Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I present the final report of the Community Affairs References Committee inquiry into Commonwealth funding and administration of mental health services, together with the Hansard record of proceedings and documents presented to the committee.

Ordered that the report be printed.

by leave—I move:

That the Senate take note of this report.

This inquiry has received a great deal of attention and a large number of submissions—in fact, 1,500 submissions. We received a lot of form letters and other correspondence and additional information. We will be presenting some more submissions subsequent to the tabling of this report, because we have had so many. This inquiry, as the title suggests, was into the government's funding and administration of mental health services in Australia. We particularly focused on the budget measures. Although the inquiry looked at other issues, the submissions we received predominantly chose to address the terms of reference related to the budget measures.

I am tabling today a majority report. That majority report details the evidence the committee received. The community affairs committee strives, whenever it can, to reach consensus on its reports. Unfortunately, on this one it did not. Although the majority agreed on the evidence, the committee has disagreed on the recommendations around that evidence. So I am tabling the majority report plus a series of additional comments and dissenting reports around the evidence. I am also tabling, as chair, additional comments. That contains recommendations flowing from the evidence. I have considered the evidence very carefully and will go very quickly into some of the recommendations.

For those who do not know what the Better Access initiative is, it means better access to psychiatrists, psychologists and GPs through the MBS. The initiative was introduced in 2006 by the Howard government. It is a very popular initiative and has provided a lot of support and treatment to large numbers of Australians. Its initial aim was high-prevalence disorders, but it is now used by a wide range of people, particularly those experiencing and suffering from severe symptoms. Although there is a lot of dispute around whether Better Access should be treating people with such severe symptoms, the fact is that it is treating those people. ATAPS—Access to Allied Psychological Services—is also a broadly used and supported initiative in the community. There is absolutely no doubt that both these programs enjoy a wide range of support in the community.

The government's changes to Better Access, which limit a number of services, amongst other things, have caused a great deal of concern in the community. Because the government, through the changes in the budget, is seeking to limit and reduce the number of services from what is currently available, from 18 to 10, there is a great deal of concern that a number of people will miss out on access to services. I can understand the government's intent to change this to better focus the mental health programs and to increase funding. However, I must admit that I do support the concern of the community. Some of the other programs the government wants to put in place are not available yet; the changes come into effect as of today. I believe that the changes to Better Access need to be delayed until it can be demonstrated that other programs, such as ATAPS, are adequately equipped to provide services to people with a severe or persistent mental illness. I also believe that the government should consider putting in place an interim program through MBS that would allow access to an additional six services under Better Access for consumers who meet tightened criteria based on the severity of their condition. In other words, those people that need the additional services would have somewhere to go while the government's changes are being put in place. Although there are changes coming through to ATAPS—and I think that concept enjoys broad community support—the simple fact is that either the Medicare Locals or the GP divisions, depending on where Medicare Locals have been rolled out, are simply not ready to roll out the additional changes to ATAPS. So there will be a gap in services provided to people who need support with mental health services. Therefore I believe that the evidence supports delaying the rollout of these changes until the government can guarantee continuity of care.

I know other senators wish to speak, so I will finish by thanking my fellow senators for dealing with these very complex issues in a manner which allowed us to remain working together and talking, even though we did not reach consensus. I would also very strongly like to thank the secretariat. This year the community affairs committee secretariat have had a great deal of work. We have had a number of long, wide-ranging inquiries, and they pulled together this report in a limited amount of time. I thank them very much for the efforts that they have put in to ensure that we were able to report today. Thank you.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

I rise to speak on the tabling of the report of the Community Affairs References Committee inquiry into the funding and administration of mental health services and, in particular, the dissenting report by coalition senators. What we set out to do in our report was to talk about, as Senator Siewert said, the primary changes. One of the main reasons why the coalition was keen to establish this inquiry was the changes that were being effected to Better Access. As a consequence of that, it was quite a broad-ranging inquiry into the funding and administration of mental health services.

