Radio interview with Minister Butler and Virginia Trioli, ABC Melbourne Mornings - 30 August 2023

Read the transcript of Minister Butler's interview with Virginia Trioli on new sector-led eating disorder strategy; psychology workforce investments; how a Voice to Parliament will improve the health of Indigenous Australians.

The Hon Mark Butler MP
Minister for Health and Aged Care

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HOST, VIRGINIA TRIOLI: You might recall some really heartbreaking stories that have been shared with me and with you on this program by parents whose kids have been dealing with eating disorders. It hit particularly hard here in Victoria and Melbourne, given how many days we were in lockdown, and that was one of the key psychiatric disorders that revealed itself, particularly amongst young people – not just young women but young men as well – and school aged children during those really difficult times. The stories we heard, again and again, was just how hard it was to get access to services, to get an appointment with a psychologist if your child was desperately unwell, to even get a bed at some of the paediatric units that deal with eating disorders.


Those stories and your stories on the Open Line told again and again. So, you may be reassured or you may have questions to ask about a national strategy that's being developed by the eating disorder sector that's being released today, hopefully to guide policies and to support people with eating disorders right across the country over the next ten years. It's been developed by the National Eating Disorders Collaboration - that's what it's called, the collaboration itself – and this strategy will hopefully provide that new roadmap. Mark Butler is launching this new roadmap. He's the federal Minister for Health and Aged Care. Minister, good to talk to you.




TRIOLI: What's been the focus of this new strategy?


BUTLER: I had an opportunity to read it on a long plane ride from Perth last night. It's a terrific document, very digestible, easy to read. Sometimes these things are a little dense and difficult to penetrate. But this is very clear in diagnosing the real challenge we've had for many years in dealing with eating disorders. They are, in many ways, I think the most complex area of mental health. It is the most dangerous and deadly of all mental health conditions. And as you said in your introduction, it is one that strikes down usually young people in the, sort of, flower of their adolescence with so much hope and opportunity stretched out before them. It really does hit families very, very hard. And I think we need to be honest that we’re no orphan here, this is common around the world, but we've not dealt with it well in the past. It's an area that, on any metric, has very little research undertaken. The vast bulk of people don't receive a formal diagnosis, and even those who do are the minority. Maybe only 1 in 5 are receiving evidence-based treatment. So I think this framework sets out all of those challenges in very clear detail, but also with their stepped system of care - so really breaking this challenge down into a series of steps - for me as the Minister, and I'm sure for many others as well who will read this document, it's a very clear pathway forward to build on some very good things that, I think, have happened over the last several years.


TRIOLI: The strategy makes clear it's not a clinical guideline and it doesn't provide recommendations or information about specific models of clinical care. But as you say, it does talk about that stepped approach and also that whole of community approach. But looking at that pragmatically, how exactly would that work? How would that be available to people who are dealing with this issue?


BUTLER: The strategy makes clear that you can either read the whole thing or you can dip into areas that are of particular interest to you as a family or you as a community group that wants to contribute to solutions here. So, you know, for example, the first step is on prevention and it makes the point, really importantly I think, that is a pretty common and basic principle in health of doing no harm. And we know that the causes of eating disorders are complex, they are multi-layered, but in many ways they're rooted in deep cultures in our community, around body image and a whole range of other things like that. So, we can't just think this is a challenge for clinicians, psychologists, doctors, dietitians and the like to deal with themselves. We have to examine ourselves as a community about what it is that is leading particularly young people, not exclusively, but particularly young people into these sorts of disorders.


I think if you are part of a community group, you're in a school, you're in a youth group, you're in the advertising industry or anything like that, having a look at those sort of basic prevention principles that are laid out in the strategy is important for the Health Minister and for state Health Ministers, as well, because they obviously have a role in this. The treatment steps there are really well set out and build on some of the work that, as I said, has been undertaken over the last few years. My predecessor, Greg Hunt from the former Coalition government - to his credit - put a range of new treatment measures in place at the Commonwealth level that we’re in the process of starting to evaluate, but I think did make a real difference. Now against that, tragically, as you said in your introduction, in the pandemic rates of eating disorders, including among some new cohorts of much younger people than traditionally have been seen in this area, really spiked and haven't started to come down yet materially, even though we've emerged from the worst phases of the pandemic. I think some of the really good things that Greg put in place were probably masked a bit by the big spike, particularly in the eastern states where there were these widespread lockdowns. So, trying to get sort of a clear eye on how those measures are really making a difference is something we're doing right now. But we're also rolling out new measures, which I've only done over the last couple of months.


TRIOLI: Mark Butler, though, one key part of this, in order for it to work - and of course, we acknowledge here that it's the states that fund the hospital sector, so I wonder if there's a degree of responsibility pushing over to the states with a national strategy like this - but unless there actually is more funding forthcoming to make sure that there are more beds in those paediatric units, that there are more places and appointments available with psychologists, that you can actually get to see someone who can help that family once they're back out in the community, manage that eating disorder in home, or the funding for the community-based services that this guideline and this roadmap speaks about. Unless there's an actual quantum of money that's promised for that, we run the risk of this just being words that whistle away in the winds. Will the federal government be putting money towards this strategy?


