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Standing Committee on Education and Employment
Mental health and workforce participation

KINCAID, Mr John Francis, State Coordinator, South Australia, Private Mental Health Consumer Carer Network (Australia)

McMAHON, Ms Janne Christine, Independent Chair and Executive Officer, Private Mental Health Consumer Carer Network (Australia)


CHAIR: Welcome. Although the committee does not require you to give evidence under oath, I should advise you that this hearing is a legal proceeding of the parliament; therefore it has the same standing as procedures of the respective houses. We have received a written submission from you; thank you very much. I now invite you both to make an opening statement and then we can proceed to questions.

Ms McMahon : Thank you very much for the opportunity of appearing before you today. This is certainly an issue that is particularly close to my heart and also John's and the many people we represent. You will know from our submission that we represent both consumers and carers of people who see private psychiatrists, private psychologists and others in their own private practice and also folk who go to private hospitals with mental health beds for inpatient care and also the other outpatient type services.

There are three issues we would like to illustrate around a lot of the misunderstanding around mental illness in terms of both training and workforce participation. It is very episodic in nature. You can have a very chronic and very debilitating mental illness but you can also have episodes within that chronicity, if you like. People can go along quite well for some time and suddenly there will be a crisis that will throw them into a real episode of mental illness. The episodic nature affects people's ability to be able to gain and, particularly, retain education and training, which is particularly important. Very often variations in treatments around medication issues can present a range of issues. Medication can make you fuzzy headed, blur your vision and make you lack concentration and a whole range of other issues like that.

People do not always necessarily display signs of mental illness. Certainly many of us do not admit to it—for a lot of the reasons we have discussed in terms of stigma and how this might affect obtaining and retaining meaningful employment et cetera. We heard the young lady talk about self-stigma and isolation being additional burdens for many people to carry.

The second point we would like to make is about the ability to resume a former career. People have perhaps had an education pathway interrupted because of the first onset of mental illness or they have gone through a career path and mental illness affects them later in life. We have seen that with a number of high profile people. We had seen Mr John Brogden and Mr Geoff Gallup, for example, who have very openly come out about the way in which it has affected their careers and the political positions they have held. People find great difficulty in re-engaging with either former education and training or former employment opportunities, and coming to terms with and handling the grief associated with that loss and the knowledge that you will never again carry on in the capacity in which you were functioning is an additional burden. The third point that we would like to stress is that, because of the development of a chronic or debilitating mental illness, in regaining some form of employment people often find themselves overqualified and they perhaps go for more mundane or more hands-on-type—driving or labour-type—positions and find that they are rejected even from those because of the overqualification of their particular areas of expertise. That can be a double disillusionment for people and very often sends them spiralling deeply into mental illness again. So people often find themselves applying for positions also in their mental state that they just find that they cannot accept the work even if they did get it, that they are struggling with.

Finally, we would like to support the announcements in the recent budget around the disability support pension. I have certainly been a recipient for some time of the disability support pension in the past, and I would like to stress that one of the issues for me was the fact that I could try to start on employment, knowing that I had a two-year period of grace; if I did not succeed, if things blew up that I was no longer in control of, that it was like a safety net sitting underneath. We certainly support that aspect in the budget announcements, and also the personal helpers and mentors coming alongside someone who is now looking for and supporting someone looking at re-engaging in training, education or employment.

We also note within the budget requirements is the mandatory assessment requirements by Centrelink staff as a lead into either obtaining the disability support pension or maintaining it. We do have some concerns around the ability of the Centrelink staff to understand the complexities of mental illness and the uniqueness of mental illness. Like everything, the workload is satisfactory enough to be able to undertake reasonable and objective assessments of people. I think for people with a mental illness who are currently on a disability support pension there is a lot of fear out there. There is a fear that, because of the episodic nature, they could be thrust into employment perhaps before they are actually able to undertake that.

