Susan Templeman (Macquarie, Australian Labor Party) Share this | Link to this | Hansard source

There have been many reports into Australia's mental health system, and its failures are well known and widely discussed: high costs for many patients and terrible shortages of psychologists and psychiatrists that mean long waits, long distances to travel or people simply not seeking the help that they need. That's particularly the case for children, with big gaps in treatment for eating disorders, failures of community care and a horrific suicide rate. Our committee already knew these things, and our inquiry has been focused on what has gotten better or worse as a result of a summer of bushfires across much of the nation and then COVID—and, of course, for areas like mine, you can add in floods.

What we've found is that COVID rushed forward what might otherwise have been tentative and overdue steps to telehealth, giving people no option if they wanted to continue their treatment and providing, for some, an easier access to new treatment. But, of course, it hasn't worked for everyone. As we say in the report:

While evidence strongly supported the increased availability of telehealth, there was broad agreement that it was most effective as part of a suite of mental health services.

We supported the calls by the Productivity Commission and others to make permanent the access to psychological therapy and psychiatric treatment by videoconference and telephone which was introduced during the COVID-19 crisis. We need to see that funding and that allowance made permanent. We'd also like to see ongoing funding for digital mental health research, considering the increased prevalence of mental health problems and the rapid expansion of this virtual mental health care.

As for any step forward, there have been steps back. The need for mental health services has blown out as a result of the disasters and the pandemic that we've experienced. I asked one witness: at what point do resilient people—like those in my community, who've faced fire, flood and COVID, affecting every aspect of their life—flounder? His answer was simple. He said, 'You're resilient until you're not.' I speak with people on an almost daily basis who say that the consequences of bushfires, floods and COVID—the impacts on their business or their work, their access to family members or the effects of isolation—have broken them as never before. We know that, when it comes to natural disasters, the greatest need is not necessarily the day after the disaster. It might be weeks, months or even years. Each one of us is different, and we can't easily predict what will break someone or what will make someone else stronger.

We do know, though, from Black Dog Institute figures, that every year more than 65,000 Australians make a suicide attempt. Suicide is the leading cause of death for Australians between 15 and 44 years of age. Young Australians are more likely to take their own lives than to die in a motor vehicle accidents, and the suicide rate among Aboriginal and Torres Strait Islander people is approximately twice that of non-Indigenous Australians.

A key recommendation of our report is to make services accessible to everybody. That means physically accessible and financially accessible. Help needs to be affordable. We recommend looking at the viability of bulk billing incentives that are currently available to GPs being similarly made available to other mental health practitioners where patient affordability is an issue. Safe access to services needs to be increased for the LGBTIQ+ communities, for people who are culturally and linguistically diverse, for people in rural and remote areas and for First Nations people. A number of the 44 recommendations in the report request urgent action on these matters.

Of course, we heard much evidence about the impact of the pandemic and natural disasters on young people. Patrick McGorry, executive director of Orygen and professor of youth mental health at the University of Melbourne, points out that, even prior to the pandemic, the system was already woefully unable to meet the level of need. He estimates a 30 per cent increase on top of the normal level and describes it as a mental health emergency, where young people who are seriously ill, in life-threatening situations, cannot get the help that they need.

I want to talk about schools and the conclusions we drew after taking much evidence about the important role they play and could play in the future in helping young people manage their mental health, helping to prevent suicide and assisting with emotional wellbeing. We heard that, as I think we in this place would all know, school counsellors play a vital role. They bring qualifications to the job that make them a key part of tackling these complicated issues in many young people's lives. We also heard of the impossibility of the task, given how few of them there are. When you hear of a counsellor having a day or two a week at a school, it's no wonder there are kids failing to access that support and that counsellors report an impossible workload. We've recommended that the government work with state and territory governments to increase the ratio of school psychologists to a minimum of one full-time equivalent onsite for every 500 students across all levels of schools. This will support the work already happening in some states, but it needs to be a minimum. We need to make sure that the best use of government funds is made in our schools to ensure quality mental health support.

