Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
Community Affairs References Committee
05/07/2018
Accessibility and quality of mental health services in rural and remote Australia

BAMBLING, Mrs Sharon Elizabeth, Acting Chief Executive Officer, Jungarni-Jutiya Indigenous Corporation

KAESLER, Ms Cheryle Ann, Manager, Social Emotional Wellbeing Unit, Yura Yungi Medical Service

LONG, Ms Robyn, Chairperson, Jungarni-Jutiya Indigenous Corporation

Committee met at 15:50

CHAIR ( Senator Siewert ): I declare open this public hearing. Welcome, and thank you for coming. Can I double check before we start that you've all received information on parliamentary privilege and the protection of witnesses and evidence?

Ms Long : I haven't received it. I've just come here with Sharon.

CHAIR: We'll make sure we get you a copy before you leave. Do any of you have any comments to make on the capacity in which you appear?

Ms Long : I also work with the health department.

CHAIR: Could I invite whoever wants to to make a short statement, and then we'll ask you questions.

Ms Kaesler : I have put in a submission on basically the background of some of the issues affecting mental health. I feel as though it's intergenerational trauma and continual trauma of loss and grief within the area from past colonial intervention, the stolen generation and the impact on families as they relocate other family members. This is still having a major effect on quite a few families. There is overcrowding, as housing is not available, and rent is far too expensive and private rent is basically non-existent. There's often in excess of five families living in a one-bedroom or two-bedroom home. There have been housing homes here but they are often only two- or three-bedroom homes and there are a lot more people than that within the family so, therefore, I feel they are far too small. There's an extensive waiting list on the housing commission, up to four to eight years. What we find is that this builds frustration. I honestly think it has sometimes led to suicide, because people are frustrated, they can't get out of it and there are arguments and things like that within families. The other thing is that food and fuel expenses are extraordinary and yet they are only getting the same government assistance as city people. They do not get any extra to live on, so, therefore, there's a lot less money for them to survive on.

On the handling of government departments, one day we were out at Mulan and it took three days for a person to get on to Centrelink to try and get his dole sorted out. This is not uncommon; they held him on the phone. A lot of these admin places out there only start at nine o'clock, close at 12 o'clock, reopen at one o'clock and then close by four o'clock. They have to hang up in that time, so we start to ring Centrelink again. It can be up to four hours before they even talk. Centrelink down here have problems. They try to sort out their payments, but unfortunately Centrelink still puts them on the phone to handle their problems.

At Yura Yungi we are doing some, but I won't go into that detail. You can ask me questions there. I feel as though what is needed is finance for training of staff and community members. We need far more employment. We also need a 24/7 crisis centre here. It is not available. There must be fully trained staff who man it and get paid. They did try one before, but they expected volunteers and that to stay. There needs to be, as I say, a lot more training of current staff in communities in mental health. Of course, as I said, there should be free mental health training in the communities.

I feel as though there should be long-term funding, as has happened in Canada. It's intergenerational funding of programs, instead of a program being only funded for three years. You no sooner get a program than you don't know whether it's starting or not. Staff don't know whether they are going to be employed again or not. A lot of them are only on 12-month contracts, and I know that in mental health here they are often only three months. It does not build stability. To me, there should be at least 10- to 15-year program funding.

CHAIR: Thank you. Mrs Bambling, are you going next?

Mrs Bambling : Yes. Jungarni is a support service. We educate the community. We're an Indigenous corporation. We do financial capability and financial counselling. Again, as I said, it's on the education side of things to make clients able to stand on their own two feet. We also have a night patrol, in which we go around and pick up the ones that are requiring attention, and we do that five nights a week as well. We commence about three o'clock, and some nights we'll be working till one o'clock in the morning. That does not have to mean that people are alcohol or drug affected; it could be just children trying to get home, children on the streets or children in crisis. We are finding it very difficult at present, because we don't feel there is the support on the ground to be able to assist these clients in mental health. That is our biggest issue.

To the things that we're talking about here—in the case of Centrelink, government departments or anything like that—we might as well add banking, which is an everyday thing, because people have to have their payments into the bank. We have no access to those here at all. This then makes them very aggressive. I have had, I think, today—

Ms Kaesler : I didn't mention the public trust and the problems with that.

Mrs Bambling : Yes, the public trust, when we put them onto the public trustee. It doesn't assist very much.

