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Community Affairs References Committee
05/06/2018
Accessibility and quality of mental health services in rural and remote Australia

CONNOR, Ms Elizabeth, Systemic Advocacy Officer, Western Australian Association for Mental Health

GAEBLER, Ms Shauna, Chief Executive Officer, Consumers of Mental Health Western Australia

PENTER, Mr Colin, Projects Lead and Policy Officer, Western Australian Association for Mental Health

SEGRE, Ms Antonella, Chief Executive Officer, ConnectGroups Support Groups Association WA Inc.

Evidence from Ms Gaebler and Ms Segre was taken via teleconference—

CHAIR: Thank you for joining us. As I understand it, you have all been given information on parliamentary privilege and the protection of witnesses and evidence. Is that right?

Ms Connor : Yes.

Mr Penter : Yes.

CHAIR: Thank you for your submissions. I now invite whoever wants to make an opening statement to do so.

Ms Connor : WAAMH is the peak body for the community mental health sector in WA and exists to champion mental wellbeing, recovery and citizenship. WAAMH recognises that a continuum of supports built on principles of human rights, recovery, coproduction, personalisation, choice, social inclusion and cultural connection are essential to the promotion, protection and restoration of mental wellbeing. WAAMH promotes and advocates for further developments in these networks of supports. We made a submission to the inquiry, which was based on data from quite a large community consultation that we did with people in regional areas, for which we received 195 submissions, did about 20 face-to-face and telephone consultations, and had a couple of written submissions. We also in that submission included data from some other projects that WAAMH has done over time to do with regional and remote mental health issues. As our submission demonstrates, there are a number of challenges which affect the access and quality of mental health services in WA.

We have provided a summary of our consultation findings and recommendations, and believe it to be pertinent to specifically mention the following key points. People in regional areas have told us that they need locally based mental health services that are accessible, appropriate and available when they are needed. These services need to be adequately staffed by people who have the appropriate skills to provide high-quality mental health services, and online services must not be used to minimise the need for face-to-face services, as we have heard from other speakers today. To ensure that this can happen, investment in the mental health workforce in regional areas must be prioritised. This does not just mean providing more staff; it also means ensuring that staff who are already in regional areas, such as GPs, are trained, encouraged and supported to provide high-quality mental health care to people across the spectrum of need.

With fewer private practitioners in regional areas, a concerted effort is also needed to invest in and strengthen the public and community based mental health services, including acute and emergency services, as these are the bedrock of mental health care in regional areas. In line with this investment, funding for mental health services and supports in regional areas must be a priority for mental health reform. Lack of funding in general, along with a high cost of delivering services in regional areas, is a key barrier to delivering mental health services in regional areas, and genuine investment in regional mental health must address the need for enhanced funding.

Finally, we are hearing from people in regional areas that mental health services alone are not enough to address mental health concerns and improve mental wellbeing in rural and remote communities. There is a need for greater investment in locally driven whole-of-community approaches that include prevention, early intervention, community education and building the capacity and strengths of people with lived experience and those in rural and remote communities. Health promotion, social determinants of health and cross-sector strategies to address health and mental health that include things like accommodation, employment and education are vital and need to be key commitments for mental health reform in regional Australia.

This information isn't new. People in rural and remote areas have told us that these issues are well known, but the conditions are slow to change. As one participant told us, 'We've been promised so much, but we haven't actually seen any of it.' We urge the committee to heed this core message from people who live in rural and remote Western Australia. People want tangible action, not more talk.

CHAIR: Thank you. Ms Segre?

Ms Segre : First and foremost, I wanted to acknowledge the committee for coming to WA and for inviting to ConnectGroups to present its findings. As the CEO I represent the voice of 617 support groups, of which 151 are regional or rural. We've been working in the peer support group space for the last 35 years. In this space, the peer support groups play a key role in the prevention of mental distress, the promotion of health and wellbeing [inaudible], community inclusion and [inaudible] and contribute to enormous [inaudible] of this experience. We wish to highlight our key recommendations, the outcomes of a consultation forum held in late 2017, where regional members from across the state, who are delivering much-needed social and emotional wellbeing services within their communities, informed our knowledge base with their experiences.

