The Mental Health Legal Services [MHLS] Project… An Introduction

1. The Mental Health Legal Services [MHLS] Project…An Introduction • Presenter: Stephen Kilkeary • Project Co-ordinator, MHLSP, Public Interest Advocacy Centre © PIAC 2008

2. The Mental Health Legal Services [MHLS] Project • A two-year project, which commenced in January 2008 • Funded by Legal Aid NSW and the Public Interest Advocacy Centre [PIAC] • Auspiced by PIAC • Overseen by a Steering Committee, whose members include lawyers, community workers and as of April 2008, consumers • The broad aim of the MHLS Project is to improve access to justice for people who are mentally unwell • Pilot strategies should be or have the potential to be state-wide • The MHLS Project is staffed by two, full-time workers

3. Project Tasks … from January 2008 • Consultation with consumers, carers, workers, academics and others • Research existing service delivery models • Research existing capacity building/training models

4. Project Tasks … from September 2008 • Pilot new legal service models • Pilot new capacity building / training models • Work with both legal and health / community services • Strive to achieve sustainable models that exist beyond the life of the Project • Develop evaluation strategies to measure the impact of pilot models on consumers / workers

5. Unmet Legal Needs Defined widely in the Project, including but not limited to… • Crimes of violence • Crimes of deception • Family law matters • Care and protection of children matters • Discrimination, harassment and vilification • Health care and service delivery • Housing and social welfare • Credit and debt

6. Priority Groups • Pilot generalist mental health legal services • And pilot models that prioritise: • Indigenous people • People in prison • People who are homeless • Young people • People from CALD backgrounds • People who have been traumatised • People in rural, regional and remote areas of NSW

7. People who have been traumatised Psychiatrist and trauma specialist, Judith Herman, has found: ‘The mental health system is filled with survivors of prolonged, repeated childhood trauma. This is true even though most people who have been abused in childhood never come to psychiatric attention’ Service providers note: Many adult survivors of child abuse had that abuse minimised or disregarded by workers within the Victorian mental health system (2005)

8. People who have been traumatised • Silje Floen and Ask Elklit (2007) found in their study of 139 patients in a psychiatric hospital in Western Norway that: • for most, their trauma histories had not been assessed at intake • a failure to assess could lead to the wrong treatments being initiated and the emergence of consequential mental health problems such as depression, anxiety and substance misuse

9. People who are Homeless • Taylor & Sharpe, 2008, Research sample of 56 homeless women and men in Sydney, aged 18-73 years, found: • 41% had a 12 month prevalence of PTSD • Compared to 1.5% for the general population • 79% had a lifetime prevalence of PTSD • Of that subset, 50% currently met the criteria for PTSD • 61% had been given a psychiatric diagnosis • 48% ‘screened positive’ for psychosis (25/52) • 40% scored in the ‘extremely severe range’ on the Depression, Anxiety and Stress Scale (DASS) (17/42) • 19% ‘met the criteria for a current diagnosis of OCD’ (8/42) • 93% ‘had experienced two or more traumatic events’ • Based on a research sample of 56 homeless women and men in Sydney, aged 18-73 years, the following mental health statistics were gleaned… • 41% had a 12 month prevalence of PTSD • Compared to 1.5% for the general population • 79% had a lifetime prevalence of PTSD • Of that subset, 50% currently met the criteria for PTSD • 61% had been given a psychiatric diagnosis • 48% ‘screened positive’ for psychosis (25/52) • 40% scored in the ‘extremely severe range’ on the Depression, Anxiety and Stress Scale (DASS) (17/42) • 19% ‘met the criteria for a current diagnosis of OCD’ (8/42) • 93% ‘had experienced two or more traumatic events’ Sharpe, 2008]

10. People who are in Prison • People who are mentally unwell more likely to end up in prison • People in prison more likely to become mentally unwell • Corrine Henderson, from the Mental Health Co-ordinating Council: ‘The over-representation of people with a mental illness in the criminal justice system is demonstration of the extent to which the social environment gives rise to mental illness, highlighting the urgent need for legislative reform and implementation of collaborative practices that break the cycle of mental illness, substance abuse, poverty, unemployment, domestic violence and interactions with the criminal justice system’ • Viable, humane solutions need to look beyond recreating ‘mini-institutions’ in the community towards stable, secure social environments that contain ‘love, respect, trust and empathy’

11. Working with Consumers - core principles • Being empathic (Carl Rogers, 1961) • Essential to any professional relationship • Builds safety, trust, respect [See Howerton, et al, 2007] • Facilitates open communication • Being client-centred (Gerard Egan, 2001) • Emphasis on subjective needs • Working towards outcomes • Assuming capacity • Being holistic (Felix Biestek, 1957) • Understanding the person in her/his situation • Addressing consumer issues in a coordinated way • Promoting consumer self-reliance

12. Legal Service Delivery Models • Specialist mental health legal centre, eg, Mental Health Legal Centre, Melbourne • Disability law centre, eg, Urban Justice Center, New York • Independent advocacy, eg, Cambridgeshire Independent Advocacy Service • Second-tier support, eg, Mental Health Law Project, Fife • Capacity and relationship building, eg, local solutions to local needs