News
A wide-ranging review of Australian mental health has
pointed to the welfare system, particularly the troubled jobactive
program, as a key driver in the crisis.
By Rick Morton.
Mental health cost of welfare
It wasn’t until Renna itemised her life and read it out aloud
to a room filled with strangers that the relentless penury of her
existence became clear in her mind.
She could see her own life as if from outside it then; she could feel the stabbing pain of that ceaseless struggle.
“I’m sorry,” she said as the tears came and
her voice broke while addressing a senate hearing about the rate of the
Newstart Allowance on Wednesday afternoon. “I don’t often sit down and
do this. I run a very tight budget, but looking at this I was in tears
the other night. It’s quite emotional. I feel exhausted.”
For the two days prior, Renna had skipped
taking the medication she is prescribed for a mental illness to save
money. It was under these circumstances she detailed to the inquiry just
how far $450 each week goes towards supporting her and her 11-year-old
daughter.
“About 12 months ago, the pressure from the
job networks became quite difficult,” she said. “They were insisting
that I either go back to full-time work or full-time study, so I managed
to scrape around, beg and borrow about $2000 for a car. I’m not sure if
that was good or bad because the expenses of having a car are huge.”
Her story is instructive.
There is a link between an unbending regime
of “compliance” checks in Australia’s social security system, the
poverty many of its subjects face and the cost of mental illness. It was
established last week, by none other than the federal government’s own
economic advisory agency, the Productivity Commission.
In its 1261-page interim report, the
commission rebuked Australia’s $7 billion jobactive program for
providing “limited assistance” and “penalising” participants with mental
ill-health, including those with complex needs.
Previously unpublished data provided to the
commission by the Department of Employment revealed “outcomes for
jobactive participants with mental illness are worse than others”.
“People deemed to have mental illness made up
13 per cent of the jobactive cohort in February 2019, but only just
over 7 per cent of job placements found between July 2015 and February
2019,” the report says.
The commission recommended the removal of
50,000 people with mental illnesses from that beleaguered program and
Disability Employment Services. Instead, it says, they should be placed
on the Individual Placement and Support program, currently used for only
about 2000 people nationwide.
It also called for sweeping health reforms,
including a doubling of the number of Medicare-funded psychological
consultations available each year – from 10 to 20 – and a radical
expansion of the $9.2 billion Carer Payment and Carer Allowance.
Unlike any previous government-led inquiry
into the issue of mental health, the Productivity Commission was able to
look beyond the health system, which desperate governments have
funnelled billions into during the past decade, faced with climbing
suicide rates and calls for action on mental health.
Figures in the commission’s report reveal the
folly of such an isolated approach. It found the single largest direct
government expenditure on mental health is income support for people
with mental illnesses and their carers, which costs almost $10 billion
each year.
The Commonwealth spends half this amount on
Medicare rebates to the mentally ill. And as it squeezes income support,
choices get taken from people.
Holly Rolfe was on the Newstart Allowance, in and out of homelessness, while she was a full-time carer for her disabled sister.
“I was living in my car in a university car
park,” she told the senate’s Newstart inquiry on Wednesday. “Without
university, I don’t know where I would have been. Not knowing where I
was night to night and not wanting to ask people for help, it’s
shameful.”
Holly says she was in the process of applying
for the disability pension, but due to her tumultuous circumstances
this has not been finalised. Another family member now cares for her
sister and they have yet to be approved for the carer payment.
Kelly Clark, a young Aboriginal woman with
complex mental health conditions who was homeless but now works
part-time with the Youth Affairs Council of Western Australia, also
addressed the inquiry this week.
“One of the things that I have experienced
myself … is the utter stress of living on Centrelink payments that are
inadequate,” she said. “Me having to choose between going to therapy to
actually get better or having food. Choosing between going to work or
having food, between having stable housing or having food. These are
things you shouldn’t have to choose between.”
Clark drew the link between the punitive
nature of the welfare system and struggles with mental health. “I am
fairly confident that I would not meet the criteria for my chronic
severe mental illness if I didn’t have to scrape by every week,” she
said, “if I could afford therapy and food.”
Most therapy is not covered by Medicare and,
if it is, the number of rebated sessions each year is capped at 10. For
people with moderate to severe issues, the average length of treatment
is between 15 and 20 sessions. Private health picks up some of the gap,
if you can afford it.
The former commissioner of the National
Mental Health Commission, Ian Hickie, a psychiatrist and co-director of
the University of Sydney’s Brain and Mind Centre, shares a sobering
thought. “For the first time ever, the No. 1 reason young people are
sticking with private health isn’t obstetrics; it’s for mental illness,”
says Hickie.
Nowadays the public system provides a safe, comfortable and affordable option for women to give birth.
“[But] you just cannot get a bed in a public hospital if you have serious mental illness,” he says.
While beds in the private system are booming, a young individual will pay between $294 and $488 a month for private cover.
The average private cover for psychiatric
admissions is $4200 a year – a quarter of a single person’s entire
income on the Newstart Allowance.
If Australia’s suicide rate since 1991 were
plotted as a line graph, it would look somewhat like a jagged mountain
range that dips in the middle before rising again – a sort of
topographical affront to modern intervention.