As part of the coalition's dissenting report, we go back to 2006 and to the Howard initiatives and why Better Access was established. Let us not forget that Better Access was part of a broader package of $1.9 billion that went to help people access mental health services. We did not discriminate against people with mild to moderate or severe mental illness. In our report, we traverse the background to this. But we also underline that the evaluation that was undertaken by the government, which took two years to do, was not a good evaluation. It was an evaluation that was based, unfortunately, on bad methodology and a dataset that was very critical. Our concern is that this evaluation did not actually test and evaluate the original objectives of the Better Access initiative. We set that out in our report. Many of the findings of that evaluation are actually qualified. At past estimates, we have been very critical of the government in relation to that evaluation. The reason why we have done this is that clearly the government has used this evaluation to cut Better Access. Our criticism of the government on this front is that, in effect, this was a cost-cutting measure and there is a real question whether this evaluation was set up to fail so that it could be simply used to justify these cuts.

We also in our report look at the history of the government's National Advisory Council on Mental Health and we traverse Professor John Mendoza's involvement in that and the fact that Professor Mendoza resigned, criticising the then Rudd government for its lack of action on mental health. The importance of this was that the Minister for Mental Health and Ageing, Minister Butler, instead of finding a new chair, set himself up as the chair of his own advisory council. How can you have an advisory council to the minister with the minister himself chairing that advisory council?

We look at these changes and we also look at the fact that, as part of this process, the government set up, on top of its council, an expert group. This expert group was criticised because it appeared to have access to information, and it appears that this expert group did give some advice in relation to these cuts. This not only led to confusion in the mental health sector but actually brought into question the point of the council and the transparency of the whole process.

One of the things that cause us concern is that nowhere in the evaluation that was done of Better Access is there justification for these cuts. We traverse in our report the fact that it is clear that about 87,000 people are going to be affected by these cuts. There is concern that these people, who will no longer have access under Better Access, will then be forced onto ATAPS, and there is then a question as to whether the ATAPS program, the Access to Allied Psychological Services program, is equipped to provide the service to those patients.

In our report, we look at what ATAPS is currently doing. We examine criticism of the ATAPS program by the ANAO, the Australian National Audit Office, which undertook an independent audit of the ATAPS program. Our concern throughout all of this is the impact that it is going to have on existing services. As with many other things in health, the minister and the government have acted before they have properly consulted the very people who needed to be consulted about these very major changes. There is no doubt that there are going to be a lot of services withdrawn from the system. A lot of money has been taken out of Better Access. The government has failed to assess the impact of these changes on existing programs—for example, headspace. We had evidence from headspace. We also had evidence in relation to EPPIC, the Early Psychosis Prevention and Intervention Centre. Yes, the government has indicated that it will expand EPPIC. But—and there is always a 'but' with this government—it will be if the states and territories come on board. That is unlike the coalition. Our commitment is to 20 early psychosis intervention centres, which will be funded by the Commonwealth, in addition to 800 mental health beds and 60 additional youth headspace sites. That was the basis of the coalition's $1.5 billion investment in mental health promised at the last federal election.

The coalition has been very strident in its criticism of the government's lack of action in mental health. It is very clear that this government has been forced kicking and screaming into taking action in mental health. Let us not forget that the Senate passed a motion in October last year calling on the government to implement these very measures. Then that same motion passed the House of Representatives in November last year. For the record, in April the Leader of the Opposition and I made further announcements of a $432 million spend in mental health to take the total spend to $1.2 billion.

In relation to headspace and EPPIC, it is important to see how these headspace and EPPIC centres roll out in conjunction with the other services before we take arbitrary decisions to cut services without carefully considering not only the impact but how this government is going to monitor the impact of these changes on patients.

