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Inquiry into Mental Health Services in Australia
Terms of reference
1.1
On 28 March 2007, on the motion of Senator Lyn Allison, the Senate
referred the matter of mental health services in Australia to the Community
Affairs Committee for inquiry and report by 30 June 2008. Following the commencement of the 42nd Parliament, the Senate readopted the inquiry on
14 February 2008. The terms of reference required the committee to
examine:
- Ongoing efforts towards improving mental health services in Australia,
with reference to the National Action Plan on Mental Health agreed upon at the
July 2006 meeting of the Council of Australian Governments, particularly
examining the commitments and contributions of the different levels of
government with regard to their respective roles and responsibilities.
- That the committee, in considering this matter, give
consideration to:
- the extent to which the action
plan assists in achieving the aims and objectives of the National Mental Health
Strategy;
- the overall contribution of the
action plan to the development of a coordinated infrastructure to support
community-based care;
- progress towards implementing the
recommendations of the Select Committee on Mental Health, as outlined in its
report A national approach to mental health – from crisis to community;
and
- identifying any possible
remaining gaps or shortfalls in funding and in the range of services available
for people with a mental illness.[1]
Interim report
1.2
This interim report outlines the committee's work to date and provides a
broad summary of the themes arising in the evidence received. Given the scale
of the reforms introduced in mental health, the substantial evidence provided
to the committee and the committee's heavy workload with other concurrent inquiries,
the committee will report in further detail and present its recommendations to
the Senate by 25 September 2008.
The committee's work to date
1.3
The committee advertised the inquiry in The Australian and on its
website. It wrote to many organisations and individuals inviting submissions to
the inquiry. The committee has received and published 55 submissions, together
with a considerable volume of additional information received at and after
public hearings which is listed at Appendix 1. It has also received a further 4
confidential submissions.
1.4
The major emphasis of the terms of reference referred to the Council of Australian
Governments' (COAG) National Action Plan on Mental Health
2006-2011. When the matter was originally referred the Action Plan had
been in place for only a short period of time. The committee determined that
the Plan needed time to be bedded down before any worthwhile assessments could
be made. The committee decide to seek submissions and conduct a roundtable in
2007, deferring public hearings until 2008.
1.5
The roundtable discussion was held in Canberra on 10 August 2007 with representatives from a range of peak bodies, professional associations, consumer
and carer organisations. Prior to commencing the public hearings, the committee
received a briefing in March 2008 from the Department of Health and Ageing and
the Department of Families, Housing, Community Services and Indigenous Affairs.
During March, April and May 2008 the committee held nine public hearings,
across each of the state and territory capital cities. Details of the public
hearings are referred to in Appendix 2. The public submissions and Hansard
transcripts of evidence may be accessed through the committee's website at http://www.aph.gov.au/senate_ca.
Australia/New Zealand Parliamentary
Committee Exchange
1.6
In April 2008 the committee was selected by the Senate President to
visit New Zealand as part of the Australia/New Zealand Parliamentary Committee
Exchange Program. This exchange, undertaken from 14–17 April, had a major focus
on mental health issues in addition to a number of other subject areas of
specific interest to the committee.
1.7
The committee met with Ministers and party spokespeople from across the
political spectrum, senior officers from relevant Departments and representatives
from NGOs. The committee was especially interested in meeting with the New
Zealand Mental Health Commission whose activities had been raised during the
earlier Senate Select Committee on Mental Health. The meetings held during this
exchange enabled committee members to gain a broad understanding of the
operation of mental health services in New Zealand, as a comparison and
contrast with Australia. Insights gained through the exchange have been valuable
to the committee in conducting this inquiry.
