Royal Commission into Victoria's Mental Health System
- Recommendations
- 74
- Report length
- 120 pages
Summary
The report's own summary: Summary, pages 9 to 38
Generated summary: written by an AI model from the report text and checked against the cited pages.
The Royal Commission into Victoria’s Mental Health System reviewed the whole system and developed proposals for reform.
It considered service access, treatment, workforce capacity and the experiences of people living with mental illness, families and carers.
The Commission found that demand exceeded service capacity, community services were insufficient and people faced barriers to timely care.
It concluded that services depended too heavily on hospitals and crisis responses, with access affected by poverty and where people lived.
The Commission made 65 final recommendations, building on nine interim recommendations, to expand community care, strengthen oversight and support leadership by people with lived experience.
In the body's own words
- Finding
The system is overwhelmed and cannot keep up with the number of people who seek treatment, care and support.
- Finding
The system is complex and fragmented and, for those who do manage to get into it, difficult to navigate.
- Finding
There is an excessive use of restrictive practices and compulsory treatment.
Recommendations 74
A commission's findings and recommendations are not findings of criminal or civil liability.
Recommendation 1
The Royal Commission recommends that the Victorian Government establishes a new entity, the Victorian Collaborative Centre for Mental Health and Wellbeing. As a first step, the Mental Health Implementation Office should establish the governance of the Collaborative Centre and begin planning for a purpose-built facility in Melbourne. The Collaborative Centre will bring people with lived experience together with researchers and experts in multidisciplinary clinical and non-clinical care to develop and provide adult mental health services, conduct research and disseminate knowledge with the aim of delivering the best possible outcomes for people living with mental illness. The centre will work within a network of partners including service and research organisations in rural and regional areas. The Collaborative Centre will: • drive exemplary practice for the full and effective participation and inclusion of people with lived experience across the mental health system • conduct interdisciplinary, translational research into new treatments and models of care and support to inform service delivery, policy and law making • educate the mental health workforce through practice improvement, training and professional development programs. Models of care for the services the Collaborative Centre provides to its local community will reflect the Commission’s final redesign of Victoria’s mental health system.
Recommendation 2
The Royal Commission recommends that the Victorian Government, through the Victorian Health and Human Services Building Authority and the Mental Health Implementation Office, provides funding for 170 additional youth and adult acute mental health beds to help address critical demand pressures. The allocation should be as follows: • 135 additional acute inpatient public mental health beds or equivalent beds, with the majority of these delivered by the end of 2021 and the remainder by mid-2022, proportionally provided to Barwon Health and to Melbourne Health, the latter in alliance with Western Health and Northern Health, using the following criteria: predicted population growth, forecast bed availability, socio-economic need and the availability of primary and community-based health services • 35 additional acute inpatient mental health beds or equivalent beds procured by the end of 2021 from a private provider to deliver clinical treatment, care and support for public patients who would otherwise be treated in a public inpatient mental health unit. The design and establishment of the additional beds should: • be contemporary, co-designed with people with lived experience, and provide high-quality care in a hospital setting • involve public, private and community health service partnerships. Assertive outreach should be used to enable acute care in a home or community residence, where possible, as a direct substitute for an inpatient bed.
Recommendation 3
The Royal Commission recommends that the Victorian Government, through the Mental Health Implementation Office, expands follow-up care and support for people after a suicide attempt by recurrently funding all area mental health services to offer the Hospital Outreach Post-suicidal after Engagement (HOPE) program. To facilitate access to HOPE, the statewide rollout should be complemented by: • broad referral pathways to give people living with mental illness who are receiving care from clinical community-based teams within area mental health services access to HOPE • additional clinical outreach services in each sub-regional health service, networked to a regional health service HOPE program, to provide support for people living in rural and regional areas • extended service delivery that allows access to support whenever it is needed, including outside standard business hours. The Commission also recommends the creation, delivery and evaluation of the first phase of a new assertive outreach and follow-up care service for children and young people who have self-harmed or who are at risk of suicide.
Recommendation 4
The Royal Commission recommends that the Victorian Government, through the Mental Health Implementation Office, expands social and emotional wellbeing teams throughout Victoria and that these teams be supported by a new Aboriginal Social and Emotional Wellbeing Centre. This should be facilitated through the following mechanisms: • dedicated recurrent funding to establish and expand multidisciplinary social and emotional wellbeing teams in Aboriginal Community Controlled Health Organisations, with statewide coverage within five years • scholarships to enable Aboriginal social and emotional wellbeing team members to obtain recognised clinical mental health qualifications from approved public tertiary providers, with a minimum of 30 scholarships awarded over the next five years • recurrent funding for the Victorian Aboriginal Community Controlled Health Organisation to develop, host and maintain the recommended Aboriginal Social and Emotional Wellbeing Centre in partnership with organisations with clinical expertise and research expertise in Aboriginal mental health. The centre will help expand social and emotional wellbeing services through: – clinical, organisational and cultural governance planning and development – workforce development—including by enabling the recommended scholarships – guidance, tools and practical supports for building clinical effectiveness in assessment, diagnosis and treatment – developing and disseminating research and evidence for social and emotional wellbeing models and convening associated communities of practice.
Recommendation 5
The Royal Commission recommends that the Victorian Government establishes Victoria’s first residential mental health service designed and delivered by people with lived experience. This should be facilitated through the Mental Health Implementation Office in co-production with people with lived experience. This service should provide short-term treatment, care and support in a residential community setting as an alternative to acute hospital-based care, and be: • delivered and operationally managed by a workforce comprising a majority of people with lived experience, working across a range of disciplines • facilitated through a partnership between an area mental health service and a mental health community support service or a community health service • independently evaluated, with findings to inform continuous improvement and guide the expansion of similar services.
Recommendation 6
The Royal Commission recommends that the Victorian Government, through the Mental Health Implementation Office, expands the consumer and family-carer lived experience workforces and enhances workplace supports for their practice. This program of work should be co-produced with people with lived experience and representatives of lived experience workforces and be implemented across area mental health services and identified non-government organisations comprising: • the development and implementation of continuing learning and development pathways, educational and training opportunities and optional qualifications for lived experience workers, including adding the Certificate IV in Mental Health Peer Work to the free TAFE course list • new organisational structures, capability and programs within services to enable practice supports, including coaching and supervision for lived experience workers • delivery of a mandatory, organisational readiness and training program for senior leaders, and induction materials for new staff, that focus on building shared understanding of the value and expertise of lived experience workers • implementation of ongoing accountability mechanisms for measuring organisational attitudes and the experiences of lived experience workers, including establishing a benchmark in 2020 of the experience of lived experience workers.
Recommendation 7
The Royal Commission recommends that the Victorian Government, through the Mental Health Implementation Office, prepares for workforce reform and addresses workforce shortages by developing educational and training pathways and recruitment strategies by providing: • public mental health services in areas of need, including in rural and regional locations, through an expression of interest process that each year offers a minimum of: – 60 new funded graduate placements for allied health and other professionals – 120 additional funded graduate placements for nurses • postgraduate mental health nurse scholarships to 140 additional nurses each year that covers the full costs of study • an agreed proportion of junior medical officers to undertake a psychiatry rotation, effective from 2021, with it being mandatory for all junior medical officers by 2023 or earlier • overseas recruitment campaigns, including resources to assist mental health services to recruit internationally, new recruitment partnerships between organisations, and mentoring programs for new employees • a ‘mental health leadership network’ with representation across the state and the various disciplines, including lived experience workforces, supported to participate collaboratively in new learning, training and mentorship opportunities • the collation and publication of the profile of the mental health workforce across all geographic areas, disciplines, settings and sub-specialties • mechanisms for continuing data collection and analysis of workforce gaps and projections, and the regular mapping of the workforce to meet these gaps.
