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House of Assembly - Fifty-First Parliament, Third Session (51-3)
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MENTAL HEALTH BILL

Second Reading

Adjourned debate on second reading.

(Continued from 12 November 2008. Page 907.)

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (15:07): I rise today to speak to the Mental Health Bill 2008. This bill was introduced by the government initially in June last year. It has a rather long gestation period to which I will refer shortly, but events have changed since June, in particular, the government appointed person with the responsibility for mental health changed from the Hon. Gail Gago in another place to the present minister who is the member for Adelaide in this house. Subsequently, on bill process, I think this matter was reintroduced by the new minister in this house in November last year.

As best as I can ascertain, there has been no change to the bill between those two periods. I stand to be corrected, but it appears that, almost without exception, other than the date, the second reading explanation of the current Minister for Mental Health is as it has been presented in the other place.

The bill purports to make provision for the treatment, care and rehabilitation of persons with serious mental illnesses, with the specific goal and objective—an important one—of bringing about their recovery. It also makes provision to confer powers to make orders for community treatment and, in that regard—this is a most important initiative—allows that to occur independently of and without the prerequisite period of detention in a nominated institution.

The bill also provides for the detention and treatment of such persons, when required, and provides protection for the freedom and legal rights of mentally ill persons. That is particularly relevant to some degree to the introduction of the new regime. In broad terms it attempts to answer a longstanding plea of relatives and carers of persons afflicted by a mental health disorder or disease, to ensure that they are able to continue to operate, as best they can, as the carer for the person. Often, of course, that is a close family member. Finally, the bill repeals the Mental Health Act 1993. In that sense, there is a process of modernising in language and, to some degree, approach—the sort of pre-emptive action that can be taken with a view to early intervention in order to assist persons who will be affected by this act.

It is fair to say that the number of people affected by the Mental Health Act represents a very small number of people relative to the total population. I say that at the outset. I understand that some 10,000 people a year in South Australia use mental health services in one way or another, whether they be in the community, at a service centre or accommodation facility, or in a hospital (whether secure or otherwise). A broad spectrum of services are available—and I will talk about the adequacy of those later—and some 10,000 people in any one year in South Australia use one or more of those services.

Only a very small number of those people attend, are admitted to or are detained in secure hospital care, often described as detention. My understanding is that about 3 per cent or 4 per cent of the population explore and seek—and sometimes get—mental health support and service. Therefore, this legislation affects those who are either unwilling or unable to make a decision, on the face of it, in their interest to undertake treatment. Historically, that process has been one which has been introduced under the protection of the act by a psychiatrist. There is an assessment by that psychiatrist and a review process by the Guardianship Board, which is an important statutory body. In some circumstances people can appeal to the court processes, usually the District Court, to seek relief at that level.

The main purpose of any mental health act is to manage that process of detention, whether it be voluntary or involuntary or, for some periods, a combination of both. That attracts and should attract some careful scrutiny. It is fair to say that the government has not rushed hastily into this; and I commend it for that. The Mental Health Act 1993—so it was enacted some 15 or 16 years ago—was reviewed. A review committee was chaired by Mr Ian Bidmeade, who is a legal policy consultant and solicitor. He was commissioned by the government in 2004 to undertake quite an extensive review of the legislation. Ultimately, he completed and provided a report of his committee, which outlines the findings and which is titled, 'Paving the way: review of mental health legislation in South Australia, April 2005'.

Within a month or so the government released that report for general consultation and public comment. Not surprisingly, that report proposed a number of changes to update and modernise the legislation, with the objective—to some degree untested, but I think there is a sufficient basis to support a reasonable expectation that it will be of benefit—of positively assisting people with mental illness. The recommendations of Mr Bidmeade's committee, on balance, had very strong support from stakeholder groups. Again, I commend the government because the report was distributed very widely.

The minister tells us that the recipients were some 500 stakeholders. I have been through that list; it is very extensive, and there are more than the usual suspects. In circumstances which I think will become clear, that was very wise and also very helpful in what proceeded to be the development of a draft consultation bill, released in September 2007; the marrying, to some degree, of the recommendations of the report, which were not, in the view of some, fairly or appropriately reflected in the legislation; and the omission of some other recommendations.

Not surprisingly, they attracted some commentary, and further submissions were accepted from them. I say 'accepted' because, having released that report, we had period in which another amendment was made before the former minister initially tabled the bill in mid 2008. It had quite a long gestation period, and one could not argue that it has not had a lot of contributions from people who are concerned not only for the welfare and protection of mental health patients but also for their recovery and support, together with the essential balance of ensuring that those who work with patients, and provide care, support and nourishment, are also in a position to make a contribution (hopefully, that will be with sufficient protection for it to be positive) and that it will be a win-win outcome for all those involved.

Members should bear in mind that, given the group we are talking about, the people who are directly involved in the care of people in this category are health professionals, police, ambulance drivers and, perhaps the most important group, the immediate family and friends of the patient. It is fair to say that, when a number of these patients attract the attention of this type of legislation, they have often burnt out many family members and their friendship support group and both government and private agencies employing health professionals are frequently left to manage the situation. As I say, historically, the Guardianship Board, which continues in an important role, has provided relief and some advocacy opportunity on behalf of patients, but it is one which is now under greater spotlight because of the introduction of the rights of others, and I wish to explore that a little further.

The action of making legislation contemporary in the sense of its wording is easy in bringing together a fair balance between the protection of the vulnerable and the capacity for those who are there to provide for them and to help, whether it be on a personal or professional level. The specific changes I propose to address are, to some degree, in the order of what has been outlined in the legislation, but I will move that to some degree.

The minister states in a reasonably neat summary (for the purposes of the recording of the opposition's position) that there is 'the need for clearer articulation of the rights of the mental health service consumers and carers; greater emphasis on community care, not just hospital or institutional care' (and with some qualification that is also recognised and supported), the 'recognition of the particular circumstances of children', and, finally, 'acknowledging the unique cultural perspective of Aboriginal and Torres Strait Islander people'. There are a number of aspects in the minister's second reading to which I wish to draw the house's attention. First, the minister opened with the following statement:

A world class mental health system depends on an effective legislative framework to ensure that society can fulfil its obligation to care for individuals with serious mental illness.

