Policy Submission: SA's Mental Health Strategic Plan

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Introduction to this Submission 

JFA Purple Orange welcomes this opportunity to provide input to the SA’s Mental Health Strategic Plan and supports the SA Mental Health Commission in leading the development of the Plan.

This is an important moment in the state’s history as it will provide strategic direction on Mental Health for the State for the five-year period 2017–2022, at a time when there is significant uncertainty and concern as the full roll out of the National Disability Insurance Scheme begins.

It is also comes at a troubling time in South Australia following the independent review into and subsequent closure of the The Makk and McLeay Nursing Home at the Older Person’s Mental Health Service, in Oakden.

Incidents like this, and associated revelations about possible failures to act early to safeguard vulnerable people, can cause South Australians to lose faith in a system that is meant to protect and support people when they are at their most vulnerable. Mental Health is a key barometric readings for society wellbeing. When the system fails, people suffer terribly.

Because mental health is influenced by many factors – such as employment, relationships, housing, mobility, income, health, trauma – it is imperative that the Government adopts a proactive, comprehensive and integrated approach to Mental Health. This demands a coherentstrategy that fully integrates with other mainstream services including housing, health, education, employment, justice and disability.

It is also crucial that the South Australian government commits to continued funding for community-based mental health services at the current level.

The SA Mental Health Strategic Plan 2017-2022 is a critical opportunity to move away from a ‘back-foot’, fragmented service system to one that systematically builds recovery and the restoration of life chances.

This submission is influenced by two main sources of information:

1) the Model of Citizenhood Support: a conceptual framework for considering the protection and advancement of a person's life chances towards a meaningful and fulfilling life, and which we think has good relevance to the challenges in mental health. 

2) the Wellington mental health reform: a root-and-branch rebuilding of the mental health service system in Wellington New Zealand 1997-1999. This was undertaken in response to a range of systemic issues, including catastrophic failure. The reform resulted in a much stronger and coherent mental health service system. The reform included a co-designed pathway, targeted treatment pathway options including those with specific cultural context, an evolved relationship with primary healthcare practitioners and other community resources, a well-resourced crisis response team, and a careful focus on patient information management. The reform outcomes included a greatly reduced reliance on ‘back-foot’ inpatient resources in favour of ‘front-foot’ resources such as step-up step-down community services, stronger mental health outcomes via primary healthcare, better patient flow between primary and specialist at the health, and better management of patient information (including access in emergency). These benefits were achieved without significant implications for recurrent costs. The other learning from the Wellington reform is the importance of maintaining arrangements for reflective practice and for leadership renewal. These were not features in the Wellington system post-reform and as a consequence the benefits have eroded over the subsequent 20 years, to the point that Wellington's mental health system is again beset with the same issues it had pre-reform 20 years ago.

Summary of recommendations

Recommendation 1

That South Australia adopt a conceptual framework for understanding, planning and measuring the components of mental health recovery, in the context of valued roles and life chances.

Recommendation 2

That South Australia’s mental health strategy include the co-designed development of a comprehensive, integrated client pathway that describes how a person moves through the mental health system.

Recommendation 3

That South Australia’s mental health strategy include a specific initiative designed to strengthen primary healthcare capacity in mental health, and to strengthen the interface between primary healthcare and specialist mental health services.

Recommendation 4

That South Australia’s mental health strategy include a tailored community initiative designed to reduce demand on inpatient beds by the heaviest users of those beds.

Recommendation 5

That South Australia’s mental health strategy include arrangements to develop best practice treatment pathways across a range of diagnostic groups, and in ways that can build capacity of mental health practitioners and primary healthcare practitioners.

Recommendation 6

That South Australia’s mental health strategy include arrangements to develop a specific pathway anchored on Aboriginal and Torres strait islander cultural values and traditional wellbeing practices, and characterised by Aboriginal leadership of that pathway.

Recommendation 7

That South Australia’s mental health strategy include a strong interface with, and highly intentional proactive actions from other mainstream services including (but not limited to) housing, employment, education and health.

Recommendation 8

That South Australia’s mental health strategy focus on a ‘front-foot’ service system, where the majority of available mental health public funds are invested in proactive, community-based services.

Recommendation 9

That South Australia’s mental health strategy include robust investment in non-clincial support services, in community-based step-up services, and in community-based step-down services such as the previously piloted Intensive Home Based Support Service.

Recommendation 10

That South Australia’s mental health strategy facilitates the advancement of co-design, coproduction (including peer networks), health literacy and supported decision-making.

Recommendation 11

That South Australia’s mental health strategy include provision for leadership development and renewal across all aspects of the mental health service system.

Recommendation 12

That South Australia’s mental health strategy include the design and implementation of an authentic outcomes measurement framework, anchored on life chances.

Recommendation 13

That South Australia’s mental health strategy facilitate the development of a system-wide approach to reflective practice, so that the mental health service system becomes a learning system, with a corresponding impact on best practice pathways to recovery.

Recommendation 14 

An emphasis on a strategic plan for supporting people who live in rural/remote parts of the state to have access to timely mental health services and review and programs which support social connectedness and have transport/infrastructure support mechanisms embedded.

Recommendation 15

That the South Australia mental health strategy include provision of Mental Health First Aid training to be rolled out across the SA sector using a best practice guideline.

Recommendation 16

That South Australia’s mental health strategy facilitate the development of a system-wide approach to patient information, so that the right information is available at the right time to support a coordinated, effective response.