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Senate Select Committee on Health
26/08/2015
Health policy, administration and expenditure

ANDERSON, Ms Janet, First Assistant Secretary, Health Services Division, Department of Health

AYRES, Dr Russell, Branch Manager, Mental Health, Department of Social Services

BARTNIK, Mr Eddie, Strategic Adviser, National Disability Insurance Agency

CHRISTIAN, Mr James, Group Manager, Disability, Employment and Carers, Department of Social Services

CORMACK, Mr Mark, Deputy Secretary, Strategic Policy and Innovation, Department of Health

HARTLAND, Dr Nick, Group Manager, National Disability Insurance Scheme, Department of Social Services

KRESTENSEN, Ms Colleen, Assistant Secretary, Mental Health Policy Branch, Department of Health

NICHOLLS, Ms Fiona, Assistant Secretary, Mental Health Services Branch, Department of Health

ACTING CHAIR: I now welcome representatives of the Department of Health, the Department of Social Services and the National Disability Insurance Agency. I remind committee members and officers that the Senate has resolved that an officer of a department of the Commonwealth or of a state shall not be asked to give opinions on matters of policy and shall be given a reasonable opportunity to refer questions asked of the officer to superior officers or to a minister. This resolution prohibits only questions asking for opinions on matters of policy and does not preclude questions asking for explanations of policies or factual questions about when and how policies were adopted. I particularly draw the attention of officers to an order of the Senate of 13 May 2009 specifying the process by which a claim of public interest immunity should be raised. Copies are available from the secretariat.

I invite you to make a brief opening statement, and then the committee will ask questions.

Mr Cormack : Thank you for the invitation to attend today's hearing. As you would be aware, the government is committed to developing a more effective and efficient mental health system to improve the lives of people with a mental illness and their families. In considering the committee's focus on mental health issues and challenges, I wanted to provide you with an overview of the activity that is currently taking place that may impact on services and supports to people with a mental illness.

As you will appreciate, it is a very busy policy space. Significant work is currently being undertaken to review and reform areas of primary health, disability support and mental health services, all of which have the capacity to improve aspects of a system that is there for many of us who will suffer from some form of mental illness in our lifetime. A substantial piece of work has been undertaken by the National Mental Health Commission, which was tasked by this government to undertake a Review of Mental Health Programs and Services. The commission's final report is a significant review of the current state of the mental health system and provides details on the breadth and complexity of the mental health sector as well as the opportunities and challenges for change. An expert reference group has been established, chaired by Ms Kate Carnell, to inform the development and implementation of the government's response to the review. The department has also used existing advisory structures, such as the Australian Suicide Prevention Advisory Council and the Aboriginal and Torres Strait Islander Mental Health and Suicide Prevention Advisory Group, to get advice on how some of the reforms proposed in the review could be taken forward. Key policy directions being considered for future development include opportunities for early intervention to reduce the impact of mental health problems; the use of stepped care to better match services to need; and improving service planning and integration, recognising that a local and integrated approach is often the best solution.

Consultations are currently underway as part of the review, with representation being sought from peak mental health bodies, health professional bodies, Indigenous mental health, child and youth mental health, and the private sector. The role of the states and territories in mental health is well recognised, and the government will also work closely with them to develop a new National Mental Health Plan. The Fifth National Mental Health Plan will provide the opportunity to pursue a commitment to delivering regional planning and service integration for mental health and suicide prevention activities, and a better way of supporting people with severe and chronic illness, given the shared responsibilities of the Commonwealth and the states and territories for this client group.

Reform of primary care to better support people with chronic and complex conditions is also important to delivering better services to people with mental illness, particularly those with more severe illness. The Primary Health Care Advisory Group, or PHCAG, is currently holding consultations on strategies to deliver stronger, more effective and better integrated and coordinated primary care services. The consultations focus on the recently released discussion paper 'Better outcomes for people with chronic and complex health conditions through primary health care'. The PHCAG's remit is to provide the government with short-, medium- and long-term options to reform the primary healthcare system. Its work will be influenced by and will also influence other reviews of the health system. There is also a review of the Medicare Benefits Schedule, with the Medicare review task force leading an accelerated program of MBS reviews to align MBS funded services with contemporary clinical evidence and improve health outcomes for patients.

Mental health is one of the six priority areas targeted for work by Primary Health Networks. This is not surprising given PHNs' key objectives of increasing the efficiency and effectiveness of primary healthcare services for patients, particularly those at risk of poor health outcomes, as are many of those with mental illness. PHNs currently receive funding for primary mental health clinical care through both Access to Allied Psychological Services and Mental Health Services in Rural and Remote Areas programs. Many PHNs are also involved in the Partners in Recovery program. PHNs are expected to deliver a strong role in supporting service planning and integrated service delivery at the regional level. They have been tasked with needs assessment and population health planning to support their role as commissioners of services. They are also expected to be central to the integration of primary, secondary and hospital services by developing strong working relationships with local hospital networks and public and private health providers. This is particularly important in addressing the needs of people with severe and chronic mental illness.

The National Disability Insurance Scheme and the establishment of the National Disability Insurance Agency also present significant opportunities for people with a disability arising from mental illness. The operation of the trial sites has provided the opportunity to work through some of the challenges in ensuring appropriate access to support through the NDIA for people with a severe and ongoing mental illness. The department continues to work with our colleagues in the Department of Social Services, the NDIA and the mental health sector to support effective transition processes.

It is also recognised that these reforms are being undertaken at a time when the respective roles of the Commonwealth and the states are being considered in the context of the reform of federation. Our understanding is that the government intends to issue a green paper, to be followed by a white paper, all within the next 12 months.

