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Community Affairs References Committee
06/07/2018
Accessibility and quality of mental health services in rural and remote Australia

HENDERSON-YATES, Dr Lynette, Chief Executive Officer, Derby Aboriginal Health Service

OZIES, Mrs Narelle, Senior Manager, Business Operations, Derby Aboriginal Health Service

PLOWRIGHT, Dr Prue, Senior Medical Officer, Derby Aboriginal Health Service

ROBERTSON, Ms Maureen, Social and Emotional Wellbeing Unit Manager, Provisional Psychologist, Derby Aboriginal Health Service

SPRY, Miss Tara, Chairperson, Derby Aboriginal Health Service

Committee met at 10:10

CHAIR ( Senator Siewert ): I would like to declare open this public hearing and welcome everyone here today. We'd also very much like to acknowledge the traditional owners of the land on which we meet and pay our respects to elders past, present and future. This is the fourth public hearing of the committee's inquiry into the accessibility and quality of mental health services in rural and remote Australia. I thank everybody who has made a submission. This is a public hearing and a Hansard transcript of the proceedings is being made, and the audio of this public hearing is also being broadcast via the internet.

As the hearing starts, I remind all present here today that in giving evidence to the committee witnesses are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee, and such action may be treated as a contempt by the Senate. It's also a contempt to give false or misleading evidence to the committee. The committee prefers all evidence to be given in public, but, under the Senate's resolutions, witnesses have the right to request to be heard in private session. If people would like to do that, can they let us know in advance, because we have to set up the broadcasting separately. I also remind everybody to render their phones silent or turn them off.

I'd now like to welcome representatives from the Derby Aboriginal Health Service. Can I just double-check that each of you have been given information on parliamentary privilege and the protection of witnesses and evidence. It would've been in the email that you were sent.

Dr Henderson-Yates : Yes.

CHAIR: I think some of you haven't, but that information's there. I'd like to invite whoever wants to to make an opening statement to begin, and then we'll bombard you with lots of questions, and then I'll have to rein everybody in so we can move on to our next witness at some stage.

Dr Henderson-Yates : When you talk about an opening statement—

CHAIR: It's any comments you would like to make to us. You don't have to, but you can if there is anything you really want us to know about access to mental health services and the quality of mental health services and how they're delivered here in Derby and the surrounding area.

Dr Henderson-Yates : Can I just clarify: is this being broadcast now?

CHAIR: Yes. I spoke earlier about giving evidence in private, so if you want to tell us something that you want kept confidential, we turn off the broadcast—we still have Hansard—and we clear the room, and whoever wants to talk to us in private gets to talk to us in private. We keep that information, but it isn't broadcast, and it's released with your permission.

Dr Henderson-Yates : Okay.

CHAIR: If anybody does want to do that, just let us know. In fact, we've done that on this inquiry. But, besides that, it's being broadcast and we've got a Hansard record, and, as you know, we have other people in the room.

Dr Henderson-Yates : As CEO, I will make a start. We obviously feel very strongly about mental health in this region, and the Derby Aboriginal Health Service can certainly speak from a town perspective but also from a community perspective, because we also look after seven remote Aboriginal communities. We provide clinical services to those remote communities. I've grown up in Derby too; I was born here and grew up here. So I guess I speak from a professional but a personal perspective, in that mental health is certainly an area that's foremost in all our minds in this region. One of the difficulties—there are quite a few difficulties in fact, but isolation is one of the greatest difficulties that we have. We are 2,300 kilometres from Perth. There are services in Broome; however, Derby itself experiences its own issues around mental health, and we'd like to expand on that as we each present.

Ms Robertson : As a manager of the SEWB, the Social and Emotional Wellbeing Unit, we find that we have a very, very broad range of presentations and a very, very complex range too. I actually went onto your website and I saw all the points. So we've written a little bit of information to address each one of those points. Recently we've had some funding changes. Within that, we also wrote a little one-pager, which we submitted to state government here—

Dr Henderson-Yates : I can expand on that a little bit more, if you like. Our Social and Emotional Wellbeing Unit is just across the road from us. As Maureen said, she is our manager there. Maureen is also a psychologist. We have a mental health clinician, an Aboriginal mental health worker, a perinatal worker and also a youth worker. Recently we were informed that we lost funding for our psychologist and for our Aboriginal mental health worker, which ended on 30 June. That's actually a huge issue for us, for the township of Derby and for the seven remote communities, because it reduces the services down for the SEWB Unit.

