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Mental health services in Western Sydney are undergoing a radical transformation, thanks to the work of Consultant Psychiatrist, Professor Vlasios Brakoulias, who has taken on a large part of the project.
The professor, who specialises in obsessive-compulsive and related disorders, is overhauling models of care for the 175 services under his remit, ranging from acute, to youth, and community mental health.
However, it is his work in changing attitudes and motivating teams that has made the biggest impact on outcomes, he said.
Encouraging participation
“When we looked at the redevelopment, it wasn’t just about new structures. It was about getting everybody on board,” said Prof Brakoulias, ahead of the Mental Health Models & Facilities Forum in July.
“I worked with teams to explain, you are the ones making decisions, so the new models of care should come from you – not from some academic centre of excellence.”
Nobody was excluded, with input invited from project managers, architects, nursing staff and the full gamut of mental health professionals across the Western Sydney local health district (LHD).
“This was to ensure we were making decisions that made sense from all angles. There was no use introducing something that was good from an architectural point of view, but not so good from a clinical one. We wanted to ensure better healthcare for our patients and, at the same time, a good environment for staff.”
However, securing this participation wasn’t easy, with staff already stretched and working long hours to deliver care for more than 1 million local residents.
“In that health service, everyone is busy – especially during COVID which is when much of the redevelopment took place. So it was a constant effort to ensure we had everyone participating and that there was representation from all key disciplines. I, myself, also worked in a clinical role during this time.”
Despite the challenges, Prof Brakoulias did not tire on his quest, knowing that he wanted his team’s heart in the transformation.
“I didn’t want to impose change on people, based on ideas I thought were good – but rather to involve them in the upgrade. I wanted everyone’s stamp on it and for them to be personally invested.”
His effort paid off, with teams showing enthusiasm about the change and contributing ideas that went on to be built into the facility.
“People gave valuable opinions and were proud and happy to see that their ideas had been translated into the design,” he said.
Consumers were also involved
The co-design process extended to consumers, who gave valuable perspectives on how they wanted to receive care.
Thanks to one consumer suggestion, a transition room was introduced into the facility.
“Consumers fed back to us that it was quite daunting entering a psychiatric facility for the first time – it could be quite overwhelming, with loud noises and erratic behaviours. A transition room is a place to brief people before entering, settle their anxiety and prepare them for what to expect.”
Consumer feedback also aided the physical design and led to the abolishment of pillars, after one consumer highlighted the potential for patients to hide behind them and potentially harm nursing staff.
Training was essential
Although many of the new design features came from staff, Prof Brakoulias recognised the need to deliver LHD-wide training with the redevelopment.
“The mental health service is a big area and there were new models of care introduced in each unit – which translates to a lot of change across the board. It was really important to refresh everyone’s education for this upgrade.”
The training explored the semantics of care models and conveyed the importance of looking beyond bureaucratic language. “This was to ensure our training was more than a tick-box exercise,” Brakoulias said.
However, a more major focus was trauma informed care, given its influence on new care models.
“People who have experienced trauma tend to relate to people differently and have an enhanced need for things like trust, autonomy and safety. This was woven into our new care models, where we allow consumers to make decisions around where their personal belongings are kept and the circumstances around their medication and discharge.”
Equally, the training has been valuable for staff, many of whom have experienced trauma in the course of their work.
“Ensuring all staff feel safe is a very important part of the equation. Many people providing care have been subject to assaults on inpatient units – so we needed to take that into consideration.”
Further insight
Sharing more about his method, Prof Brakoulias will present at the Mental Health Models & Facilities Forum in July.
This year’s event will be held on 25 July at the Crown Promenade Melbourne, and is co-located with the Medicinal Psychedelics Conference.
Learn more and register your place here.
About Prof Brakoulias
Prof Vlasios Brakoulias is affiliated with the Faculty of Medicine and Health at The University of Sydney and heads a novel service within Western Sydney Local Health District that aims to comprehensively assess and optimise treatment for patients living with obsessive-compulsive and related disorders. He is also pioneering research into the prevention and early intervention of these disorders.
Brakoulias oversaw recent redevelopments within the LHD’s mental health service, which consists of 157 services and caters for more than 1 million people. More redevelopment is being planned in the coming years.
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