Department for Health and Ageing, $3,748,814,000

South Australian Mental Health Commission, $2,011,000

Minister:

Hon. L.A. Vlahos, Minister for Disabilities, Minister for Mental Health and Substance Abuse.

Departmental Advisers:

Ms V. Kaminski, Chief Executive, SA Health.

Dr T. Bastiampillai, Executive Director, Mental Health Strategy, SA Health.

Dr A. Groves, Chief Psychiatrist, SA Health.

Ms S. Jacobi, Executive Director, Policy and Governance, SA Health.

Mr J. Woolcock, Chief Finance Officer, SA Health.

Ms S. Cormack, State Director, Drug and Alcohol Services South Australia.

Cmmr C. Burns, Mental Health Commissioner, SA Mental Health Commission.

Mr J.P. Legaspi, Ministerial Adviser.

The CHAIR: Welcome back, minister. You are now appearing in your capacity as Minister for Mental Health and Substance Abuse. I declare the proposed payments open for examination. I refer members to the Agency Statements, Volume 3. Before we start, I invite the minister to introduce any new advisers that she has and then perhaps make an opening statement, if she likes.

The Hon. L.A. VLAHOS: I have with me Vickie Kaminski, CE of SA Health; Dr Aaron Groves, Chief Psychiatrist; and Tarun Bastiampillai, Executive Director, Mental Health Strategy.

The CHAIR: Thank you. Do you have an opening statement, minister?

The Hon. L.A. VLAHOS: I would like to start with a brief opening address. I would like to outline some of the key recent milestones in the portfolio of Mental Health and Substance Abuse. Many members may recall the amendments to the Mental Health Act became operational on 5 June this year. These changes will enhance the capacity of our mental health services and reduce red tape and provide a greater range of treatment options to suit the needs of individuals with mental illness.

More consumers than ever before will have advocacy rights through the expansion of the Community Visitor Scheme. Improved accountability will see a larger range of functions reported to parliament and to the public. Changes have also been made to simplify cross-border treatments for consumers, which will improve access to mental health services for people when they travel between states.

The matters regarding Oakden have been covered broadly in the media and in parliament. As members would be aware, in the 90 days since the release of the report, several updates have been publicly made:

I held monthly meetings with groups of families that have had a loved one at Oakden;

I gave four ministerial statements to the house, providing the latest updates;

the Minister for Health made a statement on my behalf to announce the government's implementation panel;

I have met with the chair of the panel to discuss how the government will implement all six of the recommendations of the Oakden review; and

I also regularly meet with senior staff from SA Health to ensure all relevant actions are progressing.

The state government has provided $14.7 million for the construction of a new older persons' mental health facility for older South Australians with severe dementia. The funding includes $1 million to support the development of a specialised contemporary model of care and longer term service planning. This process will include a scoping study to determine the site, design and other details of this build.

In terms of staffing, as detailed in the update report released yesterday, a total of 15 staff are currently suspended pending further investigation, one staff member's employment has been terminated and another has resigned. In total, nine matters have been referred to SAPOL and 32 staff have been referred to AHPRA. I expect these numbers to fluctuate as more information comes to light throughout these investigations and as investigations are finalised.

Throughout the previous financial year, the state government has announced updates to some important parts of the portfolio, such as the South Australian Suicide Prevention Plan 2017-2021. The public consultation for this plan has now closed and feedback is now under consideration. The plan includes several areas of focus, including community suicide prevention networks, which we have been growing over the last couple of years, and improving treatment options and care planning.

The Stop the Hurt strategy that the state government undertook earlier this year involved the announcement of an investment of $8 million over four years to reduce the use of crystal methamphetamine in South Australia. This will be done by funding initiatives that will reduce supply and increase treatment, family support and education.

The South Australian Alcohol and Other Drug Strategy 2017-2021 is the state government's new drug and alcohol strategy, aiming to reduce the number of South Australians who drink at risky levels by 30 per cent by 2020. The strategy outlines 90 actions over the next five years to address key issues in the community; that is, alcohol misuse, methamphetamine use, and the impact of alcohol and drug problems on children.

Meanwhile, the South Australian Mental Health Commission has been consulting with a wide range of community members—more than 2,000—and sector stakeholders in its work to create the state's Mental Health Strategic Plan.

Membership:

Mr Knoll substituted for Mr Treloar.

The CHAIR: Member for Davenport, do you have an opening statement?

Mr DULUK: No, Chair.

The CHAIR: Do you have any questions?

Mr DULUK: I refer to Budget Paper 4, Volume 3, page 29. Can the minister advise if she has received the report from SA Health on its progress in delivering the government's response to the Chief Psychiatrist's review on the Oakden Older Person's Mental Health Service?

The Hon. L.A. VLAHOS: I have just outlined that the government has made many ministerial statements about this and the terms of reference, and in fact the minutes of some of these meetings are publicly available with some of the terms of reference, but I am happy to talk about the terms of reference.

Mr DULUK: Can you advise whether you have personally received the report from SA Health?

The Hon. L.A. VLAHOS: Which report?

Mr DULUK: The one that was due on 19 July, the interim report on the update of SA Health's progress in regard to the implementation of the Chief Psychiatrist's review.

The Hon. L.A. VLAHOS: I get the minutes every two weeks from Dr Stubbs' implementation group, and we act on a regular basis and I have ongoing conversations, as I mentioned in my opening address, about the ongoing implementations of those six review points and our status and progress on those. There is not a day that goes by that my office does not actually spend a considerable amount of our time working towards achieving those six objectives.

Mr DULUK: Obviously, yesterday your department provided details of the interim report to the media, but have you personally had a chance to look at that interim report?

The Hon. L.A. VLAHOS: As I stated before, I get two-weekly minutes from the committee overseeing the implementation of those recommendations from the review.

Mr DULUK: When do you expect to receive the final progress report? It was meant to report to you within a 90-day period.

The Hon. L.A. VLAHOS: I think the member may be confusing updates and status updates with the report he is referring to. What we have said, and I will say it again, is that the committee of implementation is beavering away. There are six separate groups under the main implementation group that Dr Stubbs is dealing with, and I am happy to talk you through those if that would be of assistance. If you just give me a second, I have to go through some of those things we have made available.

Mr DULUK: While you are doing that perhaps you could let me know if you have been speaking to any of the families of the Oakden victims at the same time in regard to the progress of the report?

The Hon. L.A. VLAHOS: Certainly. I met with a couple of them only a few days ago, and I am meeting with them on a monthly basis.

Mr DULUK: When will the minister formally publish a progress report?

The Hon. L.A. VLAHOS: As I stated before, Dr Tom Stubbs has been appointed as the chair of the oversight committee and is tasked with the implementation of all the recommendations from the Oakden report. The government has committed the funds in the budget that I talked about before. There is a further $1 million that is part of that, which is committed to support the development of a specialised contemporary model of care and long-term service planning for older public patients who suffer from severe forms of disabling mental illness and those with extreme behavioural and psychological manifestations from dementia.

The aim is to have the statewide model of care developed within the next six months. Once that has been established, plans will get underway to establish the requirements for the new build. Transitioning residents from Oakden to Northgate House was never budgeted for, but the actual costs have been incurred. We have only very good responses from the families of the people who are living in the two pods at Northgate. In fact, I have been told that one person who was non-verbal before is now speaking.

In relation to the people who migrated to private sector aged-care facilities, I read a report recently from one service provider who had taken a number of those people on to become new residents in their facility, which said that they did not feel the need for additional supports and that the transition had gone really smoothly.

The cost incurred with the provision of the additional clinical support to Oakden residents, the development of the project team leading up to the implementation of the commonwealth aged-care accreditation standards, the recommendations arising from the Chief Psychiatrist's review, the additional supports in safe transitioning of patients to Northgate and the refurbishment of the Northgate houses to be fit for purpose are as I will outline below.

