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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2009-02-18 Daily Xml
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MENTAL HEALTH BILL

Second Reading

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (16:12): I will continue my remarks. I thank the minister, though, for confirming, which she did not do yesterday in parliament, that those deaths were referred to the Coroner. Whilst a number of deaths (I think over 60 during the heatwave) have been the subject of questions to the Attorney-General in relation to an inquiry into those deaths and about resources available to the Coroner to undertake it, there has been no confirmation to the house that the people who were residents/clients/patients of the Glenside Hospital were in that category. If the minister tells me that that has been referred to the Coroner, I think it is a good thing. I am simply saying that, yesterday, the minister advised the house that there is another inquiry in relation to medication and, if they have gone to the Coroner, I will look forward to reading his or her report.

The other matter I wish to briefly refer to is the question of children, because they are in a category that has been brought under the umbrella of this legislation. Some, who have put submissions to us, have been concerned about that. It is a matter on which we are still consulting. A number of concerns were raised in a previous contribution I made to the house indicating that we would be foreshadowing a number of amendments—and that may still be the case—but I will not be dealing with that today.

I want to refer to one other matter in relation to the government's statements in support of this bill and the services provided, that there will be some provision in the redevelopment of Glenside and that there has been some other allocation of funding under this government for housing for people who have a mental health condition.

I briefly refer to an article by Margaret Springgay, the executive director of the Mental Illness Fellowship of Australia, published in this month's Sheltashortz magazine, which is a publication of Shelter SA, an advocacy group in South Australia. She outlines a very significant matter, that is, the mental health housing crisis that exists across Australia. It is not unique to South Australia, however I think it is still important that it be heeded. Margaret Springgay highlights the importance of the fact that there are many people in the community, and she uses the example of:

...a 51 year old man who has suffered with schizophrenia for more than half his life. He weighs only 52 kilos because of his increasing delusional episodes and reluctance to eat properly, despite the help of his sister and 81 year old mother, who have cared for him for years. He desperately needs supported community accommodation, but the only hostels available are a few overcrowded houses where up to five people share one room. There is no privacy, and the environment is dismal...

I raise this because it is an excellent article and it is one which the government should heed. The crux of her message is that there is no suitable supported accommodation for persons such as described in this article, and there are many of them.

I am sure that the minister receives a number of letters—I certainly do—from people who are relatives, friends, support people and carers of those in the community who desperately need supported community accommodation.

What we have seen is the government's decision in my own area of Norwood to sell off, I think, three boarding house facilities, and this puts even greater pressure on those in the community who are clearly unable to obtain or secure private rental or purchase accommodation and are at the mercy of any government that will provide some support for them, because there is no-one else.

They have often broken a lot of bridges with their own family, and their friendship networks have broken down—if they had any to start with. These are the people who slip through the net. I think that Margaret Springgay sets out very well the importance of the government understanding this problem. It is a very serious problem and it needs to be addressed.

The government has announced—it is referred to in the minister's second reading explanation—that it is going to provide some supported accommodation in the proposed redevelopment at Glenside. That is commendable, that is great, but it is a drop in the ocean compared to what has already been closed down. What is important is to extend, not just replace.

It is very important that this supported accommodation be built. I recall it being a major plank of an announcement by former prime minister Howard and former minister Christopher Pyne, with hundreds of millions of dollars being offered for social housing for people with disability and mental health issues. It concerns me that, apparently, there is money out there but that there has been no remedy of this situation and the plight of these people has largely been ignored.

So, I again plead with the government, when it looks to selling off the north-east corner of what is left of the Glenside Hospital site for private housing, that it revoke that decision and say as Monsignor Cappo says: 'We will keep that for dedicated housing for those who need step-down services, including much needed support accommodation.'

I do not know how many people have to say this. There are already these articles out there, and they keep landing on my desk and, I am sure, the minister's. This is a plight that we must not ignore if we are to give any credibility to the concept of providing a service which includes acute and community services and the things that need to go with that, including the safety and security of having their own shelter.

I move to the three amendments that I will foreshadow, which have been tabled. I will just indicate the ambit of those amendments and, by way of explanation, a number of other amendments with which we are still in consultation and which we will consider presenting between houses. There are important aspects of this bill which are well overdue, and it is not the opposition's intention to oppose its passage through this house. We have waited years for it. I am not critical of the government in this sense, because I actually think that extensive consultation was needed—and it has been—and the government has heeded some changes along the way.

I foreshadow that I will be moving amendments to, first, introduce a community visitors scheme into the bill for the purpose of it being part of the act and not an option under regulations. Secondly, that there be a provision for supervision of authorised health professionals. It is the proposal of the government to extend the category of persons who have the power to determine—particularly category one—both treatment orders and, on my reading of it, detention orders. So, it is the opposition's view that there should be direct supervision of a medical practitioner. Thirdly, to introduce a code of practice for authorised health professionals. That would be under the agreement and responsibility of the minister, as is often the case with codes of practice, to prepare and provide that. So, I just foreshadow that those are the three amendments that I propose to move in this chamber.

First, if those amendments have a fate of death and do not get through this chamber, I indicate that they will be introduced in another chamber. Secondly, additional matters will be raised which we will ask the government to give some thought to between the houses. One of those matters is about changing the fine regimes (the fines to be imposed), the maximum financial penalties in the bill. In almost every bill I deal with in this house—which is either updating, modernising or rewriting of legislation—there is a massive increase in fines, but this one seems to have missed it. There has not been an increase in financial penalties since 1993. It is proposed that, where $20,000 applies, it should be increased to $50,000 and, where $10,000 applies, it should be increased to $25,000.

I would ask the government to think about that. I think that the expansion of people who are potentially the subject of either a community treatment order or a detention order, the expansion of the categories of people who can provide, authorise or issue them and the change of definition of 'mental health' are all very significant factors in this issue. Therefore, it is important that we make sure that we add adequate protections. For as much as fines are ever some kind of instrument of discipline in these matters, or some kind of effective means of actually making people do the right thing, they should certainly attract a higher penalty and be reviewed on the basis of arguments put in other legislation.

The second matter that we will raise deals with treatment and care plans, which is a new proposed regime in the act which we support, but they should also be provided—and this is an amendment to the to the reviews undertaken by the Guardianship Board. It is recommended in the Bidmeade report. It is disappointing that it has not shown up in this draft, but we will be moving an amendment in another place on that.

Also, regarding the offence of assisting an absconded patient, this will introduce a new offence for harbouring and/or knowingly failing to report a detained person who has absconded from a treatment centre. It is similar to the existing clause 96 and is a key recommendation of the coroner. There are other similarities in the Criminal Law Consolidation Act, but I do not think I need to go into that, because I will not be moving the amendment here.

The final one is for the setting of a review date. I simply say, as I am sure others will say in another place when this amendment is moved—and I ask the government to consider the matter between the houses—that, in view of the fact that we are significantly expanding the definitions to include potential categories of patients, we need to look at whether we have a review of this legislation, because some of the legislation is controversial, particularly in the area of transfers. I am sure the minister has received significant submissions put by the Law Society and others and, although the opposition has determined that it will not be moving an amendment in relation to transfers, at least in this house, there are a number of worrying aspects that still remain.

We would be given some assurance if the government were to agree to a review after, say, four years, because that may help to provide some compensation for those who are (and remain) fearful that there is an opportunity to abuse the privilege of what is going to be given under this legislation in dealing with interstate transfers of patients who come within this category. I just foreshadow those.

I will refer in more detail to those aspects that I have identified when I move my amendments. I indicate to the house that amendments have been tabled. For the sake of those who will be following this debate, I indicate that the community visitors scheme relates to amendment Nos 1, 4, 5, 6, 7 and 9 of the document titled 41(1); the supervision of authorised health professionals relates to amendment Nos 2 and 3; and the code of practice to amendment No. 8.

The Hon. L. STEVENS (Little Para) (16:27): I am pleased to support the legislation before us which is a critical part of the tranche of reforms to mental health policy and services since the election of the Rann government in 2002. At that time, mental health reform in South Australia had completely stalled, although that is probably generous because it had barely begun. It was systemic failure on a grand scale. In a report by Peter Brennan, commissioned by the previous Liberal government in 2000, he stated:

To be absolutely certain that the need for change is completely appreciated, the key findings of our study based on South Australian data, are given below:

The number of acute institutional beds is above the national average.

Overall expenditure on mental health is above the national average

Expenditure on stand-alone psychiatric facilities is 80 per cent above the national average.

Expenditure on acute facilities in general hospitals is one-third less than the national average.

The most striking variance is in the level of expenditure on non-government organisations, particularly with respect to supported accommodation and community-based care.

We had fallen a long way behind the rest of Australia because those opposite sat on their hands for eight years. The Rann government has begun a multi-million dollar reform initiative in mental health which includes new facilities, new services and, in particular, a huge injection of funds into community-based care in the city and the country, but more work needs to be done; we still have a way to go.

Legislative review has also been considered, obviously because that sets the legal framework for whatever we do. When I was minister for health in 2004, I commissioned the work done by Ian Bidmeade and his committee in the report 'Paving the Way'. I pay tribute to Ian Bidmeade who was an obvious choice for the job. Far more than just a legal consultant and solicitor, he has had an outstanding career as an expert in public health law and mental health law, he has been a president of the Guardianship Board, worked on the original proposals for a health complaints regime for former minister Martyn Evans and, because of his public health expertise, wrote and contributed to many national and public health reports. I thank him and his committee for their work.

While it is estimated that one in five of the population will suffer a mental illness at some stage in their lives, the bill before us applies to the 3 per cent of the population who are seriously affected and suffer major mental illness. It provides a framework for providing care and treatment, while protecting the rights of the small minority of people who are unwilling to accept treatment, even though they may be placing their own safety and the safety of others in jeopardy. The bill is comprehensive in its scope and governed by a set of principles that clearly set the platform of a reformed approach to mental health policy and practice.

I know that these principles have been stated by the minister, but I just want to revisit them, because it is important to understand each one of them and realise just how far mental health and mental health policy and practice slipped behind what each one of us would expect as our right in any other sort of health care. The principles emphasise best therapeutic outcomes for patients in the least restrictive way and their recovery and participation in community life. Services should be provided according to comprehensive treatment plans developed in consultation with patients, including children, and their family, or other carers or supporters. Services should take into account the different developmental stages of children and young people and the aged—what a most basic thing to have to state.

They should also take into account different cultural backgrounds. There should be regular medical check-ups and records of every patient's mental and physical health. For so long, when people in the past—and possibly now (I hope not)—were in a mental health institution, their physical needs were suddenly not considered to be as important as their mental health needs. This is something which we would not accept in other hospitals.

Children and young people should be cared for separately. The rights, welfare and safety of the children and other dependants of patients should always be considered and protected as far as possible. Medication should not be used as a punishment or for the convenience of others. Mechanical restraints should only be used as a last resort. Patients, their family and carers should receive clear information about all aspects of their illness and care in a way that they can understand.

I think that, if people actually read and think carefully about the fact that these principles have now been placed in an act of parliament, it serves to indicate why mental health treatment has been considered to be a human rights issue in this country and in other countries around the world.

I am really pleased that the government has put those principles clearly in the act for all to see. There can be no mistaking the intent of the act and its requirement that all those who are charged with the delivery of mental health services must act according to those principles. In his report, 'Paving the Way', Ian Bidmeade gave some interesting information on the history of the current mental health legislative framework. He looked at what we ended up with in terms of the last time the act was reviewed and a new act brought in—that was in 1993. Even though there had been some important improvements, he said:

The approach taken is minimalist when compared with the statements and objectives included in the model mental health legislation which most states have adopted more fully.

The current legislation was introduced in 1993 and it made headway. But it is now 2009 and it is pleasing that at last we are addressing the matters. They should have been addressed earlier, however, better late than never. I will not go into particular aspects of the bill. I will take part in what I can in relation to the committee stage, but I would like to make a couple of further points. Mental health reform has been really evident in my own electorate of Little Para, and I have spoken about this locally. First, a new acute mental health facility, which was opened a few months ago, is attached to the Lyell McEwin Health Service. We also have one of the three community recovery centres, which I was pleased to open in June, I think, last year.

We also have a tremendous increase in community-based services that are in place to help those recovering from mental illness. That is really something about which I am proud and the government is proud. We have actually been able to start this program that has been so long coming. Certainly, when I leave parliament, I will always continue my interest in mental illness and the plight of the mentally ill to ensure that these reforms and these service changes continue, because, as I said, much work is still to be done. We are making good progress—progress that should have started a long time ago, but we are making good progress.

From the time that I have taken an interest in mental health issues I would like to pay tribute to some of the people who have provided great leadership in this area in South Australia. I would like to pay tribute to Margaret Tobin who was tragically killed when she was the director of mental health services when I was the minister. Of course, she was appointed previous to that, in the dying days of the previous Liberal government.

It was a tragic loss because she came into the position following the Brennan report and really did know her stuff in terms of how things had to change here in South Australia. She gave that leadership and she had started to get things moving. Her loss was a tragic setback for some of the things that she had already put in place. However, that has now been taken up again and moved forward. I pay tribute to her because she was an outstanding advocate and worker for mental health services.

Many people have worked very hard in this area, including many public servants, doctors and clinicians. I pay tribute to consumer advocates. The late Trevor Parry worked with Ian Bidmeade on this report. He was tireless in his efforts, and there have been many others, and it is now part of mental health understanding and policy that consumers will no longer be pushed back and ignored, that they must be part of every aspect of dealing with their own illness but also in contributing to improvements in policy and practice.

I pay tribute to the carers and families of people with a mental illness. We need to listen to them as they are the people who experience this on a daily basis. I am pleased to see the emphasis in the legislation on this. I acknowledge the efforts of Rotary in terms of its championing of mental health and for destigmatising it in the community. I do not think many of us realise just how prevalent mental illness is. It is not something to be ashamed of; it is something to deal with. An organisation like Rotary needs to be congratulated for that work.

Other very important and good workers come from non-government organisations. Some organisations, such as Uniting Care Wesley and the new ones that have now come on board because of the new money that the government has put into community-based services, are doing a very good job in terms of grassroots support (primary health care) to try to get on top of illnesses, to keep recovery on track and to keep people out of the acute system.

