News Items

1. Hercules Street, Chatswood

Chatswood and Cremorne Community Mental Health---Background 12 February 2007

Patrick Webb-----Action Foundation for Mental Health Inc

1. Mental Heath Reports

In 1992, Australian Health Ministers committed to correct decades of neglect in mental health. A national mental health policy and mechanisms were developed to:

• Move the focus of care from hospitals to the community;
• Reduce human rights abuses;
• Lift Commonwealth and State expenditures, and
• Deliver quality mental health to mainstream Australian health and welfare services
  (Commonwealth Dept of Health and Aging 2002).

 In 1993, the Burdekin report (Human Rights Commissioner’s Report) drew attention to human rights issues: overt abuse within institutions and covert neglect in the wider community.

For the next 10 years, Australian governments implemented two 5-year plans to:

·        Facilitate genuine participation for consumers and carers
(Report by the Mental Health Council of Australia(“MHCA”): Authors Dr Grace Groom &Professor Ian Hickie-April2003);

·        Develop high-quality, community-based mental health care.

In 2002 the Mental Health Council of Australia (“ MHCA’) reviewed the position and found that despite the efforts of committed politicians, government officials, service providers and community advocates, we do not have an effective or accessible mental health care system. At all levels of government, within some professions and in the wider community there is a perception of apathy, lack of accountability and lack of commitment to real change. Change needs to be supported by genuine leadership and commitment.

2. Evidence Based Research

It is widely known and acknowledged by relevant experts that community based mental health facilities should be based directly in the local geographic areas which they serve and not on the grounds of hospitals, as consumers who are in rehabilitation do not wish to visit hospitals unless absolutely necessary as many of them associate hospitals with acute periods of their illness.

The mental health service in Northern Sydney has won awards as an example of best practice. It is vital that assets should not be disposed of as they are extremely expensive, and, in practice, impossible to replace.

3. Consultation with stakeholders—Consumers, Carers and others

in terms of the Northern Sydney Health Area Mental Health Services Strategic Plan 2004-2008 one of their first goals is “To ensure that carers, consumers and other relevant service providers are involved in service planning, development, delivery and evaluation”.

4. Brief history of Chatswood Community Health.

Services in Northern Sydney were established from the mid 70’s with community services initially in North Sydney, which then moved to Cremorne/Mosman in the early 90’s where the Cremorne Community Mental Health Centre is now situate. The local Cremorne Mental Health Team is housed at this Centre.
(Cremorne/Mosman is north east of the city on the harbour. This explanation is included as this is being sent to recipients outside Sydney)

It appears that the land in Hercules Street, Chatswood was purchased in the early 1990’s. (Chatswood is on the North Shore of Sydney and is a substantial retail, office and residential centre).

The Chatswood Mental Health Team (also referred to as Extended Hours Team as is the Cremorne team) was in Hercules Street in two adjoining houses that were probably built around the 1930’s.

Until about mid 2003 they were housed in 38 Hercules Street but with the consolidation of the ARC team (Assertive Recovery in the Community Team across the road in 55 Hercules Street they took over 40 Hercules Street as well. These two houses are connected by an enclosed walk way. 

With both the Cremorne and Chatswood Mental Health Teams approximately 85% of their patients were seen at the Centres and are normally the non-acute consumers, though obviously with relapses this broad classification changes. However in addition to the normal caseload of up to 40 per case manager they also operate as the crisis team during the day in the community and new referrals.

Across at the ARC team who deal with ongoing more acute cases the case load is more of the order of 10 per case manger and some consumers may be seen several times a day.

Westview Cottage, situate at 51 Hercules Street, Chatswood, is a drop in centre for consumers and also houses the Create/Mars team involved with vocational and rehabilitation training and work programs as well as the consumer team leader. The Action Foundation for Mental Health also run psychosocial programs there such as music and art therapy and skills based programs such as computer skills.

Other community health teams such as age-care, family planning (moved 2007), child assessment and drug & alcohol (moved 2006) were also situated on this site in different houses.

