Disability and mental health

Led by Associate Professor Dr Jen Smith-Merry

How can we understand mental health in relation to disability?

Mental Disorders account for nearly one quarter of all the Years Lived with a Disability in the World. This target group is also the main contributor to global costs related to the use of health and social services and to productivity loss. In spite of these facts, persons with mental illness have less support and lower access to care services that any other chronic health condition. In Australia only one third of persons with mental disorders access health services and this ‘care gap’ is much greater in South East Asia. Even in Countries where disability schemes have been implemented, persons with mental disorders experience more problems in accessing disability benefits than any other disability group. In addition, persons with MD experience more stigma and discrimination that other persons with disabilities.
Global Burden of Disease Study, Lancet, 2013

In order to maximise participation of persons with mental disorders, more needs to be known about two key issues:

1. How to ensure parity and equitable access to disability benefits, care provision and support for persons with mental disorders?

  • In Australia
  • In the Asia Pacific Region

2. How to measure and how to reduce the existing Mental Healthcare Gap between care needs and provision of services

  • In Australia within the new National Disability Insurance Scheme
  • In the Asia Pacific Region following the UN Declaration on the Rights of People with Disabilities

3. Consumer experiences of services and policy and how these can influence service and policy development.

In order to address these knowledge gaps this workstream is focusing on these main projects:

Mind the Gap – The National Disability Insurance Scheme and mental health.

Project members: Nicola Hancock, Jennifer Smith-Merry, Amanda Bresnan (Community Mental Health Australia), John Gilroy, Gwynnyth Llewellyn, Ivy Yen (Project Manager).

Thousands of Australians will transition to the NDIS from existing mental health programs across Australia over the next few years. It is evident that there will be a proportion of the client base of these existing programs, including a significant number of indigenous Australians, who will be ineligible for the NDIS. It is also clear that even for those eligible there will be gaps between existing provision and the NDIS. Consideration must therefore be given to how people living with mental ill-health with complex needs, continue to have individualised care provided.

The National Mind the Gap report

The Mind the Gap report was created to capture stakeholder views about gaps and solutions related to the implementation of the National Disability Insurance Scheme (NDIS) for people with psychosocial disability.

The project was funded by the Sydney Policy Lab and was designed as a stakeholder exercise in response to a significant Australian policy problem, rather than a research project.

Initial discussions with project partner Community Mental Health Australia, a coalition of eight peak community mental health organisations from each state and territory, indicated their members were experiencing significant difficulties around NDIS implementation for psychosocial disability, and were concerned about the impact of implementation on other service systems.

The project therefore centred on facilitating the voice of non-government stakeholders with experiences on the ground so they could share their perspectives on gaps and propose solutions. The report reflects their experiences rather than the internal work of the NDIS, governments or any agency. Voicing stakeholder concerns, fears, and hopes for the scheme is an important element of the policy debate and can ultimately strengthen policy and program outcomes.

The authors of the report sought out a wide, national voice from service users and providers, and intentionally engaged with groups whose voices have been less heard in the past, including a strong focus on Aboriginal and Torres Strait Islander people.

Although not the primary consultation group for the report, given its focus on the experiences of service providers and consumers, in the early stages and ahead of release, the Mind the Gap report was raised with several relevant government agencies including the National Disability Insurance Agency, with an invitation for initial consultation extended to the Board Chair.

The authors welcome ongoing debate on the provision of adequate support for people with psychosocial disability.

The Victorian Mind the Gap report:

In parallel with the national report, the University of Sydney research team and Community Mental Health Australia (CMHA) were commissioned by Mental Health Victoria (previously called VICSERV) and Salvos-connect Barwon to focus in upon the experiences of consumers, family members and services providers engaged with NDIS in the Victorian's Barwon trial site. While many of the issues are consistent with those identified in the national report, there are distinct differences. Of greatest note was the apparent greater proportion of state mental health budget that had and continues to be transitioned across to the NDIS and thus the greater services gaps for the majority of Victorians living with serious mental illness who are not eligible for the NDIS.

