Booklet by Ben Allen

BETWEEN

How do we create a community centric city to challenge the access and stigma issues that currently face mental health services?

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E X E C U TI V E S U M M A RY This summary forms part of a draft research proposal for Redfern with a focus on 107 Projects and the Redfern Medical Service. The proposal is undertaken in the social agency studio stream for final year M.Arch students at UNSW.

The issue of leadership and stakeholder responsibility is a particularly interesting one. This project will argue that the current governance structures are inadequate in an interconnected era and that control of developments need not exclude the public.

This project is concerned with the creation of free, civic and green space that integrates mental health services. The goal of this study is to develop a framework, both built and digital to create deep ties between the mental health service and the community and to foster an integrated community approach to mental health that rejects stigma and promotes access and acceptance. In addition to the construction of communal interventions for strengthening ties the project also seeks to align the site with a host of measures designed to improve the resilience of Redfern such as green corridors, building a supply of energy and food and creating strong networks and leadership positions.

RESEARCH QUESTION

Why?

CIT Y RESILIENCE FRAMEWORK

Health & Wellbeing

CIT Y RESILIENCE FRAMEWORK

Economy & Society

EDITORIAL SECTION

Infrastructure & Environment

CIT Y RESILIENCE FRAMEWORK

Leadership & Stakeholders

H O W D O W E C R E AT E A COMMUNIT Y CENTRIC CIT Y TO CHALLENGE THE ACCESS AN D STIG MA I S S U E S T H AT C U R R E N T LY FA C E M E N TA L H E A LT H S E RVI C E S ?

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The health & wellbeing of everyone living and working in the city.

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Clark, R. E. 2001. “Family Support And Substance Use Outcomes For Persons With Mental Illness And Substance Use Disorders”. Schizophrenia Bulletin 27 (1): 93-101. doi:10.1093/ oxfordjournals.schbul.a006862. Vázquez-Bourgon, Salvador-Carulla, & Vázquez-Barquer 2012 PHN Central and Eastern Sydney. 2016. CESPHN Mental Health And Suicide Prevention Needs Assessment - April 2016. Ashfield, NSW: PHN Central and Eastern Sydney.

M E N TA L H E A LT H & S U B S TA N C E A B U S E Substance abuse is a common problem among people with Serious Mental Illness. Lifetime prevalence of substance use disorders for those with schizophrenia is approximately 50 percent (Regier et al. 1990). Alcohol and other drugs are associated with a wide range of negative outcomes, including increased hospitalization (Kivlahan et al. 1991), higher treatment costs (Dickey and Azeni 1996), poor treatment compliance (Owen et al. 1996), higher rates of arrest and violence (Stedman et al. 1998; Clark et al. 1999), victimization (Mueser et al. 1998), homelessness (Caton et al. 1994, 1995), and increased risk of HTV infection (Cournos et al.

potential and servicability. At a most basic level, substantial unmet need for care prevails, and about 40%–50% of persons with schizophrenia do not receive any treatment in a given year. The philosophy of mental health care reform has been built on key principles of community psychiatry, with four linked areas of action; i) deinstitutionalisation and the end of the old model of incarceration in mental hospitals; ii) development of alternative community services and programs; iii) integration with other health services; and iv) integration with social and community services.

The treatment methodology for and practices for treating serious mental disorders has progressed remarkably over the last two decades. However, science to service integration has not kept up with the scientific progress. As such, there is a gap between treatment

Left, Top 50% of Australians will experience a Mental Health Issue. Left, Bottom 51% of people with a mental health problem will not seek treatment. Leading to a higher risk of the condition worsening. Opposite, Bottom Bliciissin Doluptatem Unititled 2015 Oil on Canvas 1234 x 4321cm

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21,407 PEOPLE IN THE CITY OF SYDNEY ANNUALLY IN 2016

STATE SPECIALIST MENTAL HEALTH

8,394 PEOPLE IN THE CITY OF SYDNEY ANNUALLY IN 2016

20%

COMMONWEALTH SPECIALIST MENTAL HEALTH

51%

12,970 PEOPLE IN THE CITY OF SYDNEY ANNUALLY BY 2036

NOT TREATED

OTHER HEALTH SERVICES

15%

33,075 PEOPLE IN THE CITY OF SYDNEY ANNUALLY BY 2036

6,292 PEOPLE IN THE CITY OF SYDNEY ANNUALLY IN 2016

GP SERVICE

9,727 PEOPLE IN THE CITY OF SYDNEY ANNUALLY BY 2036

DEPARTMENT OF VETERAN AFFAIRS MENTAL HEALTH SERVICE

PHN Central and Eastern Sydney. 2016. CESPHN Mental Health And Suicide Prevention Needs Assessment April 2016. Ashfield, NSW: PHN Central and Eastern Sydney.

