STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal

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STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal

Solutions to balancing WA’s mental health system 2020
STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Acknowledge country
  The Western Australian Association for Mental Health acknowledges Aboriginal and Torres Strait Islander people
  as the Traditional Custodians of this land and its waters. We pay our deep respect to Elders past, present and
  future, and extend this to all Aboriginal and Torres Strait Islander people.

                                                                                                  Mural by Sally Gamble

  Shifting our thinking of mental health service delivery in Western
  Prevent Support Heal is a community of people with mental health challenges, our families, friends, and the
  services that support them. Together we have created a powerful voice to call on the Government to balance the
  Western Australian mental health system so that it gives dignity and respect to every person seeking help.

  We are asking for alternatives and a range of mental health options from a system that understands that when a
  person receives the support they need, their ability to lead a contributing life is vastly nurtured, along with their
  wellbeing and the wellbeing of their family and friends.

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STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
The people’s voice

What we are calling for is nothing new. What we need is a new style of leadership from our State Government
to implement the plan towards a balanced mental health system with more investment and awareness towards
mental health community supports and prevention programs.

Unfortunately, people with mental health challenges are ending up in hospital when they don’t need to be there.
WA’s mental health system is badly in need of balancing. While continued investment is needed to maintain
responsive and appropriate acute services, we simultaneously and urgently need to increase investment
in prevention and community support. This will balance our system and prevent mental health issues from
escalating, by making it easy to access the right support, at the right time, in the right place, from the right people.

Without funding going to the right
places our mental health system                  “That understanding, gentle encouragement, non-judgmental
won’t be able to cope.                           space I found in community support led me personally to a sense
                                                 of belonging. I think a sense of belonging is something people or
Ninety per cent of mental health                 systems forget about when it comes to improving people quality
funding is spent on inpatient                    of life, and mental health.”
hospital services and community
treatment, leaving just 1 per cent
for prevention and 5 per cent for community support.

The State Government’s own 10-year mental health plan, Better Choices. Better Lives. Western Australian
Mental Health, Alcohol and Other Drug Services Plan 2015–2025, states funding for prevention and community
support should increase from $50 million to more than $334 million, annually by 2025.

This funding will deliver prevention programs to increase awareness, reduce stigma and encourage early
intervention. It will also provide more resources for community services to support recovery near a person’s
home, rather than in expensive hospitals.

This Plan clearly states that with the right amount of community support in our system, people will be able to find
support before they become more unwell and cycle back to emergency departments (EDs) and hospital beds as
the only option available.

The scale and type of the investment requires significant collaboration and leadership. The
government, the mental health sector, people with lived experience and
the wider community can all work together if we are to shift to a
better, balanced system.

The people of WA have an expectation that mental health
services will be available when and where they need it.

We have a better way. This report outlines the hopes,
desires and real solutions from people with lived experience
who have mental health challenges.

These are their voices.
STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Danielle’s Story
  Within five minutes of meeting my peer worker at the community mental health service, I knew that recovery was
  not only possible, it was inevitable. I found myself in hospital following an incorrectly medicated suicide attempt.
  A mere 5 days earlier I had visited my GP with concern about my mental health. I just needed someone to talk to,
  but it was pathologized and I was prescribed unnecessary medication which had catastrophic results.

                 While I am grateful to the hospital for looking after my immediate physical safety, my mental
                   and emotional health, and life going forward, were not appropriately addressed. I was
                      discharged – scared and confused.

                                              The next day I found a brochure for a mental health community service
                                                   facility in my bag. I called this service every morning for the
                                                         next several days, until I took myself back to the hospital
                                                              because I wasn’t
                                                                 sure what to do, or where to go.

                                                                      Following this second hospital admission, I
                                                                        was ‘fast-tracked’ into that facility. This
                                                                          was where my healing began. The
                                                                           program was a recovery orientated
                                                                            and person-centered practice, that
                                                                              incorporated the holistic approach
                                                                               and acknowledged the impact of
                                                                                the social determinants of health
                                                                                and wellbeing. The biggest learning
                                                                                 was there is nothing wrong with
                                                                                 me for experiencing normal human
                                                                                 emotions in response to adverse life

                                                                              The support workers held hope for
                                                                              me while I found it for myself.

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STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
The optimal mix
The Government should fund mental health services in line with the Better Choices. Better Lives: Western
Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 (The Plan), which outlines the optimal
mix to deliver an efficient and effective mental health system.

                    Prevention                               Prevention                                   Prevention
                       3%      Community                        1%      Community                            6%
                                Support                                  Support
                                  8%                                       5%
                                               Hospital                                      Hospital                   Community
   Hospital                                     Beds                                          Beds                       Support
    Beds                                        47%                                           29%                         22%

                                  Community                                                Community
                                  Treatment                                                  Beds                      Community
                                     43%                                                      9%                       Treatment
        Community                                            Community
          Beds                                                                                                            34%
           4%                                                   4%

               Baseline                                      Latest                                     Optimal
              (2012-2013)                                 (2017-2018)                                    (2025)

*Office of Auditor General - Access to State-Managed Adult Mental Health Services 2019

The best service mix for the best outcomes would see:
• 29 per cent of the mental health spending on hospital beds. This has ballooned to 47 per cent under this
• Government investment in prevention of 6 per cent. However, the Auditor General last year revealed this has
   dropped to just 1 per cent
• 22 per cent of mental health spending on community support. This is down to 5 per cent of spending.

Campaign 2021 election commitments
The Prevent Support Heal campaign seeks 2021 election commitments from all political parties to increase
investment in prevention and staged growth in innovative approaches to community support over 5 years, in line
with The Plan targets:
• An increase in prevention spend from 1 per cent to 5 per cent of total mental health spend
• An increase in investment to increase community support by five-fold

The Plan says we need to invest $334 million in community support and prevention per year by 2025 to balance
the system.

