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

BAMFORD, Mr Todd, Team Leader, Transitional Care and Early Psychosis, and Noarlunga Emergency Mental Health Services, Southern Mental Health, Adelaide Health Service, South Australia Health

STRACHAN, Mr John, Acting Outer South Sector Manager, Southern Mental Health, Adelaide Health Service, South Australia Health

[14:57]

CHAIR: I welcome representatives from Southern Mental Health Services, Adelaide Health Service, South Australia Health to today's public hearing. 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. Therefore, it has the same standing as the procedures of the respective houses. We have not received a submission but I am aware that Todd has promised us his paper that got the ball rolling in terms of the integrated service.

Mr Bamford : That is right. There are hard copies here for you and we can certainly email that.

CHAIR: We might take that as an exhibit. I invite you to make an opening statement. I know that some of it may be repetitive. We heard a bit of it this morning, but we would appreciate getting on the record a little of the history and detail. We can then open up for some formal questions.

Mr Bamford : Thank you for the opportunity to speak today. My part of this today is to talk about the policy development work we did in SA Health in the mental health unit. The discussion paper was intended as the synthesis of the evidence based around better employment outcomes for people with serious mental illness as well as triggering some thinking amongst the relevant stakeholders around what sorts of different ways of working we would need to adopt to actually implement the evidence based practices for employment outcomes. The evidence was very clear that an integrated service delivery model is far more effective when you are looking at hours worked and length of time in employment, and even simply rates of consumers achieving employment. That was very clear. From the mapping we did, it did not look like we had anything like that evidence based model in existence. So the way we decided to consult on that evidence was in an integrated way. We brought together stakeholders from non-government employment services, non-government mental health services, clinical mental health services, consumers and carers, education providers and Centrelink. We consulted around the state. I think there were five country consultation workshops and two large metropolitan workshops. We asked people not just to tell us what they thought but also to raise the problems. We were talking about bringing together two very complex systems, the employment services sector and the health services sector. We needed those stakeholders to tell us about the problems and then start working on the solutions—and they did that. We did develop a long list of feedback out of those workshops that we could use in implementing the services. By doing that, by putting out a call to those stakeholders to do things differently, we exceeded our expectations in that people were approaching us at the conclusion of each workshop, asking, 'Why can't we do it now?' Some people were keener than others and some people had fewer barriers to contend with, but we are about to hear some examples of where people decided to pilot this within the resourcing that they had.

Briefly, I will mention that we cannot understate the role of Centrelink as a gateway to a range of benefits and services that support people with disabilities generally and certainly with mental illness in supporting employment outcomes. Centrelink approached us at Adair Clinic in 2009, wanting to run an integrated service pilot where they provided their services from our clinic. That helped destigmatise Centrelink in the minds of many consumers. We have heard a lot today about consumers having a fear of losing benefits if they dare to try and work. By providing that Centrelink service within our clinic, we were actually able to allay those fears and demonstrate to consumers that it was a shared goal—that, if they wanted to have a go at working, they would be supported through and through. Forty-two consumers participated in that pilot. Half of them were referred on to an employment service. About 40 per cent were enrolled in a form of education to further their employment goals. So we found that really effective. Over to John.

Mr Strachan : From there, in 2010 the opportunity arose for us to be able to work alongside a disability employment specialist service called Employment Access. One of the things we wanted to reinforce today was the link between the policy arm of what we do and the operational arm, and the steps you have to take to ensure you get the best outcomes you possibly can. There is often a history of plonking something with a service to say 'give it a go'. We tried to do things a little bit differently in this case, and I will take us through that journey a little bit.

The Stepping up report from 2007 was a really strong underpinning document that set the platform for broad reform in South Australia's mental health system. The discussion paper authored by Todd is also really complementary to that. It started to give us what I would describe as an opportunity to promote the shared vision of a satisfying job for every consumer who wants one. That was the premise under which we went to set up our services. The strong focus that we wanted to promote was a focus on eligibility. Often there is a whole raft of eligibility criteria, but we felt—leading on from the evidence base—that it should be about consumer choice and nothing more than that.

