Supplementary Budget Estimates
Community Affairs Legislation Committee
Mental health questions
Australian Greens spokesperson for Mental Health, Senator Penny Wright, asks questions about mental health funding, the National Mental Health Commission Review, the impact of the Budget on mental health and mental health research, among other topics.
Partners in Recovery and Medicare Locals
Senator WRIGHT: I have been in other committee, so if I ask questions that have already been asked just let me know. I understand the department has been unable to advise what plans they have for the future of Partners in Recovery contracts where the lead agency is a Medicare Local. I am interested in whether the department can provide any information about what will happen in these instances.
Mr Booth: The Medicare Locals exist until 30 June and then Primary Health Networks take over. There are a number of areas, in terms of transition, in a number of services which come to an end at the end of that particular period or, as in the case of Partners in Recovery, where the contract goes for a further year and lead agencies in that area are Medicare Locals. The answer is that we are working closely with Medicare Locals and Partners in Recovery consortia to look at how we deal with that. Our key aim with Medicare Locals, in working with them over the next six months, is to ensure that service delivery is prioritised and that there is no reduction in service delivery that they need to do. We would certainly make sure that was happening, as far as we could, with Partners in Recovery.
Senator WRIGHT: So at this stage you are working with them closely, but there is no answer for those organisations.
Mr Booth: Not yet. As we are doing with a number of different areas, we are working with the Medicare Locals; we are working with the consortia to work out the transition period.
Senator WRIGHT: When will that information definitely be available?
Mr Booth: We are working to get tender information out, as soon as we can, for the establishment of Primary Health Networks. The work we are doing in Partners in Recovery and a number of other areas is moving alongside that. We are very conscious of the need to do this as quickly as we can, and we are working as fast as we can. I do not have a specific time frame that I can give you for that, but we are working on it.
Senator WRIGHT: It is the Primary Health Networks that will deliver the Partners in Recovery program when the Medicare Locals no longer exist.
Mr Booth: It would depend. There may be a number of different options that might come out of that. Primary Health Networks are intended to be purchasers of services primarily and not providers of services, so we will need to work through with Medicare Locals exactly what happens. We discussed, a few minutes ago, the different permutations that might happen. Some Medicare Locals may bid to become a PHN and continue, in which case there is one conversation there with them as a lead agency. A Medicare Local may bid and not be successful, in which case there is another conversation with the consortia as to what happens to that contract. We need to work through all of these on a case-by-case basis, in terms of Partners in Recovery.
Senator WRIGHT: I will reiterate the concerns raised by my colleague Senator Smith. I am from a fairly large state too, South Australia. I was pretty concerned to see that there are going to be two Primary Health Networks there: one for the Adelaide metro region and one for the rest of South Australia, which is from the APY lands in the north down to Mount Gambier in the south and across. What guarantee is there for clients of Partners in Recovery that they will have continuity of care, notwithstanding these changes?
Mr Booth: To take the first part of your question in terms of South Australia, the answer is very similar to the WA answer. The PHN outside of Adelaide conforms to the country South Australia boundaries. There would be clinical councils and community advisory committees established within South Australia that conform to the boundaries of country South Australia as it operates at the moment. We would anticipate that that would work well and that we could get that work going. In terms of the specifics around Partners in Recovery, I can reiterate what I just said-that we will work with old Partners in Recovery agencies that are affected by the move to primary health networks with the intent of ensuring that nobody falls through the cracks. We are aware of the issue and we are working to do that.
Senator WRIGHT: It is my understanding that the government will defer the establishment of the remaining 13 Partners in Recovery organisations for two years, from 2013-14, saving $53.8 million. Could you confirm that that is the intention and the saving? I also understand that the money will be invested in the medical research fund. Is that correct?
Mr Booth: Yes, that is correct.
Senator WRIGHT: Will the money be invested in mental health research in the medical research fund?
Mr Booth: I do not know the answer to that question, I am sorry. It would be another area of the department.