In describing the bill, she states:

...an act to make provision for treatment, care and rehabilitation of persons with serious mental illness.

She goes on to say:

This bill is primarily about the use of powers to treat people with serious mental illness against their will and provides for the checks and balances and protection necessary for the transparent and accountable exercise of these powers.

I highlight that these are actually two different things. It is not that the first statement does not incorporate a legislative framework, but 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.

This deals with legislative framework, that is true. Although that is important, it reminds me of an analogy. I think it was Sir Eric Neal who described this to me. He said, 'Look, you can have all the structure in the world but, if you do not have the right people in there making the decisions, the structure really won't make a scrap of difference.' If really good people are running the show they can make sure that the right decisions are made.

On the other hand, you could have a brilliant structure and legislative framework for the supervision and assessment and so on but have either a lack of expertise and/or work force resources or facilities to implement the outcome of a decision, namely, provide a facility to cater for detention. Without those you will still fail in the objective.

Whilst we accept that it is important to get the legal rights and protection right, we will never have a world class mental health system unless we have the other side of the equation, that is, the adequate and appropriate resources to ensure that it is carried out. This is particularly important because it is of concern to the opposition, not because we are introducing a new regime per se but because there will be a direct consequence in the expected extension of the workload to be undertaken.

We should be under no illusion that, by introducing and expanding the opportunity essentially to either impose community treatment orders or detention, when we expand the brief we expand the workload and the demand for what is required. That is the reality. I do not suggest that the government is not mindful of this. It is a little bit like saying, as we did some years ago, that we will have a mandatory notification procedure in relation to child abuse.

What you do is you create a structure—well-intentioned as it may be—where in fact you can identify a greater demand and a greater pool of people needing the resource and then find that inadequate provision has been made to meet that new demand—and then you have another problem. I would urge the government to appreciate the importance of ensuring that we have the backup resources to implement what is otherwise, on the face of it, a good start in the reform of this legislation.

One of the recommendations of the Bidmeade report, which I will abbreviate for the purpose of this discussion as Paving the Way, was to establish a system of what is described as the community visitors scheme. I suppose its omission, having been a recommendation in the report, is one which we would need to carefully analyse, because sometimes recommendations are made and they are simply not achievable when other aspects are taken into account. However, this omission, in my view, is quite puzzling.

As I understand it, the government's position on this is that it declines to accept this recommendation and transmit it into reality in this legislation, which it had the opportunity to do, on the basis that it would require extra resources. For members of the house who are not familiar with this and who may later read any contribution that is made on this bill, the recommendation would enable visitors to patients in hospital and institutional environments to provide for independent advocacy, taking into account, if I can paraphrase the position, the vulnerability of a patient or person in an institution who would otherwise either be unable to or not have the resources to access or properly articulate their concerns.

The obvious ones are: if the patient is in a detained situation or if the patient is resident in a situation that deprives them of any income or access to funds to be able to provide any communication tools for them to alert someone to their situation, particularly to be able to be transported to or get access to some other person outside of that institution. The importance of having someone who visits to be able to assess at first-hand the circumstances of a patient or resident is something which I think Mr Bidmeade and his committee thought was meritorious.

I do not know about your situation, Madam Deputy Speaker, but I would think that any member of this house would understand the difficulty that is faced by people who have a mental health challenge: often in their capacity to understand or appreciate how they can get help or to articulate any concerns they have, let alone having the resources to do these things. We are dealing with some of the most vulnerable people in the community who we, as a community, (and the government, in particular) have a responsibility to protect.

Aside from the resourcing issue—whether these people are paid money, what they are paid and what their expenses may be in order to facilitate this—my understanding is that (and I may be wrong) the government is generally reluctant to have these consumer advocates in acute hospital services. I can imagine that, in some circumstances, it could be quite impractical or dangerous. For example, if a consumer advocate were in a secure area (usually the result of a resident or patient having high-level acuity), they would need to be provided with some security themselves and that would cost money. If they were not provided with security, and they were vulnerable to approach or injury, that raises another problem.

I think these practical and important issues need to be recognised and, if that was of concern to the government, I would understand that. But a very small number of people are in that circumstance at any one time, either in community health services or a hospital institution. In fact, in circumstances where people are receiving treatment for mental illness, either in a community setting or hospital setting, very often, apart from the front door being secure or the access door into the ward being secure, there is a freedom of movement around the facility, quite appropriately, recognising the level of acuity of the patients/residents who are there.

I do not think that is an issue for the overwhelming majority of treatment centres or facilities, whatever their nature, except for the high security areas. I do not think it is sufficient to disregard or outweigh the importance of introducing a community visitor scheme. The opposition is keen to look at this. A number of stakeholders have spoken to us about it.

Historically, successive governments (and this government) have recognised people of capacity and experience who are highly regarded—for example, Dr John Brayley, former head of the mental health department in this state, who is now the Public Advocate. He has given some considerable attention to this, and I will refer to him further in a moment. Mrs Rosemary Warmington, of Carers SA, has also been strong in supporting the introduction of a community visitor scheme.

Regrettably, the government has taken the view that it will not be adopting this and, therefore, it is completely omitted from the bill. I am not sure if it was even added in previous drafts, but my understanding is that it has never shown up in the bill, so it seems that it has been a consistent position of the government not to permit this scheme. I think that is particularly disappointing. My understanding is that—and I do not have the report in front of me—a community visiting scheme operates in Victoria. I think it has been running for a couple of years and I am advised that it works very well.