Recommendation 8
The Royal Commission recommends that the Victorian Government designs and implements a new approach to mental health investment comprising: • a new revenue mechanism (a levy or tax) for the provision of operational funding for mental health services • a dedicated capital investment fund for the mental health system. This new approach should support a substantial increase in investment in Victoria’s mental health system, supplementing the current level and future expected growth of the state’s existing funding commitments.
Recommendation 9
The Royal Commission recommends that the Victorian Government establishes a Mental Health Implementation Office—a new administrative office in relation to the Department of Health and Human Services under the Public Administration Act 2004 (Vic). The Implementation Office is to implement the Commission’s recommendations as set out in the interim report. It will operate for two years while the Commission designs final governance arrangements for the mental health system and should: • develop and publicly commit to a program of work and report annually through the Victorian Parliament on its progress against outcome measures and targets • employ and commission people with specialist skills and diverse expertise, including people with lived experience, to respond to the Commission’s recommendations • work closely with the Commission to ensure implementation of the Commission’s recommendations stay true to the original vision and intent.
Recommendation 1
The Royal Commission recommends that the Victorian Government: 1. build on the interim report’s nine recommendations and develop a Mental Health and Wellbeing Outcomes Framework to drive collective responsibility and accountability for mental health and wellbeing outcomes across government portfolios. 2. through a newly established Mental Health and Wellbeing Cabinet Subcommittee, chaired by the Premier (refer to recommendation 46(2)(a)), use the Mental Health and Wellbeing Outcomes Framework to monitor outcomes to inform planning and policy decisions. 3. use the Mental Health and Wellbeing Outcomes Framework as a mechanism to inform government investment processes and assess the benefits, including the economic benefits, of early intervention. 4. update the Mental Health and Wellbeing Outcomes Framework and publicly report on progress against outcomes at a service, system and population level, every year.
Recommendation 2
The Royal Commission recommends that the Victorian Government: 1. establish within the Mental Health and Wellbeing Division, a Mental Health and Wellbeing Promotion Office, led by a Mental Health and Wellbeing Promotion Adviser, who reports to the Chief Officer for Mental Health and Wellbeing (refer to recommendation 45(1)). 2. enable the Mental Health and Wellbeing Promotion Office to develop and coordinate a statewide approach to the promotion of good mental health and wellbeing and the prevention of mental illness which: a. delivers the economic and social benefits of good mental health and wellbeing across the population; b. is informed by public health principles; c. promotes and is informed by human rights; and d. focuses on reducing inequities in mental health and wellbeing outcomes.
Recommendation 3
The Royal Commission recommends that the Victorian Government: 1. establish a responsive and integrated mental health and wellbeing system, in which people receive most services locally and in the community throughout Victoria, close to their families, carers, supporters and networks. 2. establish service delivery across Victoria at local, area-based and statewide levels comprising: a. between 50 to 60 new Adult and Older Adult Local Mental Health and Wellbeing Services that operate with extended hours and are delivered in a variety of settings; b. 22 Adult and Older Adult Area Mental Health and Wellbeing Services delivered through partnerships between public health services or public hospitals and non-government organisations that deliver wellbeing supports; c. 13 Infant, Child and Youth Area Mental Health and Wellbeing Services delivered through partnerships between public health services or public hospitals and non-government organisations that deliver wellbeing supports; and d. statewide services that are delivered in a way that minimises the need for people to travel far to access services. 3. for planning and governance purposes, realign existing boundaries and organise mental health and wellbeing services across eight regions (refer to recommendation 4). 4. remove rigid boundaries (or catchments) for service delivery based on where people live. 5. establish the requirements for each service and the links between them through a ‘service capability framework’.
Recommendation 4
The Royal Commission recommends that the Victorian Government: 1. by mid 2021, establish eight interim regional bodies to provide advice to the Mental Health and Wellbeing Division in the Department of Health as it plans, develops, coordinates, funds and monitors a range of mental health and wellbeing services in each region. 2. by no later than the end of 2023, replace interim regional bodies with legislated Regional Mental Health and Wellbeing Boards to: a. undertake workforce, service and capital planning for mental health and wellbeing services; and b. lead engagement with their respective communities. 3. from the end of 2023 and by no later than the end of 2026, enable each Regional Mental Health and Wellbeing Board also to: a. commission mental health and wellbeing services; and b. hold individual providers to account to improve the outcomes and experiences of people who use their services. 4. in parallel with the establishment process, ensure that Regional Mental Health and Wellbeing Boards: a. acquire and maintain the required skills and capabilities to perform the above functions; b. are accountable for the delivery of agreed outcomes through new accountability arrangements; and c. are skills-based and include at least one person with lived experience of mental illness or psychological distress and one person with lived experience as a family member or carer. 5. with the assistance of the interim regional bodies, establish a multiagency panel in each region to coordinate as required the delivery of multiple mental health and wellbeing services for people living with mental illness or psychological distress, including children and young people, who may require ongoing intensive treatment, care and support.
Recommendation 5
The Royal Commission recommends that the Victorian Government: 1. commission and ensure that Adult and Older Adult Local Mental Health and Wellbeing Services and Adult and Older Adult Area Mental Health and Wellbeing Services referred to in recommendation 3(2)(a) and (b) work in collaboration to deliver in each of the 22 service areas short-term, ongoing and intensive services as required and include the following core functions: a. Core function 1: integrated treatment, care and support that comprises: • a broad range of treatments and therapies; • a broad range of wellbeing supports (formerly called psychosocial supports) for those who require them, including those who are unable to access the National Disability Insurance Scheme; • education, peer support and self-help; and • care planning and coordination. b. Core function 2: services to help people find and access treatment, care and support and, in Area Mental Health and Wellbeing Services, respond to crises 24 hours a day, seven days a week. c. Core function 3: support for primary and secondary care and related services, through primary consultation with consumers, secondary consultation with providers of those services and a formal model of comprehensive shared care. 2. commission and ensure that Adult and Older Adult Local Mental Health and Wellbeing Services and Adult and Older Adult Area Mental Health and Wellbeing Services referred to in recommendation 3(2)(a) and (b) work in collaboration to deliver multidisciplinary, holistic and integrated treatment, care and support through a range of delivery modes including: a. site-based care (such as centres or clinics); b. telehealth; c. digital technologies; and d. visits to people’s homes and other places (including targeted assertive outreach). 3. ensure Adult and Older Adult Local Mental Health and Wellbeing Services and Adult and Older Adult Area Mental Health and Wellbeing Services are accessible and responsive to the diversity of local communities.
Recommendation 6
The Royal Commission recommends that the Victorian Government: 1. ensure people can access Local Mental Health and Wellbeing Services through a referral from a general practitioner or any other service provider, or through a discussion with the relevant service’s access and navigation support worker. 2. ensure people can access Area Mental Health and Wellbeing Services through a referral from a Local Mental Health and Wellbeing Service or through direct referral from a medical practitioner. 3. ensure people can access Statewide Mental Health and Wellbeing Services through a referral from an Area Mental Health and Wellbeing Service. 4. promote, and co-produce with people with lived experience, a website that provides clear, up-to-date information about Victoria’s mental health and wellbeing system that helps users to: a. understand their mental health needs; b. identify services and supports across all relevant provider types; and c. access online self-help resources. 5. collaborate with its funded non-government helpline services to improve helplines’ connections with mental health and wellbeing services and to assist people to find and access treatment, care and support.
Recommendation 7
The Royal Commission recommends that the Victorian Government: 1. ensure mental health and wellbeing services provide three ‘needs identification and initial support’ functions: a. access and navigation support; b. initial support discussions; and c. comprehensive needs assessment and planning discussions. 2. ensure these functions are delivered based on a philosophy of ‘how can we help?’ to enable people to be supported from their first to their last contact with mental health and wellbeing services.