The clinical staff, nursing and medical allied support, 491; the project team, 173; human resources legal, 134; other supplies and services, 247; and the refurbishment of Northgate, 722. So, the total is 1,767 as an expense that has been estimated for this last financial year.

Mr DULUK: Is that dollars, thousands—

The Hon. L.A. VLAHOS: Add three zeros.

Mr DULUK: Sorry, you just said 1,767.

The Hon. L.A. VLAHOS: I thought you were following along with the Budget Papers that you asked for.

Mr DULUK: No, I am listening intently and you did not say dollars or beds and I was not sure.

The Hon. L.A. VLAHOS: I am sorry, I thought you were referring to the budget line item and that you were following in the paper.

The Hon. P. CAICA: He has not yet, so why would he?

The Hon. L.A. VLAHOS: I am being charitable. The state government has established the working groups that I mentioned before to oversee the six recommendations that are well known. The oversight committee, led by Dr Stubbs, consists of a wide range of clinical experts and senior staff from SA Health. It also has the involvement of the non-government advocacy groups, statutory office and people with lived experience with mental illness. This includes the Health Consumers Alliance, the Aged Rights Advocacy Service, the Council on the Ageing, the Public Advocate and the Principal Community Visitor.

The six core work groups that have been established under the oversight committee to implement each of the recommendations include the new model of care, the infrastructure plans, staff profile, least restrictive practice, staff culture and safety and quality. We know that the first meeting for the new model of care occurred on 7 July. As I said, I get the minutes on a fortnightly basis.

Mr DULUK: Can you please let me know what the total number of employees in Makk and McLeay was as at 30 December 2016?

The Hon. L.A. VLAHOS: I am happy to take that on notice.

Mr DULUK: I know you touched on this in your opening statement, but I am confirming that it is 32 individuals who have been referred to investigation by AHPRA?

The Hon. L.A. VLAHOS: Yes.

Mr DULUK: To confirm, how many employees have been referred to police for investigation?

The Hon. L.A. VLAHOS: I am advised there are nine who have been referred to SAPOL at this time.

Mr DULUK: How many employees have been charged by SAPOL to date?

The Hon. L.A. VLAHOS: That is a matter for SAPOL to answer. I am not responsible for SAPOL investigations, but I make sure the department refers them and I would expect SAPOL to advise us of any changes if they occurred.

Mr DULUK: Has SAPOL advised you of any employees who have been charged?

The Hon. L.A. VLAHOS: Not to my knowledge.

Mr DULUK: At the moment, how many employees are suspended from the workplace, pending further investigation?

The Hon. L.A. VLAHOS: As I stated before, there are 15 people pending investigation.

Mr DULUK: There are 15 pending investigation. How many of those are on paid leave?

The Hon. L.A. VLAHOS: All of them, I am advised.

Mr DULUK: You touched on this in your opening statement as well. Why do you believe the number of staff under investigation or referred to investigation will continue to grow and fluctuate? In the background work you have been doing, why do you feel that is going to grow?

The Hon. L.A. VLAHOS: As the investigations take place, more information comes forward and people may necessarily contribute additional information that could aid us in our investigations.

Mr DULUK: Going back to 27 June, minister Snelling let us know that there were 26 referrals to AHPRA, 18 to SAPOL and 10 people currently suspended from their workplace, pending further investigations. So, obviously, we have seen that increase to where we are today. Are there any estimates or budget provisions that you are putting in place at the moment in terms of expenditure, paid leave and provisions for further staff who will be suspended?

The Hon. L.A. VLAHOS: As I have said all along, this is a case of the department spending whatever it requires to ensure that there are quality healthcare settings across the state and an expectation that there is a good staff culture. We will work through these areas. The fact that the government has committed significant funds to working through the new model of care, the scoping study and the build for this space, moving forward, shows our commitment to that. The fact that we expended actual resources, even though they were not budgeted for the Northgate move, shows our commitment to solving the problems at Oakden and assisting the families that have had a bad experience with a loved one there.

I have made it very clear to the department that their job is to ensure that there is a good and safe environment, good staff culture and morale growing and provision of adequate training provided in an ongoing space. The Stubbs implementation committee is working through that and they will be given the resources they need.

Mr DULUK: Do you believe the initial reviews undertaken by the department into staff were inadequate?

The Hon. L.A. VLAHOS: Which initial review are you speaking of? Which budget line item is this?

Mr DULUK: Page 29, Sub-program 1.1: System Performance and Service Delivery.

The CHAIR: Member for Davenport, asking the minister what she believes opens up a pretty broad area of discussion.

Mr DULUK: Were initial reviews of staff procedures adequate?

The Hon. L.A. VLAHOS: What budget line item is that?

Mr DULUK: That refers to sub-program 1.1, second line, 'mental health', which I believe you are the minister responsible for. In terms of the current process going on, how many FTEs are involved in reviewing the conduct of practices of staff at Oakden?

Ms KAMINSKI: That is an interesting question that is difficult to answer because with all of the staff at Oakden right now there is a number of performance reviews in place. We have formal reviews being done by managers, we have a type of 360 performance review where we are asking all staff to keep track of how all staff are doing, and we also have some work being done with the new clinical director there.

We are helping staff learn how to provide care in a different standard and in a different way and are monitoring how successful we are with that. We also have some assistance from the Nightingale staff, who are on site and helping our existing staff learn new models of care and become more adept at it. The whole culture of the Oakden staff is slowly changing so that it is one of continual performance improvement with everybody contributing to that.

The Hon. L.A. VLAHOS: The Northgate environment is a vastly different environment compared to when Makk and McLeay closed. Even from January to the closure in June, Makk and McLeay were vastly different environments. Significant resources, time and energy will continue to be addressed to this problem until we are adequately satisfied that culture, practice and standard is meeting our expectations and protecting the frail and vulnerable in our care.

Mr DULUK: Who was responsible for completing the review of the Oakden staff? Is it SA Health or a third party?

The Hon. L.A. VLAHOS: SA Health.

Mr DULUK: Can I quickly go back to staff under investigation. Is it nine staff who are currently being investigated by SAPOL, or has that number fluctuated and some people have been acquitted, or is it the same nine that we have been talking about of late?

The Hon. P. CAICA: Still page 29?

Mr DULUK: Absolutely. We will be on 29 for a while.

The Hon. P. CAICA: Is that right? I cannot see it.

The Hon. L.A. VLAHOS: I am advised that it is still the same nine.

Mr DULUK: We must be, because we got an answer, Paul. Minister, thank you very much. Still on page 29, how many residents were at Makk and McLeay when the facility closed?

The Hon. L.A. VLAHOS: The Chief Psychiatrist will give you that number.

Dr GROVES: I thank the honourable member for the question. I understand on 14 June, when it closed, there were 19 people, 14 of whom were transferred to the new Northgate facility and the others to mainstream residential aged-care facilities.

Mr DULUK: Thank you, Dr Groves. Perhaps this is one on notice, minister: how many residents were at Makk and McLeay at the end of each calendar month between 30 June 2016 and 31 May 2017?

The Hon. L.A. VLAHOS: I absolutely have to take that on notice.

Mr DULUK: How many different nursing homes received residents from Makk and McLeay?

The Hon. L.A. VLAHOS: I will have to ask Dr McKellar that, but a number of different nursing homes came forward. People made choices with their families and did family planning and needs assessment. Some people chose to go to nursing homes closer to their families, others had particular nursing homes that they felt better met their family needs. I am happy to take that on notice and bring that information back to you.

Mr DULUK: Also, which nursing homes have received residents—the five? Could you please let us know what support is available to nursing homes that have received Makk and McLeay residents?

The Hon. L.A. VLAHOS: Can I go back to the question you just asked. The provision of that information may actually be a breach of privacy for those consumers.

Mr DULUK: If you can.

The Hon. L.A. VLAHOS: If I can. What was the next question you asked?

Mr DULUK: What support is available to nursing homes that have received Makk and McLeay residents from the department?

The Hon. L.A. VLAHOS: Vickie, do you want to talk about that? That is a very good question—

Mr DULUK: Thank you.

