Tuesday, 2 August 2022

Mental Health and Wellbeing Bill 2022

Second reading

Debate resumed on motion of Mr MERLINO:

That this bill be now read a second time.

Ms KEALY (Lowan) (13:32): Deputy Speaker, congratulations on your elevation to the role.

It is an honour today to be the lead speaker for the Liberals and Nationals on the Mental Health and Wellbeing Bill 2022. The reforms that are ahead for Victoria are significant in the mental health space. We know that for many years, if not decades, the mental health system in Victoria has been in gradual decline from being deemed one of the world’s best mental health systems, where people from all over the world would come and see how we do it, to now being in a state of absolute disaster, where it is becoming more and more difficult for people to get the support that they need when they need it.

The failure of this government to put relevant supports in place in the community and to keep people well has meant that there has been a catastrophic amount of pressure put on our hospital system, with waitlists at emergency departments growing. For a number of people who are in emergency departments in psychological distress or psychological crisis the wait is not just for a few hours but extending out to a number of days—and this is not just for adults, it is for children as well.

The workforce is entirely fatigued. There were warnings in the government’s own reports in 2015 that the government must urgently act to recruit more workers in the mental health sector to ensure that we have enough people to provide the support that Victorians need and to make sure we have enough mental health practitioners in the state. However, the government failed to act, and as a result the state was completely underprepared when it came to dealing with the impacts of the coronavirus pandemic, lockdowns and restrictions.

The workforce issues were emphasised again by the Royal Commission into Victoria’s Mental Health System through its interim report, which was handed down in 2019, where five of the nine recommendations were very explicit about the desperate need to invest in building Victoria’s mental health workforce so that the state would be prepared for the vast reforms that are set down and that will take place in the state of Victoria in the years ahead. This failure of the government to invest in the workforce has meant that so many Victorians over the past three years simply were not able to get the mental health support that they needed when they needed it. And this crisis is not yet over. We see an escalation in demand for mental health services that has been sustained even though our measures to lock down and restrict the state have been eased to the point where only children who are at school have a surrogate mandate to wear masks at school—no other Victorians are mandated to wear masks.

If Victoria is going to rebuild and reform our mental health system, we need to have the workers to support that important work. It is not bricks and mortar that provide mental health support and consultations to people. It is not the legislation or the papers that are before us today that will change the number of workers in the system to provide mental health support to Victorians. It is simply down to training more workers, and that is where people are looking for the light at the end of the tunnel. Mental health workers are absolutely fatigued. They have done an outstanding job over the pandemic, but they need to see that light at the end of the tunnel and to know that more workers are on their way.

In many ways, because of the workforce challenges, the timing of this legislation—while absolutely necessary as part of implementing the Royal Commission into Victoria’s Mental Health System’s recommendations—has severely limited the ability of and the availability of time for workers in the sector to fully apply themselves to all of the recommendations as they have been put forward by the royal commission. However, I think there has also been a failure of the government in terms of consultation and being fully open about the legislation that was going to be put before the house and that would define very important limitations and obligations upon the sector, particularly when it comes to decision-making around compulsory treatment, restraint and seclusion. I will go more to those elements later, as I realise that this is something that is under review and will be reformed as part of a future iteration of this legislation.

It is important at the outset to note that the Liberals and Nationals are fully supportive of the royal commission’s findings and recommendations. We know that significant reform must take place in order to shift the standard, the expectation and the supports that are available to Victorians when they are at that point of need. This goes far beyond the proverbial ambulance at the bottom of the cliff of ensuring there are more mental health beds in hospitals. We need to make sure that people are able to look after their mental health and retain their mental health in the community and can avoid having to go to an emergency department or rely on a hospital in order to get any level of mental health support.

In terms of process, there was some disappointment from the sector in terms of not seeing a full version of the legislation that is before us today prior to this document being tabled in Parliament on the last sitting day before the winter break. It is certainly seen by many people in the sector as something that should have taken place. It would have given them the opportunity to further digest and understand what the limitations were of the document, of the bill, but also where the opportunities were for small improvements that would make a big difference to the outcomes of the legislation and how it will impact and reshape Victoria’s mental health system.