We can't underestimate the benefits of early intervention of access to quality mental health services. It's obviously the right thing to do, but it's also the cost-effective thing to do. There are such big gaps for young people, and I see them in my own electorate in the Hawkesbury where there is no headspace to allow an easy access and early intervention for young people. Young people need to be able to walk through youth focused doors and deal with people who understand where they're coming from. As the Katoomba headspace shows: build it, and they will come. Katoomba's demand has exceeded its expectations since opening 18 months ago. It is shameful that there's no headspace in the Hawkesbury and that this government has done absolutely nothing to fix that problem.

One of the big obstacles that we see in many of the issues related to improving access to mental health services is workforce. There wasn't a single witness who told us that they had all the workers that they needed to meet the demand. The government needs to act on finalising the national mental workforce strategy as a matter of urgency. We have multiple recommendations in this report to address workforce issues such as extending funding to five-year cycles so organisations like primary health networks can offer some security to their workers beyond one- or two-year contracts, which may help reduce people leaving for more secure work. Another issue we looked at is around the role of peer support, and there is more work to be done to ensure that the lessons being learnt about peer workers and the role that they can play are shared across the country.

Suicide Prevention Australia told us that less than half of the people who die by suicide access, or may even need to access, the mental health system. They talked about life events that can lead to suicidal distress such as marriage breakdown, economic instability and/or job loss and housing distress. They are the elements, they said, that have an impact on a person's potential suicide risk. So, instead of a focus on mental health support, they want to see a model of peer support where it's not about a clinical issue but mates helping mates. We certainly see these approaches happening in the building industry in my electorate. These sorts of workforces are critical in ensuring there's a safety net for people, preventing them from getting into suicidal distress.

Our committee also recognised the work of pharmacists and other allied health professionals, and the extraordinary things they do in this space. We didn't overlook carers for whom the current system doesn't work well. It doesn't support them, and we recommend a national carer strategy which includes a way for unpaid carers to be integrated into care teams and to access training for suicide awareness and prevention.

I want to thank the individuals and groups who made submissions to this committee, including the Mountains Youth Services Team from my own Blue Mountains. Their evidence of the high rate of suicidal ideation that they see in clients was confronting, and the support they provide to young people in crisis situations is no doubt replicated by other similarly underfunded organisations, remembering that many of these services are designed to provide broad youth services rather than specialist mental health services.

I make particular mention of committee chair Dr Fiona Martin, the member for Reid, who has led this committee and ensured that no voice was left unheard. I want to thank both the deputy chair, the member for Dobell, and the member for Werriwa for your commitment to the intense winter days in quarantine and lockdown that we spent taking evidence. I also acknowledge my other committee members. It was clear that our collective determination to see action on these matters drove the work we did. I commend the report and thank the secretariat for their work in making it possible.

Julian Simmonds (Ryan, Liberal National Party) Share this | Link to this | Hansard source

I will start where the previous contributor to this debate left off and acknowledge all the work done by the committee. The committee chair, the member for Reid, in particular, has worked incredibly hard on this report, as have all members on the committee, including me. It has been incredibly beneficial having somebody with the qualifications and passion of the member for Reid stewarding this inquiry, and this has certainly been borne out in the recommendations.

We must all work hard to break down the stigma that has historically surrounded mental health—I know that that's something that has bipartisan support—and, further, to break down the barriers that may be present that prevent anyone from connecting with the help and the services that they need in their time of need. We know early intervention is key throughout all significant stages of life. It provides support to parents through pregnancy, the foundations in schools and, then, support as children transition to adult life. I want to commend the chair for her work in detailing what needs to be done to address, in particular, the issues surrounding the need for specialist workforces to address and continue to adapt to changing environmental factors in our lives that contribute to our mental health. I also want to thank all of those who made submissions—the many organisations that lent their considerable weight and expertise to the committee's findings.

The committee recommends increased funding for specialist services such as forensic, perinatal and autism services to innovate, expand and meet demand. Dealing with these workforce issues really is the missing piece of the puzzle. As more funding is being provided by government to Medicare and to individuals to access mental health services, too many providers, especially those targeted at the young, are reporting significant issues with filling the workforce to meet demand. The fact that the committee had a significant focus on these workforce issues is to its credit.

