Introduction
Thanks very much to Jennifer for that very warm introduction. And I would equally acknowledge your contribution in the conduct, the direction and the outcome of the national plebiscite and a change which will be defined, I think, in terms of equality and the way the nation sees itself, not just over this decade but in decades to come.
It’s been a fundamental moment and you’ve been a real leader, along with Frank, in Mental Health Australia, all of the board members and all of the members in this room.
As I came in to Old Parliament House, I looked around and I thought of the history. First of all, actually, the Indigenous history and acknowledging the role and the history of the Ngunnawal and the contemporary engagement.
The fact that now we have such magnificent members of Parliament, in Ken Wyatt and Linda Burney and Pat Dodson and so many others who are representing Indigenous Australia.
But I thought of the political history that comes with this building and the front steps and the back corridors, I think, are well known to many of you.
And of course, the personal history. Many of us in Federal Parliament have become amateur genealogists lately.
In fact, I’ve been doing some research of my own and I did discover and I re-confirmed that I was born in Frankston Hospital, that’s Frankston, Victoria - i.e. Victoria Australia!
My mother was born in Stawell, Victoria, Australia. My father was born in Peterborough, South Australia. And I was delighted to discover, and somewhat relieved that my maternal grandma was born in Ararat, her husband was born in Cobden and my paternal grandparents were born in Orange, New South Wales and Semaphore, South Australia.
One-hundred per cent pure Aussie beef.
That history which we all go through has been very, very important. I was thinking of the history of so many Australians and as we do look back in the past we discover our own stories and the stories of our family and the challenges that each person faces and each family faces.
In many ways, mental health is a reflection of that. It echoes through the generations that a crisis in one generation, whether it’s alcohol or drugs or prescription drugs, mental health can very easily translate and echo down the ages.
And I particularly want to begin today by acknowledging three women. Firstly, Grace Groom, secondly Jackie Crowe, and thirdly, Kathinka Grant, who I’ll explain in a minute.
In terms of Grace, this oration is named after someone who left the planet early but after having given so much.
A predecessor of Frank’s, and so he follows in very distinguished footsteps. But her work was the highlight of lived experience and the fact that we needed to consider mental health services from prevention to treatment to research, from the perspective of those who have lived experience.
And I look around this room to the incredible names and faces, and I won’t single you all out, are testament to her legacy that that has become a binding principle, and never more so, of the way in which mental health services are delivered within Australia.
Not perfectly yet, by any means, and there’s a long way still to go. But that road has moved from being something which was a desert and only ever travelled in the black of night, to highlighted and increasingly travelled by the light of day.
And that brings me to the second person I mentioned, Jackie Crowe. Now, I was going to talk about Jackie at the Mental Health Prize but I wasn’t able to talk about Jackie because I didn’t think I’d get through what was a very upbeat event.
So, I’ll do my best now. Now, Jackie, as we all know, had a very crushing lived experience. But she was not defined by that, she transcended it and her work on the Mental Health Council and her work in helping to lead the design of the Head to Health website was all about engaging people in a way where those who most needed help at their moment of greatest need were able to seek that help.
And so, her loss will be enormous. I won’t dwell on it because that would not be a good place for me to go today. However, I just want to acknowledge her immense work and it will not be lost and it will always be honoured.
The third person I’m going to acknowledge is Kathinka Grant. Now, you might ask who’s this. Well, for the first 25 years of her life, she was Kathinka Grant, for the second 29 years she was Kathinka Hunt.
So, this was my mum. And she was a nurse and she lived a very upbeat life. But as time wore on, she was a woman who suffered from bipolar.
And it wasn’t as difficult as some cases, it was more difficult than others. And there were all of the dark moments, which I think everybody here knows and understands. But there were also the light moments.
I think I mentioned one at the Mental Health Prize. And another one, she was an amateur gastronome, she liked to grow her own food but also to keep her own food. Unfortunately, the nature of her condition meant that sometimes she was a little out-of-touch with modern food hygiene standards.
And so, there was one occasion, which myself and some friends pointed out, that she had this thing for large salamis. We had a five-kilogram large salami hanging from the kitchen wall.
As it was turned around, it was pointed out that there might have been a large amount of mould and this had become a living experiment.