That scheme enables mental health patients and residents to have a genuine, fully informed and briefed person to advocate for them. Just in case there is any adverse inference from that comment, I should say that important advocacy groups such as the Mental Health Coalition and Mental Health Alliance and others do a good job. I want to make the point that their job is not to provide specifically for the advocacy of a specific party. They have a very important role but they see themselves as making submissions to governments, decision-makers (in the parliament, for example) and committees, including budget submissions on policy initiatives and processes, just like the assessment they made on this bill. It is an important role, but it is probably not one for which they have either the time or the remit—and certainly not the resources—to undertake with respect to the community visitors scheme.

In addition to that, their capacity to have access to a hospital service or an institution is currently denied because, if they act on a voluntary basis without the umbrella and blessing of legislation, they have no capacity to access it. So, it is really important that we remain open to not just the viability but the success, or otherwise, and the proper reviewing of what has occurred in our neighbouring state of Victoria.

I would ask the government to revisit this issue. The opposition is considering the terms of what it may move as an amendment between the houses and, to that extent, we will advise as to the terms of that hopefully before the matter is dealt with in another place. However, there have been a few stakeholders who have had different views on that, so we will bring that back to the parliament and between the houses.

I would like the government to take on notice our intention to consider this matter by way of amendment on the basis that it would be reasonable for the government to advise the parliament and have ready the particulars of what it says would be necessary to set aside—for example, in this year's budget—to make provision for a community visitors scheme. Regarding the costing of that, we would ask that that be done on the basis of the model that currently applies in Victoria, which is reasonable. Obviously, the government cannot be expected to do anything other than that without having particulars from us as to whether there should be any change. So, we ask that that be done and that the information be provided so that the parliament can properly consider whether we should have a visitors scheme at all; and, more particularly, if we do, whether it should follow the Victorian model.

The second matter is the question of whether a specific and dedicated tribunal should hear appeals rather than the current system involving the District Court. The Bidmeade report explores that and suggests that that would be meritorious, hence it forms one of its recommendations. I think it is fair to say that it is quite a key recommendation and not just something tacked on the end; there is quite a bit of background in the report to argue for this.

Over the years, we have developed all sorts of tribunals for specific purposes. For example, we have tribunals managing the relationship between landlords and tenants. Historically, previous parliaments have sometimes agreed with the view that a dedicated tribunal is needed with specifically trained people who understand a particular area of legislative management and, where required, judicial intervention with appropriate councillors or advisers, whether they be financial for tenancy arrangements or in the area of health. Another area in which a tribunal structure has been developed and extended is the determination of workers' rights.

I am not a big supporter of tribunals, and that is not because the existing tribunals are not functioning well—I do not make any specific reflection on them. In some circumstances, they can be quite useful and—again, probably because of the principle I mentioned earlier—they have good people on them, so they function very well.

The reason I indicate that the opposition will not be taking up this recommendation and asking the parliament to include it in this piece of legislation—which the Bidmeade report recommended—is because the court which hears these appeals will hear a subject matter which is at the very core of protecting fundamental human rights. The very delicate balance between the protection of a patient's rights, usually against the imposition of the advice or assessment of professionals and their proposed treatment (and the consequences of that), is one that will have a direct impact on not only the personal liberty of that person by way of detention orders but the involuntary imposition of a medication or treatment against their will.

My own personal experience of people who have been the subject of community treatment orders and detention orders—some have been family, some have been friends and many have been clients over the years—has been that it is often not the detention that is the most upsetting thing to them: it is the imposition of having to receive medication against their will while being in the institution, or in their home, that offends them so much.

It is possible (I am making a generalisation here) that, because the state of the mental health of the person who is under detention under our current law is often so severe and so acute, their capacity to understand the restriction upon their freedom—of which they are about to be deprived—is much less than when they might be in a situation of not being detained but having a drug regime imposed on them. At that time, they might be quite lucid and much more capable of understanding what is being required of them, namely, that they accept an injection or digest medication or swallow syrup against their will. In my personal experience it is often a really difficult and painful matter for the person who is affected by such an order.

Whether we are going to deprive someone of the right to be able to walk out of a room or say no to a particular medication or procedure—including electric shock treatment (as it is known colloquially)—is something that I think deserves very careful scrutiny. The only acceptable recipient of appeals, in my view, and the opposition's view, is the court. The District Court should be retained in that important capacity.

Another matter that has been raised is the question of a review date. It is not uncommon in legislation which is controversial and new, where there is a new regime to be imposed, that we review it. The opposition is not happy with some aspects of this bill, and I will be outlining them. If the government proceeds with the bill as it is, if the proposed amendments are unsuccessful, then there will be areas which we are uncomfortable with—I should not say 'uncomfortable with'; I should say that we will be less than happy with an assurance that we can be satisfied that patients will not suffer.

In that sense, we consider that it is important that there should be a review date for this legislation. The principal area to be introduced here is that a whole new group of people in the health professional community are going to have the jurisdiction and entitlement to administer orders and sign certificates under the procedures and the regime for this group of patients. Whilst we have a number of concerns about that, if, ultimately, the government is successful in having that significant expansion occur, then we would want a review date to be set.

The opposition is quite open to consideration of what that review date could be. We think four years is not unreasonable. We would not want to impose too short a period to be restrictive, but we feel that it is something that needs to be considered. There are other stakeholders; we are not alone in this. We do not just throw it up as a review because we do not like a part of the bill that the government wants to introduce. Carers SA has also raised this with us and, no doubt, the government, so we think it is reasonable that a review period be included.

Again, the old chestnut of transparency of the regulations is raised. Whenever a bill is introduced which is going to affect or deprive people of their rights, I think that, at the very least, we should receive a draft of the regulations that are proposed to be introduced. The reason for that is because, increasingly—even in the short time I have been in this parliament—there seems to be a practice almost of extending what used to be in legislation into the regulatory documents—regulations, in particular. We all know that the difference between putting it in the statute as compared to the regulations means that a minister (in terms of the latter) can change the rules subject to some scrutiny by the parliament, but a statute requires approval of the parliament before it is implemented.

There is a very big difference between being managed in the community—particularly this very vulnerable group—by people who are here in the parliament and vested with that important responsibility or whether we ask ministers to do it. The trend of having responsibilities and powers identified in regulations is very concerning. In particular, legislation that relates to the very capacity for someone to be able to move around at their free will and to resist the imbibing of medications, I think, is pretty fundamental.

