Motions

Regional Mental Health Services

Mr BELL (Mount Gambier) (11:30): I move:

That this house—

(a) recognises the significant effects of the COVID-19 pandemic on the mental health and wellbeing of South Australians;

(b) ensures regional South Australians, with the unique challenges of living in rural and remote areas, are a strong focus of future planning and funding commitments; and

(c) funds and implements a five-year strategic plan to improve regional services and attract mental health professionals to the regions.

Since I began in this place some seven years ago, mental health has been a major focus of my work. In fact, in my maiden speech I talked about the inadequacies of South Australia's regional mental health services. Our state and our regions are facing some of their biggest challenges, and ensuring the mental health and wellbeing of people in the regions is paramount as we recover from the pandemic.

For many people the pandemic has been a perfect storm, with people facing uncertainty, job losses, border closures, an increase in alcohol usage, relationship breakdowns, financial concerns, etc. Last year made us very aware of our mental health, and perhaps for the first time the stigma of asking for and accessing help and support is beginning to lift. I would like to see a time when our mental health is given the same importance as our physical health and visiting your counsellor for a check-up is just as common as visiting your GP. But that coincides with a huge demand for services—services that cannot keep up and that just are not there for regional people.

It takes a fair amount of courage to acknowledge that you need help and to pick up the phone to make an appointment with your GP to get a mental health plan or to call a counsellor. I spoke to a counselling service in the Limestone Coast that reported a large increase of first-time clients accessing their services for the first time in their lives. However, people are having to wait months and months to get their first appointment. In the Limestone Coast, the waitlist to access services, including counselling and psychologists, is anywhere up to 12 months. I spoke to a child psychologist who said that their waitlist was 12 months.

If you cannot access services and support early, problems build and build until they reach an acute stage. This is having a major impact on our hospital system, which is seeing more and more people presenting for crisis care and putting existing services under demand. The Mount Gambier hospital has six dedicated mental health beds, which are frequently full, and medical beds that are used for mental health crises. If some of these people were able to access care and support early, they would not need to be in a crisis situation and accessing acute care.

In my electorate, we are very fortunate to have some passionate and dedicated people working in this space and putting forward solutions to bridge the gaps. Last year, Leah Griffin and Samantha Benton from Lifeline South East conducted a study to determine the need for a central mental health hub in the Limestone Coast. The idea of the hub was to provide a free service for anyone experiencing mental health challenges. It would be a first point of call to access face-to-face support, information and assistance in navigating local, state and national mental health services. With 1,045 participants, the local survey produced the following insights:

even though 86 per cent of respondents reported either knowing someone who had or had themselves used local mental health services, only 53 per cent said they felt confident they could locate appropriate mental health services in our region;

nearly half of respondents showed a significant preference for accessing mental health service information through face-to-face contact, with online at 29 per cent and over the phone at 15 per cent the least preferred methods; and

over 95 per cent of people surveyed agreed with the two following statements: we need more local mental health services, and more collaboration is needed between local mental health services.

In the comments, most spoke of their support for a central hub to coordinate existing services and provide a safe space for people to get face-to-face and immediate support. They shared personal stories, some of which are very concerning. People spoke of ending up in hospital emergency departments after waiting months for appointments and of being shuffled from one service to another. They spoke of spending considerable money travelling to Victoria to see any available psychologist about being cut off from services after their plan had ended. I will read a few of the comments to you now:

My local GP had no appointments available until next year for me to get myself a mental health plan and without financial support, I can't afford my psychologist visits. It's incredibly disheartening to call up and request an appointment specifically for a mental health plan and be turned away. More communication between GPs and mental health services needs to be established and different pathways to access these services need to be promoted.

Another said:

If you are dealing with a person with serious mental health issues, they need help the day they finally have the courage to speak up and say they need help. Not months down the track. If they are feeling suicidal, chances are they won't be here to need that appointment by the time they can get in.

Finally:

I'm a psychology student so I'm fortunate to know the processes, services and steps required if I wished to access mental health services but unfortunately, I don't think many people are aware of these. A mental health hub would be so incredibly valuable in Mount Gambier and would have the potential to improve so many people's lives.

Following the results of this study, I received a statement from Lifeline Australia, which reads:

Based on the community engagement, and on Lifeline's long experience of supporting South Australians within this region we recommend a Central Hub focused on needs assessment and information and referral be situated in Mount Gambier.

A central hub would provide the following benefits to the Limestone Coast community:

support, information and advice being delivered for local community members by well-trained and supported local community members employed within the central hub—'by locals, for locals' is the hashtag;

recognising the very strong preference expressed by the community, the hub would offer face-to-face service to community members;

a single point of entry for local residents seeking information regarding mental health and counselling support services;

facilitating interservice collaboration and further developing help-seeker pathways to better match services to need;

maintaining up-to-date information regarding the mental health and counselling ecosystem within the Limestone Coast region;

needs assessment and initial triage and, where required, needs-matched referral to the right level of care in the right time frame; and

provision of non-clinical care and practical support to help-seekers and their families.

There will be unprecedented demand for mental health services in the years to come. Before the pandemic, the South Australian Mental Health Services Plan 2020-2025 recognised a potential workforce crisis looming and major shortages in country South Australia. To quote from the plan:

Workforce shortages, particularly in some geographic areas, are already a problem and this is expected to get worse.

The significant risk this poses to achieving improved mental health outcomes in the future cannot be overstated. Effort and resources need to be directed towards workforce planning to mitigate this risk.

In parts of our system, we are unable to fill vacancies and there are major shortages in country South Australia. There are not enough graduates coming through the training system and no strategic oversight of how many graduates we need in what disciplines to meet population needs.