5. Alternative plans in 2003

In 2003 there was talk of all of the Chatswood community health site facilities being moved to the RNSH site. There was strong opposition to this relating to the Mental Health Teams for the reasons set out above. There was then some effort to find a site between Cremorne and Chatswood to house both services and the RTA site opposite the Anzac Services Club was examined but this did not proceed. One of the reasons mooted for the move was the aging of the houses in Hercules Street.

Early in 2004 the Health Service proposed that one side of Hercules Street be sold as well as the Cremorne Centre and a new semi permanent building be erected between Hercules Street and Oscar Street housing all the Mental Health Teams as well as the Drug & Alcohol local team. This was to be at a cost of approximately $4.1 million dollars.

While the plan was discussed with consumer and carer representatives the actual plan has not been tabled. There was concern over the facilities being adequate for example the number of interview rooms and rooms available for programs etc as well as the strong opposition to Cremorne Centre being moved to Chatswood.

The opposition to the move of Cremorne commenced early in 2004 with a letter of the 10 May written to Dr Nick O’Connor, Director of Northern Sydney Mental Health by the Action Foundation 

Letters to, inter alia, the then Heath Minister Morris Iemma by other local community groups such as the Schizophrenia Fellowship North Shore Support Group, Club Speranza and Service Users North Shore (“SUNS”) were also sent relating to the Cremorne Centre.

This action campaign culminated in a large public meeting on the 7 September 2004 attended by the local state MP, the Mayor of Mosman, the deputy Mayor of North Sydney (the mayor was overseas) as well as the Federal minister, Joe Hockey and the Federal Minister of Health, Tony Abbott, who spoke in favour of the Cremorne Centre remaining at its present site. The meeting passed a unanimous set of resolutions relating to the Cremorne Centre remaining on its present site.

6. “Edited copy of Media Release”------15 November 2004

CLOSURE OF CHATSWOOD COMMUNITY MENTAL HEALTH CENTRE A DISASTER FOR PATIENTS AND TAXPAYERS

Statement by Patrick Webb, President of the Action Foundation for Mental Health

Northern Sydney Area Health have closed and moved the Chatswood Community Mental Health Centre to the Royal North Shore Hospital site against the wishes of users including staff.

This follows queries raised during an accreditation process and Workcover. Instead of repairing the buildings at an estimated cost of less than $10,000 Health have spent taxpayers hard earned money to the tune of an estimated $100,000 to $200,000 moving the service which they say is only temporary!  (We requested a team of an architect, engineer and builder be allowed access to inspect the building and this was refused. The original query during the accreditation process was, we understand because of a heavy compactus in one of the rooms. This could have been dismantled and extra support installed under the floor—the compactus should probably never have been installed in the first place.  There was also a problem with a lintel—simply fixed—the query was, we understand, made by a psychiatrist ( ! ) from the accrediting body. Not an engineer and certainly not cause to move the team. Workcover received a call (from who?)  and issued a notice requiring “remedy”—not moving the team. It would have been relatively easy to relocate the team in unaffected rooms while repairs were affected.

The cost of the dislocation to consumers is immeasurable and will have serious consequences. The service must be moved back to Chatswood and the community consulted about the longer term.

The Minister of Health, Morris Iemma cordially received a delegation on Thursday evening (11 November 2004—re Chatswood as well as on 9 November 2004 relating to Cremorne) to discuss the closure and undertook to attempt to postpone the closure but advised late on Friday that management had advised him they could not do so on legal grounds.

While heartened by the Minister’s response as well as his instructions to management to hold meaningful community consultations relating to the matter, I am concerned that management have a sub or hidden agenda relating to the sale of the site.

I am pleased that the Minister seems determined to ensure meaningful consultation. This appears to stem in part from the recommendations of the Health Participating Council’s report insisting on proper consultation with stakeholders.

A public meeting (facilitated by outside consultants) was held at RNSH in November at which resolutions were passed relating to the retention of both Cremorne and Chatswood Community Mental Health facilities in their then configuration.

