1 IPC Health response to Inquiry in Perinatal Services July 2017 For more information contact: Jayne Nelson Chief Strategy, Business Development and Communications

Response to Inquiry in Perinatal Services

Background: The health, care and wellbeing of mothers and babies in Victoria during the perinatal period is being examined by the Family and Community Development Committee, which is inviting community input to its inquiry into perinatal services. The economic and social impact of mental health and wellbeing is well documented in regards to the perinatal period from preconception to kindergarten, which is a critical time for mothers, fathers, their infants, families and wider communities. Maternal emotional health, such as postnatal depression, can have profound effects on all. Maternal health issues can be prevented and treated through early detection, effective treatment and holistic care. About IPC Health: IPC Health is a community health service operating across six sites in the Western Suburbs of Melbourne. The population of the Local Government Areas in which IPC Health operates is growing rapidly. We know our communities have numerous health needs, some of them complex, but all are addressable by delivering services close to home, in a culturally relevant way, and that keep people out of hospital or acute care. IPC Health aims to make the highest quality primary health care accessible to all who need it. Response to inquiry topics: IPC Health welcomes the opportunity to provide input and feedback for the following challenges and issues being considered regarding perinatal services: Availability, quality and safety of health services delivered to mothers and babies:

Most specialist support for mothers and babies is hospital based and this limits access especially for new and emerging communities - both culturally but also geographically due to transport and infrastructure;

There needs to be more flexible delivery models of mental wellbeing support including community based, cognitive behaviour therapy based work in groups, referral pathways to other health support services, and access to interpreters;

Education in pre-pregnancy is not currently tailored to the cultural setting for new migrant families (lack of broader social and family supports, role of fathers in pregnancy and parenthood is different). Understanding and navigation of the health service system an issue for new migrant families and this needs to be considered and strategies put in place.

Impact that the loss of Commonwealth funding will have:

The Commonwealth funding loss has further reduced the resources available to support access to specialist skills and expertise for women and families facing perinatal depression. This puts an additional burden on state funded services and means the services are not always reaching those most in need;

IPC Health welcomes greater investment in primary mental health from the Commonwealth Government through a shift in focus from acute mental illness to investing in regionally tailored prevention and stepped care funding available to Primary Health Networks. There is a risk however that the broader needs and prevalence of mental ill health may result in the specific needs for perinatal services to be lost and a lack of investment in the skills and coordination needed for mothers and families.

2 IPC Health response to Inquiry in Perinatal Services July 2017 For more information contact: Jayne Nelson Chief Strategy, Business Development and Communications

Access to and provision of an appropriately qualified workforce:

Incidence of impact of depression is significant, particularly in the Western suburbs of Melbourne given socio economic disadvantage and financial pressures;

Perinatal depression can be isolating in itself but in the context of new and emerging migrant communities living within Western Suburbs with limited transport and service system infrastructure the impact is far more significant on the individual, the child and the family (ref: news piece http://www.theage.com.au/victoria/when-mums-kill-charge-of-infanticide-an-offence-that-divides-the-community-20170530-gwgah7.html)

People on student visas do not get any funding assistance for ante natal care or birthing support services. These people need to have private health insurance or pay out of pocket expenses eg one of IPC Health’s Healthy Mothers Healthy Babies (HMHB) clients was faced with having to pay $30,000 for ante natal and birthing costs in Victoria. Our HMHB case worker advocated for these fees to be reduced and also applied to Cabrini Hospital philanthropic fund for financial assistance;

Access to community based services is absolutely essential. Care delivered locally can ensure that other health supports and linkages are quickly established including social support groups and other health needs which impact positively on mental health and wellbeing;

Support for community based psychological counsellors , GPs, and practice nurses and Maternal Child Health Nurses to upskill on evidence based practice including:

o Evidence based guidelines to inform practice e.g. Beyond Blue Perinatal Practice Guidelines

o Woman-centred communication skills o Utilisation of the Edinburgh Postnatal Depression Scale as a tool

Disparity in outcomes between rural, regional and metropolitan locations:

The Western suburbs of Melbourne have unique population and demographic characteristics that need special consideration in regards to mental health, wellbeing and perinatal services (see Attachment 1);

Hobsons Bay has a high child mortality rate (1-4years) driven by low birth weights and highly avoidable hospitalisations.

