We have come a long way from the days when people suffering from mental health issues were placed in asylums, discarded and forgotten. Charmaine Jones explains grass roots Cadre programme.
In those days the term mentally ill, to use the words of Ben Pike in the Daily Telegraph of 2 March 2015, covered a wide gamut of conditions, often times labelling people lunatics because of ‘domestic trouble’, ‘religious excitement’, ‘nostalgia’, ‘sun stroke’, ‘overwork’ and ‘sexual intemperance’. The wards were full of the poor, the criminal and the unwell.
The advent of psychiatry and anti-psychotic drugs saw a shift in the approach to mental health treatment and during the mid to late 20th Century, a move away from institutional care to community based treatment.
A significant exodus from institutional care through bed number reductions occurred during the 1960s and 1970s, mostly to meet budgetary pressures on the institutions, but it was with the release of the 1983 Richmond Report which recommended reforms around the culture of care, that treatment began to focus on building an integrated response, a community response.
Thirty two years on though, while there may be small, specific areas of excellent practice, mental health is still underfunded and continues to lean towards a hospital based care system, although more localised and closely aligned with other health services than in the past.
The Mental Health and Drug and Alcohol Office (MHDAO), responsible for development and coordination of the NSW Ministry of Health policy, strategy and program funding, has started to realise proactive is better than reactive, early prevention is better than managing crisis care. The Director, Peter Carter, addressing a St Vincent’s Health Network meeting in July 2015, spoke of one of the MHDAO’s goals being to change the definition of a first responder from an emergency service provider to a community member, from the local police force to the local bus driver, hairdresser and shop owner.
And it is this ‘first responder’ model the Inner City Working Group for Mental Health Recovery (working group), a coalition of government, non-government and community agencies, community members, mental health consumers and other interested stakeholders, has been promoting, under the guise of the ‘Cadre Project’ for a number of years.
The Cadre model was developed after the working group, which works across high density public housing estates in the City of Sydney local government area, repeatedly heard tenants living in the estates say they felt like quasi-mental health workers. Due to the rationalisation and restricted eligibility to public housing, since the 2005 Reshaping of Public Housing policy, and the unaffordability of private rental options, the number of people living with a mental health illness now residing in public housing has risen dramatically. The impacts, especially in the high-density high rise apartments, were visibly, and audibly, noticeable and tenants struggled to find the balance between supporting their mentally unwell neighbours and complaining about them.
After hearing about a community approach to mental health recovery delivered in Banda Aceh, Indonesia, a country with little or no mental health supports, to assist with the devastating impacts of the 2005 Tsunami, the working group approached MIND Australia, the organisation delivering the Banda Aceh program and asked for assistance in developing a program to deliver across the public housing communities.
Building on the concept that people don’t suffer mental ill-health in isolation; their illness may impact their community, their friends, family and neighbours, MIND Australia put together a program designed specifically for Inner Sydney, focused on building strong community connections with the aim of creating a holistic community approach to mental health and wellbeing.
At any given time, almost one in five Australians (20%) will be diagnosed with a mental illness. The statistics would suggest that all of us, quite regularly, will be in contact with a person experiencing a mental illness. The Cadre model is about ensuring that we, as community members, whether as the local librarian or friendly neighbour, know how to respond sensitively and supportively, while armed with the knowledge of where best to turn when help is needed.
The word Cadre is defined as a small group of people specially trained for a particular purpose or profession and the aim of the project is exactly that; to train community members to understand mental health problems and disorders, to assist them in contributing to positive change in the community through the reduction of stigma, access to information and by creating a socially inclusive community for mental health consumers.
In 2011, with initial funding from the Clover Moore’s Lord Mayor’s Salary Trust and in partnership with St Vincent’s hospital, the working group delivered Cadre training, facilitated by Mind Australia’s Senior Training and Development Officer, Anthony Stratford, across six Inner Sydney suburbs.
Cadres initially attend a full one-day workshop. Each workshop is site specific with information about the local mental health scene. There is also an introduction to the Recovery-Orientated process, The Mental Health Care system, understanding types of mental illness, and also includes some general communications and community development skills. Simple resources like the in-take form completed by the Mental Health Crisis team are supplied. David, a Cadre from Surry Hills, says ‘Just knowing what you are going to be asked when you ring the mental health line, because you are concerned about someone, makes it so much easier and quicker.’
The local network then continues to meet monthly, with a variety of mental health topics to investigate, ranging from Dual Diagnosis to the impacts of nicotine on psychiatric medications. They may wish to invite guest speakers and build relations with local case management teams – the structure of each network depends on the Cadre members involved. Some may want to just assist in reducing the stigma attached to mental health by ensuring their local community has access to factual information, other networks may wish to work hand in hand with consumers, given they have the consumers’ consent, and aid in assisting a person on their journey to recovery. The model is driven from the ground-up and is localised.
Cadres are capacity builders. They assist the local community to develop strategies to cope with the impacts of mental ill-health, build awareness in the wider community about mental health and increase the community’s capacity to respond appropriately in either an early invention or crisis situation.
Inner Sydney Regional Council, one of the Inner City Working Group for Mental Health Recovery partners, with funding from Inner West Sydney Partners In Recovery, is currently furthering the Cadre program through the development of City Cadre Connect, a Train-the-Trainer module, to allow Cadres across the inner city and inner west to facilitate the Cadre training in their local communities and to provide them with the resources to build and sustain their local networks.
With locally based trainers, there is no limit to where and when the Cadre program can be delivered. The model is not only supported by partners like Regional Council and Partners In Recovery, it has also been recognised as good practice in the NSW Mental Health Commission’s strategic plan.
If you are interested in learning more about your local Cadre network or would like to investigate establishing one in your local area, more information can be found at www.cosnp.info or by emailing firstname.lastname@example.org.
Charmaine Jones is the Executive Officer of the ISRCSD.