The region has unique requirements, and it is impacted by a lack of computer service delivery, limited resources, geographical distance and limited opportunity for skills development from real capacity builders. We are also acutely aware of the alarming rate of suicide in WA, and as an organisation operating in the mental health space we are impacted by reform direction and policy at both the state and the Commonwealth level that focused on [inaudible].

I am happy during this focus to share with you some examples that we've identified as good practice models of successful community engagement where [inaudible] and co-production. It's clear to us that local empowerment and capacity building increases the state of all long-term services. Local capacity building leverages the commitment and passion of the community who have the most to gain from effective and accessible local services. Peer support models are effective because they are [inaudible] and grow businesses from state to state and locally driven. We also have to take care that we are effecting transferable or sustainable models and [inaudible], including influencing cooperation between individuals, BP and also our services and [inaudible] community groups. When we look at that cooperation through improvement pathway, including [inaudible], and really where community need has identified a local response from one or more service providers, made up of local community members, maybe some of the most affected.

Obviously, one of the other areas of relevance to reference the attitude towards mental health therapies stands in service providers who seem to have a lot of local knowledge of the culture on this side of the north-west, and relationships with their communities.

So, [inaudible] aside, I'd like to leave you with these two messages. First is a call for local capacity building in order to improve services affecting its access, relationships of trust in the pathways we've established, and those relationships go on to build [inaudible] delivery of community [inaudible], and intervention. Service provision needs to be cooperative within the community [inaudible] understand the context. And the final message is the need for upskilling local mental health and AOD supports within the regions, which leads to real [inaudible] and results in real capacity building. I thank you for listening.

CHAIR: Thank you. Can I just confirm that that was Ms Gaebler?

Ms Segre : No, that was Antonella Segre from ConnectGroups.

CHAIR: In that case, I invite Ms Gaebler to make an opening statement.

Ms Gaebler : Thank you for the opportunity to contribute to today's hearing on behalf of COMHWA, which stands for Consumers of Mental Health WA. COMHWA is the peak body for people in WA who have personal experience of mental health issues. Our submission is based on consultative evidence which was gathered from 235 respondents in rural and remote regions. It was conducted by COMHWA, Carers WA and HelpingMinds, and also came from COMHWA's engagement with our 135 individual members and 11 organisational members who are regionally based and from broader local communities.

The common themes that we found in our discussions with people with lived experience of mental health issues who live in the country have shown major and multiple barriers to accessing mental health services. People fight inadequate availability and choice of services, a lack of after-hours services, confidentiality challenges, lack of transport and an uneven quality of local supports that make people hesitant to access the services. People have also identified the impacts of fewer social, economic and community opportunities on their mental health and suicide risk. The effects of limited cultural safety and security, and also local cultures that value and expect stoicism, self-reliance and that devalue disclosure, create communities that are intolerant and have avoidance and shame.

We're concerned that the chronic underfunding of services and the uneven quality of services is at least partly attributable to the ongoing systemic failure to adequately engage with people with lived experience in setting mental health and suicide prevention priorities and designing solutions that people with lived experience can have confidence will work on the ground. It's crucially important to invest in this missing element as part of a place-based flexible commissioning approach. Other roles that people with lived experience can play in bringing about system change include better service navigation, reducing stigma and growing popular concern and support for investing in mental health services.

We support and recommend investment across the spectrum of mental health and suicide prevention and intervention. We recommend the review, identification and resourcing of evidence-based and cost-effective solutions to transport barriers to increase access to a range of infrastructure, opportunities, services and supports to supports people's quality of life and overcome hardships and, importantly, to partner with local lived experience leaders and community members in the design and delivery of all rural mental health and suicide prevention initiatives.

CHAIR: Thank you. Senator Hinch, do you want to kick off?

Senator HINCH: Ms Connor and Mr Penter, earlier on witnesses talked about there being two issues in remote communities, especially Indigenous communities. There's the cultural issue and the mental health issue, and there is the stigma, which has just been mentioned again. What is the larger issue? Is it cultural 70-30, or is it 50-50? How do you see it?

Ms Segre : Could you repeat the question? It is very hard to hear.

Senator HINCH: Okay; repeating the question: I was just saying to Ms Connor and Mr Penter that earlier witnesses today have said that there are two issues. There is the cultural issue and there is the mental health issue, and there is the stigma that you mentioned earlier. I want to try to find out: what is predominant? Is it fifty-fifty? Is it 70-30? Is it largely cultural or is it largely medical?