And I can bet that I am the only person to have been chased around a dining room table with a mother wielding a five-kilogram mouldy salami as a potential life-threatening weapon.
And so, great joy, but also all of the great hardness. And so, we lost her earlier, as we do so many people with mental health where they are linked with chronic illnesses and conditions.
And I think that that’s a critical part of what we need to focus on in terms of our research, the linkage between mental health and chronic illness. And I see people such as Kim Ryan here and Helen Christensen, who are focussing in this area.
So, today I want to particularly focus on mental health research as part of a broader analysis around four areas. Firstly, to look at the challenge of mental health diagnosis and treatment and services in Australia.
Secondly, to look at the response, thirdly, to look at the Fifth National Mental Health and Suicide Prevention plan, and fourthly, to examine new directions in research going forward.
Before I do that, I do want to acknowledge, Frank, the work of Mental Health Australia to announce that over the coming two years, in order to assist with your coordination and leadership of national research, we will honour, through the Grace Groom Oration, an additional $300,000 to assist in that work. It’s a small recognition of the incredible leadership of everybody here and the coordinating role of Mental Health Australia.
1. The mental health challenge
So let me begin the substantive element with a focus on the challenge. Now, everybody in this room knows and breathes the challenge. They understand that there are 4 million Australians who have some form of mental health condition in any one year.
Now, that includes up to 2 million with anxiety, a million with depression, and then so many more with complex conditions, which includes suicidality, eating disorders, include bipolar and manic depression, and then different psychoses, a full range and spectrum of challenges which affects different people in different ways.
But our real task is then as we say, and here’s where I want to acknowledge the work of SANE and beyondblue, previous speakers, whether it’s Nicola Roxon, Jeff Kennett, Jennifer and so many others, is the path of destigmatisation and normalisation.
1.1 Normalisation
Now, this has been going on for two decades now, a lot longer in many ways, but only two decades, and you can almost trace it to the founding of beyondblue, and we’ve made enormous progress.
The ability now to talk about these issues, to talk about these challenges, is very, very real, and it’s part of the national discussion, the ability of individuals to be able to refer to their situation without fear of being judged in the workplace.
As we see right now with the laws relating to our medical professionals, something that Kim and I have been working on, is an example of the past still being with us, where medical professionals cannot seek treatment without having to suffer through mandatory reporting, which of course is a prohibition to people seeking treatment because of the fear that their professional world will be compromised, and that says the worst of things to the medical professionals.
So that is something which, with the other health ministers, I am pleased that we’ve made a commitment will be changed at national and state level.
That sends the message to the profession that deals on the front line that they can seek help, but it sends the message to everybody that this is part of the normal process of life, where 40 per cent of people over the course of their lives are likely to need or seek help or treatment, that that is a normal condition.
So that is the next great task, normalisation. Related to that of course, though, is services. The culture of the country is fundamental, but so are the services.
1.2 Services
So that is the next great task, normalisation. Related to that of course, though, is services. The culture of the country is fundamental, but so are the services.
So right now our task is to expand and develop services on both fronts, and that’s in hospital and out of hospital, clinical and non-clinical in terms of the psycho-social supports and some of the challenges.
The great advance of the NDIS has had a perverse effect, which I’ve discussed often in public, that some of the psycho-social services are being sucked out of the broader community arrangements. So right now we have to reverse that.
So those are the starting points in terms of the challenges. Then we go to the question of the response, and the response really covers a number of areas. Let me begin with the status and role of mental health within our Long Term National Health Plan.
So the Long Term National Health Plan has historically dealt with primary care in hospitals. We’ve expanded it out to be a four pillars structure, precisely so as to recognise the need and importance of mental health.
Primary care, which is about being able to access the doctors and nurses and medicines that people need, when they need it, where they need it, and in a way which is affordable, that is a fundamental basic of our health system.
2. Response
2.1 Long Term National Health Plan
So the Long Term National Health Plan has historically dealt with primary care and hospitals. We’ve expanded it out to be a four pillars structure, precisely so as to recognise the need and importance of mental health.
Primary care, which is about being able to access the doctors and nurses and medicines that people need, when they need it, where they need it, and in a way which is affordable, that is a fundamental basic of our health system.
The second is our acute care through our hospitals, ensuring that we have long-term, world-class hospitals at the public level, also at the private level, and through the private health insurance.