Senator O'NEILL: Basically, you just said there's no bank in town.

Mrs Bambling : No. We do not have ATMs—we're not saying we don't have an ATM. We have the small ATMs. They can get their cash out and that's it; they can't do a lot of the other things.

Senator O'NEILL: So the transactions are limited.

Ms Kaesler : They've got to go to Kununurra to do any banking.

Mrs Bambling : So many in town don't have cars. Many times we'll be told that they need to go to the closest branch, which is 370 kays away.

Senator O'NEILL: What about the local post office?

Mrs Bambling : They can do limited transactions.

Senator O'NEILL: For all banks or just some?

Mrs Bambling : For most banks they can. There are a couple of things there, though. They run out of money, because obviously they have to get their money from somewhere in here, and they can only do very basic things. Also, because of the way they are, they quite often lose their cards, so they have no access to any of these facilities. They have no access to money. It is an issue. Today we had someone—actually two different people—they get very aggressive.

CHAIR: They were frustrated because—

Mrs Bambling : They're frustrated, but they also don't have an understanding.

CHAIR: Of the system?

Mrs Bambling : They don't have an understanding of why they can't get money when they want it—that sort of thing. A lot of times they haven't had their medication; they're hungry; all those things.

Senator O'NEILL: When you say their medication, what's that primarily for in the context you're talking about?

Mrs Bambling : It could be for epilepsy, mental health, any of those things. We have a high number in town.

Senator O'NEILL: Is it lots of bipolar or schizophrenia or psychosis?

Mrs Bambling : A lot of it is here. They were saying they've now run out of a lot of the medications. I don't know what's happening there. I haven't even found out from my own clinic yet. I've only heard that today. Some of them can't have their injections, because there's no medications in Halls Creek.

Senator O'NEILL: In town?

Mrs Bambling : Yes—their medications for schizophrenia, bipolar and things like that. I also think we need a better system set up so that they can come somewhere and get their medication daily, instead of a Webster pack given to them, and they often don't know which to use and which not to. I think it would be a much better system if we could—I know Yura Yungi has tried to put a bid in place, but I think there must be some more work done on that.

CHAIR: Do you run out of medication frequently, or is this an unusual situation?

Mrs Bambling : This is the first I've heard of it. I've been running out of this particular medication. Normally we get them, and we watch who's due and who's not for their monthly injection. I don't quite know what's happened this time.

CHAIR: Ms Long, did you want to add something?

Ms Long : I've been here about 50-odd years. It's probably not a normal situation but I guess when you have change over in staff and stuff like that and you have different people dealing with different clients and they're not really aware of what's going on, sometimes those sorts of things can happen, where they don't give the right handover. My take on mental health is that we have this you-beaut mental health hub through the health department, which is drugs and mental health. But it's a place where it's very unfriendly. They've got it locked up like Fort Knox. I don't think it serves a purpose. We've got some staff that are local staff, but what they do we don't know. You've got staff that come here every fortnight or every so often. When they took away our sobering up shelter and decided to put this drug and mental health hub in there, I thought it was going to make a major difference. We wanted to keep our sobering up shelter so we could do programs and things with the people. But we got this mental health hub. I don't know that there's too many programs and preventative stuff happening. I know they've got psychiatrists and everyone else there. Even with myself, I'm not mentally—but I had a bit of an issue where I had to go to the hospital to see the doctor about something. I wanted to see somebody, and the doctor referred me to the mental health team down at the health department. I waited and waited, but I never got a call from them. Three weeks later, one of the mental health team saw me in the car park at the hospital. I was going to work. They said, 'Robyn, by the way, I think we've got a referral to you—you still want it?' I said, 'Yes, I do, but I've gone to Perth now, so I'll catch up when I come back.' But I never got a call. If that's the mental health service we get in Halls Creek, then we're all buggered. It just defeats the purpose of what people are employed for.

Senator O'NEILL: So it's 'We've got the resources here—you come to us and we'll give it to you when it suits us,' rather than the other way round, that we're coming out to help you where you are.

Mrs Bambling : Yes. That's not the first time I've had a thing with the mental health bloke. I had it with my nephew once before, a few years ago. I wanted them to catch him before he went off. They told me, 'We can't go up to him—he's got to come here, or you've got to take into the hospital.' I said, 'Well, he won't come from me. If you come and catch him now, we'll hit it on the head.' They didn't. They waited four weeks until he went off his head. The system doesn't work for people here because there's no real prevention on the ground. They're all in these flash offices with the air conditioning and everything else, but they're not on the ground out there where people can see them just having a yarn with people. Mental health doesn't have to be that bad. If you just go and have a yarn with somebody, you could stop those people from being what they are in some cases.