7. Workshops end 2004

On the Minister’s instructions for due and proper consultation, a series of 3 workshops were held late in November and December 2004 with the last on 22 December 2004. These were attended by approximately 50 people 30 of whom were staff from the Health Service. The result on 22 December 2004 was that the preferred outcome was for Cremorne to remain on its present site and for the Chatswood Mental Health team to remain on the Hercules Street site and be moved back as soon as possible. The relocation had been in the words of the Health Service “on a temporary basis”.

A workshop in January/February 2005 was to be held to follow up on this outcome. This has never been held. It appears that the outcome was not the desired one from the Health Services point of view.

8. 2006/07

We now learn that the Chatswood Mental Health team is to remain on the RNSH site to be followed in due course by the ARC team when a “6 storey community building “ is to be erected on the RNSH site on Herbert Street in St Leonards as part of the redevelopment of the RNSH. This is opposite a number of buildings ranging from 27 storeys to 10 storeys high. Not exactly a community setting. Parking is a nightmare.

We understand that a number of other community facilities such as aged care and some children’s facilities will also be located in this building. To our knowledge no consultation has taken place with users or other stakeholders of these facilities.

At a forum held at Willoughby City Council Chambers on Saturday 12 August 2006 resolutions were passed demanding the reinstatement of community health facilities in Hercules Street.

In October 2005 the NSW Health Service issued a document called “Integrated Primary Health and Community Care Services” which called for discussions to develop models of services that are best suited for local communities.

The Health Service is proposing an Integrated Primary Health centre in Hercules Street which will only have small and limited space to see mental health consumer/patients in Chatswood. At present no clients of Chatswood Mental Health (temporally based at RNSH) are seen in Hercules Street!!  Even though it is our view that repairs could be made to vacated buildings to accommodate appointments. The hospital/outpatients model has already started.

A Centre for Excellence for the treatment of Mental Health incorporating best practise guidelines would once again be an asset for the community at large as well as continuing the high esteem in which the Chatswood model has been held internationally in the past years. The Centre could possibly incorporate both public and private mental health facilities such as the mental health teams, psychiatrists in private practise, General Practitioners with specialist knowledge in Mental Health as well as psychologists (Medicare refunds are now claimable) and facilities for group work by specialist organisations. Early intervention programs as well as rehabilitation and vocational training should be included.

A true Integrated Primary Health Care facility would incorporate the mental teams location in Chatswood as well as other community health facilities.  With a community “hub and spokes” model the "hub" would be the hospital for acute bed care when hospitalisation is required and the "spoke"--- the community mental health teams in Chatswood and Cremorne.

The community based siting of community mental health teams co-located with community based psychosocial interventions and rehabilitation and pre-vocational training is the preferred option from consumers and carer’s viewpoint.

Simply having buildings on major hospital sites does not constitute a community base. It is dangerous just to relocate community based services near  Emergency Departments and elsewhere on acute hospital sites were they become de-facto outpatient departments. Consumers do not want to go to obvious hospital sites on their road to recovery and well being.

There has been no due and proper consultation relating to Hercules Street and the retention of community health facilities

What consumers and carers want and need is a community based recovery model/process and not a hospital “fortress” finance model.

Patrick Webb

Action Foundation for Mental Health Inc.

9--Latest moves at Hercules Street
In October 2008 the ARC mental health team, now called the AOT (Assertive Outreach Team) team was also moved from Hercules St to the RNSH site.

11 Mars Create Tender

28 January 2010


Mr John McMurray

Acting Director Operations

Northern Sydney Central Coast Mental Health, Drug & Alcohol

Re:Call for Expressions of Interest from  Non Government Organisations (NGO) Grant Funding for North Shore Ryde & Hornsby Ku-ring-gai Mental Health Srevice

The above is a invitation to tender for the funding of the Health Service’s Create Team (Community Recreation—Education Access—Training & Employment) which runs the award winning Mars Inc (previously Macquarie Area Rehabilitation Services).

