Senator Penny Wright asks questions about gaps in the mental health system, particularly with regard to adult survivors of childhood trauma, during Senate Estimates.
Senator WRIGHT: I want to ask some questions about a particular gap in services that has been identified to me. Pending the National Mental Health Commission's review of mental health programs and services, there are still some existing gaps in services. Specifically, stakeholders consider that the Royal Commission into Institutional Responses to Child Sexual Abuse has highlighted that many of these gaps actually relate to the needs of what they estimate to be four to five million Australian adult survivors of childhood trauma. I am interested in what plans the department has in relation to that particular gap that has been identified to me.
Prof. Halton: We have a general approach to the provision of services, which I think we have discussed with you on many occasions in the past, and I acknowledge your interest in this area and your concern. In terms of the specifics about the current inquiries, I have to say, I read almost daily those transcripts with just the most awful sentiment. They are awful; there is no other way to describe them. The things that were reported in today's press were just so distressing. We do not have a particular program that addresses those issues. You know we have done a number of things over the last number of years to address people with mild to moderate issues. And I would certainly encourage those people to avail themselves of the services that are available. I think, as we always do, we wait until the outcome and the recommendations that come from inquiries. So, the current inquiry is resulting in these testimonies that are nothing other than distressing. And I think we all feel particularly for the women we have been hearing from. But it is not just the women; for people who as children suffer these kinds of abuses, these are horrendous circumstances. So certainly we are very open to hearing what the recommendations are.
Senator WRIGHT: Certainly, and because I know time is pressing on, that was the context for the highlighting of the issue of trauma.
Prof. Halton: Absolutely.
Senator WRIGHT: But I want to be careful that we do not just confine our discussion to the royal commission.
Prof. Halton: Fair enough.
Senator WRIGHT: What I am really interested in exploring is the increasing body of knowledge about the degree to which trauma underlies a lot of the mental health conditions people experience.
Prof. Halton: Absolutely.
Senator WRIGHT: Arguably, unless we come to grips with that we are actually dealing with symptoms that-
Prof. Halton: I agree.
Senator WRIGHT: So, that is certainly a gap that has been identified. And, as I said, they estimate that it is a significant number of Australians. And it is not just sexual abuse; it is neglect and all sorts of other things and it often happens in childhood. And I guess I am interested in whether there are plans for the government, or the department, to build the capacity of a workforce which is able to work clinically with adult survivors of childhood trauma specifically identifying trauma as being a condition that needs to be worked with, as opposed to other conditions on the mild-to-moderate spectrum, to help them find those pathways to recovery. To what extent is trauma related care being investigated as an important policy approach of the department in terms of conditions and treatment?
Prof. Halton: We already do work with the survivors of torture and trauma. That is something we have a responsibility for. And we had a number of programs transferred to us a number of years ago in that respect. I think the short way to answer your question is that we are very aware of the issues with respect to the survivors of torture and trauma-we use that conjunction, but of course it encompasses a wide range of people from a wide range of circumstances. I cannot point you to any other particular response at the moment. But, as I have said, we watch the various investigations-royal commissions et cetera-with a great deal of attention, and I can promise you that particularly in the work we are doing in the mental health space, and you have already heard about the review that is going on, this is something we will take into account. And I can absolutely assure you that the office of the department-and you probably know that this is my academic background as well-
Senator WRIGHT: I was not aware of that, actually.
Prof. Halton: This is something we take incredibly seriously.
Senator WRIGHT: Perhaps I can just ask you then about particularly primary care-general practitioners. They are often the first port of call for a large number of Australians of all ages, of course, who have been affected by abuse, neglect or domestic violence in childhood. What training do GPs receive to enable them to screen for, recognise and effectively respond to those particular physical and mental health challenges related to underlying trauma? It has been put to me that too often that is not even there as an initial question that might be raised and therefore identified.
Prof. Halton: I think that is a fair enough observation. I think we need to be fair to the hardworking GPs in the community. I think it would be worthwhile for Professor Baggoley to talk about the kind of training that our legal practitioners get.
Senator WRIGHT: Absolutely. It is not a criticism of GPs; it is about what training-
Prof. Halton: Indeed. And I think we have to feel for the general practice community. The expectations for the skills that they have, the things they take account of these days-it is a bit like for teachers. They are expected to be experts in absolutely everything, but I think your point is absolutely well made. Professor Baggoley, would you like to make an observation?
Prof. Baggoley: The training program for general practice does have a significant focus on mental health and on the issues of recognition and appropriate early care and ongoing care if necessary, or referral. They have continuing professional development programs. And, as I understand it, mental health issues are an important part of that. Of course the specifics, if you wished for them, I would need to take on advice from both the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, and we would be happy to do that.
Senator WRIGHT: I would appreciate that, thank you, because certainly there is an increasing understanding about the importance of trauma in formed care, and I think best-practice principles have now been published. So I would be interested to know the extent to which those form part of any training that GPs would receive. Also, what work is being performed to integrate care for those who have drug and alcohol dependencies?-which is a common reaction, as well as mental health challenges, again due to childhood trauma. To what extent are the dots being connected up between childhood trauma and drug and alcohol dependencies and treatments that are available for people? I am basically asking about the integration of the need to consider drug and alcohol dependencies in the context of childhood trauma, and the extent to which there is any work being done in terms of services or consideration by the department for that.
Prof. Halton: Perhaps you would let us take that on notice. It is a very specific question. The whole issue of dual diagnosis, the connection between people's drug and alcohol dependence, and issues around trauma-the fact that this is a continuum; these are not individual and separate conditions-is something that is completely well understood by us. You have asked a very particular question, and I would be delighted to take it on notice.
Senator WRIGHT: Thank you for that.