Private health insurance in Australia is a fundamental part of the model that we have, and I think we have a superior model to either the United States or the United Kingdom, they’re two different versions of delivering health systems.
That’s not a negative reflection, it’s a positive reflection on Australia, but the fact that we need all three components working together, because people then have coverage, they have the ability to be in private hospital, and that takes pressure off public hospital waiting lists.
So we’ve made very good progress on that front. Thirdly, we have research and the process now of the Medical Research Future Fund, and the doubling of medical research funding around the country, and the national initiatives, including the Brain Cancer Mission which we announced very recently, which will be a galvanising moment in oncology treatment, particularly for some of our youngest Australians who face the most tragic blastomas.
And then there is the fourth pillar of mental health and preventive health, for the first time raised to the highest level within our Long Term National Health Plan. It was a deliberate, conscious decision which came about from your long-term work and advocacy, and an overdue moment where mental health was given that status.
And it may have been a long time coming, but in my judgement it’s something which will now be a permanent feature that will abide across all different governments going forward. So then that brings me to the funding, and I don’t want to dwell on this too much.
2.2 Funding
This is a very significant funding pool, just over $4.3 billion of federal funding expected this year in the mental health space, and that includes our hospitals, our Medicare services, and our medicines.
We know that there’s just over half a billion dollars of funding for prescription medicines, which can include very complex and very expensive medicines or more basic ones.
All of those are covered, but it’s my particular focus to ensure that our treatment services are expanded, and that’s why in this year’s budget we were able to place an additional $80 million into psycho-social services for outside of the NDIS treatment, to ensure that what occurs in the NDIS is replicated outside of the NDIS in terms of the psycho-social treatment.
But I’ve been working with Frank and so many of you in ensuring that the states sign up to this, because the way we’ve done it is, if I may say so, a particularly crafty piece of federalism, and that is that we said that we will match what the states will do up to $80 million.
We will not reduce that funding if one state doesn’t participate. If one state doesn’t participate, we’ll reallocate their funds to the other states.
So there is a great deal of incentive for Tasmania to sign up and to be the first state and to say to the others, if you don’t come on board we’ll take all the $80 million. But what it does is it locks in our funding, but also locks in the state funding, and I think that that’s the extremely important part of it.
In addition to that, the focus on youth mental health services over the last year through the support of headspace around the country, climbing to 100 and now to 110, with a particular focus on rural health areas and reaching out to people who are in desperate need, these are some of the initiatives that we do.
2.4 Online and telehealth
But one of the brave new fronts and bold new fronts is the combination of telehealth and eHealth, and there are many people in this room who have been involved in that task, and this is about the ability to deliver services to people in rural and remote areas, but also to deliver services to people at 2am and 3am and 4am in the morning, in the black of the night, when the risk and the need are sometimes the greatest. And so there are a series of initiatives on that front which we’ve been supporting.
As of 1 November, there are the new services available for rural telehealth psychological consultations. This is a really important initiative to expand the number of telehealth services available.
That will mean that instead of having to travel to a city, instead of having to rely on the presence of a specialist who might not be available in a small town, people will be able to access those services earlier and on a more frequent basis.
The second of the breakthrough services is the Head to Health website, and that’s a gateway. It’s not meant to be a replacement for the unbelievable work that so many in this room and elsewhere do around the country, but it becomes a portal, a guide, an avenue, a way in which people can break into the system if they don’t know where to go.
What is interesting, we threw away all of the rules and we simply designed it with the people who most needed the help. We had young Indigenous Australians, we had older veterans.
It was led by Jackie Crowe, and I’m very happy, very happy with the design of it, and only nine days before we lost Jackie, the Prime Minister and I were with her and with those who helped design the system, talking to her and the fact that this was a genuine consumer-led process.
And they didn’t hesitate to say that something was a bad idea, and to design it and to deliver it in a way in which somebody who doesn’t know anything about their issue, they just know I’ve got a crisis, they can go there and they can find their way to the very things they need.
And then all of that leads to the third of the services, which is currently being supported by the Commonwealth and being developed at the moment, is the Synergy project, the work of Black Dog and Ian Hickey and so many others is being embodied in this, which will provide a deep clinical tool, and be able to provide real diagnosis to give people an opportunity to help with their own cases.
