There have been many reports into Australia's mental health system, and its failures are well known and widely discussed: high costs for many patients and terrible shortages of psychologists and psychiatrists that mean long waits, long distances to travel or people simply not seeking the help that they need. That's particularly the case for children, with big gaps in treatment for eating disorders, failures of community care and a horrific suicide rate. Our committee already knew these things, and our inquiry has been focused on what has gotten better or worse as a result of a summer of bushfires across much of the nation and then COVID—and, of course, for areas like mine, you can add in floods.
What we've found is that COVID rushed forward what might otherwise have been tentative and overdue steps to telehealth, giving people no option if they wanted to continue their treatment and providing, for some, an easier access to new treatment. But, of course, it hasn't worked for everyone. As we say in the report:
While evidence strongly supported the increased availability of telehealth, there was broad agreement that it was most effective as part of a suite of mental health services.
We supported the calls by the Productivity Commission and others to make permanent the access to psychological therapy and psychiatric treatment by videoconference and telephone which was introduced during the COVID-19 crisis. We need to see that funding and that allowance made permanent. We'd also like to see ongoing funding for digital mental health research, considering the increased prevalence of mental health problems and the rapid expansion of this virtual mental health care.
As for any step forward, there have been steps back. The need for mental health services has blown out as a result of the disasters and the pandemic that we've experienced. I asked one witness: at what point do resilient people—like those in my community, who've faced fire, flood and COVID, affecting every aspect of their life—flounder? His answer was simple. He said, 'You're resilient until you're not.' I speak with people on an almost daily basis who say that the consequences of bushfires, floods and COVID—the impacts on their business or their work, their access to family members or the effects of isolation—have broken them as never before. We know that, when it comes to natural disasters, the greatest need is not necessarily the day after the disaster. It might be weeks, months or even years. Each one of us is different, and we can't easily predict what will break someone or what will make someone else stronger.
We do know, though, from Black Dog Institute figures, that every year more than 65,000 Australians make a suicide attempt. Suicide is the leading cause of death for Australians between 15 and 44 years of age. Young Australians are more likely to take their own lives than to die in a motor vehicle accidents, and the suicide rate among Aboriginal and Torres Strait Islander people is approximately twice that of non-Indigenous Australians.
A key recommendation of our report is to make services accessible to everybody. That means physically accessible and financially accessible. Help needs to be affordable. We recommend looking at the viability of bulk billing incentives that are currently available to GPs being similarly made available to other mental health practitioners where patient affordability is an issue. Safe access to services needs to be increased for the LGBTIQ+ communities, for people who are culturally and linguistically diverse, for people in rural and remote areas and for First Nations people. A number of the 44 recommendations in the report request urgent action on these matters.
Of course, we heard much evidence about the impact of the pandemic and natural disasters on young people. Patrick McGorry, executive director of Orygen and professor of youth mental health at the University of Melbourne, points out that, even prior to the pandemic, the system was already woefully unable to meet the level of need. He estimates a 30 per cent increase on top of the normal level and describes it as a mental health emergency, where young people who are seriously ill, in life-threatening situations, cannot get the help that they need.
I want to talk about schools and the conclusions we drew after taking much evidence about the important role they play and could play in the future in helping young people manage their mental health, helping to prevent suicide and assisting with emotional wellbeing. We heard that, as I think we in this place would all know, school counsellors play a vital role. They bring qualifications to the job that make them a key part of tackling these complicated issues in many young people's lives. We also heard of the impossibility of the task, given how few of them there are. When you hear of a counsellor having a day or two a week at a school, it's no wonder there are kids failing to access that support and that counsellors report an impossible workload. We've recommended that the government work with state and territory governments to increase the ratio of school psychologists to a minimum of one full-time equivalent onsite for every 500 students across all levels of schools. This will support the work already happening in some states, but it needs to be a minimum. We need to make sure that the best use of government funds is made in our schools to ensure quality mental health support.
We can't underestimate the benefits of early intervention of access to quality mental health services. It's obviously the right thing to do, but it's also the cost-effective thing to do. There are such big gaps for young people, and I see them in my own electorate in the Hawkesbury where there is no headspace to allow an easy access and early intervention for young people. Young people need to be able to walk through youth focused doors and deal with people who understand where they're coming from. As the Katoomba headspace shows: build it, and they will come. Katoomba's demand has exceeded its expectations since opening 18 months ago. It is shameful that there's no headspace in the Hawkesbury and that this government has done absolutely nothing to fix that problem.
One of the big obstacles that we see in many of the issues related to improving access to mental health services is workforce. There wasn't a single witness who told us that they had all the workers that they needed to meet the demand. The government needs to act on finalising the national mental workforce strategy as a matter of urgency. We have multiple recommendations in this report to address workforce issues such as extending funding to five-year cycles so organisations like primary health networks can offer some security to their workers beyond one- or two-year contracts, which may help reduce people leaving for more secure work. Another issue we looked at is around the role of peer support, and there is more work to be done to ensure that the lessons being learnt about peer workers and the role that they can play are shared across the country.
Suicide Prevention Australia told us that less than half of the people who die by suicide access, or may even need to access, the mental health system. They talked about life events that can lead to suicidal distress such as marriage breakdown, economic instability and/or job loss and housing distress. They are the elements, they said, that have an impact on a person's potential suicide risk. So, instead of a focus on mental health support, they want to see a model of peer support where it's not about a clinical issue but mates helping mates. We certainly see these approaches happening in the building industry in my electorate. These sorts of workforces are critical in ensuring there's a safety net for people, preventing them from getting into suicidal distress.
Our committee also recognised the work of pharmacists and other allied health professionals, and the extraordinary things they do in this space. We didn't overlook carers for whom the current system doesn't work well. It doesn't support them, and we recommend a national carer strategy which includes a way for unpaid carers to be integrated into care teams and to access training for suicide awareness and prevention.
I want to thank the individuals and groups who made submissions to this committee, including the Mountains Youth Services Team from my own Blue Mountains. Their evidence of the high rate of suicidal ideation that they see in clients was confronting, and the support they provide to young people in crisis situations is no doubt replicated by other similarly underfunded organisations, remembering that many of these services are designed to provide broad youth services rather than specialist mental health services.
I make particular mention of committee chair Dr Fiona Martin, the member for Reid, who has led this committee and ensured that no voice was left unheard. I want to thank both the deputy chair, the member for Dobell, and the member for Werriwa for your commitment to the intense winter days in quarantine and lockdown that we spent taking evidence. I also acknowledge my other committee members. It was clear that our collective determination to see action on these matters drove the work we did. I commend the report and thank the secretariat for their work in making it possible.