CHAIR: Where does the funding come from? Is it state or federal?

Dr Henderson-Yates : State. And it means that we can't deliver the holistic clinic and community engagement model that we have. It's quite a unique model, and it is unique in the Kimberley—our SEWB team—in that, as I said, it's a community approach model, so it actually goes out and works with people in their homes, in the school. We also travel out to the communities because we have medical flights that go out as far as the East Kimberley and as close as Pandanas Park, which you would have passed if you drove here. They provide a fantastic service, where they're doing counselling, where they're doing family support. They're working with young mums and dads. They're providing trauma counselling, for example. You might have seen, across the road, some flowers on the side of the road. A couple of weeks ago there was a very sad accident there, and our Social and Emotional Wellbeing Unit provided the counselling, not only for our staff, who were the first there on the scene, but also for those who observed it and for the families that were connected. SEWB works closely with a clinic, so Dr Prue's team actually refer clients through to SEWB. But we also have walk-ins. Because it's around social and emotional wellbeing issues, Aboriginal people are sometimes not comfortable going into the clinic. They know that they actually can walk into the SEWB Unit. The model that we have makes it more familiar to Aboriginal people, because they are used to coming to DAHS. Therefore, they're used to going through to SEWB.

They also do a lot of work with the school and youth at risk. We have a Shine group, and the Shine group works with young girls at risk, and they engage in things like art therapy, how to look after yourself, how to eat nutritionally, sexual health—all those sorts of things sexual health. We also have a Body Shop clinic for young people over there. Young doctors, male and female, go across there and run clinics for the young people, because they're less likely to go through to the clinic here. So everything that we do there is about engaging with the community, making it easy for Aboriginal people particularly to come and look after their physical and social and emotional wellbeing. We have also engaged with other organisations around town. Maureen, would you like talk about the program with Winun Ngari? I think that's a fantastic example, if you'd like to say something about that.

Ms Robertson : Basically, we were offered a little bit of funding from Winun Ngari to put something together for their Work for the Dole program guys, who they were battling a little bit with around compliance and getting the guys to work. I'll just read this little spiel—and you'll all get a copy of this—from 'Why is work an important link in developing Social and Emotional Wellbeing'. It says:

Social and Emotional Wellbeing recognises that if individuals are to gain optimum mental and physical health they need opportunities to engage meaningfully in the life of their community. A strong cultural identity—

and this is incredibly important—

work and family help people develop feelings of belonging and worth. Social and emotional wellbeing, along with Self-esteem, Personal Responsibility, Teamwork, Attitude to Work—

were presented in this workshop to develop how to manage work, how to sustain good work relationships et cetera.

This is an innovative program, and the research that we did indicated that nowhere in Australia is anyone recognising this gap between social and emotional wellbeing and those social barriers to readiness for work. The way I sometimes describe it is like this. With all good intentions, the government might come in and drop a million dollars into the community. They may say, 'This is a five-year program and it'll employ 50 guys.' This is just off the cuff; it's not real. But what happens is that, although they want to work, they're keen to work, the social and emotional barriers that long-term unemployed people face are not addressed. So with all these good intentions of putting this money and funding into the community, there's this big gap in understanding. It doesn't address how we get the people to go to work and stay in work and fulfil all of those things that tell us about social and emotional wellbeing and how we sustain social and emotional wellbeing.

These workshops focused on providing individuals with a skills based social and emotional wellbeing kit, and it provided learning. It just introduced easy techniques to help individuals stay on track and achieve success in their lives. We had a couple of workshops—this is a photo from one; I'm going to give you all a copy—where we did a men's workshop and a women's workshop, and these guys were so engaged. It was a privilege to work with them: positive, strong, beautiful men and women who come with so many cultural strengths. I've been in not-for-profits for a long time and, as funders, the lens that we look through (a) is often metrocentric and (b) doesn't understand what sort of prework needs to be done on the ground for these programs to be successful. So innovation in what we do is incredibly important, because what we really need to be able to do is respond to the community's needs as we find them.

