Chapter 10 - Support services for people facing mental health problems
Health and wellbeing are influenced by experiences and
opportunities in many intersecting areas of life. For people experiencing
mental health problems, community-based treatment is not only about 'health'
services but is intrinsically linked to supports and services in other spheres
I as a carer on occasions have been very disappointed by what I
felt was a lack of support. But is it wrong to expect the very best of care for
my son when he leaves hospital? Is it wrong to expect he should be able to live
independently which from all accounts would be better for him and his illness?
Is it wrong to expect he should be able to work so he could regain his
self-esteem and confidence again so he can feel he is a normal part of society?
I have watched him try and try to just regain his life to just have a small
part of what he had back.
Submissions to the inquiry emphasised that mental
health services need to operate within an integrated framework which links
related human services such as housing, employment, training, rehabilitation
and disability supports. The
National Mental Health Plan 2003-2008 acknowledged this need:
Improving the mental health of Australians cannot be achieved
within the health sector alone. A whole-of-government approach is required
which brings together a range of sectors that impact on the mental health of
individuals, such as housing, education, welfare and justice.
Evidence to the inquiry canvassed some of the
innovative programs that assist people experiencing mental illness, in areas
beyond the 'health' system, such as housing, employment and training and on the
essential role non-government organisations (NGO) play
in providing these services.
There are significant service gaps, that result in
poverty and homelessness and, where services are available, lack of integration
remains a significant barrier to the health and wellbeing of people with mental
illness. Numerous submissions to the inquiry called for increased linkages and
integration across service sectors.
This chapter provides a brief overview of access to
mainstream support services including accommodation, employment and training,
and income support and describes some successful programs.
This chapter does not detail all the funding streams
and available programs provided by federal, state and territory governments,
but refers interested readers to the relevant submissions for details.
Accessing mainstream services
The Australian Government submitted that:
A range of mainstream programs and services are also provided by
the Australian Government which provide essential support for people with a
mental illness. These include income support, social and community services,
disability programs, and housing assistance programs.
For every dollar spent by the Australian Government on specific
mental health services, an additional $3.20 is spent on providing community and
income support services to assist people with mental illnesses.
The Commonwealth did not indicate whether this
expenditure on support services was higher for those with mental illness than
for welfare recipients in general, although it might be expected that the
former would have greater welfare needs. The Mental Health Council of Australia
(MHCA) stated that generalist housing, education and employment services are
reluctant to provide services to mental health consumers without additional
support, and there is inadequate funding for these services to help consumers
and their carers. They also argued that:
The lack of concrete data about actual service provision, and
more importantly, consumers' access to mainstream health, housing, employment,
education and social activities is a distinct weakness in the National Mental
There is a lack of integration and coordination across
service sectors and difficulties with eligibility requirements for specific
programs and services. A strong need is identified for consumer-operated
services and increased training and education in mental health.
Lack of integration
Formal pathways between services are 'virtually
non-existent', with a lack of formal supports, agreements or protocols between
Individual case managers are left to argue the rights and wrongs
of an individual's access to services which, in a well-run system, would be
Hanover Welfare Services called for a collaborative
approach, and argued that cost savings could be made by restructuring and
rationalising the 'current fragmented and silo based programs' into an
integrated package of assistance.
Submitters called for effective leadership and governance arrangements to
ensure that integrated services operate effectively. The Mental Health
Association NSW Inc. suggested that programs 'must be whole of government, and
controlled by an inter-government/NGO advisory group'.
For inter-agency integration to work there needs to be
a culture change:
Opportunities for coordination of services would be greatly
facilitated by better communication, sharing of information and breaking down
of inter-agency “territorialism”. There are significant barriers to the
coordination of clinical and so called non-clinical or rehabilitation services
that seem to be borne out of professional jealousy, ignorance or disrespect.
This results in gaps in services to clients due to one service provider either
not knowing what other services are available and/or a service provider
believing (wrongly) that a service is being provided by another agency.
reported on research examining services for women with complex needs that found
it was important to locate mental health service expertise within other
services, such as housing services, rather than referring consumers elsewhere. Hanover
also commented that, at the least, involving support workers in the referral
process was helpful as someone in poor mental health may not be in a position
to effectively relay sufficient information to other service providers.
The Department of Families, Community Services and
Indigenous Affairs acknowledged the need for integration of services and
pointed to some of the issues:
One of the biggest barriers is privacy. You cannot share
information. Another barrier is that the different systems do not talk to each
other: IT does not talk to each other, so DEWR’s system does not talk to
Centrelink’s system. There are those sorts of issues. If you try to deliver a
number of programs through one case manager, each program’s funding has to be
kept separate and delivered separately. There are all sorts of barriers. FACS(IA)
is now convening an IDC to start to work through some of those barriers to make
joined-up service delivery more of a reality for the homeless and people who
have complex needs.
The lack of integration and coordination between mental
health and alcohol and drug services was a major issue raised and is discussed
in Chapter 14.
Training and education for service
A lack of understanding about mental health can lead to
mainstream service providers excluding people with mental illness:
Generally there exists a poor level of knowledge and skills
amongst staff within both government and non government (non mental health)
services (housing, employment, law enforcement, and community development)...
Training and consultation programmes are required to assist develop knowledge
and capacity within these agencies.
Even where a consumer, carer or support service is able to
access other community services, their problems are not over. The [National Mental
Health] Strategy does not make adequate provision for funding education and
training to enable staff in other health and community sector services to work
effectively with mental health consumers. Having won the lottery of access to
appropriate support, consumers often find continuing difficulty in dealing with
service providers who are untrained in dealing with people with mental illness.
ACROD, the National Industry Association for Disability
Services, argued that significantly greater knowledge transfer among all
service providers is necessary to improve service integration:
In policy terms, this is a long-term goal which will most
effectively be achieved by a revision in the training of all services. Put
bluntly, it will not be a question of the occasional inter-agency workshop, but
an overhaul of personnel training in which, for example, there is more
accredited multi-disciplinary training...at an acceptably high level.
Service eligibility requirements
The requirement that consumers must have a documented
diagnosis to be eligible for services creates difficulties:
...in order to access a
range of programs and/or assistance, a diagnosis is an essential pre-requisite.
A concrete example of this is the Youth Residential Rehabilitation Program
funded by the State Government, where to be eligible for housing, the person
must have a serious mental illness diagnosis. Similarly, people cannot access
other specialist services without a diagnosis.
Diagnosis can be difficult, inaccurate and time
consuming, or may be extremely challenging to obtain for people who have
limited – if any – contact with the health system. People who are homeless or
transient often do not have proof of identity or a Medicare card, let alone
suitable documentation of a diagnosis.
Divulging a diagnosis, given the stigma associated with
mental illness and real possibility of discrimination, can also be a problem.
Need for consumer-run services
Submissions emphasised the importance of consumer-run
services, and consumer representation on policy formation and advisory
There remains a severe shortage of community support services,
especially those which are consumer initiated and managed, including housing,
home help, recreation, family support, employment and education options for
people with a mental illness and their families.
The Richmond Fellowship recommended seed grants for
consumer run programs, particularly those run in partnership with larger
service providers. Further
discussion of the importance of consumer participation in service delivery is
provided in Chapter 3.
