The Department of Health and Human Services (DHHS) is responsible for protecting Victoria's children and young people from abuse and neglect. It does so through its child protection program, where child protection practitioners (CPP) receive, assess, and investigate reports of suspected child abuse and neglect. Where a child or young person needs protection, CPPs intervene and provide protective services.
Like police, emergency services and youth justice, child protection is 'frontline' work that is highly complex and requires specialist skills. CPPs are exposed to a range of mental health stressors, including:
- long and unpredictable working hours
- repeated exposure to trauma, violence, and on occasion, death
- difficult interactions with the public
- high professional expectations.
DHHS has a duty of care to CPPs under the Occupational Health and Safety Act 2004 (OHS Act) and must provide, so far as is reasonably practicable, a safe work environment that is without risks to employees' health, including psychological health.
WorkSafe Victoria is the state's occupational health and safety (OHS) regulator, responsible for monitoring and enforcing compliance with the OHS Act, among other duties.
In this audit, we examined whether CPPs are maintaining good mental health and wellbeing. In doing so, we considered how DHHS promotes good mental health, and whether DHHS identifies and appropriately manages potential and existing mental health issues. We also considered WorkSafe Victoria's role in monitoring and enforcing compliance with the OHS Act.
CPPs struggle to maintain good mental health in the face of unreasonable workloads and inadequate organisational support. While the mental health risks to CPPs arising from unreasonable workloads are largely beyond DHHS's control, it knows it needs to improve its organisational support for them.
DHHS's new Child Protection Workforce Strategy 2017–2020 (CPP Workforce Strategy), released in January 2018, aims to address many longstanding issues that contribute to the mental health risks that CPPs often face. However, without more CPPs to reduce workloads and meet the constantly growing demand, DHHS's actions will not be enough to alleviate the pressure on the overall system or the CPPs themselves.
The mental health and wellbeing of CPPs
DHHS has improved its focus on promoting and supporting good mental health for its staff. This includes the adoption of the Mental Health and Wellbeing Charter for the Victorian Public Sector (MHWC), the Victorian Public Service (VPS) Mental Health and Wellbeing Education and Training Framework, and its Building Positive Workplaces initiative.
However, DHHS is not meeting its obligation to ensure that CPPs are maintaining good mental health. When considered together, evidence from different sources—including records from DHHS's child protection workload management monitoring and review panels (workload review panels), survey data, staff interviews, and CPP WorkCover payments—shows that many CPPs are struggling to maintain their mental health in the face of significant barriers.
There are multiple risks affecting CPPs' mental health. While there are clear role‑based risks (those directly related to the nature of the CPP's role), it is the psychosocial risks (those resulting from their organisational environment) that pose the greater threat to CPPs' mental wellbeing. Unreasonable workloads are the primary risk to CPPs' good mental health. Multiple secondary psychosocial risks are also affecting CPPs, such as inadequate organisational support for good mental health management and a lack of professional respect from the community, other professionals, colleagues and the court environment.
The primary risk affecting CPPs' management of their mental health is unreasonable workloads. DHHS's assessment of the CPP workforce is that it needs to be about double its current size in order to return workloads to sustainable levels. Its most recent estimates are that about $325 million is needed annually over the next four years to address the workforce shortage.
Victoria's child protection program is widely acknowledged as 'stretched beyond its capacity'. Multiple reviews—from organisations such as the Victorian Ombudsman, the Commission for Children and Young People (CCYP), and Parliamentary inquiries, among others—all express the view that the child protection program is 'overloaded'.
Persistent underinvestment in child protection means that demand for child protection services has far exceeded the capacity of the CPP workforce. Between 2010 and 2016, the number of CPPs rose by around 26 per cent, but this has not kept pace with the:
- 121 per cent increase in child protection reports (from 48 403 in 2009 to 107 095 in 2016)
- 42 per cent increase in CPPs' average allocated case loads (from 12 in 2009 to 17 in 2016)
- increased requirements for CPPs to work on cases not assigned to them (known as unallocated cases), and thus not reflected in their work programs
- increasing administrative burdens associated with child protection activities—driven by the requirement for more comprehensive recordkeeping, increases in court‑ordered contact, and more court‑related administration tasks such as court reports, subpoenas, and coordinating specialist consultations.
Further, the inconsistent nature of funding for child protection has also limited DHHS's capacity for budget and workforce planning. Because of the lengthy nature of recruitment and development of new CPPs, and the continuously rising demand, the impact on the CPP workforce has been severe.
DHHS has a responsibility to make government fully aware of the potential liabilities of exposing CPPs to mental health issues due to unreasonable workloads. Its submissions to government have discussed the impact of resource restrictions on the delivery of protective services. However, the submissions have not sufficiently detailed the potential legal and financial implications of CPPs being exposed to unreasonable workloads.