I note also that it was pleasing to see the success of programs that were put into place during the pandemic, such as telehealth, which gave immediate access to help. There aren't too many silver linings to the COVID-19 pandemic, but this is surely one. In the normal course of business, I have no doubt that it would have taken years of consultation—probably a decade—to convince doctors and patients of the role that telehealth could play in health services. Instead, it was introduced in a matter of weeks, with patients and health professionals given a very practical demonstration of how successful it could be and the circumstances in which it could be useful. It's now an enduring legacy of the pandemic. It won't replace face-to-face health care, nor should it; that will remain paramount. But it clearly has an important role to play in ensuring that vulnerable communities have access to the services they need.

The pandemic also has elevated the importance of crisis mental health. The recommendation of the committee that the Chief Health Officer for Mental Health be present at all state and territory crisis meetings is important so that mental health considerations can be made at the time broader health orders are made. I hope to see this adopted in the future. While I don't think that considerations of those mental health impacts will change the medical advice, I hope it will ensure that mental health support that may be needed as a result of implementing some of those orders is available more quickly and to those communities that need it.

Whilst the report indeed identifies the need to prioritise youth mental health, I think there is far more that we can do. I personally have more ambition for this space than the report has and I want to see far more funding for our young people who are experiencing mental health challenges. Research clearly shows that, if we can get support for young people early, we can head off a raft of problems and pain later in life. We can assist them and prevent them from developing those chronic mental health concerns that would plague them as individuals and lead to such loss of happiness and economic potential.

The report was hesitant to single out the success of individual services, but of course I have no such hesitancy. I want to pay particular tribute to headspace for the vital work that it does for young Australians who are experiencing points of mental health crisis. It's doing magnificent work. In particular, my service in Taringa in the electorate of Ryan is the second busiest in Australia. I know that I will continue to fight for more funding, and we, as a government, need to further support and fund these centres.

I particularly know that there is extra ongoing funding on the table for these centres as a result of the recent budget. It's waiting on the support of state governments, including the Queensland government, which has shown no urgency or desire to sign up to a funding agreement with the Commonwealth. My call to them is that mental health support, particularly for young people, is beyond politics. It's something that is supported and encouraged on a bipartisan basis, and I can see no reasonable reason that the Queensland government isn't engaging in very fruitful talks with the Commonwealth government to ensure that headspace and other youth mental health services have the ongoing funding that they need.

Finally, I want to record my support for the School Chaplaincy Program. It supports over 3,000 school communities Australia wide, providing pastoral care and programs—such as breakfast clubs, activities and workshops—especially in my electorate of Ryan. Before coming to this place, I spent a decade as a local councillor working with my local schools, and I have seen firsthand, time and time again, the wonderful pastoral role that chappies play and the important impact they have in a young kid's life. They are embedded in their school community. They're strongly supported by those school communities, especially by parents, and, because they're not a teacher but one of them—so to speak—the kids feel it is much easier to talk to them about issues they might be facing both at school and at home.

I do not think there is a need to review this service, as the committee report recommends, in recommendation No. 41. I think the chappie program is effective and is greatly needed, as I have seen firsthand. But, if there is to be a review, it is my sincere expectation that its findings will show that the National School Chaplaincy Program is so effective that it should be given more funding and more support to continue the excellent work it does in our schools and to ensure it's rolled out to more schools to support the health and wellbeing of students. That's my position, and I believe it is the position of the coalition government, which has always given unwavering support to the chappie program. This committee report is the product of a lot of hard work, particularly by the chair and the committee members, and I want to thank them. I commend it to the House.

Anne Stanley (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

I rise to take note of the Select Committee on Mental Health and Suicide Prevention's final report. The committee was tasked with providing recommendations, based on a number of reports that have been released over the last three years, and providing a road map for improvements to reduce suicide and the suffering that mental ill health causes our community.

As we've all experienced in the last two years, Australia has been presented with many events both here and overseas that have challenged our normal way of life and caused stresses to many. The horrific fires of 2019 touched all Australians, with many losing their homes and livelihoods, and, just as people were getting back on their feet, many states in Australia were flooded. Since 2020, we have all endured the COVID-19 outbreak. COVID, through the necessity to keep us safe, has taken away what humans really crave the most—the support of family and friends. This was, of course, for the best of reasons, but it has increased the incredible stress on many Australians and the mental health system that supports them. Extended lockdowns have meant people have been touched by isolation. They've missed significant events with their families and friends, exacerbating the fear of the unknown, and that has affected every corner of the earth.