Our report concluded with some comments in relation to the National Mental Health Commission and the two-tiered Medicare rebate system for psychologists, which certainly generated a lot of submissions and excitement in the professions. It is unfortunate that, at a time when one in five Australians need assistance because of some sort of mental health issue, our psychologists demonstrated that there is a division within their profession. The coalition makes certain suggestions in relation to a way forward, such as potentially referring the issue of a two-tiered system to the Australian Health Practitioner Regulation Agency for further consideration.

I would like to end my comments on the subject of the National Mental Health Commission. Yes, the government has said that it is going to have a National Mental Health Commission. But it will certainly not be the independent body that so many in the sector have been advocating. Many submitters indicated that the National Mental Health Commission must be independent and must be outside government in order to fulfil its proper function of scrutiny of the sector and advice to the government. I want to repeat the coalition's concerns about the appointment of Monsignor Cappo to the National Mental Health Commission and the issues that that generated. Most importantly, I want to repeat the coalition's concerns about the lack of transparency and the lack of proper processes, which appear not to have been addressed in relation to not only Monsignor Cappo's appointment but also the appointment of the commissioners and indeed his successor. The coalition remains committed to the reform of mental health, but that reform must be undertaken with consultation, which is what this government has not done. (Time expired)

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

This report on mental health shows that there is a general shared concern in our community that there be effective mental health care. The very fact that we had to have so much discussion and came up with a unique result—I am not aware of three separate reports coming from one process before—indicates that there is a great deal of dynamic tension about the best way to respond to the mental health needs of the community. This is unlike—and I want to just once draw this to the attention of the Senate—the situation in 2006, when the previous government brought out their mental health plan. The people in the opposition had great concerns about some of the things being done. We took a bipartisan approach to that and worked together to ensure that the budget for mental health was effective. Any differences that we may have had on policy direction were worked through. That is different to what seems to be happening a little bit at this time.

The government in the 2011-12 budget delivered a package with one key message: that we needed to do more to help Australians with mental health issues. It is important that when people have issues they can get the help that they and their families need there and then. It is most important when looking at the whole mental health package to look at the role of carers and families. If you look at the submissions that our committee received, there were significant questions raised by people involved in caring for relatives and friends. They are demanding to have greater engagement in policy development and to have their needs addressed as well.

There was a great deal of agreement in the process that we went through. But the core point of disagreement was around the repositioning of the budget. The government were very clear and very open about what they had done in terms of investment in mental health in the budget. They had reassessed and rebalanced the money. Money was being withdrawn from two key areas, the Better Access program and the rebate given to providers for their mental health sessions. The idea was that the money that was being taken from those areas was going to be reinvested so that people across the country would have greater access to the services that they needed. This was not saying that Better Access as a program was not working effectively, and this was not saying that the GPs involved were not giving good service to their clients. It is important to put on record that the issue of consultation comes up in just about every inquiry that we have. There will always need to be more innovative ways to consult effectively with people who have needs in any area. But it is just wrong to say that the government did not have consultations around developing their process. There were specialist groups developed, including consumers, people who work in a range of professions and people who have knowledge of the mental health area. There were also a wide range of consultations with consumers, carers and people in the industry across the country. All of that information was taken into account in developing the package that came out in the budget. Is it a perfect package? No. There has never been a perfect package. What it is is the best possible approach to look at how we can best spend the budget on mental health services.

The core aspect around Better Access was to reinvest some of the money, after the review of Better Access was concluded, and we went into great detail through the committee process looking at how this review operated. One thing that no-one questioned was the data that indicated that over 80 per cent of people accessing the Better Access services that are there only accessed fewer than 10 services. There could be other queries about that process evaluation but no-one argued with that data. In fact, what we said was that perhaps it was better for the people who had ongoing need to look at alternative forms of getting services that we know they need. And we had evidence from a number of practitioners that people who perhaps required more interaction with practitioners could well need interaction with other forms of practitioners.

