Phoenix Australia made a submission to the Terms of Reference of the The Royal Commission into Victoria’s Mental Health System, and our Director, Professor David Forbes, was called as a witness to provide evidence in the first week of public hearings in July, within the theme of prevention and early intervention.
Professor Forbes specified at some length the many actions that need to be taken in order to prevent and treat trauma-related disorders, particularly pointing out the need to improve access to mental health services and best practice treatments. He noted that:
- Psychological trauma is a determinant of mental illness, which commonly include posttraumatic stress disorder (PTSD), depression, anxiety, substance use disorder, panic disorder and agoraphobia. Trauma can also be a risk factor for schizophrenia and other serious mental illnesses such as borderline personality disorder.
- Developmental trauma in children can be associated with developmental delay, physical health problems, interpersonal difficulties, emotional instability, low self-esteem and disordered personality development.
- When traumatic events are repetitive, prolonged and accumulative, they can also be associated with neglect and escape can be extremely difficult. These situations are referred to as complex trauma. Complex trauma is a risk factor in adults for serious mental illness (e.g. schizophrenia, borderline personality disorder), high prevalence disorders such as depression, anxiety, eating disorders and substance abuse, recently defined complex PTSD (ICD-11), learning problems, social disruption, interpersonal crises, socio-economic drift, criminal behaviour, and chronic physical health problems.
- About 70 per cent of Australians are affected by an event that meets the criteria for a traumatic event and PTSD is the second most common mental health condition nationally, with over one million Australians experiencing PTSD in any year.
- Despite the prevalence of PTSD and the severity of its impact on distress and functioning, the public mental health system in Victoria tends not to provide services for trauma-related mental health problems.
- Access to funded and trauma-related services and treatment is limited to particular groups, such as those supported through the Transport Accident Commission, veterans through the Department of Veterans’ Affairs, survivors of sexual assault through the Centres Against Sexual Assault, and people within workers’ compensation programs.
- Many of those with PTSD across the community fall outside these groups (including adult survivors of childhood physical abuse or neglect, disaster survivors, and accidental injury, to name just a few) and cannot easily access high quality PTSD treatment.
- For this large percentage of people, funded treatment is currently mainly provided through Medicare for six sessions (plus four), yet the guidelines for PTSD treatment recommend a minimum dose of 10 to 12 sessions even for simple mild to moderate PTSD.
- The commission should consider building on the existing capability and structures within community health and mental health services, to make available treatment for PTSD and other high prevalence trauma related disorders for all Victorians.
- Staff in hospitals, mental health and drug and alcohol services should receive training in trauma informed care so as to minimise the likelihood of aggravating the effects of trauma on trauma-affected people.
- Similarly, staff in service agencies supporting trauma survivors in areas such as justice and legal aid, homelessness, and employment would benefit from trauma informed care training to maximise the effectiveness of their assistance to trauma survivors.
- The service system needs to be adaptable to change in order to keep abreast of changes and advances in our knowledge and understanding of what works in helping people to recover from trauma.
The Royal Commission into Victoria’s Mental Health System was established in February 2019. The Commission is considering how Victoria’s mental health system can most effectively prevent mental illness, and deliver treatment, care and support to Victorians so that they can experience their best mental health. The Commission will deliver recommendations to improve outcomes for Victorians who experience mental illness.
Phoenix Australia keenly awaits the findings and recommendations of the Royal Commission to improve the Victorian mental health system in general, and to improve the outcomes for people affected by trauma, in particular.