The Create team reports to the Heath Service and has a close working with the independent board of Mars which includes community representatives as well as the Health Service. I am also a member of the Mars board.

I am setting out some detail and history in this communication as this letter will be copied to a number of Health Service personnel as well as a wide range of our political representatives, both NSW and Federal. We are calling for a bipartisan approach to this very urgent and serious matter.

Mars was formed in 1988 in order to create a legal employer for consumers of the local mental health services. Mars started operating the Cornucopia Cafe and Horticulture & Nursery business on the closed Gladesville hospital site in 1996. Mars employs over 50 consumers who have mental health issues. They run the cafe and horticulture/nursery business in Gladesville and more recently the horticulture business based in Wahroonga (Hornsby Ku-ring-gai Mental Health Service). These employees are managed and trained by the Create team which is part of the Health Service.

For reasons set out in Annexure A the Health Service has decided to tender out the “Create/Mars” to an NGO.

However the tender issued has some very basic flaws, namely:

1. There has been no proper consultation with consumers (employees), carers, Create staff or the Mars board as required in terms of the National Standards for Mental Health Services (the Standards”) as well as NSW Health Policy and Guidelines.
   
2. The tender stipulates that the new business will only offer employment on a transitional basis up to a maximum of 12 months. This differs from the present model which has a combination of “semi-permanent” (for those unable to gain employment outside Mars) but contribute to the viability of the business with efficiency and sufficient reliability, and others who are transitionary.  To be a viable business there must be a blend of both. I have been approached by consumers and carers in tears saying “what will we do when my son loses his job?” There is understandably a lot of anger in the community. (see Annexure A)
   
3. The amount of funding offered is too low namely $310,000, whereas we have estimated the funding at present is approximately $500,000 (excluding the social-recreation/education/general training programs that only last week have now got some separate funding via 2 new positions –see Annexure A). To be effective and viable the business, Mars, requires sufficient trainers and facilitators.

 We therefore request, as a matter of urgency, that the tender be immediately withdrawn to allow proper consultation to take place and the tender then reissued.

In principle we are not against an NGO getting involved but the present process and setting up is seriously flawed for the reasons set out herein.

The Action Foundation for Mental Health Inc. (the Foundation”) runs psycho-social programs such as art, music, outings etc  for consumers on the Lower North Shore (‘LNS”) as well as advocating on behalf of consumers and carers. We work with the Create “social-recreation/education/general training” team---see annexure A (separate from the Create –Mars staff).

As already stated I am also on the board of Mars. I have advised the board that I will be writing this letter but have not given them the details as yet. At this stage the letter is therefore from the Foundation on behalf of consumers and carers. Obviously as I am on the Mars board I am personally aware of a number of issues included herein.

Its Time--- for true consultation as required by the Standards

Unfortunately for reasons that have long escaped carers, consumers and the Foundation, in our view this Health Service has a long list of examples of a lack of true consultation as required by the Standards.

While we have some understand of your reasoning for decisions relating to “Mars/Create” you are missing some very important aspects of the present model which would have surfaced if proper consultation had been held.

 As an overall point of principal we are also calling  on our political representatives and the Health Service to urgently develop a review system relating to consultation, so that there is timely, true and proper consultation as required by the Standards.

As set out above we therefore request the tender be withdrawn and proper consultation take place before it is reissued. All parties wish to work with you to develop a best practice model flowing from this award winning business, Mars Inc.

Yours sincerely,

Patrick Webb
President

Annexure A

1. Mars Inc & Create team
   Mars was originally set up in 1988 by members of Ryde Community Health to provide a business structure for them to legally employ mental health consumers, initially in cleaning and gardening. The business activities were supervised by people employed by Ryde Community Health. The partnership gained impetus with the closing of Gladesville Hospital and the opening in 1996 0f Cornucopia Cafe and nursery on the Old Gladesville Hospital Site.
   
