FOREWORD

Mental disorders are a leading cause of disability in the community, reducing an individual’s sense of wellbeing, and placing stress on family and social relationships and the wider community. Unemployment, substance abuse, physical illness and social dislocation are generally higher among people with a serious mental disorder.

Victoria’s Mental Health Act 1986 requires persons with a mental disorder to be treated in the community wherever possible. As a consequence, Victoria, more than any other State, has transferred the treatment of patients and resources from stand-alone mental health facilities to community-based settings. People with a mental disorder can access a range of health services, including general practitioners and private psychiatrists, but public mental health services are the major source of 24-hour crisis assessment and treatment, and must be available for involuntary patients.

We have focused this audit on the provision of services for adults facing a mental health crisis. This audit identifies a range of concerns about the timeliness of service provision, the completion of key service delivery processes in compliance with relevant standards and guidelines, and the burdens placed upon carers and families. In making these findings, I do not wish to impugn the many dedicated professionals providing mental health services. It is clear that the service system is under significant stress, due to demand pressure, work force shortages and the increasing complexity of mental disorder in our society.

In responding to the findings of the audit, the Department has maintained that the absence of documentation of a particular action does not preclude the possibility that the action occurred. I agree, but would add that the opposite equally applies. Documentation does not guarantee quality outcomes. However, I encourage all agencies to work towards effectively documenting their actions because such documentation can provide:

• evidence that the planned activities which contribute to effective outcomes took place;

• information from which to learn from past experiences; and

• assurance to individuals accessing services and the wider community that appropriate actions are indeed being taken.

The findings and conclusions of this audit are based on more than simply a review of file documentation. We sought corroboration of our overall findings from various other sources, including consumers and carers. Our judgement was that, on balance, key service delivery processes may not have been undertaken adequately or in a timely fashion.

This report provides a number of suggestions to the Department of Human Services, Area Mental Health Services and the Mental Health Review Board that can improve the services provided to people with a mental illness and their carers.

On 4 September 2002, as I was finalising this report, the Government and the Department of Human Services launched a 5-year plan for public mental health services in Victoria, titled New Directions for Victoria’s Mental Health Services. Many of the things discovered in the course of the audit and discussed with the Department have been recognised in this plan. Effective implementation of the recommendations made in this report will see many of the proposals in the New Directions initiative achieved.

J.W. CAMERON

Auditor-General

17 October 2002