I compliment Jeff Kennett. I have not admired everything about Jeff Kennett but I do admire his efforts as former premier of Victoria in driving mental health reform in Victoria, putting that state right ahead of the pack, and his ongoing work and leadership through beyondblue. It is really important to have somebody of his stature, personality and presence to be able to drive through this very important issue.

Finally, I want to talk about the media and the role of the media in terms of mental health reform and dealing with the complex issues that affect people with a mental illness. I think that some sections of our media have a disgraceful record of vilifying and demonising people with a mental illness and generating unwarranted fear in the community about the mentally ill and perpetuating the mentality of 'lock them up and throw away the key'.

Some sections of the media have the propensity to take the easy way out by taking a knee-jerk reaction rather than applying a proper and considered approach. I appreciate what the minister stated in her second reading explanation about the issues of mental illness and violence:

It would be remiss of me not to point out that most people with a mental illness are not violent and that patients with psychosis are not generally violent once they have been treated and can be safely managed in the community.

That is the key. Nobody is saying that community safety is not important but, when incidents occur and an entire group of people are vilified and set back in their recovery, it is shameful.

I hope that this legislative framework, in conjunction with the new services and the new approaches that are occurring in mental health in this state, will mean that we will be able to provide the treatment in a timely way for those who need it, that we will be able to focus on recovery, that we will be able to see the majority of people living in the community in a supported way and that the media will take a more mature and less hysterical approach to these issues. I congratulate the minister on bringing the bill into the house, and I look forward to the committee stage.

Dr McFETRIDGE (Morphett) (16:46): I rise in support of this legislation. I note that the opposition has some concerns with parts of it, which the shadow minister has very eloquently addressed. Mental health will become a bigger and bigger issue for all of us in this place and also for all members of the community.

My late father had been a military policeman in the Royal Marines during the war and then a fireman, but his first job here in South Australia in 1954 was as a warder in the criminally insane ward at the then Parkside Mental Hospital. My father used to tell me stories about the way that the criminally insane were treated with straitjackets, confinements and the fairly brutal therapies that were considered normal in those days. They thought they were doing the right thing, but were often doing more harm than good, particularly with the isolation in the high stone walls at Parkside.

Since that period, there has been an amazing transition to what we see now: the mentally ill being assessed and, in many cases, put out into the community. The member for Little Para has said a lot about the issues, and I have great respect for the member for Little Para; she was a terrific health minister. I disagree with her on some things. I do not think that the former Liberal government sat on its hands: I think we were hamstrung by a lack of finances. More could have been done, but more could be done by every politician in this place, nationally, and perhaps around the world.

Mental health is becoming a bigger and bigger problem. Unfortunately, much of it is as a result of the abuse of illicit drugs, and I think that the use of highly toxic marijuana and other drugs will cause more and more problems. The violent results of mental illness are becoming more frequently reported and the anecdotal evidence is that that is a serious concern.

My nephew is an ambo and one of the first things that he had to do as part of his ambulance training was to go to the police academy and have self-defence training because of the need to protect himself from mental health patients. Quite frequently, I speak to police officers and ambulance officers and they tell me some of the horrendous stories of having to cope with people who have no idea what they are doing.

There is a need to recognise the issue as a real illness. As the member for Little Para said, people like Jeff Kennett, who was a leading politician in Australia, has championed the cause of depression through beyondblue. There are former members of parliament both interstate and in this state who have suffered severely as a result of the pressures of this job and the pressures of life. Mental illness will affect everybody in some way; if not personally it can be through family or friends. You would be surprised if you start asking people about who they know has been diagnosed with a recognised mental illness. It is a serious worry for us all. The cost to the community in both time and resources and for human and financial input will get worse and worse. It is important that we address it now, and address it in ways that will be sustainable.

I have some real issues with community placement of mental health patients, because I have seen some terrible examples of where they have not been given the support they require. I have not been able to find it, but there was a report in the Messengernewspapers a number of years ago. I am fairly certain that the headline was: 'Glenelg—Glenside's new annex'. At Glenelg we have a lot of supported residential facilities and a lot of boarding houses.

A lot of people were being placed in the community and put on medical regimes and medication, and they were not being medicated or supervised to the extent that they required. As a result, they themselves suffered even more intensely from their mental illness, and those around them were suffering as a result of this illness not being treated and not being managed the way it should be and needs to be. It was no fault, in most cases, of the people themselves, because they were mentally ill. In many cases, they did not recognise the situation they were in.

In fact, my wife was not physically abused but, certainly, verbally abused by a man in Glenelg. She just happened to walk near him, and next thing he was really abusing her. It was quite a shocking experience for her. I have heard the same story many times in and around the Bay. There are still a number of supported residential facilities in and around Glenelg. Until recently, Melanie Clark ran one in Byron Street, where a number of people were seriously ill. We worked out that Melanie was doing it for about $5 an hour; it was incredible. She is an absolute angel. These people were really ill, and she and her staff were looking after them exceptionally well.

There are other cases. Some of the chemists at Glenelg have reported to me that in some boarding houses some people were not being medicated. There are fights over money and there are fights over cigarettes and medications, so these people were suffering. If we are going to continue with placement of mentally ill people—and I think that the policy is one that could work if it is supported—we need to make sure the money will go there. But, I emphasise that it will be extremely expensive to do that.

The other episode in Glenelg relates to a case where people were making money from these poor people. A couple of guys, who thought they were being enterprising, were buying houses and turning them into what were called 'multiple use dwellings'. They changed every room. I think the member for Bright also had the same issues in her electorate; she is familiar with these gentlemen. They were turning every room in the house into a bedroom, other than the bathroom, toilet and kitchen, and sometimes they were doubling up within the rooms, and charging these people big money to stay in these places. They were not being managed or supervised and, unfortunately, some terrible issues arose.

There was one near St Leonards Primary School, about which I did media in order to force these people and the council to take the appropriate action, where people were behaving in a way that we would consider to be outrageous. But, once again, this is an illness, and they did not really comprehend the enormous effect of their actions on the rest of the community.

We need to make sure that we recognise that mental illness is serious. It is treatable in most cases, or manageable; or, if it is not, then people who need to be confined for their own safety and the community's safety need to be put in facilities that are modern and suitable for them; not the old stone walls and broken glass topped walls of Parkside, but modern facilities. I am inclined to believe that Glenside is still that facility. The basics are there now, and there is still an opportunity to use that facility and improve it without spending money on building newer facilities.

The staff who work in these places have my utmost admiration, because they need to deal with incredibly difficult cases who, because of their mental illness, are becoming physically abusive and violent. So, we need to take our hats off to these people and make sure that we are not only providing them with our support in this place but also with the infrastructure and financial support to do the job that they want to do. You have to be a very special person to work in this area. It is amazing to speak to people about the difficulties that exist for both the patients and their carers and doctors.

This house needs to take care of the issue of mental illness as a result of drug abuse. Wherever we can test for drugs, whether it is at the Big Day Out with sniffer dogs, through drug driver testing or increased vigilance and resourcing of police to reduce drug use, that will go a long way to helping reduce, I hope, the abuse of drugs and, therefore, the ongoing mental illnesses that result from the overuse of drugs.

The bill seeks to make provision for the treatment, care and rehabilitation of persons with a serious mental illness with the goal of bringing about their recovery. That is something that nobody in this place would disagree with. I hope that this bill actually does that. Certainly, while the opposition supports the bill, we do have some concerns about it. I hope the government considers our concerns and does not look at them from a pure political ideology or other political agendas.

The money is going to be hard to find, but the cost of not spending that money could be far greater than spending it. Making sure that we resource mental illness in South Australia is paramount. As the member for Little Para said, Margaret Tobin was a champion of the mentally ill. She did a wonderful job and to have a facility named after her is something that I strongly support. We need to remember people like her because, in many cases, they did a lot with incredibly little resources.

The bill wants to go a long way and let us hope that it does. We see a lot of legislation in this place containing lots of words and pages but, unfortunately, the end result is not very much. This bill is incredibly important for all South Australians.

Ms FOX (Bright) (16:58): About one in five Australians will experience mental illness at some stage in their lives. The most common mental illnesses are anxiety disorders, which affect one in 10 adults. Anxiety and depression are very closely linked, and this nation as a whole has spent the last 20 or 30 years grappling with ways of dealing with depression.

When I say 'dealing with' I do not just mean seeking medical and therapeutic treatment for the disorder, I also refer to the sociocultural struggle of admitting that anxiety and depression are illnesses, that we can admit to them and that there should be no stigma attached to those who suffer from them. I understand that some five per cent of Australians experience anxiety which is so debilitating that it impacts on every part of their lives.

Almost one in 100 Australians will experience schizophrenia during their lifetime, and three in 100 Australians will experience a psychotic illness, such as schizophrenia, bipolar disorder and, increasingly, drug-induced psychosis. I know that every single person in this house knows of someone in their immediate or wider circle who suffers from such an illness, and we all know how terrible the burden of schizophrenia can be on those who suffer from it, and their families who live with it as well.

Mental illness is the third highest incidence of disease in Australia, followed closely by cancer and cardiovascular disease, and it is the fourth most common reason to seek help from a GP. I rise to speak on this bill today because I, like many others, have had experience, not only as an MP but as a private individual, with people dealing with depression.

I would like to say, as one of the younger members of the house, that I went to university in the late 1980s and early 1990s when perhaps the results of using marijuana were not as widely understood as they are now. I am sorry to say that a number of people with whom I went to university ended up having to be cared for in institutions because of mental unwellness due to drug use. It is an absolutely tragic thing to see. It is a horrible thing to see a young person—a contemporary of one's own—destroying their life in one night because of drug use.

On a fairly recent visit to Glenside Hospital, I spoke with a nurse who worked there. She told me that there are now something like four times as many admissions to the hospital related to drug use as there used to be 15 years ago. That is a message that we absolutely need to get out to people: that drug use can make you very, very mentally ill. Somehow a lot of young people do not seem to realise that.

Like many in this house, my heart goes out to those who suffer from mental illnesses. This is not something that is easy to admit or easy to talk about but, as times change and we become better at acknowledging the incidence of mental illness in our community, it is timely that this bill is before us. I would like to congratulate the minister and her predecessors who have worked so hard to try to make it an act which is more inclusive, more supportive and more equitable.

A number of constituents in the community have approached me, deeply distressed about their children who are mentally unwell. One of the points that has been reiterated to me is that these children—often physically very well people in their 40s or 50s—are known by their parents to be at risk. Parents know their own children. They know when their children are not taking their medication. They know when things are about to turn critical. In the past, the criteria for orders for treatment of persons with mental illness have been about imminent risk but, by broadening the criteria as set out in clauses 10, 16, 21, 25 and 29 of this bill, we allow earlier intervention, and I am very pleased that this should be the case.

I am also pleased that we will see the continued role of the Guardianship Board in reviews and appeals, because I have understood, once again, through speaking to constituents about these matters that this scheme to provide legal representation for people to appeal against an order is strongly supported. I commend this bill to the house, and I would like to congratulate the minister again on her work.

Mr PISONI (Unley) (17:02): I just wanted to use this opportunity to talk about the government's approach to mental health facilities, particularly those in and around my electorate of Unley and the Glenside development. I must say that it was very disturbing to hear the Deputy Premier say today that they want to build 1,500 Housing Trust houses on the Glenside site. I think the overwhelming issue that was raised with me as I doorknocked the main avenue at Frewville on Saturday was the development of the Glenside subdivision and, in particular, the sell-off of land and the developments proposed for the Glenside site.

People could not understand why the development of a new mental health institution required the selling of government assets to fund it. Recently, we saw a $173 million development at the Flinders Medical Centre. I think it was a new emergency wing. When that came through the Public Works Committee, I asked the officers who were there if any land was being sold off to fund this addition. It was interesting that I got a very strange look. They said, 'Of course not. Of course we're not selling any land to fund this. This is coming out of the health budget.' However, when it comes to mental health, the justification for selling off the land is to pay for the new hospital.

It is interesting that we continually hear the Premier boasting about how we are going on a capital spending binge here in South Australia. Not like the other states, he says—'We haven't deferred any of our capital expenditure.' However, there are a number of capital expenditure items that have been announced as being delayed by this government, and the new hospital at Glenside is one of them. However, it has not delayed the sell-off of land, nor has it delayed the Film Corporation moving in. My understanding is that the budget to build the hospital was around about $100 million and the government did not have that kind of money.

I think the delay of two to three years was going to save about $26 million, but the government found $45 million to move the Film Corporation into those beautiful buildings in the main centre of the Glenside campus. It found that $45 million. I do not know if it was under the couch, but it certainly gives an indication of the priority that this government has for health and other services, when a delay of a $100 million hospital is announced but half that amount of money ($45 million) has been spent to move the Film Corporation from a facility at Findon, where it is operating at the moment, to Glenside.

What adds insult to injury for the Glenside patients is that, at the moment, the government is spending $5.5 million to, if you like, give it a lick of paint, do a bit of carpentry work, oil the hinges and wax the window slides, maybe even clean the windows in some of the older buildings, and, because it wants to put the Film Corporation in, is moving the patients out of the building into temporary accommodation. That was supposed to last only three years, but we are now told, at Public Works, that it may very well be used for up to seven years. The way the government has treated those patients at Glenside is an absolute disgrace.

Another concern that has been raised with me in my electorate is the fact that we are losing open space. There is an argument we hear from the those who do not understand the Parklands and who do not understand the importance of open space and, particularly, the importance of significant trees in the inner suburbs. They say, 'No-one uses it, so let's flog it off.' I put to them that everybody who drives past that open space at Glenside enjoys it, as does everybody who walks past it, and everybody who has birds and other wildlife visit their homes because of those significant trees.

I do not know, in this day and age, how a government that claims to have green credentials is happy to go in and bulldoze over 100 significant trees for developers. It is a pity and a shame. The inner suburbs are a very desirable place to live. People pay a premium to live in the inner suburbs, particularly in Unley, and in the member for Bragg's electorate. Obviously, that premium is counted in the cost of real estate but it is also counted in the fact that we have very little open space.

Not only do we have little open public space but we are also seeing an encroachment upon our private open space. Not only are we losing flora and fauna from our public open spaces, as they are diminishing, but we are also losing that from our private open spaces, as we see the influx of urban consolidation in the inner suburbs. The former minister for mental health said that a sell-off of the land at Glenside was 'part of the plan' to contain the urban growth boundary. That is in Hansard. Do not just take my word for it, it is there.

