Australia’s mental health system is fragmented. Services are not integrated with one another so that there is little shared information between them and they may have differing assessment processes. The real life impact of this is that people with lived experience of mental ill-health and carers are often asked to retell their story multiple times at different points of entry. This is a potentially re-traumatising experience. Fragmentation also means people with lived experience of mental ill-health and carers can miss out on services simply because they cannot navigate their way to them. All of this places a higher than necessary hurdle for people to access service at a time in their lives when help seeking should be encouraged.
We must simultaneously work to fix the fragmented system and in the meantime urgently provide navigation support for those who are seeking help now.
System fragmentation is not unique to the mental health system. To address this in a health system wide manner, the Consumers Health Forum of Australia’s Consumer Commission Report: Making Health Better Together recommended investment in a network of health system navigators.[1] In relation to mental health in particular, there is an incredibly valuable untapped resource, which should be drawn on in order to realise this recommendation. Who better to help people navigate the system than those who have lived experience of navigating the system through their own experience of recovery? The Lived Experience (Peer) Workforce seems uniquely placed to succeed in system navigation roles. The National Mental Health Consumer and Carer Forum describes the peer workforce as “made up of those consumers and carers who are employed specifically on the basis of their personal lived experience of:
- Mental illness and recovery (consumer peer workers); or
- Supporting family and friends with mental ill-health (carer peer worker).”[2]
A desktop analysis by the NSW Mental Health Commission identified a range of emerging literature on mental health-specific peer navigation. Some of the peer navigation functions identified in this desktop analysis included: assistance with attending appointments; helping people access entitlements and prescriptions; identifying root causes of health problems across the social determinants of health; providing information and education, skill development, emotional support and advocacy; and being a broker of resources and a role model.[3] Some of the benefits for consumers of peer navigation included significant improvement in access to and use of primary care, higher quality relationships with health professionals, decreased preference for emergency care and increased confidence in consumer self‑management of healthcare, among others.[4]
The Lived Experience (Peer) Workforce seems uniquely placed to succeed in system navigation roles.
Although there is only emerging literature specifically on peer navigation in mental health, there is a longer history of peer work in general in mental health. Peer workers often carry out peer navigation as a part of their normal role. It seems logical that this workforce will need to be supported in order for the Consumer Health Forum’s Vision of system-wide peer navigation to be realised. The Productivity Commission Inquiry into Mental Health recommended “The Australian Government should provide once-off seed funding to create a professional association for peer workers”.[5] The Australian Government responded through its ‘National Mental Health and Suicide Prevention Plan’ with 390 mental health peer work scholarships and opportunities for professional collaboration.[6] The National Mental Health Commission also released the Lived Experience (Peer) Workforce Development Guidelines.[7] These are necessary investments and initiatives but fall short of establishing a professional organisation that supports peer workers.
In addition, current funding structures do not adequately incentivise system navigation support. Fee for services models, like the Medicare Benefits Scheme’s Better Access Program and National Disability Insurance Scheme (NDIS) Individual Plans, are designed to provide specific services, not to navigate between them. Although the NDIS does offer support coordination, the scope of this coordination is limited. Government programs generally do not enable the holistic navigation support required across the social determinants of mental health. This is a missed opportunity.
… current funding structures do not adequately incentivise system navigation support.
Mental Health Australia’s NDIS Community Connectors Program exemplified how to do things differently. This outreach program connected people with psychosocial disability experiencing homelessness with the NDIS. The program’s flexibility enabled delivery partners to assist prospective NDIS participants to stabilise their lives across the social determinants of mental health as a necessary precursor to supporting their application to the NDIS. People acknowledged they would “not have been able to access the NDIS without the holistic support from the NDIS Community Connectors Program.”[8] At the program’s completion, “Program managers reflected on the ongoing need for a systemic service navigation role, and the need to support people experiencing complex barriers such as homelessness or service disengagement to build capacity before meaningfully transitioning to mainstream services.”[9]
What we know is this: multiple reviews have called out the mental health system as fragmented and detailed the complexities people face navigating this system. Our overarching goal should be improved integration of the system, but, people need help to navigate it now. There is an untapped resource of system navigation knowledge waiting to be used, if only we had the right investment and workforce support required for it to become a reality. I look forward to a time when the hard-earned expertise of people with lived experience of mental ill-health is recognised and rewarded as a unique and valuable contribution towards making holistic care a reality.
About the author
Leanne Bagley has been the CEO at Mental Health Australia since April 2020. She has clinical qualifications in Occupational Therapy and Family Therapy, a Masters of Business Leadership and a PhD in Psychology in organisational culture and performance.
Before joining Mental Health Australia, Leanne worked for Western Victoria Primary Health Network as CEO for three years. Previously she has worked in clinical settings and was also Director of Mental Health and Drugs at the Victorian Department of Health and Human Services. She has served as a non-executive director on a variety of boards including the Western Alliance Academic Health Science Centre, Tweddle Child and Family Health Centre and Eating Disorders Victoria.
References
[1] Consumers Health Forum of Australia, Consumer Commission Report: Making Health Better Together: Optimising consumer-centred health and social care for now and the future (Canberra: 2020), 6, https://chf.org.au/sites/default/files/docs/chf_consumer_commision_report_v4final.pdf
[2] “The Peer Workforce,” National Mental Health Consumer and Carer Forum, accessed February 24, 2022, https://nmhccf.org.au/our-work/advocacy-briefs/the-peer-workforce
[3] Mental Health Commission of New South Wales, Peer navigation: Desktop review (2021), https://www.nswmentalhealthcommission.com.au/evidence/peer-navigation-desktop-review
[4] Mental Health Commission of New South Wales, Peer navigation: Desktop review
[5] Australian Government Productivity Commission, Mental Health: Productivity Commission Inquiry Report: Volume 2 (Canberra: 2020), 732, https://www.pc.gov.au/inquiries/completed/mental-health#report
[6] Australian Government, Prevention Compassion Care: National Mental Health and Suicide Prevention Plan (2021), https://www.health.gov.au/sites/default/files/documents/2021/05/the-australian-government-s-national-mental-health-and-suicide-prevention-plan-national-mental-health-and-suicide-prevention-plan.pdf
[7] “Lived Experience (Peer) Workforce Development Guidelines,” National Mental Health Commission, accessed February 24, 2022, https://www.mentalhealthcommission.gov.au/Mental-health-Reform/Mental-Health-Peer-Work-Development-and-Promotion/Peer-Workforce-Development-Guidelines
[8] Mental Health Australia, Outreach and connection: NDIS National Community Connectors Program for people with psychosocial disability: Final Report (2021), 9
[9] Mental Health Australia, Outreach and connection: NDIS National Community Connectors Program for people with psychosocial disability: Final Report (2021), 13, https://mhaustralia.org/sites/default/files/docs/mental_health_australia_-_ndis_community_connectors_-_final_report_-_oct_2021.pdf