Senator O'NEILL: Where they are.

Ms Robertson : That's exactly right.

Senator O'NEILL: So what are the skills deficits that you're talking about there, in terms of social and emotional wellbeing, that are necessary for the transition into work?

Ms Robertson : I wouldn't say it's a skills deficit so much as a mental health deficit. We might have people who are trained welders, and they've got all their tickets in their truck driving and everything. Long-term unemployment in a community erodes our ability to remain resilient, erodes our ability to be able to pop up after 10 years of not working and say: 'Yes, I'm ready. I'll be at work tomorrow. I'll be there, I'll be there five days a week.' We've got entrenched drug, alcohol and mental health problems, and we need to do this work to support people to come up to that level. The other thing that's really, really important is: funders have got to realise that we need to get a lot more flexible in the way we design programs that will enable these individuals to access the same opportunities that everyone else gets. That's what we're really on about.

Dr Henderson-Yates : And what's happened is that, as of 30 June, we no longer have funding for Maureen and our Aboriginal mental health worker, which equates to just over $300,000. So DAHS now has to find $300,000 within its own budget.

Senator PRATT: What's the reason for the cut? We know, for example, that metropolitan areas get a lot more servicing with mental health services through Medicare relative to what the regions get; therefore, it means there's more reliance on state funding. So if we're trying to have a conversation with the Commonwealth about what they should be doing to improve their contribution and make it more equitable so that the burden's not just on the state to recognise that inequity, how would you frame the Commonwealth's involvement? The Medicare model might not work, because you need deeper community engagement and different ways of working.

Ms Robertson : Prue and I could both talk about Medicare. I'm a provisional psychologist. That means that I can't claim Medicare for all of the patients I see. That's one thing. Another is the two-tiered rebate model where you've got clinical psychologists, who are paid quite a lot more than a counselling psychologist. So how do we, in the remote areas of Australia, get those highly-qualified staff where we've got limited population, we've got limited service availability, we've got limited funding to support highly-trained professionals to get out into the regions? They're all realities and barriers to the Medicare model working within our regions.

Dr Plowright : I don't think there's a single clinical psychologist based in Derby. We don't have any private.

Unidentified speaker: No, we don't. We've got no—

Dr Plowright : Boab Health provides one once a fortnight, if they can recruit one. Quite often, that job is vacant.

Senator PRATT: And so because the Commonwealth's not adequately funding public mental health, the private system is biased towards particular areas, meaning that areas that really need it, because of their socioeconomic status, aren't going to have that presence of the Medicare provision.

Ms Robertson : Those clinicians are going to go where the population is. Those private clinicians are going to go where they can earn a decent living.

Senator PRATT: Where they can get a gap fee.

Ms Robertson : I can have my whole appoint book booked out for the week, and I will only get 50 per cent of those people turn up. And it's not because—it's a different level of priorities. An Aboriginal person might book an appointment with me for 10 o'clock, but they don't rock up because Nan has said to them, 'I need to go to Woolies at 10 o'clock.' I'm not prioritised. And why aren't I prioritised? I'm not prioritised because they don't have to live the rest of their life with me; they're going to live it with Nan, and Nan won't forget that they didn't take her to Woolies at 10 o'clock when she needed to go. The concept is so big that I'm not surprised that people, that funders have difficulty getting their heads around it.

Dr Henderson-Yates : It took us two years to fill Maureen's position. We interviewed, I think, five people, and each time, just before they signed, they actually withdrew. We were fortunate—very fortunate—to get Maureen.

Senator PRATT: Good on you, Maureen!

Ms Robertson : I'm having fun!

CHAIR: I can tell!

Dr Henderson-Yates : She's very passionate.

CHAIR: Can we get back to the question of the cut in funding? So we've touched on the rebate—

Dr Henderson-Yates : The history behind it is that it's state-specialised Aboriginal mental health services funding. When it started, the rest of the state was delivered through WACHS. The history with Derby was that it was funded through the Kimberley Aboriginal Medical Service instead of through WACHS. It was a special arrangement for the Kimberley. So the funding went to the Kimberley Aboriginal Medical Service, and we were funded through that to provide that service. My understanding now is that WACHS wants to be under WACHS for the whole state, which means it's withdrawn from us.

