The suc c e ss of Partne rs in Re c ove ry: A c ollaborative approac h to me ntal he alth.

Transcription

1 The suc c e ss of Partne rs in Re c ove ry: A c ollaborative approac h to me ntal he alth. July 2015

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3 Partne rs in Re c ove ry: Coordinate d Support and Fle xible Funding for Pe ople with Se ve re and Pe rsiste nt Me ntal Illne ss and Comple x Ne e ds The Pa rtne rs in Re c o ve ry (PIR) initia tive is fund e d b y the Austra lia n Go ve rnme nt De p a rtme nt o f He a lth.

4 Ac knowle dge me nts This p a p e r ha s b e e n a utho re d b y the wo rking p a rty o f the Ca p a c ity Build ing Pro je c t Na tio na l Re fe re nc e Gro up, with e d ito ria l a nd a d ministra tive sup p o rt fro m the PIR c a p a c ity b uild ing p ro je c t. The Pa rtne rs in Re c o ve ry Org a nisa tio n Re fe re nc e Gro up wishe s to a c kno wle d g e the c o ntrib utio n o f the fo llo wing ind ivid ua ls: Jud y Be ntle y Ga ry Hub b le Bill Milio tis Ad ria n Munro Antho ny Willits Pa rtne rs in Re c o ve ry c a p a c ity b uild ing p ro je c t: Ta nia She lb y-ja me s Ka trin Ra ute r Ja ne Cla yto n Mo ira Ma thie so n Ric ha rd Re e d This document also draws on the lived experiences of over fifty PIR participants and carers fro m a c ro ss Austra lia who ha ve sha re d the ir sto rie s o f re c o ve ry fo r the p urp o se s o f this p ub lic a tio n. It a lso d ra ws o n the inno va tio ns o f thirty PIR o rg a nisa tio ns a ro und Austra lia who ha ve like wise c o ntrib ute d the ir sto rie s o f syste m re fo rm to hig hlig ht the imp a c t o f PIR o n a se c to ra l le ve l. The a utho rs wish to e xp re ss the ir g ra titud e fo r a ll sto rie s sub mitte d. Fo r the p urp o se s o f this d o c ume nt, the a utho rs ha ve c ho se n to hig hlig ht a se le c tio n o f e xa mp le s tha t b e st illustra te the p rinc ip le s a nd suc c e ss o f PIR.

5 What is the Partne rs in Re c ove ry (PIR) initia tive? The Pa rtne rs in Re c o ve ry (PIR) initia tive a ims to b e tte r sup p o rt p e o p le with se ve re a nd p e rsiste nt me nta l illne ss b y p ro vid ing a mo re c o o rd ina te d syste m re sp o nse to a p e rso n s me nta l he a lth ne e d s. PIR fo c use s o n p e o p le with a live d e xp e rie nc e o f se ve re a nd p e rsiste nt me nta l illne ss a nd c o mp le x ne e d s who re q uire sup p o rt fro m multip le a g e nc ie s. Ma ny ha ve b e c o me d isc o nne c te d fro m so c ia l o r fa mily sup p o rt ne two rks a nd ha ve fa lle n thro ug h syste m g a p s. As suc h, e a c h ind ivid ua l ma y re q uire mo re inte nsive sup p o rt to me e t the c o mp le xity o f the ir ne e d s. b y p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd the ir fa milie s. This p a p e r e xp lo re s the se suc c e ss sto rie s a nd a lso a rtic ula te s the wo rk o f PIR a g e nc ie s a nd o the r se rvic e s a c ro ss Austra lia tha t ha ve b e e n instrume nta l in ro lling o ut this c o lla b o ra tive a p p ro a c h to me nta l he a lth. The PIR initia tive is a d ministe re d thro ug h a na tio na l ne two rk o f 48 PIR o rg a nisa tio ns. Ea c h o rg a nisa tio n c o mp rise s a c o nso rtium o f se rvic e p ro vid e rs who ha ve c o mmitte d to the imp le me nta tio n o f PIR within 48 g e o g ra p hic a l re g io ns. Sup p o rt Fa c ilita to rs within e a c h PIR o rg a nisa tio n a re re sp o nsib le fo r c o o rd ina ting the se rvic e s ne e d e d b y e a c h PIR p a rtic ip a nt. The Pa rtne rs in Re c o ve ry initia tive c o mme nc e d in July 2013 a nd sinc e this time the re ha ve b e e n ma ny a c hie ve me nts, p a rtic ula rly 1

6 Part One : How has PIR impac te d syste m c hange and c apac ity building? Fe e d b a c k fro m the 48 PIR o rg a nisa tio ns ha s ind ic a te d tha t the PIR initia tive ha s g e ne ra te d p o sitive syste m re fo rm a nd e nha nc e d the c a p a c ity o f se rvic e p ro vid e rs to me e t the ne e d s o f the PIR ta rg e t g ro up b y fa c ilita ting the fo llo wing : Co nso rtium a p p ro a c h to he a lthc a re ; Oppo rtunitie s fo r c o lle c tive imp a c t; Cro ss-se c to ra l p a rtne rship s; Tra ining within a nd b e yo nd the me nta l he a lth se c to r; Ac tivitie s in stig ma -re d uc tio n; Fo c us g ro up s with ma rg ina lise d p o p ula tio ns; Ne two rking a nd kno wle d g e e xc ha ng e o p p o rtunitie s; Ong o ing c o nsulta tio n with PIR p a rtic ip a nts, c a re rs a nd the ir fa milie s; Co -lo c a tio n o f PIR Sup p o rt Fa c ilita to rs a t fro ntline se rvic e s; Asse rtive o utre a c h mo d e ls; Co o rd ina tio n b y a no n-c linic a l se rvic e Cre a tive a nd inno va tive thinking ; Se rvic e g a p a na lysis; Pe rso n-c e ntre d a p p ro a c he s to we llb e ing ; a nd Be tte r c o o rd ina te d re fe rra l p a thwa ys. Consortium approac h to he althc are The c o nso rtium mo d e l tha t und e rp ins PIR ha s unite d se rvic e p ro vid e rs fro m a ra ng e o f se c to rs a nd p ro fe ssio ns tha t ma y o the rwise ne ve r ha ve c o lla b o ra te d. PIR a lso se e ks to invo lve c o mmunity a nd fa mily sup p o rt in re c o g nitio n o f the imp o rta nt p a rt the y p la y in susta ining he a lth a nd we llb e ing. This ha s g ive n rise to thre e imp o rta nt c ha ng e s in the wa y tha t he a lthc a re is d e live re d. Firstly, c o nso rtium p a rtne rs ha ve b e e n inc e ntivise d to fa c ilita te c ro ss-se c to ra l p a rtne rship s a nd b re a k d o wn the silo s tha t ha d p re vio usly p re ve nte d o p tima l se rvic e d e live ry. The tra d itio na l b o und a rie s b e twe e n he a lthc a re se rvic e s ha ve no w b e e n c ha lle ng e d. Le a d a g e nc ie s within the c o nso rtia ha ve b e e n g ive n the re so urc e s a nd the time to o ve rc o me tra d itio na l o rg a nisa tio na l b o und a rie s a nd fo rg e ne w re la tio nship s. Ind e e d, the y a re ma nd a te d to c re a te a sp a c e whe re p a rtne rship s c a n g ro w. Prio r to the c o nso rtium mo d e l o f PIR, it wa s difficult for service providers to develop a nd ma inta in stro ng p a rtne rship s a c ro ss se c to rs b e c a use o f d iffe re nc e s in o p e ra tio ns 2 a nd fund ing a rra ng e me nts. Altho ug h o rg a nisa tio ns ma y ha ve se e n the va lue in c ro ss-se c to ra l c o lla b o ra tio n, the y ha d ne ithe r the fund s no r the time to e xp lo re this. PIR ha s g ive n se rvic e p ro vid e rs this lic e nc e, a nd in d o ing so, g e ne ra te d a ne w a nd susta ina b le wa y o f wo rking. Se c o nd ly, c o nso rtia p a rtne rs ha ve b e e n c ha rg e d with the re sp o nsib ility o f e mb e d d ing re c o ve ry p ra c tic e, la ng ua g e a nd p ro mo ting ho p e. PIR ha s p ro vid e d a mo re unite d a p p ro a c h, o p e ra ting with a c o mmo n re c o ve ry fo c us a nd b ring s a ne w c o nsiste nc y in a p p ro a c h to he a lthc a re. Third ly, ind ivid ua ls who a re living with se ve re a nd p e rsiste nt me nta l illne ss no w ha ve a c c e ss to mo re ho listic he a lthc a re a nd sup p o rts tha t d ra ws fro m a ra ng e o f c linic a l, social, financial, community services a nd na tura l sup p o rts. The o utc o me s fo r p a rtic ip a nts a nd the ir fa milie s a re imp ro ve d b y o rg a nisa tio ns a nd se c to rs wo rking mo re c o lla b o ra tive ly a s info rma tio n is sha re d mo re re a d ily, the y d o n t ha ve to re p e a t the ir sto ry multip le time s a nd a g e nc ie s a re a b le to mo re q uic kly a nd e a sily link

7 c o nsume rs with the sup p o rts a nd se rvic e s the y ne e d. The c re a tio n o f PIR c o nso rtia ha ve p ro vid e d o p p o rtunitie s fo r o rg a nisa tio ns a c ro ss se c to rs to c o me to g e the r, le a rn fro m e a c h o the r, le a rn mo re a b o ut wha t se rvic e s o the r a g e nc ie s p ro vid e, a nd to b uild ra p p o rt with the ir sta ff. It a lso p ro vid e s le a d a g e nc ie s the o p p o rtunity to up d a te a ll p a rtne r a g e nc ie s o n the ir syste mic c ha ng e a nd c a p a c ity b uild ing p la ns, ho w the y a re p ro g re ssing, wha t ro le p a rtne r a g e nc ie s c a n p la y a nd what benefits their organisations can a c hie ve b y p a rtic ip a ting. This ha s le d to mo re a nd stro ng e r p a rtne rship s b e ing d e ve lo p e d in PIR re g io ns, p ro mo ting a mo re c o lla b o ra tive a p p ro a c h a nd b e tte r inte r- a g e nc y re la tio nship s. b uild ing p ro je c t na tio na lly. The PIR Org a nisa tio n Re fe re nc e Gro up c o mp rise s 17 me mb e rs who ho ld le a d e rship p o sitio ns within PIR a c ro ss a ra ng e o f PIR re g io ns, inc lud ing p a rtic ip a nt a nd c a re r re p re se nta tive s a nd who p ro vid e stra te g ic d ire c tio n o n the a c tivitie s o f the PIR c a p a c ity b uild ing p ro je c t. The PIR c a p a c ity b uild ing p ro je c t is le d b y Flind e rs Unive rsity a nd it is re sp o nsib le fo r fa c ilita ting ne two rking a nd kno wle d g e - e xc ha ng e o p p o rtunitie s fo r a ll PIR sta ff. In this wa y, the c a p a c ity b uild ing p ro je c t p la ys a ke y ro le in the fo rma tio n o f ne w p a rtne rship s within PIR a nd fo ste ring und e rsta nd ing a nd c o o p e ra tio n b e twe e n p a rtne r a g e nc ie s (se e ne two rking a nd kno wle d g e e xc ha ng e o p p o rtunitie s ). Opportunitie s for c olle c tive impac t The mo d e l a d o p te d fo r ma ny PIR o rg a nisa tio ns is re c o g nise d a s c o nsiste nt with a c o lle c tive imp a c t a p p ro a c h whic h is d e sig ne d to a d d re ss c o mp le x so c ia l p ro b le ms thro ug h multip le o rg a nisa tio ns wo rking to wa rd s a c o mmo n a g e nd a, ra the r tha n fro m the ir o wn ind ivid ua l o rg a nisa tio na l a g e nd a. Ea c h o f the PIR consortium members bring identified ke y p a rtne rs a nd e xisting ne two rks a nd re la tio nship s with o the r (no n-co nso rtium) se rvic e p ro vid e rs. The se ne two rks a re c o nsid e re d inte g ra l in a d d re ssing re g io na l se rvic e g a p s thro ug h PIR. Cross- se c toral partne rships The suc c e ss o f the Pa rtne rs in Re c o ve ry initia tive d e rive s fro m the p a rtne rship s it ha s fo rg e d a t the na tio na l, sta te, re g io na l a nd lo c a l le ve l. Na tio na l p a rtne rship s The PIR c a p a c ity b uild ing p ro je c t ha s two ke y na tio na l re p re se nta tive g ro up s: the Exp e rt Re fe re nc e Gro up a nd the PIR Org a nisa tio n Re fe re nc e Gro up. The Exp e rt Re fe re nc e Gro up is ma d e up o f 14 me mb e rs a nd inc lud e s p a rtic ip a nt a nd c a re r re p re se nta tive s who p ro vid e p ro fe ssio na l a nd e xp e rt g uid a nc e o n the stra te g ic d ire c tio n o f the PIR c a p c ity The benefit for participants and carers is that PIR takes away the stress and fear that can be associated with trying to contact agencies. Many of our participants can find the thought of having to talk to someone daunting, which can affect their anxiety. The fear of rejection by a service can stop them reaching out for help and support. PIR takes this pressure away. - PIR Support Facilitator 3

8 Sta te p a rtne rship s So me PIR o rg a nisa tio ns ha ve p a rtne re d with o the r PIR c o nso rtia in the ir sta te to fo rm a c o lle c tive re sp o nse to sta te -b a se d syste m re fo rm issue s. An e xa mp le o f this inc lud e s the think-ta nk c o -ho ste d b y the Ce ntra l Ad e la id e a nd Hills a nd the So uthe rn Ad e la id e Fle urie u Ka ng a ro o Isla nd PIR o rg a nisa tio ns. He ld in Aug ust 2014 a nd fa c ilita te d b y Dr No rma n Swa n, a he a lth jo urna list a nd me d ia p e rso na lity, the think-ta nk wa s a tte nd e d b y o ve r 100 se c to r re p re se nta tive s. The a im o f the e ve nt wa s to g e ne ra te id e a s fo r imp ro ving the re c o ve ry jo urne y fo r So uth Austra lia ns living with se ve re a nd p e rsiste nt me nta l illne ss. By fo c using o n the re c o ve ry jo urne ys o f two hyp o the tic a l PIR p a rtic ip a nts, se rvic e p ro vid e rs we re a b le to id e ntify syste mic c ha lle ng e s a nd g a p s a nd ma ke re c o mme nd a tio ns fo r future re fo rm within the sta te. The y we re a id e d b y two p a ne ls o f e xp e rts who he lp e d the m e xp lo re p o ssib le wa ys fo rwa rd a nd who he lp e d le a d d isc ussio ns a ro und c urre nt stre ng ths a nd limita tio ns o f the syste m. The Que e nsla nd PIR o rg a nisa tio ns a rra ng e d a sta te -wid e syste m re fo rm wo rksho p in Fe b rua ry Six ma jo r syste m re fo rm areas were identified. These included ho using a nd ho me le ssne ss; se rvic e b a rrie rs; p a rtic ip a nts, c a re rs a nd fa milie s; d rug a nd a lc o ho l d e p e nd e nc e ; c o ntinuity o f c a re ; a nd stig ma. A d ra ft a c tio n p la n wa s d ra wn up a nd ta b le d with the Que e nsla nd PIR Ma na g e rs Gro up to fa c ilita te the c o o rd ina tio n o f syste m c ha ng e e ffo rts a c ro ss PIR re g io ns in Que e nsla nd. In a d d itio n, ma ny PIR re g io ns no w p a rtic ip a te in re g ula r inte r-o rg a nisa tio na l me e ting s a ime d a t p ro mo ting sta te - wid e re sp o nse s to syste mic issue s. The se me e ting s a lso p ro mo te a wid e sp re a d c ulture o f re c o ve ry-o rie nte d p ra c tic e. The se sta te -wid e p a rtne rship s ha ve a lso b e e n imp o rta nt in e sta b lishing c o nsiste nc y in the imp le me nta tio n o f PIR a nd g e ne ra ting the ne two rks ne c e ssa ry to a c hie ve syste m re fo rm. Re g io n-wid e p a rtne rship s Ac ro ss the 48 PIR re g io ns in Austra lia, ne w a nd e xc iting re g io na l p a rtne rship s a re a lso b e ing fo rme d within a nd b e yo nd tra d itio na l se c to ra l, g e o g ra p hic a l a nd p ro fe ssio na l b o und a rie s. Co nso rtium p a rtne rs ha ve b e e n wo rking to g e the r fo r a lmo st two ye a rs, g iving rise to a c ulture o f c o o p e ra tio n tha t ha s le d to ne w c o lla b o ra tio ns b e twe e n se rvic e a g e nc ie s b e yo nd PIR. The se a g e nc ie s a re no w c o ming to g e the r to a p p ly fo r ne w te nd e rs, und e rta ke sha re d tra ining a nd initia te ne w p ro je c ts. All o f the se a c tivitie s ha ve inc re a se d the c a p a c ity o f se rvic e p ro vid e rs to a ffe c t syste ms c ha ng e a nd imp ro ve re c o ve ry p a thwa ys fo r p e o p le living with me nta l illness. PIR has identified that for any change to b e imp le me nte d, se nio r ma na g e rs ne e d to b e b e hind it. To e nsure this sup p o rt, PIR o rg a nisa tio ns ha ve e ng a g e d se nio r sta ff a c ro ss multip le le ve ls o f se rvic e s a nd d e le g a tio ns in the p la nning d e ve lo p me nt a nd imp le me nta tio n o f syste ms c ha ng e a nd c a p a c ity b uild ing a c tivitie s to b uild in the le ve l o f und e rsta nd ing, c o mmitme nt a nd imp le me nta tio n o f suc h c ha ng e. Lo c a l p a rtne rship s In a d d itio n to na tio na l, sta te a nd re g io na l p a rtne rship s, lo c a l p a rtne rship s within PIR ha ve a lso c o ntrib ute d to p o sitive syste ms re fo rm a nd ha ve g re a tly e nha nc e d the c a p a c ity o f the se rvic e se c to r. Fo r e xa mp le, a PIR Co mmunity Fo rum he ld in the Ca sso wa ry Co a st Co unc il a re a o f Fa r No rth Que e nsla nd in Ja nua ry 2014 ha s re invig o ra te d a lo c a l c o mmunity se rvic e s ne two rk. This ne two rk ha s no w b e e n re struc ture d to a d d re ss lo c a l syste ms re fo rm issue s mo re e ffe c tive ly. Cruc ia lly, lo c a l p a rtne rship s a re le a d ing to a g re a te r e mp ha sis o n re c o ve ry-o rie nte d p ra c tic e within c linic a l se tting s, suc h a s the me nta l he a lth units (MHUs) o f lo c a l ho sp ita ls. Fo r e xa mp le, the PIR o rg a nisa tio n in the Pe rth No rth Me tro re g io n re c e ntly fo rme d a n a llia nc e with lo c a l he a lth, multi-c ultura l a nd ho using g ro up s to c re a te a n imp ro ve d d isc ha rg e p ro c e ss fo r PIR p a rtic ip a nts who we re ho sp ita lise d. 4