Senator O'NEILL: So the timely intervention has to happen. One of the things that's rolling out across the Kimberley is that one of the suicide prevention trial sites is up here. Have you seen any impact from that in your local area? Is there anything flowing through? Can we get some of that on the record?

Ms Kaesler : They've just had one forum up here, but that's about it for now. It is still rolling out, and they've just put out to have all the coordinators. So it's still very much as the starting stage. They've only had one forum here, and now they're interviewing for coordinators to be here and work with the local people. And they want locals as coordinators.

Senator O'NEILL: When was the forum?

Ms Kaesler : The forum here was a month ago, I think.

Senator O'NEILL: May or June—something like that.

Ms Kaesler : I think it was May.

Senator O'NEILL: How much local input was there into that about the shape of this going forward?

Ms Kaesler : Probably about 20 people turned up for it.

Senator O'NEILL: Who were they? Are they people from this mental health hub or people from community?

Ms Kaesler : People were from here. The forum was run from CAMHS in Broome. There's a coordinator down there. Once they employ the local coordinator more forums will be held to get the input of local people.

Senator O'NEILL: So is your understanding that it is going to be one coordinator for this area, for Halls Creek?

Ms Kaesler : Yes, for 10 hours a week—one coordinator from here, and they're talking about splitting the Balgo one into a male and a female for cultural purposes, so it would be five hours for each for them.

Senator O'NEILL: Is it necessarily a 50D position? 50D was what we heard this morning—Aboriginal people only need apply.

Ms Kaesler : Yes. The coordinators are local Aboriginal people. The coordinator in Broome who is running the East Kimberley one is an Aboriginal person, too.

CHAIR: I just want to clarify—there's a position in Balgo; where else are their positions?

Ms Kaesler : Here in Halls Creek.

CHAIR: And that's 10 hours as well?

Ms Kaesler : Yes.

Senator O'NEILL: What is the coordinator going to be paid to do?

Ms Kaesler : They will be paid to organise the forums for the local community to come together and discuss how suicide can be prevented in this area.

Senator O'NEILL: So it's more talking and discussing, which is an important part of finding a solution. Where is the training and school development and service provision? Is that being discussed yet?

Ms Kaesler : Yes. Apparently there's $130,000 to be spent in Halls Creek area within this. If the community come up with saying they want training, of course they've got to see how much it's going to cost, but that can be one recommendation put to the main coordination area to say, 'This is what this community would like.' But of course, like I said, it's all very ground at the moment.

Senator O'NEILL: That's really helpful, to try and get a bit of the detail about that. What you think about it, Ms Long?

Ms Long : If they're going to just put one coordinator in, and you've got so many people out of at Balgo, and none of those other people are going to be employed or going to take part in actually trying to make a difference, you're pretty much wasting your time, because those people need to be given jobs as well, if they want jobs, I guess. They should be encouraged to be the ones who make the difference.

Senator O'NEILL: So you're saying there needs to be full-time people in these communities who have the job of looking after their community, and they need to be a decent wage.

Ms Long : They need to be on a decent wage.

Senator O'NEILL: With a permanent contract.

Ms Long : It needs to be a flow-on, so that other kids in the communities can know that eventually—

Senator O'NEILL: 'That's a job I want to get, and I could do that.'

Ms Long : At the moment, the way I said, there's nothing for our children much. There are a lot of outsiders who get employment here and they get all the incentives and everything to go with it, but they don't actually leave a lot behind. They take a lot of knowledge with them, and our people are not getting the training, even if it's only basic training. They talk about these crisis lines. While the crisis line is good sometimes, when you've got someone in your household going off, if you know there is someone in the community who might be able to settle that person, maybe they should be looking up those people.

Senator O'NEILL: And paying them to do the job, instead of expecting them to do it for free.

Ms Long : Even if they pay them a casual wage as a call-in or something, to pay them to be the mentor or the person that's going to come in, without having a real job. They may not want a real job, but if there are people here and there, that's another way to try and work it, as well.

