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Roxon defends mental health record -

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Roxon defends mental health record

Broadcast: 22/06/2010

Reporter: Kerry O'Brien

Health Minister Nicola Roxon defends the Government's mental health record following the
resignation of the chair of the Federal Government's National Advisory Council on Mental Health,
John Mendoza.


KERRY O'BRIEN, PRESENTER: On the program last night we featured an interview with the Rudd
Government's most senior independent mental health adviser, John Mendoza, who has resigned in
frustration over what he says is the Government's lack of vision and commitment to the mentally
ill. Professor Mendoza says the advice to the Government from his advisory council and the Health
and Hospitals Reform Commission on mental health has been ignored. In his resignation letter to the
Health Minister Nicola Roxon he said the most vulnerable of all Australians had suffered shameful
neglect and been ignored by the Government in its health funding.

To respond, the minister joins me now from Canberra.

Nicola Roxon, Professor Mendoza commands respect from within the mental health field. You obviously
respected him because you appointed him to your advisory council. His criticism of your commitment
to mental health is trenchant and I'm told that those sentiments are reflected also by the vast
bulk of other members of your advisory council. It's clear this is no fit of pique and I don't
think you'd question either his sincerity or his credentials, would you?

NICOLA ROXON, HEALTH MINISTER: No, look, of course we regard him as an important figure in mental
health. Quite rightly you say we appointed him. We set up this advisory body. The previous
government didn't have one. Of course I don't agree with all of the comments that Professor Mendoza
has made, but I do agree with a large number of them, which is there is a lot more to still be done
in mental health. I don't think we should speculate on what every other member of the advisory
council's views are. John is a very independent character, as he's absolutely entitled to be, and
that doesn't necessarily reflect everybody's views.

But I think the important issue here is I take seriously the criticisms. I don't think anyone can
pretend that we have a system in mental health in Australia that is working at 100 per cent. It
hasn't for many decades. But we believe some of the steps we're taking are good ones. They may not
be quick enough for Professor Mendoza or for others. But it isn't possible when you're undertaking
significant reform to do everything at once. And I certainly don't blame people for saying, "We
would like this area to have more." But I - I guess from a government's point of view, think that
it's fair to be able to describe the range of changes we are undertaking, what opportunities that
provides for the future, what early investments we've made, and to have an agenda for the future.
Now, ultimately, obviously Mr Mendoza doesn't share that view and that's a matter for him. But I
think, you know, that's a robust argument we can have in a country like Australia and we shouldn't
be frightened of it.

KERRY O'BRIEN: If it was just John Mendoza you might shrug it off, but here's what Australian of
the Year and eminent psychiatrist Patrick McGorry has to say about the Rudd Government's commitment
to mental health: "The system is absolutely on its knees. We have a famine-like situation and the
mental health system is getting the scraps from the table." Do you disagree with him too?

NICOLA ROXON: Well, I don't think that it is fair to say and set up that we're disagreeing with all
of these people. We share the view that both Professor McGorry and Professor Mendoza have put that
more needs to be done. We are making more investments.

KERRY O'BRIEN: No, no; they're not just saying more needs to be done, minister. They're not just
saying more needs to be done.


KERRY O'BRIEN: One says that you are ignoring, effectively, mental health as a serious health
priority. The other says that mental health is getting the scraps from the table. That's not just
saying more needs to be done.

NICOLA ROXON: Well, I think if you want to unpack those issues, we think that we are doing a lot to
improve the system. I accept that not everyone thinks it's enough. I think if you ask Patrick
McGorry whether he's pleased about the extra investments in his creation, Headspace, he would say
yes. You know, another 20,000 young people will get services because of investments we're making.


NICOLA ROXON: Now that might not be enough - well, the money starts flowing for that from 1st July
- 30 new sites ...

KERRY O'BRIEN: Hang on, the money for the new site starts flowing from 1st July; not the money for
the existing sites?

NICOLA ROXON: No, the money for the existing sites was a previous Budget decision; the previous
government didn't provide ongoing funding for the 30 Headspace services. That's already been
committed, that extra money, that's already flowing, but there are another 30 sites to be

Now, it's just a small example, and I think that Professor McGorry and John Mendoza are expressing
a view which is a legitimate one, that we have a serious problem in mental health. It's one we've
had for many, many decades. We're trying to restructure the health system to improve a whole lot of
the things that they have identified as problems. It's lack of connection, mental health patients
falling between GP services and psychologists service and hospital services. We have to fix the
foundations to be able to do some of that properly, and unfortunately that means we're not doing it
quickly enough for some people.