  The initiatives set out in this paper provide investment options to achieve that increase. They
  are labelled ‘Quick Impact’ – those initiatives expected to deliver significant benefits within
  two years, and ‘Balance the System’ – those that require further scoping and development or
  may require a longer implementation timeline before significant benefits can be seen.
STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Prevent Support Heal and COVID-19 – Now more than ever
  In a COVID-19 recovery environment, the need to balance a sustainable and effective mental health system is
  more important than ever. The pandemic tested the limits of WA’s already over-stretched mental health system
  as demand for non-clinical community support and prevention services increased because people reached out
  for help. Even people who had never accessed a service before were calling a locally based service, because they
  were told to stay away from hospital unless necessary.

  The economic impacts of COVID-19 mean the mental health crisis is not over. National modelling predicts a 10
  per cent increase in ED presentations, a 12 per cent increase in hospitalisation for self-harm, and a 14 per cent
  increase in the national suicide rate. The WA State Government has an opportunity to take a whole of government
  approach that can align prevention and mental health support with the COVID-19 social and economic recovery
  - a Mental Health in All Policies approach - that also creates jobs.

  COVID-19 Recovery through mental health jobs
  People who are unemployed or living on very low incomes have higher rates of mental health challenges. Investing
  in mental health through prevention and employment and support pathways is the best way to mitigate the
  mental health impacts of COVID-19.

  The recovery focus however has been on the recovery of male dominated ‘hard hat and high vis’ sectors. A focus
  on other areas, like mental health and community support, would support at risk groups. Research shows that 79
  per cent of new care jobs would be taken by women, increasing the employment rate for women by 3.7 per cent
  and decreasing the gender gap by 2.6 per cent. Investment in youth peer workforce development and training will
  also create jobs pathways for young people.

  Mental health investment will help us to build back better because we are investing in our greatest asset – people
  - enhancing their mental health and productivity. It will reboot our economy through jobs creation, enable social
  recovery through building community resilience, reduce hospital costs to create a more sustainable health
  system and support regional community resilience and health.

     Seven jobs are created for every $1 million invested in mental health community support (based on service
     provider data), compared to around 0.2 jobs for women and 1 job for men for every $1 million dollars spent
     on construction.

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STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Emily’s Story
I lost two of my three jobs because due to the impacts of COVID-19. After the contract of my third job ended,
I knew instantly I would have a very difficult time looking for a way to keep up my finances living out of home as
moving back with my parents wasn’t really an option for me.

Additionally, I was not eligible for JobKeeper and my Centrelink application is still ‘processing’ despite several
calls and months waiting. My experience was overall very difficult, I applied for an average of three jobs or paid
opportunities a week both within and outside my field of study or experience – anything I was remotely qualified
for. I kept myself afloat through savings and odd freelance jobs. I have very recently managed to secure an event
photography job but it is not enough to live off as the hours are very irregular.

I also managed to secure one months rent under the Rent Relief Scheme which has been a great weight off my
shoulders. The job search has had a very detrimental impact on my mental health, mainly the draining labor of
writing applications and pinning all my hopes on getting it. While I am luckier than some and have some savings to
fall back on, I am not earning enough to live on and the constant underscore
of worry is quite burdensome.

I think what would have helped me a system to help me with
the Centrelink application as that was the most challenging
application for me to complete.

In addition to that I think a system that is a mix of
JobSeeker and the Rent Relief Grant which is a short-
term no obligations payment to ease the burden while
you apply for jobs or wait for more regular government
STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Aboriginal Mental Health and Wellbeing
  Aboriginal people experience higher rates of suicide and mental health challenges than the rest of the WA
  population and Aboriginal people are consistently identified as a priority group for prevention, support and
  treatment. Specific prevention and community support or social and emotional wellbeing programs are urgently
  needed, and mainstream services must be strengthened to provide culturally secure services.

         ayne’s Story
  I am a Ballardong Noongar man who originates from Northam WA. Throughout my late 20s I had experienced a
  low point and was living a life affected by alcohol and drugs. I hit rock bottom and became suicidal. I decided to
  change my life and so my journey to help other people in particular Aboriginal men began. I studied Mental Health
  and Counselling with Marr Morrditj and soon after I was offered a position at Palmerston Association.

  I attended a meeting in Armadale organized by highly respected Aboriginal Elder Aunty Liz Hayden to discuss the
  recent suicides that had occurred within the community. Soon after the Waakal Moort Kaadajiny (WMK) Festival
  was born. Suicide amongst the Aboriginal Community is a major concern and a constant battle for families. The
  festival is a platform to raise awareness for suicide prevention and encourage community members to engage
  with services to better their overall health needs. Suicide prevention and social and emotional well-being is
  important because without these we are losing our Aboriginal People, our culture is dying, and we are becoming

                    Having lived experience with suicide ideation meant that I can understand the despair a person
                                in a similar situation is feeling and why the festival and the elements that created it
                                       were so important. Our community is struggling and crying out for support,
                                            we need services and health workers in the industry to start working
                                                collaboratively to raise awareness and encourage community
                                                  members to seek support.

                                                     The festival saw 44 health services come together in one place
                                                      which meant community members could access programs in a
                                                       culturally appropriate and non-judgmental environment and
                                                       services could have the exposure they wouldn’t otherwise
                                                        have had. With the continuation of the festival yearly it will
                                                        mean that organisations can deliver new programs and
                                                        services to community members, build clientele and focus
                                                       on lowering the numbers of suicide and suicidal ideation.

                                                     With consistent community events such as the festival it is
                                                      a start to bridge the gap between community members and
                                                      services and begin the healing of our people encouraging
                                                     social and emotional wellbeing to grow in a positive way.

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STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Election asks

1. Invest in Aboriginal Community-Controlled Health Services (ACCHS) Social
   and Emotional Wellbeing (SEWB) programs, developed and led by Aboriginal
   people and their communities, across all regions of the state.

