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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2010-09-16 Daily Xml
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HEALTH BUDGET

Ms CHAPMAN (Bragg) (12:00): I move:

That this house—

(a) condemns the Australian Labor Party for committing to cancel Medicare funding for services provided by psychologists and social workers; and

(b) expresses disappointment at Labor's failure to address mental health issues which has resulted in the resignation of Professor John Mendoza from the position of Chair of the National Advisory Council on Mental Health.

Today is budget day. When the Rudd federal government announced its budget—at least on time, because this one is about five months late in South Australia—there were a number of reforms that met with resistance, it is fair to say, in the health area across Australia. Some of the reviews that are undertaken, for which sometimes funding is lost or reduced, are perfectly justified; others are identified and highlighted and governments do a bit of a backflip on them because they realise that they are completely erroneous. At other times they are bizarre and dangerous, and that is the category in which I put this.

It is fair to say that when the federal budget came down on health matters, there was going to be a major change in respect to the recovery of funding for people who have cataract operations, based on the fact that under new medical procedures the professionals involved are able to do them much more quickly. Therefore, I think it was reasonable for the federal government to look at changing the available funding entitlement so as not to prejudice ultimately cataract operation recipients because there are many thousands of them across Australia. There was a bit of worry about that but, in fairness to the federal government, they sat down, considered the submissions that were put and changed their view. I suggest that has been reformed for the benefit of all parties.

Then, of course, we have the obstetrics and fertility issues which have also been in the media. Poor couples, who have no choice in fertility, are having to pay thousands of dollars more for reproductive treatment, and those who choose to have a private obstetrician face high obstetrics costs. These are young people in the main who are wanting to have families—and we are all trying to encourage that—who are facing an uphill battle. It is a very poor policy decision and a very poor aspect of the federal budget. But this one is the mother of all disasters—

The Hon. A. Koutsantonis interjecting:

Ms CHAPMAN: This one, on the federal budget, the mother of all disasters, is proposed to cancel the Medicare funding for services provided by psychologists and social workers. Members may recall that the previous the Howard government, with parliamentary secretary the Hon. Christopher Pyne, had announced a $1.9 billion package of measures to assist Australians with mental illness. That included being able to claim the cost of the services of psychologists and social workers on Medicare so that all Australians could afford to get ongoing help where they need.

You would think this would be something that state health ministers would have rushed to support, but they did not hear a peep out of them. In any event, it was a fantastic initiative; along with that, were the initiatives to establish 20 early psychosis intervention centres in major metropolitan and regional areas, to provide 800 beds for acute and subacute care to support the early psychosis intervention centres, and the funding of an additional 60 Headspace sites providing one-stop shops for young people to gain information and services relating to general health and wellbeing, mental health, and alcohol and drug services.

All members would be aware of the importance of early intervention and the significant impact that can have on avoiding the enormous human and financial cost of recurrent, repeat attendances of young people particularly with mental health problems at emergency departments at our major hospitals, causing an explosion of extra cost in those arenas and often disruption to the service delivery in those facilities. There is also the homelessness cost in these circumstances.

So, the benefits are obvious. The funding was there, the announcement had been made, and it was a very, very significant contribution. Indeed, Professor Pat McGorry had been appointed as the first head of the Youth Mental Health Initiative (known as 'headspace')—some would remember him as the Australian of the Year for 2010—and everything was set to go. Then the Labor government comes in and, under the Hon. Nicola Roxon in her role as Minister for Health in the Rudd government, we have this astonishing announcement that they will cancel the Medicare funding for services provided to psychologists and social workers.

So damaging was this to the bottom line of the provision of acutely needed services in the mental health area that we had an extraordinary event occurring, namely, the resignation of Professor John Mendoza from his position as the chair of the National Advisory Council on Mental Health.

So, we have the appointment to this important role and the work being undertaken. Then on 18 June this year, after the government's budget had been announced, we have the letter of resignation tendered by Professor Mendoza to the Hon. Nicola Roxon. He said, and I paraphrase that letter:

Dear Minister

It is with a deep sense of disappointment that I tender my resignation from the National Advisory Council on Mental Health.

He goes on to say:

As I and other members of Council have repeatedly indicated to you, the Council is seriously compromised in its stated mandate to provide timely independent advice to the Government.

He points out that he has undertaken a number of aspects of the council's work with clear diligence and with the high regard of other members of the council. Then he says:

However, it is now abundantly clear that there is no vision or commitment from the Rudd Government to mental health.