In summary, a number of things are happening that have the potential to positively influence mental health policy and planning at a national level and which are expected to converge in the comings months.

ACTING CHAIR: Thank you very much. Would anybody else like to add to that?

Dr Hartland : I do not want to add to that, but I should have said at the start that Felicity Hand, our deputy secretary, would normally have wanted to be here, but she is very unwell at the moment. She does regard this as a very important part of her job. It is not that she figures she has better things to do.

ACTING CHAIR: On that note, I put in apologies from our chair, who is also unwell at the moment. Senator McLucas.

Senator McLUCAS: Thanks very much for appearing today and also for coming in such numbers. It is much appreciated that you share our view that this is an important issue that needs consideration. I dare say you heard some of the discussions that have been held today, so there are some questions that I want to put from witnesses who have come before us already. Let's go first of all to the mental health service planning framework. Some of you will have heard me ask questions about this at Senate estimates over some time. Can you tell the committee where the framework is up to? You would have heard this morning that the commission indicated that they were not provided the framework and the data that sits under that framework in their deliberations in pulling together their review, so I would like an understanding of why that happened.

Mr Cormack : The framework is still under development. It is a collaborative piece of work that is being progressed through the Australian Health Ministers' Advisory Council. It is well advanced. In fact, I might ask Ms Anderson to give a more detailed update as to where that is heading.

Ms Anderson : As Mr Cormack said, the framework exists now, but it is what is known as a beta version. It has had some testing in several jurisdictions, including New South Wales, WA and Queensland. The Mental Health and Drug and Alcohol Principal Committee of AHMAC has agreed to establish a steering committee to take forward the framework into its further and final stages of development. They are aware of a number of areas where further work is required. It does need some further effort. Apparently there are some technological bugs, which I do not presume to know much about, but they also want to look more closely at some elements of the design model such as the way the care packages are put together. There are further considerations to be given to rural and remote residents in terms of mental health and also to Indigenous communities, and at the far end of all of that there is the need to seek state and territory sign-off to the framework in order for it to be a genuinely national product.

My understanding is that the expectation of the time frame is that it will take at least 11 or 12 months—probably to the middle of the next calendar year—before this work is completed. A steering committee is being established that is chaired by the Commonwealth and has representation from a number of jurisdictions. It has not yet met, and I think its first meeting will be in September. There is work now underway to establish its specific terms of reference and a work plan which will guide its efforts over the coming 12 months.

Senator McLUCAS: I understand that New South Wales was the lead agent in the initial work. Is that correct?

Ms Anderson : New South Wales did a lot of the fundamental base planning. It was seen by other jurisdictions to be a valuable effort and regarded as something which could be usefully built upon. That is the additional work that is now going to get underway.

Senator McLUCAS: What is the task of the steering committee that the Commonwealth is chairing?

Ms Anderson : Essentially to lead this additional work—to move it from a beta model to something which is—

Senator McLUCAS: Sorry; what is a beta model?

Ms Anderson : It is a testing model. It is something which is recognised as not yet fully developed but has enough of the moving parts to see how it might apply in real life but in a piloted way. It is not currently being used as a planning model, but it is being tested as if it could be used and to identify things that might need further development. Indeed, that list which I partially rendered is still being developed. There is still the need for further identification of the issues to be worked on to move it from its current testing phase into a framework which nine jurisdictions can agree to.

Senator McLUCAS: What role did DSS have? You might be able to assist us, Dr Ayres. What role did DSS have in developing the mental health service planning framework?

Dr Ayres : I think Dr Hartland might be better placed to answer that.

Dr Hartland : We have been briefed a couple of times by the officers developing the framework and aware of how it is evolving. Where it is sensible for us to do so we would offer review on what it means—any information on service or the construction of the packages in particular—but we are not directly involved in authoring it or approving its use.

Senator McLUCAS: Does it capture the services that DSS is funding currently in mental health?

Dr Hartland : Yes, it does.

Senator McLUCAS: Did DSS request a bigger presence in the process?

Dr Hartland : No.

Senator McLUCAS: You feel very confident that DSS has been well represented by this?

Dr Hartland : We are very confident that we have got visibility from our colleagues in health as to the bits of the framework that relate to us. We are very happy with the briefings we have been provided on it. They have helped us think through some issues in our areas, so we do not have any problems with the governance of the framework or our access to officers and information about how it is progressing.

Senator McLUCAS: Mr Bartnik, your NDIA was basically being born when this was all happening. Are you aware of any consultation with the NDIA around the service planning framework?

Mr Bartnik : In my previous role in Western Australia I had very direct involvement. Since joining the insurance agency, we do have regular discussions with both Health and Social Services regarding population data in the scheme. I also attend as a stakeholder the Mental Health and Drug and Alcohol Principal Committee, in which there have been some discussions about this. I am very engaged with the discussions, and we are aware of the status of the work.

Senator McLUCAS: Did the commission ask for access to the framework during their deliberations?

Ms Krestensen : I understand they did ask for the framework towards the beginning of the process of them undertaking the review. As you have heard, the framework had not been finalised. The decision was made not to release that framework to the commission at that point in time.

Senator McLUCAS: Simply because it was not finished.

Ms Krestensen : That is right.

Senator McLUCAS: Clearly, the commission would have the capability to recognise that it was in a form that was incomplete. There has been a lot of work put into this framework. Hundreds and hundreds of people have been involved.

