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Estimates: mental health and the NDIS

Estimates & Committees
Janet Rice 21 Oct 2015

Senator RICE: I want to start with the government's response to the National Mental Health Commission's report released in April. In October the minister stated that the government would respond to the review by the end of the year. Why is the government taking so long to respond to it?

Mr Cormack: The government established an expert reference group shortly after the report was released in April. The expert reference group was established to provide specific advice to the government to inform its response and how it would progress implementation of that response. It is a very eminent senior group of people who are active in the mental health space. They gave very generously of their time, but there was certainly a lot of material to work through. The first part of their work, which is to provide some advice to government, was completed last month and the government's response is now in the process of formal government consideration.

Senator RICE: Do we have an accurate time line of when we to expect a response?

Mr Cormack: The best thing I can say is that the minister is on the public record as saying that she will be making some significant statements in this space before the end of the year.

Senator RICE: In her recent statements, the minister has indicated that there will be significant structural reforms. Can you say over what time frame those reforms will take place? Will they be immediate or will they be over a 10-year period, as per the commission's suggestion?

Mr Cormack: It is premature to speculate on the timing of those. The response is, as I said, in the process of being considered by government. The timings for any changes, any structural organisation or reworking of programs or any of those sorts of things are matters for government consideration, as is the timing of those.

Senator RICE: The report covers the fact, as do many other reports, that mental health encompasses many more portfolios than just the health portfolio. I am interested to know what the government is going to do to ensure cross-collaboration between portfolios?

Mr Cormack: An interdepartmental committee has been established and has been assisting the department in bringing the emerging response into a whole-of-government context. It is a central agency. It has DSS, Defence, Veterans and Education. It is fully represented. They have been working closely with the department to progress the development of the government's response and, of course, it will be subject to a full cabinet process in the near future.

Senator RICE: That level of collaboration and making sure that it has cross-portfolio and all of cabinet fully in the response?

Mr Cormack: That is certainly what we have been working towards—yes.

Senator RICE: I will now move on to issues associated with the introduction of the NDIS. According to the Mental Health Commission's report, there are around 65,000 people with severe mental illness who will fall into the NDIS, but around 625,000 people with severe mental illness will not. The general question is: what is the government currently planning about what is going to happen to those 625,000 people?

Mr Cormack: I will turn to Ms Anderson, who can probably give a more fulsome response there, but I think the important point is that another government department has carriage of this work. We are working very closely with the DSS and the NDIA itself to address those transition implementation issues, but I think it is important that detailed questions about the NDIS implementation—

Senator RICE: It is not so much the people that are going to fall into the NDIS—I think there are going to be the programs in place through the NDIS for those—but the estimate in the Mental Health Commission's report is that that is only 65,000 people, but we have another 625,000 people who are not going to— Mr Cormack: Again, with those, that will be dealt with in the context of the response to the national Mental Health Commission report, and the government's response will have something to say about that.

Mr Butt: Can I clarify that, in fact, in our review we were saying there were 65,000 people with severe and persistent mental illness or psychosocial disability who potentially may get into the NDIS. It does not necessarily mean they will, and there is an assessment process that will look at whether they are eligible for tier 3 or not. So it is not necessarily that we are saying the 65,000 people will get into the NDIS.

Senator RICE: It is just the magnitude; 10 times as many people with severe mental illness are likely to not be eligible for the NDIS.

Mr Butt: They are very unlikely to be eligible for the NDIS, because they tend to be the people who have got severe and episodic illness. They are not regarded as having a permanent disability. So, no, they are very unlikely. A lot of those people currently would be looked after by state specialised mental health services with support from primary health care.

Senator RICE: Would the expectation be that the state would end up having to carry the responsibility for the services for those people?

Mr Butt: The states carry a lot of that responsibility now. The models that we have recommended—and, obviously, it is up to government decisions about what they do—are about taking a more regionalised approached where you are looking at Commonwealth and states working together and about how you look after those people, because there is a real issue about that particular group. With a lot of those people, their functional impairment is not necessarily high. So a lot of them are very active in the community—

Senator RICE: Absolutely. Mr Butt: in employment and in education and so forth. There are others who may have severe and episodic or severe depression, or whatever it might be, who are actually very functionally impaired and who need much greater levels of support. The recommendations we have made are about a stepped care approach where you match services to meet the needs to that individual—as their care needs go up, so you step up, and then you step down when you need less services. I would say about that group there are certainly issues about the different roles of the Commonwealth, the states and the territories in what care is provided for those people and how you keep them out of crisis and out of hospital. That is part of the issues that I know the Commonwealth is looking at both in the fifth national mental health plan and in its response to the review.

Senator RICE: I want to move on to the services provided under the Partners in Recover program. It appears to me in discussions with stakeholders that the future of the Partners in Recovery program is unclear. I understand that from 1 July next year there are going to be in kind contributions to the NDIS from Partners in Recovery, so what is this going to mean for the future of the Partners in Recovery program?