It is also disturbing that the government plans to increase the population of South Australia up to two million. It is a little hard to get the exact figure from the government, but I know it has been quoted that as high as 80 per cent of that growth is to come from infill. That is another reason why it is so important to retain this open space. Of course, I doorknocked Main Avenue in Frewville. I must say to those who doorknock regularly that it takes a couple of hours to doorknock the average street of about 70-odd homes, but it took me four hours on Saturday because everyone was so concerned that they wanted to talk. They wanted to talk about this problem of the Glenside sell-off, the impact that it will have on their standard of living and also, of course, the traffic in the street.

Already Main Avenue at Frewville is used extensively as a shortcut from Portrush Road through Conyngham Street onto Glen Osmond Road. It is a very narrow street. As a matter of fact, if cars are parked on either side of the road and you are driving a large car, you will struggle to drive between those two vehicles. I think not a week goes by when a side mirror is not collected by those less experienced in parking in that street; that is, those who do not realise that, if you park there, you need to tuck in your side mirror or risk losing it. If you look at the entry points for the housing developments on the Glenside site, you will see that they rely heavily on Conyngham Street, Main Avenue and Flemington Street. Of course, Flemington Street is not a through street, so that will put more pressure on Main Avenue.

I am not exaggerating when I say that, when I was in Main Avenue, I saw a car travelling in either direction at least every 20 to 30 seconds. The amount of traffic using that street on a Saturday afternoon was extraordinary. I will be very interested to see a traffic report from the department or someone within government that has analysed the impact that the residential development and the commercial development will have on nearby residents.

In the electorate of Unley, we are fighting hard to retain our public open space. We are fighting hard to retain our private open space. We can see that the priorities of this government are all about urban consolidation. We can see that in its population plan. It is about facilities for the Film Corporation, rather than facilities for mental health patients. Mental health patients can wait, but the Film Corporation cannot.

That is the thing which I find difficult to understand. I am still trying to find in the Cappo report where accelerating the shift of the Film Corporation into the Glenside campus and delaying the hospital will benefit mental health patients. Perhaps the minister might like to highlight that in the report with yellow, orange or green highlighter—I do not mind, whatever colour—and I will then eat my words and say that I was wrong, that in actual fact it was recommended by David Cappo that the new building be delayed and the Film Corporation be moved in forthwith. There is also the concern about the deal with the supermarket owners.

I want to give an example of where it is not right for the government to say that valuation is suitable. In my electorate of Unley, the chemist shop on the corner of Mitchell Street and King William Road was valued at $1.8 million. I think that the real estate agents were saying that, when it went to auction, it would get $1.8 million. According to the government that would be the value of that building—$1.8 million. But the surprising thing about it was that there were several very interested buyers, and on the day the hammer came down at $2.8 million—not $1.8 million, $2.8 million. A responsible government would want to ensure the best possible return for taxpayers.

The example I have given the house, comparing a valuation with an auction knock-down price, illustrates just why we feel it is not right that a single purchaser can be offered a government property at valuation, because until that property goes on the open market the true value cannot be determined. The example I gave earlier shows that the value is increased if there is more than one interested buyer, and I know for a fact that at least half a dozen people would like access to an open bid or an open tender for that property.

Then, of course, for some reason the government seems to think it is qualified to determine where shopping centres should be. I think I heard the minister or one of her representatives at some stage mention that another plan for the Glenside redevelopment was a supermarket because the area needs supermarkets. I can tell members that the electorates of Unley and Bragg are very well serviced by supermarkets. We have the Norwood Shopping Centre (both strip shopping and the shopping centre itself), we have the Burnside Shopping Centre, we have the Unley Shopping Centre and we have the Arkaba and Mitcham shopping centres. Of course, if it is a pleasant day, within 30 minutes you can walk to the mall from the Glenside campus.

As the local member, I have not been satisfied with the justification for sell-off of the land. I think it is outrageous that any other health user has their facilities paid for out of the budget but mental health patients can have their facilities only if they give something up, and that is the open space which they use and which they value. I know for a fact that many of the users of that facility claim that using those grounds is part of their rehabilitation. It is one of the things they enjoy doing during their rehabilitation process. It gets them ready to go home and to recover from the trauma they have experienced.

I think this whole Glenside debacle reflects badly on the way the government manages mental health and those with special needs. Late last year we had enormous difficulty with a Housing Trust owned property that was half tenanted to the Aboriginal arm of the Housing Trust. We had a couple of Housing Trust tenants in there. Then we had a number of tenants who were recovering from mental health issues. They were recovering from drug and alcohol abuse, and, according to the department and the minister's office, they were supposed to be under care for about 18 hours a day. However, according to the residents who live in that street, they were lucky to see someone there for 10 minutes once a day. It was an absolute hell for the residents.

One of the residents witnessed a sexual assault in their front yard. Residents were afraid to open their doors because they knew it would be one of the temporary tenants in that building either asking for money or wanting to abuse them. A mother of a young child, whose husband often spent days interstate for business, came home one evening and pulled into her driveway only to see two men fighting on her front porch, so she backed out of the driveway and went back to her mother's house. It was no way for people to live in the neighbourhood.

How did the government deal with that? I give Jay Weatherill, who was the minister at the time, credit for coming to my electorate office and meeting the 30-odd people who were in that situation and listening to them. But the only solution they could come up with was to sell that block and move out the tenants. They could not manage it, so they sold the block. I think we have a situation where people in this community are desperate for help they are not getting, and the government does not know how to deliver that help; consequently, it has thrown its hands up in the air and it is selling the assets that were there to provide that help. What happened in Fashoda Street is an example of that, as is what is happening at Glenside.

Mrs PENFOLD (Flinders) (17:22): The treatment of those diagnosed with mental illness has changed dramatically over the past few decades. Mental health is now talked about openly and some sufferers willingly admit to their problems and their need for treatment; however, many do not. It is very hard for families to have children born with a mental disability and just as hard to see those who develop one later in life from disease or accident. The medical understanding and treatment of mental illness is better than at any other time in our history and should continue to improve as we all become more aware of the complex issues that cause mental illness.

This is a positive change that is to be commended. As a society, we need to accept that mental health is an important component of the total health of each of us and, therefore, of our communities. It may be things as simple as a child being frightened when left alone in a strange place, bullying, the aftermath of the recent fires, or something as severe as a person who is unable to function in everyday life who is delusional but unaware that their reality is not the reality of those around them.

The major disaster of the Victorian bushfires has brought mental health to the forefront of the public consciousness. The distress of the fires will continue for many years and, in some cases, for a lifetime for these people. We, on the Eyre Peninsula, are still seeing the effects of the Tulka and Wangary fires, with the recent Port Lincoln and Victorian fires having reopened the mental wounds.

I am constantly angered and dismayed at this government's neglect of those who reside outside the metropolitan boundaries of Adelaide, particularly the neglect of children who do not come under the adult mental health system but a separate system that has no resident workers that I am aware of in my whole electorate. We need mental health facilities and professionals, possibly even more than city folk because of the added stresses of isolation, distance and the lack of many things such as the mobile phone and computer services that city people can take for granted.

I am concerned about the government's fanciful and ill-considered plans for mental health inpatient services now provided by Glenside. I sincerely hope that any suggestion to move the hospital to a proposed location near Mobilong Prison has been well and truly killed and buried. The support of family and friends is a significant aid in the treatment of mental illness. It beggars belief that the government would move residential treatment to a site that is impossible to get to for most South Australians. Therefore, the mooted redevelopment of the Glenside site is of paramount importance to all South Australians.

The recommendations from the Select Committee on the Proposed Sale and Redevelopment of the Glenside Hospital Site emphasise the lack of understanding this government has for its responsibility to govern for all South Australians. I trust the minister and her colleagues will take note of the considered and common-sense recommendations.

The state government's cuts to rural and regional country hospitals brings an urgency to the treatment of country mental health patients. In October 2007, the then minister for mental health and substance abuse said that psychiatrists and general practitioners would be able to order the detention of mental health patients under proposed new mental health laws so that country hospitals could provide secure care for up to seven days. However, the minister failed to explain that it is regional hospitals rather than country hospitals that will have this type of facility. Some people will have to travel 400 kilometres or more to access this type of treatment, and the reality is that treatment for some will remain the impossibility that it is now.

Some accommodation at Glenside could be purpose-built for people who are currently in the penal system as an outcome of mental health issues that cannot be (and have not been) addressed. The government's 'rack 'em, pack 'em and stack 'em' policy may give the minister a warm glow, but it does nothing for the long-term treatment of criminals with mental health issues in this state. All but a few will eventually return to society. Sound mental health treatment will ensure that a large proportion do not reoffend.

I was contacted by the distressed family of a young local person who was imprisoned at the Port Lincoln Prison until he could be assessed by appropriate mental health professionals who had to come from Adelaide. The delivery of mental health services is concentrated in the Adelaide metropolitan region, effectively ignoring rural and regional South Australia—about one-third of the state's population—leading to odd decisions such as the deployment of a person at Port Lincoln as half-time arts officer for Eyre Peninsula and half-time mental health project officer for Southern Eyre Peninsula, presumably covering half of Eyre Peninsula and probably without any funding or consideration for cost in time and money of covering this huge area.

This woman's background training and experience has enabled her to make positive inroads into what is a very curious combination of duties that are, in some ways, complementary. While we need more mental health workers in regional South Australia, I acknowledge that it is impossible for sufficient health professionals and specialists in the various mental health fields to be living and working in selected sites in rural and regional South Australia. Hence, Glenside provides a central site for the efficient and effective delivery of services.

A central site such as Glenside is an issue of social justice so that patients and their family and friends from across the state can have reasonable access, for example, for a person flying or driving to visit a patient. The support of family and friends is a vital aspect of treatment and recovery. It would be beneficial if some accommodation for country families were available on site, similar to Greenhill Lodge for cancer patients, and I understand that there is room for this at Glenside.

South Australia should aim for world's best practice that would be recognised nationally and internationally. Paying patients from other states and overseas may choose such a place for treatment. For instance, the Western Australian footballer Ben Cousins went to the United States of America for treatment for his drug problem. The diagnosis and treatment of all facets of health has advanced infinitely in recent years. We do not know what the future holds, and this is especially true for the treatment of mental health.

A drug culture has developed in our society with more and more evidence of the long-term irreversible effect of drugs such as cannabis which were previously thought to have no detrimental mental health effects. All illicit drugs are detrimental to the mental health of a person, but the effects on young people and the shocking deterioration in behaviour and honesty experienced by their families is distressing to listen to. Violence towards family members necessitating police being called in is very common and a great concern.

I heard of a woman in her 20s who would not go to a social event until she had popped a pill. These people all need mental health treatment. When we get to the stage where we admit this freely and openly, we will have made considerable advances in the 'health' part of mental health, but we are nowhere near that stage yet. Families are seeking help from their local member of parliament because they do not know where else they can go to try to get help for their children.

Our mental health workers and facilities for treatment must be easily accessible and available to all sectors of our state. Alcoholism is now recognised as a mental as well as physical disease, but it is not so long ago that the town drunk was believed to be unredeemable and was treated as just a blot on the landscape. Great advances in the treatment of alcoholics were made in this state when a doctor who was an alcoholic successfully turned to abstinence. He used his experience and knowledge to turn around medical treatment. Many of these people had formerly been incarcerated in mental institutions because they were considered hopeless.

The society we live in today is vastly different to any period in history. However, through modern media we are bombarded every day with scenes of violence and death, flood, fire and famine, and the notion that the world is in crisis through climate change and that we may possibly face being wiped off the planet. This triggers mental problems in some people that we are presently unable to cope with, particularly those who have been through similar traumas.

It is ironic that, at the same time as the government is building a monument to itself in the new Mike Rann hospital, it is reducing mental services to a point that will take the state backwards for decades. This is happening at a time when mental health is being recognised more and more as a component of physical health. Postnatal depression is a case in point. New mothers used to be told to snap out of it. It is now realised that a woman in that condition cannot just snap out of it.

School counsellors are needed. We also need people in our remote locations, where substance abuse and petrol sniffing can be treated at an early stage. Mental health is recognised as an illness, and it is also recognised that it affects children as well as adults. We need trained contact persons at the coalface so that illnesses can be treated early, thus preventing an escalation into more destructive and socially unacceptable actions and behaviours. We also need to secure central facilities with accommodation for families, for those who need it.

I will now quote Dr Fleming from Tumby Bay. An article from the Port Lincoln Times in August last year illustrates the problems that we are seeing on Eyre Peninsula. It states:

Tumby Bay GP Graham Fleming said the 'backbone' of psychiatric care in rural areas is being increasingly undertaken by GPs. Dr Fleming said a lack of psychiatric care for children and adults on Eyre Peninsula is a worrying concern. '50 per cent of mental illnesses begins in children,'...'We are never ever going to have enough child and adult psychiatrists, there's no training,'...'We need a system whereby the kids that have got the problems can be identified early. Now we're just waiting for them to fall off the tree.'

Dr Fleming said most rural areas are understaffed, and Eyre Peninsula is no different. He said the state government's mental health system is in disarray, and prisons are now the 'new mental health hospitals'.

Dr Fleming said the federal government has 'handed out a lot of money' to allow GPs to learn basic mental health skills, however, there is no one to come here and deliver the skills.

'It is a matter of delivering training to GPs to be skilled enough to work in a mental health area,'...'Most of the mental health load is managed by GPs and that's going to keep happening. The mental health system in our state is in a state of collapse.'

Dr Fleming said that what is desperately needed is a team of mental health workers, bridging the gap between GPs, psychiatrists and patients. 'The issue is that we have a very good hard-working team in Port Lincoln, but they are just overwhelmed,'...'The workers who are in the area are working flat out, and doing fantastic jobs. My criticism is against the system, who can't support the people here.' He said the division has supplied two counsellors to Lower Eyre that is filling the basic needs for the counselling side.

However, Dr Fleming said there is a high rotation of mental health workers on Eyre Peninsula because the workload forces some to eventually take stress leave. 'The reason they leave is because they get swamped and overwhelmed,' he said. 'Their workloads are astronomical.'