The process started out for us in Southern Mental Health, as you probably heard this morning, as a request for some office space. From that request, we capitalised on that opportunity. I will briefly take us through the little journey we went through, underpinning the fact that we tried to use an evidence based change management approach. What was really important to us—and you heard Todd talk about these two very complex systems that often work as polar opposites to each other—was how to bring those two systems together and ensure that we had some system connectedness, some sustainability, some strategies for spreading and an effective implementation plan. I will just read two quotes that underpin the philosophy from which we work:

Every system is perfectly designed to achieve the results it achieves.

And:

Performance is not a matter of effort but a matter of design.

That is the philosophy we took into working with our staff. We know that our staff can work incredibly hard, but how do we give them the tools and the system design to provide the services to create better consumer outcomes?

From the opportunity with UnitingCare Wesley's Port Adelaide employment access service, and using the clinical practice improvement methodology, we took some components of that and set up a fairly hefty and busy workshop where we did some fairly robust mapping and brainstorming to start to work out how we do this. We jointly designed risk management processes and we mapped the consumer journey so when we went to talk to our staff there was a journey that we were able to talk to, rather than just having it made up as we went along.

We really worked hard on developing role clarity. One of the most important things for our services in public mental health is to be clear about the service, the roles and the functions that we provide. And that was the same for the disability employment services because, again, if you want to start busting myths around what we do, the clearer we are with our roles and functions, the greater the opportunity to work together. We did a lot of training and training requirements. For example, we provided risk assessment training for the disability employment services so they understood the risk issues that we worked with in our services and the language which we use, so we could get a more informed partnership approach when working with complex consumers.

Information sharing was a big issue and we needed to make sure that there was open access to all the relevant information for each consumer that we were working with. Obviously, this is driven by consumer consent. We made sure that with consumer consent our medical records, or our case notes, were accessible to the disability employment staff. We wanted to make sure each one of our consumers in the public sector has a care plan. The intent of that care plan is a consumer-driven care plan, but we wanted the employment part of our partnership to be reflected in each consumer's participation in that care plan.

And when something goes wrong you need to have a robust incident-reporting process so you can actually look at ways you can improve from that. We made sure that there were some shared values and a shared vision for case reviews, and I think that was very important. Other things were conflict resolution, points of accountability and starting out an evaluation process, ensuring and really supporting that employment is part of the rehabilitation journey that our services provide. It is part of the journey for both clinical and psychosocial rehabilitation and has to cross both, because the principles of self-management, as well as the basic functions of your activities of daily living, are really important to be able to support someone entering into the workforce.

Out of this we developed a service model and a service-level agreement. The service started in our community rehabilitation centre, which is the Trevor Parry Centre. You heard about that this morning, but for the Hansard record I will go through a little bit about what we do there. The community rehabilitation centres are part of the step system of care, and there are three across Adelaide. There is one in the north, one in the west and one in the south. Each of these have 20 beds, but they are not traditional hospital beds—they reflect a community residential setting. It is like living in someone's home; it is a home-like environment, every unit has its own ensuite bathroom. There is only a shared kitchen space, and a group of three is the largest.

There is 24 hour-a-day care and support in there, underpinned by the delivery of assertive rehabilitation. The rehabilitation component is both clinical and psychosocial. It is a multidisciplinary environment, so it has psychiatry, psychology, social work, occupational therapy and nursing. It also has what we call community rehabilitation workers and consumers—we actually actively employ consumers with lived experience in the program, and that is an incredibly valuable resource to work alongside someone entering the workforce with complex mental health issues. The target group-the consumers we work with in the public sector-are people with severe and enduring mental illness. They do come with a whole raft of complexities and significant disability.

We felt that the change management approach that we set up really helped our engagement with our staff, and I think that the pre-staff surveys and the post-staff surveys we have done really reflect a robust uptake of what people saw as a positive way to deliver more effective rehabilitation services. From there we were able to access employment access-the disability employment service-for half a day a week. They have come into our service, and the idea is that we need a specialist service like that to come in and integrate within the service. We do not have the skills set. and we do not have the knowledge. A little bit later I will talk about some of the myth busting that that creates, but that specialist knowledge was really important in us being able to promote that this is a very valuable part of service delivery. There was a strong investment in supporting families and carers to understand that this is a positive journey for their loved ones, not something that is going to make them lose their DSP or make them fall over and go into hospital. We would like to do an evaluation and that is probably something that we would like to have commissioned externally to get as much objectivity about what we are doing as we possibly can. So that is basically that part of it in a nutshell.