Mr Cormack: There are two ways of responding to that. First up, to pick up on a final point that Mr Butt mentioned, in relation to the severe and more complex patient's mental health and their interface between the primary health care and the state health systems, that will very much be part of the fifth national mental health plan. Minister Ley, at the time of the release of the National Mental Health Commission report, also sought the approval of her state and territory colleagues to commence the development of the fifth national mental health plan. And that will focus on whole of system: the Commonwealth, state and territory approach to responding particularly to these important interface issues. That work is progressing well. It is being supported by one of the committees of the Australian Health Ministers' Advisory Council, AHMAC, and chaired by Michael Pervan, the acting secretary of the Tasmanian health department. So that work is well progressed. The Commonwealth is actively contributing to and resourcing that work. Many of those implementation issues that involve a combined Commonwealth-state response will be picked up in that piece of work. In relation to the other issues around 'where to' with Partners in Recovery activities, day-to-day living and all those sorts of programs they will be touched on and addressed within the government's response to the National Mental Health Commission report.

Senator RICE: Are you able to tell me any more about the future of the Partners in Recovery program?

Mr Cormack: It is caught up—it is not caught, it is part of—I have just told you two stories. The third story is the implementation of the NDIS, for which the department does not have carriage but we are actively contributing to that. I would certainly recommend that those sorts of issues be taken up with—

Senator RICE: You can understand the concern from the sector—if there is big money being put from Partners in Recovery into the NDIS, what does this mean for the Partners in Recovery program.

Mr Cormack: Indeed; yes.

Ms Anderson: Just to add to Mr Cormack's comments, a couple of jurisdictions are already engaging in trials, which involve Partners in Recovery or their clients participating in the NDIS. So we are stepping into, in a very considered and planned way, carefully looking at the earlier experience and learning from it and working closely with the Department of Social Services to ensure that as we move further into transition we get all the benefits of that early experience and can refine the program as we go. You mentioned the words 'in kind'. That means it is a precautionary measure. We are looking, very carefully, at not moving too many parts too quickly. We step into the trials. We move beyond trials through transition in a considered way, making sure everyone has in the forefront of their minds that this client group continues to access the services they need. That has been signed off by all governments as absolutely the most important thing to be watched for and protected as we move into implementation.

Senator RICE: Given the trials and pilots that are going on, when will you have more clarity about funding for the programs that Partners in Recovery are doing outside the NDIS, what they will end up being?

Ms Anderson: We know this sector is very keen for information. Indeed, we are determined to provide that as quickly as we can. Mr Cormack already referred to the government response to the National Mental Health Commission review, which is material, as a timing issue, that is within our minister's control. We are also undertaking an evaluation of PIR. The final report of the evaluation is due in the middle of the next calendar year. That would be expected to inform decisions that are made about Partners in Recovery into the future.

Senator RICE: In terms of the areas that do not have a Partners in Recovery scheme, is that on hold, in terms of extending Partners in Recovery?

Mr Cormack: All—and this is consistent with the minister's previous public statements—Commonwealth funded mental-health programs are now under active consideration, in the context of the response to the National Mental Health Commission report, inclusive of Partners in Recovery. The extent to which the next stages or steps with that program—and, indeed, with any of the other programs—will be part of the government's response to the National Mental Health Commission report, and we are not in a position to pre-empt that. It is not too far away; it is before the end of the year.

Senator RICE: Until then, you cannot give anyone any certainty about the timing of decisions on these programs.

Mr Cormack: What I am saying is there are a lot of programs in the mental-health space. All of them are part of a comprehensive Commonwealth response to the National Mental Health Commission's report. We cannot go through them one by one, because they are part of the government response that is under active consideration and the minister will be making a statement about that before the end of the year.

Senator RICE: Can I get some clarity about the current status, in terms of rolling over funds from the Partners in Recovery program and other in-scope programs into the NDIS pool? What is happening, at the moment?

Ms Anderson: As I said, the service providers for PIR and day to day living are participating in trial sites in New South Wales in the Hunter Region, in the ACT and in WA—both in an NDIS trial and also in a WA design trial. We are contributing in kind, so there is no cash transfer as such. The clients of those two programs— Partners in Recovery and day to day living—who are deemed eligible to move into NDIS are continuing to receive those services as NDIS clients. Those are trial sites—data is being gathered from those sites and being looked at very closely, and lessons are being derived as appropriate.

Senator RICE: The information, linkages and capacity building program—can we be informed about the ongoing level of funding for that program, and how much of that funding would be available for psycho-social disability?

Mr Cormack: Is that within the NDIS?

Ms Anderson: Yes.

Mr Cormack: It is a matter for the Department of Social Services and for the NDIA itself.

Ms Anderson: Moving on. Both the Mental Health Commission and the Senate Select Committee on Health have recommended a national stigma reduction campaign for mental health. Are you able to tell us anything the government currently has planned in terms of stigma reduction?