   The CREATE Team with the help of the MARS board have taken MARS to the position of having a turnover of $520,000 pa and employing over 50 people part time in the cafe, nursery and garden maintenance businesses. The business structure has also been used to give legality to work crews operating in Chatswood and Hornsby. Total Create staff running Mars at present at Gladesville—4.6 and 1.6 in Wahroonga giving a total of 6.2 FTE.(Full Time Equivalent staff). This is spread as follows-- 1 for cafe, 3.6 in horticulture/nursery, 1 team leader/business manager and 0.6 admin and bookkeeper. We have estimated with the new lower funding in terms of the existing tender about 3.5 staff could be employed.
   
   A separate part of the Create team has been responsible for providing social-recreational/education and general training opportunities for consumers in the Ryde/North Shore area (in the order of over 150 participants). At present there are 3 FTE employed by Health for these programs. These were to be totally scrapped but only late last week because of an outcry from stakeholders the Health Service advised that 2 new positions would be created for these programs 1 in Gladesville and 1 in the LNS—named “Community Integration Co-ordinators”.
   
2. So the present structure is:-
   
   MARS Inc------employs over 50 consumers
   
   CREATE Health Service team facilitates and trains Mars employees. Works closely with Mars board via team leader/business manager to ensure Mars viability (responsibility of Mars board).
   
   CREATE Health Services social-recreational/education/general training team runs appropriate programs mainly in Gladesville/Ryde such as art, music, computer training, healthy lifestyle etc for over 100 consumers.
   
   ACTION FOUNDATION FOR MENTAL HEALTH INC runs psycho-social programs such as music, art, computers, outings etc on LNS and liaises with appropriate Create staff based in LNS. The Foundation is a registered charity and is funded independently.

3. Governance issues.
   
   Over the years there have been numerous attempts by the independent board of Mars to better define the relationship with the Health Service through the development of a Memorandum of Understanding (“MOU”). There has always been community, carer and health representation on the board.
   
   There has been concern from the Area Health Service over the governance issues because of the lack of any finalised documented agreement (which the Mars board wanted—documentation available.)

In September 2008 consultants Walter Turnbull were employed by Area Health Service to undertake a review of the business structure. Unfortunately, again because of a lack of proper consultation, the report seriously misunderstood the structure, governance and other important aspects of Mars and Create. The report was not discussed with the Board.

The result of the main recommendations was either to tender out “Create/Mars” to an NGO or formalise the existing relationship. The tender option has been chosen by the Health Service. Details of the tender were not discussed in any detail with the Mars Board. The Health Service specifically requested that the option of the tender not be discussed with consumers or staff and be kept confidential.

As stated in the letter above we are not opposed in principal to a tender for a NGO to take over the Create/Mars operation. However the tender is flawed and it requires consultation to rectify it.

4. Consumers meeting last week and carers contacting the Foundation
   
   A meeting for consumers was held last week attended by 50 angry and articulate consumers—one of the benefits of the Mars program and the Health Service.
   
   Consumers and carers are all against the model set out in the tender.
   
   There are number of issues in the tender not dealt with in this document that also need clarification and discussion.
   
   Out of interest on a radio interview with ABC radio 702 on Wednesday 27 January after Deborah Cameron interviewed the mother of a Mars employee she questioned, on air, Ms Andrea Taylor, acting Director, Mental Health of the Area Health, who stated that no employee would lose their jobs. In terms of clause 4.3.3 of the tender documents employment opportunities would be provided “not exceeding 12 months”
   
   
5. Best Practice
   
   There is a high level of evidence for work rehabilitation programs which result in real work for real pay in improving outcomes with severe and persistent mental illness.
   
   There is widespread acknowledgement that there is a need for a range of different work programs for different needs and to provide for individual choices. There is no one size fits all.
   
   Both public and NGO services need a recovery approach and related psycho-social programs to support and motivate people in work programs.
   
   It is wide and common knowledge that transitional short term work placements will not have sustained good outcomes if they have to transfer to open jobs when at the best of times this is difficult but especially at times of high unemployment.
   
   Patrick Webb
   Action Foundation for Mental Health Inc