Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Hansard source

Mr Deputy President, I am not concerned about what questions Senator Macdonald is concerned about. I would hope that Senator Macdonald would share our concerns about mental health in Australia, but maybe not. In terms of the focus, you would understand that there was a great deal of interest and expectation amongst the mental health community around the wide standing review of mental health programs and services. People were asked to contribute, and there was focus on exactly what was the best way forward for mental health in our country.

The people who work in the mental health services and also those who are consumers of those services are a particular group who have a great sense of ownership about their area and also a sense of expectation from governments over a period of time for delivery of effective service. With that sense of expectation has also come a long history over many years of frustration that their needs have not been effectively identified and there has not been a continuing response to ensure that mental health is placed clearly on the agenda. This is not something that has been a short-term process. For many years people within the mental health community have been worried about the fact that their issues may well not have had the urgency that they think they should have.

Given that background, when the review of services was announced, there was some hope that, with changing priorities and plans, this was a time when there would be a really strong focus and an investigation of what the effective services in mental health across Australia are and what contributes the most effective response to the range of issues around mental health. This is not a simple area, and Senator McLucas and I, through a number of Senate inquiries in the Community Affairs Committee, have had the great privilege of listening to people who have great expertise as well as personal experience about the issues a real mental health and the disadvantages that can be linked to that illness in our Australian community. The Senate community affairs committee had an extensive mental health inquiry, followed by specialised inquiries into Aboriginal and Torres Strait Islander mental health linked to the scourges of petrol sniffing and to disadvantage, and then—one of the most gut-wrenching inquiries; I am looking at Senator McLucas now—the one on suicide in Australia.

There were a range of programs introduced under the Labor government to respond to the issues that were raised in those inquiry reports. Throughout, we always said that there needed to be an effective link with the community—that this could not be a government process feeding down into the community; rather, it should be an engagement process which links to the consumers in particular. I have gone on the record a number of times here about the absolute necessity of having consumer engagement in a lot of social programs, but nowhere is consumer participation more important than in mental health.

A number of Senator Gallagher's questions asked where the linkages were going to be in the ongoing advisory process or engagement process—whatever the title of the month is—for consumers to participate in the process. That has caused great interest in the community. We often say in this place that we have received a number of calls from people or people have contacted us about certain issues, and I assure you, Mr Deputy President, there has been a very strong response from the community on the issue of consumer engagement in mental health. They want to know what is going to be in the consumer participation framework, something that was mentioned by the government—that one of the core aspects of the government's ongoing response was to reinstate, re-establish in some form, an active consumer engagement model. People have been waiting to hear how that is going to operate.

As Senator Gallagher said, in the relatively short government response that we have at this stage, there is absolutely no detail about how that will be put in place—no detail at all. That is frustrating and it is also worrying because, without the detail, there is a sense that it may not happen. There is a sense that appropriate resources will not be allocated, which Senator Gallagher's questions also went to. There is a feeling that it could be just empty rhetoric—and believe me, Mr Deputy President, people with mental illness in this nation have long had concerns about empty rhetoric in response to their issues—instead of some clear definition about how the consumer participation framework will be introduced, what consultation there will be, how people who will be part of the consultation will be identified, and what the process will be.

All of these things are not too difficult. We do have a history in this country of working with consumers. Clearly, we have organisations that have already been identified that have links with the mental health consumer network and also with the professional groups that provide services. Those organisations are in place. But we need the detail of how they will be engaged in the new process. In particular, on the question of consumer involvement into the future, there need to be detailed responses back from the government about what process they are going to fund and how they are going to ensure that the consultation will be real and not some kind of token exercise: 'We've had a couple of meetings and, therefore, there has been consultation.' That is not good enough. This group of people is well informed. They want to be involved, they do not want to be dismissed and they do not want to be shown a lack of respect by there being further delays about the detail on consultation. That causes great fear, I think. And it is particularly insulting to a group of people who are already vulnerable and who have had difficulties in the past, which are clearly documented, with a lack of effective consumer engagement. When you have already had that historically, to not have that acknowledged and to effectively be given a response at this stage actually causes fear and makes you wonder: has this detail in fact already been considered and has there been appropriate consideration and resourcing put into that area?

Another issue—and there are many questions, and Senator Gallagher has done a great job in putting these very direct questions on the record—is the fact that there is going to be significant change. We know that is going to happen, but the funding for organisations working in the field now is only until 30 June 2016. So many times in this place we talk about the way that programs are advertised, how tenders will occur—and we do not know whether there will be tenders because we have no detail about what process is going to be put in place. The only thing that the organisations who are currently working in the field of mental health response know is that they are only funded until 30 June this year. They know that there has been this detailed review of mental health services in Australia. In fact, I doubt there would be a single one of those service providers who did not actively engage in putting forward information to the review. They know that they have put forward their views about what was working, what was not working, and how they could best be part of a new approach to mental health in our nation, but they have heard nothing back. There is no detail that we are aware of that has been given back to them about how the transition will occur between what we are doing now and the 'brave new plan', which is due to commence on 1 July 2016.

Too often in this place we have to talk about the problems of not giving effective information to organisations, not giving organisations time to make plans and not working through a transition process with them. That leaves organisations with a sense of loss and also panic, as Senator Gallagher pointed out, who have staffing concerns and who are looking at their own processes but, most importantly, who are looking at the needs of the people that they work for—their clients, the people with whom they have built up personal relationships. Sometimes they are in regional areas and, as you know, Mr Deputy President, regional relationships are intensely important. What we have asked the government is: what are the processes going to be in the future for looking at how new tenders will be offered, how much funding will be allocated to establish different processes and what will be the transition arrangements?