A fundamental requirement underlying the policy of community-based
care and treatment for people experiencing mental illness is the need for
appropriate accommodation. In 1993, the Burdekin Report assessed that the
'absence of suitable supported accommodation is the single biggest obstacle to
recovery and effective rehabilitation'.
Deinstitutionalisation moved thousands of people out of institutions and into
the community, but without a commensurate growth in accommodation. People with
mental health problems are not homogenous and along with extreme shortages of
short, medium and long term accommodation, the diversity of needs is not being
The only way that I could eventually find security of
accommodation for my son was to use a small life insurance payout to put a
deposit on a house for him eleven years ago, and to assist him since then with
mortgage payments. Previous to that time he had lived with relatives, friends,
a privately run sub-standard boarding house, and a small caravan in a caravan
park from where he was evicted and sent to hospital on an involuntary order. He
then began living in rental properties but all of these were eventually put up
for sale and he had to move on. The stress of continually moving and trying to
find accommodation resulted in the deterioration of my son's mental health,
Shelter and housing are basic human needs. Article 11
of the International Covenant on
Economic, Social and Cultural Rights provides that all people have the
right to adequate housing.
Suitable accommodation is critical for several fundamental reasons. Firstly, it
is an effective and cost-efficient preventative measure. Secondly, without stable housing,
people with mental illnesses experience
more frequent and prolonged periods of illness and increased disability.
Current accommodation services
Public and community housing and crisis accommodation
are the responsibility of state and territory governments. The Australian
Government has committed to contribute around $4.75 billion under the 2003-2008
Commonwealth-State Housing Agreement (CSHA), which sets the strategic
directions for housing assistance.
Public housing is the largest form of assistance
provided under the CSHA and is available to people on low incomes and those
with special needs. In 2001-02, 40.8 per cent of public housing allocations
were to people with a disability. Public housing rents are usually set at
market levels with rebates granted to low income tenants, so that they
generally pay no more than 25 per cent of their assessable income in rent. Community housing is 'rental housing
provided for low to moderate income or special needs households managed by
community-based organisations that are at least partly subsidised by government'. Funding for community housing is
typically either fully or partly provided by governments to not-for-profit
organisations or local governments. Community housing models vary across
In addition to the CSHA, the Australian Government contributes
funding to several other programs which may assist people with mental illness
to obtain housing. These include Rent Assistance for income support recipients
and low income families participating in the private rental market; the Home
and Community Care Program, co-funded with the states to support people to live
in their own homes; and the Supported Accommodation Assistance Program (SAAP).
The SAAP provides funding for transitional
accommodation and related support services for people who are homeless or at
risk of homelessness. It is a cost shared program between the federal, and
state and territory governments. Since its commencement in 1985, the SAAP has
been implemented through five-year agreements between the governments.
The strategic directions for SAAP are subject to the Australian
Government agreement, while the management and delivery of SAAP services are
the responsibility of each state and territory government.
States and territories must 'plan, purchase or fund and develop services
to meet agreed outcomes'.
Non-government agencies deliver most SAAP services, with some local government
The Department of Families, Community Services and
Indigenous Affairs advised the committee that the most recent supported
accommodation assistance agreement, signed in 2005, has a new strategic
approach including the following elements:
Early intervention and pre-crisis intervention –
aiming to assist people before they lose their housing so they do not become
Longer term support; and
Better service delivery for people with high and
complex needs, including more service linkages.
They also noted that the new agreement includes an
'innovation and investment fund' to benchmark and disseminate best practice
models of service throughout the program.
While it is extremely difficult to determine accurate
prevalence rates of mental illness among the homeless, there are clear causal
and consequential associations between the two. Studies indicate that between
30 and 80 per cent of people experiencing homelessness also experience mental
Compared to the general population, there are
significant barriers which make it very difficult for homeless people to access
community services. This includes:
financial constraints; competing basic needs; a lack of transport; insufficient
documentation, such as a Medicare card or proof-of-identity details;
disconnection from support networks and assistance; the requirement to navigate
a complex service system to access services; and discrimination, stigma and
prejudice from some providers. They may also find it difficult to make and keep
appointments. Problems may be further exacerbated if the person has co-morbid
conditions, or has had a negative experience in the past.
Homeless people with mental illness are often left in
situations further detrimental to their health. Staff of Hanover
Homeless people often end up in crowded low cost hotels and
crisis accommodation services. These places have many different types of people
and are often stressful environments. Drug dealing, assaults and theft are
commonplaces. Clients who are trying to recover from depression or
schizophrenia often find that their mental health suffers further because they
are forced to live in inappropriate places.
While real estate markets differ across regions it is
the case that housing prices have risen 124 per cent over the period 1995 to
2005, and there is an undersupply
of low cost housing making it difficult for people with mental illness to
access the private rental market. The Public Interest Law Clearing House
(PILCH) Homeless Persons' Legal Clinic recognised that housing supply is
influenced by a range of policies and argued for a 'National Housing and Taxation
Plan' that includes strategies to align the supply of affordable housing with
demand. St Vincent de Paul called
for a task force to investigate 'all aspects of the massive accommodation
crisis'. ACOSS said there is a
'chronic mismatch between housing supply and demand', and 'current policy
settings are distorting both the home ownership and rental markets and
effectively locking out low income earners'.
While the CSHA now includes indexation, making funding
for housing assistance more sustainable,
the base grant funding decreased by 54 over the last 10 years. There has been some growth in
supported housing and other targeted programs but the concurrent negligible
increase in public housing stock and loss of low cost private housing options
has resulted in overall reduction in affordable housing. The Brotherhood of St Laurence
Public housing waiting lists are currently measured in terms of
years, not months, with some consumers being told that they are unlikely to
ever obtain a public housing unit. Private rental is one of their few options,
but the cost of it leaves very little income on which to survive, even in rural
and regional areas.
One of the impacts of an undersupply of suitable
accommodation for people with mental illness is an over reliance on inpatient
services. A number of submissions indicated that many people currently in
mental health inpatient care could be appropriately cared for in community
settings if supports were available.
The Queensland Government stated that a lack of suitable accommodation and
support was a key factor in preventing discharge. In other cases, the undersupply of
suitable accommodation results in people with mental illnesses being discharged
onto the street, or into unsuitable accommodation.
Accommodation and support
Welfare organisations argued that there is a need for
both increased affordable housing and for ongoing professional support:
...a significant proportion of households under Segment One
[highest priority public housing applicants] vacate their tenancies prematurely
or involuntarily. One of the reasons for this loss of housing tenure is the
lack of support to prevent vulnerability turning into crisis for individuals
with complex issues, including psychiatric disorders.
The Queensland Public Tenants Association Inc pointed
to the unmet support needs of tenants with mental illnesses, observing that
adverse outcomes occurred not only for those experiencing mental illness, but
also their neighbours and the wider public housing system. The Association commented:
One tenant we are aware of lives in a 22 unit complex of public
housing units in a major regional centre. Within that complex there are
approximately five de-institutionalised mental health tenants. One of these
tenants screams most of the time, including at night, making a good night’s
sleep a rare event. A second tenant calls emergency services to attend up to 5
or 6 times a day. ...A third, a male tenant, frequently urinates in the open
garden area. And recently, one of our members walked out his front door and
found his neighbour had hung himself off the balcony rails.