The most recent data shows that the number of
deaths per 100,000 people from suicide is about 12, the same as it was
almost two decades ago, in 2002. It is only fractionally better than the
rate of 14 deaths in 1991.
University of Melbourne emeritus professor
Tony Jorm thought it would be illustrative to plot 17 government
programs, plans and milestones against the suicide rate from that time,
starting with the rise in antidepressant use in the early 1990s.
He also listed the development of the first National Mental Health Plan and government-funded suicide awareness campaigns.
“We seem to be getting nowhere,” he tells The Saturday Paper.
“And you’ve got to remember this is against the backdrop of decades of
antidepressant use, billions of dollars in government interventions and
we’re back to square one.”
Jorm notes the highest suicide rate in
Australia occurred during the Great Depression, when unemployment across
all age groups peaked at almost 20 per cent. It dipped to its lowest
point during World War II, largely because people were united in a
common cause.
“[There hasn’t] been a recognition that this
is not just a Health Ministry problem, this is a whole-of-government
issue that requires dealing with poverty, unemployment and other
disadvantage,” Jorm says.
And so, the Productivity Commission has
branched out and recommended the federal government should “increase the
quantum of [Commonwealth] funding for state and territory
government-provided housing and homelessness services”.
The commission has also directed the National
Disability Insurance Agency, which is due to fund about $700 million of
supported disability accommodation each year, to open up the program
“with a view to encouraging development of long-term [accommodation] for
NDIS recipients with severe and persistent mental illness”.
It said the federal government should broaden
the requirements for both the Carer Allowance and Carer Payment,
expanding the number of recipients by tens of thousands of people.
These are no small measures.
Without mentioning robo-debt or the rate of
Newstart, which has not risen in a quarter-century, the commission said:
“People experiencing financial stressors, such as low income or
poverty, and/or compromised financial security, such as being unemployed
or having excessive debt, are at increased risk of developing a mental
illness.”
On the targeted compliance framework for
welfare recipients, the commission says “there are good reasons and
plausible evidence that this could aggravate the severity of
[pre-existing mental] illness and increase distress”.
Employment Minister Michaelia Cash seems unconvinced by the Productivity Commission’s findings.
“The government makes no apologies for trying to get people off welfare and into work,” she told The Saturday Paper.
“The Morrison government spends billions
every year to provide job-seekers the best opportunity for employment
that works for them.”
But experts say we are in a race against time.
In a submission to the Productivity
Commission, the Australian Research Council Centre of Excellence for
Children and Families over the Life Course laid out its research into
why young people aged 18 to 26 end up on the disability pension for
mental health.
The centre found these recipients were 1.6
times more likely to do so if their parent, or parents, were in receipt
of the same payment when the children were aged eight to 15.
No other payment has a stronger predictive
effect. Others, such as the single parent pension and Newstart
Allowance, also equate to a surge in likelihood that children will
develop mental health disorders later in life.
The clear implication is that saving one life
can have a multiplier effect, particularly if the person is young or
the parent of a young child.
The clinical director of youth early
psychosis for headspace, Roger Gurr, says this childhood trauma has a
very real effect on the brain, freezing children developmentally at
moments of extreme distress.
“It’s no accident. Evolution doesn’t allow accidents,” he says.
“The problem comes because the child’s brain
gets changed to help it in the toxic environment until puberty then …
the brain is going to stop growing and it is going to be pruned for
efficiency, so the brain can be changing plastically to achieve
efficiency, and that can actually exacerbate the problems.”
Of the people who actually end their lives,
Gurr says, three-quarters have developmental trauma. Yet the mental
health system is absurdly ill equipped to deal with this fundamental
problem.
“I sit in on the headspace intake meetings,
so not only do I just see this severe trauma walking through the door. I
see that poor old primary care headspace is only designed to do mild to
moderate, and doesn’t have any long-term trained staff,” he says.
The Productivity Commission has recommended
the Department of Health “should cease directing Primary Health Networks
to fund headspace centres, including the headspace Youth Early
Psychosis Program” because the money may be better spent elsewhere.
“They don’t have psychiatrists and others to
ensure that you get a full diagnostic process and, even then, the
process doesn’t know where to refer these young people,” Gurr says.
He offers an experience from his practice.
“I myself have tried to refer people to local
health district staff. I have done searches around Western Sydney to
find any psychologists who actually have the skills that I think are
needed, and that are prepared to take on that age group with
developmental trauma, and I’ve only found one,” he says.
“In the whole of Western Sydney.”
As Renna wound up her testimony to this
week’s senate hearing, she noted that she’d been deliberately austere in
her submission. Like her life, there was nothing flashy about what she
wanted to tell the committee.
“I could have brought a lot more story to it, but I thought, ‘I want to really give evidence in a way that says, This is the reality of it,’ ” she said.
Instead, her final words were offered with
heartbreaking uncertainty about the future. “My daughter is 11 and about
to go into high school and I’ve got four years of university before I
get any qualification,” she said.
“I just wonder how I am going to get through. There is no end in sight.”
This article was first published in the print edition of The Saturday Paper on
Nov 9, 2019 as "Mental health cost of welfare".
Subscribe here.
No comments:
Post a Comment