Newsletter No. 64

Winston Rickards Memorial Oration 2019 Mental health services to remote places. News from National Mental Health Comm. Productivity Commission Enquiry
History Corner 1971
Winston Rickards Memorial Oration 2019
The 2019 Winston Rickards Memorial Oration will be given on Monday 18th March in the Ella Latham Lecture Theatre of the Royal Children’s Hospital. The oration:
Mental Health and Schooling –
The Educational Challenge
will be given by Professor Field Rickards, and Drs Lisa McKay-Brown and Peggy Kern. RSVP admin@mhyfvic.org
Mental Health Services to Rural and Remote communities.
A Senate Community Affairs Reference Committee held an enquiry and issued a report on “Accessibility and quality of mental health services in rural and remote Australia”. MHYFVic was one of many contributors to the enquiry and the report echoes many of the things that MHYFVic said.
The map shows the remoteness of most of Australia from services and reminds us that indigenous Australians suffer not only from remoteness but also from difficulties in provision of culturally appropriate services. It is not surprising that this contributes to higher rates of mental disorder and suicide and lower rates of treatment.
MHYF Vic Newsletter No. 64 February 2019


LIST OF RECOMMENDATIONS Recommendation 1 6.9 The committee recommends the development of a national rural and remote mental health strategy which seeks to address the low rates of access to services, workforce shortage, the high rate of suicide, cultural realities, language barriers and the social determinants of mental health in rural and remote communities. Recommendation 2 6.10 The committee recommends that the national rural and remote mental health strategy is subject to an implementation and monitoring framework which includes regular reporting to government and that these reports are tabled in Parliament. Recommendation 3
6.17 The committee recommends an overarching approach is taken by all parties to guarantee that the design of mental health and wellbeing services starts with local community input to ensure that all rural and remote mental health services meet the measure of ‘the right care in the right place at the right time’. This needs to be informed by best practice and international knowledge. Recommendation 4
6.22 The committee recommends that the National Disability Insurance Agency ensure that the implementation of the psychosocial disability stream takes into account the issues facing rural and remote communities, including barriers to accessing mental health services and the lack of knowledge and experience in both psychosocial disability and the National Disability Insurance Scheme. Recommendation 5
6.27 The committee recommends that Commonwealth, State and Territory Governments should develop longer minimum contract lengths for commissioned mental health services in regional, rural and remote locations.
Recommendation 6 6.29 The committee recommends that Commonwealth, State and Territory Governments should develop policies to allow mental health service contracts to be extended where a service provider can demonstrate the efficacy and suitability of the services provided, and a genuine connection to the local community. Recommendation 7 6.34 The committee recommends that Commonwealth, State and Territory Governments consider the reestablishment of block funding for mental health services and service providers in regional, rural, and remote areas. Recommendation 8 6.37 The committee recommends that the Commonwealth Government review the role
of Primary Health Networks in commissioning mental health services under the stepped care model to ensure effective and appropriate service delivery in regional, rural and remote areas.
Recommendation 9 6.42 The committee recommends that the Commonwealth Government consider pathways for allied health professionals and nurses in rural and remote Australia to refer patients under the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative. Recommendation 10 6.45 The committee recommends that the Commonwealth Government prioritise the development of implementation and evaluation plans for the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023. Recommendation 11 6.51 The committee recommends the Commonwealth Government implement measures to ensure that services commissioned by Primary Health Networks embody the action plans of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 and are delivered by, or in genuine long-term partnerships with, Aboriginal Community Controlled Health Services and other Aboriginal and Torres Strait Islander community organisations. Recommendation 12 6.52 The committee recommends that all Primary Health Networks have an Aboriginal and Torres Strait Islander member on their board. Recommendation 13 6.57 The committee recommends the Commonwealth Minister for Health work with health professional colleges to develop strategies for the immediate improvement of professional supports and clinical supervision for registered health practitioners working in rural and remote locations.
Recommendation 14 6.63 The committee recommends that all mental health service providers, including government and community sector, ensure their workforces are culturally competent and that such training be endorsed by and delivered in partnership with the communities into which they are embedded. Recommendation 15 6.66 The committee recommends that all providers of fly-in, fly-out mental health services ensure that mental health professionals are supported by long-term investment to enable them to provide reliable and regular support services to rural and remote communities, with consistency of personnel an essential requirement for any service provider. Recommendation 16 6.69 The committee recommends that peer support workers be given appropriate training to enable them to continue their role in helping people experiencing mental health issues. The committee further considers that peer support workers should be recognised as a valuable support service by being paid to perform this role in rural and remote communities. Recommendation 17 6.77 The committee recommends that Commonwealth, State and Territory Governments, as well as mental health service providers and local communities, continue to educate rural and remote communities about mental health and advertise local and digitally-available support services, with a view to reducing the associated stigma. Recommendation 18 6.78 The committee recommends that Commonwealth, State and Territory Governments work with mental health service providers and local communities to co-design appropriate educational materials to reduce the stigma surrounding mental health in rural and remote communities.