   ACCHS are best placed to work with their communities to identify, and respond
   to, their own health and SEWB needs. ACCHS should be funded to develop and provide SEWB programs
   that are high quality, community-based, and with an early intervention, prevention and recovery focus as
   part of state investment in community support and prevention. Strengthening the capacity of the ACCHS
   sector is also a key priority under the National Agreement on Closing the Gap signed by the WA Govern-
   ment in July 2020.

2. Local grants fund to support culturally based wellbeing and suicide prevention programs.

   Supporting the efforts of Aboriginal Elders and local communities in supporting children, young people
   and community members through cultural and SEWB activities like art workshops, community events and
   camps on Country. Cultural learning programs promote the sharing of cultural knowledge and support the
   development of Aboriginal youth to be leaders of the future. The small grants program will be available to
   unincorporated groups for costs such as food, fuel and activities.

3. Improve the continuous cultural competency of mainstream
   mental health and alcohol and other drug services through
   investing in free sector development and training pro-
   grams to support the development of workers skills,
   and culturally secure programs in mainstream
   community mental health organisations. 4 FTE
   Aboriginal mental health lead positions to be
   located within existing sector development
   programs and available state-wide.

             Looking Forward, Moving Forward Elders in Residence, Uncle Charlie and Aunty Helen Kickett.
STATE ELECTION PLATFORM - Solutions to balancing WA's mental health system 2020 - Prevent Support Heal
Suicide Prevention
  Suicide is a key issue for the health and wellbeing of WA communities and a key issue of inequity for Aboriginal
  and Torres Strait islander people in WA. The Kimberley region in WA has one of the highest suicide rates in the
  world, with previous estimates of two deaths by suicide each month of Aboriginal people in this region. The
  WA government must commit to genuine long-term, sustained and sufficient funding for suicide prevention
  initiatives in our State, with a focus on priority groups, and achieving equity for all.

     WA had:
     • the highest rate of suicides of Aboriginal and Torres Strait Islander peoples in the country (2014-2018)
     • the second highest rate of suicides in the country for children aged 5-17 years (2014-2018)
     • the third highest rate of suicides compared to the rest of Australia in 2018

  Elections asks:

  1. Announce increased and five-year funding for the regional Aboriginal Suicide Prevention Plans in the first
     100 days of government.

     With continuing and increased commitments to Aboriginal leadership and community led responses across
     metropolitan, regional and remote areas, and funding on a needs basis to support a sustained decrease in
     suicide for Aboriginal people.

  2. Fully funded comprehensive state suicide prevention strategy, and youth suicide prevention strategy, all
     released within the first year.

     Integrated with other initiatives, actions must encompass a spectrum of interventions with focus on higher
     risk groups including children and young people, rural and remote, and LGBTIQA+ communities. Initiatives
     detailed in the strategies should utilise a range of approaches including place based models, community
     capacity building, and development of suicide prevention models for groups of people at high risk.

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Leah’s story
It was five years in June since my husband Clint took his own life. Many people talk about the ripple effect after
a loved one’s suicide, and those ripples have now affected my two children so much I have presented to hospital
emergency numerous times for both of them and myself. Twelve months after Clint’s death, I checked myself
into a private mental health hospital.

When we abseiled down the QV1 fundraising for Lifeline and having our community involved it felt good.
It felt we were able to really talk about what I had gone through, was going through. I was able to be honest about
the kids and people were listening and then relaying their stories.

There was a connection with them because of what we had experienced and talking with our peers. Some people
actually sought me out to chat because they needed to get something off their chest. Others because they
needed to know the kids and I are okay. If my gorgeous husband knew there was a place to go or call, like Lifeline,
I’m not sure if Lifeline was on his radar, he could still be here.

I managed to find my feet again. I met someone new and am living in a community that supports
me as I continues to seek support for myself and my children. I want someone to talk to, who
doesn’t judge me, who gets it, someone who has gone through the same
Prevention and Promotion
  Good mental health means preventing the development of                      Estimated return on investment:
  mental health challenges before they even begin. This means                 $9 for every $1 spent on prevention
  reducing risk factors for mental health distress and enhancing
  protective factors.

  Mental health promotion involves creating healthy living conditions and environments that support mental
  health and allow people to adopt and maintain lifestyles that support their mental health.

  Mental health prevention and promotion make good sense for people, and for government. We know that mental
  health prevention offers excellent return on investment (ROI) – investing $1 in mental health prevention can
  generate a ROI of $3 to $9 or even more, with good evidence for ROI activities that focus on children, young
  people, schools, workplaces and the social determinants of health such as homelessness.

  More investment in prevention is needed to ensure the best mental health outcomes for WA communities. The
  WA government already has a number of plans at their fingertips which set out the best balance of investment in
  prevention activities, and types of program and initiatives to focus on. Now is the time to commit to those plans,
  to invest in prevention and to make change happen.

  •   Increase prevention initiatives for mental health issues, with a focus on primary (population wide) prevention,
      with targeted strategies for vulnerable groups.

