That cackling sound you can hear is Dan Andrews.
After the former premier took over as chair at the youth mental health service, Orygen, which he funded when he was premier, things have fallen apart.
He oversaw the separation of Orygen from the Parkville Youth Mental Health and Wellbeing Service, which has now been…
…beset by staff claims of deteriorating patient care and frustration with senior management…
Orygen executive director Professor Pat McGorry has become so troubled by issues within his partner organisation that he last month presented Mental Health Minister Ingrid Stitt with a six-page briefing outlining his concerns.
As well as its Parkville hospital, the service also operates in Sunshine, Footscray and Werribee, where it is co-located and works in partnership with Orygen-run headspace services.
McGorry’s briefing, seen by The Age, claims the organisation is not delivering safe, high-quality or sustainable care, and has failed to spend its budget treating desperate young people due to a lack of staff.
The state government is accused of undermining an independent watchdog, marking its own report card and manipulating judging criteria to cover up a stalled mental health overhaul.
“There are serious concerns that clinical care is being affected and that an escalation in serious incidents involving PYMHWS clients is creating significant risk for PYMHWS patients and staff, for the young people and families attending co-located headspace services and for Orygen’s headspace staff,” McGorry said.
“There are also concerns that clinical practice guidelines are no longer being consistently followed. Patients are being discharged earlier than guidelines mandate and fidelity to evidence-based treatment is declining.”
“Huge concerns that if the senior, experienced clinicians continue to leave, this valuable service will not recover.”
…Health and Community Services Union Victorian branch secretary, Paul Healey, said mental health staffing and bed shortages meant young consumers were falling through the cracks.
“The Victorian state government must urgently intervene to fund staff, implement ratios and deliver on the royal commission in the way in which it was intended,” he said.
A senior psychiatrist still working at the service said many of the managers and new clinicians had little or no expertise or interest in youth mental health and the service had abandoned its internationally recognised model that has achieved positive patient outcomes.
“There has been an exodus of expertise, including many senior leaders in the field. They have left in despair because their decades of painstaking work and progress is being destroyed.”
PYMHWS told The Age its workforce had grown by 42 per cent in its first year, with five new people hired for every one who departed, while transitioning the 500-strong workforce from Royal Melbourne Hospital into the standalone youth service.
I would guess that the decentralised care model proposed by the Royal Commission has:
- displaced the medical model of care with a community-based model
- displaced senior medical staff with undertrained social workers
- displaced the ethics of care from ‘do no harm’ etc, to ‘engage at all costs’ etc, handing enormous power to ill-equipped ‘clinicians’ who are often as mentally ill as the mentally ill
- outcomes will be even worse than disclosed because many turning to help as an act of desperation will be abused and take their own lives.
And there’s more, sadly.
A children’s mental health unit has been closed and five of its staff stood down amid allegations of bullying and the use of force against vulnerable young patients.
The unit at a major Melbourne hospital has halted admissions to its inpatient unit – which treats children under 13 for severe mental health conditions – and has been referring families to another facility since the allegations emerged last Wednesday.
The state government is accused of undermining an independent watchdog, marking its own report card and manipulating judging criteria to cover up a stalled mental health overhaul.
It also follows revelations in The Age this week that a landmark report into Victoria’s progress following the mental health royal commission had been significantly altered to remove remarks critical of the state government’s progress.
Opposition mental health spokeswoman Emma Kealy said this masthead’s reports showed the government did not want scrutiny on a system taxpayers funded directly.
“Victorians pay a dedicated Mental Health and Wellbeing Levy because Labor told them every dollar was needed to rebuild a broken system. They have every right to expect complete transparency about whether that reform is actually happening,” she said.
The issue is far worse than the situation described. The reforms recommended by the Royal Commission are themselves nonsense.
To paraphrase, it advised shifting mental health care from the centralised medical model to decentralised community-based services.
It sounds great in theory. And maybe it works elsewhere. But it has not worked in VIC.
In practice, this change has meant that decades of medical expertise have been sidelined in favour of immature and undertrained social workers who can’t tell the difference between a mental health disorder and a hippopotamus.
These frontline social workers have enormous diagnostic and legal powers emboldened by a social worker ethos that demands “engagement” over the old ethics of “do no harm” in the medical model. They are severely undertrained compared to medical professionals, have no regulator, and sit outside AHPRA (which itself is a disaster, but at least it exists as a tacit threat to harmful medical actors).
Heed my warning: if these “we know best” kindly stormtroopers approach you, run full tilt the other way. Once trapped in the web of their “supports”, there is no one to complain to.
The failed Royal Commission made sure of that by amending laws to provide these mental stormtroopers more power. With minimal supervision from experts, they can issue orders.
- compulsory mental-health assessment and treatment
- involuntary treatment orders
- how people can be detained in a mental-health service
- rights of patients and nominated support persons
- the use of restrictive interventions and seclusion
- the Mental Health Tribunal
- duties of mental-health services and authorised psychiatrists
- safeguards and review processes for compulsory treatment
As one key psychiatrist admitted to me, the system creates far more problems than it solves.
And let’s not forget that all of this followed the 2015 Rosy Batty Royal Commission, which unleashed MARAM, the other government disaster that shares your personal medical and legal records between all frontline services, allegedly to identify early if you are a developing domestic violence candidate (pre-crime, anyone?).
In practice, one misstep with an inept (or bad) social worker leads to your diagnosis and simultaneous defamation across all services that access each other’s data.
- Victoria Police
- Child Protection
- Child FIRST / family services
- The Orange Door
- Specialist family violence services
- Sexual assault services
- Family violence refuges
- Men’s behaviour change programs
- Health services and hospitals
- Mental health services
- Alcohol and other drug services
- Ambulance Victoria
- General practitioners and GP nurses
- Maternal and Child Health
- Community health services
- Aged-care services
- Disability services
- Homelessness services
- Out-of-home care
- Education services
- Early childhood services
- Housing services
- Courts and other justice-related services.
The safeguards around MARAM are a joke. Access protocols are rorted. Review processes are corrupt. Nepotism rules. Everyone goes into hiding when any diagnostic call is questioned. This psychological police state has displaced the frontline workers who used to have experience, discretion and judgement, and nobody dares challenge the Andrews panopticon.
To summarise, the two panicked royal commissions triggered by the Andrews government gutted mental health experience and ethics while radically boosting the power of deteriorating frontline judgement. This maniacal stuff was from a state government far more dedicated to perpetuating and expanding itself than to caring for its citizens. It was itself a violently unethical black hole, privileging politicised action over the benign power of doing nothing.
Lifetimes of experience and centuries of ethics were replaced by experimental reforms that have sent the vast edifice of VIC frontline services down a rabbit hole, dragging innocent Victorians with them, often never to return, so the story only leaks out now and again.
To me, this situation is the real source of anger in the system. It’s not the constant pay disputes. Good people join these services to do good things, only to have the above ‘system’ destroy their good intentions.
At the base of this issue is the same old bullshit: trying to remake the world to fit within the immigration-led economic model of population growth, stretching the public interest so thin that the system has inverted to become more dangerous than any mental health issue you might be dealing with. This situation is a mental health hazard in itself.
Abuse and failure by the government are followed by cover-up and more malinvestment in the failing Andrews panopticon.
Victoria is Arkham Asylum writ large, and Dan Andrews is the Joker.
