‘We are failing’: Premier vows to put mental health at centre of biggest social reform in generation

Each year one in five Victorians will experience mental illness, with about 200,000 meeting the criteria for severe mental illness, such as schizophrenia or bipolar disorder. Last year there were 698 deaths by suicide in Victoria.

The recommendations in the final report were in addition to nine recommendations in an interim report released in 2019 – to which the government had already agreed – including a new levy to fund mental health services.

The final report said “investment in mental health and wellbeing will be made a priority through the implementation of the levy recommended in the interim report”.

Asked if he would be willing to put the levy on hold given the COVID-19 pandemic, Mr Andrews said: “Victorians have been through a lot last year, and we don’t want to do anything that makes our economic recovery harder, but we’ll have more to say in more detail once we get around to the budget.”

Mr Andrews did not commit to a specific amount of funding to implement all the recommendations, saying the money required would be ongoing over many years.

“It’s not one year, it’s not one budget, it’s not one set of forward estimates, it’s going to take continued work and a really passionate commitment,” Mr Andrews said.

“It will take a long time, but it will be worth every effort and every dollar, because the cost of success is a fraction of the cost of failure we’re all paying right now in lives, and in dollars.”

Mr Andrews said there was a “genuine commitment” to a national partnership between Victoria and the federal government, which could become a model other states and territories could follow.

The final report recommended that between 50 and 60 new adult and older adult local mental health services with extended hours be established across the state to minimise the need for people to travel far to access services.

The royal commission said some of its recommendations were a first for Victoria, such as a new agency led by people with lived experience of mental illness.

“Some challenge the system’s traditional focus on medication alone by highlighting the importance of community and places in shaping mental health and wellbeing,” the report said.

The royal commission recommended the government act immediately to ensure compulsory treatment – where a person is medicated or committed to hospital against their will – be used only if absolutely necessary and to set targets to reduce the use and duration of compulsory treatment on a year-by-year basis.

“We are not convinced compulsory treatment is used as a last resort,” Ms Armytage said.

The royal commission said the government should act immediately to reduce the use of seclusion and restraints in mental health and aim to eliminate these practices within 10 years.

Lucy Barker, a witness before the royal commission, who has significant trauma from compulsory treatment, said the measures taken were extreme.

“You wouldn’t treat anyone else that way, but because you are perceived to have a mental illness, you can be restrained to a bed for hours or thrown in a seclusion room or chucked in the back of a divvy van or jabbed in the butt, and then knocked unconscious for a day,” Ms Barker said.

“It’s that kind of stuff that makes compulsory treatment terrible.”

The royal commission also recommended a chief officer for mental health and wellbeing be established in the Department of Health.

The royal commission found hospital emergency departments were being used as entry points, with people unable to obtain the right treatment when it would benefit them the most.

It recommended wherever possible, health professionals would respond to people experiencing crises rather than police, with triple zero calls diverted to Ambulance Victoria rather than Victoria Police.

The royal commission also recommended the existing beds at the secure Thomas Embling Hospital in Fairfield be refurbished and an extra 107 beds provided by the end of 2026.

“During our early consultations, one participant told us, ‘We don’t want to fill in the potholes, we want an entirely new road’,” Ms Armytage said.

“With these final report recommendations, we have designed a system that is an entirely new road.

“It has been fundamentally reformed – there are no Band-Aids.”

Victorian Mental Illness Awareness Council chief executive Maggie Toko welcomed the royal commission’s findings.

“At the most horrible time of our lives we shouldn’t be fearing what’s going to happen to us, where we are going to go, that it’s going to be an unsafe place,” Ms Toko said.

She was optimistic the recommendations would be adopted. “The Premier’s right when he says it’s going to take more than one go. He’s not promising a rainbow, he’s promising the truth. This is not an overnight thing.”

Mental Health Victoria chief executive Angus Clelland described the release of the report as the most significant development in mental health since de-institutionalisation in the 1990s.

“For too long, Victorians have had few options but to present to hospital emergency departments or to suffer in silence. The reforms announced today will change all that,” he said.

Youth mental health expert Patrick McGorry, who chaired a committee that provided advice to the royal commission, said it was a “watershed” moment to begin addressing the failures of mental health systems.

“A major part of this report is to offer expert care much much earlier,” Professor McGorry said.

“We wouldn’t dare turn away two out of three people who have chest pains and dismiss them, that it’s not serious enough.”

Amilia Morris, 22, said that following a suicide attempt about six years ago she ended up in the local hospital emergency department.

She said staff attempted to find a bed in the mental health ward but there was nothing available in the state.

“As a result of my interactions with the mental health system, my trust in something that was supposed to help me disappeared,” she said.

“I felt abandoned when I just really needed support. Even when I wanted to die, I struggled to get help.”

Last November the Victorian government pledged $870 million – including 120 mental health beds in Geelong, Epping, Sunshine and Melbourne – acknowledging the “broken” mental health system had been strained even further under the pressures of the COVID-19 pandemic.

It also said the government would invest $2.2 million to begin designing the Victorian Collaborative Centre for Mental Health – a key recommendation of the royal commission’s interim report.