  Abbey’s story
  When I was just six years old, I lost my dad to suicide. It was an incredibly difficult time for my mum, my younger
  sister, who was four at the time, and myself. As a child, I couldn’t understand why my dad wasn’t coming home
  anymore. Due to losing dad, we became involved in LifelineWA, volunteering at events and meeting others who
  have also lost loved ones to suicide.
  I managed to cope quite okay with the loss of dad. I was a good student who worked very hard. I was heavily
  involved in all aspects of school and had many friends from different groups. However, at the end of year 10 things
  started to go downhill. The river cruise was coming up and girls were all talking about dieting and dress sizes and
  not eating so they would look good in their dresses. I had always been self conscious about my body growing up.
  I started to restrict my intake, initially by cutting out the ‘bad foods’ and wanting to be healthier, however within
  a few months the weight started to drop off. I felt happy, or so I thought. I began to feel anxious and started
  to withdraw from people. At the start of year 11, mum took me to PMH emergency department where I was
  admitted and diagnosed with anorexia nervosa. Over the next 8 months I had 3 admissions to PMH where I was
  also diagnosed with depression and anxiety. I missed a great deal of school and my friendships were weakening.
  I was in a very dark place. Mum had me admitted to Perth Clinic as I started to feel very unsafe. Through Lifeline

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Election asks:

1. Commitment to sustained and long-term investment in prevention, as per the Better Choices. Better
   Lives. Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015–2025.
   - Increase investment in prevention to 5 per cent of the mental health budget: starting at $35 m a year
   and increasing to $77 million per year over 4 years.

   In the 1st 100 days
2. Announce and fund a targeted project to map and evaluate existing prevention initiatives and inform
   priorities for future investment.
   - This will maximize the value of existing MHC and broader prevention expenditure.
   - This should include existing community and school based, workplace and other prevention and promo-
   tion settings, and define how mental health treatment and support contribute to reducing the incidence
   and severity of distress for people already accessing mental health services - as this is of primary impor-
   tance to mental health consumers.

3. Develop and release a fully costed and funded implementation plan for the Western Australian Mental
   Health Promotion, Mental Illness, Alcohol and Other Drug Prevention Plan 2018-2025 (Prevention and
   Promotion Plan).
   - This should include a comprehensive and complimentary range of mental health strategies and activi-
   ties, including specific strategies and action plans targeted at priority groups including Aboriginal peoples,
   early years, children, young people and LGBTIQA+ communities.

   Years 2 - 4
4. Develop and implement a Local Prevention and Promotion Grant Fund.
   - This should include a central innovation and evaluation mechanism to support evidence based ap-
   - This initiative should be delivered in years 2- 4 of government.
   - Focus areas will include: building community and organisational capacity, community wide and targeted
   strategies, and enabling local governments to address mental health in their Public Health Plans.
   - Suggested eligibility: local groups, not for profits and local governments.

WA, mum met Ashlee Harrison who had set up an organisation, zero2hero, for children and teenagers to learn
positive mental health practices. My mum, my sister and I attended the first In Your Head Youth Mental Health
forum which was amazing.

Fast forward to April 2017 and I was on Camp Hero! I was extremely anxious as my eating disorder was still very
much there. It was such an empowering and inspiring experience. There was no judgement whatsoever, only
understanding, support and acceptance. I learnt skills I can use for life, skills that I’ve since shared with others. I
came home confident, optimistic and hopeful, something I hadn’t felt for a long time. I also gained a whole new
family, some of which I am still close to three years later. Since then, I’ve still had my struggles, but I have learnt
how to deal with them in much healthier ways. I did the cape2cape in 2019 which helped me further develop the
skills I learnt from camp and was one of the best experiences I’ve had.

I am at the best place I’ve been since I can remember, and I credit that to my support systems which include
zero2hero. I would not be where I am or who I am without them.
Community supports
                                                                              “Currently, community supports are
  Community supports work with people to secure a job, form                   available to only 20% of the people
  relationships, build fulfilling lives, develop skills and interests,        who need them.”
  prevent hospital admissions and issues escalating to crisis
  point, while promoting healing and keeping people living well in
  their own homes.

                                                       They are often provided by peers, who walk alongside people
     “There doesn’t seem to be much                    and provide a living example of hope and recovery.
     support out there. And what is out
     there, you are either not unwell                  Community supports are non-clinical supports that advance
     enough, too unwell, or unwell in the              people’s personal recovery, rights and opportunities. They are
     wrong way.”                                       empowering, offer hope and include people’s social context –
     -Community supports survey participant            trauma, income, community connection, culture or housing
                                                       – not just a focus on symptoms. They include peer support,
                                                       personal recovery programs, groups, family and carer support,
                                                       housing and employment programs.

  Carli’s story
  Reaching out to the community mental health organisation Grow changed my life. It was also the catalyst for
  facing my own self stigma and ultimately set me on a course of self-determination. I was a member of Grow for a
  number of years and they gave me an employment opportunity which really changed my life.

  I got to a point where I really accepted myself and I actually liked who I was even though I wouldn’t wish my
  experience on anyone, I think it has made me a better person. I’m more accepting of other people, less
          judgemental and I got to a stage where I wanted to share my life with someone.

                     My leadership and openness to my recovery resulted in my appointment as a WA Consumer
                       Representative on the National Register for Mental Health Australia and I worked for
                          Richmond Wellbeing and the WA Association for Mental Health.

                            That really opened up my world because then I had a network of peers who were
                            willing to share their knowledge and expertise with me.

                            I wanted to have employment opportunities, just like anybody, I wanted the same
                            access and not to be judged for my past experiences.

Page 14
Kerry Hawkins – WAAMH President
My husband is a smart bloke – he’s accomplished, he has 4 Masters degrees, he’s working on a PhD. When we met,
he had a well-established career, but of course, he had a back story of tremendous abuse and neglect as a child.
That all caught up with him once he started having a family. His distress really overwhelmed him, but he remains
to this day still the same beautiful, generous, funny, intelligent and accomplished man that I married. And it’s just
a tragedy that our mental health services at this point aren’t equipped to help people keep a grip on their life – the
things that matter – family, home, friends.

We overuse the word heroically, but this is a man who is used to hearing voices all day every day and still chooses
to stay alive and stay with us. So, he is my hero. The fact that he manages to fight through all of these messages
that he’s hearing and chooses to stay as a writer and a loving dad is just beyond comprehension.

