Chapter 3 - Further recommendations
In this chapter, the committee makes a large number of
recommendations. They reflect the wide and detailed terms of reference given to
the committee by the Senate, the large number of issues brought to the
committee, and the intensive interest shown by many individuals and
organisations in the committee's work.
The following recommendations arise out of evidence
received, as set out in submissions and hearings, and reflected in the
committee's extensive first report. They have been grouped according to the
major themes of the inquiry.
There were many cases where the committee was asked to
give its backing to particular programs or support expansion of specific
initiatives. While in some outstanding cases certain programs are singled out
for special mention, on the whole the committee preferred to focus on
principles and types of service, rather than particular practices or service
providers. The fact that some services are not mentioned by name should not be
taken to mean the committee was not supportive
of their work.
The committee is confident that all parties involved in
mental health will take notice of and respond to the recommendations. It
believes that it is imperative that all Australian Health Ministers recognise
and acknowledge that genuine collaboration between all levels of government is
necessary to address the current 'crisis' in mental health service delivery. The
committee looks forward to closer partnerships between the many professions
involved in mental health care, including doctors, psychologists, nurses,
social workers, counsellors and occupational therapists. And it looks forward
to a health care system that produces better outcomes for consumers and carers.
Monitoring and research
That over the next three years, all states and
report on service providers' performance against
the National Standards for Mental Health
review the National Standards (as agreed in the
Second National Mental Health Plan but not so
include in the review development of performance
indicators for mental health inpatient and dual diagnosis services which focus
on the effectiveness of treatment, discharge plans and follow up in the
implement and report against these indicators.
That all states and territories review their systems of
monitoring and reporting on the extent of use of seclusion and restraint (based
on agreed definitions), with each jurisdiction to publicly report the extent of
use on a regular basis.
That an evaluation of the effectiveness of online
services, for example depressioNet and MoodGym be undertaken,
with a view to promoting such services as integral components of primary mental
health care services, and to enhance access to mental health services in rural
and remote areas.
Consumers' rights and roles
That policies and procedures be implemented that will
reduce the use of involuntary and coercive treatment, particularly where
physical and chemical restraints are used and where drugs have harmful side
That the Human Rights and Equal Opportunity Commission
(HREOC) be requested to complete its important work on advance directives and
protocols that would recognise the rights of consumers to, for instance,
identify substitute decision-makers, appropriate treatments and other
financial, medical and personal decisions, particularly for the care of
That the National
Mental Health Advisory Committee and Commonwealth-State Mental Health Institute work collaboratively to
ensure that consumers are routinely involved in the design and conduct of
mental health research and the evaluation of treatments.
Prevention and early intervention
That the Australian Government allocates recurrent
funding to ensure prevention and early intervention programs in the education
system are ongoing, including funding for evaluation and continuous improvement
of these programs.
That the Department of Health and Ageing:
review MindMatters in secondary schools, and on this
basis consider expanding it to all schools, including an equivalent program in
primary schools; and
examine the feasibility of expanding the MindMatters
Plus and MindMatters Plus GP initiatives nationwide.
That the Australian Government fund and implement a
nationwide mass media mental illness stigma reduction and education campaign.
That state and territory governments and mental health
service providers significantly increase the use of the assertive community
treatment model and active case management to support people with severe and
prolonged mental illness to live in the community.
That local government provide leadership through
endorsement of the creation of community-based services for people with mental
illness in their jurisdictions, and through helping overcome stigma and community
resistance to such services.
That all jurisdictions implement appropriate
legislative reforms to ensure Community Treatment Orders can be given effect,
regardless of the state or territory that the person with mental illness may be
located in at a given time.
reporting of 'community based services' in the National Mental Health Report be revised to separately identify
ambulatory and any other 'community' care services provided at general
hospitals including at outpatient services.