There are other elements around the specific content of the legislation and some recommendations that have been put to me over the past few weeks for simple changes that may assist to improve the legislation and make sure that no Victorian misses out as part of the review of the Mental Health Act 2014 and the inclusion of a number of recommendations from the royal commission’s final report. I would like to go into further detail around that now; however, I realise that in having only 30 minutes to debate such a substantial bill, which is over 750 pages long, I will have to give a short nod to some of the many organisations that have taken the time to not just review the legislation over this past month but also put their thoughts together in a cohesive way and provide those recommendations to me.

I am hopeful that these thoughts put forward today will be taken on board by the minister and that if any of these changes are seen as a good idea those amendments will be made to the bill prior to it being circulated in the Legislative Council, because in no way do the Liberals or Nationals want to impede or block the bill. We understand that there is a great desire within the mental health sector to have a governing framework that will ensure we have got the foundations to rebuild Victoria’s mental health system, and in no way is it the intention, nor will our actions require, to deliberately, or non-deliberately and inadvertently, destroy the bill that has been put forward. We are simply seeking to put forward amendments that we think are quite constructive, that are well supported by the community and that we believe would make for a stronger legislative framework for Victoria’s mental health system going forward.

The first point that I would like to go to is around Youth Mental Health and Wellbeing Victoria. This is obviously a very important entity to be established as part of the legislative framework, and in no way is there any intention to detract from that. However, there are a number of organisations across the mental health sector who have flagged that it is equally important that we establish a similar entity in relation to older Victorians. That might look like an ‘Older Adult Mental Health and Wellbeing Victoria’ organisation which has a similar structure and function to the Youth Mental Health and Wellbeing Victoria. I think it would define a really important place in the Victorian policy framework. All too often older Victorians are forgotten. This is through the entirety of the policy framework but never more so than when it comes to mental health, particularly around the area of aged psychiatry, supporting people with dementia and Alzheimer’s and also making sure we have important mental health support around some of those changes you have in your life as you age—whether it is about loss of ability, which could be about not being able to be as physically active as you used to be or, for some people, disengaging from the workforce and not having that understanding of where they fit in the world and how they contribute, and getting value from those changes as to where they fit. Also it is about loss of partners, loss of friends and loss of family and the isolation that can be very, very damaging and harmful to older Victorians.

I would have loved to have put forward an amendment today to establish a new entity of this type. However, the limitations of the house mean that I cannot put forward an amendment which requires an appropriation. Obviously establishing a new entity would require a number of appropriations of a similar amount as for the Youth Mental Health and Wellbeing Victoria. However, I would like to put on the record that I strongly recommend that people in the later stages of life should have an equal focus, particularly around policy development, to ensure their mental health and wellbeing is not forgotten just because the peak of their life is behind them and not in front of them. I think that is very, very important.

There are other specifics that I would like to raise, which may be given some consideration by the minister, in terms of revisions to the legislation and improving the legislation. Again this is intended to be constructive as opposed to destructive. I note feedback from DPV Health in regard to the language used around supported decision-making principles, and this refers to part 1.5 of the legislation:

We acknowledge the definition of this principle and advocate that ‘supported’ should be substituted with ‘enabled’ decision making to define that the power sits with the consumer.

Given this is in line with many of the recommendations of the royal commission and it is aligned with the intention of the legislation and what I am hearing from people with lived and living experience of mental ill health and illness, I think that this is worthy of consideration. Further, DPV Health have recommended a revision to part 1.5, clause 20, and alike language, so it is clear that the principle applies to enabling the family or carer to make decisions impacting their caring role at the point of assessment, treatment and recovery, rather than making decisions about the person’s assessment, treatment and recovery. That is supported by the carers that they consulted with.

I would also like to raise the concerns of a registered paramedic with HMS Collective in regard to the specification within the legislation that registered paramedics must be employed by an ambulance service as defined by in section 3(1) of the Ambulance Services Act 1986. There is concern that a registered paramedic who is employed by the ambulance service would not be able to perform their full scope of work if they were not employed with Ambulance Victoria. So if they were employed through a service like HMS Collective, a community paramedic service, on a part-time, full-time or casual basis, whether they were employed by AV or not, they would no longer be able to practise to their full scope but they could do some of their practise while working outside the ambulance service. There is concern that that could actually limit the work of paramedics within certain sectors, and so they have recommended in part 1.2, ‘Interpretation’, to add ‘registered paramedic’ to the definition in clause 3, ‘authorised mental health practitioner means’, and to remove the following words after ‘registered paramedic’:

… employed by an ambulance service as defined in section 3(1) of the Ambulance Services Act 1986 …

completely from the bill.