State and territory governments'
participation
1.8
The COAG National Action Plan on Mental Health
2006–2011 specifically acknowledged that reforming the mental health system
in Australia required commitment and coordination across all levels of
government:
The success of the Plan will require continuing effort by all
governments. COAG has therefore agreed to new arrangements for the Commonwealth
and States and Territories to work together to implement our commitments in the
most effective way.[2]
1.9
Given this commitment, and that the terms of reference specifically
required the committee to examine 'the commitments and contributions of the
different levels of government with regard to their respective roles and responsibilities',
the committee was keen for state and territory governments to actively
participate in the inquiry.
1.10
The Chair of the committee wrote to all state Premiers and territory
Chief Ministers inviting written submissions to the inquiry. The committee was
pleased to receive submissions from the governments of the Australian Capital
Territory, Northern Territory, South Australia, Tasmania, Victoria, Western
Australia and Queensland. The lack of response from the Government of New
South Wales has considerably limited the committee's ability to assess the
progress of mental health reforms in that state and nationwide. It is
disappointing, given the stated inter-government commitment at the time of the COAG
National Action Plan, that the New South Wales Government chose not to make a
submission to the inquiry.
1.11
The committee was further hindered by the governments of New South Wales
and Victoria declining to participate in public hearings. This contrasted with
the Queensland Government, which although unable to participate at the
committee's Brisbane hearing subsequently enabled the Director of Mental Health
with Queensland Health to participate in a later hearing in Canberra.
1.12
Improving mental health services in Australia requires the combined
commitments of state, territory and federal governments. This has been clearly
stated and agreed on numerous occasions.[3]
Such commitment includes going beyond funding separate government initiatives,
to cooperatively review how change is progressing and whether services are
improving. The committee is disappointed that some state governments chose not
to fully contribute to the inquiry, and disturbed as to what this may indicate
about the strength of the inter-government commitment to implementing and
evaluating mental health service reforms provided for under the COAG National
Action Plan.
Context for the inquiry
1.13
As indicated in the terms of reference, the committee's inquiry followed
the inquiry of the Senate Select Committee on Mental Health, which reported to
the Senate in March and April 2006. That committee was established to
comprehensively examine mental health in Australia. This inquiry was not
intended to repeat the comprehensive examination undertaken by the earlier select
committee. Rather, in accordance with the terms of reference, the committee
focussed on the COAG National Action Plan and the progress made in mental
health service reforms and the service gaps and shortfalls that remain.
The Senate Select Committee on
Mental Health
1.14
The select committee's report added to those of a number of other
organisations that have examined mental health services in Australia and found
them wanting.[4]
The select committee found a service sector urgently in need of resources and
renewed focus and coordination. Some of the major problems highlighted
included: inadequate resources and underutilisation of existing resources,
inadequate community based care, acute care services in crises, inadequate
focus on prevention and early intervention, great geographic disparity in the
quality of care, and service silos and gaps. The select committee found that people
with mental illnesses were still stigmatised and marginalised, and situations
remained where their human rights were abused. Consumers and carers struggled
to have their voices heard in the design, conduct and evaluation of treatment.
The select committee commented that the experiences related to it, and the
facts set out for it, 'were depressingly similar' to those presented in a
report ten years earlier.[5]
1.15
The select committee, in its two reports, made 91 recommendations for
action. Some of these recommendations were directed to the Council of
Australian Governments, some to the Australian Government and some to state and
territory governments. The first report set out key directions, including
substantial increases in mental health funding, the establishment of
community-based mental health centres and multi-disciplinary treatment teams,
and funding of national bodies for monitoring and accountability, consumer and
carer advocacy and mental health research.
1.16
The second report made a suite of targeted recommendations in the
following areas: monitoring and research, consumers' rights and roles,
prevention and intervention, community treatment, non-government organisations,
workforce and training, crisis response, treatment responses, housing, families
and carers, payment for mental health care, the justice system, dual diagnosis,
children and youth, older people, culturally and linguistically diverse
communities and refugees, rural and remote communities, and Indigenous
communities.
