Bills

Mental Health (Review) Amendment Bill

Second Reading

Debate resumed.

Ms HILDYARD (Reynell) (12:39): I rise to speak today on this important bill—a bill that has arisen, as the member for Morphett said, through an extensive review of the Mental Health Act by the Office of the Chief Psychiatrist. Tragically, one in five Australians now experience mental health issues at some point in their life, 4 per cent of Australians experience a major depressive episode in a 12-month period, 14 per cent of Australians are affected by an anxiety disorder in any 12-month period, 3 per cent of Australians are affected by psychotic illness such as schizophrenia, suicide is a leading cause of death for people seriously impacted by mental illness, and mental illness is now one of the most prominent causes of disability in Australia.

Many Australian families are deeply touched by mental illness at some point and grapple with the emotional and, indeed, physical toll that this takes, as family members take on caring responsibilities, often for extended periods of time, and as they see loved ones struggle, sometimes for months and years on end, with the effects of illness and often the resultant withdrawal of family members from family and community life.

People with mental illness are amongst the most disadvantaged in our community. They confront many barriers as a direct result of their illnesses. Stigma, discrimination, isolation and the physical side effects of long-term psychotropic medication can cause major barriers to engagement in most aspects of community life. People with severe mental illness are highly likely to confront unemployment, a lack of access to education, housing stress and homelessness, financial difficulty and poverty. Changing perceptions about mental illness and a deeper collective community understanding of what a person with severe mental illness struggles with can go a long way towards breaking down some of these barriers.

Our government is deeply committed to improving the rights and participation of people with mental illness and to enhancing the capacity of mental health services to provide treatment and care with dignity and respect. We are committed to focusing on and ensuring the collaboration of government and community agencies around issues that affect those with mental illness and their families. We are committed to ensuring that every person experiencing mental illness and their family members and carers receive respect, compassion and professionalism when dealing with government and other agencies. Quality service, intervention and support for those affected by mental illness is paramount to keeping them from harm, to being included in community life and, ultimately, to giving them the best chance to recover.

There is much I have to say about mental health, but today I would like to particularly focus on community treatment orders and the Community Visitor Scheme. A community treatment order is a legal order made by the Mental Health Review Tribunal or by a magistrate. It sets out the terms under which a person must accept medication and therapy, counselling, management, rehabilitation and other services whilst living in our community. In South Australia, we currently have levels of community treatment orders, starting with level 1 as the least restrictive order type and the often less-used type. In 2014-15, there were 283 level 1 community treatment orders, 1,260 level 2 community treatment orders and 5,373 level 1 inpatient treatment orders.

To enable increased use of level 1 community treatment orders and to facilitate and improve availability of less restrictive treatment for people with mental illness, through this bill the duration of these orders will be extended from 28 days to 42 days, to provide enough time for medication and other treatments to take effect. This means that more people can be provided with treatment and care under the least restrictive order type before a level 2 community treatment order or other treatment order is considered.

Level 1 community treatment order processes are not consistent with level 1 inpatient treatment order processes, resulting in a reduction in the rights of patients, with not all level 1 community treatment orders able to be reviewed by a health professional other than the one who made the order. The amendments in this bill will remedy this by requiring that a level 1 community treatment order made by one health professional must be reviewed and then confirmed or revoked by a different health professional, a psychiatrist or authorised medical practitioner within 24 hours or as soon as practicable.

Lastly, the automatic review of all level 1 community treatment orders, regardless of whether a patient or advocate requests one, creates an inefficiency in the South Australian Civil and Administrative Tribunal processes that is wasteful, as most orders are valid most of the time. Instead, the amendments will now require a level 1 community treatment order to be reviewed only upon application by a patient or advocate.

The Community Visitor Scheme is an excellent independent statutory scheme that visits and inspects acute mental health facilities, emergency departments of hospitals, disability accommodation and supported residential facilities.

Run by Principal Community Visitor, Maurice Corcoran, who, through his enduring leadership, has been an outstanding and passionate advocate for people affected by mental illness and disability for many years, the scheme protects the rights of people experiencing an acute mental illness and those with disability who live in a disability accommodation facility or a supported residential facility. Maurice and his team have provided many South Australians affected by mental illness and disability with connection and support when they are feeling isolated and alone, and I take this opportunity to commend their work.

These amendments will improve the capacity of the scheme to carry out its important role and will improve the ability of the Principal Community Visitor to delegate powers. The amendments will also improve the structure of the act, such as moving the provision describing hospital inspector functions to a more appropriate section of the act; and enhance the rights of community patients by giving them access to the scheme.

The most significant change in this area is the inclusion of community mental health facilities, including community mental health centres, community rehabilitation centres and intermediate care centres, in the scope of the Community Visitor Scheme. Each formally-declared community facility will now have regular visits and inspections every two months from community visitors, and patients can also request visits.

