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Community Affairs Legislation Committee
24/10/2018
Estimates
HEALTH PORTFOLIO
National Mental Health Commission

National Mental Health Commission

[16:18]

Senator GRIFF: Thank you. My next question relates to the National Mental Health Commission.

Ms Edwards : Is it to the National Mental Health Commission?

Senator GRIFF: Yes.

Ms Edwards : That's the question, Chair. Are we to call the National Mental Health Commission now?

Senator WATT: We have some questions for the National Mental Health Commission which we were going to do a little bit later, but are you on a bit of a time frame?

Senator GRIFF: I'm happy to put it wherever you would like to put it if you think it's more appropriate to put it into another number.

Senator WATT: We probably have a couple of other things that we want to get through first if that's okay. They are still in mental health, though.

Senator GRIFF: Okay.

Ms Edwards : It's all the same item. It's just whether we get those officers, who have now arrived.

Senator GRIFF: In your national report, published a couple of weeks ago, you express concerns about:

… the lack of information on the Provider of Last Resort arrangements (PLR) and would encourage the NDIA to release its PLR policy as a matter of urgency.

Has there been any response from the NDIA to your encouragement?

Ms Lewis : We work very closely with the NDIA. We have established new working relationships with them and with their mental health adviser. They have taken that on notice, in terms of trying to provide a response to us, but we don't have a date as yet.

Senator GRIFF: Do you have figures on the number of people who need provider of last resort assistance and are not receiving it?

Ms Lewis : No, we wouldn't have those figures.

Senator GRIFF: Your report indicates that, despite a tripling of funds spent on annual health services over the past 20 years, to about $9 billion annually, the prevalence of mental illness has 'barely changed'. You state:

A natural inference from this is that the expenditure is either insufficient or ineffective, or possibly both. Nine billion dollars is a lot to spend on services which don't appear to be having much effect. What work have you done to determine how this money could be better spent?

Ms Lewis : In that report, we talked about looking into expenditure further across all sectors of mental health. Obviously, the commission recommended the PC inquiry into mental health services for this very reason.

Senator GRIFF: Okay, so what are your priorities for the next 12 months in this regard?

Ms Lewis : Our priorities are obviously to work closely with the PC inquiry, when the terms of reference are finalised, and to look at the key areas we have issues with—not issues, but concerns in terms of expenditure. More importantly, mental health shouldn't just sit in the Health portfolio. It's an issue across portfolios in terms of housing, social services, justice and forensic child protection, and we're really keen to make sure mental health becomes something on everyone's agenda.

Senator GRIFF: Which would make sense if there were a minister responsible for mental health—just a statement.

Ms Edwards : We do have a minister responsible for mental health. Mr Hunt is responsible for mental health.

Senator GRIFF: A separate, dedicated minister would be my view.

Senator WATT: While we have the National Mental Health Commission up at the table—and thanks for coming today—I'd like to ask a few questions about your suicide prevention target and your recommendations to that effect. My understanding is that in your 2014 review it was recommended that the government at the time adopt the target of reducing suicides and suicide attempts by 50 per cent over the next decade. How did the commission come to recommend that government adopt a suicide prevention target?

Ms Lewis : I would have to take that on notice, because it was pre my time at the commission. I've only been there since 2016. However, there has been discussion with commissioners and with mental health more broadly that currently our view is we don't agree with a 50 per cent reduction target, because we don't believe that it's okay for any person to die of suicide, and it's something we'd like to discuss further.

Senator WATT: So it's no longer your position that there should be a suicide reduction target?

Ms Lewis : There should be a suicide reduction target, but we've had discussions and thoughts that it should be zero. That may seem unrealistic; however, it's not okay or acceptable for anybody to die of suicide.

Senator WATT: Sure. You'd be aware, though, of the range of organisations and evidence that support the setting of a target as an effective mechanism to reduce suicide. Can you give us a couple of examples of that.

Ms Lewis : I guess our perspective is that there are lots of different views. We've heard about the zero target, and certainly people have mentioned that. On the whole, in states and territories, some people have 50 per cent targets and some have 30 per cent targets. Our view is that it's something we need to bring people together to urgently talk about, to get an agreed target on suicide prevention.

Senator WATT: My understanding, for instance, is that, in addition to your organisation's review in 2014—and, by the way, is there anyone from the organisation who was involved in that review here?

Ms Lewis : I don't think there's anyone at the commission who was involved in that review.

Senator WATT: Right. So, it's a completely new staffing complement?

Ms Lewis : Yes.

Senator WATT: But you'd be aware that in 2013 the World Health Assembly adopted a global target to reduce suicide and that the Chairman of Lifeline, Mr Brogden, said there should be a 25 per cent reduction target. So, there are a range of organisations that have supported the setting of a target. I absolutely acknowledge that we don't want anyone to die of suicide, or attempt suicide, but do you believe that setting a zero target is realistic and achievable?

Ms Lewis : It might be more so towards zero, but I do think we need to look at it closely. It's something we are pushing to meet urgently with the sector, in terms of suicide prevention, to actually get some agreement and consensus on that and then work towards it. As you say, there are lots of people with different numbers of targets—we would like that resolved.

Senator WATT: Is it still the commission's view that a target—whatever number that might be—should be set and is a valuable tool in reducing suicide?

Ms Lewis : I think there needs to be a reduction. Whether that's a target or not, that is something that should be considered once we've got all the information from the sector as a whole.

Senator WATT: A 2014 review isn't from that long ago, so why has there been such a significant shift in the commission's thinking?

