The Interim Report of the Royal Commission into Victoria's Mental Health System
states
The Commission offers this interim report in six parts. These parts cover the topics the Commission has examined so far and culminate in a series of recommendations that seek to address immediate needs and begin paving the way for a reformed mental health system.
• Part One explores the current state of mental health in Victoria. Here, the Commission defines key concepts such as wellbeing, recovery and the full continuum of mental illness and how people experience it differently.
• Part Two lays out the history and nature of the current Victorian mental health system. It also highlights the structural problems the Commission has identified, examines how the mental health workforce currently operates and looks at the challenges it faces.
• Part Three focuses on several themes the Commission has examined to date.
It tells the story of a system difficult to find and get into. It outlines how consumer experiences of the system can be poor and how difficult this can be for the families, carers and others providing support to those living with mental illness or experiencing poor mental health. It describes how the experiences of rural and regional Victorians are both similar and different. And it highlights the most tragic toll of all—when a person experiencing psychological distress or poor mental health takes their own life.
• Part Four quantifies the economic cost of mental health and puts forward a case for increased investment in mental health services in Victoria.
• Part Five offers nine recommendations to lay the foundations for future reform:
– establishing the Victorian Collaborative Centre for Mental Health and Wellbeing
– expanding acute services in targeted areas
– increasing investment in suicide prevention
– expanding Aboriginal social and emotional wellbeing services
– designing and delivering Victoria’s first lived experienced–led service
– supporting lived experience workforces
– ensuring workforce readiness for future reforms
– establishing a new approach to mental health investment
– setting up a Mental Health Implementation Office to drive the initial effort.
Chapter 22 looks to the future, laying out the Commission’s next steps for its final year of operation.
The Interim Report articulates 'Guiding principles for Victoria’s mental health system'
The Royal Commission acknowledges that mental health is shaped by the social, cultural, economic and physical environments in which people live and is a shared responsibility of society.
It envisages a mental health system in which:
1. The inherent dignity of people living with mental illness is respected, and necessary holistic support is provided to ensure their full and effective participation in society.
2. Family members and carers of people living with mental illness have their contributions recognised and supported.
3. Comprehensive mental health treatment, care and support services are provided on an equitable basis to those who need them and as close as possible to people’s own communities—including in rural areas.
4. Collaboration and communication occur between services within and beyond the mental health system and at all levels of government.
5. Responsive, high-quality, mental health services attract a skilled and diverse workforce.
6. People living with mental illness, their family members and carers, as well as local communities, are central to the planning and delivery of mental health treatment, care and support services.
7. Mental health services use continuing research, evaluation and innovation to respond to community needs now and into the future.
The national Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability
Group Homes issues paper released today
defines ‘group homes’ and the existing regulatory arrangements of group homes. The issues paper examines the shift in community attitudes towards people with disability since the early 20th century that led to the closure of large institutions. The issues paper notes that despite a shift to ‘deinstitutionalisation’, concerns for living arrangements for people with disability continue to be raised.
The Royal Commission states
Generally, ‘group homes’ refers to accommodation where services and supports (both within the home and the community) are provided to four to six long-term residents with disability. Group homes may include 24-hour on-site staff support.
Group homes are defined in the National Disability Insurance Scheme (Specialist Disability Accommodation) Rules 2016 as ‘houses that are enrolled (or will be enrolled) to house four or five long-term residents… typically classified as Building Class 1(b)(i) or 3 under the Building Code of Australia.’
All building work must comply with the requirements of the Building Code of Australia which provides the minimum requirements for safety, health, amenity and sustainability in the design and construction of new buildings (and new building work in existing buildings).
A group home must meet the National Disability Insurance Scheme (NDIS) criteria to be eligible for Specialist Disability Accommodation (SDA) funding. However, some group homes are run privately without SDA funding. Those homes may not comply with the Building Code requirements, and may accommodate slightly fewer, or slightly more than, four to five residents. This means that there is no official definition which covers all group homes in Australia.