The Association stated that more high needs tenants are
entering into public housing without adequate support, and that Department of
Housing struggles to manage these complex tenancies. The Association commented
that there is a need for increased education and awareness to reduce the
'double-dose of stigmatisation' received by public housing tenants with mental
illnesses, as well as increased coordination between levels of government and
service providers to meet these tenants' support needs.
Issues with SAAP
There is considerable unmet need for SAAP services.
While on an average day 187 new clients are accommodated in SAAP, just over one
in two new people seeking immediate accommodation are turned away. Turn away
rates are highest for couples (with or without children), with 81 per cent of
these people being turned away each day.
A review by the NSW Ombudsman in 2004 found that people
with mental illnesses were routinely excluded from SAAP services. Over half of
SAAP agencies had policies that allowed people to be refused service on the
basis of mental illness. There were 290 instances of people with a mental
illness being denied access to services in a six month period.
The Australian Government acknowledged the deficiency:
Compared with other areas of expressed client needs, assistance
with mental health disorders or mental illness has one of the highest levels of
unmet need in the provision of SAAP services.
Furthermore, as a
transitional program, SAAP relies on other key programs to deliver essential
services to homeless people. The
submission lists critical gaps in allied service systems which impact upon SAAP
service delivery as:
a crisis service which can respond to people
with personality disorder and disordered behaviour, including those under the
influence of drugs or alcohol;
specialist services which can respond to
homeless people with dual/multiple problems;
health and mental health services which are
appropriate for homeless people;
specialist and generic services which can
respond to, or accommodate, people with disruptive behaviour; and
ongoing support for people with high need to
enable them to retain accommodation successfully in the community.
The Queensland Government reported findings which
'indicate a growing concern among SAAP service providers about the increasing
incidence of clients with high and complex needs who require support from
services beyond SAAP'. In many
cases, SAAP agencies rated the prospect of obtaining assistance for these
clients as 'poor' or 'nil'.
A number of submissions to the inquiry advocated a
substantial increase (in the order of 40 per cent) in funding to SAAP to
service unmet need.
The Combined Community Legal Centres' Group (NSW) Inc
submitted that the expansion of 'good behaviour agreements' leaves people with
mental illness vulnerable to eviction from public housing due to behaviour
triggered by their illness. People have also been requested to give up their
government housing while temporarily incapacitated in hospital. They
recommended that good behaviour agreements be amended to accommodate the
specific need of people with mental illnesses, and that Tenancy Acts be amended
to place limitations on rent increases thus providing better security of tenure
for people with mental illness.
Residential Tenancy Databases are lists of tenants who
real estate agents considered to be a tenancy risk and are used by agents to
screen prospective tenants. People
with mental illnesses are vulnerable to being listed on these databases,
limiting their ability to access rental accommodation. Furthermore, 'they may
not be aware of the processes to remove their name or correct their listing or
have the capacity to meet the various time limitations for action that could
remove their name from the database'.
The Centre recommended that the Commonwealth should introduce a national system
for the regulation of residential tenancy databases to alleviate misuse and
abuse of these databases.
The Centre drew attention to the need for adequate
intervention and intensive support services to assist tenants with mental
illnesses in dealing with landlords or resolving issues with neighbours, before
problems escalate to eviction. They also advocated that a service should be
established which monitors the progress of tenants with mental illnesses who are
evicted from their homes.
As discussed in Chapter 11 family members carry the
large burden of care for people with mental illnesses, an arrangement that is
cost-effective for government, but not sustainable without adequate support services,
including respite accommodation.
Respite services are more likely to be available to
frail, older people with physical disabilities or dementia than those with
mental illness. Dr Yun-Hee
Jeon submitted that there should be
increased resources and flexible respite services for people with mental
illnesses, as well as better increased promotion and awareness to over to
overcome current problems in the system:
...inadequate resource allocation to respite care services; health
professional and respite staff's lack of awareness about respite care services
and access procedures; inadequate promotion of respite to family carers;
staff's negative attitudes towards the needs and experiences of family carers
of persons with severe mental illness; current service delivery models which
are not always timely and flexible, needs-based or person-centred; and lack of
collaboration in care provision.
The St Vincent de Paul Society stressed that respite
centres should not be in institutional settings, recommending provision within
adequately resourced group homes in the community.
Accommodation services – what
Consumer groups and peak bodies acknowledged as better
practice a number of models for accommodation. The Housing and Support
Initiative, Project 300 and
Shepparton Housing programs are examined below.
The Housing and Support Initiative
The Housing and Support Initiative (HASI) is a joint
initiative between the NSW departments of Health and Housing and local NGOs.
Stage one provided coordinated disability support, accommodation and health
services to people requiring high-level support to live in the community. A
12-month trial in South Eastern Sydney showed a decrease in inpatient bed days
for patients enrolled in HASI from 197 days to 32 days.
Stages one and two of HASI focussed on 578 people
residing in public and community housing and $8 million has now been allocated
to extend the program to 126 more people requiring medium to high level
disability support in their homes.
The Project 300
program assists consumers to move from psychiatric treatment and rehabilitation
facilities to the community. The Queensland Government explained:
The program provides housing, supported accommodation, community
access to services and other supports. It operates through the collaborative
efforts of disability, mental health and housing services. The Project 300 model of support is unique,
focusing on community integration and participation. It operates with the
support of, but not within, a medical model... The success of the model is
highlighted by reductions in the level of support required by many individuals
as they recover and as informal support networks increase within their own
commenced in 1995 and aimed to provide sufficient resources in the same budget
to three different departments, responsible for clinical mental health
services, disability-housing and disability services, to assist 300 people. Each was provided with a
'package', consisting of mental health services, disability support services
and community housing. The 18 month evaluation reported:
The service model demonstrated improved well being for people with
significant disability. It showed that clinical, housing and disability support
services can be brought together to meet the needs of this population. Eighteen
months after discharge, individuals continued to demonstrate improvements in
symptoms, clinical functioning and quality of life. Remarkably few
disadvantages for the clients were identified. Only 3 of the 218 client
discharged returned to long-term care.
The cost of Project
300 was also evaluated as 'considerably less expensive' than other alternatives,
such as treatment in rehabilitation or community care units. On average, clients cost around
$68,900 per client per year, as compared with $85,770 in a community care unit,
$90,880 in a rehabilitation unit and $159,500 in an acute care unit. A follow up evaluation of the
project is nearing completion.
The Queensland Alliance said the participation of NGOs
was integral to the success of Project
300 and that the integrated service model underpinning the project could be
replicated to reduce the over-representation of people with mental illness in
prisons and among the homeless.
The MHCA also commented favourably on the integrated
service models provided by Project 300
Project 300, HASI and other similar state and territory programs
demonstrate that intersectoral support for people with mental illnesses is
critical to their stabilisation and rehabilitation.
