Social Development Committee: Inquiry into the Provision of Services for People with Mental Illness under the Transition to the National Disability Insurance Scheme

The Hon. D.G.E. HOOD (15:58): I move:

That the final report of the committee be noted.

Firstly, I would like to inform members that this is a reasonably lengthy speech—some 30 pages or so—so please be prepared. I would like to take the opportunity to acknowledge and thank all those who have contributed to this inquiry on behalf of the Social Development Committee. I thank the state and commonwealth government agencies that have given evidence and thank you to the state's Chief Psychiatrist, Dr Brayley, and the South Australian NDIS Psychosocial Disability Transition Task Force for their contributions.

The committee would like to thank the Mental Health Coalition of South Australia, the group of Uniting services and Clubhouse Diamond House for their valuable input and for their numerous appearances before the committee. The committee also thanks the many other non-government community organisations (NGOs) which provide the vital psychosocial disability services in the mental health sector. Importantly, thank you to the individuals who shared their stories of living with a mental illness, with psychosocial disability, and of their journey through the mental health system.

Finally, thank you to the family members and loved ones who also gave evidence of their experiences with the mental health system and the NDIS. To you all, your evidence was invaluable. As presiding member, I wish to also thank the committee members and secretariat for their work on this inquiry. Mostly, it was a cooperative experience.

The committee has made 35 recommendations for the Minister for Health and Wellbeing as a result of this inquiry. One of these is a recommendation made jointly to the Minister for Correctional Services. Where the recommendations refer to the NDIS, they call on the Minister for Health and Wellbeing to advocate or lobby the NDIA. I make note that the Hon. Emily Bourke MLC, the Hon. Connie Bonaros MLC and Ms Diana Wortley MP dissented from recommendation 9 of the recommendations, and have consequently made a joint dissenting statement. This can be found in the list of recommendations.

I also make mention here that the state government very recently released the Mental Health Services Plan 2020-25. Although the committee had finished its evidence gathering and was in deliberations when the plan was released, it does contain some measures that are aligned with a number of the findings from the committee's own inquiry. The committee welcomes the measures that are proposed by the plan for the improvement of mental health services in South Australia and looks forward to those being implemented by the state government.

Turning to the inquiry itself, and the body of the report, I should say, we now know that in any given year one in five Australians will experience mental ill-health. The Mental Health Commission of South Australia suggests that 45 per cent of South Australians will experience some form of diagnosable mental illness at some point in their lives. For those who do not, they will likely be affected by mental illness in some other way. It is also recognised that suicide has been a leading cause of death for South Australians aged 15 to 44, with a reported 236 deaths in South Australia in 2015 alone. The number of Aboriginal and Torres Strait Islander people who die by suicide is much higher, with almost twice as many deaths across all age groups.

What this inquiry has shown and what we know is that although there have been many attempts by successive state and federal governments to address the needs of this vulnerable cohort, there will continue to be an ongoing need for mental health services irrespective of the NDIS, whether they are clinical, mainstream or community-based services, whether funded by state or by the commonwealth government, and whether they are delivered by NGOs or the private sector.

What we do not know, and what is still unclear despite the efforts of this inquiry, is just how many people there are in South Australia who have a psychosocial disability and will need support either from the NDIS or from the government of South Australia. In 2017, the Productivity Commission estimated that by 2019-20, when the NDIS is at full scheme, out of the estimated 64,000 Australians with significant and enduring psychosocial disability who would need NDIS support, 4,500 would be in South Australia.

Through this inquiry, the committee has found that the number of people who are being accepted into the NDIS does not reflect this estimation. Although total numbers are not clear, we do know that there is likely to be a large gap between the projected number and the actual number of people with a psychosocial disability who are accepted into the NDIS in South Australia at full rollout.

The committee received upgraded figures from the NDIS transition task force in November, and although the figures referenced in the report are from the previous quarter, due to a crossover in when the data was received and the committee having finished its report, these are the most recent. What the figures show is that of the 1,702 people who have been receiving SA Health funded psychosocial disability support, only 594 have been deemed eligible, while there are as many as 744—or 44 per cent—who for one reason or another have not completed their access request form and their applications have been sent back to them by the NDIA.