1.17
To date, neither the previous nor current Australian Government has
formally responded to the select committee's report and recommendations. The committee
requests that this response be made expeditiously.
1.18
Of the states and territories, only the ACT Government in its submission
to this inquiry set out a comprehensive response detailing its position on each
of the select committee's recommendations.
1.19
However, developments in policy and programs indicate that governments
have responded, at least in part, to some of the issues raised in the select committee's
inquiry and recommendations. These developments are discussed below.
The COAG National Action Plan on
Mental Health
1.20
Towards the conclusion of the select committee's inquiry, in February
2006, the Council of Australian Governments recognised that mental health was 'a
major problem for the Australian community' and that additional resources were
required 'from all governments to address the issues'.[6]
COAG tasked Senior Officials with preparation of an action plan to be brought
forward for its consideration. The action plan was to address many of the
issues that had been raised throughout the select committee inquiry.[7]
1.21
At its meeting in July 2006, COAG adopted the National Action Plan on
Mental Health 2006–2011 (hereafter the COAG Plan), including two flagship
initiatives and a separate individual implementation plan for each state,
territory and the commonwealth government. The COAG Plan aimed to 'deliver a more
seamless and connected care system, so that people with mental illness are able
to participate in the community'.[8]
1.22
The COAG Plan was directed at four outcomes:
-
reducing the prevalence and severity of mental illness in Australia;
-
reducing the prevalence of risk factors that contribute to the
onset of mental illness and prevent longer term recovery;
-
increasing the proportion of people with an emerging or
established mental illness who are able to access the right health care and
other relevant community services at the right time, with a particular focus on
early intervention; and
-
increasing the ability of people with a mental illness to
participate in the community, employment, education and training, including
through an increase in access to stable accommodation.
1.23
In order to achieve these outcomes, the plan set out five target areas
for action:
-
promotion, prevention and early intervention;
-
integrating and improving the care system;
-
participation in the community and employment, including
accommodation;
-
coordinating care; and
-
increasing workforce capacity.
1.24
The two flagship initiatives in the COAG Plan were aimed at better coordinating
care. The first, entitled 'Coordinating Care', was to make available to each
person with serious mental illness a clinical provider and community
coordinator, to provide integrated clinical management and ensure connection to
non-clinical services. The second, 'Governments Working Together' required the
establishment within each Premier or Chief Minister's department of a COAG Mental
Health Group, to oversight how commonwealth and state and territory
initiatives would be coordinated.
1.25
The Commonwealth Government's Individual Implementation Plan included 18
initiatives in the other four target areas. These initiatives involved $1.9
billion in new funding over five years, which was included in the 2006–07
Budget. The four largest budget initiatives in the Commonwealth Individual
Implementation Plan were:
-
$538 million for better access to psychiatrists, psychologists
and general practitioners through the Medical Benefits Schedule;
-
$284.8 million for new personal helpers and mentors;
-
$224.7 million for more respite care places for families and
carers;
-
$191.6 million new funding for mental health nurses.[9]
1.26
The state and territory individual implementation plans together
contained 124 initiatives and brought the total funding commitment in the COAG
Plan to approximately $4 billion.[10]
However, state and territory plans included a mixture of new and previously
allocated funds.[11]
In some cases initiatives included in the plans had already commenced.[12]
Other developments
1.27
Several governments pointed out that they had made additional major
investments in mental health services since the COAG Plan. Some examples
include:
-
The Queensland Government committed a further $528.8 million to
COAG Plan objectives in its 2007–08 Budget, bringing its total commitment
against the Plan to $895.2 million;[13]
-
The Victorian Government allocated an additional $41.2 million in
its 2007–08 Budget for new mental health initiatives and growth funding, as
well as $21.7 million for capital works;[14]
-
The South Australian Government announced $43.6 million for
mental health reform in response to the SA Social Inclusion Board's report Stepping
Up: A Social Inclusion Action Plan for Mental Health Reform 2007–2012 and a
further $50.5 million in the 2007–08 State Budget;[15]
-
The ACT Government committed an extra $12.6 million for mental
health services in its 2007–08 Budget and $8.75 million in its 2008–09 Budget.[16]
1.28
Individual state and territory government submissions provide further
detail about these additional investments.[17]
Themes in evidence
1.29
Evidence to the inquiry indicates that progress has been made against
many of the initiatives in the COAG Plan, but that widespread gaps and shortfalls
in Australia's mental health care remain. A broad summary of the issues raised with
the committee during its inquiry is given here. The committee is at this point
simply reporting the major themes presented in evidence; it is not presenting
its views, conclusions or recommendations. Clearly there are further related
issues and details to consider. The committee will consider the evidence
presented to it in further detail and report to the Senate at a later date.
