How does the Royal Commission into Victoria’s Mental Health System report help people without a home?

The Royal Commission into Victoria’s Mental Health System has released its final report, making a swathe of recommendations on how to improve mental healthcare in Victoria. The report recognises the importance of safe, supported, appropriate accommodation for people living with mental illness.

Recommendations to help people without a home

In this blog post, we detail the recommendations from the Commission’s final report that are most relevant to those dedicated to ending homelessness.

The Victorian Government have since confirmed that they will adopt every recommendation of the report. This means that the reforms detailed below should come to pass.

Housing for people with mental illness

The report builds on the fantastic start made by Victoria’s Big Housing Build, which designated 2,000 new social housing properties specifically for people with mental illness. The Commission recommends that these 2,000 properties should be utilised as supported housing – with multidisciplinary supports provided by local mental health services.

In addition to the 2,000 properties previously announced, the Commission has called for a further 500 new medium-term supported housing places for young people with mental illness and housing instability or homelessness. It is likely that the youth housing will span shared living arrangements in residential properties, clustered units and self-contained units with shared amenities.

The entirety of Chapter 16 focuses on supported housing for adults and young people, and eager readers can find it here. All recommendations from this chapter are encompassed in Recommendation 25.

The other recommendation that specifically mentions homelessness (Recommendation 50) calls for the Victorian Government to work with the Commonwealth Government and the National Cabinet Reform Committee to raise the profile of housing and homelessness services.

Beyond the explicit housing recommendations contained in the report, there are a large number of recommendations that will please those working to end homelessness.

Funding the “missing middle”

A major concern for mental health advocates over recent years has been the gap in supports between universally available services (such GP’s and the ten Medicare-funded psychology appointments per year) and acute hospital-based mental healthcare. This problem has been termed ‘the missing middle’, and has been especially prominent in Victoria since the withdrawal of funding for most community-based mental healthcare services as part of the NDIS funding agreement.

In response to this concern, the report calls for 85 to 95 new services to be established across Victoria to “work in collaboration to deliver multidisciplinary, holistic and integrated treatment, care and support”. These services are to work in every local area, as well as statewide, and are to include specialisations for adults, older people, infants, children, and young people. Some are to operate extended hours. These services will have responsibility for a suite of “core functions” from treatment, wellbeing supports, care planning and coordination, and care navigation.

Of particular interest to those without a home, this recommendation also specifies the removal of “rigid boundaries (or catchments) for service delivery based on where people live”.

A focus on trauma

A new Statewide Trauma Service will be established to deliver better mental health outcomes for people with trauma. This service will conduct multidisciplinary research, improve the mental health workforce’s education and training on trauma-informed care, and develop peer-led digital peer support platforms. It will also provide secondary consultation.

Local services across the state will also work with peer support workers to provide a range of trauma supports, and improve workforce development regarding trauma.

Peer workers and lived experience

The Royal Commission found that there is an opportunity to embed peer workers throughout the mental health system. Among other things, this specifically includes elevating the leadership of people with a lived experience of mental illness in decision making on policies and programs. It further includes efforts to prevent and address stigma, and improve awareness and understanding of the experiences and perspectives of people with lived experience of mental illness.

An agency will be established, chaired by and consisting predominantly of people with a lived experience of mental illness, in order to deliver training, develop and deliver mental health services, and promote better collaboration with people with a lived experience.

The experience of families and carers will also be embedded in leadership, training, commissioning, and therapeutic interventions.

Expanding Aboriginal Community Control

Aboriginal community-controlled health organisations will commission culturally appropriate social and emotional wellbeing services for children and young people. Further, VACCHO will work with a partner agency to establish an intensive social and emotional wellbeing support service.

New services responsible for infant, child and youth mental health will support Aboriginal community-controlled health organisations with primary consultation, secondary consultation, and shared care. Two new co-designed healing centres will be established.

New bed-based mental health services

New services will be developed to deliver acute and subacute mental healthcare in the home or community residential settings. This will allow people to receive support in an environment that’s right for them, and recognises that the setting of mental healthcare is an essential aspect of the mental healthcare system.

Redesigning bed-based services for young people

Bed-based support for young people will also be expanded. Homelessness services working with young people are familiar with Youth Prevention and Recovery Centres (YPARCs), whose services are required by many young people experiencing homelessness. Every region will have its own YPARC.

Better support for people with co-occuring mental illness and substance use

Advocates for people without a home have long been concerned by the paucity of mental health and alcohol and other drugs services to support people with “dual diagnosis”.

By the end of 2022, all mental health and wellbeing services, including crisis, community, and bed-based services will provide integrated treatment, care and support for people with mental illness and substance use or addiction. To avoid doubt, the report specifically states that mental health services will not exclude consumers with substance use or addiction from treatment and support.

Ambulances (rather than police) as first responders

Those experiencing homelessness and mental ill-health are 40 times more likely to be arrested, and 20 times more likely to be imprisoned than those in stable accommodation. The Royal Commission has recommended that wherever possible, emergency responses to people experiencing mental health crises will be led by health professionals rather than police This important change will mean that people experiencing homelessness are more likely to get the care that they need, rather than be detained or incarcerated.

Supporting the mental health and wellbeing of people in contact (or at risk of contact) with the criminal and youth justice systems

Forensic community mental health will be expanded to provide consistent treatment and care to people (including young people) in contact, or at risk of contact with the criminal justice system. Assessment and Referral Courts, which specialise in more appropriate sentencing for people with mental illness and/or cognitive impairment will also be expanded.

What does it all mean?

Council to Homeless Persons has welcomed the recommendations in the report. In particular, the expansion of housing and personalised support for people living with mental illness will keep 2,000 adults and 500 young people housed and well.

It is also fair to say that when services exist to meet people’s needs before their crisis culminates in homelessness, fewer people experience homelessness and housing precarity. These reforms will achieve a better mental health service system, better able to support people whose mental illness might otherwise lead to a housing crisis. The reforms listed above will have a special relevance to people without a home, and will improve the lives of many of those with whom we work.

The Commission also found however that some 12,800 people who used Victoria’s public mental health services last year, also sought homelessness support. As the Commissioners noted in the report, with 2,000 properties to be delivered between now and 2024 for people with mental illness, a similar scale of investment will need to be ongoing and continue into the future.