ACTivate Arts Therapy speaks with the Royal Commission into Victoria’s Mental Health System

Today, Dr Alisoun Neville AThR, Caroline Liuzzi (EO Creative Art Therapy Australia) and I met with representatives of the Royal Commission into Victoria’s Mental Health System. We were met warmly, and informed that we did not need to convince our audience of the value of Arts Therapy, they hold our profession in high regard.

They want to use our submissions and made it clear that they appreciate all the work we have put into giving them what they need. They thanked us for drawing attention to the problems excluding Arts Therapists from working in positions such as the Mental Health Practitioner in Schools roles. We spoke at length about diversifying the workforce and the value that Arts Therapists bring to multi-disciplinary teams. And we spoke about the many possible policy and funding levers to elevate the status of Arts Therapy and increase access.

Here is our submission:

ACTivate Arts Therapy

Submission to the Royal Commission into Victoria’s Mental Health System

19th September 2020

We, Dr Carla van Laar AThR and Dr Alisoun Neville AThR, write in our capacity as representatives and lead organisers of the “ACTivate Arts Therapy” grass roots collective. The other lead organisers are Alana Stewart AThR, Angus Donald (veteran advocate) and Donika Fazilou BAT. We are a collective of 300 Arts Therapists and allies who are service users of Arts Therapy, their friends, family and carers, and our colleagues in Health, Allied Health and Education. With over 4500 supporters who have written testimonials, and campaign collaborators Australian National Veterans Art Museum (ANVAM) and Creative Art Therapy Australia (CATA), we are lobbying the Victorian Government to make legislative changes that will see Master’s qualified Arts Therapists mobilised to help with the current Victorian mental health crisis.

The campaign began when numbers of experienced and well qualified Arts Therapists were told they could not apply for the new ‘Mental Health Practitioner in Schools’ positions because their profession is not listed in the 2014 Victorian Mental Health Act. Those listed in the act include Psychologists, Social Workers, Occupational Therapists and Registered Nurses.

The legislation is outdated and is preventing us from helping the community in this time of greatest need. Arts Therapists are highly trained Mental Health Practitioners with Master’s level Government approved qualifications, and many Arts Therapists already work in mental health and education settings. We are imploring the State Government to change the legislation to reflect the reality and mobilise a work force who are trained and ready to go.

We wrote to the Victorian Minister for Mental Health on 22 July 2020 seeking advice about expanding the definition of Mental Health Practitioner in the 2014 Victorian Mental Health Act to include Professional Arts Therapists. We drew his attention to Arts Therapists as an untapped workforce of Mental Health Practitioners who are trained, ready and willing to support the community during this COVID-19 crisis and beyond.

Since we first wrote to The Hon Martin Foley, over four and a half thousand people who are Arts Therapists, service users of Arts Therapy, their family, friends and carers, Allied Health and Education professionals, have joined the collective and written testimonials.

We subsequently met with Kate Grieve as Advisor to Minister Foley and were encouraged to make this submission to your inquiry to ensure consideration of this legislative change. We were also encouraged to write to the Minister for Education to encourage a broadening of eligibility for the Mental Health Practitioners in Schools positions beyond the definition in the Mental Health Act and will be sending this letter today.

In addition to supporting young people and the broader community through the mental health impacts of COVID-19 and an anticipated economic recession, expanding access to publicly funded arts therapy can contribute to increased social and economic participation across the life span. This includes arts therapists themselves who, without recognition through local legislation and funding schemes, are often under-utilized and/or operating as sole traders whose livelihoods have now been further impacted by the Stage 4 restrictions in Victoria.

About Arts Therapy

Arts Therapists work flexibly across a spectrum of responses to Mental Health, including arts engagement for well-being, health promotion activities, prevention, treatment, acute care and recovery. One of the well-known strengths of Arts Therapy is its capacity to connect with people in ways that go beyond words. Engaging through Art is often more accessible and culturally sensitive than the Western medical model of talking through problems. Engaging in the Arts actually empowers people to develop skills that help them to cope with the challenges of life, like strengthened relationships, connection with community, self-efficacy and hope.

Arts Therapists can work in non-clinical settings including community and outdoor environments. We are experienced in working with groups of people, not just individuals. In these ways, Arts Therapy contributes to the health and well-being of whole communities, through engaging and connecting people in shared, enlivening and meaningful creative endeavours.

Dr van Laar has been an Arts Therapist and Arts Therapy educator for the past 20 years. She says, “Arts Therapists are holistic and adaptable mental health practitioners, many of whom have come to the profession through our own lived experiences of life challenges including grief and loss, trauma, and mental distress. We each have our own lived experiences of how the arts have supported our own well-being, care, healing and recovery. It is through this first-hand understanding that we connect and engage with others who are going through their own struggles. We value self-efficacy and choice for the people we work with, and we are passionate about facilitating opportunities for people to have voices, to be seen and heard, and exercise agency when it comes to managing their own mental health care”.

For example, in an interview earlier this year, Aboriginal Arts Therapist Marnie Weule noted that: “One of the things I love most about art therapy is the self-determining nature the process provides and the relationship between the art, materials and person, and how these are able to support the therapeutic work. For me, this is culturally sound practice.”