Progress
1.30
The COAG Plan made progress in a number of areas towards achieving the
aims of the National Mental Health Strategy and the recommendations of the
Senate Select Committee on Mental Health. It helped put mental health high
on the agenda across government departments, at both state and federal
levels. It recognised that mental health was not just a health portfolio
responsibility, but required a broader, community-based response.
1.31
The recent announcement of the creation of a National Advisory Council
on Mental Health reflects the priority that has been given to mental health at
the national level.[18]
The Council is expected to provide the Government with independent advice from
experts on mental health and will assist the coordination of Commonwealth,
State and Territory mental health services so as to improve support for people
with mental illness and their carers.[19]
It is important that the membership of this Council includes consumers and
carers and that the Council is able to function independently and provide
independent advice as has been clearly indicated by the Government.
1.32
The COAG Plan put desperately needed money into the mental health
community sector. Many non-government organisations now have new funding to
help provide a range of community-based services.
1.33
The new community-based program with the largest budget, and the one
about which the committee received most comment, is the Commonwealth's Personal
Helpers and Mentors program (PHaMs). This program provides funding to the
non-government sector and was designed to engage 900 personal helpers and
mentors to assist people with a mental illness who are living in the community
to better manage their daily activities.[20]
The first two funding rounds of the program have been conducted and in 48 sites
across the country personal helper and mentor workers are available to support
people with mental illness in their recovery journey. So far around 400
personal helpers and mentors have been engaged, well short of the program
target.[21]
Non-government organisations are keen for progress to be made on the third
PHaMs funding round, reflecting the positive experience with the program so far
and the need for further services of this kind.
1.34
There is widespread support for the PHaMs program, particularly the peer
support component, which in many areas provides a service that was lacking.
Consumers can self refer into the program and do not have to have a formal
diagnosis. As such it provides a pathway into services from outside the
traditional, clinical settings. It is a program with the potential and flexibility
to engage those who have not been accessing services. However, there are also
concerns as to how PHaMs sits with other local services, its limited geographic
coverage, whether it is being accessed by those with the most complex needs and
whether providers are trained and equipped to meet these complex needs.
1.35
The COAG Plan markedly increased access to some clinical services.
In particular, more than 726,000 people have been able to access cheaper
primary mental health care under new Medicare arrangements.[22]
Previously underutilised members of the mental health workforce, such as psychologists,
have been made more accessible. The Better Access initiative provides Medicare
rebates for certain GP provided mental health services and consultations with
psychiatrists. It also provides Medicare rebates for specified allied health
professional consultations (psychologists, occupational therapists and social
workers) where patients have been referred under a GP mental health care plan
or by a psychiatrist or paediatrician.[23]
1.36
The Better Access initiative provides an example where shifts have
occurred in mental health services since the select committee's inquiry. The
cry for so called 'talking therapies' was a prominent theme in evidence to the
select committee. Consumers and carers expressed frustration at rigid medical
models and the dominance of pharmaceutical treatments. This theme was less
emphasised in the current inquiry, indicating the shift that Better Access has
made in recognising evidence-based talking therapies. These therapies are now more
prominent and widely available than they were previously.