Mr Cormack : We certainly acknowledge that, but it is important to recognise the governance of this. It is a Commonwealth/state piece of work. It obviously has very significant implications for the way services are planned, designed, delivered and resourced. Any endeavour that requires collaboration across the Commonwealth, state and territory governments on matters that would potentially require changes or increases in their levels of resourcing do require a significant degree of scrutiny within the budget processes of nine jurisdictions. Accordingly, there are appropriate safeguards on the release of unfinished, unapproved work. So it is not unusual for something that is in its development stage within this governance context not to be made more broadly available, particularly as it is subject to change. Whatever version they might have been access at that point in time may not even have been the beta version; it may have been an earlier version. Clearly, things have moved on.

Senator McLUCAS: After the request from the commission was made to the Department of Health, did the Department of Health request of state colleagues, through the ministerial council, permission to release the framework to the commission?

Mr Cormack : We would probably need to check the facts on that one. I am not quite sure what the story was.

Senator McLUCAS: Thank you. I now go to the Fifth National Mental Health Plan, which you referenced in your opening comments. What involvement does DSS have in the development of that plan? How does DSS engage with the development of that plan?

Mr Cormack : Probably an important point to note is that the Fifth National Mental Health Plan was a decision taken by the COAG health council to progress that work. It is really just in its early stages. It has been assigned to be led by Tasmania under the Mental Health and Drug and Alcohol Principal Committee of AHMAC auspices, and a working group has been established to progress that work. Through the course of the development of The Fifth National Mental Health Plan there will be extensive consultation with a wide range of stakeholders within the Commonwealth and also within state and territory governments, the NGO sector and the private sector. At this stage—Ms Krestensen might be able to add some further detail—I think there have been two meetings of the working group. It is hitting its straps, but it is certainly not into the level where they would be ready for wide-scale consultation with the sector. That has always been the process for previous national mental health plans. There is extensive consultation, and that will be the case with the Fifth National Mental Health Plan.

Senator McLUCAS: Given the recommendations of the commission that go to the fact that mental health is not a health-only issue—according to Professor Fels this morning, it very much sits in every single department of the Commonwealth and the states—has there been consideration that the Fifth National Mental Health Plan might have a different construction from the first four, which were basically based in health?

Mr Cormack : To go back to the governance of the process: we are, as public officials, responding to a decision of the COAG health council. They determined the pathway and the governance for this. So I think that is an important point to note. Certainly in the development of the National Mental Health Plan we will be recognising—as indeed will the states and territories—the context of the commission's work. It is a landmark piece of work. I outlined in my opening statement the other moving parts that are going on at the moment. Our expectation is that there will be full engagement across government. The fact that it has been carried by the COAG health council through a health process does not in any way give it a licence to minimise the scope or not consult appropriately with the full range of Commonwealth, state and territory government agencies.

Senator McLUCAS: The report of the commission was leaked only four days before, I think, the last COAG health council meeting. There has not been a subsequent one?

Mr Cormack : It was the one before. It was in April.

Senator McLUCAS: There has been a subsequent ministerial council meeting?

Mr Cormack : Yes. There was one in Darwin only a couple of weeks ago, and I was up there for that.

Senator McLUCAS: Was the Fifth National Mental Health Plan on the agenda for that meeting?

Mr Cormack : I would have to check. I do not have the agenda with me.

Senator McLUCAS: Maybe other staff could answer that.

Mr Cormack : They do not have the agenda with them either.

Senator McLUCAS: If we could have an answer on notice, that would be great.

Mr Cormack : Sure.

Senator McLUCAS: Can I now go to the Expert Reference Group. Once again, you talked about that in your opening remarks. Has the Expert Reference Group asked for or been briefed on the Mental Health Service Planning Framework?

Mr Cormack : They have met on a number of occasions now and they have gone through in great detail the National Mental Health Commission's report, the themes that underpin the recommendations and indeed some of the specific recommendations. The context of the work they are doing is still deliberative it at this stage. They are getting to the business end of providing their advice to government. It is not really appropriate for me to foreshadow or forecast what their advice to government will be. But certainly we have been supporting that group, and the framework is very much a topic of conversation among the many aspects of the National Mental Health Commission report they have been working through. I would be very surprised if they do not have something to say about that. Again, it is their prerogative and it is their report to the minister.

Senator McLUCAS: Have they requested to receive either the beta version of the framework or a briefing on the framework?

Mr Cormack : I am not aware of a specific request. Ms Nicholls and Ms Krestensen are very actively involved in the process and I have sat through a number of the meetings. I have to say that they are an Expert Reference Group and many of them would have a pretty clear line of sight through their other roles. Some of them are very active in working with the state governments, for example. So I would be very surprised if the views of some of them had not been sought—not through our process but through the AHMAC process. I would be surprised if a number of them are not reasonably familiar with varying versions of the framework. As I mentioned, it has been raised in discussions but they are yet to come to a landing in terms of the advice they will be providing to government.

Senator McLUCAS: I think what you are telling me is yes, they have seen the framework.

Mr Cormack : They have not asked for the framework—

Senator McLUCAS: I think what you are saying is that they did not need to.

Mr Cormack : I am saying they have not asked us for the framework. So all I am saying is that they are experts in the field and a number of them would have broad familiarity with the framework, as indeed many other people in the sector do.

Senator McLUCAS: In the Fourth National Mental Health Plan one of the items was that the framework would be published. Has a decision been made not to pursue that action item or is that in abeyance?

Mr Cormack : I am not sure whether a decision has been taken to publish or not publish. All I know is that the Fourth National Mental Health Plan has been somewhat overtaken by events and we are now in the process of developing the Fifth National Mental Health Plan. And obviously the Commonwealth's response to the National Mental Health Commission report will consider the importance of the framework. It clearly features prominently in the Mental Health Commission's report, but I am not aware of any specific decision to publish or not publish.