Until recently group homes were regulated and monitored by State agencies such as Community Visitors and Disability Commissioners. However, following the establishment of the National Disability Insurance Scheme (NDIS), the roles and responsibilities of some of these groups have been progressively transferred to the NDIS Quality and Safeguards Commission.
Independently of the NDIS, there are many Commonwealth and State laws that apply to group homes. These include legislation relating to workplace health and safety; planning and environmental protection; and the regulation of the charities which operate some group homes.
Why is the Royal Commission looking at group homes?
Housing people with disability in residential institutions (often referred to as institutionalisation) in Australia can be traced back to the late 1800s. Typically institutions accommodated large numbers of people with disability in conditions that were often extremely harsh. Many people with disability living in institutions were denied basic human rights and had little or no access to the wider community. This left residents isolated and at risk of violence, abuse, exploitation and neglect.
In the mid-to-late 20th century, community attitudes about people with disability and institutions began to shift. From the 1970s, the disability rights movement advocated for an end to institutionalisation. The United Nations proclaimed 1981 to be the ‘International Year of Disabled Persons’, and emphasised the importance of full participation and equality for people with disability. Disability advocates called on governments to legislate to prevent discrimination against people with disability and to promote the inclusion of people with disability within the Australian community.
The Commonwealth Parliament responded to the arguments of the disability community by enacting:
• The Disability Services Act 1986 (Cth) which provides a comprehensive framework for the funding and provision of support services so as to enable persons with disability to work towards full participation as members of the community; and
• The Disability Discrimination Act 1992 (Cth) which aims to eliminate discrimination against people with disabilities, ensure equality before the law and promote acceptance within the community of the fundamental rights of people with disabilities.
These developments encouraged the closure of large institutions and the relocation of people with disability to alternative forms of accommodation. Despite the marked shift away from relying on institutions, concerns regarding the living arrangements for people with disability continue to be raised. Many advocates claim that people with disability continue to experience exclusion and isolation in group homes.
Over time, group homes have become a common form of accommodation for people with disability who were moved out of institutional care. The group home model was intended to provide people with disability with more independence and meaningful life choices.
Many people think that group homes do not achieve these benefits. Disability advocates point to research highlighting that segregated environments such as group homes increase the risk of violence, abuse, neglect and exploitation for people with disability. Concerns have also been raised about the use of restrictive practices in group homes. Restrictive practices are actions that restrict the rights or freedom of movement of a person with disability; some examples are using medication, locking a person in a room or tying them to a bed.
The Questions asked by the Commission are -
Question 1: Have you, any member of your family, or anyone you care for, lived in group homes? Are you willing to share your experiences or those of another person with the Royal Commission?
Question 2: What is your opinion of the quality of life for people with disability in a group home?
Question 3: Are you aware of any violence, abuse, neglect or exploitation of people with disability in group homes? Are you willing to share your knowledge with the Royal Commission?
Question 4: When violence, abuse, neglect and exploitation occurs in group homes, what do you think are the causes? What can be done to prevent violence, abuse, neglect or exploitation in group homes?
Question 5: Do you consider the experiences of violence, abuse, neglect and exploitation in group homes different for particular groups of people with disability? For example, how does a person’s gender, age, or cultural or sexual identity impact on their experiences? What are the experiences of First Nations people in relation to group homes?
Question 6: Is there a continuing role for group homes in providing accommodation for people with disability? If so, what is the role? If not, what are the alternatives?
Question 7: Are you aware of the use of restrictive practices in group homes that you can share with the Royal Commission? If so, what needs to change or happen to eliminate the use of restrictive practices in group homes?
Question 8: What barriers or obstacles exist for people with disability identifying, disclosing or reporting incidents of violence, abuse, neglect or exploitation? What should be done to encourage investigating and reporting of violence, abuse, neglect or exploitation in group homes when it occurs?
Question 9: Should anything be done to improve or change staffing in group homes to better support the choices and potential of people with disability?
Question 10: What else should we know? Have we missed anything?