Almost three-quarters—or 71 per cent—of clients in the mutual support and self-help program have started yet not completed their applications for NDIS access. It is somewhat of a different story for the clients in supported residential facilities, with 461 out of the 506 clients deemed eligible. However, while that is a 90 per cent success rate for this group and that is duly acknowledged, overall the rate of uptake has not occurred as expected.

The committee notes the efforts of the NDIS psychosocial disability transition task force and understands the Office of the Chief Psychiatrist has now established a psychosocial support services governance committee to oversee the client transition process and resolve any service matters with service partners, including local health networks, the non-government sector and the NDIA. The governance committee will address specific issues with the transition of SA Health clients.

It is understood that work by the governance committee has already commenced, and the committee has made a recommendation that the NDIS psychosocial disability transition task force continue its work post full rollout of the NDIS. This will ensure there is continued monitoring, reviewing and advocacy of both state-based and community mental health services and the provision of services to South Australian NDIS participants.

The committee acknowledges that the work already commenced is encouraging; however, this inquiry has also identified there is still more work to be done. For example, the updates provided by the NDIA to the Council of Australian Governments (COAG) show that in South Australia, in the first quarter of the seventh year of the NDIS—September 2019—only 1,349 people with psychosocial disability were active NDIS participants. This is some 231 more participants than in the previous quarter, but it is still a long way from the expected 4,500.

The questions on this which have been most pertinent for the committee concern where people with serious psychosocial disability who are not already accessing the NDIS are receiving support and how many people in our community are dealing with a psychosocial disability without support—that is, how many people are there who are still in need of support? Some submissions to this inquiry suggested there are in excess of 18,000 people in South Australia with a psychosocial disability who need some level of support. To this end, the committee has made a recommendation that there should urgently be a detailed gaps analysis undertaken to address the need for mental health services and psychosocial disability support services in our community.

In particular the gaps analysis should seek to detail the numbers of people who have a need for services and who have applied for the NDIS and have been deemed not eligible or who are not 'in-scope', as they call it, for the NDIS. The committee has also recommended the Minister for Health and Wellbeing develop an action plan in coordination with government departments, NGOs and those responsible for delivering mental health services to ensure those who are ineligible for the NDIS are able to access some form of support in the community.

Further to this, it is the committee's recommendation that the minister also seek assurances from the commonwealth that the services being funded by the commonwealth, including the National Psychosocial Support Measure, which is being administered through the primary health networks, and the Continuity of Support program for older people with mental illness, include a strategy to allow for NGOs to continue to provide support for their existing clients and to provide ongoing support services.

The South Australian component of the NPS measure will be implemented through the Intensive Home Based Support Service (IHBSS). The South Australian Mental Health Services Plan 2020-2025 outlines detailed plans for future services in SA. The committee recommends that further services funding plans are made to allow for community organisations to plan their services in advance. This should be based on current and future unmet need for mental health and psychosocial disability services.

The committee heard much evidence from NGOs and people with lived experience of psychosocial disability that the commonwealth-funded Personal Helpers and Mentors Service (PHaMs) has been incredibly valued in the community. Many stakeholders did not want to see this service defunded, and one of the greatest concerns was how the loss of the funding for the PHaMs would impact on service provision by the NGOs who had been receiving that funding. I will get to that in due course. It is clear there is a need in our community for a similar service which can be substituted for the PHaMs. There needs to be a service for people in our community with psychosocial disability who cannot access the NDIS but who nevertheless have a need for support, whether they have a formal diagnosis of mental illness or not. This was the success of the PHaMs.

The Individual Psychosocial Rehabilitation and Support Services (IPRSS) provided by the state government is an important service in this state, but it is not without its limitations, and it does not have the open-door features of the PHaMs: it requires a referral through a clinical pathway. However, it is this committee's recommendation that this service should be reviewed with the aim of making it more accessible and more equitable. The committee would like to see the pathways to and from this service expanded and continued to be funded and resourced.

On top of this, whether it is the IPRSS or another service, it will be important, and the committee recommends, that there is an easy-to-access, so-called soft-entry support service available in the community for people who need that help. Along these lines, the NDIA has also begun implementing the Information, Linkages and Capacity Building (ILC) program, which forms part of tier two of the Productivity Commission's recommended three-tiered system of disability supports. The ILC has the capacity to provide information, linkages and referrals to people with disability, their families and carers whose needs are not met by the NDIS. The focus of the ILC is individual development, community inclusion and capacity building and it is expected that the ILC will work in with state-based and community-based services.

