Mental Health (Review) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 21 June 2016.)

The Hon. T.T. NGO (16:33): I rise to speak on the Mental Health (Review) Amendment Bill. This bill seeks to amend the Mental Health Act, which was only established six years ago. The object of the act is to ensure that people with serious mental illnesses receive a comprehensive range of services for their treatment, care and rehabilitation. Furthermore, provisions within the act aim to ensure that these services are provided whilst patients retain their freedom, rights, dignity and self-respect, as long as it is consistent with their protection and that of others.

The act also confers limited powers to make orders for community treatments or inpatient treatment. I will discuss some of the important changes in this area later in my contribution. The bill arises from a mandatory review of the act, which was conducted by the Office of the Chief Psychiatrist. On this note, I would like to acknowledge the hard work of Dr Aaron Groves, the South Australian Chief Psychiatrist, and Mr Ben Sunstrom from his office, on this very comprehensive review.

The Chief Psychiatrist is an independent statutory officer appointed by the Governor on recommendation of the cabinet. The broad functions of the position are to promote the continuous improvement of mental health services; monitor the treatment of patients and the use of restraint and seclusion; monitor the administration of the act and the standard of care; and advise the minister on psychiatry and report matters of concern.

The Chief Psychiatrist also has a number of specific administrative functions within the act, including the determination of authorised officers and the presentation of an annual report to the minister to be laid before each house of parliament. The Office of the Chief Psychiatrist established the review in 2014. It considered a register of issues from the first four years of the act's operation. The review made 72 recommendations with 65 being progressed by the government. The other seven are being deferred for the next review of the act, likely to be in 2020 or 2021.

On the role of the Office of the Chief Psychiatrist itself, there are some important changes that have been drafted. The bill proposes to amend the act to transfer six existing administrative functions from the minister to the Chief Psychiatrist. These include the ability to approve forms and statements of rights, determine authorised health professionals, authorise medical practitioners, and approve treatment centres and limited treatment centres.

This change will make the act consistent with the majority of legislation and practice in other states. Where the statutory officer responsible for the administration of the act holds all administrative functions, the minister holds high level functions relating to service development and provision, as well as intersectorial collaboration and community awareness and promotion. These changes will further strengthen the independence of the Office of the Chief Psychiatrist.

It is important to note that the office sits within the Department for Health and Ageing for administrative purposes, but more importantly there are no provisions making the Chief Psychiatrist subject to the direction of the chief executive, therefore he or she will not be influenced by the government of the day.

Moving on, there are some important changes proposed to definitions and language within the act which, having reviewed them individually, seem entirely appropriate to me. This bill also seeks to establish broad ranging principles to guide access to service delivery for both consumers and carers. Without spending too much time going through some of the administrative and service delivery changes to the act in this bill, there are a couple of particularly significant changes which are being made.

Firstly, there is chronic underuse of level 1 community treatment orders in our mental health system. These orders are the least obstructive to a mental health patient. In the last financial year, only 283 of these community treatment orders were issued, compared to 1,260 Level 2 community treatment orders and 5,373 level 1 inpatient orders. To facilitate more level 1 community treatment orders to be issued, a structural impediment currently in the act will be removed. The duration of days that is allowed for certain types of therapy to take effect will be relaxed from 28 to 42 days. It is also my understanding that currently there is no avenue for review of a decision made by one health professional by another health professional when it comes to the confirmation or revocation of a level 1 community treatment order. This will now be addressed through this bill.

The final reform in this area, which I am also extremely supportive of, is the removal of an automatic review of all level 1 community treatment orders that are triggered, regardless of whether a patient or advocate requests one. These reviews are dealt with through the South Australian Civil and Administrative Tribunal. This automatic review is inefficient, as these orders can be reviewed upon request by a patient or advocate. I support some of our community's most vulnerable people receiving treatment and care under the least restrictive setting possible, whenever possible.

The second area of service delivery that I also want to speak about is the proposed changes to allow for patient assistance requests. Currently, if a person on a community treatment order refuses treatment when a community mental health team visits their home, they are escorted by an ambulance or police to a hospital, where they are medicated involuntarily. There is evidence that shows this is quite traumatic for the person and their family.

