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Wednesday, 28 November 2012
Page: 13855


Mr LAMING (Bowman) (12:34): Male suicide in rural Queensland is 2½ times more common than in our major cities. That is a really important point that came out of the suicide in remote and rural Australia report that was released this month. It also shone light back on the perennial challenge for health systems: mental health. Obviously, one of the great challenges for regional Australia is that the current government does not have a regional health services portfolio, so that leaves it to us on the coalition side to run around the country and constantly hold this government to account for its activities in mental health. People living with mental health issues deserve all the support that we can muster. It is a $6 billion issue for the economy and for the nation. Of course, a combination of great therapists, world-leading drugs, early intervention, recognition and high levels of awareness all play a really important role. We welcome the release of another report this month. The message to the government clearly has to be that it is way more important to provide cutting-edge, state-of-the-art care for people living with mental health issues than it is to release reports. We do not want reports that accumulate dust on bookshelves. We need real-life solutions, particularly in regional and rural Australia, where they bear the brunt of mental-health morbidity, for the obvious reasons: people living in regional Australia are a long way from services, incomes are in general lower, and out-of-pocket expenses for health services are generally higher. It is very hard to coordinate care for chronic and complex conditions. At every level we need to look at those living in regional and remote parts of this country. We know that, if we get it right out there, we will be getting it right in the cities as well.

It was very disappointing to see a breakthrough drug already approved in three other countries around the world being refused by the PBAC not once, not twice, but three times in March of this year. This is a process that both sides of government should be respecting. Certainly the coalition has the record of doing that in government. What we have is a new challenge to our PBAC and the price-referencing that they rigidly apply, which we strongly support—that is, in categories of disease that are relatively slow-moving for new breakthrough drugs, where the existing treatment has now fallen to a generic price, it becomes very hard for new arriving treatments to be price referenced according to their cost effectiveness. Instead they are price referenced often according to a generic price. It basically means that it is very hard to get payment for a brand-new breakthrough drug and the cost it has taken to bring it down the pipeline. Contrast that with cancer, where there are so many new breakthroughs all the time that cost comparisons are always with a brand-new and usually very expensive drug.

This is a challenge for mental health, where we have not seen new drugs for a very long time. As my colleague Andrew Robb wrote in Black Dog Days, we know how tough it can be switching between medications when you are struggling in this situation. This is particularly so with depression, where there are strong effects to one's sleep. Without sleeping well, a productive and successful life can be turned into a misery. Agomelatine offered a solution to that issue. The drug has been refused three times and the manufacturer have given up. They have left and will not be trying again.

That might seem like a sob story from an individual pharmaceutical manufacturer, but it does mean that we now have a two-tiered system in this country. We have the wealthy, who can pay for the best drugs, and everyone else makes do with what is left. That should be of concern to every government. Without making too much of a political point, because we all support the price referencing and the foundations of the PBAC process, let us also be aware that when there are specific challenges they make it almost impossible for a new drug to prove its worth in this country, quite simply because the comparators used are only costing a few dollars. For the sake of people whose lives could be turned around—there are 10,000 of them in this country who may benefit from this as an alternative treatment for depression—we should be looking for ways to make sure that our PBAC process supports that.

We know from the report released this month that there are social, cultural and economic underpinnings to the distribution of depression around this country. We know that a combination of macho Australian attitudes, fluctuations in the economy for those living on the land and of course the effects of fires, droughts and bushfires have already had a compounding effect. This makes it really hard to convince many people living in remote areas to step out of where they live and where they work and actually talk about the challenges that they have. We can do that together, with both sides of politics, but I do implore this government to respect the PBAC process. If a drug is approved, do not let it be held up in cabinet. Respect that process; do not second-guess it. If you are going to have a recommendation and ignore it at cabinet level then do not have the committee just make the whole thing politicised. Do not live in this middle world where you accept the experts' reports but you do not actually act on them. That is the challenge of the PBAC, and it is one we should support on both sides of the chamber.