Lyn Allison (Victoria, Australian Democrats) Share this | Hansard source

I present the first report of the Select Committee on Mental Health entitled A national approach to mental health: from crisis to community, together with the Hansard record of proceedings and documents presented to the committee.

Ordered that the report be printed.

I seek leave to move a motion in relation to the report.

Leave granted.

I move:

That the Senate take note of the report.

I seek leave to incorporate my tabling speech in Hansard.

Leave granted.

The speech read as follows—

The Senate Select Committee on Mental Health provided its members with a unique opportunity to meet with people in the mental health sector—consumers, carers, health professionals and administrators. We received enormous community support, reaped the benefits of the hard work and dedication of many, and have been shown great hospitality around the country. I wish to thank all those who assisted the committee and its work.

We received over 600 submissions—from individuals and parents and carers of people describing the tragic outcome of a mental health system that failed them. Submissions came from state, territory and local government, from peak mental health organisations, from consumers from doctors and nurses, from police and prison services …. and they told stories that provided the committee with a rich resource of material describing the complex system that is mental health in this country.

Mental health reform is now quite rightly at the top of the policy agenda for all governments. As a result, in February 2006 the Council of Australian Governments agreed to initiate a rapid process of discussion and policy development on mental health. In order to inform the CoAG interest and process, the report we table today comprises the bulk of our deliberations and a suite of recommendations that the committee believes should be addressed in the CoAG policy reforms.

A brief additional report will follow shortly, and its recommendations will be no less important. However, this arrangement ensures that the Committee’s findings will contribute to and guide CoAG’s policy reform discussion. We sincerely hope that in addition to CoAG, all governments, agencies and organisations will respond positively to the recommendations included in both reports.

The Committee heard an enormous range of evidence on many different issues. Some evidence reflected a strong consensus among contributors.  Without a doubt, there is an urgent need for more mental health services. Reducing the stigma associated with mental health is important, but little help when little or no service is available to those who look for it. More services means more funding (Recommendation 1), but funding for mental health must also be used more constructively.

One message came through very clearly in this inquiry: there needs to be more community-based mental health care. More is needed because there is an unacceptably high level of unmet need. More is needed because too many people are failing to get service until they end up seriously ill in hospital. More is needed because community care can be better at fostering rehabilitation and recovery in, as the NMHS declares necessary, in the least restrictive environment.

We propose a Better Mental Health in the Community initiative, comprising the establishment of a large number—we estimate 400—community-based mental health centres; the distribution primarily determined on the basis of populations and their needs. These Centres will be staffed by truly multidisciplinary teams comprising psychiatrists, psychologists, GPs, psychiatric nurses and social workers.

The Better Mental Health in the Community infrastructure program should be rolled out over 4-5 years with contributions from both the States and Territories and the Commonwealth, with the latter establishing direct Medicare recurrent funding arrangements for employed or contracted mental health staff, and the former providing infrastructure and on-going management. With two levels of government sharing the load, the services will be responsive to the needs of the local community and provide better access for those in need.

The Committee also believes that the Better Outcomes initiative should be reformed. It was a very good initiative of the Government but has been limited by the small number of participating GPs and the caps that apply for patients and for the Divisions of GPs arrangements.

There is a strong argument for the relatively untapped pool of clinical psychologists to be much better utilised in Better Outcomes. We propose that there be a new set of Medicare schedule fees for mental health for psychologists, GPs and psychiatrists and that they acknowledge the time that the so-called talking therapies take. This would bring psychologists into the system as primary health carers but we accept that there needs to be an assurance for the government that this won’t cause huge budget blow-outs.  I doubt there are enough clinical psychologists in private practice to cause a massive increase but in any case, we argue in our recommendations that participation in Better Outcomes would come with an obligation to collaborate with other mental health professionals, in combination or in conjunction with the mental health centre. This way, GPs and psychiatrists benefit from the knowledge and experience of psychologists and vice versa and patients would benefit from better coordinated care—which was the purpose of Better Outcomes in the first place. The fact that the Better Outcomes budget was so significantly underspent demonstrates the need for reform but we don’t want to throw the baby out with the bathwater.

We have confidence in the Divisions of GPs and in their work on Better Outcomes and they should continue to provide training for GPs who seek it but we have recommended the pre-requisite of training be dropped for participation in the program. It was always somewhat perverse that the GPs least trained in mental health were the ones dealing with these patients without assistance from mental health professionals and doubts were raised about the effectiveness of 6 hours training for level one. We understood that this was an incentive to get GPs involved in training but there is no evidence that the current rate of 20% of doctors participating in Better Outcomes will improve any time soon yet 100% of GPs will be seeing people affected by mental illness daily. It is also clear that the more integrated and collaborative our primary health system can be the more expertise will be developed by virtue of this collaboration.