Committee members visited two programs in Shepparton,
Victoria: the Specialist Residential Rehabilitation
Program (SRRP) and the Prevention and Recovery Care project (PARC on Maude).
The SRRP is an innovative housing project, developed through collaboration
between the Goulburn Valley Area Mental Health Service and the Mental Illness
Fellowship. The committee also heard from the Cairns District Health Service
about a proposal to establish a similar project in that city.
Residential programs such as this aim to allow people
with mental illness 'learn or relearn living skills' in a safe environment, with
professional support. The Cairns
project outlined the approach as having these features:
- Services should be flexible, and program-based,
not facility-based. Facilities provided are part of the program.
- The Program should be centred in the community, and
link with natural community settings whenever possible.
- Operate within a rehabilitation framework that
recognises participants potential for personal growth and the right to
opportunities which support growth.
These residential services aim to integrate all aspects
of recovery-based care, including assistance with employment, and vocational
training and education and involve cooperation of different services, and
between the government and non-government sectors. Although formal evaluations
were not complete, early indications were that this type of program was
successful with consumers and cost effective. Residential services are
discussed in more detail in Chapter 9.
A tenant driven initiative involving the Queensland
Department of Housing and seven community-based organisations has established a
set of formal protocols for complex tenancies:
The Protocol process begins with the area office of the
Department of Housing, identifying an ‘at risk’ tenancy i.e. a tenant who is
issued with a notice to remedy breach which threatens the sustainability of
their tenancy. This tenant is then asked if they would agree to being referred
to the network of supporting organisations for help. Of course, tenants retain
their right to privacy, and have the right to refuse help. The network of
organisations then provides the tenant and their family with the support
necessary to resolve whatever issue is threatening their tenancy.
The Queensland Public Tenants Association reported 'an
80 per cent reduction in evictions from public housing over a two year period'
following adoption of the protocols.
Employment and training
The strong correlation between mental illness and
unemployment is well established.
The participation rate of people with mental illness in the workforce in Australia
is low compared with the population in general, people with other disabilities
and people with mental illness in other OECD countries. The MHCA submitted that less than
30 per cent of people with a mental illness participate in the workforce,
despite evidence that working is therapeutic.
A lack of employment options for people experiencing
mental illness has significant financial and social impacts: lost income; reduced
development opportunities, social interaction and networks; and feelings of
self worth. The MHCA stated that 'it is an essential part of early
intervention, primary and secondary care for people to maintain engagement with
work if at all possible and to be able to achieve an orderly and successful
return to work where their illness has required them to leave'.
Supporting people with mental illness to participate in
the workforce also has broader society-wide benefits through increased
productivity and savings on income support payments and health services.
Employment and training services
The Commonwealth State Territory Disability Agreement
provides the national framework for the delivery, funding and development of
specialist disability services. Under the agreement the Commonwealth has
responsibility for specialised employment assistance. The Commonwealth also funds Job
mainstream employment assistance program.
Job Network is a national network of community and
private organisations contracted to find jobs for the unemployed. A general
discussion of the history, role and effectiveness of the Job Network is
provided in the Community Affairs References Committee report on poverty and
financial hardship. In summary
the current Job Network has two major functions:
Job search support – offering job search
training programs; and
Intensive support and customised assistance –
the most personalised and intensive forms of assistance offered, including job
search assistance, work experience, vocational training, language and literacy
training and post placement support. Providers have access to a pool of funds,
the 'job-seeker account', to purchase assistance to help eligible people into
A number of
providers in the Job Network have specialist capabilities in working with job
seekers with a disability or mental health problem.
Two specialist services which may assist people with a
mental illness into employment are the Disability Open Employment Services and
the Personal Support Program. Disability Open Employment Services assists job
seekers with disabilities who have significant or ongoing support needs,
through training, job placement and on the job support. The Australian Government advised
that in 2003-04, Open Disability Employment Services helped 48,431 people with
moderate to severe disabilities find and keep work, 24 per cent of whom had a
The Personal Support Program (PSP) aims to bridge the
gap between crisis assistance and employment assistance. The program is targeted
at people receiving income support 'whose non-vocational barriers (such as
homelessness, mental health problems or mental illness, drug or gambling
problems or social isolation) prevent them from getting a job or benefiting
from employment assistance services'.
The Department of Workplace Relations advised that 46 per cent of participants
have a mental health problem.
PSP participants are identified by Centrelink and may
access the program for up to two years. The program is delivered by a network
of private and community organisations. Currently 142 organisations, covering
600 sites are funded to deliver services. Approximately 60 sites are registered
as having a speciality in mental health.
Services offered under the program include counselling
and personal support, referral and advocacy, practical support, outreach
activities and ongoing assessment. The Australian Government stated that 'while
getting a job is the ultimate goal, the program recognises that this may not be
possible for all people at all times. Social outcomes may be the ﬁrst
steps towards independence'.
The Australian Government funds vocational
rehabilitation through CRS Australia (previously Commonwealth Rehabilitation
Services) and described their programs as 'tailored to individual needs and can
include vocational assessment and counselling, job preparation, placement and
training, injury management and workplace modifications'. CRS Australia assists over 35,000
people annually, with 29 per cent having a mental health condition as their
Financial incentives are available to employers who
employ workers with disabilities through the Workplace Modifications Scheme,
which reimburses employers for costs such as modifying the workplace or
providing specialist equipment when employing people with disabilities, and the
Wage Subsidy Scheme, which subsidises wages for people with disabilities
entering work. Funding under the
Wage Subsidy Scheme is only available through Open Employment Services and CRS
Australia. The wages of each eligible worker may be fully or partially
subsidised up to 13 weeks of pay, to a maximum of $1500.
$1 million has been allocated to research into the area
of mental health and income support, including the development of tools
providing practical advice to employers about employing people with mental
Employment and training issues
People with mental health problems can experience a
range of difficulties in accessing and retaining meaningful work. The barriers
include cognitive: perceptual and social impacts associated with the illness
itself or with treatment; the potential impact on health and supplementary
income benefits of returning to work; ignorance and stigma present in
workplaces and among service providers; inadequacy of programs and training to
assist people with mental illness into employment; and lack of suitably
Stigma is still a barrier to workplace participation:
The stigma attached to mental illness is wide-spread in the work
force. A person may have ample qualifications and work experience to be able to
successfully undertake a position, but if mention is made of suffering from a
mental illness, you can almost guarantee that the job will go to someone else.
The only instance where this doesn’t occur is in consumer based employment
where a “living knowledge” of mental illness is sought to assist others
learning about or living with mental illness. There are not very many of these
jobs out there and employers need to be made aware that they are often passing
up the most appropriate people for the job.
Submissions called for better education about mental
illness in the workplace:
Supervisory staff, managers and employees in all workplaces,
including insurers need more education and training about mental illness. This
might decrease workplaces harassment of people with mental illness and reduce
their feeling of alienation.
The MHCA argued that addressing workplace stigma has
been left out of the National Mental Health Strategy:
By not addressing these issues (workplace stigma), the Strategy
fails to provide pressure, impetus or leadership for the necessary changes in
support services and the average workplace. It is an essential part of early
intervention, primary and secondary care for people to maintain engagement with
work if at all possible and to be able to achieve an orderly and successful
return to work where their illness has required them to leave.