He goes on to say:

The Rudd Government is publicly claiming credit for the increased investment in mental health when almost all of this is a consequence of the work of the Howard Government. As the report released yesterday by the NSW Bureau of Crime Statistics...

and he quotes from the report:

'Australia's prisons are the repositories of the mentally ill, the drug and alcohol-addicted and the under-educated'.

He goes on to say:

The AIHW hospital data released this week also shows that unlike almost every other area of health, the number of hospital beds for mental health are declining by an average of almost 4 per cent a year.

He goes on to canvas the issues of the continued high rates of suicide and the damaging aspects of social exclusion for those who ultimately end up in those statistics and he concludes by saying:

I regarded my appointment as chair of NACMH as the most important public service responsibility of my life. However, I have now formed the view that my efforts to influence the development of improved mental health services and end the shameful neglect of those with mental health disorders will be better served in other roles.

What a sad day for Australia—and particularly for the mental health patients and sufferers in our community and their families and carers, on whose behalf Professor Mendoza had undertaken his responsibility and role—when this resignation was tendered.

This is not just an announcement by government which has implications socially and of which oppositions and other members of parliament make complaints or criticism. Those who are out there at the highest level as independent advocates, who have given a lifetime of service to the importance of these areas, who have commended an important initiative of the previous government and condemned the announcement earlier this year of the Rudd government, to see them resigning and moving away from this important national body, I think is a tragedy.

It is probably no surprise that we did not hear a squeak out of the state Minister for Health or from the minister for mental health at the time. To be fair to new members, I remind the house that at that time the minister for mental health was the Hon. Jane Lomax-Smith, who, of course, is no longer in the house, and the Minister for Health, who had overall responsibility, is the Hon. John Hill. There was not a squeak out of either of them or presentation to their federal colleagues in the Australian Labor Party to say, 'This just can't be done.'

What is interesting about that is that not only did we not hear from them, not only did they not make any public statement saying that that was not right, even when it came to the new agreement being negotiated with the federal government by the state health ministers there was still not a squeak about this issue being dealt with adequately in the new agreement. We still do not know what is in this new agreement or how it will work. We do know that the state government is expected to hand over 30 per cent of its revenue from GST in exchange for a commitment to a 60 per cent contribution on the overall health budget, but there are a whole lot of aspects of health that will move from one jurisdiction to another and for which there will be primary or shared responsibility, the detail of which we still do not know.

We had complaints by the minister for health during the Howard years that there had been a move away from 50:50 funding. Members might recall that we went through all that 'no blame' era for three years under the Rudd administration and then there was this magnificent agreement reached, about which we still do not know. What we do know is that Western Australia has had a good look at it and has said, 'No way; we're not signing up to that. We are much worse off.'

So apart from not resolving the blame game, we now have a funding formula which, hopefully, when we see the budget this afternoon, might indicate some joy. I hope I am wrong, but at this stage I think we will be badly stung. While GST money is raining in people do not seem to care, especially the Treasurer. He is just happy to spend it all. However, times come when things get tighter, when we have high unemployment and higher health needs, and we need financial management and an assurance that these agreements will improve.

In the meantime the state government has persisted in continuing to sell off 42 per cent of the Glenside Hospital site to build film corporations and allow for supermarkets, retail shopping precincts and private housing—all to go onto this land. The state government says we do not need to have this high level of acute beds at this facility anymore because it has put some out in the other general hospitals and because it is putting so much more into general community health.

If, in fact, that had been put in place before they started bulldozing buildings at the Glenside Hospital site we may have had some capacity to accept the government's good intentions in this regard. However, for the government to claim it will do that and then allow its own federal colleagues in Canberra to remove the opportunity for community mental health services to thrive and expand—namely, by allowing people to have a Medicare rebate by going to see their psychologist and social worker to, first, relieve the high level pressure on psychiatrists and other professionals and, secondly, to be able to treat families and patients affordably before they get to need acute care—is a complete mystery to me.

It is a complete mystery as to why we not only have the silence but also a continuation along this line, when the government's colleagues are really just extracting out the very basis we need to have security of and access to affordable health services for mental health patients. It is beyond belief that we have not had a tweak, let alone a tweet, out of the Minister for Health, who now has the total portfolio under this new administration, about this shameful abandonment of people in mental health across Australia. If members of the house are not keen to listen to me on it, they should read the letter that has come from Professor Mendoza, who makes abundantly clear the desperate situation that is out there and the disgraceful treatment by the federal Labor Party and its axing of this important service to assist our mentally unwell.

