Thursday, 30 March 2006
Mental Health Committee; Report
I present the first report of the Select Committee on Mental Health entitled A national approach to mental health: from crisis to community, together with the Hansard record of proceedings and documents presented to the committee.
Ordered that the report be printed.
I seek leave to move a motion in relation to the report.
That the Senate take note of the report.
I seek leave to incorporate my tabling speech in Hansard.
The speech read as follows—
The Senate Select Committee on Mental Health provided its members with a unique opportunity to meet with people in the mental health sector—consumers, carers, health professionals and administrators. We received enormous community support, reaped the benefits of the hard work and dedication of many, and have been shown great hospitality around the country. I wish to thank all those who assisted the committee and its work.
We received over 600 submissions—from individuals and parents and carers of people describing the tragic outcome of a mental health system that failed them. Submissions came from state, territory and local government, from peak mental health organisations, from consumers from doctors and nurses, from police and prison services …. and they told stories that provided the committee with a rich resource of material describing the complex system that is mental health in this country.
Mental health reform is now quite rightly at the top of the policy agenda for all governments. As a result, in February 2006 the Council of Australian Governments agreed to initiate a rapid process of discussion and policy development on mental health. In order to inform the CoAG interest and process, the report we table today comprises the bulk of our deliberations and a suite of recommendations that the committee believes should be addressed in the CoAG policy reforms.
A brief additional report will follow shortly, and its recommendations will be no less important. However, this arrangement ensures that the Committee’s findings will contribute to and guide CoAG’s policy reform discussion. We sincerely hope that in addition to CoAG, all governments, agencies and organisations will respond positively to the recommendations included in both reports.
The Committee heard an enormous range of evidence on many different issues. Some evidence reflected a strong consensus among contributors. Without a doubt, there is an urgent need for more mental health services. Reducing the stigma associated with mental health is important, but little help when little or no service is available to those who look for it. More services means more funding (Recommendation 1), but funding for mental health must also be used more constructively.
One message came through very clearly in this inquiry: there needs to be more community-based mental health care. More is needed because there is an unacceptably high level of unmet need. More is needed because too many people are failing to get service until they end up seriously ill in hospital. More is needed because community care can be better at fostering rehabilitation and recovery in, as the NMHS declares necessary, in the least restrictive environment.
We propose a Better Mental Health in the Community initiative, comprising the establishment of a large number—we estimate 400—community-based mental health centres; the distribution primarily determined on the basis of populations and their needs. These Centres will be staffed by truly multidisciplinary teams comprising psychiatrists, psychologists, GPs, psychiatric nurses and social workers.
The Better Mental Health in the Community infrastructure program should be rolled out over 4-5 years with contributions from both the States and Territories and the Commonwealth, with the latter establishing direct Medicare recurrent funding arrangements for employed or contracted mental health staff, and the former providing infrastructure and on-going management. With two levels of government sharing the load, the services will be responsive to the needs of the local community and provide better access for those in need.
The Committee also believes that the Better Outcomes initiative should be reformed. It was a very good initiative of the Government but has been limited by the small number of participating GPs and the caps that apply for patients and for the Divisions of GPs arrangements.
There is a strong argument for the relatively untapped pool of clinical psychologists to be much better utilised in Better Outcomes. We propose that there be a new set of Medicare schedule fees for mental health for psychologists, GPs and psychiatrists and that they acknowledge the time that the so-called talking therapies take. This would bring psychologists into the system as primary health carers but we accept that there needs to be an assurance for the government that this won’t cause huge budget blow-outs. I doubt there are enough clinical psychologists in private practice to cause a massive increase but in any case, we argue in our recommendations that participation in Better Outcomes would come with an obligation to collaborate with other mental health professionals, in combination or in conjunction with the mental health centre. This way, GPs and psychiatrists benefit from the knowledge and experience of psychologists and vice versa and patients would benefit from better coordinated care—which was the purpose of Better Outcomes in the first place. The fact that the Better Outcomes budget was so significantly underspent demonstrates the need for reform but we don’t want to throw the baby out with the bathwater.