The 2020 productivity report, the Royal Commission into Victoria's Mental Health System and various other investigations into Australia's mental health provisions have highlighted that the system is suffering from unaffordable access for all Australians who need support for their mental health. Issues with your mental health can affect every part of your life, including your relationships and physical health. It can affect a person's capacity to care for themselves and others and hinder a person's capability of participating in social and family events. Approximately one in five Australians and nearly half of all adults will experience some sort of mental or behavioural condition in their lifetime. It can be episodic, acute or chronic.

It is clear from the evidence the committee heard that early intervention and proper evidence based support is what can make a difference in people's lives and ensure they are able to improve their mental health as soon as possible. The committee heard that, although advances have been made with respect to many conditions, misunderstanding and stigmatisation are still a problem for many people, and this stigma leads to deferred action and can lengthen the time that someone is unwell.

The final report released by this committee proposes evidence based recommendations that will steer our approach to mental health in the right direction. It shows there is a need for a big-picture approach to mental health in Australia to account for the long-term effects of the pandemic. I see it in my community, where rates of mental ill health are skyrocketing, without appropriate services to deal with them.

The Pulse of South West Sydney CALD communities: amplifying voices during COVID-19 report, which was recently released by the Western Sydney Migrant Resource Centre, found the impact on mental health was the biggest issue across diverse backgrounds. This is also a feeling among diverse communities across the country. This is why the committee recommended that the Commonwealth fund training resources for the mental health workforce to provide culturally appropriate and sensitive services to Aboriginal and Torres Strait Islander people, CALD communities and gender-diverse individuals.

Time and again during the hearings we were told about the lack of appropriate services to support those who were struggling. Teenagers are waiting months for support in a time of unprecedented stress. For two consecutive years, year 12s came in and out of online learning with an HSC around the corner. This is an exam that in the best of circumstances can cause extreme stress for its participants.

We also heard in successive hearings about the severe lack of services in regional and remote areas. There needs to be decisive and comprehensive action to address issues in this sector. Professor Ian Hickie said that the mental health system should provide the right care first time. He believes that governments need to model in advance what the outcomes of our system should be, who needs to be involved in the service delivery and how best that can be achieved moving forward. Professor Hickie put to the committee that modelling has shown that, if all these things are agreed upon around Australia, we could spend approximately $14 billion a year on mental health. If we don't make these decisions and continue a business-as-usual approach, we will see Australians spending $22 billion a year on a system that is still not functioning efficiently.

All the evidence the committee heard pointed to workforce shortages and overwork of those professionals in the system. At times in some communities, especially in our outer suburbs and regional and remote areas, there are long waiting lists. Improvements in mental health are best achieved with timely support and appropriate medical assessment and interventions by, in many cases, multidisciplinary teams. We need more psychologists in schools, better access to professionals, affordable services, the expansion of digital services, and funding for regional and remote services and for culturally appropriate support for CALD and First Nations citizens.

The committee recommended the Commonwealth invest in research to determine the long-term impacts of trauma and how it is being compounded by successive natural disasters. Any decisions that are made require data to ensure that plans are made properly and that limited resources are being used efficiently to make a difference.

The committee also recommended that accessibility be at the forefront of all policymaking. This recommendation, along with the investment to determine the long-term impacts of trauma, will go far in identifying mental ill health in Australia. Identifying the causes and being aware of these causes is a fundamental step in the process of mental health and suicide prevention. The inclusion by the Department of Health and the National Mental Health Workforce Strategy Taskforce of national standards of suicide prevention training for all health and allied health professionals in the National Mental Health Workforce Strategy is one recommendation which will have a positive blanket effect on mental health and suicide prevention.