Last year, I spoke to the house on regional mental health being a focus of the 2021 state budget. Obviously the state's response and recovery to COVID-19 has been the focus, and rightly so; however, now is the time to focus on long-term planning and a region-by-region approach. The needs of the Limestone Coast are different from those of metropolitan Adelaide. It is no use announcing funding for mental health services when we cannot staff the existing services we have.

There need to be retention and recruitment strategies for mental health workers in regional centres. Right now, in regional cities like Mount Gambier it is an ongoing challenge to find experienced staff, such as mental health nurses. Not only does there need to be retention and relocation support to fill these positions but there also need to be career progression opportunities. We cannot expect to keep highly skilled people if there are not the jobs for them to progress to.

On the Limestone Coast, we are lucky to have groups like Lifeboat, The Junction, the Mount Gambier and Districts Suicide Prevention Network, and the Mount Gambier and Districts Health Advisory Council. But many of these services, particularly Lifeboat and The Junction, are volunteer run and receive no state government support. These are headed by dedicated and passionate people, such as Matthew Brookes, Maureen Klintberg and Nel Jans.

We are also lucky to have huge community support behind events such as the Full Monty, which raised more than $50,000 for local mental health organisations; however, this should not be the main funding source for this early intervention. To continue their important work, they need a long-term funding commitment by the state government. I have spoken to the health minister many times on this issue, and I take this opportunity to invite the health minister to the Limestone Coast to look at the hub model.

In today's Advertiser, the Victorian government is fast-tracking mental health treatment centres due to a landmark report that highlighted that the state's mental health provision is a fractured system. Quite coincidentally, the new system will focus on providing a front door for people to access care and initiatives that are there, so it is very similar to exactly what this study was aiming to achieve and what I am talking about today. I will quote a few little parts from this because I think it is informative for our South Australian system. It states:

Victoria's mental health system will be torn up and transformed after a two-year Royal Commission found the state had been failed by an 'antiquated' system that was driven by crisis.

A new Mental Health Commission will be established, services will be moved and expanded into local communities…sweeping changes to the state's patchwork of struggling services.

In a damning 3,000 page report tabled to parliament on Tuesday morning, the Royal Commission found the current system was overwhelmed and that more than 95,000 people missed out on needed services during the 2019-20 financial year.

The report found this was vital to ensure people with poor mental health were picked up early, did not slip through the cracks of the system and received the right treatment.

Again, that is exactly what I am aiming to highlight here today in this parliament. The report also found that under-resourcing has led to an over-reliance on medication. That is certainly very similar to the experience I am seeing in people coming into my electorate office talking about their loved ones or their experiences. It continues:

We know a collection of discrete reforms to an antiquated system is not enough. We have recommended a fundamental redesign.

I encourage people to read the stories in today's Advertiser of people who have fallen through the cracks and, unfortunately, in many instances highlighted here and similarly in our regions, that falling through the cracks can result in people taking their own lives.

I want to highlight the work that has gone on in Victoria, the work that Lifeline in the South-East has done with this one-stop shop, this face-to-face referral where people can come in, understand the services that are already offered and they are matched with those services. But, of course, it highlights a greater need in the mental health space, and that is that without serious focus from the state government on this issue we are going to continue to see people falling through the cracks.

I see it as a workforce development issue in terms of working with the universities to train more and more people in this area, attraction packages to regional areas to attract those skills to our region, a retention package and career progression so that we retain those skills in our regional areas long term, and, of course, early intervention.

We need to make sure we fund early intervention adequately so that, where possible, we reduce the number of people who are progressing through to an acute stage that ends up with hospitalisation and, of course, reduce the most tragic of circumstances, where people who have fallen through the cracks take their own life. With those words, I commend the motion to the house.

The Hon. J.A.W. GARDNER (Morialta—Minister for Education) (11:47): I am pleased to rise on this motion on behalf of the government and indicate our support for the motion, for the most part. I thank the member for Mount Gambier for bringing the motion to the house and recognise in particular his long-held level of concern and focus on these issues, not just in the seven years he has been in the parliament. I know, through the people I have spoken to, of his engagement in schooling around the South-East in Mount Gambier and other parts of the state, where the member for Mount Gambier previously also worked hard to support the mental health needs of students in regional and rural South Australia.

In supporting the motion, I indicate that the government wishes to offer what I hope will be an uncontroversial amendment and which I have spoken to the member for Mount Gambier about. He can indicate whether or not he is comfortable with it in his response, but I certainly got the impression from him that he did not object to it. I will start with that amendment and then reflect more broadly on the motion because in (a) and (b), the first two parts of the motion, the government unambiguously supports and is absolutely committed to agreement with those.

In paragraph (c), I think we have a better way to express what (c) is seeking to determine. Of course, we do not appropriate funding through the motions part of the house's work. Indeed, there are a couple of programs where I think it is appropriate to acknowledge the investment that is in place and, indeed, through those investments some of the specific examples the member for Mount Gambier has brought, and I am sure others will bring as well, can therefore be reflected on in the work that the Department for Health and Wellbeing are going to be undertaking and will be in place for the people of rural and regional South Australia.

Therefore, particularly the three areas that the member for Mount Gambier reflected on are captured in his intention in paragraph (c) and certainly are captured in our proposed amendment to paragraph (c) to ensure that funding and investment in rural and regional mental health services is present and that there is a heavy focus on workforce development issues.

The member for Mount Gambier identified some of the challenges in those areas, and meeting those challenges requires that work to be done with long-term thinking and, indeed, long-term strategic thinking about the process altogether. The motion refers to a five-year strategic plan in the proposal and the amendment recognises that. I therefore seek to amend the motion as described so that it would read as follows:

That this house—

(a) recognises the significant effects of the COVID-19 pandemic on the mental health and wellbeing of South Australians;

(b) ensures regional South Australians, with the unique challenges of living in rural and remote areas, are a strong focus of future planning and funding commitments; and

(c) acknowledges the Marshall and Morrison governments' combined approximate $100 million investment towards new mental health initiatives and services in South Australia and welcomes the implementation of the Mental Health Services Plan 2020-25 and the Rural Health Workforce Strategy.

