Building a recovery-oriented mental health system: The perspective of the Mental Health Coalition of SA

1. Building a recovery-oriented mental health system: The perspective of the Mental Health Coalition of SA Professor Ann Crocker President: Mental Health Coalition of South Australia

2. What is the Mental Health Coalition? The peak NGO body in the mental health sector made up of the 13 consumer/carer based NGOs in SA and 5 of the mainstream NGOs that provide support and services to people with mental illness The stimuli for its formation were shared concerns about the situation and unmet non-clinical needs of people in SA affected by mental illness

3. What are its major objectives? To represent, support and advocate for consumers, carers and families affected by mental illness To advocate for the provision of best practice community-based psychiatric disability support services To reduce stigma and discrimination associated with mental illness To participate in the development of the NGO sector The Coalition has a recovery agenda

4. What is recovery? National Mental Health Plan 2003-2008 uses the definition of Anthony (2000): A deeply personal, unique experience of changing one�s attitudes, values, feelings, goals, skills and, or roles. A way of living a satisfying, hopeful and contributing life. Recovery involves the development of new meaning and purpose in one�s life�..

5. Evidence for a recovery agenda Consumer experiences and writings (e.g. Deegan, Chamberlin, Leete, etc) attesting to the fact that people can and do recover from mental illness Recognition from professionals that severe mental illness is not normally associated with progressive deterioration ( Harding et al) Work of Anthony and his associates - 1990s �decade of recovery�

6. The recovery process (Deegan, 1997) Recovery is a unique personal experience in which people accept and overcome the challenges of their disability An essential component is hope - that recovery is possible,which involves a focus on strengths, a re-ordering of priorities and goals, optimism Recovery can not be forced on people, there must be a willingness to participate

7. Other key elements of recovery Recovery is facilitated by the support of others, e.g.families,friends,professionals The recovery process is not linear and acknowledgement of this in service planning is essential Unique, personal process so important that a wide variety of options are available to meet individual needs

8. Elements of the recovery process(Jacobson and Green,2001) Hope Healing - made up of defining a self apart from illness and taking control Empowerment - autonomy to act as an independent agent and to take responsibility, which includes knowledge and availability of choices Connection - rejoining the social world, finding roles to play, �getting a life�

9. External Conditions facilitating recovery Human rights, comprising: reducing stigma and discrimination ensuring the rights of people in the service system, by incorporating them into all decisions providing equal opportunities in education, housing, employment access to health and social services that can aid recovery (job training, supported housing and employment programs)

10. Recovery and rehabilitation Important to distinguish between the process of recovery and rehabilitation Rehabilitation made up of the services which build on and nurture the individual recovery process In recovery-oriented services the person must be an active participant in decisions about their recovery, in collaboration with carers, families, friends and professionals

11. Principles which nurture recovery in rehabilitation programs (Deegan, 1997) Programs: must have flexible entry criteria and easy accessibility Must be non-linear - have multiple entry points and levels of programs Must be fail proof - participants can come back to try again and be welcomed Acknowledge recovery is unique, so offer wide variety of options Recognise value of peer support Acknowledge importance of empathic and accepting staff attitudes

12. What services facilitate recovery? Providing psychiatric disability support services (PDSS) which recognise human rights; the impact that mental illness has on cognitive, emotional, behavioral and social areas of living; and loss of: Social role (self esteem) Social functioning (immediate social networks, relationships, extended social network relationships) Productivity (homemaker, student, wage earner) Independent living, self care (management of household, budget, eating, sleeping, hygiene)

13. What are psychiatric disability support services? Rehabilitation programmes generally delivered in the community Psycho-education programmes Consumer and carer education (family) programmes Social skills training programmes Employment programmes Recreational programmes Consumer and carer respite options Housing options, ranging from 24 h supported accommodation, supported group housing, to support for people to live in their own homes

14. What is the situation in Australia? In 1993, VICSERV, adopted 15 principles for psychosocial rehabilitation for their community-based services These services include accommodation options, psychosocial rehabilitation, employment training and options, carer programs The VICSERV principles embrace those developed internationally by consumers and professionals to provide a recovery - oriented mental health system As did Project 300 in Queensland

15. What is the situation in SA? A key element of recovery-oriented mental health systems is that they include partnerships between government, non-government and consumer sectors to deliver services in the community This partnership has not developed in SA The NGO sector is grossly under-funded and its potential to be a stakeholder in service policy, planning and delivery provision remains unacknowledged

16. Distribution of Mental Health funds in SA

17. Largest proportion of funding goes to public psychiatric beds, despite recommendations of National Mental Health Plan Only 0.3% is spent on accommodation options (5% of national average) SA expenditure in the NGO/PDSS category is 2.5% of the total MH budget in SA (<50% of the national average and <25% of the Victorian figure) The result is SA has few PDS services: Home based support Supported accommodation Respite and rehabilitation day programs Carer support and respite Information, education services, etc.

18. Why is this? In SA, mental health services have a medical emphasis which focusses primarily on treating the acute biological effects of mental illness Few services are delivered to facilitate and support the on-going recovery of people with mental illness This results in a �catch 22� situation: an increasing and unrelenting demand on acute medical (hospital) care - �revolving door� syndrome no funds for community services

19. Initiatives in SA Include numbers of good recovery-based service delivery and other initiatives: comprehensive case management practice early intervention programs consumer and carer education the Supported Housing in the North� project Peer Worker Projects Self Management projects AND others (for discussion in small groups!)

20. What are the barriers to change? Mental Health system in SA does not recognise roles and human rights of people affected by mental illness (consumers, carers, families) Stigma associated with mental illness is a barrier to treatment (particularly early interventions) and support options Widespread discrimination against people with mental illness which results in their exclusion from the community

21. What are the barriers to change? Projects are often not funded beyond the pilot stage, despite positive evaluations This results in a demoralised, disengaged mental health sector (both government and non-government) No transference of information and experience (re-inventing the wheel!) Ignoring successful practice elsewhere Absence of opportunities for discourse The lack of a comprehensive, funded plan for MHS which has engaged all stakeholders

22. Challenges and Solutions The mental health system in SA needs to have a biopsychosocial approach The major challenge is for planners to engage and consult with ALL stakeholders and service providers in the planning and delivery of a balanced, integrated mental health system, which includes community based PDS services with a focus on recovery Genuine collaborations and partnerships are essential to bring about these changes