Section 47 of this bill inserts section 54A into the act, which allows for the issuing of patient assistance requests. This allows an ambulance or police officer to deliver a person's medication to their home, so that it can still be administered involuntarily, but in what I would hope would be a less traumatic way. It would also be more efficient from a public resource and service perspective.

In this very difficult area of public policy, it is good to see that the government is continually looking at ways of improving our mental health system for both consumers and their carers. I therefore commend this bill to the house.

The Hon. J.S.L. DAWKINS (16:43): I am pleased to rise to speak on the Mental Health Review Amendment Bill 2015. This legislation has come to the parliament as a result of a lengthy review and consultation period by the Office of the Chief Psychiatrist, going back as far as 2013. This was required by section 111 of the Mental Health Act 2009, and I was happy to participate in that process with the Office of the Chief Psychiatrist late in 2013. The review itself made 72 recommendations and the government has endorsed 65 of them. It was also interesting to note that the review found that the act only required amendment and updating, rather than a major overhaul.

I note and support the comments of my colleague the shadow minister for health, the Hon. Mr Wade, particularly when he stated that there is broad sector support for this bill and that this has stemmed from a thorough consultation process. I do commend the Office of the Chief Psychiatrist, firstly, under the leadership of Dr Peter Tyllis, and more recently Dr Aaron Groves, and the small but dedicated staff who undertook the review of the Mental Health Act 2009, as I indicated earlier. Certainly, it is a small and dedicated group. I will refer to them a little bit more later.

I am grateful to my colleague the Hon. Tung Ngo for putting down some explanation about the role of the position of Chief Psychiatrist and his office. I would be grateful if perhaps more members of the government supported the Hon. Tung Ngo in getting to know more about that role and that body. I will demonstrate later the need for more resources to be provided to it. I would also like to put on the record that I am pleased that this bill has finally been brought before the parliament under the stewardship of the now Minister for Mental Health and Substance Abuse, the Hon. Leesa Vlahos, the member for Taylor in another place. Rather starkly, it never appeared under her predecessor.

The member for Taylor's genuine interest in and care about the field of mental health has been apparent to those involved in the sector for some time. This stands in stark contrast to the lethargy and disinterest in the needs of mental health services consumers and those who care about them whilst this important portfolio was under the watch of the member for Playford. I have particularly noted the concerns raised by the Aboriginal Health Council of South Australia regarding the lack of references to Aboriginal health in the guiding principles. I hope the minister will heed the suggestion of my colleague the Hon. Mr Wade to amend this bill to enable that inclusion. I understand that further conversations on that matter and others will be happening before this bill concludes in this place.

The government has recently and finally established the long-touted Mental Health Commission. This was an election promise made by the Labor government in the last days of the 2014 state election campaign, but it has taken until now, not much more than a year and a half before the next election, to actually see the commitment properly fulfilled. We had an acting commissioner for a while. I think the Hon. Mr Wade outlined the limitations on the amount of money provided and the number of staff who have been appointed compared to what the promise was, and I refer people to the Hon. Mr Wade's details on that fact.

Significantly, what has been delivered has been quite different to what was promised in February-March 2014. I think this reflects again the disregard which the government, and particularly the previous minister, showed towards the mental health sector. I do hope that the new body, with the leadership from the new minister, will place a greater emphasis on the importance of services to South Australian mental health services consumers. While this bill and the commission are a step in the right direction, the reality is that the organisations which service the ever growing number of mental health services consumers day in and day out need more support and more services, not necessarily legislative change.

As the Hon. Mr Wade has stated in this place, the delays experienced by mental health consumers in obtaining an adequate mental health bed when presenting at an emergency department is appalling, and funding must be allocated by the government in a way that will have a meaningful and positive impact on wait times and on the level of mental health services to consumers. One of the vital pieces of work that requires support is the compilation of the state's next suicide prevention strategy, noting that the current 2012-16 strategy expires at the end of this year. I note that we only have a 2012-16 strategy because of the motions that both the member for Adelaide in another place and I put through the parliament in 2011.

