Analysis of the Royal Commission into Victoria’s Mental Health System's Final Report

The final report from the Royal Commission into Victoria’s Mental Health System was released in March, and will lead to a once-in-a-generation roadmap for reform with specific ‘investment in and attention to the mental health and wellbeing of young people’.  

Young people have been leading the call for a new mental health system and YACVic has supported hundreds of young people and youth workers to connect and share their experiences, ideas and vision for a better mental health system.   

YACVic believes that the specific focus on young people and detailed recommendations are appropriate and positive. Importantly, the unique needs of rural and regional young people were recognised in the final report.   

We are hopeful that the implementation of the final report and recommendations will meet the vision of young people and create a new future where young people are supported and have access to the best quality mental health care whenever and wherever it is needed. 

‘I am placing an immense amount of hope in the new system, and look forward to witnessing this once-in-a-generation final report unfold.’ - Jen from Camperdown 

We believe that consideration is needed in the final report’s implementation to guarantee that young people are included in the governance of the new mental health system, and that young women, disabled young people, international students and migrant and refugee young people receive the support they need. 

YACVic published a detailed list of recommendations from the final report which are relevant to young people.  

The New System for Young People 

The Royal Commission has made two primary recommendations specific to young people which will completely redesign services. This restructure is a welcome change and will create a new service system specifically for young people. 

Recommendation 20 establishes a ‘dedicated service stream for young people’ aged 12-25, consisting of new ‘Youth Area Mental Health and Wellbeing Services’ by the end of 2022. The recommendation requires that age boundaries be ‘applied flexibly by services in partnership with young people and their families, carers and supporters’.  New Infant, Child and Youth Area Mental Health and Wellbeing Services are expected to ‘become the preferred providers of headspace centres’. This is a positive recommendation which will ensure consistency in services for young people across Victoria. 

Recommendation 21 calls for review, reform and implementation of new models of multidisciplinary care for bed-based services for young people. Bed-based and inpatient services will be transformed and made more accessible for young people across the state. Every region will have a Youth Prevention and Recovery Centre (YPRC) for young people aged 16 to 25 and a ‘new stream of inpatient beds across Victoria for young people aged 18 to 25’. Hospital in the Home services will also be made available to young people as an alternative to acute hospital-based treatment. These are exciting reforms which will ensure young people have access to appropriate care at the time they need it.  

Rural and Regional Access 

The Royal Commission has recognised that young people in rural and regional communities need better access to treatment, care, and support for mental illness. The final report acknowledges that rates of suicide are higher in rural and regional areas, and that this risk is compounded by mental health workforce shortages.  

The final report outlines a plan to establish eight Regional Mental Health and Wellbeing Boards across the state to address these issues. The Regional Boards will commission Local and Area Mental Health and Wellbeing Services, that will include a dedicated service stream for young people. This tailored stream will give regional and rural young people better access to support services. 

The Royal Commission has acknowledged the unique problems young people in rural Victoria face when trying to access mental health services, and addressed these issues with assurance.

–Jen from Camperdown

Although the Royal Commission’s final report acknowledges that mental health funding models in rural and regional areas require urgent adaptation – particularly in relation to the funding of community outreach and home visits – the Commission does not provide a specific recommendation for the Victorian Government to provide increased funding to incentivise the use of community outreach services. Young people in remote areas would particularly benefit from incentivised community outreach and home visits because those who don’t live in regional centres have limited access to appropriate transport options. 

Given the higher prevalence of suicide within remote and rural communities, it is essential that suicide prevention initiatives are targeted towards these communities. In order to facilitate suicide prevention, the Royal Commission’s final report has recommended that localised suicide prevention initiatives receive funding. Although rural communities are mentioned as being particularly suited to community-led localised suicide prevention activities, the final report does not provide any indication that rural communities will receive priority funding for these suicide prevention initiatives.  

Youth Participation and Peer Work 

The final report includes a significant focus on lived experience, co-design and the inclusion of young people in the design and leadership of the new mental health system. Recommendations include a new agency led by people with lived experience of mental illness or psychological distress. The final report also recommends that young people co-design four new safe space facilities which will provide drop-in and crisis response services for young people.  

As a peer worker and lived experience advocate, I was over the moon that the Royal Commission’s Report had a strong focus on lived experience.

–Emily from Melbourne

The Royal Commission has importantly acknowledged the importance of co-design with young people stating, ‘to establish the youth mental health and wellbeing service stream will require an ambitious program of reform … importantly, these reforms must be implemented through co-design with young people and their families, carers and supporters.’ This imperative shows the Royal Commission has listened to young people. Young people are experts in their own lives and services will only be successful if their design includes young people. The inclusion of young people in the design of the new service stream is a priority in the implementation of the recommendations from the final report.   

