A scathing royal commission report on Victoria’s mental health crisis has found the mental health system is “crisis-driven”, not designed to support people living with mental illness or psychological distress, and is overly reliant on medication and hospitals to treat people.
The mental health royal commission report challenged the system’s traditional focus on medical treatment alone and recommended a redesign of mental health services, finding that being part of a community and having access to stable and secure housing also affect mental health and wellbeing.
Responding to the findings, the Victorian premier, Daniel Andrews, said: “The truth is that suffering just isn’t being taken seriously enough.
“People are either ‘not sick enough’ for help, or ‘too sick’ to treat outside a hospital.
“These big gaps in the system mean that people are falling between the cracks. Instead of help early on, we’re leaving people until it’s too late and they need to be treated in our emergency departments.
“And when Victorians and their loved ones look for help, instead they find dead-ends and closed doors.”
The royal commission was established in February 2019 and tabled its final report to parliament on Tuesday, after hearing from mental health experts including health workers, carers, researchers and people living with mental illness. It found good mental health and wellbeing have been a low priority of governments at all levels and the community.
“Due to system constraints, services are often inaccessible at the times when they would make the most difference, and the system largely operates in crisis mode – that is, it tends to react to mental health crises rather than preventing them,” the commission found. “The system is complex and fragmented and, for those who do manage to get into it, difficult to navigate. People experience enormous frustration and distress when trying to identify the right mental health services for themselves or someone else.”
The system is overwhelmed and cannot keep up with the number of people who seek treatment, care and support, while community-based services are undersupplied. The system has become imbalanced, with an over-reliance on medication, the commission found.
“A large and growing group of people have needs that are too ‘complex’, too ‘severe’ and/or too ‘enduring’ to be supported through primary care alone, but not ‘severe’ enough to meet the strict criteria for entry into specialist mental health services. As a result, people receive inadequate treatment, support and care.”
People cannot access suitable services, the commission found, with people living with mental illness or psychological distress waiting long periods and becoming “sicker” before they can access help. The final report describes how “increasingly, a person must exhibit signs of major distress or crisis before treatment, care and support are provided”.
The commission made 65 recommendations it said are needed to transform Victoria’s mental health system. They include:
Establishing a responsive and integrated mental health and wellbeing system, in which people receive most services locally and in the community close to their families, carers, supporters and networks;
Ensuring that, wherever possible, emergency services’ responses to people experiencing time-critical mental health crises are led by health professionals rather than police;
Creating new models for bed-based services that are delivered in a range of settings, including in a person’s home rather than just in hospitals.
There were also several specific recommendations for establishing mentally healthy workplaces. Employers must be encouraged to develop and provide resources to assist employees and address workplace barriers to good mental health. Managers should promote inclusive workplaces that are free from stigma and discrimination, and support people experiencing mental illness at work, the commission found.
The commission recommended the Victorian government fund evidence-informed initiatives in schools, including anti-stigma and anti-bullying programs. There are also specific recommendations to support the mental health of new parents, Aboriginal and Torres Strait Islanders, and older people.
The commission emphasised the need for community housing assigned to Victorians living with mental illness.
“Stable housing can be transformative, bringing a sense of purpose, hope and opportunity,” the report said.
Suicide Prevention Australia chief executive Nieves Murray said that she was heartened by the commission’s proposal for a suicide prevention and response centre. But she added it was important to remember that “not all of those who experience mental distress will be suicidal, and not all those in suicidal crisis have pre-existing mental health conditions”.
“It is encouraging to see the report’s candid reflections of the system in Victoria,” Murray said. “We can’t forget that every system failure has a direct impact on the lives of Australians. It’s positive to see the recommendations in this report supporting people after a suicide attempt.
“We know that support following a suicide attempt saves lives.”
The premier said every recommendation would be implemented.
“As a government, we recognise these profound failures,” he said. “None of this work can be achieved overnight. It will take our ongoing action and effort and commitment. But our goal is as simple as it is necessary: taking mental health out of the ‘too hard basket’ once and for all – and making sure Victorians can access the care they need, when they need it, wherever they need it.
“Lives are counting on it.”
• To get help 24/7, phone Lifeline on 13 11 14 or the Suicide Call Back Service on 1300 659 467.
