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Standing Committee on Education and Employment
07/06/2011
Mental health and workforce participation

JOHNSON, Ms Fiona, Team Leader, PHaMs West Program, Mental Illness Fellowship of South Australia

MILIOTIS, Ms Natasha, Chief Executive Officer, Mental Illness Fellowship of South Australia

REECE, Ms Sarah, Participant, PHaMs West Program

[12:45]

CHAIR: Today the committee will hear from a range of organisations and I am very pleased to welcome our first group, the Mental Illness Fellowship of South Australia. I now welcome you to today's public hearing. Now a little bit of formality: although the committee does not require you to give evidence under oath, I should advise you that this hearing is a legal proceeding of the parliament and therefore has the same standing as proceedings of the respective houses. We have received a written submission, which we thank you for, but what I might do now is give each of you the opportunity to make an opening statement and then we will proceed to questions.

Ms Miliotis : I would like to just introduce MIFSA and then to pass to Fiona and to Sarah to give more background on the PHaMs program and our experience around employment barriers as well as successes. The Mental Illness Fellowship of South Australia, or MIFSA, is a community based organisation that delivers a broad range of programs to people who are living with mental illness, as well as their families and friends and the community. We reach about 10,000 people a year, so we are a significant provider and our programs range from Commonwealth based activity programs, through support for day-to-day living in the community, to support groups. We have an education program which educates corporates, organisations and businesses around mental health and mental illness topics. We have a peer work training program, and I know you will be hearing about the peer work project in another submission. We have our therapeutic groups program, which assists people along their health self-management journeys and recovery journeys. We have respite programs both for carers and for the person experiencing mental illness to have a fabulous experience in terms of progressing their recovery journey, and we have personal helpers and mentors programs, which are a one-to-one program; you will hear more from Fiona in a moment. In addition, there are other programs such as counselling. We have a helpline, fact sheets and a library. So, as you can hear, it is a comprehensive service. It means that, no matter where a person enters our various sites or connects with us in the community, we hope that they are able to find a MIFSA service that can assist them in those goals that they have. What we find is that many people with mental illness are looking for goals around employment and education; it is one of those life areas that are very important for our sense of health and wellbeing and self-esteem. At MIFSA we take very much a whole-of-life perspective. We have people who find that, by increasing either their health self-management or their awareness around their mental illness, that leads them to a point where they can even start thinking about employment or education goals.

Without saying too much more at this point, I guess some of the things that we would like to share, in my opening statement, are that it really is about the tools to do the job and it is not just the job seeker. Yes, there is a job seeker who needs to have that health self-management and that awareness as well as the training and assistance to achieve education or employment, but there are also the employers, and I am sure you have heard a lot about stigma and the importance of education for employers to create conducive environments. Lastly, but just as importantly, it is about the family or support systems. As human beings, we are social creatures. It is so important for the family and the social group, the network and the friends of the person who is living with mental illness to have the supports they need to understand about the health condition and to support their loved one. Hopefully that sets a context.

We are also as MIFSA part of the Mental Illness Fellowship of Australia, which is our national body, which has branches in every state and territory. We are very happy to be a part of these inquiries and committees and so forth because, across the country, we reach tens of thousands, hundreds of thousands, of people and we hope we can bring that authentic voice of lived experience, given that that is something that is very important at MIFSA. So, just in finishing, 75 per cent at MIFSA have mental illness. It is not something that for us is a theory or a concept; it is something that we live and practice, and we would like to bring that to the meeting today.

CHAIR: Thank you.

Ms Johnson : I am here just to give a bit of context around the personal helpers and mentors program, otherwise known as the PHaMS program. It is a Commonwealth funded program that is run nationwide. MIFSA is very fortunate that we actually look after six sites within South Australia, so that is pretty exciting for us. It is a non-clinical program, based on psycho-social rehabilitation, so the focus is really looking at the life areas for somebody where their mental illness is impacting. The majority of our program is looking at those individuals who slip between the cracks of the present mental health system. An individual does not need a formal diagnosis of a mental illness in order to access our support, which is wonderful. It means we capture a lot of those people who may not present as sick enough or at danger. It means we can work with a lot more individuals who would basically slip between the cracks.

