Newsletters

February 2013

Newsletter No. 37

Winston Rickards Memorial Oration 2013 Kid’s Life Centres History Corner 1873 Mental Health News

WINSTON RICKARDS MEMORIAL ORATION 2013

MHYFVic Committee is pleased to announce that the orator for the 2013 WRMO will be Professor Alan Fels, Chairman of the newly established National Mental Health Commission. The response will be given by last year’s orator, The Hon Alastair Nicholson.
The oration will be held in the Ella Latham Theatre at the Royal Children’s Hospital on Monday 13th May at 7.30pm. Please make a note of this important event in your calendar.
More information about the Oration will be published in our next newsletter.

KID’S LIFE CENTRES

When Professor Patrick McGorry was Australian of the Year he had outstanding success in advocacy for improvements in mental health services for adolescents. His particular area of interest, the early identification and intervention in cases of early psychosis, predicated his recommendation of dedicated specialist mental health services for adolescents. The common co-morbidities of mood disorders and substance abuse were also integral to his proposed treatment services but the emphasis on individual patient approaches was seen as a distinct shift away from the family focus of pre-existing child and adolescent mental health services. Some critics protested that service developments of this kind would be at the expense of reduced services for the broad range of other family and child mental health programs, which would be an undesirable outcome. The response to this criticism was that effective advocacy was needed for those other programs, not the inhibition of improvements in adolescent services to continue an unsatisfactory status quo.

One of the important developments occurring as a consequence of the heightened interest in adolescent mental health has been the establishment of the ‘Headspace’ network. This network was deliberately designed to be an alternative pathway outside orthodox mental health services which were seen as stigmatising, old-fashioned and dominated by an older generation out of touch with present-day youth. Many young people also had concerns about loss of privacy though involvement of families and fears of being medicated and controlled.

The new network tries to engage clients through the use of contemporary forms of communication such as ‘Facebook’ and ‘Twitter’ and internet website information about problems and possible solutions that young people can search for themselves before making their own decisions about seeking assistance. If they do decide to seek help a multi-disciplinary staff of counsellors is available, including psychiatrists and psychologists, who can provide individualised evidence-based programs appropriate to the needs of the person. Crucial to the success of this service is that it is a self-referral one-stop-shop without the hurdles of a formal specialist referral process. This hugely enhances the ‘street credibility’ of the service and the level of commitment to treatment they have chosen to undertake.

The professional sponsorship of the service ensures that it is properly monitored for quality and effectiveness. Outcome research is built into the system and there is also the potential for trial of innovative approaches such as internet on-line treatment programs. Although it is too early to show significant public health impact, the level of acceptability of the service is very high and it is positively changing the attitudes of young people towards mental health issues.
Workers in the child, adolescent and family mental health field have actually seen a decline to 9% from the previous 11% of the mental health budget over the last several years, a very serious loss of support which fuelled the abovementioned anxiety about the success of the adolescent sector advocacy. The injunction to ‘go thou and do likewise’ has been picked up by the formation of a ‘Children’s Mental; Health Coalition’ which aims to develop proposals for a network of ‘Kid’s Life Centres’ that could do for child and family mental health what Headspace Centres have done for adolescent mental health.

The concept is for a network of community-based ‘one-stop-shop’ centres that could offer support for a variety of child development and mental health issues for children and their families through the collaboration of non-government agencies and a range of specialist public sector services. The major part of the service would be through utilisation of existing programs that would be made more flexible and comprehensive by specialist consultative contributions from the specialist agencies. Although referral of appropriate cases to the specialist services would remain as one of the options, the strengthened capacity of the community agency and its breadth of support would be expected to cater for a high proportion of the concerns. The proposal also includes provision for a website of comparable usefulness to that of ‘Headspace’ and a professional and executive management team. Central to the whole concept is reduction of the fragmenting effect of specialist silos through their collaboration in generic support. It is not to diminish the importance of specialist knowledge and skills but to ensure that such knowledge strengthens the generic services.
The ‘Children’s Mental Health Coalition’ has representatives from the Faculty of Child Psychiatry of the Royal Australian & New Zealand College of Psychiatrists, the Australian Psychological Society, the Australian Medical Association Section of General Practice, Monash University Centre for Developmental Psychiatry, Melbourne University Centre for Community Child Health, MHYFVic and a range of other community organizations. It will be interesting to see whether, in this stringent economic climate, this influential group can have its voice of reason heard in the budgetary cacophony.

Dr Allan Mawdsley.