Ms Gaebler : The feedback we've had is that, from a cultural perspective, the mental health system can't help our people recover as it is not holistic or culturally suited.

Ms Segre : Can I add to that: ConnectGroups runs a program called Dream it Forward, and where we've found success factors is where there are local solutions so that there is a complete bottom-up approach with local leaders identifying the needs for their community. So there is the cultural. As to the question, I think it's a cultural context. Programs are encouraging social, emotional and spiritual wellbeing and local communities are alerting us to the fact that the clinical programs or systems are not meeting their needs or are not culturally appropriate.

Senator HINCH: Ms Connor?

Ms Connor : I'm not an Aboriginal person and I don't live in those communities, so what we have in our submission is based on what people in those communities have told us, but I think I would agree with what they have said so far. I wouldn't be able to put a number on it, but people have told us that there is a lack of culturally safe services for mental health. They haven't told us specifically whether it's culture or mental health that is the bigger issue, but they have indicated that, whatever the issue—whatever gets you to your mental health problem—you then don't have services that are appropriate for you in those communities, which is causing the problems.

Ms Segre : I could provide you with a quote which says: 'Activating cultural strength is a protective factor that improves social and emotional wellbeing outcomes.'

Mr Penter : It's a very hard question to answer, Senator. I'll try to take a punt at it. WAAMH's role is to represent the non-government community mental health sector. Many from the sector spoke today and gave really outstanding evidence, I thought. In terms of culture, are you talking Aboriginal culture—in terms of service for Aboriginal people?

Senator HINCH: Yes.

Mr Penter : One of the strong messages that WAAMH has got from the work we've done is that mainstream services, be they provided by the public mental health system—in this case, by WACHS, who gave evidence this morning—or by the non-government sector, and many from that sector were here today, or by GPs, are often culturally inappropriate for Aboriginal people. The challenge then is how to make those services more culturally appropriate. Certainly there are efforts being made to do that, and the WACHS people today spoke about the state-wide Aboriginal mental health service, which is clearly the attempt by the public mental health system to address that issue.

For the community mental health non-government sector, certainly there's a lack of Aboriginal people employed in that workforce. We did some work last year which showed that there's a need to develop the Aboriginal workforce in the non-government mental health sector. So we need more Aboriginal people employed in the non-government mental health sector.

But the other issue which hasn't come up today is the role of the Aboriginal community-controlled health sector—Aboriginal medical services. Aboriginal people and those services will tell you that Aboriginal people, by and large—not always, but by and large—prefer to use the Aboriginal community-controlled sector agencies. But there has been hesitancy to fund those services to provide mental health services—or social and emotional wellbeing services, as they describe them. So, we've got a problem in that a lot of the resources have been invested in making the mainstream services more culturally appropriate—with probably some improvements—but there hasn't yet been the investment in the Aboriginal community controlled mental health sector. In a way, that's an underutilised resource in meeting the needs of Aboriginal people around mental health. And they're the AMSs which operate around Australia that really are underutilised in terms of their capacity to serve Aboriginal people on mental health issues.

CHAIR: The social and emotional wellbeing framework was released in August last year. As far as I'm aware, there hasn't been any funding committed to it yet.

Mr Penter : I don't know that. Antonella or Liz, do you know? I don't know if anyone else knows the answer to that. There does seem to be a hesitancy to support the Aboriginal community controlled sector to provide more mental health services to Aboriginal people. I'm sure there are complex reasons for that. Aboriginal people are probably better to speak about that than me.

CHAIR: We'll be in the Kimberley in July, so we'll be following that up.

Mr Penter : Shauna or Antonella, do you have thoughts about that issue in terms of the Aboriginal community controlled sector?

Ms Segre : ConnectGroups in the last three years has received minimal funding through the Mental Health Commission to run this program named Dream it Forward, which is around providing intervention for funding for local solutions addressing mental health and, obviously, suicide prevention. Again, in line with what Colin from WAAMH was saying, we've identified that a very small source of funding can make a difference. They're very much moving away from funding mainstream and moving more towards empowering local communities to identify services required to address their emotional and spiritual wellbeing and help-seeking behaviours.

