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Page 1

LIVING WELL
PUTTING PEOPLE AT THE CENTRE OF MENTAL HEALTH

REFORM IN NSW: A REPORT

OCTOBER 2014

Page 2

© 2014 State of New South Wales

You may copy, distribute, display, download and
otherwise freely deal with this work for any purpose,
provided that you attribute the Mental Health
Commission of NSW as the owner. However, you must
obtain permission if you wish to (a) charge others for
access to the work (other than at cost), (b) include the
work in advertising or a product for sale, (c) modify the
work or (d) publish the work to a website.

This Report is available on our website:
www.nswmentalhealthcommission.com.au

ISBN 978-0-9923065-3-3

This Report may be cited as:
NSW Mental Health Commission (2014). Living Well:
Putting people at the centre of mental health reform in
NSW. Sydney, NSW Mental Health Commission.

Publication of this Report:
In accordance with Section 17(2) of the Mental Health
Commission Act 2012 the Mental Health Commission
of NSW recommends that this Report be made public
immediately.

Page 73

POSITIVE CHANGE WILL REQUIRE
• a statewide approach and

more funding for training and
education and the establishment
of a network of workers with
a special interest in how drugs
and alcohol interact with mental
health

• more and better research and
evaluation

• a common language across
sectors

• ensuring programs don’t rely
on a single person so they can
continue to operate even if that
staff member is no longer there

• expert multidisciplinary teams
in settings nearby to clients

• supporting alternative
approaches such as eHealth
initiatives which are emerging
as a key force

• training for police and youth
liaison officers

• ongoing training to address
attitudes towards drug users
for GPs and corrective, youth
and housing agencies.

ACCESS & QUALITY

The health system tends to
operate as a series of silos which
makes access to quality, timely
and integrated interventions
difficult and inadequate. This is
particularly so for people living
with multiple, interacting issues.

A person’s drug or alcohol
misuse can be a criterion for
exclusion from access to mental
health services.

TOWARDS CHANGE

Any system should support the integration and delivery of evidence-
based care to address the significant unmet need for people living with
mental illness and drug and alcohol problems. But a one-size-fits-all
approach is neither suitable nor sustainable.

Best practice comes from services whose guidelines for dealing with
interacting conditions are integrated into routine practice. This also
means having clear policies and procedures regarding such conditions.

We must see a shift in focus from beds to community to reinforce the
idea of self-agency, where people have access to the right supports and
services to manage well in the community.

When consumers go from home – the
community – to a detox or rehabilitation
setting, there are many protective factors
and structures in place. When they go
back into the community, many of these
are removed and a lack of adequate
follow-up leaves people at greater risk of
relapse and overdose.

Families and carers of consumers must be
taken into account to enhance access to

care pathways. It is often families
or others who facilitate entry to
services and this is usually at a
time of crisis.

Consumers are often required to
tell their stories or history over and
over again, which can lead to
treatment fatigue. This reinforces
the need for a collaborative,
shared-care approach by services.

ANXIETY DISORDERS AFFECTIVE DISORDERS

22%

11% 12%

5%

smokers

never
smoked

smokers
never
smoked

Prevalence of smoking in people with

71

Page 74

72

WHAT WE NEED
The reform directions presented in this document represent
broad principles, and aspirations for a new approach to
mental health and wellbeing in NSW.

They represent a fundamental shift – to a future in which a person,
family or community sits at the heart of our thinking, services, delivery
systems and planning.

That in turn presents enormous challenges to government and
community-sector agencies charged with delivering not only health care
but also social services, education, housing and the many other services
that are critical in the lives of people who experience mental illness.

To make these changes effectively, we will need to incrementally
transform the structures we have in place to deliver services –
our buildings, workforce, information technology and budgets –
reconfiguring them over time so that they can fulfil their primary
function of supporting the things that people really need.

This section presents some
initial ideas about the changes
that will be required to create
capable, flexible and responsive
infrastructure to take us
forward into a new generation
of mental health reform. These
will evolve, as new evidence
emerges to support particular
programs and approaches, as
new technological developments
create opportunities to do
things smarter and faster, and as
changing national approaches
remodel the NSW mental health
funding landscape.

INFORMATION IS POWER
We have barely begun to tap the
potential of data collection and
analysis as a means of improving
our services, by giving us real-
time feedback not only on the
technical performance of systems
of support but – crucially – on
the experience of people who
use them, and on whether their
mental health and wellbeing
improve as a consequence.

The cost of technology is falling
rapidly, vastly expanding our
options as we consider how to
use information systems to
support mental health. For
example, hand-held devices that
can quickly record key details at
the point of contact between a
service and a consumer are now
becoming cheap enough to be
widely deployed to mental health

workers who travel to people’s
homes. That may reduce the
burden of paperwork and increase
the chance that the system will
hold an accurate and up-to-date
record of the person’s care and
concerns, leading to better quality
care and treatment in future.

The continuing development of
secure, internet-based technologies
for data sharing and data linkage
presents new possibilities for
collaboration among government,
the community sector, consumers,
carers, families and clinicians,
giving them access to information
that can improve planning and
help determine the best support
for individuals.

Information systems can improve
continuity of care between clinical

care and community services
and community, family and peer
supports for people living with
an illness in the community. With
effective information sharing,
there is less chance of the
person living in the community
inadvertently losing touch with
the service system and the carers,
clinicians and other people in
their community such as friends
and relatives who can assist with
recovery.

But first, people who experience
mental illness must have the
assurance that their privacy
will be respected, and that
information about them will
be available only to the people
and agencies that really need to
know it, because they are directly
involved in supporting them.

Page 145

143

Kruse, J., N. Schmitz and W. Thefeld
(2003). “On the Association Between
Diabetes and Mental Disorders in a
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and Examination Survey.” Diabetes
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JOURNEY 8 – LIVING LONG AND
STRONG

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Population by Age and Sex, Australian
States and Territories, Jun 2010. cat.
no. 3201.0. Canberra, Australian
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Draper, B. and L.-F. Low (2010).
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McGrath, V. Carr, R. Bush, D. Castle,
M. Cohen and C. Harvey (2012).
“People living with psychotic illness in
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survey of psychosis.” Australian and
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46(8): 735-752.

Infographics
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P. Hogan, A. Kalache and S. Olshansky
(2011). Global population ageing:
Peril or promise. Geneva. World
Economic Forum.
Australian Institute of Health and
Welfare (2013). Depression in
residential aged care 2008–2012.
cat no. AGE 73. Canberra, Australian
Institute of Health and Welfare.

ARE WE GETTING THERE?

Australian Institute of Health and
Welfare (2011). Mental health
services in Australia: Expenditure on
specialised mental health services.
Canberra, Australian Institute of
Health and Welfare.

Australian Institute of Health and
Welfare (2014). Mental health
establishments NMDS 2011-12.
Canberra, Australian Institute of
Health and Welfare.
Expert Reference Group to COAG
Working Group on Mental Health
Reform (2013). National targets and
indicators for mental health reform.
Sydney, National Mental Health
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