Recommendation 8
The Royal Commission recommends that the Victorian Government: 1. ensure each Adult and Older Adult Area Mental Health and Wellbeing Service delivers a centrally coordinated 24-hours-a-day telephone/telehealth crisis response service accessible to both service providers and to members of the community of all ages that provides: a. crisis assessment and immediate support; b. mobilisation of a crisis outreach team or emergency service response where necessary; and c. referral for follow-up by mental health and wellbeing services and/or other appropriate services. 2. expand crisis outreach services in each Adult and Older Adult Area Mental Health and Wellbeing Service to provide treatment, care and support from a clinician and non-clinical worker such as a peer worker. 3. improve emergency departments’ ability to respond to mental health crises by: a. establishing a classification framework for all emergency departments and urgent care centres, based on their capability to respond to people experiencing mental health crises; b. using the classification framework to ensure that health services are appropriately resourced to perform their role in a regional network of emergency departments and urgent care centres; and c. ensuring there is at least one highest-level emergency department suitable for mental health and alcohol and other drug treatment in each region.
Recommendation 9
The Royal Commission recommends that the Victorian Government: 1. invest in diverse and innovative ‘safe spaces’ and crisis respite facilities for the resolution of mental health and suicidal crises which are consumer led and, where appropriate, delivered in partnership with non-government organisations. 2. in collaboration with the new agency led by people with lived experience of mental illness or psychological distress (refer to recommendation 29) and non-government organisations that deliver wellbeing supports, establish: a. one drop-in or crisis respite facility for adults and older Victorians per region (refer to recommendation 3(3)); and b. four safe space facilities across the state, comprising a mix of drop-in spaces and crisis response services, co-designed with and for young people. 3. establish a crisis stabilisation facility, in consultation with people with lived experience, led by a public health service or public hospital in partnership with a non-government organisation that delivers wellbeing supports.
Recommendation 10
The Royal Commission recommends that the Victorian Government: 1. ensure that, wherever possible, emergency services’ responses to people experiencing time-critical mental health crises are led by health professionals rather than police. 2. support Ambulance Victoria, Victoria Police and the Emergency Services Telecommunications Authority to work together to revise current protocols and practices such that, wherever possible and safe: a. Triple Zero (000) calls concerning mental health crises are diverted to Ambulance Victoria rather than Victoria Police; and b. responses to mental health crises requiring the attendance of both ambulance and police are led by paramedics (with support from mental health clinicians where required). 3. ensure that mental health clinical assistance is available to ambulance and police via: a. 24-hours-a-day telehealth consultation systems for officers responding to mental health crises; b. in-person co-responders in high-volume areas and time periods; and c. diversion secondary triage and referral services for Triple Zero (000) callers who do not require a police or ambulance dispatch.
Recommendation 11
The Royal Commission recommends that the Victorian Government: 1. review, reform and implement new models of multidisciplinary care for bed-based services that are delivered in a range of settings, including in a person’s home and in fit-for-purpose community and hospital environments. 2. deliver a broad range of bed-based services, including as a matter of immediate priority: a. expanding Hospital in the Home services as an alternative to acute hospital-based treatment, care and support where appropriate; b. investing in a wide range of time-limited and flexible residential respite services informed by local priorities, including establishing a peer-led residential respite service at a demonstration site; and c. developing new bed-based rehabilitation services (refer to recommendation 12). 3. build on the interim report’s recommendation 2 about the need for the expansion of acute mental health services and deliver at least 100 additional beds in settings that reflect optimal allocation and distribution across Victoria. 4. periodically review the allocation of new beds as part of the statewide and regional planning processes recommended by the Royal Commission (refer to recommendation 47) and audit the outcomes.
Recommendation 12
The Royal Commission recommends that the Victorian Government: 1. implement the new whole-of-system rehabilitation pathway described by the Royal Commission in its final report, which includes two new bed-based rehabilitation models of care, for people living with mental illness who require ongoing intensive treatment, care and support. 2. consistent with the ‘design and quality features’ described by the Royal Commission in its final report, co-design with consumers, clinicians and relevant non-government organisations and services: a. the new community rehabilitation model of care and deliver it at a community care unit demonstration site; and b. the new intensive rehabilitation model of care and deliver it at a secure extended care unit demonstration site. 3. subject to the evaluation and required adaptation of the new rehabilitation models of care, apply these models to existing community care and secure extended care units and enhance and expand infrastructure accordingly.
Recommendation 13
The Royal Commission recommends that the Victorian Government: 1. ensure that all new mental health inpatient facilities: a. are built and designed with the necessary scale and flexible infrastructure to enable gender-based separation in all bedrooms and bathrooms; and b. provide separate communal spaces as required. 2. by mid-2022, ensure that existing high dependency units in inpatient facilities allow for gender-based separation. 3. review and retrofit existing inpatient facilities on a case-by-case basis to: a. achieve gender-based separation where possible; and b. as a matter of priority, ensure that each facility meets the minimum standards for gender safety set out in the Chief Psychiatrist’s guideline: Promoting sexual safety, responding to sexual activity and managing allegations of sexual assault in adult acute inpatient units. 4. ensure that the Mental Health and Wellbeing Division supports mental health and wellbeing services to eliminate sexual and gender-based violence in bed-based service settings.
Recommendation 14
The Royal Commission recommends that the Victorian Government: 1. work with the Independent Hospital Pricing Authority and the Commonwealth Government to: a. ensure mental health consultation liaison services for consumers admitted for physical health reasons are formally recognised and adequately funded as part of routine care; and b. ensure mental health consultation liaison services are incorporated, costed and priced in the relevant classifications and standards. 2. ensure public health services and public hospitals: a. receive adequate temporary funding to embed and deliver in-hospital mental health consultation liaison services as part of routine care until joint funding arrangements between the Commonwealth and Victorian Governments are established; b. are accountable for delivering in-hospital mental health consultation liaison services and, whenever required, provide such services to consumers admitted for physical health reasons; and c. are accountable for providing the sustained delivery of high-quality integrated mental health treatment, care and support across the hospital system.
Recommendation 15
The Royal Commission recommends that the Victorian Government: 1. establish and recurrently resource ‘community collectives’ for mental health and wellbeing in each local government area. 2. support each community collective to bring together a diversity of local leaders and community members to guide and lead efforts to promote social connection and inclusion in Victorian communities. 3. test and develop a range of initiatives that support community participation, inclusion and connection. 4. by the end of 2022, establish one social prescribing trial per region (refer to recommendation 3(3)) in Local Mental Health and Wellbeing Services to support healthcare professionals to refer people, particularly older Victorians, living with mental illness, into community initiatives.
Recommendation 16
The Royal Commission recommends that the Victorian Government: 1. as an initiative of the Mental Health and Wellbeing Cabinet Subcommittee (refer to recommendation 46(2)(a)): a. foster the commitment of employers to create mentally healthy workplaces; b. advise on, develop and provide resources to assist employers and employees across Victorian businesses to: • promote good mental health in workplaces; • address workplace barriers to good mental health; • promote inclusive workplaces that are free from stigma and discrimination; and • support people experiencing mental illness at work. 2. sponsor industry-based trials to demonstrate how to adapt and implement comprehensive mentally healthy workplace approaches in an industry context.
Recommendation 17
The Royal Commission recommends that the Victorian Government: 1. fund evidence-informed initiatives, including anti-stigma and anti-bullying programs, to assist schools in supporting students’ mental health and wellbeing. 2. develop a digital platform that contains a validated list of these initiatives. 3. develop a fund, modelled on School Readiness Funding for kindergartens, to support schools, with priority given to those in rural and regional areas, to select the most appropriate suite of initiatives for them.
Recommendation 18
The Royal Commission recommends that the Victorian Government: 1. expand and reform the community perinatal mental health teams in each Adult and Older Adult Area Mental Health and Wellbeing Service across Victoria to adapt and deliver the core functions as set out in recommendation 5, including by providing consultation to primary and secondary care and related services for prospective and new parents, including maternal and child health nurses. 2. review approaches to perinatal mental health screening.