Senator McLUCAS: Can I go to the time frame for the Expert Reference Group. It was meant to report in October?

Mr Cormack : That is correct. That is the time frame we have been supporting the Expert Reference Group to work towards. Certainly from our observation they are well advanced in their work.

Senator McLUCAS: Has there been a consumer or carer representative appointed too?

Mr Cormack : Yes, there has.

Senator McLUCAS: Is that in addition to the original names that were published?

Ms Krestensen : The original names that were published included Julie Anderson, who is a consumer representative.

Senator McLUCAS: And that was subsequent to the original announcement?

Ms Krestensen : No, it was part of the original announcement.

Senator McLUCAS: Sorry, I do not have that material with me. And is that a carer representative too?

Ms Krestensen : No. Julie Anderson is a consumer representative. There is no carer representative on the committee.

Senator McLUCAS: Was consideration given to adding a carer representative following the calls for that from the community?

Mr Cormack : We provided a whole range of advice to government in relation to the establishment of the Expert Reference Group in terms of some names of people. The decisions were taken and we have the Expert Reference Group that has been published.

Senator McLUCAS: So it was a decision of government?

Mr Cormack : Indeed, it was.

Ms Krestensen : I would just add that we have separately consulted consumers and carers through a stakeholder workshop, through a separate consumer/carer forum that was held this week and also through their participation in some of the other specific consultations which were built on existing forums such as the ASPAC forum.

Senator McLUCAS: But you would have heard the calls for the inclusion of a carer representative on the ERG following the announcement of the membership.

Ms Krestensen : Yes. I understand the issues you are raising.

Senator McLUCAS: Mr Cormack, you made the point about how many balls we have got in the air at the moment.

Mr Cormack : There are a lot.

Senator McLUCAS: We have got the ERG and this lovely report; it is doing my left arm a lot of good carrying it around the country, so I thank them for that! We have got the reform of federation, the Medicare item number review and the primary healthcare review. The time lines for all those reviews are different. How are you lining that all up in the department? Dr Hartland, are you engaged in any of those reviews? Sure, they are in health, but they do have impacts for mental health consumers in the country.

Mr Cormack : I would like to make a comment on that. There is a very senior Commonwealth officials group that is working to pull together the many threads of reform that are the subject of development or consultation or indeed implementation across the health sector. That includes a senior official from DSS who is a member of the interdepartmental group that I chair. In fact, we had a meeting today. Certainly DSS is being kept well briefed on the range of activities. Indeed, the senior official there also gave us some good cross-briefing on other areas of policy activity within the DSS portfolio.

Senator McLUCAS: Dr Hartland, do you want to add anything to that?

Dr Hartland : We are happy with our level of engagement. One of our central policy people participates in the group Mr Cormack just mentioned. In addition, we work through issues offline with our colleagues in the health department as they arise in my area or in James's area. So we certainly do not feel that we have a lack of visibility or an inability to put our points of view or engage on these matters. But we are not seeking to get more work either. We do not have any complaints. It seems to be working relatively smoothly.

Senator McLUCAS: Mr Cormack, the ERG is tracking to report in October?

Mr Cormack : That's right.

Senator McLUCAS: Let's go to the recommendations from the commission around Primary Health Networks. As I said this morning, Primary Health Networks are one month and 25 days old today. This big change that the commission is proposing would come into their purview. What work, if any, is being done at this time to plan for that sort of change?

Mr Cormack : The PHNs officially came into being on 1 July. However, the transition process from the former Medicare Locals has been going on for quite some time. The first year of operation of the PHNs is obviously focused on their initial establishment, and that is largely underway—getting their governance arrangements in place, including their consultative mechanisms. They are required to undertake in their first 12 months a detailed regional needs assessment, which they will undertake in conjunction with the local hospital networks, public and private providers. On the basis of that, they will be required to begin to commission services within the geographical area that line up with the specific needs that they have identified in their service planning.

Mental health has always been one of the six priority areas identified for PHNs in their role as service integrators and commissioners. The former Medicare Locals were undertaking a range of service delivery functions in the mental health space, so it is not as if they are unfamiliar with the territory. They are certainly not unfamiliar with primary health care. We are working with them on their planning efforts to build their capability with commissioners and also to provide a number of funding pools so that they can have some program funds and some flexible funds available for them to put in place services that are responsive to local needs. In the fullness of time, that will include mental health services. A number of them are already doing that. As you know, the specifics, the timing and the scope of all of those have been identified in some detail in the commission's report. But the government has not yet provided a full response. That will certainly follow shortly after the conclusion of the ERG's advice and, no doubt, the government will have something to say at that time about the extent to which PHNs will have an expanded, different or modified role to what they currently have.

Senator McLUCAS: That is part of the ERG's work at the moment—to look at what amendments might need to be made to PHNs.

Mr Cormack : The ERG's role is to work its way through the themes in the commission report, and I think we have covered off on what some of those themes are. They will be providing specific advice to government on virtually all aspects of the report, including the potentially different or bigger role for PHNs. Again, I cannot pre-empt what they are going to say and nor can I pre-empt what the government is going to decide in its response.

Senator McLUCAS: ATAPS will continue to be delivered by the Medicare Locals? Who is delivering ATAPS now?