News from the National
Mental Health Commission
The December newsletter of the Commission included the following information about membership:
This year we said farewell to outgoing Chair Professor Allan Fels AO, and formally welcomed Lucy Brogden as Chair. Dr Peggy Brown AO finished as CEO, and this month it was announced that Christine Morgan will be joining the Commission in March 2019 as CEO. Christine brings a wealth of experience to lead the Commission and drive cross-sector collaboration and whole-of-life approaches to mental health and suicide prevention. Kerry Hawkins, Rabbi Mendel Kastel OAM and Christina McGuffie joined us as Commissioners. Professor Ngaire Brown’s role as Commissioner was extended, and we said farewell to Commissioners Samuel Hockey and Professor Ian Hickie AM.
It also included several other items of interest to MHYFVic.
• Steps to reduce Australia’s suicide rate
• Personality Disorder
• AHURI Housing report Next steps to reduce Australia’s suicide rate 06 December 2018 The National Mental Health Commission has today made a series of recommendations to the Minister for Health, the Hon. Greg Hunt MP, as a result of the National Suicide Prevention Summit held in Canberra earlier this week.
On Monday, experts and community leaders, including representatives of the Commonwealth, state and territory governments, came together to discuss new approaches to tackling Australia’s rising suicide rate.
Minister Hunt asked the Commission to convene an urgent summit after the release of figures showing that 3128 people took their own lives in 2017, an increase of 9.1 per cent from 2016.
Minister Hunt addressed the summit, urging participants to work together to establish a clear set of actions that he could take forward. The summit was also privileged to hear from Liane and Tony Drummond about their experience in caring for their son, David, who tragically took his own life in 2016.
During subsequent discussions, participants highlighted the need to integrate mental health and suicide prevention across all areas of government, not just health portfolios, in recognition of the complex interaction between clinical, social and emotional factors in suicide and suicidal behaviour. The summit also discussed the critical need for a national approach to the collection of much more timely information on suicide and suicidal behaviour to enable resources to be focused where they are needed most.
Greater community engagement and participation in both treatment and prevention was also highlighted, as was the need to implement measures aimed specifically at Aboriginal and Torres Strait Islander communities. As a result of the summit, the National Mental Health Commission has today written to Minister Hunt recommending three key actions:
Make suicide prevention a whole-of- government issue and a COAG priority, including consideration of a suicide prevention taskforce, recognizing that the social determinants of health are the policy focus of a range of portfolios, including for example, education, employment and housing.
• Establish a national system for the collection, coordination and timely delivery of regional and demographic-specific information on the incidence of suicide and suicidal behaviour. Ideally, this system should have an additional focus on collecting data on psychological distress and wellbeing, to enable focused and timely preventive actions to be implemented.
• Strengthen support for Primary Health Networks (PHNs) to enable them to respond effectively to this data and deliver tailored approaches, including non-clinical community alternatives and Aboriginal and Torres Strait Islander-led interventions (guided by ATSISPEP.)
National Mental Health Commission chair, Lucy Brogden, said the summit provided much-needed clarity and a way forward, while also providing a powerful reminder of why this task is so important.
“It was extremely moving to hear Liane speak of their love for their son and all the family did to keep him alive. Sadly, their story is one of many,” she said. “The actions of the meeting on Monday reflect the social determinants of health and strengthening of clinical services through a whole-of-government response – so that when love is not enough, family is not enough – we are ready. “Reducing the incidence of suicide in Australia is a profoundly important task and we stand ready to work with all governments, stakeholders and the community on this issue,” Lucy said.
Personality Disorder
Personality disorder treatment and support research The National Mental Health Commission and SANE Australia have released a report on research into the needs of Australians living with personality disorder. The Commission believes this work is important to help put a spotlight on personality disorders and prompt further discussion.
The full report was informed by an advisory group and the membership outlined below:
Michelle Blanchard, General Manager Research, Policy and Programs, SANE Australia (Project Principal Investigator) Elise Carrotte, Research Assistant, SANE Australia (Project Associate Investigator) Andrew Chanen, Deputy Director of Research, Orygen: The National Centre of Excellence in Youth Mental Health
Kelly Clark, Lived Experience Representative Nigel Denning, Counselling Psychologist, Integrative Psychology Aaron Fornarino, Lived Experience Representative Brin Grenyer, Professor of Psychology and Chief Executive Officer of Project Air, University of Wollongong Jack Heath, Chief Executive Officer, SANE Australia Maureen Lewis, Deputy Chief Executive Officer, National Mental Health Commission Julien McDonald, Chair, Australian Borderline Personality Disorder Foundation Janne McMahon, Private Mental Health Consumer Carer Network Sathya Rao, Executive Clinical Director, Spectrum: the Personality Disorder Service for Victoria.
