SA Health Mental Health Services Plan

We want to hear from South Australians about the priorities that should be addressed in the SA Health Mental Health Services Plan for the following areas:

  • access to mental health services
  • defining best practice in mental health care
  • providing continuity of service through partnerships within and outside government services
  • inpatient and community-based recovery and rehabilitation services
  • promoting wellbeing, prevention and early intervention.

Provide your feedback on one or more areas by leaving a comment below.

Comments closed

Sue Oldfield

29 Nov 2018

I see the ice epidemic putting a strain on the already inefficient mental health system. Rural areas struggle in this area, weeks to see a specialist, patients hospitalised to only be let walk free without any follow up. A follow up should include notification to family members & not just the patient as some patients wont divulge to family. While there is the confidentiality act, I believe the family of patients with mental health issues should be included in some of the treatment process. If a patient doesn't want help & don't have the family to support them then this is why I believe there are such a high number of suicides! How does it happen that in a rural region 2 mental health workers take their own life within a few months! To me it just goes to show how severe the mental health system issues are!

sarah sutton

29 Nov 2018

I have multiple roles within the mental health sector. I am a Clinical Psychologist working in private practice in primary mental health care, a Forensic Psychologist working in the SA public service (but deliberately not working within mental health services), a mental health advocate in my role as SANE Australia Peer Ambassador, and a family member of two brothers with complex mental illness, thus an unpaid carer. These roles are sometimes NOT possible to separate, and some of these roles are definitely looked upon less favourably than others. There are great differences in power that I hold when I am wearing my different hats. For example, I was involved in planning the carer forum of TheMHS until I was kicked off the committee as they didn’t like what I had to say as a carer. If I am on a committee and I am introduced as a Psychologist with 17 years’ experience in this role I hold substantially more power and credibility than if I am introduced as an individual who has two family members with schizophrenia diagnoses. This is despite the fact that I have ten years more experience in my caring role and I believe it provides me with a much better understanding of the effect mental illness can have on people’s lives!

I have two brothers with disabilities. In 1991, my oldest brother was king hit at a party at the age of 21. He sustained an acquired brain injury and over time he withdrew from his friends, his family, his life. He wouldn't go to medical appointments, he stopped eating, he became distrustful of others. As he became more vulnerable he was taken advantage of by others including his friends.

My other brother, aged 17 at the time, perhaps from the trauma of witnessing all of this, quite suddenly also became unwell. He was seen at school engaging in risky behaviours and it was thought he was attempting to take his life. He went from a “straight a” student to a young man who wouldn't get out of bed to go to school and one day my parents found him hiding in a cupboard, extremely afraid.

I am always torn as I want to honour my brothers’ privacy but they are so disempowered by society, that they have no voice and are unable to advocate for themselves. They have no power and they are not given adequate support nor advocacy to make decisions for themselves.

Because of a lack of support by the mental health system, my brothers have difficulty getting motivated, organising themselves, learning new things, putting together ingredients to make a meal, communicating their needs, concentrating on complex tasks, and looking after their own health and well-being, People don't visit my brothers, they have no friends to ask them how they are, they don't get invited to parties, they don't work, they experience severe symptoms of mental illness and extreme side effects of medications such as diabetes, and the community discriminates against them.

One of my brothers does not talk as he was assaulted by police a number of years ago - for simply running away as he did not want to be detained involuntarily. He hadn't done anything wrong. Over the years he has been secluded and mechanically and chemically restrained against his will. His basic rights of communication and freedom of movement have been taken away.

I definitely agree that I can not understand what it is like to have a diagnosis of Schizophrenia, however I don’t believe that I can NOT advocate for individuals with severe and persistent mental illness.

People are not ill in isolation, particularly people with severe mental illnesses like Schizophrenia and carers in this situation often play a significant role in the support of their loved ones. Carers are the ones that continue to provide ongoing and daily support for those with complex mental illness, even into old age. My brothers, and in fact our family, have been working towards recovery for 27 years.

