HON ALISON XAMON (North Metropolitan) [9.59 pm]: I rise because I note that a number of reports are tabled at this time of the year and members could be forgiven for not having a chance to peruse all of them. A few specific reports attract my attention every year and I leap on them straightaway. One of them is the report from the Mental Health Advocacy Service, and I draw members’ attention to that report. For those people who do not know, it is a particularly important report because the Mental Health Advocacy Service is a statutory body established under the Mental Health Act and has the responsibility to report directly to Parliament about what is happening particularly within our locked wards, but also at a number of other mental health sites in Western Australia. This service is responsible for assisting people who are on involuntary treatment orders, people who are in psychiatric hostels, people who have been referred for psychiatric assessment, people who are subject to custody orders and a number of other classes of people who require assistance, such as children who are on voluntary orders. Of course, I want to acknowledge, as I always do, the really great work that is done by that service and the really good work that is undertaken by the advocates, because they are on the front line. This year they provided services to 3 117 people, including 93 children.

A particular strength of the annual report is that the consumer voice is given prominence and it includes stories of people’s experience in the system. Unfortunately, it again provides clear on-the-ground evidence of the failings of our mental health system. As our Chief Mental Health Advocate, Debora Colvin, notes in her foreword, the general themes of the report this year are fragmentation and the ongoing problem with the lack of integration of care. There is evidence that too often people fail to receive the services that they need in the community—this story is not unfamiliar to us—and reach crisis point, when they need emergency care. The report particularly emphasised that nowhere is this more evident than for 16 and 17-year-olds who experience a constant lack of services. The report notes that these children are falling through the gaps between our child services and our adult services. That means that we have a system that is not giving them continuity of care or appropriate post-discharge support. We know that there are not enough hospital beds. We know that there is not enough accommodation. This should be of particular concern because the number of 16 and 17-year-olds who are being placed on involuntary orders has almost doubled over the last three years. I am not suggesting that that is necessarily a bad thing on face value. Maybe it means that people are finally getting support, but if we do not have the services to back that up, that is a huge problem.

In 2018–19, 43 people aged between 18 and 24 years found themselves in prolonged hospitalisation in this state simply because of a lack of critical accommodation services. They were all excluded from step-up, step-down supported transitional accommodation services because they did not meet the admission criterion of having a discharge address. One young person was hospitalised for 110 days due to a lack of suitable accommodation in the community. I point out that the cost of that is astronomical. This is not a problem that is just of this government’s making. This has been a problem with the way the step-up, step-down services have been set up from day dot. These important services that we are establishing right around the state do not have policies that recognise that a lot of the people who require them are effectively homeless and do not have stable addresses. The fact that they are being denied this critical service strikes me as diabolical. I want to know why this is still a problem and why this has not been sorted out yet.

We know that it is a critical time for children around this age, and it is vital that children access services as soon as they possibly can. The research shows that 75 per cent of mental health issues that people experience will begin to develop when they are under the age of 25 years. If there is a lack of services for this age group when they are reaching out and needing it, this is creating a very, very real problem. Coincidentally, I note that Mission Australia sent, I presume, to all members—I got it—a report written in collaboration with Black Dog Institute Australia, which also raises the issue of increasing levels of psychological distress amongst our young people and finds that youth mental health is a serious challenge that needs to be addressed as an absolute priority. That report found that almost one in four young people said they were experiencing mental health challenges, with young females twice as likely as males to face this issue and a high proportion of Aboriginal and Torres Strait Islander young people also meeting the criteria for psychological distress. I think this makes the Mental Health Advocacy Service’s comments about services for young people even more concerning. We know we have an urgent need for improved access to services that are timely, accessible and appropriate for young people. I think the annual report is demonstrating how far we still are from being able to get there.

Other issues that were raised in the Mental Health Advocacy Service annual report were that consumers with eating disorders are experiencing fragmented care and that people with intellectual or developmental disabilities are being inappropriately placed in mental health acute wards, because it is simply becoming a provider of last resort. This is particularly so when people are displaying challenging behaviours. I have to say, I think I see a disproportionate number of people in this system because a lot of them get referred to my office. I think I have developed a bit of a reputation as someone who is happy to assist these quite complex cases. I need to acknowledge that the Minister for Disability Services’ office has been really good when I have had to liaise with it around some of those really complex matters, but it is a problem of a crisis with the system. People are being left in emergency departments or mental health observation areas—MHOAs—for days before they are admitted or released. The Mental Health Act allows for referral and associated detention orders in metro hospitals for a maximum of three days, and longer in some regional areas, but the Mental Health Advocacy Service has found that this is being breached all the time because the services are not there. The report states —

... people are stuck in hospital beds, delaying their recovery because there is nowhere for them to go, and others are effectively discharged into homelessness, only to find themselves back in EDs and hospital wards a short time later.

That is a direct quote from the report. Aboriginal people are 50 per cent more likely to be placed on involuntary orders than the broader population. The report found that there are wards with dirty, unsafe and dangerous conditions; there is a failure to communicate with family and with personal support persons; and that prisoners—surprise, surprise—are unable to access mental health services, something that I talk about in this place a lot. The report notes that at times during the year, up to 10 prisoners were waiting for a single mental health bed, and there is an ongoing lack of forensic inpatient beds, including for young people and women. It also outlined a lack of National Disability Insurance Scheme support for consumers with complex and/or chronic mental health conditions and, despite all these situations, the chronic underfunding of the Mental Health Advocacy Service itself, with the potential to have a significant impact on this vital service. One reason we should find that particularly concerning is that the Mental Health Advocacy Service has a lot of its activity defined by statute. It has to see patients within a certain time frame and it has to meet certain obligations.

There is a lot more in this report that I could mention, but I will not. I recommend that those people who have a specific interest in mental health consider the many issues that have been raised by the Chief Mental Health Advocate, who has been appointed to bring these issues to our attention. Many of the issues that remain in the report are ongoing. I would like to see some effort on the government’s part to address concerns raised in the report, and I would like to see some serious attention paid to making sure that the Mental Health Advocacy Service gets the funding it needs.


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