The report by SANE includes a literature review, an environmental scan and a qualitative study. It discusses:
What is known about the prevalence of personality disorders in Australia, including the percentage of people presenting to emergency departments living with personality disorder
A review of evidence-based treatments for personality disorder
The barriers faced by Australians living with personality disorder in accessing a sufficient level of support
How people living with personality disorders are impacted by stigma and discrimination.
Full report: Understanding how best to respond to the needs of Australians living with personality disorder
The Commission developed a summary of the research report which outlines the key messages and themes of the research. The summary explores the experiences of people living with personality disorder and their carers and other support persons as well as what the research means for mental health professionals and Primary Health Networks (PHNs).
Summary report: Treatment and support for personality disorder: A summary of research by SANE Australia
AHURI Housing report summary
In 2017, the Commission embarked on a period of focused work on the link between homelessness and mental health. Following a national consultation, the Commission funded the Australian Housing and Urban Research Institute (AHURI) to conduct in-depth research on housing, homelessness and mental health. The AHURI report on this research sets out 19 policy options, including actions that can be quickly implemented and collaboration- building activities to drive long-term change
The Executive Summary makes the following points: This research progresses the priority areas identified by the National Mental Health Commission (Commission) and provides evidence about the systemic issues and policy levers that need to be addressed to provide more and better housing and more and better services for people with lived experience with mental ill health.
A review of the evidence on housing and mental health identified the following key issues:
* there is a lack of affordable, safe and appropriate housing for people with lived experience of mental ill health * secure tenure allows people to focus on mental health treatment and rehabilitation
* integrated programs addressing housing and mental health are effective but do not meet demand for these services * discharge from institutions poses significant risks for homelessness and mental health
* housing, homelessness and mental health are interrelated * the National Disability Insurance Scheme (NDIS) is reshaping the mental health system
* there is a mental health service provision gap under the NDIS * housing, homelessness and mental health are separate policy systems with little integration, which contributes to poor housing and health outcomes for people with lived experience of mental ill health.
PRODUCTIVITY COMMISSION ENQUIRY
The Productivity Commission has released “The Social and Economic Benefits of Improving Mental Health – Issues paper”. Please see the Productivity Commission’s website for further information: https://www.pc.gov.au/inquiries/current/m ental-health#issues
The Commission invites submissions on
how to improve population mental health so as to realise benefits from increased social and economic participation and contribution to the wider community in both the near and long term. There are four streams of assessment:
Consequences of mental ill-health
• What it is costing individuals, their carers and Australia more broadly to forgo the participation and full contribution of those with mental ill-health
Effectiveness & cost of current programs and supports
• Effectiveness in improving mental health, preventing suicides, improving social and economic participation and contribution to wider community
• Value-for-money of current programs and supports Gaps in current programs and supports available
• Gaps in continuity of care for particular demographic groups (such as those with less severe or episodic mental ill-health Likely effectiveness of alternative programs and supports
• Improvements in outcomes possible and additional long-term benefits for particular consumer and carer groups and for Australia more broadly
Submissions to the Inquiry are due by 5 April 2019. The National Mental Health Commission has recently published two Statements:
1. Statement on the mental health of refugees and asylum seekers
2. Statement on the development of a responsive system of care for those affected by child sexual abuse
The Statements can be read at:
http://www.mentalhealthcommission.gov.a u/our-work/position-statements.aspx
HISTORY CORNER, 1971
     
In commemoration of John Francis Williams (born: 8 October, 1899, Tatura; died: 4 July, 1971, Mount Macedon)
Child and adolescent mental health in Australia owes a lot to the work of John
Francis Williams who was the first psychiatrist appointed to the Children’s Hospital in 1928.
Dr Williams’ father died when John was five years old and his mother and her two sons moved to Melbourne, where John was educated at Wesley College. Soon after finishing school, he joined the Australian
Infantry Force and arrived in France not long before the Armistice in 1918, aged 19 years. He returned to Melbourne to study medicine
at Queen’s College, graduating with honours
in medicine in 1924. His obituary records that he also obtained a Doctorate in Medicine from the University of Melbourne, but the date is unrecorded.
