Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Hansard source

I also rise to express my disappointment and frustration—I think is the other word—at the fact that the questions that Senator Gallagher asked the Minister for Health in January this year are now overdue to be answered. There has been no reason given as to why there is this delay in responding to these questions. They have just said that there is a delay; they have not been answered. This is disappointing. These are reasonable and legitimate questions and they should be answered in the time frame—and they could be answered. If they cannot be answered then we have got a really big problem.

This minister and her predecessor have form when it comes to transparency and engagement and, in fact, even any notion of co-design when it comes to the mental health plan. Let's look back at what has happened over the last 2½ years. In the election of 2013, the then opposition, now government, gave a commitment in the mental health space that they would undertake a review. That is reasonable. I think it is a bit lazy, but it is reasonable that, given the reforms that had occurred under our government, an incoming government might want to have a look at the state of play. We accepted that the review would be undertaken, but right back then we started questioning the transparency of that review. At that time, I called on the government to publish the submissions—not the private submissions but the sector submissions—to this review. They did not. Some organisations published their own but there was no collected, comprehensive set of submissions to what should have been a big conversation about mental health in our country. The sector expected that, once the report was undertaken by the Mental Health Commission, it would be published. It was received on time on 1 December 2014 and, quite legitimately, the sector thought: 'Right. They've had nearly a full year to do this work. There would have been an iterative process between the commission and the department. We expect they will publish the report, and they will publish a government response in December 2014.' That did not happen.

So the next potential opportunity for the publishing of the report would have been in the lead-up to the budget of 2015. That is a normal government process. In the lead-up to a budget or even as part of a budget, the requesting document—in this case, the report of the Mental Health Commission and the response to that report—are published, along with the funding arrangements that sit around that. So we assumed that that would happen in the lead-up to the budget of 2015. As we know, that did not happen either. During the course of last year, on three separate occasions, I used the system of return to order in this Senate. All senators, bar the National and Liberal Party senators, supported my return to order that the government publish the report of the National Mental Health Commission. On three separate occasions the government did not follow the request to publish the documents of the Senate. The frustration must have been palpable.

We do not know who did it, but it ended up with the leaking of the report. Last year, the report was leaked to the ABC and the Crikey website. Last year, after that happened, I asked the Secretary of the Department of Health last year whether he was going to follow up on the leaking of that report. He said that he was not going to do that. I think he understood—I am presuming here, but I think he probably understood—that it was pretty embarrassing that it had gone on for so long. At least we had the report of the National Mental Health Commission in the public arena, but we still did not have any response from the government.

The next opportunity was National Mental Health Week, towards the end of last year. The sector was pretty sure that it would get a response from government to the comprehensive report that the commission had done. Again, they were let down. It was finally received on 29 November last year. The report I am holding up here is the document, Mr Deputy President. It is a very thin document. The report of the National Mental Health Commission is in volumes; there are thousands of pages. But the document that responds to that comprehensive report is scant.

You can have a number of types of government responses to reports. You can have quite slender documents like this, and that is not unusual. But behind a document like this has to be a lot of work, otherwise how would you be able to write the words in this document? That is why it is quite legitimate and reasonable for Senator Gallagher to ask the types of questions that she has been asking—because those are the questions that I would expect a minister to be asking in order to come up with the response that is covered in this report.

Quite substantial changes are being proposed in the government response, and they would have had to have had considerable work done to come to that view. We now know, though, that funding arrangements and service delivery contracts will expire at the end of June. We also know that good employment practice would require that, if changes to funding arrangements are going to occur, the government should give three months notice. We are about to get into March; these contracts are meant to start on 1 July. I suggest that we have a timing problem that has to be addressed and should be addressed. So I ask: is this government hiding the information that it should have, as I suggest has been happening over the last 12 months, or has the work not yet been done? If it is the latter, then I think there is real concern—frankly, either way there is real concern.

The mental health sector requires transparency. It requires an understanding and a sense of shared view about which way we are going forward, but I cannot see that over the last two and a half years since the change of government. As others speakers in this debate have spoken of, to get the trust that is so important in the delivery of mental health services, you need to have certainty, and people who are living with mental ill health need to have faith that the services are going to be there and that the type of service design will suit their needs as well as be able to respond to their changing needs. My observation is that mental health consumers do have increased levels of anxiety. They are concerned about service continuity. They are not being included at the levels that they should be expected to be, both as mental health consumers and as mental health carers, in the potential co-design of what are significant changes, which are proposed in this government response.