The ILC services have potential to meet some of the psychosocial support needs of many South Australians with less severe symptoms of mental illness. However, the committee found the lack of advocacy for people who have psychosocial disability and are in need of services is an important factor that can and does at times prevent a person from being able to access the services they need.

There are many points of entry for a person who is unwell and in need of support. When faced with mental ill health and psychosocial disability, the very act of finding an appropriate service can be challenging. More often than not, the absence of any assistance can lead to crisis, which ultimately sees more people in our emergency departments. This may be especially true for South Australians who live in our rural and remote areas. We know that they face additional challenges in accessing services. The committee has made a recommendation that the Minister for Health and Wellbeing pursue a rural psychosocial disability services strategy and ensure that there is a provider of last resort for people in country areas.

As a further commitment to providing South Australians with a holistic, wraparound mental health service, the committee has recommended that the government fund and develop a mental health options hub, which will assist people, whether they are located in the city, metro, regional or rural areas, to find a service to suit their needs. The hub would include a greater online toolkit, which would provide people with self-assessment tools, information and assistance. This is not to say that this service should replace face-to-face service availability; instead, it should function as a conduit for more information and resources for people to easily access.

On top of this, the committee heard that the local area coordinators (LACs), who provide support to people trying to access the NDIS or other services, should be better equipped to provide those services. The committee heard in some instances that there were cases of LACs having no real understanding or experience with psychosocial disability, and they were not able to provide the level of help needed. The hub would ideally work in with those other services, such as those run through the PHNs as well as the NDIS, to provide a more comprehensively integrated mental health support system. The committee has recommended that the minister lobby the federal government to increase the amount of resources given to the LACs to assist them to fulfil their functions.

Housing for people who have complex psychosocial or severe mental illness needs also requires urgent attention from the state government, particularly to ensure that existing housing supports have not been jeopardised by the NDIS rollout. We have recently seen an increase in our state's homelessness rate. The issues that go with homelessness are, for many, multifarious and complex. This committee would like to see, and has recommended to that effect, that a statewide review be conducted on the ongoing impact of mental illness on homelessness and housing-related issues.

Once undertaken, the review results should inform the development of a strategy to address the needs of people for housing where mental illness and psychosocial disability is implicated as specifically relevant to a person's circumstances. It is recommended that the government develop an integrated housing and support program that will be flexible and can work with the NDIS in order to provide appropriate support. This includes developing and undertaking a study of the needs of Aboriginal people and Torres Strait Islanders, who have a higher housing need than non-Aboriginal people. The committee has recommended that this part be undertaken jointly by the state and federal governments.

There is no doubt that all members are in support of the need for the government to continue and improve our state's mental health services. Importantly, this is what the committee heard from witnesses, and it is what was relayed to the committee in the written submissions to the inquiry. This is not in dispute. What has been disputed is the source of funds allocated to the NDIS as part of the bilateral agreement on the NDIS between the state and the commonwealth.

In the 2019-20 financial year, $24.73 million, or 5.9 per cent of the total mental health budget, is allocated for psychosocial disability programs. From 1 July 2019, 25 per cent of that $24.73 million and 100 per cent of the former supported residential facilities funds were removed from the department's budget and transferred to the NDIS. This was agreed to as part of the state's commitment to the bilateral agreement on the NDIS with the commonwealth.

The Minister for Health and Wellbeing advised in June this year that the government would transfer $6.8 million in funding to the NDIA for the financial year 2019-20 as South Australian clients transition to the NDIS from state-funded services at that time. The committee heard that this impacted those NGOs who were providing services for clients, and the awarding of funding by the state government to the NGO sector was reduced to three-month blocks.

Stakeholders advised that this was an untenable situation as they could not recruit staff for such short periods and continue to provide the level of service to their clients. Stakeholders also said that they needed reassurance that there will be provision for block-funded psychosocial services beyond the three-month contract. There were, of course, reasons for this, which were in part explained to the committee by the Chief Psychiatrist. However, we now know, after the government released the state's Mental Health Services Plan 2020-25, that there is a commitment to continue the contracts with NGOs, giving NGOs a bigger role in the future of mental health services provision in this state.

Stakeholders, including NGOs, advocated for the state government to invest more in the peer workforce across the South Australian mental health system, given the model has shown to have strong and long-lasting results for all those involved. The committee made a recommendation to the government to pursue this and notes that it is provided for in the Mental Health Services Plan also.