Many would want to go face to face. Many will want to work over the telephone, but sometimes the very nature of the conditions that we all face means that people will want to seek first help online and to understand their own challenges, and this is now a possible and emerging and an increasingly important part of our armoury, particularly for young people.
3. Fifth National Mental Health and Suicide Prevention Plan
So then this brings me to the overarching framework, the Fifth National Mental Health and Suicide Prevention Plan. And I want to break this up into three parts myself, mental health, suicide prevention, and then the vision going forwards.
In terms of mental health and the Fifth National Plan, there are really three parts that I want to draw out and emphasise, and the plan is available and out there.
It’s come about from genuine deep consultation, but firstly, there is the opportunity for workplace reform and the workplace as being a frontline way of supporting those who have emerging mental health challenges.
3.1 Workplace
This is something that Jennifer and I talked about with her BCA hat on, and I believe that we should now work towards the top 50 companies in Australia, and progressively the top 100, and as well as the small business initiative for workplace mental health identification and support.
I don’t mean in terms of mandatory reporting, completely the opposite, but creating a culture and a support network where individuals feel that they can seek assistance, and if you can do this early, it is one of those areas where, of course, there can be a supportive peer environment.
And so the top 50 companies, through the ASX, as well as the private, is something that we’ll be working on with the BCA, and we’ll be working with the Small Business Council on providing small business support going forward.
3.2 Indigenous mental health
Second of the areas is Indigenous Australians. Now, in terms of Indigenous Australia, we know that there are higher rates of alcoholism, chronic tobacco use, prescription addiction and non-prescription drug addiction and abuse.
This is related, both in terms of cause and effect, to many of the mental health challenges. So we will be working on a real Indigenous Australian mental health plan and initiative as part of the Indigenous Health Plan that Ken Wyatt is bringing forward.
We’re looking to bring that forward by the middle of 2018, and mental health will now be, for the first time, one of the fundamental pillars of the Indigenous Australians Health Plan.
3.3 Eating disorders
Then the third of the areas, which is a personal focus, and I see Christine here from The Butterfly Foundation, is eating disorders.
And one of the strange things since I’ve been in this role is just the amount that you discover, and I was aware of and I knew people who had been through challenges of eating disorders. I’d not quite understood the extent and scope of it, and then the degree to which it is one of our truly chronic and hidden conditions. In other areas, we know that there are role models.
This is a harder area for role models. The very nature of emphasising the challenge that young people, overwhelmingly young women, face, but then carry with them over the course of many years, and in some cases decades, means that it’s not tailor-made for role models, therefore, we have to provide the supporting services.
In that respect, I’ve asked the Medicare taskforce, led by Professor Bruce Robinson, to strongly consider new Medicare items to assist with those who face eating disorders to provide the additional care and support that are required.
The costs aren’t just prohibitive, they can be crushing in many cases, and so we have to change that paradigm and provide more services and more Medicare support in order to do that, and I am confident that over the course of the next year we will achieve that outcome.
So they are three of the particular areas of focus, but there are many more within it.
3.4 Suicide prevention
The other part in this, of course, is that we recast from being the Fifth National Mental Health Plan deliberately to being the Fifth National Mental Health and Suicide Prevention Plan.
I wanted to do that after talking with many in this room to say that this is a national crisis. Three-thousand Australians on average at the moment are taking their own lives. The human scale, of course, is close to 100 times that when you take the ripple effects of schools, families, communities, workplaces.
This year, we’ve had a 5 per cent reduction, a reduction of 60 people. That’s two busloads of lives that have been saved, but there are still close to 3000 who take their lives, which is a catastrophic outcome.
So going forwards, our task will be to expand the research and the resources, but in particular, to focus on, amongst other areas, the discharge from hospitals of those who have had suicide attempts or who have been admitted for suicidality and self-harm. And I say that because this is the area where we have the single highest rate of identification beforehand of those who go on to take their own lives.
So we know the individuals, the individuals who are most at risk, and therefore, working with states and the sector, the post-discharge task is right up the top of our list.
There is, however, more to do than just the Fifth National Mental Health and Suicide Prevention Plan.
We held a roundtable only a week ago, less than a week ago, with many in this room, to focus on the great tasks ahead, and the combination of Kim and Peggy Brown laid out to me something that I hadn’t realised, that in a way there was no overarching long-term national vision for mental health.