This was followed by a letter to the editor the following week. It states:

After reading Dr Fleming's article in the Times on August 14, I felt compelled to respond.

I am in full support with what Dr Fleming is saying.

As a person who has 'been there done that', I feel for the GPs on Eyre Peninsula and the mental health services, with the increasing amount of people becoming mentally unwell, and the lack of availability to access psychiatrists and psychologists.

I am a community member, not attached to any organisation but am constantly called upon to assist people in mental health crisis in my own time.

We don't only need social workers, mental health nurses, psychiatrists, psychologists, we need female psychologists to deal with the traumas people experience as children and for children who experience trauma, before they enter the adult mental health system (some people feel more comfortable speaking to a female than a male, and we should have a choice).

I know from my own experience, most of my traumas happened in childhood and young adolescence, but I was never diagnosed until middle age as having mental health issues. I was able to recover thanks to Dr Elaine Skinner who was a resident psychiatrist years ago, but we no longer have that privilege.

I agree that the mental health services are understaffed and overloaded, which is the reason the retention rate of professional staff is difficult.

I feel we should not be sending our people to Adelaide for psychiatric care. They are isolated from their families, friends and any support networks the people have, which I believe adds to the person's stress.

I also believe everybody has a right to quality of care, in particular, when they need to see a psychiatrist their appointments should not be cut short due to the number of clients the psychiatrist needs to see in the short time they are here as visiting psychiatrists.

If one in five adults do get mental illness then there must be about 4,400 on the Eyre Peninsula who have had, who have or who will have a mental illness. I hope this bill will help those people and their loved ones, as well as those who live near the cities.

Mr HANNA (Mitchell) (17:36): I have some remarks to make about the government's significant reform of the mental health sector. This legislation has been through a fairly long process of development. I am pleased to say that many of the initial concerns that I had, very grave concerns about the initial proposals, have been answered by the changes that have been made to the bill. The legislation which the minister has now brought into the House of Assembly is certainly not as dangerous as the first draft.

I want to make a couple of general remarks about the mental health area before turning directly to the bill. It is an issue that comes up again and again in my electorate of the south-western suburbs of Adelaide, the Marion and Reynella districts. Not a month would go by, probably, without some fairly significant mental illness issue being presented. Very often it comes in the form of a family member who finds that their child, or perhaps another relative, has not been able to get adequate care.

In many cases the family member concerned is in the community, and may have spent some time in psychiatric care. In many cases, whether the person lives at home or by themselves, they do not receive sufficient visitation from nurses or psychiatrists or mental health workers, and very often problems arise when the person concerned stops taking their medication because they feel fine or because they forgot and then severe problems, even violent episodes or psychotic episodes, can be easily triggered.

I have dealt with a number of families in particular where I have worked with the parents to try to obtain adequate care for their sons. I can think of at least half a dozen families in my local area where this problem has arisen. One issue, of course, is that some of the conditions that we are speaking about are triggered or accentuated by illicit drugs. That is probably a question for another day, but I must mention it in the course of this discussion, because the proliferation of new chemical drugs in particular seem to have a particularly adverse effect on those susceptible to psychosis and, in particular, they seem to create the conditions for extremely violent outbursts.

An honourable member interjecting:

Mr HANNA: No, not this time. One of the problems has been comorbidity. In other words, where there has been drug usage as well as inherent mental illness, I have dealt with situations where psychiatrists have refused to treat someone because they will not leave alcohol or some other drug alone. At the same time, the drug and alcohol worker assigned to that person throws up their hands and says that they can do nothing because the issues are really psychiatric. So, people have been sent from pillar to post trying to seek some effective remedy.

I must say that, even though those individual cases have eventually been resolved one way or another, none of them have really had happy outcomes. Most of the people concerned—and these are young men I am talking about—have ended up in institutions, some in psychiatric care, but others in the more commonly used institution for the mentally ill, and I refer to our prison system.

People talk about the deinstitutionalisation of mental health care since the 1980s. There was the closure of Hillcrest Hospital and there was a policy that people with mental illness could, and should, live in the community with adequate support so they could live what is termed a normal life. In reality, institutionalisation never went away: it is just that the primary place of care for a very significant number of our mentally ill remains our prison system. So, it is a different kind of institution. It is probably not much less expensive to run than a place like Glenside. There is certainly a lot less psychiatric help available to people in places like Yatala or even the Remand Centre, and I suspect that most of the passengers through those institutions end up worse, not better.

The other place where we find a number of mentally ill people, sometimes after they have come out of prison or other institutional care, such as Glenside, is in the Parklands. It is not an institution, but it is certainly a disturbing phenomenon that many of our homeless exhibit mental illness. It is particularly difficult to treat a person when they do not have a fixed place of address. At least in prison, there is some prospect of a psychiatrist ending up dealing with someone, at least superficially. When people do not have a fixed address, it is that much harder to provide psychiatric care and the support services necessary to get them back on track, should they wish to get back on track.

I have taken a very close look at the Stepping Up report that came out a number of years ago. It is a really excellent blueprint for improvement of mental health care services in South Australia. I believe that there is progress taking place, but it is very slow. Part of the problem, of course, is the financial constraint under which we work. We actually need more buildings to offer housing and support services to our mentally ill.

One particular idea that I have been pushing, since I had to deal with those very troubled 18 to 25 year old men who have occasional violent psychotic episodes, is a sort of safe house where a number of such people could live with constant mental health nursing capacity available and perhaps some sort of curfew whereby they could work and socialise during the day and early evening but there would be some requirement for the people who live there to return in the evening to ensure they take their medication and generally to make sure that they are on track.

These sort of ideas are controversial because, as soon as you start talking about that sort of institution, people react to the very notion of an institution. To me, institution is not a dirty word but, if we are going to develop new mental health care facilities, they are not going to be like the institutions of the old days. They are not going to be like the prison hulks that we used to have off Largs Bay. They are not going to be like the insane asylum that used to be situated just off North Terrace—not this one, but a little bit further up the road!

We are going to have facilities which will be more transparent and, I hope, recognise the different grades of mental illness. That was one of the good things about the Stepping Up report, because it recognised that it is not a matter of people being in an institution or out of an institution; it is a matter of offering a range of different kinds of facilities depending on the nature of the mental illness.

I turn to the bill and the general nature of the concerns I have about this type of legislation. I refer to that balance between liberty and enforcing care on people who cannot very well care for themselves. It is very difficult judgment to make. It is almost a matter of life and death. Fortunately, we have a very large number of excellent professionals, in terms of mental health workers, psychiatrists, psychologists and so on, in South Australia but connecting the right people to the right type of care remains the problem. This balance between liberty, on the one hand, and enforced care, sometimes enforced sedation, is a difficult one.

Lest it be thought that I am blowing the civil liberties trumpet and warranting the do-gooder tag that the Premier sometimes throws at people who talk about liberty of our South Australian citizens, I think we should spell out some of the infringements on liberty that are permitted at present. The fact that we still have electric shock therapy or electro-convulsive therapy in South Australia is something that probably most of the community do not even know about. The fact that even surgery like lobotomy could be allowed is a fairly sobering prospect—startling, probably, to many in the community.

The fact that people can be sedated and shipped interstate under our current legislation and under the proposed legislation would probably shock a lot of people in our community if they thought about it. Most people in the community, of course, think 'This can't happen to me. I am perfectly all right.' However, these things do happen to somebody's kin, somebody's friend. We need to be very careful about striking a balance if we are going to allow such gross infringements on people's personal liberty.

To demonstrate that this sort of thing is not far-fetched, there is the notable case of Cornelia Rau, a woman I knew decades ago. Members will recall that she was found speaking in German, I think in Queensland initially, and was considered to be an illegal German immigrant and so she was incarcerated and, at times, stripped and kept in solitary confinement. I think her case demonstrates that, in Australia today, there is ample power for authorities essentially to capture and keep innocent people and not provide them with adequate care.

As I said at the outset, the government has taken on board many of the concerns that I and others have had about the legislation, and that is really pleasing. Later on, we will have to deal with questions of the Guardianship Board and the way that it makes its decisions, because this legislation ties in with that guardianship process whereby orders can be made for people's incarceration and enforced psychiatric treatment. One of the issues that arises from the families I have dealt with where there is a history of mental illness on the part of someone in the family is the issue of patient confidentiality.

It has been extremely frustrating for family members, including parents, to find out that their son has been released from Glenside without their being informed. In this sort of situation, in the past, people have been released from Glenside, apparently quite well, but because they have not been delivered back to their family, they can relapse and come into a situation of great danger. For those who care about people in that situation, it is extremely frustrating if they cannot get the information to be able to connect with their loved one and therefore provide family care for them.

This goes the other way as well, because I have also had contact with women who have been bashed by men who have been placed under psychiatric care and have not been informed of their release. There are a number of situations where it seems that there is a very powerful reason to go behind the normal respect we would have for people with mental illness and to breach confidentiality about some of their circumstances. It is a very difficult balance to strike and I think that this bill, in the end, is probably not a bad solution, but I know that will we continue to have problems.

I will summarise by saying again that the minister has thought through the issues, as far as I can see. The minister has taken on board many of the submissions that have been put to her to refine that balance between liberty and enforced psychiatric care, including medication and rendition to other jurisdictions. There will be problems no matter what. You can always have the legislation that sets the balance, but when it comes to the practical situations, people will make decisions one way or the other which will be debatable. It is significant that the legislation increases the number of people who can make those sort of decisions, for example, ambulance officers.

On the whole, I am happy to support the legislation because I think there is more positive in it than cause for concern. I do believe it is very important that we have a community visitor scheme so that there is some significant level of oversight into our psychiatric institutions. Later, when we deal with the Guardianship Board, I want to make it very clear that people should have the right to legal representation when decisions are being made about their liberty. For now, I am happy to support the second reading of this bill.

Mr VENNING (Schubert) (17:55): This bill seeks to replace the Mental Health Act 1993 and provides the basis for the provision of services to people with serious mental illness who are either unable or unwilling to consent to their own treatment. This bill is very important and needs to be treated and debated as such, and I do appreciate the remarks of those members who have contributed to the debate so far. It is also very complex and detailed, so I will speak only briefly. It is not a subject about which I have natural knowledge. People who are seriously mentally ill may not always seek or be willing to accept treatment for their illness, even though they may be placing their own safety or that of others in jeopardy.

The major focus of this bill is the use of powers to treat people against their will who have a serious mental illness. I think it is extremely important that the appropriate checks, balances and protections for the correct execution of these powers is legislated in this bill because effectively detaining or treating a person against their will, mentally ill or not, does take away their civil liberties. One area of concern for the people working in the mental health sector is that this bill enables more people to be detained, which some say is questionable and not always a good idea.

I have sought this information from the people who would certainly know. Many believe we should be reducing the number of mental health detainees we have in South Australia, not increasing them. The international trend is to reduce authoritarian or custodial retention, not increase it, so why are we going in the opposite direction? I am not saying that I necessarily disagree with that, but that is what has been said to me by people I trust to know what they are talking about. However, as I said earlier, in some cases release into the community may not always be possible as someone with a severe mental illness may pose a danger to themselves or others.

Many problems will arise if the number of mentally ill people detained increase, the most notable being space—where will we put them all? The state Rann Labor government continues to push ahead with the sale of half of Glenside. Not only will that remove the only safe facility for country people who suffer from mental illness but also it is one of the few facilities for our metropolitan patients who need care. I also note that the recommendations of the select committee into mental health said that the number of rural beds at Glenside should be doubled from 23 to 46. I would be interested to hear what the minister has to say about that.

The recommendations are there. We would agree with those recommendations, and hopefully the minister in her wrap-up will highlight that. The act will increase the number of mentally ill people in care, and the government must ensure that, with the increase in demand, the extra services go with it. The part of the bill that relates to access jurisdiction, which seeks to deal with patients who travel interstate to avoid community treatment orders, I think is a good idea. This may prevent a mentally ill person from harming themselves or someone else, or racing off interstate to avoid treatment. It is a very difficult area.

Mental illness is often a silent problem. One in five people we know will be somewhat affected by this disease. Anxiety and depression are so common. It is a silent illness and so many of us live very close to it. We do live with it. I am lucky to serve in the Barossa Valley, a wonderful place where I can go for my rest and recreation. In fact, I have guests in the gallery tonight who will share with me some of the wonderful things that I enjoy in the Barossa. It is great to have people from the Faith Lutheran School here tonight to share dinner with me. I also pay credit to Jeff Kennett, as did the member for Elizabeth, and the beyondblue organisation. I think that we need to give Jeff Kennett praise.

All of us live with some degree of mental health. We all have different degrees of wellness when it comes to our mental capacity. Some people would say that to be in this job for 18 years you need to have some treatment. I have to say that with an excellent electorate like I have, with good family backing and with good Christian ethic we can survive, and that is what it is all about—it is about people coping with their lot. It is a very important area. Glenside has been fantastic as a mental health facility, and I am concerned that large lumps are being sold off. We support the bill; and, hopefully, we will put up two or three amendments.


[Sitting suspended from 18:00 to 19:30]


Mr PEDERICK (Hammond) (19:30): I rise this evening to speak briefly to this bill which seeks to make provision for the treatment, care and rehabilitation of persons with serious mental illness with the goal of bringing about their recovery as far as is possible; to confer powers to make orders for community treatment, or detention and treatment, of such persons where required; to provide protections of the freedom and legal rights of mentally ill persons; to repeal the Mental Health Act 1993; and for other purposes.

The bill was first introduced to the parliament on 4 June 2008. The chief purpose of the Mental Health Act is to manage the process of detention and treatment, voluntary and involuntary. The revision of the Mental Health Act 1993 is intended to implement the recommendations of Ian Bidmeade's 2005 report entitled 'Paving the way'. This report proposed a number of changes to modernise the legislation and improve responses to people with mental illness.

The recommendations of this report are strongly supported by stakeholder groups and organisations. Many changes have occurred since the draft consultation bill was released in September 2007 and some stakeholders are concerned that the spirit of Ian Bidmeade's report is not fully implemented in this final bill.