Recommendation 19
The Royal Commission recommends that the Victorian Government: 1. establish one responsive and integrated infant, child and youth mental health and wellbeing system to provide developmentally appropriate mental health and wellbeing treatment, care and support for newborns to 25-year-olds. 2. by the end of 2022, establish a dedicated service stream for infants, children and their families, consisting of Infant, Child and Family Area Mental Health and Wellbeing Services, within the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(c)) to: a. provide developmentally appropriate mental health and wellbeing treatment, care and support services for newborns to 11-year-olds and their families; and b. adapt and deliver the core functions of community mental health and wellbeing services (refer to recommendation 5), including through a range of delivery modes, ensuring services are accessible and responsive to the diversity of local communities. 3. by the end of 2022, and in partnership with the Commonwealth, establish three infant, child and family health and wellbeing multidisciplinary community-based hubs. 4. deliver evidence-informed online parenting programs and group-based parenting sessions. 5. establish two statewide subacute residential family admission centres located in the community.
Recommendation 20
The Royal Commission recommends that the Victorian Government: 1. by the end of 2022, establish a dedicated service stream for young people, consisting of Youth Area Mental Health and Wellbeing Services, within the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(c)) to: a. appropriately adapt and deliver the core functions of community mental health and wellbeing services set out in recommendation 5, including through a range of delivery modes and ensuring services are accessible and responsive to the diversity of local communities; and b. provide both short-term and ongoing treatment, care and support to young people, including those who require ongoing intensive treatment, care and support. 2. ensure Youth Area Mental Health and Wellbeing Services are available for young people aged 12 to 25 (until a person’s 26th birthday), with age boundaries and transitions to be applied flexibly by services in partnership with young people and their families, carers and supporters. 3. support the development of formal partnerships, step-up and step-down referral pathways, shared staff and infrastructure and co-location between headspace centres and Infant, Child and Youth Area Mental Health and Wellbeing Services. 4. work with the Commonwealth Government, headspace National and Primary Health Networks to ensure that Infant, Child and Youth Area Mental Health and Wellbeing Services become the preferred providers of headspace centres where they exist or are established in Victoria.
Recommendation 21
The Royal Commission recommends that the Victorian Government: 1. review, reform and implement new models of multidisciplinary care for bed-based services for young people that are delivered in a range of settings, including in young people’s homes and in fit-for-purpose community and hospital environments. 2. deliver a broad range of bed-based services, including as a matter of immediate priority: a. ensuring every region has a Youth Prevention and Recovery Centre for young people aged 16 to 25, supported through a common and consistent model of care; b. creating a new stream of inpatient beds across Victoria for young people aged 18 to 25 by reconfiguring existing inpatient beds for adults and using an allocation of the 100 new beds referred to in recommendation 11(3); and c. ensuring Hospital in the Home services are available for young people as an alternative to acute hospital-based treatment, care and support where appropriate. 3. formally review the Youth Residential Rehabilitation Program, in consultation with young people, as well as families, carers and supporters.
Recommendation 22
The Royal Commission recommends that the Victorian Government: 1. establish a responsive and integrated mental health and wellbeing service stream for older Victorians, that focuses on improving their mental health and wellbeing outcomes. 2. ensure older Victorians have access to the same mental health treatment, care and support as the rest of the adult population. 3. establish older adult mental health and wellbeing specialist multidisciplinary teams in Adult and Older Adult Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(b)), to: a. provide specialist mental health treatment, care and support for people with complex and compounding mental health needs generally related to ageing; and b. assist primary and secondary care and related services that support older Victorians, including aged care, through primary consultation, secondary consultation and shared care.
Recommendation 23
The Royal Commission recommends that the Victorian Government: 1. by the end of 2022, establish a Statewide Trauma Service hosted within the Collaborative Centre for Mental Health and Wellbeing, to deliver the best possible mental health and wellbeing outcomes for people of all ages with lived experience of trauma. 2. fund the Statewide Trauma Service to bring together mental health practitioners, trauma experts, peer workers and consumers with lived experience of trauma to: a. conduct multidisciplinary and translational trauma research; b. develop and deliver education and training that supports Victoria’s mental health and wellbeing workforce to deliver trauma-informed care; c. develop and oversee digital peer-led support platforms offering consumers access to peer support networks; and d. coordinate and facilitate access to specialist trauma expertise, including secondary consultation for mental health practitioners and peer workers across Victoria’s mental health and wellbeing system.
Recommendation 24
The Royal Commission recommends that the Victorian Government: 1. in collaboration with the Statewide Trauma Service (refer to recommendation 23), enable each of the 22 Adult and Older Adult Area Mental Health and Wellbeing Services and each of the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(b) and (c)) to employ up to three specialist trauma practitioners to: a. work with peer support workers in Local Mental Health and Wellbeing Services to provide and facilitate access to a broad range of trauma supports for consumers of all ages and backgrounds; and b. contribute to the ongoing learning and professional development of the mental health and wellbeing workforce through supervision, consultation and shared clinical care.
Recommendation 25
The Royal Commission recommends that the Victorian Government: 1. recognise people who are living with mental illness as a priority population group as part of Victoria’s 10-year strategy for social and affordable housing and ensure that, during the next decade, people living with mental illness are allocated a continuing substantial proportion of social and affordable housing. 2. revise the Victorian Housing Register’s Special Housing Needs ‘priority access’ categories to include people living with mental illness, including people who need ongoing intensive treatment, care and support. 3. ensure that the 2,000 dwellings assigned to Victorians living with mental illness in the Big Housing Build are delivered as supported housing and are prioritised for people living with mental illness who require ongoing intensive treatment, care and support, with Area Mental Health and Wellbeing Services assisting with the selection process. 4. in addition to the 2,000 dwellings, invest in a further 500 new medium-term (up to two years) supported housing places for young people aged between 18 to 25 who are living with mental illness and experiencing unstable housing or homelessness. 5. ensure that the supported housing homes for adults and young people living with mental illness are: a. delivered in a range of housing configurations including stand-alone units, self-contained units with shared amenities and various forms of clustered independent units on a single-site property; b. appropriately located, provide for the requirements of people living with mental illness and are co-designed by Homes Victoria, representatives appointed by the Mental Health and Wellbeing Division and people with lived experience of mental illness; and c. accompanied by an appropriate level of integrated, multidisciplinary and individually tailored mental health and wellbeing treatment, care and support. 6. periodically review the allocation of supported housing homes as part of the statewide and regional planning processes recommended by the Royal Commission (refer to recommendation 47) and audit the outcomes.
Recommendation 26
The Royal Commission recommends that the Victorian Government: 1. establish in the Mental Health and Wellbeing Division, a Suicide Prevention and Response Office, led by a State Suicide Prevention and Response Adviser who reports to the Chief Officer for Mental Health and Wellbeing (refer to recommendation 45(1)). 2. enable the Suicide Prevention and Response Office to: a. establish a system-based approach to suicide prevention and response efforts; b. work with people with lived experience of suicidal behaviour, family members and carers, and people with lived experience of bereavement by suicide to co-produce, implement and monitor a new suicide prevention and response strategy for Victoria; c. work closely with the Commonwealth Government to ensure suicide prevention and response efforts in Victoria are coordinated with, and complement, national approaches; d. facilitate a community-wide and government-wide approach to suicide prevention and response efforts; e. work within governance structures that encompass all government departments and relevant agencies, with Deputy Secretary and Secretary level membership; and f. employ people with lived experience of suicidal behaviour, family members and carers, and people with lived experience of bereavement by suicide.