CHAIR: I see. The money's being taken from KAMS and put back into WACHS.

Dr Henderson-Yates : That's right.

CHAIR: And WACHS has decided not to fund it.

Dr Henderson-Yates : That's right. We asked if we could be subcontracted, but apparently that wasn't possible. We tried to work out some arrangement where we could continue to have these two positions, and there wasn't one. We've decided we're going to continue with the two positions. If we have to tighten our belt a little bit more we will do that, but it will be with great difficulty because some difficult choices have to be made.

Senator O'NEILL: Because you're not going to change your model; you've actually found your model.

Dr Henderson-Yates : No, because it works.

CHAIR: I just want to finish this line of inquiry. You just said there's no clinical psychologist here. Are they providing a service?

Dr Henderson-Yates : My understanding is that they're going to employ more Aboriginal mental health workers, even though we have one already. It's definitely left a gap. We're going to continue because we believe our model actually works. There's no way in the world that we're going to break up the SEWB team.

Senator O'NEILL: I really want your model to work. What evidence have you got that the outcomes you're achieving are better than other models that we've observed?

Ms Robertson : In our reporting structures we're always hitting our outcomes or doing better. I think with really good management support and great clinical support we're able to do some of those things that I talked about before which look at the needs of the community, and we're actually able to try and address those needs directly. With some research, with some consideration, with some partnerships, with a lot of talking and a lot of meetings to try and flesh out what it is that we need, we go forward and we attempt innovative approaches. Our approach is a multilevel approach. We've got clinical referral pathways that come directly from our GPs. We have shared care partnership arrangements with the government, WACHS and the KMHDS team—the Kimberley Mental Health and Drug Service team. We have shared care arrangements with them and we co-manage clients and patients with them.

We have a community engagement model where a number of our workers—our youth worker, our perinatal worker and our Aboriginal mental health worker—actually spend a lot of time out in the community. So it's a more relaxed approach. The way I describe it is that frequently Ash, our male Aboriginal health worker, may go footy training out of work hours and he may lean on the fence and have a yarn with someone. It's in a very relaxed environment where the client or the patient feels comfortable, but there's a consultation going on here. So we're reaching out.

Dr Plowright : Someone used to call it Toyota therapy. She'd pick someone up from their house and go for a drive out to the jetty—everyone drives a Toyota here, as you've probably noticed. So it's not here in a clinical setting and it's not in their house, out in the back streets or wherever they are; they go somewhere they can relax, where they feel safe and they know no-one's watching them and going, 'Why is she talking to that mental health worker?'

CHAIR: Not going into a clinic where everybody sees you walk in.

Dr Plowright : They go out to the trough—the famous trough—or the jetty, and that's where people can feel safe and relaxed and talk to you guys.

Dr Henderson-Yates : I think our model is all about support and prevention so that it's not escalated to the next level of acute mental health. Tara, you might want to add a bit more to the work that SEWB does in the community. A lot of Aboriginal people also will not go to state mental health because of the stigma and the fear attached to it, particularly as it's seen as an institution. We know in the history of Aboriginal people institutionalisation has been a feature of the last few hundred years. So that fear is still there whereas, for SEWB, we understand the model and it's a link to the clinic and to DAHS.

Ms Robertson : We have a lot of facts and figures. Our outcomes are always met. But there's a lot of anecdotal information that comes back. And this is not once or twice; we're getting up to around 10 or 12 anecdotal pieces of information that have come back to us on what has happened as a result of some of the programs we've run.

Miss Spry : I reckon personally when we do go to the hospital sometimes I don't know whether they listen to the actual family. Because we know that person is not right, it probably is a cry for help. You need someone to ask them because they could say one thing and then they don't go through with it.