Senator PRATT: Can I ask about access to services for children in Halls Creek and surrounding communities, in terms of working with families to identify issues that children might have and what kind of services they do or don't have access to?

Ms Kaesler : Most of our funding is for 16 and over.

Senator PRATT: I know. That's why I'm asking the question. Is there any service for children in the region at all?

Ms Kaesler : I think the Shire council, I'm not sure.

Senator PRATT: They have youth service?

Ms Long : That's 16 to 25 or something, as well. I think they only really have about 30 clients. They seem to be the same people all the time.

Senator PRATT: So if children were suffering from anxiety or depression or any other conditions, you'd have to hope that the schools were picking it up, because they're not necessarily going to—

Ms Long : From my understanding, they've got someone that comes in for maybe a week a month or something. I'm not sure. A child psychologist. The experience I had with them was that they never wanted to support any of our kids, just to talk to them about different things. It's really hard to get any real support out of the school.

Ms Kaesler : There's a child psychiatrist at school, but during school holidays there's no-one here.

Senator PRATT: Is the school psychiatrist here permanently?

Ms Kaesler : Yes.

Senator PRATT: So there is the school psychiatrist. That's good to know.

CHAIR: Plus somebody who comes in once a month?

Ms Kaesler : No, she's here full-time.

CHAIR: No, plus—

Ms Kaesler : Yes, plus—

CHAIR: So, one at school and one at the—

Ms Kaesler : Yes.

Senator PRATT: So the school psychiatrist doesn't see other community members, only children?

Senator O'NEILL: Is she a he?

Ms Kaesler : A she, but there is a male who comes—

Senator O'NEILL: Irregularly.

Ms Kaesler : Yes. He is the district one, as far as I can ascertain.

Senator O'NEILL: Is the school psychologist a counsellor or a psychologist?

Ms Kaesler : A psychologist.

Senator O'NEILL: So she is a trained professional psychologist, not just a counsellor?

Ms Kaesler : That's right.

Senator O'NEILL: Is she delivering therapeutic treatments to kids in school, or is she just being used to—

Ms Kaesler : As far as I know they are pretty good. We've had a bit to do with them when there's been a suicide. She has been doing quite well. They have good programs, as far as I know, at the school. But for after hours and out of school there are not many other services for—

Senator PRATT: I would like to ask about any parenting and children's services. Clearly, if the mother is under stress with a newborn child, that can lead to postnatal depression and, therefore, other demands on mental health services. Is there good integration between family and community support services and mental health services?

Ms Kaesler : We have a maternity and a childworker at the hospital. Yura Yungi did have one, but, unfortunately, at the moment, we haven't. We can see the mothers and their babies, but—

Senator PRATT: So you don't have one at the moment?

Ms Kaesler : No, we don't.

Senator PRATT: Is that an issue with funding, or—

Ms Kaesler : No, the person has left, and we haven't had—

Senator PRATT: You haven't had a chance to replace them?

Ms Kaesler : Yes.

CHAIR: Is that an issue of not having had the time? Is it recent?

Ms Kaesler : That's right. It's only just happened.

CHAIR: Do you have trouble attracting and retaining staff?

Ms Kaesler : Yes.

CHAIR: Sorry, I had to put that on the record. I know it makes me sound silly asking that, but I needed to get it on the record.

Ms Kaesler : That's fine.

Senator O'NEILL: What needs to happen to fix that problem?

Ms Long : They have the child health nurse up at community health. She does a pretty good job, and so does the midwife. But they also need support people to help them, because—

Senator PRATT: Yes, and they need cultural people in the support—

Ms Long : Even just assistants or Aboriginal healthworkers to go in and help them with their jobs. They've got two in community health, but they do chronic disease and everything else. You need a ratio of Aboriginal people to a ratio of staff.

Senator PRATT: It's understaffed.

Ms Kaesler : Our Aboriginal healthworker who has been working with child health is in training now. She's an Aboriginal healthworker, and she'll also be with children. She's being trained up at the moment.

Senator O'NEILL: She's a local girl.

Ms Kaesler : But we still need a midwife-cum-childworker.

CHAIR: That's in your service?

Ms Kaesler : That's in Yura Yungi.

Senator O'NEILL: What has to happen to attract and retain the type of staff you need? How much is the quality of schooling, the quality of life and the quality of health care in the local community preventing you attracting and retaining staff?

Ms Kaesler : I've never had a child at the school, so I really can't fully answer that.

