Social Development Committee: Comorbidity

Ms WORTLEY (Torrens) (11:50): I move:

That the 38^th report of the committee, on comorbidity, be noted.

In June 2014, on a motion from the Hon. Kelly Vincent, the Social Development Committee resolved that the inquiry into comorbidity should commence. The committee commenced its hearings on 15 September 2014 and concluded on 9 February 2015.

I would like to take this opportunity to thank members from the other place who provided valuable input into the inquiry: the presiding member, the Hon. Gerry Kandelaars; the Hon. Kelly Vincent; and the Hon. Jing Lee. From this chamber, I would also like to thank the member for Reynell, who was a member of the Social Development Committee up until February 2015; the member for Fisher, who was appointed to the committee in February 2015; and the member for Hammond.

Inquiries such as this would not be possible without the valuable contribution of the many individuals and organisations that give up their time to come forward and give information. We thank all those who presented evidence for this inquiry, either in writing or by appearing before the committee.

Comorbidity is essentially a clinical term that refers to the co-occurrence of two or more medical issues, or more than one physical and/or psychological issue, in the same person. A large number of people in our community experience comorbidity. They have increased rates of severe physical and mental illness, hospital admissions and mental health sectioning, and increased rates of noncompliance with treatment orders. They have fewer social supports, use more public services and are more dependent on welfare benefits. They are at greater risk of homelessness, incarceration and suicide, and have a significant decrease in quality of life.

The committee heard evidence from a number of witnesses about the dual or multiple needs of people with comorbidity. The committee believes that the introduction of consistent terminology and shared frameworks will lay the groundwork for consistency in policymaking, service provision and research. The committee heard that to guarantee that desired outcomes are met for people with comorbidity, funding and service agreements need to have outcomes that are clearly articulated and measured against performance.

The committee also heard that people with mental illnesses are significantly overrepresented in the criminal justice system. Evidence-based research suggests that mentally ill people are three or four times more prevalent in prison populations than in the general community. Evidence shows that silos and overlaps are a consequence of the different laws that may be invoked in response to a person with comorbidity. There is an overlap between the Mental Health Act, the Guardian Administration Act and the Criminal Law Consolidation Act. Individuals may also be subject to the provisions of the Public Intoxication Act.

The committee heard that multiple orders may be in place, with compounding restrictions. For example, a person may be placed under a Mental Health Act order when the criteria for an inpatient treatment order or community treatment order are met. The same person may also have a guardian or administrator appointed under the Guardian Administration Act.

Other relevant legislation includes the Disability Services Act, which determines the funding and provision of disability services in South Australia, and the Supported Residential Facilities Act, which provides for the care of people living in this form of accommodation. The committee heard that the application and potential overlap of these laws can be problematic for people with comorbidity.

The committee believes there is a need to develop further capacity within the disability, health, mental health, and alcohol and other drugs sectors to treat and provide support for people with comorbidity, and that measures should be introduced to improve comorbidity training and increase skills and knowledge in the area of assessing and treating comorbidity. In recognition of the key role that family, paid disability support workers and others in the community play in supporting people with comorbidity, the committee endorses the need for access to relevant information and resources to aid this support. It is only through informed choices that an individual with comorbidity, their family and paid carers can ensure that they have the opportunity for positive life experiences. Yesterday, the Social Development Committee presented the inquiry into comorbidity report before the house.

Ms COOK (Fisher) (11:54): I am pleased to speak on the comorbidity report as tabled by the member for Torrens, whom I joined on the Social Development Committee along with the member for Hammond from this chamber. This report is the culmination of a vision of the Hon. Kelly Vincent as well as of hard work by herself and other members from the other place, Presiding Member the Hon. Gerry Kandelaars and the Hon. Jing Lee. Thank you to all individuals and organisations that supported the inquiry by contributing 23 written submissions and 15 oral evidence presentations. Thank you also to the parliamentary staff for their professionalism.

The committee commenced its hearings on 15 September 2014 and concluded on 9 February 2015. Comorbidity is essentially the clinical term that refers to the co-occurrence of two or more medical issues or more than one physical and/or psychological issue in the same person. Having worked in health care as a registered nurse for nearly 30 years, I have a deep understanding of the prevalence and impact of comorbidity in our community.

This inquiry was mandated to investigate and report on issues associated with the dual diagnoses of both intellectual disability and/or acquired brain injury and/or mental illness and/or chronic substance abuse. The compelling evidence brought by key agencies led the committee to consider a much broader range of conditions, such as epilepsy, autism spectrum disorders and more. The focus of the investigation was on the facilities providing treatment to the patient group, the training for clinicians charged with providing this treatment, and information and support for individuals and carers as well as other related matters.

Their complex care needs, combined with limited capacity to self advocate, makes this client group extremely vulnerable. It is therefore essential that the government does everything possible to identify any areas of risk, and then it needs to support the appropriate planning and delivery of optimal care pathways. Like all areas of social need this is a matter where prevention is better than cure, with the expected outcomes of clients with comorbidities in all situations at high risk of complications, increased negative sequelae and, more often than not, a higher cost. One only has to consider the cost to society of prolonged hospital admissions, non-compliance with treatment orders, dependence on welfare benefits, homelessness and recidivism to justify investment in this area.

Many powerful case studies were offered as examples to the committee. This narrative is vital in order to provide members with tangible evidence and a reference from which to connect this evidence. There were 40 competency recommendations that came out of this inquiry, and they are grouped under the headings of Comorbidity Service Systems, Service System Planning and Treatment Support Options, Screening and Assessment, Forensic Clients, Legislative Amendments, Workforce Development and Training, Data Collection, and Service and Support for People with Comorbidity, Family Carers and Support Workers.

The recommendations of the committee sit well with the state government's reform of hospital-based care and Transforming Health, with that expectation that all community members access best care first time every time. The committee believes that community members with comorbidity must experience an integrated treatment and service system that has a 'no wrong door' approach, where they receive timely and appropriate screening and assessment, and are assisted with all their treatment and service needs. I ask you to consider specific examples such as forensic clients with comorbidities such as autism spectrum disorder and how they cope within the judicial system.

With comorbidities ever-increasing, along with a need to control our health budget amongst an array of competing demands, the successful response to these complex recommendations is challenging but essential, and I commend the report to the house.

Debate adjourned on motion of Mr Gardner.