Unmet Needs Report

Adjourned debate on motion of Hon. C. Bonaros:

That this council—

1. Recognises the final report commissioned by the Office of the Chief Psychiatrist on 'Unmet mental health service need in South Australia that could be met by the NGO sector' (Unmet Needs report), dated February 2023.

2. Acknowledges the findings and recommendations of the Unmet Needs report, including:

(a) 19,000 South Australians with severe mental illness require psychosocial support services each year but are not having their needs met;

(b) an estimated $125 million per annum is required to address the shortfall; and

(c) addressing the unmet needs in the South Australian mental health system would significantly reduce the demand for hospital-based emergency services related to mental distress and lead to reduced ramping and wait times.

3. Recognises the 19,000 South Australians identified in the Unmet Needs report represent a substantial increase compared to the Productivity Commission’s estimated 11,000 South Australians in 2020, highlighting the results of years of mental health policy failure from successive governments.

4. Notes the 2023-24 state budget provided no additional investment in psychosocial support, with the state government indicating it was awaiting the findings of the Unmet Needs report before making any decisions.

5. Notes the 2024-25 state budget similarly did not provide the necessary increase in funding towards psychosocial support.

6. Notes there has been no formal state government response to the findings and recommendations of the Unmet Needs report.

7. Calls on the Malinauskas Labor government to provide a formal response to the findings and recommendations of the Unmet Needs report by no later than 1 September 2024.

(Continued from 19 June 2024.)

The Hon. J.S. LEE (21:49): I rise today in strong support of this motion, which acknowledges the findings of the 2023 Unmet Needs report commissioned by the Office of the Chief Psychiatrist. The report confirmed what many of us already know: our mental health system is under pressure, and too many South Australians are slipping through the cracks. This report conservatively estimated that 26,000 people with severe mental illness required psychosocial support in 2021-22, yet only 3,200 were supported through the NDIS and 4,489 through other programs, leaving nearly 19,000 people without services. That was 75 per cent of those in need back in 2021-22. How many more have slipped through the cracks in the three years that have passed since then?

As I highlighted in my matter of interest speech relating to the Mental Health Coalition in August 2023, psychosocial supports are not just about clinical care, they are about helping people live. They help individuals manage daily tasks, connect with their communities and avoid crisis care. They are essential to recovery and wellbeing. However, the rollout of the NDIS has unintentionally created a dangerous gap. Many programs lost funding under the assumption that the NDIS would cover all needs.

It is clear from the report that a significant proportion of people with severe and persistent mental illness are not eligible for the NDIS, yet they still require ongoing psychosocial support. The current system does not adequately meet their needs. Without targeted investment, these individuals will continue to fall through the cracks. This is not just a policy oversight, it is a systemic failure, and it is one that continues today. Despite the clear evidence and urgent recommendations, the 2025-26 state budget has failed to deliver the necessary investment.

In 2023, the government stated that they were waiting for the findings of this report before making decisions. The report was released over two years ago. There has been no meaningful increase in funding for community-based mental health services, no dedicated strategy to empower NGOs and no plan to address the tens of thousands of South Australians left in limbo. The report called for $125 million per year to close the gap. I recognise that this funding obligation is not just for the state but is also a federal responsibility, but that was three years ago. What has the Malinauskas government done since then?

While I welcome the recognition that psychosocial support is a shared responsibility between state and federal governments, I am deeply disappointed that the Malinauskas government has once again failed to provide necessary funding in the recently released 2025-26 state budget. The amendments proposed by the Hon. Tung Ngo remove key references to the scale of unmet need, the $125 million funding shortfall and the lack of state action to date. These omissions risk downplaying the urgency of the crisis and the responsibility of this government to act.

South Australians living with severe mental illness cannot wait for another round of national negotiations. They need support now. As we consider who is most impacted by these gaps, we must not overlook the unique challenges faced by culturally and linguistically diverse communities. As highlighted by Embrace Multicultural Mental Health, barriers such as stigma, language and a lack of culturally appropriate care continue to prevent many from accessing the support they need.