Mrs Bambling : Looking at both sides, I believe that quality of schooling would be a major issue if you had children.

Ms Long : The quality of schooling here is way behind the eight ball. Kids coming out of school in high school still can't read and write. We've been talking about these types of things for a number of years, and very little seems to change. They bring in new principals, and they tell us: 'Yes, it's going to change. The kids are going to get educated.' But then they put in a program called RAS, a school attendance program, and they put all their money into concentrating on getting the kids who don't come to school to come to school. Those kids then misbehave, because some of them don’t want to be there. They are put in classes and classes are disrupted, so the kids who are there can't learn. It depends too on what the teacher is like and the Aboriginal worker—if they've got one. There was a stage where they were just putting all the, what they call, 'naughty' kids into those classes and putting one teacher with them. That teacher couldn't manage those kids, so most of those kids wouldn't really have learnt very much.

Senator O'NEILL: How frequent is staff turnover in your schools?

Mrs Bambling : I'm not involved with the school a lot, so I can't comment. I believe, though, that they come up and do their 12-month contract, but that's probably it. I also—

Ms Long : Some do 12 months; some do three years; some do five years.

Mrs Bambling : We also believe that a lot of them—a fair percentage—are straight out of college, because, obviously, they're the ones that do come. So that makes it difficult for them as well.

Ms Long : I think, too, they have to look at the whole dynamics of the classroom. It doesn't matter to me whether you're a graduate or not; if you've got other teachers or an AEW or someone who can really help you in the classroom, then you can become a better teacher, and that has been proven in the school. There's no real routine. The kids just move up from one grade to the other, so if there are naughty kids in this class and they haven't learnt for that year, they'll just move up to the next year, and they'll still be those same naughty and disruptive kids, so they'll do the same thing the next year. There's no real emphasis on getting those kids under control so that the rest of the class can learn.

Senator O'NEILL: And there's no alternative provided to help them learn in a different way or in a different context.

Ms Long : No. I think they said that they might bring in this Kimberley Schools Project. I guess that means that they're going to go down this road of explicit learning, but that depends on the principal of the day, so I was told, and then it depends on whether the teachers are all going to do the same thing.

Senator O'NEILL: I can tell you explicitly it doesn't work for every kid, that's for sure.

CHAIR: How much effort and attention is directed at prevention by all the services that you have interactions with? I don't mean that in terms of people not caring about prevention; it's how much of it is a capacity issue.

Ms Kaesler : Do you mean promotion?

CHAIR: Promotion, education, health promotion.

Ms Kaesler : We do have a male and female every Monday and Tuesday—Monday's male and Tuesday's female. We do have a lot of training—health promotions, mental health, domestic violence. Different ones come in. Last year we had an expo for all the services to come in and allow the community to know. This year we're again planning one towards the end of the year so that the local services can come forward and let the community know what is available for them, and we hope to continue with that and to get more health promotions out there.

Mrs Bambling : For myself, though, I don't think the support is there, and that's not saying that Yura Yungi doesn't do it. I think they are very thin on the ground, so they're only able to do so much. They also cover a very vast area.

CHAIR: I want to come to that, so keep going.

Mrs Bambling : There are many times when we need that support and there's no access at all.

Ms Long : The Health Department has got one that sits in Broome. They don't actually do anything much over here; they just talk to the staff and then it's up to the staff, who are quite busy, to go and do the little bit that they can do.

CHAIR: I ask both organisations: what is your coverage for the region?

Ms Kaesler : My coverage is the actual Shire of Halls Creek, which means Warmun, Ringer Soak, Balgo, Mulan, Billaluna and Halls Creek. I have only five staff here and two out at Balgo now. We get very, very tired and frustrated that we can't do a lot more, because we just do not have the finance. Now the PHaMs program is being dwindled down. We don't know how much continual funding there will be. Therefore we don't know how much more we will be able to help the people that can't go onto NDIS that will still need mental health, and also my staff have to go off for training, because I've got three going to university. So they go to Batchelor or CDU for training. That makes a big hole within my numbers to help and go out to communities. Plus they've got Halls Creek. They would be flat out just doing Halls Creek, let alone the other areas.

CHAIR: I understand what you've said about Balgo, but how often would your staff be able to get out to the other communities?