Recommendation 27
The Royal Commission recommends that the Victorian Government: 1. build on the interim report’s recommendation 3 on suicide prevention and response and develop initiatives to support people experiencing suicidal behaviour including: a. providing training in appropriate responses for members of workforces likely to come into contact with people experiencing suicidal behaviour; b. providing free, online evidence-informed ‘community gatekeeper training’ for Victorians to develop suicide awareness and prevention skills; c. enabling Aboriginal people to design culturally safe ‘community gatekeeper training’ for Aboriginal people; and d. facilitating Victorian industries and businesses to invest in evidence-informed workplace suicide prevention and response programs, with an initial focus on forming partnerships with high-risk industries. 2. develop initiatives to support people at risk of experiencing suicidal behaviour, by: a. co-producing an aftercare service for lesbian, gay, bisexual, trans and gender diverse, intersex, queer and questioning people following a suicide attempt; and b. in partnership with the Commonwealth Government, implementing statewide postvention bereavement support, so that every person bereaved by suicide is automatically referred to a postvention bereavement provider. 3. develop an intensive 14-day support program for adults who are experiencing psychological distress, modelled on Scotland’s Distress Brief Intervention program.
Recommendation 28
The Royal Commission recommends that the Victorian Government: 1. in addition to the nominated roles specified in other recommendations, develop key roles across the mental health and wellbeing system for people with lived experience of mental illness or psychological distress. 2. enable the Mental Health and Wellbeing Commission (refer to recommendation 44) to: a. elevate the leadership and support the full and effective participation of people with lived experience of mental illness or psychological distress in decision-making about policies and programs, including those directly affecting them; b. develop and support the leadership capabilities of people with lived experience of mental illness or psychological distress through learning and development opportunities; c. design and deliver initiatives to prevent and address stigma towards people living with mental illness or psychological distress; and d. design and deliver initiatives to develop awareness and understanding of the experiences and perspectives of people with lived experience of mental illness or psychological distress.
Recommendation 29
The Royal Commission recommends that the Victorian Government: 1. build on the interim report’s recommendation 5 and establish a new non-government agency, overseen by a skills-based board chaired by and consisting of a majority of people with lived experience of mental illness or psychological distress, to: a. deliver accredited training and resources to aid the development of organisations led by people with lived experience of mental illness or psychological distress; b. develop and deliver mental health and wellbeing services led by people with lived experience of mental illness or psychological distress; and c. facilitate co-location, shared resourcing, learning opportunities and the creation of new partnerships and networks between people with lived experience of mental illness or psychological distress and the organisations they lead.
Recommendation 30
The Royal Commission recommends that the Victorian Government: 1. in addition to the nominated roles specified in other recommendations, develop key roles across the mental health and wellbeing system for people with lived experience as family members and carers. 2. enable the Mental Health and Wellbeing Commission (refer to recommendation 44) to: a. elevate the leadership and promote the valued role of family members and carers of people living with mental illness or psychological distress throughout the mental health and wellbeing system; and b. develop and support the leadership and governance capabilities of families and carers of people living with mental illness or psychological distress through learning and development opportunities. 3. ensure that: a. in commissioning mental health and wellbeing services, expectations are set for working with families, carers and supporters; b. families, carers and supporters are included in a range of therapeutic interventions in each Area Mental Health and Wellbeing Service; and c. working with families, carers and supporters is part of system-wide workforce training. 4. in addition to reforms to improve information sharing outlined in other recommendations, develop standards for services and practitioners to guide the sharing of appropriate information with families, carers and supporters.
Recommendation 31
The Royal Commission recommends that the Victorian Government: 1. by the end of 2022, commission non-government organisations to use consistent branding and deliver one family and carer-led centre in each of the eight regions (refer to recommendation 3(3)) to: a. provide tailored information and supports for families, carers and supporters in the region; b. work with families, carers and supporters to help identify their needs and connect them to the supports that will best respond to those needs; c. provide access to increased funds for immediate practical needs including short-term respite (brokerage); and d. deliver support for family and carer peer support groups in the region. 2. establish a statewide peer call-back service for families, carers and supporters caring for people experiencing suicidal behaviour. 3. ensure there is tailored information for families, carers and supporters, such as on the new statewide mental health website (refer to recommendation 6(4)).
Recommendation 32
The Royal Commission recommends that the Victorian Government: 1. by the end of 2022, fund a non-government organisation such as the Satellite Foundation to co-design and expand the range of supports across Victoria for young carers and children and young people who have a family member living with mental illness or psychological distress. 2. by the end of 2022, broaden the scope and reach of the Families where a Parent has a Mental Illness program, including by: a. enabling each Area Mental Health and Wellbeing Service to employ new workers to support young carers in their local environment; and b. increasing the funding available to young carers to help with practical needs (brokerage). 3. strengthen identification and referral pathways for young carers through the mental health and education systems.
Recommendation 33
The Royal Commission recommends that the Victorian Government: 1. build on the interim report’s recommendation 4 to support Aboriginal social and emotional wellbeing, and resource the Social and Emotional Wellbeing Centre to establish two co-designed healing centres. 2. resource Infant, Child and Youth Area Mental Health and Wellbeing Services to support Aboriginal community-controlled health organisations by providing primary consultation, secondary consultation and shared care. 3. resource Aboriginal community-controlled health organisations to commission the delivery of culturally appropriate, family-oriented, social and emotional wellbeing services for children and young people. 4. resource the Victorian Aboriginal Community Controlled Health Organisation, in partnership with an Infant, Child and Youth Area Mental Health and Wellbeing Service, to design and establish a culturally appropriate, family-oriented service for infants and children who require intensive social and emotional wellbeing supports.
Recommendation 34
The Royal Commission recommends that the Victorian Government: 1. ensure the active engagement of Victoria’s diverse communities throughout the process of planning, implementing and managing the reformed mental health and wellbeing system. 2. legislatively provide that the Secretary of the Department of Health is responsible for the delivery of a mental health and wellbeing system that responds to the needs of Victoria’s diverse communities and promotes access and equity of outcomes, with this function able to be delegated to the Chief Officer for Mental Health and Wellbeing (refer to recommendation 45(1)). 3. ensure that the Mental Health and Wellbeing Division: a. collects, analyses and reports on data on the mental health and wellbeing of Victoria’s diverse communities for planning and funding purposes and to improve transparency in mental health and wellbeing outcomes for diverse communities; b. ensures that Victorians, regardless of first or preferred language, hearing, literacy or neurocognitive ability, have access to appropriate mental health and wellbeing information and means of communication throughout the mental health and wellbeing system; c. enables Victoria’s diverse communities and community-led organisations to: • design and deliver mental health and wellbeing information and awareness campaigns; and • assist their communities to navigate the mental health and wellbeing system. 4. by the end of 2021, provide recurrent funding to Switchboard Victoria to deliver its Rainbow Door program, at scale, to support people who identify as lesbian, gay, bisexual, trans and gender diverse, intersex, queer and questioning to navigate and access the mental health and wellbeing system. 5. enable the development of digital technologies to support the delivery of language services that assist access to and engagement with mental health and wellbeing services.
Recommendation 35
The Royal Commission recommends that the Victorian Government: 1. by the end of 2022, in addition to ensuring there is at least one highest-level emergency department suitable for mental health and alcohol and other drug treatment in every region (refer to recommendations 3(3) and 8(3)(c)), ensure that all mental health and wellbeing services, across all age-based systems, including crisis services, community-based services and bed-based services: a. provide integrated treatment, care and support to people living with mental illness and substance use or addiction; and b. do not exclude consumers living with substance use or addiction from accessing treatment, care and support.
Recommendation 36
The Royal Commission recommends that the Victorian Government: 1. establish a new statewide specialist service, built on the foundations established by the Victorian Dual Diagnosis Initiative, to: a. undertake dedicated research into mental illness and substance use or addiction; b. support education and training initiatives for a broad range of mental health and alcohol and other drug practitioners and clinicians; c. provide primary consultation to people living with mental illness and substance use or addiction who have complex support needs; and d. provide secondary consultation to mental health and wellbeing and alcohol and other drug practitioners and clinicians across both sectors. 2. as a matter of priority, increase the number of addiction specialists (addiction medicine physicians and addiction psychiatrists) in Victoria. 3. work with the Commonwealth Government to explore opportunities for funded addiction specialist trainee positions in Victoria.