3.5 Vision 2030
And so today I want to announce, in honour of Grace Groom and in recognition of the needs outlined by those in this room, that we will develop a Vision 2030 long-term national mental health blueprint.
I think this is going to be a seminal document, and a fundamental blueprint going forward. It’s not just going to be something that sits on the shelf, it will take what we’ve done with our successive National Mental Health Plans, but it will cast out a national vision and a direction which will hopefully survive different governments and different incarnations of governments and be something that will be periodically updated so as we have a Vision 2030, and in time that will be evolved to a Vision 2040 and Vision 2050 by successive governments.
And I think this is critical and I want to acknowledge, Peggy and Kim, your suggestions in developing and allowing us to create that blueprint for the first time in Australian history.
4. Research
Then this takes me to mental health research. Now, research is one of our critical pillars in the Long Term National Mental Health Plan, but within mental health I believe there is the ability to give greater emphasis than that which has previously been delivered.
4.1 Importance
Let me begin with what we have done recently. In terms of recent action, I was delighted at the Budget that we were able to support the Thompson Institute on the Sunshine Coast with a $5 million grant to focus on youth depression and anxiety and other illness.
We were able to support Black Dog Institute along with the Hunter Institute in their research to assisting with chronic conditions.
And then we were able to support Orygen in Melbourne and the work of Professor Patrick McGorry and others in providing youth reach out services and looking at the headspace model.
4.2 Medical Research Future Fund
Those were tremendously important steps forward, but now we have for the first time the Medical Research Future Fund.
The Fund, as a whole, is growing from $60 million to $120 million this year, to $220 million, to $380, and $640 million. Mental health research will be part of what we do. The structure that we’re using is patients, researchers, national missions and translation.
I want to announce today that one of the national missions, in addition to what we’re doing with the Australian Brain Cancer Mission, will be a national mental health million minds mission and that will be twinned with what we do in the 2030 blueprint to aim to improve and to help a million minds over the course of that period.
There will be funding that will come to it that will be announced in the Budget process and we will work this through, the content of the national mission, as we develop the vision 2030 blueprint.
4.3 National Health and Medical Research Council
Related to that then, of course, is the National Health and Medical Research Council. We’ve had some tremendous outcomes, $29 million announced earlier this year but one of the gaps has been that there has been no specialist National Health and Medical Research Council mental health advisory committee.
I am delighted to announce today that there will be a National Health and Medical Research Council medical research advisory committee. It will be led by Professor Jane Gunn from the University of Melbourne with a total of nine members, the names of which will be shortly released, and that will help focus the work of the NHMRC on mental health research.
And this means that we will be covering neuropathology, we will be covering social determinants, optimal treatment regime and the particular needs of indications and patient groups around the country.
Then, associated with all of that, where I want to finish today is with the joyful task of being able to announce that this year’s National Health and Medical Research Council major projects, chronic disease and program funding, will include 47 new projects and recipients with $53 million allocated to mental health research in Australia.
That funding will include $3.1 million for the Menzies School of Health Research to focus in particular on one of the very things I began with today, which is Indigenous communities and the challenge and relationship between substance abuse, anxiety, depression and the steps forward in breaking that cycle.
It’s a difficult task, it’s a fundamental national task. In human terms, there can be very little of more challenge for this country at this moment in time. And in addition to that, $1.5 million to be led by the University of New South Wales for work on youth substance abuse and the relationship with mental health.
Forty-five other projects which you’ll be able to read about over the course of the day, but all of these recognise that mental health requires the three things that we set out at the outset, it requires normalisation and recognition of the task and the fact that this is something we have to talk about, it requires the treatment and the services, and it requires research to identify the neuropathology, the causes, whether it’s social or physical or psychological, and the pathways to resolution.
Conclusion
Today, we honour Grace Groom. We honour Jackie Crowe. I honour my mother and all of you honour those members of your families and yourselves who have had to struggle with the challenge.
It’s always been a challenge, mental health, but my view and my belief is that at this moment in history, we are making progress and there will be more opportunities than ever before and better understanding and better social acceptance that this is something that is a part of life but something from which each of us can move and take steps forward to be able to be our best selves.
I thank you and I honour you.