9 This a llia nc e he lp s e nsure tha t p e o p le who we re re g iste re d with PIR ha d a muc h smo o the r a nd mo re sup p o rte d tra nsitio n b a c k into the c o mmunity. Ano the r e xa mp le o f lo c a l p a rtne rship s inc lud e s a ne w a llia nc e b e twe e n the PIR o rg a nisa tio n in the No rthe rn Te rrito ry, the Ce ntra l Austra lia n Me nta l He a lth Se rvic e s -Co mmunity te a m a nd the Na tio na l Disa b ility Insura nc e Ag e nc y. This c o lla b o ra tio n g e ne ra te d a n o p p o rtunity fo r a lo c a l PIR p a rtic ip a nt to und e rta ke a tra ine e ship a t a re mo te c a ttle sta tio n a nd fulfil an important recovery goal. Ye t a no the r e xa mp le o f lo c a l p a rtne rship s is the c re a tio n o f Fa r No rth Stre e t So c c e r, a so c c e r p ro g ra m o p e n to Fa r No rth Que e nsla nd re sid e nts with a live d e xp e rie nc e o f me nta l illne ss. The p ro g ra m wa s d e ve lo p e d thro ug h a p a rtne rship b e twe e n the PIR o rg a nisa tio n in Fa r No rth Que e nsla nd, the Sa lva tio n Army, Stra tfo rd Do lp hins Fo o tb a ll Club a nd Ca irns Ha rd wa re. Mo d e lle d o n the inte rna tio na l ve rsio n o f stre e t so c c e r, the Fa r No rth Stre e t So c c e r p ro g ra m fo c use s o n re c o ve ry thro ug h p hysic a l e xe rc ise a nd so c ia l inte ra c tio n. This initia tive re p re se nts the typ e o f no n-tra d itio na l a llia nc e s tha t a re b e ing fo rme d within PIR to he lp p a rtic ip a nts le a d a c o ntrib uting life. Before PIR I would miss appointments and fall behind on my health regime. Since PIR began to help, I am able to link in and get to all these services. My Support Facilitator has come to appointments with me and advocated for me. My standard of living has improved enormously. - PIR Participant 5

10 Training within and be yond the me ntal he alth se c tor As a re sult o f PIR, se rvic e a g e nc ie s within a nd b e yo nd the me nta l he a lth se c to r ha ve b e e n g ive n the o p p o rtunity to a tte nd fre e tra ining in re c o ve ry-o rie nte d practice, trauma-informed care, conflict ma na g e me nt a nd suic id e p re ve ntio n. This ha s inc re a se d the a b ility o f se rvic e p ro vid e rs to d e live r re c o ve ry-o rie nte d c a re a nd re sulte d in b e tte r sup p o rts a nd o utc o me s fo r PIR p a rtic ip a nts, the ir c a re rs a nd fa milie s. By o p e ning up tra ining o p p o rtunitie s b e yo nd the me nta l he a lth se c to r, a d ive rse range of service providers have benefited fro m ne w skills in me nta l he a lth sup p o rt. The se inc lud e sta ff fro m the ho using, yo uth a nd e mp lo yme nt se c to rs, a s we ll a s se rvic e s who sp e c ia lise in a d d re ssing the ne e d s o f Ind ig e no us Austra lia ns, c ultura lly a nd ling uistic a lly d ive rse (CALD) c o mmunitie s, a nd p e o p le who id e ntify a s b e ing le sb ia n, g a y, b ise xua l, tra nsg e nd e r, inte rse x o r q ue e r (LGBTIQ). This is imp o rta nt b e c a use ind ivid ua ls re q uiring me nta l he a lth sup p o rt fre q ue ntly p re se nt a t the se a g e nc ie s ho we ve r sta ff re p o rt the y a re no t ne c e ssa rily e q uip p e d to re sp o nd a p p ro p ria te ly to the ir ne e d s a s me nta l he a lth se rvic e s a re no t the ir c o re fo c us. The Be ntle y-arma d a le PIR Re g io n ha s p ro vid e d me nta l he a lth tra ining to sta ff fro m o the r se c to rs to b e tte r e q uip the m with the skills the y ne e d to re la te to ind ivid ua ls living with me nta l illne ss. Cruc ia lly, this tra ining ha s he lp e d sta ff o f the se o rg a nisa tio ns a p p ro a c h the ne e d s o f p a rtic ip a nts in a mo re ho listic wa y a nd id e ntify whe n it ma y b e a p p ro p ria te to re fe r a n ind ivid ua l to a me nta l he a lth se rvic e p ro vid e r. In this wa y, ind ivid ua ls living with a me nta l illne ss a re mo re like ly to re c e ive the sup p o rt the y ne e d whe n the y ne e d it, a nd sta ff a re mo re like ly to b e e ffe c tive in the ir sup p o rt ro le. The We ste rn Syd ne y PIR o rg a nisa tio n imp le me nte d re c o ve ry tra ining tha t wa s o p e n to ke y sta ke ho ld e rs in the re g io n. The a im wa s to inc re a se und e rsta nd ing o f re c o ve ry a mo ng st a ll a g e nc ie s, p a rtic ula rly tho se o utsid e o f the PIR o rg a nisa tio n suc h 6 a s ho using a nd justic e se rvic e s d ue to the identified needs of PIR participants. Similarly, in the So uthe rn Ad e la id e Fle urie u a nd Ka ng a ro o Isla nd re g io n, tra ining wa s o ffe re d to p e o p le fro m multip le se c to rs a s a wa y to p ro mo te re c o ve ry p rinc ip le s a nd re c o ve ry o rie nte d p ra c tise. The imp o rta nc e a nd va lue o f p a rtic ip a tio n b y p e o p le with a live d e xp e rie nc e d a nd c a re rs is a c kno wle d g e d b y PIR o rg a nisa tio ns. It is sta nd a rd in so me PIR o rg a nisa tio ns fo r PIR p a rtic ip a nts a nd the ir c a re rs to b e d ire c tly invo lve d in c ro ss se c to ra l me nta l he a lth tra ining. This re c o g nise s tha t the tra ining e xp e rie nc e is e nric he d whe n the vo ic e o f tho se with a live d e xp e rie nc e is p re se nt. PIR sta ff wo rk a c ro ss se c to rs a nd ha ve found providers differ in their definitions o f re c o ve ry a nd a re a t d iffe re nt sta g e s in imp le me nting re c o ve ry o rie nta te d p ra c tic e. We ste rn Syd ne y PIR ha s d e ve lo p e d a suite o f re c o ve ry tra ining o p p o rtunitie s in c o njunc tio n with insid e o ut & a sso c ia te s a ustra lia. The ir a im wa s to inc re a se und e rsta nd ing o f re c o ve ry, in p a rtic ula r within a g e nc ie s c ritic a l to PIR p a rtic ip a nts, suc h a s ho using a nd justic e. Tra ining ha s b e e n d e live re d to PIR sta ff a nd ke y sta ke ho ld e rs a c ro ss the We ste rn Syd ne y re g io n. The a im wa s to a llo w p e o p le time to e xp lo re the c o nc e p t o f re c o ve ry o rie nta te d practice, consider how it fits into their daily p ra c tic e, a nd ta ke ste p s to b uild c a p a b ility to sup p o rt p e o p le with a live d e xp e rie nc e o f me nta l illne ss. This tra ining ha s se e n a ra ng e o f p o sitive o utc o me s tha t ha ve imp ro ve d the e xp e rie nc e o f p a rtic ip a nts a nd c a re rs. The se inc lud e ; a n imp ro ve me nt o f re fe rra l p a thwa ys a nd c a re c o o rd ina tio n with p a rtic ip a nts a nd b e twe e n a g e nc ie s; a g re a te r fo c us o n the p a rtic ip a nt, c a re c o o rd ina tio n a nd q ua lity o f a ssista nc e ra the r tha n p ro c e ss; b e tte r und e rsta nd ing o f c o mp le x issue s a nd ho w c urre nt p ra c tic e s ma y ha ve a n a d ve rse imp a c t o n p a rtic ip a nts; imp ro ve d c la rity a b o ut the ro le s o f d iffe re nt p ro vid e rs in a c o mp le x syste m; a nd c o lla b o ra tio n to stre a mline a nd minimise d up lic a tio n.

11 The So uthe rn Ad e la id e, Fle urie u a nd Ka ng a ro o Isla nd PIR ha s c o nd uc te d wo rksho p s o n Co nc e p tua lising Re c o ve ry a nd Sup p o rting the Re c o ve ry Pro c e ss a ime d to imp ro ve the a b ility o f wo rke rs a c ro ss a ra ng e o f se c to rs to b e tte r re sp o nd to p e o p le e xp e rie nc ing me nta l d istre ss a nd to shift la ng ua g e a nd und e rsta nd ing to wa rd s p e rso n c e ntre d re c o ve ry o rie nte d p ra c tic e. By e xp lo ring the o re tic a l a nd p ra c tic a l e le me nts o f re c o ve ry, wo rksho p p a rtic ip a nts a re e nc o ura g e d to a p p ly learnings to daily work and reflect on their e xp e rie nc e s. Na tio na l Me nto r Pro g ra m The ne w a nd uniq ue na ture o f the Sup p o rt Fa c ilita to r ro le b ring s with it ma ny ne w c ha lle ng e s. The PIR Sup p o rt Fa c ilita to r Me nto r Sup p o rt Pro g ra m p ro vid e s sup p o rt to PIR Sup p o rt Fa c ilita to r Me nto rs wo rking within the ir PIR o rg a nisa tio n. The a im o f the me nto ring p ro g ra m is to fo ste r kno wle d g e e xc ha ng e a nd p ro b le m-so lving within the Sup p o rt Fa c ilita to r c o mmunity, a nd e na b le Support Facilitators to benefit from a shared p o o l o f skills a nd e xp e rie nc e. The PIR c a p a c ity b uild ing p ro je c t ha s a d ire c to ry o f Sup p o rt Fa c ilita to r me nto rs. The se me nto rs a re Sup p o rt Fa c ilita to rs with a b ro a d ra ng e o f skills who ha ve vo lunte e re d to b e a va ila b le to o the r Sup p o rt Fa c ilita to rs to p ro vid e o n-the -jo b a d vic e a nd a ssist with p ro b le m-so lving. Sup p o rt Fa c ilita to rs a re e nc o ura g e d to c o nta c t a ny me nto r in the d ire c to ry to d isc uss o n-the -jo b c ha lle ng e s via tha t me nto r s p re fe rre d c o mmunic a tio n me d ium. Co lle c tive ly, the me nto rs fo rm the Sup p o rt Fa c ilita to r Me nto ring a nd Le a d e rship Gro up, a vita l p a rt o f the g o ve rna nc e struc ture o f the c a p a c ity b uild ing p ro je c t. PIR are builders of a network for mental health and seem to have a plan for the future, and want to include consumers and carers in this plan. - PIR Carer 7

12 Ac tivitie s in stigma-re duc tion The Na tio na l Sta nd a rd s fo r Me nta l He a lth Se rvic e s (2010) d e sc rib e six g uid ing p rinc ip le s fo r re c o ve ry-o rie nte d me nta l he a lth p ra c tic e, o f whic h d ig nity a nd re sp e c t is o ne 1. Re c o ve ry o rie nta te d me nta l he a lth p ra c tic e invo lve s c ha lle ng ing d isc rimina tio n a nd stig ma within the se rvic e se c to r a nd the b ro a d e r c o mmunity. Stig ma is d e trime nta l to the re c o ve ry p ro c e ss. Stig ma b y o the rs a nd the inte rna lisa tio n o f stig ma tising me ssa g e s a b o ut me nta l illne ss c a n inhib it he lp se e king b e ha vio ur, inc re a se d istre ss a nd a d ve rse ly imp a c t up o n re c o ve ry a nd a c hie ve me nt o f e d uc a tio na l, vo c a tio na l a nd life g o a ls. Initia tive s suc h a s SANE Stig ma Wa tc h a nd o rg a nisa tio ns suc h a s b e yo nd b lue a re e nd e a vo uring to re d uc e stig ma in Austra lia a nd whilst p ro mising g a ins ha ve b e e n ma d e, furthe r c ha ng e is ne e d e d. I don t feel lost in the system anymore. - PIR Participant In line with the Na tio na l Me nta l He a lth Sta te me nt o f Rig hts a nd Re sp o nsib ilitie s (2012) 2, the PIR initia tive ha s imp le me nte d a susta ine d a nd c o mp re he nsive stra te g y to re d uc e stig ma a nd d isc rimina tio n fo r p e o p le with a live d e xp e rie nc e o f me nta l illne ss. This stra te g y c o mp rise s a numb e r o f stig ma -re d uc ing a c tivitie s, inc lud ing : the re c ruitme nt o f p e e r wo rke rs to id e ntify with, a nd p ro vid e sup p o rt to PIR p a rtic ip a nts d uring the ir re c o ve ry jo urne y; the invo lve me nt o f PIR p a rtic ip a nts a nd c a re rs a t a ll le ve ls o f PIR g o ve rna nc e a nd in the d e live ry o f p ro c e sse s a nd sup p o rts; a nd the c re a tio n o f c o mmunity e ve nts a nd ro a d sho ws tha t c ha lle ng e vie ws a b o ut 1 Austra lia Go ve rnme nt 2010, Na tio na l Sta nd a rd s fo r Me nta l He a lth Se rvic e s 2010, p Austra lia n Go ve rnme nt 2012, Me nta l He a lth Sta te me nt o f Rig hts a nd Re sp o nsib ilitie s 8 me nta l illne ss a nd e d uc a te the se rvic e se c to r a b o ut PIR s a ims a nd o b je c tive s. Re d uc ing so c ia l stig ma is c ruc ia l to re c o ve ry a nd c a n sta rt whe n p e o p le with a live d e xp e rie nc e a nd c a re rs ha ve the o p p o rtunity to b e invo lve d in the e d uc a tio n o f the c o mmunity a nd o the r se rvic e p ro vid e rs. This ma y inc lud e a c tivitie s suc h a s sc ho o l e d uc a tio n p ro g ra ms, p ub lic info rma tio n nig hts a nd jo int initia tive s d e ve lo p e d with o the r a g e nc ie s. Cha mp io ns4cha ng e c a mp a ig n The PIR o rg a nisa tio n in the Fa r No rth Que e nsla nd re g io n is d e ve lo p ing a n e ffe c tive ve hic le fo r re d uc ing stig ma in the c o mmunity thro ug h the Cha mp io ns 4 Cha ng e c a mp a ig n. The c a mp a ig n a sks p e o p le to d e c id e whic h me nta l he a lth issue s a re mo st imp o rta nt to the m a nd the n sta nd up a nd b e c o me a sp o ke sp e rso n fo r tho se issue s. The c a mp a ig n is g a ining tra c tio n in the Fa r No rth Que e nsla nd re g io n a nd so me c o mp e lling me ssa g e s ha ve a lre a d y b e e n p ro d uc e d b y lo c a l c ha mp io ns inc lud ing b y p e o p le with a live d e xp e rie nc e o f me nta l illne ss, lo c a l me mb e rs o f p a rlia me nt a nd NRL p la ye rs. Me nta l He a lth First Aid tra ining Co urse s in Me nta l He a lth First Aid ha ve b e c o me p re va le nt a c ro ss PIR re g io ns a nd ha ve p ro ve n to b e a n e ffe c tive wa y o f e d uc a ting c a re rs a nd c o mmunity me mb e rs a b o ut ho w to re c o g nise a nd re sp o nd to a me nta l he a lth c risis. As a n e xa mp le, the Ce ntra l Co a st NSW PIR used flexible funding to deliver Me nta l He a lth First Aid tra ining within the lo c a l c o mmunity. The a im wa s to e q uip c o mmunity me mb e rs to id e ntify sig ns o f d istre ss a nd lo c a te a p p ro p ria te me nta l he a lth se rvic e s. In a d d itio n to inc re a sing a wa re ne ss o f the d a ma g ing a nd lo ng -te rm imp a c t o f stig ma, the tra ining le d to the c re a tio n o f ne w sup p o rt ne two rks within the c o mmunity.