MHCA recommended that simple and effective measures for
improving workforce participation include 'targeted workplace support programs,
workplace education initiatives, providing meaningful re-training and
employment options and improving workplace practices'.
Wagorn and Mr
argued that stigma can be counteracted through 'strategic disclosure to
employers and to other third parties throughout vocational rehabilitation' by
vocational professionals. They
also noted that the services of education and advocacy centres run by mental
health consumer organisations are often overlooked in the workplace and can
help to educate professionals and service providers.
Limitations of employment services
The number of places available in the main specialist
program of employment assistance for people with disabilities, Open Employment
Services, is capped and, as stated by ACOSS, a relatively low proportion of
disability pension recipients in Australia receive help with employment or
programs are not strong in this area by OECD standards. Similarly, ACOSS noted that
funding for Disability Employment Assistance and CRS Australia programs are
capped and often have waiting lists.
Ms O'Toole, Manager of Advance Employment Inc (a
Disability Open Employment Service provider) expressed frustration about the
impact of funding caps:
Our agency is capped at 78 ...a drop in a very large pond. I
consistently have a waiting list of 25 to 30 people. It is soul destroying for
me because, for a number of people that come along, their needs are so great
initially. Open employment down the track is definitely possible, but we do not
receive enough funding to allow us to put the programs in place to assist these
people to get to that place.
Open employment providers have previously argued for
the removal of the cap on the appropriation for open employment services. The Australian Government
indicated that changing the cap 'would be a major decision for Government and
it is not being considered'.
Although uncapped funding may not be feasible, periodic
review of each provider's capacity may be appropriate. Ms
I could demonstrate quite clearly over the past 12 months what
our waiting list has been. I could demonstrate clearly enough that we could
have our outlet capacity increased from 78 to, say, 98, because I have had a
consistent waiting list.
...if we can demonstrate it...I think that is fair and reasonable.
That allows another employment consultant to be employed to look after those
ACOSS argued that while places in the Job Network are
not capped, the program is not properly resourced. The highest level of
assistance with the Job Network is 'Customised Assistance', however, as ACOSS
...the amount available for each highly disadvantaged job seeker
is only about $1,300. This won't buy much rehabilitation or training and people
will not generally be eligible for this level of assistance until they have
been with the Job Network provider for 12 months.
also pointed out that while Disability Open Employment Service providers must
be accredited against disability service standards, Job Network providers do
not have to meet this requirement.
MHCA indicated that even more targeted assistance
programs, like the PSP, are not producing effective outcomes and need to be
better integrated with other services. Mr
...in some way we have to better connect government programs and
not have this shower head effect where people who are, say, on the PSP program
for two years really do not have the economic means themselves, nor can the
providers that are receiving that PSP change the circumstances for those
people. So they simply remain maintained rather than having programs that can
intervene effectively and change the circumstances.
a PSP provider, reported increasing numbers of clients in its programs with
mental illnesses; anxiety disorders and depression the most common. They say
there are systemic gaps in the programs for clients with mental illnesses,
including: limited availability, accessibility and affordability of specialist
services; a lack of supported accommodation, living skills services, education
and training, transport, employment and rehabilitation; and funding for
medication and other needs. Some clients also did not want to continue with
counselling, and some services refused to work with clients because of a
history of violence.
commented that the most important strategy to improve PSP for people with mental
illness is to increase funding for health services, including the provision of
'culturally appropriate services and services for survivors of child abuse',
and increased access to health care providers who bulk bill.
Other suggestions include: more holistic service
delivery; free training in mental health for service providers; more supported
accommodation and employment options; small group programs, including life skills
and personal development; more sustained follow up of clients; and recruitment of
specialist volunteers to provide additional support to people with mental
While the Australian Government noted that the
Workplace Modifications Scheme and Wage Subsidy Schemes are financial
incentives for employers who employ people with disabilities, reviews suggest
that these programs are not used widely to assist people with mental illness. A review by the
Department of Families, Community Services and Indigenous Affairs showed that
from 1998 to 2002, the Workplace Modifications Scheme was most commonly used to
assist employees with a visual impairment (37 per cent of approved
applications) and employees with a physical disability (33 per cent).
Similarly, information about the Wage Subsidy Scheme for 1998 to 2000 shows that
most assisted workers had an intellectual disability (42 per cent), with only
around 16 per cent of those assisted having psychiatric disabilities.
MHCA suggested employer incentive schemes are not
adequately promoted. Employer forums reported:
There were calls for greater financial support to employers for
the provision of workplace modifications for people with mental illness. This
includes financial support to enable more flexibility in terms of hours worked,
timing of work and workload and the provision of mental health services for
those employees requiring ongoing assistance in the workplace. The current
workplace modification schemes were virtually unknown and seen as overly narrow
Employment service providers
ACROD, the National Industry Association for Disability
Services, observed that the episodic
nature of mental illness poses particular problems for employment services.
ACROD said that the results-based accountability and performance reporting set
in employment providers' service agreements may not adequately reflect the
reality of service provision for people with mental illnesses:
The requisite benchmarks, milestones or performance indicators
cannot be predicted or met as readily as in the case of people with physical or
ACROD also submitted that employment services need to
provide varied levels of support over time in accordance with a person's state
of mental health. Therefore, the episodic nature of mental illness results in
greater levels of personalised support, without additional funding necessarily
being available. ACROD summarised that such difficulties create 'a perverse
incentive not to take on clients with mental health problems'.
Some of these difficulties are demonstrated in the
following case study:
J is a 32-year-old male with bipolar disorder. He gained a job
through a disability employment service provider, working continuously for 24
weeks. A fortnight before the 26 weeks of work needed for a Case Based Funding
(CBF) Worker Outcome he again became seriously ill. J lost his job and was
suspended from CBF for three months.
The employment agency tried to get J a case manager with the
local Community Mental Health team when some of the early warning signs of his
illness became apparent. Community Mental Health did not consider J to be a
high need case, so no manager was assigned. His condition worsened to the point
where he agreed voluntarily to go to intake (crisis care). The employment
service had to accompany J to make sure he got there safely, the only
alternative being to call the police. J was immediately admitted to hospital,
remaining there for six weeks. During this time he lost his private
It was only because of his critical illness that J was able to
obtain mental health support. But by this time it was too late to stop him
losing his job and his accommodation.
Emerging service models
Research into the effectiveness of vocational
rehabilitation for people with mental illness is moving away from comparisons
across services, to focus on the key characteristics underpinning successful
vocational rehabilitation. Evidence
from controlled trials supports seven key principles for mental health
vocational rehabilitation. The principles are:
Eligibility for services is based on consumer
choice – no attempt is made to screen out participants;
Vocational rehabilitation is integrated with
mental health care;
A goal of competitive, mainstream employment;
Rapid commencement of job search activities;
Services are based on consumer preferences,
strengths, prior work experience and interests, rather than on a pool of
Continuing support to retain employment – with
no end date;
Income support and benefits counselling – to
help consumers make well informed decisions about their entitlements.