Whilst the regulatory power is there for good reason—to deal with the machinery implementation of what the parliament decides—we do not have any draft available. The transparency of these regulations will be critical to the operation of the act and we express our displeasure at the absence of their being provided at least in draft.

The operation of the Guardianship Act is another concern which was a bit of a theme by stakeholders, and there is some reference to this in the Bidmeade report. Members will be aware that this is a specific tribunal which has a role in relation to the protection of persons, their assets and medical treatment, and is housed out in the ABC building at Collinswood.

Those people have the difficult job, I think, of assisting people to manage their business, estates and general financial circumstances in addition to their medical treatment, medication and management generally. That is very difficult, and I place on the record the importance of the work that is done by this group, because they are not only often dealing with people with diminished capacity being the subject of any applications or hearings there but also dealing with carers and relatives who are often in conflict themselves, not just with the person who is the subject of an application but, of course, within family groups.

It is not unusual for the Guardianship Board, which ultimately has the responsibility of making decisions in this area, to deal with a very severely fractured family support situation—or lack thereof as a result of those fractures—surrounding the subject applicant, and that is not always easy. Of course, we have fights in other arenas among family members, whether it is on the dissolution of a marriage or the fight over the spoils after someone dies in estate and probate matters, and there are plenty of cases to support that contention.

Equally, however, there can be quite a lot of friction and quite terse relations between the relatives of the subject person of the application, and this usually just compounds the difficulty of Guardianship Board members making a determination of what is in the overall best interests of the subject person. So, I commend them for what they do.

They too need to have some upgrade of the structure and the powers in the way that they operate. This legislation is sitting behind—or over or next to or however you want to describe it—the board and its employees, and it is inadequate for 2009. Frankly, I am a little bit concerned—and this is not a reflection specifically on the current minister—that there has not been a corresponding development of reform to bring to the parliament a revised Guardianship Act, because that also needs some attention.

Sometimes legislation works in tandem. It is important, if you are fixing up or, in this case, expanding both the responsibility and operation to a much broader group of people under the proposed new mental health act, to sort out the Guardianship Act as well. We are dealing with this act; there is nothing else blowing in the wind. I am not aware of any draft guardianship bill out for consultation or whether that has even hit the radar of the department or the minister's office at all. I find that very disappointing, particularly because it is not something on which the important stakeholders have been silent.

The Mental Health Coalition, for example, has raised this issue, and it seems to have just gone unheeded. I am not sure why this has not been updated with it. Even under the new mental health act, the Guardianship Board will still have a very significant role, if not a greater one. I would hazard a guess that there will probably be more disputes and more challenges and they may even be longer, particularly if we do not have adequate representation of these people at Guardianship Board hearings. We are going to have a bigger workload, and that needs to be fixed up as well.

That is disappointing, but I cannot, I know, introduce an amendment to this bill that will remedy the defects in the Guardianship Act as it currently stands, and some of that I think will cause a bit of difficulty in the actual carrying out of those duties. I am disappointed in that, and ask that the government review that at least between the houses because, if there were some assurance that that would be undertaken, or that some complementary legislative reform of that act would be forthcoming in the near future, I would be well pleased to receive it, and, after the appropriate scrutiny, support amendments that would also help to dovetail into the objectives—meritorious as they are—under the bill currently before us.

Again this is an issue raised by the Mental Health Coalition, particularly concerning those who are in prison, as to whether there is a diversion program for people with mental health illnesses. This is something we do not take up specifically. We know that there is a major problem in our prison system. I was speaking to a mental health nurse recently. He said to me, 'Every time you take a bed out of the mental health system, you add a bed to the prison system.' It seems that, on the information we have, which is pretty sobering statistics, currently 40 per cent of people in our prison system have a diagnosed psychiatric condition. I was also told only last night that approximately 85 per cent have an alcohol or substance abuse addiction. That is very concerning because clearly that is increasing, particularly the reliance on drugs and alcohol.

You can take this away from people while they are in prison—often not totally as they seem to be able to get it somehow—for a large period of time, and significant effort is made to deprive them of that substance. Whilst they might have some treatment for the addiction—methadone treatment or the like—I think that a diversion program for people with mental illnesses would assist. Essentially, this would mean that they be given the opportunity to undertake a certain treatment instead of being incarcerated. As I would see it, their application to and compliance with that undertaking would be the prerequisite to their being able to remain free from incarceration.

Some of that has been put to us. We do not see it as something that has to be part of this bill. To some degree, it is a separate issue, but it is particularly important if we are going to pass this legislation—which, on our expectation, will place a much greater demand on mental health services—that we clearly understand that, if we do not have room for a person who has a psychiatric problem in our mental health services and they do not get treatment, there is every likelihood that they will be at risk of ending up in prison. Therefore, we can expect an increased demand but with no adequate opportunity to have a diversion program. So I think, again, it is terribly important that we have a look at this question of demand.

It was drawn to my attention only last night that the current government's State Strategic Plan has a target to significantly increase the population of the state. That is a target I support, but it means that over the next few decades we will have a vast number of extra people in this state. One cannot assume that that extra number will all be free of mental health conditions or that they will be excluded or in some way quarantined from acquiring some mental health condition which will need to be treated and helped.


[Sitting extended beyond 17:00 on motion of Hon. J.D. Lomax-Smith]


Ms CHAPMAN: So, if we have this extra population, we will need even more resources on the basis that, logically, a portion of those will need extra services. So the 10,000 people a year who might be using our services will substantially increase.

There was also a matter raised about the lack of reference in this bill to the Health and Community Services Complaints Commissioner. This is a role that was established a few years ago by the current government. I think, from memory, the former minister for health (Hon. Lea Stevens) introduced this legislation. It was designed essentially to expand the capacity for health, community and like complaints to be able to be dealt with in an ombudsman-like style.

