Access to supportive mental healthcare is essential. This is particularly relevant for people living with complex mental health issues, whose needs often benefit from ongoing and frequent access to multiple mental healthcare services. The experiential quality of mental healthcare service access is an important part of the treatment and recovery process. It can promote positive treatment outcomes if supportive, welcoming and encouraging; or if negative, can lead to poor outcomes by discouraging treatment participation and help seeking. "I have been denied services at the ER because of my borderline personality disorder - I have been told that I will ‘always feel suicidal... it's chronic and I should learn how to live with it’ and was denied admission to the ER despite saying I was extremely suicidal, was unsafe to go home and would hurt myself if I went home." – Our Turn to Speak participant, Victoria Participants shared experiences of perceived and anticipated stigma in accessing residential, rehabilitation or hospital-based mental health services. There were many accounts of people being denied care, discharged prematurely, excluded from treatment planning, as well as the use of restrictive practices. For some, these experiences resulted in them withdrawing from seeking support and treatment opportunities in mental healthcare services. A number of participants drew comparisons with the private mental health system, which they reported as offering more therapeutic and accessible services. “The gap between the standard of care in the public mental health system - especially the hospital system and the private system needs to close. The public mental health system needs a big injection of funds and attention.” – Our Turn to Speak participant Queensland Many of the experiences reported in this domain echo the findings of previous inquiries into the public mental health systems across Australia. Consistently, access, support coordination, navigation and workforce capacity have been cited as areas requiring reform. Stigma and discrimination negatively impact people affected by complex mental health issues and those accessing the mental health system. Urgent investment and reform are required to address the fundamental structural issues which perpetuate much of the stigma and discrimination experienced by service users. Recommendations for action Facilitate shared decision-making in clinical settings by embedding it in professional development programs for clinicians; and increasing uptake of advance care directives. Increase funding for holistic clinical and psychosocial mental health services, support coordination and system navigation specific to the needs of people affected by complex mental health issues. Increase training and professional development for mental health professionals inclusive of the outcomes of complaint processes, the legislative context and overarching human rights framework.
