Monday, January 12, 2004


Page: 58 Matter of Public Importance

Ms CLOVER MOORE (Bligh) [4.43 p.m.]: Today I speak about the shocking situation for people with mental illness, and call for urgent government action. There have been calls for reform of mental health services as far back as the 1983 Richmond report, followed by the 1988 Barclay report and the 1993 Burdekin report.

The 2002 Legislative Council inquiry into mental health services in New South Wales again exposed a grossly unmet need, particularly for supported accommodation; poor co-ordination, with no strategic leadership; and lack of accountability and transparency in funding and services.

The Premier has announced a review of the Mental Health Act, but the evidence shows that the problem is not policy but implementation. The 2003 Mental Health Council of Australia report entitled "Out of hospital, out of mind" concluded: A nationwide review ... documented that current community-based systems fail to provide adequate services.

Specifically these services are characterised by: restricted access; variable quality; poor continuity; lack of support for recovery from illness and [lack of] protection against human rights abuses [and] this does not represent a failure of policy.

Instead, it is a failure of implementation through: poor administration; lack of accountability; lack of ongoing government commitment to genuine reform; and, failure to support the degree of community development required to achieve high quality mental health care outside institutional settings.

Mental illness affects 860,000 people in New South Wales; 20 per cent of Australians have a mental illness; and 40 per cent will have a mental illness during their life. Mental illness represents 13 per(2) fatal disease burden in Australia.

However, the Mental Health Council shows that Australia allocates only 7 per cent of health spending to mental health, while most developed countries spend 10 to 14 per cent. The national increase in recent years largely covers increased population, rising Pharmaceutical Benefits Scheme drug costs—a 402 per cent increase—and new technologies.

The Premier says that the Government has doubled the mental health budget since 1995. But New South Wales performs poorly in comparison with other States. New South Wales has been the least funded of all States, and the increase over the last National Mental Health Strategy was only 18 per cent, while the Commonwealth funds rose by 73 per cent. New South Wales spent about $77 per head on mental health, yet Western Australia managed $96 per capita.

The 2002 National Mental Health Report shows that Victoria provides 20 24-hour staffed community beds per 100,000 people, while New South Wales provides only 4.3 beds. Over the course of the first National Mental Health Strategy, Victoria increased spending on residential psychiatric services to $14.96 per capita, while New South Wales increased spending to $3.54 per capita, from a paltry $3.11.

Victoria increased funding to non- government officers from $2.36 per capita in 1992-93 to $7.69 in 1999-2000, while New South Wales only increased spending from $0.87 to $1.20 per capita. Frontline workers say that clinical services have declined as a result of government requiring new partnerships and ways of working to be developed within existing budgets. While these reforms were necessary, extra funds were also needed.

The Human Rights and Equal Opportunities Commission says that the lack of supported accommodation is the single largest obstacle to recovery and rehabilitation for people with mental illness. Without treatment and ongoing support they are at high risk of becoming homeless. Yet mentally ill people are discharged before they are(3) stable, without support, into crisis refuges, boarding houses, caravan parks or motels, or on the street. Is that what was intended by the Richmond report? Homeless people with a mental illness need medium- to long-term residential rehabilitation, yet many only ever receive treatment when admitted to an acute psychiatric facility.

The Legislative Council inquiry found that homelessness and prison are the mental health services of last resort, and shockingly 30 per cent of people are in prison because of their mental illness.

Expensive hospitals, prisons and acute psychiatric facilities cover for the lack of accommodation and community support. The Legislative Council inquiry reported that planned increases in funds and supported accommodation beds were still insufficient to meet need. A long-term solution to homelessness for mentally ill people requires genuine high-level government commitment and massive funding increases, particularly for supported accommodation.

Many people are caught in a vicious cycle: going from crisis accommodation to the streets, prison and hospital. Nearly one quarter of SAAP refuge clients are caught in this revolving door, and most have an addiction and/or mental illness, and 5 per cent were in institutional care directly before their housing crisis.

But refuges and hostels do not have the skills or resources to care for mentally ill clients with complex needs—just ask those at Matthew Talbot hostel, Edward Eager Lodge, Foster House or even Department of Housing tenants in Surry Hills or Redfern.

The Government's policy is that people who have recently experienced an acute episode require 24-hour or 8-hour to 16-hour staffed support services with both clinical care and disability support, yet the reality is they are discharged into crisis accommodation services, and often end up on the street.

There is an extremely high level of unmet need for psychiatric treatment among Sydney's homeless population—75 per cent of homeless people have at least one mental illness. Homelessness(4) reduces psychological functioning and general health, and increases the risk of substance abuse, and the need for more intensive treatment.