Recommendation 37
The Royal Commission recommends that the Victorian Government: 1. expand the Assessment and Referral Court to each of the 12 headquarter Magistrates’ Courts to meet demand at both existing and new locations. 2. expand the existing forensic community model to: a. enable Adult and Older Adult Area Mental Health and Wellbeing Services and Infant, Child and Youth Area Mental and Wellbeing Services (refer to recommendation 3(2)(b) and (c)) to provide consistency in treatment, care and support to people in contact with, or at risk of coming into contact with, the criminal justice system; and b. establish the specialist behaviour response team described by the Royal Commission in its final report. 3. establish a program for people in prison living with mental illness who require ongoing intensive treatment, care and support to transition the delivery of supports from correctional settings to the mainstream mental health and wellbeing system upon their release. 4. expand specialist youth forensic mental health programs to a statewide model, including across the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(c)), to provide consistent and appropriately specialised treatment, care and support to children and young people in contact with, or at risk of coming into contact with, the youth justice system.
Recommendation 38
The Royal Commission recommends that the Victorian Government: 1. in line with master planning for Thomas Embling Hospital and the proposal of the Victorian Health and Human Services Building Authority: a. refurbish the existing 136 beds; and b. by the end of 2026, provide an additional 107 beds, a small number of which should be allocated for people living with mental illness whose treatment, care and support requirements cannot be safely and appropriately met in acute inpatient settings or through the forensic community model (refer to recommendation 37(2)). 2. provide up to 20 beds, in addition to the 107 beds referred to in recommendation 38(1) (b) and the additional beds in recommendation 11(3), to support people living with mental illness whose treatment, care and support requirements cannot be, or are unlikely to be, safely and effectively met in other extended rehabilitation settings.
Recommendation 39
The Royal Commission recommends that the Victorian Government: 1. in addition to ensuring rural and regional communities receive the benefits of the Royal Commission’s recommended responsive and integrated mental health and wellbeing system: a. provide additional resources to enable mental health and wellbeing services operating in regional Victoria to deliver services to small or geographically isolated rural communities; and b. by the end of 2022, trial two new digital service delivery initiatives in rural and regional areas that meet the needs of local communities.
Recommendation 40
The Royal Commission recommends that the Victorian Government: 1. address mental health and wellbeing workforce supply needs in rural and regional areas and establish an incentive scheme to: a. attract mental health and wellbeing workers to rural and regional mental health and wellbeing services; and b. retain mental health and wellbeing workers in such services.
Recommendation 41
The Royal Commission recommends that the Victorian Government: 1. fund and support the Mental Health and Wellbeing Commission (refer to recommendation 44) to work with a network of partners, including research organisations, to lead the design and delivery of anti-stigma programs that: a. continue on a long-term basis; and b. aim to reduce the impact of stigma in a range of settings including, but not limited to, healthcare settings, workplaces and schools. 2. design and deliver an anti-stigma grants program to: a. support community-led organisations and community members to deliver projects that challenge stigma in Victorian settings and communities; and b. focus, as an immediate priority, on communities and social groups at increased risk of stigma. 3. conduct a comprehensive evaluation of anti-stigma efforts to: a. develop evidence about effective ways to address mental health stigma across Victoria; and b. inform the design and delivery of anti-stigma programs. 4. support and establish mechanisms to: a. address systemic issues of mental health discrimination; b. enhance individual access to legal protection from mental health discrimination; and c. enable one or two independent legal services with a demonstrated connection or ability to connect with people with lived experience of mental illness or psychological distress to initiate legal claims, including test cases relating to systemic mental health discrimination.
Recommendation 42
The Royal Commission recommends that the Victorian Government: 1. repeal the Mental Health Act 2014 (Vic) and enact a new Mental Health and Wellbeing Act, preferably by the end of 2021 and no later than mid-2022, to: a. promote good mental health and wellbeing; b. reset the legislative foundations underpinning the mental health and wellbeing system; and c. support the delivery of services that are responsive to the needs and preferences of Victorians. 2. ensure the Mental Health and Wellbeing Act: a. includes new objectives and mental health principles, with its primary objective to achieve the highest attainable standard of mental health and wellbeing for the people of Victoria by: • promoting conditions in which people can experience good mental health and wellbeing; • reducing inequities in access to, and the delivery of, mental health and wellbeing services; and • providing a diverse range of comprehensive, safe and high-quality mental health and wellbeing services. b. clarifies the roles, responsibilities and governance arrangements of the new mental health and wellbeing system; c. establishes the bodies and roles referred to in other recommendations, including the Mental Health and Wellbeing Commission (refer to recommendation 44), the Chief Officer for Mental Health and Wellbeing (refer to recommendation 45(1)) and Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)); d. strengthens accountability mechanisms and monitoring arrangements for service delivery; e. specifies measures to reduce rates and negative impacts of compulsory assessment and treatment, seclusion and restraint; f. simplifies and clarifies the statutory provisions relating to compulsory assessment and treatment such that they are no longer the defining feature of Victoria’s mental health laws; and g. specifies the ways in which information about mental health and wellbeing may be collected and used.
Recommendation 43
The Royal Commission recommends that the Victorian Government: 1. commission an independent review of Victoria’s mental health laws five to seven years after the enactment of the Mental Health and Wellbeing Act. 2. co-design terms of reference for the review that focus on ensuring mental health laws remain contemporary, effective and responsive to the needs and preferences of consumers, families, carers and supporters. 3. as part of this review, consider the role and functions of the Mental Health Tribunal and Chief Psychiatrist to ensure they remain appropriate.
Recommendation 44
The Royal Commission recommends that the Victorian Government: 1. establish an independent statutory authority, the Mental Health and Wellbeing Commission, to: a. hold government to account for the performance and quality and safety of the mental health and wellbeing system; b. support people living with mental illness or psychological distress, families, carers and supporters to lead and partner in the improvement of the system; c. monitor the Victorian Government’s progress in implementing the Royal Commission’s recommendations; and d. address stigma related to mental health. 2. ensure the Mental Health and Wellbeing Commission: a. is led by a Chair Commissioner and who is supported by a small group of Commissioners, all of whom are appointed by the Governor-in-Council; and b. includes at least one Commissioner with lived experience of mental illness or psychological distress and one Commissioner with lived experience as a family member or carer. 3. enable the Mental Health and Wellbeing Commission to: a. obtain data and information about mental health and wellbeing service delivery, system performance and outcomes, and other relevant information, from all government agencies; b. work with and share data and information with the Department of Health and other relevant entities (for example, the Collaborative Centre for Mental Health and Wellbeing and Safer Care Victoria); c. initiate its own inquiries into matters that support its objectives; d. handle and investigate complaints about mental health and wellbeing service delivery; e. make recommendations to the Premier, any minister and the heads of public service bodies; and f. publish reports on the performance and quality and safety of the mental health and wellbeing system.
Recommendation 45
The Royal Commission recommends that the Victorian Government: 1. establish in legislation the role of Chief Officer for Mental Health and Wellbeing to lead the Mental Health and Wellbeing Division in the Department of Health, and set out in that legislation that this Chief Officer is: a. delegated the functions and powers conferred on the Secretary of the Department of Health under the new Mental Health and Wellbeing Act (refer to recommendation 42); b. appointed by and reports to the Secretary; and c. at the level of a Deputy Secretary. 2. empower the Chief Officer to take responsibility for the implementation of the Royal Commission’s recommendations, unless otherwise stated in these recommendations. 3. transfer the functions of Mental Health Reform Victoria (which was established pursuant to the interim report’s recommendation 9) to the division by mid-2021. 4. ensure that the division employs people with lived experience of mental illness or psychological distress and people with lived experience of caring for someone living with mental illness in multiple, substantive positions, including leadership positions.