1.37
According to the COAG Plan, the Better Access initiative aimed to
'improve access to, and better teamwork between, psychiatrists, clinical
psychologists, GPs and other allied health professionals'.[24]
While extensive use of these professional services was clear, evidence of
better teamwork between service providers was less conclusive. Certainly the
initiative falls short of the select committee's recommendation, which was to
establish community-based mental health centres staffed by multidisciplinary
teams.[25]
1.38
A number of concerns were expressed about the Better Access initiative.
For example, whether it is making services accessible for the most seriously
ill, particularly as gap payments and the low rate of bulk billing among some
providers mean that services can still be expensive. There are fewer mental
health professionals outside the metropolitan areas, making service access
inequitable. Further, there are concerns about how well the initiative is being
monitored. Certainly uptake has been higher than originally foreseen and
further budget allocation was necessary.[26]
While use of the Medicare items provided under the initiative is being
monitored, there is no information as to the effect of the services on people's
mental health.
1.39
Funding for mental health nurses in the COAG Plan was also designed to
improve access to care. Funding was provided for mental health nurses to work
in a range of clinical teams including with private psychiatrists and in
general practices. The aim was for mental health nurses to assist in
coordinating care, managing medication and making links to other medical
professionals and services. The committee heard examples where mental health nurses
were being better utilised to improve service accessibility and coordination.
However, the initiative has been undersubscribed, partly resulting from
workforce shortages.
1.40
The COAG Plan recognised that connecting all the available services is
fundamental to improving Australia's mental health care. The Plan
recognised that people with severe mental illness and complex needs are most at
risk of falling through the gaps in the system. While the Plan stated that
people within the target group would be offered a clinical provider and
community coordinator from Commonwealth and/or State and Territory Government
funded services, there have been very different approaches to 'care
coordination' across the jurisdictions. Concerns raised include the lack of funding
for this initiative, how it fits with existing local services and whether
better integration of services is actually occurring.
1.41
The COAG Plan recognised that the commonwealth, state and territory
governments need to work together to provide mental health care. Each state
and territory was to form a COAG Mental Health Group, convened by the Premier
or Chief Minister's Department. These groups were to provide a forum for
'oversight and collaboration on how the different initiatives from the
Commonwealth and State and Territory governments will be coordinated and
delivered in a seamless way'. Coordinating mental health groups exist in each
jurisdiction, however there is significant variation in the composition of the
groups, regularity of their meetings and extent of involvement and
communication with stakeholders. The Queensland COAG Mental Health Group meets
regularly and produces a regular newsletter providing information about
progress under the COAG Plan. In contrast, in some areas there was confusion as
to the existence, membership and role of the state COAG Mental Health Group.
The adequacy of the consultation of some COAG Mental Health Groups with
consumers, carers and service providers was an area of concern.
Gaps and shortfalls
1.42
While there is widespread support for the COAG Plan initiatives and the
new funding that has gone into mental health services, there is also broad
agreement through the evidence provided to the committee that there is a lot
further to go in creating an available, accessible, community-based mental
health care system. There are a number of outcomes the COAG Plan has not achieved.
It failed to set out a vision for Australian mental health services into
the future. While the COAG Plan has been recognised for giving a higher priority
and funding to mental health services, there is a lack of clarity as to how it
fits with the National Mental Health Strategy and the intended direction once
each of the Plan's initiatives has been implemented.
1.43
The potential for the COAG Plan to make a substantial difference to the
lives of those with mental illness depends heavily on wider supports that, if
lacking, will compromise the efforts made under the Plan. In particular, affordable
housing and supported accommodation are keystones to furthering other
efforts towards mental health. Increased housing stress throughout the
population puts further pressure on already stretched services, making
accommodation even more difficult to obtain for those with complex needs such
as mental illness. Stable housing is conducive to health and wellbeing and,
particularly for those with complex needs, housing and other supports need to
be linked. While some of the state and territory Individual Implementation
Plans allocated funding to supported accommodation and residential services,
such as step-up and step-down facilities, critical shortages remain.
