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Tuesday, 1 June 2010
Page: 4843

Mrs HULL (4:31 PM) —To continue my discussion from last evening on Appropriation Bill (No. 1) 2010-2011 and related bills, I would like to again alert the House to the fact that the changes the Minister for Health and Ageing is proposing and has deferred for nine months will have a marked and disproportionate impact on regional people. I was speaking last night about the Wagga Wagga community and how health and mental health services currently operate and would operate in most of the major communities across Australia. I have been advised that if you take away the Medicare rebate, the people in community mental health teams will not be able to refer the low-risk clients that I spoke about because they know that those clients will not be able to afford the treatment. Those clients will stay on the books of the community mental health teams but they will be put down as a low priority. The high-priority clients will always receive first preference and the low-priority clients will be put to the bottom of the pile. If the low-priority clients are not given appropriate care, then I think you can assume that many of them will turn into high-priority cases simply because they have not been accessing the appropriate treatment. This, of course, is a vicious circle. The budget paper says, on page 320:

From 1 July 2010, support for allied health workers, such as occupational therapists and social workers, will transfer from the Better Access initiative to the new ATAPS service stream. The new arrangements will provide a more flexible funding pool for care packages, and increase the role of allied health workers in the provision of new care packages for people with severe—

I repeat, severe—

mental illness.

This is where the problem lies. The budget paper goes on to say:

Patients receiving treatment from these providers as at 1 July 2010, will be eligible to complete that course of treatment under ‘no disadvantage’ arrangements.

It talks about using the workforce to ‘support individuals with severe mental illness’, who it says ‘often receive inadequate or fragmented care’. But the early intervention service that had been used for this has obviously been shelved. So those who could benefit greatly from early intervention will certainly now just be part of the new statistics of mental health.

The point is that this will disadvantage rural areas because we have minimal clinical and registered psychologists. People rely on the social workers for the early intervention services. But it appears that, with the changes that the minister has made, the social workers will now be relied on for the acute treatment. This is a difficult and major problem that is confronting us in regional Australia.

I am going to refer to some comments that I have received out of my electorate on this. I will quote from an email without naming the sender, but it is a local provider of service. The provider of the service says:

This is in relation to the proposed cuts to the Better Access to Mental Health Services Medicare rebates.

As of 1 July 2010, Medicare rebates for new clients accessing accredited mental health workers with social work qualifications (and occupational therapy qualifications) will cease. This will severely restrict people’s access to mental health counsellors—particularly rural and regional people. Please could you advocate for current levels of Medicare support to be retained in the interests of all people but particularly for those outside of metropolitan areas? Social workers, as opposed to psychologists, are much more likely to be based in regional/rural areas and your local university is a major player in the education of social workers in Australia as we have one of the largest and most respected social work degrees. Social workers provide high quality, holistic and effective mental health services and it is not sensible to restrict clients access to high quality professionals.

The next letter, again from a person in my local community, says:

As a Social Worker in Wagga Wagga, I ask you consider in the budget estimates the point of retaining the funding of Mental Health Social Workers and Occupational Therapists under the Medicare Better Access scheme as it stands as of today.

Better Access was designed as an early intervention measure to avoid the high ongoing and cyclical cost of mental illness as it worsens. Mental illness also affects family and friends of the individual sufferer and this creates a snowball effect of service provision (e.g. GP, emergency departments, counselling, Centrelink, welfare, education, legal—family law—etc). Under the scheme, people were encouraged to seek help for mental health issues if they were in the early-mid stages of the illness, or if they didn’t fit the current mental health system, if they were not able to access the mental health system due to distance or for financial reasons.

This system was also intended to stop people ending up in hospitals and GP’s and thus draining resources that did not necessarily fix them. Thus, we had persons being provided with inappropriate and inconsistent services. This was also a ‘market driven’ approach in many respects because people sought help when needed and private social workers only got paid upon use of service. This was designed to be targeted and flexible but most importantly early.

I think that is the clear issue here: the early intervention that is required. The letter goes on:

Mental Health social workers undergo a rigorous screening process to ensure that they are able to provide mental health services. It is not a system by which poorly trained people can make lots of money by rorting the system—far from it. Many of the social workers in practice have taken income cuts to practice privately, don’t charge gaps and have many years of clinical experience.

It is painfully clear Nicola Roxon has missed the point when she says: “we must deliver these monies to services for the severely ill” and her way of doing this is to remove social workers out of the early intervention model and put them in situations where they manage severely ill peoples cases.