I do not wish to be accused of self congratulation, but my early work in suicide prevention brought a stony silence from the government at that stage, particularly the then minister, John Hill, who refused to put any state government money into suicide prevention work. We have seen some improvement, but I assure the government that we need to do far more. I am assured that the process for developing the 2017-20 suicide prevention strategy is underway. I do, however, remain to be convinced that adequate resources have been provided to the Office of the Chief Psychiatrist to ensure that there is no gap between the conclusion of the current strategy and the commencement of the next.

It is important that we do not rely too much on that dedicated and small team who I described in the Office of the Chief Psychiatrist, who are doing sterling work in rolling out the suicide prevention networks around this state, but to think that they can do all that work sufficiently to meet the needs of the community, and to also develop this next strategy, without extra resources, is expecting far too much from a very small entity within government. So, I will be watching the development and keeping a very close eye on when we are going to get that, and will continue to urge the government to provide adequate resourcing to do this important task.

I say that in the sense that, as a result, I suppose, of my advocacy and agitation, the previous minister for mental health announced at the estimates process in mid-2014 that there would be a new position added to the Office of the Chief Psychiatrist to roll out the suicide prevention strategy, and in particular the networks. It took 15 months for that position to actually come to fruition—15 months! That was the sort of interest the previous minister had in suicide prevention or mental health at all.

So, I say to the government: let's not drop the ball. I am pretty keen and confident that the new minister will not do that, but she also needs to be backed up from within the great resources of the health department. She does not have a budget of her own; it all goes back to the health minister, who previously failed in this area. I do not want to delay the chamber greatly but one of the things, as well as obviously the legislative changes that have been supported by the mental health sector, that I see when moving around this state—particularly there is a greater movement in metropolitan areas—is community awareness about mental health generally but also the threat of suicide to our communities.

With that there is an extraordinary willingness from unlikely sources within the community, whether they be sporting clubs, service clubs, church groups or a range of organisations that have not necessarily had as their core focus anything to do with health or mental health, or particularly suicide, who are now saying, 'We actually want to be involved in combating this in the community.' A lot of the work that they do does not cost anything—it costs in voluntary time but it does not cost the coffers of the government and the health department anything. What they do require is a bit of moral support on the ground for the work they do. I have given a lot of that moral support to particularly the suicide prevention networks and I have given it to other organisations in the general mental health field and also particularly to those who assist the families of people bereaved by suicide.

However, I have not yet seen a great deal of effort on her behalf in that field, and I trust that we will because she has had some other matters to deal with. What I have not seen from any member of the government, the cabinet particularly, is that effort to go out and support on the ground those people who are doing that voluntary work. They are looking for it; they are looking for confirmation, some affirmation of the effort they are making. They get it from me, but I humbly say to the government that they are looking for someone from government to give them that support as well, and it has been extraordinarily absent.

I must qualify that by saying that some of my greatest supporters in the work I do in suicide prevention have been from the Labor Party. I must say that I get great support in that area right across the parliament, but I am still just a bit gobsmacked that there is not more of that effort on the ground. I get emails every week, sometimes more than once a week, from the groups that are having activities in this field right around the state. We need more of them, and we will get more of them as the Office of the Chief Psychiatrist gets the time and effort to help get them established, but every week I get that. I cannot go to them all. I keep in contact with them and I go to them when I can, but I do not see any of that physical attendance or support from senior levels of government, so I urge government members to continue to put pressure on the government to make sure that that is changed.

In conclusion, I thought I might just leave honourable members with some statistics from the National Mental Health Commission which highlight just how vital the delivery of effective mental health services is to all South Australians. That is, 45 per cent of Australians aged 16 to 85, which equates to approximately 7.3 million people, experience some kind of mental disorder during their life. In 2013-14, one in five Australians experienced symptoms of mental health issues. The need for more support, more resources and more effective policy, and as I have just said, more demonstration by feet on the ground, by physical presence at events from all levels of government, from all parties. It cannot be clearer. I am certainly happy to support the second reading.

The Hon. P. MALINAUSKAS (Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety) (17:00): We thank everyone for their contribution and look forward to dealing with the bill further at the committee stage.

Bill read a second time.