Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I present an interim report of the Community Affairs Committee on its inquiry into mental health services in Australia. I seek leave to give a notice of motion

Leave granted.

I give notice that, on the next day of sitting, I shall move:

That the final report of the Community Affairs Committee on its inquiry into mental health services in Australia be presented by 25 September 2008.

I also move:

That the Senate take note of the report.

I wish to make a few comments on this interim report and then I intend to hand over to Senator Allison. One particular reason that we the Senate Standing Committee on Community Affairs wanted to give notice today of our committee report was so that Senator Allison could speak to this area. We all know that it is one which she has held very close to her heart and that she, with other senators, has been instrumental in bringing forward the issues of mental health in Australia. I hope people do take the opportunity of reading this interim report, because it gives an indication of the commitment that has been shared by so many people across our country to improving the areas of mental health across Australia. We, again, were astounded by the interests, the commitment, the passion and the generosity of time that was given to us by people across this country who are committed to ensuring that mental health services will be improved and that there will be a common acceptance of the need for more support for people who identify with mental health issues and also for the carers, the practitioners and the people who face this issue on a daily basis, working with them as they move forward with their lives.

That is all I am going to say about this matter, because I think it is important that other senators do have a chance to speak. Our committee will continue and, when the report is finally presented in September, we will have a series of recommendations which will clearly reinforce the need for cooperation. The only way these issues will be given the importance they demand is by all areas of government—particularly state and federal but also increasingly local government—and medical practitioners, carers and people who identify as consumers working on the issue. But now I am very keen for Senator Allison to talk to us—I hope not for the last time, but perhaps for the last time as a senator on this very important issue.

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

First of all, my sincere thanks to Senator Moore, Chair of the Senate Standing Committee on Community Affairs, and to the rest of the committee for agreeing to deliver an interim report on this important inquiry. I recognise that it has been done for my benefit, since I will not be around on 25 September for the final report. That disappoints me somewhat. However, when I saw the interim report, as drafted by the chair, I felt very confident that that inquiry and its report are in extremely good hands. Again, I thank the committee for taking on the first inquiry into mental health services in this country, and to you, Senator Humphries, as chair at the time, I say thank you for your efforts.

It is my view that the community affairs committee is one of the best in the Senate. We work collaboratively, we work cooperatively and we deliver excellent reports, and that is because we pick up on issues which are very important to the community. Almost all of our inquiries receive an enormous number of submissions, even from state governments now and again, so we have that cooperation in inquiring into these very difficult and complex areas of service delivery where there is a crossover of jurisdiction and responsibility between state and federal governments. Mental health is probably one of the most complex areas in respect of crossing over jurisdictions.

As I said, I was enormously pleased with the interim report. It succinctly covered the issues. I thought our first report was very comprehensive. The recommendations we made were sound, so we felt it was important that we followed up with a second report to look at the COAG process. An enormous amount had changed since the previous report. Not only did we liberate $6 billion worth of new mental health services from the Commonwealth, state and territory governments but it seems that our work in this place has generated a lot of thinking about mental health and, if I can be so bold, has even encouraged state and Commonwealth agencies to work much more closely together for a common aim, instead of engaging in the usual buck-passing and cost shifting that we have seen in the past. I count that as one of my most important actions on behalf of the committee since I have been here and that, I think, says something. When you understand the effect of mental illness on the lives of people and their families who are directly impacted you begin to understand the scope of the problem. I think it is fair to say that in the past in this country we have, as have many countries, tended to bury this issue and not tackle it directly head-on. We discovered in the first inquiry and in this one that, whilst there was adequate care—although even that was under pressure at the acute end of the mental illness spectrum—people whose illness could be interrupted, intervened upon, even prevented were being ignored in the whole process.

This penultimate report is the sum of an enormous amount of work which is being done not just by our committee but also by agencies who have put in the time and effort to make submissions, who have appeared before our committee right round the country. It is a collaborative, collective effort of many people, and I want to acknowledge that. I want to thank the secretariat for their work. This report was done in record time and, as I said, it is very rare for me to look at a report prepared by the secretariat and have absolutely no corrections I want to make or additions I want to put to it. I just read it and I thought, ‘Yes.’ Congratulations to the committee for delivering that report. It was a great pleasure to read and it certainly reflected all of the key issues. I know the next report will come out with much more detail. It will have what people actually said to us in submissions and in evidence given before the committee and it may have some recommendations—I do not know what they will be—but I am very confident in the ability of the chair, Senator Moore, to deliver an important report again. In all, I am enormously pleased to have been part of this process. I know that it makes a difference to people’s lives in a way that probably not much else in this chamber that we do does.