13 Ad e la id e me nta l he a lth think-ta nk The Ce ntra l Ad e la id e a nd Hills a nd the So uthe rn Ad e la id e Fle urie u Ka ng a ro o Isla nd PIR o rg a nisa tio n s ho ste d a think-ta nk in 2014 to fo ste r inte r-a g e nc y c o lla b o ra tio n. The think-ta nk invo lve d p e o p le with a live d e xp e rie nc e a nd re p re se nta tive s fro m the me nta l he a lth, ho using, d isa b ility, c o mmunity a nd g e ne ra l p ra c tic e se c to rs. It c re a te d a n imp o rta nt o p p o rtunity fo r se rvic e sta ff to d isc uss wa ys the y c o uld imp ro ve p a thwa ys to re c o ve ry (fo r furthe r info rma tio n, se e sta te p a rtne rship s ). Disc ussio ns ind ic a te d tha t whist stig ma ha s d e c re a se d o ve r the la st 20 ye a rs, the re wa s still muc h wo rk to b e d o ne in b re a king d o wn myths a nd unfo und e d fe a rs a b o ut me nta l illne ss. A c o mmitme nt to re d uc ing stig ma in So uth Austra lia e me rg e d a s a ke y a c tio n ite m, to b e a c hie ve d thro ug h p ro visio n o f o ng o ing tra ining with se rvic e p ro vid e rs, c o mmunity me mb e rs, a nd p e o p le with a live d e xp e rie nc e o f me nta l illne ss. Ke y le a rning s inc lud e d the fa c t tha t p e o p le living with me nta l illne ss usua lly re q uire d sup p o rt lo ng b e fo re the y re a c he d c risis p o int, a nd tha t se rvic e p ro vid e rs ne e d e d to e xe rc ise mo re c a utio n a nd se nsitivity a ro und the e xc ha ng e o f p e rso na l info rma tio n with o the r a g e nc ie s, a s this o fte n le d to d isc rimina tio n d o wn the line. Fo r e xa mp le, stig ma tisa tio n c o uld o c c ur whe n a n ind ivid ua l wa s a tte nd ing a he a lth se rvic e fo r a p hysic a l he a lth c o nd itio n, a nd that stigma often had a negative flowo n imp a c t o n ma ny p a rts o f a p e rso n s life, suc h a s e mp lo yme nt a nd o b ta ining insura nc e. Muste ring We llne ss initia tive The PIR o rg a nisa tio n in the Fa r No rth Que e nsla nd re g io n ha s a lso p a rtne re d with the Gulf Ca ttle ma n s Asso c ia tio n to he lp re d uc e the stig ma o f me nta l illne ss a mo ng no rth Que e nsla nd s c a ttle fa rme rs. The Muste ring We llne ss initia tive p ro mo te s re silie nc e a nd ho p e fo r fa rme rs e xp e rie nc ing d ro ug ht in no rth Que e nsla nd a nd the Gulf. PIR is wo rking with the Asso c ia tio n to o p e n a d ia lo g ue a b o ut me nta l illne ss, suic id e a nd stig ma a nd d e ve lo p ne w c o nte nt a b o ut the se issue s fo r 9 the No rthe rn Gulf Re so urc e Ma na g e me nt we b site. It is ho p e d tha t the Muste ring We llne ss initia tive will a lso b e ta ke n up rig ht a c ro ss the to p e nd, with c a ttle me n s a sso c ia tio ns in the No rthe rn Te rrito ry a nd We ste rn Austra lia a lso inte re ste d in the c o nc e p t. Foc us groups with marginalise d populations PIR fo c use s o n e ng a g e me nt stra te g ie s fo r re a c hing p e o p le with hig h a nd c o mp le x sup p o rt ne e d s. Ma rg ina lise d g ro up s in Austra lia ha ve a d d itio na l le ve ls o f c o mp le xity whic h, a t time s, c re a te s furthe r b a rrie rs fo r a c c e ss to se rvic e s. Ma rg ina lise d g ro up s inc lud e Ind ig e no us Austra lia ns, the c ultura lly a nd ling uistic a lly d ive rse (CALD), a nd tho se tha t id e ntify a s b e ing le sb ia n, g a y, b ise xua l, tra nsg e nd e r, inte rse x o r q ue e r (LGBTIQ). The se fo c us g ro up s p ro vid e a n o p p o rtunity fo r se rvic e p ro vid e rs a nd p e o p le with a live d e xp e rie nc e, the ir c a re rs a nd fa milie s to d isc uss the syste m b a rrie rs tha t re la te to their community. As the needs of specific p o p ula tio ns ma y d iffe r fro m e a c h o the r a nd fro m the b ro a d e r p o p ula tio n, the fo c us g ro up s e na b le ta rg e te d ne e d s to b e identified and an action plan created. Go ve rnme nt re p re se nta tive s a nd c o mmunity o rg a nisa tio ns ha ve b e e n invite d to a tte nd fo c us g ro up s: this ha s he lp e d e d uc a te p o lic yma ke rs a nd c o mmunity decision-makers about the specific service ne e d s o f ma rg ina lise d g ro up s. PIR re c o g nise s the uniq ue ne e d s o f Australia s first people. Aboriginal Elders in a numb e r o f PIR re g io ns ha ve b e e n invite d to c o ntrib ute to fo c us g ro up s o n the me nta l he a lth ne e d s o f Ind ig e no us Austra lia ns. This ha s c re a te d a fe e ling a mo ng Ind ig e no us Austra lia n c o mmunitie s o f b e ing he a rd a nd und e rsto o d, inste a d o f b e ing lump e d to g e the r with o the r mino rity g ro up s. By inc o rp o ra ting the wisd o m o f Ab o rig ina l Eld e rs to info rm re c o ve ry p ra c tic e, PIR is d e ve lo p ing c ultura lly sa fe a nd a p p ro p ria te se rvic e s a nd is sta rting to re a c h Ind ig e no us Austra lia ns tha t ha d fa lle n thro ug h the g a p s.

14 An e xa mp le is the Lo o king Fo rwa rd p ro je c t in We ste rn Austra lia. The g o a l o f the p ro je c t is to d e ve lo p a c ultura lly sa fe me nta l he a lth framework that will benefit the c o mmunity a nd p ro vid e a b e nc hma rk fo r se rvic e s to fo llo w. The Lo o king Fo rwa rd p ro je c t ha s sta rte d linking se rvic e p ro vid e rs with Ab o rig ina l Eld e rs in o rd e r to d e ve lo p a c ultura lly sa fe me nta l he a lth fra me wo rk fo r Ind ig e no us Austra lia ns. As a re sult o f this initia tive, re fe rra ls o f Ind ig e no us Austra lia ns to PIR in the Be ntle y-arma d a le re g io n ha ve inc re a se d significantly. I have been treated with respect and honesty. - PIR Participant Ne two rking a nd kno wle d g e e xc ha ng e a re c o re p rinc ip le s o f PIR a nd ha ve b e e n instrume nta l in the fo rma tio n o f inte r- o rg a nisa tio na l a llia nc e s a nd the d e live ry o f c o lle c tive imp a c t stra te g ie s. 10

15 The PIR c apac ity building proje c t The PIR c a p a c ity b uild ing p ro je c t ha s b e e n the fo rma l me c ha nism thro ug h whic h sta te a nd na tio na l ne two rking o p p o rtunitie s ha ve b e e n fa c ilita te d. The c a p a c ity b uild ing p ro je c t p ro mo te s kno wle d g e e xc ha ng e b e twe e n PIR o rg a nisa tio ns thro ug h the fo llo wing me a ns: PIR c a p a c ity b uild ing p o rta l Pro vid e s PIR o rg a nisa tio ns with a c e ntra l p o int o f a c c e ss to the to o ls a nd re so urc e s tha t ha ve b e e n d e ve lo p e d to imp le me nt a nd e va lua te PIR. The p o rta l c o nta ins o nline fo rums whic h p ro vid e a sha re -p o int fo r PIR me mb e rs to b lo g a b o ut ne ws a nd e xp e rie nc e s, sha re b e st p ra c tic e a p p ro a c he s to PIR, a nd a sk q ue stio ns o f the wid e r PIR ne two rk. Na tio na l me e ting He ld o nc e a ye a r to a llo w PIR o rg a nisa tio ns to re vie w the b ig p ic ture o f PIR, b uild ne two rks, a nd c o lle c tive ly a d d re ss c ha lle ng e s a nd o p p o rtunitie s o f na tio na l re le va nc e. Sta te wo rksho p s He ld twic e a ye a r fo r e a c h sta te / te rrito ry to a llo w PIR sta ff to fo c us o n ma tte rs o f re g io na l imp o rta nc e a nd re info rc e sta te -b a se d re la tio nship s. Me e ting s within e a c h sta te He ld o n a re g ula r b a sis to a llo w PIR ma na g e rs the o p p o rtunity to le a rn fro m the a c tivitie s o f ne ig hb o uring PIR re g io ns a nd c o lla b o ra te o n sta te - wid e syste m c ha ng e initia tive s. Online tra ining mo d ule s The se a re inte nd e d to e q uip PIR sta ff with b a sic kno wle d g e in ke y a re a s o f se rvic e c o o rd ina tio n. To p ic s c o ve re d to d a te inc lud e re c o ve ry p rinc ip le s, ne e d s a sse ssme nt, a c tio n p la nning, sup p o rt fa c ilita tio n, p a rtne rship s, e lig ib ility c rite ria a nd syste ms re fo rm. We b ina rs Pro vid e a n o p p o rtunity fo r PIR sta ff fro m a ll o ve r Austra lia to me e t in a virtua l e nviro nme nt a nd d isc uss the me s o f ke y imp o rta nc e to PIR. To p ic s to d a te ha ve inc lud e d sup p o rt fa c ilita tio n, flexible funding, assertive o utre a c h, syste ms re fo rm a nd wo rking with ma rg ina lise d g ro up s. Sup p o rt Fa c ilita to r te le c o nfe re nc e s He ld mo nthly fo r a ll Sup p o rt Fa c ilita to rs to sha re e xp e rie nc e s, e sta b lish ne w c o nta c ts a nd a sk q ue stio ns o f e a c h o the r a nd the c a p a c ity b uild ing p ro je c t. Ema il up d a te s Circ ula te d we e kly to ke e p PIR sta ff a b re a st o f up c o ming e ve nts, tre nd s a nd o utc o me s within the na tio na l PIR c o mmunity. 11

16 The re a re ma ny e xa mp le s o f ho w ne two rking within PIR ha s inc re a se d the c a p a c ity o f the se rvic e se c to r a nd he lp e d id e ntify ke y a re a s fo r re fo rm, so me o f whic h a re o utline d b e lo w: Re c o ve ry e ve nt fo r Sto le n Ge ne ra tio ns On Na tio na l So rry Da y o n 26 Ma y 2015, the PIR te a m in the Syd ne y No rth Sho re a nd Be a c he s re g io n p a rtne re d with the lo c a l First Austra lia n c o mmunity to c o -ho st a n e ve nt o n tra uma re c o ve ry fo r me mb e rs o f the Sto le n Ge ne ra tio ns. The e ve nt he lp e d to inc re a se c o mmunity und e rsta nd ing a b o ut the inte rg e ne ra tio na l tra uma c a use d b y p a st re mo va l p o lic ie s. The e ve nt a lso he lp e d to e d uc a te se rvic e p ro vid e rs a nd p o lic y-ma ke rs a b o ut the c o mp le x so c ia l a nd e mo tio na l re c o ve ry ne e d s o f Austra lia s First p e o p le s. Imp o rta ntly, the e ve nt d e mo nstra te d ho w First Austra lia n p hilo so p hie s o f we llne ss c o uld info rm ma instre a m se rvic e s. Co mmunity Se rvic e s Ne two rk o n Ka ng a ro o Isla nd (So uth Austra lia ) The PIR o rg a nisa tio n in the So uthe rn Ad e la id e Fle urie u Ka ng a ro o Isla nd re g io n ha s he lp e d fo rma lise a ne two rk o f c o mmunity se rvic e p ro vid e rs in the re mo te re g io n o f Ka ng a ro o Isla nd (KI). As a re sult o f this initia tive, the ne two rk ha s g ro wn to 30 me mb e rs a nd ne wly re c ruite d sta ff a re mo re q uic kly ind uc te d into the se rvic e syste m witho ut le ng thy tra nsitio n p e rio d s. The ne two rk ha s a lso a llo we d kno wle d g e to b e transferred more efficiently b e twe e n se rvic e p ro vid e rs o n KI a nd the ma inla nd, which has significantly imp ro ve d the le ve l o f c a re re c e ive d b y PIR p a rtic ip a nts. Co mmunity Se rvic e s Ne two rk in Fa r No rth Que e nsla nd The PIR o rg a nisa tio n in the Fa r No rth Que e nsla nd re g io n ha s e sta b lishe d a Co mmunity Se rvic e s Ne two rk to imp ro ve c o lla b o ra tio n b e twe e n c linic a l a nd c o mmunityb a se d se rvic e s. This ha s c o ntrib ute d to c o nsid e ra b le syste m imp ro ve me nts in the Fa r No rth Que e nsla nd re g io n, inc lud ing a p e rc e ive d inc re a se in the q ua lity o f lo c a l se rvic e s o ffe re d to PIR p a rtic ip a nts a nd c a re rs. Be ntle y-arma d a le ne two rking e ve nt The PIR o rg a nisa tio n in the Be ntle y-arma d a le re g io n o f We ste rn Austra lia ro utine ly c re a te s o p p o rtunitie s fo r se rvic e p ro vid e rs a nd c o mmunity g ro up s to ne two rk with p ub lic me nta l he a lth p ro vid e rs. The p urp o se o f the se e ve nts is to imp ro ve wo rking re la tio nship s b e twe e n se rvic e s a nd c re a te mo re c o nne c te d se rvic e p a thwa ys fo r PIR p a rtic ip a nts a nd c a re rs. 12 No rthe rn Te rrito ry ne two rking e ve nt The PIR o rg a nisa tio n in the No rthe rn Te rrito ry ha s twic e fa c ilita te d a two - d a y wo rksho p fo r p a rtne r a g e nc ie s a nd me mb e rs o f the se rvic e se c to r to d isc uss the d ive rsity o f se rvic e ne e d s a c ro ss the Te rrito ry. Gue st sp e a ke rs p re se nte d o n to p ic s suc h a s p a rtne rship s, c ro ss c ultura l a wa re ne ss, inte rg e ne ra tio na l tra uma a nd c o lle c tive imp a c t whic h ha s le d to imp ro ve d und e rsta nd ing o f c urre nt sup p o rts a nd g a p s a nd g e ne ra te d the ne two rks ne c e ssa ry to initia te a p p ro p ria te syste ms re fo rm. Rura l a nd Re mo te Dinne r, Alb ury NSW The PIR c a p a c ity b uild ing p ro je c t sp o nso re d a d inne r in re g io na l NSW, p ro vid ing a ne two rking o p p o rtunity fo r nine rura l a nd re mo te PIR o rg a nisa tio ns. While a sc a rc ity o f se rvic e s in re g io na l Austra lia p o se s a c ha lle ng e, PIR o rg a nisa tio ns a re fo c using o n b uild ing c o mmunity c a p a c ity to a d d re ss the issue s o f p e o p le with me nta l illne ss living o utsid e c a p ita l c itie s. This ma y inc lud e p ro vid ing a n a lte rna tive sup p o rt struc ture fo r p a rtic ip a nts b y ta p p ing into na tura l sup p o rts suc h a s fa mily, frie nd s, c ultura l a nd c o mmunity g ro up s in the a b se nc e o f fo rma l struc ture s, a nd p ro mo ting the c o nc e p t o f re c o ve ry to lo c a l he a lth se rvic e s a nd c o mmunity me mb e rs. The imp o rta nc e o f b uild ing c o lla b o ra tive, wo rking re la tio nship s with

17 Ab o rig ina l Eld e rs in o rd e r to d e live r c ultura lly sa fe a nd a p p ro p ria te se rvic e s wa s ra ise d. The p o te ntia l o f te c hno lo g y, suc h a vid e o c o nfe re nc ing, to c o mp le me nt fa c e to fa c e me e ting s to re a c h p a rtic ip a nts in re mo te a re a s wa s a lso hig hlig hte d. Ongoing c onsultation with PIR partic ipants, c are rs and the ir familie s Inc re a sing the invo lve me nt o f p a rtic ip a nts a nd c a re rs in g o ve rna nc e Pa rtne rs in Re c o ve ry o rg a nisa tio ns ha ve e nsure d tha t p e o p le with a live d e xp e rie nc e a nd c a re rs sit o n the Go ve rna nc e Pa ne l in e a c h re g io n. Und e r the Na tio na l Me nta l He a lth Sta nd a rd s, the imp o rta nc e o f p a rtic ip a nt a nd c a re r invo lve me nt in d e ve lo p me nt, p la nning, d e live ry a nd e va lua tio n o f se rvic e s is re c o g nise d [Sta nd a rd 3: Co nsume r a nd Ca re r Pa rtic ip a tio n]. The inc lusio n o f p a rtic ip a nts a nd c a re rs ha s e nric he d the d e live ry o f the PIR initia tive a nd ha s e nsure d tha t p a rtic ip a nt a nd c a re rs ne e d s, ho p e s a nd a sp ira tio ns a re re p re se nte d a t e ve ry le ve l, a nd thro ug ho ut e ve ry sta g e o f se rvic e d e live ry. Vo ic e o f p a rtic ip a nts a nd fa mily me mb e rs invo lve d in p la nning a nd imp le me nta tio n Pa rtne rs in Re c o ve ry a c kno wle d g e s the sub sta ntia l c o ntrib utio n tha t fa milie s, c a re rs a nd significant others make in sup p o rting a p e rso n with me nta l illne ss o n the ir re c o ve ry jo urne y a nd p ro mo te s a nd sup p o rts the ir invo lve me nt. Pa rtic ip a nts a nd c a re rs ha ve b e e n invo lve d in e a c h ste p o f the p ro c e ss o f p la nning a nd imp le me nting PIR in the ir re g io ns. This ha s inc lud e d p a rtic ip a tio n in c re a tio n o f PIR resources such as flyers, b ro c hure s, we b site lo g o s, we b site info rma tio n a nd in ne two rking me e ting s. This invo lve me nt mo ve s p a st the superficial to a meaningful c o ntrib utio n a nd imme rsio n in the d e ve lo p me nt, p la nning, d e live ry a nd e va lua tio n. This invo lve me nt sup p o rts the d e sire o f p a rtic ip a nts a nd c o nsume rs to e nsure info rma tio n is re a d ily und e rsto o d a nd re c o ve ry g o a ls a re a c hie va b le. A c o nsume r a d viso ry g ro up in Ce ntra l No rth We st Queensland identified as a g a p the a va ila b ility o f use r frie nd ly info rma tio n a b o ut se rvic e s in the Mo unt Isa Re g io n. The c o nsume r a d viso ry g ro up, in c o njunc tio n with Ce ntra l a nd No rth We st Que e nsla nd PIR a nd Ce nta c a re No rth Que e nsla nd a re wo rking to d e ve lo p the Mo unt Isa Co mmunity & 13 He a lth Se rvic e s Bo o kle t. The b o o kle t a ims to he lp p a rtic ip a nts b e tte r und e rsta nd ho w to na vig a te a nd a c c e ss se rvic e s.