We have confidence in the Divisions of GPs and in their work on Better Outcomes and they should continue to provide training for GPs who seek it but we have recommended the pre-requisite of training be dropped for participation in the program. It was always somewhat perverse that the GPs least trained in mental health were the ones dealing with these patients without assistance from mental health professionals and doubts were raised about the effectiveness of 6 hours training for level one. We understood that this was an incentive to get GPs involved in training but there is no evidence that the current rate of 20% of doctors participating in Better Outcomes will improve any time soon yet 100% of GPs will be seeing people affected by mental illness daily. It is also clear that the more integrated and collaborative our primary health system can be the more expertise will be developed by virtue of this collaboration.
It would make sense for the Divisions of General Practice to be restructured as Divisions of Primary Health so other disciplines could be brought into the system.
De-institutionalisation is a policy with the right goals, but the job remains incomplete.
What did we hope to achieve when no State or Territory in Australia has adequate community-based care? Area mental health services were set up but they too only deal with the most unwell. The obvious but unacceptable consequence was a shift in care for the seriously ill from psychiatric institutions to prisons, emergency departments, families, or worst of all, neglect and homelessness. We must do better. And not the piecemeal response of funding only pilot projects and short term grant-based programs which don’t go on to be funded, regardless of how worthy or successful they are. Funding must move to a more sustainable basis and perhaps governments need to forgo the satisfaction it gives them to announce brand new projects on a regular basis.
Assessing the success of the National Mental Health Strategy was at the core of our inquiry and we were convinced of the need for better defined targets, monitoring and of the need for all states to be brought into line with the national mental health plans. There must also be more explicit protection of consumers rights in the Strategy
In addition to the National Mental Health Strategy and Plan, several other national strategies have implications for people who need mental health services. Unfortunately, these strategies are not always well integrated and sometime lead to perverse outcomes.
For instance, people experiencing psychosis while addicted to alcohol and drug have been refused assistance by both mental health services and alcohol and drug services; each claiming that the individual is more rightly served by the other service. One way to counter this is to integrate the NMHS, National Drug Strategy, National Suicide Prevention Strategy and National Alcohol Strategy. The specification of achievable targets and outcomes within these strategies is central to achieving this (Recommendation 2).
Mental illness is often poorly understood by the community, and even health professionals and researchers have limited knowledge about some conditions. People with a mental illness experience discrimination, marginalisation and often get too little say in their own treatment.
The committee believes that knowledge needs to be improved, discrimination eliminated, and consumers given a greater say in their own treatment. Existing organisations in the area of mental health can help in the pursuit of these goals.
The Mental Health Council and the Human Rights and Equal Opportunity Commission each have significant parts to play in the monitoring of progress on mental health service reform and monitoring human rights and discrimination. The committee has recommended that each of these bodies be given additional resources. It believes the Mental Health Council can play a role in regularly monitoring and reporting on progress under the National Mental Health Strategy.
The capacity of the Human Rights and Equal Opportunity Commission should be enhanced, to allow it to more fully examine human rights abuses and discrimination against people with mental illness. The committee was also particularly concerned about the barriers that people with mental illness face in getting access to supported accommodation. Discrimination in this area is something the committee would like to see HREOC investigate as soon as possible.
While existing bodies can perform these valuable functions, two new organisations are needed. It is essential that consumers and carers have a greater role as advocates, as experts and as promoters of good mental health. While some steps have been taken in this direction, the committee calls for the formation of a National Mental Health Advisory Council, made up of consumers, carers and service providers. This body should advise CoAG on consumer and carer issues, and act as promoters of mental wellbeing, illness prevention, and consumer involvement in service provision.
The committee also concluded that a Mental Health Institute is needed.
There needs to be more research in the area of mental health. There must be greater dissemination of that research. A Mental Health Institute would help set research and evaluation priorities for mental health. It would also disseminate information about successful pilot programs for service delivery.
Currently, treatment options for many consumers are too limited, and are too focussed on pharmacological therapies. The Mental health Institute would review evidence on treatment cost and effectiveness, and disseminate the results of those reviews.
As the Senate will know, the committee was given an extension to report on this inquiry until end April but on advice from the sector, we pulled out all stops to get the bulk of our report completed in time for it to be useful to decision making in CoAG, currently underway. This means we will follow this report with the many other important but perhaps less urgent recommendations the committee wishes to make and we will table those in the next week or so.
It also means that a supreme effort to finalise this report was made by the committee and its secretariat.
I would like to thank sincerely my fellow committee members, Senator Humphries, Forshaw, Troeth, Webber, Moore and Scullion for working through 10,000 pages of written submissions, a record number of hearings and travel into each state and territory and into remote locations.
