Good afternoon. I’m joined today by Dr Ruth Vine, the former chief psychiatrist in Victoria and now the first Deputy Chief Medical Officer of Australia for Mental Health. And it’s a real privilege to have Ruth with not just a storied academic but in particular, a clinical career in mental health and above all else, somebody who’s compassionate and gets the challenges that people face.
In terms of those challenges, as Australia has gone through the coronavirus epidemic, one of the things we know that is immensely important is the mental health impacts. Anxiety and depression, other clinical conditions, are associated with the fear that comes with health concerns, the loneliness of isolation, and the deep concern that people have with regards to their employment, or their business.
So many small business owners are feeling the weight of cash flow, of pressures, in the same way that families are with mortgages. So the economic consequences of coronavirus can have a huge impact on the mental health, safety, stability and concerns of individuals.
So today, I'm very pleased that we're announcing the third stage of our mental health response to COVID-19. It's $20 million, which includes $17 million of specific grants that have been approved under the Medical Research Future Fund. There's a particular focus on suicide prevention with just over $10 million, $10.3 million for suicide prevention and $6.75 million for better tailored precision medicines for mental health.
On top of that, there's $3 million looking very specifically at the mental health impacts of COVID-19. Both generalised research but specific programs to help individuals through our leading academic institutions and that program will open on 1 June. So as we focus rightly on the health of Australians, we must never lose sight of the mental health of Australians.
Everybody in this room, everybody in any other room in Australia, will, if not themselves or their families, be deeply associated with people that have had stress, anxiety and pressure at different points in their lives, but particularly during an unprecedented health crisis, which has an unprecedented economic impact on the country.
As part of this, I'd like to give you an update on the health situation in Australia more generally. In particular, I want to address the containment process or the flattening of the health curve. We now have over five consecutive weeks of days in which the growth rate of new cases in Australia has been less than half a per cent.
That's an extraordinary national achievement and I want to say to Australians, thank you. You are the ones that have done this. The Federal Government, the State and Territory Governments have worked together to help provide the framework, but Australians have been extraordinary in the way in which they have adapted to the most difficult of circumstances.
Related to that is six new cases in 24 hours to 6.30am this morning and very small numbers coming from the states and territories through the day, but each day we'll update those figures. That's a very important step forward.
We continue with our border measures and the importance of those is emphasised by the fact that a significant proportion of new cases are those that show up in hotel quarantine. Border protection and hotel quarantine is literally saving lives and protecting lives and will continue to be a fundamental part of our national health and strategic defence going forward.
Secondly, in terms of our testing regime, we now have 485 testing clinics of either Commonwealth only or Commonwealth jointly with state around the country. 177,000 tests in the last week. Over 25,000 a day on average. A more than doubling of the previous average. And that's an extremely important part of our defence. So our testing is going up.
The cases we're finding is going down. We're now at 0.6 per cent positivity over all of the tests we've conducted – one of the lowest rates in the world. So we have one of the broadest testing regimes in the world, and as the London School of Hygiene and Tropical Medicine has said, one of the most accurate testing regimes in the world.
That's then linked to our ability to trace where there is a cluster, an outbreak, whether it's in northwest Tasmania, in New South Wales in a nursing home, in Victoria and the Cedar Meats facility. Chasing those cases down and finding them is immensely important. The COVIDSafe app is a very important part of that. It's about protecting in case we have major outbreaks.
We've now passed, as you know, the six million mark. I think the last figure I have is 6,027,000 downloads and registrations. But we’d urge Australians to continue to download the COVIDSafe app. I think I saw on the weekend the great Melbourne ruckman, Maxy Gawn, had downloaded and was emphasising the app himself. So, people from all walks of life are embracing it and it remains a very important part of our national health defence mechanisms going forward.
And then of course, there are the isolation measures. And whilst we're emerging thankfully from the restrictions, the importance of distancing and hand hygiene and cough etiquette cannot be understated. They are fundamental. That keeping the physical distance will help save lives and protect lives, and that’s something that each of us can do to help protect others and protect our own families.
Now all of this brings me to the fact that, as of this morning, we are at 7112 cases and sadly, 102 lives lost. Importantly, 6509 people have recovered, which means there are 501 active cases in Australia. And of those, we're down to 32 cases in hospital and five cases in ICU, all of which are on ventilation. So these are exceptionally important.