18 Pa rtic ip a nt a nd c a re r invo lve me nt in nurse e d uc a tio n se ssio ns within a me nta l he a lth unit in the Fa r No rth Que e nsla nd PIR re g io n e na b le d p a rtic ip a nts a nd c a re rs to sha re sug g e stio ns o n ho w to wo rk c o lla b o ra tive ly to imp ro ve se rvic e s. The se ssio ns he lp e d me nta l he a lth c linic a l nurse s to se e se rvic e p ro visio n fro m the p e rsp e c tive o f p a rtic ip a nts a nd c a re rs. The a c c o unts fro m a p a rtic ip a nt a nd c a re r p e rsp e c tive e na b le d nurse s to se e p a rtic ip a nts in a ho listic ma nne r, ra the r tha n just a numb e r in the syste m a nd he lp e d the m re c o g nise the imp a c t o f a lo ve d o ne s me nta l illne ss o n c a re rs. This kind o f invo lve me nt he lp s in the p ro mo tio n o f p o sitive ima g e s o f p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd e na b le s uniq ue a nd va lua b le kno wle d g e insig hts to b e inc o rp o ra te d in stra te g ie s to imp ro ve me nta l he a lth se rvic e s a nd re la te d c o mmunity sup p o rts. Thro ug h PIR, p a rtic ip a nts a nd c a re rs ha ve b e e n sup p o rte d to a tte nd tra ining, e na b ling a c c e ss to up skilling o p p o rtunitie s fo r p e o p le tha t ma y o the rwise no t ha ve ha d the o p p o rtunity to a tte nd. Imp ro ving the kno wle d g e b a se o f c a re rs ha s re sulte d in c a re rs re p o rting the y fe e l b e tte r e q uip p e d to re sp o nd to the ne e d s o f the ir lo ve d o ne, a nd the y fe lt mo re info rme d o n a va ila b le se rvic e s a nd ho w to a c c e ss the se. Ce ntra l Ad e la id e a nd Hills PIR o rg a nisa tio n fa c ilita te d a se rie s o f wo rksho p s und e rta ke n b y the Austra lia n Bo rd e rline Pe rso na lity Diso rd e r Fo und a tio n. The se wo rksho p s p ro vid e d re so urc e s, d isc ussio ns a nd stra te g ie s to p a rtic ip a nts, c a re rs, PIR Sup p o rt Fa c ilita to rs a nd sta ff fro m Ho using, Disa b ility a nd Me nta l He a lth se rvic e s. Mo re le a rning o p p o rtunitie s a re p la nne d fo r la te r in the ye a r. Invo lving c a re rs a nd fa mily me mb e rs in re c o ve ry p la ns The Ne w Eng la nd PIR o rg a nisa tio n ha s d e ve lo p e d Re c o ve ry Inte g ra tio n Pla ns to sha re g o a ls a nd he lp e va lua te p ro g re ss. The invo lve me nt o f fa mily me mb e rs, d e ve lo p ing trust a nd ma inta ining ho p e a re c e ntra l fe a ture s o f the p la ns. Co- loc ation of PIR Support Fac ilitators at frontline se rvic e s As Pa rtne rs in Re c o ve ry ha s c o ntinue d to g a in mo me ntum, ma ny PIR o rg a nisa tio ns ha ve lo o ke d a t c re a tive a nd inno va tive wa ys o f fa c ilita ting wra p a ro und se rvic e s fo r PIR Pa rtic ip a nts. PIR Sup p o rt Fa c ilita to rs a nd sta ff ha ve re p o rte d tha t c o -lo c a tio n is fo rg ing stro ng wo rking p a rtne rship s a c ro ss se c to rs a nd is imp ro ving the re fe rra l p ro c e ss fo r PIR p a rtic ip a nts. Co -lo c a tio n is a stra te g y tha t a ssists with a numb e r o f c ha lle ng e s a sso c ia te d with e xte rna l se rvic e c o lla b o ra tio n. PIR s ha ve fo und tha t c o -lo c a tio n c o ntrib ute s to mo re e ffe c tive wo rking re la tio nship s with p a rtne r o rg a nisa tio ns a nd ke y sta ke ho ld e rs. Fo r e xa mp le in the No rthe rn Te rrito ry PIR, the c o -lo c a tio n o f PIR Sup p o rt Fa c ilita to rs o ne d a y p e r we e k in a p syc hia tric inp a tie nt unit ha s imp ro ve d d isc ha rg e p la nning p ro c e sse s. PIR o rg a nisa tio ns ha ve a lso re p o rte d tha t c o -lo c a tio n is inc re a sing the c ultura l c o mp e te nc e o f PIR sta ff who wo rk with Ind ig e no us a nd CALD p o p ula tio ns, a nd is he lp ing ra ise a wa re ne ss o f PIR in the c o mmunity. Co -lo c a tio n ha s a lso e na b le d PIR sta ff to mo d e l a c o lla b o ra tive a p p ro a c h to se rvic e p ro visio n a nd ha s he lp e d e nc o ura g e d c o llo c a te d o rg a nisa tio ns to use re c o ve ry o rie nte d p ra c tic e. Exa mp le s o f c o -lo c a tio n fro m PIR o rg a nisa tio ns Housing issues are identified as one of the to p 5 unme t ne e d s fo r PIR p a rtic ip a nts. We ste rn Syd ne y PIR ha s p la c e d sta ff in the offices of Housing NSW in three regions to he lp e na b le a stre a mline d p ro c e ss o f inte g ra tio n b e twe e n the two a g e nc ie s. Te a me d with Ce ntre link a nd ho me le ssne ss p ro vid e rs, PIR ha s c re a te d a hub o f essential services on set days in each office. This c o -lo c a tio n a lso e na b le s o rg a nisa tio ns to id e ntify c ha lle ng e s a nd wo rk to g e the r to b e tte r und e rsta nd ho w the o p e ra tio na l p o lic ie s a nd p ra c tic e s o f e a c h o rg a nisa tio n imp a c t o n o utc o me s fo r se rvic e use rs. 14

19 Po sitive o utc o me s inc lud e inc re a se d re fe rra ls to PIR, o p p o rtunitie s to ra ise a wa re ne ss o f re c o ve ry o rie nte d p ra c tic e a nd b e tte r ho using o utc o me s fo r PIR p a rtic ip a nts. The se ha ve b e e n a c hie ve d thro ug h PIR sta ff ha ving g re a te r und e rsta nd ing o f wha t Ho using NSW re q uire s fo r a p p lic a tio ns, e na b ling b e tte r sup p o rt to c o mp le te fo rms a nd na vig a te the a p p lic a tio n p ro c e ss. Ad d itio na lly, sup p o rting PIR p a rtic ip a nts thro ug h te na nc y ma na g e me nt ha s inc re a se d the like liho o d the y will susta in the ir te na nc ie s. Ce ntra l Ad e la id e a nd Hills (CAH) PIR o rg a nisa tio n ha s c o -lo c a te d Sup p o rt Fa c ilita to rs a t we lfa re, a c c o mmo d a tio n a nd he a lth a g e nc ie s; lo c a tio ns whe re p e o p le with me nta l illne ss a re re g ula rly p re se nt, b ut who se me nta l he a lth ne e d s a re no t a sse sse d o r me t. This ha s e na b le d the intro d uc tio n o f a wra p -a ro und se rvic e mo d e l a nd ha s he lp e d to p re ve nt o utc o me s suc h a s imp riso nme nt o r ho me le ssne ss. The CAH PIR o rg a nisa tio n a lso wo rks with sta ff a nd p a rtic ip a nts a t lo c a tio ns suc h a s the Hutt Stre e t Ce ntre, with a ra ng e o f d o me stic vio le nc e se rvic e s a nd va rio us o the r so c ia l a nd he a lth se rvic e s. Simila r stra te g ie s a re a lso utilise d in Vic to ria a nd Ta sma nia a nd a ra ng e o f o the r PIR re g io ns in o rd e r to b e tte r e ng a g e in inte ra g e nc y c o lla b o ra tio n. The No rthe rn Te rrito ry PIR o rg a nisa tio n ha s c o -lo c a te d with c o mmunity o rg a nisa tio ns a nd g o ve rnme nt a g e nc ie s in re mo te a re a s suc h a s the Ba rkly Re g io n a nd Te nna nt Cre e k. Se rvic e s in the se re g io ns o fte n ha ve to tra ve l va st d ista nc e s to visit re mo te c o mmunitie s. Sup p o rt Fa c ilita to rs ha ve c o o rd ina te d visits to re mo te to wnship s a nd c a r p o o le d with sta ff fro m o the r se rvic e s, p ro vid ing o p p o rtunitie s to sha re ho w PIR c a n a ssist a nd to le a rn wha t e a c h se rvic e c a n o ffe r in te rms o f wra p a ro und c a re to c o mmunitie s with limite d se rvic e o p tio ns. Ano the r a d va nta g e o f this a p p ro a c h ha s b e e n imp ro ve d c o mmunic a tio n with c o mmunitie s: this mo d e l ha s se e n c o mmunitie s kno w who is c o ming a nd whe n. Eld e rs a re a lso invo lve d, a nd ha ve a ssiste d in c o o rd ina ting PIR p a rtic ip a nts to b e a va ila b le whe n visits o c c ur. Onc e in a 15 c o mmunity, PIR a nd se rvic e p ro vid e rs sha re an office and may conduct joint home visits. Asse rtive outre ac h mode ls The Fo urth Na tio na l Me nta l He a lth Pla n (The Plan) has identified as a p rio rity the d e ve lo p me nt o f a n inte g ra te d a p p ro a c h b e twe e n se c to rs to fa c ilita te a c c e ss to se rvic e s. The Pla n no te s tha t inte rve ning to a d d re ss ne e d s ma y re q uire assertive and flexible models of care, a nd e ng a g ing the p e rso n a t a time a nd lo c a tio n tha t b e st me e ts the ir ne e d s, a nd in a wa y tha t sup p o rts c o ntinuity thro ug h ke y tra nsitio n p e rio d s. 1 One wa y to a c hie ve this a im is thro ug h the use o f a sse rtive o utre a c h. Asse rtive outreach focuses on outreach and flexibility; tha t is, thinking a nd d o ing thing s d iffe re ntly. Assertive outreach has been identified as a uniq ue a p p ro a c h to me e t se rvic e -use r ne e d s, whic h c a nno t b e re p lic a te d o r suc c e ssfully d e live re d thro ug h o the r mo d e ls or a rigid set of predefined outcomes. Asse rtive o utre a c h ha s b e e n p re d o mina te ly d e live re d via te a ms c o mp rising o f va rio us c linic a l a nd no n-c linic a l sta ff. PIR ha s hig hlig hte d the a b se nc e o f a le a d e r in c o o rd ina ting c a re a nd sup p o rt. PIR ha s suc c e ssfully b rid g e d this d ivid e, a nd ha s c re a te d c a p a c ity in se rvic e s to think a nd d o thing s d iffe re ntly. The PIR a p p ro a c h is to b uild a te a m a ro und the p e rso n whe re the te a m is no t a c o lle c tio n o f sta ff fro m o ne se rvic e, b ut ra the r sta ff fro m multip le se rvic e s tha t will he lp to me e t the ne e d s o f the p a rtic ip a nt, with the PIR Sup p o rt Fa c ilita to r a c ting a s the le a d e r o f the te a m. A ke y e le me nt o f Pa rtne rs in Re c o ve ry is its capacity to invest the time and flexibility to e ng a g e with p e o p le with a live d e xp e rie nc e o f me nta l illne ss, to und e rsta nd the ir ne e d s a nd ho p e s, a nd to inve st in g e tting the rig ht se rvic e s a t the rig ht time. 1 Co mmo nwe a lth o f Austra lia (2009): Fo urth Na tio na l Me nta l He a lth Pla n: An a g e nd a fo r c o lla b - o ra tive g o ve rnme nt a c tio n in me nta l he a lth , p a g e 29.

20 PIR has identified three crucial factors for suc c e ssful a sse rtive o utre a c h: 1. Find the p e o p le who ne e d a nd wa nt sup p o rt in the ir re c o ve ry Utilising e xisting ne two rks is the mo st effective way of finding people who ma y b e in ne e d o f PIR sup p o rt. Co unc il services, public space liaison officers and ho me le ssne ss p ro g ra ms a re ric h so urc e s o f info rma tio n a b o ut whe re p o te ntia l p a rtic ip a nts mig ht b e fo und. 2. Build the trust o f p o te ntia l p a rtic ip a nts Build ing trust a nd c re d ib ility in the ir e ye s o f p o te ntia l p a rtic ip a nts is p a ra mo unt to a suc c e ssful o utre a c h re la tio nship. Ra p p o rt c a n b e b uilt b y: Tre a ting the p e rso n a nd the ir ho me with re sp e c t: he o r she ma y b e sle e p ing ro ug h, b ut it is imp o rta nt to b e ha ve like a g ue st a nd a sk p e rmissio n to e nte r the p e rso n s sp a c e ; Ha ving p e rso n-c e ntre d c o nve rsa tio ns a b o ut wha t is imp o rta nt a nd wo rk with the ir va lue s a nd p rio ritie s, no t yo ur o wn; Ac hie ving q uic k wins b y a d d re ssing imme d ia te, sho rt-te rm ne e d s suc h a s fo o d, inc o me, o r re c o nne c ting with fa mily a s a p re c urso r to id e ntifying me d ium a nd lo ng e r-te rm ne e d s; Ma king sure ne e d s c a n b e me t: d o n t p ro mise thing s yo u c a n t d e live r; a nd Giving the p e rso n the c ho ic e o f whe n to b e invo lve d : simp ly p la n to re visit a g a in in the future (yo u d o n t ha ve to win someone over on the first try). I feel hope and validation. - PIR Participant 16