They are the four major areas: the stigma associated with mental illness, the misunderstanding of it, the chronic and episodic nature; and the budget recommendations that we support. My particular circumstances are—and it is something that I do not usually share, certainly in a public forum, so this is going very public with the Hansard; it will be out there for the world to see—I had a former position as a very successful salesperson in real estate, which is probably a relatively difficult area in terms of anxiety and so forth. I found that I could not continue in that because of my mental illness. I went down and down and down and found that I became a mental cripple, if you like, isolated in my own home. There were no peer support agencies or peer support people. MIFSA at that stage was the Schizophrenia Fellowship, so only dealing with those folk. I look now at the difficulty that I had in trying to drag myself up, knowing that, in terms of myself and my family, I could not continue in that nature and I decided to go into Volunteering SA, the organisation that people go to looking for volunteers within their organisations. Just to get in there, to sit at an interview and to be offered a voluntary position within the organisation itself for three hours a day, one day a week, was the most extraordinarily difficult job that I have ever done in my life. But, having said that, I think you come to the realisation that you have got to do something sooner or later. For me—and it is something that I feel very strongly about, and I am sure that John will be very happy to discuss things as well—employment or doing something positive is and was, in my mind, the key to me regaining my health.

After the volunteering episode, which I plugged away at and took multiple valium and so on just to get me through three hours into the city, I was offered to sit as an advocate in the private mental health sector. That would involve a full day meeting about four times a year. It would take me two to three weeks to recover from just sitting around a table. But my saving grace has been hanging onto the work that I do as an advocate, the passion that I have and, more particularly, the fact that, if I let go, I am actually quite frightened about kind of sliding back into that position that I have been in before. It is not easy. It is hard.

We in the private sector see many people who come out of WorkCover area. In terms of inpatient admissions, they are usually looked after within the private hospital sector. I heard the folk previously talking about their peer support, which really does not exist within the private sector. Given that we have a large chunk now of mental health—beds and workforce and all the rest of it—is a very sobering thought. If it had been my experience to have someone come alongside and support me, then I think the task (a) would have been easier and (b) would have been much quicker. I am certainly happy to take any questions but John may wish to add his perspectives.

Mr Kincaid : Yes. Thanks, Janne. I would like to say my time of mental illness only happened in my adult life, but when I recognised and admitted to it, I found that it did go for quite a few number of years prior to that. I am originally from Ireland. I was one of the £10 immigrants and we came to Australia in 1964. Things were a little bit different then. It was an Irish-Catholic family. As with a lot of the Irish males in that period, alcoholism was bred into my father. No other parts of our family came to Australia, so we no longer had any aunts, uncles, grandparents or such. We were placed initially in Whyalla but had to come down close to Adelaide for family reasons. I got put into Elizabeth, which was about 95 per cent English residents. That also seemed to be the times that the IRA was bombing London, so anyone with an Irish accent at that stage—although I came from Southern Ireland, that was of no concern to them—was Irish and we were bombing London, so if you opened your mouth you ended up on the floor. I also went to a Catholic school, which was in a different suburb altogether, closer to Adelaide. After school each time there were no peers, classmates or anything to refer to, so I was just going back home to an abusive father, where achievements were never congratulated but nonachievements were punished. That is the delight that I grew up with. I did not have any brothers—I only had three sisters. Looking back, now that I am willing to admit it, depression and anxiety started a long time before I got to be an adult and it continued on. My form of self-medication was also alcohol, which I was fairly successful at I must admit! Once again, only when I found it was just leading me down to the gutter did I then quit my job—which was a well-paid, high-positioned job in an insurance company—and put myself into a private health area to get myself rehabilitated. That was 14 years ago, thankfully, and I have not looked at a drop ever since.

I then came out of the rehabilitation and, very similar to Janne, I found myself asking, 'What the devil do I do now? The exit door is closed, and now I have to go home to an empty house. What do I do? What can I do?' To tell you the honest truth I could not figure out anything that I could do or not do. I thought I had better keep my skills up so I volunteered to work with Oxfam SA and eventually they offered me a job, which I competed in there for a while for about two years. Then thought I should go a little bit further. I had a bit more confidence in myself and decided to become a carer for the mentally disabled people in the organisations around Adelaide.

I went to an agency after I had done my certification, and the person who was supposed to do my job interview was away ill that day. I was interviewed by the CEO of the organisation and I thought, 'Well, should I admit to my prior illness or not?' I do not know whether I flipped a coin or made a decision; one way or the other I told them, because I could see that hiding the secret was only adding to my anxiety in front of the interview. So she heard the information up front and said, 'That is okay. Well, let's give it a go-when do you start?' I have been with them for about eight years now and looking after people from what used to be called the Julia Farr Centre-Hampstead Hospital-with the rehabilitation people, and enjoying the devil out of it. That is good.

Also one of the advantages was that with an agency I could accept the workload that I could take on. If I felt that I could only take 20 or 25 hours a week, that was well and good as far as they were concerned. That is the way the story ends. Of course, I became a member of the national network-

CHAIR: Could not stay out of trouble!