Ms Gaebler : There are a couple of issues. Whatever you're doing and whoever does it, it's around the way that it's done. One would presume perhaps with the Aboriginal controlled services that that would be more in line in being more of a holistic service that understands some of the cultural and spiritual overlays. The other feedback that we've had from Aboriginal community members has been around the generational trauma and lack of role models for young people, housing and poverty. It's some of the bigger issues as well. There are a couple of issues to be addressed, as I say, from the Aboriginal cultural controlled organisations. I would presume that that would be a really good step, but there are some other determinants. It's a little bit more complicated or extends further.

Ms Segre : In line with Shauna, that is precisely what the programs that we're running stress. We have found local leadership, specifically from women, stepping up and taking action in this space.

Senator BROCKMAN: My question is to Ms Connor. I want to follow up on the survey work you did. It looks like it's about one-third users of mental health services, one-third carers and one-third service providers. Is there anything that you learnt in that process about the different priorities from those three distinct groups?

Ms Connor : We had the capacity to do that in the analysis but we didn't do it for the purpose of the submission, so no. All the results were used for the most part except for a few things to do with the National Disability Insurance Scheme, which we stratified down into just service providers. Everything else was just everyone in together, so no.

Mr Penter : One of the issues that came up a lot this morning came out from the service providers. One of the most significant issues that they raised was the same issue that was raised today, which was about the impact of the funding and contracting regimes on rural and remote areas, where service providers are constantly facing uncertainty about their future and uncertainty about delivering those services. That was certainly a very strong message from the service providers. As Liz said, we didn't differentiate, in a sense, in our submission. Shauna may have stronger views and knowledge than we do on the consumer views about those issues.

CHAIR: Shauna, do you want to answer that?

Ms Gaebler : We did include service providers, carers, families and consumers in our survey. What we found was that there was actually quite a crossover of people who had lived experience and were also family carers and/or service providers. It was hard to segment them up because people could have more than one classification.

Mr Penter : True, true.

Ms Connor : I would say that we found the same thing.

Senator PRATT: Ms Connor and Mr Penter, because you have been diligently listening to the evidence all day, I'd like to ask whether you have any particular observations based on some of the other evidence today?

Ms Connor : Across the board, I would say that all the issues that came up today are the same ones that came up in our consultations. If you're looking for triangulation, it doesn't really matter what way you cut it; everyone's saying the same thing. For me, that was the standout message.

Mr Penter : I was struck by the similarities between what we'd flagged in our submission and what other people were raising. There were a couple that didn't come up to the extent that I thought they would. The issue around farmer communities emerged in our consultations. There were some very impassioned and profoundly emotional statements from people who responded to our survey—and it's in our submission—around the extent of mental health problems in farming communities in Western Australia. Tragically, we've had one recent event that has really shocked people, which some of you would be aware of. I was struck by the passion with which those people contributed and the extent to which their plaintive cries were, 'Don't just send us a survey; come and speak with us,' and some of the comments people were making about no services, no GPs, no access to services, long distances to travel to access a service, the issue of stigma—which was the other one that people were flagging today—and the anxiety about being seen to have to seek support for a mental health issue in those farming communities. That was one that was very poignant in our consultations.

The other one that came up today, with the NGOs, that struck me was the impact of non-mental health issues—I guess we use the term 'social determinants of health'—on people's mental health conditions in rural and remote areas: isolation, travel, financial stress, housing, transport. What I heard people saying, and what is certainly in our submission, was that, even if people have an underlying mental health struggle, the impact of those other factors can create a more serious or acute mental health crisis. So I guess that's a message we would really emphasise: that those social determinants of mental health—transport, housing, income, employment, poverty and Aboriginality—are heightened outside the metropolitan area. That's a real challenge: how do we address those outside the mental health sector? I don't envy your task there. It is a huge issue, yes.

Ms Connor : When we did our consultation, I guess there was a bit of a hierarchy of things that people thought were important, and prevention, social determinants and health promotion were very clearly the second most important thing, after actually being able to access services. It was all those other things around it, especially things like—I know it was mentioned earlier—just knowing what services are out there, so having information about what there is, because people don't even know what's available in their area, and having community education about what mental health is all about. I think that ties into the stigma issue. People were literally using the words 'prevention' and 'social determinants' and all those other things.