Dr Plowright : As a GP, we get a lot of ED notifications. They're like automatic triage notes. Every time a patient presents to the emergency department, we get a brief summary just to say that they've been there. It's quite concerning to see how many people do turn up to emergency with quite often suicidal ideation or self harm. Quite often, on such a brief summary, it will say: reviewed by mental health, discharge home. You don't get any other sort of feedback and, if it wasn't for those ED notifications, we probably wouldn't have even found out about it. But there is quite a high volume of that, and sometimes it makes me wonder what is actually happening about these cries for help.

CHAIR: Miss Spry, that's what you were referring to when you go into ED with somebody. The family explains what is happening and they're not listened to. And Dr Plowright just said they then get released with no support.

Miss Spry : They could get checked. They could be put on 24-hour suicide watch. Family come in maybe. It is just difficult. A family member was in there and it took me a long time to go and see that person because I didn't know how to react and how he was going to react. So I went to social and emotional wellbeing, Bob Ashley. He had to come and I had to talk to him because I got that fear thing for mental health. I think: 'You're going to put him in straitjacket and take him to Broome.' That's what I think. But he sat down with me and talked to me. It took me all morning and all afternoon to go there. We had a good conversation and then I went and saw him. It was very difficult even to go in the room but I went with my aunty.

The doctors will tell you he's of age, which is a thing too. Because when they are over 18, you can't do nothing. But we know, as family, there's something wrong. We then had a psychiatrist telling us, 'Oh yeah, we're going to admit him.' We had a group meeting the next day and then she said, 'Oh no we're not going to admit him now because he's of age.' She's then telling one thing to the family and another thing to others. Like we say, we know he's got a problem but we just got to sit there. They give us tablets for him. He's of age but they give the parents the tablets, and I'm going, 'Why are you giving us tablets when you just told us that he's of age?' Then they'll discharge him because he can sit there. They'll be assessing him to say it is all clear, but the patient can just sit there and lie to get out of the hospital—I'm being honest. We know, as family, he has a problem but there's nothing we can do. We try to get help. And then, as soon as he comes out maybe on Friday, because the services are nine-to-five, all weekend we have to ring around family to say, 'If you see this person, can you let me know. If he's talking suicidal, can you let us know.' That's all I can do. That's Saturday and Sunday, and then I go back to mental health and I give them back that tablet. I said, 'Why should I, because he's going to keep coming back to me'. I wanted the tablet. They looked at me and I said, 'I don't want nothing to do with that'. I just walked out, because I didn't know what else to do, as family and grassroots people.

Senator O'NEILL: Despaired.

Miss Spry : Yes. So I don't know.

Senator PRATT: What psychological screening tool do you all use currently?

Ms Robertson : For suicidal ideation we use a K10. In our software system MMEx we've got K10, DASS and the EPDS. We use the Kimberley Mum's Mood Scale up here, and that's probably for the more acute presentations. That's basically what we use. The doctors all do some of the screening and I'll do some screening as well. But as far as other types of screenings, I don't know if you're familiar with the WISC and other Wechsler intelligence scales. They cost a fortune. I can't even justify purchasing those screening tools because our budgets just don't go that far.

Senator PRATT: That's an issue, because they're into the intellectual property of the companies that provide them?

Ms Robertson : That's correct.

Senator PRATT: Is there something government should be doing to reduce the costs of those screening tools, if you find them useful?

Dr Plowright : I haven't used those ones myself. We tend to just—

Ms Robertson : No. I've had long conversations with my supervisor about this stuff, because there are quite a lot of diagnoses of FASD et cetera and it would be very, very helpful if we had some of these expensive screening tools. However, they cost $5,000 and $6,000 dollars a pop. You can buy all sorts of different levels. You can have the online, you can have the hard copy, you can buy them for a single use or 10 uses but basically it's very, very hard to manage. Whereas, probably in the metro area a group of psychologists could get together and say, 'We'll buy a membership to these tools for 10 years', and then between them they could cover the costs but we don't have that sort of fortunate situation.

Dr Henderson-Yates : Particularly when it comes down to we have to cut costs, so that we can keep people employed.

CHAIR: Dr Plowright, when you said that you get ED notifications what happens then?