Our family are the ones that have written my brothers’ NDIS applications, we are the ones that attend meetings for them and make complaints about their inadequate care. Last week, my Mum, Dad and myself attended an NDIS initial NDIS planning meeting – all three hours – as my brother could not himself be there. My family have spent the last 18 months attending Administration Tribunal hearings in SA and just a couple of weeks ago the matter was finalised, with our family successfully regaining control of my brother’s money from the Public Trustee, who had earlier this year closed his bank account with no notice, and left him to flounder with no money for 6 weeks. Not 6 hours, not 6 days but 6 weeks !!!! As you would all be aware, in SA there is no adequately supported accommodation available for people who struggle to live independently. My parents have bought my brothers a house to live in rent free for the rest of their lives and yet even this was questioned recently by the Admin Tribunal simply because we had no legal document which guaranteed he could live there – as if he would be any safer anywhere else?

The physical and mental toll that advocacy has had on our family is immense. We live in constant fear everyday that something terrible might happen to my brothers, we have experienced many services drop out because my brothers are deemed ‘too hard’. As a result of always being in fight flight mode, every member of my family has developed autoimmune conditions.

Of course, we will continue to provide assistance as a family, but my brothers actually don't want that kind of help from their family. Sometimes my oldest brother and I aren’t quite on the same page. I’m his younger sister AND a psychologist, what would I know? Most often, my brothers and I just want to be siblings.

Being an unpaid carer and not working in a paid carer lived experience role, I am often NOT notified of opportunities to provide contributions, feedback or suggestions. Lucky I am a serial stalker on Twitter and I am mostly aware of what is happening around my state and the country. It is often the case that the opinions of carers are often undervalued and also deliberately disregarded and our family has been told on more than one occasion by service providers to "back away" and have a break. I can’t tell you how much we would all LOVE a break.

It is really important to hear the voices of carers to gain additional information about a person, particularly if they are acutely unwell. Sometimes consumers cannot speak out due to fear of discrimination and mistreatment. A consumer can also be very very scared of disclosing information about their experiences because of unjustified shame or for fear of being hospitalised and they will only talk about how this is impacting on their lives with people they trust – their carers.

Carers, however, desperately need more information and support – they are so busy in their caring role that they do not have time to attend information sessions and consultations – carers want to know about the NDIS, but they are confused and exhausted by this new scheme that is finally a light at the end of the tunnel for their family members, and they are often put off by media reports about the failings of the system.

These experiences leave me feeling so so sad and upset and it is so difficult and almost impossible for me to stand by and watch the atrocities that are committed against my brothers by the ‘alleged’ mental health system, and the resulting consequences that they have on them and their lives. My brothers aren't seen as human beings, they are seen as burdens. They are NOT. They are kind, strong, patient, resilient, brave and gentle souls. That is why I speak up.

I worry too about those individuals out there that are in similar circumstances, but have no family or friends advocating for their rights. We especially have an obligation to those with a mental illness who do NOT have family members that love and support them, and do NOT have someone to advocate for them.

It is so important for consumers and carers to be given information about mental illness and the legal rights and responsibilities for consumers and carers, such as the Carers Recognition Act, and to be guided in how to navigate the mental health services. It is our right to ask any service provider questions and know about the benefits and side effects of medications and treatments, adverse consequences, whether there are alternatives to what is being offered.

My oldest brother is involved with 7 agencies, and we as a family ensure that regular meetings are held between the organisations to prioritise working together.

He previously received a Housing and Support Package, but due to the block funded organisation putting his life in danger, we were able to transfer his care to Uniting SA, with a guarantee that the funding would follow him. However, this did not occur, and Uniting SA have been supporting him three times a day for 7 days a week on meagre Individual Psychosocial Rehabilitation Support funding.

My advice for those with lived experience and their carers is to find great mentors and good providers, ask your peers who is good. It is really important to gain advice from those with lived experience and living experience.

We are all human and we all face challenges so why not face these challenges together? Mental Illness CAN happen to anyone. Prior to my brothers’ diagnoses, there was no history of severe mental illness in my family.

I believe that ALL mental health advocacy is important and that we all need to work TOGETHER on common goals such as improving services and supports. 13% should be spent on Mental Health Services – most countries only spend 2%!!!! We need improved and expanded community services, collaboration in education and advocacy, empowering consumers and carers and instilling hope.

