Those whose mental ill-health is mild or transient (about 40% of the total) require access to skilled assessment for the same reasons we expect access to expertise for mild or transient physical ill-health. It is not always clear which problems may be transient. Without appropriate help, even transient mental ill- health can result in death or serious injury.”
Professor Fitzgerald went on to say that “these issues have not been sidelined; it is just that they haven’t been forthrightly presented by enough advocates to ensure that they are sufficiently in the public’s attention.”
Therein lies the rub. Patrick McGorry is a wonderful advocate, and we wish him well in his endeavours for youth. We need similar advocates for services for young children and families, but the reality is complex. Advocacy is a primary goal of MHYF Vic but we have not taken the public confrontational approach that gets the media attention. Regrettably, however,
the quiet diplomacy of seeking private discussions with Departmental officers has not been successful this year, with our several requests being met with diversionary tactics that avoided meetings. We will be seeking to re-establish contact through the new Head of the Department in the near future.
Several major tasks have pre-occupied the Committee during the last twelve months. These were the AICAFMHA Conference, the IACAPAP Conference and the Winston Rickards Oration.
The Infant, Child, Adolescent and Family Mental Health Association (AICAFMHA) Conference in South Australia late last year, in addition to its usual focus on mental health promotion and the involvement of consumers and carers in service development, also incorporated workshops on children of parents who have mental illness. This, too, is a theme strongly supported by MHYF Vic. Several of our members contributed at the conference.
The International Association for Child & Adolescent Psychiatry and Allied Professions held its Congress in Beijing in June this year. A number of MHYF Vic participants attended to present papers and seminars, particularly on the contributions of consumers and carers to improving mental health services, which is an unfamiliar topic in the less-developed countries but which was seen by IACAPAP as being of great significance for the future. Although the members who are mental health professionals paid their own way to the conference, three members who are not professionals were sponsored by Collingwood Rotary Club, for which we express our grateful thanks. I am most pleased to be able to inform you that one of our committee, Dr Suzie Dean, has been made a Vice-President of IACAPAP. We have now taken active roles in presentations at IACAPAP Congresses in Melbourne, Istanbul, Beijing, and with Suzie’s appointment will obviously also be involved in Paris and Delhi Congresses.
The inaugural Winston Rickards Memorial Oration was held at Queens College on Wednesday 24th March this year. The Orator was Professor Bruce Tonge, who spoke on the topic of “Promoting recovery from Youth Mental Illness”. The Mental Health Foundation gave publicity support and there was a large enthusiastic audience for the Oration. It was a most memorable occasion and we have set a high standard to live up to in future Orations.
Our involvement with IACAPAP has prompted development of an indigenous mental health project. A project group headed by Suzie Dean aims to encourage indigenous participants to present their views on the best ways to improve mental health of indigenous communities, initially for a seminar at a IACAPAP Congress and subsequently in advocacy to Government. We hope to achieve this largely through alliances with existing indigenous mental health advocacy groups with the added help of koori services volunteers like David Mushin and Rita Gordon.
With our preoccupation with these major tasks, the attention paid to our local work has not been as much as we would have liked. However, we have reviewed our Strategic Plan and updated it for the coming five year period. A significant number of our Targets have been achieved and work is ongoing at a reasonable pace with others. The main challenges are in developing our Project Groups, extending our membership base, making our website more informative and interactive, and strengthening our input from young people and consumers generally.
I must say that our Committee has contributed a great deal in the time available. Dr Suzie Dean, in particular, has done an immense amount of work acting as Secretary for several months between the departure of our previous hard-working Secretary, Jacinta Bleeser, and the recruitment of our new Secretary, Nitha Prakash. Lillian Tribe took on the tasks of Treasurer and memberships Administrator from our previous Treasurer, Suzanne Robson.
The frequency and scope of our electronic newsletters has increased this year through the editorship hard work of Dr Jo Grimwade, and our website has been revised by Webmaster Ron Ingram with advice from younger committee members Sarina Smale, Nitha Prakash and Paul Tribe. Jenny Luntz continues her invaluable contributions to our workload and serves as a Director of AICAFMHA, thereby helping to bridge the gap between State and Federal issues.
We have given quite a bit of thought to the matter of developing linkages between ourselves and other organizations interested in child and adolescent mental health. We are grateful that Miriam Tisher has joined the Committee to facilitate linkage with the Victorian Association of Family Therapists. Dialogue is under way regarding linkages with the child psychologists’ special interest group within the Australian Psychological Association, also the Child Psychotherapists Association and with the faculty of Child & Adolescent Psychiatry of the RANZCP.
I will not be standing for election as President this year as I deem it healthier for the organization to have progressive infusion of new ideas and leadership. I remain committed to the ideals of MHYF Vic and will be standing for election as a Committee member in the hope of providing some continuity and ongoing participation. I would like to express my gratitude to all our committee for their wonderful support during the year and look forward to the continuation of MHYF Vic’s great work.
Allan Mawdsley

COMMITTEE ELECTIONS
The Meeting confirmed Nitha Prakash as Secretary and confirmed the additional role of Membership Secretary for our ongoing Treasurer, Lillian Tribe.
The biggest change was the handing on of the Presidential baton from Allan Mawdsley to Jo Grimwade. The Newsletter Editor role will pass back to Allan Mawdsley in the future.