The focus of the bill is the use of powers to treat people with serious mental illness against their will and provides for the checks, balances and protections for the transparent and accountable exercise of those powers. This bill is designed to provide a framework for providing the essential care and treatment while protecting the rights of the minority of people who are unwilling to accept treatment, even though they may be placing their own safety and that of others at risk. Key changes to the 1993 act made by this bill are:

the treatment of juveniles will be the same as adults for some conditions;

the introduction of audiovisual conferencing for medical examination, and I note this is mostly for rural and regional consumers, and it will be vitally important in a seat like mine which stretches out to the Victorian border, up to Swan Reach on the river and then down towards Clayton in the south;

level 1 community treatment orders to be invoked by an authorised medical officer, as well as the Guardianship Board;

to decrease the amount of South Australia Police time in dealing with incidents relating to mental illness by empowering mental health workers and ambulance officers to order the assessment of an individual;

treatment plans are to be more specific—for example, specifying which treatment is compulsory and which is voluntary;

the timeframes of treatment orders are to be made at more appropriate times, instead of people having treatment at 12am, for example; and

a new position is to be created of chief psychiatrist, with monitoring and review powers.

The Liberal Party is supporting the bill, although we will be moving some amendments. We are very concerned that only 23 beds are now allocated for rural and remote beds at Glenside and that the Select Committee into the Proposed Sale and Redevelopment of the Glenside Hospital Site has recommended in its final report that the number of beds be doubled to 46. I think the government really needs to listen to the select committee and to the needs of people in the country.

That is something that did not happen when the government initially brought out its so-called Country Health Care Plan. The government needs to take note that people in the country need as much or, in fact, because of the distances travelled by people, more access to care than people living in the city. People should not be denied decent access to care just because of where they live, especially in the mental health sector.

Today, I headed down to see the opening of the potable pipeline for Narrung and Meningie residents and there is some happiness that that has happened in the area. However, the mental health issues for a lot of those people over the last couple of years have been astounding. I compliment the doctors, the counsellors and the ministers in that area who, as far as I know, have got the area through without one suicide. I commend the volunteers, neighbours, whoever saw someone who looked as though they were at risk.

I recall hearing a story where a neighbour saw a person out in their paddock just wandering around looking lost, and they went over and talked to them and got them through it. This is why we need adequate mental health care for those who live in the bush because too often the Labor government has forgotten about them. A third of the population lives outside Gepps Cross and Glen Osmond, and sometimes I wonder if its voice is heard.

We have certainly had lot of issues in the last couple of years with dry seasons and exceptional circumstances over almost all the state except for the Lower South-East, and people are doing it pretty tough. I do note that there are extra counsellors out in the community, but we have to make sure that people's mental health needs are well looked after.

There are the pressures of drought, and I also note that river communities all the way along the river in South Australia are under a lot of stress. Irrigators at Berri or Renmark are spending hundreds of thousands, if not millions, on buying more water, and irrigators on the Lower Lakes and areas like Langhorne Creek and Narrung have not been able to access water for irrigation for a couple of seasons now. It has been damn tough for them all, and they certainly need the support.

Even though the construction of the proposed prison expansion at Mobilong has been deferred, the government's plan is to replace James Nash House with a facility there. I think the government really needs to have a good look at whether or not that is appropriate and whether or not it can get the staff down there for that facility because there is certainly not room in the current medical facilities around Murray Bridge to cater for an influx of mental health patients, let alone people with extra physical needs.

The government really needs to listen, see what is going on and make it attractive for people to live in rural areas, to stay there and work, study and learn the skills, or make it attractive for people to come out there. I think a rural electorate is a great place to be, to live and work, and a great place to grow up, but I do understand that, if you have lived in the city all your life, it can be like hitting a brick wall. I know what it was like for me when I came to school in Adelaide for one year.

Mr Pengilly interjecting:

Mr PEDERICK: I don't think so! I wondered what the heck I had got into. In conclusion, we need to make sure that the mental health needs of everyone in this state are catered for and not just those of the people of Adelaide. We need to make sure that there are enough beds for rural and remote people and that their health needs, especially in the mental health area, are met in a dignified way. I commend the bill.

Ms BREUER (Giles) (19:40): I think this bill is very important, and I endorse the member for Hammond's comments about living in the country and rural electorates. I certainly would not want to live in the metropolitan area. I find it very difficult after three or four days here and am hanging out to go back to my electorate.

This Mental Health Bill is very important, and we do need changes. Obviously, what we have had until now is not working all that well. As members of parliament we probably see more mental health issues than in any of the other roles that we have enjoyed in our past lives. We tend to be the end of the road, the last resort, for many people, families and friends of people with mental illness and people with mental illness themselves.

People come to see us to try to get help and in most cases we cannot give that help, we do not have the resources or the ability to give that help. Apart from sitting there listening and letting them explode and tell us their issues and problems, we cannot do much to help people, because mental health issues are such a difficult area to deal with. It is not easy. You cannot give them a pill and cure all their woes; there is a lot more to it with mental health issues. I am sure that most of us have had people who have come to us, family or friends, with someone in mind who they know is about to harm themselves or harm someone else. They know this is going to happen but it has been impossible to do anything about those people.

Everybody knows that there is an issue of concern but until they actually do something to themselves, harm themselves or harm someone else, we are pretty much powerless to be able to do very much about that. This is what I am pleased about with this bill, that we will be addressing that issue to some extent. I think that is really important. People get to that point where they are going to do harm to themselves and no-one is able to help them. Perhaps now we will be able to do something along those lines.

I remember in the past on a couple of occasions we have called Crisis Care, an ambulance or the police because we were really concerned about someone. There was one person with an alcohol problem, and there was very little we could do. Nobody could go out and check on him. It was a very sad situation, and short of going out there myself there was not much that I could do for them. I think this legislation will change that situation somewhat and perhaps in the future things might be better. As I said, the system does not seem to be working all that well now. It is working but not as well as it could, or we probably would not be standing here now in this place speaking about it.

On the issue of country hospitals, I have heard a couple of members opposite speak about the fact that they are taking beds away from Glenside, and the issue is: maybe they are, but they are actually going back into our communities. I would think that the members opposite would be embracing that. We all know how difficult it is, when you need medical treatment, to have to leave your community and come to Adelaide for that treatment. You are leaving behind your family, friends, community resources, the feeling of comfort, your comfort zone, to come away, and particularly for people with mental health issues it must be so much harder.

I am sure we all know of instances where somebody has come to Adelaide for treatment, they have had a quite violent or psychotic incident in their life and they get sent to Adelaide in a hurry, to Glenside (or whatever), they are treated with medication and then perhaps put on a bus (or whatever) and sent back to their community. By the time they get back to their community the cycle has started all over again.

Surely, it is much better to be treating people in our communities with our resources, with the support of family and friends around them. It seems to me a much better solution, and I am very happy that the people in my community will be able to get some local treatment, rather than having to come to Adelaide. So, I welcome that. I think it is a very important part of this legislation that we are looking at.

I want to pay tribute to staff in regional areas who deal with mental health issues. They are a small band, but they do do incredible work against all odds. The fact of the matter is, and I think this is still currently the case, that there is not one resident psychiatrist in country South Australia, rural South Australia, not one resident psychiatrist. Everywhere is visited by psychiatrists but not by any who live locally. You may find that you see a psychiatrist one week and then, three weeks later, you see a completely different one, so it is difficult to bond with them. The service is not terribly satisfactory, and it is very difficult for people.

There are limited numbers of psychologists in our regional areas, although a few of the bigger centres have some who are often connected with the education department. However, there are very few resident psychologists in country regions, mainly because you cannot get them to go out there. They will not leave the leafy suburbs or lose sight of the Adelaide Town Hall. They think their throats have been cut if they have to go past Gepps Cross or the Adelaide Hills, and this is our problem.

We have mental health nurses who work in isolated conditions with very little back-up support or places where they can download and talk to their peers about any issues and problems, but they do an incredible job. Generally, they are trained psychiatric or mental health nurses, although sometimes they are GPs, nursing staff or whatever. It is very difficult for them, so I think they deserve the highest accolade we can give them because they work in far more difficult situations and circumstances than their Adelaide counterparts. I think it is important for us, as country members, to pay tribute to them.

I feel as though I have a lot of experience with mental health issues because I have often said that everyone around me is mad and that I am the only sane person I know—but perhaps that is not the case! I visited Glenside once when the Hon. Lea Stevens was the minister for health. She arranged for some of us to visit and, quite frankly, I was absolutely horrified. I thought it was the most awful place I had ever been. I have been to gaols and visited the Bluebush Unit at Port Augusta Prison, as well as a couple of other places, but I thought Glenside was worse and I did not like it at all.

Again, taking beds out of Glenside suits me fine, and I am very happy about it. I understand that planning has commenced for 30 intermediate care beds to be located in country regions, and I am pleased about that. I think it is really important to get them out there, keep them in our communities and work with them there. As I said, you cannot solve mental health issues with a pill, although certainly medication helps create a better situation for people. So many other things are involved in the treatment of mental health, and I think it is important to make sure that their circumstances and surroundings are as comfortable as possible.

This is parliament, so certainly we need to be political, but I think, with an issue as important as this, we should not be too political. Let us be political about other issues but not about those that concern people's minds and lives. We are dealing with people who are so depressed that they cannot get out of bed in the morning and spend their whole day lying around their house or in bed because they cannot get themselves motivated. I think we all have mental health problems at some stage in our life, but the philosophy in my family is, 'Shake your feathers, get up and get on with it. Toughen up, soldier.' That works very well for some of my family, but for others it does not work well at all. It is not an easy situation.

Let us not be political about this legislation but support and embrace it, as it can only be for the good. It is not working at the moment, so let us get on and make it easier for people. Let us make this work. I support this legislation.

Mr PENGILLY (Finniss) (19:49): I also support the bill, and I look forward to the government's joining in the amendments that will be put forward by the member for Bragg. I hope that the government sees its way to support them, as I think they are in the best interests of the bill, but time will tell.

Mental health is, indeed, a very personal issue for so many people. Over many years, my family has not been exempt from the issues relating to mental health. I will not go into the details, but it has affected our family on a number of occasions. I have seen full well the dramatic effects that poor mental health can have within families.

I also add that my wife, who has been nursing since 1975, has on many occasions come home beside herself with issues dealing with patients, principally at Kangaroo Island Hospital where she has done the majority of the work. She has come home in a fair state of distress over some issues. Interestingly enough, my daughter, who now also works in the public health sector in the country, has her fair share of dramas about which she rings up and talks to her mother, and they share their worries about this. So, it does not escape anyone.

One of my major concerns is that only 23 beds are going to be allocated to our country mental health patients. I really do not think that is good enough. It is almost as though it is okay if you are in the metropolitan area but, if you come from the bush, once the 23 beds are filled, you are in big trouble. It is something that the new member for Frome may well take on board—that this Rann Labor government seems intent on screwing the bush for all it is worth, whatever aspect it is. He may need to take time to consider that.

Mental health is an enormous issue. If I go back to around the year 1975 or 1976, I can remember that we had five, I think it was, mainly young people who suicided on the island in the space of abound 12 months, purely because they could not cope with life as it was, and probably as it still is for many people. That had a dramatic effect on the people of the island. I know that, in my electorate now, there are numerous people who experience degrees of anguish over their mental health. Indeed, just down from my office, there is a facility that cares for a good number of those people. It is extremely sad.

Even those of us in this place at this time cannot escape the fact that, at some stage, we may be impacted by some degree of mental health disruption, and we will just have to cope with it. More to the point, the good people who deal with these issues through the health system will probably have to deal with some of us. We cannot hide from that. That is just life. The increasing pressures of life these days impinge on everyone. It is not the fault of individuals that they suffer from mental health problems, but we earnestly hope that everything possible can be done to bring them back to a sense of normality.

Indeed, amongst our political colleagues around Australia, you only have to look at what happened to Geoff Gallop, the former Western Australian premier who just gave up the job. He chose to get out the premier's job—a job he obviously loved—and get out of politics because of the depression that he was suffering. It was extremely sad. It was very sad for him, his family and for the wider Western Australian community. We do not want to forget about these things.

It is absolutely imperative that, through education and our normal health services, and more particularly in this case, the Mental Health Bill that the government has introduced, we address these issues and continue to strive to achieve improvements in the best interests of all those sufferers across the nation and, indeed, the world. I support the bill and I ask that the minister and the government consider favourably some of the amendments that we have put forward.

The Hon. J.D. LOMAX-SMITH (Adelaide—Minister for Education, Minister for Mental Health and Substance Abuse, Minister for Tourism, Minister for the City of Adelaide) (19:55): I thank the deputy leader and other members for their contribution to the bill. I am pleased that the members are generally supportive of the bill and recognise, as the deputy leader has, that this bill has taken a long while to reach this stage and there has been a massive amount of consultation, with many of the suggestions and concerns of those making representations being taken into account.

This bill was first introduced by the previous minister in June 2008. I made two changes prior to reintroducing the bill. These were to insert a requirement into part 10 of the bill, that any decision to send a person interstate either when they are in detention and treatment order or for assessment must be in the best interests of the person concerned. So clause 6(a)(ii) which deals with the objects was also modified to include protection of the person.

I am pleased that the Deputy Leader of the Opposition agrees with the government position that the District Court is an appropriate recipient of appeals against orders. She also agrees that the bill is explicit in that it recognises that a community treatment order is preferable to a detention and treatment order.

The guiding principles of the bill state that the services should be provided on a voluntary basis as far as possible and otherwise in the least restrictive way and in the least restrictive environment that is consistent with their efficacy and public safety. The criteria for each order also requires that any order under consideration must be the least restrictive means of ensuring appropriate treatment for the person's illness.

Similarly, the deputy leader has stated that the stakeholder group expressed concern that there is no reference to the Health and Community Services Complaints Commissioner in the bill. I think we would agree that it is not actually necessary to do so because all the complaints avenues that a person may have do not need to be listed in the bill. The bill does, however, mention the commissioner, and it is in clause 48, where there is a list of people who have a right to have unrestricted communication with patients. The Health and Community Services Complaints Commissioner and her staff are people included in this provision; so the bill does mention the commissioner.

Whilst there are many areas of agreement between myself and the Deputy Leader of the Opposition, there are a few matters that need to be corrected just for the record. She states that the community visitors scheme is completely omitted from the bill and that it is her understanding that it has never shown up in the bill.

Ms Chapman interjecting:

The Hon. J.D. LOMAX-SMITH: Did I misunderstand? I am sorry.