The long-term strategic thinking is necessary and the workforce strategy is, I think, central to the intent of the member's motion. As I say, the amendment is intended to be uncontroversial but express the intention of the motion in a manner that we feel is slightly more appropriate.

This motion is important because it gives the parliament an opportunity to reflect on this important issue. It gives the government the opportunity to engage constructively with the member for Mount Gambier and indeed for all members to provide suggestions for the consideration of the investment that is coming.

We know that the negative effects of drought and bushfires, in addition to the pandemic, on the mental health and wellbeing of South Australians is significant and that is particularly evident for those living in regional areas of South Australia. Recent data, reported by Rural and Remote Mental Health Services indicates a 23 per cent increase in calls to the Emergency Triage and Liaison Service's phone line and a 17 per cent increase in presentations to community mental health services from January 2019 to December 2020.

This has been further highlighted through the COVID-19 Mental Health Support Line, established in April last year, which has received over 4,800 incoming calls, more than 2,000 ongoing support calls and support for over 10,000 people in hotel quarantine. The continued demand and uptake of mental health services across all age groups throughout COVID-19 highlights the impact the pandemic is having on the mental health and wellbeing of the South Australian community.

The government has responded to the needs of regional South Australians by providing funding to increase clinical staffing in the Rural and Remote Mental Health Service, the Emergency Triage and Liaison Service and the older persons mental health rapid inreach service. The increased demand is being closely monitored and this funding will be maintained while the need remains.

Access to mental health services for regional South Australians has improved in recent years with technology, increased awareness and reduced stigma relating to mental illness and better understanding of the impact of mental illness on individuals, families and communities. A substantial improvement enabling better access to mental health services to country residents is through the Digital Telehealth Network. The platform has brought clinical assessments and care to consumers living in the most remote areas of the state, in addition to a range of other supports and services.

Given the established technology, our mental health teams were able to offer regional and remote consumers a seamless service transition during the COVID-19 shutdown, using existing digital modality such as the Digital Telehealth Network and trialling new platforms for delivering services remotely. Evidence suggests that care close to home improves outcomes for all consumers of health services. Reducing travel to Adelaide for regional consumers is a key benefit, enabling greater family and carer involvement and support.

Within regional mental health, three integrated mental health units each with six beds are located at Whyalla, the Riverland and Mount Gambier. These mental health units have supported evidence-based care and provided a vital expansion of country-wide acute mental health services. These facilities have supported consumers and carers with high-level acute care, including a stepped model of care closer to their homes.

Positive feedback from consumers, carers and the community supports the Integrated Mental Health Inpatient Unit as a welcoming and calming environment for therapeutic care. This model of regional inpatient care has also reduced pressure on metropolitan services. A constant focus of rural and remote mental health services is on recovery for country people from mental ill health. This focus is in the form of the provision of clinical support to all regional local health networks and a program of continual review and evaluation to explore alternative opportunities to enhance recovery services.

The rate of suicide by South Australians living in regional areas compared to metropolitan areas continues to be an area of concern. Wellbeing SA is now responsible for the implementation of the South Australian Suicide Prevention Strategy, which includes supporting existing suicide prevention networks and establishing new networks, in addition to developing a new state suicide prevention plan.

Wellbeing SA works with rural and regional organisations to engage local communities in establishing new suicide prevention networks. The regional local health networks are working with the Office of the Chief Psychiatrist together with rural and remote mental health services to form a Towards Zero Suicide steering group to implement a consistent and comprehensive zero suicide strategy in regional South Australia.

The evidence further indicates that people who have experienced previous traumatic events prior to COVID-19, or indeed bushfire or drought, are at greater risk of having mental health concerns following a subsequent event. The risk was realised after the Adelaide Hills and Kangaroo Island bushfires, with an immediate increase in the acuity of existing mental health consumers.

At the onset of COVID-19, these communities required a comprehensive and specialised clinical mental health response to mitigate a second layer of trauma. The Marshall Liberal government responded by providing specific funding to employ five additional clinicians across both areas for a two-year period. Further supports have also been provided in response to the bushfires, including funding for Wellbeing SA to work with communities and co-design plans and activities to strengthen their mental health and wellbeing.

Addressing mental health and wellbeing in peri-urban and regional communities goes beyond having specialist mental health services available to treat mental illness. It is also critically important that we have a regional mental health planning project. It is currently reviewing statewide mental health services across all levels of care. The needs of rural and remote residents are a strong focus in that planning.

The extensive consultation led to the SA Mental Health Services Plan 2020-2025 identifying service gaps and recommendations for new services already being delivered. A focus for that Rural and Remote Mental Health Service will be input into the plan from Aboriginal consumers and carers. Implementation of the plan includes the workforce plan, and recommendations from the regional mental health planning projects will be included in the regional local health network's commissioning plans over the next five years. I thank the member for bringing the motion to the house.

Mr PICTON (Kaurna) (11:57): I congratulate the member for Mount Gambier on moving this very important motion and absolutely, on behalf of the opposition, indicate our support for the original motion that has been moved by the member for Mount Gambier and our opposition to the amendment that has been moved by the Minister for Education.

We know that the pandemic has had a serious effect on the lives of many South Australians, and that is particularly true when it comes to the mental health effects of the pandemic. We know that it is true when it comes to people's employment, people's livelihoods, people's uncertainty and people's anxieties. We know that it has certainly destabilised a lot of families, and we know that the isolation during various parts of last year have taken a toll on people. We need to make sure that our response as a government, as the Parliament of South Australia, keeps in touch with the fact of those increasing needs.