There were some expectations a month and a half ago that Australians would run out of ventilator capacity. We built that capacity to 7500. Now there are five Australians on ventilation. All of them obviously in a very serious situation but in the best of care and we have that capacity, which is what has allowed us to return elective surgery on the path back to normality.
I would make this point – that whilst we're doing well at home - internationally we have seen an acceleration of cases. In Latin America, the Middle East, Eastern Europe and South Asia. Countries with large populations, with rapidly expanding cases. And there is a very real chance that the world will move from five to six million at the fastest rate of growth for any one million additional cases.
That means that whilst Australia has made progress, the world is not out of the woods. And I think it’s important to remember that we remain an island sanctuary in a difficult world. That brings me to mental health, because one of the critical things with mental health is the ability to have hope for the future, and so a strong domestic economy is fundamentally important to that.
We know that economic anxiety, fear of mortgage stress, fear of losing one's business, fear of losing one's job – they're all so important. And so, adding support to people with mental health challenges is extremely humane and decent and fundamental and part of the Australian story. So today, we're announcing the third stage of our mental health package for coronavirus.
The first was $74 million, which addressed, in particular, outreach services. The second was $48 million, which supported the National Mental Health Pandemic Plan. And this $20 million focuses especially on suicide prevention, but also, it includes funding for coronavirus research in terms of the mental health impacts and it has a particular emphasis on what we're doing with regards to men's and boys’ mental health and pharmacogenomics or the tailoring of medicines.
All of these things come together to give Australians the best possible chance. Whilst we've been flattening the curve in terms of our health, we want to make sure that we are protecting Australians going forward with regards to their mental health. And I'm delighted to invite Dr Ruth Vine to speak more about this and after that we'll happily take questions.
Thank you very much and look, I'm absolutely thrilled to have this position. I’ve worked in mental health now for about three decades across government and clinical services, and hope that I can add to this.
I'm of course looking forward to working very closely with Professor Brendan Murphy and with Christine Morgan, the Head of the National Mental Health Commission and Suicide Prevention Task Force.
I think, as the Minister has outlined, having additional, if you like, additional grunt from the mental health side reflects the importance of a holistic approach, reflects the importance of understanding that while perhaps initially we were most concerned with the physical impact of the coronavirus, increasingly we are seeing there are increased demands on helplines, increased demands on some of our other help services.
And that will continue to unfold, it will have a longer tail, because some of the impacts, particularly around social connectedness, and finance, and employment, are expected to have a longer impact. I think it has been from my point of view, really overwhelming to see the speed with which the clinical sector converted to telehealth. I think it's almost about 50 per cent now of mental health
MBS items are provided through telehealth.
And of course that's good for the recipient in terms of access and availability. There's a lot we don't know. We don't know how many of those people who are getting MBS support are new clients, and I think one of the key aspects of the National Mental Health Pandemic Plan was to improve our data and our modelling, to enable us to better understand who is accessing health and other services and the outcomes of that.
I think it’s also really important in that plan to note the importance of outreach and connectivity. Getting health services to people in the right place has always been a problem in the mental health sector, particularly as our mental health system is fragmented and it does need to work harder at having a more sort of joined up system across primary care.
GPs remain the cornerstone of those- who people go to, to access support and help. But across primary care, privately funded services, and of course, state-funded clinical mental health services. So there's much to be done. The recent initiatives around suicide funding are very, very welcome. But a lot of research takes time to carry out and certainly time to evaluate. And I look forward to being part of that as it progresses.
Could I ask just on your last point, we had some suicide figures from the Minister, I think a week or two ago. Do you have updated suicide figures?
Secondly, who is this money, the suicide money, actually who are the organisations it's going to? And also, could you elaborate on your comments that were quoted this morning about the Sydney study please?
I'll try and remember all three. The first part, look, one of the investments recently has been to improve the timeliness of data about suicide, because it’s always been a problem that suicide is a determination by coroner, so there’s a delay.
So our data is becoming more timely. To the best of my knowledge, there has not been a discernible increase in suicides. That is not to say that we shouldn't be constantly striving to lower that number, but there's not been a discernible increase. But I do think it's something we need to continue to watch. The second point - where the money is going - and I may need the Minister's help with this.
