(2011) Evaluation of the Victorian Dual Diagnosis Initiative

6. Completion of the Reform Process
6.1.2 Contractual arrangements and governance structures
The VDDI governance arrangements as summarised in Figure 3-4 have provided a fundamental
challenge to the implementation of a statewide initiative. The various structures that have been
developed at different points have all added some value but have failed to address the fundamental
need to drive a strong statewide focus for the initiative and the decision by the Department of Health to
not mandate specific screening and assessment tools has added significantly to the challenge.
Individual contracts with four different organisations as well as the lack of a unifying structure and/or
strategic plan with common KPIs, has meant that the initiative has been quite fragmented and this has
led to inconsistency in training and to a diversity of screening and assessment tools. It has also meant
greater difficulty in promoting the initiative as a major reform across all three sectors given that some
services are unaware of the initiative, although they may know the name of their local team. The
structural arrangements have also allowed the auspice organisations some capacity to determine which
sectors they choose to service in their region, over and above others, which has seen PDRSS not
provided with input in some cases and a lack of assistance to clinical mental health teams in another
case.
The VDDI team leaders, which were left with the responsibility of developing a memorandum of
understanding between the four teams, including rural workers have been in a very difficult position. On
the one hand their auspice has wanted them to go in a particular direction, the department another and
then each team has had its own view of what training should occur and so on. The Department did not
provide the necessary authorising environment for the leaders to form a single statewide VDDI plan or
for the ETU in leading workforce development.
Another consequence of the fragmentation has been significant duplication in resource development
between the teams, although the rural practitioners have generally sought to share ideas, approaches
and materials.
The contractual arrangements for rural practitioners have not resulted in access to additional support for
most of them. Moreover, it has placed workers, rural host organisations and metro teams in a difficult
position at times.
It would also appear that the major drive for the initiative has come from within the AOD section of the
Department and that this has not been carried as strongly through mental health and that gaining
organisational commitment has been most difficult in clinical mental health. The question of where
within the department the carriage of VDDI should sit, given its focus across mental health, AOD, Sector
Quality and Workforce Development, is one that will need careful consideration.
Whilst Key Directions included the Dual Diagnosis Action Plan, there was no formal process following its
release, which brought the activities undertaken through VDDI under the umbrella of a single plan. In
future it is proposed that a 3 year VDDI Statewide Strategic Plan (VSSP) that covers all aspects of the
initiative and which includes KPIs, be developed through a Central Steering Group appointed by the
Department of Health. There are a number of areas that the VSSP could potentially address, including:
• Finalisation of scope of practice and required competencies for each of the sectors
• Workforce development priorities including an emphasis on Aged and CAMHS teams and
youth for AOD
• Organisational change across clinical mental health
62