More maternal emotional counselling is needed in the Western Suburbs of Melbourne;

Evidence suggests people from South Asia are prone to still births and the high population of South Asian people living in the Western Suburbs of Melbourne means a potential higher risk of still birth which adds further complexity;

There needs to be recognition of the growing population needs and delivery of flexible models of mental and other health care.

Communities should have access to tailored resources especially where language barriers may exist;

The current perinatal system is oriented to centre based services mostly targeted at acute illness, not meeting needs of many families. Delays regarding care, support, and education increases complexity and the financial burden to the Victorian health system.

IPC Health is focused on improving and promoting community health and addresses a full range of community health conditions most prominently contributing to health burden in Melbourne’s West and acknowledges the need to be at the forefront of health promotion in areas such as mental health and wellbeing, family violence prevention, physical inactivity, gambling prevention and alcohol and drug consumption.

3 IPC Health response to Inquiry in Perinatal Services July 2017 For more information contact: Jayne Nelson Chief Strategy, Business Development and Communications

Attachment 1: Local Government Area Health Profiles – Western Melbourne

Brimbank

Hobsons Bay

Wyndham

Melton

Low English Proficiency

Percentage of residents born outside Australia

50% 32% 34% 27.8%

Largest groups with limited English

Vietnamese, Maltese, Italian,

Greek, Macedonian, Fillipino, Cantonese,

Arabic

Karen, Vietnamese, Cantonese, Mandarin

Italian, Mandarin, Hindi, Karen,

Maltese, Italian, Macedonian, Vietnamese

Aging population

Growing population Slowing growth Dominant age is 25

– 29 years Largest increase by 2026 will be the 70

– 74 age group

16.3% growth for under 17s

28.5% growth for over 60s

Largest service group in 2026 is

Parents and Homebuilders

Exponential growth over 200 new

residents/ week including 12 babies /

day 101% growth for under

17s 117% growth for over

60s Largest service group in 2026 is Parents and

Homebuilders

Large Aboriginal and TI population

Low intake of fresh fruit & veg

Physical inactivity

High levels of Obesity

High levels of socio-economic disadvantage

Laverton, Altona North, Brooklyn, Altona Meadows

High level of unemployment

Commuting more than 2 hours per day

Food Insecurity

Excessive alcohol consumption

High level gambling

High levels smoking adults

High levels smoking young people

High levels of housing stress

High levels of psychological stress

Rising recorded incidence of family violence

Higher than average rates of hospitalisation

4 IPC Health response to Inquiry in Perinatal Services July 2017 For more information contact: Jayne Nelson Chief Strategy, Business Development and Communications

LGA Health Profiles continued

Brimbank

Hobsons Bay

Wyndham

Melton

Most common cause for hospitalisation in children

Asthma Asthma Asthma Asthma

Most common cause for hospitalisation in young people

Chronic tonsillitis Treatment for abnormal growth

Chronic tonsillitis Acute appendicitis

Most common cause for hospitalisation in adults

Diabetes Diabetes Diabetes

Child mortality

Child and maternal health

Child decayed and missing teeth

Children are developmentally vulnerable

Adolescent wellbeing issues

Adolescent smoking

Low high school retention rates

High teenage pregnancies

Need to improve sexual and reproductive health

Older residents on very low incomes

Premature mortality

Most common cause for premature mortality

Diabetes Bowel cancer, breast cancer, heart disease,

diabetes

Lung cancer, COPD

Dental health issues

Shortage of GPs