Call for investment into preventative mental health care for our vulnerable

People sleeping rough, couch surfing or not having stable accommodation aren't getting the care they need when coupled with mental health issues that end up in crisis.

Experts in the community service area in Ballarat say more needs to be done if we want to help our whole community.

The Courier spoke with four voices in this field to see how mental health services can help those who are vulnerable - an ever increasing need.

CatholicCare Victoria homelessness and housing support manager James Treloar said people's needs are not being met.

"Clients often don't have access to a mobile phone and can't wait in a queue to speak to mental health triage, have no transport to access the Emergency Department, and because they are homeless, they are not eligible to be placed in the Prevention and Recovery Care Centre (PARC) as they would have no exit address after treatment," he said.

"This means that a client with significant ill health can remain in crisis with limited access to supports and - as a result of their ill health- they are often unable to sustain any form of housing, even short term, without appropriate mental health support."

Uniting Vic homelessness senior manager Adam Liversage said the stigma around people living rough, many who faced acute mental health issues, needed to stop.

"We know that a high or majority of our rough sleepers and people experiencing homelessness do have significant mental health issues," he said.

"Our agencies or our teams don't have the capacity or the knowledge or expertise to be able to deal with that ongoing so we rely on tertiary mental health to be able to provide that mental health support to a lot of our homeless community."

Tertiary mental health supports include acute level support or high complex mental health disorders.

It is estimated that around 50 to 80 people are sleeping rough every night in Ballarat, but hundreds more are in unstable housing, or couch surfing.

Mr Liversage said having good sustained mental health was really integral to holding onto housing.

"We do know of a lot of housing breakdowns that do occur because they're not getting the mental health, service or treatment that they actually need," he said.

On the other side, Mr Liversage said when people do have mental health issues and are sleeping rough, it's had a considerable impact.

"We get significant mental health deterioration as a result of rough sleeping, especially those who are long-term rough sleeping," he said.

"Without tertiary mental health assistance, it almost gets to the point of no return."

Mr Liversage said working with mental health supports was key to helping someone get into a better place in life.

"If we get early or brief intervention, or crisis intervention we can get a person to base level and get them treated with appropriate treatment they need to function, and live independently," he said.

Mr Liversage said there was a "massive difference" between those who have mental health supports and those who don't.

"When we're working with someone in long-term housing and providing that wraparound support, that difference is massive there, they're functioning, they're happy, they're engaging, they're sustaining tenancies, and they're more willing to do things within their communities as well," he said.

A hard part of getting people to that base line of health was access, especially when people need medication.

"Community-based organisations like Uniting shouldn't have to take the full responsibility when you're treating someone with significant mental health issues," Mr Liversage said.

"That's not what we're trying to do. Yes, we do have mental health counselling and things like that. But when it comes to psychiatry and treatment orders, we don't have those expertise and ability to provide that response.

"We can't write scripts."

Mr Liversage said while it might be alarming, people with mental health issues sleeping rough aren't dangerous.

"That seems to be the perception," he said.

"We do know that rough sleepers do experience a deterioration in mental health, but no, it doesn't mean they're dangerous.

"We can see some really unusual behaviours and they can display some volatile and aggressive behaviours."

Mr Liversage said it was important the Ballarat community not get drawn into those behaviours.

"These people are significantly unwell," he said.

"It's important to get the message out there, there are isolated incidents.

"The people at White Flat Oval had experienced significant longevity in regards to rough sleeping and really severe mental health deterioration.

"That's certainly not a representation of our homeless or rough sleepers in a homeless community."

Grampians Health director for mental health and wellbeing Mark Thornett said one of the biggest mental health challenges was "stigma" around getting help early.

"That delays people actually seeking care earlier so people can be a bit more unwell by the time they seek care," he said.

Ballarat has 33 public mental health beds for people in need of in-patient care, which is for people in need of acute mental health care, 23 for adults and 10 older persons, and 12 beds in the PARC unit.

Mr Thornett said there are a number of mental health care supports for people to reach out to, firstly being support lines.

"You've got things like Lifeline and Suicide Call-back which are really good support services that help guide people to the right place, because people don't always know where to ring or where to go," he said.

Grampians Health has a mental health support line, which is a 24/7 service where a clinician can help triage.

"If it's during business hours, we've got a team who can go out and actually see someone in their home and try and help them that way," Mr Thornett said.

"We're always available in the emergency department for people to come and see us there."

Mr Thornett advised to speak to a GP for information as well.

"A lot of the other community health services have got mental health programs and will provide a level of urgent support rather than crisis support as well," he said.

"There are a lot of sort of different levels of opportunity for people to get some help and we work very closely with the ambulance and the police services as well because quite often people will come to their attention as well and we try to work with them closely."

Mr Thornett said due to the Royal Commission report into mental health reforms changes on how services were rolled out were in the works.

"Some of it is around having enough staff and a lot of services are struggling to get staff at the moment," he said.

"We're trying to make sure that we provide enough opportunity to meet those crisis needs, even if we haven't got a fully staffed complement."

Mr Thornett said PARC was used to offer early intervention.

"It's not like a hospital but it has 24/7 staffing so that people can get that care before they get really unwell," he said.

"We've just had some funding and we're about to start building a youth PARC."

While mental health care beds will be increasing in the next few years, Mr Thornett said people looking for help earlier would make the difference.

"How do we actually get that aspects happening a little bit sort of sooner, so that we can support people before they get unwell, because there's a lot of things we can do to avoid someone getting into a crisis," he said.

When it came to those living homeless and struggling with mental health, Mr Thornett said it was a "point of major concern".

"Particularly in the current climate of cost of living crisis and there's a lot more people needing that sort of support," he said.

Mr Thornett said Grampians Health worked closely with community services.

"It is that way of actually collaboratively working together, all those agencies coming together to say, what can we do to wrap around people to help them?" he said.

Grampians Health does have an acute response team.

"It works much more closely with the community teams and all the other services that we've got here within Ballarat Health," Mr Thornett said.

This includes people who might not have a permanent address.

While Children and Family Services (Cafs) don't offer mental health supports, they see the impact of mental health issues and the need for access with their clients.

Cafs client outcomes executive manager Rhiannon Williams said a lack of access to mental health services can have a "huge impact" on vulnerable people.

"What's the opportunity to succeed across lots of different areas? How can we expect someone to be able to hear what we're saying about a different level of support, a different program of support, a parenting support, if the mental health can't be attended?" she said.

The breadth of Cafs covers 50 programs for a range of clients from housing, homelessness, gambling help, financial counselling, out-of-home care and family violence intervention programs.

"Our clients come into Cafs with complex lives, their own histories and needs," Ms Williams said.

"There is a really important requirement for holistic wraparound responses that include mental health because, you know, that's obviously really important.

"There is increasing pressures, cost of living pressures, housing stress pressures. We know how pervasive family violence is and the impact that can have on the heart and mind. We do need to see a wide range of investment."

Ms Williams said Cafs understood there were "big wait lists for acute support services" which were in need of additional resources but so did early intervention.

"We need to have the cash to have the actual services now but what's the additional investment we need to see to start working with younger people particularly those who might have a trauma background?

"That might interrupt the need to have the acute mental health services in the future. What are other investments we can make to support people earlier?"

Ms Williams said when it came to mental health supports, the earlier people can be connected into a model of care, the better the outcome can be.

Ms Williams said while everyone had a different lived experience the difference between having mental health supports and not can be a person position to be able to work on other aspects of their lives.

"It is again that idea of a holistic support, holistic service system for people to make sure that not one bit falls over that might interrupt their capacity to lead a flourishing life," she said.