This is an area where the needs were already exceeding the available resources and the available help for people in need. Now we have had an additional burden but have not kept pace with that. Sadly, on a per capita basis we have seen the lowest level of support for COVID mental health effects of any state or territory around the country, and that is clearly unacceptable. It clearly means that we will undoubtably face more pressure from the mental health effects of this pandemic if we do not take those steps to help people earlier on. That ultimately impacts upon our communities, our social services and our hospitals, through ramping and overburdened emergency departments, because people have nowhere else to turn for help.

Even before this happened, we saw cuts to mental health services in the community. They were designed to help people stay out of hospital and stay healthy, yet we saw a 25 per cent cut taking place to those services. Now there is additional need, and we are not seeing the services keep pace with that additional need.

As per the motion from the member for Mount Gambier, this only becomes exacerbated when we are looking at regional South Australia. Frankly, there are many, many parts of regional South Australia that do not really have any mental health services available at all. The regional centres that do are clearly overstretched, clearly overburdened and do not have the appropriate resources to care for the people in their area.

That is why this motion to highlight these those issues and to ask the government to commit to a plan and to fund a plan to address those issues is so important. What we are seeing from the government, though, is that they are not listening to that advice. They are saying that we should amend this motion not to commit additional funding, not to address these significant concerns in regional South Australia, but to give the government a big pat on the back and say how great they are for all the great work they are doing.

That is the response this minister wants us to pass as a parliament today. He wants us to acknowledge 'the Marshall and Morrison governments' combined approximate $100 million investment towards new mental health initiatives and services in South Australia and welcomes the implementation of the Mental Health Services Plan 2020-2025 and the Rural Health Workforce Strategy'.

Let's just pick that apart. Firstly, in this amendment they acknowledge that clearly there is not enough state government funding going in for them to pat themselves on the back. They are having to acknowledge federal government funding to make up this supposed $100 million of funding. Clearly, there is not enough help from the state government.

Secondly, they mention the implementation of the Mental Health Services Plan. This Mental Health Services Plan would have to be one of the most unique plans that a state government has ever come up with, in that we have a plan but then we have the government's response to the plan. This is not actually their plan. What they are doing is only in their response to the plan. They are not actually implementing all the measures in the plan; they are only implementing what was in their response to the plan. What a bizarre situation that the government releases a plan and they are not actually committing to implementing that plan.

This amendment by the Minister for Education is not actually correct because they are not implementing that Mental Health Services Plan. They have plucked only a couple of components from it and funded and supported those, but the vast majority of the other features in that plan that was developed by experts are being ignored or put in the too-hard basket or are going to get dusty on the shelf. They are not being paid attention to by this government whatsoever.

That is why the motion from the member for Mount Gambier is so important—because there is more work that needs to happen. There is more funding that needs to go in, and the government is clearly not acknowledging that. There is more help that needs to happen because of COVID, there is more help needed for regional areas and, frankly, as has been talked about in a number of different reports over many years, including the recent Productivity Commission report, there is the missing middle in our mental health services.

That is where there are primary health services in terms of access to psychologists through GPs and the Better Access program and there are acute mental health services through our tertiary hospitals, but we have a missing middle, in that there are not enough support services between those two to keep people out of hospital and to keep them healthy in the community.

That is what we have seen the funding being eroded from in the past two years under this state government. I refer to those services that were in the community that you could well argue should have been expanded but they have actually been reducing on the misnomer that this is all being picked up by the NDIS, which frankly is absolutely not happening whatsoever. So there are more people who cannot get access to those services now and it is exacerbating that problem.

Adding to that, the acute services that we have available in the city—and, clearly, you only have to turn on the news to see the ramping situation outside our hospitals to know that they are significantly overburdened. Look at what happened in terms of a patient this week spending 88 hours stuck in an emergency department waiting for a bed who in all likelihood would have been a mental health patient.

They are clearly overburdened but, as the member for Mount Gambier would know very well, as the member for Frome would know very well, as the member for Giles would know very well, those services do not exist in regional South Australia to the same extent, and sometimes not at all. I know, Deputy Speaker, your electorate is another electorate where there are significant gaps in major regional centres.

There needs to be significant work to address those issues. It obviously involves government funding and initiatives but it also involves significant work in relation to attracting and retaining the workforce in those areas, because clearly those workforce shortages are one of the key reasons there are great difficulties in regional areas getting access to those services.

It means that people do not get help early when they could do, it means that ultimately their situation gets worse and, potentially, they may need to come to the city to go into acute settings. Sadly, some of them may commit suicide, which is an unfortunate reality of the sad state of mental health in South Australia, but that does occur more than we would want it to.

So let's support what the member for Mount Gambier is proposing today. Let's make sure that we commit the funding and support that is necessary and make sure that we address, not only what is a particular need for COVID right now but what has been a need in regional areas that is now being exacerbated by that additional demand that the community clearly wants us to do better on.

Mr PEDERICK (Hammond) (12:07): I rise to support the amended motion and recognise the mover of the original motion, the member for Mount Gambier, and the absolute need for support for the amended motion, which reads:

That this house—

(a) recognises the significant effects of the COVID-19 pandemic on the mental health and wellbeing of South Australians;

(b) ensures regional South Australians, with the unique challenges of living in rural and remote areas, are a strong focus of future planning and funding commitments; and

(c) acknowledges the Marshall and Morrison governments' combined approximate $100 million investment towards new mental health initiatives and services in South Australia and welcomes the implementation of the Mental Health Services Plan 2020-2025 and the Rural Health Workforce Strategy.

In my electorate, I am well aware of issues of mental health that come up and I want to acknowledge the vital work that Headspace do in my electorate. They are based in Murray Bridge at the old railway station and I know that they are based in other areas around South Australia. This is a concentration on youth mental health, which is absolutely vital especially in this digital age.