The Hon. L.A. VLAHOS: —and it has been very successful, as I outlined before.

Ms KAMINSKI: We did offer all the nursing home companies and individual nursing homes that took clients that we would provide ongoing assistance, so if they needed some additional nursing staff, if they needed to bring in Nightingale staff to help the patients come, then we were quite prepared to pay for that and to provide the staff as they needed. We have just had one of our receiving nursing homes write and say that it has been a very successful transfer, they feel that they no longer need the support and that things are going well for the clients that they took, and we are expecting to see that kind of gradual drop-off. What we have said is that whatever we need to make this transition work, if we have it available in-house we will supply it; if you need external specialty advice, then we will pay for that.

Mr DULUK: Is there a cap on the total amount of support or supplementary funding available that the department will give to each nursing home?

The Hon. L.A. VLAHOS: No. I have made it very clear that people who are transitioning to the private sector are to be supported until they have settled in their new environment.

Mr DULUK: Could you let me know how that support has been calculated and provided for in the budget?

The Hon. L.A. VLAHOS: Through existing SA Health resources.

Mr DULUK: Can you confirm how much funding was provided in the financial year 2016-17 in relation to this? It would only be a month's worth but—

The Hon. L.A. VLAHOS: I can get that number.

Mr DULUK: Has the department actually budgeted a figure for 2017-18, or is it all out of existing resources?

Ms KAMINSKI: We have a budget for Northgate, of course, and we are looking at what that budget is. What we have done, though, is take money from the existing NALHN mental health budget and we are allocating it across Northgate as we need to, and as we bring in extra resources like Nightingale we are paying for it out of that existing budget.

Mr DULUK: But, minister, not just to Northgate, but to the other nursing homes as well that have taken clients from Makk and McLeay.

The Hon. L.A. VLAHOS: I have just answered that question. We have made it clear that we will provide any information that we mentioned earlier.

Mr DULUK: No, but in budgeted terms.

The Hon. L.A. VLAHOS: Happy to get the number, as I said earlier.

Mr DULUK: Thank you very much. Does the government have a contract with each nursing home or does it relate to the individual patient, or does the contract with the nursing home relate to the patient or the placement?

The Hon. L.A. VLAHOS: Effectively, with the consumer, the resident, who is moving out of state government or SA Health's care, we helped their families transition to coming into the private aged-care sector and those families entered into those contracts. Any additional resources that those residents need to make the transition smoothly and settle into their new homes in those facilities is where the state government has supported them in that transition.

Mr DULUK: What are the terms of the agreements? Are they generic agreements for each resident going to the nursing home?

The Hon. L.A. VLAHOS: My understanding—and I would have to speak to Dr McKellar who oversaw these individualised care transition plans, and perhaps Dr Groves might like to comment more—is they were individualised and focused on the resident's needs and the family's position about where they wished to go and how that person's needs would be best addressed. Dr Groves?

Dr GROVES: Yes, that is correct. I have nothing further to add to what the minister has said.

Mr DULUK: Thank you, Dr Groves. How many placements in nursing homes have been discontinued as the nursing home has been able to meet the needs of the residents?

The Hon. L.A. VLAHOS: I have not been advised that any of them have at this point in time.

Mr DULUK: So, at this stage, all nursing homes that are looking after residents who were previously at Makk and McLeay are still receiving ongoing government assistance?

The Hon. L.A. VLAHOS: No, we said before that we had received notification from one of the people, one of the sites and aged-care providers, that they no longer needed those additional resources and the transition had gone smoothly for those residents who had moved across to that aged-care provider.

Mr DULUK: I refer to Budget Paper 4, Volume 3, page 43. Unfortunately, the member for Colton is not here. How many aged-care residential licences were held at Makk and McLeay?

The Hon. L.A. VLAHOS: There were 55 licences, I am advised.

Mr DULUK: How many of these licences were transferred to Northgate?

The Hon. L.A. VLAHOS: Zero.

Mr DULUK: Does that mean that SA Health still holds all of the licences that were previously linked to Makk and McLeay?

The Hon. L.A. VLAHOS: Correct.

Mr DULUK: To what facility are these licences currently being linked?

The Hon. L.A. VLAHOS: They have been parked in Country Health.

Mr DULUK: And more broadly within Country Health, which particular hospitals?

The Hon. L.A. VLAHOS: No, the licences are currently with Country Health. If you give me a few moments, I will find the correct briefing note to give you some more details.

Mr DULUK: Wonderful. And at the same time, in the longer term, what is SA Health intending to do with those licences?

The Hon. L.A. VLAHOS: The commonwealth funding of residential aged-care beds at Oakden was moved to SA Health on an offline status until such time as the SA government has finalised a statewide model of care and determined the infrastructure requirements for this new facility or facilities. While NALHN no longer operates aged-care bed licences, the commonwealth's Department of Health's regulatory processes continue, as NALHN remains the approved provider under the Aged Care Act 1997 of the commonwealth. The sanctions will naturally expire—if you are going to ask about those—on 17 September this year.

To enable a smooth transition back to the aged-care facility, NALHN is running Northgate consistent with the commonwealth government requirements, and the state government obviously continues to work in this space with the implementation of the six recommendations of the Oakden review.

Mr DULUK: Going back to page 29, how many FTEs are currently employed at the Office of the Chief Psychiatrist?

The Hon. L.A. VLAHOS: Dr Groves will answer that question.

Dr GROVES: There are currently 11 FTEs.

Mr DULUK: Currently employed?

Dr GROVES: Yes.

Mr DULUK: Wonderful. In the Principal Community Visitor Annual Report: Mental Health Services 2015-16 it is noted that the Office of the Chief Psychiatrist had its numbers reduced from 16 to 12. Is this correct, minister?

The Hon. L.A. VLAHOS: Which budget line item does that refer to?

Mr DULUK: Page 29.

The Hon. L.A. VLAHOS: Page 29. From time to time the Chief Psychiatrist does do particular projects, I am advised. Dr Groves?

Dr GROVES: That is correct.

Mr DULUK: Just confirming that the numbers have been cut from 16 to 12?

The Hon. L.A. VLAHOS: The issue of staffing is a matter for the SA Health CE, Ms Kaminski. I have stated that a number of times. I do not get involved in individual unit staffing numbers or the contractual agreements or terms and conditions and leave arrangements. That is a matter for SA Health.

Mr DULUK: I appreciate that, but with the CE of SA Health next to you, could you ask if it is correct that the numbers have been reduced from 16 to 12?

The CHAIR: The minister is not responsible for those numbers, no matter who is sitting next to her. She is at liberty to answer.

Mr DULUK: I leave it for the minister to take it at her liberty.

The CHAIR: We have an hour left here. I am not going to shut you down at all, but the simple fact is that if it rests in SA Health, it does not matter whether the CE is sitting next to her or not.

The Hon. L.A. VLAHOS: Dr Groves will outline some further facts.

Dr GROVES: You refer to numbers that were in the community visitor's annual report. They cover a period of time in which there were restructures within the Department of Health in which some of the functions that sat with the office were actually transferred elsewhere, with those staff transferred elsewhere, so that the number of staff attached to the responsibilities that my office currently has is the same as it was when I commenced in the office in February 2015.

Mr DULUK: Thank you very much, Dr Groves, through the minister. So, just confirming that the reduction, minister, in FTEs in the Office of the Chief Psychiatrist has not had any negative impact on the ability of the office to undertake its work?

The Hon. L.A. VLAHOS: That is why I let the Chief Psychiatrist speak about his capacity and his team's capacity to assist the people of South Australia on a daily basis. I think they do exceptional work.

Dr GROVES: Thank you, minister. The capacity for my office to undertake the work that we do is the same as when I arrived. We have, importantly, needed to implement significant amendments to legislation commencing in the middle of last year. During that period of time, the chief executive of the department made available two additional staff for my office to undertake those responsibilities. There is a clear process within the department that if there is additional work for my office to undertake, I can put forward a case to the chief executive for consideration, and my experience has been that when I have put that forward, that has been successful.