Ms Chapman interjecting:

The Hon. J.D. LOMAX-SMITH: That is what I wanted to explain. I am sorry; I misunderstood the deputy leader. As she points out, it is mentioned and, therefore, we believe that a scheme of this type should be well thought out and should enable all the services which may benefit from a community visitor to be included before one is included in a bill in this way. The community visitors scheme is relevant to a range of different groups, and this needs to be factored in from the outset. Therefore, I will oppose the amendments concerning a scheme of this type, not because I necessarily disagree in principle but because it requires a more strategic approach to its development.

The bill does, indeed, enable a scheme to be developed in the regulations but this would not occur until all the agencies with an interest and stakeholders have had an opportunity to consider the most appropriate model. After so many years of consultation I think it would be a pity to introduce something at the last minute that had not been part of the overall formal discussion.

The Deputy Leader of the Opposition also stated that she believes that 10,000 people a year in South Australia use mental health services in one way or another. It is worth correcting this information because I believe it is inaccurate. The document South Australian: Our Health and Health Services 2008, prepared by the Department of Health, provides verifiable data on mental illness and the use of health services in South Australia. As members will be aware, our State Strategic Plan has, as one of its targets, reducing psychological distress—that is, using the Kessler Psychological Distress 10-item Scale used to measure anxiety and depressive disorders in the general population.

This measure is widely used throughout the community and between 2002-03 and 2006-07 the proportion in our society with high levels of psychological distress actually decreased from 10.6 per cent to 9.5 per cent for people aged over 16 years. At the same time, the number of people admitted to public hospitals for mental health related illness based on the patient's principal diagnosis increased by 3.1 per cent. During the same period, there was an increase in community mental health contacts to about 21.7 per cent.

What the data tells us is that the mental health of people in the state and the mental health system are moving in the direction we want, in that people are more often involved in community mental health contacts than they were previously, and the level of psychological distress has fallen.

Let us return to the 10,000 people mentioned by the deputy opposition leader. I refer to our records from the 2009 edition of the Report on Government Services, which is released annually and which provides a range of data on government services. This was part of the Council of Australian Governments' work looking at the effectiveness of government services. That report for South Australia recognises that, in 2006-07, all up, 4.5 per cent of the population made some use of mental health services. Calculated through these means, looking at the Medicare fees and the number that were involved in clinical mental health services that were state funded, I am informed that this means that 23,700 people in fact—more than double the deputy leader's estimate—received services from the state mental health system. This is a very significant number of people.

The other matter on which I would like to comment is the matter relating to the amount of staff working within the system. Certainly, we do believe that a well-functioning system relates to the staff, the legislative framework and the services available. During the deputy leader's second reading contribution she said:

...I would not want it to be accepted that, in the opposition's welcoming of some of the aspirational changes in updating this legislation, a change in the legislative framework in any way reflects some coincident introduction of a world-class mental health system.

I think we all realise that, as I stated in the second reading explanation, a world-class mental health system depends on effective legislation, as well as an effective framework, and that by itself is not sufficient to create a world-class mental health service. It also depends on services and good law working together.

In fact, the South Australian government in its services review in the 2009 report suggests that expenditure on each person in South Australia has risen between 2002-03 and 2006-07 by 35 per cent. During the same period, the national average increase in expenditure was only 25 per cent. Staffing figures for our mental health services have also shown significant improvement and have the highest population ratio for full-time equivalent health professionals directly related to direct care staff working in the mental health service. The ratio for full-time equivalent health professional direct care staff for South Australia in 2006-07 was 116 per 100,000 people, compared with figures for Australia as a whole (which were 20 per cent lower) at only 97 full-time equivalent health professionals for 100,000 individuals. South Australia has the highest mental health staffing ratio in Australia, and that is a very sound base from which to work to improve our system.

One area in which we need to be particularly careful about how we use and describe data is in relation to suicides. I do not wish to labour the point that the deputy opposition leader has made an error, but she did say that, in regional South Australia, there is a death by suicide every four days. I want to make it clear: any death by suicide is one death too many. However, it can be distressing for people in regional areas to believe that there are so many suicides occurring, and therefore I would like to give the accurate figures to the house.

Based on data supplied by the National Coroner's Information System, between 2001 and 2006 there has been an average of 157 suicides per year for metropolitan Adelaide and an average of 38 suicides a year from regional and rural South Australia, making an average of 195 suicides in South Australia each year. Certainly, this is 195 too many, but that absolute number has decreased somewhat in recent years and there has been an overall decline in suicide of 19.1 per cent, with a drop of 17.1 per cent in metro South Australia and a drop of 26.7 per cent in rural South Australia. Just to correct the record, there is not a death from suicide in rural South Australia every four days. If that were the case, there would be approximately 90 a year in rural and regional South Australia. The average over five years is only 38. Members can do the arithmetic themselves, but I think it is fair to get those facts on the record.

I know the deputy opposition leader expressed her displeasure that she does not have the draft regulations yet, along with the bill, and I know this is something she comments on regularly, but, in fact, I am told that it is not appropriate and not normal to have draft regulations tabled at the same time as a bill. In fact, the Office of the Parliamentary Counsel has stated that it would be inappropriate to approach the bill in that way because it prejudices how the bill may leave the parliament when one is not in the knowledge—

Ms Chapman interjecting:

The Hon. J.D. LOMAX-SMITH: —yes—of how the bill will end up being shaped through amendments. Anyone who has looked at the bill and the current act and its regulations would see that the provisions concerning interstate transfers are indeed included in the bill. All the major powers and responsibilities are in the bill and the regulations need to be transparent, and I would welcome the deputy leader's input during the consultation period. I would really welcome her input as to how those regulations might be shaped. I can advise that the Guardianship and Administration Act is under active management and review as part of the Attorney-General's legislative agenda. If the act can be improved and a bill eventuates, the public can provide comments on the proposal to the Attorney-General.

In regard to the Glenside redevelopment, the government will be providing a formal response to the recently tabled select committee inquiry in due course. I can advise the parliament that it is currently anticipated that the limited treatment centre, which the bill provides for, will enable country residents to be admitted and treated in some country hospitals, and they will be opened as soon as practicable following the proclamation of the new act. A number of issues need to be attended to, including the design of these facilities and appropriate staffing (which will include training) and the services being appropriately integrated into primary, secondary and tertiary mental health services so that clinical services and staff are properly supported.

It is anticipated that these new services should be on line by 2011-12. I have to say that the members have been very supportive of the bill. A number of issues have been raised and I have responded to each of these. One issue to which I have given further thought is enabling a person to appeal against a decision that they should be transferred to their home state. I understand the arguments that have been made about this, therefore I will table an amendment which requires the approval of the chief psychiatrist for a transfer to occur and which enables the person to appeal this decision.

Mental health services in South Australia are being rebuilt. The bill complements these changes, and the data I have discussed demonstrates that the system is being turned around and our strategies are being effective. The training of staff and the implementation of the bill is being planned. Stakeholders are supportive of the bill which is designed to enable South Australia to provide an effective, efficient and contemporary mental health service and which recognises and respects the rights of patients and their families.

We must remember that in the main it is families who bear the brunt of mental illness. It is families who recognise that something is amiss with a family member, encourage them to seek help and provide the ongoing support while that person is on the road to recovery. This bill aims to make the system more responsive to both the person with the mental illness and their families who need to be considered as partners with the professionals. The community now knows a lot more about mental illness than it did even 10 years ago. The stigma associated with mental illness is slowly being broken down. One commentator on mental illness recently stated that the greatest abuse of her human rights in a contemporary mental health system comes not from people being detained and treated unnecessarily but from people not being treated.

Mental illness can be a prison which restricts an individual's ability to act autonomously and determine what is best for them. This bill aims to free individuals from this prison by helping them get assistance when they need it.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 and 2 passed.

Clause 3.

Ms CHAPMAN: I move:

Page 6, after line 37—After definition of community treatment order insert:

community visitor means—

(a) the person appointed to the position of Principal Community Visitor under Part 8 Division 2; or

(b) a person appointed to a position of Community Visitor under Part 8 Division 2;

Madam Chair, with your permission and the indulgence of the minister, I propose to proceed on the basis that we have three general proposals for reform, the first of which is the proposed introduction of a community visitor scheme within the legislation, rather than possibly being pursued by regulation, as the minister has pointed out.

Those amendments relate to amendment Nos 1, 4, 5, 6, 7 and 9, so I am happy to present the proposal for this amendment on the basis that, should it fail, each of those will fail. Are you happy to deal with it on that basis, Madam Chair?

The CHAIR: Deputy leader, are you moving amendment No. 1?

Ms CHAPMAN: Yes.

The CHAIR: Are you indicating that, should this fail, you will not proceed with the other amendments?

Ms CHAPMAN: I will not proceed with the others I have noted.

The CHAIR: Thank you.

Ms CHAPMAN: Amendments Nos 2 and 3 relate to the supervision of authorised health professionals, so they will be dealt with together as well. Amendment No. 8 relates to the code of practice for authorised health professionals. That is a stand-alone category. For those that are multiple amendments, I will make all my comments on this one.

The opposition moves this amendment (supported by other amendments as identified) which proposes the establishment of a community visitor scheme which was recommended by Mr Bidmeade in his review entitled 'Paving the Way', which has been referred to, and which the government has decided not to include in the legislation. However, as the minister has confirmed, the legislation already contains the power for a community visitor scheme to be developed and introduced by way of regulation.

Whilst it is noted, it is not adequate in our view. Not only has this recommendation been available for consideration by the government (to work out the detail, the appropriate model, etc.) for a number of years now but it has been recommended by a number of stakeholders. I have referred to some of them in the second reading. It is already underway in other jurisdictions—in particular, Victoria and New South Wales. The government has had ample opportunity to consider whether a different model should apply or whether we should have something similar to theirs. This is a very important aspect which has the support of senior stakeholders, including Mr Bidmeade.

The scheme which is being developed is set out in detail in my amendment No. 7. It sets out how the community visitor scheme would be established and operate. It has been drafted to take into account the Victorian/New South Wales scheme, but it is slightly different in that it adopts the approach taken by the SA Health and Community Services Complaints Commissioner as a precedent. That legislation was introduced a few years ago and appointed a commissioner. There is a certain process for the appointment and carrying out of functions in that legislation and, therefore, that has been used as a precedent in respect of the style of the appointment of the community visitors and the reporting functions in order to be consistent with that legislation.

So, we have actually accommodated the fact that the South Australian environment is slightly different from the Victorian environment. We have followed the legislation of the government in the model it has had before so we would say there should be no impediment to the government joining with us to actually establish this model.

In essence, this model is one where there would be appointment to the position of a principal community visitor, who has certain obligations in respect of reporting and, having been appointed by the Governor, there are certain direct obligations to provide full statements in relation to supervision, and to the process of reappointment in the event of their death, bankruptcy, etc.—or what I call the usual factors.

There are the specific functions that they have to conduct visits and inspections to treatment centres, to act as advocates, to refer matters of concern to the relevant people, including the minister, and the chief psychiatrist, to whom I am going to refer in a moment, and, generally, to oversee and coordinate the performance of the community visitors' function, which is done by the principal community visitor.

There are certain access entitlements to treatment centres by these personnel, who are appointed, again, effectively under the supervision of the principal community visitor. The patient or a guardian or medical agent or relative or carer or friend of a patient, or any person who is providing support to the patient, may make a request to see a community visitor.

Then there are various reporting processes. The reporting processes include a report being tabled in the parliament. So it is comprehensive. It is modelled on the SA Health and Community Services Complaints Commissioner to a large degree, which was introduced by the current government, and so, I suggest, it should be welcomed and made available.

What is to be new clause 48 under the bill—Patients' Rights to Communicate with Others outside the Treatment Centre—gives the patient the entitlement to communicate with other people, to receive visitors and to be afforded reasonable privacy. The right to have restricted access for others to come to the centre is highly restrictive.

As the minister has pointed out, there are no restrictions or conditions on those patients who want to communicate by post to these other important people, including the minister, the board, the Public Advocate, the chief psychiatrist, the Health and Community Services Complaints Commissioner, a member of parliament, or a legal practitioner, obviously in certain circumstances, that is, in the practitioner's professional capacity.

Let us just consider those. Firstly, there is the minister. No minister—and, I am sure, not even this minister—is in a position to be able to respond to the individual requests for communications and visits with all of those who may complain. That is just clearly logistically impossible.

The board has some capacity to do that but, again, it is conducting the hearings out in the ABC building. It has a lot to do. The Public Advocate is appointed to be a representative at hearings and also to be able to give advice to governments and so forth. Its job is not to go in and out of institutions at random. There is the chief psychiatrist, and I will come back to him or her in a moment.

We have the Health and Community Services Complaints Commissioner. It is not her job to do this. Her job is to receive and investigate individual complaints. She has some educative responsibilities. This is not one of them.

A member of parliament—this is one of many. All members of parliament who have spoken on this almost without exception have highlighted the significance in their own electorates of the workload that is generated from those who are suffering from mental health problems or who are relatives or carers of someone with mental health problems. The legal practitioner, of course, is only there in a professional capacity.

The other issue is this: a visitor program is one which has this very special entitlement for access to the institutions. It is not to spy on them—there are enough other people to provide regulation, etc.—but the people who are on this list, quite frankly, get a sanitised version of visits. I do not know of any school or health institution that I have been to, in carrying on my responsibility of opposition spokesperson on hospitals and school services, where there has not been a sort of tidying up before I get there.

The CHAIR: Deputy leader, I need to intervene here. While I was very pleased to facilitate matters by looking at the overall picture of the package of amendments, the detailed discussion about a particular amendment and a particular clause, under standing orders, needs to wait until that clause is open. While I am very broadly entertaining debate and argument about your amendment No. 1, as you have indicated the consequences, the detail to which you are going is extending beyond the limits that standing orders allow.

Mr Hanna: We could drag this out all night then.

The CHAIR: I fear this is the case and I want to accommodate the deputy leader and make it as easy as possible. However, perhaps if she can indicate the principles rather than the detail at this stage.

Ms CHAPMAN: Let me say that in clause 48 one of our proposals on the visitor scheme is that we amend clause 48 to add in a community visitor, so that is actually clause 6. I am happy to go through and do 15 minutes on each, but what I was attempting to do was do the whole lot together.