Ms Lewis : I think part of that was some of our commissioners, who were on the board at the time. Ms Jackie Crowe was one of our commissioners who passed away. Her view was very strong, to the CEO and to the other commissioners, that it's not okay to have a 50 per cent target and that the commission had to come out with a statement and change their view from 2014.

Senator WATT: Has the minister or his office ever spoken to you about their views regarding the setting of a target?

Ms Lewis : Not to me. Personally, no.

Senator WATT: And you're not aware of any contact having been made with your officers?

Ms Lewis : No.

Senator WATT: That 2014 review made a number of other recommendations. Have they all fallen by the wayside now as well?

Ms Lewis : No. Actually, in our annual report this year there is a section that talks about, since the 2014 review, which actions are progressing, and it's the majority of them.

Senator WATT: Really the notion of a target is one of the few recommendations that is no longer supported by the commission?

Ms Lewis : Correct.

Senator WATT: Or at least a 50 per cent target?

Ms Lewis : Yes, the 50 per cent. Correct.

Senator WATT: I might leave those questions, but I think Senator Singh has got some more for you.

ACTING CHAIR ( Senator Dean Smith ): Are they still on the issue of targets?

Senator WATT: No.

Senator SINGH: They're still on the commission.

ACTING CHAIR: I've got some questions with regard to targets. What was the position of the COAG's report, The Fifth National Mental Health and Suicide Prevention Plan, when it came to the issue of targets?

Ms Lewis : I don't think, in that particular report, we talked about targets. There's an indicator that measures suicides in the fifth national mental health report, but it doesn't go into the question of should there or shouldn't there be a target.

ACTING CHAIR: Why would that be? Why wouldn't the issue of targets have been canvassed?

Ms Lewis : It's because in the particular actions of the fifth plan the job is to monitor what the rates are. This year we have a baseline report, because it's the first progress report. From there on in, we will start to see if there's some sort of trend, and then we will provide commentary on that.

ACTING CHAIR: Just at a general level, what is the evidence that supports the use of targets?

Ms Lewis : A lot of people talk about the WHO and obviously take leadership from WHO, in terms of the fact that they have a target. I think it's up for debate at the moment. It's kind of an opinion view. That's why we want to bring the key people together—the key leaders and the experts—to see what that should be or if there should be a target.

ACTING CHAIR: So the effectiveness of targets in reducing suicide is contested. Is that what you're saying?

Ms Lewis : That's the commission's view.

ACTING CHAIR: When people talk about having a target of 40 per cent or 50 per cent or 60 per cent, is there an evidence base that supports the idea that it should be at 40 or at 50 or at 60?

Ms Lewis : There may be an evidence base, but the commission are contesting that at the moment.

ACTING CHAIR: Thank you.

Senator SIEWERT: On whether we have targets or not, before we change topics, is the commission planning to look at what would be a substitute in terms of areas and what you could use as a target to make sure we've got progression in reducing the rate?

Ms Lewis : Sure. That's the purpose of bringing the key leaders in this space together shortly to discuss that. If it's not a target, what is it? The aim for all of us is to reduce suicides.

Senator SIEWERT: Are you investigating or doing some research around what the things are that we could use to take to the table in that discussion?

Ms Lewis : The purpose when we have the discussion is bringing all parties to the table to have that discussion. We'll all be bringing information together. The commission hasn't done a lot in that space previously, with our limited resources at the time. However, it is a space we're moving into in our monitoring and reporting role. So all parties who come to that discussion will absolutely be bringing those things to the table.

Senator SIEWERT: When is that planned for?

Ms Lewis : We're hoping to bring people together in early December.

Senator SIEWERT: So it is relatively soon?

Ms Lewis : Very soon.

Senator SIEWERT: Thank you.

Senator SINGH: We have some more questions for the commission. Ms Lewis, obviously you're aware of the ongoing suffering and trauma of children on Nauru. Given the NMHC is the government advisory body on mental health, and the mental health of those children has been fairly well reported and evidence has been provided, has the government approached the commission for any advice on the mental health of those children and/or their families on Nauru in detention, and/or have you provided and offered such advice?

Ms Lewis : It's an area that the commission has not looked into in the past. Now that we've been strengthened in the last budget, we now have almost doubled our staff. So it is something that's on the commission's agenda, and in fact we've been talking with commissioners about this very matter. We have meetings in November with them, and it's something that we are going to look at and address. We haven't been approached by anyone for a view on that.

Senator SINGH: You haven't been approached by anyone from government.

Ms Lewis : No, not yet.

Senator SINGH: Are you saying it's been a budget issue, staffing wise?

Ms Lewis : Yes, staffing wise. We had four policy staff previously. We now have 12. We now have the new role with the fifth plan in terms of monitoring and reporting. Prior to our strengthening, we had a very limited capacity. However, that's not the case now—hence why we will be looking into this issue.

Senator SINGH: At your November meeting?

Ms Lewis : Yes.

Senator SINGH: Great. Do you think it's odd that the commission has not been approached at all considering this has been going on for a length of time? You haven't been approached for any advice on this issue?

Ms Lewis : I'm not sure that it's odd, because I think people were aware of the size of the commission. If all we are to do with four staff is to monitor and report, that would take up all of our resources. So I don't think it's odd if you look back on things. To be honest, right now, because we haven't had a chance to discuss it with our commissioners and have a commission view—because it's important the commission's view is in with the view of the staff at the commission—we probably wouldn't be able to offer any advice—hence why it's on the agenda for November. We realise we do need to get into the space.

Senator SINGH: Thank you.