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payments, they may live in public housing, they may use employment agencies, and they may access public or private medical services. They may also have legal problems and seek legal services. PIAC and HPLS [Homeless Persons’ Legal Service] lawyers see many people with mental illness seeking such services. It is our observation that the interface between these services is often uneven and leads to a ragged transfer of people with mental illness from one service to the next. As a result, continuity of care breaks down and the individual is then reliant on their own resources, which are usually meagre. 90 This description is consistent with the situation in the ACT. The need for broader links between CLCs and mental health services is evidenced by the high proportion of mental health consumers who access community legal services, the high number of cases in which no legal remedy is available and the importance of connecting often anxious and frustrated clients with other services who may be able to assist and address the broader social and welfare implications of their grievance (for example, homelessness due to eviction, poverty due to loss of entitlements etc). Individuals with a mental illness in such positions of stress are particularly vulnerable to an acute mental health episode or ‘falling off the edge’ in some other way. The Welfare Rights and Legal Centre (WRLC) noted that most clients with a mental health condition do not identify as such in their contact with an advice service. In some cases, it was observed that mental illness impaired an individual’s capacity to approach a legal process in a focussed and logical way, with affected individuals likely to disengage from the process out of frustration or lack of motivation. CLCs can play an important linking role in the chain of services. This potential role is complicated by confidentiality obligations which would prevent CLCs from contacting other services without the consent of a client. However, in situations where a client needs and wishes to receive assistance from another service, CLCs are able to make contact and refer clients on. For these reasons, energy and resources should be directed to improving linkages between CLCs and other community services, and to including CLCs and Legal Aid in relevant cross-sectoral networks. DISABILITY SERVICES There are two key aspects of the relationship between mental health and disability services. One is the conceptualising of mental health as a psychiatric disability, and the second is coordinating dualdisability services for clients with a physical disability and mental illness (psychiatric disability). The conceptual segregation of mental health and disability is evident in the ‘siloing’ between government disability and mental health departments. Participants remarked on the segregated bureaucracies and parallel policy processes around issues like complex need. Some highlighted the intersections between disability, mental health and poverty which needed to be addressed for housing, disability and Home and Community Care (HACC) services. This ‘siloing’ is, in many respects, mirrored in the community sector, with both the disability and mental health sectors regarding themselves as separate ‘sub-sectors’ and little service coordination. However, there is some movement to reconceptualise mental health as a disability for the purposes of policy development, advocacy and representation and some alliances developing between mental health consumer advocacy services and disability advocacy services. The shift in thinking around mental health and disability is best reflected in the role that ADACAS plays in providing individual advocacy services for people with physical and/or psychiatric disabilities and the aged. On the second issue, consultation participants highlighted problems around dual-disability clients. The Dual Disability Service, a joint initiative between Mental Health ACT and Disability ACT, provides information and advice to community workers working with people with a physical disability and mental illness. This is a valuable and welcome ___________________________________________________________________________________________________________________________ 90 Public Interest Advocacy Centre, Submission to the Senate Select Committee on Mental Health, 20 May 2005 at 8. 33 Towards an integrated mental health service system in the ACT•June 2007 NO WRONG DOORS
development, however does not address the systemic divide between mental health and disability sub-sectors and the resulting failures of service coordination. For example, consultation participants reported that intellectual disability services will often not provide services to people with psychosis, and vice versa. Some community sector services expressed concern that they did not have the resources to deal with dual-disability clients even though these clients were sometimes referred to their service. This suggests the need for the two sub-sectors to better coordinate services, and to develop coordinated dualdisability services. A necessary part of this process is the development of dual-disability guidelines and referral pathways for both mental health and disability services, to inform their approach to dealing with dual-disability clients. RECOMMENDATIONS: IMPROVING THE RELATIONSHIP BETWEEN THE COMMUNITY MENTAL HEALTH SECTOR AND OTHER PARTS OF THE COMMUNITY SOCIAL SERVICE SECTOR 6. Engage in the mapping of community sector service delivery to those affected by mental illness, identifying service gaps and needs 91 A service system map should be devised, including government and community sector services, to identify gaps in service delivery, service pressure points (e.g. long waiting lists), segregated sub-sectors (i.e. with few or poor linkages), priority new services and priority innovation areas. We note that the ACT Mental Health Promotion, Prevention and Early Intervention (PPEI) Project, which commenced in 2003, engaged in a mapping process of all PPEI activity in the ACT. 92 In this recommendation, we propose that this initiative be extended to address whole-of-service system service gaps and network failures. 7. Fund and facilitate a permanent ACT cross-sectoral mental health planning network, involving community sector service managers, front-line workers and mental health consumers The ACT Action Plan for Mental Health Promotion, Prevention and Early Intervention 2006-2008 includes a proposal for Government and community agencies to: ‘provide forums for continuing development of mental health promotion, prevention and early intervention in the ACT through regular discussion between sectors connected to mental health and the broader community, and regular review of progress in implementing the PPEI Plan.’ In addition, the COAG National Action Plan on Mental Health 2006-2011 recognised the need to improve referral pathways between services, consistent with consultation feedback. 93 This recommendation develops the above proposal, advocating that a network be developed of community sector organisations involved in mental health service delivery, those from related sub-sectors and mental health consumers. Government should draw upon the expertise of the network in government policy planning at all levels. However, the network would provide an opportunity for community sector managers and workers from across the service system to establish contact, develop trust, referral networks and linkages. It would also be an opportunity for consumer input into service coordination strategies and models. Research suggests that such networks ___________________________________________________________________________________________________________________________ 91 This reflects recommendation 6 of The Australian Psychiatric Disability Coalition Inc and The Head Injury Council of Australia Inc, Trying Desperately: The Role of Non-Government Organisations in an Integrated System of Care for People with Psychiatric Disability or Acquired Brain Injury, Tony Wade and Associates P/L, Brisbane, May 1995 at 9. This was also recommended by the Human Rights and Equal Opportunity Commission, Report of the National Inquiry into the Human Rights of People with a Mental Illness, (1993) (‘Burdekin Report’). This paper is intended to be a contribution to the mapping process, but more detailed research needs to be undertaken. 92 See The ACT Action Plan for Mental Health Promotion, Prevention and Early Intervention 2006-2008 at 31. 93 At 4. NO WRONG DOORS Towards an integrated mental health service system in the ACT•June 2007 34
Page 2 and 3: no wrong doors Towards an integrate
Page 4 and 5: Table of contents ABOUT ACTCOSS....
Page 6 and 7: executive summary The purpose of th
Page 8 and 9: 9. Youth aged between 18 and 25 yea
Page 10 and 11: part 1: introduction BACKGROUND AND
Page 12 and 13: care’ initiatives as a key fundin
Page 14 and 15: A belief in the value of coordinati
Page 16 and 17: to effective collaboration include:
Page 18 and 19: THE ACT SOCIAL COMPACT Relations Go
Page 20 and 21: health sector has long been ‘unde
Page 22 and 23: Consultations conducted in the deve
Page 24 and 25: 5. Commit to the development, with
Page 26 and 27: Failures of service coordination an
Page 28 and 29: esults for the individual concerned
Page 30 and 31: development of clear guidelines of
Page 32 and 33: and by the reluctance of some parti
Page 36 and 37: work most effectively when working
Page 38 and 39: seeking help with other services. U
Page 40 and 41: health and social and emotional wel
Page 42 and 43: eferences Government policy documen
Page 44 and 45: appendix B CONSULTATION QUESTIONS T

actcoss text final.indd - ACT Council of Social Service

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