It is sad when you hear examples of quite young children, in many cases, and youth who feel bullied on social media. People do not realise the pain they inflict on people through social media. Sometimes people decide it is too much. I feel strongly for the families of these children. I cannot speak for those who have passed—I guess I can, but I cannot speak to them. I am so sad that it got to a stage where, because of some form of online bullying, in the main, they took their own lives—a terrible situation. These things are not broadcast, but you do hear about them from time to time.

It is interesting to hear the member for Kaurna express his support for regional health, when all they did when they were in power—and he was a health adviser—was shut the Repat and instigate Transforming Health, which was a complete disaster, with $500 million wasted on the EPAS reporting program. To be preached to by people who would not even know where the regions are, I find interesting, to say the least.

I would like to acknowledge the regional health services that are happening in regional areas. Certainly there is support in mental health areas. I am very proud that late last year, along with the minister, the Hon. Stephen Wade, I opened the new emergency department in Murray Bridge, which is so vital, especially in this day and age when all sorts of incidents come in, with people having psychotic episodes and or road accidents.

We have the motorsport park at Tailem Bend, and that makes its own contribution to emergency department admissions, just by the nature of it. It is all part of the nature of a growing community. At the moment, you cannot get a rental in Murray Bridge. We have 22,000 people, and our biggest industry, Thomas Foods meatworks, has been closed since it burnt down on 3 January 2018. We will need up to 2,000 workers from the end of next year onwards as that new meatworks comes into play.

It is great to see this burgeoning area. It means that not only are people coming to the regions to live, because it is a better place to be than living in the city, but also that there are so many opportunities in the regions, whether in agriculture, small industry, medium industry, some of the bigger industries or value-add industries. Obviously there is a lot of value-adding in the regions in the food industries. There is plenty in my area with the mushroom farm, the Big River Pork pig abattoir, and the Thomas Foods facility for cattle and sheep, which is on the way as we speak.

It was a proud moment to open that new emergency centre, and it was very pleasing to run into Dr Peter Rischbieth, who works there with Bridge Clinic. He came and saw me on Saturday when we were at the Murray Bridge races—another great event that happens in the community. He just wanted to thank me for how well the emergency department was working, because finally they have a functional space with about nine treatment rooms, where people can be segregated and families can be together. There are quiet rooms. There are designated rooms for staff. It is an A1 facility compared with the old facility they had there, which basically had curtains between the three emergency beds and the two resuscitation beds, which were in the same room. It is good to see.

I note the call for more mental health services in the regions. There are units, and I think there are six beds each in the Riverland, Mount Gambier and Whyalla. There is always a call to get more help around Murray Bridge. I also note our closeness to regional beds based in the city. That does not mean we should not have regional beds there, and I will be interested in the rollout of the mental health plan in the next few years to see what focus is put on getting mental health beds into Murray Bridge, servicing not just the areas around Murray Bridge but the areas the Murray Bridge health service looks after, which are the Mallee, the Upper South-East, up around the river at Mannum and also out more towards the north-west around Sedan, Cambrai and that area. As you go up the road, Murray Bridge is operating, there is Mount Barker and then you get to the city.

COVID-19 has certainly impacted on border communities probably as much as anywhere. It has been difficult, and the member for Mount Gambier knows this only too well, as do the members for Chaffey and MacKillop. It is tough when we as country MPs know exactly how our border communities work. We know that you need people from across the border to make our communities work on our border, and it works both ways.

While I am speaking about that, I want to acknowledge the Victorian Cross Border Commissioner, who keeps us in touch with what is going on on the Victorian side. It is almost like North Korea and South Korea at the moment with razor wire and pill boxes. It is not quite like that but sometimes it feels like that. You have to wake up and work out, 'What are we doing with Victoria today or what are they doing with us?'

I note that people turn up at the border. I know my brother turned up in a truck the other day and they said, 'Where's your ET form?' He said, 'What?' I will credit the police with what they are doing on the border because this is a tough time, and this does impact on people's mental health, especially those who have had to travel across the border daily for their work. To the police's credit, they fixed him up with his form online and away he went.

It has been tough. When you look at my border community of Pinnaroo and Murrayville, I think seven biosecurity inspectors live in Murrayville, including their boss. You have plenty of health people, nurses, people running their own private health clinics, teachers and mechanics working in dealerships such as Emmetts and Ronco Motors. There has been a huge impact on border communities. We must keep progressing so that we always get better outcomes for border communities and I do not mean just people on our side but also those on the adjacent Victorian side. I note that things have improved in recent times, which is really good.

I fully support this amended motion. Health is one of those things you would have to be a fool to say we could always fully fund because it is virtually impossible. It takes 30 per cent of our state budget, but we must strive to make sure that those dollars go further and further to get the right outcomes for South Australians, especially in regional areas.

The Hon. G.G. BROCK (Frome) (12:17): I thank everybody for their participation in this. It is with great pride that I rise to speak on the member for Mount Gambier's motion. I notice that the Minister for Education has moved an amendment, which I understand the member for Mount Gambier is agreeable to.

Regarding the impacts of the COVID-19 pandemic, we have not seen the real end of it at this particular point. I think this is an issue that the world is not really addressing properly at the moment but certainly in Australia, in South Australia in particular, we have done extremely well. As I said earlier, I do not think we have seen the real impact at this particular point. I think the big wall is going to come in about another two or three months' time with the real impact of the realisation of people with no jobs and the financial impact on those in the community not being able to provide food, housing and things like that.

This is exactly why I previously submitted that this house establish a select committee to discuss the same issue the member for Mount Gambier put forward today, but this motion for a select committee was adjourned by the government at that particular point, and from hereon in we need to concentrate on the member for Mount Gambier's motion.

