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Wednesday, 17 October 1973
Page: 2257

Dr EVERINGHAM (Capricornia) (Minister for Health) - I move:

That the Bill be now read a second time.

The Bill will expand the involvement of the Australian Government in mental health and related health fields. It replaces the States Grants (Mental Health Institutions) Act under which grants were made towards the capital cost of mental health institutions. That Act expired on 30 June 1973. The Bill adopts a different approach, while taking on a much wider view of mental health, than that of the earlier Act. It outlines forward looking and visible action, starting with some of the most neglected health areas and most care deprived groups in the Australian community. The Government proposes grants for the capital costs of approved additional community facilities for alcohol and drug dependent persons and the mentally disturbed or disabled. These will not be inside mental hospitals. They will include both non-residential and hostel facilities for prevention, outpatient treatment, training and rehabilitation. Besides funding capital projects we will make grants to meet maintenance costs of approved non-residential services for alcohol, drug and mental problems, including prevention, teaching, research and the evaluation of treatment programs.

Under the Bill the Minister for Health will approve schemes and projects submitted by the States, local governing bodies and voluntary organisations. State schemes may include projects of voluntary organisations within the State. Research shows that community health care is often more effective than institutional care. Persons suffering from psychiatric and similar problems return to coping normally much more quickly when treated in their usual community environment, with their families and friends around them. Preventive, early treatment, education and aftercare services will be a feature of the projects to be undertaken. We shall be shifting the emphasis away from so called 'tow-away medicine'.

We must abandon the institutionalised and quite often inflexible approach to health care. This approach, which unfortunately has almost grown to acceptance through habit rather than reason, involves ad hoc responses to urgent requests for health care along with the hope that things will work out. This has not been, nor will it ever be, a satisfactory approach to Australia's health needs. Government, and Government agencies, can no longer sit pat waiting for the next urgent call for help. Through planning and research we must anticipate these calls. It is now a well recognised policy in the United Kingdom, the United States of America and Canada that the large and often impersonal mental hospitals and other similar institutions need to be substantially phased out and replaced by the types of services to be funded by this Bill with additional beds integrated into general hospitals.

As the community health program gets further under way and as the Australian Hospitals and Health Services Commission completes its recommendations on hospitals and all other forms of institutional care we can expect to see similar developments accelerated in Australia. Consequently the Government intends that care in the community should henceforth be placed, in effect, at 'shop-front' clinics and, indeed, 'at the door-step' of families which might otherwise delay going to an institution for help. Early diagnosis and treatment, social support and follow-up will be closer to the approach of the old village doctor, parish priest or other traditional family friends. Decentralised services in local communities will be staffed by specialised, but not starch-fronted, personnel such as mental health visitors, psychologists, social workers and psychiatrists, all of whom will work closely with general medical practitioners and other community health people.

Alongside community health programs will be an expansion of hostel and 'half-way house' accommodation for persons with chronic mental problems or social handicaps, who need residential care but not the more costly care of mental and general hospitals and nursing homes. The addition of community based services for alcoholism and drug dependency along with our new emphasis on other aspects of community mental health is a vital forward step in combating those serious community problems in a systematic way. Available manpower and other resources can thus be spread more widely and be more available at local level. In the next few years, further increasing local integration with community health, education and welfare services will remove more of the old stigma attaching to those need-, ing help which is not just physical.

The Bill provides for allocations of up to $7.5m for each of the years 1973-74 and 1974-75 after which such services will continue to be supported under, and will be integrated with, the broader Australian community health program. Payments up to the level of approved allocations will be made as expenditure is incurred. However, the Bill also provides for advances to be made, and this provision will be widely used to cut through the timidity and red tape that so often strangles promising plans.

The Bill authorises the Minister to make grants to voluntary organisations which have a role of co-ordinating the services, in more than one State, of their own organisation or other organisations. Claims in respect of expenditure incurred during 1973-74 or 1974-75 under approved schemes may be submitted up to 30 June 1976. Approvals may be subject to conditions and allocations may be varied during development of approved schemes. These provisions will give valuable flexibility to the recipients and enable adjustments to be made in the light of the rate of progress of individual projects. The Bill will bring, in a more effective and 'flexible way than the former assistance in the field of mental health, bridges to the developing broad community health field being expanded by the Government on the advice of the Interim Committee of the Australian Hospitals and Health Services Commission, whose first report on this subject I was privileged to table on 30 May last. I commend the Bill to the House.

Debate (on motion by Mr Lynch) adjourned.

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