The UN report on the rights of those with disabilities stated that the medical model of care is preventing good services. We need to improve access to a range of community services, not a focus on costly hospital beds and medication and involuntary treatment, which often adds to levels of trauma. Psychosocial interventions, not medication, should be the first line treatment of mental illnesses.

There is a huge gap in this country between the GP and ED. This is the missing middle. ALL people with mental health issues need easy access to the right support at the right level, at the right time, first time and every time.

Since 1980 the city of Trieste in Italy closed psychiatric hospitals and set up a network of 24-hour community mental health centres to support clients in their daily life, with a view towards recovery and social inclusion. How good would that be!

People want to work, garden, interact with the community. People have not in the past had the supports to recover. Human rights and social justice also need to be the core business of mental health services.

I am so glad that the NDIS includes those with mental illness and psychosocial disability, and state systems also need to assist and empower people to access and use these supports.

We need increased psychology sessions for those with severe mental illness. You can see a Psychologist ten times a year, but can see a Psychiatrist 50 times a year. We need a list of bulk billing psychologists, psychiatrists AND other allied health professionals, and also a list of lived experience workers – paid consumers and carers.

One of my brothers saw a Psychologist a few times in the community and was never followed up, and my other brother has never been offered psychotherapy in the community to deal with the initial trauma which triggered his mental illness, nor to deal with the ongoing trauma that he has experienced over the years including the ongoing grief he experiences due to lost opportunities in his life.

We also need continued and expanded funding for community mental health services like Partners in Recovery, Personal Helpers and Mentors Program, Day to Day Living, Intensive Home Based Support Services, crisis respite, and step up and step down intermediate care centres and community rehabilitation centres are ALL much better options, are more cost effective and are less traumatising. These need to continue receiving funding by the states, territories and federal government.

There are many peer led services which are effective, but are not readily available in SA. These include alternatives to suicide, intentional peer support and survivor led crisis services.

There also aren’t enough service providers that are caring, flexible, empathic, non-judgmental, compassionate and willing and able to spend time with my brothers, sit with them, get to know them, and help him find hope and meaning in life. Some service providers have risked my brother’s life and safety in the past as they would not change their services to meet his specific needs. Empathy and compassion is even more important in a worker than qualifications, and if the worker themselves also has lived experience of mental illness – well that is a super worker right there!

There are things we can ALL do to make the journey a lot easier.

Everyone deserves a contributing life, including safe and stable accommodation, support and something meaningful to do with their time.
We need to work together to reduce the fear that the general community has of people with severe and persistent mental illness, Schizophrenia in particular. We need to work together to educate the general AND mental health communities about mental illness.

People with Schizophrenia diagnoses are often marginalised and due to a lack of support and good services, they often become homeless due to a lack of adequately supported accommodation options.

Australia’s Fifth National Mental Health Plan priorities include providing integrated and coordinated treatment and supports for people with severe and complex mental illness. What a joke in SA! We have a wellness plan for the state, what about those with severe and persistent mental illness, those that are falling through the gaps, those that are homeless or living in jail.

We need to make changes for ALL severities of illness, including those that have not yet recovered and are vulnerable and cannot speak for themselves. However, those who are vulnerable and in the minority need to be given power and support and not be expected to hold all the responsibility. This is what Janet Meagher spoke of recently - the reluctance of the alienated.

Services have yet to learn how to properly overcome common barriers such as when people have a severe mental illness, for instance, when a person is acutely unwell and does not necessarily easily accept the need for support.

Service providers need to realise that experts are those with lived experience. If we wanted to know how to play the piano then we would ask an expert pianist. Why don't we ask those who have recovered from being unwell about how to do things better?

A Cochrane review found that peer workers are no better or worse than professionals, and other research demonstrates that peer workers can reduce hospital re-admission rates. All voices involved in a problem need to be heard. All perspectives need to be treated as valid.
When a project is consumer or carer led it looks different and BETTER. Lived experience workers – including peer specialists and carer consultants - assist those within systems to better navigate services, be informed about their rights and what services are available. How good would it be to have consumers and carers employed in all community mental health settings and also ED.

Lived experience workers also need access to regular training and supervision, and need to have clear processes for making complaints. Lived experience involvement needs to be included within services as KPIs and providing financial incentives for service providers to engage with those with lived experience would be welcome. We need to embed human rights into KPIs rather than “risk”.