1.44
The COAG Plan did not give consumers a priority voice in
formulating policy and implementing programs. The Plan itself appears to have
had little direct consumer input and it did not set out principles or
initiatives for promoting consumer involvement in service delivery and a
recovery model of service. COAG Mental Health Groups were required to 'engage'
and 'consult' with non-government organisations, the private sector and
consumer and carer representatives. This falls short of the select committee's
recommendation that all governments establish benchmarks for the employment of
consumer and carer consultants in mental health services and that all service
providers have formal mechanisms for consumer and carer participation.[27]
1.45
Perhaps reflecting efforts at cross jurisdiction coordination, mental
health policy in recent years and the COAG Plan have been dominated by
government-to-government negotiation and agreement. Witnesses identified capacity
building and support for consumer advocacy as a shortfall in mental health
service reform.
1.46
There is a clear need for more consumer and carer run services. Consumers
and carers are in a unique position to contribute to training, education and
awareness raising, advocacy and recovery support. There are a few excellent
examples of consumer run support services, where great outcomes have been
achieved by people with mental illness, including facilitating recovery and
reducing hospital readmission and other service use over time. However,
consumer and carer run services are few and far between, and in most areas
there are none.
1.47
Despite the COAG Plan's focus on coordination, coordinating mental
health services remains a critical issue. The articulated aim of 'a more
seamless and connected care system' has not yet translated into common practice.
This is evident at multiple levels. Further coordination is required across
jurisdictions, within jurisdictions and in the actual delivery of services. Across
the states and territories levels of mental health funding and provision of the
services intended to accompany de-institutionalisation, including investment in
community-based services, still vary greatly. A consistent, national approach
has not been articulated. Differences in legislation across jurisdictions means
that maintaining stable treatment across state boundaries can still be
challenging.
1.48
Improved coordination can be achieved between commonwealth areas of
responsibility, such as allied health professionals, employment programs and
education and state responsibilities, such as in-patient care, residential
services and corrective services. Both levels of government provide funding to non-government
organisations to deliver mental health services and the fit between programs
funded by each needs careful consideration. The demands on non-government
organisations in tendering for and reporting on multiple programs, at both
state and federal levels, can be onerous.
1.49
Within jurisdictions the structure of mental health services varies
greatly. Some states and territories have a much higher proportion of their
mental health funding and programs situated within government public mental
health services, while others use non-government organisations and the private
sector more extensively. These differences have implications for service
delivery and how effectively some of the COAG initiatives can be rolled out and
accessed. The fit between national programs and local contexts and services
needs close attention.
1.50
At a service delivery level, there are still gaps and integration issues.
Although COAG initiatives such as 'coordinating care' recognise the importance
of linking up services in response to an individual's needs, this remains a
real challenge. Coordination is important, not only across designated mental
health services, but with wider supports such as accommodation, employment and
income support. Linkages need to be made across public, private and non-government
organisation services. With additional programs being rolled out into the
community through the COAG Plan initiatives, the need for information about
what services are available and linkages between them has become, if anything,
heightened.
1.51
A particular issue raised with the select committee, and again in this
inquiry, is the linkage of mental health and alcohol and other drug services.
While some states are making progress, it remains a key area where those with
complex and high levels of need are falling through the gaps.
1.52
Sustainability of services is an issue. Much of the
community-based funding in the COAG Plan is short-term, contract funding for
specific programs. Non-government organisations have raised concerns about the
demands and effects of competitive tendering processes and there are questions
about the future of programs after the budgeted funding expires.
1.53
There are some great, innovative models of care and some very
resourceful service providers. However, many services remain oversubscribed.