Ms Kaesler : We're only just going to Ringer Soak. I don't think they'd seen anyone for nearly five years out there. Mulan and Billiluna I think are very similar. I know Mental Health, and Drug and Alcohol, go out to that area. Yura Yungi haven't been there a lot, because we just haven't got the staff or the finance for the staff. When the staff go out there you have to pay them travelling allowance and all that. Fortunately out at Balgo we have just got accommodation and offices. We didn't even have an office out there until this year. We had a little one for six months in the admin area and it was noisy and there was no way you could talk to people, especially with mental health, in that admin building.

Senator PRATT: I wanted to ask you what the professional qualifications are of you and your staff and what diagnostic tools you use. Clearly you're trying to be the broad net that accesses the whole community, and you've got to refer to psychiatrists and clinical psychologists and others.

Ms Kaesler : That's right.

Senator PRATT: But clearly you're the front line of working out what people's issues are. How do you go about doing that?

Ms Kaesler : I've got a Bachelor of Social Welfare. I was also an RN, and I've done a lot in mental health. And I have a master's in public health. My staff are learning. I have one doing nursing, and she'll go into mental health. I hold regular sessions on motivational interviewing for them, how to see the client. They see the clients; I don't, basically, because I'm not culturally—

Senator PRATT: But do you use particular screening tools—

Ms Kaesler : Yes.

Senator PRATT: surveys that ask people about their mood and how long a particular mood has been with them—

Ms Kaesler : K10 is what we use, Kimberley No. 10.

Senator PRATT: So that's culturally specific screening?

Ms Kaesler : The cultural one—we have got a special one with the team that we've drawn up. The males will see the males and the females will see the females. They have learnt how to fill those forms out and also do the follow-up.

Senator PRATT: Have you rewritten those forms to make them culturally appropriate?

Ms Kaesler : Yes.

Senator PRATT: What kinds of changes have you made to the forms? Are you able to send us an example?

Ms Kaesler : Yes.

Senator PRATT: It would be interesting for the committee to see how cultural determinants should change the context of those profiling forms for mental health.

Ms Kaesler : Yes. We have also changed our evaluation form so that it's easier for the people to say whether or not they have been happy with it and things like that.

Senator O'NEILL: Once you've developed these tools and you've actually got people trained and ready to use them—all the things we were talking about: staff and retaining staff—you manage all that and you have got the system working. Then, when you get the diagnostic back from that, how do you apportion services?

Ms Kaesler : Most of the diagnostic is done by mental health. We only see them in the personal helper and mentor range. We don't diagnose people.

Senator O'NEILL: So you're just picking up the problem.

Ms Kaesler : That's right.

Senator O'NEILL: Then you move them along to the next part of the process, which is mental health. Is that that mental health hub that they have to go to that Robyn was talking about?

Ms Kaesler : Yes.

Senator O'NEILL: Where they're not very welcome.

Ms Kaesler : But we've also got to send it first to Kununurra, and they've got to be triaged in Kununurra. Then it will come back to the mental health here.

Senator O'NEILL: What sort of time lines are we talking about to go through that whole process?

Ms Kaesler : That can be quite a few weeks.

Senator O'NEILL: What happens to people in the interim following their interaction with you where you identify that there's a need, you make a recommendation, it goes to Kununurra and Kununurra talks to the mental health unit, who might ring you or not—or maybe they'll see you in the car park and say, 'Yes, we've got you'?

Ms Kaesler : Mostly, if they come to us, we see them all the time. My team will go and sit down and talk.

Senator O'NEILL: You maintain care in the interim?

Ms Kaesler : Yes, they'll go and talk to them. Other agents might ring up and say, 'We've got a little problem with somebody.' They will go down and talk to them and sit around. They won't just abandon them.

Mrs Bambling : But that is the major issue, though.

Ms Kaesler : Yes, it is.

Mrs Bambling : We'll have people present to us with some of these issues. My staff are not trained in that sort of thing.

Senator O'NEILL: When you say 'issues', are you referring to severe depression, bipolar, schizophrenia—

Mrs Bambling : Mental health in general. Yes, any of those.

CHAIR: So they'll present being unwell, basically.

Mrs Bambling : Yes.

CHAIR: Very unwell?

Mrs Bambling : Yes.

Senator O'NEILL: And aggressive?