21 3. Cre a te a ne two rk o f sup p o rt Ce ntra l to susta ina b le we llb e ing is a we b o f sup p o rt g iving p a rtic ip a nts mo re tha n o ne p e rso n o r se rvic e to turn to in time s o f distress. The first step is establishing if the p a rtic ip a nt ha s a ny p re -e xisting sup p o rts tha t c a n p ro vid e the fo und a tio n fo r a la rg e r sup p o rt ne two rk. The se sup p o rts ma y inc lud e se rvic e wo rke rs p a st a nd p re se nt, fa mily, frie nd s o r a sso c ia te s. The se c o nd ste p is to e ng a g e the se sup p o rt p e o p le in the p a rtic ip a nt s re c o ve ry jo urne y, so tha t the y ha ve a c o mmunity to o ffe r se c urity a nd a ssista nc e. Whe re no sup p o rts e xist, ne w o ne s will ne e d to b e fo rg e d. In a d d itio n, PIR o rg a nisa tio ns ha ve und e rta ke n a sse rtive a d vo c a c y o n b e ha lf o f c lie nts a nd se rvic e s, p a rtic ula rly in ne g o tia ting b o und a ry/ e lig ib ility issue s. PIR Sup p o rt Fa c ilita to rs a re b ra ve, c re a tive, re lish c ha lle ng e s a nd ha ve e ne rg y a nd c urio sity. 1 The y me e t p e o p le whe re the y a re a nd g o o ut a nd g e ne ra te wo rk PIR is no t a p a ssive re c e ive r o f re fe rra ls, it is a d rive r. Fo r e xa mp le, the Ea ste rn Syd ne y PIR o rg a nisa tio n ha s d e ve lo p e d Wa y2ho me, a n a sse rtive o utre a c h p ro g ra m a s a me a ns to a d d re ss ho me le ssne ss. By se nd ing o ut o utre a c h wo rke rs to e ng a g e with ro ug h sle e p e rs a nd b ring ho using se rvic e s to the m, PIR ha ve re p o rte d inc re a se d suc c e ss in re a c hing vulne ra b le p e o p le, b uilt trust a nd b e tte r wra p a ro und c a re. Furthe r, b y se c uring p riva te re nta ls whe n no p ub lic ho using sto c k wa s a va ila b le, Wa y2ho me is a b le to p ro vid e imme d ia te ho using so lutio ns a nd a g re a te r va rie ty o f lo c a tio n a nd p ro p e rty typ e fo r p a rtic ip a nts. The ACT PIR o rg a nisa tio n ha s b e e n a tte nd ing Ca nb e rra Uniting Churc h s Ea rly Mo rning Ce ntre re g ula rly a nd is wo rking with a numb e r o f p e o p le, inc lud ing p a rtic ip a nts with a long history of significant mental ill he a lth a nd c hro nic ho me le ssne ss. This c o lla b o ra tio n ha s imp ro ve d linka g e s via a d ro p in style se rvic e to fa c ilita te a c c e ss to 1 Lo we, J; The Pro g re ss o f Asse rtive Outre a c h Services: Reflections and Examples. The Mental He a lth Re vie w, De c 2003; 8, 4, 31-33, p a g e me nta l he a lth a nd p hysic a l he a lth se rvic e s. This c o lla b o ra tio n ha s ta p p e d into a n unme t ne e d fo r p e o p le e xp e rie nc ing ho me le ssne ss a nd p ro vid e s a sa fe a nd sup p o rtive e nviro nme nt. This ha s b e e n e sta b lishe d thro ug h hig h q ua lity ra p p o rt c re a te d b y PIR a nd o the r wo rke r d e ve lo p e d o ve r time a nd ha s imp ro ve d trust in the me nta l he a lth syste m a nd imp ro ve d c o o rd ina tio n o f c a re b e twe e n the c linic a l a nd c o mmunity se c to rs. Pa rtic ip a nt fe e d b a c k hig hlig hts the significant role and impact PIR is having for p e o p le e xp e rie nc ing ho me le ssne ss: My Support Facilitator got to know what my needs could be and this was then acted upon...i am certain I would not be in the position I am now without her and not to mention the PIR team. She reconnected me with a community organisation and I am now residing at one of their residences. - PIR Participant Co o rd ina tio n b y a no n-c linic a l se rvic e The PIR initia tive ha s d e mo nstra te d tha t ind ivid ua ls living with me nta l illne ss c a n b e e ffe c tive ly sup p o rte d in the c o mmunity witho ut ne c e ssa rily ha ving this ro le p e rfo rme d b y a c linic a l sta ff me mb e r. This ha s b e e n sho wn to e a se the p re ssure o n p ub lic me nta l he a lth se rvic e s a nd ha s a lso sho wn tha t the e xp e rtise o f c o mmunity b a se d o rg a nisa tio ns a d d s a ne w d ime nsio n to the c a re c o o rd ina tio n o f the ind ivid ua l. Co mmunity b a se d Sup p o rt Fa c ilita to rs a re we ll ne two rke d in c o mmunity b a se d se rvic e s a c ro ss a ra ng e o f se c to rs, whic h me a ns re fe rra ls a re ho listic in na ture, ra the r tha n fo c usse d o n c linic a l se rvic e s. This c o mp le me nts the c linic a l se rvic e s the p a rtic ip a nt is re c e iving a nd b uild s o n the stre ng ths o f this sup p o rt to a ssist the ind ivid ua l in the ir p e rso na l re c o ve ry.

22 Cre ative and innovative thinking Sinc e inc e p tio n o f the PIR initia tive, e a c h re g io n ha s d e ve lo p e d ta ilo re d, c re a tive a nd inno va tive wa ys to a c hie ve the g o a ls o f the initia tive a nd imp o rta ntly, to a ssist the fa c ilita tio n o f re c o ve ry g o a ls re q ue ste d b y p a rtic ip a nts a nd the ir c a re rs to c re a te lo ng e r te rm we llb e ing a nd re silie nc e. PIR o rg a nisa tio ns ta ke into a c c o unt the g e o g ra p hic a nd d e mo g ra p hic fa c to rs a nd se rvic e s a va ila b le in the ir re g io n, id e ntify g a p s a nd inc o rp o ra te s c o mmunity fe e d b a c k to d e ve lo p ing a mo d e l o f p ra c tic e to b e st me e t lo c a l ne e d, whilst a lso up ho ld ing the p urp o se a nd inte nt o f PIR. The syste ms re fo rm p ro je c ts a nd a c tivitie s d e ve lo p e d a nd sup p o rte d b y PIR va ry g re a tly b e twe e n re g io ns, ho we ve r the c o mmitme nt to re fo rm is c o nsiste nt. A numb e r o f fa c to rs ha ve re q uire d stra te g ic a nd c re a tive thinking a nd p la nning to d e ve lo p PIR within the re g io ns to d e live r sup p o rt fa c ilita tio n fo r p a rtic ip a nts a nd syste ms re fo rm suc h a s: Re mo te / rura l a re a s Lo w so c io -e c o no mic a re a s Limite d a va ila b ility o r a c c e ss to se rvic e s Re sista nc e to c ha ng e Culture / la ng ua g e Co mp le x ne e d s Limite d tra nsp o rta tio n Limite d und e rsta nd ing o f re c o ve ry Stig ma Clinic a lly fo c usse d se rvic e s a s p rima ry c a re This is no t a n e xha ustive list a nd e a c h re g io n has identified both commonalties and d iffe re nc e s in the c ha lle ng e s the y fa c e a nd inno va tive a nd c re a tive wa ys the se ha ve b e e n o ve rc o me. The na tio na l a nd sta te PIR wo rksho p s a ssist in the sha ring o f info rma tio n a nd the uniq ue wa ys the se c ha lle ng e s ha ve b e e n minimise d o r e limina te d in the c o nte xt o f o ng o ing syste m re fo rm. Ma ny o f the PIR sto rie s re p o rt p o sitive c ha ng e s within the live s o f ind ivid ua ls, c a re rs a nd within se rvic e s. Pa rtic ip a nts ha ve sta te d : The y [PIR] try to g e t me the b e st he lp a nd d o n t just fo b me o ff with wha t s e a sy o r o b vio us, a nd I ha ve le a rne d mo re a b o ut myse lf in the p a st 10 we e ks tha n in the p re vio us 59 ye a rs. The se c o mme nts a re ind ic a tive tha t PIR is g iving p a rtic ip a nts the o p p o rtunity to e mb a rk up o n a uniq ue re c o ve ry p a thwa y, wo rking in a wa y tha t is d iffe re nt to p re vio us initia tive s a nd is imp ro ving syste m c o lla b o ra tio n a nd re sp o nse. Fle xib le fund s a re a n imp o rta nt c o mp o ne nt of PIR. The flexible funding pool d iffe re ntia te s PIR fro m o the r ne two rking o r c o o rd ina tio n mo d e ls in tha t Sup p o rt Fa c ilita to rs a re a b le to p urc ha se se rvic e s a nd a p p ro p ria te sup p o rts to re d uc e b a rrie rs to re c o ve ry whe n p a rtic ip a nt ne e d s a re identified but cannot be met through no rma l c ha nne ls. This ha s e na b le d Sup p o rt Fa c ilita to rs to c re a tive ly a d d re ss ne e d s whic h ma y ha ve o the rwise b e e n re g a rd e d a s to o c ha lle ng ing o r b e yo nd the sc o p e the ir se rvic e s c a p a c ity. Sup p o rt Fa c ilita to rs have identified that it is often the little thing s tha t p ro ve d the turning p o int fo r p a rtic ip a nts, a nd tha t this wa s c o ntrib uting to a p o sitive c ulture o f re c o ve ry, in whic h p a rtic ip a nts a re sup p o rte d fo r p e rso na l suc c e ss. In the No rthe rn Te rrito ry, a Sup p o rt Fa c ilita to r ha s wo rke d with a n Ind ig e no us p a rtic ip a nt to id e ntify c ultura lly a p p ro p ria te re c o ve ry g o a ls, inc lud ing e mp lo yme nt a nd has used flexible funds to remove barriers to p a rtic ip a tio n. The p a rtic ip a nt s b ro the r wa s p a rt o f the p a rtic ip a nt s re c o ve ry jo urne y a nd ha s a lso re p o rte d tha t his me nta l he a lth ha s imp ro ve d. The p a rtic ip a nts mo the r ha s a lso re p o rte d a n imp ro ve me nt in he r q ua lity o f life d ue to he r so ns b e ing le ss re lia nt o n he r. PIR is great, I would recommend it to anyone. - PIR Participant 18

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24 Also in the No rthe rn Te rrito ry, me e ting sho rt term need has led to significant long term c ha ng e. A PIR p a rtic ip a nt ha d e xha uste d the fe w se rvic e s tha t we re a va ila b le in the No rthe rn Te rrito ry b e fo re he wa s a c c e p te d a s a PIR p a rtic ip a nt. Re fe rre d b y the Na tio na l Disa b ility Insura nc e Ag e nc y und e r a c o mmunity tre a tme nt o rd e r, the p a rtic ip a nt e xp re sse d a stro ng d e sire to wo rk o n a c a ttle sta tio n a s o ne o f his re c o ve ry g o a ls. The lo c a l Sup p o rt Fa c ilita to r a rra ng e d fo r him to me e t with a lo c a l sta tio n-o wne r to d isc uss a p o ssib le tra ine e ship. Imp re sse d b y his wo rth e thic a nd a b ility, the sta tio n-o wne r to o k him o n a s a tra ine e. Fle xib le fund s we re use d to p a y fo r wo rk c lo the s a nd a c c o mmo d a tio n fo r two we e ks. This o p p o rtunity le d to a tra ine e ship with a vie w to e mp lo yme nt, a t whic h time the p a rtic ip a nt will b e in a financial position to start managing his own e xp e nse s. The flexible funding pool enables PIR o rg a nisa tio ns to b uy-in se rvic e s tha t wo uld b e o the rwise una va ila b le a nd sup p o rts the c o mp o ne nt o f b uild ing syste m c a p a c ity for the benefit of PIR participants. Building syste m c a p a c ity re fe rs to the imp o rta nc e fo r PIR p a rtic ip a nts to a c c e ss o r c o ntinue with se rvic e s a va ila b le fro m a ra ng e o f e xisting se rvic e p ro vid e rs, ra the r tha n build a reliance on the flexible funding. An e xa mp le wo uld b e a ssisting a p a rtic ip a nt with the c o st o f me d ic a tio ns while a ny issue s re g a rd ing a c c e ss to a he a lth c a re c a rd o r Me d ic a re a re b e ing re so lve d. In d o ing so the p a rtic ip a nt ma inta ins the ir me d ic a tio n re q uire me nts, c o ntinue s links with me d ic a l p ro fe ssio na ls a nd is sup p o rte d to susta in the se links with the se rvic e p ro vid e rs o nc e the b a rrie r ha s b e e n re so lve d, witho ut the a ssista nc e o f o ng o ing flexible funding. The PIR c a p a c ity b uild ing p ro je c t we b site se rve s to sha re e xa mp le s o f the p o te ntia l of flexible funding to build sector capacity b y a d d re ssing ne e d s in ne w wa ys. Co untry No rth SA PIR c o ntrib ute d so me o f the ir regional flexible funding to the creation o f a Fa c e b o o k-typ e p ho ne a p p lic a tio n ( a p p ) to he lp PIR p a rtic ip a nts a nd the ir sup p o rt ne two rks sta y in to uc h. The a p p e na b le s p a rtic ip a nts to no mina te p e o p le to b e c o me a p a rt o f the ir o nline c o mmunity. The c o mmunity mig ht inc lud e c linic ia ns, fa mily me mb e rs, frie nd s a nd / o r PIR sta ff. Pa rtic ip a nts c a n the n sha re imp o rta nt mile sto ne s a nd g e ne ra l up d a te s o n he a lth a nd we llb e ing with tho se the y trust mo st. The a p p a lso re c o rd s ke y a p p o intme nts so tha t e ve ryo ne is o n the sa me p a g e a nd kno ws wha t is ha p p e ning a nd whe n. The a p p c a n b e re ta ine d b e yo nd invo lve me nt in PIR, so p a rtic ip a nts c a n susta in a c o mmunity o f sup p o rt, a nd fa milie s c a n b e ke p t in the lo o p re g a rd ing the he a lth a nd we llb e ing o f the ir lo ve d o ne. So me PIR o rg a nisa tio ns a re a llo c a ting p e e r wo rke rs to he lp wa itliste d p a rtic ip a nts sta rt the ir re c o ve ry jo urne y p rio r to b e ing a c c e p te d into PIR a s p a rt o f a n a c tive wa itlist p ro g ra m. This a lso he lp s to e nsure tha t c ha ng e s in ne e d a re re g ula rly a sse sse d a nd tha t tho se o n the wa itlist c a n b e mo nito re d in te rms o f ne e d ra the r tha n b e c o ming lo st in the syste m. I felt like a speck in the ocean. I felt like I was going in circles as I got no answers. I have turned around since PIR has come in. I m accessing an occupational therapist, speech therapist and a dietician, starting fishing again as well as going to church. I am about to start seeing a counsellor. I don t feel so isolated now. - PIR Participant 20

25 Se rvic e gap analysis Pa rtne rs in Re c o ve ry o rg a nisa tio ns und e rta ke d e ta ile d se rvic e ma p p ing a nd g a p a na lysis a c ro ss b o th me nta l he a lth a nd the b ro a d e r he a lth se rvic e syste ms in the ir re g io n. The p ro c e ss he lp s info rm he a lth a nd sup p o rt ne e d s fa c e d b y p e o p le with a mental illness and establishes a profile o f the p o te ntia l b a rrie rs, c a p a c itie s, a nd g a p s within the se rvic e d e live ry syste ms in the re g io n. Se rvic e ma p p ing he lp e d to identify specific regional strategies with the a im o f a c hie ving susta ina b le syste m imp ro ve me nts. Imp o rta ntly, PIR o rg a nisa tio ns b uilt o n p re vio us p o p ula tio n he a lth p la nning a nd ma p p ing d a ta to id e ntify p rio rity ta rg e t g ro up s, se rvic e s a nd stra te g ie s. The se ta rg e t g ro up s ma y va ry fo r e a c h re g io n a nd inc lud e (b ut a re no t limite d to ): Ab o rig ina l a nd To rre s Stra it Isla nd e r p e o p le ; Pe o p le who a re ho me le ss o r living in inse c ure a c c o mmo d a tio n; Ex-o ffe nd e rs; Ca re rs; Iso la te d fa rme rs; Re fug e e s; Pe o p le with c o -mo rb id issue s; a nd Une mp lo ye d p e o p le. PIR o rg a nisa tio ns wo rk a t the syste ms le ve l a nd a re the me c ha nism to d rive c o lla b o ra tio n b e twe e n re le va nt se c to rs, se rvic e s, a nd sup p o rts within the re g io n to e nsure the ra ng e o f ne e d s o f p e o p le in the ta rg e t g ro up a re me t. PIR ha s imp ro ve d : Ac c e ss to a p p ro p ria te he a lth a nd c o mmunity se rvic e s; Co mmunic a tio n a nd c o lla b o ra tio n b e twe e n se rvic e s; Suita b le sup p o rte d a c c o mmo d a tio n; Ed uc a tio n a nd und e rsta nd ing o f me nta l illne ss; Ac c e ss to GP s a nd GP visiting se rvic e s; Syste m/ se rvic e na vig a tio n; a nd kno wle d g e o f c o mmunity a nd he a lth se rvic e s. Stra te g ie s: Inte g ra tio n within a nd b e twe e n se rvic e s re g a rd ing c a p a c ity b uild ing a nd wo rkfo rc e d e ve lo p me nt ha s b e e n the fo c us o f ma ny PIR o rg a nisa tio ns. PIR ha s suc c e ssfully inte g ra te d se rvic e s to c o mp le me nt e a c h other, filled gaps, avoided duplication and sub se q ue ntly a d d re sse d p a rtic ip a nt ne e d s. The rig ht mix o f se rvic e s, inte r-a g e nc y c o lla b o ra tio n a nd p a rtne rship s ha s le d to c o o rd ina te d sup p o rt a nd stre a mline d re fe rra l p a thwa ys. PIR o rg a nisa tio ns a re utilising existing networks to influence c ha ng e a nd c re a ting ne w p a rtne rship s to b e tte r c o o rd ina te se rvic e s a nd id e ntify o p p o rtunitie s fo r imp ro ve d sup p o rt. Co o rd ina te d Sup p o rt: To c o lle c tive ly a d d re ss a p a rtic ip a nt s le g a l ma tte rs, The No rthe rn Te rrito ry PIR o rg a nisa tio n ha s c o o rd ina te d se rvic e s b e twe e n Missio n Austra lia, Ce ntra l Austra lia n Me nta l He a lth Se rvic e, Pa p unya Clinic, Ro ya l Flying Do c to r Se rvic e Re mo te Me nta l He a lth Te a m, Co mmunity Co rre c tio ns a nd Ab o rig ina l Le g a l Aid. The p a rtic ip a nt wa s fa c ing a p o ssib le c usto d ia l se nte nc e, b ut a s a re sult o f a d vo c a c y a nd c o o rd ina te d a ssista nc e, this wa s a vo id e d a nd inste a d the p a rtic ip a nts ne e d s we re a d d re sse d a nd sup p o rts p ut in p la c e to a d d re ss the issue s und e rlying the o ffe nc e. Ce ntra l Ad e la id e a nd Hills Pa rtne rs in Re c o ve ry o rg a nisa tio n suc c e ssfully c o o rd ina te d a jo int c o mmunity p la n whic h sa w a p ub lic ho sp ita l me d ic a l wa rd, sta te fund e d d isa b ility a nd me nta l he a lth se rvic e s a nd a n NGO tra nsitio n a p a rtic ip a nt o ut o f a me d ic a l wa rd into he r o wn a c c o mmo d a tio n (with a p p ro p ria te c o mmunity sup p o rts). The p a rtic ip a nt ha d e nd ure d o ve r 1000 d a ys in the me d ic a l wa rd, no t b e c a use she ne e d e d c a re b ut b e c a use the re wa s no whe re fo r he r to g o. 21