To achieve this increase in scope, within available resources, the frequency of visits to treatment centres will change from once per month to once every two months. The Community Visitor Scheme will carry out the same number of visits and inspections in total, but will now cover both inpatient and community services. Crucially, the rights of and advocacy for people with mental illness who are connected with community services are, as I said, to be included in the work of the Community Visitor Scheme for the first time.

These are all changes which will absolutely and directly benefit those people with mental illness, their families and their dedicated carers. I wholeheartedly endorse this important bill as one that will enhance connection and access to advocacy and support for some of the most isolated members of our South Australian community. I commend the minister's work on this bill and the many health and community service professionals, carers and, importantly, consumers, who have helped to shape these important amendments.

Mr DULUK (Davenport) (12:46): I also rise to make a contribution on the Mental Health (Review) Amendment Bill 2015. As we know, the Mental Health Act commenced in 2009 and came into operation in July 2010. Reading the objects of the act, they are to ensure that people with a serious mental illness receive a comprehensive range of services for their treatment, care and rehabilitation; that those services are recovery orientated; that people retain their freedom, rights, dignity and self-respect as far as is consistent with their protection and the protection of others; and to confer limited powers to make orders for community or inpatient treatment.

Under section 111 of the act, the minister was to ensure that the report was written on the operation of the act and was laid before each house of parliament within four years of commencement of the act. That four-year period ended on 30 June 2014 and, of course, today is 22 March 2016.

Mental illness is a serious problem that significantly affects how a person thinks, behaves and interacts with other people. Unfortunately, as we all know, it is a growing problem that needs our attention. In Australia each year, it is estimated that more than 3.6 million people aged between 16 and 85 experience mental illness, representing more than 20 per cent of adults.

In addition, almost 600,000 children and youths between the ages of four and 17 are affected by a clinically significant mental health problem. Over a lifetime, nearly half of all the Australian adult population will experience mental illness at some point, equating to nearly 7.3 million Australians aged between 16 and 85. Unfortunately, less than half will access treatment.

There are an estimated 9,000 premature deaths each year among people with a severe mental illness. The gap in life expectancy for people with psychosis compared to the general population is estimated to be between 14 and 23 years. In 2014, 2,864 people died by suicide, almost eight per day; that is one every three hours. In South Australia, there were 240 suicides in this 12-month period. Suicide remains the leading cause of death for Australians between the ages of 15 and 44.

The economic cost of mental illness is enormous. The National Mental Health Commission report estimates that about $28.6 billion a year is the amount of direct and indirect cost associated with mental illness, and that ranges from loss of productivity to job turnover, which further contributes to the economic cost of mental illness.

Mental illness is one of the leading causes of non-fatal disease burden in this nation and accounts for about 13 per cent of Australia's total burden of disease. This means that of the non-fatal disease burden—that is, years of healthy life lost through illness and disease in Australia—24 per cent was lost through the effects of mental illness. Anxiety and depression, alcohol abuse and personality disorders accounted for almost three-quarters of this burden. The significance of these direct and indirect costs is that mental illness not only affects individuals, their families and other people as well but it also affects the standard of living of every Australian and our community more broadly.

This bill amends the Mental Health Act 2009 in response to recommendations by the Office of the Chief Psychiatrist which followed a review of the act. This side of the house supports the amendments to the act and thanks the Office of the Chief Psychiatrist for its commitment to the continuous improvement of mental health services. However, whilst it is important to ensure that the legal rights and protections for people with mental illness are suitable and effective, it is only half of the equation. A world-class mental health system must also have adequate and appropriate resources to ensure prevention and treatment measures can be effectively implemented.

One thing that worries me about not so much the bill but those who are in charge of this bill and those who are in charge of administering is that this government has made a lot of promises in this area but fallen very short on delivering. The Labor government has made election commitment after election commitment in regard to healthcare spending. One election commitment was to establish an independent mental health commission, claiming that it would help drive the state's mental health plan through to 2020.

Then came the budget announcement. In the 2014-15 budget, the government committed $8.4 million over four years to establish and operate the Mental Health Commission. There was an additional $600,000 to establish the office. It is now almost two years since the government's budget announcement, so it would seem reasonable to ask: how is the Mental Health Commission going and what contribution has it made to mental health policy in South Australia? Indeed, the answer is quite simple, however quite disappointing: none. The question is: why? Because almost 21 months since the budget announcement there is still no commission.

An interim commissioner was appointed in October last year, more than 12 months after the budget announcement, but after all this time there is still not a definitive commissioner. No commission, no commissioner, but at least there is $9 million allocated to establish South Australia's inaugural Mental Health Commission—

The Hon. L.A. Vlahos interjecting:

Mr DULUK: —you would hope so—but that is not the case either. The former minister for mental health admitted late last year that in 2014-15 appropriation of almost $2.5 million had been spent on the commission. No. On mental health? Possibly. The minister himself reflected in estimates that if it had been spent (that is, the $2.5 million), it would have been spent in other areas of mental health.