That state and territory governments refrain from
dismantling community-based mental health services, for co-location with
That with respect to the non-government, not-for-profit
the sector be given a greater role in delivering
mental health services;
governments recognise the problems associated
with the short-term, non-recurrent grant approach to funding and move to more
secure funding decision-making, based on evaluations of effectiveness; and
at a minimum that grants to NGO mental health
providers be indexed based on the CPI.
Further to recommendation 10 in the committee's first
report, support be provided for base load recurrent funding for specialist
telephone services, assessed on a case by case basis.
Workforce and training
That the Australian Government, after consultation with
the sector, consider funding stand-alone specialist degrees for mental health
nurses as an alternative to current post-graduate specialisation.
That supported placements for nursing and allied health
students be provided in mental health services.
That current undergraduate nursing programs be reviewed
to ensure greater consistency and increased content in the psychiatric
components offered in courses (currently they vary from between zero and 17.4
That, as a priority, the number of funded positions
available in postgraduate programs in psychiatric/mental health nursing be
That universities work collaboratively with general
practices and community mental health facilities to expand temporary work
placement programs for postgraduate psychology and other allied health
That mobile intensive treatment teams or crisis
assessment teams be adequately resourced to provide mental health crisis
responses 24 hours a day, 7 days a week, minimising the need for police and
ambulance attendance and, in many cases, avoiding inpatient admission.
That access to effective non-pharmacological treatment
options be improved across the mental health system through:
Better access to therapies (including so-called
'talking therapies') provided by psychologists, psychotherapists and
counsellors with particular attention to therapy for people with histories of
child abuse and neglect; and
Greater investment in research of alternative
That federal, state and territory governments ensure
that the full range of short, medium and long-term supported accommodation is
available to those with mental illness who need it. Modes of innovative service
delivery that should be considered include:
The Housing and Support Initiative (HASI), a
joint initiative between the NSW departments of Health and Housing and local
NGOs, providing 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.
300 program, conducted in Queensland to assist 300 consumers to move from
psychiatric treatment and rehabilitation facilities to the community. The
18-month evaluation reported 'improved well being for people with significant
disability' and following 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 clients
discharged returned to long-term care'.
That each state and territory establish formal measures
to better manage public and private tenancies to address the needs of people
with mental illness living in the community.
That each state and territory provide specialist crisis
accommodation services for people with dual diagnosis and complex conditions
involving disruptive behaviour.
Employment and income support services
That disability open employment service arrangements be
reviewed, to consider:
creation of a regular automatic provider review
the results-based performance reporting in
disability open employment providers' service agreements, to take account of
the episodic nature of mental illness; and
removal of funding caps for providers who
demonstrate high demand for their services and the capacity to respond
effectively to that demand.
That the federal, state and territory governments
sponsor a regular forum for disability open employment providers, consumers and
carers, to facilitate information and knowledge exchange in relation to
employment assistance for people with mental illness.
That nationwide workplace education and advocacy
programs be rolled out to counter workplace stigma and promote employment for
people with mental illness.
That the Australian Government review the services of
the Commonwealth Rehabilitation Service and the compliance requirements of
NewStart and Youth Allowance to ensure that
they address the special needs of people living with enduring and episodic mental
That the Australian Government review the extent to
which experiences of mental illness, dual diagnosis and homelessness impact upon
people's ability to access the Disability Support Pension.
Families and carers
That government health, welfare and income support
agencies recognise the special needs and income and cost implications of caring
for people with mental illness, in determining eligibility for, and amount of,
carers' allowance available.
That each jurisdiction establish a register of
community care services delivered within the public, private and NGO sectors,
to be made a available as a resource for consumers and carers.
That recurrent funding is provided to develop and
disseminate community-based programs providing peer support, training and
information to carers and families, addressing issues such as education about the
causes of, treatments for and recovery from mental illness, support services
available, building family resilience and parenting skills, and meeting the
special needs of young carers.
That governments increase targeted, intensive programs
for high risk parents such as those with personality disorder, substance abuse
disorders and parents with a history of abuse and neglect.