Following a review of current services, a further four
principles were identified:
Intensive on-site support;
A multidisciplinary team approach;
Emphasis on the 'rehabilitation alliance' (a
shared understanding of the staff member's
and consumer's roles in rehabilitation); and
Explicit stigma and disclosure strategies.
No Australian service meets all the above principles,
with Disability Open Employment Services and CRS Australia Services rating the
highest. Aspects commonly missing from Australian services include: integrating
vocational rehabilitation and mental health care; providing intensive on-site
support; using multidisciplinary teams, and incorporating strategies for
countering stigma and managing disclosure.
Mr Geoff Waghorn
argued that pooling mental health knowledge and expertise with vocational
expertise is a key element that could be achieved quickly in Australia.
The Centre of Full Employment and Equity (CofFEE)
submitted that Commonwealth employment programs have focussed heavily on labour
supply, without addressing the concurrent issue of labour demand. CofFEE argued
that there are two related problems:
(a) a demand-deficient labour market excludes a disproportionate
number of people with mental illness by placing them at the bottom of the queue
awaiting work; and
(b) the design of available jobs may be inappropriate for those
experiencing episodic illness.
CofFEE advocated the introduction of a Job Guarantee
for people with mental disorders. Under this model the federal government would
provide an adequate number of Job Guarantee jobs, with positions flexibly designed
to meet the varied support needs or workers with a mental illness:
Under the JG, the Federal government would maintain a ‘buffer
stock’ of minimum wage, public sector jobs to provide secure paid employment
for disadvantaged citizens. The pool of JG workers would expand when the level
of private sector activity falls and contract when private demand for labour
The Job Guarantee model would enable employers to hire
from a pool of people with mental health conditions who are already working and
maintaining essential labour market skills, rather than hiring from a pool of
people who have experienced long-term unemployment or long-term dependence on
the Disability Support Pension.
At the same time, CofFEE submitted that Job Guarantee jobs would be designed to
accommodate the needs of those with episodic illnesses and be integrated with
medical, rehabilitation and support services.
The MHCA also commented on the impacts of the changing
nature of the labour market, noting that demand for skilled labour and
employment in the service sector has increased, while more traditional sectors
such as manufacturing have declined. The Council observed that while employment
flexibility in the form of part-time and casual employment has increased
dramatically, 'mental health problems are more prevalent amongst those who have
not benefited from the increased labour-force flexibility and have been
excluded'. The MHCA assessed
that while employment has many benefits, jobs with high stress and low levels
of control can have adverse consequences. The MHCA stated that 'Good job design
can support the wellbeing of current and future employees, including those with
pre-existing health needs be they physical or mental'.
Submitters argued that open, competitive employment is
an achievable aim as long as appropriate support is provided. Ms
O'Toole emphasised the need for employment
providers to focus on what people can do, rather than what they cannot do:
We believe that they can do what they want to do. I had a woman
who came to me once and said, ‘I am looking for a cleaning job’. She happened
to have her resume with her, and she had university qualifications. She was an
Indigenous person, and I said, ‘I think you’re going to be bored.’ She said,
‘No, I don’t want anything with responsibility’. Well, she is now working in a
government position. I did not go down the cleaning road. She was absolutely
terrified, and with the right support and the talk with her and the building of
her confidence and the belief in her, within three months she was working in a
government department doing an excellent job. That is the stuff people need.
Impacts on employment for carers
Many people with mental illnesses are dependent on
family members for care and support, which in turn can impact on the ability of
carers to participate in the labour market. In some cases carers either leave
work or reduce their employment hours to support family members. Employment
stress for carers can in turn impact on their financial and social wellbeing
and that of their family.
As for myself, I have had the privelege [sic] of having to
abandon my job as a teacher, because there was simply no other way, to cope
with the outcomes presented to relatives by this lunatic legislation
[deinstitutionalisation]. I was a very good teacher of maths and science, and,
what is more, enjoyed doing it very much – all my education and experience has
been lost to both myself, and the community, and my role as a carer has ensured
that I enjoy an old age of certain poverty – no superannuation for me!
The suicidal tendencies had worsened and she was still heavily
medicated. I was fortunate enough to obtain fulltime employment, with a very
understanding organization, as I frequently had to take days off to rush her
back to hospital when she suffered an episode and required hospitalisation. ...I
had to find full-time employment so that our family could continue to function
and to enable our daughter to access a reasonable level of treatment.
While much of the evidence relating to education and
training focussed on employment-related training, there is also a need to
support people with mental health problems in mainstream education. The onset
of some of the most severe mental disorders occurs in the teenage years and
early twenties, at a time the completion of secondary and tertiary education is
important and career pathways are being mapped, as is shown in research.
In their discussion paper, Mr
and Mr Chris
Lloyd argued that welfare, vocational
rehabilitation and disability employment service reform in Australia
throughout the 1990s addressed obtaining employment to the exclusion of higher
education and substantive vocational training. They argued:
Specific strategies are needed to allocate responsibilities for
the funding and delivery of disability-specific education assistance in
primary, secondary, vocational, and higher education, over and above the generic
assistance available to people with all categories of disability at education
Mental illness can have a significant impact on
people's income through disruptions to both employment and opportunities (such
as education) which are instrumental to later career development. Reduced
income limits the capacity of consumers to obtain the supports and services
needed to manage their illness. As discussed in Chapter 6 the costs of mental
health care are prohibitive for many people with mental illnesses.
ACOSS observed that all mental disorders are much more
prevalent among income support recipients than non-recipients, with almost one
in three income support recipients having a diagnosable mental disorder
compared with one in five Australian adults not receiving income support.
Income support services
The principal source of direct income support for
people with a mental illness is the Australian Government's Disability Support
Pension (DSP). At June 2004, one quarter of DSP recipients were people whose
primary disability was a psychiatric or psychological condition. This was the
second largest consumer group, behind those with musculo-skeletal and
connective tissue conditions (34 per cent). In 2003-04, $1,903 million was
provided through the DSP to people experiencing mental health conditions.
Other income assistance includes:
Sickness Allowance – for eligible people who are
temporarily unable to undertake their usual work or study due to illness or
injury, and have a job or study to return to when they are fit;
Newstart Allowance – for eligible unemployed
people who are seeking paid work or undertaking other activities to improve
their employment prospects;
Youth Allowance – for eligible people aged 16-24
years who are engaged in activities such as education, training or job search
that will to enhance their capacity for economic independence.
People receiving DSP also receive the Pensioner
Concession Card entitling them to concessions on prescription drugs through the
Pharmaceutical Benefits Scheme.
Changes to income support payments
The legislative reforms announced in the 2005-06 budget
and passed in December 2005 substantially change the operation of DSP. They
also change the operation of Parenting Payments which may also be relevant to
people with mental illness.
The Senate Community Affairs Legislation Committee in
November 2005, inquired into the Employment and Workplace Relations Legislation
Amendment (Welfare to Work and other Measures) Bill 2005 and Family and
Community Services Legislation Amendment (Welfare to Work) Bill 2005. A detailed examination of the
changes and their anticipated impacts is not provided here, rather interested
readers are referred to the committee's report.
