A summary on the progress of the implementation of the recommendations to improve mental health services for those affected by severe and complex adolescent mental health issues in Queensland is now on the DEVELOPMENTS page at severeyouthmentalhealth.org. This includes links to more detail via the Queensland Health Communiqués released following each Steering Committee meeting as well as other recently tabled reports.
A couple of documents that are likely to be of particular interest are those relating to RECOMMENDATION #4 – THE DEVELOPMENT OF A NEW ADOLESCENT EXTENDED TREATMENT FACILITY (AETF). The Thematic Analysis Report summarises the web feedback provided on the draft Model of Service for the AETF so whether or not you were in a position to complete the online survey, the feedback from that makes for interesting reading. In addition, there is an External Review of the Model of Service by Dr Paul Robertson, a Victorian based child and adolescent psychiatrist of 25 years experience, who undertook consultations with a number of groups and individuals as well as being given access to relevant documentation. His insights will undoubtedly also play in a role in the development of not only the new facility but will encourage a strong focus on the full continuum of care for young people with mental health issues in Queensland (the child and youth mental health services continuum ie. CYMHSC, as Dr Robertson refers to it) and the ongoing co-design process i.e. “A structure to support ongoing consumer and carer participation in the broader CYMHSC system is recommended“.
So a complete and integrated CYMHSC system that will allow access across the state for all young people with mental health issues to a full range of treatment and other service options will be a key issue in the future. This will not only ensure stable and informed transitions from one care/education/support service to another but will hopefully mean that some young people who might otherwise have needed extended inpatient care could achieve recovery without that. For, although the clinical experts who gave evidence at the Barrett Inquiry made clear that there will always be a group of young people whose conditions and individual circumstances are so severe and complex that community-based care will not adequately support their progress, the objective is always to facilitate recovery in the least restrictive environment possible. Queensland needs a statewide service like the AETF but it also needs a complete system within which collaboration and communication are the foundation of operations. Mental health issues impact all aspects of people’s lives and when the individual needs and situations of those suffering are acknowledged, understood and met as effectively and immediately as possible, all our communities will benefit. So Dr Robertson’s urging that collaborative planning does not begin and end with a new facility is extremely pertinent.
He also stresses the need for RESEARCH to be a key component of the new AETF i.e.
Reference is made to the AETF undertaking research. It should be obliged to collect sufficient data to allow appropriate review of its functioning. Adequate resources, funding and time should be allocated for this to occur. Research will not occur without appropriate funding and partnerships with universities or other research organisations. Both appropriate data collection and analysis and research would require an active and resourced plan.
Existing and developing technologies should ensure that research extends beyond the new facility and across all the components of the CYMHSC. Collecting data on the services that precede and follow a young AETF patient’s inpatient treatment – will provide insights into this cohort of young people that is currently lacking across the globe. AND compiling extensive evidence on all youth mental health issues must be seen as a priority in a country where available data states that one in four young Australians currently has a mental health condition [ABS National Survey of Mental Health and Wellbeing: Summary of Results 2007 (2008), p 9] and we are regularly made aware that the risk in our youth population only continues to grow. So methods of gathering and collating information on the challenges faced by our young people that not only avoid any negative impact on the vulnerable but may, in fact, have potential for therapeutic benefit require prioritised consideration.
The STATEWIDE FORUMS facilitated by the Health and Education Departments along with Health Consumers Queensland have now concluded and summary information from those should soon become available. Consumers and carer representatives attended these with the support of HCQ and, with a number of factors influencing the ability of local consumers and carers to attend, it has also been invaluable to have Leonie Sanderson, the dedicated HCQ Engagement Advisor, continually open to accepting input via a range of communication avenues (surveys, emails, teleconferences and meetings for specific subgroups) to ensure that anyone in Queensland with insights into service provision in this area have had – and will continue to have – their voices heard.
THE ROLE OF HEALTH CONSUMERS QUEENSLAND has been extremely important in the process so far – supporting and facilitating the active involvement of consumers and carers. And HCQ’s enthusiasm for the project was highlighted when they made it the theme of the Plenary Session at their annual forum (video and written info on that session is available here), with Katherine Moodie and Jeannine Kimber – two of the consumer/carer representatives on the Steering Committee – on the panel alongside John Allan, Executive Director, MHAODB, Queensland Health; Gunther De Graeve, the Managing Director of the consulting firm undertaking the design of the new AETF; and Stacie Hansel, Executive Director, Dept Education & Training. The discussion highlighted the great potential of this project to not only produce innovative and more effective outcomes but to influence the way that future service planning should proceed. Participants significantly endorsed the tangible value of consumer/carer input as Gunther De Graeve stated:
There has been an enormous change in our design development, actually, through this process. … This co-design process really allowed us to reach very deep into the operational requirements, into the therapeutic requirements, the day-to-day requirements and then safety overlays etc. of this facility and it gave us a very wide platform. Traditionally, this engagement goes to clinicians and nursing staff and therapeutic staff and very little with the consumers. … It was a genuine process of actually trying to understand what the needs were and, to date, I still say that if we didn’t do that process we would have designed a very different facility and it probably wouldn’t have been – definitely not – as therapeutic as that facility could be for the patients.
So, as progress goes, it would seem that in many ways we are at the beginning of something bigger than a response to the Inquiry recommendations. Although the planning for the new AETF is well underway and the examination of transition procedures, service agreements and other vital elements that underlay the provision of services has been undertaken, the potential of this project to have an effect on other aspects of service delivery (education, vocational training, support for carers and families, justice and legal issues, housing and accommodation etc.), of approaches and attitudes to mental health and to ALL those affected by these issues must make this project only the start. People with lived experience must have a permanent seat at the table – not just on listening tours and wider consultation but at levels of decision-making and influence. And that includes not only consumers of services and their carers and families but those professionals who have dedicated years of clinical, educational and other practice to these consumers and carers. Those who work daily to improve the lives of others by being part of the reality, by knowing the individuals and supporting them in their journey must always be encouraged to give insights on the practicalities, the impediments, the successes.
Only through true collaboration will success be achieved. And if there is any area in which we must achieve, it is in keeping our young people alive and giving them hope for a better life.