Mr DULUK: Thank you, Dr Groves. Budget Paper 4, volume 3, page 36. When did the minister receive a copy of the Action Plan for People Living with Borderline Personality Disorder 2017-2020 from the Mental Health Commissioner?

The Hon. L.A. VLAHOS: I continue to work almost on a weekly basis on the implementation of the borderline personality disorder recommendations and review. I would have to actually go back through emails to establish the date that you are reflecting on, but I know that it is something I am very close to bringing forward to the general public in this state. In fact, I have met with people it directly impacts on this week to discuss the strategy and the space.

It is a very serious mental illness with significant morbidity and mortality, and we are very committed, and I have a longstanding commitment to supporting people with borderline personality and their families and carers. Their loved ones often have a very hard road as they support their family members through this space, and it was one of the first things we asked the South Australian Mental Health Commission to explore further as an issue.

The commission completed the state's first action plan for people living with borderline personality, and we are in the final stages of preparing a policy response from that. There are effective psychological therapies to support recovery from borderline personality disorder, and the current National Health and Medical Research Council Clinical Practice Guidelines for the management of borderline personality disorder from 2012 has determined that there is insufficient evidence to formulate evidence-based recommendations around the role of specialised services in this space.

The action plan was developed by the commissioner. He is not recommending the development of a single specialist outpatient or inpatient location at a major metropolitan hospital. The idea is that we establish a statewide personality disorder hub and a working program that is similar to the Project Air personality disorder strategy in New South Wales.

The hub will probably consist of some training, some clinical, some lived experience. We will be talking to SAPOL, the Department for Correctional Services, Department for Communities and Social Inclusion and the Department for Education and Child Development to upskill their staff on awareness of this issue and the need to develop appropriate approaches for people who engage with their services because we know that it is a critical point for people who are living with borderline personality.

SA Health will also include some ongoing training, and that is significant from what I have heard about borderline personality disorder; when I have gone to visit the Sanctuary Group, they have spoken about interaction and case management. All these things are up for consideration, and we are very close to providing a response to the community. I have given my word that I will speak to the borderline personality consumers, their carers and family first off before I make any public announcements in that space, and I have only met with them in the last couple of days to continue that dialogue.

Mr DULUK: Going back to my initial question, when you did receive a copy of the action plan? Was it this year? Was it last year? Was it before Christmas?

The Hon. L.A. VLAHOS: I will reflect on my records and come back to you.

Mr DULUK: And you said that in the not too distant future you will release the action plan. Will it be in the next six weeks, two months, three months? Do you have a figure in mind?

The Hon. L.A. VLAHOS: It will be before the end of the year, and I will continue to have ongoing conversations with that important sector that this piece of important policy work is designed to assist and support. I have given them my word, and we will be helping them.

Mr DULUK: Has funding been allocated to implement the action plan?

The Hon. L.A. VLAHOS: When I make my announcement, funding will be attached.

Mr DULUK: Is there any funding in the current budget?

The Hon. L.A. VLAHOS: My understanding is that it is through existing resources.

Mr DULUK: Minister, are you concerned that it might be almost 12 months since possibly receiving the report and the action plan being in place? By the end of the year, it certainly will be 12 months. Is it a concern for you that it has taken so long to get this right?

The Hon. L.A. VLAHOS: This is an important piece of policy. Conversations with the sector and having the right information for a poorly diagnosed and misunderstood condition are important. It is fair to say, Dr Groves, that it is a largely feminised condition. Having those conversations and working with that sector, the caregivers and the family members is an important process. Their care and concerns are something the department is very focused on and is very aware of, more than perhaps it ever has been in the past, but we will not be rushed into a response that will fail. I want to make sure that this is a successful initiative to support those families.

Ms REDMOND: Minister, perhaps we could switch to a couple of questions on substance abuse. I refer in particular to Budget Paper 4, Volume 3, page 31, under Sub-Program 1.1: System Performance and Service Delivery. In regard to tobacco products regulations, in 2015-16, 15 expiation notices were issued, and a very low target of six was suggested for the just finished year because it was hoped that there would be more compliance and obviously there would not be a need to issue notices, but the estimated result was again at 15.

The explanation was that the number of expiation notices under the Tobacco Products Regulations had increased due to repeated noncompliance with part 4 of the act. I am wondering whether the minister can give any indication as to the particular aspects, because part 4 goes into a series of different areas of noncompliance. Smoking is banned in enclosed public spaces, workplaces and shared areas, for instance, and in certain playgrounds and so on. Can the minister give any indication as to where specifically the problem is that is leading to these ongoing problems with tobacco regulation?

The Hon. P. CAICA: That is a good question.

The Hon. L.A. VLAHOS: Certainly. I will just consult with the head of DASSA. I will have to dig a bit deeper for the individual prosecutions, but I am happy to provide that. It is something I have a longstanding passion for. We have introduced significant reforms in this space with outdoor dining. In fact, when someone wrote to my office this year complaining about a particular site and how the dining area was dealt with, we had that investigated.

When we introduced the outdoor dining reform, we did an extensive public education campaign and we also worked with the AHA, the Cancer Council and various other heart foundations around information giving, but that is an ongoing piece of work of prevention and ensuring compliance with the act. If people bring information of that nature to my office, we take it very seriously and I would expect the same of the department. We will dig deeper for the member for Heysen and bring back that information for her, and that would be an absolute pleasure.

Ms REDMOND: Could I further ask how it is policed in regard to one of my particular bugbears, that is, the prohibition of smoking in a motor vehicle if a child is present. My experience is that if a person is likely to be caught doing it then they are doing it regularly. That is in an enclosed space.

The Hon. L.A. VLAHOS: Very toxic.

Ms REDMOND: It is extremely toxic to young children. Some of these other places, like pubs and so on, concern adults who are making their own choices. What puzzles me is whilst I can understand, for instance, compliance officers going into a public place, do they have any authority to book someone or is that a police responsibility? If it is, how is that issue going to be addressed?

The Hon. L.A. VLAHOS: Simone Cormack, who is the head of DASSA in our state, will address that question. It does require a degree of cooperation with SAPOL and observation.

Ms CORMACK: Authorised officers under the act include staff from SA Health and also include police.

Ms REDMOND: But are they specifically tasking our police force? For instance, the police are doing a lot about using mobile phones whilst driving and so on, but I have yet to see or hear of anyone actually being fined for this infringement, which I take very seriously.

The Hon. L.A. VLAHOS: I am happy to inquire of the police what recommendations for operational priorities have been given and whether they are policing this part of the act. I am sure that there would be times when the police observe things, as you have outlined, and I am happy to seek advice from my colleague in the upper house about this matter.

The Hon. P. CAICA: You mentioned that the authorised officers are police and departmental people. Are there authorised officers from councils or are they being considered in the future? I say that in the context of the outstanding success of the ban on smoking in Henley Square.

The Hon. L.A. VLAHOS: Councils can apply to have authorised officers, but it depends on each local government as to whether they choose to participate. Obviously, the Henley Square reform is great for family-friendly dining and recreation. Many people feel quite ill if they are not smokers and they experience cigarette smoke, so having that council move into that space and seek our support to make that a smoke-free area is something that we would love to see more local government sections of the community do.

Mr DULUK: Can we move to Budget Paper 4, Volume 3, page 51. What was the budget for CAMHS in the last financial year, 2016-17?

The Hon. L.A. VLAHOS: I am advised that for CAMHS, which does provide a variety of different services around the state, the 2017-18 budget expenditure was $35.339 million, less revenue. Excluding appropriations, it was $3.179 million, operating recurrent is $32.160 million and investment capital at this point is zero. These are estimated results to a certain extent.

Mr DULUK: Do you have what the 2016-17 budget was for CAMHS as well?

