It’s a MHAD, MHAD World

1. It’s a MHAD, MHAD World The Brave New World of the Mental Health & Drugs Division

2. It’s a MHAD … • The pervasive social context, the lens through which we view particular issues, is both a consequence and driver of Government Policy. • Alcohol and drug use and mental health problems are major social, health and economic issues affecting the whole population. • Programs and services for people with acute mental illness and/or abusing drugs or alcohol affect some of the population. • Our job is both…

3. Kids • ANCD Report:‘Supporting Families of young people with problematic drug use’ • One in ten 12 to 17 yr olds binge drink at harmful levels. • One in five 16 yr olds drink at harmful levels. • One in seven secondary school students used cannabis in the last 12 months. • 25% of young drinkers report being verbally abusive while under the influence of alcohol. • 16% reported that they had attended work or school while under the influence of alcohol.

4. Families • One in eight Australian children live with a problem drinker or drug user. • 230,000 children live in households at risk of exposure to a binge drinker. • 40,000 live in a house where an adult uses cannabis daily. • There is a need to help families cope with young people with AOD issues. • Importance of AOD services recognising the value of addressing familial feelings of shame, guilt, helplessness and isolation.

5. Its all about the drink… • The numbers of young people entering our treatment system where alcohol is their primary drug of choice has more than doubled from 18% in 2000-2001 to 40% in 2006-2007. • In some rural areas the proportions are up to 50%. Alcohol and Drug Information System

6. ‘Alcohol fuelled anarchy’The Age, 21/02/08

7. Media & market driven Will Corey’s brain grow up?

8. Moody teens are wired for spleen ‘1’- Leigh Dayton, Science Writer, The Australian, 26/02/08 • THE aggressive, moody, whiny, excessive behaviour that drives the parents of teenagers wild is all part of the lopsided way the adolescent brain matures. • That's especially true for boys, as Melbourne teenager Corey Worthington demonstrated when he hosted a wild party for about 500 young revellers last month. • The claim comes from Australian and US researchers who scanned the brains of 137 Melbournians aged 11 1/2 to nearly 14. • Team leader Nicholas Allen, a clinical psychologist with the University of Melbourne and the Orygen Research Centre, said: “The good news is that to a certain extent it's a phase. Parents do find it helpful to understand that some of the inexplicable behaviours teenagers come up with is part of a brain developmental phase”.

9. Moody teens are wired for spleen ‘2’– Leigh Dayton, Science Writer, The Australian, 26/02/08 • Associate Professor Allen, himself the father of two teenaged boys, said the new work built on emerging evidence that the human brain was not fully mature until the early 20s. That's when the cerebral cortex, the “thinking'' brain, is fully wired to and in control of the rest of the brain. • Writing in the US journal Proceedings of the National Academy of Sciences, Professor Allen and his group reported that teenagers with a large amygdala are prone to prolonged, aggressive disputes with their parents. • The amygdala is found deep inside the cerebral cortex and is involved in memory, mood and emotional behaviour. • The team also found that obnoxious teenage behaviour was at its worse if a boy with a large amygdala still had a relatively small anterior cingulate cortex or orbitofrontal cortex. Both brain bits are involved in keeping the amygdala and its antisocial proclivities in check. • According to Professor Allen, Corey's brain had apparently not outgrown its adolescent anatomical asymmetry. • “One presumes he'll look back on that (incident) and he'll cringe,'' he said.

10. Therapists

11. “The Tipping Point is the biography of an idea, and the idea is very simple. It is that the best way to understand the emergence of fashion trends, the ebb and flow of crime waves, or, for that matter, the transformation of unknown books into bestsellers, or the rise of teenage smoking, or the phenomena of word of mouth, or any number of the other mysterious changes that mark everyday life is to think of them as epidemics. Ideas and products and messages and behaviors spread just like viruses do” (p. 7). “We are, as humans, heavily socialised to make a kind of rough approximation between cause and effect....To appreciate the power of epidemics, we have to abandon this expectation about proportionality. We need to prepare ourselves for the possibility that sometimes big changes follow from small events, and that sometimes these changes can happen very quickly” (p. 10-11). Tipping points

12. Tipping points “The point of all this is to answer two simple questions that lie at the heart of what we would like to accomplish as educators, parents, marketers, business people and policymakers. Why is it that some ideas or behaviors or products start epidemics and others don't? And what can we do to deliberately start and control positive epidemics of our own?” (P. 14). Source: “The Tipping Point: How Little Things Can Make a Big Difference”, Little, Brown and Co., Boston, 2000.

13. Public perception/ attention Social paradigms Law and order/control Health Choice/rights Technology Major catastrophic events Research Personal experience Good policy and service provision should be affected by and affecting each of these. Drivers

14. Mental Health & Drugs – A New Paradigm • Strategic Connection • Establishing a collective approach and focus on shared responsibility across government for AOD and MH. • Participating in the National Co-morbidity Agenda. • Health, wellbeing, prevention and recovery. • Community understanding and expectations.

15. Mental Health & Drugs – A New Paradigm • Integrated Connection • Develop integrated clinical and community framework for AOD and MH. • Identify linkages and interfaces with other systems and frameworks e.g. public health to address broader social, health and economic issues. • Shared service provider forums across AOD and MH sectors/training.

16. Mental Health & Drugs – A New Paradigm • Quality Connection • Undertake service type reviews across both sectors. • Research into effective practice and service innovation. • Support and applaud joint responses • Hume Alcohol Assessment Project • Koori Home based withdrawal • Forensic Interventions Unit

17. Mental Health & Drugs – A New Paradigm • Workforce • Influence curriculum at undergraduate and postgraduate level. • Identify common core competencies across AOD and MH. • Identify integrated training opportunities. • Support/encourage cross sectoral mentoring and placements. • Incorporate cross sectoral workforce development, i.e. with GPs and other health and welfare service providers.

18. Evolving policy context • Federal Government commitment to bring mental health back to COAG. • Some specific federal commitments requiring state action, e.g. perinatal screening. • Broader COAG health reform agenda – opportunities for mental health. • New Commonwealth social inclusion agenda and disability policies. • Victorian Government priorities for chronic disease, early childhood, vulnerable youth, alcohol related harm, joined up government.

19. Victorian Alcohol Action Plan • Will be multifaceted and consider how to improve treatment outcomes and sustain these over a long period of time. • Your work and the partnerships you build will be crucial in achieving the Plan’s objectives.

20. Key priorities • A focus on evidence and outcomes – making a difference. • Leadership across Government – particularly Education, Justice and Housing. • A stronger focus on children and young people. • Opportunities for reform. • Mental Health and Drugs – a new paradigm. • Shared service development forums across AOD and MH sectors. • Evolution of Mental Health Strategy to the Mental Health and Drugs Strategy.

21. Mental Health & Drugs Division • Not just a change of name. • Build on relationships across government, DHS, regions. • Repository of knowledge, expertise. • Leadership role in policy formulation.

22. CONCLUSION • This is a period of opportunity. • Opportunities and challenges for significant shifts, better recognition and intervention for chronic illness, high prevalence disorders as well as focus on youth and early intervention. • Community expectations of better services in AOD and MH are high – will need strong leadership at Government and service level. • Need to maintain optimism for exploration of reform, new models, evidence based practice and change, better outcomes for individuals and community. • More to mental health and drugs than “dual diagnosis”.