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Grand vision to rebuild mental health system

Grand vision to rebuild mental health system

The Andrews Government will implement all of the mental health royal commission’s sweeping recommendations to reform the ‘broken’ mental health sector.

The Royal Commission into Victoria’s Mental Health System released its report and final recommendations in a joint state parliamentary sitting on 2 March at the Royal Exhibition Building.

Many of the 65 recommendations from the final report align with the priorities outlined in the ANMF (Vic Branch) royal commission submission which include fixing funding, retaining clinical mental health services in the hospital system, connecting fragmented services and improving the safety of the mental health workforce.

ANMF (Vic Branch) Assistant Secretary Madeleine Harradence said ‘On first review, ANMF supports all of the recommendations and we look forward to working with the government to ensure mental health nurses and nurse-led models, particularly in the community, are part of the solution.

Chair of the Royal Commission into Victoria’s Mental Health System, Penny Armytage, said their vision was to bring a ‘broken and traumatic’ mental health system out of the ‘shadows’ of the health system.

The recommendations promise to deliver a new system based on compassion, prevention, wellness and recovery. Well-funded and resourced, integrated services will be underpinned with a ‘how can we help?’ philosophy.

The report acknowledges that the ‘broken system’ has harmed not helped many of those who took the difficult step of asking for support.

It also recognises the trauma mental health nurses and others, working in an under-resourced and disconnected system, have experienced because they were unable to meet the overwhelming needs of unwell Victorians.

The report found the service delivery environment had created a culture focused on risk, and reduced the capacity of workers to use their skills to deliver therapeutic care.

People working in mental health contexts, including mental health nurses, reported experiencing low morale and constraints on their ability to fully apply their professional skills. This could lead to staff burnout and poor wellbeing which impacts staff recruitment and retention.

Premier Daniel Andrews said the government would build a new mental health system from the ‘ground up’.

‘That means building a system that actually provides people the care they need early – before they reach the ED, and in too many cases, before it’s too late,’ he said.

He said it also meant ‘giving our dedicated mental health professionals real support, real funding and realistic caseloads’.


The royal commission’s key findings include:

  1. The underfunded and under-resourced system was unable to ‘keep up with the number of people who seek treatment, care and support’.
  2. People could not access treatment close to their homes and in their communities.
  3. The system is unbalanced with an over-reliance on medication as the main or only source of treatment.
  4. There is a ‘missing middle’ which describes a large and growing group of people who have needs that are too ‘complex’, too ‘severe’ and/or too ‘enduring to be supported through primary care alone, but not ‘severe’ enough to meet strict criteria for entry into specialist services.
  5. Getting help is difficult.


The mental health royal commission’s key recommendations include:

Recommendation 3

Establishing a responsive and integrated mental health and wellbeing system. Services will be delivered at a local, area-based and statewide levels. This includes:

  • 50 to 60 new Adult and Older Local Mental Health and Wellbeing Services that operate with extended hours (the first six sites, announced on 3 March, are Benalla, Brimbank, Frankston, Greater Geelong, Latrobe Valley, Whittlesea and will open between mid to late 2022)
  • 22 adult and Older Adult Area Mental Health and Wellbeing Services delivered through partnerships between public health services or public hospitals and non-government organisations that deliver wellbeing supports
  • statewide services are delivered in a way that minimises the need for people to travel far to access services.

Recommendation 8

Improve crisis response. Each Adult and Older Adult Mental Area Mental Health and Wellbeing service will deliver centrally co-ordinated 24-hours-a-day telephone/telehealth crisis response service accessible to both service providers and to members of the community including crisis assessment and immediate support, crisis outreach team and emergency service response. Crisis outreach services will be expanded. Emergency department’s ability to respond to mental health crisis will be improved.

Recommendation 10

Where possible health professionals, not police, will respond to people experiencing a time-critical mental health crisis. Mental health-Triple Zero (000) calls will be diverted to Ambulance Victoria. When both ambulance and police are required the response will be led by paramedics with support from mental health clinicians when required.

(On 4 March, Mental Health Minister James Merlino announced a new $6 million Centre of Excellence for emergency service workers – a dedicated facility to provide better mental health support for these workers and volunteers, including those who have retired. Discussions will also start in coming weeks with stakeholders to work through how to implement the changes to the mental health response.)

Recommendation 42

A new Mental Health and Wellbeing Act, preferably by the end of 2021 and no later than mid-2022.

Recommendation 57

High level workforce strategy, planning and structural reform. Improved data collection, analysis and planning.

Recommendation 58

Workforce safety and wellbeing. Identify, monitor and address existing physical safety and wellbeing risks as well as those that may emerge through the reform process. This also includes working with unions to implement a range of measures to support the wellbeing of the workforce.

ANMF is reviewing the five-volume, 3195-page report and will provide further detailed analysis to our mental health nurse members.