Improving supports for carers is also a concern that was raised frequently during the inquiry. Evidence suggests there are risks associated with carers having to pay fees for respite services, where they formerly received support from the commonwealth Mental Health Respite: Carer Support program. With the reduction in funding and finishing up of the Carer Support program, the committee understands there are real concerns that those who provide care for family or loved ones will be forced to go without.

Although it is not yet clear how many carers may face this issue, the South Australian government advised it will continue support for carers through the existing state-funded carer support program. The committee would like to see this maintained and work with the commonwealth Integrated Carer Support Service once that is implemented.

I will discuss now the issues and concerns raised in relation to the National Disability Insurance Scheme itself and the administration of the scheme by the National Disability Insurance Agency. The committee received much evidence that showed there were ongoing issues in the NDIS application process. The committee recognises the implementation by the NDIA of the streamlined psychosocial disability access process and that this will benefit some applicants with some aspects of the process.

However, the streamlining will not benefit a large and difficult to reach group of people, such as those who have previously avoided contact with mental health services. The streamlined process is also only available to people who have previously been receiving commonwealth or state services. This could be remedied to be inclusive of all people with psychosocial disability wishing to apply.

The committee heard there was an abundance of concern about the evidence that is needed to support a person's NDIS application. The kinds of evidence we are talking about are specialist psychological, neurological and occupational therapy reports. These can be costly, difficult to obtain or may not contain enough or the right kind of information required by the NDIA for assessment purposes. The committee learnt that psychosocial disability concerns the 'social consequences of disability'; that is, the effect on a person's ability to participate fully in life as result of mental ill health.

Many people with mental illness have a high degree of symptoms, such as low mood, fatigue, inability to concentrate, detachment, stress, panic, hallucinations, and trauma-related mental and physical responses to everyday situations. Managing the symptoms of psychosocial disability can cause a person to be inhibited from, or find difficulty in, engaging in many areas of life and the opportunities participation might present, such as in education, working, cultural activities and achieving goals and aspirations.

Costs involved in obtaining the reports was also raised as problematic, where the majority of applicants are on fixed or low incomes. This was found to be more challenging for hard-to-reach cohorts, such as people facing homelessness, culturally and linguistically diverse groups (CALD) and Aboriginal and Torres Strait Islanders.

The committee determined that on the basis of the evidence the NDIA's policy, which emphasises it is the applicant's responsibility and burden to provide the proof that they meet the access criteria, is excessively unfair for this cohort. The committee has made a recommendation that proposes there be greater support provided by the agency from the outset of the application process, which includes rolling the burden of evidence gathering into an administrative function of the agency.

It was also identified that testing eligibility was identified as a disempowering process. Some evidence showed applicants felt there was a focus on a clinical diagnosis, yet there is no requirement under the NDIS Act for a diagnosis for a person to apply. This was coupled with an overwhelming sense by some that the application process focused on the applicant's deficits not their capabilities, which had a doubly demoralising effect. In some cases, the requirement for certain types of evidence was demonstrated to be inconsistently administered and badly explained to applicants. This turns on the training of NDIA and local area coordinator staff, along with the agency's interpretation of the legislation in its policymaking.

Other concerns raised in the evidence shows there is still a widespread degree of prejudice against people with mental illness. This was referenced by witnesses, who claimed they had been treated with dismissive language or in an overly bureaucratic manner by NDIA or LAC staff. The prevalence of concerns among NDIS applicants and their advocates is not unrecognised by the NDIA. The NDIA acknowledged the concerns raised in the committee's evidence and advised it had implemented training in psychosocial disabilities for some staff, which was to be completed in June. It will be necessary for the results of this training to be monitored to gauge if it has been beneficial to applicants with psychosocial disabilities.

For those applicants who are successful in their NDIS applications, once they have a plan, it was identified that the ratio of supports, which is broken into two types, core support and capacity building, is skewed against some participants achieving optimal success from their plans. It was found that for participants with psychosocial disability, a plan with a greater level of funding for capacity building was more likely to provide the participant with greater opportunities.

Support coordination was found to be very important for people to have as part of their plan, as it provides the support around the participant's ability to exercise choice making. Some participants told advocates that the support coordination had been conducted over the phone and that there had been no face-to-face contact, making it challenging for the participant to communicate to the support coordinators what their day-to-day needs were.

