Commonwealth response to 'The hidden toll: suicide in Australia'

4.1 Roles and responsibilities

Page last updated: 2010

Recommendation 9
Recommendation 10
Recommendation 11
Recommendation 12
Recommendation 13
Recommendation 14

Recommendation 9

4.79 The Committee recommends that Commonwealth, State and Territory governments mandate that hospital emergency departments maintain at least one person with mental health training and capacity to conduct suicide risk assessments at all times.

Recommendation 10

4.80 The Committee recommends that Commonwealth, State and Territory governments review debriefing procedures and counselling support available to frontline workers regularly exposed to suicide and attempted suicide related incidents.

Recommendation 11

4.82 The Committee recommends that Commonwealth, State and Territory governments establish mandatory procedures to provide follow up support to persons who have been in psychiatric care, have been treated following an attempted suicide or who are assessed as being at risk of suicide.

Recommendation 12

4.84 The Committee recommends that Commonwealth, State and Territory governments provide funding for programs to identify and link agencies and services involved in the care of persons at risk of suicide. These programs should aim to implement agreements and protocols between police, hospitals, mental health services, telephone crisis support services and community organizations and to improve:
  • awareness by different personnel of suicide prevention roles;
  • expectations; and
  • handover procedures and continuity of care for persons at risk of suicide.
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Response

The Australian Government broadly supports each recommendation in relation to the roles and responsibilities of the Australian workforce, noting:
  • that State and Territory governments have responsibility for the management of hospital emergency departments, including staffing levels and mix, and training; and
  • legislative limitations in relation to privacy.

Strengthening the system

The Commonwealth Government will continue to work with states and territories, with the exception of Western Australia, to build a better hospital system through the implementation of National Health and Hospital Network (NHHN) reforms.

As part of these reforms, COAG have agreed, with the exception of Western Australia, to undertake further work on the scope for additional mental health service reform for report back in 2011.

The inclusion of suicide prevention in the Action Areas of the Fourth National Mental Health Plan will ensure for the first time that Commonwealth agencies and states and territories align and support each other's suicide prevention efforts. The Commonwealth is working with states and territories to progress relevant actions under the Plan to undertake promotion, prevention and early intervention; improve information flow for integrated care; and develop protocols to guide transitions between services, sectors and jurisdictions. An implementation strategy for all actions under the Plan has been endorsed by Australian Health Ministers.

The Commonwealth is working with states and territories to implement the revised National Standards for Mental Health Services11, which provide a blueprint for new and existing services to guide quality improvement and service enhancement. Consumers and carers can use the Standards as a checklist for service quality and as a guide about what to expect from mental health services. They cover public, private and non-government organisations and will be able to be applied in other places where mental health care is delivered such as emergency departments and primary care.

Supporting people on the ground

Specifically in relation to Recommendation 10, the Australian Government notes that professional supervision is a widely adopted policy principle and practice in many government and non-government organisations. For example, the Department of Immigration and Citizenship, and contracted service providers of this agency, have professional debriefing and counselling support available to staff exposed to critical incidents, including suicide and attempted suicide. Centrelink Social Workers are also available to help debrief and support local front-line workers who are exposed to suicide and attempted suicide in their day-to-day work.

Through Medicare Locals, the Government will address Recommendation 12 by expanding models of care which support linkages for improved safety and continuity of care.

Since 2008, the ATAPS Additional Support for Patients at Risk of Suicide and Self Harm Demonstration Project has provided intensive, prioritised service and post-discharge follow-up and coordinated care for those who have made a recent suicide attempt, have recently self-harmed, or have been identified by a General Practitioner to be experiencing suicidal thoughts. This project incorporates the services of the National Suicide Helpline and engages hospital emergency departments in both referral and continuity of care. It broadens the referral options of emergency department staff when patients assessed to be at risk of suicide are discharged from hospital. In addressing Recommendation 11, the Mental health: Taking Action to Tackle Suicide package will enable this pilot to be rolled out nationally through a $23.6 million investment.

The package will provide $115 million over three years to provide more clinical services for people with mental ill health, and those at risk of suicide. This includes: $22.7 million for More psychiatry services for people with severe mental illness to improve access to specialist psychiatry services in the community; and $60 million to Boost non-clinical support services for people with severe mental illness.