Dr Plowright : In the past we didn't. I think those ED notifications are quite a new thing that's only really been happening this year. It just made me realise how many of those presentations we weren't finding out about, because there wasn't a formal discharge because the patient wasn't being formally admitted. They were being reviewed by the triage nurse and told, 'They're not suicidal anymore. They can go home under the care of their family'. And not just suicide but really serious domestic violence and things like that. Finally, now that we're getting these brief summaries, particularly if you notice that it's several presentations for the same thing, we can put them on our recall or we email one of these guys and they'll go out and do a welfare check.

CHAIR: So you can then follow-up. It seems like that's progress in terms of at least now you know, but how did that process start? It sounds like you didn't know it was going to happen.

Dr Plowright : I'm not quite sure when that ED notification became compulsory—

CHAIR: Was the service notified?

Dr Plowright : I think that's a nationwide thing. I think all emergency services should email the GP about presentations.

CHAIR: So the service is down as the—

Senator PRATT: Is there anything else you should be getting notifications for, do you think?

Dr Plowright : Regarding mental health presentation, these guys have a shared care meeting arrangement, so I think we do have quite a good relationship with the Kimberley Mental Health and Drug Service, because the patients do tend to go between both sometimes.

Ms Robertson : The other place that we do get notifications from is the justice department. So if they need support—say, they may have someone being released from prison and they're coming back to our community—they'll flag it with us. Prisons and work in prisons is another deficit area. In our perinatal program we'll have mums who may be pregnant or with young bubs moving to Derby, because their partner is incarcerated here. We can engage with them through our perinatal program, and we can provide some education and support. But we know that the guys are going to be released from prison, and what the women tell us is that they're worried because they've tried to get things on track, but he's going to come out and it's going to be a changed situation—there's a new baby or mum might be feeling that she would like to repair or whatever. So I think there are funding opportunities to work with that prison population and those perinatal clients as well in a combined approach, but that's something we haven't had time or any spare money to really address, even though we've talked to prison about it. So there are a number of sort of areas that we could expand our services.

CHAIR: We've been interrupting you asking questions, I'm sorry. You've prepared this for us, which is fantastic; thank you very much. Before I throw it open to questions in the last couple of minutes that we've got, is there anything else that you wanted to cover and that we haven't, because we've been asking you other questions?

Dr Henderson-Yates : I think we know how we want to operate, we know what the needs are and we know what we believe the answers are. We're restricted by funding, because the approaches we want to take and we do take—like Maureen said—are innovative, because they're actually according to the needs of the community. There are so many more things that we can do, like working with the 28 men. This team and Winun Ngari are now going to present at the mental health conference in Adelaide next month around this model. We want to continue this model, but it comes down to funding.

Senator PRATT: Is it the quantum of funding or is it also what you can apply the funding to—the shaping of it?

Dr Henderson-Yates : Yes, it's both.

Ms Robertson : It's the structure; it's both.

Senator PRATT: Can you tell us about the limitations with the way the funding is shaped both Commonwealth and state? Clearly Medicare is a good example. What are the other ones?

Ms Robertson : The outcomes are often 'bums on seats,' I call them. So they want to know numbers that you've had through. So on a typical day in the SEWB you start off with your appointment book full, or perhaps half full, and then a crisis of some sort will come in, and it may not even appear to be a crisis. So someone will come to the door and they might just say a few small words and then we bring them in, offer them a cup of tea and that could turn into something really quite serious, where our workers will then probably have the whole day sucked out. So, if we're talking bums on seats, that's one person. We may have had to get that person and some children out of a domestic violence situation, find them temporary housing, get them some food, get them some clothes, all sorts of things. But you've got two workers on that probably, because we try not to send people out in the field by themselves. So you've got two people spending a whole day with one client. So, with the way we report that outcome, you cannot put that whole story into the reporting framework—that just doesn't work. I used a tiny little example here that funding outcomes need to be structured in a way that encourages innovation and wider engagement, where one funder actually asked: 'What's the most innovative and successful activity you've undertaken in the funding period?' This was the first question they asked. So what did that tell us? That told us that they want us to do innovating things, they want to hear about where our little successes and wins are happening and not to worry too much if it's not within that funding structure, if you like, or so many consults or whatever.

Senator O'NEILL: So throughput rather than output is being measured?