Recommendation 46
The Royal Commission recommends that the Victorian Government: 1. establish governance structures to: a. facilitate government-wide and community-wide approaches to improving mental health and wellbeing; and b. oversee the implementation of the Royal Commission’s recommendations. 2. ensure these governance structures comprise: a. a Mental Health and Wellbeing Cabinet Subcommittee, chaired by the Premier for at least two years; b. a Mental Health and Wellbeing Secretaries’ Board, chaired by the Department of Premier and Cabinet and comprising: the Secretaries of the Department of Health, the Department of Families, Fairness and Housing, the Department of Education and Training, the Department of Justice and Community Safety and the Department of Treasury and Finance, as well as the Chief Officer for Mental Health and Wellbeing; c. a Suicide Prevention and Response Secretaries’ Board Subcommittee, co-chaired by the Department of Premier and Cabinet and the Department of Health, attended and supported by the State Suicide Prevention and Response Adviser (refer to recommendation 26(1)) and comprising all state government departments and relevant agencies, with Deputy Secretary and Secretary-level membership; and d. an Interdepartmental Committee on Mental Health and Wellbeing Promotion, co-chaired by the Department of Premier and Cabinet and the Department of Health, attended and supported by the Mental Health and Wellbeing Promotion Adviser (refer to recommendation 2(1)) and comprising all state government departments and relevant agencies, with Deputy Secretary level membership.
Recommendation 47
The Royal Commission recommends that the Victorian Government: 1. establish a process for assessing the Victorian population’s need for mental health and wellbeing services by initially using a substantially adjusted version of the National Mental Health Service Planning Framework. 2. develop and publish a statewide mental health and wellbeing service and capital plan and eight regional mental health and wellbeing service and capital plans, with the first plans to be endorsed by the Mental Health and Wellbeing Secretaries’ Board (refer to recommendation 46(2)(b)) by the end of 2022, with the remainder approved by the end of 2023. 3. update the statewide mental health and wellbeing service and capital plan every three years. 4. by no later than the end of 2026, empower Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)) to update regional mental health and wellbeing service and capital plans every three years.
Recommendation 48
The Royal Commission recommends that the Victorian Government: 1. build on the interim report’s recommendation 8 regarding a new approach to mental health investment and use, and empower Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)) to use, new service standards developed by the Royal Commission to select providers of mental health and wellbeing services, including new providers and provider partnerships. 2. support the further development of new and existing providers to meet the long-term ambition of the service standards. 3. develop new ways of funding providers that encourage the provision of mental health and wellbeing services that consumers, families, carers and supporters value and result in an equitable allocation of resources through: a. trialling then implementing an activity-based funding model for both bed-based and community-based mental health and wellbeing services; b. working with the Collaborative Centre for Mental Health and Wellbeing to develop and implement an approach to bundling funding into one price for an evidence-informed pathway that is linked to improving outcomes; and c. developing and trialling a capitation funding model that provides a tailored package for consumers, families, carers and supporters.
Recommendation 49
The Royal Commission recommends that the Victorian Government: 1. establish a new performance monitoring and accountability framework to: a. hold, and empower Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)) to hold, mental health and wellbeing service providers to account and improve performance over time; b. improve the outcomes and experiences of consumers, families, carers and supporters; and c. measure the effectiveness of mental health and wellbeing services from the perspectives of consumers, families, carers and supporters.
Recommendation 50
The Royal Commission recommends that the Victorian Government: 1. work with the Commonwealth Government and the National Cabinet Reform Committee to: a. delineate the responsibilities of governments in providing a structured, coordinated, long-term approach to planning, investment and reform through the new National Mental Health and Suicide Prevention Agreement; b. raise the profile of: • mental health and wellbeing, and suicide prevention and response services; • associated supports such as housing and homelessness services; and • lived experience leadership. c. ensure a strong focus on the implementation of mental health and wellbeing strategies.
Recommendation 51
The Royal Commission recommends that the Victorian Government: 1. build on new ways of resourcing and monitoring mental health and wellbeing services (refer to recommendations 48 and 49) and empower Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)) to: a. commission one demonstration project in each region (refer to recommendation 3(3)) in which a provider or providers deliver multiple services to people living with mental illness who require ongoing intensive treatment, care and support; b. commission demonstration projects in each region in which a provider or providers deliver multiple services to people living with mental illness who require short-term treatment, care or support and who are in the ‘missing middle’; c. evaluate demonstration projects to inform decisions on scaling approaches and expanding to new providers or provider partnerships that are tailored to the needs of communities and span the full age spectrum; and d. monitor provider partnerships using a common set of indicators with an emphasis on improving mental health and wellbeing outcomes. 2. in collaboration with Regional Mental Health and Wellbeing Boards (refer to recommendation 4(2)), work with the Commonwealth and Primary Health Networks to establish a co-commissioning approach for Commonwealth and state-funded mental health and wellbeing services that: a. builds on joint Commonwealth–state planning approaches to mental health and wellbeing service delivery; and b. leverages existing commitments including in the Addendum to the National Health Reform Agreement 2020–2025.
Recommendation 52
The Royal Commission recommends that the Victorian Government: 1. by no later than the end of 2021, establish a Mental Health Improvement Unit within Safer Care Victoria to provide a multidisciplinary approach to improving the quality and safety of mental health and wellbeing services. 2. enable the Mental Health Improvement Unit to work with mental health and wellbeing services to: a. provide system leadership on quality and safety improvement; b. provide professional, clinical and practice leadership for mental health and wellbeing services; c. promote awareness and understanding of high-quality service delivery across the mental health and wellbeing system; d. co-design quality and safety improvement programs with people with lived experience; and e. issue practice guidelines and frameworks.
Recommendation 53
The Royal Commission recommends that the Victorian Government: 1. enable the Mental Health and Wellbeing Commission (refer to recommendation 44) to use its full suite of complaints and oversight functions (refer to recommendation 44(3)) to monitor, inquire into and report on system-wide quality and safety. 2. facilitate the Mental Health and Wellbeing Commission to monitor, as matters of priority, the: a. use of seclusion and restraint; b. use of compulsory treatment; c. incidence of gender-based violence in mental health facilities; and d. incidence of suicides in healthcare settings. 3. enable the Mental Health and Wellbeing Commission to: a. work with the Department of Health and relevant regulators to build a comprehensive understanding of quality and safety issues in mental health and wellbeing services; b. ensure on an ongoing basis that complaints-handling and investigation approaches: • meet the needs of consumers, families, carers, and supporters and • support services to resolve concerns; c. advise government on issues of concern and areas for improvement; and d. record, report and publish service-level complaints and other relevant data and information.
Recommendation 54
The Royal Commission recommends that the Victorian Government: 1. act immediately to reduce the use of seclusion and restraint in mental health and wellbeing service delivery, with the aim to eliminate these practices within 10 years. 2. regulate the use of chemical restraint through legislative provisions in the new Mental Health and Wellbeing Act (refer to recommendation 42(2)(e)). 3. ensure the Chief Officer for Mental Health and Wellbeing (refer to recommendation 45(1)) develops and leads a strategy to reduce the use of seclusion and restraint. 4. enable the Mental Health Improvement Unit within Safer Care Victoria (refer to recommendation 52(1)) to co-design with mental health and wellbeing services and people with lived experience a range of programs and supports aligned with the strategy that focus on: a. working with each mental health and wellbeing service to investigate local data and practices in order to identify priority areas for change; b. making workforce training available for services; and c. continuing to support services to embed Safewards.
