OutcomeThe community has a better understanding of the importance and role of mental health and wellbeing, and recognises the impact of mental illness. People with mental health problems and mental illness have improved outcomes in relation to housing, employment, income and overall health and are valued and supported by their communities. Service delivery is organised to deliver more coordinated care across health and social domains.
Summary of actions
- Improve community and service understanding and attitudes through a sustained and comprehensive national stigma reduction strategy.
- Coordinate the health, education and employment sectors to expand supported education, employment and vocational programs which are linked to mental health programs.
- Improve coordination between primary care and specialist mental health services in the community to enhance consumer choice and facilitate 'wrap around' service provision.
- Adopt a recovery oriented culture within mental health services, underpinned by appropriate values and service models.
- Develop integrated programs between mental health support services and housing agencies to provide tailored assistance to people with mental illness and mental health problems living in the community.
- Develop integrated approaches between housing, justice, community and aged care sectors to facilitate access to mental health programs for people at risk of homelessness and other forms of disadvantage.
- Lead the development of coordinated actions to implement a renewed Aboriginal and Torres Strait Islander Social and Emotional Well Being Framework. Top of page
Cross-portfolio implicationsTo support a collaborative whole of government approach, these actions will require work across areas outside health such as employment, education, justice (including police, courts and correctional services), Indigenous, aged services, community services and housing and the arts.
Indicators for monitoring change
- Participation rates by people with mental illness of working age in employment
- Participation rates by young people aged 16–30 with mental illness in education and employment
- Rates of stigmatising attitudes within the community *
- Percentage of mental health consumers living in stable housing *
- Rates of community participation by people with mental illness * Top of page
DiscussionMental health and wellbeing are important for the whole community, including the broad spectrum of people who experience mental illness. Consumers and their families have highlighted that stigma and discriminatory attitudes to mental illness are still prevalent. They have told us that stable housing and meaningful occupation - key elements of social inclusion - are important aspects of their recovery and self determination.
People should feel a valued part of their community, and be able to exert choice in where and how they live. Some groups are at risk of entrenched social exclusion, including those with chronic and persistent mental illness. Developing pathways that support community participation and that allow movement towards greater independence minimises the risk of social exclusion.
Policy and service development needs to recognise the importance of a holistic and socially inclusive approach to health in promoting mental health and wellbeing, that includes social as well as health domains and supports people to establish community engagement and connectivity. This applies to all members of the community including those from culturally and linguistically diverse backgrounds and new arrivals. A socially inclusive approach is especially important during times of economic downturn. The role of the family in promoting wellbeing and recovery needs to be recognised, as does the importance of community acceptance.
There have been significant developments in these areas, including establishment of a national Social Inclusion Board, the development of the Homelessness White Paper and the COAG National Partnership Agreement on Homelessness.
Maintaining connections and support can be especially crucial during adverse events or periods of transition such as loss of employment, exposure to domestic violence, exiting from prison, and family breakdown and disruption. Management of mental illness also needs to be linked to good physical health, with engagement between primary and specialised treatment and care. Likewise, physical illness is often associated with mental distress and illness.
There are many good examples where mental health promotion has supported greater social inclusion. The Melbourne Charter for Promoting Mental Health and Preventing Mental and Behavioural Disorders developed in 2008 brings together a number of key findings in the area of promotion and prevention. Elements of this include the importance of population based approaches to redress inequities and discriminatory practices, and joining up policies and practices across sectors. Information regarding mental health, mental health promotion and mental health interventions should be widely available, culturally appropriate and accessible, including to young people.
Despite very effective initiatives directed to promoting mental health and wellbeing (e.g. VicHealth), and improving awareness and understanding of mental illness (e.g. beyondblue), those with mental illness are still at risk of being discriminated against in areas such as employment and housing, and there are still stigmatising attitudes evident in the media and community. Discriminatory behaviour and stigmatising attitudes also occur within the health sector. The mental health workforce in clinical and community living support services needs to respect and adopt a recovery philosophy in how they provide services. The role of 'step up/step down' services and community support is particularly important in preventing relapse and supporting community based recovery.
Recovery in the context of mental illness is often dependent on good clinical care, but means much more than a lessening or absence of symptoms of illness. Recovery is not synonymous with cure. For many people who experience mental illness, the problems will recur, or will be persistent. Adopting a recovery approach is relevant across diagnoses and levels of severity. It represents a personal journey toward a new and valued sense of identity, role and purpose together with an understanding and accepting of mental illness with its attendant risks. A recovery philosophy emphasises the importance of hope, empowerment, choice, responsibility and citizenship. It includes working to minimise any residual difficulty while maximising individual potential. This is relevant to all ages, including the elderly, and to all those involved - the individual consumer, their family and carers, and service providers.
Within current service delivery, a recovery focus has mainly been championed by the non-government community support sector and consumer advocacy bodies. This fourth plan intends that the attitudes and expectations that underpin a recovery focus are also taken up by clinical staff within the public and private sectors - both bed based and community based. This will strengthen the partnership and sharing of responsibility between the consumer, their families and carers, and service providers. Top of page
Definitions of recoveryThe definition provided in the National Mental Health Policy 2008 is:
A personal process of changing one's attitudes, values, feelings, goals, skills and/or roles. It involves the development of new meaning and purpose and a satisfying, hopeful and contributing life as the person grows beyond the effects of psychiatric disability. The process of recovery must be supported by individually-identified essential services and resources.
The definition developed by Patricia Deegan, a consumer who contributed greatly in this area, is:
Recovery is a process, a way of life, an attitude, and a way of approaching the day's challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup and start again… The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work and love in a community in which one makes a significant contribution.
The definition provided by the New Zealand Mental Health Advocacy Coalition in Destination Recovery is:
… a philosophy and approach to services focusing on hope, self determination, active citizenship and a holistic range of services.
* These indicators require further development