Ms Robertson : Very, very often. It's around the qualitative and quantitative types of data. You can't tell this qualitative story very well within these great big huge spreadsheets that you report into. That little example gave us the confidence to talk about the successful ways we've been reaching our clients, and it made us feel confident that, 'Hey, we're on the right track, and we don't have to hide those extra bits we do or those difficulties that we have.' So that was a real eye-opener.

Senator PRATT: But you're not funded for that, and larger organisations can deal with that churn of numbers as well as get the other bits and bobs that come through their door done. But it's much harder for smaller organisations to do that.

Dr Plowright : The other thing is that, being a small organisation with limited staff, the amount of time it takes to do that kind of funding is nearly taking one person off the ground; it's almost a full-time job.

CHAIR: Yes, and you have to keep looking for bits of funding all over the place.

Ms Robertson : That's it. We have to put our hand up for every little bucket—every little $5,000 or whatever it is. We chase it all, all the time, don't we, Narelle?

CHAIR: It's obviously your job!

Dr Henderson-Yates : I just want to emphasise too the work that SEWB do with young people, with children. We do have to look to the next generation, and if this generation are experiencing serious problems, which they are, then we've got a problem for the future generations of Aboriginal people. So the prevention work, working with young people like Ashley does with the kids and the schools—he's not here at the moment, but he is such a role model. In fact WACHS tried to get him to move over, but he refused. I also want to mention the remote communities that we provide a service to, and we have Ambrose who is from Kandiwal as one of the community. Ambrose is also a director on the board. We run a medical flight out to Kandiwal every six weeks. Our medical flights to the communities are not government funded. We provide that out of our own money and have done for many years. We've tried to get funding; we've never received funding. Those flights cost us almost $200,000 a year because we send out doctors and nurses. So every fortnight they travel out—now we had to reduce the flights down from weekly to the communities at the Gibb River because it was costing almost $200,000. We've reduced down to fortnightly, now which has reduced that cost. However, we still carry the cost of those clinical flights.

Senator PRATT: Clearly the government is taking for granted that you're doing that. It has to be costed in there somehow otherwise; if every bit of money is tied they would just take that money out of your budget anyway, and sometimes that happens.

Mrs Ozies : We have to incorporate the flights now as part of our budget. Our flight to Kandiwal every six weeks costs just over $6,000, not including the doctors' time, the nurses' time and everything like that.

Dr Henderson-Yates : When we talk about remote communities around mental health, they experience even more difficulties than we do in town. We try to get our team out but we have a very, very small team. They do hop on the flights where possible to provide that service. Obviously, when they come into town they're able to access the SEWB team, but it is much more difficult. If you talk about technology and whether people can actually get on the other end of a video conference, teleconference or whatever, it's not so easy. You've got to be literate in using the technology, you've got to have the technology, and there's the maintenance of the technology. All those things are issues. Also, Aboriginal people do prefer face to face.

CHAIR: We've run massively over the time. I've done that on purpose because your evidence is so valuable and important to us. You can ask a couple of questions but can we make them short.

Senator O'NEILL: So do you get a psychiatrist visit every six weeks?

Dr Henderson-Yates : Every six weeks we get a clinical psychologist.

Senator O'NEILL: Is there a waitlist to see the psychiatrist? That's the psychiatrist you share with the prison that we've just come from?

Dr Henderson-Yates : Yes. He is here for three days, so it's shared between here and the prison every six weeks.

Senator O'NEILL: That's enough for you to meet your needs?

Dr Plowright : I'm not too sure what the waitlist is like at the moment.

Ms Robertson : It's not too bad. I think having a psychologist come on board—I've been here one year—has really reduced that waiting list, because people had no clinician. With Kevin Smith, the psychiatrist, he can refer to me and I can refer to him. So we've got a better pathway—

Senator O'NEILL: You can triage down.

Ms Robertson : That's it. We can. Exactly.

Senator O'NEILL: My second question is about attracting and retaining staff.