Recommendation 55
The Royal Commission recommends that the Victorian Government: 1. act immediately to ensure that the use of compulsory treatment is only used as a last resort. 2. set targets to reduce the use and duration of compulsory treatment on a year-by-year basis and gather and publish service-level and system-wide data in this regard. 3. when commissioning mental health and wellbeing services, set expectations they will provide non-coercive options for people living with mental illness or psychological distress, including those at risk of compulsory treatment, in both Local Mental Health and Wellbeing Services and Area Mental Health and Wellbeing Services. 4. ensure the Mental Health Improvement Unit within Safer Care Victoria (refer to recommendation 52(1)) works with mental health and wellbeing services to: a. increase consumer leadership and participation in all activities to reduce compulsory treatment; b. support the design and implementation of local programs, informed by data, to reduce compulsory treatment; and c. make available workforce training on non-coercive options for treatment that is underpinned by human rights and supported decision-making principles.
Recommendation 56
The Royal Commission recommends that the Victorian Government: 1. promote, protect and ensure the right of people living with mental illness or psychological distress to the enjoyment of the highest attainable standard of mental health and wellbeing without discrimination. 2. include a legislative provision in the new Mental Health and Wellbeing Act (refer to recommendation 42) enabling an opt-out model of access to non-legal advocacy services for consumers who are subject to or at risk of compulsory treatment. 3. increase access to legal representation for consumers who appear before the Mental Health Tribunal, particularly when consecutive compulsory treatment orders in the community are being sought. 4. align mental health laws over time with other decision-making laws with a view to promoting supported decision-making principles and practices.
Recommendation 57
The Royal Commission recommends that the Victorian Government: 1. ensure that the range of expanded mental health and wellbeing services is delivered by a diverse, multidisciplinary mental health and wellbeing workforce of the necessary size and composition across Victoria. 2. by the end of 2023, implement and support structural workforce reforms to: a. attract, train and transition staff to deliver the core functions of services across Local, Area and Statewide Mental Health and Wellbeing Services (refer to recommendation 5); and b. develop new and enhanced workforce roles as described by the Royal Commission in its final report. 3. develop, implement and maintain a Workforce Strategy and Implementation Plan and, by the end of 2021, enable the Department of Health to: a. conduct ongoing workforce data collection, analysis and planning; b. establish a dedicated workforce planning and strategy function; and c. encourage collaborative engagement and partnerships with relevant workforce stakeholders in implementing recommendations.
Recommendation 58
The Royal Commission recommends that the Victorian Government: 1. through the Department of Health, by the end of 2021, define the knowledge, skills and attributes required of a diverse, multidisciplinary mental health and wellbeing workforce, starting with the priorities as described by the Royal Commission. 2. develop a Victorian Mental Health and Wellbeing Workforce Capability Framework as a component of this. 3. detail the approach to capability development across the mental health and wellbeing workforce as part of the workforce strategy and implementation plan. 4. build on the interim report’s recommendation 1 and enable the Collaborative Centre for Mental Health and Wellbeing, in collaboration with training providers, mental health and wellbeing services and people with lived experience, to coordinate learning and professional development activities across the whole mental health and wellbeing workforce.
Recommendation 59
The Royal Commission recommends that the Victorian Government: 1. by the end of 2021, establish an ongoing Mental Health Workforce Wellbeing Committee to address occupational health and safety needs, co-chaired by the Department of Health and WorkSafe Victoria that will: a. identify, monitor and address existing physical safety and wellbeing risks as well as those that may emerge throughout the reform process; and b. develop tailored monitoring approaches for the psychological health and safety of staff in the mental health and wellbeing workforce. 2. work with service providers, workers (including lived experience workers), unions, representative and professional bodies to set clear expectations and implement a range of measures to support the professional wellbeing of the mental health and wellbeing workforce, as described by the Royal Commission in its final report. 3. beginning in 2021, work with the Mental Health Workforce Wellbeing Committee to monitor workforce wellbeing outcomes at least once a year.
Recommendation 60
The Royal Commission recommends that the Victorian Government: 1. develop new statewide digital service requirements for all publicly funded mental health and wellbeing service providers that outline the consistent minimum digital functionality every provider should offer to consumers, families, carers and supporters. 2. support mental health and wellbeing service providers to adopt digital technologies, where safe and appropriate to do so, through: a. developing regulatory arrangements; b. providing funding; and c. building the ability of mental health and wellbeing service providers to integrate digital technologies. 3. enable mental health and wellbeing services to offer people living with mental illness or psychological distress access to devices, data and digital literacy support, where it is their preference to use digital services but they are otherwise unable to do so.
Recommendation 61
The Royal Commission recommends that the Victorian Government: 1. develop policies, standards and protocols to enable the effective, safe and efficient collection and sharing of mental health and wellbeing information. 2. set expectations that mental health and wellbeing services will provide opportunities for consumers to contribute to the information held about them and gain easy access to it. 3. collaborate with consumers to introduce a consent-driven approach to information sharing with mental health and wellbeing services and individuals outside of the mental health and wellbeing system.
Recommendation 62
The Royal Commission recommends that the Victorian Government: 1. develop, fund and implement modern infrastructure for Information and Communications Technology (ICT) systems, including: a. a new statewide electronic Mental Health and Wellbeing Record for mental health and wellbeing services to replace the current Client Management Interface/ Operational Data Store (CMI/ODS) system; b. a review of data items currently required for service delivery and system administration, the removal of unused items and the addition of new items that accurately reflect mental health service activity and consumer outcomes; c. a new Mental Health Information and Data Exchange that allows interoperability between the proposed Mental Health and Wellbeing Record and other services’ major ICT systems to support information sharing in real-time within and across services and sectors; d. a new user-friendly online consumer portal (web and mobile) connected to the Mental Health Information and Data Exchange that allows consumers to view key information about themselves and authorise sharing of information with members of their care team, including families, carers and supporters; and e. a comprehensive data repository and associated clinical registries for mental health (within the recommended Mental Health Information and Data Exchange) that will support outcome measurement, future service planning, continuous improvement and mental health research.
Recommendation 63
The Royal Commission recommends that the Victorian Government: 1. building on the interim report’s recommendation 1, by the end of 2023, enable the Collaborative Centre for Mental Health and Wellbeing, to: a. facilitate translational research throughout the mental health and wellbeing system, including in collaboration with other research centres and institutes; b. ensure new research aligns with initial reform priorities identified by the Royal Commission; c. strengthen and support a formal network of academic service leaders responsible for sharing and applying research in service settings; d. ensure that evidence informs workforce education and training, and promotes cultures of inquiry, innovation and learning; e. provide a ‘clearing house’ to collect, combine and share information from research, innovation projects and evaluations; and f. provide authoritative advice on evidence-informed approaches to treatment, care and support to inform policy development, planning and investment. 2. identify and promote opportunities to increase collaboration in translational research on the mental health and wellbeing of infants, children and young people.
Recommendation 64
The Royal Commission recommends that the Victorian Government: 1. commission an existing entity to provide dedicated support and resources for innovation in mental health treatment, care and support. 2. fund this entity to: a. administer a dedicated mental health innovation fund for projects selected by an expert panel; b. establish and promote collaborative networks to drive and facilitate innovation in mental health treatment, care and support; and c. provide practical support to services to implement and test new approaches to mental health treatment, care and support.
Recommendation 65
The Royal Commission recommends that the Victorian Government: 1. set an expectation that adequate evaluation is a condition of funding for all new mental health and wellbeing programs, initiatives and innovations. 2. develop and fund a strategy to ensure evaluation routinely informs the implementation of reforms and ongoing decision making about policies and investment. 3. promote and improve evaluation practices throughout the mental health and wellbeing system by issuing guidance and facilitating access to evaluation expertise.
About the inquiry
- Interim report
- Final report
Official documents 2
Interim Report and Summary
Document details
- Recommendations
- 9
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Final Report
Document details
- Recommendations
- 65
- Recommendations status
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