Mr Penter : I'd also support the evidence of Ben Headlam from Palmerston. That issue of the co-occurring nature of drug and alcohol issues and mental health issues is a huge challenge for the non-government mental health sector, partly because they're not funded to provide mental health and drug and alcohol services; they're funded to provide mental health services or they're funded to provide drug and alcohol services. So when you're getting clients such as Ben was describing, with very serious mental health issues that may be induced by the drug and alcohol use—

Senator HINCH: Or vice versa.

Mr Penter : Or vice versa—yes, thank you. You're funded to provide mental health services, but you're having to deal with drugs and alcohol, or in Ben's case you're funded to provide drug and alcohol services but you're having to deal primarily with drug-induced psychosis. So those are really huge issues. In the non-government sector, we struggle to deal with those issues effectively, as does the public mental health sector.

CHAIR: I think you were in the room when the WA country mental health service were saying that in two regions they're funded to provide mental health and drug and alcohol services. So I ask all of you what your thoughts are on more funding along those lines, where community based organisations are funded for an integrated service.

Mr Penter : My understanding is that, for those two services, that was primarily because there were few non-government providers who could provide the drug and alcohol services, as distinct from a deliberate, integrated model. That's my understanding. I may be misrepresenting that. But in most other parts the drug and alcohol services are funded through the community drug service teams, which are usually a non-government agency, and then you'd have mental health services funded by WACHS, the Mental Health Commission or the Commonwealth through WAPHA. So I think there probably hasn't been a strategic model of how we might integrate drug and alcohol and mental health services outside the metropolitan area.

Ms Segre : We have an example in Bunbury where there's a high utilisation of meth, and there's been a complete absence of crisis services to support families. That is a clear example where, by building the local capacity and the local leadership with an organisation called Doors Wide Open, they entered into this space. We're seeing, through our peer support members, that they're really articulating the gap, be that mental health or AOD, and they're sort of stepping into that space. They're completely non-resourced. So, there's a huge opportunity there.

CHAIR: Sorry, Louise; I'll hand back to you in a sec. Can I go down this line a little bit. Do you think it is worth putting more research or consideration into looking at whether that's a better approach—the integrated service—maybe in some areas at least?

Ms Segre : One of my key recommendations was around really investing in building local capacity.

CHAIR: I appreciate that. Should that local capacity be also in this more integrated approach so you are able, and organisations have the capacity, to do both mental health and drug and alcohol, since, as was articulated today, more organisations are having to do that anyway, unfunded?

Ms Gaebler : We're certainly very supportive of increasing the capabilities of mental health services to meet the needs of people with co-occurring issues and vice versa with drug and alcohol. I'm just a bit aware that there are some services that are drug and alcohol and mental health but still have cultural issues to address between the two systems, so it needs quite a deliberate response to have them working as one. The other consideration—a strong one for people with lived experience of mental health issues—is looking at choice and control. I think it always needs to be weighed up, with increasing the size of a particular organisation or service, as to what that does for choice and control. That needs to be weighed against how people with diverse needs are best supported whilst not taking away their control and choice.

CHAIR: Yes, good point.

Senator PRATT: One of the questions I have asked other witnesses today is about the overlay of Commonwealth and state responsibilities with respect to mental health and what levers the Commonwealth has to pull to improve mental health outcomes in regional areas. The weighting of the funding was clearly a problem. I'm wondering if you would point to that or to anything else that we might be able to draw on specifically in terms of the Commonwealth's responsibility.

Mr Penter : That's a very good question. If I think about WAAMH's work—we did a workforce project 12 months ago where we looked at the workforce needs of the community mental health workforce—the non-government workforce—and the main issue that came out of that was the impact of the contracting and funding regimes on the capacity to recruit, retain and employ staff. So, that would be one.

Senator PRATT: And irrespective of whether it's the Commonwealth or the state funding that. Because the Commonwealth is contributing, we could put pressure on the states to put that in the contract.

Mr Penter : Yes, and I guess many of the problems that the NGO sector runs into are as a result of Commonwealth funding. People spoke about them today. There are a range of other funding programs that impact directly upon mental health, like the National Partnership Agreement on Homelessness, where those sorts of problems occur all the time. So, that would be one.