The focus is on long-term support for individuals. It is not time limited, which means that our program worker and a participant can work on goals at a pace that suits the individual. The design is that they connect with services that are appropriate to the participant at the participant's request. The goal setting is focused on life areas that I will list. There is a handout I have here for each of you that goes through each of the life areas. We have areas such as communication, interpersonal relationships, education, transportation, social and community activities, accommodation, domestic routines and clinical and self-care. With relevance to today, we also focus strongly on employment and what it means to become employed and maintain employment—which the majority of our participants within the program, regardless of any site, feel they would like to move into at some stage—and also what it actually means to goal-set towards that and to have maintainable goals that take into consideration self-care around their mental health. So, on that point, it is quite timely for me to pass to Sarah, who is a participant of our PHaMS West program.

Ms Reece : Hello. I have a mental illness. In a nutshell, the barriers to employment that I face are that whenever I put in a job application I am competing with other applicants who have done more training than I have, who do not have long gaps in their work history where they have been ill, who can work longer hours than I am able to at the moment and who have better referees than I do. That makes it extremely difficult even to get to an interview.

I have had a mental illness for most of life. I had difficulties in childhood. I found that when I became ill as a child I was able to reaccess school when I was doing better, but when I became ill in my first year of uni everything derailed and there was not such an easy path back. I did extremely well academically in school; I got two perfect 20s in my SACE and a TR of 98.4, so I am academically very comfortable. But my illness altered everything and I was not able to stay in uni and maintain my study. This was really devastating for me because that was where my whole focus had been up until that point. So I took stock at the time and I changed direction. I thought: 'Well, anything to do with my time is better than nothing. I need to look for a blue-collar job and to stabilise things and go from there.'

I spent a year actively job hunting and putting in my resume to several places a week at least. I was turned down for every single place I applied for. I made it through to interview on only one occasion, where I was told by the employer that they were not interested in somebody with my academic background because they would only train me to have me disappear off to uni. So there really was not much of road back. I was advised to downplay my academic credentials and try and hide that that was really where my focus had been, but without much relevant work experience in my history, that meant that my resume would kind of just have my name and address on it. The experience of that, on top of having an illness, absolutely shattered my confidence. It left me really afraid that I would never be able to get a job and it left me really afraid of my ability to cope even if I could get one. I desperately wanted to work. Every time that I get asked by a new person I meet, 'So what do you do?' and I have to say, 'I am sick,' I desperately want to be in employment.

I reset my sights on university and went, 'That is obviously the path I have got to take,' and over the next few years I made three more attempts to get back into my study. I found that the support at university was primarily geared for people with physical mobility issues and not so much for people with mental health problems. In fact, when I screwed up my courage and disclosed to the counsellor whom I had been seeing there a few times the nature of my mental illness, she told me I was not to come back to the service and closed the entire counselling support service to me at the university, which devastated me and left me without any support on site and I withdrew. In fact, I failed at each of my attempts to re-engage university.

With higher education there are particular challenges for somebody in my position so, for example, I find it quite difficult being in an environment with a lot of strangers on a large campus, and managing public transport is another challenge for me. The general attitude I encountered at university was that I should go away and get better, and then I should come back and re-engage. The problem is that re-engaging is part of getting better and for somebody in my shoes, to a certain extent, there are some things that are not necessarily going to get better—they are things I am going to have to live with and learn to manage. So some of the things I needed were somebody safe on campus whom I could talk to about how I was doing and what I was experiencing and a safe, quiet place I could retreat to if I became overwhelmed, where I could gather myself, collect myself, and then go back to lectures and go back to what I was doing.

Failing at each of my attempts at uni felt kind of like being a fly trying to get through a window pane. It was really hard work and it shattered my confidence even more and left me even more uncertain about where I was going to go and what I was going to be able to do. So I changed focus again and I went, 'Right, I need to work on my resume and I need to get into some volunteering work.' Over the next year I applied to many different volunteering agencies and I was knocked back by all of those as well. One of them told me directly, 'You are not one of the people who helps; you are one of the people who needs help.' There was a line in my world that I just could not cross over. As things stand at that point, I have got a number of blank years on my resume with nothing to account for it, I have no higher education, I cannot seem to make it in academia and I cannot seem to get a job anywhere else. There does not seem to be a place anywhere for somebody like me and handing in job applications starts to feel like I am trying to sell damaged goods.