Mrs VLAHOS (Taylor) (12:15): I rise to oppose the motion. The government wishes to place on the record its response to some of the things that have been said by members on the other side of the house, particularly the member for Bragg.

On 1 November 2006, Medicare rebates were introduced to allow patients diagnosed with mental disorders to receive up to 12 individual and 12 group allied mental health services per calendar year. These items are part of the better access to psychiatrists, psychologists and general practitioners through the Medicare Benefits Schedule, Better Access initiative, which forms part of the Australian government's component of the Council of Australian Government's National Action for Mental Health 2006-11.

Allied mental health services that can be provided under this initiative include psychological therapy services provided by eligible clinical psychologists and Focussed Psychological Strategy services provided by eligible psychologists, social workers and occupational therapists. In the 2010-11 federal budget it was announced that, from 1 July 2010, social workers and occupational therapists would no longer be eligible to provide Medicare-rebated services under the Better Access initiative.

Access to these allied health practitioners will be transferred to another Australian government program under the Access to Allied Psychological Services (ATAPS) initiative, which will deliver new packages of care to people with severe mental illness living in our community.

On 19 May 2010 the federal Minister for Health and Ageing announced that the implementation of the new care package, and the associated changes to the Medicare Benefits Schedule items for occupational therapists and social workers, has subsequently been deferred until 1 April 2011. This was in response to ensure that future Better Access reforms were informed by the evaluation and the detailed design of care packages that can be developed in consultation with the professional groups mentioned. Until then, the current arrangements will stay in place.

Professor John Mendoza resigned from his position as Chair of the National Advisory Council on Mental Health on 18 June 2010. It is understood that Professor Mendoza cited a number of reasons for his resignation, including that the Australian government had no vision or commitment to mental health. The federal Minister for Health and Ageing rejected this assertion.

The federal Minister for Health and Ageing, when announcing the changes to the Better Access government program, stated that the Australian government was committed to reforming Australia's mental health care system so that it provides better integrated care to those most in need in our community.

The government of South Australia is also very committed to reforming mental health services. In response to the Social Inclusion Board's Stepping Up: A Social Inclusion Action Plan for Mental Health Reform 2007-12, the state government has committed an additional $107.9 million to the reforms. This additional funding is to implement the Stepping Up reform program, which takes the total investment to mental health services and infrastructure by the state government to over $300 million.

Significant improvements in mental health services have already been made and others are underway. These important changes will provide many of our vulnerable consumers and their carers with improved services to assist the recovery from mental health issues and illness. The state government has:

completed a new strategic mental health bed plan to implement the new stepped system of care. Overall the plan will deliver 86 more adult beds and places across a variety of levels of care;

completed new models of care for the stepped system of care;

built three 20-bed community recovery centres in the western, northern and southern metropolitan areas;

provided new funding for $36.8 million over four years to non-government organisations (NGO) to deliver community-based psychosocial services to mental health consumers. New service models have been designed in consultation with the NGO sector and new contracts commenced in April 2009;

issued tenders for the construction of the first three 15-bed intermediate care facilities to be developed at Glenside, Noarlunga and Queenstown. Construction of the Glenside facility (which the member opposite is very passionate about) will be completed by mid-October 2010 and the Noarlunga facility is expected to be completed by late October 2010. Construction at Queenstown in the western metropolitan area is to be completed around May 2011. A search for a site in the northern metropolitan area is continuing and it is something which I am very passionate about. Intermediate care is a new model of care in the stepped system of care and it is important that we do it correctly;

completed a review of community mental health and approved some $34 million to develop six community mental health centres across the metropolitan area. The first of the centres is currently under construction at Marion and will be completed in early 2011. The development of a second site in the eastern metropolitan area is anticipated to commence this year and be completed by July 2011. The other four facilities will be progressively completed in the 2012, 2013 calendar years;

developed a new Youth First Episode Psychosis service to assist mental health staff provide early treatment to young people experiencing mental health for the first time;

planning is also advanced for the development of the first 18 non-facility based intermediate care places in the country for the 2010-11 calendar year;

under the Social Inclusion Board reforms, funding was provided for the development of 53 supported accommodation places across the metropolitan area. These will be developed by NGO community housing providers and are scheduled for completion by June 2011. Construction will commence on 20 supported accommodation units on the Glenside site during the 2010-11 calendar year and will be completed around mid-2011. Experienced non-government community mental health organisations have been selected to support these consumers. Once again, this is another new level of stepped care for these consumers;

the Mental Health Bill was passed by the parliament in 2009 and the new Mental Health Act 2009 implemented on 1 July 2010. The new mental health legislation affirms the rights, dignity and civil liberties of mental health care patients and their carers, and aims to make it easier for patients to access treatment; and

in April 2008, the government released a master plan for the Glenside campus. The plan outlined the development of a new, world-class 129-bed hospital for mental illness and substance abuse. Construction is expected to be completed by mid-2012.