I think people spoke today about some of those issues around access to the Better Access program and some of the tensions there. We're running a project at the moment with young people who've had experience of the mental health system, and for many of those young people the Better Access program is their only access to mental health support. Those sorts of problems flow down and impact on young people at critical points in their journey through the mental health system. So, that would be another one. The issue of the funding of the Aboriginal-community controlled sector, in terms of social and emotional wellbeing and mental health, would be another. That's primarily Commonwealth funding. I think there are a lot of policy and funding levers that could make a real difference in rural and remote areas; yes, absolutely. There are probably others that Shauna and Antonella might know about as well.

Ms Gaebler : The WA government's 10-year mental health and drug and alcohol plan is an important blueprint for reform based on WA's population needs, so an alignment of any funding between the Commonwealth and the state to meet these needs is important. We are concerned that funding committed so far to community mental health services for the continued support of those who aren't eligible for the NDIS is unlikely to adequately meet needs. I guess that goes to the interface between the Commonwealth and the state and the logistics of how it's managed so that it's a more effective and efficient service as opposed to the potential for accidentally and inadvertently decreasing or duplicating services.

Senator PRATT: Can you explain for the committee how it might decrease or duplicate services? You might think it's obvious, but it might be worth explaining.

Ms Gaebler : The NDIS is an example where the Commonwealth has invested in servicing people who have severe mental health issues, and there are still issues with what the state has been doing. In the complexity of the NDIS there are people who have significant mental health issues who aren't eligible, but the funds for state based programs have been shifted across into the NDIS. So, you have a group that the NDIS is servicing who now have got access to programs that have been taken away from people who, for whatever reason, aren't eligible or choose not to be in the NDIS.

Senator PRATT: Yes, that certainly does make sense. Thank you for explaining that.

CHAIR: That's where I want to go—to the NDIS.

Mr Penter : Wouldn't we all!

CHAIR: Well, I reckon some people might go, 'No!'

Mr Penter : True.

CHAIR: Psychosocial disability is an area that a number of people have been paying close attention to—and I notice it came out in your survey—because of the issues around the difficulties with psychosocial disabilities and the NDIS. Could you take us a little bit further through what some people are experiencing. You make a recommendation around monitoring it. It seems to me we might be trying to shut the door after the horse has bolted, if all we're doing is monitoring.

Mr Penter : It's such a challenging issue, in a way, because of the time frames and the fact that we've got some parts of WA where people have access to the NDIS and some where people don't. People talk today about the problem of people in Albany who had a package in the city, move to Albany and now have another package, and they have significant problems as a result of that. So, you've got problems around the rollout, where some people have access to it and some people don't.

I think one of the real concerns that's coming through for people with psychosocial disability is: how well do the local area coordinators and the planners understand the nature of psychosocial disability? Our experience has been that local area coordinators—and this is not a criticism of the system—often don't understand the episodic nature of psychosocial disability. They don't understand the way that may manifest itself in the way people present at certain times and therefore their eligibility for the NDIS.

There is a whole array of issues around the capacity of the system to understand psychosocial disability and the extent to which those staff who will be in those roles have been prepared for dealing with people with psychosocial disability.

You also heard today about the experience of service providers who may not have been prepared adequately for the NDIS. I think the range of problems we're seeing is fairly overwhelming for people whilst there are still success stories for people, so there's both good news and bad news. I guess it's compounded here as well because of that issue with the Disability Services Commission that no longer exists and has been amalgamated with the Department of Communities, so we don't know a lot about some of that activity. I guess Western Australia is unique in that sense. But certainly that concern, which you'd be well aware of, around the transfer of programs like PhaMs and PIR and the implications of that for many people. I was listening to the NDIA give evidence at the Senate last week.

CHAIR: Wasn't that joyful?

Mr Penter : They confirmed what service has been saying: that only 20 per cent of people receiving PhaMs or PIR are going to be eligible for the NDIS, so what happens to the rest? There are good-news stories—no doubt about that—but there are also a lot of concerns that we have and that were flagged only briefly in here.

CHAIR: Antonella or Shauna, have you got any comments on psychosocial disability and access to NDIS?

Ms Segre : No. We don't enter into that space with our services.

