Today our President Paul Creedon was invited to present to the Health Services Committee at Parliament House on the Unmet Needs report. Here is his speech.

I would like to acknowledge that we are meeting on the lands of the Kaurna people and pay our respects to elders past and present and recognise their cultural, spiritual and emotional.

I would also like to acknowledge those with Lived Experience, past and present, who have worked tirelessly and advocated for the acknowledgement, and acceptance, of the value lived experience brings.

When we last met we were asking the Government to release a report that quantified the unmet need for psychosocial support for people living with severe mental illness.

Since then that report commissioned by the Office of the Chief Psychiatrist and officially titled ‘Unmet Mental Health Service Needs that could be met by the NGO Sector’-  has been released.

And what did we learn?

That 19,000 South Australians  with severe mental illness who need psychosocial support services each year –  are missing out.

They are people who are cycling in and out of Emergency Departments and hospital wards, they are living alone or being cared for by aging families.

They are people who could be living well with their mental health challenges but for one reason or another are becoming unwell and watching their life potentially unravel because no one is there to help them navigate what they are going through.

They are across all ages, demographics and a third are living in rural and regional areas.

Today I want to not only brief you on the unmet needs study but inform you on how we got here, review what the Government knew in the lead up to this study, their response to date and where to from here.

The Unmet Needs Study was commissioned by the Office of the Chief Psychiatrist to determine the level of shortfall and future investment required in non-government delivered psychosocial services. This determination would then presumably inform future service planning and funding.

The Report compares existing psychosocial support services currently provided against the resources needed for the number of people with complex and severe mental illness as predicted by the National Mental Health Services Planning Framework – we will call this the Framework for short.

The Framework is used across the country and has been developed specifically for state public mental health services. It was developed to determine the resources needed to deliver adequate mental health services to different population groups.

In the context of the Framework – when talking about adequate services we mean the amount of services – clinical and non-clinical, bed-based and community-based – that are necessary to provide effective support to people in our community living with mental health challenges to manage illness and live well.

Any gaps in service provision mean gaps in the effectiveness of the public mental health system to adequately support people with mental health challenges.

The costing elements of the Framework were developed with assumptions of what would be efficient pricing.

The SA Unmet Needs Report conservatively estimated that 26,810 people per year with severe mental illness required psychosocial support in 2021/2022. Of those 3,200 people were receiving support via the NDIS and a further 4,489 from all other state and Commonwealth funded programs including through Primary Health Networks.

The key finding of the Report was that ‘the population receiving services is well below that predicted by the model, with some 19,000 persons not receiving services that the model predicts requires them.’

This number of 19,000 equates to approximately 75% of the ‘minimum threshold’ of people with severe mental illness who require psychosocial services. Or put more simply, one in four people with severe mental illness are not receiving the support they need.

Using the Framework the Report estimated that $125m per annum is required to fix the shortfall.

So to put it in the language of the Framework, an investment of $125m is required for 19000 people with severe mental illness to get adequate service from the state’s public mental health system.

To be clear, we can invest as much as we like in other areas of health or mental health, but that doesn’t fix this problem. And until we do address this particular problem, three out of every four people with severe mental illness who need psychosocial support will continue to experience an inadequate mental health service every year.

This is a massive gap in our public mental health system. I would argue it’s the biggest gap, though not the most expensive one.

One of the primary recommendations arising from the UnMet Needs Study  is the requirement for cross agency, interjurisdictional service planning for psychosocial supports. In our advocacy work we have been trying to explain to Ministers across all portfolios that investing in psychosocial supports would see a multitude of benefits that are not only social but economic.

During Mental Health Month in October we hosted a Roundtable with over 100 people from across a range of sectors including mental health, the police, ambulance, housing, Domestic Violence, youth and the regions discussed the impacts of not fixing this gap as well as the benefits of fixing it for other portfolios.

For now let’s stay focused on the health portfolio. The benefits of fixing the Unmet Need in the South Australian mental health system would immediately see a dramatic reduction in people needing hospital based crisis and emergency services, it would also reduce ramping and wait times related to mental distress. Evaluations of existing South Australian programs show 51.4% of people in metropolitan Adelaide receiving a psychosocial support program said it helped them avoid hospital admission. This is even higher in regional South Australia, with 60.7% of participants avoiding admission.

Since the release of the Unmet needs study we have not had a formal response on what the South Australian Government will do to address this other than send the report to the Commonwealth Government. While solving this crisis does require both jurisdictions to fix this, we are deeply disappointed with the ‘pass the buck’ attitude we have seen. Especially since this crisis has been known since 2019 and we still have no agreement between governments. And there is no relief in sight with no date when services will hit the ground.

In 2019 the South Australian Parliament Social Development Committee – Report #42 recommended the State Government work out the gap in mental health services and people needing support and fill it. This came on the back of an inquiry into the impact of the rollout of the NDIS scheme on people living with complex mental illness.

We presented to that Committee and said “What we need is a comprehensive, integrated mental health system that includes community supports in addition to NDIS, primary and tertiary care to adequately support South Australians living with mental illness. Any service re-design should focus on the social determinants of health and incorporate co-design with people with lived experience of mental illness and carers.”

At that time we knew there was a large number of South Australians with complex mental health needs who would require psychosocial support, however only a small proportion were the target for support under the NDIS.

We also knew that prior to NDIS, that even at that time, the combined Commonwealth and State investment in psychosocial support was supporting only a relatively small proportion of the total number. We also knew that half of the successful applicants to NDIS with primary psychosocial disability are new to the system – which was further evidence that there was a massive gap in the number of people being supported prior to NDIS. And that was before the cuts to both state and Commonwealth programs outside of the NDIS.

