Response to the Royal Commission into Victoria’s Mental Health System Interim Report

The Victorian Refugee Health Network commends the Royal Commission on its Interim Report. We highlight some issues below for the Royal Commission’s consideration as it progresses toward the final report and recommendations.

1. The Royal Commission’s final recommendations must address prevention and early intervention:  The interim report’s recommendations necessarily address immediate issues at the acute end of the spectrum of care. The final report must translate the acknowledgement of inadequate mental health promotion and prevention activity (p.96) into concrete recommendations.
2. A statewide mental health prevention and promotion strategy should target stigma and mental health literacy in refugee background communities.  Stigma is acknowledged in the interim report (p.211) as a significant issue in many refugee background communities. It has harms wellbeing and reduces help-seeking behaviours. There should be a targeted approach to the mental health promotion and primary prevention activities for refugee communities, including initiatives which address stigma. These should be designed and delivered in partnership with target communities.   
3. We suggest integrating mental health promotion and prevention activity with existing services. Integrating Victorian state-funded mental health promotion initiatives into settlement supports for newly arrived communities would helpfully complement other system learning in this early settlement period.  The Refugee Health Program could also be developed to prioritise early screening and a proactive approach to mental health vulnerability.
4. We look forward to recommendations regarding a system-wide approach to embedding cultural inclusivity and responsiveness within mainstream Victorian mental health services. The Royal Commission is alert to the fact that mainstream mental health services inadequately respond to cultural and linguistic diversity. This lack of responsiveness inhibits both access and engagement for those of refugee backgrounds.
5. We reiterate our recommendations to the Royal Commission that mental health services must have both the funding and the capabilities to offer quality language services to all people who require them. This requires work across multiple areas. The Government should ensure mental health services are funded and workforces capable of working effectively with interpreters and sharing translated written information where possible. Services should be required to collect data on the need for language services, and report on whether the service is meeting these needs. Developing interpreter workforce supply and capabilities is also an important consideration. The Royal Commission could explore options for incentivising interpreter training for people speaking under-served languages. They might also promote and incentivise currently certified interpreters to undertake NAATI’s Specialist Health Interpreter Certification.
6. Culturally responsive suicide prevention must be a requirement, not a benchmark. Considering the relatively high rates of mental illness and suicidality among those of refugee backgrounds, we welcome the Royal Commission’s recommendation for the HOPE program to be expanded to each area mental health service in Victoria. We note cultural inclusivity is one of the core principles of the HOPE program (p.449). We recommend the Victorian Government explore how to measure the cultural inclusivity of the HOPE program, and ensure funded services are accountable to these measures.
7. A cultural and linguistically diverse mental health workforce is important, as is specialist knowledge in transcultural mental health and the specific impacts of pre and post-migration experiences on refugee mental health. The interim report’s recommendations regarding workforce address issues of supply. We would hope to see the final recommendations address reasons underlying problems with workforce supply (as discussed in the Interim Report, Chapter 6), and look to recommendations which address workforce diversity, workforce capabilities and maintenance.
8. The Royal Commission could consider recommending scholarships for people of CALD/refugee backgrounds to undertake training in mental health professions, as an extension to the recommendations aimed at building the Aboriginal mental health workforce.
9. The Royal Commission has recommended introducing a quota of psychiatry rotations for junior medical officers (19.3.3). We reiterate our recommendation for a psychiatry registrar to be added to the Refugee Fellows program. A psychiatrist in the Refugee Fellows program would be an invaluable specialist resource for junior medical officer psychiatry rotations.