Mr Cormack : A number of PHNs are involved in delivering ATAPS. They are going through a transitioning phase from being service deliverers to service commissioners. Also, the government will provide a much clearer picture on all of the mental health programs. As you are aware, with many of the programs the funding agreements have been extended for 12 months and that in many ways was to enable the government to fully consider the National Mental Health Commission report and indeed the advice it gets from the ERG. Once that advice is received the government makes its response. Then no doubt it will be clearer on the scope and range of any changes to program configuration and the extent to which they come within the commissioning purview of the PHNs.

Senator McLUCAS: You may not have heard—I think it was Mr Quinlan this morning who gave very specific evidence to the committee that said that if he was providing a program and a staff member were to resign, or leave, or go he could offer only an eight-month contract to someone to replace that staff member because of the contract ending on 30 June next year. He expressed concern that this was going to provide difficulties for continuity of service. We had exactly the same problem in November of last year when Mental Health Australia did a survey of their members, which showed a lot of extreme uncertainty in the ability to deliver ongoing mental health services. I think his point is that we are going down that same track and we will get to that same point in November of this year where people will not be able to fill positions in their services and, therefore, people with mental illness will not be able to get the services that they need. I am sure the department is aware of that. I am sure the government is aware of that. What work is being done to mitigate exactly that same scenario being developed by November this year?

Mr Cormack : You are right—we are aware of the concerns that have been raised. I think Mr Quinlan is a very articulate and well-informed advocate for the sector and freely provides detailed advice to us on those issues. We are in agreement that there has been some level of uncertainty, and that level of uncertainty is not ideal. What we are working to do is to support the Expert Reference Group to complete its advice to government. Government will then release its response to the commission's report and within that response we anticipate that there will be a greater degree of certainty about the timing for contract extensions, renewals and any changes or modifications in the way that services are delivered. Certainly our minister has been making sure that we support the work of the Expert Reference Group to get the advice to her as quickly as possible and then it is really a matter for government decision making. As I said, we believe that the information from the ERG will be made available to government in the time that it is requested and then the deliberations of government will continue on from there, at which time we should be able to identify the impacts on the sector as a result of government decision making.

Senator McLUCAS: So you cannot point to a date that you are expecting the government review.

Mr Cormack : We are confident that we will be providing the—

Senator McLUCAS: Sorry, I mean the government response to be received.

Mr Cormack : The precise timing of the government response is a matter for government. But all the indications are that they want us to support that being delivered very quickly.

Senator McLUCAS: I want to go to transition to the NDIS. This is why we invited those people on that side of the table to come along as well. The four programs that are in scope for the NDIS have been the subject of a lot of the commission's report, the subject of a lot of what we have heard today. People are recognising that we are inventing a huge change to the way we deliver disability services in our country and that for those people who are currently receiving a Partners in Recovery or a PHaMs service and will get a tier 3 package that is a good thing. But there is concern around those people who may currently be receiving either a PIR or a PHaMs package but when they go through the process of assessment for NDIS are found not to be in tier 3.

Can you talk to us about the guarantee in the intergovernmental agreement that a person will be no worse off—that is, a person who is currently receiving a service will continue to receive that service—and how that happens in practice? What is the process for the agency, Mr Bartnik, for the referral of a person who is not deemed eligible for a tier 3 package but clearly needs support?

Mr Hartland : I will start, then we will go round to the people who know what is going on, on the ground, which is probably where you want to go. As you recognise, the intergovernment agreements for the trial stage of the NDIS had a commitment from all governments that people currently receiving services would get, what we call, continuity of support. If they are receiving a program at the moment and their program gets rolled into the NDIS and they are not eligible for the NDIS—or, alternatively, they do not get the same service offer—the government is committed to providing, outside the NDIS, continuations of service.

We keep working with our colleagues in health and watching our own programs to make sure that happens. We have not yet heard of cases where that commitment is not being met, and I will pass on in a moment. Also, it is relevant that for many of these people the reason they do not get an NDIS package is that their needs are not high enough to get into the scheme. They might have a need but it is not the type of need that is best addressed by an individually funded support package.

In addition to the continuity-of-support guarantee, as you would be aware, there is capacity in the NDIS to fund programs outside of individually funded programs. We have toyed with various names for this. We have called it tier 2—which, of course, meant nothing to anyone who did not know what tier 1 and tier 3 meant—so we have now tried to call it 'information linkages and capacity building'. Unfortunately, that is about as opaque as tier 2. We move forward gradually into these policy areas and we hope we are making progress, but there is capacity for the scheme to fund support for people who do not get the individual package.

That service office is still developing so, in the medium to long term, if someone is in a program and is not eligible for an individually funded package that may well also be a source of support. I think I have told the Senate community affairs committee this before, but it is worth repeating. When we were looking in detail about how, at a policy level, this information linkages and capacity building should work we were very mindful of a couple of areas where it had been raised with us that it was going to be an issue. Mental health was one of them. So we made sure that how we described this ILC service offer fitted in with, what we understood to be, what you would get in these programs if you had a fairly low need and wanted to go in and out of programs.

We certainly described that in a way that should be pretty seamless. With a number of these things—as you pointed out, if you look at the NDIS it is only just three-quarters through its trial phase, so we are continuing to watch this area to make sure that it works. We will continue to do that until the end of trial and start of transition. We do not yet see any huge problem. There are obvious issues that we work through with Frank and others who are part of this area. It will work for people to make sure that they continue to get support or there is a source of support once the NDIS rolls in. I will see if we can add to that about the specific ways in which it is being—

Mr Christian : I will start at a very high level. We do have a set of principles for determining the responsibilities of the NDIS and other service systems. They were agreed by COAG in April 2013. They do cover 11 service-system domains, including mental health. We also have to complement that with an agreed set of tables of support, which assist decision makers—whether they are in the NDIA, in a state agency responsible for mental health or in DSS or DSS funded programs—to determine whether particular services are eligible in the trial sites and at full scheme.