One of the fundamental shifts that we have to make is that we have to stop looking to try and fix people and their
brains and it has to start in their social context – understanding what’s happened to them and what’s happening
for them now. It has to be based around keeping people engaged with their lives, making sure that they can stay
in work, working with the whole family so that the impact on the whole family is understood. Making sure that
people’s relationships are intact, making sure their home and safety around their home is intact.

                                                        The shift is really from trying to look inside someone’s
                                                           brain and sort that out and looking at their life in
                                                               complete context, including their past histories
                                                                  of trauma and providing the right resources
                                                                      and supports for people that are addressed
                                                                        more at fixing what’s going on for them
                                                                          rather than what’s going on inside their
                                                                            brain. It would be a fundamental shift
                                                                             in approach. Psych wards are great
                                                                              for stabilising people and there
                                                                               is absolutely no question that
                                                                                there is a role for clinical services.
                                                                                Medication saved my husband’s

                                                                                 The public health hospitals have
                                                                                saved his life on more than one
                                                                                occasion. But they don’t reconnect
                                                                               people with their life. And that’s what
                                                                              matters to people.
Elections asks:

  The 1st 100 days
  1. Conduct a needs analysis and expand individual
     advocacy services.                                             “I’ve needed help accessing disability
     The Plan states that advocacy should be available for          payments, housing etc the help I needed
     all consumers, family members and carers. Conduct              was the applications and advocacy.”
     a review of existing programs and analysis of needs
     for vulnerable groups and specific issues, and ex-
     pand general advocacy services to enable statewide

  2. Integrated community treatment and community support to enhance community management and
     reduce ED presentations and hospital admissions. Non-government organisations (NGOs) will work in
     tandem with community treatment teams to provide seamless community recovery pathways, hold people
     during distress, and offer case management and support coordination. Targeted to the 10% of consumers
     who use 90% of hospital bed and half of ED services to support them to manage well in the community,
     reducing admissions as well as costs to the overall mental health system - with savings expected in the first

     Years 2 - 4
  3. Expand personal recovery programs and innovative community support options, with a costed plan to fill
     service gaps released by the end of the first year, for investment in years 2- 4.

     Current investment in community support is patchy, with regional areas and some groups of people in high

     Expansion of community supports and personal recovery programs is urgent. This is especially so for
     groups most in need - children and young people, people with multiple unmet needs and high acuity, and
     Aboriginal people - and to fill regional, rural and remote service gaps. Enabling people to access early inter-
     vention and adequate support services will support them to live well in the community and reduce acute
     service demand. Innovative developments such as Recovery Colleges should be expanded to extend access
     across the state.

          “Turned away because of the wait list or being out of
          area. Told my circumstances were too complex or not
          complex enough…”

Page 16
Claire’s Story
My most recent mental health admission was at the beginning
of 2017, and after presenting to an emergency department in a
very vulnerable state, was admitted to Perth Clinic. The short
time I spent in this emergency department was extremely
traumatising, and the weeks to follow would be some of my

At the time, and post my inpatient admission at the Clinic, I had
no idea about the Community Mental Health services available
to support me.

I had always assumed that because I was ‘high functioning’ – I could
hold down a job, was able to study, and had a good family and friends
support network, that I wouldn’t be eligible for these services, as they
were for people who were more unwell than me. It took me a good two
years to get back on my feet after my 5 weeks as an inpatient, and I wonder
now, if I had adequate supports through Community Mental Health Services, would
it have taken me this long?

Looking back now, it makes me think that these types of services could have been helping me throughout my
entire teenage and young adult life, had I known about them, and requested access.

I began to understand the significant impact community mental health services organisations could have on the
lives of those with mental health issues when I started working for one, purely by chance through an internship
as part of my university studies.

The organisation I worked for gave people, just like me, hope, a sense of belonging, and supported their recovery.
Young people
  Prevention, early intervention and integrated support pathways for young people’s recovery are the best ways to
  improve the health and wellbeing of our population and save long term costs.

  There are alarming gaps and growing demand despite increased investment. Wholesale system redesign is
  urgently needed to increase existing mental health and alcohol and other drug (AOD) services, build new ones to
  meet need, and reduce fragmentation.

  The Young People’s Priority Framework - to be released by end 2020 - must address these issues (not just tinker
  around the edges), and be genuinely co-designed with young people of all ages and diversities.

     In YACWA’s COVID-19 Youth Survey 88% of respondents were concerned about their mental health. 78% of
     young people were fearful for the global economy and job market, linking these concerns to a decline in
     their wellbeing.

          “We do not want services:
          …that say that they’re inclusive without hiring any of those people on staff
          …that don’t know how to book or offer interpreters
          …that force people into models of recovery that are white-centric, ableist, cis/heteronormative”
          (Youth Focus Group)

Page 18
Elections asks:

Implement the Young People Priority Framework:
1. Release a funded Implementation Plan for the forthcoming Young People Priority Framework within the
   first 100 days to include priority investments in a planned pathway of integrated supports across:
   - Youth prevention and promotion programs and a whole of government approach to the social determi-
   nants of mental health, including housing and unemployment
   - Innovative non-clinical recovery community support options including peer workers, that are linked to
   expanded clinical supports across the state
   - Supported accommodation options and safe places to stay
   - Youth specific crisis options offering alternatives to current crisis pathways
   - Peer led parent support, information and capacity building programs.

   Key gaps include young people not well served by existing options, supports and services for young people
   aged 12 – 14 and 14 – 17, and young people in acute distress.
   New initiatives should:
   - Prioritise existing gaps by location, age and diversity
   - Integrate and partner with existing youth/mental
   health services to leverage strengths and smooth path-             “Reflect youth help seeking behaviour by
   ways                                                               being available outside 9 – 5 hours, with
   - Grow and develop peer-based services and supports,               later hours and 24/7 support for older
   and connect young people to relationships and the com-             young people.”
   - Be based on active cultural competency, and respon-
   sive to the needs of diverse young people across race,
   class, gender, sexuality, and migrant or refugee status.