We needed the Unmet needs study back then to help determine the number of people transitioning from existing mental health programs into the NDIS for the Government to be convinced this problem was coming and would only get bigger.

We knew the plan to reduce funding for mental health programs in proportion to numbers eligible for NDIS supports was not good mental health policy. We argued that maintaining investment in existing mental health services as NDIS rolls out was the appropriate policy pending doing the work of estimating the unmet need.

Our calls went unheeded and then in 2020, the Productivity Commission estimated that 11,000 South Australians with severe mental illness had an unmet need for psychosocial support. The report stated that ‘State and Territory Governments, with support from the Australian Government, should, over time, increase the quantum of funding allocated to psychosocial supports to meet the estimated shortfall.’

Also in 2020, the Australian Institute of Health and Welfare reported around a third of mental health inpatients could potentially be discharged from hospital if appropriate accommodation and support services were available in the community.

Providers of homelessness services in South Australia also reported around a quarter of clients who require mental health services did not have any provided to them, or were not referred on to another provider. They also said two thirds of people requiring long term housing were not provided with any accommodation, or referred to another service provider.

Still, no action was taken.

Then when the South Australian Mental Health Services Plan was being developed – for 2021/22 – the Framework was used to estimate that we had 80 more acute beds than we needed (albeit a significant shortfall of subacute and residential beds).

And yet the Framework was not used to analyse the gap in psychosocial supports nor was any increase proposed in psychosocial supports to start to address the unmet need that was already evident.

Meanwhile, the reports kept piling up.

Then in the Country South Australia Primary Health Networks Needs Assessment Report 2022 – 2025 it identified a statistically significant increase in the proportion of individuals living with a mental health condition in rural, regional and remote South Australia.

And the Australian College for Emergency Medicine State of Emergency Report November 2022 found South Australian emergency departments had the highest percentage of patients presenting with mental health or behavioural problems in Australia.

By this stage the newish South Australian Labor Government was well aware an investment in psychosocial supports would reduce this. However they did nothing in their first budget indicating that they were waiting for the findings of the Unmet Needs Report.

Then the Auditor General’s Report was delivered to Parliament in September 2022 and highlighted that in 2020 – 2021, there were 27,468 mental health related emergency department presentations, and nearly 19000 overnight admitted mental health hospitalisations, with 15% of patients readmitted within 28 days of discharge.

The Auditor General also identified that SA Health’s key planning, monitoring and reporting processes for the provision of access to mental health services were not operating effectively. Because of these gaps, SA Health is not able to demonstrate how well it is performing in providing the public with access to the right mental health services at the right time.

So using figures in the Auditor General’s Report an average stay in a specialised mental health hospital cost something north of $16,000 per person, with a total cost of over $312 million. Meanwhile the average cost per person of psychosocial support is $7000 per person or $125m for 19000 people currently missing out. Not forgetting of course that the evaluations of SA psychosocial programs show that they massively reduce the need for bed based services.

So effectively the Government has been told its ‘intergenerational spend on mental health’ may actually be going to waste because its own department can not tell tax payers whether their tax payer dollars were working effectively to address our mental health crisis.

It is now 2023 where after the Unmet Needs Study we also have the release of the Rural Mental Health Services Report which was produced in response to a coroners report in the Riverland. It had many recommendations on how to improve the services in country SA, and also recommended addressing the lack of psychosocial support services.

So now we can clearly say the findings of the Study – that is a high level of unmet need – was no surprise to the Government, it certainly wasn’t to us. We can also clearly say that the scale of the increase from the Productivity Commission’s 11000 people to the SA study of 19000 reflects the dramatic impact of policy and investment failure. We can also say Premier Malinasauskas and Minister Picton have been told multiple times – not just from us – they need to invest in psychosocial supports and the action they are taking with the ‘generational investment’ will not fix this problem.

So where to from here?

We need immediate and urgent action to fix the problem now to ensure it does not escalate further.

We asked the State Government to begin closing this gap by investing 50% of the $125m in the 2023 mid-budget review – that is $62.5m. This did not happen and last week in the State Budget we saw no funding for this either.

Meanwhile the Commonwealth continues to finalise a national study across the country before it can negotiate a deal to fix the other half of the problem.

Let’s not forget, there is not even a formal written response from the Government to this Report. Sending the Unmet Needs report to the Commonwealth is not good enough. Whilst there is agreement to measure the scale of the problem, there is no agreement or timeframe to fix the problem.

Effectively it means that 19,000 South Australians with severe mental illness could continue to go without adequate support for years.

Meanwhile we will continue to see ramping, hospital wait times or bed blockages in the news, and often the blame falling on people in mental health distress.

South Australians with mental illness currently spend more time in emergency departments and other hospital-based services than they would need to if there was adequate access to psychosocial supports that support them to stay well in their homes and needing less support from our hospital system.

I have come here today to explain the problem and ask for your help. As elected members of this Parliament, I am asking for your help to fix this problem for the 19,000 living with complex mental illness, their families, loved ones, carers and support workers. Not just for another report to be ignored.

While we are after leadership what we are getting is political theatre. A response that points to a ‘generational investment’ in something else in mental health is not a good enough response. A response that says there are other priorities in health is not a response. Sending the Report to the Commonwealth with no agreements on funding and timeframes leaves the burden in our community.

Our health and mental health leaders are out of step with those in the rest of the world who understand that good mental health is a human right and we need to do things differently.

To quote from the World Health Organisation’s most recent report titled: ‘Mental health, human rights and legislation’: ‘…most countries are at the early stages of reform, and greater political will, investment and action are now needed to move mental health systems towards approaches that are rights-based and person-centred.’

We were the first in the country to do this unmet need study – lets be the first to fix the problem.

No more reports, no more stalling, no more passing the buck.

You can read the full Hansard with questions from committee members here.