Any investment in psychosocial services must include a commitment to culturally responsive care, ensuring that all South Australians, regardless of background, can access services that respect and reflect their lived experience. The government cannot continue to ignore this. They must act on the recommendations. These services that keep people well and out of crisis need urgent funding. Earlier today, when I was speaking to another motion, I spoke about the drought and also the impact of viruses on primary producers and farmers. The impacts of mental health also need to be addressed in regional South Australia.

We need services that meet vulnerable members of society where they are at, in their homes and in their communities. It is up to us here in this place to ensure that no-one is left behind simply because they do not fit neatly into the funding model. I commend the motion and I thank the Hon. Connie Bonaros for her leadership in bringing this motion to the Legislative Council.

The Hon. J.M.A. LENSINK (21:54): I rise to speak in support of this motion, which calls for recognition of the findings contained in the unmet needs report commissioned by the Office of the Chief Psychiatrist and finalised in February 2023. The facts, as stated in the report, are that 19,000 South Australians who live with severe mental illness are going without the psychosocial supports they need to live safely and with dignity and stability in their communities.

These are not abstract figures; they are individuals who face daily challenges without community-based care, rehabilitation services, care supports or home-based programs, which are the building blocks of a functioning mental health system. They are often the first to be neglected when governments fail to act.

The report estimates that $125 million per year is needed to close this service gap, based on a fifty-fifty cost share with the commonwealth. Yet despite repeated promises to consider the findings, the Malinauskas Labor government has failed to deliver any meaningful funding response in either the 2023-24 or 2024-25 state budgets. In fact, the government's record to date amounts to tokenistic investment in narrow initiatives while thousands of people remain without the support they need.

On this side of the chamber, we remember why this report was commissioned. It came from the former Liberal government's commitment to evidence-based reform and follows national findings by the Productivity Commission that exposed systemic gaps in psychosocial services and gaps that fall outside the scope of the NDIS, which are growing year by year.

Since that time, peak bodies such as the Mental Health Coalition of South Australia have amplified the call for funding, even resorting to public campaigns to draw attention to the silence from this government. We have joined every state and territory in calling for bilateral action, yet no formal response has been issued. No timeline has been given.

Mental health care does not end in the hospitals, and nor should it. Acute beds are necessary but they are not sufficient. Without psychosocial support, patients cycle in and out of emergency departments and put growing pressure on our hospitals, ambulance services and community. This motion is timely and grounded in evidence. We support it and we will be opposing the government's amendments. I commend the motion to the house.

The Hon. T.T. NGO (21:57): I move the following amendments, as tabled and circulated:

Paragraph 1:

Leave out 'dated February 2023' and insert 'publicly released on 25 July 2024'

Paragraph 2:

Leave out 'including'

Leave out subparagraphs (a), (b) and (c)

Leave out paragraphs 3 to 7 and insert new paragraphs as follows:

3. Recognises the commonwealth 'Analysis of unmet need for psychosocial supports outside of the NDIS' released on 16 August 2024 which highlighted this as a national concern;

4. Acknowledges that the provision of psychosocial supports is a shared responsibility between the commonwealth and state and territory governments;

5. Recognises that state, territory and commonwealth ministers have agreed that addressing unmet psychosocial needs will be one of the central priorities in consideration of the next National Mental Health and Suicide Prevention Agreement; and

6. Recognises that state, territory and commonwealth ministers have agreed to consult with lived experience and sector representatives in their jurisdiction, to inform negotiations of the next National Agreement, and report back at the next Health and Mental Health Ministers meeting, to determine shared priorities and investment plans.

Mental health funding was sharply reduced under the former Liberal government. This unmet needs report was commissioned by the former Liberal government, basically to assess their own cuts. From 2018-19 to 2020-21, the funding for psychosocial services delivered by NGOs fell by 19.2 per cent. Once inflation is considered, this cut is even deeper.