Essentially, we have ombudsmen to keep a check on all sorts of things and this was an area of the ombudsman's responsibility—and, in particular, the services provided by government. This parliament agreed to the notion that it ought to be able to expand its jurisdiction of inquiry into not just health matters in the public sector but also concerns of consumers and patients in the private sector and that it should not be confined to just health services providing a particular treatment or service but also include community services.

I remember the debate because there were questions raised such as: could you lodge a complaint against a nurse in a school if they gave two aspirins instead of one to a child in the sick bay? I remember issues such as that were raised at the time. There were questions about where it would all stop, who would be responsible and whether volunteers would be at risk of complaint, because the number of people who would be subject to review by a new commissioner would be vastly expanded. Sure enough, we have had a couple of reports from the Health and Community Services Complaints Commissioner, who provides reports to the parliament. She regularly tells us that she needs more resources to do what she is doing. I will not go into the merits or otherwise of that, but I simply say that there is a big workload, which already includes her receiving and dealing with complaints in respect of mental health services.

Even though this issue has been raised—and I am not sure whether or not the government has raised it—already a significant number of complaints that she receives involves people who have got some complaint or concern about the provision of a mental health service. It may not be in isolation but, rather, in conjunction with other services provided, but it has a significant profile.

If ones looks through old annual reports of the Ombudsman in relation to health complaints in public institutions, health complaints are second in number only to prisons. By number of complaints, prisoners in South Australia complain the most. They seem to complain about whether they get their tuckshop money or poached eggs instead of fried eggs, and a whole lot of other things, so they have a lot of complaints to the Ombudsman. I do not mean to trivialise them in the sense of those being the only examples—often they have substantial complaints—but there are lots of them.

In relation to portfolios, the second was health and the third was families and communities. The health aspects in number are concerning, and there is reference to the process of recognising the Health and Community Services Complaints Commissioner and its being added into the bill. We do not take specific issue on it. It is happening already but, as a matter of completeness, it could be included.

Another issue was raised by the mental health coalition; that is, there is no explicit reference to the preference of community treatment as against involuntary treatment. Some members would say that it is obvious that, if we take the view that detention is an act of last resort, to detain someone on an involuntary basis, and be dealing with someone who is upset, angry or distressed about what they have been deprived of, in particular their liberty, it would be obvious it would be better, if it were available, safe, appropriate and in the best interests of the patient, to have treatment in the community, either in their own home or at a local community health service or centre which does not involve their being physically detained or their liberty being deprived.

It is stating the bleeding obvious, to use a colloquialism, so I was not overly excited or concerned about that not being specifically provided for in the bill. In some ways it could act against those in the health professional community who continue to say to me that they do not accept that, for some patients about whom we are talking here, it is appropriate or safe or in the best interests of the patient to either go into or remain in a community setting. That is interesting but, by way of explanation, I am told that, whilst we here of sound mind—

An honourable member interjecting:

Ms CHAPMAN: That is right; first of all, that we are of sound mind. I am told that, whilst we of sound mind may presume that the patient would be better off in a community setting, because that is something we would like if we were sick—we would rather be at home being looked after than being in a hospital, for example—it does not mean that someone who is mentally unwell, unstable or insecure thinks the same. It was quite a confronting statement when it was put to me: 'You should not necessarily assume that they are functioning at the same level or capacity to have the benefit of staying in the community.'

It usually relates to the person's psychiatric condition, from what I am told by those who think that sometimes it is important to have hospital care, to provide safety and security for the patient, to protect them from others who may be more predatory, in all sorts of ways, and to give them some sense of safety so that they are able to positively progress with their healing without the burden of fear.

I am paraphrasing what has been put to me, but it makes some sense to understand that sometimes patients who are in this category need a safe and secure healing environment, which can provide them with an ambience that is positive for their recovery and rehabilitation.

When I was alerted to this fact, I felt it was something that must be given due weight. So, to state this preference as some kind of principle in the objects of the act may work against us, and certainly against the patient, if the assessment of the health professional is that they are in need of that treatment. I suppose what they are seeking is some kind of statement of a presumption of freedom, and I suppose what we have been alerted to is that that is not always the best for the patient.

I have touched on the issue of demand, with an increasing population. In doing so, I mentioned legislation to expand the range, and therefore the number, of professionals who will be authorised by this bill to have the power to carry out community treatment orders. What a number of stakeholders have identified (and I do not think the government ignores this but it is something, I am sure, that it will have to address in the budget) is that you increase the range of people who can act to do these things; you increase accessibility to the imposition of a community treatment order, and then someone has to do it. Therefore, there is a direct nexus with the extension of resources necessary to implement it.

In terms of extended professionals and more people having community treatment orders, the philosophy of this bill is to promote early intervention and use of community treatment orders on the basis that it will save people's health from deteriorating to the extent of needing hospital treatment and/or institutional care. All of those aspirations are fine, but the truth is that you still need to deal with the level of extra support needed for the community treatment order.

It does not necessarily mean that just because you have early intervention you will suddenly have demonstrably reduced demand at the other end of the stream; that may take years, and there will be a significant overlap. But, if there is to be an improvement—that is, a decrease in the number of people requiring more acute care and intervention down the track or longer periods of hospital care—it may take many years for it to have that outcome.

Again, I have spoken to a number of psychiatrists, particularly in this area. No matter what is provided, if you couple the increase in population with the people who have serious mental health problems who have a direct connection with the use or abuse of drugs (particularly their overindulgence), we will have a problem. That can only become a situation, they say, which will require a sustained and extended provision of acute health services.

No matter how we look at it, this bill will increase the number of people we will need at the intermediary and early stages, but it will not necessarily give any relief at the pointy end, and, if it does, it may be many years away, and that could be overtaken by the reasonable expectation of an increased population. There is no easy way out of this. If we want to address this problem, it will cost more and it will require extra resources.

I do not suggest for the purpose of this discussion that there is any aspect of our system that is worse than interstate, but it is fair to say that we already have a system of mental health services that is running on the smell of an oily rag. Many people cannot access or obtain help or services in a timely manner, or at all, and we have a long way to go before we can adequately provide for them.