The government response talks about changing funding arrangements—that some services will be tendered out and some services will not be tendered out. Let us get some clarity on which is which and what people need to prepare to do. As Senator Moore indicated, there is a big change in the funding arrangements through the Primary Health Networks. These Primary Health Networks are quite new organisations. Some are having considerable difficulty in bedding down. There needs to be very strong management of the funding shift from the previous service array—which included in some respects the Medicare Locals but not all—to the pooled funding arrangements that are proposed through the Primary Health Networks. I put on record that there are some Primary Health Networks that are having a lot of difficulty trying to work out how they manage their services and the scope of services that they are going to have. We have heard of significant job losses as the transition from Medicare Local into the PHNs has occurred, and this is occurring around about now.

These questions that Senator Gallagher has asked are, as I have said, very legitimate. We want to know where the funding for the individual packages will come from. How does that interface with the rollout of the National Disability Insurance Scheme? We think, in principle, that the model of developing individual packages is a good and proper thing, but we need to know where that money is coming from. We want to know when the individual packages will commence and how many of them will be available in 2016 and the out years from there. Why do we ask that? Because consumers want to know the answer to that and the service sector wants to know the answer to that.

Senators will recall Mental Health Australia undertaking a survey of the service sector at the end of 2014. That survey showed there was considerable anxiety in the service sector back then. That is when, essentially, the funding was going to be rolled over. Now we are looking at considerable change. How many workers in the mental health sector are now thinking that they should be moving on? I hope that we can retain these passionate workers. They are people who have given hugely to serve the cohort of people who use their services. They are people with specific talents and skills that are not found easily in our community. Surely they deserve the respect of knowing what is going to happen come the end of June of this year.

The questions that Senator Gallagher asked also went to Aboriginal and Torres Strait Islander mental health and to suicide prevention more broadly. On the question of suicide, the government's response to the review states:

The Government will move to immediately implement a new national suicide prevention strategy with four critical components …

One of those components is:

…a systematic and planned regional approach to community based suicide prevention, which recognises the take-up of local evidence based strategies. This approach will be led by PHNs who will commission regionally appropriate activities, in partnership with LHNs and other local organisations …

The important words there are: 'The Government will move … immediately,' and 'systematic and planned regional approach'. If that is going to happen, why can't we have an answer to this question? If that is what the government has said they are going to do then why can't these questions that Senator Gallagher has asked be answered?

We are asking questions about what is going to happen about perinatal mental health. We know that this is a small but very identifiable group of people who do suffer from higher levels of mental health issues than the rest of the community. They are a group of people we can work quickly and easily with, if the funding is there. That is why we want to know what amount of funding is going to be allocated to perinatal mental health.

There is an important program operating in the country called the Mental Health Nurse Incentive Program—a very successful program. Evidence shows it has worked very well. But we want to know what changes are going to be made to the Mental Health Nurse Incentive Program. And, given the timing, the government should have the answer to that by now.

We want to know: aside from the $85 million in funding for Aboriginal and Torres Strait Islander mental health, will any extra funding be included as part of the implementation of the package, and how much and what will this funding be spent on? We want to know: is this $85 million new money or is it reallocated money, out of existing funding sources? That is an important piece of detail that not only is it reasonable for the Labor Party to understand but also, on behalf of the community more broadly, we need to know.

The final question that Senator Gallagher asked is on the interface between the National Disability Insurance Scheme and how the changed mental health funding arrangements will work. The National Disability Insurance Scheme will provide packages for a number of very severely ill people with persistent and chronic mental illness. We need to be able to work out the timing of those packages in line with the rollout of the National Disability Insurance Scheme and the rollout of this program. Surely the government is working across those two departments to ensure that this does happen in a timely way? We want to know, and it is reasonable for us to know, how those packages will roll out.

But, as Senator Moore quite rightly identified, we do have an issue with how we are going to provide services for people who are quite ill. They are people who are very ill, who do need ongoing packages of support. But they will not be eligible under the National Disability Insurance Scheme for a package of support under that definition of persistent and chronic mental illness. Those people are very concerned, and it is reasonable and legitimate for us to be asking questions like: 'What resources and funding have been allocated for the people with complex care needs who are not accepted into the National Disability Insurance Scheme?' If that work has not been done, we are in big trouble. If that work has been done and the question is not being answered, then this minister is being contemptuous, in my view, of questions that are asked in the Senate.

Here we are, 2½ years after this government was elected—2½ years in—and we still do not know where we are heading when it comes to mental health. It is my view that, with, firstly, the change of minister in the health portfolio, and, secondly, with not having a mental health minister in this government, we are in a situation where there is simply not the focus being placed by today's government on mental health in Australia.

Mental health is a growing concern in our community. We have not sorted out the way we need to provide mental health services in our country yet. But this delay, this lack of attention and this dismissive approach that this government has to people living with mental illness and the people who care for them is frustrating. It makes people very angry. And 'disappointment' is far too weak a word to describe the frustration and anger that people are experiencing.

I call on the minister to answer these legitimate and proper questions not only so that the parliament understands what is happening but also so that the people living with mental illness, their families and carers and the sector that serves them can get some proper answers to these questions.