The Malinauskas Labor government has reversed this course with a generational reinvestment. Since taking office, this government has lifted state-commissioned psychosocial funding by 24 per cent from 2021-22 to 2024-25 and through the 2023-24 Mid-Year Budget Review. This added a further $6 million over four years, increasing funding to an extra $2 million a year. This boost in funding, along with redesigned NGO contracts, will enable more than 1,000 extra South Australians each year to receive one-to-one psychosocial support.

The South Australian Unmet Needs report aligns with the commonwealth's national report released on 16 August 2024, confirming that unmet psychosocial need is a national issue. In response to these findings, the federal government has set up a cross-jurisdictional working group to identify service gaps not covered by the NDIS and to help guide future funding decisions. At last week's meeting for state, territory and commonwealth health ministers, on 30 June 2024, all ministers committed to the following:

reaffirmed their shared responsibility for psychosocial care;

made unmet need a central priority for the next National Mental Health and Suicide Prevention Agreement;

pledged to maintain at least current psychosocial funding to safeguard service continuity; and

guaranteed to consult people with lived experience and sector experts before finalising joint priorities and investments.

Running alongside these commitments is a new Foundational Supports Strategy and a key NDIS review recommendation. This aims to create additional psychosocial services that are jointly commissioned by the commonwealth and the states. These services will be delivered through existing systems and phased in over time.

This report highlights that when NGO psychosocial services are properly funded they can step in early, keeping people connected to work, school and family, which in turn reduces homelessness, hospital stays and run-ins with the justice system. The state government is committed to the delivery of short-term, one-to-one NGO psychosocial services so we can better support South Australians in distress. The Labor government supports the amended form of this motion.

The Hon. T.A. FRANKS (22:01): I rise to support this motion, which calls on better South Australian government action on the unmet needs with regard to mental ill-health in this state. I have to reflect as well that the Hon. Tung Ngo's contribution just ascribed the commissioning of this report by the former health minister, Stephen Wade, as somehow done, and I quote him, 'basically to assess their own cuts under the Liberal government'. I would reject that assertion. This Unmet Needs study was done at the behest of the sector, asking governments, of whatever colour, to assess the unmet needs when it comes to mental health. What then happened under the Malinauskas government and this current minister was for years they kept the report hidden from South Australians.

Back then in 2020, there was an estimated—the Hon. Tung Ngo, you should not look so encouragingly at me as I say this—110,000 people affected by this unmet needs gap in our mental health and psychosocial services that should be there for all South Australians when they are in need, and now over 190,000 South Australians fall into that gap. We have to stop passing the buck to Canberra and start acting to ensure that we address the gap and we give South Australians the good mental health they need they need to live well and live well in recovery or not fall into acute need.

It is now the two-year anniversary of the final, eventual report. After great public campaigning, particularly by groups such as the Mental Health Coalition of South Australia, calling for this report to actually be released to the public, we are now about to see the two-year anniversary of that report and still there is no actual addressing of the needs, no putting money where it is needed. While sadly this will probably be a massive election issue politically, particularly for those who advocate for good mental health supports in this state for those who need it, for it to be given to them when they need it and accessed by them in the way that keeps them well and living a good life, it should actually be something that is cross-party and not politicised. But that is going to be through the failure of this government to act, even to address the problem by releasing the report in the first place and then to actually respond to the report once they were forced to release it. To somehow play politics and blame Stephen Wade, as the former minister, as somehow responsible for this is extraordinary and I reject it, as I reject the government amendments to this motion.