We gained a preliminary understanding of CPPs' experiences in managing their mental health by reviewing CPPs' responses to the annual People Matter Survey (PMS), administered by the Victorian Public Sector Commission. We supplemented this by also:
- conducting our own survey of Victoria's CPPs
- interviewing more than 100 CPPs and child protection executives from various offices across the state
- visiting CPP worksites and holding focus group discussions at three metropolitan offices, two regional offices and the child protection program's central office in Melbourne.
The negative mental health impacts of unreasonable workloads were a common theme in our focus groups and interviews with CPPs, as well as in responses to our survey.
Records of the child protection program's workload review panels—established to monitor and address workload demand issues—show regular discussions of teams being unable to meet workload requirements. The records also reflect ongoing concerns with CPPs' mental health.
DHHS's OHS reporting program and its commissioned reviews, along with PMS results and CPP WorkCover payments data, support the finding that CPPs face unreasonable workloads.
CPPs' responses to the PMS reflect increasing work‑related stress levels over time. In 2013, 51 per cent of CPP respondents agreed that they did not feel too stressed at work. In 2016 however, only 33 per cent of CPP respondents reported no to low or mild stress levels. Likewise, in 2015, 58 per cent of CPP respondents agreed that they could manage their workload. In 2016, only 34 per cent agreed that their workload was appropriate for the job they do.
Over the last four years, CPPs have consistently reported high levels of dissatisfaction with work-life balance in the PMS, and 50 per cent of CPPs who responded to our survey felt that they could not reasonably manage the demands of work as well as their personal lives.
CPPs' struggle to cope with mental health risks is also reflected in WorkCover claims. DHHS data shows that in 2016–17, 49 per cent of the 37 CPP WorkCover claims related to mental health. WorkSafe Victoria's site visits to child protection offices are also primarily in response to complaints of excessive workloads.
In our interviews, CPPs repeatedly reported feeling that meeting workload requirements comes at the cost of their mental health. Pressure to meet demands around case loads, supervised contact and court-related administration impedes CPPs' efforts to maintain good mental health and wellbeing.
CPPs described how meeting these demands meant regularly working overtime. However, a fear of being seen as needing more than a 'standard working day' to complete assigned work influences their decisions to under-report their working hours. The requirement to complete heavy workloads within strict statutory time lines, coupled with the need to keep CPP teams staffed at all times, also creates competition for access to work breaks and leave.
In addition, from 2015 to 2017, records of DHHS's workload review panels repeatedly comment on the impact of the heavy workloads on CPPs, describing their high levels of fatigue and stress.
Supporting CPP mental health management
A range of secondary risks also affect CPPs' ability to manage their mental health.
Of the 190 CPPs who responded to our survey, 80 per cent either somewhat agreed or strongly agreed that DHHS provides services to support their psychological health. However, in CPP focus group discussions and interviews, a common theme was that those services, discussed below, did not adequately meet their needs.
Inconsistent or inadequate provision of mental health support
DHHS does not consistently apply its key processes for supporting mental health management. Regular, scheduled supervision between CPPs and their line manager is child protection's primary support tool. However, to meet statutory time lines, CPPs at all levels regularly de-prioritise either providing or attending supervision sessions.
DHHS actively promotes its employee assistance program (EAP). However, CPPs report that access challenges when the EAP service is offsite, and privacy concerns when it is onsite, can make CPPs reluctant to use the service. Further, while CPPs appreciate having these services available, they typically reported needing a more clinically advanced level of support.
The absence of professional respect
In discussions with CPPs and DHHS executives, we learned that an absence of appropriate respect for the child protection profession fuels frequent poor behaviour by clients and community members, in court environments, and even in child protection workplaces. Poor behaviour towards CPPs has also been a subject of concern in past Parliamentary reports.
The need for education and training on mental health and wellbeing
DHHS's OHS training has historically focused on 'traditional' health and safety areas such as manual handling, injury prevention and occupational violence risk assessment. However, its December 2016 adoption of the MHWC includes implementing an education and training framework to improve employees' capability in identifying mental illness and awareness of the support available.
As a part of this, DHHS is delivering a series of mental health and wellbeing awareness programs for staff at all levels. While the programs are not specific to the mental health of CPPs, it is reasonable to expect that CPPs will benefit from increased department-wide capability in supporting mental health.
Confusing mental health reporting processes and lack of oversight of CPP mental health
DHHS's health and safety incident reporting process does not sufficiently consider mental health and DHHS does not appropriately monitor CPPs' excessive working hours, or balance them with compensatory leave.