Prior to these changes, eligibility for DSP was
dependent upon the following:
...a person must have a
permanent physical, intellectual or psychiatric impairment of at least 20
points under the impairment tables. An impairment is defined as permanent if it
is fully diagnosed, treated and stabilised and likely to last for at least two
years without significant functional improvement. The person must also be
unable to do any work for at least 30 hours a week at award wages, or be
reskilled for any work, for at least the next two years because of the
impairment; or be permanently blind.
Under the new legislation, people will not be eligible
for DSP if they can work 15 hours or more a week at award wages without ongoing
support within the two years from assessment. These people will instead be
eligible for Newstart or Youth Allowance. Newstart and Youth Allowance have
lower payment rates than DSP and the implications of private income on these
payments differ to DSP.
Newstart and Youth Allowance, unlike DSP, are also
subject to part-time participation requirements. This means that people assessed as able to work at
least 15 hours per week unsupported are required to:
undertake 30 hours per fortnight of paid work;
job search for part-time work, participate in
appropriate employment services, and/or undertake an annual Mutual Obligation
The Community Affairs Legislation Committee received
mixed evidence as to whether the package of legislative changes would achieve
the aims of reducing welfare dependency and encouraging workforce participation.
Evidence to that inquiry indicated that DSP recipients assessed as suitable for
Newstart stood to be worse off financially following the changes. Others indicated that the new
arrangements focussed on getting a job, and that those with the capacity to
work stood to be better off financially receiving Newstart and engaging 15
hours of paid work, than receiving DSP.
ACOSS, St Vincent de Paul and Hanover argued that the overall
outcome for people with disabilities would be increased hardship, poverty and/or
disadvantage. The Department of
Employment and Workplace Relations said that relevant safeguards for people
with disabilities had been incorporated into the legislation, including for
people with episodic mental illnesses.
The government majority on the Community Affairs
Legislation Committee concluded there was 'nothing in this legislation which
ineluctably will force or coerce any person who is not able to work off income
support benefit'. Other
committee members dissented from the report with the ALP, Australian Greens and
Australian Democrats recommending the bills be opposed on the basis that the
'necessary amendments amount to a complete redraft of the bill'.
Role of Centrelink
Centrelink determines eligibility for income support
payments and is the gatekeeper for the Job Network, although people on DSP are
now able to register directly with Job Network. Centrelink, along with Job
Network providers, also identifies people eligible for participation in the
Personal Support Program.
The Australian Government submitted that measures are
in place to 'ensure that Centrelink and its staff respond appropriately to
people with mental health problems or mental illness'. These include that Centrelink:
- works in partnership with many community and
mental health services in relation to suicide prevention strategies;
- liaises locally with mental health services to
coordinate service provision;
- conducts training for internal staff and
external services in relation to identifying and assisting people with mental
health problems or mental illness to access government income support benefits;
- has developed service guidelines to ensure
appropriate income support services are provided to people with mental health
problems or mental illness.
The Australian Government stated that Centrelink has a
range of specially trained staff, including Centrelink Disability Officers
(CDOs) who assist customers and provide training to other staff, 500 social
workers who conduct assessments, provide telephone based counselling and
provide referrals to other services, and 250 psychologists who target early
identification in relation to mental health illness for people on income
Comprehensive work capacity
Under the 'welfare to work' provisions a new assessment
process – comprehensive work capacity assessment (CWCAs) –apply for people with
disabilities seeking income support. These will involve face-to-face interviews
with a range of allied health professionals, such as counsellors, occupational
therapists and psychologists.
The Australian Government submitted that:
The assessment will be a positive, holistic exploration of a job
seeker’s participation barriers, work capacity and the nature of interventions
and assistance needed to improve current and future work capacity. At the
completion of the assessment, assessors will discuss appropriate participation
assistance options available to the job seeker and will arrange rapid referral
of the job seeker to an appropriate provider.
Assessors will have access to a new Prevocational
Assistance Account, to organise short-term assistance aimed at improving work
capacity, such as 'pain management courses, work conditioning courses (such as
fitness for work) or mental health interventions'.
It is not entirely clear how these one-off assessments
will facilitate a comprehensive assessment of the work capacity of people who
experience mental illnesses, particularly those who with disorders that are
episodic in nature. Professor Ian
Webster submitted that 'medical specialists
unfamiliar with real-life situations of people in their communities make hard
indeed punitive decisions about a person's capacity'. He argued that professionals
engaged in the ongoing follow up of particular patients are those best placed
to make judgements about the severity of a person's disability.
The Australian Government noted that a pilot program is
currently being conducted which will inform the set up of the CWCA measure. The
pilot will examine the extent and nature of short-term interventions, current
service gaps and whether direct purchase of recommended short-term
interventions by employment service providers is feasible. It is suggested that
the pilot will be of particular relevance to those with a mental illness, as
'the pilot will identify job seekers who, for example, may need access to a
short period of cognitive behaviour therapy or counselling to address anxiety
and depression prior to commencing focused employment assistance activity, and
the success of otherwise in obtaining these services'.
Income support issues
The committee heard about three main areas of concern:
the adequacy of income support, the onerousness of compliance requirements, and
problems dealing with Centrelink.
Adequacy of income support
Submissions raised concern about the adequacy of income
the fact that social security payments are generally pegged and
paid below the Henderson Poverty Line, is a significant contributor to people
either living in or being at risk of poverty, homelessness and poor mental
health across Australia.
The link between inadequate income support and poverty
was reported as particularly problematic:
In addition to being excluded from the earning of adequate
income, people with disabilities often have higher costs of living associated
with their disabilities. This can be the high and continual cost of medication,
equipment or aids, appropriate housing, transport, and services related to
personal care or maintenance of a person’s home.
The combination of higher costs of living, along with income
deprivation, leads to a strong connection between disability, illness and
Anglicare Tasmania observed that the 'poverty
experienced by so many people with mental illness doesn't simply restrict their
capacity to choose services or activities which are health promoting; it can
actively aggravate illness and be a direct cause of hospitalization'. Anglicare described the destitute
circumstances of many people with severe mental illness in areas of basic need,
such as food, clothing and accommodation.
The Brotherhood of St Laurence reported consumers'
experiences of living on income support long term. One consumer said:
There is just not enough money to live on, so what you do is rob
Peter to pay Paul.
Your electricity is going to be cut off so you go into a cycle of debt—you
borrow from friends and family and then you borrow from someone else to pay it
back. It ends up borrowing and borrowing and borrowing, and you are a burden on
the people you know and they start avoiding you because you always need
something...you start feeling like a leech. And then you don’t want to be seen in
the supermarket buying food because you still owe someone money. You wear out
your family, you wear out your friends, and you start avoiding people and they
start avoiding you. It adds to your exclusion and the other awful thing that
follows quickly is that it is very hard to fight the bitterness and the
resentment that you start to feel about everything.
Compliance requirements – breaches
Breach penalties apply to those who fail to comply with
requirements linked to their payments. There are two types of breaches –
activity test and administrative. Activity test breaches can be failing to
accept a reasonable offer of employment or failing to attend a job interview.
An administrative breach can be failure to attend an interview with Centrelink.