T H E P R E VA L E N C E O F M E N TA L H E A LT H ISSU ES IN AUSTR ALIA 16.8% of the adult population and 13.9% of the children experience mental health every year. Over a lifetime, nearly half of all Australian’s with experience mental illness at some point. Mental health is ubiqutious. Based on the national data, it is estimated that close to 280,000 people in the Central and Eastern Sydney region, aged four to 85 years of age experience mental illness (including substance use disorders) in the CES region. Based on national prevalence studies, nearly three-quarters (74.4%) of these are adults of working age (15 to 64 years), 15.4% are children aged 0 to 14 years, and the remaining 10.2% are older adults aged 65 years or more. In 2011–2012 there were approximately 53,000 people living in the CESPHN region with severe disorders, 78,600 with moderate disorders, and 156,000 with mild disorders.

An estimated 9,000 premature deaths occur nationally among people with a severe mental illness each year and the gap in life expectancy for people with psychosis compared to the general population is estimated to be between 14 and 23 years. Around 80% of this higher mortality rate can be attributed to the much higher rates of physical illnesses. People with mental illnesses have high rates of comorbidities – that is, people with mental illnesses have higher rates of high blood pressure, some cancers, obesity and diabetes, respiratory illnesses and musculoskeletal system diseases. Chronic illnesses bring about a higher chance of the individual developing a mental illness. The pattern is reciprocal poor health be it mental or physical can increase your likelihood of developing the other.

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Opposite, top Traditional Treatment Model Dr. Evans Opposite, Bottom Recovery Oriented System of Care Dr. Evans

C A S E S T U DY P H I L A D E L P H I A’ S D E PA R T M E N T O F B E H AV I O R A L H E A LT H AN D INTELLEC TUAL D I SA B I LIT Y S E RVI C E S Arthur Evans Jr., PhD became the head of the Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services in 2004. Dr Evan’s envisioned a system “that focuses on recovery for adults, resilience for children and self-determination for all people who access intellectual disability services.“ This recovery-oriented model responds to the individual client rather than working within a predetermined framework.

Whilst the Recovery Orientated System of care places people at the centre of the system. The model integrates treatment & rehab as a singular piece of a larger puzzle that is focused around a whole person recovery rather than just treating or correcting a mental condition temporarily. The philosophy of mental health care reform has been built on key principles of community psychiatry, mentioned above. Contemporary psychaitry is enaging with a community centred model.

The mental health system is passive, it waits for problems to come to it. It is acute care, and creates a cyclical problem where individuals are given a one size fits all treatment and then expected to leave the treatment facility ‘recovered’ and integrate into the community.

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ALMOST 80% OF THE COST IN THE TOP 5%

PRE-EMPTIVE MEASURES HERE PREVENT PEOPLE NEED MORE SIGNIFICANT CARE LATER.

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COMMUNIT Y APPROACH E S RE D U CE COSTS BY PREVENTIN G MORE SEVERE CASES FROM OCCURING . Community Coalitions with community, business, education and engagement services reaching a host of formelrly unreachable people, prevents people coming during the treatment stage and allows for a preemptive connection. By providing holistic approaches to health improvement and by improving the social outlooks for the individuals by providing affordable care or housing a number of the stressors that lead to poor health are reduced. Economic support and care has a significant outcome on the patients health. Clark produced a study of people with a serious mental health issue and their progress over three years. He concluded that ‘Assistance in securing basic necessities, primarily through in-kind contributions, may have a greater impact

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on substance use than does nonpecuniary help from family and friends. The implication is that clients with dual disorders can address substance use problems more effectively when their basic economic needs are met.