In addition, there is a large pool in the community, such as the prison community to which I have referred, who are not getting any real access to services. We have a burgeoning group sitting over in the prison community who are not, I think, adequately dealt with in any way in respect of mental health treatment. It is shameful for all of us that we allow that to occur, but I suggest that it is exacerbated by the fact that if you do not provide health care for people they will end up in the prison system, dead or destroyed in their capacity to function independently. To be rendered into some disabled state where ultimately they are unable to function in a meaningful way in the community and have decent lives, I think, should be looked at very carefully.

The current situation with respect to community treatment orders is that they are done by the Guardianship Board. I have referred to the board before, the legislative structure underneath which its members sit and the importance of modernising it. They have this role. The information was provided by, I think, Dr John Brayley, who is now the Public Advocate but who was a former director of mental health services in this state. Dr Brayley gave evidence from the United Kingdom demonstrating that community treatment orders should be used carefully and that the best alternative is what is described as 'assertive care'. For the benefit of those reading this debate, that is a broad range of well-resourced support services.

If we are to proceed down this line, a very effective set of checks and balances must be applied when these CTOs are used. I suppose the insurance on this type of new approach in terms of expanding a range of people who can authorise community treatment orders comes with the training of whatever category of person is given this extra responsibility. This comes then to the question of what training they might need specifically. If we do not ensure they have adequate training, that is, we simply expand the range of professionals who can do this and they do not have adequate training, one of the problems we create is that they will not necessarily be sufficiently skilled to administer a CTO or not administer a CTO that is in the best interests of the patient.

Also, we must be mindful that these new powers—which need extra training—are there to ensure that the new person who has the power is neither too vigorous nor too lax in their decisions to detain. We will raise this a little later. Again, we are still exploring that, and we are likely to explore it in more detail in another place. One thing that will be pertinent to this to quarantine against risk or to provide the insurance is to ensure that the training occurs and that the money is there, of course, to ensure that it actually happens. Again, you can broaden the range and give everyone these new powers, but we could have a disastrous situation if we do not properly train them, and if you want to properly train them it will cost money.

We must understand the consequences of the legislation if we are to do it properly. If we do not have the money or the government says, 'We do not have the money to do that', or, 'We don't need it' (which I think would be wrong), then one must raise the question about whether we expand the range of professionals to do this now. You make a commitment to do this on the basis that, overall, we think it would be good for mental health patients to have the capacity for early intervention and for community treatment orders to occur without waiting to go through the pointy end of the system. It all sounds good, but there is not much point in doing that if we are going to create a situation which is going to be worse for the patient in another way.

I hope that the government does not see this as a backdoor way of saving money. I think that the aspirational statements of the minister in her contribution to the parliament from the government's perspective do not suggest that. The government would clearly not admit to it even if it did, I suppose. I am not suggesting that has occurred, but it always worries me.

I have to deal with a lot of these bills in the parliament now where we are being asked to change legislation or reconsider policy to allow for professions other than those that have the existing capacity to make decisions. Let me give you a classic example. Last year (I think it was last year, it may have been the year before) we created the power for opticians—people whom we usually see to get our glasses and those sorts of things—to be able to do some of the things that previously only the ophthalmology end of the spectrum of specialists could do.

Some people say that this spreads the load and makes it cheaper for the product or the process, that is, the service of providing treatment for an eye condition. It is usually related to an extension of a particular group being able to administer drugs. In the case of eyes, it is the opticians being able to prescribe and use medications (often drops) for the eyes, and the like.

Eye surgery is still done by a certain speciality, but a whole lot of other duties are needed to be expanded into groups that have different qualifications, not necessarily lesser qualifications, but different qualifications which do not necessarily give them the sufficient expertise to carry out what they are going to be asked to do.

One example of that was when there was a new fad where young people—I understand mostly girls; I do not have any daughters, a granddaughter but no daughters—would wear these coloured lenses. The logical question was going to be: if we have a requirement to say that young people cannot buy these lenses to put in their eyes to make them look like cat's eyes, or make their eyes blue, green, brown or purple (or whatever), we protect them from causing damage, and ultimately blindness, if they do not use them properly by leaving them in overnight, or whatever the problem might be.

So, we have to set up some protection when we make these decisions. Should they only be available on prescription? If they are only available on prescription, should opticians be able to administer those prescriptions? These are the sorts of things that come about from what starts as, usually, a request for the opposition to consider, not necessarily always from the government but from other stakeholders who say, 'Well, look, we can solve this work force problem. We could make a process or a service cheaper if we expand the qualifications of the range of individuals who can undertake this particular task.'

That is something on which I have occasionally agreed with the particular person putting the submission—or the government—but I am very cautious of it, and equally so in this legislation. I am very cautious of it, because this is not just a medical procedure, this is the deprivation of a liberty which the rest of us take for granted. So, all the more reason, I think, that there are problems with extending the authorised health professional ambit to be able to undertake these services.

The issue of extra demand is one which I raise, and I go on to refer to the government's submission, and particularly the minister's second reading explanation when she said that the bill will 'complement the government's recently announced $107.9 million mental health reform package to implement the Social Inclusions Board's recommendations'. She then went on to list what the funding will do—in particular, the rebuild of part of Glenside Hospital, the only stand-alone mental health hospital that we now have in South Australia. There are a number of services attached to other health facilities in metropolitan Adelaide.

The minister goes on to say that there will be a number of other plans regarding the provision of service at a community level. I will not go through all those individually (it is in her second reading contribution), but I do want to comment on them. The government's claim that this bill will complement it, coupled with the demand issue to which I have just referred, is, I think, simply unacceptable. Furthermore, the opposition does not agree that the announced direction by the government going with the redevelopment of Glenside Hospital is in any way consistent with the report prepared by Monsignor Cappo. Indeed, that has been borne out by the recent findings of a select committee of this parliament, whose report was tabled two days ago in another place.

