Senator TIERNEY (1:24 PM) —I rise today in this matter of public interest debate to draw to the attention of the Senate the plight of the mentally ill. Over time, society has taken very different approaches to people living with mental illness. It was not long ago that the most vulnerable people were locked up in asylums, never to be seen again by their friends and family. We have come a long way in the area of mental health, and we have seen far-reaching reforms over the last two decades. Yet we still see many people living with mental illness who are not receiving the care and the support that they need. Nationally we are now in the early stage of the third mental health plan, which will run from 2003 to 2008. It is a fine plan and it has been agreed to by all the federal, state and territory governments. This plan has received favourable international recognition. The World Health Organization's 2001 report Mental health: new understanding, new hope noted that our national health strategy:

It is a great plan, but does the reality match up?

The problem is that, like its two predecessors, it is unlikely to substantially improve the disgraceful state of mental health care, because its funding by the responsible state governments is uneven and grossly inadequate. The worst offender is my own state of New South Wales, which is at the bottom of the mental health funding league across all the states. Overall, mental health takes up 14 per cent of the disease burden in Australia but accounts for only 9.6 per cent of the funding. Like many other nations, Australia's mental health strategy has deliberately shifted our focus from institutional care to community based care. Resources previously targeted towards maintaining centralised mental health facilities have been redirected to provide services delivered through a spectrum of service models, which include the use of general practitioners, community centres, day centres, specialist general hospital wards and small specialist hospitals. But the funding has not followed.

The progress of Australia's reform agenda has been documented in a series of national mental health reports which provide information that helps consumers, their families and service providers to continue to monitor the progress against the plan's defined objectives. However, as noted in the latest national mental health report, while Australia made significant progress against the national reform agenda, there are many challenges still to be addressed. The number of mentally ill people who are committing suicide is rising, families do not have access to the services that they so desperately need, and the state governments simply are not allocating the funds necessary to help people suffering from mental illness and to help the service providers on the front line.

David Richmond, the author of the Richmond report that began the process of de-institutionalisation across the country in the 1980s, told Channel 9's Sunday program last weekend that when he made the recommendations to move patients from institutions to the community his preference was that the states would allocate the resources no longer being used by institutions to the community. Over the past 18 years, the state government's program of de-institutionalisation was supposed to move people out of institutional care into community homes with supervision and care. The reality is grim. What we see in New South Wales is a shadow of the original Richmond scheme. The state government treasuries have grabbed back the lion's share of the savings from de-institutionalisation, with only 10 per cent of the money going back to supporting people with mental illness.

Brian Burdekin, former commissioner for human rights, has acknowledged that de-institutionalisation has largely failed because not enough resources have been allocated to front-line services by state governments. State government spending on mental health is appalling, with my state of New South Wales having the lowest rate of expenditure. This means that, despite applauding mental health plans, families are struggling to get access to services quickly when they need the support most. In my state of New South Wales the Richmond report vision, of community care groups supported by case managers and community based mental health teams, has been lost as a result of a lack of funding by the state government. Our mental health system in New South Wales is at breaking point. David Richmond himself has called for more targeted and transparent funding of mental health. The states have the constitutional responsibility and the resources to implement the original aims of the Richmond scheme—case managing and rehabilitating people with mental illness in a group home setting. The Carr government in New South Wales obviously does not see mental illness as a priority, and it is our most vulnerable that are suffering.

Some people have put to me that mental health is not receiving the funding it deserves because it is not an issue that affects votes. I find this difficult to understand as the prevalence of mental illness in our community is staggering, with many people suffering from mental illnesses such as depression. Many more Australians know someone who is living with a mental illness, and families often bear the burden of caring for loved ones who are suffering. It is thought that up to 23 per cent of Australians will suffer from a diagnosable mental illness each year. It is an issue that is relevant to voters, and state governments need to step up to the plate and provide the services that are so desperately needed.

Former Victorian Premier Jeff Kennett, who is now chair of beyondblue, said that he believed that mental health was an issue that people cared about and that access to emergency services and good training for GPs were important to people and their families. In 2002 the New South Wales Legislative Council Select Committee on Mental Illness conducted an inquiry into mental health services in the state. The inquiry was the first parliamentary inquiry specifically into mental health since 1846—more than 150 years ago. Clearly, the tides are turning and the public is becoming more literate regarding the challenges and needs of those who live with a mental illness.