We in DSS, are engaging with our colleagues in other agencies—health, in particular—around the four mental-health programs that are moving to the NDIS and have developed detailed transition plans for the programs. In those plans we do specifically have a focus on continuity of support and the transition of clients to the NDIS. The key areas covered in those plans, for example, are strategies to identify and address potential service gaps linked to continuity of support in trial sites, including reviewing eligibility decisions and refining operational processes, and identifying funding and transitional Commonwealth programs that might need to be there to complement continuity of support from the period 2016-17 onwards.

If there is an issue identified in the trial sites—and we know there have been some issues identified—we do escalate. There is a process to escalate and resolve issues. But it may be a little more reassuring to know that in Barwon and the Hunter, of those PHaMs clients who are currently eligible, it has been assessed that 80 per cent of them are eligible for NDIS.

Senator McLUCAS: That is very important. So 80 per cent are eligible from the PHaMs client group.

Mr Christian : Yes.

ACTING CHAIR: I am going to have to jump in here because we are running out of time. Senator Williams would like to ask a couple of questions.

Senator WILLIAMS: Mr Cormack, I made a point earlier on, to witnesses here today prior to you, that we seem to have a lot of groups, and many of them are not here. Are most of those groups funded by the department to carry out their services?

Mr Cormack : Which groups you are referring to?

Senator WILLIAMS: The groups we have here today. I can call a list of them out. We have Anglicare, the Salvation Army, Black Dog Institute, United Synergies, BoysTown, SANE Australia, Mental Health Australia, RichmondPRA, and the Brain and Mind Centre—that would not be under the university. The point I am getting to is: has the department looked at bringing some of these groups together by not having so many groups, so they see that all of the services are covered or covered better?

Mr Cormack : We are aware of the large number of groups and organisations involved in the provision of mental-health services. We do, from time to time, have a look at opportunities to streamline programs to look at whether there are areas of overlap or duplication. We do look for opportunities to address those. The government, in response to the National Mental Health Commission report, will have some things to say about the future of the system as a whole, and the system is very heavily reliant on the non-government sector for its delivery mechanisms. Rather than comment on any specific plans or ideas that may or may not be on the table, I think it is just best to wait for the government's response to the commission report, which I do not think will be too far away. I am sure they will have something to say about the range of programs that are delivered and if there are ways to make them work more efficiently, more effectively and in a better coordinated way to better support individual clients.

Senator WILLIAMS: Mr Christian, I can say with total confidence that my impression is that with the introduction of NDIS mental health will not be neglected in any way whatsoever. We are getting evidence today about people being excluded from the program because of the NDIS introduction. Can you elaborate on that please?

Dr Hartland : Certainly. We do not believe there is any reason why they should be excluded from programs because of the NDIS introduction. Actually, we would recognise that we have heard concerns that the way in which a person should come into the scheme—the application process, the planning process—does perhaps need to be handled slightly differently for some people with a mental illness than you would normally for someone with, for example, quadriplegia. Mr Bartnik might like to tell you about the work he is doing on that issue. So we do recognise there is some work we need to do on that.

Mr Bartnik : When I first started with the NDIA, this was the biggest issue—that is, the language of the scheme, the processes, the forms, and how individuals who sometimes become quite suspicious of government or institutions would engage with the scheme. My early work was around establishing a national mental health sector reference group where we got consumers and carers, families, sector people, government people and agency people all around the table. We scoped a number of reviews, but the first and the biggest was a review of the access process. We had five working groups and we had very strong leadership from people with lived experience and people from the sector. We have just completed the analysis part of the review. There are 39 recommendations; about half of those are to do with the language and the processes of the scheme. We are now around the implementation phase of those: rectifying documentation, communication, making the forms easier. We also have a stream of work around outreach, knowing there are programs like Partners in Recovery, for example, and also some of the specialist mental health programs, for example the Street to Home program, that do a great job of going out to where people are and supporting people, and we will use those to assist people to connect with the scheme. We have a very substantial piece of work underway, having reviewed the access process, and now we are into the serious business of implementing the recommendations.

I do want to say that I think the first two trial sites got started quite some time ago. There was a lot of learning not only about their very best intentions and their very good work but also about more respectful language, more engaging processes and to support people to access the scheme in an easier way. We are confident that we have a good work plan there and, with those recommendations, that will go a long way.

Senator WILLIAMS: Can anyone tell me: is it the case, with the funding heading towards the NDIS, that funding has been reduced for mental health services?

Dr Hartland : Not in total, no. What happens with the NDIS is that in some programs, in our PHaMs program for example, funding in the PHaMs program will roll into the NDIS and so people, instead of getting support via DSS giving money to a PHaMs provider, will become a participant in the NDIS and the money is maintained. In fact, in the NDIS there is actually a massive investment in mental health. So the actual funding available for mental health will increase.

Senator WILLIAMS: That explains the words of the previous witnesses today.

Senator McLUCAS: Dr Ayres, you said that 80 per cent of current PHaMs clients are being assessed as getting a tier 3 package. That is very comforting. That is in Barwon and the Hunter. That is across both sites?

Dr Ayres : Yes.

Senator McLUCAS: What is the experience in Tasmania of the adolescents that are coming into the program there? Would any of those people have been PHaMs or PIR clients already, or is it just that the cohort is too small?

Dr Ayres : I think it is a small cohort. I might have to take on notice to provide you with the detail about Tasmania, but I believe the numbers are quite small in Tasmania.