Other concerns for the participants include:

the quality of some plans varies, and they are often developed by people who may not have the skills to draw out the true needs of a participant with a psychosocial disability;

support coordination is funded in many plans; however, case management is not included, which would be highly beneficial for some participants;

there is inadequate funding to educate people on the benefits of accessing support, and there is a risk that if a potential applicant for the NDIS refuses support there is little room to explore reasons, motivation or the right fit for that person;

there is a risk of exploitation by unscrupulous providers, especially given that the NDIA does not require a base qualification for support workers;

NDIS participants with psychosocial disabilities have relayed to mental health advocates that there is still a lack of understanding and communication from NDIA staff;

participants need access to NDIA advice and require availability of service providers outside regular business hours; and

there is the need for a policy that covers all SA government services that interact with people with psychosocial disability, including all places of detention such as prisons and mental health services, to adopt protocols to identify whether people entering their service are NDIS participants or potentially eligible to be so, and to facilitate relevant needs accordingly.

The committee has made recommendations that address these concerns. Where an application for NDIS access is rejected, witnesses told the committee that it is more likely than not that the applicant will not continue with a review or appeal of the decision as the process is long and complicated, and can be even more traumatising.

The committee heard there are instances of some people having to wait for up to 12 months for a decision on their application, only to be told they did not meet the necessary criteria. Others, after having been rejected, lodged a request for review of the decision and were also waiting anywhere from three to nine months for a decision. The same was identified where a participant sought a review of their plan. The committee was told of cases where, after initiating a review, some participants also had to wait months for an answer to their request.

While representatives of the NDIA gave evidence that these extraordinarily long wait times were being dealt with by the agency, the committee has recommended that the Minister for Health and Wellbeing lobby the federal government to address this issue. The committee further recommends that the minister advocates to the NDIA to improve the 'reasons for decision notices' to applicants whose access requests are rejected, and for participants whose request for changes to their plans are, on review, denied.

The committee also recommended that the NDIA be lobbied by the minister to urgently finalise a policy and procedure to allow for flexibility to be built into NDIS plan structures to respond to the fluctuating needs of participants with a psychosocial disability and to allow for minor adjustments to be made without the need for a full plan review.

Chief amongst other concerns is the adequacy of the systems and supports for older South Australians who have mental illness or psychosocial disability but who are not eligible for the NDIS. The committee found there are gaps between the services available to this particularly vulnerable group, and has made a recommendation for an assessment to be undertaken in relation to issues of equity of access.

This will assist older people who may be exiting an existing program or who have not accessed any services for a while and need extra help to do so. On top of this the committee has recommended that the minister ask the NDIA to fund an assertive outreach program for particularly vulnerable and prospective NDIS applicants.

The NDIS is a wide-reaching change to Australian social policy. It is an insurance scheme; it is there so that we all know that if it is needed, support will be given. In order for the principles that underpin the NDIS act to remain the focal point in service to people with severe and enduring psychosocial disabilities, it will require the NDIA to continue to make improvements to the policies, procedures and practices within the agency and in connection to services provided by third parties.

Based on the evidence, the report shows that there are many good things about the NDIS that have been and will continue to be of support to people with psychosocial disability, and there are many achievements to acknowledge in the mental health services sector in South Australia. However, there are still many issues that need immediate and long-term attention, action and resourcing in order to ensure that South Australians who grapple with the severest degree of mental illness and psychosocial disability are provided with meaningful and responsive care, and that those who do not meet the NDIS criteria for support have somewhere to go to get the right sort of assistance they need.

To conclude the noting of this report to you, sir, I want to highlight that the report provides recommendations to give our state's most vulnerable the best opportunities to experience recovery and to be able to contribute to their chosen community. I would like to thank the other members of the committee. It was quite a lengthy report, as you can tell by my contribution today, and I think we worked quite cooperatively in dealing with a very important issue. I would also like to thank Robyn Schutte, the committee secretary, and Mary-Ann Bloomfield, our research officer. I commend the report.

The Hon. E.S. BOURKE (16:25): I would like to thank the Hon. Dennis Hood for his very detailed overview of the committee. It is a very important community issue and I thank him for his address on this topic. As a member of the Social Development Committee and mover of the inquiry into the provisions of mental health services under the transition to the NDIS, I rise to speak on this report.