Indigenous people are overrepresented as involuntary and forensic patients in homelessness figures. The Legislative Council inquiry recommended more Aboriginal mental health workers, changes to mainstream services, and partnerships with bodies such as the Redfern Aboriginal Medical Service.

The Mental Health Council says that only 38 per cent of people with mental illness access mental health services; most see general practitioners who have limited expertise in mental illness and lack support from specialist services. The 2002 National Mental Health Report showed that while acute mental health beds have remained static at around 18.1 per 100,000 since 1992-93, non-acute beds have fallen from 26.2 to 11.6 in 1999-2000. In New South Wales the number of 24-hour staffed beds dropped from 283 in 1992-93 to 276 in 1999-2000.

Mental health case managers help clients get the services they need; however, many case managers have 50 or 60 clients on their books and cannot devote the time required. Studies in the United States of America show that case management is most effective with caseloads of less than 10.

Yet our case managers have 50 to 60 clients. Mental health crisis teams therefore cannot provide consistent, responsive care when they are overloaded and overstretched. The Legislative Council inquiry recommended an assertive community treatment program based on successful programs in the United States of America, and this innovative approach should be used in New South Wales.

Another issue is that many reports on mental health show that mental health funds are being allocated to cover for other health services, and that there is sleight-of-hand in reporting on mental health funds. No-one can assess these claims because there is a dearth of information about services and needs, and the extremely limited data published is years out of date. Repeated calls have(5) been made for area health services to report against identified measures. It is really difficult to assess just how bad the situation is.

Government mental health services are unable to provide me with information about their services, clients or needs, and non- government organisations are reluctant to criticise the agencies that fund their services. My requests to the Minister for Health to provide information about mental health funding and needs have gone unanswered.

The inadequacies of the mental health system are obvious in the parks and public places of our cities. About half of the rough sleepers in my electorate have a mental illness. In June 2003 there were no vacancies in the inner city for residential rehabilitation or housing programs with visiting support.

The Independent Community Living Association informed me that many people wait up to a year for a place with the appropriate level of support. One client waited nearly 10 years. The Richmond Fellowship told me that people often "remain in hospital at high cost" until a place becomes available, and that organisation had over 40 people on its waiting list for central Sydney. The Bea Miles Women's Housing Scheme had over 80 people on its waiting list, and the After Care Association's Clovelly House had to rehouse its five tenants when funding ran out.

The significant disadvantaged indigenous populations in Woolloomooloo and Redfern-Darlington require additional resources and specific strategies. As well, for the significant numbers of people with HIV and AIDS, their special mental health needs include support for effective services such as the Bobby Goldsmith Foundation's Floating Care Initiative.

Local service providers tell me that they have good rapport with the Darlinghurst Community Mental Health Team, and recognise that the team does a good job in very difficult circumstances, where a crisis response can take hours, and the team has to recommend police attendance because they simply are not able to handle the workload.

Urgent action is needed. I am about to run out of time to address this part(6) of my speech. However, I will cover what is needed in my speech in reply. [Time expired.]

Miss CHERIE BURTON (Kogarah—Parliamentary Secretary) [14.54 p.m.]: The Government recognises the challenge of mental health in New South Wales. Mental health problems affect one in five Australians. At any given time up to one million people in New South Wales may be suffering mental health problems.

It is likely that this epidemic will get worse before it gets better, and it will continue to be exacerbated by other societal pressures, such as family trauma and breakdown, child abuse and neglect, growing drug and alcohol abuse, the psychological impact of violence, unemployment, and the growing gaps in society.

We must recognise that mental health issues touch everyone. Mental health is everybody's business. That is why we have already doubled the mental health budget since we came to government in 1995.

We have opened 215 new beds, including 150 in rural and regional areas; approved over 40 mental health nurse positions in hospital emergency departments; built a work force of over 50 Aboriginal mental health workers as well as traineeships for Aboriginal people in the mental health; established a task force to deal with the co-occurrence of mental health and drug and alcohol problems; and put in place major initiatives, with over $10 million over three years to 2003-04, to build our mental health work force, and resource mental health nurses, psychiatrists and other mental health professionals.

The pace of production of new mental health beds has increased. From 1997 to 2001, 86 new mental health beds were opened; in 2002 and 2003, 246 beds have been completed or are due to open; and in 2004 and 2005 nearly 200 more new beds have been approved and are currently being planned or built.