Senator WRIGHT: Who should I ask about that? I wonder whether Senator Nash could assist with that. Is that a decision that the research fund itself would make or is that a decision that government would make?
Senator Nash: I am not aware of that, but I am happy to take it on notice for you.
Senator WRIGHT: Thank you. I will wait. Let me know if there is someone else I could ask today. I come to the National Mental Health Commission review. Will the government respond to the National Mental Health Commission review?
Mr Booth: As you know, Senator, the review is due to report at the end of November. I would imagine that the report will be presented to government. I cannot say exactly what the response would be, but I would expect that there would be some response.
Senator WRIGHT: Would the response be by the department or the minister?
Mr Booth: It is a report to government, so the government would respond. The department will certainly do the work the department does in terms of analysis and advice-
Senator WRIGHT: By government you mean the executive government?
Mr Booth: It is a report to government.
Senator WRIGHT: So you would imagine that it would be the executive government that would respond?
Mr Booth: I would need to double-check, but it is a report to government.
Senator WRIGHT: So we really do not know whether there will be a response or when that response might be and what the expected time frame for that might be?
Mr Booth: We do not have time frames yet.
Senator WRIGHT: Mr Butt, do you have any indication?
Mr Butt: No, I know nothing further other than the fact that we need to deliver the report to government by 30 November and that it is a report to government. It is then up to the government as to what it does with it.
Senator WRIGHT: Certainly the sector has indicated concerns. It seems that a lot of things have been put on hold pending the review. People are concerned that there is a risk that this might-with respect, Mr Butt, and with regard to all the work you are putting into it-end up being just another report that sits on the shelf gathering dust. Is there any way that we know that is not going to be the case? Is there any guarantee that we can have that there will be a response and that there will be a meaningful response to the review?
Senator Nash: The government will consider it in the way we consider reports in the usual process. There has been a very clear intent from government that this is a very important review and it was commissioned for a range of reasons that were very important. I can certainly indicate to you the level of importance of the review.
CHAIR: We will have to leave it there. We are due to suspend for lunch. I advise that we still have some time to go on this outcome. After lunch, we would expect to go to outcome 5 for a little while longer.
The Hidden Toll
Senator WRIGHT: I want to go to the recommendations of the 'The hidden toll: suicide in Australia', the Senate report into suicide in 2010. This might be a question for Senator Nash to start with. I note that their National Party's 2013 federal election policy platform included a commitment to implementing the recommendations of the Hidden Toll report. Is the minister able to comment on the government's intention to keep that commitment?
Senator Nash: Not at this stage. We are certainly well aware of those issues, but not at this stage.
Senator WRIGHT: When you say you are 'well aware of those issues', do you mean the issue of the National Party making that pre-election commitment?
Senator Nash: I mean the issues contained in the report. It would be a matter for the senior minister, and I would be happy to take that on notice for you.
Senator WRIGHT: Leaving aside that particular issue of her pre-election commitment, does the government have any intention to implement the recommendations of that report at any time and what sort of time frame might that have?
Senator Nash: Again, it is the responsibility of the senior minister and I am happy to take that on notice.
Frozen indexation of mental health programs
Senator WRIGHT: I would like to ask now about the fact that it has emerged that there will be around about $20 million, arguably possibly more, of mental health program funding which will have its indexation frozen for up to four years. Is that correct?
Mr Booth: I am not sure. Could you give me some more information?
Senator WRIGHT: I might have to wait and get some more information about that.
Senator WRIGHT: I was not cut off, but I just did not have the information to assist the department with the questions. I now have it, so I could perhaps go to those programs.
CHAIR: Yes, you can have a few more minutes.
Senator WRIGHT: Thank you very much, Chair. Mr Booth, if you remember, I was asking you about the fact that it seems that there is around $20 million, arguably more, of mental health program funding which will have its indexation frozen for up to four years. I am going on a response to a question that was asked by Senator Wong of Senator Cormann after the budget. It was a question on notice on 2 July. It was with reference to the budget measure 'administered program indexation pause'. Are you familiar with that program?