Ms McMahon : I guess for us, the key is that it has been something that we have done ourselves. We have thought, 'I cannot live like this any longer'. Employment for us was starting off in a voluntary capacity, but in any form it has changed our lives back into something meaningful. I do also say that neither John nor I can resume our previous areas of expertise. One door shuts and another one opens. That is pretty much the experience of many people that we represent in the private sector.

CHAIR: We might go to questions now, because I have a few and I am sure everyone else does. One particular area of interest that we have heard—and I am very interested to hear from your perspective in the private sector—is that at times, as we have heard this in a number of hearings, there is a difference between people being in employment services and the perspective of the employment service and the clinical staff and the coordination. We have heard this morning and we will hear a bit later on about the bringing together in the public service of the employment coordinator and the clinical services. In the private sector that may not be as coordinated as in the public service. Are you seeing any evidence that private psychiatrists, psychologists and hospitals are starting to work with employment agencies to realise that shared outcome for clients that do want to get back to work, or do you feel that that level of coordination in the private sector is missing and needs to be an area that is encouraged and addressed? I am aware that, as you mentioned, a lot more people are going to the private sector with better access, opening the doors. There is a significant group in the private sector, but is there some concern when it comes to employment that there is a lack of education and knowledge out there—a lack of coordination? You both went out and found that job yourselves. So how do we help those people in the private sector engage with employment services and encourage that clinical side of things to engage with the employment side of things?

Ms McMahon : That would be ideal, wouldn't it? I think patients of private psychiatrists and psychologists—whomever—really require that good integration of either education or training or employment services. There are two main employment services, and my understanding is that it does not preclude anyone from going and accessing the services, but it has been my experience—and perhaps John might speak to this—that there does not seem to be anything other than a suggestion: 'This would be good for you, Janne, if you were to go to this.' In the public sector, for example, when people are coming through the system and they are looking at doing something with their lives, it is almost a mandatory requirement to at least have an interview with CRS—Commonwealth Rehabilitation Services—and some of the other two organisations. I would like to see much greater and much better coordination with the private sector so, even if people do not get to the private hospitals, there is some sort of sharing of pathways. Certainly sharing of the clinical and employment services would go a long way. I think that, as a general rule, private practitioners tend to sit and hear the problem of the day or work on a specific issue, rather than looking at a whole person or a holistic approach. How can it be done? I think it requires goodwill and better understanding of private practitioners: that our focus is more than just the clinical setting and that, while we sit in a room and discuss issues and problems and working through those, you still leave the session and walk out that door and then there is that ability for you, either yourself or perhaps with support from your family, to do something. The public sector is far more attuned to the greater needs, in my opinion, than the private sector. And I think that is a very big gap that is missing—one of a number of big gaps.

CHAIR: Especially in the area you alluded to, employment, training and education.

Ms McMahon : Yes. I am a surveyor with the Australian Council on Healthcare Standards and I have the pleasure of going to a number of mental health services across the country. I see pretty much all public, although there are some private, hospitals and see these fabulous initiatives that really aid and assist people out of their situation and into something meaningful. The VETE program, for example, in New South Wales started off as a pilot and it allows a metal health support person to sit with a consumer in the TAFE area. It is in two areas, horticulture and hospitality. People then move, in a support sense, from that into some employment. So there certainly needs to be greater awareness, greater understanding and most certainly greater integration with employment services.

CHAIR: Excellent. Thank you, so much. I will hand over to perhaps the Deputy-Chair.

Mr RAMSEY: Thank you very much, Chair. Janne and John, thank you very for sharing your stories with us. I am a bit interested in your organisation, the Private Mental Health Consumer Carer Network. I am guessing that is a voluntary organisation, but I am not sure. Do you advocate on behalf of individuals or in a general sense, or do people come to you in frustration and say, 'Look, can you open this door for me'? I am just wondering what level that operates at.

Ms McMahon : It started off as a voluntary organisation and then we had some seed funding from three organisations. We now have funding from seven organisations and they are: the Australian Medical Association, beyondblue, the Australian Private Hospitals Association, the Australian Health Insurance Association, the Royal Australian and New Zealand College of Psychiatrists and the Australian Psychological Society, and from the Australian government Department of Health and Ageing. So we are not beholden to anyone, which gives us an advantage to be able to advocate on behalf of consumers and carers from the private sector. Our members are grassroots consumers and carers across the country, not just South Australia.