Do you want me to start?
Yeah, you go.
One chunk of that is going to a group led by Professor Jane Perkis, who has been a long-standing researcher in the area of suicide. She's working with a group of people, but they're particularly focused on building on and evaluating a number of initiatives that are already in place.
And in particularly directed towards men, and younger men, and that's building on- I can't remember the various titles of the group - but it's about encouraging men to be able to more openly talk about the stresses that they're under, and that of course being a precursor to better help seeking.
And just on that, I think it's important to note that for a long- it's always been the case, I think, that males have a higher suicide rate than do women, but a lower help seeking rate and a lower use of counselling services.
So that's the first one. I think-
Your comments, this morning.
Oh and sorry, there are two other organisations getting funding through that. One looking at how new fathers are responding, again, an at-risk group. I feel particularly positive about that, because I think the early times of a child's life are the most important in terms of their subsequent resilience.
So having strong families when you're a wee small babe is an important one. And the third one, I cannot remember.
The third one is the University of New South Wales. That's Professor Helen Christensen. $3.7 million for the use digital services to help those who are not in contact with care. One of the things that's come through- out of this crisis, is the ability to use telehealth. And it could, you can either use obviously the telephone or the online services.
And these are the ways of reaching out to people in the dark of the night, at 3.00am, when often the degree of hopelessness or just the loss of belief in the future can be at its most pressing. So these means of going forwards are very powerful.
In addition to that, in terms of the $6.75m for pharmacogenomics for more tailored psychological or psychiatric medicines, there's $1.4 million to the University of Melbourne for depressive disorder work, the Queensland Medical Research Institute, $1.3 million for improving the performance of pharmacogenomics, of tailoring medicines to your particular needs.
The Neuroscience Research Australia, a million dollars for pharmacogenomics, signatures of bipolar disorder, something that's very important. And St Vincent's Hospital of Sydney, $2.95 million for comparison of standard medicines versus pharmacogenomics. In other words, tailoring the medicine to the body's particular need with $3 million of that will be open to new competitive rounds.
And the third point I think you were asking about is the modelling work?
Yes. Your comments today on that. You were quoted as having some views on that.
Yes, I think the issue I think you're referring to here is suicide, we know that suicide is multi-factorial and very hard to predict. We know that when modelling works are done, what is sort of difficult, I think, is to know what assumptions are built into a model and how those assumptions are tested.
And my comments were that we need to continue to watch that and continue to think about how to determine what groups might be at increased risk or what interventions might be most important. But that really, I think- I think making statements that there is likely to be an increase, I think is unwarranted at this time. I think there are many things that have been put in place and I think we need to continue to do everything we can to reduce the suicide rate.
But I- and I think that some of the things that we have put in place, particularly, as I've said, those increased sort of community connectedness and increasing the accessibility of services are important steps.
Minister, given that Treasury was using epidemiological data as part of its assessment for the $130 billion Job Keeper package that it has since overestimated the value of, did the epidemiologists here in Australia overestimate the impact that coronavirus could have here?
No, not in my view. I think what we have done is we’ve planned for the worst and we’ve been able to deliver the best. And all of this needs to be put in the context - and that's why I mentioned not what's occurred in Europe or North America, which is already well known to us, but the fact that this disease is now spreading at an accelerated rate through Latin America, the Middle East, Eastern
Europe, South Asia, it tells us that this is a deadly and contagious virus.
That actually puts into context what Australia has done. Australians have done magnificently, but I think when you look at the world, we've actually done even better than we have acknowledged. That the degree of gravity, the speed of spread, the extent of contagion globally, is even greater than anybody had predicted in the early days.
And it shows that what we have avoided in Australia could have been catastrophic on a scale unimagined, unimaginable and not something that was faced since 1919. And so, had we not done what we did, all of the difficult steps and mechanisms, Australians would have suffered not just an outbreak of disease but huge human suffering, economic suffering.
And the steps that we took on the health front have meant that we’ve been able to reap an economy benefit and that’s attribute to the health system, it’s attribute to what the National Cabinet and the governments together have done and above all else, it’s attribute to just the extraordinary discipline and concern for others that Australians have shown.