HISTORY CORNER, 1873

1873 was the year Elizabeth Packard published Modern Persecution. It is an account of how the law in Illinois confined her to an asylum and how this applied to most other states of the United States. Through her activism, laws related to the incarceration of wives by husbands were changed in 38 states. The law was quite straightforward: a husband who deemed his wife insane could have put into an asylum, so long as the asylum director agreed. Elizabeth Packard’s husband was a Presbyterian minister and his assertion of her insanity was accepted.

As a young teacher, overwrought by her duties, young Elizabeth was admitted to the Worcester Asylum of the Insane, but recovered in five weeks. Later she married a pastor, Theophilus Packard and had five boys and a girl. In 1860 she started attending a bible class run by a progressive deacon, who challenged her to entertain a richer, liberal view of scripture than her husband would tolerate. The husband then replaced the radical with a conservative and forbade his wife from bible classes. This greatly distressed Mrs Packard. He then offered for her to travel to visit a relative in Europe, but refused to give her any money to spend while on the journey. Only one child who was ill was to be allowed to travel with her. When she refused to take the trip, he then asserted she was mad.

In 1868, she wrote The Prisoner’s Life, setting out the circumstances by which her husband forced her into the asylum:

He construed my earnestness into anger, and thrust me from him, determining to risk this result at all hazards. From that fatal time, all good influences seemed to have forsaken him, and he left to pursue his downward way, with no power to resist evil or flee from the tempter.

Reason, conscience, judgment, prudence, consistency and affection, all, all directly sunk into the fatal sleep of stupidity or death. From that point on, I have never had a protector in my husband. He has only been my persecutor!
In a few weeks from that time, he forcibly entombed me within the massive walls of Jacksonville Asylum Prison to rise no more, if he could prevent it. He told me he did this, to give the impression that I was insane, so that my opinions need not be believed … (p 18).

The eldest son managed to get his mother out of the asylum after three years. But then she was locked up at home. Whereas it had been legal for a husband to have his wife incarcerated, it was illegal to lock up one’s wife. In January, 1864, a court decided that she was sane and free. She returned to Massachusetts: but without her children. After writing The Prisoner’s Life, she sought custody of her children from Massachusetts and was reunited in 1869, after nearly decade. She then began her campaign to have the laws associated with madness in dependents changed across the country.
This is not just a story about mental health institutions and the law; it is an inspiring example of feminism. If we think of the law in Australia in 1963, or, indeed, in 2013, we might still shudder for the same reasons we “tutt tutt” about the treatment of Elizabeth Packard. When I first heard the story, I was astonished, not just because of its grave implications for mental health practice, but because such a story had been buried long ago. Mental health consumerism has a long history, but we need to engage with such advocacy, over and over.

Jolyon Grimwade

MENTAL HEALTH NEWS

The following letter is reproduced from Australasian Psychiatry Vol 21 Number 1 February 2013 pp78-79, because it reflects exactly the viewpoint held by MHYFVic. It was titled:
Collaborative quality improvement: consumers, carers and mental health service providers working together in service co-design.

Dear Sir,

An innovative research methodology developed from 2006-2011 in Victoria has brought consumers, carers and mental health service providers together in a collaborative process of quality improvement. Evidence-based, action-oriented and effective, this initiative offers a promising way forward for consumer and carer participation in mental health research and evaluation.

Consumer and carer participation is a key feature of state1 and federal2 mental health policy and the National Standards for Mental Health Services (2010),3 and is increasingly linked to quality and improvement in services.4,5 A growing body of literature describes how consumer and carer involvement in research adds value and is effective.6 However, significant barriers remain and involvement is still limited.

Through Mental Health Experience Co-Design (MH ECO), the Victorian consumer and carer peak bodies established a consumer and carer research team. Employing researchers with lived experience as consumer and carers, the team was central throughout the initiative’s development and implementation.

Consumer-carer relations have often been characterized by conflict. However, the consumer and carer team members developed a strong working relationship and rapport. The joint training that they undertook contributed significantly, as did a common vision for the project and a clearly articulated set of values: these were empowerment, partnership, transparency, commitment to improving consumer and carer experiences, and recovery.8
Previously, Victorian consumers had been surveyed as to their ‘satisfaction’ with mental health services. These surveys had elicited low response rates which meant that they had limited utility in effecting change and did not necessarily address the issues which were important to consumers and carers.9 Accordingly, a new questionnaire was developed which focused on eliciting consumers’ and carers’ experiences of services. It was informed by a series of discussion groups with consumers and carers in metropolitan and rural Victoria, in which they were asked what questions they felt were most important to include.