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The social & financial institutions that enable urban populations to live peacefully, and collectively.

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BRIDGING THE S PA C E B E T W E E N T O C R E AT E 2 4 H O U R SOCIAL PEDESTRIAN WA L K WAY S L E V E R A G E C O M M U N I T Y, C U LT U R A L AND BUSINESS E N G A G E M E N T. Creating a 24 hour safe place that bridges the existing 107 projects roof space creates a culturallty inclusive and connected space that does not restrict public access via the over pass and allows for continuous activation. Sitting amongst the current addition to the Redfern Medical Centre and the future (theoretical) addition to the Aboriginal Medical Centre is a garden with a light weight scaffolding structure that allows for varied density and programmatic distribution relative to the current needs.

T H E 1 :1 P R O P O S A L The proposed structure is community run, the structure holds a mixed tenure of established businesses and creative enterprises. Each established business pays a market rent, which is then used to subsidise overhead costs for the start ups, creative industries and fledgling business. Established companies benefit through skill sharing, community engagement and creative collaboration. The flexibility of the structure lends it to a myriad of configurations and reinterpretations. The 1:1 program is aimed to ensure economic prosperity to Redfern whilst maintaining the creative and experimental zeitgeist of 107 Projects.

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The way in which man-made & natural infrastructure provides critical services and protects urban citizens.

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GSEducationalVersion

EXISTING GREEN S PA C E A N A LY S I S There is no substantial green space between Chalmers and Regent Street on Redfern Street. The graph shows the existing green space as well as the neglected areas. The City of Sydney 2030 Vision indicates that there should be a green area every 250m, The cones indicate 250m radial distance from the closest green space. The areas meet atop 107 Projects.

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GSEducationalVersion

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Private

Semi - Private

Semi - Public

Public

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PUBLIC POCKETS There are few truely public, safe and 24 hour spaces in Redfern. The bridiing project aims to solve that by creating a community led courtyard and mixed use structure that is programmatically dictated by the people of Redfern.

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Effective leadership, empowered stakeholders, and intergrated planning.

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Leadership & Strategy

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The City of Sydney. 2017. Governance. Sydney: City of Sydney.

DRAFT G OVE RNA N CE S TU D I E S To develop an architectural and digital framework for including the community in ongoing governance and development it was necessary to study the existing governance structures at 107 Projects, City of Sydney Council and the Redfern Medical Service. The degree to which the bodies collaborated was most relevant to my research question, the findings show minimal collaboration upon first investigation, however this will need to be further developed through on-site investigations and interviews.

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A M A L G A M AT E D

D I G I TA L M A S T E R P L A N Contemporary interventions into an urban environment need to be able to adapt their programs to respond to the contemporary conditons of the site. As such, it appeared manifestly unsuitable to only rely on a built or policy initiative to promote connection when the majority of contemporary â&#x20AC;&#x2DC;connectionâ&#x20AC;&#x2122; occurs digitally. The challenge is how to build on the digital literacy and appetite of the citizens of Sydney to develop a framework that encourages active participation and investment in their city.

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Identify Site Launch Theoretical Proposal Proposal Submission & Petition

S it e ion sit cq u i

Collaboration & Discussion Project Progression Consultantation Proposal Review Project Initiation

Pro je P r op o c t s als De P r o ve l

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Competition Callouts

Community Digital Architecture Framework

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1:1 Community Identify stakeholders Community Proposal Collaboration and Partnership Community Investment Community Programs

Eve Prognts & rams

Ongoing Programs Workshops & Training Community Events Project Events Education

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Crowd Sourcing & Investment Ongoing Programs Product Recycling 1:1 Grants Project Funding Education & Cultural Sponsorship

lo v e ca De ppli A

Events & Programs

ComCrowd mun Sourcing & ity In vestm ent

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Developing a virtual network of community connection in an increasingly disconnected spatial paradigm.

Local Problem (Real of Theoretical Competition Collaboration Competition Submission Submission Review Community Consultation Project Realisation?

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Stakeholder Engagement Crowd Sourcing/Funding Ownership Aggregation

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Construction and Sharing Volunteering Training Funding

Development Applications Funding Lodgement Commentary