Young people have also emphasised that more work is needed to ensure that peer work is valued and included in the system. Further work us required to identify how young people with specific lived experience can be included and supported as peer workers in services. 

It can be highly inappropriate to group all lived experience under one bracket, and there is incredible value in creating dedicated positions for specific lived experiences, especially for marginalised and minority communities. There will also need to be further thinking about the provision of lived experience at all levels of a mental health service. It is easy to imagine how beneficial it would be to walk into a mental health service and know that the receptionist, or the café staff have similar lived experience to you.

–Emily from Melbourne

It is also important that young people are genuinely included in the governance of the mental health system. The final report specifically identifies that people with lived experience and young people should be included in the design and governance of new service systems. This must include the new Regional Mental Health and Wellbeing Boards, Community Collectives and service-specific governance structures. 

Education Providers 

The final report recognises that schools, universities, TAFE, and other education providers are crucial to the mental wellbeing of young people. The Commission recommends that primary and secondary schools receive additional funding to expand their mental health and wellbeing programs and services, with regional and rural schools to be made the priority. Successful implementation of this recommendation will require a clear and detailed plan that outlines how existing services can be improved for young people.  

The Commission also suggests that universities and TAFEs establish close partnerships with ethno-specific and multicultural community-led organisations to better engage with international students experiencing mental illness. International students are at a much higher risk of experiencing poor mental health compared to domestic students, and less likely to seek support from services. Chapter 21 of the final report recommends that community-led organisations receive ongoing, flexible funding to improve access to mental health services alongside other institutions.  

Whilst this is an important acknowledgement, tertiary education providers also need to strengthen existing support services to assist community-led initiatives. A third of the university population are international students, therefore community-led organisations will need priority support from universities to ensure that all students can access mental health support when they need it. 

Disabled Young People 

The Royal Commission acknowledged that ‘[p]eople with disabilities also face barriers to accessing appropriate treatment, care and support’. The final report recommends specific funding ‘to enable community organisations to deliver effective and meaningful support’, including ‘for Deaf community leaders and organisations, young people with a disability, and emerging communities’. 

However, there is relatively little detail on how disabled young people will specifically be supported in the new mental health system. Disabled young people experience intersecting barriers to the mental health system and need accessible services which provide equal opportunity to access supports. For our submission to the Royal Commission, YACVic consulted with disabled young people who told us that mental health services are currently inaccessible. YACVic recommended training for mental health services and workers to improve their understanding of disability and improve access to services for disabled young people. 

To create a mental health system that is accessible for disabled young people there will need to be greater consultation and specific priorities which ensure that all people can benefit from the new system.  

Refugee and Migrant Young People 

The Commission found that young people from refugee and/or migrant backgrounds are presenting to mental health services less frequently than expected. This can be due to a lack of culturally and linguistically appropriate services, stigma and discrimination. Ensuring that young people from refugee and/or migrant backgrounds can access safe and appropriate mental health services is critical, as they are at a greater risk of experiencing mental ill-health. 

The final report recognises that community-led organisations are an important source of support for refugee and/or migrant young people. The Commission recommends that partnerships be established between the Victorian Government and these organisations to strengthen community-led mental health support and services.   

These partnerships should also be strengthened in tandem with improved cultural and linguistic accessibility in all public health and wellbeing services. This can be achieved by ensuring that schools, local services, hospitals, and other support systems are equipped with a diverse and skilled workforce that reflect the needs and experiences of young people from refugee and/or migrant backgrounds. This will ensure that young people have a range of entry points to the mental health system and receive support at the earliest possible stage.  

Aboriginal and Torres Strait Islander Young People 

The final report recognises the importance of creating a mental health system “where Aboriginal self-determination is respected and upheld in the design and delivery of treatment, care and support.” The Commission found that Aboriginal and Torres Strait Islander young people experience higher levels of psychological distress than their non-Aboriginal peers.  

Recommendation 33 outlines the Commission's commitment to resourcing Aboriginal community-controlled health organisations to design and deliver social and emotional wellbeing services for children and young people. This commitment could be enhanced by a greater focus on consulting with Aboriginal and Torres Strait Islander young people to ensure that Aboriginal community health services are accessible for Aboriginal and Torres Strait Islander young people and responsive to their needs.  

Moreover, the Aboriginal social and emotional wellbeing teams that will form part of the Aboriginal Social and Emotional Wellbeing Centre will initially focus on Aboriginal and Torres Strait Islander adults aged 16 years and over. The work of these social and emotional wellbeing teams could be strengthened by the provision of funding for community-led ‘Marram Nganyin’ mentoring programs for Aboriginal and Torres Strait Islander young people. This mentoring model is already established as an effective method of improving mental health outcomes for Aboriginal and Torres Strait Islander young people, and was recommended by YACVic in its submission to the Royal Commission.  