I will turn to the outcomes that we have achieved in the 11 months that we have been doing this, keeping in mind there are 21 residents that have gone through, with severe and enduring mental illness. Of those 21 residents, 14 have now registered with the Employment Access service and are starting to talk about employment options with that particular worker that comes in. In terms of the benefits, historically we would say to a consumer, 'Why don't you go down and visit that service down at Morphett Vale,' or something along those lines. The difference now is the consumers have trust and are in an environment that they feel supported and valued in because we were able to provide that integrated service within our own team setting, which was a very big plus for our consumers.

We have had had nine consumers complete a job capacity assessment. The number who have applied for paid employment is six. The number who have commenced paid employment is now three. The number who enrolled in studying and training is three. And the number who have commenced volunteer work is four. We feel very proud of each of those outcomes because prior to this opportunity none of these consumers were actively working with us to access open and full employment. Historically speaking, our experiences have been in a sheltered workshop kind of environment. For us there was not a lot of satisfaction in that, and I can assure you that many of our consumers were not necessarily satisfied with those sorts of options made available to them.

I will just briefly talk about the other side of this, which is the service model we developed. We are really quite proud, as part of the metropolitan Adelaide services, that we share the service model with our colleagues in the central and northern areas. That was a really positive thing because, if you have got consistency in service model and service delivery, if a consumer moves from the Noarlunga region to perhaps the north-east their actual service provision is quite consistent. That is what we are trying to achieve, not only in the broader reform system, and we are able to achieve it in this particular model. So it went to Club 84, which is a psychosocial rehabilitation program in the north-east which you heard a little bit about this morning.

I will just read through some of the outcomes that that service has achieved because, again, it is very exceptional, considering that this is being built within current resources. They have got three hours a week with a disability employment service provider coming in and being part of the integrated team. They have had 20 consumers register with Employment Access. They have had eight complete a job capacity assessment. Five have completed resumes. They have had four who have applied for paid employment. Six individuals have attended interviews. We have had four who have commenced and been successful in gaining paid employment, and this is full employment. We have had three who have undertaken further studying and training, and four who have undertaken and commenced volunteer work. So, again, some really wonderful outcomes and, again, working with those consumers with the most severe and enduring mental illness and disabilities associated with that.

Mr RAMSEY: John, does the 84 stand for anything?

Mr Strachan : I think historically it was the number of the street address.

Mr RAMSEY: I was just wondering what it had to do with numbers of clients or something.

Mr Strachan : I think they have got around 180 members, they call them, who come in there. That is a fantastic achievement, considering it is about eight staff that they work with. So it is really big achievement and it is complementary to the clinical services that are provided in the clinic settings, like the clinic you visited this morning.

The other component of the integrated partnership is the disability employment provider. We feel quite proud and very supported to have the UnitingCare Wesley Port Adelaide Employment Access service working alongside us in this. They were very passionate and quite committed to wanting to work with us. They really saw the benefit of participating in the change management approach to try and get an agreed shared vision; they saw that real need and the desire for change. I guess the important things from the UnitedCare Wesley service provision was that they were the specialists that came in and were able to dispel an enormous amount of myth. I think you heard this morning that our staff had some knowledge, but limited knowledge of the real intricacies of the disability support pension and how many hours you can work. So how did we start to dispel those myths with our consumers, carers and families? I can imagine that the last thing a carer or a family or a consumer would want was to lose their benefits. What we did was turn what was once seen as a threat into a genuine opportunity to improve not only their self-esteem but their ability to self-manage. Another side of our set-up is that the employment access team comes from a strengths approach, and that is really complementary to the clinical services that we provide—again, from an empowerment and strengths approach as well.

Another aspect of it is the ability of this service to have specialist knowledge and actually work with the employers. We have found that to be incredibly empowering, and it is something that we do not do well. Keep in mind that, before we did this, this was built into our care coordination or case management approach. It is not something that we specialise in. Having that specialist service come in and be part of our team, to be able to go out and canvass and work with employers and dispel some of the myths associated with what they were actually about to encounter was great.

Another positive aspect was that this team brought in one of their employers, who was a person with lived experience themselves, and they were able to talk about their journey and how going through this kind of program got them into running their own business, where they were then employing people with severe and enduring mental illness. That was really valuable to and rewarding for our staff.