Areas of identified need include new inpatients facilities at Wyong, Liverpool and the Blue Mountains, and new children's units at Westmead, Campbelltown, Sydney Children's Hospital and(7) Newcastle.

That is not to mention an extensive capital works program right around the State, like the new 135-bed forensic hospital, a new psychiatric intensive care unit at Macquarie Hospital, a new non-acute mental health unit in south-western Sydney, and the 118 supported accommodation beds in partnership with non-government organisations.

The Premier recently announced stage one of the Government's response to the growing demand for mental health services. It includes the allocation of $77.5 million over the next five years to areas identified as most in need to expand the range of specialist mental health staff in emergency departments; to expand child and adolescent mental health services; to boost partnerships with non- government organisations for rehabilitation and accommodation services for the chronically ill; to support clinical performance, workplace training, mental health information systems and evaluation; as well as better support and access for our elderly.

The Government will also embark on a review of the legislation in this area—the first major State-based review since 1990. Following consultation with key stakeholders, we will focus on issues relating to families and carers, operational issues and our forensic system.

We will make the legislation more inclusive of carers and families. We will ensure the ongoing sharing of information between carers, families and health care providers. We will work with health care professionals to better streamline admissions. And we will also review the provision of medical services to involuntary patients under the Mental Health Act.

Then there is the forensic patient system. It is time to get the balance right between humane care and treatment of this patient population, whilst ensuring community safety at all times. The Government is addressing mental health care with the diligence and respect it deserves. We are in the midst of finalising our whole-of- government response to the select committee inquiry into mental health services. I would point out that many of the issues raised by(8) the honourable member for Bligh are in the recommendations that currently are being considered by the Government.

I would also like to say that in my role as Parliamentary Secretary I have been all over the State speaking to carers, consumers and mental health workers, and I have visited all inpatient supported accommodation facilities and long-term and medium-term facilities.

The Government is very much aware of this complex issue. It is a very difficult issue to fix because at the end of the day we are talking about a need that is extremely specialised. It is not like doing 100 knee and hip procedures a day. Each patient needs specialised care.

As the incidence of mental health problems continues to increase dramatically, I reiterate the Government's commitment to ensuring that patients get continuity of care through their sickness to getting well and being able to function in the community. We are committed to ensuring mental health workers get the support they need.

The Government has taken many steps towards ensuring that everyone is able to access care, and get the resources and support they need. Mental health services will remain a priority of this Government. The Government is currently preparing a response to the Pezzutti inquiry, which will be implemented over the term of this Government.

Mr BARRY O'FARRELL (Ku-ring-gai—Deputy Leader of the Opposition) [5.00 p.m.]: Regrettably, the priority of the Government is reflected in the inability of the honourable member for Bligh to finish her contribution. She has more than sufficient notes to continue the story of the state of mental health in New South Wales.

The Government's response to an issue that the Parliamentary Secretary would have us believe it is giving some priority to went for all of six minutes. I would prefer to have heard the last four minutes from the honourable member for Bligh, who today courageously raised an issue that has too little attention in this place.

We go on with a whole range of issues to suit daily media agendas, but we rarely address the fundamental underlying issues in this community.(9) One need only walk outside this place any night of the week, particularly when we are leaving on a late sitting night, to see the homeless people who congregate between the State Library and Parliament House, and outside the Zegna store opposite.

As the honourable member for Bligh said, at least half of them are sleeping rough because of mental illness. As the honourable member for Bligh indicated, we have had report after report. The first report into mental illness in New South Wales dates back to 1846, before this bicameral legislature was established. To some extent we do not need reports, we need action. As the honourable member for Bligh said, the problem was not the Richmond report but the failure to implement all of its recommendations, particularly those that relate to the establishment and provision of community-based services.

The Parliamentary Secretary said in her contribution, "Mental health is everybody's business." The problem with that is that it is no-one's responsibility. Clearly, the six-minute contribution by the Parliamentary Secretary demonstrates a lack of commitment. As a Liberal in this place and a Coalition shadow Minister I am proud that the one person who sought to put this on the agenda at the leadership level during the State election campaign was the Leader of the Opposition when, in March, he committed a future Coalition Government to an additional $45 million over three years to mental
health services, and specifically to boost community-based mental health services across New South Wales.

I understand why the honourable member for Kogarah is so concerned: As Parliamentary Secretary she has been in the job for eight months and she tells us she has been around the State and is on top this issue, but she made only a six-minute speech when she had 10 minutes to reply to such an important issue, an issue on which the honourable member for Bligh could speak for hours.