Mental illness touches one in every five families at least. We know the prevalence of mental illness. We know the shortcomings of our system. We know the number of people who are homeless, who are unemployed, who fail to get services, and this committee has been able to do something about that. It was a record response by the Howard government to this. I think we had the cheque for $1.9 billion on the table within days of tabling our last report. That must be a record in this place. The department and the government showed a keen interest in the whole of our inquiry. I understand we had departmental people who were monitoring the whole process, so they were benefiting, if I can put it that way, from the evidence that we heard very directly and very immediately.

All in all, it was a very pleasing response. But it did tell us, as I said, that the $4 billion was not enough, that the level of spending on mental health services still did not match what is called the DALYs, the disease burden on the community, and that mental health has always been the poor cousin of other areas of health in terms of a unmet need and attention to this difficult area. And the committee found that there were some aspects of the COAG proposals which we thought could have been done better. In fact, we would just rather that all state and territory governments had picked up on all our recommendations.

However, there are other points of view and clearly some of those recommendations were taken up and some were not. One of the central questions here was whether or not we were getting good return on the investment. An extra $4 billion is a lot of money to be spending on mental health, so central to this second inquiry was the question, in relation to our evaluation and our collection of data, of whether even at a later stage—it is early in the process—we would be able to look at the data and say, ‘Yes, this works.’ I think central to what we found was that it is possibly not the case and that we need to be much better at evaluating the programs that are in place and seriously questioning whether they are best practice.

Unfortunately, in mental health as in so much else we inherit an existing system which is a mix of public and private, a mix of providers, and if you just tweak around the edges you probably do not get as far as might be possible if you had a clean slate. So we have to work with the systems that we have, and that is certainly what the government has done. But I think we need to look carefully at how effective that is.

Our second inquiry provided us with important mechanisms for identifying the problems with the new initiatives and to highlight the service gaps and shortfalls which still remain, as well as showing us that progress had been made and it was substantial. A long overdue injection of funding has allowed the provision of more community based services along with much greater access to clinical services provided by psychologists and other allied health workers. That is perhaps one of the most important initiatives that was taken up by the previous government and continued with this government—the ability of general practitioners to be able to refer patients to, particularly, clinical psychologists. They were the ones who did most of the consults for people to get what we call the talking treatment, to not just be put on medication and pharmaceutical products but be able to have their needs met by other professionals, who, to be honest, will have much more training in mental health than many GPs, who may go through their undergraduate medical courses without having done any training in this area. It is not that they are not doing a good job; the question is, is it good enough?

Some of our responses—at least mine—to the COAG proposals were negative, and I have to say that the Personal Helpers and Mentors Program was one of those. Again, an enormous amount of money was to be spent on this, and some of us were sceptical about whether this would work. It did not seem to have been integrated into services and that was a central theme of our first inquiry. But it turned out that this had been—

Steve Hutchins (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Senator, could you just quickly say some final words?

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

This was one of the programs, I think, which worked through the system and was very effective in the end so—

The Acting Deputy President:

Thank you, Senator.

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

I seek leave to incorporate the remainder of my remarks.

Leave granted.

The remainder of the speech read as follows—

The enthusiasm for the Personal Helpers and Mentors program is testament to the positive experiences that new services have provided for many people who may not have been accessing services otherwise.

That is not to discount the concerns that exist about the ability of the program to accommodate those with more complex needs or the limited geographical reach of the service.

Equally we can not overlook the concerns that the Better Access to Mental Health Care program may be benefiting most those who were already accessing services and can afford to pay the large out-of-pocket costs, while those that live in areas with a shortage of mental health professionals or who can not afford the gap payments continue to go without.

The essential message of this interim report is that more remains to be done.

Services are still patchy and inconsistent. Many areas still need more mental health care and we need more carer and consumer involvement.

Coordination of services still need improvement and state and territory government have not yet truly engaged with the critical issue of accommodation and employment for people with mental illness.

Affordable housing and accommodation are fundamental to achieving other mental health outcomes while employment is important for maintaining mental health and as part of the rehabilitation and recovery journey for people with mental illness.

Unfortunately the COAG response was predicated on working within the exiting structures and framework for mental health service provision.

This means that any improvements to mental health care will always be limited by the lack of a coherent national vision underlying services.

Without this we will continue to see ad-hoc, uncoordinated and opportunistic service delivery.

This is why it is disappointing that the federal Government have not taken the opportunity to purse the Senate Select Committees recommendation of a network of community-based mental health centres staffed by multidisciplinary teams.

Such an approach would provide the structure for seamless, co-ordinated and integrated care.

And act as a focus for the many solutions for mental health which lie outside of the health sector.

This report continues the Senate’s contribution to the development of better services for people with mental illness. And no doubt the final report, which will contain specific recommendations, will continue the dialogue.