I also note comments from the Australian Nursing and Midwifery Federation, who are largely supportive of the legislation as it sits. However, they do have some further questions in relation to the responsibilities and roles. I think this is specifically in relation to a health-led response rather than a police-led response, and this is a theme that was raised a number of times by particularly people who work on the front lines and also mental health practitioners who highlighted those powers, which are seen I guess as the equivalent of police powers, to enter into a building to seize items and the like. They are in the 2014 iteration of the mental health legislation. However, the shift in focus to a health-led response may require a significant amount of education, training and perhaps additional funding as well to ensure that we have enough people on the front line in the health sector to be able to meet those requirements. I therefore urge the government to ensure that all elements of the mental health sector are appropriately funded to be able to deliver the services they need to make this pivot and switch from a police-led response to health-led response and ensure that there is sufficient time and funding for education and development of the supporting policies and procedures and other training requirements that may be required.

I would also like to refer to some of the recommendations which were received from PANDA, Perinatal Anxiety & Depression Australia. They are a fantastic organisation. I cannot speak highly enough of them. They really are the peak body when it comes to providing that important support for women throughout their pregnancy and once the baby is in the room. They note that there is no mention of pregnancy or care or pregnant persons at all in the bill, and given it is a bill that governs all restraint and seclusion practices it would be good to articulate the special circumstances of restraining or using physical restraint or chemical restraint on persons who are pregnant. I hope that this element of the legislation, particularly in regard to restraint, may be considered in the upcoming review over the coming year. They also make note that there is no principle of mental health related to age or state of development in the outline of the principles. Age and state underpin a significant amount of the mental health structure in Australia; however, it is not articulated and made explicit in this legislation. This is an opportunity to improve the legislation, and I think it should definitely be considered in terms of reviewing the bill before it goes to the Legislative Council.

The last piece of feedback that I would like to share is from the Australian Medical Association. They have some concerns which have been aired through the media, and I understand that they have been in contact with the previous Minister for Mental Health, particularly around the elimination of restrictive interventions within 10 years. I understand that this is a very difficult line to get right, because I have also heard from the Victorian Mental Illness Awareness Council, the lead body for people with lived experience and living with mental ill health and illness. There is a feeling from them that the government did not go far enough when it came to being specific and being more explicit and detailed in regard to elimination of these restrictive interventions within 10 years. I understand the concerns of the mental health workforce, because they go back to my comments when I opened the debate around the significant shortfall of workers which means so often there is no choice about whether restrictive practices are used because there simply are not enough workers available to provide that support to Victorians when they need it. That is absolutely critical. We see more and more use of restrictive practices and restraint in emergency departments because they have been completely overwhelmed by demand over the pandemic. I am very sympathetic to those views; however, I completely understand and support the view that restrictive practices should be ended within 10 years.

We certainly should have the aspiration to do so, but in order to do that we must be able to deliver an enhanced workforce so that every Victorian has that critical care circle around them and so that we can ensure that people do not get to that point of crisis in the first instance and that is the first point of care that they are able to access when they are in mental health crisis. But we also need to make sure we are supporting the workers to make sure they are safe, that there is not an increase in violence in the workplace and that they have enough workers so they can apply that support they want to deliver for an individual who is in mental health crisis. There is no clinician I have spoken to who wants to use that as a first port of call; however, the extreme limitation in the workforce means that is their only option. It is not supportive of the workforce. It is not supportive of people who are in mental health crisis. It is not supportive of their friends and family. I absolutely see that there is much more work that needs to be done in that area, and I encourage the government to ensure that that work is completed as quickly as possible because I am concerned that there is a window of opportunity where there is a mandate under the recommendations of the royal commission to take action in this critical area, particularly around restraint and seclusion but also compulsory treatment. We need to make sure we use this window of opportunity wisely and respond quickly. Otherwise I fear that window may close and the mental health sector, including the lived experience and carer sector, will not be able to see the outcomes that they so strongly desire in the near future. I urge the government to take immediate action on that to ensure that we do continue the momentum of the royal commission and see some real change for Victorians who need mental health support around those sensitive areas.