26 The PIR o rg a nisa tio n in Pe rth No rth Me tro, ha s c ha mp io ne d the My Ho me p ro g ra m to he lp lo ng te rm re sid e nts o f the Gra yla nd s Ho sp ita l. My Ho me ha s c re a te d the o p p o rtunity fo r six p a rtic ip a nts to mo ve into p riva te re nta l ho me s with g o o d a c c e ss to fa c ilitie s. The Sunshine Co a st PIR o rg a nisa tio n, Luthe ra n Co mmunity Ca re, Co a st2ba y Ho using a nd the Sunshine Co a st Ho sp ita l a nd He a lth Se rvic e ha ve se c ure d sho rt-sta y a c c o mmo d a tio n fo r up to e ig ht p e o p le a t risk o f ho me le ssne ss up o n d isc ha rg e fro m ho sp ita l. While sta ying in the te mp o ra ry a c c o mmo d a tio n fa c ility, re sid e nts ha ve a c c e ss to a PIR Sup p o rt Fa c ilita to r who he lp s the m c o nne c t with e mp lo yme nt sup p o rt, we lfa re se rvic e s, o ng o ing me nta l he a lth c a re a nd p e rma ne nt ho using, p utting in p la c e the fo und a tio ns o f the ir re c o ve ry jo urne y. It is ho p e d this p ro je c t will a lso imp ro ve syste m c a p a c ity b y fre e ing up b e d s fo r a c ute p a tie nts in urg e nt ne e d o f ho sp ita l se rvic e s. In So uth Austra lia, the So uthe rn Ad e la id e, Fle urie u a nd Ka ng a ro o Isla nd SAFKI PIR ha s p ro vid e d o p p o rtunitie s fo r iso la te d a nd visiting wo rke rs to c o lla b o ra te a nd sha re info rma tio n a b o ut the se rvic e s the y o ffe r, a nd the ra ng e o f se rvic e s a va ila b le in the re g io n. This c o lla b o ra tio n ha s e na b le d b e tte r c a re c o o rd ina tio n a nd linke d p e o p le to re so urc e s ne e d e d fo r the ir re c o ve ry jo urne y. Stre a mline d re fe rra l p a thwa ys Hunte r PIR is und e rta king a GP Pro je c t to inc re a se the invo lve me nt o f GPs. The a im is to imp ro ve the p ro visio n o f o ng o ing c a re fo r Hunte r PIR p a rtic ip a nts a nd ma ximise a c c e ss to p rima ry c a re se rvic e s in o rd e r to e nha nc e he a lth a nd we llb e ing. Hunte r PIR d o c ume nte d the ra ng e o f b a rrie rs, a t b o th a p ra c tic e a nd syste m le ve l, tha t d isc o ura g e GP s invo lve me nt, a nd up skille d p a rtic ip a ting GP s to imp ro ve the ir expertise and confidence in supporting p a tie nts with a live d e xp e rie nc e o f me nta l illne ss. Whilst this p ro je c t is in its infa nc y, the a im is to re d uc e d e ma nd fo r Eme rg e nc y De p a rtme nt p re se nta tio ns a nd re lie ve p re ssure o n o fte n stre tc he d me nta l he a lth 22 se rvic e s in the re g io n. The Be ntle y-arma d a le PIR o rg a nisa tio n is a me mb e r o f the Lo o king Fo rwa rd Pro je c t. Twe lve o rg a niza tio ns fro m the me nta l he a lth a nd d rug a nd a lc o ho l se rvic e se c to rs ha ve ma d e a c o mmitme nt to wo rk c o nstruc tive ly with a g ro up o f 15 Nyo o ng a r Eld e rs fo r the ne xt thre e ye a rs. Pa rtic ip a nts ha ve c o mmitte d to d e ve lo p ing c ultura lly sa fe wo rk p ra c tise s so a s to ma rke d ly imp ro ve se rvic e p ro visio n fo r Nyo o ng a r fa milie s living with me nta l he a lth a nd d rug a nd a lc o ho l issue s in the so uthe a st me tro p o lita n re g io n o f Pe rth. Furthe r id e a s to stre ng the n the PIR re sp o nse inc lud e wo rking with c o mmunity g ro up s to c re a te we e ke nd sup p o rt p ro g ra ms whe n re g ula r se rvic e s a re c lo se d ; e nlisting the sup p o rt o f Lio ns a nd Ro ta ry g ro up s to p ro vid e re c re a tio na l o utle ts fo r p a rtic ip a nts; e sta b lishing a Fa c e b o o k c o mmunity fo r Sup p o rt Fa c ilita to rs; a nd a c q uiring the se rvic e s o f a c o mmunity b us to he lp p a rtic ip a nts tra ve l to b ig g e r to wns to sho p o r c o nne c t with o the r se rvic e s. The Me tro No rth Brisb a ne PIR o rg a nisa tio n has pooled regional flexible funds to e sta b lish the No rth Brisb a ne Pa rtne rs in Re c o ve ry Inno va tio n Fund, to a d d re ss ke y re fo rm issue s in the Brisb a ne No rth a nd the Mo re to n Ba y re g io ns. Exte nsive c o nsulta tio ns we re und e rta ke n o ve r six mo nths to id e ntify the ke y syste m re fo rm issue s with the a im to e nsure tha t the me nta l he a lth syste m c a n b e tte r sup p o rt the re c o ve ry o f p e o p le with a me nta l illne ss. Pro je c ts fund e d thus fa r inc lud e a p ilo t p ro g ra m to ta c kle ho a rd ing a nd sq ua lo r; p ro g ra ms fo r e mp lo ye rs a nd e mp lo yme nt se rvic e s p ro vid e rs to imp ro ve re c ruitme nt a nd re te ntio n o f e mp lo ye e s living with a me nta l illne ss; p e e r sup p o rt p ro g ra ms; a nd Me nta l He a lth First Aid tra ining. Gold Coast PIR has used flexible funding to p ilo t the Vo ic e b o x Pro je c t a ime d a t he lp ing p e o p le with a live d e xp e rie nc e o f me nta l illne ss d e ve lo p skills in a d vo c a c y, p ub lic sp e a king a nd p e e r sup p o rt. Pa rtic ip a nts we re p a rt o f p ro je c t d e ve lo p me nt,

27 c o ntra c to r se le c tio n p ro c e ss a nd the ste e ring g ro up. The g o a l wa s to c o ntrib ute to a stro ng e r a nd mo re skille d c o nsume r/ p a rtic ip a nt-d rive n vo ic e to info rm a nd d rive imp ro ve me nts in a c c e ss to he a lth a nd c o mmunity se rvic e s. Thirty p e o p le p a rtic ip a te d in 18 wo rksho p s re sulting in the p ro d uc tio n o f 17 vid e o s a nd two sho wc a se s. Susta ina b ility ha s b e e n the ke y fa c to r in d e ve lo p ing p ro je c ts a nd und e rta king syste m c ha ng e. Fle xib le fund ing is uniq ue a nd ha s b e e n suc c e ssfully utilise d b y PIR o rg a nisa tio ns to a d d re ss syste m g a p s, fa c ilita te syste ms c ha ng e a nd sup p o rt c a p a c ity b uild ing. Pe rson- c e ntre d approac he s to we llbe ing The he a lth c a re syste m in Austra lia ha s typ ic a lly o p e ra te d und e r b lo c k fund ing, g ua ra nte e d o ve r a p e rio d o f time. Fund ing ha s typ ic a lly re q uire d the a p p lic a tio n o f stric t e lig ib ility c rite ria fo r se rvic e s. This ha s re sulte d in a mo d e l tha t p o te ntia lly ma ke s it difficult to take into account individual ne e d s a nd c irc umsta nc e s, p a rtic ula rly o f ma rg ina lise d g ro up s a nd ha s c o ntrib ute d to p e o p le fa lling thro ug h the g a p s. In c o ntra st, re c o ve ry-o rie nte d se rvic e s a re c e ntre d o n a nd a d a p t to p a rtic ip a nts a sp ira tio ns a nd ne e d s, ra the r tha n re q uiring the p a rtic ip a nt to a d a p t to the re q uire me nts a nd p rio ritie s o f the se rvic e. PIR ha s b e e n a n a ve nue fo r syste mic c ha ng e to wa rd s a p e rso n c e ntre d a p p ro a c h whic h lo o ks fo r wa ys to inc lud e c o nsume rs a nd p ro vid e a se rvic e. This a p p ro a c h e na b le s se rvic e s to b e tte r re sp o nd to ne e d b y ta ilo ring se rvic e s whic h e nsure s p e o p le re c e ive the sup p o rt the y d e sp e ra te ly ne e d. I feel like a person rather than someone with a mental illness. - PIR Participant 23

28 Part Two: How has PIR advanc e d re c ove ry prac tic e? PIR is different because it helped me to set goals, respect myself as a human being, I feel trust and I feel valued as a human being. Now I have hope. - PIR Participant The Na tio na l Sta nd a rd s fo r Me nta l He a lth Se rvic e s (2010) sta te : The p urp o se o f p rinc ip le s o f re c o ve ry o rie nta te d me nta l he a lth p ra c tic e is to e nsure tha t me nta l he a lth se rvic e s a re b e ing d e live re d in a wa y tha t sup p o rts the re c o ve ry o f me nta l he a lth c o nsume rs. Re c o ve ry p rinc ip le s re q uire a p hilo so p hy o r a se t o f va lue s tha t e nc a p sula te s ho p e a s a p rima ry fo c us a nd tha t re c o g nise s uniq ue ne ss, p ro vid e s re a l c ho ic e, e nsure s re sp e c t, a nd p ro mo te s a nd p ro te c ts the rig hts o f the ind ivid ua l. Re c o ve ry o rie nta te d p ra c tic e is a truly c o lla b o ra tive p ro c e ss with p e rso na l c ho ic e, d ig nity, p a rtne rship, c o mmunic a tio n a nd trust und e rp inning the re la tio nship. PIR use s re c ove ry orie ntate d language La ng ua g e p la ys a n imp o rta nt ro le a nd syste mic a lly a ssists in c ha ng ing the b e lie fs a nd a ssump tio ns o f se rvic e p ro vid e rs, p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd the ir c a re rs. Pa rtne rs in Re c o ve ry utilise s la ng ua g e tha t p ro mo te s a nd c o mmunic a te s re c o ve ry p rinc ip le s, ind ivid ua lity, stre ng ths a nd we llne ss. Re c o ve ry la ng ua g e fo c use s o n no n- la b e lling a nd a wa y fro m d ia g no se s fo r ind ivid ua ls a nd inste a d inc lud e s a nd e nc o ura g e s p a rtic ip a nts a nd the ir c a re rs to ta ke the le a d o n c o nve rsa tio ns tha t a re re la te d to the ir ne e d s o r wa nts a nd fo llo ws the p rinc ip le no thing a b o ut yo u, witho ut yo u. I find great meaning and benefit in developing my recovery plan I found importance in identifying my strengths.i am determined to move forward in my recovery and I feel hopeful for the future. - PIR Participant PIR is e ffe c tive ly a nd syste ma tic a lly d e ve lo p ing la ng ua g e within the se c to r tha t p ro mo te s we llne ss, re d uc e s stig ma a nd e nc o ura g e s p a rtic ip a nts to b e c ha ng e a g e nts o f the ir o wn live s. PIR fo ste rs e mp o we rme nt a nd re silie nc e, e na b le s p a rtic ip a nts to id e ntify stre ng ths a nd utilise la ng ua g e tha t e nc o ura g e s a nd p ro mo te s re c o ve ry. I have lifted my self-esteem, respect, pride and confidence. PIR offers me a safe place to speak my mind without judgement. -PIR Participant Build ing a re c o ve ry mind se t within the me nta l he a lth se c to r a nd the b ro a d e r c o mmunity is a sub sta ntia l und e rta king a nd re q uire s syste m re fo rm a c tivitie s tha t re a c h not only a significant number of people but that also influence decision makers who c a n b uild a fra me wo rk tha t will c o ntinue into the future. Do ing so will sup p o rt the lo ng e vity a nd e ffe c tive ne ss o f re c o ve ry p ra c tic e. To e nc o ura g e c ha ng e in the lo ng e r te rm, PIR o rg a nisa tio ns wo rk with c o mmunitie s, ind ivid ua ls, c a re rs a nd p ro fe ssio na ls to id e ntify a re a s o f the syste m, b o th fo rma l and informal, that could benefit from imp ro ve d c o lla b o ra tio n, re so urc e sha ring a nd info rma tio n o n re c o ve ry o rie nta te d p rinc ip le s. Pro je c ts a nd a c tivitie s ha ve b e e n d e ve lo p e d a ro und the se ne e d s a nd d e live re d b y multip le sta ke ho ld e rs to e nc o ura g e c o lla b o ra tio n. The se p ro je c ts ha ve se e n a g e nc ie s a nd o rg a nisa tio ns 24

29 wo rking a lo ng sid e c o nsume rs a nd c a re rs in a p o sitive ma nne r a nd in a wa y tha t se e ks to va lue a ll c o ntrib utio ns. PIR brings toge the r the se rvic e s ne e de d to support re c ove ry PIR ha s suc c e ssfully b ro ug ht to g e the r a g e nc ie s tha t ha ve no t histo ric a lly wo rke d to g e the r. The se syste m re fo rm p ro je c ts ha ve b ro ug ht to g e the r re so urc e s, id e a sha ring, c o ntrib utio ns a nd imp ro ve d c o mmunic a tio n a c ro ss the re g io n a s we ll a s b e g inning a p ro c e ss o f c ha ng e fo r the future. So me o f the se ne w c o lla b o ra tio ns inc lud e ind ivid ua ls a nd a g e nc ie s fro m le ss tra d itio na l se c to rs, whic h is o p e ning up ne w wa ys o f a p p ro a c hing e ntre nc he d issue s. Fo r e xa mp le, o ne Que e nsla nd PIR o rg a nisa tio n ha s e nliste d the he a d c o a c h o f the ir lo c a l NRL te a m to wo rk with se rvic e p ro vid e rs in a p ro je c t to p re ve nt suic id e a mo ng NRL p la ye rs a nd the b ro a d e r c o mmunity. se rvic e s, frustra tio n le ve ls a re usua lly hig h whe n it c o me s to ha ving to re te ll the ir sto ry time a nd time a g a in. Thro ug h the c o -o rd ina tio n o f se rvic e s b y the Sup p o rt Fa c ilita to r, PIR ha s c re a te d a smo o the r p a thwa y fo r p a rtic ip a nts. This ha s c re a te d a p a lp a b le se nse o f re lie f fo r the p a rtic ip a nt a nd c a re rs o nc e the re is a re a lisa tio n tha t the Sup p o rt Fa c ilita to r is the re to he lp c o o rd ina te a nd a c c e ss the se rvic e s tha t a re re q uire d. One yo ung c a re r in the No rthe rn Te rrito ry summe d it up a s fo llo ws: When Mum was sick and there was only myself and my younger sister to care for her it was like living in a dark room. When PIR came along it was like they opened the door and let the light in and helped Mum, and my sister and I, access the services that we needed. -PIR Carer PIR be tte r c oordinate s re fe rral pathways The PIR initia tive ha s a no wro ng d o o r a p p ro a c h whic h links p a rtic ip a nts into se rvic e s p a rtic ip a nts id e ntify a s imp o rta nt to the ir re c o ve ry. Se rvic e ma p p ing, e ffe c tive ne two rking, c o -lo c a tio n, kno wle d g e e xc ha ng e a nd the d e ve lo p me nt o f susta ina b le re la tio nship s ha s re sulte d in b e tte r c o o rd ina te d re fe rra l p a thwa ys b e twe e n se rvic e s. As a re sult, p a rtic ip a nts a nd c a re rs ha ve a c c e ss to a b e tte r c o nne c te d se rvic e p a thwa y re sulting in a mo d e l o f wra p a ro und c a re. Sup p o rt Fa c ilita to rs ha ve re p o rte d tha t fe e d b a c k fro m re fe rre rs ind ic a te s tha t PIR o rg a nisa tio ns ha ve re sp o nd e d in a time ly ma nne r in ma king initia l c o nta c t a nd fo llo wing up with p o te ntia l PIR p a rtic ip a nts, a nd tha t this time ly re sp o nse ha s b e e n instrume nta l in c re a ting b e tte r re fe rra l p a thwa ys. A ke y stre ng th o f the PIR initia tive ha s b e e n a re d uc tio n in the numb e r o f time s a p a rtic ip a nt ha s to re te ll the ir p e rso na l sto ry in o rd e r to a c c e ss se rvic e s. As mo st p a rtic ip a nts a nd c a re rs ha ve ha d c o nta c t fo r so me time with a p le tho ra o f d iffe re nt 25 By utilising a p e rso n c e ntre d a p p ro a c h a nd to o ls b a se d o n a re c o ve ry mo d e l, Sup p o rt Fa c ilita to rs ha ve fo und tha t the y a re a b le to c o mp re he nsive ly e xp lo re a nd g a in a b e tte r und e rsta nd ing o f a p e rso n s ne e d s. Ad d itio na lly, a ho listic a p p ro a c h ta ke s into a c c o unt the ne e d s o f the c a re r to a c c e ss sup p o rt fo r the mse lve s, ha ve the ir o wn p e e r sup p o rt o r a d vo c a c y fo r the ir o wn ne e d s. Finally there is someone in our lives who wants to work with us to achieve the best possible outcome for my son. Our Support Facilitator listens to me and understands my fears. I am not alone any more. - PIR Carer

