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Monday, 7 November 2011
Page: 8436

Senator BOYCE (Queensland) (22:05): I have pointed out before that there were only three submissions to the recent Senate Standing Committee on Community Affairs inquiry into mental health that dealt with the issue of people with intellectual disability and mental health issues. I would like to emphasise that this is not because of lack of interest from the mental health and intellectual disability sector but because it is such a very small sector in Australia and how it desperately needs to grow, given the size of the problems experienced by people with intellectual disability with mental health issues.

The three submitters made the point that the 2011 Commonwealth budget for mental health lacked emphasis on the high burden of mental ill health experienced by people with intellectual disability, and they also pointed out that the same budget lacked specific strategies to target the difficulties experien­ced by people with an intellectual disability in accessing mental health support. I would like to focus on some of the changes that have been proposed by this government to the mental health services available and point out the problems that arise, firstly in terms of the rationalisation of GP mental health services and the impact of a two-tiered rebate structure for clinical assessment and preparation of a care plan by GPs. It is already well documented that people with an intellectual disability require much longer sessions with their GP in all aspects of health, partly because of communication problems, partly because they often have atypical symptoms related to their illness and partly because of the lack of knowledge by GPs of the problems experienced, in many cases, by people with intellectual disability.

The submitters to our inquiry made the point that they were very concerned about the introduction of a two-tiered Medicare rebate system for psychologists because they think it will have a very significant impact on the accessibility of services for people with intellectual disability who currently receive their mental health care treatment, such as it is, by referrals to clinical and non-clinical psychologists via GPs. There are very few psychologists currently practicing in the specific area of intellectual disability mental health and if we change the rebate structures there is a very strong concern that that tiered system of access will further reduce the incentives for specialist psycho­logists to work in this very specialised area. In fact, it will get to the situation where it will probably be impossible for specialist psychologists to make a living treating that group of clientele because they will not be able to be compensated for the amount of time that each appointment, if it is dealt with properly, will take.

The submitters to this inquiry have asked that the government look at those changes to the Better Access initiative to make very sure we know what the impact of the changes on people with intellectual disability and mental health needs will be. It is a serious concern.

The concerns continue. One of the other terms of reference for this inquiry was mental health workforce issues. The point has been made by submitters that Australia already has a really significant skill shortage in intellectual disability health. Research shows that GPs, psychiatrists and trainees lack confidence and training in relation to people with intellectual disability and mental disorders. There has been research over many years showing that people with intellectual disability and mental disorders receive a very poor standard of care and that the community mental health support for those people is inadequate.

I notice that one of the submissions here has about seven references to the point of the poor standard of care and the inadequate community mental health reports. The oldest of the studies that they quote from is 1995 and the most recent is 2008. There are only isolated pockets of expertise in intellectual disability in mental health. Yet, as has been pointed out by numerous organisations in the sector, there are over 400,000 people in Australia with intellectual disability, and the point prevalence of mental health problems amongst that population has been shown by research to be about 40 per cent. This is not an area where we need tiny little handfuls of expertise, yet within the public mental health service across Australia there are no full-time staff specialist positions—not one!—devoted to this need, and only a handful of nursing positions.

There is one recently established academic Chair of Intellectual Disability Mental Health at the University of New South Wales, which is trying to offer some advanced traineeships. But if you cannot see how you can make a living in the field and if you cannot see that there is any likelihood of coming up with a specialist position that is offered by a state or federal government body, why would you undertake such a traineeship?

By contrast, in the UK there is a very well-developed specialty in intellectual disability mental health and this has led to a large development and much improved situation for people with intellectual disability and mental disorders. We have to build capacity and improve training. At this very time the need is being pointed out to the federal government. We have the clear message that it is expensive, both in terms of the human cost of not treating mental disorders amongst people with intellectual disability and in terms of the sheer funding needed because of the need for readmissions and constant treatment that is brought about by treatments being wrong and not being carefully undertaken by people who know what they are doing in the first place.

A number of the submissions set out not only the human cost for individuals of wrong diagnoses or lack of expertise but also the financial cost to the system of people who are misdiagnosed and medicated wrongly, and how often these people can go through mental hospitals before we finally get a solution. Yet, at the very same time, we have heard of an example from Queensland which quite disgusts me. Since 2008 the Queensland Centre for Intellectual and Developmental Disability, which is based at the Mater Hospital, has received $120,000 per year. We are not used to figures under the millions or billions in this place but this is a miserable sum of $120,000 from Queensland Health every year to deliver vocational training in the field of intellectual disability and health.

The Queensland Centre for Intellectual and Developmental Disability have used that $120,000 to increase their undergraduate teaching program, to develop a new entry to teaching program in the UQ Bachelor of Oral Health, to develop a new entry to teaching program in the UQ Bachelor of Human Movements and to actively include people with intellectual disability as co-presenters to undergraduates in the field of intellectual disability. They have helped to develop the Royal Australian College of GPs's curriculum on disability, a hugely undermet need. They have redeveloped the Managing Menstruation Kit for free download for people with intellectual disability. Given, as I was saying earlier, that poor menstrual management is one of the reasons that people try to force sterilisation on women with intellectual disabilities, I think it is particularly bad that the funding is being ceased. They have also been involved with the Brisbane South Division of General Practice in e-health initiatives for people with intellectual disability.

The Queensland government want to stop this funding. They have said they will cease this funding. We must do better in the field of intellectual disability. (Time expired)