The committee recommended that more work should be done in schools to combat mental ill health. This includes an independent evaluation of the effectiveness of all existing programs supporting the wellbeing of students in schools. Increasing the number of psychologists in schools will have a huge impact on the outcome of these programs. Also, training teachers in wellbeing and mental health support is essential for positive outcomes. Teachers need to be prepared to respond appropriately if a student reaches out for help.

Throughout the hearings we also heard about the importance of IT coordinated care. Professor Hickie urged that receiving the right care first time is crucial. He argued for the widespread adoption of smart healthcare technologies. They could easily be developed to support a wide range of organisations. Australia is a leader in mental healthcare innovation, but we lack the fundamental IT backing that can improve support across the sector. Access to the NBN and to telehealth is a problem throughout Australia, but particularly in regional areas, and there is also a lack of face-to-face appointments with medical specialists in the community. Professor Hickie talked about the urgent need for support in regional and remote areas. He believes the system as it stands is not structured for the benefit of regional areas, and non-government organisations are doing little to help. Professor Hickie also advocated for regionalisation, which means cooperation between federally funded primary health networks, state-run services and the non-government sector, as well as strong action from private health to address the gaps in services.

I would like now to thank everyone who took the time to make submissions and who so generously provided their expertise in hearings over the past nine months. Your insights and assistance with our questions are very much appreciated, and I hope you can see your particular information in our report. I would also like to thank the secretariat for their practical support during this inquiry. I appreciate so much their organisation of online forums when for much of the time they were also working remotely. I would like to thank my fellow committee members for their collegiate and bipartisan approach to this committee, especially the member for Macquarie; the deputy chair, the member for Dobell; and the chair, Dr Fiona Martin, the member for Reid. I'm truly grateful to all of you for assisting me to understand this area of policy formation. I commend the recommendations of the report to the House.

Julian Leeser (Berowra, Liberal Party) Share this | Link to this | Hansard source

It's a pleasure to follow my friend the member for Werriwa, and I note her good work on this committee—as I note your work on this committee as well, Deputy Speaker O'Brien. I also note the leadership of the member for Reid and the member for Dobell, as well as other members, including the member for Ryan, the member for Stirling, the member for Macquarie and the member for Barker.

This is a very important and serious report. Although I am not a member of this committee, I chair the Parliamentary Friends of Suicide Prevention and have a long interest in this issue, having been bereaved by suicide when I lost my father—a matter I spoke about in my maiden speech some years ago. You can see the amount of work that has been done on this report by the fact that it's 336 pages, and there are 44 highly considered recommendations.

One of the things the government has done recently is to put together a whole series of streams of advice on mental health and suicide prevention, of which this report is the latest. Anybody who has had a chance to read the Productivity Commission report—I know the Productivity Commission report will have been thoroughly considered by this committee—will know the way in which they tried to consider the whole environment, the whole regulatory architecture and the interplay of Commonwealth, state and non-government sectors in dealing with mental health and suicide prevention.

The most significant thing in the Productivity Commission report was the statement about universal aftercare, and I'm very pleased that the government, in its budget earlier this year, committed to providing universal aftercare. I believe that is the game changer in making a serious dent in the suicide numbers in this country. I think there is one thing the Productivity Commission did not get right. They actually understated the number of people whose lives would be saved as a result of universal aftercare. After you have a hip replacement or a knee replacement you go into rehabilitation; they don't just send you home. But in too many of Australia's states, unfortunately, after a person has been admitted to a mental health unit the practice has been to discharge them into the night, into the street. That's not appropriate. Universal aftercare provides step-down rehabilitation, constant contact for people who have suffered a mental health illness or, indeed, have attempted to take their own life.

Why this particular measure can make such a difference is that, unlike other measures in the suicide prevention area, we know the people who are most at risk of dying by suicide are people who have made a previous attempt. So, if you've made a previous attempt and we know who you are and we know where you live, we can put into place things to take care of you. We won't save every life, but with proper universal aftercare we will certainly save more lives than we are saving now, so I want to commend the government for that.