I thank them for their enthusiasm, their cooperation in delivering on an impossibly short time frame, for assisting with the 600 very detailed pages of report and for their willingness to be bold in our recommendations.
And I thank the secretariat for their above and well beyond the call of duty efforts in making it happen. I know they have put in a huge effort and am appreciative of their intelligence, dedication and excellent management of the process. So thank you to Dr Ian Holland, Secretary, Ms Kelly Paxman, Ms Lisa Fenn, Ms Eleesa Hodgkinson, Ms Jill Manning, Ms Loes Slattery, Mr Tim Davies, Mr Terry Brown and Dr Robyn Clough for a remarkable effort and a report I hope they can be as proud of as I am.
I rise to make a few comments with regard to this comprehensive report that has been tabled today, recognising that in the short time available it will be impossible to do justice to it. I believe it is one of the most important reports tabled in this parliament for many years. It was certainly one of the most important inquiries that I have been involved in. The report runs to 17 chapters and hundreds of pages covering the evidence and submissions that were presented to the committee inquiry.
This report that we have tabled today is a first report. It comprises the bulk of the report plus what we would describe as the primary recommendations. We have released the first report and the initial recommendations ahead of the final reporting date that was established by the Senate to ensure that our proposals and findings are available to the federal and state governments in the lead-up to the coming COAG discussions.
It is a unanimous report. As I said, it catalogues the enormous input from many groups and individuals who appeared before us in public hearings and/or made written submissions. The inquiry visited all states and territories and took evidence from groups, individuals, state and territory governments and professional groups. Effectively we heard from all of the participants involved in dealing with, experiencing and treating mental illness.
Many people showed enormous personal courage in making a submission or appearing before the inquiry. Anyone who knows anything about mental illness knows how hard it is for people to talk about it. Notwithstanding the improvements in recent years and I think the greater understanding that is developing in the community regarding mental illness, there is still a large stigma attached to it. It attaches not just to those people who suffer mental illness but to their families and carers as well. I think it exists because at the end of the day most of us, if we have not experienced a mental illness, find it difficult to understand what it involves. I will come back to that at the conclusion of my remarks.
The essential message of this report is that we as a society and our health system have not served the mentally ill well. Some argued that we have failed. Many argued that it is a crisis situation. We certainly know that one in five Australians on average will at some point in their lives experience a mental illness. Fortunately for many, if they do experience one it will be a mild case of depression, but for many others it can involve a lifelong illness. That can be depression, bipolar disorder or schizophrenia. We all know the types of mental illness that people in our community have to endure.
I want to deal quickly with a couple of the key aspects of our report and recommendations, recognising that it is simply not possible to cover it all in one short speech. It is widely accepted today that the move to deinstitutionalisation, particularly following the Richmond report in New South Wales, was not a complete success. I would not say that it was a complete failure, but it certainly has left a lot to be desired. It is well recognised today that, in closing the institutions and many of the major psychiatric hospitals in this country, state and federal governments failed to provide the community based services that were supposed to replace those institutions.
Many people today cannot get access to affordable and adequate housing. Community based medical services, particularly CAT teams, are stretched to the limit. There is a lack of proper employment assistance. We know that there is a growing link between poverty and mental illness. We also know that comorbidity—that is, combined illnesses such as mental illness and drug or alcohol abuse problems—is on the increase.
There are huge pressures on the hospital and acute care system. We heard evidence constantly of people being unable to get proper care and access to an acute bed when it was needed because of the logjams that occur in emergency and accident centres around this country. We heard evidence very early in the piece that the first call is often on our police services, who find themselves increasingly involved in taking people who might be suffering a psychosis to the emergency and accident centre at a hospital and then being stuck there for long periods of time. We are aware also of the pressures on carers and families.
Our primary recommendations go to asking governments to significantly increase the funding for mental health services so that it reaches a figure of between nine and 12 per cent of the total health budget by 2012. We submit that that should be primarily directed to community based services. We make very detailed recommendations about the sorts of areas in which we believe those services should be improved and new arrangements established. We envisage the establishment of a better mental health in the community initiative which would lead to the establishment of around 300 to 400 community based mental health centres throughout the nation.
