00:01We need to look at mental health really differently in Australia.
00:04It's interesting what you say about inquiries.
00:06We've probably had about 60 since the 1990s.
00:0960?
00:1060, 6-0 national and state inquiries into mental health services.
00:14Often precipitated by a tragedy, and I must say this is a real tragedy
00:17for all of the individuals, families and people concerned.
00:20So we've had coronal inquiries, state inquiries,
00:23human rights inquiries, government inquiries
00:25that have trouble getting to the heart of the problem.
00:27When you said preventative,
00:28what we're really saying is in the community,
00:30outside of hospitals, in the community,
00:32connecting particularly with those in greatest need.
00:35The real tragedy here was that the individual involved
00:38was effectively treated in Queensland and well,
00:41and a threat to nobody.
00:43The breakdown in that system, the move to New South Wales,
00:46the disconnection, the homelessness,
00:48and like many young men, I'm afraid to say,
00:50up and down the eastern seaboard of Australia,
00:52homeless, disconnected, and therefore not in contact
00:55with any effective services that might have prevented
00:58this particular tragedy.
01:00So you agree with this assessment that there's a serious lack
01:02of community-based treatment focused on chronic care needs?
01:06Yes.
01:07So those with most severe chronic and persisting needs,
01:10the reality is you've got to have a home address and be known.
01:13You have to have a home, not just a house, a home,
01:15where you're resident, where you're known,
01:17where people can take care of you, for our services to connect.
01:20The moment you don't, and given the housing affordability crisis,
01:24given the difficulty, particularly for single people,
01:26those who are without regular income,
01:28those without regular family support, to have a home,
01:31the chance that our services will find you is very low.
01:34You have to come to us.
01:36So that when you say preventive, what we would say is proactive,
01:39out there connecting with those who would benefit most
01:42from continuing clinical care, but also social care and support,
01:47housing support, employment support,
01:49those things that value you as a member of a community
01:52and connect you with effective care.
01:54There was a startling figure mentioned today.
01:57Back in 1991 in Sydney,
01:59there was something like 1,100 short-stay beds available
02:02in Sydney's four main shelters,
02:04and now there's fewer than 300 temporary beds available.
02:09Does that tally with what you know?
02:11Yes, tragically, what we've seen,
02:13because of housing affordability,
02:15many places where we had not just short-term accommodation,
02:18but short-term and longer-term rooms,
02:21availability, shared housing,
02:23because of the pressure on housing,
02:25have made this really difficult for the most marginalised.
02:27And if you travel up and down the eastern seaboard,
02:29you will see many men living out of their cars,
02:31living out of vans, who are disconnected.
02:34They've become disconnected through illness.
02:36They're no longer connected with their families.
02:38This is a well-known problem.
02:39But our services, if anything,
02:41have retreated back into hospitals and emergency departments.
02:43If there have been 60 enquiries over the years,
02:46how can that possibly be the case?
02:48Because we just don't really want to come to terms
02:50with the complexity here.
02:51You need clinical services, but you need homes,
02:54and you need proactive outreach services.
02:56New South Wales, in particular, was very famous in the 1980s
03:00for actually going out into the community.
03:02Largely since then, we've seen a retreat back into hospitals,
03:05concerns about staff safety, concerns about other sets of issues.
03:09It's easier to organise services.
03:11Another really important announcement today
03:12was by St Vincent's Healthcare saying,
03:14in the future, they're going to spend 50% of their money
03:16outside of hospitals.
03:18Get outside the hospital model again
03:20to really connect with people.
03:21And those with severe and enduring mental illness
03:23are one of the most important sources of that.
03:26We've got to go out and connect with people.
03:28They have to have homes.
03:29They have to have an address.
03:30They have to have a family who knows who they are
03:32so that services have a chance of providing effective care.
03:36And so, how do you effectively start turning the system around
03:40so it does cater to people that way?
03:42You cannot just operate at the national level,
03:44the federal level, the state level.
03:45We've just seen the Productivity Commission
03:47produce another report saying the last federal state agreement,
03:51just signed prior to the Morrison government,
03:53moving out of office, got nowhere.