There are multiple avenues that CPPs can use to identify a need for mental health support. These include scheduled supervision sessions, OHS incident reporting, EAP services, workload review panels, DHHS's Critical Incident Response Management (CIRM) framework and its Positive and Fair Workplace (PAFW) policy.
While having many ways to identify mental health concerns is a positive thing, inconsistent direction about which tools they should use under which circumstances is confusing for some CPPs. Further, offices with consistently high staff turnover can struggle with retaining organisational knowledge, which can exacerbate this confusion.
In combination, these issues muddy DHHS's data on mental health, delay resolution processes and can reduce CPPs' confidence in reporting processes. Further, they prevent DHHS from having a consolidated view of CPPs' mental health concerns identified through the various reporting avenues. Consequently, it does not have an informed understanding of the current state of CPPs' mental health, the systemic risks they face, or the effectiveness of the support tools available.
Results from the PMS and our own survey show that while CPPs have confidence in their immediate line managers, this does not extend to the broader organisational environment, processes for reporting issues and concerns, or processes for ensuring staff accountability.
While WorkSafe Victoria is the state's OHS regulator, its small workforce prevents it from actively monitoring organisations. However, its 2017–18 business plan identifies social assistance services—≠which includes CPPs—as one of its top priorities.
The impact of inadequate mental health support on CPPs
The cumulative impact of primary and secondary risks to CPPs' mental health also creates downstream implications for DHHS.
The majority of CPPs' mental injury WorkCover payments from 2012 to 2016 were for work‐related harassment and/or workplace bullying.
In 2016, work‐related harassment and/or workplace bullying WorkCover payments accounted for 61 per cent of all CPP mental injury payments. The second most common type of CPP WorkCover mental injury payment was for work pressure.
From 2012–13 to 2016–17, the average tenure of child protection's core case‑carrying staff, CPP-3s (practitioners) and CPP-4s (advanced practitioners), was 2.56 years and 6.14 years respectively. This creates a need for constant recruitment and training—an avoidable financial burden for DHHS.
DHHS's reform of child protection
To address concerns about the mental health of CPPs, DHHS has committed to improve its support to CPPs. This includes the implementation of its CPP Workforce Strategy (released in January 2018), which is also underpinned by the MHWC. The strategy focuses on:
- attracting and recruiting the best people
- growing and developing staff
- engaging and retaining staff
- maintaining the wellbeing of CPPs
- building a professional identity for the workforce.
Many of the initiatives in the strategy, if implemented effectively, will help to address the secondary mental health risks that CPPs face. These initiatives include improved CPP wellbeing support programs and better processes for recruitment and retention, professional development and professional recognition.
In addition, DHHS's commitment to the MHWC is an opportunity for DHHS to gain a more sophisticated understanding of CPPs' mental health. By better managing information, DHHS should also be able to address current inadequacies in its understanding about the mental health of the CPP workforce. It should also help DHHS to better demonstrate its need for additional resources.
In 2017, DHHS received non-recurrent funding totalling $72.242 million for the child protection workforce. This funding is enabling DHHS to trial new administrative supports to help ease CPP workloads. However, as DHHS recruits new staff, the funding will transfer to staffing and these support programs will cease.
We recommend that the Department of Health and Human Services:
- advise government of:
- the current level of risk to the mental health of the CPP workforce due to unreasonable workload and (see Section 2.3)
- the resources required to fully address current and future demand, based on accurate time and resource modelling (see Section 2.3)
- develop and implement modelling tools to support demand forecasting (see Section 2.3)
- establish a holistic view of child protection practitioners' mental health through the use of consolidated mental health data sources; and use this view to monitor CPP mental health, and identify trends and areas requiring focus or further investigation (see Section 3.5)
- determine the effectiveness of current mental health support tools for child protection practitioners (see Section 3.5)
- establish and consistently provide specialist mental health support services for child protection practitioners (see Sections 3.2, 3.3, 3.4 and 3.5)
- ensure that child protection practitioners are sufficiently aware of the available mental health support services and the correct processes for raising mental health concerns (see Section 3.5)
- establish and implement a plan to improve CPPs' experiences in the court environment, in consultation with the courts, the Department of Justice and Regulation, and Victoria Legal Aid (see Section 2.4).
Responses to recommendations
We have consulted with DHHS and WorkSafe Victoria, and we considered their views when reaching our audit conclusions. As required by section 16(3) of the Audit Act 1994, we gave a draft copy of this report to those agencies and asked for their submissions or comments. We also provided a copy of the report to the Department of Premier and Cabinet.
The following is a summary of those responses. The full responses are included in Appendix A.
DHHS acknowledged the report's findings and that more is required to support the CPP workforce. It also accepted the recommendations and provided an action plan detailing how it will address them.
While the recommendations were not directed to WorkSafe, it has also acknowledged the report's findings and recommendations.