Minister, the DCMO Paul Kelly said there is no medical reason he can see for the state borders to remain closed. Is that a view that you share? And given that view, are you speaking to the State Premiers about rolling back those border restrictions given the risk versus reward. It seems because of the DCMO's comments that we would be better off lifting them?
The DCMO was reflecting the views of what's called the Australian Health Protection Principal Committee or the Medical Expert Panel. They have not made any recommendations as a matter of fact, in terms of state borders nor has the National Cabinet. And so these are matters that are discussed obviously through the National Cabinet process and through the Medical Expert Panel.
And at this point, there’ve been no Commonwealth recommendations in favour, there’ve been no National Cabinet recommendations in favour and there has been no Medical Expert Panels in favour of state border closures, and indeed the National Cabinet three-step plan for recovery also included the progressive restriction- the progressive movement and lifting of state border restrictions.
Minister, you've spoken about remarkably low transmission rates in Australia, I think now for five weeks, you were saying. Notwithstanding that, we're still seeing pictures of in some cases, large crowds of people gathering. There was one in Melbourne yesterday, I think at a popular bushwalking spot, where people just clearly needed to get out and about.
Are they right at least to some extent to now conclude: look, we've had these rates for so long, this ought to be reasonably safe? Or do you look at scenes like that and worry? Can I put that to yourself and you too?
We absolutely have to keep our physical distance. So we want to lift the restrictions but the things that we must do to keep us safe - our hygiene, our physical distance and we'd encourage people to download the app. And the biggest risk in Australia is complacency.
We are doing amazingly well but keeping distance, washing our hands and observing cough etiquette and giving ourselves the extra protection of the COVIDSafe app, these are the things that are going to help protect Australians.
So as I've said before, we are winning but we have not won and we could easily lose it if we gave up on the things that have kept us safe.
Do you see complacency?
What I see is Australians overwhelmingly doing a magnificent job. I just saw it in my community on the weekend when people were out walking and generally keeping their distance; when people were at the shops, they were doing an amazing job.
I saw that at the chemist and at the supermarket. But there will be choke points and that's when people, we encourage them to be absolutely alert because any one of us can save a life and any one of us can inadvertently risk a life. Now is the moment where as we have greater freedoms, we need greater vigilance.
Minister, on the way into the pandemic, we closed down so rapidly that the medical experts weren't able to pinpoint which measures were the most effective from an epidemiological point of view.
Given that states such as New South Wales are now racing ahead of that plan, are you confident that we will still have the necessary two-week period to judge the impact of each individual measure?
And given that speed, is it possible that we- has the Government yet decided or the AHPPC been tasked with looking at measures beyond those three steps, beyond July yet?
Yes. So two things there. One is the Medical Expert Panel; they're constantly reviewing the success and the risks of lifting measures. That's a permanent job. You know, as they meet every day, their overriding concern is to make sure that we are maintaining the protections that are necessary. Borders, testing, tracing - all of those remain.
The one area, of course, where we are lifting is in terms of the physical isolation but maintaining physical distance. And so when you think of it, of the four principle mechanisms, there's only one that we're actually lifting and that's allowing people thankfully, to try to return to as much normality as possible. But that's under constant review and then we are looking forwards.
I mentioned last week that we're looking at things such as the capacity for international students to come back through quarantine. Some of the states have already begun to put forward proposals for mandatory supervised self-paid quarantine in order to help bring back international students at the same time as Australian students.
And these are the sorts of things that are beyond the three stages that are being considered. So important questions.
Minister, you just mentioned complacency being the biggest risk. What do you then make of the NRL's suggestion they want to try and get crowds back from 1 July? Is that complacent and how realistic is going for that target?
So, the answer there is very simple. We'll be guided by the Medical Expert Panel. There is a process which has been set up with the states and the Medical Expert Panel to review all of the professional sports and they will make judgements without fear or favour. They won't be influenced by economic imperatives or other things.
Our goal is to get Australians back to as much normality as possible, as soon as possible but our guideline is to do it safely. And the great thing about the Medical Expert Panel, right from the outset, we set the expectation that they had to be able to give fearless advice.
And if there's a governance success in Australia, it's that relationship between the experts and the decision-makers that they’ve given fearless advice. And they will continue to do that and so if it's safe, then they'll allow progressive steps forward. If it's not safe, it won't happen.