The Hon. L.A. VLAHOS: The estimated results for those areas are $35.994 million, in line with what I spoke about before, $3.176 million, $32.818 million and zero for capital investment. What we do know about the Child and Adolescent Mental Health Service is that it is a statewide service providing therapy and group programs—you would understand that—and consultation liaison from infants and children to adolescents and also perinatal women.

There are 19 community sites across South Australia, including 14 in the non-metro locations. CAMHS also covers over 30 regular outreach sites in non-metropolitan locations. It is very diverse in staff profile and locations. People have to commute sometimes to support the people whom they need to work with. These teams often house multidisciplinary teams to provide individual and group interventions as they are needed.

The inpatient service is also provided to individuals with acute mental health issues, and this includes the paediatric Boylan Ward at the Women's and Children's Hospital and Helen Mayo House, both of which I have had the opportunity to visit to provide support with, in particular Helen Mayo House at Glenside for women with mental health issues in the perinatal period.

Mr DULUK: How many FTEs were employed by CAMHS at 30 June 2017?

The Hon. L.A. VLAHOS: The 2016-17 year estimated result is 274.03.

Mr DULUK: Has the new CAMHS model of care, developed more than three years ago, been implemented?

The Hon. L.A. VLAHOS: The reform of community CAMHS is ongoing. We are having ongoing conversations. In fact, there has been ongoing work in the last month in this space. The proposed service restructure is cost neutral and aims to make the best use of the existing CAMHS resources for the delivery of a contemporary and quality mental health service across the state. The continuity of high-quality care for young people with mental health issues is the most important priority, and we will continue to use any future service models that are appropriate to achieve that goal.

We know that in the last month we continue to have conversations with workforce, unions and providers around this space, and we have announced the closure of the Enfield site. The Department for Education has been off that site for a long time. In fact, we are getting positive feedback from many families who are no longer having to commute into Enfield and who are able to get the support they need in their local areas.

Mr DULUK: In relation to CAMHS, how many offices have closed in the last 12 months, or are scheduled to close by June next year?

The Hon. L.A. VLAHOS: Offices?

Mr DULUK: Correct.

The Hon. L.A. VLAHOS: As in physical locations?

Mr DULUK: Yes.

The Hon. L.A. VLAHOS: I would have to go back to the head of that unit and ask that specifically. What we might be doing is just flexing the location. It may be in the same zone, but it will be based around need. Where the concentration of support is needed, we may potentially be moving it. So, it is not closure; it is maybe redirecting the services to the priority needs of our population in the state.

Ms REDMOND: As a supplementary to your previous answer about CAMHS and the care of children with mental health disorders, my understanding might be out of date—and I am happy to be corrected—but it was the case that our system was basically coping with children going into hospital and having a diagnosis, but once there was a diagnosis of a mental health problem there was no capacity for our system to keep them in care while that was treated.

I assume, given that mental health disorders with adults sometimes involves having inpatient requirements, that the same would apply to children, but I may be wrong. Is there a capacity for our system to have children with diagnosed mental health disorders accommodated on an inpatient basis for treatment?

The Hon. L.A. VLAHOS: There are 12 beds at the Boylan Ward at the Women's and Children's Hospital for acutely unwell young people. The goal of treatment at the Boylan Ward, when I visited, is that young people are better off in the community with family support and the appropriate medical triage wrapped around them. They may come in for a short amount of time, but we then try to make sure that they have support around them—sufficient outpatient support and community liaison support—for them to have ongoing care in the community so they can resume their lives.

Only this morning, I spoke to over 900 educators, nurses and clinicians at the NextGen conference about mental health and wellbeing for young people in our state. The most concerning thing that we know from our learnings from our Mental Health Commission strategic planning exercise of investing in the over 268,000 young South Australians is that many of them (up to 45 per cent) will have an episode in that first period of time up until they are 24 or 25 years of age. That is a really important strategic action plan that I am very keen to see supported through the Mental Health Commission.

We need to get the right interventions up early. I know that primary healthcare networks in this state are very interested in Adelaide and country areas. I have worked with headspace at Edinburgh North and various other sites around the state, with the commonwealth government's support, and I have also worked with Orygen and people in other states. Youth mental health is something that we are very concerned about and actively working to improve in those early years, but also the state where neurophysiology is still being wired for young men up to 30 and young people under the age of 18. I am happy to take an extra question on that, Isobel.

Mr DULUK: I refer to Budget Paper 4, Volume 3, page 35. Is the Mental Health Commission funded through the forward estimates?

The Hon. L.A. VLAHOS: The commissioner is aware of the funding for this space. Once we have the strategic plan in place, we will also need to do a review of the commission. It started operating at full capacity—

Mr DULUK: Just a yes or no answer—

The CHAIR: No, no, hang on, member for Davenport, the minister is allowed to contextualise.

The Hon. L.A. VLAHOS: Actually, I am the minister, and I will give you the answer to the question, thank you very much. It is an opportunity for me to explain what the commission does for you, because I think sometimes you do not understand that.

The CHAIR: Order! The most important thing coming out of that is that, when we talk over each other, Hansard cannot record any of what we are saying, so all of it is superfluous. I would like you to recognise that the minister can contextualise her answer as she wishes.

Mr Duluk interjecting:

The CHAIR: You can repeat your question, yes.

Mr DULUK: Is the Mental Health Commission funded through the forward estimates?

The Hon. L.A. VLAHOS: We know that the budget for this year is in the budget estimate papers and that there will be a strategic plan coming out very shortly, in October—I am hoping—and we will be doing an ongoing review of the needs there. There are number of action plans that will come out of the strategic mental health plan, the implementation of which I imagine the commission would need to oversee.

Mr DULUK: I will take that as a no.

The Hon. L.A. VLAHOS: That is not what I said.

Mr DULUK: No, that is true. Will the government funding for the commission be ongoing once the mental health plan is completed, at this stage, to your knowledge?

The Hon. L.A. VLAHOS: Once we have reviewed the strategic plan, the action plans, and considered the most appropriate way forward, I am sure there will be a need for the Mental Health Commission.

Mr DULUK: Wonderful; thank you very much. Will the mental health plan be released directly to the public, or will the approval of the minister or cabinet be required before it is released?

The Hon. L.A. VLAHOS: As you might not be aware, having not been in government for a long time, many important decisions do need to go through the department and then up to cabinet for approval and release. In fact, the Oakden report went to cabinet because it was such a significant document and the whole of government should have been aware and supported the recommendations. The strategic mental health plan of our state is a very significant government document and will go to cabinet.

Mr DULUK: Is the Mental Health Commissioner independent of government?

The Hon. L.A. VLAHOS: The Mental Health Commissioner, Commissioner Burns, who is sitting beside me, is the equivalent of a CE in SA Health. He acts in an independent way to conduct his business unit, as do all of the other people who are within SA Health. He reports to me on a monthly basis and we have regular meetings. Where necessary, I cooperate with his team with community engagement. I have visited the lived experience group who were assisting, and I would advise the commissioner to talk about some of the other work he has been doing lately with community engagement. Over 2,000 people have participated in giving us their thoughts, and it is an ongoing piece of work.

Cmmr BURNS: To guide the development of the strategic plan, we have formed a project steering group, which includes representation from the primary health networks in terms of commonwealth funding, from the non-government organisations and from those with lived experience. Importantly, because we are taking a whole-of-government approach to the development of the plan, we have representation on that steering group from other government agencies such as Corrections, Police, Education, Communities and Social Inclusion, Treasury and Finance and the Premier's office. That is to give it that whole-of-government perspective.

Subordinate to that, there are two reference groups that also provide guidance on the development of the plan. Most importantly, we have formed a community advisory committee, which is a group of people who have volunteered with a range of clinical and lived experience to provide us with their advice of their experiences. Indeed, we have a subgroup of that called a youth advisory group so that we have a group of youths who are telling us what their experiences and expectations are. We have that true whole-of-government and whole-of-community perspective advising us on the development of the plan.

Mr DULUK: Minister, through you, if I can speak to the Mental Health Commissioner, does he believe he has funding beyond the forward estimates to complete his role?