Mr Booth: I know that there was an indexation pause across a number of programs, yes, but I am not certain of the detail.
Senator WRIGHT: That is the document I am referring to. I am just interested in understanding better what it means. I will take you to some of the programs that are mentioned in the Health portfolio. There were 32 programs altogether. I am interested in the mental health ones. In the national depression initiative, it looks like the total savings from the commencement date on 1 July 2015 for the following three years would be $1.020 million. There is the Better Access to Psychiatrists, Psychologists and GPs MBS program. The saving there appears to be $0.873 million. There is COAG Mental Health-additional places; COAG Mental Health-support for children; COAG Mental Health-support for day-to-day living in the community; COAG Mental Health-telephone counselling; Leadership in Mental Health Reform; Mental Health More Options Better Outcomes; and the National Mental Health Program. That might be it for the mental health area. They are the types of programs I am talking about. Are you familiar with what I am talking about?
Mr Booth: Yes, Senator. I can make some comments and my colleague Mr Cotterell may make some comments as well.
Senator WRIGHT: Thank you for that. I am interested in knowing what model was done to inform the government's decisions about which programs had their indexation frozen.
Mr Cotterell: This was a whole-of-government exercise where the indexation was frozen across a large number of programs across all portfolios. It was a decision taken at whole-of-government level, that large programs would need to freeze indexation as part of the general fiscal discipline. There was not specific modelling on these programs. The indexations are a very small percentage of the overall size of the programs. Each program is taking a save.
Senator WRIGHT: Who determined which programs were going to be targeted in the Department of Health? Was that a Department of Health decision or was that a decision from elsewhere?
Mr Cotterell: It was a whole-of-government decision and, as said, it applied to programs right across government, not just the Department of Health.
Senator WRIGHT: But not every Department of Health program was affected, so I am interested. I do not know what a whole-of-government-
Mr Cotterell: It is in relation to grants programs.
Senator WRIGHT: Was it every grants program or just some of them?
Mr Cotterell: Every grants program.
Senator WRIGHT: Is there any possibility that some service providers who are operating under these programs may not have enough funding to meet need as a result of the freeze to indexation?
Mr Booth: As Mr Cotterell said in terms of the mental health area, my understanding is that, regarding indexation, the savings do not come in until 2015. They are not there yet. There are indexations set. They are a fairly small amount of the total that is coming on. We will work with organisations to look at how they use their funding to try and ensure that there is no impact on service delivery.
Senator WRIGHT: I suppose I am coming from the viewpoint that, in terms of the allocation of funding for mental health in comparison to the burden of disease, many people argue that it is about half of what it should be, if you are going to do a direct contrast between burden of disease and the amount of funding that mental health gets. So we are looking at programs that have had their funding further reduced by having a freeze on the indexation. There will potentially be services that cannot be provided because less money sometimes means fewer services, but you do not have any modelling at this stage about what the effects will be?
Mr Booth: Not at this stage.
Senator WRIGHT: Where will the savings from that freeze go?
Mr Cotterell: All of the savings publicly announced in the budget will go into the Medical Research Future Fund.
Senator WRIGHT: My question is: how much, if any, of the funds of the medical research fund are going to mental health research? Would program 1 tonight be the time to ask about that?
Mr Booth: I think it is program 1. I think it is Acute Care, who were on this morning.
Ms Flanagan: Senator, your questions are going across whole of portfolio, in terms of the budget strategy and the budget decisions that were taken across the portfolio. If you specifically want to ask about Medical Research Future Fund, I think it is an outcome 1 later on today.
Senator WRIGHT: What I want to ascertain is: if mental health is an area that has been required to effectively take a cut because the indexation has been frozen, who is going to benefit from that? Will it actually go to mental health research? Where does it go? That is in the context of arguments that mental health does not get enough funding as it is.
Ms Flanagan: We can answer that later on.