The last thing is also around their specialist knowledge of myth-busting the issues with disclosure in the workplace. What we worked out and started to learn very fast was that, if we were able to respectfully disclose, with consumer consent, we could set up a really strong support system around that consumer and employer to make sure that we give that person every chance of genuine success in maintaining and sustaining their employment.

Mr Bamford : I just wondered whether it would help the committee if I gave an example of why it is important for the employment specialist and the mental health service to be on the same team.

CHAIR: Yes.

Mr Bamford : Okay. We have heard some consumers this afternoon talk about the impact of sedating medications or anxiety in the workplace on their ability to participate in work and hold down that job. With the employment specialist, who is focused on that goal, attending the same clinical review where the care plans are discussed for that consumer in the health service, the employment specialist has the opportunity, in real time, to say: 'Look, he really wants to be a panel beater, and I've found him a place. The employer's really good, willing to give him a go, but he's got to start at eight o'clock and he's too zonked out on medication to do that. Is there anything we can do?' The treating doctor who is in that room would be able to say: 'Actually, things have been going so well, I was thinking about making an adjustment there. Why don't we give this a go? What supports can we put in around that?' Now, you just do not get that confluence of employment plan and care plan if you are chasing each other on the phone, if you have signed, formal consents to get through. Even the best, most committed partnerships in the world cannot achieve what teamwork can in that regard.

CHAIR: That was going to be one of my questions. Is that how that sort of thing gets into the care plan, sitting at a table together? Obviously, as we heard this morning, if Marg or whoever is in there—it is used as a bit of a drop-in centre—she will start talking to a consumer who comes in. Is that how something then gets translated into a care plan, when perhaps their clinician did not know about it? She is sitting around the table; she says, 'Hey, such and such came to me and showed an interest.' Is that how it gets momentum? I am just not sure how that works. I understand the integration of the case notes et cetera; but how does it get from there? If the client drops in and has a chat, is that—

Mr Strachan : In the community rehabilitation centre, we promoted the idea of the Disability Employment Services—so Marg, in this case, and Di—to come and sit in on our case reviews. In the case reviews, they were able to say, 'That person sounds like someone we should be approaching.' So it started to promote that level of discussion from within a clinical discussion, which we had not been doing in that respect. What we try and do, with the best of intentions, is to develop the care plan with the consumer and the stakeholders around the consumer, and it is quite a holistic and broad care-planning process. The fact that people like that are part of your integrated team means that, when you actually go and develop the care plan with your care consumer and family, they are part of that team that goes in.

CHAIR: Or if there is an amendment, because the clinicians may not have raised where they can—

Mr Strachan : That is right. Absolutely.

CHAIR: The person might not have thought of work. But, then, they may have approached an employment service about work. I guess I am trying to work out how that ends up as an amendment to the care plan, so that it becomes the focus of everyone in that team.

Mr Strachan : And, just in the current state, there is a single author of the care plan, which is your care coordinator or key worker, but the idea then is that the disability or specialist worker who is part of your integrated team will also have access to try and support the development of that care plan. We do have some tricky situations when trying to give people access to author their own care plans; we have not got quite that far yet.

CHAIR: Excellent. Thanks.

Mr RAMSEY: I ask a question about the practical application of having this group of people working on a single care plan. I have seen this type of thing—particularly in the country; it gets really hard—where six people are supposed to be there and 1½ show up, and you are supposed to have a coordinated response. You have a number of clients in beds, a doctor for each one and a different carer. When you sit down to do this, how often can you get most of the people you need? Otherwise, people spend all their lives travelling to and from meetings.

Mr Strachan : I can speak for the community rehabilitation centre in this instance. Part of the benefits of having this environment is that we have a group of consumers who have to consent and want to be there. That is a really big shift. There is an involuntary nature to the public mental health system—as we would know through the various legislation we have to assert treatment on to people. In this case, the consumers want to be there. We coordinate—specifically set with lots of advance notice—for carers, family members and so on to come. The national mandate, for us, is every three months. In the CRC we do it every six weeks because we have the ability. We have people around us to be able to do that. It has made it a little easier in that environment.