The other aspect I want to quickly turn to is that there is still a need for an adequate and appropriate acute care system. We find today that the acute care beds of psychiatric units are invariably located in public hospitals. In many cases, certainly in ones that I have visited, they are not appropriate and are inadequate. People who need an acute care stay for a mental illness are generally not going to be confined to bed. They need space and room. It is ultimately about stabilisation and hopefully rehabilitation and recovery, and many of those facilities are not adequate. We are finding that the beds are not available in many cases. People go in through the A&E—the accident and emergency—service and they go back out the door again because they cannot get an acute care bed. So we are also urging that there be moves to improve that sector of mental health services delivery.
There are so many more issues that we could talk about—and I am sure that, in future remarks in this chamber, we will get a chance to deal with them—including: the workforce, human rights, issues that particularly affect Indigenous people or young people, the difficulties that women face in prenatal and postnatal depression, and the relationship between mental health and the criminal justice system. Those issues are all covered in our report.
I want to finish by saying that the best and most apt comment I ever heard about mental illness was said to me by my mother, who suffered from severe depression all her life. She once said to me, ‘Mental illness is the most painful illness of all because it is the pain you cannot explain.’ She did not mean any disrespect to anybody suffering from any other illness, but her comment adequately summed up what is at the heart of the issue. People suffering from mental illness often cannot explain that illness to others in ways we understand. Hopefully our report will assist people who suffer from mental illness, so that they can have access to appropriate and better services and can ultimately recover to lead fulfilling lives in our community.
It gives me great pleasure today to be able to share in the task of putting this important report before the Senate. Hopefully it starts a debate in this place, in the broader community and in particular in the governments of Australia on solutions to what is an enormous problem facing our community. Mental illness is Australia’s great invisible epidemic. Of all of the diseases in our community, it exhibits the grossest mismatch between the cost of the disease, the disease burden, and the amount that is spent collectively by the community to address that cost.
In excess of about 60 per cent of mental illness goes undiagnosed and untreated. We would not accept that level of untreated illness in any other area of medical help. It is a disease which is little understood and, compared with other diseases, little talked about. If one’s Aunt May suffers from, say, cancer, we can be sure that she will be flooded with sympathetic cards, phone calls to inquire about her health, and other attentions. If our Aunt May suffers from bipolar disorder, the chances are that people will look the other way.
It is difficult to know exactly how much mental illness there is in the Australian community. We do not fully understand the physiology of mental illness: the causes and the pathway that those types of illnesses follow. Sadly, much mental illness eludes complete cure. One witness said that it is better to speak of recovery from mental illness rather than a cure. Of course, most profoundly, those who suffer from mental illness in Australia today do not talk about that illness in many situations for the very reasons that Senator Forshaw just alluded to. Indeed, in some cases it is difficult to define what mental illness is. Mental illnesses are juxtaposed to mental dysfunction, ranging from florid psychosis all the way through to eccentricity.
Much mental illness is internalised or privatised—that is, people suffer in silence because of the crushing weight of social stigma. But, conversely, when a person does not react in that way to their illness, there is a huge potential impact on the people around them—not just on their immediate family and friends but on the whole community. It is in this form that mental illness becomes in some ways the most socialised of illnesses, in that we all bear a cost for the failure to adequately address it. This point is made clear when we understand that many experience mental illness and self-medicate to deal with that reality. That is difficult to quantify because so much is unknown about the course of this illness, but a great deal of alcoholism and drug use, both licit and illicit, in the Australian community is attributable to the phenomenon of people self-medicating an undiagnosed or untreated mental illness. Of course, that phenomenon occasions an enormous cost on the Australian community.
For example, a death in a car accident caused by a person who is heavily alcoholic may not be put down to mental illness but, in fact, can be linked very clearly to that problem. It follows, of course, that to adequately deal with mental illness, to bring it under the umbrella of treatment and care, we need to engineer the reduction of stigma which inhibits so many people in this community from seeking treatment. We simply have to stop looking the other way when mental illness manifests itself in our community.
When Kylie Minogue announced some 12 months ago that she was suffering from breast cancer, there was a huge wave of public sympathy. I have to doubt whether that same kind of sympathy would have been exhibited had the announcement been that Kylie Minogue suffered from schizophrenia or bipolar disorder or manic depression.
The committee found that the failure to diagnose and treat mental illness early and effectively has huge downstream costs for the community. We talk a lot in this place about the benefits of early intervention, but it is here that we find the most powerful example of the costs that are occasioned to us all by the failure to deliver early intervention.