Senator WRIGHT: Thank you very much.
Austerity measures + mental health impacts
Senator WRIGHT: I come back to some questions in relation to advice. There have been a lot of concerns raised about the potential effects on mental health and mental ill health of young people particularly who will be subject to proposed changes under the budget in terms of not being able to be in receipt of payments under Newstart and so on. I am interested in what consultation and work might have been done between the Department of Social Services-who have the carriage of that particular legislation, of course-and the health department in relation to those proposed changes to welfare and the impact those changes will have on people with episodic mental illness, for instance. Was there any consultation undertaken? Was there any advice sought from your department?
Mr Booth: Again, I would need to take that on notice. As you said, this is an initiative that other agencies do, and I know that they run a number of their own mental health services in various areas, but I do not have the answer to that question, I am afraid.
Senator WRIGHT: I am trying to work out how executive government operates, I suppose. I am interested in the consideration of those budget measures which were proposed in the budget. Was there any procedure in place whereby the Department of Health, which is the federal government department that is responsible for mental health programs and mental health data, had its advice sought-or was any modelling done-from the department of social security or the government in terms of those proposed budget measures?
Mr Booth: Again, I would need to take that on notice. I do not know the answer to that. In terms of general budget areas, it is not this division that would look at issues around general budget issues or decisions.
Senator WRIGHT: I suppose it is not specifically, necessarily, a financial issue.
Mr Booth: Yes, there is the impact.
Senator WRIGHT: I am interested in what, I think, people increasingly are seeing as a concern, which is the silo approach to governing, whereby something that seems like a good idea to some people might have predictable flow-on effects-not just financial but human. That is why I am interested when you respond and say there may be some NGOs or some other organisations that are doing this work. I am also interested in understanding what the role of the Department of Health is in terms of that work or pulling that information together and giving good advice about policy. If you could take that on notice, that would be good.
Mr Booth: Yes.
Senator WRIGHT: Does the Department of Health plan to offer any programs or any training to the department of social security in relation to young people with mental illness to ensure they are not improperly cut off from their benefits? Would it be envisaged in any way that the expertise that the Department of Health might have could be utilised in that way?
Mr Booth: There are no specific plans for training to be offered by the Department of Health to other departments in that way. We would not do that kind of training, no.
Senator WRIGHT: I am interested in whether the department, or indeed the minister, is aware of recent research which indicates links between austerity measures-which have been undertaken in other countries, for instance-and an increase in suicide rates. There are some publications that have come out recently. Is any work being done in that area, or is there any information that is known to the department or the minister?
Mr Booth: As you know, the issue of suicide is a kind of multifaceted issue. Really, suicide rates, we know, are impacted by a whole host of different societal areas. We are aware of research that is done both within Australia and internationally around suicide rates, particularly among different groups in different areas. As you know, the government, through its Taking Action to Tackle Suicide policy and the Suicide Prevention Program, funds a number of different organisations-quite a large number of organisations-to work within different groups in society and also within different areas to try and minimise the impact and to do as much work on suicide prevention as possible. It is quite a wide question as to research that has been done. We are aware of a lot of research that has been done, and we use that to inform policy and to inform policy advice to government.
Senator WRIGHT: I am interested in what policy advice to government has been requested. The reason I am asking it is that there has been significant concern raised by credible and experienced mental health commentators throughout Australia particularly in response to the proposed changes to Newstart for young people under 30 and, if the legislation were to be passed, the consequences for them not being in receipt of income for periods of up to six months. It is a really important issue to know whether or not the Department of Health has had any input or is using any of its resources to talk not generally about suicide-because of course we are all concerned about suicide strategies-but about the fact that there may be a government policy that could inadvertently lead to such a significant consequence. I do not get the feeling that you are going to be able to answer my question in any more detail at this point, but I am specifically asking about research in Scandinavia and other places that have linked austerity measures to an increase in suicide rates among the population. You are not aware of anything like that, specifically, as I understand it.