The Government also provides follow-up support and case management services for veterans and their families through the VVCS - Veterans and Veterans Families Counselling Service.

The Complex Case Support program for humanitarian entrants to Australia aims to provide individualised intensive case management support to assist clients with complex needs to overcome the barriers in accessing mainstream services by advocacy, coordinating care and assisting mainstream providers deliver services to clients in a culturally sensitive manner. The funding to service providers includes interpreting costs associated with delivering services to clients.Top of page

Recommendation 13

4.86 The Committee recommends that Commonwealth, State and Territory governments provide additional funding for graded accommodation options for people at risk of suicide and people with severe mental illness.

Response

The Australian Government notes this recommendation and is working with states and territories to implement a range of measures in this area.

The provision of affordable, safe and sustainable housing is key to enabling people to actively contribute within their communities, and achieve social, economic and educational participation and good health outcomes.

Reducing homelessness is a national priority. People experiencing, or at risk of homelessness, also have high levels of mental ill health. There have been significant reforms to Australia's housing and homelessness services, set out in the White Paper on Homelessness The Road Home: A National Approach to Reducing Homelessness12, supported by unprecedented levels of investment and policy attention across governments.

The National Affordable Housing Agreement provides Commonwealth funding of $6.2 billion for housing assistance to low and middle income Australians for the first five years from 2008–09. This is complemented by Commonwealth and state and territory funding through National Partnerships Agreements (NPAs), including $1.1 billion joint funding from the Commonwealth and State and Territory governments for the NPA on Homelessness; $400 million in Commonwealth funding for the NPA on Social Housing; and $5.5 billion in Commonwealth funding for the National Partnership Remote Indigenous Housing.

The NPA on Homelessness included an additional output: 'Services to assist homeless people with mental health issues to secure or maintain stable accommodation'. There are various initiatives run by the states and territories under this initiative.

Access to supported accommodation will also be improved by the Australian Government's $1.6 billion commitment to expand sub-acute care services by more than 1,300 new sub acute care beds and community-based equivalents nationally by 2013–14. This significant investment will increase access to palliative care, rehabilitation, geriatric care (comprising geriatric evaluation and management and psychogeriatric care) and 'step up, step down' mental health care in hospital and community settings. States and territories are currently developing their four-year Implementation Plans for the Commonwealth's consideration.

The Government is also providing $25.5 million over four years to expand the Early Psychosis Prevention and Intervention Centre (EPPIC) model beyond Victoria as a best practice standard of care in partnership with interested states and territories. The model targets young people early in the cycle of severe metal illness by providing early detection and management of psychosis through holistic support, including help with managing housing, education and employment goals.

The VVCS - Veterans and Veterans Families Counselling Service (VVCS) provides a Crisis Assistance Time Out Program to provide short-term accommodation to Vietnam veterans in crisis for up to five days, allowing time for the individual to seek VVCS assistance to help address the issues that precipitated the crisis, and to reintegrate them into the family and/or community.

Recommendation 14

4.88 The Committee recommends that the Commonwealth Government oblige health care staff to offer prior consent agreements, such as advance health directives and standing medical powers of attorney, to patients at risk of suicide.

Response

The Australian Government notes this recommendation and will raise it with states and territories through cross jurisdictional mechanisms and, as appropriate, with the Australian Health Ministers' Advisory Council. The Commonwealth's National Palliative Care Programs 'Respecting Patient Choices' project has been successfully trialed in hospitals, community palliative care services and aged care homes. Building on this trial, the Australian Government is working with states and territories on a draft National Framework for Advance Care Directives. The Australian Health Ministers Conference has released a proposed outline in “A National Framework for Advance Care Directives – consultation draft” (2010)13.

Footnotes

11 National Standards for Mental Health Services, Department of Health and Ageing: Canberra.
12 White Paper on Homelessness The Road Home: A National Approach to Reducing Homelessness, Department of Family, Housing, Community Services and Indigenous Affairs: Canberra
13 A National Framework for Advance Care Directives – consultation draft, 2010. Australian Health ministers advisory Council: Canberra. PDF available on Aged & Community Services website (www.agedcommunity.asn.au)