30 PIR has introduc e d a ne w role : the Support Fac ilitator If it wasn t for the support of Partners in Recovery generally, and my Support Facilitator specifically, my life wouldn t be moving forward as smoothly as it is now. - PIR Participant The Sup p o rt Fa c ilita to r ro le is ne w to the me nta l he a lth wo rkfo rc e in Austra lia a nd is pioneering a significantly new way of wo rking in the me nta l he a lth la nd sc a p e. Unlike d ire c t c a se ma na g e me nt o r se rvic e p ro visio n, whic h invo lve s p ro vid ing imme d ia te re so urc e s suc h a s c o unse lling o r a c c o mmo d a tio n, Sup p o rt Fa c ilita to rs a im to c o o rd ina te (no t sup p ly) the se re so urc e s o n b e ha lf o f a p a rtic ip a nt. Sup p o rt Fa c ilita tio n ha s b e e n d e sc rib e d a s the a rt o f ma king thing s p o ssib le. Sup p o rt Fa c ilita tio n ta ke s a ste p b e yo nd c a re c o o rd ina tio n to inc lud e the syste m re fo rm a nd c a p a c ity b uild ing syno nymo us with the PIR a p p ro a c h. Da vid Me ld rum, CEO o f the Me nta l Illne ss Fe llo wship fa c ilita te d a se ssio n o n the Sup p o rt Fa c ilita to r a t the Vic to ria n a nd Ta sma nia n PIR wo rksho p in De le g a te s d e te rmine d tha t the ke y re sp o nsib ilitie s o f a Sup p o rt Fa c ilita to r we re : Ca re c o o rd ina tio n utilising a re c o ve ry a p p ro a c h; Eng a g ing with the p a rtic ip a nt a nd c a re rs to id e ntify the ir p rio ritie s a nd me e t the ir ne e d s; Syste m c ha ng e within the Sup p o rt Fa c ilita to r ro le to me e t c o nsume r a nd c a re r ne e d s; a nd Cre a ting mo re e ffe c tive inte r-a g e nc y a nd c o mmunity re la tio nship s. Pe o p le with c o mp le x ne e d s o fte n re q uire multip le se rvic e s tha t ind ivid ua lly p ro vid e sp e c ia lise d kno wle d g e, skills, a nd se rvic e s. Sup p o rt Fa c ilita to rs p la y a p ivo ta l ro le in e na b ling e ffe c tive c o o rd ina tio n a nd d e c isio n ma king to p ro vid e a c o mp re he nsive, c o he re nt, a nd c o ntinuo us re sp o nse to a n ind ivid ua l s uniq ue c irc umsta nc e. The ma in c o mp o ne nts o f the Sup p o rt Fa c ilita to r ro le a re a s fo llo ws: Ta ke s a p a rtne rship a p p ro a c h: p a rtic ip a nt d rive n; Sup p o rts p e o p le in the ir re c o ve ry; Links p a rtic ip a nts to the sup p o rts the y ne e d ; Undertakes advocacy, as identified by the p a rtic ip a nt; Mo d e ls c a re c o o rd ina tio n to o the r se rvic e s; Und e rta ke s se rvic e lia iso n; Ensure s inte ra g e nc y a c c o unta b ility; Build s re la tio nship s with se rvic e s a nd p a rtic ip a nts; Identifies gaps in services; Ad vo c a te s fo r syste ms re fo rm; a nd Imp le me nts syste ms c ha ng e ; A numb e r o f the uniq ue c ha ra c te ristic s o f the Sup p o rt Fa c ilita to r ro le tha t a d va nc e re c o ve ry o rie nta te d p ra c tic e a re e la b o ra te d b e lo w: Enc o ura g ing re c o ve ry o rie nta te d p ra c tic e Effe c tive Sup p o rt Fa c ilita to rs lo o k p a st a p a rtic ip a nt s illne ss a nd c o nne c t with the p e rso n und e rne a th a nd ho ld o nto ho p e until the p a rtic ip a nt is in a p o sitio n to ta ke it b a c k fo r the mse lve s. In We ste rn Austra lia, the Pe rth Ce ntra l a nd Ea st Me tro PIR o rg a nisa tio n ha ve a ssiste d Brinle y in g e tting his life b a c k o n tra c k. Brinle y ha s sha re d a truly insp iring sto ry; his sto ry a nd jo urne y to re c o ve ry. Brinle y s sto ry c a n b e fo und o n the Pe rth Ce ntra l a nd Ea st Me tro Me d ic a re Lo c a l Yo utub e c ha nne l a t PIR Pe rso na l Sto ry with Brinle y. Before PIR, I didn t have the confidence to reach out for support, I didn t feel strong. Now I have a voice in my life. - PIR Participant 26

31 Ta king a p e rso n c e ntre d a p p ro a c h to e ng a g e me nt a nd inta ke Mo st se rvic e s ha ve re stric tio ns o n the time a llo c a te d to wo rk with a p e rso n a nd a numb e r o f ke y p e rfo rma nc e o utc o me s whic h limits ho w a se rvic e c a n wo rk with a participant. PIR has flexibility in how ind ivid ua ls a re sup p o rte d o n the ir re c o ve ry jo urne y a nd this ha s a llo we d Sup p o rt Fa c ilita to rs to sp e nd time with e ng a g ing p e o p le with a live d e xp e rie nc e o f me nta l illne ss. Pe o p le with a live d e xp e rie nc e ha ve ind ic a te d tha t d istrust o f the syste m ha s b e e n a ma jo r b a rrie r to the ir e ng a g e me nt. Pa rtic ip a nts ind ic a te tha t ta king time to b uild trust a nd truly liste ning to the ne e d s o f the p e rso n ha s b e e n a p o sitive fe a ture o f the PIR initia tive. Sup p o rt Fa c ilita to rs ha ve re p o rte d tha t the a b ility to liste n is mo re beneficial than the ability to manage the re c o ve ry p ro c e ss. This is c o nsid e re d to b e e sp e c ia lly true fo r p e o p le who se p a st e xp e rie nc e s o f a utho rity ha s b e e n ne g a tive. o f the ir o wn live s a nd p ro mo te a p e rso n s se lf-d e te rmina tio n. Sup p o rt Fa c ilita to rs d isc uss with the p e rso n the ir ne e d s, ho p e s a nd a sp ira tio ns a nd a ssists the p e rso n to d isc o ve r wha t re c o ve ry me a ns to the m. PIR a ssists with linking the p e rso n to the sup p o rt a nd se rvic e s the y ha ve identified as important to their recovery, a s we ll a s a ssisting with the c o o rd ina tio n o f the sup p o rt re q uire d. PIR wo rks with the p e rso n to a c hie ve the ma ximum le ve l o f ind e p e nd e nc e tha t is p o ssib le. This is d rive n b y the p e rso n, a nd PIR o rg a nisa tio ns a c tive ly b e lie ve in no thing a b o ut yo u witho ut yo u. Ensuring a p e rso n c e ntre d a p p ro a c h to re c o ve ry Sup p o rt Fa c ilita to rs a c tive ly e ng a g e with p a rtic ip a nts, the ir ne two rks a nd o the r a g e nc ie s to o ffe r a nd se e k so lutio ns to c o mp le x issue s in a re so urc e ful ma nne r. Using a re c o ve ry-o rie nte d, p e rso n c e ntre d a p p ro a c h, Sup p o rt Fa c ilita to rs he lp p a rtic ip a nts id e ntify the ir ind ivid ua l g o a ls a nd ne e d s a nd he lp link the m to the se rvic e s, c o mmunity a nd na tura l sup p o rts tha t c a n sup p o rt the ir re c o ve ry jo urne y. This p la n is d e ve lo p e d in p a rtne rship with the p a rtic ip a nt, the ir c a re rs a nd fa mily (a t the p e rso n s re q ue st). Sup p o rt Fa c ilita to rs e nc o ura g e se lf-a d vo c a c y a nd e nsure p e o p le c a n a c c e ss sup p o rt in a c o o rd ina te d a nd inte g ra te d wa y. Sup p o rt Fa c ilita to rs he lp to e nsure the d e live ry o f the rig ht se rvic e s in the rig ht o rd e r, a t the rig ht time. Sup p o rt Fa c ilita to rs ta ke a stre ng th-b a se d a p p ro a c h, fo c using o n the ne e d s o f p a rtic ip a nts a nd a d d ing to the ir e xisting c o mp e te nc ie s. PIR o rg a nisa tio ns b e lie ve p e o p le a re the e xp e rts a nd c ha ng e a g e nts 27

32 PIR a c ro ss the na tio n is p ro mo ting a c o mmunity b a se d re c o ve ry mo d e l b y invo lving na tura l sup p o rts whe re a p p ro p ria te ; re sp e c tfully c ha lle ng ing o rg a nisa tio ns whe re a p p ro p ria te ; re se a rc hing c o mmunity o rg a nisa tio ns a nd b uild ing re la tio nship s a c ro ss se c to rs. Sup p o rt Fa c ilita to rs a re no t c linic a lly fo c use d Sup p o rt Fa c ilita to rs d o no t ne e d to b e c linic a lly fo c use d a s the y a re wo rking in a re c o ve ry o rie nta te d p ra c tic e fra me wo rk a nd wo rk in c o lla b o ra tio n with c linic a l a nd o the r te a ms to sup p o rt p a rtic ip a nts. Re c o ve ry o rie nta tio n invo lve s a ho listic a p p ro a c h tha t a d d re sse s a ra ng e o f fa c to rs, inc lud ing so c ia l d e te rmina nts, tha t imp a c t o n the we llb e ing a nd so c ia l inc lusio n o f p e o p le e xp e rie nc ing me nta l he a lth issue s a nd the ir fa milie s, inc lud ing ho using, e d uc a tio n, e mp lo yme nt, inc o me, iso la tio n a nd g e o g ra p hic d ista nc e, re la tio nship s, so c ia l c o nne c te d ne ss, p e rso na l sa fe ty, tra uma, stig ma, d isc rimina tio n a nd so c io e c o no mic ha rd ship. In te rms o f c linic a l se rvic e s, the ro le o f the Sup p o rt Fa c ilita to r is to wo rk in p a rtne rship with the c linic a l e xp e rts within the field. Fo c using o n id e ntifying g a p s a nd b a rrie rs Sup p o rt Fa c ilita to rs wo rk to id e ntify a nd find ways to reduce system barriers thro ug h b rid g ing g a p s a nd imp ro ving c o mmunic a tio n. Sup p o rt Fa c ilita to rs d e ve lo p p a rtne rship s a nd re la tio nship s re q uire d a t the lo c a l le ve l to sup p o rt the d e live ry o f PIR. Sup p o rt Fa c ilita to rs a lso ha ve a c o mmunity d e ve lo p me nt a p p ro a c h, b uild ing lo c a l kno wle d g e o f va rio us c linic a l a nd c o mmunity sup p o rt se rvic e s a nd re so urc e s a nd e nc o ura g ing inte g ra tio n o f se rvic e s a nd lo c a l re sp o nse s. Sup p o rt Fa c ilita to rs p la y a ke y ro le in c re a ting links b e twe e n se rvic e s a nd b uild ing the c a p a c ity o f b o th p a rtic ip a nts a nd the c o mmunity to susta in lo ng -te rm we llb e ing o utsid e o f PIR. Me asuring re c ove ry impac t In d e ve lo p ing a p e rso n-c e ntre d a p p ro a c h, PIR o rg a nisa tio ns ha ve a c c e ss to a ra ng e o f to o ls to no t o nly p ro mo te re c o ve ry, b ut to a lso me a sure the p ro g re ss o f a n ind ivid ua l s re c o ve ry jo urne y. The se to o ls a lso he lp g uid e a nd a sse ss a n a g e nc y s up ta ke o f re c o ve ry o rie nte d p ra c tic e. Ca mb e rwe ll Asse ssme nt o f Ne e d (C ANSAS) Ea c h PIR o rg a nisa tio n is re q uire d to g uid e a nd a sse ss a n ind ivid ua l s re c o ve ry ne e d s thro ug h the Ca mb e rwe ll Asse ssme nt o f Ne e d s Sho rt Ve rsio n (CANSAS), d e ve lo p e d b y the Ro ya l Co lle g e o f Psyc hia try (Lo nd o n UK). The CANSAS is use d to und e rsta nd the he a lth a nd so c ia l ne e d s o f p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd inc lud e s d o ma ins suc h a s a c c o mmo d a tio n, fo o d, se lf-c a re, d a ytime a c tivitie s, symp to ms, c hild c a re, mo ne y, p hysic a l he a lth a nd re la tio nship s. PIR wa s g ra nte d a p p ro va l fro m the Ro ya l Co lle g e o f Psyc hia try to a d d thre e furthe r d o ma ins to the CANSAS, thus e na b ling a mo re c o mp re he nsive a sse ssme nt o f a n ind ivid ua l s ne e d s. Sup p o rt Fa c ilita to rs ha ve b e e n tra ine d to a ssist PIR p a rtic ip a nts in se lf-a sse ssing the ir ne e d s using the CANSAS. By e na b ling se lf-a sse ssme nt, a n e mp ha sis is p la c e d o n se lf-d e te rmina tio n a nd sup p o rting p e o p le a nd the ir fa mily me mb e rs a nd c a re rs to b e d e c isio n-ma ke rs in the ir re c o ve ry process. In addition, de-identified data c o lle c te d thro ug h the CANSAS a ssists in a na lysing the c o lle c tive ne e d o f PIR p a rtic ip a nts a nd info rms e a c h re g io n o f the p rio rity a re a o f ne e d s tha t mig ht a lso b e a d d re sse d thro ug h syste m re fo rm a c tivitie s. The CANSAS c a n a lso b e re vie we d with participants to provide data that reflects the me e ting o f ne e d s o ve r time. 28

33 Me nta l He a lth Re c o ve ry Sta r Re c o g nising tha t re c o ve ry p ro g re ss c a n b e va rie d d e p e nd ing o n a n ind ivid ua l s situa tio n a nd le ve l o f we llne ss, the Re c o ve ry Sta r a ssists p a rtic ip a nts to b e tte r und e rsta nd the ir re c o ve ry p ro g re ss a nd the sta g e s tha t ma ny g o thro ug h d uring re c o ve ry. The re c o ve ry sta r fo c use s o n te n d iffe re nt life d o ma ins a nd e a c h is sc o re d b y e ithe r the p e rso n o r the ir Sup p o rt Fa c ilita to r to ind ic a te whe re the p e rso n fe e ls the y c urre ntly a re a nd wha t the ne xt ste p mig ht b e. A ke y va lue o f the Re c o ve ry Sta r is tha t it p ro vid e s a p e rso n-c e ntre d a p p ro a c h to e sta b lishing a nd tra c king re c o ve ry g o a ls o ve r time. The to o l a lso p ro vid e s p a rtic ip a nts a nd Sup p o rt Fa c ilita to rs with a me a ns to me a sure a nd a sse ss the p ro g re ss o f c ha ng e (re c o ve ry) a nd p ro vid e s a visua l re p re se nta tio n o f tha t p ro g re ss. imp le me nt re c o ve ry o rie nte d p ra c tic e re g a rd le ss o f d ire c t invo lve me nt with PIR, ma king it p a rt o f the re c o ve ry o rie nte d le g a c y o f PIR. The a b o ve me ntio ne d to o ls (a mo ng st o the rs) ha ve a ssiste d PIR re g io ns to mo re e ffe c tive ly ro ll o ut re c o ve ry o rie nte d p ra c tic e with p a rtne rs a nd o the r a g e nc ie s. The to o ls sup p o rt the e ffo rts o f PIR to e nsure a p e rso n c e ntre d a p p ro a c h tha t a ssists p a rtic ip a nts to no t o nly se lf-d e te rmine the ir re c o ve ry, b ut a lso p ro vid e a me a ns o f mo nito ring the ir o wn re c o ve ry p ro g re ss. The to o ls a lso p ro vid e so me fo rma lity in a sse ssing the p ro g re ss o f PIR p a rtic ip a nts re c o ve ry a nd c a n b e use d (with p e rmissio n and de-identified) as part of the evaluation o f PIR suc c e ss. Re c o ve ry Asse ssme nt Sc a le - Do ma ins a nd Sta g e s (RAS-DS) Ano the r se lf-a sse ssme nt to o l, the RAS-DS c a n b e use d to a ssist no t just the p a rtic ip a nt to und e rsta nd the ir o wn re c o ve ry, b ut a lso a ssist the a g e nc y to b re a k d o wn the p e rso n s re c o ve ry se lf-a sse ssme nt into fo ur d o ma ins: Func tio na l; Pe rso na l; Clinic a l; a nd So c ia l re c o ve ry. The RAS-DS ha s a p a rtic ula r e mp ha sis o n ho p e a nd se lf-d e te rmina tio n a nd c o nta ins a ra ng e o f sta te me nts tha t d e sc rib e ho w p e o p le so me time s fe e l a b o ut the mse lve s a nd the ir live s a nd is sc o re d b y the p a rtic ip a nt a c c o rd ing to ho w the y fe e l a t the time. Re c o ve ry Orie nte d Se rvic e Se lf-asse ssme nt To o lkit Ve rsio n 2 (RO SSAT) The Re c o ve ry Orie nte d Se rvic e Se lf- Asse ssme nt To o lkit (ROSSAT) p ro vid e s a to o l fo r o rg a nisa tio ns a nd wo rke rs to id e ntify the e xte nt to whic h re c o ve ry o rie nte d p ra c tic e is e mb e d d e d into the va rio us c o mp o ne nts o f the ir o rg a nisa tio n. The ROSSAT c a n b e use d a s: a g uid e to the imp le me nta tio n o f re c o ve ry p ra c tic e ; a n a ud it to o l; a nd a me c ha nism to id e ntify tra ining a nd d e ve lo p me nt ne e d s. The ROSSAT is a to o l tha t c a n b e use d b y a g e nc ie s to 29