Mr Booth: Certainly we are aware of research that links suicide rates through to different areas and different situations.
Senator WRIGHT: What about that particular issue?
Mr Booth: Off the top of my head, there is nothing that I have read or looked at very recently from the Scandinavian research in particular. As I said, there is a lot of Australian research and that kind of thing that we do look at, but I am not aware of the Scandinavian research. Having said that, I am not across all the research that comes into the department. I can certainly have a look and get some advice from our experts in the mental health area to see if they are aware of research that has been done overseas, particularly in Scandinavia, to do that. The other comment I would make is that there is often interdepartmental work being done on some of these issues but I do not know the specifics around that particular area as to what work has been done and what has happened there, so I would need to look at that.
Senator WRIGHT: You will take that on notice for me; thank you. That is really what I would like you to do. Also, perhaps you could help me understand whether this is the sort of situation where-and forgive my ignorance of how government departments work-you would have to wait to be requested to provide that kind of input, or it is one where, if people within your department were concerned about that and it was within your bailiwick, I suppose, they could offer to provide information or policy advice to another department. How would that work?
Mr Booth: I will have a look at that, Senator.
Senator WRIGHT: I would like to come back to those other questions at some point. I will quickly get them, but I will pass now.
Research + mental health
Senator WRIGHT: It is about mental health research generally. I am interested in how much money has been allocated to mental health research in the Medical Research Future Fund.
Ms Flanagan: There are probably two parts to this. The National Health and Medical Research Council can probably give you an indication about what sort of money has gone into mental health research in terms of the program they run. Part of the question I think you were asking earlier on today was around what might happen with the Medical Research Future Fund. We are currently discussing with the minister a proposal of how the draw downs from the Medical Research Future Fund would occur and that will need to be agreed to by cabinet. There will need to be some assessment criteria about how to prioritise the draw downs of the Medical Research Future Fund. As I say, that is being discussed with the minister and ultimately will need to be agreed to by government.
Senator WRIGHT: That has not been decided yet?
Ms Flanagan: No, we are still coming up with the methodology and what sort of governance arrangements and advisory arrangements there might be around how to actually use the funds out of the Medical Research Future Fund.
Senator WRIGHT: Earlier today I was asking questions about the freezing of indexation as a budget measure across various programs, including programs in the Department of Health, some of which were mental health programs. The figure I was advised of was about $20 million worth of money. I was advised that the savings were going into the Medical Research Future Fund. I was asking whether or not those savings from those mental health programs would be devoted to mental health research, but is there no way that I can be told that at this stage?
Ms Flanagan: Just to be clear, the savings are going into the research fund. It will gradually build a $20 billion. What will occur is that that $20 billion will be secured and it will actually be the draw down, the investment return, on the $20 billion that will be actually used for research. For example, next year I think it is estimated that if the fund managers-the Department of Finance is setting up the fund and there will be fund managers-do a good job in investing this money, the estimated draw down from the fund to be used for research is around $20 million. That will build the time to hopefully be around $1 billion a year.
Senator WRIGHT: So the prediction is it may be around $20 million next year as it builds up?
Ms Flanagan: Yes, so that would be the total from all of the savings that are being invested.
Senator WRIGHT: There are a couple of aspects to my question. One is that, in terms of the burden of disease of mental health, I have been told the figure is about 13 or 14 per cent, and yet the proportion of the health budget given to mental health is about seven per cent. So there is a common view that the funding for mental health is about half of what the burden of disease is. There are always concerns about the underfunding of mental health treatments and programs. Among many, there is also an acknowledged dearth of research funding for mental health as opposed to other conditions and other illnesses, and yet it has a huge effect on productivity and certainly on morbidity and so on. To what extent will those sorts of issues be taken into account when determining how that fund is going to be allocated?