The CHAIR: Hang on; no, you cannot ask the minister what the Mental Health Commissioner believes.

Mr DULUK: Minister, when do you expect the final report to be publicly released?

The Hon. L.A. VLAHOS: Which final report?

Mr DULUK: The one that the Mental Health Commissioner is currently completing?

The Hon. L.A. VLAHOS: I outlined that in the answer I gave before. It is in the coming months.

Mr DULUK: Wonderful; thank you. I note that in the Chief Psychiatrist's report on Oakden he considered the Stepping Up report to be the 'the only State-wide Mental Health Plan…under the National Mental Health Strategy'. That plan concluded in 2012. Does the minister consider the lack of a plan for the last five years has impaired the development of the mental health sector?

The Hon. L.A. VLAHOS: The Stepping Up report was a very important social inclusion document in this state. We know that there were Stepping Up recommendations in the disability portfolio that I am involved in as well. There is a high degree of comorbidity and mortality associated with the two sectors. Psychosocial disability is one thing that we are working through with the NDIS at the federal scoping level at the moment, and there are high-level conversations about that. SA Health continues to work in the intersectoral space with those matters.

For a lot of our time in the last couple of years, we have obviously been reforming CAMHS and continuing to do that to make sure it meets the needs of our contemporary population in this state. We have also been undertaking significant work in the growth of suicide prevention networks across the state that are community led. They are fantastic opportunities for local members to become involved in significant community building opportunities in our state. It is about wellbeing. We have also been doing significant work to reduce emergency department waiting times and have made significant inroads in that area.

We continue to look at how we can reform our community mental health services on the ground as well as a hospital delivery because having the right mix of beds and support, post discharge, are things that do not stay static. Plans are guidelines, they are necessary, but we know that this all of life and all of community journey in the strategic mental health plan that the commissioner is working on is a significant step forward for this state.

Mr DULUK: Going back to Budget Paper 4, Volume 3, page 29. Have you been asked to provide a statement to Commissioner Lander?

The Hon. L.A. VLAHOS: As you would know, anything that Commissioner Lander investigates are matters for Commissioner Lander to deal with, and I am not going to answer that question.

Mr KNOLL: Can I add a supplementary there?

The CHAIR: You cannot add a supplementary to the question since she has refused to answer.

The Hon. L.A. VLAHOS: And what budget line?

The CHAIR: Supplementary questions are out of order anyway, so if you have a question, ask the question.

Mr DULUK: Page 29, program 1.1.

Mr KNOLL: Can I ask a question?

The CHAIR: You can ask a question, yes.

Mr KNOLL: Thank you. It has been made pretty clear that the parliament and parliamentary privilege has a higher standing than the independent corruption commissioner, so there is an opportunity for you to be able to correct the record here. I think this a matter of public interest. It is a matter that has been very widely canvassed, and so there is an opportunity for you to clear the air here and I would invite you to do so.

The CHAIR: No, this is a speech. This is not a question.

The Hon. L.A. VLAHOS: As the minister, my goal is to work on ensuring that everyone who had contact with Oakden is supported. If they had unsatisfactory experiences in Oakden, those people who were residents at the time have been moved to Northgate or other facilities, as I have stated. We are getting on with fixing the problems. We are cooperating with all inquiries that may be occurring at a variety of levels, whether it is the federal inquiry or any other inquiries by AHPRA.

My goal is to support people who have experienced unsatisfactory care in the dementia space under the state government. I have issued a full apology to those people and their families, and we continue to support people and move forward to fix this problem.

Mr DULUK: Will the cost of Crown legal advice provided to mental health FTEs appearing before the Commissioner Lander inquiry be backdated to your department?

The Hon. L.A. VLAHOS: Ms Kaminski will answer that question.

Ms KAMINSKI: The Crown has indicated that they will be supporting all staff through all inquiries unless some particular issue arises where staff would be represented by their own lawyer.

Mr DULUK: Minister, is it fair to say that Commissioner Lander is operating his investigation more in the role of an ombudsman, in terms of his review into Oakden?

The CHAIR: The minister does not need to comment on the commissioner's role.

The Hon. P. CAICA: Or whether it is fair to say.

The CHAIR: Or whether it is fair to say anything about what the commissioner is doing. It is completely out of order.

Mr DULUK: Thank you, Chair.

The CHAIR: You are welcome.

Mr DULUK: Minister, has Commissioner Lander asked you to appear before his committee?

The CHAIR: That is out of order, too.

An honourable member interjecting:

The CHAIR: It is. I am advised that the minister can choose not to answer that question.

Mr DULUK: Still on page 29, as we know, the NDIS is moving to full implementation with future steps to include psychosocial disabilities. Can you please advise what level of funding will be transferred out of the state mental health budget as part of the resource allocation agreement under the NDIS in response to the inclusion of psychosocial disabilities?

The Hon. L.A. VLAHOS: One of the pieces of work we are doing with intellectual disability, mental health and psychosocial is around the centre for disease at Modbury. That is a really important and much-loved part of the community. I wish somebody had asked me about that in Disabilities; I would have given you more detail about it at that time.

It is something regarding which we have been working on significantly with the community. They are very passionate about that space and are looking forward to migrating into SA Health in the coming months. I believe December is when it is due to migrate. The South Australian government is committed to ensuring people with severe mental health, who are not eligible for the scheme, are supported with the services to live quality lives in the community.

As I have stated in previous hearings today, adults 18 to 64 become eligible to access NDIS from 1 July this year. It is a geographical rollout, as I outlined earlier, but eligible people who receive services through Disability SA and have mental illness will transition to the scheme. Eligible public mental health clients receive SA Health-funded psychosocial support and will transition to the scheme from 1 July 2018.

The South Australian government has submitted information to the joint standing committee inquiry into the provision of NDIS services for people with psychosocial disability to ensure SA citizens do have adequate support and the committee's report is expected very shortly, on 10 August, I am advised.

In early 2017, SA Health also established a mental health NDIS implementation group to work in partnership with the non-government (NGO) sector to prepare for this implementation, but all existing psychosocial community contracts, on my understanding, have been extended for one year to assist us through this transition period and to reassure consumers living in the community that they have support as they need it.

Ms REDMOND: Can you just clarify, minister, though, I think the question was: is there going to be a cost to the budget for the psychosocial component that is currently under your control as minister? Because of that transfer of people to the NDIS system, is that going to mean that there is a transfer of money from the money that is in your current budget that deals with that psychosocial issue to the NDIS and how much is it?

The Hon. L.A. VLAHOS: Across government, the South Australian government has committed over $723 million, I believe, to the NDIS rollout. That comes from a variety of different sources, and drilling it down into the particular departments has been a complicated and ongoing part of the disability service reform because we do need to negotiate with each one of those departments to ensure they are resourced. What we are discovering is that, say, in the northern suburbs, as adults move into there, there is particular unease about change. People feel nervous about that and existing block funding arrangements, and the community sector is learning how to work with the NDIS.

What we are working very strongly to ensure in the community mental health sector that we are involved in is that no-one is worse off, but we do know that we did suffer significant cuts from the federal government, with them walking away from the national partnership arrangements last year. That affected our supports in the country. It was over $20 million that the national partnerships stepped away from.

We are endeavouring to do the very best we can for this important part of our community who are frail and vulnerable, and it is something that I advocated very strongly on at the Disability Reform Council. In fact, we took a paper there and it has now been made part of the work plan for the senior officer group. SA Health is very intent on working through these problems and it is something that I speak about almost on a fortnightly basis with peak meetings on this issue. We are working very hard to make sure that they are supported.

Mr DULUK: Budget Paper 5, page 50, Stop the Hurt Strategy. Can the minister confirm that the funding of $8 million over four years for the Stop the Hurt strategy includes $3.6 million to fund a 50 per cent increase in outpatient counselling appointments and at least 15 new regional, residential rehabilitation beds, as highlighted in Stop the Hurt, caused by the crystal meth news release of 15 June 2017?