At this point I stumbled across the Mental Illness Fellowship, who let me into their volunteer program and were quite comfortable having a person with a mental illness in their volunteer program, which is fantastic. So I took advantage of that and every training course around that I could get my hands on and started rebuilding my resume. I also referred myself to the PHaMS program and I have been working for the last 16 months with a PHaMS worker. I decided, with her, that I need to work up to university and that jumping from being really ill to trying to go back to full-time uni was too big a task, so I have started with a number of short WEA courses and then I have gone into a semester of TAFE and now I am looking at getting back into uni, perhaps next year, on a smaller campus, with fewer students and with a course that is more streamlined, so I will be seeing the same faces day in and day out and I am with a university that has a bit of a better reputation for providing support to people with mental health problems. I have also trained since as a peer support worker and I am now employed on a casual basis through the Mental Illness Fellowship, which is wonderful. It has given me a lot of confidence back, I have gained a lot of skills, I have a resume that looks a lot healthier than it did and spending time with people who think I have potential as well as limitations has made a really big difference.

The fact of the matter is I am still who I was when I finished high school. I still have all of those skills and I still have all of that potential. I just have some extra vulnerabilities that I need some assistance to work around. I am now finding a road back to achieving my goals but it has been incredibly long and lonely and frightening and it did not need to be this difficult. And, because it has been so hard, there have been times when I nearly did not make it.

CHAIR: Thank you very much. We really appreciate hearing all of that. Just a question for Sarah, we have heard that who the disability support worker is at university makes all the difference, and we have also heard that a mental illness is not well understood and that sometimes the service is geared up for physical illness as opposed to mental illness. I am quite surprised to hear that they withdrew the counselling.

Ms Reece : Like me.

CHAIR: It is quite a difficult situation, I think. When you are looking at going to university or at some of the studies that you have already done at TAFE or at any of those places, have you found other support? Have they given you that extra support, or have you relied on the PHaMs worker to help you through that?

Ms Reece : I have not found a great deal, to be honest. They are quite happy to organise things like a pathway for me to ask for extensions or something like that, but as far as understanding that it is helpful to have somebody on campus that you can refer to I have not had a lot of very good experiences in that respect. I do use a PHaMs worker and rely on her, but she is not going to come onto the grounds with me. It is really helpful to have somebody there who also knows the university system and who knows who I should go to to ask this question or how I should manage that.

CHAIR: So the flexibility is there in terms of extensions and that sort of thing but that one-on-one connection, feeling connected to the university or the TAFE or the training, is not there and that would be really helpful to support you in your endeavours.

Ms Reece : It is a very challenging environment, and it helps if you can find a few spaces in it where you feel safe, you do not feel judged and you can talk about what is going on, because certainly walking into a tutorial and sitting there with a group of school leavers and saying, 'I have a mental illness,' is probably not the way I tend to introduce myself. So I am wandering around feeling quite isolated, and that is very difficult.

CHAIR: You said that you have been to a lot of interviews and found it a pretty difficult situation getting knocked back all of those times. Did you disclose upfront about your mental illness or did you not, and why or why not did you disclose it?

Ms Reece : Well, actually, I only got to interview once on that particular occasion when I was job hunting, and I did not disclose it. I was also advised not to by the same people that were saying, 'Tailor your resume down'.

CHAIR: So you were getting some assistance from an employment organisation at that time?

Ms Reece : No, I was not. That was just me digging up every bit of advice I could come up with at the time from anybody. That is a really hard call. I have worked prior to that period in my life; I have worked before and, no, I did not tell my employer about my mental illness. I suspect I would not have got the job if I had. It is a really hard call to make because not telling them leaves me really scared that they might find out, which means that if you are doing something like accessing support at a place like the Mental Illness Fellowship you are always worried that someone might see you someone going in that door. It is very difficult. It also leaves you without any sort of support if things do get a bit rocky. I worked as a childcare worker and I was quite unwell for some of that and struggling a lot to maintain employment—sneaking off to cry in the toilets and then pulling myself together and going back. It is quite lonely and quite frightening to do it that way, but the alternative of dealing with an employer that does not understand mental illness and is frightened of you or of what might happen if you get unwell and does not know how to manage any of that—probably they just will not take a risk on you. If they have got two applicants with similar abilities and applications and one has a mental illness and one does not why, from their perspective, would they take the risk on the person with the mental illness?