Even people in immediate crisis may be turned away. Some of the COAG
initiatives which aim to better coordinate care can only be fully effective if
services exist in the area for people to access. Despite the increase in
funding which the COAG Plan achieved, many areas still need more mental health care.
1.54
Meeting the needs of the most seriously ill remains an area of
concern. Acute care services remain under strain and it is too early to assess
whether new community-based initiatives are enough to in any way relieve the
demands on in-patient services. Achieving a continuum of care remains an
important goal. The committee heard some examples where community-based
services have been able to link in with hospital in-patient services, but
comprehensive discharge planning and associated supports were not held to be
widely available.
1.55
Service standards are not uniform and people with mental illness still
report instances of poor treatment and abuse. Systems for monitoring standards
differ across jurisdictions, as do mental health acts. Concerns were raised
about transparency and accountability. Ensuring the rights of people with
mental illness remains an area requiring close attention.
1.56
Services currently remain patchy and inconsistent and people in
some areas receive more service than others. The lower number of mental health
care professionals in rural, regional and particularly in remote areas means
that, even with Medicare rebates, their services are not consistently accessible.
Services are structured differently across the states and territories and in
some areas there is not a substantive non-government sector to fully utilise
new funding for community-based services. Concerns were raised that COAG Plan funding
to mental health services in rural and remote areas is inadequate to address
the additional barriers these communities face in accessing mental health care.
1.57
Some groups of people, including those with the most complex needs, find
it particularly hard to access the kinds of services they need. While COAG Plan
initiatives put funding into some targeted programs, services are not widely
available to meet the needs of specific groups.
1.58
Culturally appropriate and accessible mental health services are needed
for Indigenous Australians. A whole range of interrelated issues, such as
poverty, alcohol and drug use, abuse, physical illness, community loss and
remote location mean that there are complex mental health needs in many
Indigenous communities. Generic services are often inaccessible or
inappropriate. Some COAG Plan funding was allocated through the Commonwealth
and some state implementation plans to improve the capacity of Indigenous
mental health services. However Indigenous mental health was identified as an
area with significant unmet need requiring further investment, effort and new
ways of working.
1.59
Culturally and linguistically diverse (CALD) communities require a range
of specialised services to meet their mental health needs. Examples range from translated,
appropriate information about services and rights, through to mental health
trained interpreters and services with specialist abilities in the areas of
trauma and torture. There are different needs within CALD communities, for
example, refugees have a high risk of mental illness requiring special care and
support. Services tailored to CALD communities remain sparse in the
metropolitan areas and virtually non-existent outside the major cities.
1.60
Although promotion, prevention and early intervention was listed as a
specific area for action in the COAG Plan, and each government funded
initiatives under this banner, further services that meet the needs of young
people with mental illness are required. The large majority of mental health
problems emerge in adolescence and early adulthood, so this is a key group to
engage for early intervention. The headspace National Youth Mental
Health Foundation provides an innovative example of progress in youth mental
health services. It is a consortium model with $69 million of Commonwealth
funding, aiming to address the mental health needs of young people aged 12 to
25. Thirty headspace sites have been funded across each state and
territory and are designed to provide a single entry point for young people to
the range of clinical, community and other supports they need. The headspace
website is a key information source and forum for engaging young people.
While headspace is widely supported, witnesses pointed to the need for
further recognition and support for youth services throughout the mental health
system. Acute care was a particular example where basing services around
children and adult populations fails to meet the specific needs of youth with
mental illness.
1.61
People with comorbidity, the homeless, the elderly and people who have
experienced sexual abuse and other trauma are other groups that were identified
as having particular mental health care needs not adequately met by current
services.
1.62
Forensic mental health care remains an area where there are
service shortfalls. The select committee reported that the rate of mental
illness amongst inmates 'is unacceptably high' and this committee did not
receive evidence to suggest that this situation has changed.[28]
As well as targeted services to provide health care to mentally ill prisoners,
preventative services and community-based supports are necessary to reduce the
numbers of people with mental illness coming into contact with the criminal
justice system. Discharge and post-prison care, as with other transitional
services, remain inadequate.