The questionnaire was administered to consumers and carers using computer-assisted telephone interviewing (CATI). In-depth qualitative data was then collected through face-to-face individual interviews and focus groups carried out by the consumer and carer researchers.

The second phase of the initiative was the development of a collaborative process of service redesign called ‘co-design’. Co-design is based on the work of Bate and Robert in experience-based design.10 This phase involved using the key issues identified during data collection as a basis for action plans for quality improvement. The process used is outlined below.

In each service, consumer and carer participants volunteered to be involved. Staff participants included service managers and other service staff. The consumer and carer researchers provided a training session for the consumer and carer participants which aimed to support effective participation in groups. The session also explored consumer and carer participants’ feelings about working with staff on an equal basis. A second training session for the consumer, carer and staff participants aimed to foster a collaborative ethos as well as to enhance understanding of the co-design process. The training sessions were later identified as a key component contributing to the initiative’s success.
Three ‘co-design groups’ were established, consisting of consumers, carers and staff. Each group met three times, to: (a) discuss and map the current processes in relation to the identified key issue; (b) investigate examples of good practice; and (c) develop a concrete action plan. The action plans were reviewed and recommendations made for their implementation. Follow-up meetings were held to assess outcomes and the progress of implementing change.
By way of illustration, an action plan in a clinical service led to a new ‘discharge process’ being established which was intended to increase consumer and carer involvement in discharge planning. Another action plan led to staff being trained in the provision of information to consumers and carers. An external evaluation found that the initiative was strongly supported by the consumers, carers and services involved (Goodrick D and Bhagwandas R, unpublished data, 2011). Working collaboratively meant that consumers, carers and staff had shared ownership of the process and this harnessed their collective commitment to change. This was illustrated by the following quotes:
Really looked forward to our sessions, everyone contributed, we all worked toward a common goal. (Consumer)

It has given me more hope that the mental health system is changing and growing to meet the needs of not only the consumer but also their carers. I enjoyed knowing that I am at least doing my bit. (Carer)
Increased my confidence and commitment to working collaboratively with consumers and carers. (Mental health professional)

MH ECO is a practical and inclusive methodology. It offers a way forward for meaningful consumer and carer involvement in service evaluation and quality improvement. More information is available at www.mheco.org.au

References

1. Department of Human Services. Strengthening consumer participation in Victoria’s public mental health services; action plan. Melbourne: Victorian Government, 2009.
2. Australian Health Ministers. National mental health plan 2009-2014. Canberra: Australian Government, 2009.
3. Australian Health Ministers. National standards for mental health services. Canberra: Australian Government, 2010.
4. Department of Human Services. Victorian strategy for safety and quality in public mental health services 2004-2008. Melbourne: Victorian Government, 2004.
5. Wadsworth Y and Epstein M. Understanding and involvement (U&I), Volume 2:a project unfolds. Melbourne; Victorian Mental Illness Awareness Council, 1996.
5. See for example; Minogue V and Girdlestone J. Building capacity for service user involvement in research: _the implications and impact of best research for best health. Int J Health Care Qual Assur 2010; 21:422-435.
7. See for example: Horsfall J, Cleary M, Walter G, et al. Challenging conventional practice; placing consumers at the centre of the research enterprise. Issues Ment Health Nurs 2007; 281 1201-1213.
8. Callander R, Ning L, Crowley A, et al. Consumers and carers as partners in mental health research; reflections on the experience of two project teams in Victoria, Australia. Int J Ment Health Nurs 2011; 20: 263-273.
9. Department of Human Services. Review of the 2003-04 Victorian surveys of consumer and carer experience of the public mental health system. Melbourne: Victorian Government, 2005.
l0. Bate P and Robert G. Bringing user experience to healthcare improvement: the concepts, methods and practices of experience-based design. Abingdon, UK; Radcliffe Publishing, 2007.
Nicola Paton, Rosemary Callander, Marina Cavill Victorian Mental Health Carers Network, Australia
Lei Ning, Wayne Weavell Victorian Mental Illness Awareness Council, Australia

2013 MHYF Vic Committee

* President, Jo Grimwade
* Vice-President, Jenny Luntz
* Past President: Allan Mawdsley
* Secretary, Zoe Vinen
* Treasurer & Membership Secretary,
Lillian Tribe
* Projects Coordinator, Kylie Cassar
* WebMaster, Ron Ingram
* Newsletter Editor, Allan Mawdsley
* Youth Consumer Representative, vacant
* Members without portfolio:
Suzie Dean, Miriam Tisher, Sarina Smale

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