This pandemic has had a very dramatic impact on the economic performance of many industries, small and large across Australia. We in South Australia have performed very well due to not only the health directions we have been complying with but also, very importantly, the community's dedication and compliance in doing everything possible to reduce and potentially remove this horrible disease from our communities.

Our communities need to take credit for lots of stuff out there, because we have complied with everything and we have done everything: the social distancing, the wearing of the masks, the restrictions in hospitality and things like that. Again, sometimes we do not give enough credit to our communities for doing exactly the right thing to adhere to the health requirements.

In my travels across all regional South Australia in particular, I talk to people across all divides. There is currently positivity from those in particular who have employment, but there are many out there who either have had their employment removed or reduced or have much uncertainty about their own future.

I mentioned previously in another speech that the federal government has done a very good job with JobKeeker for those whose employment has been impacted by COVID-19, but there are those out there who are not eligible for JobKeeker and have to survive on JobSeeker. This assistance packaging, JobSeeker, has been drastically reduced. In particular, JobSeeker has been virtually returned to the original pre-COVID payment, which equates to just over $45 per day.

I ask any member of this house and anyone in the general public to comply and survive on $45 per day. Whilst you might be able to do that just buying food and things like that, that would be with no bills coming in, but the rent has to be paid, the car cannot fall apart and overheads still come in. Again, we have to be realistic about that issue: $45 a day or thereabouts is not going to be sustainable, and going forward there is going to be a lot of impact on the mental health of those people.

From memory, the federal government recently reviewed this payment and increased it with assistance of just $3.25 per day. Again, we have a lot of media saying this is good and things like that, but $3.25 a day is absolutely an insult to those people in terms of their existence. These people are trying to live a reasonable, decent life and at the same time having to apply for more positions, which entails them spending more money on petrol and also, when applying for positions, the dress code for potential employment has to be very good. If you do not have the best of clothes, and you go in there wearing your jeans or dilapidated clothing, you do not get an opportunity to reach the finals of that particular job application, even though you may be the very best person for that job.

Whilst I agree there are many people on JobSeeker who may not put in a real attempt to get a job, there are numerous people out there—and I mean numerous—who make every attempt to get employment. There are several communities, particularly in rural and regional South Australia, where there are definitely virtually no chances of employment, which requires these people to travel to a location where employment may be available.

We must remember that many of these people may not have a vehicle to travel in or that there is no transport for them to get to their locations specifically for training in TAFE, which the government is now reducing dramatically, or to report and get a potential prospective employer to sign the documentation.

With all these issues, I do not think we have reached the wall at this particular point. They will come to a head when there is a real realisation that there is virtually no direction or opportunities for these people. We must always remember that these issues are being experienced by adults, and where they are being experienced by the adults the children also see these tensions, and this in turn has a very dramatic impact on the health and wellbeing of those children.

Whilst I know that governments state that there is money in budgets, etc., we must always remember that there are basically no people out there—trained people in particular and particularly in regional South Australia—to actually assist and/or actually see these people to walk them through the very dramatic direction they are experiencing. I believe we will see many more drastic results, particularly in mental health, such as complete breakdowns and, unfortunately, as I think the member for Mount Gambier indicated, perhaps people attempting to take their lives.

I have spoken previously in this house about mental health and the stigma of mental health affecting men in particular. I have taken the challenge: I have been open about the fact that I have had an anxiety issue over many years. I do not hide that. I think we have to get the information out there. I lost a brother to mental health issues because there was not anybody. He lived in Melbourne, and he could not get help. That is the other issue: we need to take that stigma out of it and have these people able to talk to somebody, not on Zoom and not on the telephone. I believe that there will be many more drastic results, particularly with mental health and complete breakdowns and, unfortunately, there will be more suicide attempts.

Parts of the member's motion call for a strong focus planning and funding opportunities. There could not be any more importance than this, and I congratulate the member for Mount Gambier on doing this. I have spoken previously in this house about this and I have spoken to the Minister for Health. I have taken the challenge of the stigma of mental health, on men in particular, to raise funds for a Lifeline Connect Centre in Port Pirie. I raised just over $21,000 for that, and it will go a small way towards doing it. The Connect Centre will hopefully have some trained counsellors for people to talk to.

I have spoken to the Minister for Health, and we have also had some forums in Port Pirie. We have three clinics in Port Pirie. When people have an issue with anxiety and things like that, they need to see a medical practitioner. In Port Pirie we have three clinics. We have a shortage of doctors compared with the federal proponent; we are supposed to have 17, but we have nine doctors in our community, so we are very, very short. I have personally seen the waiting list of each clinic, and there are approximately 130 to 150 per day who are not able to get in to see a doctor.

Those people may be suffering from an anxiety issue, they may want to talk to someone and get some medication. So where do they go? They go to the A&E. The A&Es are struggling. They are being overwhelmed at the moment. We need to really look at training more people and we need to be able to get those people out into the regional areas. I noticed the Minister for Education indicated there is $100 million extra from the federal government for, I think he said, South Australia. I stand to be corrected.

Mr Bell: It is South Australia.

The Hon. G.G. BROCK: It is for South Australia. From my quick calculations, that equates to around $58 per day for each person in South Australia. Whilst it is welcome, we need to get more money out there. We need to train people in regional areas. I encourage the state government and federal government to look at every opportunity to get those people out in there in the regions so these people can actually talk to them, not on the telephone, not on Zoom, but get there and personally talk to them and see them directly so they can see the anxiety in their body language and in their emotions.

Again, I commend the member for Mount Gambier for bringing this motion to the house. I understand he is going to accept the amendment of the Minister for Education. I certainly encourage the state government to activate this as quickly as possible.

Mr McBRIDE (MacKillop) (12:27): It a great privilege to speak to and support the motion brought by the member for Mount Gambier, with the amendment of the Minister for Education, representing our Minister for Health. I thank the member for Mount Gambier for bringing this motion to the house. He and I both know that we have worked together solidly for nearly 12 months, supporting the Limestone Coast and our cross-border community through this difficult period of the pandemic and border closures.