That funding be allocated to develop and expand services
specifically designed for supporting children who have a parent or parents with
That there be an evaluation of the effectiveness of the
Parentline telephone counselling
service that assists parents and carers in Queensland and the Northern
Territory with behavioural management, parenting skills, and interpersonal relationships,
with the view to expanding the service across all states and territories.
That better links be created between child and maternal
health services and mental health services, and funding be provided for
programs to assist families identified through maternal and child health
services as having, or at risk of, mental health issues.
That there be a commitment to the provision of mental
health services for care leavers recommended in the Senate Community Affairs
References Committee Report Forgotten
Australians, A report on Australians who experienced institutional or
out-of-home care as children.
That the Australian Health Ministers agree to establish
a national post-natal depression helpline and provide recurrent funding for its
That the Australian Health Ministers develop a national
strategy for perinatal health services, including early identification,
intervention, prevention and education and support of new parents regarding perinatal
Paying for mental health care
That the Australian Government reviews the adequacy of
benefits for psychiatric illnesses among health insurance products, and take
action to outlaw products that are not 'fit for purpose'.
That the Australian Government review the arrangements
governing the portability of benefits between health funds where a contract of service
between a health fund and a private hospital or provider ends, so as to
increase the opportunity for patients to remain with their existing mental
health specialist if they so choose.
That there be a significant expansion of mental health
courts and diversion programs, focussed on keeping people with mental illness
out of prison and supporting them with health, housing and employment services
that will reduce offending behaviour and assist with recovery.
That responsibility for the decision to release
forensic patients be placed routinely with mental health courts or mental
health tribunals within each state and territory.
That state and territory governments aim as far as
possible for the treatment of all people with mental illness in the justice
system to take place in forensic facilities that are physically and
operationally separate from prisons, and incorporate this aim into
infrastructure planning, and that the Thomas Embling Hospital in Victoria be
used as a model for such facilities.
That the Australian, state and territory governments
review funding for prescription medicines and medical care to examine anomalies
and differences in quality of care between community primary care and care currently
provided in prisons.
That governments establish protocols for mental health
assessments for prisoners on entry into the criminal justice system.
That the Commonwealth-State
Health Research Institute in conjunction with forensic mental health
services investigate best practice models for the delivery of forensic mental
health care to adolescents.
That the states establish separate dedicated forensic
mental health facilities for women with a number of beds that reflects the prevalence
of women with mental illness in prisons.
That HREOC be tasked to undertake a national review of
the treatment of women with mental health problems within the criminal justice
and prison systems.
That state and territory governments, taking into
account best practice models, substantially increase the provision of step-down
supported accommodation programs to facilitate reintegration into the community
following release from incarceration and forensic facilities.
That a more holistic approach be taken
in community-based mental health centres, particularly those for young people,
integrating other related services, peer supports and drug and alcohol services
with mental health services.
That in reforming the Better Outcomes in Mental
Health program the Australian Government considers mechanisms
which enable general practitioners and other mental health professionals to
provide services not only in private practices but also in environments
targeting youth needs.
That the state and territory governments reform dual
diagnosis services to achieve greater consistency, and that the Mental
Health Council of Australia, in reporting on progress under
the National Mental Health Strategy, report state specific progress in the
reform of dual diagnosis services.
That state and federal governments agree on and
implement a national action plan to upgrade skills for assessment, referral and
treatment of dual diagnosis, including:
the development of training modules for dual
diagnosis for undergraduate nurses and other allied health professionals;
the development of nationally consistent
training modules in dual diagnosis for mental health and drug and alcohol
incentive-based training opportunities for
general practitioners to build knowledge of dual diagnosis.
That state and federal governments facilitate within
their service agencies:
training on the implementation of service
protocols and memoranda of understanding at a local level;
of staff across agencies in the different service sectors to promote cross-skilling;
targeted strategies to increase numbers and
upgrade skills among Indigenous health care workers to address the complex
needs of Aboriginal and Torres Strait Islander communities.