03:55So the Productivity Commission said this in 2020.
03:57It said the current arrangements don't work.
03:59Because they don't get down to the regions.
04:02They don't get down to the places in which people live and operate.
04:05So state-funded regional health services
04:08have to work in the community in which you live.
04:10We have about 50 such communities in Australia,
04:12so the system has to work in each of those 50 communities.
04:15It's different in Bondi Junction, to the north coast,
04:18to far north Queensland.
04:19I've just been in south-west and western Australia.
04:21They're different, but they need to work with those communities,
04:24with housing, with social support,
04:26and effective clinical services for those most in need.
04:29Do you see any appetite for this from the current federal government?
04:33Yes. So the current minister, Mark Butler,
04:35has made it very clear in looking at reform of the NDIS
04:38and psychosocial support.
04:39He makes the comment,
04:40where we've really failed in many ways over the last 30 years,
04:43is providing the community support that we really need.
04:46So the federal government needs to not just say it.
04:49It needs to buy in,
04:50particularly in the housing affordability side,
04:52and through the national debisitability insurance system
04:54for the services.
04:55They're the so-called social services.
04:57The states, I'm afraid to say,
04:59have to provide the serious clinical services,
05:02not in their emergency departments,
05:04but in people's homes and where people are,
05:06including on the street, in cars, proactively,
05:10in trying to stabilise their illness
05:11and then stabilise those people
05:13as valuable parts of our communities.
05:15And have any of the states started taking that approach?
05:18The states find it hard,
05:19and we end up with where we are now,
05:20a fight about money, largely,
05:22between the Commonwealth and the states.
05:24Yes, it requires investment,
05:26but it really requires doing things differently,
05:28connecting with people where they are.
05:30So I'm afraid to say,
05:31we have to relearn what we learned in the 1980s,
05:33and unless you're out there doing that,
05:35the risk of tragedies like this repeating themselves continues.
05:39How does it feel for someone like you
05:41who's worked in the sector over the decades
05:43and you've seen these changes in policies
05:46and coming back around, like going full circle?
05:49Well, there's a great frustration at one level.
05:52I must say, the Australian community has changed a great deal.
05:54So in the 1980s, we had the philosophy,
05:56but we didn't have community support
05:58to implement that philosophy.
06:00Now I think the community has a much more positive view,
06:02but like other areas of healthcare,
06:04if you've got cancer, you've got heart disease,
06:06we expect the services to be there,
06:08and we expect them to be there in our state hospitals for everyone,
06:11not just for those who can afford the better care.
06:13And that's really where a lot of people
06:15with mental health problems miss out.
06:17They become poor, they become disconnected,
06:19they require much greater support from the state
06:22to be able to function as members of our community.
06:24So the pressure is on the states on the clinical side,
06:27but the pressure is on the Commonwealth,
06:29on the housing and the social support and the other services.
06:31And we've got to get our act together.
06:33The Productivity Commission is quite helpful.
06:34It says, get your act together and deliver it locally.
06:38That becomes harder at the political level,
06:40but I think the communities in Australia
06:42are on board for that approach.
06:44And are you optimistic there could be some momentum
06:47from the recommendations out of this?
06:49We have got to learn out of these tragedies.
06:51We've had tragedies,
06:52the risk is unless we really seriously deal with the problem,
06:55we will have further tragedies.
06:56But on the upside,
06:58we do know there are effective treatments for mental illness.
07:00The tragedy of this particular case,
07:02this man was effectively treated in public services in Queensland
07:06and was a threat to nobody.
07:08The breakdown in that system in Queensland
07:11and then the transfer to New South Wales happened.
07:13We've seen this before.
07:14I don't know if you remember Cornelia Rowell,
07:16very famously disappearing in far north Queensland
07:18and ending up in immigration detention in South Australia
07:20unrecognised with a similar illness.
07:22We've seen this before.
07:24Mick Palmer did an inquiry again 30 years ago saying exactly this.
07:28You can't lose people from one place to another
07:31and not expect bad things to happen.
07:33So we need to get down to the regional level.
07:35Productivity Commission says governments, get on with it.
07:38I think the community expectation is governments, get on with it.
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