BUTLER: We've only just received the strategy. As I told your listeners, I only read it last night. And the Collaboration, which, as you pointed out, has done this terrific work with clinicians and researchers and most importantly, people with lived experience and their families now has the job of working on implementation on this. But I did make the point, I think, earlier that this for me and I'm sure for my state and territory colleagues will be a really important guide to what we do in the future. As I said, we've rolled out some new measures only over the last couple of months, some of which were contemplated in this strategy. For example, one is that the Collaboration will be funded to work in primary health network regions - so with primary care providers - to help families navigate what is a very complex system, that's a challenge that was set out in the strategy. But as you say, there certainly is still clearly unmet demand, unmet need for services, including in acute or hospital settings. And I know my state and territory colleagues are trying to do something about that.


TRIOLI: That's right. And also – just to jump in there - because we know how hard it is and how expensive it is to fund those places in hospitals. I get that. It's not as simple as me saying just give them more money and you get more beds. Many eating disorder patients say they've been turned away from care because they're not sick enough, which goes to the community-based approach that this strategy outlines - try and actually deal with it at the source or deal with it early on, so you don't end up in hospital. How will this help those who aren't critical but could very well end up there if we don't have the funded services in the community?


BUTLER: We've built a range of new funded services, particularly in Medicare.There's a very substantial entitlement to psychological and dietetic or dietitian support services that, as I said, Greg Hunt put in place. And it really is quite a substantial entitlement to treatment, which is really quite new. We're evaluating it right now. But one of the challenges I was going to point out is, it’s not just finding the money, it's finding the workers.




BUTLER: And we're seeing this right across the health system.


TRIOLI: And it's in aged care in particular.


BUTLER: It's not just an Australian challenge. This is a challenge right across the world right now. There is a global health workforce shortage, and we have one here in psychology. So, in the Budget we put in place a range of measures to train more psychologists. But that's not like switching on a light switch. I mean, that takes a bit of time to train up psychologists. This is a big challenge for all governments - not only to find the money, but to have the workers in place to actually implement the funding that we decide in our health budgets.


TRIOLI: Yeah, indeed. So, what are you doing about that? Because we've been reading stories this morning that some people who are here on visas, who are working in the aged care sector, they're going to be forced to go back home. They're trying to become permanent residents. And instead, we might end up losing part of our workforce from the aged care sector as well. So, when you're dealing with that, and as you say, you're quite right, it's a workforce issue when it comes to eating disorders, too. How will you secure that workforce?


BUTLER: We've got to train more psychologists. That's really the point. And we put in place quite substantial funding in the Budget in May to train additional psychologists through university to give them more supervised training opportunities out in the sector which they need, obviously, to qualify. But we won't be able to do that overnight. I mean, it takes a little bit of time to do that. So, we're evaluating this Medicare-funded program to see quite how it's been operating. It's still only relatively new. Greg Hunt put it in place only a few years ago, but we're also putting in place other community programs, with funding that I announced only a couple of months ago. There really is a multi-layered approach here. We're working with states to roll out community residential treatment centres, we're working with Victoria on one that will be run by Alfred Health, and that's rolling out, it's not open yet, but the funding is rolling out right now to make sure that's in place.


But I think your listeners who have an experience of this will, I know, be frustrated because there is still a very large unmet need here for services. We understand that. I talk with my state and territory colleagues about that a lot. Some of that is going to take some time to respond to because we just don't have the workforce sitting around idle waiting for some government funding to activate them. We really need to train up the workforce to make sure there's enough, not just to deal with this area of mental health need, but a range of other areas of mental health need that have been there for some time and in some cases really did spike during Covid, and this current cost of living crisis that's sweeping the world as well.


TRIOLI: Mark Butler, I have to move on, and I know you do, too. But I just quickly wanted to ask you before I let you go, the date of the Voice referendum will be announced today by the Prime Minister. He'll be doing that in Adelaide in just a couple of hours’ time. 63 of Victoria's 79 local councils have told the ABC they're not taking a position ahead of the national vote. Some have suggested that they might change their stance as they get near the poll. Do you think it's important that local councils have a voice of their own on this and advocate a position or not?


BUTLER: I think generally it's best that one level of government not tell another level of government how to do their job. They'll do what they think is right as local councils. My focus is on trying to talk to as many people in the community as I can, particularly as Health Minister, about what this will do to improve health outcomes for Aboriginal and Torres Strait Islander people. And I can't think of an area of policy where a Voice to the Parliament, but also to the Health Minister and the Health Department, about the yawning gap in health outcomes between Indigenous and non-Indigenous Australians will be more valuable, and lead to better outcomes in an area where we just have to be honest - with the best of intentions and substantial investment, the current approach just isn't working.


TRIOLI: Good to talk to you today, Mark Butler, thank you for your time.


Thanks, Virginia.

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