2. Resource a specialist youth mental health development team to run a 4-year partnership program to
   strengthen the mental health expertise of existing specialist youth services, and support public and NGO
   mental health services to build their youth expertise. The program would support workforce development
   and growth including youth peer workers and leaders. It would deliver state-wide training, tailored consul-
   tancy support and sector events; develop lived experience leadership and tools and frameworks; and tackle
   integration across the system.

   “Some young people need the ability to leave violent and unsafe homes quickly and easily”
   (Youth Focus Group)
  The mental health of children is an area of high need in WA. Demand for mental health services for children and
  young people is increasing, and many children are not accessing the services they need.

  Mental health in childhood can have a significant impact on short- and long-term wellbeing. Childhood is a key time
  for intervention in mental health to ensure positive future outcomes. Prevention, early intervention, appropriate
  access to treatment and a focus on equity and vulnerable groups is vital to ensure the ongoing mental wellbeing
  of WA children.

  The government has access to a range of existing reports and plans which identify key priority actions to
  support the mental health and wellbeing of children in WA, including The Plan, the Prevention and Promotion
  Plan, suicide prevention inquiries and reports from the Commissioner for Children and Young People.

  •   A recent report from the Commissioner for Children and Yong People has identified little or in some cases
      no progress towards improving mental health service coordination and delivery for children and young
      people, or that their mental health is any better than it was almost a decade ago

      “Prevention and support with mental ill health has to start with children and families and not waiting until
      they are teenagers.”

      Our Call
      The Prevent Support Heal campaign calls for increased focus on the mental health of children, from infancy
      to adolescence and young adulthood. Efficient, sustainable, and balanced investment across a full range of
      services based on need and appropriate consultation and co-design with stakeholders is urgently required.

      The campaign also supports calls for the development of a whole-of-government Child Wellbeing Strategy
      for WA, with a priority on targeted, early intervention approaches for vulnerable WA children, young people
      and their families, including mental health and well-being initiatives.

  Key facts:
  • We need 4.2 times as much community treatment for babies, children and adolescents as we have now
  • There are bigger qaps in northern and remote areas, as well as southern country areas

      “For infants there’s a lot of focus on the parent/child relationship, parenting supports and families at risk. The
      Under 12s group are very limited in supports they can access.” (service consultation)

Page 20
Rural and Remote
There is a mental health services gap in rural and remote areas, and lack of access to mental health services is
a key driver of poor outcomes. Our mental health system is not efficiently responding to the needs of rural and
remote communities:
• Rates of suicide and emergency admissions for mental illness increase with remoteness.
• We need 33 times as much community support in regional, rural and remote areas as we have now.

   “There are few or no support groups in rural areas, and particularly for young people … It’s not just a gap
   in services; it’s a dangerous abyss.”

Telehealth and online access are often assumed to be a rural health panacea, but rural and remote communities
have lower levels of digital literacy, internet use and access, and poorer connectivity and broadband bandwidth.
A combination of telehealth and face-to-face delivery is needed for the best outcomes. Consumers, family
members and service providers across WA are calling for investment in local, place based community connect-
ed prevention and support options.

Election asks

Year 1
1. Expand personal recovery programs with a costed plan to fill service gaps in rural and remote areas re-
   leased by the end of the first year, for investment in years 2- 4.
   Expansion of personal recovery programs, locally based family and carer support, regional supported ac-
   commodation services, supports for children and young people, and for people with multiple unmet needs.
   Current investment in community support is patchy, with regional areas and some groups of people in high

   Programs will drive COVID-19 recovery by building regional jobs for a local workforce including the devel-
   opment of local peer workers and youth and female employment pathways. Place-based options will build
   community resilience and the capacity of local people and local organisations. Preferred provider procure-
   ment to existing local services and community resource centres/neighbourhood centres will maximise
   regional benefits.

  “There are no cmh supports available in our town, the nearest major town with these services is more than
  an hour by road away with no public transport. All the services are in major cities or towns, it’s easy to ignore
  tiny towns like mine. The bigger ‘business’ agencies get most of the funding, leaving little or nothing for small
  grass roots organisations like small family/neighbourhood centres.”

Year 2
2. Establish Rural and Remote Neighborhood Centres with early
   intervention and recovery capability.                                         “Face to face meetings are
                                                                                 essential, I felt very alone and
   Build mental health supports into place-based neighbourhood
                                                                                 isolated having to rely on virtual
   centres where everyone is welcome to drop in and socially connect
   in a welcoming space, and through shared activities. A focus on
   practical support is offered as needed before emotional needs are
   addressed, opportunities to heal on Country for Aboriginal people,
   and one on one recovery support. Skilled, locally trained staff and
   peer workers, and in some areas Aboriginal Health Workers, are
IPS                                                                   “… all good to offer the support but
                                                                        without ability to engage with an
  Investing in integrated mental health and employment                  employment provider, we will, for the
  pathways is the best way to mitigate the mental health                rest of our lives, live in extreme poverty.”
  impacts of COVID-19. Individual Placement and Support
  (IPS) pairs specialist vocational workers with mental health
  services to support people with mental health challenges to successfully get a job in the open competitive jobs
  market. International evidence shows that IPS is the most effective program in the world for assisting people
  with mental health challenges into the workforce.

  It is person-centred, fostering hope and promoting social inclusion. IPS can be used both to complement mental
  health prevention and early intervention with young people, and as a key component for recovery with adults
  with enduring mental health challenges.
  • Nearly 60 per cent of young people not in employment, education or training had already experienced more
        than one mental health problem in childhood or adolescence, compared to around 35 per cent of young
        people who were engaged.
  • Where the IPS program has been implemented and successfully managed, employment outcomes for people
        with a lived experience of mental illness have been as high as 54 percent compared to traditional employment
        methods of just 24 per cent.
  • The IPS trial linked to Headspace supported 48 per cent of young people involved to successfully enter
        education or gain employment: 512 gained jobs and 136 young people entered education.