Ms Flanagan: These are discussions that we are having at the moment with the minister in terms of how you might set priorities. One of them may be looking at the burden of disease as one of your criteria against which you would say we need to allocate a particular amount of funding. There could be many things that would be chosen in terms of priorities. If there is a particular industry in Australia that is nearly there in terms of finding some sort of a breakthrough, would it be worth investing money in that? Those are the sorts of things that the minister, as well as government, will need to decide on in terms of setting how the fund will draw down.
Senator WRIGHT: The other aspect of that question is that it would seem to be a bit of cold comfort for people who have current issues in relation to mental ill health that would benefit but whose needs may not be met because of the freezing of that indexation over a period of time. With the freezing of the indexation, the savings are going into a fund and there is no guarantee that they will end up getting any benefit from it in terms of the money being allocated to mental health research.
Ms Flanagan: The freeze has happened right across whole of government. It was a whole-of-government decision. It has impacted not only mental health programs but many others as well.
Senator WRIGHT: I understand that. But I am talking about the fact that it is people with mental ill health who may be missing out, and this is a fund in relation to health research. Potentially, they could get a benefit or they may not. I think you also mentioned that the National Health and Medical Research Council may have some further information they could provide to me about mental health research. Is that right?
Ms Flanagan: Now that I have said that they can, I hope that that will be true.
Senator WRIGHT: We will see. They may not thank you for that! Professor Anderson, I am just interested in knowing if you can give me any figures or take on notice to provide any information about the extent of funding in the NHMRC budget that is going to mental health related research.
Prof. Anderson: I can. There has been some publicity in the last couple of days, so I have been looking at the figures just to make sure. Around 60 per cent of our total funding goes on the national health priority areas, and the proportion of that is pretty much lined up with the burden of disease. So mental health funding is number 3 after cancer and cardiovascular disease in terms of the national health priorities. We would like more applications. Only 10 per cent of our applications are for mental health.
Senator WRIGHT: Did you say 10 per cent?
Prof. Anderson: Only 10 per cent of applications and about 10 per cent of funding. So it is proportional to the requests for mental health research. Having said that, we have put special effort into some capacity building in mental health research over recent years, with a $26.2 million special package a couple of years ago. That was to build centres of research excellence, a couple of targeted calls for research in early intervention and, because we were concerned about leadership and capacity building in the sector, we have given two very large fellowships-the largest fellowships we give-especially in mental health, and all of that is rolling out. That is only two or three years old, so it will take a while to build capacity.
We have done a couple of additional priority areas in recent years, one on suicide prevention in Aboriginal and Torres Strait Islander people. I have already mentioned the two large fellowships named after John Cade who, as you probably know, was the Australian discoverer of lithium as a treatment for depression. I could give you a breakdown of the various areas of mental health on notice if you like.
Senator WRIGHT: I would appreciate that. Thank you. Can I just check this: the suicide prevention funding, would that be something that you would characterise as being mental health funding?
Prof. Anderson: It was. It came as a call for help from what we call Principal Committee Indigenous Caucus, who are the Indigenous people on all NHMRC principal committees. They were worried about the causes of mental health problems in Aboriginal communities and wanted some very applied targeted research undertaken.
Eating disorders - data and funding
Senator WRIGHT: I will now come to the issue of eating disorders. I am interested to know what data the department has in relation to the prevalence of eating disorders in Australia in 2014 or recently.
Mr Booth: Again, I do not have that information on me. We would need to take that on notice and see who the appropriate organisation is that collects that type of data. We can certainly look into it and we would be happy to make that information available.
Senator WRIGHT: When you say 'the appropriate organisation', would that be a part of the department or an NGO?
Mr Booth: That is what we will look at. I do not have the eating disorder information with me at the moment but I am aware that a number of different organisations and a number of different NGOs work in the area of eating disorders. I am not clear and I cannot think off the top of my head whether there is a consistent data collection across all of them to pull that information together, but I will certainly look into it.
Senator WRIGHT: What is the current level of government funding allocated to address eating disorders in Australia?
Mr Booth: I would need to take that on notice.
Senator WRIGHT: Could you separate that into direct and indirect funding?