Mr Bamford : You have touched on one of the key drivers for why this works well. There is a relationship between the employment specialist and the mental health care coordinator or the mental health specialist. When they are part of the same team, they do not have to show up to a special meeting that happens only infrequently; they are in contact with one another all the time. That relationship is ongoing and daily. That then overcomes the batching of all the big decisions to a three-monthly case conference or clinical review. We use a variety of business rules and processes to manage the clinical care. In an integrated employment service, they would be participating in those. The clinical review opportunities would be weekly. The clinical handover opportunities occur daily and sometimes multiple times a day. There are multiple opportunities to influence that care plan. It helps to overcome that kind of problem.

CHAIR: You are obviously looking at relatively small numbers. You are looking specifically at the community rehabilitation. What potential does this model have to be extended to the community-based clients who still have a care plan but access it more infrequently? Is there the potential to roll this out for those clients?

Mr Strachan : We would love to do that. The potential is there. The desire is there. Our staff want it. Our staff keep asking for it. But it is capacity.

Mr Bamford : One of the evidence-based principles—it is one of the important ones; they are all important—is that the only eligibility criterion for this type of service is that the consumer wants one. In that sense, it needs to be accessible to anyone with a mental illness. I echo what John said.

CHAIR: From the in-patient all the way up to the community-based—

Mr Strachan : Through all the consumer journey, it should be made available—in every aspect of continuant care.

Ms O'NEILL: Before we were leaving this morning I spoke briefly with you about the translatable nature of what you are doing. Some of the most fantastic things happen that are driven by a very serendipitous organisation of key people who have a similar philosophy at a particular place at a particular time. When one or more of those people move, the whole thing collapses. It looks like you have done a lot towards creating a system. What do you think needs to be done to make this a structural vehicle that can be delivered by other people in other areas? How far along the journey towards that goal are you?

Mr Strachan : We can answer that on a couple of levels. One is that, if we approach it from a system's connectedness and a change-management perspective, it is applicable to all. You can roll out what we have done in any other particular service at this point in time. We have got the nuts and bolts that will pull together to cover all of the relevant issues around risk management. All the things that I went through before that underpin the content of a service model are applicable to all aspects. Part of the primary driver for using this approach was to try and look at two things: sustainability and the strategies for spreading. How do we make sure that what we do can be taken and handed to someone else to do the same? So I believe that it is genuinely possible.

Mr Bamford : When I hear that question, I think about documented procedures and business rules for how we work, and that is one of complexities of implementation: there is already a complex set of procedures and rules for employment services that are geared towards their funding system in particular, really. Likewise, we have a bunch of systems geared towards supporting health outcomes. John talked about shared risk assessment and consenting; they are the types of processes that need to be made transparent so that everyone is clear on how they are to work together. And then it is just managed as one service. I do not think we have a documented set of procedures specific to this service. It needs to be built into what a community mental health service looks like. That is one idea of how this can be achieved, and it is then built into the service when a consumer expresses an interest in work. They are given an appointment with the employment specialist that is part of that team. Then it is really about the processes and business rules of the community mental health service that support the sustainability of the service.

I suppose the employment services are already funded to provide employment outcomes for people with a mental illness and we are already funded to provide mental health outcomes. But, for integration to happen, someone needs to support that integration—someone to actively support that change and then embed that change over time. John talked a bit about how they have done it within existing resources, and that is half a day a week from the employment specialist.

Mr Strachan : To further answer your question, though, we gave what we developed around a service level agreement and the guidelines that underpinned the model to the Club 84 service in the central and northern areas, and that is what they used to roll out their model. It has now gone to another psychosocial day program in the north-east. So I think the underpinnings of what we did are transferrable across the system.

Ms O'NEILL: That is excellent. Just to follow up on that, there can be some differentiation across the different participants in terms of KPIs. Are there critical KPIs that you could identify, that all partners need to have as part of their accountability, to enhance and to drive this kind of change where there might be resistance?

Mr Bamford : I think we could look to some of our existing KPIs as a mental health service, but we could add to them. One of the things we successfully did in 2008, when we developed the discussion paper, was getting employment into the care plan. We got it on the radar—I think it is on the front page of the care plan—that every clinician and every consumer of our public mental health services is required to have one. We got clinicians entering on that, whether the consumer was in employment, seeking employment or studying. So that is on the radar and we can monitor that now. I am not aware that we are monitoring it, but it is not a difficult thing.