Dr Henderson-Yates : It's very difficult because we're not Broome; we're Derby. But there are benefits of working in Derby. But it is very, very difficult to get staff—particularly professional staff—to come into Derby. Like I said, it took two years for us to fill Maureen's position. It's difficult for other positions as well: we've tried for so long for a midwife it's not funny, because we can't compete salary wise and benefit wise with other organisations. We can only offer what we can afford, if you like. So it's always difficult to actually fill positions. We were without an SMO for quite a while. We had to recruit from England for someone to come across, because we just could not attract another SMO here. Fortunately Prue now is our SMO, and Prue's been at DAHS for seven or eight years.

Senator O'NEILL: So that's a direct hit. You got her. What made you stay?

Dr Plowright : I came here to do my GP training and fell in love with Derby. For me it was easy, because I'd always been passionate about Aboriginal health and I knew that's where I wanted to be. So I found DAHS and Derby and met my husband up here. So they are all things that have kept us here. We love it, and we're not planning to leave, but it's very hard to find GPs, and any other health provider really, and retain them.

Dr Henderson-Yates : I think particularly around mental health. That's the area that we find most difficult.

Senator PRATT: But doing your training here was clearly an important part of being able to stay?

Dr Plowright : That was definitely a big thing.

Senator PRATT: So making sure people get the opportunity to train in the regions is really important?

Dr Plowright : Yes, and I'm a big advocate for programs like the Community Residency Program. That's what brought me up to the Kimberley initially, when it used to be the PGPPP. I know they have got that going again, but it's a shame because we have a CRP resident here but she's only based at the hospital, which is completely different to what we do. When I did it was in Broome but I did six weeks at AMS and six weeks at the hospital. I think if you want to get people—particularly in general practice or in that sort of community role to really feel like part of the community—it would be really good if they could actually experience GP-type stuff, and not just the hospital acute medicine. It's important to recruit more doctors back to country hospitals as well, but I feel that there might be a greater need in general practice.

Senator PRATT: So you're saying GP training placements are no longer available?

Dr Plowright : This year we didn't have any applicants. I've got a few theories on why that was. I don't think it was very well advertised down in the tertiary hospitals. But we kind of got a bit more proactive, so we managed to do a bit more going down there, and a doctor who was here also at the same time I trained went down into the hospitals, did the rounds, KAMS did the same and we managed to get three applicants for next year. So I think having the financial support to help those registrars come up here, because it is expensive, but also to promote it a bit more and to have programs like that community residency program, where people who may not have had any experience working or living in a rural area can have that little taste of it and hopefully have a really positive experience and be really keen to come back as a registrar or as a GP or a doctor later on.

Senator O'NEILL: I have a whole lot of questions around your Winun Ngari partnership; as well as mental, social and emotional health stuff; and also your Shine group with girls?

Dr Henderson-Yates : When they attend Shine, it's actually counted as attendance at school. So that's the innovation. They've started up their own group as well.

CHAIR: So if we put some questions on notice—that's our official lingo for wanting to ask you more questions—is that okay. I'm very conscious of not overburdening you with questions and things.

Dr Henderson-Yates : We're very keen.

CHAIR: But it would be great if we could send you some questions on notice. That would be fantastic.

Senator O'NEILL: I want to know how you get long-term unemployed people with drug and alcohol issues back to work.

CHAIR: Yes.

Mrs Ozies : The Winun Ngari deal is funded through the Department of the Prime Minister and Cabinet.

CHAIR: Okay. That was through IAS funding, wasn't it? I see nodding at the back there. We also may put some questions in to PM&C about that program as well.

Thank you so much for your time, for your hospitality and for allowing us to take over some of your space.

Dr Henderson-Yates : Thank you for giving us the opportunity to chat about ourselves. We're very passionate about this.

CHAIR: We can absolutely tell that.

Senator O'NEILL: Senator Dodson would have loved to come too.

CHAIR: Thank you so much.

Senator O'NEILL: He said we had to come. We've seen the jail.

Dr Henderson-Yates : Excellent.

Ms Robertson : That little piece that I've given you may address some of the questions.

CHAIR: Was that in this—

Ms Robertson : That's in the pack.

CHAIR: I was going to suggest that we read that, and then we'll have more questions.

Ms Robertson : Exactly.

CHAIR: Questions will develop out of that as well, and we'll probably be able to hone our questions better, in fact.

Senator O'NEILL: We'll do our homework.

CHAIR: Thank you so much.