That report followed an interim report which the committee tabled on 11 September 2008 and which primarily related to a recommendation that the Glenside Hospital have a specific charter and that there be a health research and training institute established at the site. I do not want to dwell on that. It was a good recommendation and, quite frankly, if the government presses ahead with the expansion of professionals and therefore provides extra demand, I simply make the obvious case that it will be even more important that this institute has the capacity to provide a high level training facility that is highly regarded as well as a core capacity for the multiple health professionals in this area to collocate and undertake both their research and training together. I refer to that report, but I will not quote from it other than to say it should be taken into account in the redevelopment.

Some considerable contribution was made by the minister on the question of the Glenside concept master plan, and in particular the services it says it will provide. In relation to that, I would like to say that what the minister, in her contribution, says is brilliant about the redevelopment is far from what is presented in pamphlets and websites. It has come under heavy fire. It has had lots of criticism from me, which does not necessarily mean it is a good or a bad thing, but I will not give up on it. It has come under fire by almost every possible different group in the community.

Often an idea is presented by a government which some people in the local community might not like, that a particular community of interest does not like. It might be a development, which is opposed by people who want open space, which the developer wants to make some money out of and, therefore, you get competition and friction, and often it concludes in some resolution that both parties are unhappy with. That is not unusual.

But after last night's meeting, it ought to be clear to the government that the Glenside concept master plan, released in September 2007 by the former minister, has the anger and opposition of almost every different group in the community that could be relevant to the service and the site and to all it influences in the neighbouring community and throughout the services it provides across the state.

I have never known an issue where so many different stakeholders have raised concerns. So, it is not surprising that the select committee has made a number of recommendations and findings which totally contradict what has been put out in the public to date by the government in support of its plan. One thing is very telling in this report regarding the provision of mental health services generally. It says that all the current high-care patients at Glenside need to be provided with a dedicated care plan outlining their treatment and its location. Some of that is because rebuilding can have some impact on the delivery of services.

It is very interesting that the government takes the view that it is all right to place those mental health patients who are left at the Glenside campus in a situation where they will have to play 'musical beds' over the next few years around the campus, and this is incurring the ire and outrage of patients, relatives and staff so much so that now some of them are going public on this.

It is all right for these mental health patients to have a major redevelopment on their home. Remember that a number of them live there long term. They are not just in there for a broken leg and a quick patch-up in the Royal Adelaide Hospital, then they go home. These people live there. It is all right for them to have jackhammers next door to their home and a new shopping complex and supermarket built next to them, but it is not acceptable for the government.

The main reason the government says it cannot redevelop the Royal Adelaide Hospital is that it has to move that acute service down the other end of North Terrace. It is a telling thing, isn't it? It is not good enough for mental health patients. As I said, a number of these patients are not there for just a short time: they are going to face a long period of many years in coping with this redevelopment. It will now be added to by another two years because part of this redevelopment has been adjourned because of the economic meltdown. It is good enough for them to have to suffer that, which is unacceptable, they say, for the rest of the population who go through the acute services at the Royal Adelaide.

I do not accept the notion that you cannot redevelop a hospital or health service on a current site. Obviously, notwithstanding the state government's view on the Royal Adelaide Hospital, it does not accept that either, because it is already doing it at the Lyell McEwin Hospital and has just completed it at the Queen Elizabeth Hospital, so it is an utter nonsense to suggest such. Is it not interesting that they say that it is good enough for the mental health patients at the Glenside Hospital, who have to put up with being moved around the campus until they get pods built at aged care services for the aged psychiatric patients, which, it has been announced, will happen one day at the Queen Elizabeth Hospital next to Cramond House?

They have to put up with all the redevelopment of the historical buildings in the middle of their campus to accommodate the Film Corporation. They have to put up with the demolition of buildings (one has already been demolished at the old laundry site) to be able to put in transportables—which has already occurred—and tip out staff and some patients from some of the other facilities. They have to put up with being moved from one building to another in the meantime, while the Chapley family—or another developer if the Chapleys do not buy it—build a massive supermarket and dig up the oval. They are about to have Ground Zero in their own backyard and, at the end of it, they will end up with 50 per cent of the total site, and only a portion of that will be available for a facility of design yet unknown for mental health services. Guess what? They will not only have the patients there now but also all the drug and alcohol services patients.

They are about to have a major disruption to a service. When the select committee was asked to consider the effect on the delivery of services during the transitional period of building, which will now be another couple of years down the track, particularly as once they have done all these other things and built all the new private housing they will have to build the hospital, and it will go on for years, it had a long look at the period during which all the building would go on. It also considered the issue of the collocation of services and the extraordinary extra responsibility that needed to be addressed of providing protection and security of patients, staff, visitors and all the other people who would go in there—Burnside shoppers, you name it—and use the site. They made a strong recommendation not only about the detailed care plan for the patients but also about ensuring that they get it right when they develop this site for the patients, when it is an 'all in together' model in specifically collocating services.

As somebody described to me last night at a public meeting on the planning aspect of this, it is putting together the most desperate and the most vulnerable. It was described by the person putting that submission at this meeting last night—a mental health nurse at the Glenside hospital—as genocide by stealth, just to give some taste of the views of health professionals in this regard.

So, it is hardly surprising that the committee would come up with these recommendations and, in addition, recommend a very high level of security and that a proper plan be developed for that to occur. That is just to deal with the protection of patients and staff and making sure that there is a minimum impact in that regard. I will try to summarise these, because I do not propose to go through every recommendation of the select committee. I have not brought my annotated select committee report with me, so I will have to go back to the whole report.

The next aspect relevant to this debate is the question of not selling any portion of the property. Recommendation 11 is that plans for the sale of land for residential and commercial purposes be discarded and that the government explore alternate funding models, including those suggested by the Public Advocate, that is, Mr John Brayley.

A number of other recommendations relate to increasing services, particularly for rural and remote patients, remembering that nearly 400,000 people who live outside metropolitan Adelaide do not have any resident psychiatrists and they have almost no acute mental health services in the regions. I will refer to that again later but, currently, there is a significant lack of facilities out there.