CHAIR: This question is probably for Fiona. One of the things that we have heard is that getting the coordination between some of the lifestyle, psychosocial rehabilitation and the clinical services—we heard this morning down at the Trevor Parry Centre that there is starting to be that connection between clinical services and employment services, for example. I am wondering about your experience, of how you work from the psychosocial. I know you said that a lot of people fall through the cracks and perhaps are not getting that clinical support but, for those that are, how do you work with the clinical services to get employment or educational goals on the agenda and work with the clinical services for a shared outcome for the client?

Ms Johnson : Within the PHaMs program, although we are nonclinical, we do really appreciate any form of clinical support that is in collaboration with us. It is very important that we appreciate that there are some areas of the clinical services that are very effective and are much needed. With regard to the employment side of things, and education, we find that the clinical services that are involved are quite supportive. We are constantly working together to bust a lot of that stigma that is out there—very similar to what Sarah was just explaining. We have prepared together, as a group, some of the main barriers and strategies which participants would face. One of the big ones, one that constantly comes back, is stigma and what it means to enter a workplace that is not educated on mental health or mental illness. Also, it is about job network providers and job agencies and their awareness of what mental illness really is, their inflexibility in placing individuals, possibly not giving all the relevant information when someone is placed, and what it means to follow up that placement support. We find that in the PHaMS program we do a lot of that follow-up employment support that, theoretically, one would hope a job network provider would be doing.

CHAIR: Can I just ask a follow up question: have you seen a difference between a generic job network provider—I hate to use the term—and a disability network provider and a mental health specialist provider? Have you seen a difference in outcome, or perhaps you are not aware of the different outcomes these different job providers—

Ms Johnson : I can speak specifically from the west—that is the area that I take care of. We have noticed a difference with regards to job network providers that do look at mental illness clients. We find that there is heightened collaboration with some of their workers, which is excellent. It is still not at a point where we would find it proactive and helpful. We are finding that we are doing a lot of the communication and beginning to foster those linkages, and we are finding we are doing more of the education side of things. So, yes, it is moving forward in a good direction, but it still needs a lot of work, I think.

CHAIR: One question would be about the people who refer to your service and do not have a diagnosis. They probably could not access the mental health specialist stream or perhaps even the disability services.

Ms Johnson : Based on their criteria, yes. If you do not have a diagnosed mental illness, it can make it quite difficult.

CHAIR: So if those clients wanted to find work and you wanted to work with an employment agency, they would go into a generic—

Ms Johnson : Possibly, yes, and they would possibly be assisted to do that through Centrelink as well. That can make it a bit different for support altogether.

Ms Miliotis : It is correct that you do not need a diagnosis, which is one of the beauties of the program. However, PHaMS works with people who are obviously facing barriers that are a result of mental health issues. So is it true to say that, along the track, often they do get a diagnosis; it just has not been a barrier that we have put in their way before they can access us, such as needing a diagnosis at the door? There is the concept that they can get in the door—no wrong door concept—they can get the service and then, along the path, they get the diagnosis and we can connect them with the specialist services.

Ms Johnson : Definitely.

Mr RAMSEY: Just on PHaMS, if you have a commitment not to limit your time to anyone and they do not actually have to have a diagnosis, how is it funded?

Ms Johnson : How is it funded? We are funded on a funding cycle. Do you mean with regard to participants moving through the program?

Mr RAMSEY: How is the whole operation funded? Where does your base funding come from?

Ms Johnson : Through FHaCSIA.

Mr RAMSEY: How do you meet your funding requirements if you are not actually ticking off on a patient load?

Ms Johnson : I am going to give you this so that you can actually see this now. Please take one and pass them around. I will show you what I am referring to.

Mr RAMSEY: The concept in government that you can actually deal unlimited with a client—and in fact the client might not be a client in someone else's office—is quite foreign.

Ms Johnson : Yes, exactly. I will be honest with you: it was quite an interesting concept for me when I started in 2007. It is a program that really looks at that qualitative side of the outcomes as well. Quantitatively we do collect that information around participants that enter our program: what type of diagnosis; if they have a diagnosis, what they have. This purple laminated document is a participant journey—an example of someone who has gone through the program. As you can see, the bubbles are the life areas that I mentioned earlier. The orange boxes are the levels of support. We need to document, on a six-monthly basis, how many individuals are moving through each of the processes. Within the concept of psycho-social rehabilitation, recovery is not necessarily a cyclical process. People can move within the levels, based on the fact that, as they begin to gain confidence within their recovery, new challenges come up and they may find themselves once again needing intensive support as opposed to continuing care.

