2021

The release of the Final Report of the Royal Commission into Victoria’s Mental Health System was a historic day for mental health system and service reform in Victoria, Orygen’s executive director, Professor Patrick McGorry said today.

Professor McGorry welcomed the report and its recommendations, and expressed his gratitude to the Commissioners, the Royal Commission team, the Expert Advisory Committee and all stakeholders, organisations and individuals across Victoria who contributed their experience and expertise to the process; working tirelessly to secure a better future for all Victorians living with mental ill-health.

The final report, spanning 5 volumes, delivers 65 recommendations to the Victorian Government, in addition to the 9 recommendations from the Interim report. The Victorian Government has committed to implementing all recommendations.

The Royal Commission’s final report describes the challenges and shortcomings that have plagued the mental health system and prevented Victorians experiencing mental ill-health, and their families, from accessing the care they need.  These have included:

• an insufficient level of political and policy attention which has resulted in the de-prioritisation of mental health within the health system;
• inadequate investment, which has resulted in an under-resourced, overworked and crisis-driven mental health system and workforce;
• the existence of a ‘missing middle’, with the Commission estimating there were 94,500 Victorians who needed specialist care did not access services in 2019-20; and
• an inequitable and poorly integrated service system typified by a ‘postcode lottery’ when accessing care.

Professor McGorry said this diagnosis of the failings of the system resonated with his experience of working in mental health for 40 years. “These local failings have led to a profound human toll of many thousands of preventable deaths, blighted lives and immeasurable suffering,” Professor McGorry said.

“Victorians will be deeply grateful to the Premier and his government for realising the only way to create the authorising environment for the scale of reform required was a Royal Commission. And Victoria has responded magnificently to this opportunity.”

The final report provides a series of major statewide legislative, governance and systemic reforms focused on increasing accountability, monitoring and reporting. These include:

• the introduction of a new Mental Health and Wellbeing Act;
• a new Mental Health and Wellbeing Outcomes Framework to be reported against annually;
• a new Mental Health and Wellbeing Sub-Committee of Cabinet chaired by the Premier;
• the establishment of an independent and statutory Mental Health and Wellbeing Commission;
• the appointment of a Chief Officer for Mental Health and Wellbeing Division within the Department of Health; and
• the establishment of a Suicide Prevention and Response Office, led by a State Suicide Prevention and Response Adviser.

The final report also recommends significant changes to the way services and supports will be structured and delivered in Victoria. This includes a new six-level service system across:

1. Families, community, carers and other informal supports;
2. Government and community services;
3. Primary and secondary mental health services;
4. Local Mental Health and Wellbeing Services (50-60 new adult to older adult services);
5. Area Mental Health Services (22 new Adult Services for specialist care and 13 new Infant Child and Youth Services) with the removal of rigid catchment boundaries; and
6. Statewide services (for people whose needs are unable to be met across the other five levels).

The new system will be designed around eight (8) regional areas, governed by Regional Mental Health and Wellbeing Boards that will be responsible for planning, contracting and commissioning local mental health and wellbeing services and area mental health services. 

Professor McGorry said these major changes to governance, financing and transparency would mean mental health care would be empowered and protected within the health system. “No more will we see precious mental health dollars diverted to areas perceived as more worthy,” he said. “The establishment of the eight Regional Boards will shift the centre of gravity away from large hospitals which inevitably struggle to value and support community mental healthcare. The ‘missing middle’ of people who are unable to access appropriate mental health care will no longer be marooned in no-man’s land.”

The report also recommended a number of new or expanded Statewide Services including: a Statewide Trauma Service; expansion of existing specialist youth forensic services to a statewide model and a new statewide specialist service for people living with mental illness and substance use or addiction.

In addition, the Royal Commission has recommended the Victorian Government commission an existing entity to provide dedicated support and resources for innovation, testing new approaches in mental health treatment, care and support, and supported by a new dedicated mental health and wellbeing innovation fund.

Recommendations for young people and youth mental health

The Royal Commission highlighted the adverse impacts of mental ill-health on young people, noting that this is a stage in life when the majority of people will first experience mental ill-health. The Royal Commission found a strong case for investment in and attention to the mental health and wellbeing of young people.

The Royal Commission recommended the Victorian Government establish a new responsive and integrated infant, child and youth mental health and wellbeing system. This system will provide developmentally appropriate treatment, care and support for newborns to 25-year-olds.

This new system will include a new, dedicated youth mental health and wellbeing service stream for 12-25 year olds, with existing youth services to be reformed and expanded with age boundaries and transitions to be applied flexibly in consultation with young people and their families. The inclusion of the lived experience of young people and their families in the design and delivery of these youth services will be fundamentally important.

Professor McGorry said young people bore the major burden of onset for mental disorders, a burden that is increasing for them year by year, and that has been heavily impacted by COVID. “One of the most overdue and far reaching recommendations that the Royal Commission has made is to shift the upper boundary for specialist youth mental care to the 26^th birthday to align with headspace and all the scientific evidence,” Professor McGorry said. “We need to make youth mental health the strongest part of the system.  Heavy investment during this stage of life in early intervention is the best buy in mental health care, will pay for itself and steadily shrink the flow of people into longer term care within the adult mental health system. The Commission’s changes here are transformational.

Other recommendations to improve supports and services for young Victorians include:

• the employment of up to three specialist trauma practitioners in each of the each of the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services;

• establishment of a Youth Prevention and Recovery Centre for young people aged 16-25 years in each of the eight regions;
• a new stream of inpatient beds across Victoria for young people aged 18 to 25 created by reconfiguring existing inpatient beds for adults and using an allocation of the additional 100 new beds recommended across the system;
• Hospital in the Home services to be made available for young people as an alternative to acute hospital-based treatment, care and support where appropriate;
• investment in four youth specific ‘safe spaces’ and crisis respite facilities for the resolution of mental health and suicidal crises which are co-designed with young people;
• funding for evidence-informed initiatives in schools, including anti-stigma and anti-bullying programs, to assist in supporting students’ mental health and wellbeing;
• expansion of specialist youth forensic mental health programs to a statewide model 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;
• investment in 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; and
• funding for 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.

THE TIME FOR TRANSFORMATION IS NOW

In its executive summary (page 32) the Royal Commission gives a clear call to action: “The Commission’s inquiry is over; the time for decisive and deliberate action is now.””

Professor McGorry said it was critical that the reform process start immediately. “The Commissioners emphasise that implementation of this historic blueprint is now our challenge. They warn against those responsible repeating the work of the Commission or revisiting the decisions,” he said. “Reform is hard and there are always those who have something to lose. I have spent my whole working life seeking to engineer reform and know first-hand that some will seek to delay and even derail the changes that are long overdue and have public support. At Orygen, we look forward to working with the Victorian Government to undertake the significant work that is needed to be done and to seeing Victoria become the epicentre of national, even global, reform in mental health.”