He married in 1925 and was soon off to London for further training at the Bethlem Hospital and then the Cassell, where he enjoyed the company of many pioneers: Gordon Holmes, Bernard Hart, and RD Gillespie. He was awarded a London DPM in 1927, having been elected a member of the Royal College of Physicians in the previous
year.
Immediately after graduation he had begun work with Dr Henry (Hal) Maudsley, who was
the founder, in many ways, of Australian psychiatry (he was also the grand-nephew of the man whose name is celebrated as a partner hospital to the Bethlem; the first Dr Henry Maudsley wrote a significant textbook in 1895 entitled: How soon can a child go mad?). Dr Hal Maudsley appointed Dr Williams to the Melbourne Hospital (now RMH) and to the Royal Park Receiving Hospital (now closed) to follow his interest in psychiatry.
When Dr Williams returned to Melbourne in 1928 as Clinical Assistant to Dr Maudsley, he
had these same appointments, along with an Honorary position at St Vincent’s, which included the foundational Honorary Psychiatrist role at the Children’s Hospital. This was the primary professional contribution of Dr Williams, but he was also very important figure in the formation of a professional body for psychiatry in 1946: the Australasian Association of Psychiatrists, of which he became President in 1951 and about which he wrote a brief history at the time of this organization becoming the Australian and
New Zealand College of Psychiatry, in 1964 (his mentor, Dr Maudsley, was the prime
mover for formation of the association and
served two, two-year terms as President).
Dr Williams was a very active member of the Victorian Council for Mental Hygiene which was founded in 1949.
In 1952, Dr Williams was sponsored by the Rockefeller Foundation to take a study tour of child psychiatric hospitals in the United States and the United Kingdom. This was a prelude to the foundation of the Children’s Hospital department of psychiatry inaugurated under his protégé, Dr Winston Rickards, in 1955. Child and adolescent mental health was
properly founded with the leadership of Dr Rickards in Victoria and with his influence in all other States of Australia. Upon retirement in 1959, at the age of sixty years, Dr Williams was appointed as Visiting Specialist to both the Alfred Hospitals and to the Children’s Hospital.
This was a very full professional life, influenced in many ways by the forces that shaped the child guidance movement in the United States. The first US CG clinics were funded by the Harkness family’s Commonwealth fund (the Harknesses and Rockefellers were philanthropists having been partners in the finding of oil in western Pennsylvania). The Demonstration Clinics were established in 1922, just six years before Dr Williams role at the Children’s Hospital began. Behind the move to do something about delinquency in newly urbanized America was the wish to prevent the tragedy of mental illness. This had been instigated by Clifford Beers with the foundation of the Council for Mental Hygiene in 1907 in Connecticut and the National Council in 1908; this also became an international movement that arrived in Victoria, Australia, after the Second World War.
Dr Williams is virtually unknown to the members of the wider child and adolescent mental health profession.
Jo Grimwade
2018 MHYF Vic Committee
* President : Jo Grimwade * Vice-President : Jenny Luntz * Past President: Allan Mawdsley * Secretary : Cecelia Winkelman * Treasurer : Anne Booth * Membership Secretary:Kaye Geoghegan * Projects Coordinator, Allan Mawdsley * WebMaster, Ron Ingram * Newsletter Editor, Allan Mawdsley * Youth Consumer Representative, vacant * Members without portfolio:
Suzie Dean, Miriam Tisher, Celia Godfrey.
MEMBERSHIP SUBSCRIPTIONS
Annual membership of MHYFVic runs for the Financial Year. Only paid-up members are entitled to vote at our AGM, normally held in August each year. Friends and associates who are not paid-up will still receive our electronic newsletters and notices because it is our mission to promote improvements in mental health for the young and their families.
However, it is important to reflect upon the difference between paid-up and non paid-up members.
Membership subscriptions of $50 per annum enable the organisation to maintain its website, mailbox, telephone service and to undertake its administrative tasks. If you value the work that MHYFVic does, we need your financial as well as your ethical support.
Our mail address is PO Box 206, Parkville, Vic 3052. If you prefer to pay by Direct Funds Transfer, the BSB is 033 090 A/C Number 315188 with your name in the Reference tab. It would be appreciated if you could also send a confirmatory email to admin@mhyfvic.org
OUR UPDATED WEBSITE
After much thought our website has been significantly revised to give casual visitors immediate information about what we do and what we stand for, whilst at the same time allowing members to go straight to specific sections such as Projects or Newsletters or Events, without having to navigate past reams of information.
Now that the main revision has been implemented we are working on tasks of development of Projects to give us the evidence base for our advocacy. There are quite a few items under development at the present time which are not yet reflected in the website but over the next few months we expect to see a burgeoning of activity.
Visit us on mhyfvic.org