Breach penalties, such as loss of income for even a
short period, can have a significant impact on the welfare of people with a
mental illness reliant on income support. Anglicare Tasmania
The new reforms are being heralded as introducing a better
compliance framework, based on a new suspension model. However, this system
also contains financial penalties for non-compliance (no back pay of suspended
income if the allowee’s excuse for non-compliance is not deemed reasonable, and
100 per cent loss of income on fourth suspension)... Concerns about the fate of
vulnerable jobseekers and children in households with suspended incomes have been
responded to with the promise of more intensive case management of vulnerable
jobseekers which will ensure that essential bills are paid when suspension
penalties are in place. However, with no funding apparently attached to this
initiative it is not clear whether this means referral to the Emergency Relief
network or a direct crisis voucher system administered by Centrelink. Nor is
there any clarity about what constitutes an essential bill. Either way it
appears to introduce more complexity into an already punitive and difficult
Complying with activity and administrative
requirements, such as keeping appointments, can be exceedingly challenging for
consumers during a period of illness. Other compliance requirements, such as
proof of identity, are also challenging for people with mental illness in
particularly vulnerable situations, such as homelessness. It was suggested that
proof of identity requirements be changed so that homeless people can use a
letter from a homelessness assistance provider.
Experiences dealing with Centrelink
Evidence from consumers and carers was at odds with the
government's description of Centrelink's services and approach:
I believe that the accountability and proficiency of agencies
such as Centrelink needs to be urgently reviewed. Their treatment of persons
with a psychiatric illness and carers is – in my opinion and experience –
absolutely appalling. ...I believe that Centrelink staff dealing with the
mentally ill should have comprehensive training, that outdated claim forms
should be replaced, and that it should be compulsory for Centrelink staff to
liaise with health professionals when considering claims from and reviews of
disability pensions, carer pensions and carer allowances.
As I can only work approximately 10-12 hours per week, and am on
a part-pension I have had many dealing with Centrelink. There were times when I
was so frustrated with Centrelink that I ended up feeling completely helpless
and extremely distressed. Having to fill out the often complicated forms is
also a very difficult task for someone with an illness. Turning up for
appointments at Centrelink or at a prospective employers is sometimes
impossible for someone with anxiety, depression or any other mental illness.
However Centrelink threatens to cut our payments if appointments are not met.
During this time, she failed to attend an interview, which would
have provided her with a disability pension. Owing to her illness, she would
often perceive her family members as enemies, so that visiting her was like
walking an emotional tight rope. On a rare visit, if I had not accidentally
come across the letter informing her that she would not receive the
pension because she had failed to attend the appointment, I am certain that she
would have continued on her downward spiral. It seemed ironic that the severity
of her disability had almost jeopardised her chances of receiving assistance.
No attempt had been made to follow up her lack of attendance. This seems to
indicate yet another lapse in the support network.
These experiences was also reported by a health
I visited a patient who was under my care in Liverpool
Hospital; he was a long standing
patient. He was very poor and had major health problems and depended totally on
income support for bare survival. He was extremely disabled.
When I arrived at the bedside he was weeping. He showed me a
letter he just received from CentreLink which had cancelled his Disability
Support Pension. I can't recall the exact reason but it was a trivial
requirement of failing to respond to a request of some kind. I tried there and
then to contact the Department to find out what was going on. From my point of
view, indeed of anyone who could see, he was a person with severe disability
which was unchanged, indeed deteriorating.
That was frustrating. All I achieved was going into a
“pushbutton” queue in ever increasing circles. Later in the day I decided to
visit the CentreLink office in Liverpool to speak
directly to a responsible officer. That did not work either. There was an
apologetic somewhat embarrassed officer who did not know what to do: the most
that could be offered was a form to fill in...
There is a preoccupation around testable medical states, a
search for objectivity and a philosophy which seems to accept that the
prime task is to protect the social welfare system against fraud and
The committee notes that some of these issues may be
picked up in the early intervention and engagement pilot currently being run by
Centrelink, although it is not a
project specifically targeted at avoiding the access and compliance problems
reported in incidents such as those described above.
The committee received evidence of the importance of
community participation and social involvement for people with mental
illnesses. The St Vincent de Paul Society commented:
The system we now have is setting people up to fail. Social
isolation and loneliness are guaranteed to trigger episodes of mental illness
and suicide and the vicious cycle starts all over again.
NGOs are 'fast becoming the only providers of social
and recreational services, effective and relevant advocacy, living skills
training and rehabilitation'.
The Society argued that social and recreational facilities and friendship
programs need to be developed, funded and promoted.
Bond, Visiting International Speaker for
Schizophrenia Awareness Week, argued for services to enhance people's wellbeing
and fulfilment. He noted that in the United
States, mental health and rehabilitation
services are increasingly looking at the personal goals of consumers:
...many mental health programs have been aimed at stabilisation
and ensuring that clients take their medication and not be a nuisance in
society. The broader vision of mental health services is to look at what are
their personal goals and aspirations. It turns out that most people with
psychiatric disabilities have the same goals, wishes and dreams for their lives
that all of us have. If you asked a person with a mental illness, ‘What would
you like for your life?’ they would say, ‘I want a nice place to live, I want
to have a girlfriend, I want to have a job’ —a job is very high in their
priorities—‘and I just want to have a decent life.’
It turns out that helping people to achieve these basic goals is
a win-win situation. These are the goals that family members have for their
loved ones and, in terms of society, that we want for our fellow citizens who
have a mental illness—that is, they are well-integrated in the community, they
are contributing members to the society and they are productive members of
society and so on.
While many dedicated people are working to advance
mental health in Australia, evidence to this inquiry shows that due to service
gaps and lack of integration, these 'win win' situations are not being
The National Mental Health Strategy recognises that all
areas of government, not just the health sector, have a role in mental health.
However, the high levels of poverty and homelessness among people with mentally
illness demonstrates that cross-sectoral support is inadequate. There are
significant service gaps, and lack of integration and coordination between
existing services is a major problem.
If 'mainstream' welfare services are to be relied upon
to provide the range of supports necessary for people with mental illness, it
is essential that service staff are educated about mental health issues.
Programs need to be designed to be responsive to the episodic nature of some
illnesses and staff need to be equipped to work effectively with people
The provision of suitable accommodation for people with
mental illness requires urgent attention. More than a decade after the Burdekin
Report brought to light the dire accommodation circumstances of many people
with mental illness, many people remain homeless or transient, living in
accommodation unconducive to their mental health, or dependent on family
members. Crisis accommodation services cannot meet demand and are generally not
targeted to meet the needs of people with mental illness. Low cost independent
housing is in short supply and supported accommodation remains scarce.
While governments have recognised that employment plays
an important role in prevention and recovery from mental illness, participation
rates among people with mental illness in Australia
remain low. This is a key area for better education and advocacy, to counter
workplace stigma. The committee met inspiring employment providers who are
providing long-term support to help achieve stable employment for people with
mental illnesses. There is a need for effective information and knowledge
sharing in this field, to build on such experiences.
As discussed in the previous chapter, community-based
mental health services are needed to reduce demand for acute services and
increase experiences of mental health. It is imperative that these community
services are not silos of 'health' services, but provide the broader supports
necessary to sustain independent living.
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