That is not to say that Better Access did not serve a purpose, because you and I know, Mr Acting Deputy President, that, when you have need for help, you will take what is available—and up until now one of the core aspects of available services was Better Access. We said in this budget that we thought there should be more funding put into the ATAPS program, and when I have more time I will speak more about that and the alternative service it operates; also, greater use of making sure that we have an effective workforce relationship and we have access to psychiatrists so that people who have more serious needs and have to move up a level may be better serviced by having access to psychiatrists. That was a core aspect of the discussion.

I think we need to ensure that through this report—as I say consistently, a report is but a stage—we look at the range of recommendations and at the range of concerns and that we work together to see whether we can have an ongoing response. That is to acknowledge to all the people who gave their time to this process that we value your input, we value your needs and we know that there needs to be ongoing work on mental health services in this country. Again, that is something I can say that there is no argument about.

I would like to go on and talk more about the commission and those things, but we will have more time when we get through different stages of the budget in the future. I can say that the government are determined that we will completely reinvest every dollar into new mental health services, targeting some of the most disadvantaged people in our community—because, as always, one of the things we saw was that the services provided did not reach the people who were in the lower socioeconomic areas in our nation, and that is something about which we must all be concerned. The data is there. We now have a challenge to see whether the enhanced ATAPS, the e-health initiatives and the community care processes that are part of the budget initiatives will meet the challenges to make sure that they do reach those people—and we have a commitment in this place to work to make sure that happens.

Penny Wright (SA, Australian Greens) Share this | Link to this | Hansard source

As the Greens' spokesperson for mental health I am pleased to rise to speak in relation to the tabling of the Community Affairs References Committee Inquiry into Commonwealth funding and administration of mental health servicesreport, and I thank Senator Moore for her generosity in sharing her time with me.

The Australian Greens welcomed the government's commitment of increased funding for mental health in the May budget. The budget also introduced some substantial and far-reaching initiatives which the Greens have been consistently calling for, in particular a focus on children, youth services, early intervention and case management, and the establishment of a dedicated Mental Health Commission. However, it is fair to say that there were also implications from the budget decisions which were of concern to the Greens and certainly received mixed reactions from various sectors.

There are several particular issues that I will refer to briefly in the time available. Some submissions expressed concern about the process of consultation which occurred before these initiatives were announced, and I share that concern. A particular issue that was raised related to the existing National Advisory Council on Mental Health. Another body was established, the Mental Health Expert Working Group, which does not include a consumer representative.

Often in the past, in Australia's mental health history, mental health consumers and carers of those who experience mental health conditions have had things done to them without sufficient consultation. It is absolutely crucial, for programs and initiatives to be effective and accountable, that the voice of consumers and carers be included and heard at every stage.

The other matter I want to address in the brief time available is in relation to Better Access and the change to the number of sessions available. Although I understand the reasoning behind the government's decision to rely less on Better Access and to focus more on the ATAPS program—for example, because there are suggestions that Better Access has not reached hard-to-reach communities such as lower socioeconomic groups or those in rural and remote areas as well as ATAPS has done—it is clear from submissions received from many organisations and practitioners that the result of these reduced sessions will be that there will be clients who have a compelling need for treatment and, where practitioners have clients like that, naturally they use the mechanisms available to help them. They are extremely concerned at the possibility that many of those clients will not be able to access treatment if these changes go ahead.

There is a need for the government to better identify the objectives for Better Access, in my view. And, like my colleague Senator Siewert, the chair of the committee, in her additional comments, I urge the government to delay the implementation of the Better Access changes until it is clear that other programs such as ATAPS can provide treatment to people with severe or persistent mental illness.

I would like to thank the secretariat for their diligence in dealing with the amount of correspondence generated—as has been said, there were over 1,500 submissions, so clearly it is of great concern in the community—for their handling of some contentious issues which are discussed in the report and for their accurate and thorough compilation of the evidence received. I seek leave to continue my remarks.

Leave granted; debate adjourned.

Sitting suspended from 18:29 to 19:30