Senate debates

Tuesday, 4 December 2018


Community Affairs References Committee; Report

6:58 pm

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

I present the report of the Community Affairs References Committee inquiry into mental health services in rural and remote Australia, together with the Hansard record of proceedings and documents presented to the committee, and move:

That the Senate take note of the report.

This is a very comprehensive report looking at the accessibility and quality of mental health services in rural and remote Australia. I'm going to keep my comments brief because there are a number of reports to table, and I know Senator O'Neill wants to make a contribution. Senator O'Neill and I referred this matter to the committee inquiry. Before I continue, I would like to thank all our witnesses, who did such a superb job sharing, in some cases, very personal experiences. I would like to thank all those who made a submission, and I'd also like to thank the secretariat.

The committee makes 18 recommendations about how to fix accessibility and the quality of services for people in rural and remote Australia. We held 16 hearings. We went to rural and remote Australia and made sure that we listened to people in rural and remote Australia and got evidence from people in those areas. There's absolutely no doubt that people in rural and remote Australia are not getting access to the services that they need and deserve. It is absolutely clear that there are some fundamental changes that need to be made. There are many barriers to people being able to access services in rural and remote Australia. Those include not being able to get access to the workforce in particular, and the workforce not being properly trained in support for rural and remote Australia; the nature of the social determinants of health of people in rural and remote Australia, the lack of access to 24-hour services; the lack of access to the right services; the very significant burden of mental health in many areas; and the cultural competence of the services that are available. There is also the fact that people have to go to emergency—and, in some cases, need to be drugged in order that they can be transported to the nearest largest centre—to get access to services, the fact that the emergency rooms in many regional areas are simply not designed adequately to deal with people who are having a mental health crisis and the fact that there is not appropriate funding available to properly implement the stepped approach to mental health that is now being very strongly supported by funding bodies and government services but which is not being implemented effectively through the services available through the PHNs.

So our first recommendation is that a national rural and remote mental health strategy be developed to address the low rates of access to services, workforce shortages, the high rate of suicide—which is almost double in remote areas—cultural realities, language barriers and the social determinants of mental health. That strategy needs to be developed, then implemented, and there needs to be regular reporting to the government, with those reports being tabled in parliament. We need to make sure the NDIS is working properly for psychosocial disabilities. We heard many accounts of the NDIS not properly meeting rural and remote needs, particularly the needs of Aboriginal and Torres Strait Islander peoples. It is absolutely critical that we make sure that services to Aboriginal and Torres Strait Islander peoples are delivered by Aboriginal and Torres Strait Islander peoples, that they're developed with them, that we have and develop a peer workforce and that we recognise the cultural competence that our First Nations peoples have in dealing with and addressing mental health. So often we heard accounts of providers and the workforce arriving in a remote community, going straight to the person who is the usual person of support in a remote community and asking them for help—an unpaid person who very often is bearing the responsibility for and supporting so many people in that community. We need to recognise that. We need to support those persons and actually make sure that we're paying for people who are providing that sort of support, because they are providing very vital services in remote communities.

In the very short time that we have available, I'm not able to do justice to this report. I beg everybody to read this report and I beg government to have a very close look at the recommendations. I will make sure that I allow time for other people to speak on this report and other reports.

7:04 pm

Photo of Deborah O'NeillDeborah O'Neill (NSW, Australian Labor Party, Shadow Assistant Minister for Innovation) Share this | | Hansard source

I do concur with the remarks that Senator Siewert has already put on the record. I'm delighted to let the Senate know that the Community Affairs References Committee has landed a unanimous report on mental health services in rural and remote Australia after 16 amazing hearings, which took us travelling to nearly every state and territory, from Derby in WA to Mount Isa in Queensland, to hear firsthand of the service gaps that are, in some cases, cavernous and gaping.

We spoke to locals from very diverse backgrounds, including mental health consumers, farmers, miners, Aboriginal and Torres Strait Islander peoples, local councils, teachers, nurses, doctors, academics and committed volunteers at the frontline of suicide prevention. I want to thank each and every one of you for your critical evidence and for the courage to come forward and share with us what were often very personal and at times traumatic experiences.

Whilst the prevalence of mental illness is similar across urban, rural and remote Australia, there is a much higher level of need in rural and remote locations, complicated by lower rates of access to mental health services in those contexts. Sadly, as remoteness increases, so does the rate of suicide. Between 2010 and 2017, the rate of suicide in remote areas was almost double that of major cities, while the rate in very remote regions was almost 2.5 times that of major cities. One of the things that struck me in this inquiry is that we kept hearing about people who were more afraid of living than they were of dying.

The barriers that exist range from the obvious, such as the actual presence or availability of services and health professionals in an area, to the more subtle, such as the attitudes towards mental health within the community or the effects of social determinants of health, such as socioeconomic status or employment. I'm strongly of the belief that one's location should not affect the capacity to access quality services, especially in these days when digital capacity, if the technology is stable and affordable enough, can facilitate ongoing, stable therapeutic relationships with a health practitioner of a person's choice in another state or context. The other thing is that access through digital means, supported by great local physical support, allows people to get around the perceived stigma that still remains with regard to mental health in our public health conversations these days.

The committee made a swathe of recommendations to improve the quality and accessibility of mental health services in rural and remote communities. For confidence in certainty and continuity of care, we've recommended that governments at all levels should develop longer minimum contract length terms. In rural and remote areas, this is absolutely essential to attracting and retaining a suitable workforce who can build over time the quality of therapeutic relationships necessary to deliver effective outcomes from treatment. Some contracts we heard of, and increasingly in the course of this government, were for just 12 months at a time. The impact of such a choice by the government is devastating because services are simply being removed from community.

We've also recommended, very importantly, that all primary health networks have a First Nations member on the board. This representative is crucial for fostering greater trust, connectivity and culturally appropriate care. It was horrifying to hear that translation services were simply denied. The assumption was that somebody who was expressing mental ill health and who was finally able to connect with a service provider had to bring their own family member to talk about matters that were deeply personal, because the funding and the staffing of interpreter services simply didn't exist. We know, sadly, that suicide continues to disproportionately impact Indigenous communities, with Aboriginal and Torres Strait Islander people twice as likely to die by suicide.

I'd like to close with a few necessary and sincere acknowledgments. I'd like to thank the chair, Senator Siewert. We enjoyed a great period of conversation with many people after the hearings; there just wasn't enough time to hear everything they really wanted to put on the record. I'd particularly like to thank my Labor colleagues on the team with me who participated in the various hearings, including: Senator Pratt in Western Australia; Senator Watt, that man of action, in the Queensland area; and Senator Polley and Senator Brown for their presence at hearings in Tasmania. Together, we've worked towards a really great outcome. If these recommendations are adopted in their entirety, they will provide a vital change that's required in our rural and remote communities.

I also want to thank the secretariat for bringing this report together and for travelling with us across the breadth of this great country. Their hard work, assistance and dedication throughout have been fundamental in this report being a record of the great state of need in our community, at this time, and delivered here today. I'd also like to thank the state government bodies, the mental health service providers, academics, peak representative organisations, local PHNs and community members who provided evidence to the committee, for without their submissions and firsthand accounts, we would not have the full breadth of information about the quality and accessibility of mental health services. Thank you to those who shared their lived experiences with us, and I am hopeful that our report can play a vital part in ensuring the change necessary to deliver access to services, for people, where they live. I seek leave to continue my remarks.

Leave granted. Debate adjourned.