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Senator Penny Wright speaks on the second reading of the Medical Research Future Fund Bill

Speeches in Parliament
Penny Wright 12 Aug 2015

Senator WRIGHT (South Australia) (18:29): I rise to speak on the Medical Research Future Fund Bill 2015 and related bill. This is a bill which provides for the establishment of the Medical Research Future Fund, the MRFF as it is colloquially known. I want to put on the record, and reiterate essentially, what the Leader of the Australian Greens, my colleague, Dr Richard Di Natale, has said, and that is that we are keen to support health and medical research in Australia. We welcome the intention of the MRFF-that the fund strategies and priorities will foster innovation and translation. The Medical Research Future Fund is a transformative initiative that will provide significant funding in Australia and support innovative work to bridge the gap between pure research and the application of research results in the field.

It was only fairly recently in my career that I came to hear the phrase 'translational research'. I do not have a scientific background as such. Although I am very interested in science, I come more from a humanities and legal background so I had not actually heard that expression until I met a very impressive mental health practitioner, Dr Jayashri Kulkarni, who is associated with the Monash Alfred Psychiatry Research Centre, who talked to me about the importance of having translational research, particularly in relation to mental health research. So, as the Greens spokesperson for mental health, I am going to be making a particular case in speaking to this bill about the desirability of having much more dedicated and directed funding for research into mental health. I think it is not difficult at all if you look at the evidence to make the case for that.

Let us go back to what we know about mental ill health prevalence in Australian society in 2015. Mental illness is the third-highest cause of disability and premature death in Australia. In fact, it is very well accepted that one in four of us will experience some form of mental illness or mental ill health in our lifetimes. We also know, and it is not really contested, that mental illness costs the Australian community billions of dollars a year in both direct and indirect costs.

Recently, the chair of the National Mental Health Commission, Professor Allan Fels, was on the record talking about the incredible cost to the Australian community in terms of personal cost in lives lost and productive lives lost and participation, and also the financial cost to the community in lost productivity that flows from mental ill health in Australia. We know that it costs us all a great deal of money as well as quality of life. In fact, there is report after report that establishes the cost of untreated and undertreated mental ill health in Australia. A national survey of people living with psychotic illness in 2010, which was overseen by the organisation, SANE, found that for people with psychotic illness-just as one example-education achievement was low; 78 per cent of those people were unemployed; 16 per cent were either homeless or living in supported group housing; and 74 per cent were single. It does not take much imagination to understand the incredible loss of productivity just in that subgroup of people who experience mental ill health in Australia.

The fundamental problem is that the treatment of mental disorders in Australia has not progressed sufficiently. I think our awareness of the prevalence of mental ill health has progressed. Our understanding of the need to get adequate treatment has progressed. But in fact the treatment of mental disorders has not progressed at the same rate, particularly when we compare it with treatments of other illnesses, which once were much more debilitating than they perhaps are now-illnesses like cancer and heart disease. Once, decades ago, a diagnosis of most forms of cancer would have been a terminal diagnosis, and with amazing treatments and research that has occurred in those intervening decades there is a lot more hope for people who experience those sorts of illnesses.

So, despite the fact that there is such a huge financial loss from untreated and undertreated mental illness in Australia, only about 3.5 per cent of Australia's total medical research budget, for instance, was spent on research into depression and psychosis. Depression is a very prevalent mental ill health condition in Australia, and psychosis, while less prevalent, has very, very debilitating and life-affecting consequences for people.

Basic science research is important. Speaking to Dr Kulkarni and others, I have come to understand the absolute importance of having that research then translated forward into the development of new and effective treatments for people with mental illness, so that practically speaking there is absolutely important hope offered to those people. Early intervention is necessary but its impacts are only as good as the treatments that are available.

Service reform is also important, and there is huge a debate, conversation and dialogue going on at the moment in Australia, particularly on the back of the most recent National Mental Health Commission's review report as to how we improve service provision. But ultimately services will be impotent without new treatments to deliver to sufferers. So there is an absolute need to have better mental health research and translational research to provide the treatments that are needed.