I proposed the Social Development Committee investigate how the transition would impact South Australians with mental illness because the community had voiced concerns that South Australians with a mental illness were being left behind in the transition to the NDIS, with one of the goals being that the committee would provide recommendations about how the provision of mental health services in South Australia could be improved, given the transition to the NDIS.

I went into this inquiry concerned about the reports my office was receiving, but the feedback from witnesses and from written submissions was worse than I had anticipated. The National Disability Insurance Scheme is one of the most progressive social reforms since the introduction of Medicare in 1970, and like Medicare, this significant economic and social reform was introduced by an outgoing federal Labor government. Unfortunately, since federal Labor's introduction of the scheme, successive Liberal governments have not funded a workforce capable of meeting demand of the community to process and support NDIS applications.

The NDIS is a fully funded scheme established to perform the unmet need of support for people living with disabilities and mental illness. It was expected that the NDIS would give greater individual choice and control over services being provided and increase the capacity of participants to engage in their communities. However, no-one had anticipated the level of unmet need in the community for disability and mental health support. Now, the NDIS is at breaking point and urgently needs a bigger workforce to support it. The scheme simply does not have enough people to approve plans for people with disabilities or mental health illnesses. We heard this from witnesses time and time again.

As the Hon. Dennis Hood has just pointed out, it is understood that one in five South Australians experienced diagnosable mental illnesses in 2018. It is also recognised that in 2015, suicide was the leading cause of death for South Australians aged 15 to 44, with 236 deaths reported in South Australia.

The Mental Health Commission of South Australia suggests that 45 per cent of South Australians will experience some form of diagnosable mental illness at some point in their lives. For those who do not, they will likely be affected by mental illness in some way while supporting a loved one or a friend experiencing mental illness. A staggering 18,000 South Australians who, as the committee was advised, need support will not receive that support from the NDIS.

The Southern Adelaide Local Health Network (SALHN) raised concerns, through their submission to the committee, that they had observed there had only been 227 successful NDIS applications in South Australia, and that a significant uplift would be needed if clients were to receive the necessary support required. SALHN also stated there were significant gaps in the projected numbers and actual take-up in the southern suburbs of Adelaide.

SALHN considers a significant proportion of South Australians with a mental illness will still require some form of clinical, psychosocial and disability support, even at the full NDIS roll-out. This was also raised by the Executive Director of the Mental Health Coalition of SA, Mr Geoff Harris, who stated that the emerging gap was a matter of urgency for agencies and the state government. Mr Harris said:

…there are a lot of people who currently do not have access to effective supports from the NDIS, and the numbers that were anticipated by the commonwealth don't reflect what's actually happening. The commonwealth was estimating that about 90 per cent of people in mental health programs will get onto the NDIS. It's looking a lot lower than that, but we don't know where that will actually land at the end of June.

Considering the number of people who will never access the NDIS but who experience mental health illnesses, a continued provision of services is required outside the NDIS scheme. The National Disability Insurance Scheme is nearing its seventh year of operation, but we are still unable to clarify the number of South Australians who have gained access to the NDIS. This is as a result of the high rate of applications that have been withdrawn, cancelled or rejected.

Dr John Brayley, when he appeared before the committee, provided figures that highlighted the challenges faced by applicants during the application process. As at 15 April 2019, figures show that there were 514 clients, out of a total of 1,702, who had not been deemed eligible, while only 364 clients had received an approved plan and around 150 clients were awaiting an approved plan. Across all the state-based programs, 338 clients had been deemed ineligible.

The eligibility process is time consuming and stressful for many applicants and is a process that is difficult for many to navigate, especially when you are amongst most vulnerable in our community. People who are experiencing mental health illness are being confronted with a application process that requires them to discuss and admit that they have a mental illness. In itself, this is a significant deterrent.

Many recommendations were put forward that all members were able to support, seeking to address the concerns that I have just discussed, particularly Nos 28 to 34. Unfortunately, the concerns do not stop at the eligibility process of the NDIS. As I have just mentioned, we are not seeing as many people with mental illness as originally expected transitioning to the NDIS, not because of need but because of accessibility to the scheme. This is where our front-line community mental health services play a vital preventative health role and support the many South Australians who will not be eligible for the NDIS.