The second thing I want to note—and, in doing so, I want to draw attention to a particular part of this excellent report—is that the government has announced a $114 million grants program for organisations to engage in community suicide prevention activities, which I think is very important. I think the missing piece in what we have rolled out in terms of suicide prevention is universal suicide first aid that can be rolled out in workplaces. I will illustrate why I think workplaces are important in a moment. One of the most important things that we can do is to look out for others and to notice the signs and know what to do if we see the signs that somebody might be contemplating suicide. I note that the inquiry report talks about promoting wellbeing in the workplace and says:

There is now greater recognition 'peer based early intervention case management models can dispense with the need for professional gatekeepers' and thereby help ease the burden on the health system.

Through its own experience, MATES in Construction stated the issues seen in workplaces 'are not going to be a surprise to anyone—relationship issues for 38 per cent of those presenting, work related issues are about a quarter, family issues are about a quarter, and financial stress is about one in seven cases'

Recognising the 'fluid factors' in suicide prevention and the fact a significant number of people may not see a psychologist or other mental health professional, the Australian Association of Psychologists Inc (AAPi) spoke in support of a community focus on suicide prevention, including education in the workforce and in areas where rates of suicide may be higher.

The Chamber of Minerals and Energy of Western Australia agreed that mental health issues in society require a holistic approach, acknowledging the role employers have to play in addressing mental health as a community issue.

I want to commend the work of MATES in Construction and MATES in Mining and other organisations that are workplace based in terms of providing that suicide first aid.

I want to explain why I think workplace based suicide first aid delivered nationally is going to be such an important thing. In 2018 I challenged my community in Berowra to become a suicide-safe community. What did I do? I gathered 170 community leaders, from 170 different organisations in my community, together for a night at the local RSL club, and I had one of Lifeline's suicide prevention trainers come and talk to the community organisations and put them through what was then called a Lifeline accidental counsellor course. I then challenged those community organisations to go and roll out a similar course within their organisation, whether it was a church, a P&C, a Rotary club, a local community progress group or a scouting body. We also had the council and the hospitals, public and private, there with us. I'm pleased to say that around 20 organisations took up that offer and put on events like that. I'm also pleased to say that a new organisation, Mentoring Men, founded by Ian Westmoreland, was born as a result of that night and that other organisations, like the Hornsby Ku-Ring-Gai Community College, staged a suicide prevention day as a result of that.

But where I saw real uptake of the suicide first-aid courses was in the large employer organisations—the hospitals and the council. It made me realise that, while my original objective had been 'Let's get it done at the community level; let's get people in community groups to stage this,' actually there is a real benefit to staging suicide prevention training in the workplace in a way that is appropriate to the particular workers, the particular employees, and the particular management of that workplace. That's something, I think, that MATES in Construction and MATES in Mining do so well. There are other organisations, like Lifeline, like Wesley LifeForce, that provide similar sorts of courses. I know that staff in this place do the mental health first-aid version of a course from an organisation called Mental Health First Aid as part of the services that are offered by Ministerial and Parliamentary Services. I commend the parliament for providing those services. This shouldn't be something that's just available to people who work in this place. This should be something that is available to everyone. In my view, we can put in place structures to improve the operation of the medical side of the system and the psychological side of the system. We can do things like the increase the government has approved in the number of Medicare funded psychological counselling sessions that you can have in any one year. But the thing that will make more of a difference on the ground than anything is having more people looking at their neighbours, their friends and their family to see whether their conduct has changed and, if so, asking the difficult question: are you contemplating suicide? Having asked the question, they need to know what to do if the answer is yes.

I support an idea that's not covered in this report and I want to use this occasion to raise it publicly. I think organisations like those I've mentioned and others need to take advantage of the $114 million suicide prevention grants that are available to work together to roll out a national workplace based suicide prevention training program, so all of us can better look out for our neighbours, our friends and our colleagues. I think this would have a really significant impact on the suicide rate in this country, which, sadly, remains far too high. I want to again commend colleagues on both sides of the House for the way in which they worked to produce this very significant contribution to the public discussion and to public policy in relation to mental health and suicide prevention in this country. In my view, there is no more important social policy issue than to save the lives of our fellow citizens. There are far too many people dying by suicide in this country every single day, and I believe that these recommendations deserve serious consideration by government and other public policymakers in terms of what we can do to improve Australians' mental health and reduce the suicide rate in this country.

Debate adjourned.