I was interested to see that there was a very impressive and interesting article in The Medical Journal of Australia that was published in 2011. The authors of that article were like a who's who of some of the most influential thinkers and practitioners in the mental health space in Australia. So we had Helen Christensen of the Black Dog Institute, Philip Batterham, Ian Hickie, Professor Pat McGorry, Philip Mitchell and, as I mentioned earlier, Dr Jayashri Kulkarni. They did some research into comparing funding for mental health research between 2001 and 2010. They were really questioning whether or not the gap which we are aware of in relation to the proportion of the health research dollars that is going to mental health research had narrowed over that decade. They compared it with the research being done into other national health priority areas.

The findings of that research, reported in that Medical Journal of Australia article, were really concerning and did in fact confirm the fact that most people know that mental health research does receive lower levels of funding. They started off by looking at particular illnesses like cardiovascular disease and cancer research. They found that mental health research had received 9.5 per cent of funding, cardiovascular disease had received 21.7 per cent of funding and cancer research had received 14.9 per cent of funding. When they made adjustments for the burden of disease, they looked at things like-forgive me for the acronym-DALY, which basically is a way of trying to apportion the significance and the implications of particular illnesses and conditions on people's lives and functioning. DALY standards for disability adjusted life years. When they made adjustments for the burden of disease they found that diabetes, asthma, cancer, arthritis and cardiovascular disease, all important and life-affecting conditions, all receive proportionately more research dollars per disability adjusted life year than mental health conditions such as depression, anxiety, psychosis and so on.

For people who are very aware of the prevalence and the effects of mental ill health on people in their daily lives, that causes us a great deal of concern. In a sense, I suppose it reflects some kind of illogical way that we have developed our funding in the health system generally in relation to treatment of mental ill health. It is almost as though we have some kind of mind-body split where we privilege illnesses and conditions from the neck down perhaps more than we do illnesses and conditions which affect people from the neck up.

Mental health has traditionally always been neglected in terms of health funding dollars. There is a common understanding that in terms of burden of disease generally and mental health funding while the burden of disease associated with mental ill health is 13 to 14 per cent, in fact the proportion of health spending that is directed towards mental health funding is about half of that at six to seven per cent. So for a long time mental health advocates have been saying that we need to double the funding that is available to meet the incredible unmet need throughout Australia. Those people who have been following the sorts of work I have been doing over the last four years as spokesperson for mental health for the Greens will know that I have done a lot of work particularly in relation to unmet mental illness and mental ill health needs in rural areas of Australia. So while the funding for the burden of disease overall is about half what is needed, it is even less than that in rural areas, particularly when we acknowledge that 30 per cent of Australians live in rural, regional and remote areas and there is a great lack of both community based and clinical services, that there are too few practitioners who are qualified and living and working in those areas. That is a real problem for country people. Unfortunately we see the results of that in the recent Garvin institute report which came out last week and showed that country people are 66 per cent more likely to take their own lives. That is just one example of the effect of that unfairness and disproportion of funding in the system which does not flow on to people living in rural, regional and remote areas.

The Australian Greens are very clearly on the record as calling for increased funding of mental health research. Indeed after having spoken to Dr Kulkarni and being very impressed with the proposal which she brought to me in relation to a national institute of mental illness research, which would look at coordinating the often wonderful, exciting research which is happening in different institutions across Australia, with a need to coordinate that the Australian Greens developed comprehensive and thorough policy to support more mental health research that we took to the 2013 federal election having had it costed by the Parliamentary Budget Office. We did that on the basis that we understood that there is a desperate need for the development of new treatments which offer hope particularly for people who live with chronic and debilitating illnesses like schizophrenia, bipolar disorder and schizoaffective disorder. We need the development of new treatments for mental illness. Similarly for people who experience chronic depression, GPs and specialists need strongly to have tools in their tool kit which can offer people hope when they come to get the assistance they need.

On the basis of knowing that mental illness is the third highest cause of disability and premature death in Australia and does already cost the Australian community billions of dollars, how can we argue with the idea that investing properly in appropriate research and translational research and treatments would not be a good reward or good down-payment on that investment? The Australian Greens came up with a proposal to invest $150 million over three years to establish a national institute for mental illness research as an overarching, supervisory body for mental illness research in Australia. It was based on the well-thought-through proposal and that is still there. We are not talking about that today. We do not have the option to be promoting that but I hope I have made the case for much more dedicated and significant funding for mental ill health and mental illness in terms of the medical funding of research generally.

The Greens will be supporting this bill but I will be putting in a particular plug that when decisions are being made about which research should be funded that mental health stops being a Cinderella area and gets the priority it deserves.


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