1.63
Families and others who care for people with mental illness are
under strain. While it was acknowledged that the COAG Plan allocated funding
for respite services, such services need to be designed to meet the specific
needs of those caring for people with mental illnesses. The Commonwealth
Government's support for respite under the COAG Plan targeted elderly carers,
and concerns were raised that the needs of young carers have been overlooked. Further,
respite is an inherently short-term form of assistance. Relieving the burden on
carers in the longer term requires more community supports and treatment
services for people with mental illness.
1.64
Community attitudes are changing, but people with mental illnesses
are still stigmatised. The COAG Plan provided funding for some targeted
awareness raising and promotion programs, such as 'Alerting the Community to
the Links between Illicit Drugs and Mental Illness' and 'Early Intervention
Services for Parents, Children and Young People'. However the COAG Plan stopped
short of a nationwide mental illness stigma reduction and eduction campaign, as
recommended by the select committee.[29]
New Zealand's Like Minds, Like Mine campaign was held up as a positive
example of a national mental health education initiative.
1.65
Workforce supply, training and development are essential to
fulfilling on the commitments made in the COAG Plan. Initiatives such as Better
Access, using new Medicare items, can only improve access to mental health care
if there are adequate professionals available to provide the services. The
mental health nurses initiative, which has been undersubscribed and now has
reduced funding, shows the limitations of good initiatives when the workforce
is inadequate to implement them. Skilled workforce shortages and associated
competition for staff are also affecting the non-government sector, which is
under strain implementing several major new mental health initiatives
concurrently.
1.66
There are shortfalls in employment strategies for people with
mental illness. Employment is important both for prevention in helping to
maintain mental health, and as part of the rehabilitation and recovery journey
for people with mental illness. Barriers to employment for people with mental
illness continue to exist, such as stigma in the workplace and inadequate
workplace supports. Concerns were also expressed about the ramifications of 'welfare
to work' arrangements on the health and welfare of people with mental illness.
The importance of reliable income support was emphasised. More broadly it was
noted that social disadvantage needs to be addressed in conjunction with
specific mental health initiatives.
1.67
The select committee promoted a substantial increase in funding for mental
health research, recognising the importance of research to developing more
effective treatments, understanding consumer needs, and developing better ways
to deliver services. Little focus was given to research in the COAG Plan; it
remains an area for ongoing attention.
1.68
The COAG Plan paid minimal attention to evaluation and outcome
measurement. Currently, there are few outcome measures to show whether
initiatives are working. Are fewer people experiencing mental illness? Are more
people achieving recovery? To what extent are people with a mental illness able
to go on to live out their potential and the possibilities they see for their
lives? Efforts towards improving mental health services in Australia remain a
work in progress and answering these questions will be important in assessing
the contribution that the COAG National Action Plan has made.
Concluding comment
1.69
There is widespread appreciation of the funding that has gone into
mental health services through the COAG Plan, however there is caution at this
stage as to how effective the new initiatives will be in filling existing
service gaps and shortfalls. There is also widespread recognition that
achieving a seamless and connected system of care that meets the mental health
needs of the most seriously ill, let alone other Australians, will require
further investment, leadership and cooperation between all those involved.
Acknowledgments
1.70
The committee acknowledges and thanks all those who have assisted with the
inquiry to date, by making submissions, attending hearings and giving evidence,
providing additional information and other forms of assistance. As with previous
inquiries, consumers and carers have been generous in sharing their lives and
experiences to help us better understand mental illness and the services that are
being provided and those that are still required. Many individuals and
organisations that participated in the inquiry have been contributing to mental
health reform for decades. The committee thanks them for their dedication and
willingness to contribute again through this inquiry.
Senator Claire
Moore
Chair
June 2008
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