Mrs Bambling : Aggressive. We've had windows smashed. This is the sort of thing that we're trying to handle. You're right there, because, when I do refer to the right areas that we're meant to, I have been told that it could take two to three weeks for that to be assessed. I have someone in front of me who is going completely—you know—

Senator O'NEILL: They're on a trajectory to a crisis situation, which is what you talked about, Robyn. You can see, and you made an attempt to prevent, but the access to services is really limited. Then, after that period, they actually get to the point where they get the service or treatment that they need. We've talked here about gaps in services. Even once you get to the starting gate, you have no continuity of care guaranteed, because you have changing staff.

Ms Kaesler : Yes. When my staff are out at Balgo, Billiluna or wherever in the area, if Jungarni rings me and says, 'Can you send one of the males down to help us with this,' I have to say, 'No, I can't.'

Senator O'NEILL: So you're so thin on the ground, even when you know what to do and even if you have the resources. They're just not there.

Ms Kaesler : Yes.

Senator O'NEILL: The other thing is that, if you have people who are presenting and they're aggressive, there's a chance that they're going to get up in violent behaviour, so domestic violence might flow from that. The police are going to get involved. Can we just finish off with a bit of a discussion about the connection between mental ill health, service failure and the next stages, which are juvenile detention and jail for people.

Ms Kaesler : That's right.

Senator O'NEILL: What's happening there? We're going to Derby tomorrow, because Senator Pat Dodson said we have to go and see the jail, because he said that's where a lot of the mental health challenges are ending up. So I'm interested in your perspective on the ground here and what's going on so we know what we're seeing when we get to Derby.

Ms Kaesler : There is nothing here for them. Probably four or five of them could go into a house and be cared for by someone else, and they wouldn't have to wander down the street and things like that and get picked up by the police. Then, of course, they get frustrated down there. They may get teased. They will then hit out at someone. The police come and pick them up, they get charged and then they go off to jail. That's basically what it is. These people have mental health problems, but there just isn't anybody there to come and help them, because of the lack of staff and the lack of services.

CHAIR: So, Mrs Bambling, from being in a situation where they're in crisis when they enter your services, they can get aggressive. You can't get support for them. There is interaction with police.

Mrs Bambling : Yes.

CHAIR: And they end up in the system.

Mrs Bambling : That's correct. On average, we'll have to call the police at least three times a week.

Senator O'NEILL: So is it quicker to get yourself into jail than to get yourself into health care?

Mrs Bambling : Definitely.

Senator O'NEILL: That's a very big problem, then, isn't it?

Mrs Bambling : Definitely. And, once they have been to jail, they come out more level because they've had their medication in that time, but then they will be—

Ms Long : Some will come out worse.

Mrs Bambling : Yes, some will come out worse.

Senator O'NEILL: Why is that, Ms Long? Why will they come out worse—not all but some of them?

Ms Long : Because of whatever happened to them in jail—the way they were treated, I guess. Also, they then come home, but there's no real support at home.

CHAIR: Yes, so the cycle starts again.

Ms Long : There's no support from their family, in some cases. Some of them just spend their time on the street during the day, and then they get teased by the kids, the police are called, and that behaviour starts again because they're trying to defend themselves.

Mrs Bambling : Also, when they get released from Derby, they have to find their own way back.

Ms Long : There is nothing for anyone who comes out.

Mrs Bambling : So that's just a—

Senator PRATT: It's a formula for needing to commit a crime to get somewhere they can stay.

Senator O'NEILL: To get some help.

Ms Kaesler : When I was in Alice Springs, there was a prison release scheme; there seems to be none here.

Senator O'NEILL: What about juvenile detention? How does that work around here?

Ms Long : There's nothing for them when they come home.

Senator O'NEILL: How do they get picked up? What's the process?

Ms Long : Picked up from where?

Mrs Bambling : From wherever?

Senator O'NEILL: Yes.

Mrs Bambling : I would say that their family would need to provide them with funds to catch a bus or something to be able to come back—or they are released to a person who really is not interested in them, and so they again go back to the same thing.

CHAIR: I've run us over time.

Mrs Bambling : Sorry.

CHAIR: No, don't you apologise. Your evidence is so useful to us that I deliberately let us go over time, which is a bit naughty. Thank you very much for your time today. You've already made a submission. If you think of anything else, please don't hesitate to let us know. The same goes for you, Mrs Bambling and Ms Long: if you have any further thoughts, please feel free to send us more information. We're very, very keen to find out as much as we can. Thank you very much.