On 3 September the Minister for Health—not the monkey but the organ grinder—told the upper House estimates committee that we would have an imminent response to the Pezzutti inquiry, the Legislative Council inquiry into mental health. The committee sat (10) from December 2001 until December 2002. The inquiry received 300 submissions, 90 per cent of which were from members of the community.

It held 12 hearings and one public seminar. Some 91 witnesses came forward and they all told the same story, regardless of what the Parliamentary Secretary says, about the paucity of services, particularly community services, across this State dealing with mental illness.

It ill behoves the Parliamentary Secretary to attack anyone on this issue. The reality is that there should be a bipartisan policy to provide necessary services to eradicate from our community the sorts of things that the honourable member for Bligh so eloquently addressed and that she lives with on a daily basis as a parliamentary representative for a precinct that has so many people who sleep rough.

I make no apology for standing in this place as a supporter of the Leader of the Opposition, who is committed to addressing this issue. He has a track record of statements trying to elevate this issue in the public domain. I will continue to support him.

Psychiatrists in this State are concerned that one of the consequences of the lack of adequate and effective services for people with mental illness is the number of suicides. People with mental illnesses are committing suicide, yet the figures are not being released.

Psychiatrists have said to me that for some time they have been asking the Department of Health to release those figures so that we can start to measure the failings of government policy, regardless of which side is in office, that is having such a devastating impact upon people in our society that they are taking their own lives.

I commend the honourable member for Bligh, for a change, for raising this important issue that deserves a considered response. It is about time the Government got serious with the Pezzutti inquiry.

Ms CLOVER MOORE (Bligh) [5.05 p.m.]: I thank the honourable member for Kogarah and the Deputy Leader of the Opposition for contributing to this very important debate. Over the past 20 years I have called for reform of a system that has failed our mentally ill,(11) particularly in relation to supported accommodation and treatment.

Even though mental illness affects 860,000 people in New South Wales, this is the least funded of all the States. People who are mentally ill need somewhere to live, they need treatment and they need support. Yet mentally ill people are discharged into crisis refuges, boarding houses, caravan parks or motels. They end up on the streets or in prison. Some 30 per cent of people are in prison because they have a mental illness.

Hospital, prisons and acute psychiatric facilities cover for the lack of accommodation and community support. Many people are caught in a vicious cycle going from crisis accommodation to the streets to prison and then to hospital. I am not describing Dickensian England but twenty-first century sophisticated, affluent New South Wales. There is an extremely high level of unmet need for psychiatric treatment among Sydney's homeless population. Indigenous people are overrepresented in this group. Only 38 per cent of people with mental illness have access to mental health services. Mental health case managers have 50 or 60 clients on their books, even though they should have only 10. Mental health crisis teams cannot provide an adequate response, so they call upon the police to fill in the gaps.

This is a shocking indictment upon us as a society and on the Government. I note the Parliamentary Secretary said that the Government is currently considering recommendations of the Legislative Council inquiry. I call upon the Government to respond as a matter of urgency to those recommendations, and in doing so to dramatically expand mental health funding to 15 per cent of overall health funding within five years, consistent with other States and other developed countries; expand supported accommodation places for people with a mental illness to provide an average of 12 adult beds per 100,000 people for 24-hour high need supported accommodation; expand staffing in mental health crisis teams so that they can immediately help people with acute mental illnesses; establish a central mental health office with authority to spearhead(12) development of mental health policy and services; recruit Aboriginal mental health workers in each region to address poor service faced by indigenous people; and provide annual public reports on mental health needs and services in all regions.

This is the very least a responsible and compassionate Government can do for the most disadvantaged and shockingly neglected group in our community. I thank Chloe Toundrow, who is in the gallery. She worked for months on this issue in my office trying to discover just how bad the situation was—I have the highest number of mentally ill people in the State in my electorate. I also thank Roy Bishop, my electorate officer, who has also worked very hard on this issue and continues to do so. I hope that the Government will respond.

Our record as a community, society and Parliament in this area is absolutely disgraceful. One has only to wander around the streets of my electorate or just walk outside the Parliament to see how neglected our mentally ill are. The fact that they are in prison, in Department of Housing accommodation, on the streets or in boarding houses is an indictment on us.

This is not what Richmond intended. He did not intend us to dump our mentally ill in prisons. He did not intend us to dump our mentally ill on the street. He did not intend such a horrific situation to continue. I call upon the Government once and for all to address the issue. Discussion concluded.

Proof NSW Legislative Assembly Hansard Article No.28 of 12/11/2003.

Posted 12 January 04


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