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Royal Commission into Victoria’s Mental Health System

Personal story:

Alison: frontline worker

Alison* is a social worker at an acute adult mental health inpatient unit in Victoria, and she believes that the way services are currently provided in acute mental health can be much improved.

Social workers are key players in acute mental health precisely because we focus on the psychosocial stressors that have triggered relapses, first episodes or crises leading to admission. The role of social workers on the ward is to support individuals to overcome some of their major psychosocial stressors by advocating for them and supporting them to navigate other systems (Centrelink, housing) to move towards an improved quality of life outside the ward.

Alison sees a huge imbalance in supply and demand. On the ward Alison works in, there is only one full-time graduate social worker and one part-time senior social worker for 25 consumers.

The medical model and the role of medication is indisputably important; however, the funding of public mental health facilities needs to be more balanced across disciplines to allow for holistic, ethical treatment and to further enable consumers’ recovery in the community.

In Alison’s experience, it is often psychosocial stress that leads to people experiencing poor mental health. Psychosocial stressors that she witnesses on her ward include child protection involvement, family violence, forensic and legal issues, seeking asylum and migration, neighbourhood safety, substance use, homelessness (or risk of), unemployment, Centrelink and other financial stressors.

Psychosocial stressors define the role of social workers like Alison.

Some examples are:

  • advocating for consumers’ rights on and off the ward
  • support for consumers who are experiencing homelessness to engage with the appropriate services
  • involving child protection services when there are children at risk
  • creating safety plans and referring consumers to family violence services
  • providing support letters for those trying to navigate the Commonwealth Department of Home Affairs to stabilise visa issues.

Alison is very aware that medication cannot fix psychosocial stressors; it simply helps to reduce the person’s symptoms to allow them to try to navigate the stressors themselves.

We are in a society where, cruelly, the most disadvantaged and impoverished people are often engaged with and have to navigate the most complex and under-resourced services that exist, for example Centrelink and Office of Housing. These stressors do not disappear when they are in hospital—they simmer in the background creating only more stress.

Alison would like to see more social workers on acute inpatient wards, indicating that if it remains as it is acute mental health service provision and recovery for consumers will be significantly compromised and discharges will be less sustainable.

Community mental health is managing to harness the focus on the link between psychosocial stress and mental health well, however acute mental health lingers in the medical model.

For a sustainable and ethical approach to treating consumers in acute mental health, and to act on the commitment to consumers and to a best practice recovery framework, more funding for social work on wards is vital.

Source: Interim Report, November 2019

Note: *Name has been changed to protect privacy.