How many ICU beds and ventilators are there in Australia at the moment? And how much has that grown or increased by since the beginning of the pandemic?
So we had 2200 standing capacity. That was doubled within the hospitals to 4400. And then we've expanded that capacity through additional acquisitions to a 7500 capacity which can be mobilised if needed.
We’ve actually purchased more than that; 5500 units from Resmed, great Australian company. They've supplied Australia's needs; they're now supplying the rest of the world. We’ve also enrolled over 20,000 nurses in their upskilling so as they can have ICU capacity.
So just two questions. So one for you and one for the doctor. In terms of an outbreak, how bad would it have to get before you go back to implementing more restrictions?
And Dr Vine, just in terms of since you stepped into the role, has there been any discussion about lifting the number of rebated psychology sessions from 10 to 20?
Okay. So, I'll deal with the first one. What we've developed is rapid response capability. So, the best example is what happened in northwest Tasmania. So there was an outbreak and quite a serious outbreak. Tasmania, with Commonwealth assistance, responded immediately. They ring fenced the area.
So effectively, they brought into what we call a Stage 4 lockdown – probably the most severe lockdown that Australia has had so far. That’s actually contained that area and reduced the cases dramatically. It saved lives. And that’s the model that we have for Australia.
So if there’s a suburban, if there’s a facility-based, or if there’s a regional outbreak, we want those localised rings of containment. It would only be if there was a systemic, state-wide outbreak that you would look at reversing. At this stage, our belief is that is highly unlikely.
So, in relation to Medicare number of counselling sessions, a few things. Firstly, I think we have to wait for the outcome of the MBS Taskforce. They’re sort of tasked with looking at how MBS billing is going across a number of areas. And I think the second thing is we need to understand better how it’s being used.
It’s of interest, I think, that the average number is actually not the maximum at all – the average number of sessions, I think, is about 4.5. And of course, that sort of service provision is supplemented by a whole raft of other mental health programs funded through the PHN. So I think it's not as straightforward as just saying we need more sessions.
Minister Hunt, just regarding mental health, do you have any particular concerns around the mental well-being of those that are still recovering from the bushfires and now obviously are having to manage isolation during COVID-19?
Look, we have been very focused on that. Fortunately, they have two layers of support. Everything that is in place with regards to COVID-19, but we also put into place a specific $76 million package for bushfire recovery, which has had additional counselling services, additional MBS services, as per the previous question, but also local community activities.
Now, those community activities where they were going to be in terms of physical proximity, like the rest of the country, they have had to be put on hold, but the counselling services, the online services and the psychological services have all continued. And I think one of the heartening things is the country has learned about telehealth, and that has been an immensely important step forward.
I’ll take David. One, two, three and Clare, I think, and then we’re done.
I have a question about universities. We’ve had months of debate about schools being closed, and now we’re seeing the reopening and there’s been a lot of opinion about whether they should reopen.
With universities, we’re seeing universities at different stages in different locations. Some are opening up, some are staying closed. Has there been any health advice at the AHPPC level about whether universities should be closed or open? What’s your opinion, as a Minister, on whether they’re okay to open up now?
Sure. So, I’ll break that into two parts. Our goal as a government, my goal as a Minister, is wherever it’s safe to get people safe to get back to their normal activities. That’s the principle. Then, again, the protective mechanism is the advice of the AHPCC.
My understanding is that they are working with the universities now, and there’s a general principle that they’re looking and then they may be looking at specific plans. I apologise, I don't have the details of which universities have put forward specific plans.
But for example, last week, when I was at Monash University with Professor Margaret Gardner, the Vice Chancellor and one of the leading figures in the Group of Eight, we talked specifically about the fact that they had now brought some of their labs back, and they were working with the State Chief Health Officer on a pathway to bringing students back in a COVID-safe way.
And then, the third step for them would be to bring back international students, subject to an agreed plan.
Given Simon Birmingham overnight has said that even if domestic borders are closed for longer, that shouldn’t stand in the way of the potential of a tourism bubble between New Zealand and Australia.
Where is that progressing at the moment? What’s the AHPPC considering when they’re thinking about opening an international border? And have any other countries in the region made representations to Australia to be included in a bubble like that?
