Introduction by Croakey: As Croakey and other media outlets have reported extensively, the Victorian Labor Government’s plans to abolish VicHealth as an independent standalone health promotion agency have been widely condemned – and the Government can expect the chorus of opposition to continue in the weeks and months ahead.
The Allan Government is also under fire over wide-ranging cuts to lived experience roles across the mental health sector. The cuts, another outcome of the Silver Review into the Victorian Public Service, undermine implementation of recommendations from the Royal Commission into Victoria’s Mental Health System.
Katie Larsen, a lived experience leader and researcher, writes below that the cuts are short-sighted as investment in lived experience leadership roles “changes culture, challenges the status quo, drives innovation and destigmatises mental health challenges”.
Katie Larsen writes:
Since the Royal Commission into Victoria’s Mental Health System concluded in 2021, huge steps have been made towards improving Victoria’s approach to mental health.
These reforms were deeply necessary and important. The Victorian Labor Government should be rightly praised for its initiative.
But now that progress is endangered, through the actions of the same Government.
This is because a series of recent changes by the Victorian Government are set to remove all the most senior lived experience roles in the mental health system. These roles were all created following the recommendations of the Royal Commission.
First, the Mental Health and Wellbeing Commission – the system regulator – is set to lose three of its four commissioners (two of these were lived experience positions).
Meanwhile, the Victorian Collaborative Centre for Mental Health and Wellbeing – a unique institution combining ‘lived and living experience leadership, innovative service delivery and cutting-edge research‘ – will no longer be required to have a lived experience co-CEO role.
The Department of Health is likewise losing the executive-level lived experience leadership position and other senior roles, and is dissolving the Lived Experience Branch. Critical lived experience perspectives are set to once again be absent from the most senior decision-making tables.
People with lived experience of mental health distress and suicide, and the mental health sector more broadly, are now hurting. They are asking how we got here, and how progress can slip away. There is a rising chorus of voices against the changes from across the sector and divergent political actors.
The Royal Commission found that Victoria’s mental health system was catastrophically failing. The findings imagined an improved future mental health system where lived experience leadership and oversight would be central. The Commissioners saw this as fundamental to an inclusive, compassionate and humane mental health and wellbeing system.
The Victorian Government committed to implementing this transformative vision.
But now, five years on, we are seeing the active dismantling and defunding of much of this new system of lived experience leadership and governance.
On the one hand, you can understand the challenging position of the Victorian Government. It is facing very real financial constraints and must act prudently to ensure efficient and effective outcomes.
Sadly though, these changes endanger the very heart of a reform process the Government itself started. This makes these changes, and this attempt at savings, troublingly short-sighted.
Experience and evidence
Victoria’s approach to lived experience leadership has been the envy of many around the world. This work is essential to improving community responses to mental health distress and suicide.
It has inspired mental health organisations to better invest in and develop genuine approaches to lived experience leadership at executive and senior leadership levels – with flow on effects for staff and service users.
My own experience, as one of the first lived experience executive leaders, is that this investment changes culture, challenges the status quo, drives innovation and destigmatises mental health challenges. This is exactly the transformative vision the Royal Commission laid out. A vision the Government and sector started building. And a vision we are watching dissolve right now.
As a sector, it feels as though the fundamentals of Victorian lived experience leadership are being dismantled without proper explanation or justification. From the outside, it seems the decision is financial, conveniently linked to the Silver Review of the Victorian Public Service.
Tellingly though, while innovative lived experience roles are being lost, the existing systems of operating and institutional power within mental health remain untouched. This seems to cut against the Royal Commission finding of why the system – and its prior mode of operation – was found to be failing Victorians.
This means the default response to human distress and trauma remains one that too often seeks to medicalise, stigmatise, isolate, disconnect and suppress. Sadly, this dominance exists despite time and again proving largely ineffective, and even harmful.
Don’t we owe the people who delivered raw and courageous testimonies to the Royal Commission, reliving their trauma and begging for change, a little more than that?
Lived experience leadership and services are often framed as a risky alternative – by both the ill-informed and those whose power they stand to threaten.
But there is significant evidence to the contrary. Lived experience improves innovation, quality of care, reduces service costs, promotes greater focus on person-led care and supports more equitable relationships between services and users.
International studies show service models led by people with lived experience have the potential to significantly reduce hospital admissions, in some cases by up to 70% (see here and here) and have been consistently demanded by people who use services in Australia.
In big reforms, things are rarely perfect at the beginning. Instead of cuts, what we need now is time.
This will allow for the foundations of reform to solidify – for the mental health power structures to adjust, for understanding of lived experience to increase and for change to be felt more strongly in communities.
Real change, cultural and transformational change, takes investment, creativity, courage, deep discomfort and defiant persistence. All things people with lived experience know a hell of a lot about.
It’s not too late. Victoria is still well placed to realise the transformative opportunity of lived experience in our mental health system, but they must reconsider these lived experience-specific cuts.
Or, we could go back to where we were five years ago. This means accepting that the system that prevails, one that we are all likely to need at some point in all our lives – whether for ourselves, or for those we love – may catastrophically fail us. This isn’t the vision we were promised.
• Katie Larsen is a lived experience leader and researcher, member of the Victorian Mental Health Ministerial Advisory Committee and the Executive Director of Lived Experience at Mind Australia.
See Croakey’s archive of articles on mental health reform