Mr Strachan : I am sure it has even become reportable in our management reports and our performance markers.

Mr Bamford : Yes. Likewise, I am sure that employment services monitor KPIs around employment outcomes and sustained employment outcomes as well. So it would be a bringing together of, again, some existing structures.

Mr Strachan : And I think I would like to see us offering the service as well, as an indicator, because the question is: is everyone getting equal access and equity in regards to being offered this and being able to go and actually meet with an employment provider like this? That would be interesting to measure if we rolled it out in the broader community setting—because rolling it out to a community team with 500 consumers is taking a whole other journey compared to rolling it out to the CRC, the community rehab centre, with 20 residents.

Ms O'NEILL: And then, of course, we heard from the private sector as well.

Mr Strachan : That is correct.

Ms O'NEILL: And that is another layer.

Mr Strachan : That is right.

Ms O'NEILL: Thank you.

Mr Bamford : I have got to say now, just in case the committee has not been presented with the information before—and, unfortunately, I do not have a rigorous slide to give you—that, at the time we developed the discussion paper and the policy work we did, we came across plenty of information that suggested that consumers who are working use services less because they keep themselves well. They are motivated and they are busy.

Mr RAMSEY: They do not have time, like the rest of us.

Mr Bamford : That is right. So I think there are multiple drivers compelling us to look at this.

CHAIR: With the focus on health, not illness.

Mr Bamford : That is right.

CHAIR: There is a complete focus on health and not constantly all those appointments.

Mr Bamford : We constantly struggle to support people who are not as motivated as we would like them to be to do things that help them stay well, and one of the big reasons for that is that they say: 'Why? If don't have a regular thing to do with my day that I value and feel valuable for doing, what does it matter if I'm a bit depressed?'

Ms O'NEILL: 'At least if I'm sick, someone can pay attention to me'?

Mr Strachan : Yes. The other side of it for us is also quality of life and how we promote a constructive quality of life. The primary goal of what we do is to support our consumers to be genuine citizens in their chosen community. When we look at the health status of many consumers with severe and enduring mental illness, we find they have a life expectancy of up to 20 years less than the general population. We have a duty of care to keep trying to contribute and to provide services that actually minimise that and start to close that gap.

Ms O'NEILL: That adds a productivity dimension to this too.

Mr Strachan : Yes, absolutely.

CHAIR: All right. Mike.

Mr SYMON: Thank you, Chair. Just a couple of questions. What percentage of your funding comes from the federal government at present?

Mr Strachan : At this very point in time, in the public system that we work in?

Mr SYMON: Yes.

Mr Strachan : Very little, I would say. Most of the Commonwealth, or federal, funding goes to the non-government sector, although in recent times there has been the emergency access task force funding that has gone into emergency departments. We have also had the most recent sweep of announcements which we are very, very excited about around emergency respite. The stimulus housing has been an incredibly rewarding and fantastic experience. In fact, in the south alone we have housed 53 consumers with severe enduring mental illness into social supported housing, and we have another 22 that we are housing into a very high level supported housing model, I think with up to 30-plus hours of support a week going into that. That is all federally driven.

Mr SYMON: So, beyond that, is every other dollar you get from the state government? Or are there other areas where the money comes from?

Mr Strachan : I believe that, apart from government funding, the public sector does not receive funding from outside of that realm. We could get you the correct information from our metahealth unit in SA Health.

Mr SYMON: It would be interesting, because I think there is a very high degree of interest federally to go with that interest. I think it is a fair argument to put up that you have got to show the money as well.

Mr Strachan : Yes, and in this case I am led to believe that the disability employment service that we are using is federally funded. So this is where you have got the state-federal interface that we are working with.

CHAIR: That is an interesting point, especially considering the recent uncapping of places. The point was made this morning—and I think we should probably record it—that the uncapping of places has actually made a big difference to UnitingCare Wesley's ability to come out and seek clients from your service.

Mr Bamford : Yes. I have really got to support that because, when we consulted on the evidence based model, there was still a lot of capping, and that was raised just about everywhere as a barrier to being able to provide an evidence based service.

CHAIR: And it fits in with a couple of employment mental health specialist services that have said that, with the uncapping of places, they are looking for clients. They are actually searching for clients. So the uncapping does provide a unique opportunity to expand into areas people have not gone before, rather than having to manage a waiting list when no-one wants to go out and find more business.