Typically, a person with mental illness will find themselves with enough insight to see that they are slipping into an episode of serious illness. They will seek help. Most commonly, that help will not be available. Their condition will deteriorate. They will either conduct themselves in a way that brings them to the attention of crisis services or end up in an accident and emergency department where, quite often, they will be turned away unless they are actually threatening harm to other people. Even the threat of self-harm does not constitute, in some cases, an adequate reason for being admitted to care in public hospitals in this country. By the time they are admitted, the level of illness is very serious and often necessitates very long bed stays. The medical costs to the community can be very significant, but the costs are even greater where an illness spirals into destructive behaviour which can ripple out into the rest of the community and is sometimes, in fact, no more than an appeal for help.
It is the committee’s clear view that we must establish an effective community based safety net designed and funded to give the mentally ill timely and effective treatment at an early stage of an illness. We suggest in our recommendations that that safety net should constitute a network of community based mental health centres employing a combination of general practitioners, psychiatrists, psychologists, psychiatric nurses and allied health professionals. Those services should focus on the high-prevalence low-acuity conditions which are largely overlooked in contemporary treatment arrangements, such as depression, which goes largely untreated. In case you think it is wasteful to focus major attention on illnesses such as depression which are widely experienced, bear in mind that depression generates the highest burden of disability of any disease in Australia today. More than 500,000 Australians each year are severely affected by depression. It has a massive impact on the quality of life of Australians.
Much mental illness must necessarily be treated with drugs, and indeed the Commonwealth government has dramatically increased spending on drugs to treat mental illness in recent years. Regrettably, the reliance on drugs does overshadow the fact that a great deal of good can be effected with respect to mental illness by the use of lower level therapies, or talking therapies, as they are often described. That is the kind of focus which we believe the mental health system needs to acquire in order to provide effective interventions.
In other words, we believe that the centre of gravity of our response to mental illness in Australia needs to come down from acute-care wards in hospitals, where people so often end up when they are severely ill. Instead, our response should be delivered in the community by those with a sympathetic approach to the problems that are experienced by the mentally ill, in a way which provides the best kind of care. Very often, a person with severe mental illness may need, most appropriately, a bed and compassionate assistance—someone to listen, someone to talk to, someone to keep them on a medication regime. That kind of intervention can so often be very effective and prevent a great deal of illness as well as reduce the cost to the rest of the community.
This report contributes to an important debate at an important time in the development of better services for the Australian community. It is very important too that this report is a unanimous report, as Senator Forshaw noted. It is an example, I think, of Senate committees working at their best. We have taken evidence throughout this country and we have heard many hitherto unheard stories—that was itself a very cathartic experience for many people. We have conducted an exhaustive exploration of this issue and we have produced some consensual bipartisan recommendations which we believe the Council of Australian Governments, most immediately, can readily look at, pick up and adopt as solutions to these problems.
I want to thank the other members of the committee for their contribution to the spirit of this inquiry. I want to thank the committee secretariat, who worked under exceptionally difficult conditions to produce a report in very short order. I strongly commend this report to the Senate and hope it will be the basis of much important and immediate action in the future.
I will commence my brief remarks where Senator Humphries left off: I would also like to—and, I am sure, on behalf of all the members of the committee—thank the very diligent, professional and hardworking members of the secretariat, who were placed under enormous pressure in recent days; they went on an incredible journey with every member of this committee. Like Senator Forshaw, I also thank the many people who wrote submissions and were actually brave enough to appear before the committee and talk about their personal challenges and the journeys that they had been on. Like Senator Humphries, I place on the record my thanks to and acknowledgement of every member of this committee. It is a journey that seven individual members of this place have taken. For us to have come up with such a substantial report that we all feel confident we can agree on and commit to is, I think, an achievement worth noting.
As has been remarked, mental illness is an issue that touches every section of our community. It is said that it affects up to 20 per cent of our population. In looking at the recommendations that our report contains, in looking at a holistic approach, I am sure it is the aim of every member of this committee not only to say to every government of every persuasion, ‘This must be one of your key priorities in addressing the health needs of our community,’ but also to come up with a solution that says to someone with a mental illness: ‘There is no longer a wrong door for you to go through. We are going to treat you as a whole person and we are going to try to come up with a solution that addresses your needs.’
As I have said in this place before, I live in the suburb of Mount Hawthorn in Western Australia. There are currently 3,912 people on the electoral roll in Mount Hawthorn. So, if you accept the 20 per cent marker I mentioned, approximately 780 people in my own suburb will actually be suffering from some kind of mental illness or mental distress at any one time.