Some mental health nurses are working out in the field, but it is probably the most under-resourced area of health service in the country and, largely, there are workforce-related reasons for that. As a result of this situation, country people have only the Glenside Hospital for acute services. So, if somebody needs to be detained or provided with acute services, they have to come to Adelaide. Very often they are flown in by the Royal Flying Doctor Service, often heavily sedated and sometimes physically secured. It is not a very pleasant situation, and it is quite a prolonged exercise for the patient, the police and/or the health personnel who travel with them. It is difficult, but that is the situation that prevails at the moment. They simply do not have anything out there.

I will divert for just one moment to say that I note the government has indicated in some announcements that it proposes to increase mental health services—amongst other things—at hospital services currently at Mount Gambier, Berri, Whyalla and Port Lincoln and that, although its country health plan has been bulldozed and withdrawn, it has nevertheless made a commitment to continue to enhance these hospitals with services—and they need them. They will need them for a lot of reasons, not least of which is the fact that, in the advent of any diminution of services in other district or local hospitals (or whatever they will be called in the future), there will be extra demand on the four major regional centres that I have named.

The government should have been more strategic when locating those regional centres, because about 70 per cent of country South Australians live east of Port Augusta and north of Keith, and it is closer for them to come to Adelaide than it is to go to any of those four regional centres. However, I commend the government for giving a commitment to enhance services in those four locations, if they ever receive the resources to do it.

This week, I received a letter from a country medical practitioner, who was heartened to hear about the extension of the mental health services at the Lyell McEwen Hospital, although he did make some observations about the opening of the 50-bed mental facility at that hospital. Incidentally, under the supervision and stewardship of the former minister for health (the member for Little Para) there had been a proposal for a 60-bed mental health facility. However, after her departure from that portfolio, the new minister cut that down to a 50-bed facility. In his letter, the country medical practitioner says:

I understand from my colleagues that the Lyell McEwin would have a drainage population of about 300,000. This estimate could be debated but would probably not exceed 400,000 and may in fact be as low as 250,000.

Please note that...[our region], which drains a population in excess of 60,000 has no mental health facility. We have no resident psychiatrist and therefore cannot have a mental health unit with in-hospital beds due to the lack of psychiatrists.

We do have some mental health nurses who do a sterling job and who we rely on greatly but as they are not trained psychiatrists, there is no facility...[in that regional hospital] which could be declared a mental health unit, even if the hospital designates 2 beds in the Medical Ward for mental health patients, under the bed-care of the physician of the day.

He went on to argue that that country region at least deserved a five-bed mental health unit, yet it continues to have none.

So, it is a live issue out there in the country. They have a real problem. They are utterly reliant on the Glenside Hospital (now called the Glenside Campus of the Royal Adelaide Hospital) for acute care services for their patients. So, not surprisingly, one of the recommendations of the select committee this week was that the 23 beds that are currently allocated for regional and rural people should be doubled to 46 beds. I welcome that recommendation, and I hope the government reads the report and applies that recommendation. If the government does not, we will continue to have a major problem in the country.

We have a new member for Frome in the parliament. He would know full well, having held office at local government level as mayor of Port Pirie, the challenges that regional South Australians are facing at the moment. Much of the area he represents relies on rainfall and/or the River Murray for water, and there is not much of either. That is putting enough pressure on them as it is, not to mention whether his Nyrstar factory might close down if it has emissions trading scheme impositions put on it in the next 12 months. I think they say that it will probably cost them about $70 million. It will bowl over about 2,000 jobs in Port Pirie in one fell swoop. As the sitting member I am sure he will be fighting to make sure that that does not happen and will give the Prime Minister a very clear message about what he should be doing about that.

In any event, he would understand that in regional South Australia there is a death by suicide every four days. He would understand not just the plight of people who are in primary industry and rely on water so heavily, but the plight of people in business, including tourism. One cannot even run a local bed and breakfast operation in a cottage on a property in a small regional town unless there is plenty of water, because tourists like to have showers and generally use a lot of water. It is very important to understand that people in our rural communities are under immense pressure. The only thing that they can get access to for acute mental health care in South Australia is the 23 beds at the Glenside Hospital.

Let me read to the parliament one of the most impressive contributions that I have received from the many relatives of mental health patients who either currently use the health services at Glenside Hospital or have previously had need of those services and expect to use them again. This comes from Mrs Helen Beck, who lives at Streaky Bay on the West Coast of South Australia. Recently, she wrote to a panel which is making a decision about whether to allow the rezoning of the Glenside Hospital as a place where you can put private housing, new supermarkets, retail and commercial shops and so on. The government has to do that under the planning law because you cannot change something from a mental health service facility to commercial and private housing unless the zoning is changed. If the government owns the facility it does not have to go to the local government authority, as we do, to apply for approval for a development. The government itself can do it under its own rules but it still has to go to the public before it changes the rules.

As part of that process the minister, the Hon Paul Holloway in another place, has had to do that; he has called a public meeting and called for public submissions where they are required. Mrs Beck pleads with the panel not to rezone the Glenside Hospital campus, and states:

...I express my disapproval, because this land, dedicated to the pursuit of mental health, is still required to meet the needs of current and future clients.

I wish to voice my concerns and that of many other people, who through fear of stigma, are reticent about speaking out. But please be aware, as there is much concern being suffered and privately expressed, particularly by those who stand to be the most severely affected—the consumers and consumer families; that is, those who are the most vulnerable and virtually defenceless.

As we have a family member with a serious mental illness, my family and I have been involved in mental health services over a long period of time in such ways as advocacy, providing support and generally promoting good mental health, as, for example, in the establishment of a support group and venue in our rural home town.

Thus it can be said in summary that we have a good working understanding of the overall situation, including knowledge of and familiarity with the Glenside Hospital site, gained by us over the years with frequent hospital admissions of a family member.

I seek leave to continue my remarks.

Leave granted; debate adjourned.

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