Mr Cormack: I am sorry to repeat my earlier response, but the government and the minister have announced that this is landmark review, it covers all aspects of mental health programs. The government is in the process of considering its response, and no doubt aspects in that space will be considered and responded to in due course.

Senator RICE: Once we get a response?

Mr Cormack: As part of the response.

Senator RICE: The government talks a lot about front line services. Can you please explain what is meant in terms of mental health front line services?

Mr Cormack: As a general comment, they would be programs that are funded by the Commonwealth that deliver services and that support the delivery of services directly to individuals who may be affected by mental illness, to carers and to others who are involved in supporting or working with people with mental illness or who are at risk of mental illness. Front line services would fall into the general description I have just given.

Senator RICE: Does the government recognise peer-to-peer support for front line services?

Mr Cormack: I would think that it probably would. I am not deeply familiar with the program but I am sure that there is somebody in the room here who is. The extent to which the government, through its programs, is supporting the groups that I just mentioned—that would probably be considered to be a front line service.

Senator RICE: So you think it is?

Mr Cormack: There is a common, dictionary, general understanding of what the term 'front line' means. There is not a precise—

Senator RICE: I think that people who are concerned about peer-to-peer services—there is obviously some uncertainty as to whether they are considered as a front line service—want to know whether they are.

Mr Cormack: Sure.

Ms Anderson: By way of addendum, I am not going to reflect directly on the definition, but what I can say, categorically, is that there is an appreciation of the value of peer-to-peer services. Whether they fall in or outside of that categorisation is another question, but we are very aware of the value that individuals with mental illness and their carers place on those services, and certainly we know that there is strong therapeutic benefit from that sort of relationship.

Senator RICE: And you would recognise the value of supporting and resourcing those peer-to-peer services?

Ms Anderson: Without making a comment on the definition, yes.

Senator RICE: In a recent speech, Minister Ley said that it was very important the consumer remains front of policy mind. What are the minister and the government doing to ensure that people with lived experience and their carers are involved in the development of the fifth national mental health plan and the current reforms?

Mr Cormack: The development of the fifth national mental health plan is a partnership between the Commonwealth and the states. It is getting underway and there is some good early work. It would certainly be the Commonwealth's expectation that a fifth national mental health plan—as was the case with the fourth, the third, the second and the first—would involve significant engagement with and involvement by consumers past and present, family members and carers. That is very much part of the way Australia's mental health system does engage. It would certainly be our expectation that that would be part of the process of developing the fifth plan.

Senator RICE: Can you be any more explicit about the mechanisms that will be used and perhaps about any differences between this plan and the previous plan?

Mr Booth: To add a bit of detail to that, there already has been one consultation meeting held. It was held last week with the members of those who are tasked with writing it, plus representatives from state and territory organisations of people who have experience or who work with people with mental health issues. There is certainly that consultation being done at the moment. We are also expecting to do much more targeted consultation as the development of the plan continues. Certainly, a big part of that would be specific consumer and carer consultation sessions we are already planning to undertake. So, yes, there are going to be targeted consultations around that. We also have some representation in the organisation of the writer's group being set up. So there is some consumer representation with people who are actually going to be doing some of the drafting of the plan. So there is very strong involvement of consumer carers in the process.

Senator RICE: Has there been a specific focus on this compared with the previous plan? Has there been an attempt to have much more detailed involvement of people with lived experience in the development?

Mr Cormack: I think that is part of the way that the modern health system is evolving. Mental health is probably in many ways the leader in that area, where it has been a well-established part of policy development, program design and governance—even at a local service delivery level—to have consumers as part of that overall governance arrangement. I think what Mr Booth has just outlined is a continued development, probably even deeper than the previous iterations of the national mental health plans.

Senator RICE: One last topic is the issue of funding. Given we are obviously in a period of considerable change and uncertainty, is the government planning to roll over funding again for another year, as it has done for the last two years, while the changes are taking place?

Mr Cormack: All aspects of the government's program funding will be considered as part of the response. We are not in a position to pre-empt the different arrangements.

Senator RICE: There are programs whose funding is running out in eight months time. I was speaking to a stakeholder yesterday who said that they have no certainty of funding following—

Mr Cormack: We are certainly very aware of that and the government is aware of that. The government will be providing its response to the National Mental Health Commission's report, and all matters to do with program activity and related funding will be addressed then.

Senator RICE: If at the end of that there are tender processes being initiated, what will the government be doing to ensure stability in services and support during that change in the process?

Mr Cormack: We are very closely in touch with our partner organisations and stakeholders. We are acutely aware of their individual organisational circumstances and the extent to which they are concerned and are having to make business decisions about their future beyond their existing funding period. We are in active dialogue with them, and we will make sure that all of those factors are considered as part of the government's consideration of the response to the National Mental Health Commission's report.

Senator RICE: Thank you. 

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