That undergraduate and postgraduate medical courses
give greater emphasis to the specific needs of people with developmental
disabilities who are affected by mental illness, and that centres of expertise
be established to improve assessment and treatments.
Children and youth
That governments promote education and awareness
training for health care providers and the community on the risks of
pharmacological mental health treatment for children and young people and
ensure the availability of family supports and alternative therapies.
That, utilising expertise from clinical psychology,
clinical psychiatry and institutes of mental health research, standardised risk
assessment tools and processes for identifying at-risk children be developed
specifically for use in a range of community and health settings.
That the Australian Government commits recurrent
funding to ensure the future sustainability of the National Youth Mental
That governments develop and provide education and
awareness training for health care providers, aged care providers and the
community on mental health problems in older Australians.
CALD communities and refugees
That state and territory mental health services provide
CALD consumers, their carers and families with information on their rights
under state and territory legislation in an understandable manner appropriate
to their language and culture.
That the Australian Government review funding levels to
providers of mental health services to refugee communities, to ensure those levels
reflect the high levels of need amongst this population.
That appropriate assessment protocols for CALD
consumers be developed and disseminated to increase the capacity of primary
care providers to detect and manage the early signs and symptoms of mental
health problems and mental illness.
That culturally specific mental health services be
developed in partnership between all levels of government, migrant resource centres
and other organisations, including the Forum of Australian Services for
Survivors of Torture and Trauma.
That funding be provided to develop and disseminate
throughout CALD communities translated information delivered in a variety of
media about early signs and symptoms of mental health problems and mental
disorders, where to get help and how to provide support.
there be a review of health care policies for
the delivery of health care for refugee and asylum seekers in both the
Australian community and Australian run detention centres, with a view to
developing more culturally sensitive and comprehensive policies and standards
that recognise the complex needs of asylum seekers; and
there be consideration of providing access to
Medicare rebates during refugee determination processes.
Rural and remote
That there be wider availability of community
information, services, and initiatives for raising awareness of mental health
issues in rural and remote areas.
That in determining the allocation of community-based
mental health centres and ratios of mental health professionals to populations
(Recommendation 1) remoteness and other factors of disadvantage be included in the
That greater flexibility in the allocation of Medicare
provider numbers for mental health service provision (for instance psychiatric
nurse practitioners and counsellors), is exercised in rural and remote areas in
recognition of the shortage of psychiatrists and psychologists in these areas.
That state and territory governments provide and
support greater training to the existing medical workforce in the treatment of
mental illness and ensure that the special needs of people with mental illness
are considered when acute care services in rural areas are being reviewed.
That ongoing incentives and supports be provided to GPs
and mental health professionals to promote working in rural and remote areas.
That a review be commissioned into the adequacy of
income support and travel assistance allowances for carers in rural and remote
areas, who have to travel long distances to access treatment and support.
In recognition that in rural areas police and ambulance
services often attend and manage crisis situations without specialist
assistance, ensure that rural police and ambulance services are a high priority
for mental health first aid training.
That 'Indigenous only' education venues for Indigenous
health workers are adequately funded and supported to provide collaborative,
culturally affirming learning environments for Indigenous people. Consideration
should be directed to extending the capacity of facilities such as the Bachelor
Institute Indigenous College, the Djirruwang Program at Charles Sturt
University, or the introduction of scholarships for Indigenous health
professionals, and incorporation of Indigenous Health curriculum in mainstream
That governments fund the Commonwealth-State Mental Health
Institute in collaboration with the National Aboriginal Community
Controlled Health Organisation to research the most effective means of
addressing Indigenous mental health needs, including the development of
appropriate diagnostic tools for assessment of mental illness among the
Indigenous population, collection of data and provision of information.
That governments direct recurrent funding to Indigenous
community controlled health services to administer the development,
implementation and evaluation of appropriate mental health programs.
Senator Lyn Allison
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