  Jesse’s Story
  Jesse is a 19-year-old young man who has been a participant of the headspace Broome Individual Placement and
  Support (IPS) trial since 2018. Diagnosed as being on the ASD spectrum, experiencing bullying, social isolation
  and a lack of academic success Jesse found himself disengaged from his Year 11 classes at school.
  Jesse was introduced to IPS at headspace by a friend who also accessed the service. Working with his Vocational
  Specialist to meet with local employers, Jesse finally landed a role in a busy tavern, unfortunately he was let go
  after a few weeks. This set back provided an opportunity to focus on his strengths, gain a deeper insight into
  himself and what he wanted out of employment and how he saw his place in the community.

  Jesse volunteered and became involved in the setup of a headspace group “System Restore” that focused on
  inclusiveness for those that are socially isolated and have an interest in gaming. Jesse became a leading voice
  in the direction of the group and by being around people with similar circumstances to his own was able to form
  a strong social connection in a safe environment. With the group focused on vocational skills each week, and
  members sharing their employment experiences, Jesse’s desire to obtain meaningful paid employment was

  The change in focus for Jesse was increasingly noticeable to others around him. Jesse got a job
  at a local cleaning company where he has successfully worked for more than 6 months. Jesse
  continues to receive regular support from his headspace GP, intensive and individualised
  follow along support from his IPS Vocational Specialist and his disability employment
  service case manager. He has a supportive employer who has taken time to mentor him
  in life skills and train him in the various parts of the business. Jesse’s next goal is to obtain
  his driver’s licence.
Page 22
Election asks:

IPS Adult
1. Integrate employment specialists into community mental health treatment teams and community sup-
    port centres using the evidence based Individual Placement and Support model. This will support people
    with significant mental distress to access real jobs, as a key mental health and COVID-19 recovery strat-
    egy. Services should be located in towns and cities with high rates of unemployment and mental distress,
    across each of east, north and south metropolitan and Kimberley, Pilbara, Goldfields, Midwest, South West,
    Wheatbelt and Great Southern.

         “The employment sector needs improving or service to help engage. For example I really need/
         want to work but my disability job network provider is not equipped to help me.”

IPS Youth
2. Mitigate the impacts of COVID-19 by supporting young people into education, training and employ-
    ment – all protective factors for mental health - through 5 pilots Youth IPS employment programs that
    integrate 2 dedicated employment workers into specialist youth services.

   Utilising the most effective and evidence-based employment program in the world - Individual Placement
   and Support - the pilots would place a vocational specialist into existing specialist youth services, link with
   COVID employment and training initiatives, focus on skills development and financial skills, and have strong
   links to youth mental health services.

   Targeting areas with historically high levels of youth unemployment, high suicide rates and significant gaps
   in community mental health support including Peel, South Metro, East Kimberley and Bunbury.

   The IPS trial linked to Headspace supported 48 per cent of young people involved to successfully enter ed-
   ucation or employment. The pilots would complement a Federally funded initiative in three headspace trial
   sites in WA by embedding the same model in specialist youth services in communities with persistently high
   rates of youth unemployment. This will reduce their medium to long term risks of mental health issues and
   reduce future demands on State funded service systems including mental health and housing.
Peer Options
  Peer support has been part of the mental health care system of Western countries for decades and is widely
  recognised as an important component of recovery-oriented models of mental health care.

  The options outlined in this section were developed during a codesign and consultation process with almost
  200 consumers and carers – many of whom asked for peer-only services to be one of the options what is avail-
  able. These models will advance government commitment and consumer and family access to peer work and
  peer-led options focused on hope, recovery, empowerment and belonging.

  Sue’s Story
  My son was identified as a vulnerable kid at the age of 4 and was diagnosed with schizophrenia at the age of
  16. Despite all the protective factors he had in his life, he was still stricken with this debilitating and tormenting
  illness. Not only did his illness affect him so gravely, it had huge impacts on our family and our two older daughters.
  It is fortunate that we were such a close-knit family, or I believe we may have disintegrated. Our son had those
  critically important years stolen from him which has led to a high level of grief within our family.

  I want the best for my son. I want him to feel loved and respected, content in his life, maintain a level of good health,
  make a contribution to society through meaningful activity, have a caring and supportive network of friends and
  family, know the joy of attaining his dreams, complete his education and find useful employment. In other words,
  I want him to feel respected, included and worthwhile as a human being. For most of us, many of these hopes are
  realised on some level throughout life. For my son, he experiences none of those aspirations apart from knowing
  that I am here for him and his sisters try their best to support and care for him. His father passed away suddenly
  so he no longer has his loving support.

  I am constantly amazed by the fact that he has the courage to get out of bed each morning to face another day
  of indescribable loneliness, rejection and utter despair. He has attempted suicide more than twice and has talked
  about wanting to just go to sleep and never wake up for such a long time. His tenacity and courage help me to keep
  fighting and supporting him. So how has my son stayed alive? Is he healing through prevention and support? I
  would have to answer no. I believe the critical factor missing in this is the importance of people who are informed,
  educated but who truly care. We must have a person-centred approach. My husband always said to me, ‘our son
  would not be alive if not for me standing side by side with my son’. I am an educated and tenacious person who,
                    following my son’s diagnosis, began the challenging journey of searching out organisations that
                           could support both my son and my family.

                                   It was a difficult area to navigate through and there are many well-intentioned
                                      carers, parents, loved ones and workers who do not have the ability for a
                                       number of reasons to provide the necessary support. It may be due to
                                        distance from resources, time due to their caring role, energy and mental
                                         strength to continue the battle on a daily basis, misinformation, the lack of
                                         understanding of mental health issues, fear, stigma that still exists within
                                          our communities.