Although the final report of the Royal Commission acknowledges that Aboriginal and Torres Strait Islander young people experience much higher rates of death by suicide, the final report provides relatively little detail about how the new mental health system will specifically target and support Aboriginal and Torres Strait Islander young people at risk of experiencing suicide. It is positive to see that the final report has recognised that community gatekeeper training – a community initiative aimed at facilitating suicide prevention – needs to be culturally safe and ‘developed and delivered by Aboriginal people’. However, in order to ensure a successful reduction in suicide rates of Aboriginal and Torres Strait Islander young people there needs to be more focus on community-generated suicide prevention initiatives.1 Similarly, increasing suicide risk screening of Aboriginal and Torres Strait Islander young people should also be considered, as research indicates screening groups at high risk of suicide can help identify those at risk of suicide and facilitate a reduction in suicide deaths. ²  

Gender and Mental Health 

Whilst the final report includes recommendations about access to mental health support for diverse communities, it does not adequately acknowledge the intersection of gender-based discrimination and mental health experiences for young people. Young people experiencing gender-based discrimination face unique mental health and wellbeing challenges that require tailored treatment and care.  

Although the final report provides essential recommendations that aim to eliminate gender-based violence in mental health facilities, it is surprising that it provides only limited recognition of the impacts of gender in how people access mental health services.  

Recommendations 20 and 21 take important steps towards ensuring that young people have specific streams of support and access to inpatient beds. However, there is no mention of how these services will be made safe for young people who have experienced gender-based discrimination. To make sure that all young people feel safe in these environments, the Victorian Government will need to consult a range of young people during the design and implementation of the new mental health system. Similarly, in order to ensure gender does not limit young people’s engagement with the mental health system, the implementation of Victoria’s new mental health system will need to prioritise the inclusion of gender-specific mental health services.  

The creation of a youth mental health system that provides gender sensitive care and is adaptable to the needs of young people in the long term will require ongoing data collection, monitoring and a commitment to providing evidence-based mental health care. Recommendation 44 and 53 both refer to the collection and diffusion of mental health data. The Royal Commission does not specify in either of these sections whether specific priority will be given to the collection of gender-disaggregated mental health data. It is concerning that the need for gender-disaggregated data is not acknowledged in the final report given that the lack of gender-specific mental health data. ³    

LGBTIQA+ Young People 

LGBTIQA+ young people face unique barriers and challenges when they engage with the mental health system. The final report recognises that an accessible and strong mental health system will need to be responsive to the needs of diverse communities. The final report recognises that LGBTIQA+ young people are significantly more likely to attempt suicide, and it is encouraging that it also provides a specific recommendation for the creation of an aftercare service for LGBTIQA+ people following a suicide attempt. It is also promising that the final report has recommended ongoing funding for Switchboard, Victoria’s Rainbow Door program which will provide continued support to LGBTIQA+ young people to access mental health care.   

Ensuring accessibility and inclusion across all levels of the mental health system will be vital to ensure LGBTIQA+ young people can receive timely and appropriate mental health care. As the Royal Commission’s recommendations position most Youth Local Mental Health and Wellbeing Services to be run by headspace centres, it is vital that all headspace centres are required to establish themselves as inclusive and welcoming places for LGBTIQA+ young people.  

YACVic’s submission to the Royal Commission recommended that the mental health system should prioritise providing tailored support to, and strive to reduce the stigma and discrimination faced by, LGBTIQA+ young people living in rural and regional areas. The Royal Commission's recommendations could be strengthened by ensuring that the anti-stigma programs that will be implemented in schools include education that aims to address the discrimination faced by LGBTIQA+ young people who live in rural and regional Victoria.  

Conclusion 

Overall, the final report recognises young people’s calls for change in Victoria’s Mental Health System. YACVic welcomes the recommendations made by  the Commission, and endorses those that specifically address young people’s concerns about the mental health system. They are an important step towards positive reform and provide the framework for a revitalised mental health system. However, embedding young people in the implementation of these recommendations will be vital to its success. This will ensure that Victoria’s new mental health system reflects the diverse needs of young people and their experiences of mental illness.

1. Ridani, R., Shand, F. L., Christensen, H., McKay, K., Tighe, J., Burns, J., & Hunter, E. (2015). Suicide Prevention in Australian Aboriginal Communities: A Review of Past and Present Programs. Suicide & Life-Threatening Behavior, 45(1), 111–140. https://doi.org/10.1111/sltb.12121 
2. Clifford, A. C., Doran, C. M., & Tsey, K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BMC Public Health, 13, 463. https://doi.org/10.1186/1471-2458-13-463 
3. Jean Hailes for Women’s Health, (2018). ‘The current state of women’s health in Australia’. p.28. Retrieved from https://consultations.health.gov.au/population-health-and-sport-division-1/establishing-a-national-womens-health-strategy/supporting_documents/Evidence%20ReviewThe%20current%20state%20of%20womens%20health.pdf