Ms Gaebler : We have had a lot of consumer and service provider feedback around difficulties for people with mental health issues entering the psychosocial disability arena. Being able to have an environment that understands mental health and recovery and that can provide suitable advocacy—and also the potential and actual impacts that are being seen with a reduction in potential services to meet their needs with relation to the business-related aspect of NDIS for the service providers. People who are within NDIS have difficulties with getting into it. They have difficulties then being able to plan their recovery support, because they enter into an area that's well established and very different from mental health, and somehow people in NDIS have to go between the bridge of disability services and mental health services. A bit like drug and alcohol and mental health, it's created another interface between two very different services and organisations. It's another area where there's need for a bridging to help people not fall in between.

CHAIR: Thank you. I suspect you would have got little feedback from people from regional areas having had experience with the NDIS at the moment other than if they were reporting under My Way for—

Mr Penter : We did get some feedback from individual cases of people who had moved to one area where they had a package from another area. I think Samuel Rose raised that problem this morning. One of the problems in those situations is that in areas there are often no psychosocial disability services currently registered under the NDIS. We heard of one situation where a person was referred to a disability agency that had no connection with mental health, because that was the only registered provider in that region, because the NDIS hadn't been rolled out. So you're right. It's something people often are concerned about, but they may not have personally experienced it.

Ms Gaebler : One of the things that has been fed back a reasonable amount which NDIS has some impact on and which Antonella has touched on with regard to the local service provision is the concern with regard to services. This has seemingly become a little bit more evident as NDIS has begun to roll out with disability services also entering into the mental health area. It becomes very difficult for local small NGOs to maintain services, and there's a tendency now for the larger NGOs to move into the region. That's causing some distress to the local community members.

CHAIR: Okay. So the community members themselves are getting upset, not the small orgs?

Ms Gaebler : I think it's both.

CHAIR: Okay. I want to come at this from a strengths based approach if we can. Because NDIS is still rolling out in regions, what are the things that we could be saying and recommending that could be done to circumvent some of the problems we're already seeing in the cities? Given the issues we're already seeing in the regions, what could we recommend, saying, 'You could try this or do that to avoid some of these problems'?

Mr Penter : There are a couple of things that immediately come to mind. One is currently being reviews: the funding levels under the NDIS. What we're hearing in rural and remote areas is an increasing reliance on lower-skilled staff. The pricing structures mean that agencies will employ people who will have a lesser qualification, because that's all they can afford. You might have a cert. IV rather than a tertiary qualification. That's not necessarily a problem, but, if that is a consistent issue, that raises concerns that I think were raised by Shauna about the quality of service.

The issue of the funding levels is critical. The other issue is the understanding of the local area coordinators and those agencies that run that service, be it the NDIA or contracted out, who understand psychosocial disability. I don't know about the east cost, but you hear it's very variable, and certainly it's not clear how well those people are equipped to deal with people with psychosocial disability. As Shauna raised as well, there is also understanding the contemporary nature of service delivery in mental health, which is recovery focused, client centred and co-designed, and that's not a tradition well established in other jurisdictions. To ensure that local area coordinators are skilled in contemporary mental health service delivery and understand psychosocial disability would be another.

I think the other issue is that the mental health agencies haven't been well prepared for what's coming. Certainly that's probably true in WA. I can't speak for other states. But better preparation of mental health services to be able to operate in this new environment, because that hasn't been done well up till now. So they'd be three. With a bit more thought, there are probably others that we could offer you.

CHAIR: If you have any more thoughts, you can provide them on notice.

Mr Penter : Yes.

Ms Segre : Can I just conclude with Colin—through the forum we ran, that need for upskilling in order to provide better service provision was highlighted as well.

CHAIR: Upskilling?

Ms Segre : Upskilling of local providers. Our conversation in our forum wasn't specifically to the NDIS; it was thinking more about a holistic approach to regional service delivery around mental health and AOD. With that, there hasn't been an investment around upskilling those that are going to be well placed to provide the services, and it goes back to not having those transient services coming in and out.

CHAIR: Thank you very much for your evidence today; it's very much appreciated. The surveys are very, very useful—the most up-to-date information. We very much appreciate the work that your organisations have done and contributed to the inquiry. I'd like to particularly thank all our witnesses today for bearing with us, our secretariat for helping us get through today and, of course, broadcasting for—although you didn't actually broadcast!—ensuring that we captured everybody's evidence. So thank you very much for your evidence today, and thank you to everybody who's contributed to us being able to make the day very usefully for our inquiry.

Committee adjourned at 16 : 21