Keynote Address to
the MHCA AGM
Senator the Hon. Lyn
Allison, Chair of the Senate Inquiry into Mental Health
Thanks to
the Mental Health Council for their briefings to the committee, advice,
submissions, feedback, various reports, including Out
of Hospital, Out of Mind and Not for Service.
The
inquiry has received 550 submissions, 16 formal days of hearings, 3-4 to come
and several informal visits and meetings.
Examples
of informal meetings – post natal depression group PANDA, gay and lesbian
groups,
Our main
findings:
Mental
health services in
Not for Service - the
title drawn from the formal categorisation used in
The
evidence provided to the Senate mental health inquiry is that seriously ill
people are routinely triaged away from public hospitals in every state. Those who are admitted are typically out a
day or two later having received no treatment other than stabilisation of their
medication, and no follow up support. They soon return to the revolving door of
the A&E department and some become a suicide statistic. The inquiry has received dozens of letters
from parents and carers outlining the tragic story of their
son or daughter or spouse’s failed efforts at getting services, being
turned away again and again and ending up dead.
It doesn’t
have to be this way. Isolated examples of
sensible, humane practice exist but they are almost always under threat. In our report I want to spell out those good
practices so people who don't have access to them can demand to know why
not.
The collaborative
model set up in
Another
provides short term housing, supervision and clinical support, 24 hours of
every day, for those who feel they are becoming unwell or are recovering from
inpatient admission.
These
excellent programs are keeping people out of hospital, not by stamping their
files ‘not for service’ but by offering early intervention and a real chance of
a normal life. And what’s more, it’s
proving cost effective!
State governments
are focused almost exclusively on acute care, in line with Plan 3 of the
National Mental Health Strategy, but it’s failing. The Shepparton programs, like so much good
but patchy work around the country, are unlikely to be properly evaluated or
replicated and will close unless there is a re-think of the short-term,
competitive, grant-based funding model with which governments persist.
We are
knowingly withholding service which is attainable. The International Covenant on Economic Social
and Cultural Rights, Article 12 recognises the right of everyone to the
enjoyment of the highest attainable standard of physical and mental health.
Our
inquiry is finding increasing demand, almost no prevention and early
intervention, little integration of services, ongoing stigma and discrimination,
a lack of government accountability, shortages of trained staff, under-use of
consumers in decision-making and serious under-funding.
These
shortcomings are evident in our prisons and in the community where families and
friends are de facto mental health workers and death is common.
Many say
deinstitutionalisation was an abject failure because extremely vulnerable
people ended up abandoned. This
certainly happened but it was because no services were provided in the community
and most highly institutionalised inmates were released without supports or coping skills.
The
failures of deinstitutionalisation are not reasons to again commit thousands to
a more or less permanent state of isolation where treatment is at best dubious
and recovery unlikely.
The constant
bickering between the state and federal governments over which is responsible
for fixing the mess is debilitating and one of the reasons the National Mental
Health Strategy lets governments spectacularly off the hook with no targets or
timelines.
The
health ministers were so touchy about their mental health services that none would
appear before the inquiry. But now the time for buck-passing has surely
passed. Mental health has been the poor
cousin of health for many years and it urgently needs the efforts of all
governments, not to discover who is to
blame but work out how we fix the situation.
Some of
the issues in more detail:
-
divvy vans and security guards vs
–
children, adolescents, the aged, Indigenous,
intellectually disabled
–
children of adults with MI
–
mothers and post natal depression, mothers who
adopt out, care leavers
–
under and post graduate, geographic distribution,
attitudes
–
mental health first aid/hairdressers in Horsham
-
Should there be mental health ministers/budgets/departments?
-
Perhaps a Mental Health Commission like NZ
-
Role for LG?
-
Collaboration, benchmarks and targets, standards
-
Medicare and psychologists, BOMHI
-
Mental health and public community health centres
-
Transparency of decision-making – next plan???
-
Anti discrimination law reform, privacy
-
Italian experience/Trieste – tax incentives for
employment of people with MI
-
Leadership – where will it come from?