As highlighted in the report, the committee received no evidence highlighting that block funding should be withdrawn from the NGOs. This is why the committee was to report on a number of provisions, including the ongoing requirement for block-funded mental health services to be provided by the state government after the NDIS transition and the reduction in funding to the Personal Helpers and Mentors program and the mental health respite program and the impact this will have on people with mental illnesses.

I note these provisions, as they led me to the concerns I held, as they did the Hon. Connie Bonaros and my Labor colleague in the other place, the member for Torrens, Dana Wortley, especially in regard to recommendation 9. As it stands, recommendation 9 reads:

The Minister for Health and Wellbeing provide additional block-funding and extend current contract lengths beyond three-month blocks for existing community mental health organisations to maintain delivery of services in local communities to support people with psychosocial disability.

I would like to put on the record that this recommendation was only supported by government members of the committee, which resulted in the remaining members, whom I have just mentioned, putting in a dissenting statement for recommendation 9. The Hon. Connie Bonaros, the member for Torrens and I submitted a dissenting statement because the report tabled, in particular recommendation 9, does not reflect the voices of the community that the committee heard from.

Voices like those of the Department of Social Services, the Department for Health and the NDIA have submitted to the committee that the success of the NDIS requires state and territory governments to continue funding, into the future, services for people with psychosocial needs. The voice of the executive director of Diamond House has also highlighted the need for state government block funding to continue after the NDIS transition.

The voice of Esther, who lives with schizoaffective disorder, post-traumatic stress disorder and compulsive disorder, has highlighted that she relies on the support that she receives to clean her house and to get to her local supermarket and medical appointments. When Esther appeared before the committee, she was receiving support from NGOs UnitingCare Wesley and Diamond House, but not through the NDIS. Esther's application for the NDIS had been rejected, and with the help of Diamond House she was going through the process all over again. When asked how she would cope without this support, Esther simply replied, 'I do not know.'

As a member of the committee, I submitted multiple versions of recommendation 9, willing to compromise for a positive outcome. But the government members were unwilling to accept any version which referred to cuts in government funding or calls to cover the 25 per cent reduction of funding transitioned to the NDIA in 2019 or a time line to continue to fund psychosocial services provided by NGOs through state-based funding until 2022.

By omitting any reference to a time frame regarding funding or any forward plan highlighting what services will be available for people with mental illnesses or psychosocial disabilities who do not meet the NDIS eligibility criteria but nevertheless require its support, recommendation 9 falls short of reflecting the voices of witnesses. Quite simply, recommendation 9 does not reflect the calls for certainty and clarity about the future of funding for community-based mental health services.

As I previously mentioned, we know that 18,000 South Australians will be outside the NDIS but will nevertheless need support. The committee heard that NGOs are providing support to those South Australians but will not be able to for much longer without the support of state government block funding. Rather, recommendation 9 is a hollow recommendation that does not require measurable actions from Premier Marshall's government to address the community's concern in an open and transparent manner.

This is particularly concerning when we consider that South Australia has the highest level of hospital presentation for mental health in Australia. That is why it is imperative that the government focuses on preventative health to keep people out of hospitals and in their community by providing certainty to the community mental health services. As Kim Smith from Diamond House highlighted to the committee, if a member of Diamond House is admitted to a psychiatric ward, it would cost $10,500 per week, whereas it costs to SA Health around $2,400 per year to support one person through Diamond House in their programs, so around $46 per person per week, in comparison to $10,500. Whilst the government may be saving some money by not committing to continuing block funding NGOs until 2020 to 2021, it will cost more in the long run.

The need for the state's funding has not decreased. Any reduction will result in a risk to South Australians and increased emergency room visitations. Unfortunately, we have a long way to go in supporting the thousands of South Australians who are experiencing mental illness. The inquiry provided individual opportunity for members of the community to put their thoughts on the record in the hope to make change in this under-pressure sector. I hope those voices do not go unheard.

Putting aside recommendation 9, as the Hon. Dennis Hood has said, the inquiry provided much-needed clarity about the issues that applicants are being confronted with regarding the NDIS. I would like to thank the members of the committee: the Chair, the Hon. Dennis Hood; the Hon. Connie Bonaros; the member for Torrens in the other place, Dana Wortley; the member for Newland in the other place, Richard Harvey; and the member for King in the other place, Paula Luethen. I would also like to thank the committee secretary, Robyn Schutte, and the research officer, Mary-Ann Bloomfield.

Debate adjourned on motion of Hon. I.K. Hunter.