It would make sense for the Divisions of General Practice to be restructured as Divisions of Primary Health so other disciplines could be brought into the system.

De-institutionalisation is a policy with the right goals, but the job remains incomplete.

What did we hope to achieve when no State or Territory in Australia has adequate community-based care? Area mental health services were set up but they too only deal with the most unwell. The obvious but unacceptable consequence was a shift in care for the seriously ill from psychiatric institutions to prisons, emergency departments, families, or worst of all, neglect and homelessness. We must do better. And not the piecemeal response of funding only pilot projects and short term grant-based programs which don’t go on to be funded, regardless of how worthy or successful they are. Funding must move to a more sustainable basis and perhaps governments need to forgo the satisfaction it gives them to announce brand new projects on a regular basis.

Assessing the success of the National Mental Health Strategy was at the core of our inquiry and we were convinced of the need for better defined targets, monitoring and of the need for all states to be brought into line with the national mental health plans. There must also be more explicit protection of consumers rights in the Strategy

In addition to the National Mental Health Strategy and Plan, several other national strategies have implications for people who need mental health services. Unfortunately, these strategies are not always well integrated and sometime lead to perverse outcomes.

For instance, people experiencing psychosis while addicted to alcohol and drug have been refused assistance by both mental health services and alcohol and drug services; each claiming that the individual is more rightly served by the other service. One way to counter this is to integrate the NMHS, National Drug Strategy, National Suicide Prevention Strategy and National Alcohol Strategy. The specification of achievable targets and outcomes within these strategies is central to achieving this (Recommendation 2).

Mental illness is often poorly understood by the community, and even health professionals and researchers have limited knowledge about some conditions. People with a mental illness experience discrimination, marginalisation and often get too little say in their own treatment.

The committee believes that knowledge needs to be improved, discrimination eliminated, and consumers given a greater say in their own treatment. Existing organisations in the area of mental health can help in the pursuit of these goals.

The Mental Health Council and the Human Rights and Equal Opportunity Commission each have significant parts to play in the monitoring of progress on mental health service reform and monitoring human rights and discrimination. The committee has recommended that each of these bodies be given additional resources. It believes the Mental Health Council can play a role in regularly monitoring and reporting on progress under the National Mental Health Strategy.

The capacity of the Human Rights and Equal Opportunity Commission should be enhanced, to allow it to more fully examine human rights abuses and discrimination against people with mental illness. The committee was also particularly concerned about the barriers that people with mental illness face in getting access to supported accommodation. Discrimination in this area is something the committee would like to see HREOC investigate as soon as possible.

While existing bodies can perform these valuable functions, two new organisations are needed. It is essential that consumers and carers have a greater role as advocates, as experts and as promoters of good mental health. While some steps have been taken in this direction, the committee calls for the formation of a National Mental Health Advisory Council, made up of consumers, carers and service providers. This body should advise CoAG on consumer and carer issues, and act as promoters of mental wellbeing, illness prevention, and consumer involvement in service provision.

The committee also concluded that a Mental Health Institute is needed.

There needs to be more research in the area of mental health. There must be greater dissemination of that research. A Mental Health Institute would help set research and evaluation priorities for mental health. It would also disseminate information about successful pilot programs for service delivery.

Currently, treatment options for many consumers are too limited, and are too focussed on pharmacological therapies. The Mental health Institute would review evidence on treatment cost and effectiveness, and disseminate the results of those reviews.

As the Senate will know, the committee was given an extension to report on this inquiry until end April but on advice from the sector, we pulled out all stops to get the bulk of our report completed in time for it to be useful to decision making in CoAG, currently underway. This means we will follow this report with the many other important but perhaps less urgent recommendations the committee wishes to make and we will table those in the next week or so.

It also means that a supreme effort to finalise this report was made by the committee and its secretariat.

I would like to thank sincerely my fellow committee members, Senator Humphries, Forshaw, Troeth, Webber, Moore and Scullion for working through 10,000 pages of written submissions, a record number of hearings and travel into each state and territory and into remote locations.

I thank them for their enthusiasm, their cooperation in delivering on an impossibly short time frame, for assisting with the 600 very detailed pages of report and for their willingness to be bold in our recommendations.

And I thank the secretariat for their above and well beyond the call of duty efforts in making it happen. I know they have put in a huge effort and am appreciative of their intelligence, dedication and excellent management of the process. So thank you to Dr Ian Holland, Secretary, Ms Kelly Paxman, Ms Lisa Fenn, Ms Eleesa Hodgkinson, Ms Jill Manning, Ms Loes Slattery, Mr Tim Davies, Mr Terry Brown and Dr Robyn Clough for a remarkable effort and a report I hope they can be as proud of as I am.