Mr RAMSEY: What do you mean by member?

Ms McMahon : People join in a voluntary capacity. There is no fee to join our organisation. We have state committees in most jurisdictions except the Northern Territory and we are struggling a bit in Tasmania, to be honest. They can bring grassroots issues that are affecting them in their service delivery, within the state or territory, up to the national committee, which we can then advocate for systemic change, or it could be a health insurance issue et cetera.

Mr RAMSEY: So you have a community group who meet and then you try and push a policy issue up the triangle and then you can lobby for that.

Ms McMahon : That is right, and we do.

Mr RAMSEY: Okay, that is what I was trying to understand.

Ms McMahon : We have pretty good coverage of the private sector, to be honest. As chair and executive officer I certainly know pretty much what is happening in jurisdictions with regard to the private sector, what is happening with private hospitals, what is happening with health insurers. So it is a very good and workable kind of structure that we have, keeping in touch with our grassroots consumers and carers.

Mr RAMSEY: Thank you.

Mr SYMON: This is not a question I have asked before but how does private health insurance interact with the services that are provided in the private sector with regard to mental health? Is it a standard cover that comes with the policy as an add-on? I do not understand that bit. As I say, I am quite naive, I have never looked at that.

Ms McMahon : It is very complicated, to be honest, but under legislation every health insurer is required to pay a basic default payment for someone who goes into a private hospital, for example. That figure is around about—from memory, and it changes—$300 a day, whereas private hospitals are charging round about $550-$570 a day. So there is a significant gap difference per day. In terms of what private hospitals can provide, the legislation changed under the broader health cover of recent years—which is something which we advocated government for—to allow health insurers to pay for services which are delivered not as an admitted patient, which it was in the past. In other words, previously you had to be an admitted patient for programs or groups or whatever and health insurers could only reimburse the hospital for that service. Now health insurers can look more broadly-they can look into the community. So if an organisation were providing a particular service external to the hospital, like the non-government sector, then under a contractual arrangement between that provider and the health insurer their members could approach and engage that organisation. It is a very interesting question that you raise, because in my mind it certainly would benefit some sort of investigation as to how health insurers and external non-government organisations could look at the education, training and employment areas of people. We heard what wonderful work they are doing and I think the door is open, but you need the health insurers to be willing to look at something like that.

Mr SYMON: You need that.

Ms McMahon : But it does not preclude them, from my understanding, any more.

Mr SYMON: Do you know what the percentage is of people who present with mental health issues that go through the private system rather than the public or NGO side of the system?

Ms McMahon : If you are looking at private hospitals, I think that probably they now care for about 20 per cent of hospital beds—a little bit less: between 16 and 20 per cent. If you look at the broader private sector and look at private psychiatrists, psychologists and mental health practitioners within their private practices, you are looking at a huge number—you are looking at about 60 or 70 per cent of people actually receiving care from private sector services in that broader sense.

CHAIR: Which does have some Medicare benefit, but that is the only public—

Ms McMahon : Absolutely. That is right. So if you are a psychologist or an OT or a social worker under the Better Access initiative and are providing mental health care, and it requires the Medibank rebate, then that is assumed to be the private sector. Yes.

Mr SYMON: Is there a pathway from all of those that you just described, presuming people are on the mend, into preparing for employment? We have heard a lot about that from the NGO sector, and I will ask a similar question of you.

Ms McMahon : I am not aware of anything, which is very concerning. That is why I am very strongly supportive of anything that can be done, certainly based on our own experiences. There are only a few hospitals in Victoria and two in New South Wales that actually have consumer consultants, and I would not even call them peer support workers. It is a growing thing in the public sector and something that I think is very welcome. You have to have people like that standing alongside, whether it is in-patient or in the community sector. The other point I would like to raise is that if you are cared for within the private sector, being able to access any of those supports in the public sector is pretty much precluded, other than a non-government organisation like MIFSA, for example. There is probably nothing stopping anyone from actually getting themselves to MIFSA or an organisation like that.

Mr SYMON: There are two separate systems.

Ms McMahon : Yes, there are two separate systems. If you are looking at community care in the public sector, you just cannot access it if you have a private psychiatrist. If you ring, for example, the crisis line, one of the first questions is, 'Do you have a private psychiatrist?' If you say 'yes', the answer, at, say, two o'clock in the morning, will be, 'I'm sorry, you'll have to ring their office at 8 am' These are the facts—there are two systems in this country.