Funders: University of Sydney Policy Lab funding; Vicserv and Salvos Connect

The reports are available here: Mind The Gap

Utilising Coroner data to understand intentional and unintentional mental health related deaths in NSW

Project lead: Jen Smith-Merry, Research Assistant: Ivy Yen

The project uses Coronial data and aims to provide a qualitative analysis of both unintentional mental health related deaths and intentional deaths in NSW over a 10 year period from 2007-2016.
The aim is to create a set of data that will allow for the development of evidence-informed quality improvement for services engaging with people with mental ill-health.

Funder: NSW Mental Health Commission

The World Health Organisation, mental health and the Asia-Pacific Region

This project seeks to develop an understanding of international mental health policy in WHO’s Western Pacific and South-East Asian regions. The project looks at the actions that WHO takes to influence mental health policy development in these regions and the in-country factors which characterise effectiveness.

Project lead: Jen Smith-Merry
Collaborators: Carmen Huckel-Schneider and Jim Gillespie (Menzies Centre for Health Policy); Luis Salvador-Carulla (Centre for Mental Health, ANU).

Recently completed projects:

Recovery Narrative Project

Project leads: Jen Smith-Merry and Nicola Hancock. Research Fellow: Sarah Wayland.

Funder: Wentwest

This project developed narratives of recovery from people with severe and complex mental ill-health living in Western Sydney. The aim was to understand the recovery experiences of this group and develop practical resources for both mental health consumers and clinicians.

A copy of the consumer resource developed through the project What Recovery Means to Us: Understanding Real-Life Recovery is available here

Custody to Community (C2C): Transitioning people with mental ill-health from the criminal justice system to the community

Project leads: Jen Smith-Merry and Nicola Hancock. Research Assistant: Kirsty McKenzie. Project Partners: Paul Clenaghan (Sydney LHD Mental Health); Cecy Bradley (Mission Australia); John Downie (New Horizons); Trevor Perry (Justice Health).

Funder: New Horizons.

The Custody to Community Living (C2C) project was a community-derived project which aimed to address the frequent issues encountered by staff attempting to work with people with mental ill-health exiting correctional facilities and transitioning into the community within the Sydney Local Health District. The C2C intervention identified best-practice in transition support and attempted to implement this practice for people with mental ill-health transitioning from the criminal justice system into the Sydney Local Health District (LHD). For C2C participants the following were prioritised: in-reach where contact is made by community mental health prior to release, stable accommodation, that the individual has a GP, the individual is seen by community mental health within seven days of release and if an individual moves out of catchment referral is made to services in new region. Inclusion in Partners in Recovery (PIR) was also prioritised for all participants.

The final project report can be found here.

Recent publications in the Mental Health Workstream:

These three publications arise from the evaluation of the Partners in Recovery intervention for people with severe and complex mental ill-health in two regions in Western Sydney:

Hancock, N. Scanlan, J, Gillespie, J. Smith-Merry J. (2017, forthcoming) Partners in Recovery program evaluation: changes in unmet needs and recovery. Australian Health Review, In press, accepted April 2017.

Hancock, N. Smith-Merry, J, Gillespie, J Yen I (2017) Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs? Australian Health Review, 2017, 41, 566–572

Fernandez A, Gillespie J, Smith-Merry J, Feng X, Astell-Burt T, Maas C and Salvador-Carulla L (2016) The Integrated Mental Health Atlas of Western Sydney Local Health District: Gaps and Recommendations, Australian Health Review, 2016 41, 38–44.

These two publications arise from work led by CDRP Associate Damian Mellifont, examining anxiety disorders accommodations in the workplace:

Mellifont, D., J. Smith-Merry and J. Scanlan (2016) Pitching a Yerkes-Dodson Curve Ball? A study exploring enhanced workplace performance for individuals with anxiety disorders. Journal of Workplace Behavioural Health, 31(2), 71-86

Mellifont, D. J. Smith-Merry, J. Scanlan. (2016) Disabling Accommodation Barriers: A study exploring how to better accommodate government employees with anxiety disorders. WORK: A Journal of Prevention, Assessment, and Rehabilitation. 55(3), 549-564.

Publications and Enquiries

For publications and other information about Associate Professor Smith-Merry, please see the academic profile here

Associate Professor Smith-Merry also welcomes enquiries to her e-mail address jennifer.smith-merry@sydney.edu.au