Arts Therapists are expert practitioners informed by trauma-informed approaches. We understand that talking about trauma is often not helpful for healing, or even possible. When we work with people through the arts, we engage in somatic, sensory and embodied mindfulness and present moment practices that are soothing, calming and assist with developing skills in emotional regulation. Creative expression through art-based practices can enable safe ways of communicating and processing emotions that might be too complex to verbalise. We work in relational ways, valuing and centralising safety, real connection, empathy and understanding. Our practice is informed by ancient wisdom traditions, and very contemporary evidence emerging from relational and somatic neuroscience, including the role of the vagus nerve in emotional regulation and the impacts of trauma.

The World Health Organisation (WHO) has confirmed the effectiveness of the arts and arts therapies for helping people experiencing mental illness at all stages of the life course, and has reported studies suggesting good cost–effectiveness. A core strength of arts therapy is that it responds to the needs of each person rather than a one-size-fits-all approach. The WHO Report finds specifically that the beneficial impacts of arts therapy could be furthered through better acknowledging and acting on the growing evidence base (WHO Health Evidence Network Synthesis Report 2019).

Preliminary research suggests that Victoria is behind other jurisdictions, including but not limited to the Commonwealth through the National Disability Insurance Scheme (NDIS), in its recognition of both Arts and Music Therapy. Professional Arts Therapists are trained to Master’s level and utilise visual arts, dance, movement, drama, music, poetry, digital and other creative forms in their work. They are professional members of the Australian New Zealand and Asian Creative Arts Therapies Association (ANZACATA) and, through this, Allied Health Professions Australia (AHPA).

While our campaign focuses on recognition of Professional Arts Therapists, we endorse the submission made by Australian Music Therapy Association. In relation to our own profession, we use the term “arts” as inclusive of all of the arts.

Campaign Supporters

As a collective of Victorian Arts Therapists, we consulted our national professional association, ANZACATA, and formalised this initiative as a Victorian member led campaign. This includes a campaign website in which 17 local Arts Therapists talk about their experience working in mental health contexts, the unique potentials of Arts Therapy, and why this campaign is so important.

Those who have signed on to the campaign include many people with lived experience providing moving testimonials about why they have signed the petition and their first-hand experience of the benefits of Arts Therapy. This includes Debbie (Victorian School Teacher and lived experience advocate for Arts Therapy), who has shared her story publicly in the hope that young people today can access this form of help much earlier.

We have secured formal statements of support from Professor Patrick McGorry AO, (Professor of Youth Mental Health at the University of Melbourne and Director of Orygen Youth Health Research Centre), Dayne Beams (AFL Footballer and lived experience advocate for Arts Therapy), Mark Watt AM (CEO-Big Brothers Big Sisters).

Professor McGorry’s statement notes that: “For many people struggling with their mental health, Arts Therapy provides opportunities for help-seeking and engagement that offer something different to traditional talking therapies. It is a mental health promotion activity as well as a therapeutic exercise.”

We are also supported by Jill Gallagher AO, (CEO of the Victorian Aboriginal Community Controlled Health Organisation, VACCHO, and former Treaty Advancement Commissioner), and Antoinette Braybook, (CEO of Djirra), encouraging access to art therapy by Aboriginal and Torres Strait Islander communities.

Ms Braybrook reports: “In 2019 Djirra engaged an arts therapist to work with our women who were caught up in the justice system, in recognition of the complex sources and impacts of trauma on Aboriginal victim/survivors of family violence. This strategy was successful, offering something very meaningful to women who find it difficult to trust mainstream approaches after years of racist and discriminatory experiences in the broader service system.”

Ms Gallagher has given verbal confirmation of her support for the campaign and our submission to the Commission, in recognition that arts therapy can be more culturally appropriate and accessible for many Aboriginal and Torres Strait Islander people. She is working on a formal statement which will be provided to the Commission as soon as it is available.

Ann Soo Lawrence AThR has run Arts Therapy groups through Foundation House Sunshine, for the past two years. In her statement, she says “For many in this client population, the concept of mental health was unfamiliar and largely dependent on their cultural frame of reference. Therefore, talking about mental health and engaging clients with its importance required a different kind of ‘language’… Where participants could not find the words, mark making, collage and creating a vision boards, engaged them in making and building their story through the felt sense and in construction of their trauma and torture histories. These creations became a springboard to each participant telling their story firstly, with their hands and then, with their voices”.

Ms Lawrence highlights how it was through these powerful processes that mental health was supported, explored, storied and de-mystified. Ms Lawrence’ statement provides evidence of the use of arts therapies in migrant and refugee communities, with regard to cultural relevance of the arts in healing and the potential benefits for community members for whom communicating verbally in English may not always be adequate or appropriate. Prof. McGorry likewise notes the important work being done by Arts Therapists “in refugee mental health and it is time to expand access to this support”.