This does not make sense economically as these people use many resources before they are considered “severely ill” and then become in the revolving door of crisis driven mental health care. It makes sense to retain well trained, private providers who are providing market driven early intervention services to avoid the devastation that occurs when people do become severely mentally ill.

With this in mind I ask you to say no to the proposed changes that will become effective in April 2011, and that you vote in favour of Mental Health Social Workers and Occupational Therapists under the Medicare Better Access scheme as it stands as of today.

That is a cry from providers, but there will also be a cry from the people.

I would like to raise another issue that was in the budget: the cut of $4.5 million overall from the counselling services provided within family relationship centres. Family relationship centres provide family counselling to assist people to resolve their family relationship issues. Sometimes this keeps families together. This service prevents family breakdown and reduces family conflicts, particularly where couples go on to separation. It also helps families to adjust to separation with their children and it does it in the most sensible way to try to give the best outcome for the children of Australia. To cut $4.5 million from this essential program represents a lack of understanding of what is provided and what is required to support families through the trauma of partnership breakdown and to support the children who are the casualties of partnership breakdown. But this is like Tim Shaw: there is more; there is a set of steak knives as well. Not only is there a cut of $4.5 million from this essential program but, in briefings that the sector had with the Attorney-General’s Department, they found out that future cuts of more than $40 million in the next year are flagged. But these cuts do not appear in the 2010 federal budget papers.

I am really concerned that there is a clear lack of understanding of how family relationship centres help deliver better outcomes for the children of Australia. Before they were available in rural and regional Australia we had to contend with many different systems. That leads me to the next problem we have, and that is the Attorney-General’s determination to remove family law from the Federal Magistrates Court. When the former coalition government introduced the Federal Magistrates Court, we were receiving no Family Court circuits in regional Australia—maybe we had one here and one there, but they were very few and far between. For regional Australia it was a most costly process to try and resolve your partnership breakdown issues. We introduced the Federal Magistrates Court, which has been a roaring and raging success. It has 33 regional lists in New South Wales, Victoria, Queensland, the Northern Territory, South Australia and Tasmania.

What you get in the Federal Magistrates Court that you do not get in the Family Court is that, once you have commenced with a judicial officer, you usually stay with that one officer until the finish. What we have is a user friendly, less adversarial and less legalistic process for families. The protocol of the Family Magistrates Court to deal with family law is a trial within six months and judgment within three months of trial. We have over 86 per cent of our family law cases being resolved within six months of filing. People get access outside court circuit time for recovery orders, injunctions and urgent relocation orders, and there is a customised service to deal with the various issues that arise as a result of partnership breakdown.

The FMC currently does more than 80 per cent of the work of family law. Here we have a very successful process with the ability for regional people to access it. It is much less adversarial and it is much less costly. But this is what the Attorney-General has decided will happen: he will allow the Family Magistrates Court to be retained but he will remove all family law from the Magistrates Court and put it into a Family Court structure. It will be a single court that will deal with all the family law matters. He will have a restructured Family Court, which will have two divisions. There will be a superior division, which will hear all the complex cases, which are about five per cent of cases. They will get 90 per cent of the funding to do about five per cent of the cases—the Family Court is currently the most expensive court. There will also be a general division, which will hear the other 95 per cent of cases—the high volume, less complex family law and child support cases.

The Attorney-General is saying that the federal magistrates who are currently in the Federal Magistrates Court would perhaps come across and do some of this and accept commissions. I say to you that is not what the federal magistrates want. They do not want to come across to the Family Court system; they do not want to come under the administration of the Family Court. We should not have a Federal Magistrates Court just left there to get dual commissions with the Federal Court and the military court—because we will have a military court established now in accordance with chapter III of the Constitution.

Now, this is a travesty. This is devastating for regional families. This is devastating for people who can currently resolve their issues without costly battles. This is devastating for the children of those families who will go on to partnership breakdowns, because they will be stuck in a revolving system that will see mums and dads fighting each other in court for three and four years before decisions are made.

Seriously, when the Standing Committee on Family and Community Affairs of which I was chair did the child custody report Every picture tells a story, where we ended up with a bipartisan report, we agreed that the Family Court should be disbanded. The Family Court should be gone. The Family Court is an indictment of the people of Australia. The Family Court does not offer sensible solutions for the Australian children who find themselves caught up in a mess not of their making.

I would urge the Attorney-General to seriously reconsider this. It is the Federal Magistrates Court that should be hearing the family law cases. You should turn it into a district court that enables regional Australia to have access to the most appropriate resolution of partnership breakdowns that will see the least damage done to the children of today and the children of the future. Thank you.