These are very straightforward questions that are looking at areas particularly to do with the new Primary Health Networks, which are relatively new organisations that the government has put in place. I could speak for another long period about my concerns about the PHNs, their geographic coverage and what they are expected to do.

What we had, up until the change of government, was a structure that was based on the Medicare Local model, where exciting work had been done on mental health right across the country, particularly in my state, in regional and rural Australia. Medicare Locals had prioritised mental health in their program plans and had established networks and immediate responses which engaged people locally and looked seriously at the issues of mental health in the community. Those have all been closed. In some cases there have been ongoing discussions, but the role of the Medicare Locals has been completely dismissed.

Now that the new PHNs have been put in place, we have been advised that they will be concerned with the issue of mental health. There is no detail about how that is going to operate, there is no detail about how the funding will happen, and there is no detail about what services will be available to people who have already-identified mental health needs and where services need to be provided at local levels. None of that detail has been provided. All we know is that the PHNs will have a priority interest in mental health. That is not particularly comforting if you want to know where services are going to be provided in your area.

We have years of evidence about the need to have effective transition processes in place when you are looking at change and about the impact that change can have on individuals in terms of their own lives—all that is documented. We have had extensive Senate inquiries over the last two rounds of grant programming—both the DSS model and the Prime Minister and Cabinet model—for Aboriginal and Torres Strait Islander services. There were recommendations aplenty which talked about the need to have this detail, so that people are engaged in the process and know what is going on. There were inches of paper making these recommendations.

I remember very clearly—and I have told this story many times—going to an Aboriginal community in Western Australia, where one of the community leaders arrived with a wheelbarrow full of printed reports, put them down and said to those of us who were visiting, 'If you had done any of the work that you had promised you would do in response to the recommendations you made in these previous reports, we would not need to have the conversation we are now having.' I echo that community leader's views when we are talking about these questions on mental health in our community.

I know that the points have been well made, but it is so important that we get a response back from the government which gives body to the commitment that they have already made in response to issues that were raised in the review that they commissioned into mental health programs and services in our country. We need to have the detail because it has been so clear in the past that documents without detail not only are relatively useless in making a commitment to future action but are quite dangerous in setting up expectations about needs that will not be met. If a community knows what the plan is going to be and how the funding is going to be allocated in the areas of youth mental health, Aboriginal and Torres Strait Islander mental health and suicide prevention, they can at least work within that framework. But if it is just left in this nebulous mass—almost like that concept of 'trust us, we know better'—that will cause more damage to a group that has already identified that it has needs in this area.

Senator Gallagher mentioned a couple of questions that were put on notice about the NDIS. Consistently from the time the NDIS was in the planning stage, and also when we did the initial Senate inquiry into the development of the legislation on the NDIS in Australia, there was a very strong message from people in the mental health area who were concerned about how mental illness would be affected by the introduction of the NDIS. Senator Gallagher said that we are so grateful that there will be many people in Australia who will benefit from the NDIS. There has been great concern in the mental health community that perhaps the nature of mental illness could make it more difficult for individuals to be able to benefit from the NDIS program as it is being rolled out. This has been a major issue not only in the trial sites that are looking at people of all ages but also in the Tasmanian trial site that is looking at young people. The issue of how mental health, suicide and depression are going to be handled by the NDIS format is something that has been of genuine interest to people across the community.

There were quite clear questions about resources and funding allocated for people with complex care needs who are not accepted in the NDIS. We know—and it has been discussed many times here—that not every person with complex care needs will be eligible for full or even part packages under the NDIS. What we need to know is what wraparound services in the community will be available for those people who are not able to access NDIS. Those questions were very clear. None of the questions that Senator Gallagher put forward on 13 January should have come as a surprise to either the minister or her department. These are issues which are fundamental to any response to the review of mental health programs and services. They are the kinds of detailed questions that need to be answered so that people can do effective planning into the future. Just giving a response to a review does not end the need to continue communication.

We know that the response was a first-round response looking at general principles. The core issue now is how that general principle will be translated into action on the ground and how people will be affected by the change. Senator Gallagher had set out to find the detail that would respond to those questions. It is disappointing that we have not had any direct answers to those questions. It is also frustrating, because during the recent Senate estimates—which as, you know, Mr Deputy President, is the short estimates and so there is no time to follow up on these questions—we were not able to question the department closely about these matters. But we felt confident that, because Senator Gallagher had put these questions on notice, we would be able to get the answers. So we decided that we would not take the time in the limited space we have in the short estimates period in health to follow-up on these questions or to put on record how seriously we feel about the detail being critical to us having an effective response to mental health in our country. We did not do that because we felt that these detailed questions were being taken up in another way. We missed that opportunity at Senate estimates, although we can clearly put on notice to the minister that we take this issue very seriously.

Over one month has gone by without those detailed questions being answered. The implementation of the plan is 1 July, and we have a lot of worried people out in the community. This is not good enough. It is important to get a response, particularly as this Senate has consistently reinforced its concern and commitment to having effective mental health services in our community. This lack of detail shows neither that commitment nor that concern.