The Mental Health Commission does not even make it into the 2015 budget as a line item. Let's say that again: the Mental Health Commission does not even make it into the 2015 budget as a line item. This is a government that talks a lot but a government that delivers very little. The Minister for Health himself has acknowledged the acute need to help people with a mental illness, stating:

People with chronic mental illness often suffer from unemployment, poverty, substance addiction and other serious health conditions. We need to change that.

And I agree: we definitely need to change that. The current Minister for Health also stated that he wants 'the Mental Health Commission to look at practical ways to improve the health and wellbeing of people with a mental illness'. We all do. We all want the Mental Health Commission to get stuck in and get on with the job of helping people with a mental illness through prevention, treatment and protecting their rights, but instead we are still waiting for this to happen.

The government has also stated that a key priority of the Mental Health Commission is the development of a five-year mental health plan. The previous plan expired in 2015. We are yet to see any urgency from this government on the new mental health plan. After 14 years, the Labor government has failed to deliver better outcomes for South Australians with a mental health illness and better outcomes for their families, carers and service providers.

The health minister also set a goal two years ago for his department to ensure that no mental health patient should wait more than 24 hours in a South Australian emergency department by 1 January 2016. What is the current result? I know the member for Morphett touched on this in his contribution. On multiple occasions this year, patients have not only waited more than 24 hours but waited several days before being admitted, so the government is failing in its own benchmarks.

On 8 March this year, 10 mental health patients had been waiting in an emergency department for more than 24 hours—six at the Royal Adelaide Hospital and four at The Queen Elizabeth Hospital. On 10 March, three mental health patients had been waiting in the Royal Adelaide Hospital emergency department for five days running, five days running from a government that has a commitment from 1 January this year to have no-one waiting more than 24 hours. Five more mental health patients had been in the ED for three days in a row and one had been there for four days—more promises and more promises, but more failures, unfortunately.

The South Australian hospital network is struggling under the weight of mental health patients. Mental health beds within the hospital network are either at or exceeding capacity in all our major hospitals. In the last nine days, the occupancy of the mental health beds at the Royal Adelaide Hospital, the Lyell McEwin Hospital and The QEH has exceeded capacity every day. The occupancy rates at the RAH have been 13 to 26 beds above capacity each and every day. What does this government do? How does this government propose to help address the chronic shortage of mental health beds in our hospital network? In fact, it is closing our hospitals. It is downgrading emergency services departments and it is closing the Repat.

How does this government propose to help address the chronic shortage of mental health beds in the system? Once again, it closes these hospitals and it announces grand plans and then scales them back. The new mental health unit at Glenside to replace Ward 17 at the Repatriation Hospital has been scaled back to fit within the government's budget constraints. Under the government's plans, veterans previously treated for post-traumatic stress disorder at the Repat will have to travel to Glenside instead.

The irony is that, in moving Ward 17 to Glenside, patients of Ward 17 with comorbidity issues will now need to be transferred to other hospitals to deal with their secondary conditions. Currently, Ward 17 patients at the Repat have access to on-site medical and surgical care. Allied health services, such as occupational therapy, pain management, physiotherapy and podiatry, as well as the diabetic clinic and the sleep disorder unit, are all available to patients at the Repatriation Hospital. These services will no longer be available to these patients on site at Glenside. Rather than helping patients, this government is adding to their woes.

If Ward 17 patients have heart disease or issues with their kidneys or liver, they will now need to be transported between hospitals to receive medical attention. Ward 17 Glenside patients will also lose access to their on-site pool facilities, with the government proposing to provide access to a pool on Glen Osmond Road. Professor Warren Jones, in his evidence to the Legislative Council's Select Committee on Transforming Health, told the committee:

…it beggars belief that [the expert panel] could recommend the move to Glenside without considering the detailed medical needs of the vets and how they would be met.

This is another broken promise in a long line of broken promises on this issue. It all comes at great cost and at great inconvenience and stress to patients.

In conclusion, mental health illness is a significant issue for our community. It needs to be taken seriously and treated with the same weight as other health issues, and it needs to be a priority, not just an opportunity for headline grabs with another hollow announcement and promise. We need to have tangible outcomes and a committed government—a government that is prepared not only to talk the talk but actually to walk the walk.

We need a government committed to providing the best possible care and support for people confronting a mental health challenge. We need a government committed to focusing on prevention and early intervention to reduce mental ill health. We need a government committed to delivering a mental health system that is able to provide meaningful support to mental health patients, their families and communities.

Debate adjourned on motion of Mr Treloar.

Sitting suspended from 13:00 to 14:00.