The CHAIR: Deputy leader, I do not want to be difficult. I understand that you have that right and I am being very broad in terms of accommodating your argument in general, but if you could make the argument in general in terms of the test clause and the argument in particular if we reach the other clauses.

Ms CHAPMAN: Then we will have to go through every clause. I thought we had resolved at the beginning to do it all together. I am simply saying that there are seven clauses, and they all relate to the community visitor scheme.

The CHAIR: I understand that.

Ms CHAPMAN: I am happy to talk about the mechanics of why we want it and why we think the rest of the bill does not provide adequately for it, then we will vote on amendment No. 1 and if the parliament says no then I will not be proceeding even to discuss the others.

The CHAIR: I understand that.

Ms CHAPMAN: I am happy to do it clause by clause if you like.

The CHAIR: I just ask you to argue the principle at this stage. The principle of the community visitor scheme is extending beyond what would normally be allowed, but I am doing so because I understand that there is a much slower way of doing it, but at the same time I have to be somewhat careful of what standing orders say.

Ms CHAPMAN: I will go back to amendment No. 1, which proposes that there be a community visitor definition in the bill. One of the reasons we say it is important that that be introduced is, obviously, so that we can set up the scheme for it to be implemented. A principal reason for the need to have a scheme is that the other provisions for the protection of patients who we think need to have this scheme in place is the list in clause 48.

What I was presenting to you, Madam Chair, is that, when these other people come to hospitals—boards, ministers and the like—they get the sort of sanitised preparation. The reason I mention that is purely that we say that it means that you do not necessarily get the true picture. I will give a very simple example of this.

I remember a person coming to me, as a member of parliament, to complain about the cleanliness of a particular health facility. They said to me, 'Look, I was stunned. I was there visiting my child in hospital, and next thing all these people came into the room like the dustbusters and the place was cleaned up like a shiny new pin. I said to them, "What's going on?" And they said, "Well, actually, we're tidying all this up because the minister's about to arrive."'

My point is this: that of course whatever institution is open for inspection or visit is going to present the best position that it can. I am not critical of that. I simply say that an unscheduled, as such, access to the facility, and to the patient in particular, is one which is very important for this scheme and, we say, the implementation of it.

Therefore, we say that, with all the notice and advice it has received, and the recommendations before it, the government should be ready; if it is not, it can get ready, look at our model and positively embrace it so that, even if it opposes it today, we hope that it considers supporting it in another place.

There is one person on the list I have not referred to, that is, the chief psychiatrist. This is a new role and, from some of the material I have looked at, I think that the government may take the view that it has other people there to cover this, including the new supervisory role of the new chief psychiatrist position. Members of the department briefed me on this matter, and I appreciate their answering a number of my queries about this legislation. I was very pleased to meet Dr Margaret Honeyman who also attended and introduced herself as the proposed new chief psychiatrist and who, once this bill goes through, will undertake that position.

Dr Honeyman outlined what she felt was the very important role she would play. I must say that it is quite interesting that someone is told that they will be appointed before the bill is actually passed. However, leaving that aside for the moment, she told me she had come from New Zealand and that she would take up the position when the bill went through. Under part 12, division 2, clauses 83, 84 and 85, she has a certain role to undertake.

From what I read, her role will be largely to advise the minister on policy matters and on areas where she may recommend some improvement. She does not actually provide any report that is tabled in the parliament, but she does do a number of other things, namely, promotes improvement in the organisation and delivery of services; monitors the treatment of voluntary patients and patients to whom detention and treatment orders apply; monitors the administration of the standard of psychiatric care; advises the minister; and performs any other functions requested by the minister.

The chief psychiatrist will have an important role but, as I pointed out to her at the briefing, she does not have any power. I find that quite extraordinary since the bill provides all sorts of powers to the minister to delegate to the chief executive (currently, Mr Derek Wright) and so on. She has an important role, and certain people have to report various undertakings to her, such was when a community treatment order or a detention order is made, and she has to check whether they have done their plan, which is a new initiative in this bill. Presumably, she will receive that, collate it and give advice to the minister from time to time.

However, the chief psychiatrist has no power that I can see. She has less power than a National Parks and Wildlife officer to whom we have given all sorts of powers, including the power to enter property. I remember the bill that gave power to the native vegetation people to enter property, take photographs and do all sorts of things to make sure that people were doing the right thing. They had the power to demand names and addresses, and there were fines for people who disobeyed them and so on. I know one member of parliament who always gives a fairly fiery contribution about public servants who have what he sees as an excess of powers.

I understand that Dr Honeyman is a qualified psychiatrist. I assume for the purposes of this exercise that she is very experienced. However, it seems to me that, on the basis of this, her office will be an overqualified, glorified filing system of reports given to her and answers to questions that may or may not be answered and over which he has no power.

I just point out that, whilst there might be some merit in this appointment—and this is no reflection on her personally, because she might actually be better utilised here in the mental health services in another way—it seems to me that she is going to have a title and an office and there would be a whole lot of things that she is supposed to keep an eye on over which she has no power. It is one thing to set out the provision for the duties, but you also have to arm them with something to do it. If she is going to suddenly have a whole lot of powers in regulations, it seems to me that we should know what they are.

Nevertheless, on the face of it, it seems like her role is a nice thing to have, some of which is probably currently undertaken by the chief executive, Mr Wright, who, as it happens, is also a qualified clinician. Of course, it may be that his position is filled by someone who is not, so it begs the question of what we are actually creating this position for.

From what I read between the lines, it seems to me that this is being presented to us in the parliament to support on the basis that, because we are going to expand the community treatment orders so that you no longer have to wait until you have been in an institution before being directed to take certain medication, etc, over a period of weeks, months or whatever, we are now going to introduce it at this early stage under the early intervention model—and that is great. It may be because we are going to expand the number of people that can actually impose these orders or directions, so it may be a good idea.

However, I will just point out that I do not have any comfort in a person undertaking the role to monitor and provide as an individual advocate for someone who is sitting in an institution, or who is the subject of an order, taking up their case. I think that is what is missing. That is why we say it is so important that the community visitors scheme be invoked and secured in the legislation: so that we are not at the mercy of the minister's determination about whether a certain model is developed adequately and is acceptable and so that we are not at the mercy of a subsequent minister who may decide that, even if we have one, they do not like it and dispose of it. I say that it is so important—so did Mr Bidmeade and so do so many other stakeholders, including carer associations, and the like—and absolutely imperative that this be introduced.

Mr HANNA: I am supporting the amendments to the bill moved by Vickie Chapman. In particular, these amendments deal with the establishment of community visitors. The idea is that the community visitors would be a layer of supervision to ensure that treatment centres for people needing psychiatric treatment are being run properly in every way.

The amendments establish a scheme of community visitors who would regularly visit treatment centres throughout South Australia. They would be able to refer matters of concern to the minister, the chief psychiatrist or any other appropriate person or body. They would act as advocates for patients, and they might do so at the instigation of a guardian, friend or family. They would visit treatment centres at least once a month. They might be visits called on at short notice so that a realistic picture of the activities and the management of the treatment centre can be established. It is important to note that, on such visits, at least one of the community visitors is to be a medical practitioner, a registered psychologist or a former medico or psychologist. So, we are talking about people with some experience and understanding of mental health care. I believe it is an important layer of protection.

I spoke earlier in relation to the principle underpinning this bill in terms of the balance between a citizen's liberty and, on the other hand, the need for enforced mental health treatment, even medication and incarceration. Because the stakes are so high, I think we need a community visitors scheme. It works in New South Wales and Victoria; there is no reason why it could not work here. There would be some expense but what we would achieve with that expense is an extra level of guarantee that our treatment centres are going to be doing the right thing by patients.

I underline that point about liberties by referring to the notion again that it could be one of our family, one of our friends, at some stage during our lives. Indeed, we really cannot rule out that it could be any one of us in a psychiatric treatment centre in South Australia at some stage in the future. We would want to know that there was someone we could turn to readily, someone who would be inspecting the place on a regular basis, even without notice, to ensure that it is all being run properly.

The honourable member for Bragg has referred to the powers of the community visitor as laid out in these amendments compared with the powers of the chief psychiatrist. I think it is a good thing that we are creating the role of the chief psychiatrist but it is also important to have people who have the time and capacity on the ground to go and visit people in psychiatric treatment centres. I had identical amendments drafted because I think this is an important issue and a really significant omission in the government reform, so I am more than pleased to support the amendments moved by the Liberal opposition on this occasion.

The Hon. J.D. LOMAX-SMITH: I understand the views put forward by both the deputy leader and other members opposite. Certainly, if there were community visitors, of course they would have the powers to enter and visit unannounced. It is the best way to visit schools I always think. Clearly, that opportunity would exist. However, I still have to oppose this amendment. I have tried to compromise and incorporate all the suggestions so that we have the best bill possible.

As the member for Mitchell said, this is an uncosted proposal as well, but, more importantly, it does seem to me that there are other opportunities to link this with other portfolios and it would be better if this proposal were further worked up before it was introduced. In terms of the chief psychiatrist, if I could just mention that point, the position was recommended by the Social Inclusion Unit as a way of replacing the existing position of chief adviser in psychiatry. The chief psychiatrist was to have the authority to monitor and review the performance of mental health services with a focus on promoting continuous improvement.

The powers were quite extensive in that they could continuously monitor, they had the power to set standards and they have various powers under the Health Care Act so that any standards issued by this person under this section would be binding on any hospital that is an incorporated hospital, and binding as a condition of the licence in force in respect of any private hospital, in addition, and they would have the authority to conduct inspection of premises and operations of any hospital that is an incorporated hospital, and be taken to be an inspector under part 10 of the Health Care Act 2008. So, their powers do seem quite considerable to me.

I think it is a serious position which is not, as has been suggested, one without any authority or power. Of course, they would make their advice available to the minister but, notwithstanding what the minister might do, it does appear that they have some considerable authority. For the reasons that I gave earlier in my closing speech and the comments I have made here, I will be opposing not just this amendment but the other amendments that are subsequent to this one.

The committee divided on the amendment:

AYES (12)
Chapman, V.A. (teller) Evans, I.F. Goldsworthy, M.R.
Griffiths, S.P. Hanna, K. McFetridge, D.
Pederick, A.S. Penfold, E.M. Pengilly, M.
Pisoni, D.G. Redmond, I.M. Williams, M.R.
NOES (27)
Atkinson, M.J. Bedford, F.E. Bignell, L.W.
Breuer, L.R. Brock, G.G. Caica, P.
Ciccarello, V. Conlon, P.F. Foley, K.O.
Fox, C.C. Geraghty, R.K. Hill, J.D.
Kenyon, T.R. Key, S.W. Lomax-Smith, J.D. (teller)
Maywald, K.A. McEwen, R.J. O'Brien, M.F.
Piccolo, T. Portolesi, G. Rankine, J.M.
Rau, J.R. Simmons, L.A. Snelling, J.J.
Stevens, L. White, P.L. Wright, M.J.

Majority of 15 for the noes.

Amendment thus negatived; clause passed.

Clauses 4 to 9 passed.

Clause 10.

Ms CHAPMAN: I move:

Page 12, line 4 [clause 10(1)]—After 'authorised health professional' insert:

acting under the direct supervision of a medical practitioner

I indicate that amendment No. 3, which deals with clause 21, also seeks to do exactly the same thing to that clause. In essence, if I can briefly summarise the position outlined in this bill, certain persons—medical practitioners, psychiatrists and the like—have powers at present under the Mental Health Act, and it is proposed that a new extended category of persons (to be known as authorised health professionals) will have powers to carry out functions, including the provision of a level 1 community treatment order.

I was interested to discuss with some paramedics on the weekend their view on this, that is, the extension of the role, because paramedics are highly skilled and trained in ambulance service provision. They are usually attached to SA Ambulance Service, although there are some private operators. For emergency care, paramedics are often on the street or at a home on the front line and they are being called in to provide assistance in dealing with the care and sometimes detention of persons suffering from a mental illness.

It is sometimes very complex and difficult to handle and, historically, assessments on whether a person should be detained under the current act have been left to a police officer or medical practitioner. The paramedics say to me that they are often called out now. They have an agreement with the police department—which has been referred to in the second reading contributions, so I will not repeat them—but they are called out and they are very happy to undertake this responsibility to have this extra role to assist in the assessment for the purposes of taking someone into care. I emphasise the term 'taken into care' as I do not think 'taken into custody' is the ideal term.

I have been at some of these scenes and they can be very ugly for the patient, police officers and ambulance personnel. It is also a situation where frequently the person is taken into care with necessary force and, in order to restrain the individual, sometimes they are administered with drugs. We can dress these things up in the nicest possible way and the calmest language, but the truth is they can be very unpleasant situations, particularly for the patient. It is not easy to hold someone down and, without their consent when they are often quite violent and verbally expressive, inject them with a drug to sedate them in order to render them into a state where they are transportable in a manner that is safe for them and others who are in the vehicle.

With the modern arrangements, every effort is made between the medical profession, the paramedics and, where necessary, police for there to be a good deal of cooperation. In addition to that, every effort is made to try to calm, placate or encourage the person who is going to be detained (even on a temporary basis) until they are transported, usually to an emergency department facility.

Under current protocols, psychiatric patients—people who are to be subject to detention in this situation—are often held for hours at the emergency department before they are actually seen and assessed by a medical practitioner. There is no problem with the assessment. Everybody is happy to do that; paramedics tell me that they are very happy to take on that role.

However, a big dispute seems to be going on in relation to who will take responsibility for these people while they are waiting for a service in an emergency department. The police do not want to do that. Currently, they are often stuck there for hours. They say they have other things to do, other jurisdictions and other responsibilities and they do not really want to have this responsibility.

I should add for the record that one of the reasons that patients are nowadays taken to an emergency department of a general hospital rather than straight to a mental health service—such as Margaret Tobin or Cramond House or other facilities—is that they may have imbibed some drugs, they may have caused injury to themselves, and they may need to have a medical assessment for any life-threatening condition that they may have either subjected themselves to or lapsed into which needs to be treated before their mental or emotional state can be addressed.

That is the practice, and the hard question is: who is going to stay there and look after them? I can tell you that the paramedics do not want to do it. They are actually busy as well, and they say that they need to be out dealing with other services, that they are fully stretched as it is.