Dr Hartland : [inaudible] I cannot tell you. Obviously, someone has the numbers, but we cannot tell you them now. Dr Ayres is right; the numbers of people going in are fewer as a proportion than in New South Wales and Victoria. I think he is right, too, that that would be explained by the age cohort. If you look at the overall age cohort of people with a mental illness, they tend to be most concentrated in the 25- to 64-year-old group, which I guess reflects the experience of people with a need with that condition. Because the Tasmanian trial is targeted to younger people, you would not expect to see the same numbers, but there are—

Senator McLUCAS: Although they are adolescents, and there is a high propensity of mental illness around adolescence.

Dr Hartland : Yes, but the point is that it is less than the older groups. The incidence is still less than in the older groups. So, yes, it is a concern, but you would not expect it to be at the same level as the other trials. It looks like it is about 10 per cent overall, but we can get you some detailed notes. As I said, we have got them. We can pull the numbers. We just do not have them in a numeric way that we can quote back to you.

Dr Ayres : It might also be worth mentioning that for that age group, in terms of the program offerings through the Department of Social Services, we have the Family Mental Health Support Services, which are particularly focused on children, including that age group. That program is not in scope for rolling into NDIS, so for that cohort in Tasmania I suspect quite a number of them would be being serviced through the FMHSS.

Senator McLUCAS: Is there anything you can provide on Western Australia to the committee, particularly around take-up in the two different trial approaches? Mr Bartnik might be able to help us.

Dr Hartland : Mr Bartnik might be able to help us.

Mr Bartnik : I can in a general sense, not specifically for the Commonwealth programs. The last figures I saw for the My Way Lower South West site are that there were 89 people with a primary psychosocial disability. In the Midland site, where the phase was much later, there were about 20 that had come in—

Senator McLUCAS: They are raw numbers.

Mr Bartnik : So it is good progress but small.

Dr Hartland : They are small numbers and they reflect the phasing of those sites, not the population.

Senator McLUCAS: The 80 per cent figure on the PHaMs participants—do we know what number of former Partners in Recovery participants have been able to achieve a tier 3 package?

Dr Ayres : I do not have that. I do not know if colleagues from the Department of Health do.

Ms Nicholls : I do not think we have that data yet. We do not have a Partners in Recovery site in the Barwon trial. We have a Partners in Recovery site in the Hunter trial and we are working closely with them, but I do not know that we have up-to-date data.

Senator McLUCAS: Essentially, what I am trying to ascertain is what proportion of people who currently receive PIR, as with PHaMs, do get a package. Is there any early indication of what that proportion is?

Dr Hartland : In relation to the PIR site in the Hunter, the only information I have—and I am going on my memory—is that there was some initial concern about the administrative arrangements and people being able to talk to each other, which largely seems to have been resolved. Like Ms Nicholls, we have not yet done a full analysis of the kind of cohort who were in the service before and then tracked them through. We can do that and that is what we have done with the PHaMs groups, but you need everybody who is going to go in to get in and then you can trace them back through the NDIS system and find out at what point they exit it. Just on the 80 per cent—can we just go back to that for a sec?

Senator McLUCAS: Yes.

Dr Hartland : The 80 per cent figure is of people who complete an access request, and 80 per cent of the people who complete an access request become participants in the scheme. That is the experience in the Barwon PHaMs group. There are quite a few people who do not complete an access request. I am actually very optimistic about the 80 per cent figure. It is tremendously reassuring to me given that, initially, people were claiming that it was 20 per cent.

Senator McLUCAS: That was evidence we received today.

Dr Hartland : I can tell you I was very relieved to find out that there were substantial numbers of people getting in. The number of people who do not complete an access request is substantial, and we are trying to examine why that is. The evidence at the moment appears to be that, actually, they have just left the area. The people were on the books of the providers. A letter was sent out saying, 'You should get in contact with the NDIA,' the people never get back to the NDIA and do not complete an access request—actually probably because they live in Queensland. Of course it is a possibility that there are people, as Mr Bartnik talked about, with quite severe needs who do not necessarily think that a big new organisation with a government stamp on it is the thing they want in their lives just at that point in time. So we still need to work on outreach and making sure that we are getting all of the people in.

Mr Bartnik : I think the Barwon site is a good example because they have been at it the longest and have more of a full population. In fact, we have had a series of two or three meetings with the consumer and carer advocates, the providers and the clinical mental health services. We sat around a table like this with all those people, looked at the data and asked everybody: are there people who we are missing? At the last meeting I was part of the feeling was that it was a very, very small number of people, who were too unwell at this point in time to be accessing the scheme. But it was a very small number according to all the providers around the table. So I have a level of confidence that for people now in the target group for tier 3 of the scheme we are very close to reaching the most appropriate people.

Senator McLUCAS: But that is not picking up the people Dr Hartland is talking about, who are the people who have disappeared from the system somehow.

Dr Hartland : There would be a group who are too unwell to complete it.

Senator McLUCAS: Yes, I understand.

Dr Hartland : Of course, they can apply later. That is the group that you want to be really concerned about, but there are another group who probably have just left the area or do not have a need and did not see the need to get in contact with the agency. It is the group who are very unwell and need a bespoke, special way of accessing the scheme who are the ones of most concern. As Mr Bartnik is saying, that looks like a very small group, so it would not radically change the 80 per cent figure.