The Hon. L.A. VLAHOS: Just bear with me while we do a swap about, with DASSA coming to the table. The answer is yes.

Mr DULUK: Wonderful. Is the minister confident that the $3.6 million is sufficient to open and operate the 15 additional beds?

The Hon. L.A. VLAHOS: Ms Cormack will actively answer that question. She is in the process of preparing for the tender at the moment, I understand. I will not put words in her mouth. I will let her answer that.

Ms CORMACK: Increasing access to treatment is $3.6 million. Currently, no decision has been made on the location of additional treatment services in regional areas. DASSA is currently undertaking a service planning and procurement process, leading to the negotiation and execution of service contracts. We intend that the new treatment services will commence operation by 31 December 2017. So, the short answer is yes, we are confident.

The Hon. L.A. VLAHOS: That will be based on evidence about the need in those particular areas, so it is data on population and profile; socio-economic status; service demand; utilisation and the drug and alcohol and other hospitalisations that have occurred in the area; existing service provision infrastructure and footprints, including having the right clinical staff with the right degrees of qualification; supervisors to provide people if they are detoxing; quality accreditation standards that are national that need to be met; and a demonstrated clinical governance framework.

One area I am particularly passionate about—and I have written to both of the federal ministers about this—is having a national standard for people who are doing drug rehabilitation. There was a very sad story on the ABC on Four Corners about this and how there is a lack of standards. People's families are desperate, seeking treatment and having their superannuation ripped out of them with very little outcome for the people, preying on people who are recovering from addiction. Having a high-quality service environment is what SA Health and DASSA are aiming to address in this space.

Mr DULUK: Going back to the cost, if you could provide us on notice the estimated average daily operation cost per bed?

The Hon. L.A. VLAHOS: Which type of unit are you talking about?

Mr DULUK: In regard to the 15 additional beds.

The Hon. L.A. VLAHOS: That may be commercial-in-confidence because we are in contract negotiations for service provision at the moment and I would hate to jeopardise getting those services on the ground.

Mr DULUK: Indeed.

The Hon. L.A. VLAHOS: I am sure you would understand that.

Mr DULUK: Very much so. I know you have not finalised the location, but will all 15 beds be located on a single site or are we looking at multiple sites?

The Hon. L.A. VLAHOS: There is a preference for multiple sites. We are a very regional and diverse state, as you know.

Mr DULUK: Indeed. I refer you to Budget Paper 4, volume 3, page 43. When did you receive the Forensic Mental Health Service Review, dated July 2015?

The Hon. L.A. VLAHOS: I would have to go through the records again. That is an important document that has been informing SA Health about how they can work in this space for quite a while. I know it has impacted on service delivery on the ground, particularly in NALHN, and many of the recommendations have actually been undertaken. The review made 24 recommendations, including three recommendations that are a priority—

Mr DULUK: Sorry, just going back a step, when did you receive it? I think what you are about to answer is in my other questions, but if you could just let me know when you believe you received—

The Hon. L.A. VLAHOS: I did answer that before; I said I have to go and check my records.

Mr DULUK: When did the minister release the Forensic Mental Health Service Review?

The Hon. L.A. VLAHOS: My understanding is SA Health released that report; it is not something that I released.

Mr DULUK: For the benefit of the committee, given there are members of SA Health here, could you please provide the committee with when that release was?

The CHAIR: If the minister was not the minister responsible for its release, then no.

Mr DULUK: The minister is the responsible minister for this.

The CHAIR: I am sorry if I misunderstood what the minister said—

The Hon. L.A. VLAHOS: I am happy to answer the question.

The CHAIR: If you are happy to answer it, but were you suggesting the Minister for Health was the responsible minister?

The Hon. L.A. VLAHOS: No, I was not. Forensic mental health is my responsibility.

The CHAIR: Okay. I was wrong, Member for Davenport, carry on.

Mr DULUK: Not at all, sir.

The Hon. L.A. VLAHOS: I am happy to answer it. The department released the report last week. As I was saying before, the review made 24 recommendations, including three priority recommendations and eight program recommendations, four strategic recommendations and nine legislative recommendations. It was initiated by the Northern Adelaide Local Health Network as an internal review to provide advice about improving forensic mental health service provision and existing program resources in the state. It was never intended to be a public report, it was always to inform about how we conduct business internally and improve outcomes.

The review has, however, been published in line with the government's commitment to greater transparency in relation to mental health services, as outlined last week by the department. Health officials, including the Chief Psychiatrist, have accessed and used the review's findings to inform them about forensic mental health in the state, particularly at James Nash House, where a lot of that work is undertaken.

The review consideration ranges from management, culture, standards of care and forensic mental health services, but also with a particular focus on James Nash House. The review had 24 recommendations, including encompassing program strategy, relationship management, legislation issues and three priority recommendations. Significant progress has been made by NALHN and the Chief Psychiatrist's office about addressing many of these recommendations relating to operationalisation and program issues identified in the review.

Two of the three priority recommendations concerning bed capacity issues have been addressed, and work is underway to progress the third priority recommendation to review the staffing model for high security inpatient services to support a clinical approach for risk management. I know that the Birdwood Ward has been renovated to make sure that people with an intellectual disability or brain acquired injury have a special space within a forensic mental health setting. That is something we have done. We have also opened the Kenneth O'Brien Rehabilitation Centre in recent years, and seven of the recommendations were supported in principle, because they required us to work through further service delivery and legislation and financial implications.

Forensic mental health is something that is very important to this state, something on which we work with SAPOL, Correctional Services and the court system on a regular basis. We will continue to work in a friendly and cooperative manner to constantly contemporise and improve our service delivery.

Mr DULUK: Minister, can you confirm that in your statement you said it was not intended for the review to be publicly released?

The Hon. L.A. VLAHOS: We released it in line with SA Health public transparency—

Mr DULUK: Did you say that initially it was not your intention—

The Hon. L.A. VLAHOS: It was an internal document that was developed by NALHN to inform service delivery, as I outlined, but in line with transparency, as with many documents, we release things. We do proactive disclosure on our travel arrangements, as you know, and on electoral office expenses, for example. It is another example of the government being transparent.

Mr DULUK: It is very important, and I suppose that transparency and that desire to release the report probably came on the back of the Principal Community Visitor's report in 2015-16, which said that the review should be made public through parliament. Obviously, another 15 months later it did become public in parliament.

I move on to page 39 in regard to James Nash House. Has a specialist unit been established within James Nash House to accommodate people with a primary intellectual disability rather than a mental health issue?

The Hon. L.A. VLAHOS: I have spoken about Birdwood. Seven beds in Birdwood were developed into an intellectual disability and acquired brain injury unit. It is something I have been following since I was a parliamentary secretary in this space. Ten beds were also in the newly built Kenneth O'Brien Rehabilitation Centre, and the completion of the Ashton House step-down unit in 2013, which is 10 beds, added to our capacity in the forensic mental health service.

We have been working and responding to an increasing demand for forensic services through the expansion of our forensic bed based services, increasing the net forensic beds from a bed capacity of 40 to 60 over recent periods of time. Forensic services are experiencing an increase in demand; an increasing number of defendants are being found guilty by reason of mental incapacity or impairment or of being unfit to plead under section 269 of the Criminal Law Consolidation Act 1935. A number of prisoners and people on remand also require specialist mental health treatment prior to returning to prison or to the community.

It is a complex part of the department and the people who work in that section of forensic mental health are to be praised. It is quite challenging on a day-to-day basis when they go to work, but they do their work for the best benefit of all the people they are caring for and also to keep our community safe.

Mr DULUK: How many people in James Nash House have a primary intellectual disability rather than a mental health diagnosis?

The Hon. L.A. VLAHOS: The numbers flex up and down as people come out of custodial arrangements. We would have to check that, and I am happy to pull that information from the department for you as of this date.

Mr DULUK: Is the Principal Community Visitor empowered to visit forensic mental health patients in correctional facilities?