MEET THE PREZ
Who is Jo Grimwade? Jo trained as clinical psychologist at the University of Melbourne in the early 1980s and supplemented this training with experience in Albury, New South Wales, where Austin Child Psychiatry consultants provided further training and led to membership of VAFT in 1989.
Before moving back to the Family Unit at Travancore in 1989, Jo also worked in the southern suburbs of Adelaide at the first ever Australian CAMHS. After Travancore, Jo worked as an academic at Victoria University teaching postgrad clinical psychologists and completing his PhD on referral and intake to CAMHS in 2006. In 2007 to 2010, Jo held part-time appointments at Australian Catholic University and expanded the small private practice Jo had conducted from 1992 into full-time work in Essendon and Moreland. Then, just recently, Jo was appointed Associate Professor (Clinical Services) at the Cairnmillar Institute.
Jo has presented at many conferences and has focused particularly upon the application of psychodynamic understanding to work with families.
Along the way, Jo has been rewarded with contact with so many wonderful colleagues, educators, and students (all four elected Secretaries of MHYF Vic have been past students, the recent Acting Secretary was his PhD supervisor, and most of the professional members of the MHYF Vic Executive participated in his PhD research).

Membership renewal
We are all reminded that subscriptions are now due for the year 31 August 2010 to Sept 2011. The fee remains at $20 and applies to organizations as well as individuals.
Indigenous family mental health
A new project group has been meeting to develop an advocacy program relating to provision of mental health services to Aboriginal families. The group would gladly welcome input from interested people – please contact the chair, Suzie Dean, on suz.dean@bigpond.net.au.

31st Australian Family Therapy Conference
A symposium on Mental Health advocacy has been accepted in principle by the conference organizers. MHYF Vic is looking for other advocacy groups to join in on a 90-minute session. Contact Jo Grimwade or Miriam Tisher.

HISTORY CORNER: 1787 and 1986
The address of Dr Radovini included the responsibilities of the Chief Psychiatrist as laid out in the 1986 Victorian Mental Health Act. There are strong resemblances to the original mental health instruction to Governor Phillip before he left to found the colony in New Holland.
And whereas it belongeth to us in right of our Royal Prerogative to have the custody of ideots and their estates and to take the profits thereof to provide for the custody of lunaticks and their estates without taking the profits thereof to our own use. (Phillip’s Commission, 1787; cited in Neil, 1992)

Mental Health Act, 1986
The Chief Psychiatrist is responsible for the medical care and welfare of persons receiving treatment or care for a mental illness; and has such powers, duties, functions and immunities as are conferred or imposed upon the chief psychiatrist by or under this or any other Act. (s.105)

Child & Youth Mental Health 2010 – Challenges and Future Directions Or Current Directions & Future Challenges?? Dr S Radovini

The dilemma
Our clients are highly vulnerable young people and their families with multiple and complex needs, that reflect ongoing disadvantage, with cumulative harm, in the context of mental health problems. However, the service system is fragmented with multiple providers across multiple sectors with various policies and funding streams.
The results of all can be poor access to services and poor outcomes.

The challenge
We need to design and implement a client – centered, responsive, integrated, flexible system able to provide ‘One stop shop’ service within a ‘no wrong door’ policy. The system needs to embrace complexity and provide a holistic response across a range of domains to improve functioning: that is, the ‘right help at the right time’
Dr Radovini then described examples of initiatives being implemented.

Key activities of the Office of Chief Psychiatrist (OCP)
• Clinical leadership (guidelines, education, forums, etc).
• Statutory practices monitoring (seclusion, restraint, annual exams, reportable deaths).
• Forensic patient reviews/Forensic Leave Panel.
• ECT licensing and practice monitoring.
• Enquiries & complaints from service users/members of the public.
• Advice to Mental Health clinical sector on practice/legislation (MH Act, Privacy).
• High risk/complex clients. • Clinical reviews and special inquiries/investigations.
• Project management/contribution to divisional projects.
• Advice to Division/Minister.

Role of Chief Psychiatrist in respect of youth
The role has a broad scope with focus on the needs of children and youth.
• Child and youth focus on usual
• activities of OCP
• Child and Adolescent Mental Health expertise on individual client matters or CAMHS
• Better links between policy, operations, and training through the Research and Mental Health Divisions.
• Strengthen linkages with Human Services and develop more coordinated response to needs of more vulnerable children, youth and families with multiple and complex needs involving children in care, children with disability, and youth justice.
• Develop coordinated and supportive processes for collaboration with Education Department School Student Support staff.

Dr Radovini had described a broad range of activities, roles, and responsibilities. The MHYF Vic members then pursued certain details through questions. Early intervention was certainly what Dr Radovini has in mind. Training of Mental Health staff to do such work was part of her other role through Mindful.
MHYF Vic thanks Dr Radovini for her broad and thoughtful address. An important outcome of her talk was to renew connections with key Government personnel.

EARLY INTERVENTION
MHYF Vic sees early intervention as most important. As pointed out in the departing President’s address, there are two sorts of early intervention being discussed in the media. MHYF Vic is keen for young people with signs of psychosis to receive intensive service to avoid the serious consequences of such a period of ill health. MHYF Vic is just as keen for Governmental resourcing of programs that prevent all sorts of mental ill health by intervention in the period before children get to school and in the first years of primary school.

MHYF Vic Committee
• President, Jo Grimwade
• Vice-President, Jenny Luntz
• Immediate Past President: Allan Mawdsley
• Secretary, Nitha Prakash
• Treasurer& Membership Secretary, Lillian Tribe
• Projects Coordinator, Suzie Dean
• WebMaster, Ron Ingram
• Newsletter Editor, Jo Grimwade
• Youth Consumer Representative, vacant
Members without portfolio: Miriam Tisher, Sarina Smale

Calendar of events
6–8 October, Australian Family Therapy Conference, Melbourne
29 May to 2 June, RANZCP, 2011 Congress–, Northern Territory

PASS IT ON
The MHYF Vic Newsletter is for all people involved in advocating for service for young people and their families such that the worst consequences of illness and disadvantage are avoided. We want our Newsletter to fall into the hands of school teachers et al.