As part of our funding agreement we need to demonstrate quantitatively who is in each of these cycles, who has moved within them, how many hours a week we spend with the individual and things like that. We quantitatively gather that down, and qualitatively we need to present the deidentified case studies at six-monthly intervals as well.

Regarding our case load, each full-time equivalent staff member has ten to twelve participants—so it is really quality over quantity. That participant case load is monitored quite closely by the team leaders within MIFSA around movement. It is not the case that because the case list is full it stays that way; we do have quite good throughput at the moment. The ultimate goal for us is having throughput, but we do see movement because of these levels of support, not only being supported by the funding body but team members actually understanding that this is the direction that recovery needs to go in for a participant. Participants are very aware when they get on board. It is quite interesting: when they realise that they do not need a formal diagnosis and it is not time limited, they do not feel the need to demonstrate that they are sick in order to keep the support. I hope that makes sense.

Mr RAMSEY: How do they get onto the program in the first place?

Ms Johnson : Self-referral is encouraged. In the early stages we put our brochures in obscure places like libraries, dental surgeries and GP offices—places like that. People would pick them up and self-refer. We find we do get a lot of referrals through the typical clinical services, such as assessment and crisis intervention services, psychiatrists, whether private or public, and the mental health system. Family, friends and carers are also a source. If anyone rings MIFSA and says, 'I need something for my son or my daughter,' we encourage them to refer their loved ones in for support. But self-referral is a beautiful starting point, because individuals are almost ready right there and then. They are actually saying, 'I need the support.' They are almost ready to go.

Our assessment process is a very interesting process as well. It looks at the functional limitations of the individual. When I meet with a potential participant, it is essentially a conversational tool around the barriers to them getting back into employment, education and social and community activities. Through that conversation, the reasons come out and you often find that they are based around some form of mental illness—or mental ill health, as we call it if someone is not formally diagnosed. It is a program that, from the outlook, does not appear to have that real nuts and bolts numerical data—

Mr RAMSEY: This is not a hostile comment at all, but I find that, with the way government works, normally everyone has to justify their existence.

Ms Johnson : Yes.

Mr RAMSEY: For instance, has the Auditor-General looked at PHaMs? It is just that it is a surprising way of doing government business. That does not mean to say you are not doing great stuff, but I am surprised that you do not have to justify your existence to someone. If someone can self-refer and they do not really have a time line for getting out, it sort of—

Ms Johnson : It is very open, isn't it?

Mr RAMSEY: It is.

Ms Johnson : Our six-monthly reports are lodged through the FaHCSIA portal, so the information is constantly there and available. We also have a process whereby, when we are at capacity, we need to log every referral that comes in and is classed as a turn-away. When anyone cannot access this service, we need to immediately register the reason. We have quite a helpful portal website provided by FaHCSIA that documents this information on a daily basis.

Mr RAMSEY: What happens if your workload overloads you? If you just have too many people coming in the door, how do you deal with that?

Ms Johnson : Part of our funding agreement is the expectation that, if we cannot provide a service, we need to find a service that will. As you can imagine, that can be quite difficult, particularly in our non-metro regions. We become quite creative in how we provide that support. For a lot of the individuals who may refer to PHaMs and we do not have the case load available, it is a matter of looking at what other supports may suit them. A classic example is when someone is referring themselves and we are at capacity. We look at whether they have a carer on board, informal or formal, anyone who drops in or makes a phone call for them. Then we will talk about what it means to access the respite program: six to 12 weeks of support, almost immediate pickup and something in the interim before PHaMS can pick them up. In the instance that they do not have a carer or it is not what they are after, we will look at bringing them in to our activities program because, although it is more group based, we look at goals for the individual to get back into the community. If we are at capacity we need to demonstrate through that portal function who we have referred the individual to that no stone has been left unturned. It is hard work in that respect, but we get creative.

Mr RAMSEY: I guess there are not many times you are under capacity.

Ms Johnson : We are pretty much at capacity all the time.

Ms O'NEILL: It sounds like you are doing amazing work and, Sarah, I congratulate you on your bravery to come and tell us your story today. Thank you for sharing it with us.

Ms Reece : Thank you.

Ms O'NEILL: I have just come out of the education sector at university. I am particularly interested in the experiences that you had at university. If you were to make some recommendations based on your experiences so far, what important things do you think need to be put in place to prevent the experiences that you had? What would you ask us to make happen?