The Hon. L.A. VLAHOS: Dr Groves will answer that.

Dr GROVES: The Principal Community Visitor is not because they are not authorised mental health facilities for the purposes of the Mental Health Act. What changed on 5 June was that James Nash House, because it holds people who are forensic patients who are the equivalent now of mental health patients, became in scope. So, James Nash House is now in scope for the Principal Community Visitor to visit and talk to all consumers who are in James Nash House, but not those who are residing in prison on a ministerial direction.

Mr DULUK: Going back to the Forensic Mental Health Service Review, why has the number of people detained in prison increased rather than decreased since the review was completed?

The Hon. L.A. VLAHOS: That is a complex issue. Dr Groves could give a clinical view on that matter.

Dr GROVES: People who are held in prison are there on ministerial direction, they are there because there is no practical alternative for them. That represents people who have a range of problems, it includes people who were found not guilty by reason of mental incompetence due to either intellectual disability or mental illness. For a number of those people they have breached licence conditions, they are no longer in clinical need for a clinical service, which they would get in James Nash House, and in those circumstances, where they have breached what would otherwise be considered to be conditions of orders, they are then on ministerial direction to a correctional facility.

Mr DULUK: Thank you, Dr Groves. Minister, what is the longest time that a current forensic mental health patient has been detained in a correctional facility?

The Hon. L.A. VLAHOS: As I have outlined before, the number of patients who intersect across these two spaces can vary and depends on their condition as they enter the service. It may deteriorate during their time on remand. I would have to seek advice on the numbers on this particular day, but those numbers go up and down on a regular basis.

Mr DULUK: Thank you. Just for Hansard's benefit: the longest time that a current forensic mental health patient has been detained in a correctional facility. In relation to the two patients identified in recommendation 1.1 of the Forensic Mental Health Service Review, who had been in correctional facilities for a prolonged period, how long had each of the patients been in correctional facilities for?

The Hon. L.A. VLAHOS: I will take that on notice. Actually, I believe Dr Groves can provide you with an answer.

Dr GROVES: I think it would only be appropriate for me to answer it in relation to one person who is no longer in this country. That person had been in there for six years and his circumstances are fairly well publicly known. I do not think it is appropriate for me to comment in relation to the other person.

Mr DULUK: Recommendation 2.2 of the Forensic Mental Health Service Review states that recommendations need to be developed following the release of the SA Mental Health Plan in October 2017. How is it possible for the Older Persons Mental Health Service model of care to be developed before the mental health plan but forensic mental services cannot be?

The Hon. L.A. VLAHOS: The continuum of care and the way we work on models of care with the oversight committee, they are looking at different models of care and particularly the older persons mental health space is something that is ongoing. As I have said, there are six separate groups working towards the objective of improving our service delivery and the build and design for that potential service change. We continue to take extra information as we require. It is not something that is static, member for Davenport. We take information that is relevant and timely and useful that is evidence based.

Mr DULUK: Given that, would it be fair to say that the Older Persons Mental Health Service was one of those static moments that jumped up and needed a new model of care?

The Hon. L.A. VLAHOS: The Older Persons Mental Health Service oversight committee, which I have spoken about earlier today—contemporising practice is something that I am very committed to as the minister. I have spoken to almost all service delivery units about the need to continually improve the quality of care and not stay static in old practices. I know the CE of Health and the deputy of the department are very committed to ensuring that we provide contemporary models of care that meet the needs of all South Australians, regardless of what age groups they are in.

Ms REDMOND: Mr Chairman, may have I the call, please?

The CHAIR: Yes, please take the floor.

Ms REDMOND: Thank you. Minister, can we jump back to substance abuse. All these questions on substance abuse from the teetotalling non-smoker.

The Hon. L.A. VLAHOS: Are you a teetotaller?

Ms REDMOND: Absolute teetotaller.

The Hon. L.A. VLAHOS: You and Frances get on well then.

Ms REDMOND: Frances and I have always got on well, and I did not even know she was a teetotaller. You mentioned this in your opening address, but I will refer to Budget Paper 4, Volume 3, page 31, Performance indicators. I understand the progress report on drug strategy states that we have not actually managed to achieve any improvement and that this risky alcohol consumption still rests at about 26 per cent. That figure of 26 per cent amazes me. If that is 26 per cent of our overall adult population, that is more than one in four. First of all, could you tell me how you define risky alcohol consumption? I suspect most of the people I know must be risky alcohol consumers if one in four—

The Hon. P. CAICA: Who are you looking at?

Ms REDMOND: I looked nowhere. I did have one famous event with alcohol, which is why I have been a non-consumer for a long time.

The CHAIR: Is there a question here?

Ms REDMOND: Yes, there is a question here. Minister, can you explain how you define that risky consumption? My understanding is, of course, that the younger the age at which the alcohol consumption begins, the riskier it is going to be, not just in a physical sense but also in the mental and brain development sense. What is the strategy for dealing with this consistently high figure? But first I need to understand how you define it to get it that high.

The Hon. L.A. VLAHOS: Absolutely. Ms Cormack will answer the question, but we make no apologies for having quite hard targets with alcohol use declining and also in tobacco within particular cohorts of society where the risky behaviour is more prevalent.

Ms CORMACK: The National Health and Medical Research Council publishes recommendations in relation to harms around alcohol, and we take the definition for risky alcohol use from their recommendations. Essentially, the definition that you are referring to—26 per cent of the adult population—is defined as four or more drinks on a single occasion within the last month. This is an evidence-based assessment of where it is more likely to experience short-term harms as a result of—

Ms REDMOND: Is physical harm to a person defined as what you would have in a young person consuming alcohol and damaging their brain, or harm from someone being stupid enough to get into a car after they have been drinking, or harm from falls? How do they define 'harm' in that sense?

Ms CORMACK: The analysis you are referring to is only in relation to 18 years and over, essentially. We are not looking at the specific issues around young people. There is a lot of evidence that any alcohol consumption is risky, but, statistically speaking, we are not looking at that. What we are looking at is the prediction of harm in terms of, for example, falls, injuries, violence—short-term harms.

The Hon. L.A. VLAHOS: This information is gathered. I am an old records administrator and we used to code discharge diagnosis. When you come into the hospital they want to know the principal reason: what was the harm? For example, car accident, motor vehicle, where it occurred, what the underlying conditions and substances were and the toxicology that might be incurred. If it is a rape case, there are a whole lot of ways that the system acquires this epidemiological data, and then it forms these harm categories at a national level.

Ms CORMACK: Just to correct one thing I said: it is 15 years and over that the analysis is done on, not 18 and over.

The CHAIR: One last question.

Mr DULUK: Minister, possibly on notice, Budget Paper 4, Volume 3, page 38, how many subacute mental health beds does SA currently have? Is this more or less than the number we had 12 months ago, and how many subacute mental health beds were there in each hospital and facility as at 30 June 2016 and 2017?

The Hon. L.A. VLAHOS: I am happy to give you that now. Just bear with me. I know that we have that number.

Mr DULUK: Very good; excellent.

The Hon. L.A. VLAHOS: We have 146 subacute residential beds across the state at a variety of locations: Queenstown, intermediate care; Noarlunga, intermediate care; Mile End, community rehabilitation centre; Noarlunga, community rehabilitation centre; Playford, community rehabilitation centre; Whyalla, community rehabilitation service; and Glenside, supported accommodation. Northgate, Older Persons Mental Health Service, is part of that subacute and the forensic step-down at Oakden is part of the statewide NALHN.

Mr DULUK: One more?

The CHAIR: No, we are way over time.

Mr DULUK: We started late.

The CHAIR: And we are finishing about two minutes late. On behalf of the committee, I want to thank you, minister, and your advisers for coming in today and for all of your hard work. I declare the examination of the proposed payments for the South Australian Mental Health Commission completed, and the proposed payments for the Department for Health and Ageing referred to Committee A.

At 17:32 the committee adjourned to Monday 31 July 2017 at 09:00.