There is one further element which I would like to reference, and this is something that has been a gradual shift in terms of where the alcohol and other drug sector fits in terms of mental health. Traditionally alcohol and other drug support services and treatment have sat within the portfolio of mental health. In the change during the pandemic, where the former Minister for Health was previously the Minister for Mental Health, they took the AOD portfolio with them and the Minister for Mental Health did not continue with that element. The member for Monbulk did not have responsibility for the alcohol and other drug sector; it was just mental health. The member for Albert Park, just for clarity, had responsibility for AOD, including health. This has led to the alcohol and other drug sector feeling like they have been left out of the room when it comes to mental health reform discussions. We know of the close correlation between the work that the AOD sector does and people with mental ill health and mental illness and, vice versa, the cross-correlation, I guess, the dual diagnosis of people with mental ill health and illness who in many instances are self-medicating with alcohol and other drugs, which can lead to very, very harmful behaviours and exacerbate existing underlying mental illness. Therefore, under standing orders, I wish to advise the house of an amendment to this bill and request that it be circulated.

Opposition amendment circulated by Ms KEALY under standing orders.

Ms KEALY: This is a very simple amendment which will insert ‘including alcohol and other drug support services and treatment’ into clause 12, page 36, line 9, after the term ‘wellbeing’. This is a very important shift in the legislation. It is intended to be constructive rather than destructive and will ensure that the alcohol and other drugs sector is explicitly defined as part of the mental health and wellbeing sector. This is something, as I said, that is strongly supported by the alcohol and other drugs sector and builds upon other work that the Liberals and Nationals have been doing to ensure that the alcohol and other drugs sector, including support services and treatment, is not forgotten as we go forward in implementing the royal commission’s reforms. Importantly, by including a specific reference to the alcohol and other drugs sector within the objectives of the bill it will enable the alcohol and other drugs sector to be seen as an acceptable entity to be funded as part of the expenditure of the mental health surcharge.

Now, this is not intended to take a big bite out of that cherry, but the alcohol and other drugs sector at the moment is floundering. It is sitting between this large sum of money which is going to be raised and allocated to the mental health sector as part of the mental health levy and the funding behemoth of health, and it is being squeezed out. We are seeing that have a devastating impact on alcohol and other drugs services across the state. This year was the first year in over 17 years when there has been a net funding cut to the alcohol and other drugs segment. We also know that there has been a significant cut in support of their workforce, with 100 FTE alcohol and other drugs workers cut from the budget as part of this year’s vast series of cuts to various services across the state. We have also seen a $40 million cut this year to the alcohol and other drugs sector.

As was found in the Pandemic Declaration Accountability and Oversight Committee hearings, there has been an escalation in demand for alcohol and other drugs support services right across the state. That is why the Liberals and Nationals last week committed to an additional 180 alcohol and other drugs treatment beds right across the state. This is treatment, and it covers off on withdrawal services as well—because we know there is a critical gap when it comes to accessing detox, which is the first step towards being able to secure a residential rehabilitation bed. This will meet many of the requirements that have been set out by Infrastructure Victoria and fill the gaps across the state, particularly in areas like Mildura, Warrnambool and Shepparton; the Latrobe Valley, where they have not got access to adult alcohol and other drugs services; and also Frankston, where they have missed out for such a long time on access to critical residential rehabilitation services. We will also establish a 30-bed withdrawal facility here in Melbourne, which will end the bottleneck. We know that this is desperately needed. There are now over 4000 Victorians on the waitlist for alcohol and other drugs treatment services, and yet we have seen cuts by the Andrews Labor government. This is such an important element of the mental health sector and of overall treatment.

It is essential that the alcohol and other drugs sector is not forgotten as part of these important mental health reforms. It is something that has been highlighted through the royal commission—the importance of dealing with alcohol and other drugs as a dual diagnosis as part of the mental health sector—and so that is why the Liberal-Nationals today will put forward this amendment that I urge the government to support, and the crossbenchers also, to make sure that alcohol and other drugs are explicitly recognised and seen as an important spoke in the mental health sector going forward.

I would like to continue after this; I think I have got about 3 minutes to go but 30 seconds until the break. These are the key elements that I see as important in the bill. We need to make sure we support these important changes, we support the royal commission’s recommendations and we finally rebuild Victoria’s mental health system. We need to make sure people can get the mental health support that they need when they need it. But most important is that we include the reference to the alcohol and other drugs sector and we make sure that we rebuild Victoria’s mental health workforce so that workers can see the light at the end of the tunnel and know that they have got support on the way.

Business interrupted under resolution of house today.