It is therefore an issue that touches every aspect of our community and, I am sure, everyone in this building in a different way. Senator Forshaw has talked about his personal experience from a family point of view. It does not leave a section of our society untouched. Our former Premier in Western Australia has also been touched by mental illness and has gone on a very long and hard journey himself. We have people from the likes of Geoff Gallop to the woman who lives next door to me. She is of Greek origin. She has lived in her home for 40-odd years and has progressively suffered from very debilitating episodes of manic depression. Indeed, when I first moved into my home 10 years ago, she was in an institution, and so I did not realise the difficulties that family had faced. Not only did they have to battle with the stigma that Senator Humphries has rightly identified; but the stigma within our immigrant communities, within the more marginalised parts of our society, is even greater than within the mainstream or decision-making groups within our community.
In trying to finalise my very brief remarks, because I know the pressures this chamber is under and I am anxious that other members of the committee get the opportunity to speak, I just want to say that what has really struck me most of all the evidence that we saw was some evidence that we got from some young people in Victoria. There was one young woman in particular who talked about the challenges that she has faced from adolescence—she is now in her early 20s—and the impact that they have not only on her health and wellbeing but her ability to be a fully formed member of our community and her ability to obtain and maintain employment and training. At that point in time, she was feeling well and she was employed—she felt she had the capacity to be further employed than she was but she did not want to risk her mental wellbeing. She summed up her journey by saying, ‘They don’t hand out gold medals for the race that I have run.’ I think that is a fitting note on which to allow others to contribute.
I would also like to go on record today, on the day our report has been tabled, to acknowledge the amazing courage and contributions from so many people who felt that there was some genuine value in giving evidence to our Senate committee. When people read this report—and again, as I have said many times in this place, when the Senate produces a report that reflects the views of people from our community, there is an expectation that people will take the opportunity to read it—and see that over 500 people, organisations and practitioners felt that there was need in our community to respond to the issues of mental health, they will see that across our community there are people who have hope. They have hope that we as a society will listen to their stories and that we as a society will band together to respond. What we heard was that Australia has, over many years, acknowledged that we have the capacity to respond to the issues of mental illness in our community and at times we have been acknowledged as a leader in this area. We saw wonderful stories of treatments, collaborations and experiments that have involved many people and that have led to an expectation that there will doors. I think Senator Webber used that expression.
However, in our committee a great deal of frustration was mentioned. Before we move on to the next step—inevitably there must be a next step—it is important that we note this afternoon that, amidst the hope, a great deal of frustration was expressed by very many people: people who identified themselves as having mental illness at some time, their families, the people who worked with them through the journey of this illness and the people who worked to provide some response in this area. They consistently told us that they were angry because their concerns had not been listened to. Over many years, people had taken the time to come forward to tell governments at all levels and of all flavours that there was a need to respond with research, to look at the illnesses that had been identified and to work effectively with those people who were prepared to do so to come up with ways that will not be ‘one size fits all’. There is always a danger that people will come up with one solution that seems to be effective and try to force all problems to meet that one solution.
Out of this report it is clear that there is not one simple response—there is not one simple solution—but there can be a collaborative approach involving governments, health practitioners and the people who have the bravery to acknowledge that they are unwell. There must be that cooperation in our community because, if there is not, we will continue to run away from these issues. As we have heard from other speakers this afternoon, a sense of isolation and abandonment was identified by some families. They felt that their issues were not acknowledged and that their illness was not given the same respect as others in the community.
There are at the moment a number of clear recommendations that look directly at the COAG process. The important thing in bringing down this report today is that it is not overlooked in the various decisions that have been already announced and anticipated by the Prime Minister and by the various state governments, because we can do better. For too long, I think, we have run away from the issue. We as the Senate have a responsibility, because the people of Australia who want to be part of the solution have told us that they want us to respond to their needs.
To the secretariat, of course, I say thank you very much. You shared this journey. However, I think the real response will be in the future. We put down a number of recommendations. We now look to governments and to the community to put these into place. I do not want to come back to this place in a number of years time to find that once again people have had to be brave enough to come to their government and say, ‘You can help us, and there can be some result.’ I do not want to look at that despair, because that would mean that the effort that we have put in over the last few months will be wasted, and I do not think that we can walk away from that challenge. I seek leave to continue my remarks later.
Leave granted; debate adjourned.