I believe that there is a solution. The national health plans have been a world leading initiative and we have across all levels of government an agreed basis on which to move forward. We need to convert our mental health plans into action. There is no glory in having an internationally renowned plan that is not being implemented. There is too much at stake, including so many people's lives. The states are clearly not delivering when it comes to allocating resources to those who are in need and those who support people, such as the GPs, nurses, social workers and other health care practitioners who are on the front line. Over the next eight years, from 2005 to 2013, they need to bring into line the proportion of the health budget to match the proportion of the total disease burden that mental health represents. In particular, we need to rebalance these resources. This imbalance will be made up when 14 per cent of the disease burden is matched by 14 per cent of the expenditure instead of the current 9.6 per cent. We clearly need increased resources in mental health so that by the end of the fourth national health plan in 2013 these will be in balance.

We need also to increase other support services as part of this plan, particularly counselling support. The only 24-hour crisis counselling in Australia is run by Lifeline, and there is a high turnover of the volunteers who man this program. The average length of service is only 2½ years. Pressure has increased on this service in recent years because of the decline in after hours mobile crisis care mental health teams as the state governments have failed to contribute adequate resources to the area. Governments should fund the training of Lifeline counsellors and dedicate the Lifeline 24-hour crisis counselling line as a telecommunications universal service obligation by adding the 131114 number to the USO schedule.

We need also to expand resources to help GPs as primary health carers. Two-thirds of all patients who present with mental health issues do so to a GP. The general practitioner often does not have the counselling skills, the time or the financial incentives to provide the level of treatment necessary. We need to improve the quantity and quality of the time that the GP spends with patients by increasing access to in-service training, expanding further the excellent psychiatric help line consultation service that is now being brought in for GPs, and we may need to look at higher payment for extended consultation times.

We need also to re-establish after hours mobile crisis care teams. On-the-spot assistance for people who have their first mental health episode is now often in the hands of police. This should be the last resort, not the first. Health issues should be dealt with by the health system. Why are state governments withdrawing services from such a critical service? We actually need to double the number of acute care beds. The deinstitutionalisation of mental patient care by state governments over the last 40 years has reduced the number of acute care beds to 10 per cent of their earlier establishment, and that is approximately half of what is actually needed. In accordance with the trend to mainstream, mental health services closed wards in general hospitals—and I think that the Carr government in my state has closed 8,000 beds over the last nine years. These wards should be reopened and some of them dedicated by state governments as acute care mental health wards. The number of acute care beds should be doubled between 2004 and 2013. We need to develop and extend community based residential care. The deinstitutionalisation of mental health care by the state governments has never been matched by sufficient community care places with appropriate support. Many people who in former times would have been institutionalised are inappropriately accommodated, or homeless, with little or no support.

We need to establish also appropriate forensic facilities in all states. The management of forensic patients is very patchy across the state jurisdiction. Under Premier Jeff Kennett in Victoria best practice was developed with the Thomas Embling unit. Other state governments should shut down their jail based forensic units and establish facilities based on the Thomas Embling model. Jails should not be de facto mental health institutions.

Mental health has a stigma due to a lack of public understanding of the nature and the causes of mental illness. We need a series of media campaigns to explain the nature of various mental health problems and illnesses. We need to focus our clinical services and the school curriculum on youth mental health. Seventy-five per cent of mental health illness begins with youth aged 15 to 25. We need to focus on the mental health problems of our younger Australians by providing specific programs and facilities for them. We need to place a greater emphasis on the understanding of mental health illness in the school curriculum. Elective studies in psychology should also be available in the senior years.

We need to increase the supply of mental health staff. There is a shortage of professionals working in this field, particularly psychiatrists and psychiatric nurses. This is particularly the case in rural and regional Australia. We need to introduce bonded scholarships for psychiatric doctors and nurses, with a requirement for country service. We also need to increase research funding for mental health, and this should take a higher priority in our research budget. We need to fund best practice in mental health care. In recent years many pilot and clinical trial projects with promising results for improving mental health have not been implemented widely, despite their demonstrated effectiveness, because of a lack of ongoing funding. We need to establish a best practice fund for the implementation of wide-scale, evidence based best practice pilot projects and clinical trials. We need to also expand access to mental health care using e-technology.

Consumers and professionals requiring mental health expertise in remote locations often find services difficult to access. We need to implement on a wider scale successful e-technology trials and we also need to expand access to respite care. Carers of people with mental health illness often lack access to respite care and we need to expand these facilities. In our rapidly changing society the mental health disease burden is likely to rise. The states have shown that they are unlikely to have the interest in or commitment to putting the resources towards this challenge. Intervention by Australian governments since 1992 has established a firm framework for tackling this disgraceful situation. We must improve the amount of resources allocated and we must try to catch up the backlog created by state governments over many years, because the mark of how civilised our society is can be measured by the way in which we treat those who are unable to help themselves, and surely the most vulnerable are those with a mental illness.