It should not surprise anyone in this house and no-one should be unaware of the depth and breadth of what the closure of the border has meant for those who are living on the border both in South Australia and Victoria and also those who live further away from the border. They may not be what we call our cross-border community, but they are people who have family, business, education and health outcomes either side of the border.

Our electoral offices—the one in Mount Gambier and the one for MacKillop in Naracoorte have worked closely together in supporting this community in its wide breadth of issues, absorbing all the general anxiety, stress and concern that has been put into this region due to protecting our state. Obviously and without a doubt, some of the best management systems have been put in place for the management of COVID, and we now have the privileges in this state, being free of the disease and the pandemic, and our freedoms that we have seen thus far compared to other jurisdictions in Australia and around the world.

Coming back to the motion of support that the member for Mount Gambier highlights, there is also the fact that we are highlighting, from the government's perspective, our 2020-25 plan in the amendment, where we acknowledge the Marshall and Morrison governments' combined approximate $100 million investment towards new mental health initiatives and services in South Australia and welcomes the implementation of the Mental Health Services Plan 2020-2025 for the Rural Health Workforce Strategy. This is so important in regard to what has happened over the last 12 months. I got up because I wanted to say something in support of the member for Mount Gambier's motion.

I think the issues are still bubbling away and I want to give some home experiences of taking phone calls and listening to stories that are deeply distressing on the other side and that are given to members who are on the border. I expect that this can be extrapolated right up the border between Victoria and South Australia, and the member for Hammond and on to the member for Chaffey. We have experienced those sorts of issues, and we are trying to navigate the best possible outcomes to relieve the stresses that these border closures have put on our communities.

When the border closures happened, some things were noted earlier on, and there are a couple of descriptions. We learnt that a husband and wife, a couple, were known to live in Victoria but South Australia was known to be their home where they did all their general shopping and met their sporting needs and their community club needs. They were supported in every way, shape and fashion coming into South Australia, but suddenly they were denied that option because of our border closures. Again, obviously we know they were closed because we wanted to protect South Australians, but that did not help the situation the couple found themselves in.

We found married couples, who might have been together for 50-odd years, could not even talk to each other as a husband and wife unit as they had done over the last 50 years because of the stresses they were going through. They could not get to their Probus club. They could not get to their golf club and participate with their friends and family in South Australia. They found it really difficult even coming into South Australia because sometimes they were ostracised because of their Victorian numberplates, or because perhaps they should have had a mask on when they needed to go into a hospital because they were Victorian, even though South Australians did not have to wear one in a South Australian hospital.

All these elements made a whole process of a line in the sand that had never needed to be addressed before as it was during this pandemic management. We took the brunt of this and we tried to find solutions and answers as best we possibly could for these constituents. They were not my constituents, in the sense that they voted for me, but they represented and stood in my community and supported my community of MacKillop, and no doubt they would have done the same thing if they were in the member for Mount Gambier's area as well. The member for Mount Gambier looks after a major regional centre, and major regional centres like Mount Gambier have Victorians come in to utilise the services within that city. This sort of blockade really put the wind up a lot of people along the border.

Another matter raised with me by a constituent really hit home. A gentleman who lived in Naracoorte who wanted to get back to his farm and family, his children back in Victoria where his family farm was, said, 'It wasn't until the border was closed that I really had an understanding of world turmoil where you see boundaries and borders, such as those between Palestine and Israel, where people are willing to fight to the death for the right to be able to go where they think they should be or ought to be. I now have a better understanding of their fight and their willingness to lose their life over such restrictions.'

He said that he had never comprehended that turmoil in Palestine and Israel until he saw the Victorian border being closed and not being able to go and see his asset, be it the family farm or be it his son, who was looking after the business and who was perhaps helping to look after him. In other words, it may have been paying him some sort of dividend in his retirement, as he was living in Naracoorte. When that comprehension was explained to me as the sitting member for MacKillop, I tried to find answers and work with our health authorities to navigate a way that he could go about his daily life in a better way. This whole issue about the border closure, COVID and mental anxiety comes back to asking how our hospitals and medical facilities are looking after our regions.

We have already heard and we know that there is a lack of GPs in the regions. We know that if you want to make an appointment for a general check-up—you may not be suffering any ailments but you want a general check-up—there might be a four-week wait or there might be a two-month wait because there is a backlog and a shortage of GPs. We know that the hospitals and towns are using locums to try to fill this gap, and we know that is a difficult area and we are still trying to find solutions.

However, if you think about the mental health issues and stress, and the difficulty of going to see your local GP if you want to talk about these sorts of issues—you might not want to explain everything that is going on over the phone—you can then understand that you are not going to get the next appointment with a mental health expert in this area and everything is delayed. As we heard in the speech from the member for Mount Gambier, when you start delaying mental health solutions, finding the right people for the right answers, then it becomes worse and worse. It roller-coasts down and snowballs; ultimately, people may contemplate and even go through with taking their own life because of these shortfalls. This is a real issue.

We have heard about the pandemic being a bit of a reset button for society, and we are talking about recognising our local tourism events, we are talking about recognising our local peer groups, our local families, staying at home, being well connected and enjoying things local. One of the other outcomes from this whole pandemic would be a real recognition of understanding regional health, its shortfalls and lack of mental health facilities and specialists and the like, and being able to pick up what the mental health issues are out in our regions.

They are not just because of COVID; they have been roller-coasting on for many years prior to this. It is one of these things that society in general, right around regional Australia, is learning to combat and find solutions to, because in regional South Australia there are many elements that our city-centric population—I think more than three-quarters of Australia's population live in a town of more than 100,000 people—sometimes forgets about, and may not understand all the dynamics they have to work through, as we become more urbanised in Australia than ever before.