KERRY O'BRIEN: OK. Well, he says on - this isn't just some people; these are key people in mental
health. He says that the Headspace funding that you have allocated is barely enough to keep the
original 30 youth-friendly mental health centres established under John Howard going, let alone
fund another 30. He says that the new funding for mental health represents about two per cent of
your total health spend of - new health spend of $7.3 billion. Dr Leslie Russell, the policy
advisor to Julia Gillard when she was Shadow Health Minister, has estimated - and she's got 20
years experience in health policy. She calculates that the Rudd Government has cut $354 million
from mental health programs in its first three budgets so far. Is she wrong too?

NICOLA ROXON: Well I haven't seen her calculations of those figures. We have across all of our
areas in the health portfolio made changes where there were underspends in certain areas because I
think that the mental health sector agrees that some of these programs were not having a good take
up, mostly because of a workforce shortage, again another legacy from the previous government which
we're trynna turn around. But we can't create doctors and nurses and psychologists and
psychiatrists overnight. Those sorts of investments, unfortunately, take a long time to come
online. And we are going right back to the source to make sure that we've got enough of the
workforce to do this work, to make sure the structures are right so people don't fall between the
gaps of the system. And I do not pretend for a minute and take very seriously these criticisms that
there - that everything is fixed. I've never tried to pretend that. But, when you are undertaking

KERRY O'BRIEN: But, sorry, again, minister, with - again, with respect ...

NICOLA ROXON: Well, Kerry, just let me finish, though. What I'm saying is: when you are undertaking
very significant reform, you have to do it step at a time, carefully and sensibly, so you can build
on the foundational changes, and that's what we're doing.

KERRY O'BRIEN: But with respect, minister, you are understating the strengths of the concerns being
expressed by people like John Mendoza, David Crosby, Ian Hickie and many others. Did your office
ask Professor Mendoza and two other advisory council members - Professor Ian Hickie and David
Crosby - in November last year asked them to work up a proposal for you on spending for mental
health, that after months of work they gave you a detailed set of policy proposals for $250 million
a year over four years, a total of $1 billion, which they regarded as a modest start on what was
critically needed and which you reduced to $115 million over four years.

NICOLA ROXON: We've had lots of proposals, both from those people that you've mentioned and from
others. We get a lot of advice from the advisory council and individually from members on it
because most of them represent particular stakeholder groups. We have taken a lot of that advice.
We haven't acted on all of that advice yet, and I think that that is what is causing some

But I think your listeners would be surprised to learn from the coverage over the last few days
that one of the reforms that was urged upon us early in our term in government was to get one level
of government responsible for mental health, a proposal was put forward that that should be the
states which our advisory council vehemently opposed. We asked them to conduct some urgent
consultations on it. They advised us against it. We took that advice. They then asked us, quite
rightly, to see whether the Federal Government could take more control. We got that agreement in
part at the COAG agreement this year in April, with the Commonwealth taking on more control for
community mental health. We cannot afford, in a system which is already significantly under stress
in mental health, to completely throw all the pieces up in the air. We have to keep providing the
services that are there and try to reform things at the same time.

So, I just don't think it's fair to pick out some of the examples when we've taken their advice on
many issues. It is an advisory council; it's not a decision-making body and it is the Government's
chance to take that advice or not. Many of the ideas are still being worked on and considered by
the Government. We think there's a lot of work to be done and their work is valuable. But,
ultimately, Mr Mendoza needs to make a choice whether he wanted to be in the tent to work for that
change or whether he wanted to advocate outside the advisory council role and he's made that

KERRY O'BRIEN: Well he obviously decided there was no point staying inside the tent because he
felt, as I'm told others in that council also feel, that you simply either have not listened to
their advice or you have not been capable of acting on it within the budget process.

NICOLA ROXON: Well, I think that listening to their advice and being able to act on it are
different things. We have listened very carefully and taken very seriously their advice, and I take
very seriously this criticism. I mean, no Health minister could pretend that mental health services
are operating perfectly across this country.

KERRY O'BRIEN: In crisis, minister; they're in crisis.

NICOLA ROXON: Well, we have a lot of our health system that is under severe pressure. I don't think

KERRY O'BRIEN: But isn't it also true that these people are the least able to represent themselves?
These are people whose voice has so often in the past been the least heard, that their votes don't
necessarily count with government?

NICOLA ROXON: Well, I can absolutely assure you and your listeners that no decisions have been made
based on whether people vote or not for these issues. We've got a serious reform agenda underway.
We are doing a lot of things that all of the political advisors would tell ya not to do because
it's too hard. If we were just in it for the votes, then we wouldn't have undertaken the
comprehensive, detailed and very difficult health reform that we're in the middle of. So, I don't
think that is a fair accusation to make.


NICOLA ROXON: And we look forward to being able to work further on these issues as we rollout the
rest of our health reforms.

KERRY O'BRIEN: Nicola Roxon, thanks very much for coming on.


KERRY O'BRIEN: Thankyou.