Recovery was introduced into mental health in order to ensure everyone was given the opportunity to live a better life, by providing an environment of hope around them. However, people with severe mental illness are still falling through the gaps because they may be unable to articulate “goals and strategies to achieve those goals” in other words, they don’t “fit” into the agencies’ idea of what recovery means.

We need to share stories of hope and survival and demonstrate that things can improve with the right supports. I am given hope by consumer stories of braveness and resilience.

My brothers also inspire me daily, seeing them deal with the lack of support provided by the mental health system is very traumatic and the grief is immense, but it also demonstrates to me their great strength, resilience, persistence and patience.

We all need to work together better to pave a better future for others to live an enjoyable and meaningful life.

Pamela Brear > sarah sutton

30 Nov 2018

Thank you for sharing your story Sarah - it is stories like yours that need to be listened to, and listened to carefully!

Judith de Lang

22 Nov 2018

The dominant discourse limited to a bio-psychiatric approach seems fixed and unshakable against current evidence regarding trauma-informed care approaches. Evidence regarding the damaging effects of neuroleptic medication appears to be ignored along with evidence regarding the effects of childhood trauma. Individuals are entitled to be fully informed about the treatment being offered. People are not 'standard' and treatments can never be standardised. Workers are encouraged to be innovative and creative and then prevented from implementing any change. There is more than one kind of evidence. Those with the most power implement their preferred view, those with the least are afforded little to no voice. Often, those who rail against the system are silenced. Passionate workers and clients continue in their attempts to create inclusive, caring and responsive systems.

Moira-Jane Conahan > Judith de Lang

27 Nov 2018

Totally agree with this comment

Brenda George > Judith de Lang

28 Nov 2018

Agree with this comment to. Treatment like many illnesses is not a one size fits all. It also annoys me that the trendy option is taken first not neccessarily the best option for the patient. They are to quick to say do shock therapy without much consideration to the distress it has on the patient when they lose memory.

Pat Bradley > Judith de Lang

30 Nov 2018

I agree - the language is changing and softening but the system prevails. There is so much need and distress yet access to therapeutic services remain elusive for many.

Pamela Brear > Judith de Lang

30 Nov 2018

So true Judith. And yes, 'passionate workers continue in their attempts to create inclusive, caring and responsive systems', yet that workforce eliminates well qualified and competent PACFA Registered counsellors!

Rachael Dianne

21 Nov 2018

Priorities that need addressing would be 'the ice epedemic in the mid north'
More Programs are needed to promote community based recovery with rehabilitation services. healthy living, social skills and general wellbeing helping with the prevention of drug use and early intervention. Parenting programs, healthy relationships , building social skills with social events, courses, basic life skills and life after drugs, education.

David Hains

19 Nov 2018

Our policy documents are becoming too full of clichés but there's not enough substance.
For example, we can't keep saying that we provide "person-centred care" while we continue to provide services based on a medical model with a strong biological focus. It doesn't matter how many times they use the phrase "evidence-based" in an attempt to justify what they do. Unless we actually stop and take the time to walk alongside someone, ask them about their desires and needs, and individualise a package of care (rather than enforce "treatment"), we will never be able to create a State of Wellbeing.

(comments are personal as a citizen of South Australia, and do not represent the organisation who I work for)

Moira-Jane Conahan > David Hains

27 Nov 2018

And agree with this too, also in my capacity as a private citizen

Brenda George > David Hains

28 Nov 2018

Very true it is so not person centred care and the whol process of it all at the moment and for at least 20 years or more is totally dysfunctional. It breaks down often and people are sent home early and left to care for themselves. Or it is placed on their families who get highly stressed and the advocacy that has to be done for the patient is beyond a joke.

David Johnston

14 Nov 2018

Regional areas come a bery poor last ehen it comes to service for Mental Health. Eg Port Lincoln Hospotal has a mental health ward but no practicing specialists to man it and look after patients. It even a 12 week wait for a visiting private specialist. Nothing at all for peple who are in crises. NEEDS TO CHANGE!!

Brenda George > David Johnston

28 Nov 2018

True rural areas are suffering big time and something seriously needs to be done to improve this.