                                        We need champions in this area who are skilled through lived experience
                                       and education to stand beside teachers from early childhood, through
                                      adolescence and into adulthood and across the life span to provide
                                    encouragement and mentoring to those people courageous enough to work
                                  with people such as my son.
Page 24
Election asks:

1. Peer Led Crisis and Recovery Centres for people with high acuity and multiple unmet needs, including
   co-occurring AOD

   A peer-led service that offers various ways to access help and connect with others – including a safe space
   for drop in, appointments for more structured recovery support, warm line, 24/7 crisis responses, broker-
   age and outreach. A safe space with specialist peer workers accessible to people otherwise excluded from
   or not accessing services, with locations prioritised on areas with the greatest levels of distress and gaps in

   “My mental health issues do not stop at the end of the traditional working day. Weekends and evenings are
   the times I feel most isolated and at risk, it would be good to have more supports and services operating in
   these times.”

2. Peer Family and Carer Recovery Centres with warm line
   A centre-based, drop in space to engage informally with peers, plus a structured peer mentoring program
   and warm line. Within these relationships, family members and carers can access supports to support their
   loved one and for their own recovery and explore other support options including using the capacity within
   their existing networks. Mental health and co-occurring AOD inclusive. Locations prioritised on areas with
   the greatest levels of distress and gaps in support.

3. Establish a peer warm line: a calm place to talk with a trained peer without needing to be in crisis. Acces-
   sible 24/7, 365 days a year - people can acccess by phone, text or messaging apps. This service pre-empts
   crises developing through access to peer support, and links to other support options, if needed.

   A warm line is distinct from a crisis line or helpline as it’s not about providing information and you do not need
   to be in crisis to call. A warm line is about somebody calling to have a conversation. The person receiving the
   call is trained to listen and not to give advice. The idea is for people to connect with another person at any time
   of the day or night and be treated with respect in a non judgemental manner. In the US there are about 100
   warm lines in operation; many of them are run by peers and have been immensely successful in preventing
   mental health crises. In Canterbury, New Zealand a warm line resulted in the number of admissions to their
   Emergency Department and the number of visits to GP’s reduced considerably. To be effective the warmline
   needs to operate 24/7 every day of the year. Such a service would reduce the demand on our crisis lines and
   permit those who really are in crisis to get through.
Howard’s Story
  I lost my mother to cancer when I was twelve years old. This proved to have a significant effect on my life. When
  I first started work, I discovered alcohol and for a number of years that seemed to fix everything. Eventually I
  was able to put the top on the bottle. About ten years after that that I was training to be a psychotherapist and
  realized that I was not well myself. A visit to my GP resulted in my first lot of happy pills.

  The pattern over the next fifteen years was a period of depression followed by a period of being OK. It never
  occurred to me over this period to seek out help from community groups. I was aware of GROW but felt that
  it was too structured for me. I did not know other groups existed. In December 2017 I ended up in Graylands
  hospital which in some ways was the major turning point for me. I found among some of the staff and particularly
  one of the peer support workers a measure of support which I had not experienced previously.

  I admit that I came out of there feeling worse than when I went in but once the medication settled down it was
  OK. I was told to get community support which I went on to do. Secondly the psychologist suggested that I get
  more structure in my life. The third lesson was to do whatever it took not to return to Graylands. One Sunday
                                 afternoon I was feeling down and made about six phone calls to Beyond Blue and
                                        the others. I was unable to speak with a single person. That got me thinking
                                             about setting up a service myself. I have since learnt that such a service
                                                is called a “Warm Line”. A place where one can simply have a chat,
                                                     where the caller is heard and listened to. It would have made a
                                                       difference to me on that Sunday afternoon. I rang my sister
                                                          in the finish.

                                                             A service such as this is sorely needed in WA and would
                                                              fulfill a vital role in preventing escalation of mental
                                                               health issues. Today I have much to be grateful for. I
                                                                no longer need medication. I have four adult children
                                                                 who I enjoy mutually supportive relationships with.
                                                                 I volunteer with several organizations and belong
                                                                 to a few community support groups.

                                                                  Above all I am privileged to have a network of
                                                                 friends who I can call when needed for support.

                                                                    I once thought that life was hopeless,
                                                                     now I have HOPE.

Page 26
Supported accommodation
Safe, affordable housing and mental wellbeing are intrinsically connected – in order to be well, people need a
safe place to call home. Homelessness and a gap in supported accommodation services are key issues impact-
ing the mental health system in WA.

   A 2019 snapshot found that 27%, or 178 people, in a mental health hospital bed had no clinical need to
   be there - they could be discharged if there was community accommodation or community support
   available to help.

Elections asks:

Year 1
Increase investment in supported accommodation, across the pathway from high to low support needs.
Services need to include both community support and community bed-based service streams.

1. Supported accommodation pathways across the continuum from high needs settings to lower needs
   accommodation services with a balance of staffed residential services, transitional support and long term
   individualised packages, based on the development work and models of service developed by the MHC in
   2019 and a Housing First approach.

   In addition to the MHC focus cohorts of youth, adult and forensic, additional services are urgently required
   for people with high acuity and multiple unmet needs, rural and remote areas, and Aboriginal people.

  Providing housing with linked community mental health support can save the WA hospital system
  $84,000 per person per year through preventing acute mental health admission
  – the saving would be achieved in the first year.

Year 2
2. Commission tenancy support services for people in public and private rental to sustain their tenancy, as a
   foundation for recovery.

Year 3
3. Offer peer led supported accommodation options through developing peer led safe spaces to enable ac-
   cess to peer led supported accommodation options as part of the suite of available services.

              Peer-led Safe Spaces provide an alternative to hospital through a peer-led,
              non-judgemental environment where people can be safe. Residential and social
              components focus on independent living and building relationships, meaningful
              connections and links to other services. Example: Piri Pono, New Zealand.
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