Ms Reece : Particularly at university level?

Ms O'NEILL: No, you have more than university experience to give us. What things would critically have improved your life outcomes to this point of your life?

Ms Reece : Early referral to a job network provider that caters for mental health. Part of the issue was that it took me quite a while to get a diagnosis which meant I spent a long time on short-term incapacity with Centrelink, doing a lot of job hunting with them and I was quite terrified that I would get a job I was not well enough to do. I was quite frightened to go to a job network provider, even if one of them were on offer, because I thought I would be under enormous pressure to take on things I simply was not ready to take on. Something geared specifically to mental health would have been fantastic.

As far as university goes, something on campus—a group for people that have mental illnesses trying to study at a tertiary level or disability liaison officer support specifically geared to mental illness that understand doing it alone. At university you are doing it alone, you are self-managing a lot without necessarily having a peer group that somebody without a mental illness has. You are not going out on Friday nights and getting drunk with the rest of them because it clashes with your meds. There are a lot of those barriers to linking up to social support, so some assistance to do that would have been enormously helpful. Some space somewhere at the university to retreat, a quiet room or something like that, would have been of great benefit to me.

The volunteering side of things has been very important to me and made a great difference to me. I did not find out about MIFSA until I happened to do a Google engine search for a particular book I was looking for and discovered it was in their library. I had been sick for years, and nobody told me about them. I wish I had found a service like that years before. Part of it is not necessarily creating services, it is creating pathways so that somebody like me finds out about them. That gave me access to volunteering that was geared towards somebody with a mental illness, whereas with every other volunteering position I had looked at they did not want to touch me, did not want to take me on; they were quite nervous about it.

There should be support for voluntary work and job provider networks that are geared towards disability. On that front you would have to have employers that are happy to employ such people. It is great to have a job network provider that is on board, but I could be dealing with employers that do not understand the nature of mental illness, that do not have the flexibility to offer me, 'If you become unwell, we can work around that' as opposed to, 'If you can't work the 30 hours a week then you need to be looking for another job.' Employers need to understand that although it is a disability and a limitation, I have also learnt a tremendous number of skills through my experience and I do have a lot to offer. I am an asset to a workplace; I am not just a liability. Employers need to see as an advantage some of what I have come through, what I have experienced and what I have learnt. The reason I am going into the mental health sector at the moment is it is starting to be seen that way, whereas if I am going for employment in most other areas it is not seen that way at all.

Ms O'NEILL: That echoes something that we heard this morning: 'My experience is my asset, not necessarily my liability.'

Ms Reece : Yes, absolutely.

Ms O'NEILL: This is a very challenging question, but you might be a person who can answer it for me. If I were the employer you described who has a choice between somebody who has all the assets and liabilities that you bring and another person who has assets and liabilities that are much less disclosed or known about, what do you think is the thing that will make me as the employer employ you? Is there a critical thing that you think would change employers' behaviours?

Ms Reece : I guess to a certain extent, from my perspective, a person without a diagnosis of mental illness is not necessarily any less at risk of becoming unwell or having a major life crisis. I do not really see myself as being at high risk. Considering that I have lived with my particular conditions for a long time and I have demonstrated an excellent ability to manage them, I look at my situation and go, 'I am lower risk.' I have come through major life crises. I have been homeless. I have experienced domestic violence. I have come through all sorts of stuff, but I am still here. That means I have some pretty good skills at managing my stuff. The idea that the universe is split up into the people who are well and the people who are sick has not been my experience. Everybody is potentially one major life crisis away from becoming quite unwell. All employees are a bit of a risk and everybody with a mental illness has potentially, with the right support and a good network, a way of getting everything back on track and being able to be a contributing member of society in that respect.

Ms Johnson : It has been quite interesting with regard to employers that are aware, probably having already employed individuals who are living with mental illness. But it is just highly covered over and concealed incredibly. It is really fascinating.

Ms Miliotis : Here is what we are finding with our education program with those large organisations. We are repeat trainers for the ATO, the Australian Taxation Office, for many years with our education program, where we go in for six sessions. We do training on understanding particular mental illnesses, awareness around mental health and the workplace, and how to manage stress, because a lot of the larger corporates are now doing their figures. They will have 500 employees: 'One in five of my employees will have a mental illness this year. Oh, my goodness! I think I might get an education program in to build the resilience and the capacity of us as a HR department or a management team or as a workforce to be able to support each other.'