34 Summary During the first two years of Partners In Re c o ve ry a ra ng e o f d a ta ha s b e e n c o lle c te d thro ug h fo rma l a nd a ne c d o ta l me a ns d e mo nstra ting tha t the initia tive ha s b e e n suc c e ssful. We ha ve he a rd fro m p a rtic ip a nts, c a re rs, wo rke rs a nd c o mmunity me mb e rs a like, sta ting tha t PIR ha s no t o nly b e e n a ne w mo d e l o f c a re c o o rd ina tio n, b ut ha s in fa c t b e e n life c ha ng ing. Syste m c hange and c apac ity building While PIR ha s a na tio na l a p p ro a c h with c o o rd ina te d c a p a c ity b uild ing, the initia tive is uniq ue in its fre e d o m to flexibly roll out service delivery tailored to e a c h re g io n. The inc lusio n o f the flexible funding component has provided o p p o rtunity to a d d re ss unme t ne e d a nd barriers to recovery specific to each re g io n. Syste m re fo rm, whic h c a n se e m like a n insurmo unta b le ta sk, is b e ing a c hie ve d. Lo c a l issue s a re b e ing ta c kle d in a c o lla b o ra tive ma nne r, le a d ing to inno va tive a nd ne w wa ys o f wo rking. At the sta te a nd na tio na l le ve l PIR Re g io ns a re c o o p e ra ting to tra nsfo rm syste ms o r a d vo c a te fo r wid e sp re a d re fo rm. PIR is b a se d o n so lid re se a rc h into the ne e d s o f p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd the ir c a re rs. PIR e mb o d ie s the re c o ve ry o rie nta tio n e le me nts o f the Na tio na l Sta nd a rd s fo r Me nta l He a lth Se rvic e s (2010), p ro vid ing a ta ng ib le e xa mp le to o the r p ro vid e rs o f a shift in p ra c tic e tha t is b uilt o n e q ua l p a rtne rship, liste ning to the ne e d s o f p a rtic ip a nts, ho p e -p ro mo tio n a nd fa c ilita tio n o f se lf-d e te rmina tio n. Re c o ve ry a nd re silie nc e a re b e ing e mb e d d e d into a g e nc y va lue s a nd p ra c tic e. PIR ta ke s a p e rso n-c e ntre d a p p ro a c h to we llb e ing, ha rne ssing a p e rso ns stre ng ths, p re fe re nc e s a nd mo tiva tio ns to sup p o rt re c o ve ry a nd linking p a rtic ip a nts to the se rvic e s a nd sup p o rts the y id e ntify. 30

35 Re c ove ry orie ntate d prac tic e PIR ha s a n e mp ha sis o n e mb e d d ing re c o ve ry o rie nte d p ra c tic e a nd ma rks a mo ve a wa y fro m a na rro we r fo c us o n c linic a l tre a tme nt a s the ro ute to we ll b e ing. Ag e nc ie s, wo rke rs, ind ivid ua ls a nd fa mily me mb e rs p a rtne r to g e the r to imp le me nt re c o ve ry o rie nte d p ra c tic e s. Ca re c o o rd ina tio n is sup p o rting p e o p le to a c c e ss se rvic e s mo re re a d ily a nd in a ma nne r d ire c te d b y the ne e d s a nd a sp ira tio ns o f p a rtic ip a nts. PIR sup p o rts p e o p le b y b re a king d o wn se rvic e silo s a nd ta king a c o nso rtium a p p ro a c h, p la c ing a g re a te r e mp ha sis o n se rvic e s suc h a s ho using, frie nd s a nd so c ia l ne two rks, e d uc a tio n a nd e mp lo yme nt a lo ng sid e c linic a l c a re a nd tre a tme nt. PIR ha s utilise d c o mmunity re so urc e s, p e e rs with live d e xp e rie nc e, me mb e rs o f the c o mmunity a nd o the r na tura l sup p o rt to p ro mo te inc lusio n a nd so c ia l c o nne c tio n. This a p p ro a c h ha s se e n a g e nc ie s tha t ha ve tra d itio na lly no t wo rke d to g e the r c o lla b o ra ting, re sulting in syste m c ha ng e a nd c a p a c ity b uild ing a nd ultima te ly a hig he r q ua lity o f se rvic e a nd sup p o rt fo r p a rtic ip a nts. Org a nisa tio ns b e c o me mo re a wa re o f the ir use o f re c o ve ry la ng ua g e, a nd mo re reflective regarding recovery-oriented p ra c tic e a lo ng sid e c linic a l c a re a nd tre a tme nt. Tra ining In response to identified regional gaps, a ra ng e o f tra ining ha s b e e n imp le me nte d a c ro ss se c to rs with the imp a c t o f no t o nly inc re a sing kno wle d g e b ut initia ting o r furthe r d e ve lo p ing ne two rk a nd p a rtne rship o p p o rtunitie s. Also re sulting fro m tra ining ha s b e e n the o rg a nic d e ve lo p me nt o f le a rning c irc le s a nd fo rma l/ info rma l me nto ring o f sta ff a c ro ss a g e nc ie s a nd p ro fe ssio ns. p ra c tic e, b ut a lso g uid e furthe r p ro fe ssio na l a nd a g e nc y d e ve lo p me nt o p p o rtunitie s. Involve me nt of familie s and c are rs Fa milie s a nd c a re rs c a n o fte n b e the fo rg o tte n p a rtne rs in re c o ve ry ye t the ir invo lve me nt in o ng o ing sup p o rt c a n b e c ruc ia l e le me nts tha t a ffe c t a p e rso n s lo ng -te rm re c o ve ry. PIR wa s p re d ic a te d o n the wisd o m o f p e o p le with a live d e xp e rie nc e a nd the ir fa milie s. PIR ha s sta ye d true to its o rig ina l inte nt to no t just ha ve p e o p le d riving the ir o wn re c o ve ry, b ut a s fa r a s p o ssib le inc lud e c a re rs a nd fa mily me mb e rs a s a c tive p a rtic ip a nts in the ir lo ve d o ne s re c o ve ry. Fa milie s a nd c a re rs a lso ha ve the ir o wn ne e d s, tha t whe n me t, e na b le the m to b e e ffe c tive p a rtne rs in sup p o rting re c o ve ry. This ha s p ro ve n to b e a significant change supported by PIR and has been beneficial to all stakeholders. The imp o rta nc e a nd d iffe re nc e tha t invo lving p e o p le with a live d e xp e rie nc e o f me nta l illne ss a nd the ir c a re rs c a n ma ke to se rvic e s p la nning a nd d e ve lo p me nt is re c o g nise d in g o ve rnme nt p o lic y. Me nta l health services and systems benefit from their inclusion. They can influence and c ha ng e se rvic e c ulture a nd p ra c tic e, a nd b rid g e g a p s b e twe e n o the r p ro fe ssio na ls. The p rinc ip le s o f use r p a rtic ip a tio n a lso he lp to a d d re ss wid e r issue s, suc h a s the rig hts o f p e o p le with me nta l ill he a lth to se lf-d e te rmina tio n a nd re sp e c t. Inc lusio n o f p e o p le with a live d e xp e rie nc e a nd c a re rs a lso p ro vid e s se rvic e s with a n info rme d vie wp o int o f the d yna mic s o f re c o ve ry a nd e nha nc e s sta ff und e rsta nd ing a nd a wa re ne ss o f the imp o rta nc e o f p e rso n- c e ntre d p ra c tic e s. Furthe r invo lve me nt in g o ve rna nc e a nd se rvic e p la nning sho uld b e e nc o ura g e d to he lp sup p o rt p o sitive c ha ng e in o rg a nisa tio na l c ulture a nd a n imp ro ve d re c o ve ry fo c us. Re c ove ry orie ntate d tools Ra the r tha n just a ssuming tha t re c o ve ry o rie nta tio n ha s b e e n e mb e d d e d into e ve ryd a y p ra c tic e, the re ha s b e e n a n inc re a se in the use o f me a suring to o ls (e g ROSSAT) tha t no t o nly p ro vid e e vid e nc e o f 31

36 Whe re to from he re? Transition to the National Disability Insuranc e Sc he me The Na tio na l Disa b ility Insura nc e Sc he me (NDIS) re p re se nts a lo ng -a wa ite d, a nd significant reform to the nature, focus, a nd fund ing o f d isa b ility sup p o rt se rvic e s in Austra lia. Se rvic e s fo r p e o p le living with d isa b ility ha ve b e e n fra g me nte d, ha ve g e ne ra lly b e e n b lo c k fund e d a nd the sup p o rt p ro vid e d ha s va rie d d e p e nd ing o n lo c a tio n, typ e o f d isa b ility a nd whe n, whe re a nd ho w a d isa b ility wa s a c q uire d o r d e ve lo p e d. The NDIS re p re se nts a d iffe ring a p p ro a c h, a nd will p ro vid e life time sup p o rt to p e o p le a ffe c te d b y d isa b ility, b a se d o n a p e rso n s ind ivid ua l ne e d s. It ha s g re a t p o te ntia l to imp ro ve the live s o f p e o p le with p syc ho so c ia l d isa b ility a sso c ia te d with me nta l illne ss. Imp o rta ntly, NDIS will p ut the p e rso n a t the c e ntre, sup p o rting c ho ic e fo r p e o p le with a live d e xp e rie nc e o f me nta l illne ss, the ir fa milie s a nd c a re rs, a nd p ut p e o p le in c o ntro l o f the c a re a nd sup p o rt the y re c e ive to p a rtic ip a te in the so c ia l a nd e c o no mic life o f the ir c o mmunity. A fund a me nta l p rinc ip le o f the NDIS is to c o nsid e r a p e rso n s c a re a nd sup p o rt ne e d s o ve r the ir life time. Ta king a lo ng -te rm vie w o f p e o p le s c a re a nd sup p o rt ne e d s will he lp e nsure tha t p e o p le g e t the rig ht sup p o rt e a rlie r, ra the r tha n wa iting until the y re a c h c risis p o int. Psyc ho so c ia l d isa b ility wa s a d d e d to the NDIS re la tive ly la te in d e ve lo p me nt o f the sc he me. A numb e r o f the a sp e c ts re g a rd ing e lig ib ility c rite ria a nd the definition of permanent have been ra ise d b y o rg a nisa tio ns re p re se nting a nd p ro mo ting the vie ws o f p e o p le with a live d e xp e rie nc e, c a re rs a nd the me nta l he a lth se c to r. The Na tio na l Disa b ility Insura nc e Ag e nc y (who will imp le me nt the Sc he me ) ha s re c o g nise d the ne e d to inte g ra te the p rinc ip le s o f me nta l he a lth re c o ve ry d e sc rib e d in the Na tio na l Re c o ve ry Fra me wo rk with the ne e d to d e mo nstra te tha t a p e rso n s p syc ho so c ia l d isa b ility is, o r is like ly to b e p e rma ne nt in o rd e r to a c c e ss ind ivid ua lise d fund ing thro ug h the NDIS. The e xp e rie nc e o f PIR o rg a nisa tio ns hig hlig hts the imp o rta nc e o f no t withd ra wing sup p o rt whe n a p e rso n is we ll in o rd e r to ma ximise we llne ss a nd re c o ve ry a c ro ss a life time. Furthe rmo re, the tra nsitio n to the NDIS will re q uire c a re ful imp le me nta tio n to e nsure the sc he me d e live rs the mo st e ffe c tive a nd susta ina b le o utc o me s fo r p a rtic ip a nts, p ro vid e rs, a nd g o ve rnme nts. So me o the r ke y p rinc ip le s tha t ha ve c o ntrib ute d to p o sitive o utc o me s in PIR, a nd c o uld b e c o nsid e re d in the tra nsitio n to the NDIS inc lud e the imp o rta nc e o f: Fle xib ility in imp le me nta tio n; Ma inta ining a fo c us o n re c o ve ry a nd we llb e ing ; Build ing c a p a c ity, in ind ivid ua ls, the se rvic e se c to r a nd the b ro a d e r c o mmunity; a nd A wo rkfo rc e with re c o ve ry-o rie nte d me nta l he a lth skills. Syste m re form proje c ts ove r the ne xt 12 months Ac ro ss the c o untry, PIR re g io ns ha ve c o mme nc e d ma ny a nd va rie d syste m re fo rm p ro je c ts a nd a c tivitie s. Ma ny o f the se p ro je c ts will c o ntinue in the ne xt year and will have significant influence on syste m re fo rm. While b uild ing a c o he re nt syste m o f c a re ha s b e e n a c ha lle ng ing ta sk, PIR o rg a nisa tio ns ha ve d e ve lo p e d ne w a nd e ffe c tive wa ys to c o o rd ina te se rvic e s to b e tte r me e t the ne e d s o f p e o p le with a live d e xp e rie nc e o f me nta l illne ss. PIR o rg a nisa tio ns ha ve und e rta ke n p ro je c ts, d e ve lo p e d p ro c e d ure s a nd c o nc e p ts whic h ha ve c o ntrib ute d to me a ning ful syste m re fo rm. Do c ume nting the se initia tive s, a nd the le sso ns le a rne d (b o th p o sitive a nd ne g a tive ) c o uld re p re se nt a n imp o rta nt le g a c y o f PIR, a nd e nsure the living kno wle d g e within PIR o rg a nisa tio ns is no t lo st b ut inste a d c o ntinue s to info rm 32

37 c ha ng e a nd b uild c a p a c ity b e yo nd the e nd o f the initia tive. The c re a tio n o f a na tio na l b a nk o f re so urc e s c o uld he lp d isse mina te b e st p ra c tic e a c ro ss Austra lia, info rm future p ra c tic e a nd e na b le d e c isio ns to b e b a se d o n p ra c tic a l e xp e rie nc e. This info rma tio n, o nc e c a p ture d, c a n b e use d to stre a mline future p ro je c ts. Pote ntial for e xte nsion of the Partne rs in Re c ove ry Initiative The first two years of PIR have had significant and positive impact on the live s o f p e o p le with a me nta l illne ss, the ir c a re rs a nd fa milie s. The PIR mo d e l o f c a re c o o rd ina tio n ha s p ro ve n to b e e ffe c tive and the final year of the initiative will build up o n this suc c e ss. Ho we ve r, the re re ma ins ma ny p e o p le who ha ve no t a c c e sse d PIR that may also benefit from the unique form o f re c o ve ry sup p o rt. Ad d re ssing the ne e d s o f p e o p le living with a se ve re a nd p e rsiste nt me nta l illne ss re q uire s a c o mp le x syste m o f c a re a nd sup p o rt, re q uiring the e ng a g e me nt o f multip le a re a s o f g o ve rnme nt, inc lud ing he a lth, ho using, inc o me sup p o rt, d isa b ility, e d uc a tio n a nd e mp lo yme nt. In a n inte rim re p o rt o n the imp le me nta tio n o f the Na tio na l Disa b ility Insura nc e Sc he me c o mmissio ne d b y the Bo a rd o f the Na tio na l Disa b ility Insura nc e Ag e nc y, it is no te d tha t wo rk is o ng o ing o n ho w the NDIS will link to ma instre a m se rvic e p ro visio n (e.g. he a lth, c rimina l justic e, e d uc a tio n, c hild c a re / p ro te c tio n) 1. To d o so ma y ta ke time. PIR could help fulfil an important need for a vulne ra b le c o ho rt o f p e o p le while the NDIS d e ve lo p s the c a p a c ity a nd c a p a b ility to fulfil this function. 1 KPMG (2014) Inte rim Re p o rt: Re vie w o f the o p tima l a p p ro a c h to tra nsitio n to the full NDIS, p. 8 33

38 Conc lusion At the time o f writing, the Pa rtne rs in Re c o ve ry Initia tive ha s o ne ye a r le ft in it s c urre nt fund ing c yc le. It wo uld b e fa ir to sa y tha t the initia tive ha s in ma ny wa ys e xc e e d e d the e xp e c ta tio ns o f p a rtic ip a nts a nd the ir c a re rs. Also, d e sp ite its sho rt e xiste nc e, PIR ha s significantly and positively impacted the mental health sector. We look forward to the ne xt ye a r a s we a ntic ip a te furthe r c o nso lid a tio n o f the mo d e l a nd the ma ny syste m re fo rm a c tivitie s tha t a re und e rwa y a c ro ss Austra lia. Pe o p le s live s ha ve b e e n c ha ng ing. Pra c tic e fra me wo rks ha ve b e e n c ha ng ing. Syste ms ha ve b e e n c ha ng ing. Ma ny p e o p le a nd a g e nc ie s a c ro ss the c o untry ha ve b e e n p rivile g e d to b e p a rt o f this c ha ng e. This is the ir sto ry. 34

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