We have data and testimonials from professional arts therapists already working in schools, offering crucial services which are not always accessible to the young people who most need them. For example, as Dr. Neville says of her work at Doveton College: “I am in partnership with the school to support on-site access to art therapy for children with disability through an NDIS registered provider. I am often asked how other children can access me. It always saddens me to answer this, as the financial reality of many of these families is such that, without access to NDIS funding, arts therapy is simply out of their reach.”

Mental Health Workforce Pressures

There is much information in the media about the devastating impacts of COVID-19 on the mental health of young people, including alarming increases in self-harm and suicide and the inability of the current system to meet this growing need. For example, a recent study on mental health during COVID-19 conducted by the Commission for Children and Young People has found that:

• A significant number of children and young people reported inadequate access to mental health services, including the unavailability of programs, long wait lists and the lack of services tailored to young people;
• Most children and young people felt the pandemic had a negative impact on their mental health and wellbeing; and
• Some young people reported that the pandemic exacerbated their existing mental health issues.

This report also noted additional and potentially disproportionate mental health impacts on specific communities, including in particular young people from African-Australian communities and Aboriginal young people, who are affected by international events associated with the Black Lives Matter Movement, and who have reported feeling targeted and harassed by police in the enforcement of lockdown restrictions.

The Royal Commission interim report agrees that mental health demand has overtaken capacity, and that the system cannot keep up with the number of people who need treatment, care and support. There are serious workforce shortages and the system is driven by crisis, leading to risk-averse models of care and inadequate access to early therapeutic and psychosocial supports.

Following the Victorian State Government’s most recent announcements of additional funds to schools and a $59.7 million investment in mental health more broadly, the existing pressures on the workforce can only increase.

The Victorian State Government’s Mental Health Practitioners in Schools Initiative Information for Schools FAQ sheet also states “there are known workforce supply shortages in the mental health sector”. And yet Professional Arts Therapists are unable to help fill important roles such as the Mental Health Practitioner in Schools positions. We have also heard of Arts Therapists being rejected from new Employee Assistance Program (EAP) roles to support frontline workers, because of the lack of understanding of our mental health expertise, as reflected in the current definitions under the Act.

This occurs in the midst of “a surge in Victorians presenting with depression and anxiety amidst the second wave, including a 33% increase in young people presenting to emergency departments for intentional self-harm over the past six weeks, relative to the same time in 2019” (Crikey 10 August 2020; ABC News 8 August 2020).

As Professor McGorry states: “Arts Therapists can play a role in the new Mental Health Practitioner in Schools program. It is a lateral solution to a very real need. They are essential allies in the Mental Health workforce and have the skills and training to address this major threat to mental health in our community.” 

Prior to COVID-19, the interim report recognises that young people were already adversely affected by mental health and that there is a compelling case for greater investment in and attention to the mental health of children and young people.

Kate Grieve, Advisor on Mental Health to Minister Foley, mentioned in our recent meeting that mental health workforce pressures for Victorian Aboriginal communities are also a key concern. This is consistent with another of the identified themes in the interim report, which notes the impacts of colonisation, post-invasion government activity and other additional factors on the mental health of Aboriginal communities, and acknowledges clearly that access to services is not egalitarian.

The interim report recognises that “the close relationship between trauma and mental illness and the need for trauma-informed and mental health treatment care and support are starting to be recognised, but there is much work to be done.” Moreover, “a failing system can itself be the source of trauma.”

Acknowledging your commitment to both support and expand the lived experience workforce, which we support in full, your other recommendations to expand the workforce are currently narrow, with a focus on funded graduate positions, postgraduate scholarships, psychiatry rotations and overseas recruitment in the four professions already recognised under the Act, without an explicit consideration of expanding the list of professions itself. Our recommendations below formally request urgent reconsideration that will enable Arts Therapists who are already trained to better support the community in this time of need.

As noted above, the NDIS sets a strong precedent for a more inclusive list of allied health practitioners, with parallel requirements and oversight of professional qualifications, membership of relevant professional associations and other safeguards to ensure ongoing quality practice. Both Arts and Music Therapists are included on this list.

As a person with lived experience herself, Dr. Neville emphasises the need to break down more of the professional hierarchies that serve to undervalue practitioners with lived experience. The ACTivate Arts Therapy collective supports this position. For example, there are significant barriers to public self-disclosures, and a real need for mentors, public role models and meaningful career pathways to those of us whose knowledge of ‘what works’ is informed by our own lives and mental health experiences. This must include targeted support and pathways for people seeking careers in arts therapy who are informed by diverse cultural perspectives and understandings. We strongly believe in the potential of the Arts and creative expression to support the voices of people who may otherwise be silenced and marginalised by the broader service systems.

Recommendations

We urge the Royal Commission to prioritise the inclusion of Arts Therapists as essential allies in Victoria’s mental health system in the following ways:

• Include ‘Professional Arts Therapists’ in the definition of ‘Mental Health Practitioner’ in the Victorian Mental Health Act 2014.

• Expand public access to Arts Therapy by ensuring new positions are open to Arts Therapists in publicly funded mental health services and initiatives, including specifically the Mental Health Practitioners in Schools Program.

• Enable access by Arts Therapists and Art Therapy organisations to Victorian Government funded mental health resources.