The royal commission acknowledged some Victorians are excluded from receiving mental health treatment until they enter the criminal justice system. It found the over-representation of people with a mental illness in the criminal justice system was caused by a lack of services in the community combined with a criminal justice system that is not sufficiently resourced to support recovery.
The final report detailed the gaps in the forensic mental health system which make it challenging to treat and support people to recover from acute mental illness while in prison or under non-custodial or custodial supervision at Thomas Embling Hospital. The royal commission also focused on the sector’s fragmentation and lack of resources to support people to recover, stay well and successfully transition back into the community.
Its recommendations are designed to reduce the pressures on the prison system, the workforce and hospital emergency departments and acute beds. There are two recommendations specific to Forensicare (Volume 3, chapter 23 – ‘Improving mental health outcomes across the criminal justice, forensic mental and youth justice systems’).
Recommendation 37. Supporting the mental health and wellbeing of people in contact with, or at risk of coming into contact with, the criminal and youth justice systems
The Royal Commission recommends that the Victorian Government:
- expand the Assessment and Referral Court to each of the 12 headquarter Magistrates’ Courts to meet demand at both existing and new locations.
- expand the existing forensic community model to:
a) enable Adult and Older Adult Area Mental Health and Wellbeing Services and Infant, Child and Youth Area Mental and Wellbeing Services (refer to recommendation 3(2)(c)) to provide consistency in treatment, care and support to people in contact with, or at risk of coming into contact with, the criminal justice system; and
b) establish the specialist behaviour response team described by the Royal Commission in its final report. - establish a program of supports for people in prison living with mental illness who require ongoing intensive treatment, care and support to transition the delivery from correctional settings to the mainstream mental health and wellbeing system upon their release.
- expand specialist youth forensic mental health programs to a statewide model, including across the 13 Infant, Child and Youth Area Mental Health and Wellbeing Services (refer to recommendation 3(2)(b) and (c)), to provide consistent and appropriately specialised treatment, care and support to children and young people in contact with, or at risk of coming into contact with, the youth justice system.
Recommendation 38. Providing safe and appropriate mental health treatment, care and support at Thomas Embling Hospital
The Royal Commission recommends that the Victorian Government:
- in line with master planning for Thomas Embling Hospital and the proposal of the Victorian Health and Human Services Building Authority:
a) refurbish the existing 136 beds; and
b) by the end of 2026, provide an additional 107 beds, a small number of which should be allocated for people living with mental illness whose treatment, care and support requirements cannot be safely and appropriately met in acute inpatient settings or through the forensic community model (refer to recommendation 37(2)). - provide up to 20 beds, in addition to the 107 beds referred to in recommendation 38(1)(b) and the additional beds in recommendation 11(3), to support people living with mental illness whose treatment, care and support requirements cannot be, or are unlikely to be, safely and effectively met in other extended rehabilitation settings.
What is the Victorian Government doing?
When Premier Daniel Andrews responded to the royal commission’s final report on 2 March 2021, he repeated his promise to implement all the recommendations.
The Victorian Andrews Government 2021-22 budget was announced on 20 May 2021. Acting Premier James Merlino, also the Mental Health and Education Minister, announced a $3.8 billion investment in rebuilding Victoria’s mental health services. The list of initiatives is long and includes:
- $349.6 million for a major upgrade at Thomas Embling Hospital including an additional 82 forensic mental health beds comprising a new dedicated 34-bed women’s precinct and a 48-bed medium security men’s facility.
- $30.7 million to support the mental health and wellbeing of people in contact with, or at risk of coming into contact with, the criminal and youth justice system.
- $42.4 million to establish statewide specialist services for people living with mental illness and substance use or addiction. Support to educate and build dual diagnosis workforce capacity.
- An additional 3000 mental health positions. This including $206 million for an annual 120 graduate places for nurses and 140 postgraduate mental health scholarships.
- $13.2 million for an additional 200,000 clinical placement days for undergraduate student nurses and midwives. This is on top of 1101 additional graduate places between 2019 and 2021 as part of the government’s Nursing and Midwifery Workforce Development Fund. It is also in addition to the free Diploma of Nursing provided at Victoria TAFEs since 2019.