However while the regular attention of the Senate is beneficial, it is no replacement for a more permanent accountability mechanism with an ongoing role of systematic monitoring, evaluation and reporting on mental health services ...including progress or lack thereof in improving the lived experiences of people with a mental illness.

There are many mental health strategies, plans and activities at all levels of government but without measurable outcomes and regular collection of data to see if programs are delivering on health outcomes and services it will be difficult to know whether the additional money we are spending is well- targeted and services are going to those who need them most.

Perhaps the recently announced National Advisory Council on Mental Health will be resourced to undertake this role. If so it is vital that it is able to operate independently of government and that consumer and carers are intimately involved.

I would like to end by thanking the secretariat for the efforts they have put in to bring together this interim report. They have done a great job.

And also by acknowledging and thanking all those who put in submissions, attended hearings and shared their stories with the Committee. Their commitment and efforts to improving mental health care, often over many years, is invaluable.

Kerry O'Brien (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to incorporate Senator Polley’s speech.

Leave granted.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

The incorporated speech read as follows—

Mr President I rise to speak on the interim report into the state of Mental Health Services in Australia.

Before I start please let me express my thanks to Elton Humphrey Secretary of the Community Affairs Committee and all the members of the secretariat who do such a good job in making sure we are able to put together these reports. They are a valuable resource to all of us and without them I doubt we would be able to do half as much work.

I would also thank the community and other organisations, Government Departments and State Governments as well as the individuals who took the time to present submissions to us. There are also all those we met with in New Zealand earlier this year regarding Mental Health issues. The trip to New Zealand was certainly informative and gave us a good understanding of how those on the other side of the Tasman are handling similar issues.

We heard during the course of these hearings that there has been some progress towards many of the initiatives in the COAG plan that was set forward by the previous Select Committee on Mental Health, but that there is much work still to be done. However, since this is still only an interim report we are not able to present any recommendations at this point - these will follow in due course and will provide a greater insight into areas that can be improved or changed.

For a long time Mental Health was one of those issues that were rarely talked about in the public sphere. From serious illnesses such as schizophrenia to the darkness of clinical depression, these issues were hidden away and not readily discussed. The fact that nearly 1 in 5 Australians will experience some form of mental illness each year, that will cost the country almost $9.6 billion in lost productivity shows just how important the treatment and management of mental illnesses are.

Thankfully we have moved past that and into an era where we treat these issues for what they are - diseases that can cripple individuals as surely as any other. It’s important that we have frank discussions on mental health in order to get better outcomes for all concerned.

As I stated earlier the previous COAG plan made some progress towards implementing the National Mental Health Strategy. In addition to that progress, the recent Federal Government announcement of the establishment of a National Advisory Council on Mental Health to act in an advisory capacity is a step in the right direction. The council will be able to provide independent advice to the Government and will hopefully include consumers and carers.

Through the course of this inquiry we have heard from the various interest groups that there are still a number of issues that we can do better. The main one that seemed to stand out is coordination of mental health services.

Further coordination is required in both the provision and the running of mental health services - and it is in this area that the Rudd Governments National Advisory Council can help, by articulating a consistent national approach and bringing together all levels of government. This can deliver the better outcomes that I talked about earlier.

I should also point out, and I think it is mentioned in the report itself, that the links between mental health services, and those assisting alcohol and drug dependent individuals was a key area that should be further looked at. It is important that any strategy for helping the mentally ill recognises that these other facets can contribute to mental illness.

In many ways, treating mental illness in a vacuum without looking at the various societal pressures that can contribute is treating symptoms without looking at the causes. At the end of a day, a considered holistic approach will be much more beneficial than a piecemeal one.

With regard to my own state, it was pleasing to read the Tasmanian Government submission and see that the Government has put a great deal of thought into its own efforts with regard to supporting mental health services, and identified many of the same issues in the state that we ourselves have noticed on a Federal level.

Tasmania’s own COAG Mental Health Group, set up after the recommendations of the previous Select Committee, has developed its own model for collaboration between the various sectors in this area. It was also pleasing to hear how the Tasmanian Government is planning to improve mental health outcomes within our state.

I’d like to commend the Tasmanian Labor Government for their efforts, and all the work that has already been done to help those who suffer from mental illness, their families, carers and other support groups. It has been great to see and I hope that they continue their efforts.

This inquiry has certainly been something that I am proud to have been involved in. The state of our mental health services is something that should be continually looked at and evaluated, and I am glad that that Government has taken up this challenge through the establishment of the National Advisory Council.

I am sure that when the final report is delivered we will have been able to put forward some recommendations which will show where real improvement can be delivered for the mentally ill.

I commend this interim report to the Senate.

Question agreed to.