Dear Ms Gumley
A National Quality Framework to support quality services for people experiencing homelessness
Thank you for the opportunity to provide comments on the development of a National Quality Framework to support quality services for people experiencing homelessness.
Given the significant link between mental illness and homelessness and the important role of a quality framework in setting service standards and focussing service quality, the MHCA is pleased to be able to contribute to this process.
The Mental Health Council of Australia (MHCA) is the peak, national non-government organisation representing and promoting the interests of the Australian mental health sector, committed to achieving better mental health for all Australians. The membership of the MHCA includes national organisations of mental health service consumers, carers, special needs groups, clinical service providers, community and private mental health.
In 2009, the MHCA released Home Truths: Mental Health Housing and Homelessness in Australia.1 The report documents the intimate and clear links between mental illness and homelessness and the need for key cross-sectoral, whole of government approaches to address the urgent housing needs for people with mental illness.
While these links are acknowledged by governments, they are not yet well reflected in policies on the ground. The Home Truths report details ten home truths about what needs to be done around homelessness and mental illness and provides a crucial context for the development of a national quality framework for services for people experiencing homelessness. The full report and a summary are available on the MHCA website at http://www.mhca.org.au/publications and I have enclosed a published copy.
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Features of a national quality framework
The list of characteristics of quality service provision that is outlined in the discussion paper A National Quality Framework to support quality services for people experiencing homelessness2 should include that, quality service provision:
'.recognises the link between mental illness and homelessness;
.is designed around the needs of consumers and carers;
.is delivered in equal partnership with consumers and carers.'
It is worth noting here that carers can also play a major role in the lives of mental health consumers3 as they do in most sectors of the Australian community. Therefore, when addressing the needs of people with mental illness, it is imperative to engage with carers and seek their input on requirements for appropriate service provision.
These overarching characteristics should be placed at the top of the list and reflect the importance of the centrality of the needs of mental health consumers to policy development. Designing services that address consumer-identified needs ensures that services are more accessible, effective and sustainable.4 This principle is not confined to the mental health sector.
These additions support but do not replace the other important characteristic, already listed in the discussion paper:
'enables the client to participate in the decision making process and support them to make their own decisions and achieve their goals'
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Importance of support for services
The negative perception of mental illness and people with mental illness in the Australian community plays a major role in devaluing consumer-identified needs. This perception results in stigma and discrimination that operates at all levels including amongst professionals and policy makers. Its effects are even evident within the mental health sector. Extra focus will need to be made to ensure that services are able to overcome stigma to provide appropriate quality service.
The experience in the mental health sector is that to develop and deliver quality consumer and carer centred services, senior management commitment, support and resources need to be provided to policy developers, administrators, service management and personnel for:
- education about mental illness, recovery and stigma;5
- skills development around working more effectively with consumers and carers;6
- exploration and change of service delivery practices;7
- regular and independent evaluation against common criteria to allow for program comparison with transparent assessment and reporting.8
The final chapter of the MHCA Home Truths report identifies a number of case studies as examples of good practice service provision for mental health consumers who are homeless, in unstable housing or have difficulty keeping their homes. These illustrate how services have overcome the challenges meeting the needs of mental health consumers using innovations such as integrated service delivery models, supported housing, assertive outreach and building service links. The characteristics of these services provide good examples of consumer and carer centred approaches and supporting services to improve quality through implementing change.
The MHCA urges you to consider the recommendations of the report Home Truths: Mental Health, Housing and Homelessness in Australia and the needs of mental health consumers as a significant component of the National Quality Framework to support quality services for people experiencing homelessness.
15 April 2010
- Mental Health Council of Australia, 2009, Home Truths: Mental Health, Housing and Homelessness in Australia, MHCA
- 2Housing Ministers Conference 2010, A national quality framework to support quality services for people experiencing homelessness, Department of Families, Housing Community Services and Indigenous Affairs, accessed from website April 2010 www.fahcsia.gov.au .
- In the mental health sector, people with mental illness and clients of services identify themselves as consumers.
- National Mental Health Consumer and Carer Forum, 2004, NMHCCF Consumer and Carer Participation Policy, A framework for the mental health sector, NMHCCF.
- Rickwood, D, 2004, Recovery in Australia: slowly but surely, Australian e-journal for the Advancement of Mental Health Vol 3 Issue 1.
- National Mental Health Consumer and Carer Forum 2009, Ending seclusion and restraint in Australian mental health services, NMHCCF.
- Mental Health Council of Australia, 2009, op cit.