In any event, we are going to increase the categories of people who can actually undertake this assessment and impose community orders. We say that this needs to be under the direct supervision of a medical practitioner. In the regional areas of South Australia, we do not see this as a problem because, under the video provisions in this bill, that medium will have the same status as if it were a personal inspection. Therefore, that is not the problem.

The problem is in a situation where a person is going to be placed under an order where they are remote from a facility or from a medical practitioner. To protect the patients in such a case, we think that an authorised health professional should not be someone who is just trained up and in the category; we think that there needs to be direct supervision of a medical practitioner. The principal reason is not because these other people are not trustworthy or in any way less committed to the cause of providing well for these prospective patients or the person who is going to be subject to an order. It is a question of qualification.

We hear much in this chamber about quality standards. I have just read 'Ahealthy future for all Australians', the interim report from December 2008 from the national inquiry which talks about quality standards also in the mental health area. I think that it is important that we make provision for the direct supervision of medical practitioner.

At the moment we can already make mistakes under the current act. Let me give you an example of this. Some members may be aware or may have seen on television just recently a circumstance where a person in an aged care facility, a male in his eighties, was detained under an order under the current Mental Health Act. There had been an assessment made that this person was psychiatrically unwell to the extent of the current legislation's requirements. It was subsequently found on review that in fact he was not mentally unwell and he was allowed to return to his residence, which in this case was a nursing home.

There are a number of questions to be asked about that, particularly as he was handcuffed on the occasion, removed from the premises, transported to the treatment centre and detained for some days—and he only had one leg. So, there are two issues involved. One is, how is it that someone who is deemed to be sane, as such, and not justify an order which was subsequently determined by the Guardianship Board, could be assessed as being in need of that?

That can happen; quite reasonably. There can be behaviour that would indicate that in some circumstances that could be an assessment that could be borderline, but to actually have handcuffed this person, who is an 80 year old with one leg and is in a wheelchair, raises some serious questions. So, even under the current legislation we can have borderline cases.

In this proposed bill there is an expansion of people who can do the job and there is also a new definition, a much broader definition, which, in theory at least, will capture more, potentially, because we are not only looking at people who are likely to cause harm to themselves or others but those who have a mental health condition that may deteriorate and that could result in that. So, we actually have a much broader group.

I note schedule 1 in the bill, that although there are a whole lot of behaviours that are specifically excluded, including that a person expresses a particular political opinion, religious opinion, philosophy or sexual preference, or a number of others, these are all deemed to be not evidence to be used for the purposes of a detention or the imposition of an order.

One of those behaviours to be excluded is for a person who engages in antisocial behaviour. That is specifically identified as a behaviour that is not to be used to identify a mental illness merely because of that conduct. We are expanding the definition, we are expanding the people who can do it, and we are expanding the days of detention and the extent of these orders. So, even under the current legislation where you can have on one side of the ledger a cantankerous 80 year old who is difficult to manage causing disruption or disturbance in the aged care home and is generally a pain in the neck, he is caught under the current legislation.

It is very important that we build in some protections here. If we are going to expand all of these levels, and we already have risks in the current legislation, then it is very important that we require that the authorised health professional, when implementing a level 1 order, must be working under the direct supervision of a medical practitioner, and I would urge the government to support this.

The Hon. J.D. LOMAX-SMITH: I oppose the amendment because there are several elements that are not clearly articulated that are important to understand. This is about community treatment orders. One of the things that is so necessary in our community is that there should be early intervention and early treatment. The research in this area definitely makes the point that the sooner major mental illnesses, such as schizophrenia, are diagnosed and treated the better the outcomes for the patient. The criteria for orders aims to enable people to obtain an early assessment and treatment if required. So, this is about improving the treatment for patients.

The issue about who should make an order is an important one. The introduction to the clause, 'acting under the direct supervision of a medical practitioner', negates the opportunity to pick up more people earlier. In fact, it is tempting to listen to some kind of shock jock television program and imagine that they have it right. Sometimes there are other sides to those stories and, without going into personal issues, I think we should stick to the logic of the documentation, rather than something that was on a television program.

In terms of the community treatment orders, having specialised authorised health professionals was one of the recommendations of the Ian Bidmeade report. It was recommended that there should be people, such as psychologists, specially trained nurses and social workers, who could perform this very particular function. As a doctor, I hold the skills and the professional standing of the medical profession very closely to my chest, and you might imagine that I would not want to delegate any of these responsibilities to random professionals.

However, the reality of the situation in South Australia is that one cannot always have doctors on the spot when emergencies occur. The intention was to have perhaps 20 especially experienced and trained people, such as nurse practitioners, psychologists and so on, out in the community who could work on these issues, and they will be particularly well trained. The clause further provides that their determination has to be confirmed by a qualified psychologist within 24 hours.

My view is that we perhaps do too little now, and the requirement is that it should always be the least restrictive means possible to ensure appropriate treatment for a person's illness. The maximum amount of time is 28 days for treatment and seven days for detention and treatment. It is worth recognising that the word is 'authorised', and that part of the title is very significant. They have to be highly experienced, demonstrate competency and be additionally trained in the application of the act to ensure that their practice is professional and legally appropriate.

I do not think that this amendment does justice to those people in the community who we know are missing out. This is a way of getting treatment to more people sooner, and I think it will get genuine general community support. There is a view in the community, and many people are concerned, that those who are at risk find it too difficult to get treatment. So, we oppose this and the consequential subsequent amendment.

Amendment negatived; clause passed.

Clauses 11 to 41 passed.

Clause 42.

Mr HANNA: I have a couple of questions for the minister about the practice of electro-convulsive therapy or electric-shock therapy. I must admit that, until a couple of years ago, I thought it was a thing of the past, but I spoke to a medical practitioner who assured me that it is still routinely carried out as a matter of psychiatric treatment.

The clause is here, and there are comparable provisions in our current legislation, to make it more difficult. That is to say, there must be a clearly demonstrated need before this sort of therapy can be carried out. The same applies with neurosurgery, as it is called in the legislation—things like lobotomies, and so on.

If the minister has the information available, I want to ask the extent to which this therapy is being carried out; approximately how many people would be regularly treated by electro-shock therapy; and is there any trend of this being used less or more? It is a point of particular concern.

The Hon. J.D. LOMAX-SMITH: In relation to lobotomies, anecdotally we do not believe there is a record of them occurring in living memory, but that is not entirely certain. I would not like to say that is a verified fact. In relation to ECT, the treatment occurs currently throughout many systems across Australia. It is the treatment of last resort, but I understand that, under some circumstances, it is particularly effective. Having said that, we do not appear to have any records of how often it has occurred, and I have no knowledge of whether it is declining or increasing. I am afraid I do not have that information, but the chief psychiatrist would be in a position to collect this data in the future and then we could have that material available.

Mr HANNA: Can I ask the minister to make some investigations in relation to that and get back to me at a later date? Secondly, in relation to lobotomies, or neurosurgery, to use the general term, if this has not been a practice in South Australia for a very long time, why not simply ban it?

The Hon. J.D. LOMAX-SMITH: I am happy to get back to the member with information about ECT. I do not have it to hand. In terms of lobotomies, I do not think that politicians in the middle of the night should make a decision on medical treatments and their occurrence. I think we would put more attention into tail docking in dogs than we would into this matter. I think it would be unwise to just ban a procedure when we do not know how often it occurs—if it is occurring. We do not know if it is required. I think it would be better to get the information. I am very happy to get the information and any data for you, and then you can form a judgment based on those facts.

Ms CHAPMAN: I indicated in my general contribution that, on the question of penalties which relate to this, we have foreshadowed an amendment in another place. Any breach by any health professional who has the power to undertake either ECT or neurosurgery, we think, should face a significant penalty. If fines are a deterrent, we think that they should be commensurate to what could be imposed.

I consulted with the prospective chief psychiatrist, who I indicated earlier was Dr Margaret Honeyman. She advised that ECT was still being used, although she was not aware of the frequency. Anecdotally, I am certainly aware of the continued use of it in the public and private sector for the treatment of patients. There are certainly some in the psychiatry field who take the view that it is an essential although not oft used procedure which is sometimes necessary for the capacity to give any chance of recovery for their patients. I am not in a position to judge that, but it is certainly happening, and it needs to be closely monitored. I support the government's inclusion of the safeguards that are there.

As to neurosurgery, the chief psychiatrist informed me that she was not aware of any neurosurgery (lobotomy is the obvious one we read or hear about and see in films in eras gone by) but she was not aware that that procedure was currently being used anywhere in the world. That was the note I made of her statement in that regard. However, she also explained that there are circumstances, from time to time, where neurosurgery is used as an intervention, for example, in the treatment of epilepsy. I assume that disconnects a piece of the physiology of the human brain to minimise the episodes of epileptic fits. That may or may not be a useful or important act in the armoury of treatments for epilepsy but epilepsy is not a mental health condition.

I agree with the Hon. Ann Bressington in another place who has foreshadowed, at least in the media, that she considers that there should be no provision for neurosurgery for psychiatric conditions unless and until we have validated data from professionals with whom we would take advice, particularly psychiatrists, and those who are able to identify that there is a procedure that could be implemented for the benefit of a patient in the treatment of a mental health disorder.

I am not proposing to enter any amendment on this but I am certainly mindful that this is an issue we have had discussions about with other parties, including the Hon. Ann Bressington, and which I canvassed with the prospective chief psychiatrist when she attended the briefing. I hope that can be of some additional help. I also look forward to receiving some data on this. I do not think the public health department keeps any record or even inquires as to what happens in the private sector so, unless it turned up as medical complaint to the Health Complaints Commissioner, we would probably never know about it. However, I think it would be useful especially as we are about to introduce a very severe regime for penalty if there is a breach of those rules.

Clause passed.

Clauses 43 to 64 passed.

Clause 65.

The Hon. J.D. LOMAX-SMITH: I move:

Page 40, line 18 [clause 65(1)]—After 'may' insert:

, with the approval of the Chief Psychiatrist,

The amendment to clause 65 seeks to add an extra level of protection for the patient. There has been much discussion about these interstate movements. They occur irregularly and, clearly, it is an emotive issue about whether a patient should be sent back to a family interstate; whether it is good for them or bad for them. Very often, for parents who do not know where their children are, it can be quite concerning if they happen to have travelled interstate. An added level of protection is that it requires the chief psychiatrist to approve an interstate transfer of a patient. It is a very simple clause.

Amendment carried.

The Hon. J.D. LOMAX-SMITH: I move:

Page 41, after line 3—After subclause (5) insert:

(6) A patient must not be transferred to an interstate treatment centre pursuant to a direction under this section until the period allowed for appeal against the direction has expired or, if an appeal has been instituted, until the appeal is finally determined or lapses.

The intent of this is to ensure that patients' rights to appeal against the decision that I discussed previously to transfer them interstate are respected. This provision requires that the patient not be transferred until the time in which an appeal may be lodged has lapsed or an appeal is finally determined. Again another layer of protection for the patient.

Ms CHAPMAN: The opposition welcomes this amendment and we support it.

Mr HANNA: I am very glad to see that the minister has taken some of the community's concerns on board. I think this is an excellent layer of protection to provide. I applaud the minister for her efforts to strike the right balance.

Amendment carried; clause as amended passed.

Clauses 66 to 77 passed.

New clause 77A.

The Hon. J.D. LOMAX-SMITH: I move:

Page 46, after line 34—After clause 77 insert:

77A—Appeals to board against transfer to interstate treatment centre

(1) Any of the following persons who is dissatisfied with a direction under section 65 for the transfer to an interstate treatment centre of a patient may appeal to the board against the direction:

(a) the patient;

(b) the public advocate;

(c) a guardian, medical agent, relative, carer or friend of the patient;

(d) any other person who satisfied the board that he or she has a proper interest in the matter.

(2) An appeal under this section must be instituted within 14 days after the giving of the direction.

(3) The board may, on hearing an appeal against a direction, affirm or revoke the direction.

This is again about the matter of interstate transfers. It is another layer of protection. This is to insert the capacity to make appeals to the board against transfer by other people as well as the patient. It is to ensure that a patient and other people have a right to appeal against a decision to transfer them interstate. This appeal must be instituted within 14 days after the direction to transfer has been made. Stakeholders have previously expressed support for a provision of this type and we are trying to make them feel comfortable about this movement interstate, which otherwise received some adverse discussion relating again to the fact that, whilst we might think adult children (adults) would be better off going back to their parents, there are circumstances where that might not be the case.

Ms CHAPMAN: Again the opposition welcomes this amendment. This is the important substantive amendment, although obviously the one we have just passed allows for the protection against any removal or transfer until we have had an opportunity to appeal. For this appeal opportunity now to be written into the legislation is very welcome. I think this is absolutely critical and, I hope, will alleviate a number of fears that have been raised quite genuinely about the opportunity for abuse of interstate transfers, particularly to subvert other legislation, for example, where it would avoid the need to proceed with extradition after certain behaviour. Therefore, we very much welcome this amendment.

New clause inserted.

Clauses 78 to 87 passed.

New clause 87A.

Ms CHAPMAN: I move:

Page 50, after line 11—After clause 87 insert:

87A—Code of practice for authorised health professionals

(1) The minister may, by notice in the gazette, approve or endorse a code of practice governing the exercise of powers by authorised health professionals under this act.

(2) The minister may, by subsequent notice in the gazette, vary or revoke a notice under subsection (1).

Again this is a matter relating to authorised health professionals. It is proposed that there be the imposition, I suppose, of a code of practice that is to be developed for authorised health professionals. The amendment is in recognition of the fact that the authorised health professional will be able to deprive patients of their liberty, and therefore a code of practice should be gazetted which legally binds them in their professional conduct.

I understand that the minister has considered this amendment and will support the same, for which I thank her, because I think this will be an instrument of security, particularly given that previous amendments for direct supervision have not been supported. I anticipate the minister's favourable consideration of this amendment.

The Hon. J.D. LOMAX-SMITH: I think this amendment is consistent with the aims of the bill and it would be appropriate for us to agree to it. I commend it to the committee.

New clause inserted.

Remaining clauses (88 to 101), schedules and title passed.

Bill reported with amendments.

Third Reading

Bill read a third time and passed.


At 21:25 the house adjourned until Thursday 19 February 2009 at 10:30.


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