Mr SYMON: If I could just finish off with one last question: do you have any opportunity or mechanism to deal with the private mental health sector?

Mr Strachan : We do work with the private sector on a regular basis, and many of the consumers we work with will have a private psychiatrist or a private psychologist involved in their particular care.

Mr SYMON: And is that leading to employment outcomes?

Mr Strachan : If that person is with us and we are working with them, absolutely. They can participate in any of those programs.

Mr SYMON: But, if your organisations were not involved, would that be the case—if it was private care only?

Mr Strachan : I am not 100 per cent clear on what the private sector itself can do, but they can, for example, refer clients to disability employment services.

Mr Bamford : That is right. My understanding is that any consumer can walk up to a disability employment service or any employment service, or be referred by Centrelink, after a job capacity assessment and request a service. What we have tried to do is encourage our staff to get in there to Centrelink, be part of the job capacity assessment and get to the employment service. So I do not imagine, where there is a private service provider involved, that there would not be a way to support that kind of collaboration. Their structures, with their booked appointments and types of services, are obviously very different, but there will always be a way around that. The employment—

Mr SYMON: Is there a way to streamline that? You are talking about ways to get around it. Wouldn't the default option be straight through rather than work out a way to deal with it?

Mr Strachan : I think the benefits of the public sector are in the multidisciplinary nature of service delivery. I think the private sector has quite an isolated service delivery model, where it is an individual providing a service follower. I think the benefits of a multidisciplinary service are where you see the collective input of people with different visions and different perspectives from their particular backgrounds and training.

Mr SYMON: That is why I was asking if someone goes through the private and ends up where you are is that a direct path at the moment to get to an employment outcome, as it were?

Mr Strachan : Our experience is that people do not come into the public sector to gain access to employment services.

CHAIR: You might find this a difficult question to answer because you do not work in the area, but is there any capacity under the mental healthcare plan put together by GPs as part of the Better Access program for referral? I understand that it is not a completely integrated service but, as a pathway for GPs that are sending people off to Better Access, is it an option on that plan? Is it part of that plan to refer to a disability mental health specialist as well?

Mr Strachan : I do not think I can answer that accurately. As Todd was alluding to before, it is an open referral process for anyone in Better Access. For example, as a psychologist or a social worker or someone providing that service, they can link those consumers into the disability employment sector.

CHAIR: Maybe they do not know how to do it?

Mr Strachan : It is whether they know it is there or not, or it is on the radar.

Mr Bamford : I would suggest that some of the employment specialists are in touch with GPs because they would need opinions on specific things that might relate to somebody's safety operating machinery, or medical opinions.

CHAIR: But it is a question of whether it is just that level or whether they decide to take it to the next level of using it as a discussion to open up; whether it is just an exchange of letters or whether it is opening up a true dialogue about employment options.

Mr Strachan : One of the options that we could start to talk about is a public education campaign that starts to really showcase to the public and everyone involved that there are greater alternatives than what they might have thought.

CHAIR: Thank you very much for providing the information today. The point you made about translating the policy, about developing that evidence based policy is really helpful. It is heartening to hear that it is being translated on the ground into a service model that is getting results, starting off and building momentum. It is great to hear, and also great to hear some of the specifics that helped make it work. We have heard people previously say, 'Just put an employment consultant in every mental health facility.' Obviously what you have gone through about breaking down the stigma with staff and clients, talking about risk and talking about a shared vision shows it is a lot more complex than just putting an employment consultant in the mental health facility. I think it has provided us real detail, drilling down into what actually works, so we appreciate that and appreciate your time.

We have accepted this as an exhibit, but if there is anything else you would like forward to the committee please do not hesitate to do so. It is an ongoing process where we are looking to table our report either at the end of the year or early next year. You will certainly get a copy of that, but if there is anything you would like to add along the way, any updates of the figures or reviews, please do not hesitate to send it to the committee. You will also be sent a copy of the transcript of evidence to which you can make corrections to grammar or facts. Thank you very much.

Resolved:

That this committee authorises publication, including publication on the parliamentary database, of the transcript of evidence given before it at public hearing today.

Committee adjourned at 15 : 39