This is one of the great challenges at all levels of government—local, state and federal—trying to work out solutions to these mental health issues and combating the problems that are already out there. The COVID issues that have come up have highlighted those issues. We impose these types of restrictions, lock down people, lock down couples who are in marriages or partnerships that perhaps have some underlying elements that all rise to the surface. That is why this motion and its amendment are well worth supporting. I thank the member for Mount Gambier for raising this.

Mr HUGHES (Giles) (12:37): I rise to support the motion in its original form. It is an excellent motion that certainly highlights some of the real challenges in regional South Australia when it comes to accessing services.

A number of members have commented on the lack of GPs in regional South Australia. Initially, that started in some of the smaller communities some years back, and it has now spread to larger communities in regional South Australia. In places like Whyalla, Port Augusta and Port Pirie, we have a lack of GPs and not enough GPs to service the need.

A lot of money has been spent in different ways trying to increase the GP services in country South Australia—GPs are often the first point of contact when it comes to mental health issues—but many of the commitments that have been entered into have had only a peripheral effect. Some years ago there was an increase in GP numbers, but there is a serious misallocation when it comes to GPs in this state, and indeed in other states, a misallocation that sees a concentration in the capital cities, especially in the more salubrious parts of our capital cities.

We know that both mental health impacts and physical health impacts in regional communities are in general worse than in the city, so we have this strange relationship where we have this lack of services in the places they are needed the most. We are struggling to get enough GPs in country South Australia, and that might get worse unless some real action is taken.

When it comes to some of the basic mental health services, I believe there is only one resident psychiatrist in the whole of regional South Australia, and that is in Whyalla. I am not even sure if that person is still a resident psychiatrist. There was one in Port Lincoln some years ago, but I think that person has moved on and was there for coincidental reasons, not there particularly to be a psychiatrist in that very beautiful community.

We have very few psychologists who are resident in regional South Australia. Psychologists do a lot of the heavy lifting when it comes to mental health services, along with the community mental health teams, the trained nurses and social workers who work for those teams. It is very difficult to get psychologists in regional South Australia. My daughter will become a psychologist in the very near future, and she does work in the region.

Even though there have been massive other cutbacks to mental health services and health services in general, one of the good initiatives of the current federal government has been the Headspace model for young people in a number of regional communities. Port Lincoln has Headspace, as do Whyalla and Port Augusta; Port Pirie does not. I am not sure, but I would expect that Mount Gambier would have a Headspace service. But that only focuses on young people, and young people with very tight criteria in relation to mental health services.

When it comes to some of the acute mental health episodes that people can experience—a psychotic episode—one of the really tragic things was to see, say, in a community like Whyalla, people bundled into a paddy wagon who had to be taken to Adelaide to access the acute mental health services. A number of people have commented that Labor did not do anything for the regions. They certainly did for some of the communities, because it was under Labor, when we came to power, that an acute psychiatric facility was put in at Whyalla Hospital. There are six beds there and, as I said, I think there is still a resident psychiatrist there, but the visiting psychiatrists who come to regional communities have very long waiting lists indeed. There is clearly demand there, and that demand is not being met.

I note that in my community we have community mental health beds, and those are still being funded by the state government, but when Whyalla was going through the steel crisis and we lost over 1,000 direct jobs and had all the anxieties surrounding going into administration, the federal Liberal government decided to walk away from that partnership with the state and pull $10 million in funding from the community mental health beds in Whyalla. It was the state Labor government, especially given the situation in Whyalla at the time, that stepped in to do the right thing by our community.

I do not know how we address the issue of getting more professionals to come and live in regional South Australia. Clearly, you can put incentives in place, but I reckon, when it comes to those services that are using Medicare provider numbers, we have to do some fundamental reform at a federal level. Other countries see an allocation of GPs and other medical services on the basis of need and population ratios.

We do not have that in Australia. That is why we have a whole heap of GPs where they are not necessarily needed in the city and a lack out there in the country. We should be looking at a model where Medicare provider numbers are provided on the basis of population ratio and health needs. I think that would start to address some of the shortages that we experience in regional South Australia, plus there are other things that we can do.

The member for Frome touched on an important point about unemployment, the pittance an unemployed person has to live on and the issues that come with that, the stigma associated with being unemployed. We know that the unemployed suffer in greater numbers from a range of mental health conditions. When you look at regional communities, the unemployment rate in some is really good, but in a place like Port Pirie the latest figure is an 11.25 per cent unemployment rate. That is significantly above the state average, which is the highest in the country at the moment.

When you look at Port Augusta, it is 10.6 per cent, and Whyalla is 9.5 per cent. Hopefully, that is going to improve as time goes on, but they are high levels of unemployment that do have an impact on mental health conditions in our communities. Anything we can do in terms of funding and support to get more professionals out into our communities is incredibly important. Employment is not a panacea for mental health conditions—there is a whole raft of mental health conditions that are independent of that—but it is a contributing factor in those communities with high rates of unemployment.

I could touch upon some of the really remote parts of our state, where the services are just not there. When you look at some of the Aboriginal communities in our state, such as the APY lands, once again appalling figures came out the other day. The average life expectancy in the APY lands is 52 years. There are suburbs in Adelaide where the average life expectancy is over 80 years. That gap, which we all acknowledge, is horrendous.

There are complex social needs there. Health services are only part of it, but if we do not have decent primary health services for both physical ailments and mental ailments, people in regional communities, and especially in some of our remote communities, will continue to suffer. There is even a lack of basic counselling services, not psychologists. It could be social workers or it could be other trained people. There is even a lack of basic counselling services for drug use and alcohol use, which contribute to mental health issues. There is a real lack in country South Australia, and it is something that we do need to seriously turn our minds to and address.