The Hon. C. BONAROS (22:05): I start by thanking the Hon. Jing Lee, the Hon. Michelle Lensink, the Hon. Tung Ngo and the Hon. Tammy Franks for their contributions. It should come as no surprise that I will not be supporting—and I am grateful to hear that other honourable members will not be supporting—the amendments to this motion. I thank the Hon. Tammy Franks for that summary in relation to how this report came about and how it unfolded, and in so doing I also acknowledge and thank the persistence and work of the Mental Health Coalition in this.

It has been nearly two years, as we have heard, that we have been waiting for a response to this. As the Hon. Tammy Franks has articulated, we want to know what South Australia is doing in relation to this. It is now four years since the Productivity Commission inquiry into mental health recommended addressing unmet needs, 30 years since the Burdekin report, 30 years since this was an important issue to address in mental health reform and 40 years since it was formally recognised in the Richmond report.

In this year's budget, the state budget continued with unsustainable health investment. We saw an extra $2 billion, but mostly focused on crisis points and business as usual. This does not deal with crisis; this is all about being proactive and preventing crisis in the first place. A key part of the solution in terms of addressing the unsustainable approach to mental health is addressing the unmet needs for psychosocial supports. We know what the cost is: it is $125 million to enable those 190,000 South Australians with severe mental illness to get the support they need to live better lives and reduce their reliance on an already overstretched crisis and emergency system. It is nearly two years since the report was released and so far we have allocated something like 2 per cent of what is required to address this gap.

The communiqué the Hon. Tung Ngo refers to is important. It was issued on 13 June and it is important given that I think it is this Friday that the mental health ministers' meeting is happening, the new Mental Health and Suicide Prevention Agreement and bilateral agreement are currently being negotiated, and of course, as we have mentioned now about four times this evening, we have an election coming up next year.

The Hon. E.S. Bourke interjecting:

The Hon. C. BONAROS: Next year. Is it next year? I think last week I may have referred to this year as 2026 because I got a bit ahead of myself, but now I am firmly placed in 2025. That communiqué from 13 June says:

Psychosocial Supports

Ministers reaffirmed Commonwealth, state and territory governments' shared responsibility and acknowledged the importance of investing in and delivering psychosocial supports to better meet need in the community.

Ministers agreed that addressing unmet psychosocial needs will be one of the central priorities in consideration of the next National Mental Health and Suicide Prevention Agreement. Ministers also agreed to at least maintain—

at least maintain—

…funding for psychosocial support services delivered through the Commonwealth and State and Territory governments—

at a state level, that is 2 per cent that we got in additional money in the budget announcements that just occurred—

to ensure service continuity for the community

All Ministers agree to consult with lived experience and sector representatives in their Jurisdiction, to inform negotiations of the next National Agreement, and report back at the next Health and Mental Health Ministers meeting, to determine shared priorities and investment plans.

I read that out because it is important in this context. What we have had now is a cost-shifting exercise between the states and the feds, and we are not going to budge here—that is what we hear from this government—until the feds budge, and the feds are saying, 'Well, you need to do your bit as well.'

We just keep passing this baton back and forth between state and federal and in the meantime the 190,000 South Australians suffering from mental health are going to increase. It is not going to do anything to improve our health crisis. It is not useful pointing to the figure that we have put in because that is money that is going towards crisis services. This is about being proactive, not reactive, and getting in before a person gets to that crisis point. That was the point of the report insofar as addressing the needs and what we need to do and what it will take to address that unmet need. We have all those answers now. The Chief Psychiatrist has given us the answers we need. We just need to get on and do it.

I am disappointed that the government has sought to rip the guts out of this because we know that those figures are not figures any of us in here came up with or any parliamentary inquiry came up with. They are fact and they are the facts we have to come to terms with and we have to address. We cannot go to this next meeting and pat each other on the back and say, 'We are committed to at least doing what we have been doing up until now,' because what we have been doing up until now simply is not working and it has failed us. We need to do more.

In closing, I thank honourable members for their support. I thank in particular the Mental Health Coalition for its ongoing advocacy in this area. I hope that we will see the light.

Amendments negatived; motion carried.