Inclusive Health Symposium 2019

Our Inclusive Health annual symposium delved deep into the core complexities, challenges and successes of our work, to discover how we can grow our mission to care for the most vulnerable groups in society. Presenting to 105 attendees, our keynote speaker Fay Jackson, challenged us to rethink how we deliver mental health services to include a greater number of staff with lived experience who can inform the development and delivery of our services in ways that are most relevant to vulnerable populations. John Willis, Group Manager Inclusive Health, presented our Big Data Project and the ways in which we might use these insights to inform and guide the strategic direction of the Inclusive Health Program. Improved identification of vulnerable patients was recognised as a focus area to ensure we respond effectively and meet the needs of these groups. Advocacy was a key theme where a clear plan was outlined to progress our work in this area with support from clinicians across the organisation.

Several outcomes and actionable insights emerged as part of this symposium giving the Inclusive Health team a strong direction and strategy for future focus. The inclusion and integration of more staff with lived experience throughout the Program was recognised as a priority, along with two specific actions to execute. Firstly, that a role should be offered at the national IHAC for someone with lived experience to inform the governance of the Inclusive Health Program. In addition, the team agreed to explore the concept of co-design through the idea, “Nothing about us, without us”, which highlighted the importance of consulting vulnerable populations before making decisions on their behalf. The ongoing analysis of the Big Data Project was recognised as a crucial resource in informing the strategic directions of the Inclusive Health Program. Specifically, the development and promotion of an Inclusive Health research strategy that would assist in guiding strategic planning for vulnerable populations. Also, the Big Data Project plans to inform the Sydney Inclusive Health strategic planning project and will provide Melbourne with ongoing feedback and analysis to assist in the development of services to vulnerable populations. It was also recognised that we need to increase the level and effectiveness of our advocacy endeavours regarding valuable populations. Specifically, to facilitate a link between the IHP projects and the Advocacy team to ensure the latest research can be used to ‘advocate’ on behalf of vulnerable populations.

Lived Experience Changes Cultures & Creates New Possibilities

“People with lived experience are both fragile and fierce”, explained Faye Jackson as she discussed the importance of incorporating staff with lived experience of mental illness and recovery across SVHA to better care for and support vulnerable patients. People with lived experience change cultures, help break down barriers and challenge assumptions about the way in which we provide services to vulnerable people. Faye discussed how we might increase the employment of such staff across all levels of service to better inform the development and delivery of our services to vulnerable populations. Fay invited us to “empower others to empower ourselves”; we were challenged to have the crucial conversations within our teams and across the organisation, to change the way we think about our services, to listen and value the influence of Lived Experience, to not be afraid and to not make others afraid, and to review policies that might make a difference. Fay said, “Engage and empower the lived experience and carer experience voice and you will change the culture. Change the culture, and you will see new possibilities, new ideas, new outcomes”. One specific challenge issue by Fay was the rethinking our use of ‘fishbowls’ (nurses stations) in mental health inpatient units. She outlined evidence that indicates such a move this does decrease violence incidents against staff.

Big Data Brings Vulnerabilities to Light

John Willis addressed the many factors that impact vulnerable groups in society and the challenges this raises in providing equity in healthcare across these groups. While these groups are categorised as separate, the complexity and overlap is extensive. The Big Data Project, a key pillar in the Inclusive Health strategy, is providing us with a picture of the vulnerable people we serve. It also generates a lens through which we can explore this complexity and an evidence-base for areas of future focus, strategy and Inclusive Health investment funding. Key findings show us that one in five of all SVHM patients are from vulnerable groups; the most prolific vulnerability is mental illness with 73 percent of this population presenting with this issue and the overlap between vulnerabilities is significant, with over 50 percent of vulnerable patients having between two and four other vulnerabilities. The most common was those with a dual diagnosis of addiction and mental illness.

So what do these findings mean for our future work as an organisation and how might we grow our mission to the most vulnerable? Firstly, this data shows that vulnerable patients are coming to SVHM for care in a greater proportion than had previously. This reinforces our mission to provide compassionate care resulting in people and services often making SVHA their first choice for care. Secondly, there are some indications from this data that some areas require more attention.

• Capacity to Identify: We need to improve our methods for screening for vulnerable populations so we can better address their needs. We have done good work in the areas of Aboriginal and Torres Strait Islander patients, domestic violence screening and elder abuse but we must work on identification of homeless and potentially homeless and those trapped in human trafficking and modern slavery.
• Trial New Models of Care: The IHP has supported a number of innovative and successful models. For example, the Safe Have Cafe, the RaSP program and the Managed Alcohol Program (MAP). We need to continue to be bold and explore new ways we can better serve those margins. We need to continue to evaluate our work to ensure we are making a difference to those we are trying to serve. At an individual, facility and national level.
• Efficacy of Models of Care: The Big Data Project in addition to other statewide hospital data and working with our university partners, provides a solid foundation of insights and information to continue to explore the effectiveness of our interventions. Our work with the Big Data Project is currently being developed into a NHMRC partnership grant proposal - the first of its kind in Australia.

Build on Experience: We need to build on this growing experience and knowledge

SVHA & Inclusive Health Leading the Way

Advocacy is a core pillar of the SVHA mission and was a focus of the small group discussions and presentation at the symposium. The role of advocacy in our organisation was defined and a plan to achieve advocacy goals was clearly identified in actionable steps by our groups. We outlined what success will look like in terms of advocacy in 2025 and how we will influence and created a model for how staff members can decide ‘when to speak up’ to affect advocacy in private or public domains. The Corporate Affairs team put together a snapshot of our current advocacy work and spoke out about what they need from the rest of the organisation to affect the change they desire as well as defining where they will focus their advocacy efforts.

The IHP and SVHA as an organisation has the opportunity to lead the health sector in the care of vulnerable patients, boldly stepping into areas other providers and governments don’t tend to go. The challenge is to continue to explore innovative ways to improve the equity of access to our services, to lead research on vulnerability, encourage the Catholic sector to engage more with this type of research, and expand our partnerships beyond the standard to bridge the gap between hospital and community.