These are just some of the many initiatives that the South Australian government has committed to improve the wellbeing of our vulnerable mental health consumers and their carers. We remain committed to the development of a modern, best practice mental health system for all South Australians, particularly those who are vulnerable or who have a history of mental health complaints.

Mr GARDNER (Morialta) (12:22): One of the great frustrations of being a new member of the opposition in this place is the difficulties we have in getting anything done when issues of public policy which concern us greatly arise, or, indeed, when matters which we raised during our election campaigns in our electorates come up. Being in opposition, of course, you can write to the minister, you can speak publicly about your concerns and you can raise ideas in this place, but getting anything done can often be like bashing your head against a wall.

I make those comments because the issue of mental health, I think, highlights for me the disappointment of the sort of futility of our position in opposition in many ways more than any other. Today we have a motion moved by the member for Bragg that this house condemns the Australian Labor Party for committing to cancel Medicare funding for services provided by psychologists and social workers; and expresses disappointment at Labor's failure to address mental health issues which has resulted in the resignation of Professor John Mendoza from the position of Chair of the National Advisory Council on Mental Health, and I support that motion.

I wish we could do more than move a motion. I wish we could do more than speak to this motion. It is deeply personally frustrating. I am sure that we will spend a great deal more time talking about what more needs to be done for mental health in this state in the years ahead and in the years that I hope to serve in this chamber, but, most importantly, we need to do more, and I urge those on the other side to do that. In particular, I urge them to speak up when the federal government makes extraordinary decisions such as this year's budget decision to cancel Medicare funding for services provided by psychologists and social workers.

When this decision was made in early 2006 and the Howard government provided support for psychological referrals for someone presenting with potentially the early signs of psychological problems or mental health problems, it was seen as a great step forward and it was found to be a great step forward for many Australians who were able to take advantage of these referrals.

In Australia, members would be aware that one in four Australians suffers from some sort of mental health problem. That means that, in every family, either mum or dad or the daughter or the son, chances are one of them is going to suffer from some sort of mental health difficulty, whether it be depression or anxiety or something more serious like schizophrenia. I would imagine that most members in this place, if not all, have a brother, a sister, a mother or father, a grandparent or a child who suffers from some sort of mental health problem.

The opportunity to access a referral to a psychologist from a GP has been of great assistance to many Australians and the curtailing of this opportunity is a cruel blow to all of us and it is a cruel blow to community wellbeing. As a primary concern, it is bad for Australia in terms of productivity. The loss of productivity in Australian due to people being unable to fulfil their potential as they are overwhelmed by their affliction is of great concern, and, more importantly, of great concern to our families.

I noted in the government member's response that the government seems to think that the new packages for severe mental health problems available under the Better Access program are sufficient to address the need in society and that the current Medicare funding for those referral services is unnecessary.

This was discussed by the National Advisory Council on Mental Health in the lead up to Professor Mendoza's resignation from that council as its chairman. I note that it was reported in The Canberra Times on 26 June:

Most experts on the advisory council believe the program—

that is, the Better Access program—

is sucking money from where it is needed—in services for growing numbers of mentally unwell young people—and that it is shutting out men, the poor and rural Australians.

It goes on to report:

Federal Health Minister Nicola Roxon told ABC television this week a 'lot more' still had to be done in relation to mental health. 'But we believe some of the steps we are taking are good ones,' she said.

Well, some of the steps they are taking may be good ones but that does not excuse this extraordinary blight on this year's federal budget and this extraordinary wound that the federal Labor government has delivered to Australians dealing with mental illness and their families and all of those affected.

The resignation of John Mendoza should be a ringing bell to everybody who is concerned in government, whether it be state or federal government, about the shocking decision made by the federal government this year. I would urge those opposite to reconsider their opposition to this motion. This motion is all that we can do from opposition in relation to this matter, and if it can ring that bell for those in government to provide further services to those needing treatment for mental illness—and particularly in the early stages—then I think it is worthwhile. I urge all members to support this motion.

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