Senator McLUCAS: It is concerning to me that the evidence from earlier today from a pretty respected witness was that 20 per cent of people on PHaMs are getting a package, compared with the evidence here, which is 80 per cent. I do appreciate the fact that you have tried to explain that to the committee. What I now want to see is how many people we have lost. What is the number of people who used to be on the PHaMs list but are now not completing an access request, not those who are very sick—I accept your point, Mr Bartnik; we can probably tell you the names of that group of people because they are pretty close to the system—but the other group that we seem to have lost somewhere?

Dr Hartland : The problem with the group who do not complete an access request is that you cannot go back and ask them why not because many of them you just do not make contact with. So I think we—

Senator McLUCAS: I understand what you are saying. You cannot go to that individual and say, 'You didn't fill the form in,' but surely we can learn stuff from the current providers of PHaMs around what numbers they cannot see in the cohort that have a tier-3 package. I accept the confidentiality aspect too.

Dr Ayres : We are aware of this issue and, as Dr Hartland has said, it is one that we are looking to tackle. As part of our data collection strategy, we have plans for gathering as much information through the PHaMs providers as we can about that particular cohort. We will be dependent on what the PHaMs providers know about them. It is a voluntary scheme and program, so, if a participant drops off the books because they choose to, there is not a lot we can do about chasing them down. There will be some limits to how far we can go with collecting that data, but we have a data strategy in place to get as good data as we possibly can about that cohort, as well as the cohort who get into the NDIS and those who do not get through the access process.

Senator McLUCAS: I accept that; thank you. Dr Hartland, have you done any work to identify the number of people who will fit into that tier 2 group, or the ILC group, who we know will not get a tier 3 package but will need to be able to be in touch with the NDIA or with mental health services on an ongoing basis? How many of those people exist in the country, given the population-wide thinking that we had when we designed the NDIS? How many of those people are there?

Dr Hartland : The answer is complex. Initially when we were talking about the eligibility criteria we did look overall at the numbers, which was the difference between the number of people who needed an individually funded package and those who have—

Senator McLUCAS: Perhaps I could clarify that. I am talking only about mental health.

Dr Hartland : Yes. I am trying to step carefully to the answer. So, there is a group of people who have a disability and have a support need, and then a smaller group who need an individually funded package, and the difference between the two is about 200,000 people. Mental health would be a part of that cohort. We have not gone much further than that at this stage. To some degree we would be relying on the finalisation of the planning framework to get a feel for the actual numbers outside of that, and we would also be relying on where we think we are going to get to in relation to numbers of people with a mental illness who have an individually funded package. The NDIS was budgeted for on the basis that basically 57,000 to 60,000 people with a mental illness would have an individually funded package. Whether it ends up at that we will, of course, still have to wait and see. We are on track for something close to that but perhaps slightly under, and I think we would need more information from the population planning framework to then make an assessment about the tier 2 effort. So, no: we do not have an answer. We have a feel for it but not a precise answer.

Senator McLUCAS: But you are aware of that document that is in the commission's report—in the summary, not in the actual report, on page 14. You might want to take a look at that, and perhaps you could take it on notice—because it is nearly five o'clock—and see whether those figures are the same sorts of figures you are looking at to identify that group of people who will be eligible for tier 2 support. And perhaps you could answer the question for me in the rough—how many people are we really talking about who will need a tier 2 support or an ILC or whatever it is called? The way the commission has classified people is that there are about 65,000 people who have severe and persistent illness, there are about 210,000 who have chronic illness with major limitations and then two per cent of people have severe but episodic presentations. My final question, Dr Hartland, is: how much money is allocated for the tier 2 component in the current budgeting arrangement?

Dr Hartland : At full scheme it is about one per cent of costs, I believe. I think we get to about $100 million a year in addition to provision for LACs, which will be funded outside of that. So, there is a fairly substantial capacity in the scheme to fund this type of work. I am aware of these figures. They are somewhat similar to the early work that was done to derive the PC estimate of mental illness, which stepped through the mental health figures in a similar way. As with other disabilities, they show that there is a core group that needs an individually funded package—and the scheme is funded to provide that—and then there is a wider group of people who have a constant need but do not have very high needs or have a need that fluctuates. For that group, while it is a substantial number of people—here you get to 150,000 plus 400,000, which is a lot of people—they do not all need support at the same time.

So, the issue really is: how do you design a scheme that can support these people at what will remain, at the state level, outside of the scheme? We know this is something you have been interested in, and I am surprised we have not been asked about it—we still have a couple of minutes! That is also an issue about what remains outside of the scheme at the state level to support these people. We continue to look at that. The scheme does increase funding for people with a mental health condition, and I would be surprised, if we could not get it right, if we did not go backwards. There is still an issue about the design of ILC and what remains outside it that we need to keep monitoring, and we will do that as the trials roll out.

Senator McLUCAS: I am going to have to finish, because I have to go and talk on ABC Radio to the regional people of Queensland. But my favourite story is the story of a woman who was quite ill and was a Partners in Recovery client. The cost of making her well was the cost of a bicycle. They bought her a bicycle and she then could go to volunteer at the animal refuge, where she went every day, every week, and she is as happy as Larry and very well. For one bike, we fixed somebody. It is a good story to remind us that not everyone needs a lot of money; they just need the right service. Thank you very much for your evidence today. This committee is hoping to report soon, and if we need to we will send you some questions in writing.

ACTING CHAIR: Thank you very much for appearing before us today. I would like to seek resolution on a date of return of answers to questions on notice. The date of 18 September has been suggested. Is that all good?

Senator McLUCAS: Yes, that would be great.

ACTING CHAIR: Okay. Then I would like to thank all the witnesses who appeared before the committee for giving their time today. I wish the chair, Senator Deborah O'Neill, a speedy recovery.

Committee adjourned at 17 : 03