Mr SYMON: I have one last question, and it is a complete change of tack. It goes back to your submission. I just want to clarify this, because your submission on page 2 states:

Not all consumers are on a Disability Support Pension (DSP), but if they are, the system can discourage a consumer from trialling employment as their DSP is immediately reviewed. There needs to be a lengthy period of grace where the consumer can gradually return to work without their DSP being affected, until such time they have resumed on a fulltime and long-term basis.

My understanding is that there is a two-year window there, and we spoke not at the hearing but on our site visits this morning about that. I would like you to reconcile the two points I have on that, if you could.

Ms McMahon : It was in the last budget, wasn't it? That was the situation that was in place when I was on disability support pension for quite some years. It was that ability to know that it was sitting underneath as a safety net which gave me the impetus to try open employment. I note that this is certainly something that is there now in that 2011-12 budget.

Mr SYMON: Yes—for the 30 hours, and I believe it has been there for the 15 hours last couple of years. But it is one of these perceptions that we were talking about, though again not in the hearing this morning, that people in the system do not know, and if they think that that is sitting there, it is what I would see as a very big barrier to going through.

Ms McMahon : It is, and people tend to rely a lot on the disability support pension. It is a pretty frightening thing to step out there, if you have a disability, knowing that you might not be able to meet your rent or you might not be able to work sufficiently or you might lose your income and wondering whether you then might have to go back and be reassessed. What are your thoughts, John?

Mr Kincaid : Yes, I think very much the same. It is a sort of 'what if?' situation: 'I am coping at the moment with the benefit that I have, but if I go out and try and am not successful, then I have to start down at the bottom again and go up and possibly not get the pension again.' You are possibly showing more availability for employment, so you are considered differently.

Ms McMahon : I guess there is the Newstart benefit, but the requirement of that is that people must apply for a couple of jobs and show evidence.

Mr SYMON: And it is much less.

Ms McMahon : Exactly. One of our colleagues was on Newstart, and his psychiatrist said, 'would you consider the disability support pension?' But he was not in any condition to meet the requirements of Newstart, and he was placed on the Personal Support Program, which made a huge difference to him; it meant that he was not required to apply for the jobs in the same way as he would have been required to do had he been on Newstart. He was sent to a counsellor at Mission Australia at that time, and they helped him to deal significantly with the issues that he had on his plate. He was a highly-placed bureaucrat in state government, and they came alongside him and supported him both with his applications and with the work that he was doing and also for some months afterwards.

One of the things with mental illness, and I would really like to quickly mention this, is the disclosure—whether you should, whether you should not. There is also the education area, in the university sector—do you disclose or do you not?

In his case, he was lagging behind in the work that he was doing—he had long applications to process and he was not doing it quickly—so his supervisor came alongside and said, 'Do you have an issue?' A bit like John, he tossed the coin and said, 'Will I reveal my depressive state or will I not?' He took the plunge and he did. Whilst the supervisor did not focus on that, she gave him some strategies to speed up his work. That was with the Department of Health and Ageing. He has since gone on to regain his health and is now a very senior bureaucrat within another Commonwealth department. The interesting thing is that, irrespective of the position he currently holds, or has held previously, in applying for equal positions within the Department of Health and Ageing he now, despite wonderful references, does not even get to first base. He is absolutely sure that his disclosure has meant that that particular department is closed to him. He is fortunate in that he has regained his health again through employment—I cannot stress that enough. He is now in a very senior position and does briefing notes for the particular minister.

Ms O'NEILL: I was going to ask a PSP question, so you just answered my question. Thank you.

CHAIR: Thank you very much; we really appreciate it. We have heard from both of your experiences just how important work has been in getting back. You have also highlighted a very unique perspective, being people and consumers that use the private sector, and some of the areas where there is lack of coordination. We have also heard of your experience with the disability support pension and some of the complexities: the positives about it and some of the—I would not say negatives—things that might hold people back from actually reaching their full potential. We appreciate that very much.

For your information, if you ever want to make any additions to your submission, you are more than welcome to do that. You can forward that through the secretariat. You will also be sent a copy of the transcripts of your evidence to which you can make corrections for grammar or fact. This hearing today, as with all the other hearings, will go into helping the committee formulate its report, which will make recommendations to be tabled in the parliament and will require a government response. It will really assist us in that.

Ms McMahon : Thank you for the opportunity of appearing before you today.