That absolutely echoes the importance of education programs and, of course, the education for the families as well. Just to echo what Sarah was saying about the social supports around, each one of us will have either a family or friends. Hopefully each one of us has some network where, if those people are understanding and resourced to be able to support the person when they are experiencing mental illness, they have a better chance of succeeding and getting back on their journey of recovery. Suppose we can get those elements in place and have well-resourced programs such as Well Ways—and there are others—that support carers and families to care more effectively for themselves, and back that up with education for workplaces. We train the psychiatric registrars of future years. We are going to schools of nursing to teach the professionals of tomorrow to give them the sense of lived experience perspective and the importance of mental health awareness. If we do that with families and friends, and we do that with potential employees, it makes the work of a job seeker that much easier.

Mr SYMON: You have spoken a lot about PHaMs today. What happened before that?

Ms Reece : It is a good question. PHaMs has been a bit of a revolution since 2006 and 2007. There were one-to-one services before that that supported people. I guess what you have heard today is that there is no magic around working one-to-one with someone. It is about setting goals; it is about looking at what the person aims to achieve and then breaking that down and achieving that. What PHaMs has brought is the capacity for people to get help earlier instead of having to wait till they are sick enough to say, 'I am sick enough now; I need a worker.'

Mr SYMON: And that is self-referral.

Ms Reece : And that is the self-referral pathway. That is the 'no wrong door' concept. That is the fact that you do not need a formal diagnosis. Please do not hear that that does not mean the person is not experiencing mental distress; they are. We are working with people with mental illness; they just do not have the formal psychiatrist's letter that says, 'You have x, y or z,' but they have been managing the functional limitation as a result of mental health problems for some time.

What has been revolutionary with PHaMs is it has been a nationwide program that with, I believe, over 175 sites across the country is reaching 10,000 people and assisting them in their journeys. What we know is that there are about 40,000 people that are missing out. If, through programs such as PHaMs and respite programs and activity programs, we can connect people with that early intervention, their trajectory and their recovery journey just has so much faster and better an outcome.

Mr SYMON: The other area I want to explore is the other programs that MIFSA runs that are in the field of getting people engaged with employment. We have heard about PHaMS but there are obviously other areas that you work in with the same goal.

Ms Miliotis : Absolutely. There actually isn't a program that we offer that does not have an employment focus. All of our programs are about the person's goals in life. So if the person has that goal, and most people do want meaningful activity in their daytime—for some people that is volunteering; sometimes it is training, education or employment—then our programs are assisting. What is beautiful about the various mental health programs that we offer at MIFSA is that the person can come in and, instead of fitting the person to the service, we can find the service that fits them. So if they want a group environment, a therapeutic group program to learn health self-management and get tips and strategies on how to create space for employment education, that is what they are connected with. If it is around the activity programs so they can learn more about their mental health, go on a Out There Program, do an art group or whatever it is that gives them that social connection and builds their self-esteem and confidence, then they can connect with that. Or it might be about peer work training, and I know you will be hearing about that shortly. That is just three programs but there are various programs where we are always working from a rehabilitation recovery perspective.

Mr SYMON: One last question, which you may not know the answer to: to the best of your knowledge, is that true of the other providers that operate in this area as well?

Ms Miliotis : The non-government sector is a diverse and very rich area. I think I would like to echo what Sarah said, which is that there is a lot of excellent resources out there and a lot of excellent programs and services. It is about connecting those up sometimes. MIFSA is the largest specialist provider of mental health services—everything we do is mental health. We have a diverse range of mental health services but there are certainly other organisations that have a good array of programs that people can connect with. In South Australia we do that particularly well, and it happens across the country that as community service providers—non-government service providers—we create connections between each other so there are pathways for people between services. So if we do not, for example, provide a housing service, we have other organisations that offer that service from within MIFSA or we make referrals to mainstream services when participants are ready to take that step.

Mr SYMON: So that is the no-wrong-door approach.

Ms Miliotis : All the time. Yes, absolutely.

CHAIR: Thank you very much. We appreciate each of your contributions, and if there is any additional information that you would like to provide the committee you are more than welcome to forward it on. The procedure now, so you know what we are going to do, is that we will work to provide a report with recommendations to government about where we see opportunities in this area for the government to make a difference. You will also be sent a copy of the transcript of your evidence to which you can make corrections of grammar or facts. Thank you very much.