I’d have to ask the Foreign Minister to give you advice on that. That’s not one that I’ve been involved with in terms of other countries. In terms of New Zealand, that is something that I think offers real prospect and hope for people on both sides of the ditch.
It's a really important thing that, if we can have greater international movement that is safe, we do that. The Prime Minister has already flagged it. The New Zealand Prime Minister was part of the National Cabinet. I think quite a historic step and precedent. As to the timing, I will leave that to the AHPPC. They’ll look at when they think it’s safe.
Has the Australian Government and other governments been a little too hasty in ruling out the virus coming from a lab, escaping from a lab, given Professor Nikolai Petrovski’s comments. Also, he says he’s four to six weeks away from a trial- human trials of a vaccine. Would that be an Australian first?
So, one, in terms of the origins of the virus, our best advice remains that it came from zoonotic or animal sources. But this is precisely why, precisely why, we argued for an impartial and independent and comprehensive international evaluation and why I think the result at the World Health Assembly last week, a unanimous decision, co-sponsored by 137 countries. Australia and the EU working together was so important.
And now we will have our disease detectives with the capacity to be real disease detectives. But we know it eventuated in Wuhan. We know the first case was within- first detected case was within the wet market. As to the precise origins of transfer, well, that’s for the disease detectives, but our overwhelming advice is that it likely came from animals to humans.
The four to six week human trials that he is claiming he will have started?
Well, there are many vaccine candidates. We hope any and all of them work. As to which ones do, that will be a matter for medical science. My job and our job is to make sure that there is support for it; that it’s done in a safe way, which adheres to the highest medical standards; and that if a vaccine candidate is successful, we have the capacity to produce in Australia.
And I have spoken with, directly, CSL now, at the Chief Scientist and at the global head level, and they are ready to produce, in Australia, if there’s an Australian candidate all ready to produce under license for a global candidate, if it’s someone from outside of Australia. So, if it is successful, we’ll be one of the first.
Since you spoke at the World Health Assembly last week, there’s obviously been some commentary from China about what the agreed to inquiry would look like, versus what yourself and the Morrison Government had pitched. What is the next stage for getting that inquiry to look more like what Australia wanted?
And given that China put that caveat of when the pandemic is under control as to when it might ever start, and that we’re seeing in Latin America, South Asia, as you mentioned, bigger outbreaks, are you concerned they could kick that issue significantly down the road because the outbreak is likely to keep expanding in those other countries?
No. I think what came out of the World Health Assembly was an immensely important road forward for the world, and it was an immensely important step. What's called the Independent Oversight Advisory Committee is, at this point I understand, taking the lead.
Australian officials are now working both from DFAT and Health, through the World Health Organization in Geneva, and I'm very confident that that process will begin to take form. We’ve got that motion. Many thought that it was an impossibility that we would have a motion passed, calling for an independent and comprehensive evaluation.
It didn't just pass, it passed unanimously. It passed with 137 co-sponsors. It passed with a partnership between the EU and Australia and many, many others. Very strong support from Africa, which was extremely heartening. So, there’s momentum, and we will continue to work constructively. I’ll take one very last and then we must go.
Thank you so much. Just on the statement about originating in Wuhan, there was a case in France, that they back-tested pneumonia samples and found a positive coronavirus case back in December 27, and it’s not really known how that happened or that kind of happened at the same time as the Wuhan outbreak.
Do you have any advice about that? Do you know how that happened? Have there been any discussions about what that means about the outbreak of this virus?
No, I don’t have any details on that. What that emphasises though is the importance of a comprehensive investigation. The more we know about the earliest origins, the more we are able to trace back to the likely source.
The overwhelming belief that it has an animal or zoonotic origin. But a full investigation is not just in the interests of this pandemic, it’s the interest of helping to prevent and to protect against a future pandemic.
But ultimately, at a time when we’re nearly at 5.5 million people who are infected, over 340,000 lives lost, we’re clearly heading to 6 million people to have infections, it is about honouring the legacy of all of those who have been infected, all of those whose lives have been turned upside down by the health and the economic impacts, and all of those who have sadly been lost.
That's why we need, that's why we have, and that's why we will deliver a comprehensive investigation. Thank you very much.