The end of an era: Learnings, loss & legacy of the mental health program at Spiritual Health Association

A look back to where it began… as recalled by Ros Cairns, shared by Jenny Greenham

As SHA transitions into a new iteration of itself, and the mental health component of SHA completes its current cycle, Ros and I have been looking back over the mental health program and its evolution to see that it has been through many iterations, and dates back many more years than I had been previously aware.

Ros has provided a detailed account of Mental Healthcare Chaplaincy in the State of Victoria that dates to 1913 when the Superintendent of the Mont Park Psychiatric Hospital arranged for the appointment of 4 chaplains, representing the Anglican, Catholic, Methodist and Presbyterian traditions. This as Ros suggests was a revolutionary move for the times and became the catalyst for spiritual care to be an integral part of psychiatric services since the early part of the twentieth century in Victoria.

The fortunes of spiritual care continued to ebb and flow through the ensuing decades reaching a low point in the 1995 when the 11 full time government funded mental health chaplains received advise from the Department of Human Services (DHS) stating they were ‘now surplus to need.’

Moving forward from this setback a small amount of funding was secured to support three chaplains to evolve a community-based support program in line with the philosophy of deinstitutionalisation with an emphasis on the provision of education. The funding to support this work in 1996 came from the Office of Psychiatric Services under the auspice by ICCVI later to become HCCVI, SHV and eventually SHA.

Over time the three positions became one, and one-on-one community pastoral care gave way to a focus on education and advocacy to equip others with the skills and confidence to attend to spiritual needs. Ros emerged as the Manager of the Mental Healthcare Chaplaincy Program and for the next 18 years until retirement in 2014 devised an education program that evolved into a 5-day course titled, ‘Mental Health and Spirituality’, later becoming an accredited university subject at Australian Catholic University and Stirling, University of Divinity. Other innovations in the period under Ros’s stewardship included facilitating a bi-annual mental health and spirituality conference and submitting joint funding prospectuses for the reinstatement of some mental health pastoral positions back into specific health services and community agencies.

Musing from the last nine years… by Jenny Greenham

I have always known that when you create a safe space and give people permission to speak about spirituality, it becomes difficult to get another word in! This theory has played out time and again since I began in my role as Mental Health Leader at Spiritual Health Association in 2015. Over the last nine years I have engaged in conversation with people across the full spectrum of the mental health workforce and sector; be they consumers, carers, peer consultants, community workers, clinicians, academics, and even some departmental policy people; across all settings, be they education sessions, conference presentations, workshops, informal gatherings, or meetings; the outcome has always been the same – when offered space people respond to the opportunity to reflect upon and deepen their understanding of the relationship between spirituality, mental health and wellbeing.

Yet we have arrived here, the end of road, a road that felt innovative, responsive and in keeping with holistic healthcare ideals and principles. Somehow spirituality as a domain of mental health and wellbeing and spiritual care as a modality to support that expression has not been able to garner the support or investment needed to build upon the initiative and legacy that was seeded over 100 years ago in Victoria.  

When I entered the mental health workforce in the late 1980’s the shift away from institutions was occurring, and it felt like Victoria was taking the lead with a focus on holistic care dedicated to addressing recovery, yet at the same time established chaplaincy services did not translate into the community, as was the direct experience of Ros and her colleagues at the time. Any recognition that spirituality/spiritual care was a genuine part of mental health psychosocial support, closely related and very aligned to the emergent recovery model failed to gain traction.

The subsequent decades saw general investment in mental health care and services deteriorate to such a degree that a Royal Commission into Victoria’s Mental Health Services was set in place. In 2021 the findings recommended a system underpinned by the rights of consumers and the prioritisation of lived and living experience. By June of that year the Spiritual Health Lived Experience Advisory Committee (SHLEAC) was founded under the auspice of SHA to contribute to the reform process. Members of SHLEAC have given voice to how their spirituality has and continues to be a protective mechanism against mental health vulnerability. They have become accomplished spokespeople and ambassadors for spiritual care advocacy. The absence of ongoing funding to continue this work regrettably means lived experience and other narratives will no longer be heard in relation to spiritual health. Is it just me, or does it feel like the rhetoric around lived experience being central to systems change somehow doesn’t apply to the integration of the spirituality in mental health care? Sadly, the Royal Commission has felt like a missed opportunity for innovative, person centred and true holistic reform, inclusive of the spiritual domain that could have built upon the long history and legacy in this space in Victoria.

In my last weeks at SHA, I had the privilege to facilitate a reflective practice space for mental health clinicians that explores issues of spirituality & diversity in their workplaces. This program is the product of a very rewarding 7-year association with our valued colleagues at Victorian Transcultural Mental Health service. The last session focused on the highly relevant topic, Moral Stress: A part of your working landscape? No less rich than every other topic we have engaged with over the years, we heard how mental health clinicians are just beginning to find the language to describe their experiences of value clashes, the unease felt when attempting to speak up about transgressions, and the heaviness and cumulative toll that surrounds these experiences. Moral stress is very real in our healthcare populations and will impact workforces detrimentally if not addressed. Investment in spiritual health education and spiritual care of our mental health sector colleagues is fundamental. The loss of funding to SHA’s mental health program comes ironically at a time when nurturing a spiritual literacy appears to be the call, if the enthusiastic and thoughtful engagement in this recent professional development session is anything to go by.

It is not easy stepping away from a role when you absolutely know in your heart that the work has been so valued by so many. The fact that there is an agency such as SHA in existence at all was a great curiosity for many people I met along the way, let alone it having a mental health program. This was not only of great comfort for many, but also regarded as so progressive. If I had a dollar for all the conversations, I have had over the last nine years about that alone, we may still be in business! 

As I prepare to pack up my desk to move onto the next chapter, the highlight of this role has undoubtably been the connections made. I have loved working with the various networks I have been entrusted with, and the opportunity to affirm individual practice and innate wisdom whilst encouraging people to find their voice, stand in their authority and shine brightly. It has been an immense privilege to work in this space, to connect with and understand the world through many different lenses. Thank you for your collegiality, inspiration, humour and support.

Let us hope the wheel of evolution turns again in favour of compassionate person-centred care and we witness a renaissance and further advance of work in this space.

Jenny Greenham, June 2024