Victoria’s mental health system operates in crisis mode, has “catastrophically failed to live up to expectations” and must be rebuilt, a damning report from the state’s mental health royal commission has found.

There need to be major changes to stop hospital emergency departments being entry points to assistance and a boost to community-based services which are currently underfunded, the report says.

Among the final report’s 65 recommendations, outlined in a mammoth five-volume report, are the phasing out of seclusion and restraints treatments over the next decade, and making compulsory treatments an option of last resort.

The report says the system is “over-reliant” on medication.

The COVID-19 pandemic and last year’s bushfires have highlighted the system’s failures.

The royal commission’s chair, Penny Armytage, said more than 12,500 submissions from individuals and organisations were received over the two years.

“The contributions we received left us in no doubt that the system had indeed failed, and had been failing for decades,” she said.

Demand has now overtaken the capacity of the system, prompting the royal commission to recommend up to 60 community-based adult mental health services be established across the state, with another 22 high-level treatment services delivered in partnership with local hospitals.

The report says there should also be 13 services specific to young people who can access those services up until their 26th birthday.

All of these services should have 24-hour care and phone service available.

Among other recommendations are for triple-0 calls regarding mental health crises to be directed to ambulance officers instead of police, in an effort to provide a care response.

The state would be divided into eight regions, with each to have at least one top-level emergency department equipped to deal with mental health crisis and addiction treatment.

Access to services in rural and regional areas needs to be improved in order to stop people having to travel vast distances to get help.

“The present system is not designed or equipped to support the diverse needs of people living with mental illness of psychological distress, families, cares and supporters, let alone to cope with unforeseen pressures that may arise,” the report says.

To address the gap in services in the rural and regional areas, the commission calls for incentives to attract and retain workers in the bush.

Every year around one in five Victorians experience mental health issues.

About 3 per cent of the population – roughly 200,000 people – have a “severe” mental illness such as schizophrenia or bipolar disorder.

The report calls for seclusion of mental health patients to be phased out. Photo: ABC/Victorian Mental Illness Awareness Council

Government to rebuild system ‘from the ground up’

The major reform is likely to cost billions of dollars.

The report has recommended Victoria work closely with the Commonwealth and other states to properly implement change.

Premier Daniel Andrews will outline his full response on Tuesday afternoon, but said his government was committed to providing better care.

“As a government, we recognise these profound failures and commit ourselves to implementing every single one of the commission’s recommendations,” Mr Andrews said in a statement.

“These recommendations will serve as our blueprint for delivering the biggest social reform in a generation: building our mental health – from the ground up.”

Report calls for more services, upgraded facilities and law reform

The report calls for the renovation and expansion of the Thomas Embling secure forensic mental health hospital in Fairfield. Photo: ABC News

More options for in-home care need to be established, and at least 100 new beds for acute services need to be set up across the state, the report says.

The Thomas Embling Hospital in Fairfield needs to be renovated and expanded with 107 new beds created for treatment. An additional 20-bed unit needs to be set up for patients who cannot be safely treated in the system.

The state’s justice system also needs to be more able to assist people with mental health, with prison often being the first time people have received care, the report says.

Victoria’s Mental Health and Wellbeing Act must also be repealed and re-written with a focus on strengthening accountability, service monitoring and reducing rates of restrictive practices and compulsory treatment.

A new Mental Health and Wellbeing Commission would also be established and act as the watchdog for complaints, including on the use of restraints and compulsory treatment.

The Premier should also chair a Cabinet sub-committee on mental health and a new Chief Officer of Mental Health be established in the Department of Health, the report says.

Much of the report focuses on integration of services and listening to the experiences of people with mental health when designing services.

The report builds on an interim report released 18 months ago, in which the commission recommended a tax or levy to help fund new mental health services.

The government is still to outline how it will adopt those measures, which was delayed due to COVID-19.

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-ABC