AN independent review into Victoria’s alcohol, drug and mental health support services has confirmed what we already knew in Bass Coast, that hundreds of Victoria’s most vulnerable people are falling through the cracks.
The review, commissioned by the Minister for Mental Health, Martin Foley, and led by Aspex Consulting, was set up to identify problems resulting from the former state government’s recommissioning of Mental Health Community Support Services and Alcohol and Drug Treatment Services.
Under the recommissioning, the way community-based services were organised, delivered and funded was changed.
Many service providers found funding ceased for vital work and nothing put in its place.
The recommissioning also changed the way people gained access to community services, through a new intake and assessment process. But reports from the sector highlighted that the changes had made it harder, not easier for people in need to get into the system.
In fact the report revealed a 21 per cent drop in drug treatment service contacts and a 19 per cent reduction in mental health support packages, not because demand had reduced, quite the opposite.
It was because those in need could not get through the new referral process in a timely fashion, could not link up with regionally based intake hubs or gave up trying.
It was exactly this experience which was highlighted in a front page article in the Sentinel-Times on Tuesday, October 13, headed ‘System Failure’ focussing on the shortcomings of ACSO in Traralgon, the regional mental health support and alcohol and other drug treatment, intake and referral service.
“This independent review confirms many of the concerns that the sector has shared with us in regards to this rushed, botched recommissioning,” Minister Foley said.
“We must fix this before more people fall through the cracks,” he said.
“The Andrews Labor Government is working to improve access to high-quality alcohol and drug and mental health services to ensure no Victorian is left behind, and everyone is able to participate fully in their community.”
“Our upcoming ten-year mental health plan will outline our vision and goals for mental health in Victoria.”
Victorian Healthcare Association (VHA) CEO Tom Symondson said the VHA had for a long time voiced concerns and called for an independent review of the assessment and intake system that was failing too many people seeking AOD and mental health support.
“The unintended consequences of the 2014 changes have seen people needing help being turned away at the door and asked to call their regional assessment centre before even being considered for treatment,” Mr Symondson said.
“There is a very small window for engaging and providing help to someone in need and we must ensure we provide support to every one of them in a timely manner,” Mr Symondson said.
Wrong system, poorly targeted and supported
FRUSTRATION with phone-based intake and a poorly designed system of access and assessment has left hundreds of people in need of drug, alcohol and mental health treatment on the outer.
Here’s an excerpt from the Aspex Consulting report ‘Independent Review of New Arrangements for the delivery of Mental Health Community Support Services and Drug Treatment Services’ commissioned by the State Government:
In relation to intake and assessment, a key issue related to the challenges of phone-based access and the difficulties this poses for both vulnerable clients and referrers in navigating the service system.
To some extent this was a ‘challenge of change’ issue but 12 months into the reforms, “there remains strongly expressed discontent with the relevance of phone-based intake for vulnerable client groups who often lack the confidence, trust and resources to easily use this mode of access”.
The report noted that despite there being some opportunity for face-to-face access, there was typically a reliance on phone-based intake which frustrated both clients and referrers alike.
“From the referrer perspective, there is reported to be continued frustration, lack of awareness and reluctance to use catchment-based intake. Some interim mitigation measures have proven effective, specifically the introduction of a GP hot-line has minimised call wait times and expedited access. However, the disruption of long-established referral pathways has created ongoing challenges.
“For example, streamlined placement of clients from clinical mental health services is reported to be more difficult. Service providers with established protocols in working with homeless services and ATSI clients are unable to facilitate direct intake, with the intake and assessment requirement a hurdle for reluctant clients.
“The criticism of the catchment-based intake and assessment role goes beyond a concern that the system may create inconvenience to clients and referrers. A more fundamental critique is that some vulnerable clients are no longer accessing services at all as a consequence of the barriers experienced.
“Drug treatment service providers in particular have emphasised that there has been a substantial reduction in the volume of referrals subsequent to the reforms.”
For both sectors, alcohol/drug and mental health, there is a view that the screening process doesn’t suit the problem and clients at risk were not being picked up because they didn’t present as being in serious need.
Concern was also expressed about the lack of support provided to people left on a waiting list after completing intake procedures.
“Whilst there is an expectation that support be provided by intake and assessment providers for clients on waiting lists, many regarded this as token and advocated for an enhanced support focus including provision of evidence-based ‘brief interventions’.”
They said there was also little effort made to help carers and family members.
Assessment with treatment
“A further stakeholder criticism is that there has been a narrowing of program focus, with the intake and assessment process focused tightly around eligibility for MHCSS (community mental health services) and drug treatment services respectively but with insufficient focus on clients with multiple service needs including dual diagnosis clients and homeless clients.
A fundamental issue, specific to the drug treatment sector, concerns the separation of the assessment role from the treatment role. This issue drew overwhelming criticism on three counts:
• The quality of assessments is considered to be variable and this results in treatment providers repeating assessments;
• Clients are having to re-tell their story; and
• There is a disruption to the therapeutic intervention and rapport-building.
The recommendation is that intake and assessment be returned to the local area but this could take one to two years to achieve in an orderly fashion.
The full 88-page review is available at https://www2.health.vic.gov.au/about/publications/ResearchAndReports/review-of-mental-health-community-support-services-and-drug-treatment-services