Hornsby Electorate Child and Adolescent Mental Health Facility



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SpeakersHopwood Mrs Judy; Lynch Mr Paul; Aplin Mr Greg; Berejiklian Ms Gladys
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HORNSBY ELECTORATE CHILD AND ADOLESCENT MENTAL HEALTH FACILITY
Page: 8305

Mrs JUDY HOPWOOD (Hornsby) [12.09 p.m.]: I move:
      That this House:

      (1) notes the specific needs of children and adolescents with mental illness; and

      (2) calls on the Government to establish a child and adolescent mental health facility at Hornsby Hospital.
I am extremely concerned about the welfare of children and adolescents in the Hornsby electorate. Indeed, facilities specifically designed for children and adolescents with mental illness are inadequate across New South Wales. I note that Hornsby hospital has a mental health unit of long standing. The recent addition of a psychiatric emergency care centre to the accident and emergency department has provided four beds for use by mental health patients. There is also a mental health intensive care unit, to which I will refer later. However, the specific needs of children and adolescents in the Hornsby area have not been met. This is an immense problem for those children and adolescents and for their parents and significant others.

I note that this year's budget, which was delivered on Tuesday, mentions further planning and some expenditure related to a local mental health unit. Unfortunately, the details are not known. I do not know whether it will be specifically for children and adolescents, and I await information in that regard. Most areas of New South Wales urgently need child and adolescent mental health facilities, and since my election to this place in 2002 I have called for their establishment. There is nothing more distressing than receiving a telephone call in the middle of the afternoon from a mother who says that her 18-year-old daughter—a good student studying for her Higher School Certificate—is experiencing a psychotic episode and standing on a station platform removing her clothes.

In that instance police and ambulance officers were called. The girl was in danger of falling from the platform into the path of an oncoming train. I assisted the mother with the transfer of her daughter to the accident and emergency department but I knew that there was no child and adolescent facility at Hornsby hospital into which she could be admitted later. That is an absolute disgrace. The girl was assessed in the accident and emergency department and ultimately admitted into the mental health unit. I pay tribute to the staff of that facility. They work very hard as the unit is usually understaffed. However, it is totally inappropriate to admit children to adult wards. This young girl—and all other young people who present for admission into mental health facilities—requires specific, appropriate care.

A couple of years ago I held an eating disorders forum in my electorate. Eating disorders such as anorexia nervosa and bulimia are a great concern in our community and there are not enough beds for young people who suffer from them. Some 200 people attended the forum at Hornsby RSL club. One hundred were sufferers of anorexia nervosa or bulimia and the other 100 attendees were their parents and significant others. I alert the Government yet again to the need not only to provide child and adolescent mental health facilities in the Hornsby electorate—specifically on the campus of Hornsby hospital—but to devote parts of such units specifically to the treatment of eating disorders. I have discussed this issue many times with the parents of young people with mental illness, local community groups and health professionals. I pay tribute to the work of Hornsby Ku-ring-gai Association Inc. Action for Mental Health, whose many calls to establish a specific child and adolescent mental health unit at Hornsby hospital have gone unheeded.

Mental health facilities in the Hornsby area include an early psychosis intervention centre in the grounds of Hornsby hospital. It is an extremely busy unit and its services are in constant demand. A child and adolescent psychiatrist works out of the hospital, and there are other similar support facilities. Future child and adolescent psychiatrists are trained through the local psychiatrist-in-training program. However, there is no unit into which to admit children and young people with mental health problems. The Hornsby hospital accident and emergency department and the four-bed psychiatric emergency care centre act as pseudo child and adolescent wards. The only option for many young people who present to the accident and emergency department is to be placed in a bed in the psychiatric emergency care centre. However, this solution is not adequate as those young people can remain in the unit for only 48 hours and must then be transferred elsewhere—inevitably into the adult ward of the mental health unit.
Some $7 million has been spent on the mental health intensive care unit, which was built specifically with last year's State election in mind. But the Government gave no adequate consideration to staffing it, and the unit remained empty for 11 months. The unit has many problems, and considerable funds will have to be spent correcting design faults. Since the unit has had the ability to take patients—11 months and one day after being completed—the 12-bed unit has housed between one and four patients. Although that intensive care unit is needed, a child and adolescent mental health facility was required more urgently. Young people continue to be admitted into the mental health unit and not placed appropriately into the mental health intensive care unit because of understaffing and its design faults.
The expenditure of $7 million, the inclusion of the psychiatric emergency care centre in the accident and emergency department, the training of future child and adolescent psychiatrists, and the existence of a child psychiatrist and an early prevention intervention facility point to the fact that there is a yawning gap in the services provided by Hornsby hospital and in its ability to meet the needs of local children and adolescents with mental health problems. It is absolutely imperative that the Government establish, sooner rather than later, a child and adolescent mental health facility in the grounds of the hospital. Such a facility would be a logical inclusion and enable admission into a unit that specifically meets the needs of young people. The establishment of such a facility would allay the concerns of parents and significant others of young people who are admitted into the accident and emergency department or directly into the mental health unit and adult wards. They are not happy with the current state of affairs and lobby me continually about the establishment of a child and adolescent facility at Hornsby hospital.
The current situation is not good enough. Considering the Government's focus on mental health, this is a glaring oversight that requires rectification. We are seeking immediate clarification of what the Government plans to build in Hornsby in the future. I note the child and adolescent facility in the long-term plan for infrastructure but it needs to be provided sooner rather than later. It is an absolute emergency. Young people with mental illness are not accommodated in an appropriate way in the Hornsby area.
      Mr PAUL LYNCH (Liverpool—Minister for Local Government, Minister for Aboriginal Affairs, and Minister Assisting the Minister for Health (Mental Health)) [12.20 p.m.]: I move:

      That the motion be amended by deleting paragraph (2).
The mental health of children and adolescents is a major public health issue and vital to the future wellbeing of individuals, families and the community. Robust international research indicates that the majority of adults with mental disorders had recognisable problems by the age of 15. New South Wales Health is building a more secure base for children and adolescents to maximise their potential and increase their chances of a positive future. To provide a comprehensive system to address the mental health needs of children, adolescents and their families, the full range of interventions needs to be available through linked partnerships, including those with adult mental health services; generalist health services; general practitioners drug and alcohol services; early childhood, paediatric, child and family and youth health services; private practitioners; the departments of Education and Training, Community Services, Juvenile Justice, and Ageing, Disability and Home Care; and inevitably non-Government organisations.

Mental health problems in this age-group require comprehensive approaches including specialist community-based services for children and adolescents and their families; specialist day programs for more intensive treatment; specialist acute and non-acute inpatient services for children and adolescents; specialist outreach services such as the telepsychiatry program to increase support for families and service providers in rural communities; support for children of parents with a mental illness; and forensic services for adolescents whose mental health problems have led to interaction with the justice system. The great majority of children and young people with mental health problems who receive treatment do so in a community setting. Community-based child and adolescent mental health services are therefore the service foundation. However, some young people with more severe or complex problems require a period of specialist assessment and treatment in hospital.
When the Labor Government was elected in 1995 there was only one unit in New South Wales that could provide the full range of acute inpatient services to children and adolescents: the Acute Adolescent Unit at Redbank House, Westmead Hospital. There are now additional child and adolescent acute mental health inpatient services at Campbelltown Hospital, John Hunter Hospital, the Children's Hospital at Westmead and the Sydney Children's Hospital. Further units are planned for Orange, Shellharbour and Hornsby, and 16 adolescent beds are planned for the new Forensic Hospital at Malabar. The budget is now three times what it was when we came to office. There are now 47 specialist child and adolescent mental health acute beds in New South Wales, with more in the planning and design phase. A new specialist acute child and adolescent mental health inpatient unit is about to commence operation at Lismore. Indeed, it was formally opened last week.
The development of inpatient units in regional centres allows more families to receive more comprehensive specialist treatment closer to home. Construction is also nearing completion for a new specialist child and adolescent mental health unit within the new mental health precinct at Concord hospital. This service will complement the existing specialist programs at Rivendell in the adjacent Thomas Walker Hospital. It will fill a statewide role providing specialist high intensity longer stay inpatient care for 12 young patients. This new unit will also have capacity for two beds for parents or carers, which will help young people's transitions in and out of hospital and improve family involvement in care planning and treatment. Planning has also commenced for an upgrade of the Sydney Children's Hospital inpatient service to fill a higher acuity role.
In 2005-06 the funding for New South Wales Child and Adolescent Mental Health Services [CAMHS] was approximately $98 million, which represented 10.3 per cent of the overall mental health program budget. CAMHS was expanded further during 2005-06 with the allocation of $4 million enhancement funding across area health services, including Justice Health and the Children's Hospital Westmead. The 2007-08 budget provided an additional $2 million enhancement for CAMHS across New South Wales. A further measure of this Government's commitment is the provision of additional funding in the 2008-09 budget of $2.6 million for new and enhanced child and adolescent outpatient services across New South Wales. Area health services will be funded to offer community care for children and adolescents with a mental illness and to improve the linkages between inpatient treatment and local community-based teams.
    The Child and Adolescent Mental Health Statewide Network [CAMHSNET] was established in March 2003 to support existing child and adolescent services and to provide ongoing education and training for specialist staff. CAMHSNET has now evolved into its next phase of development as MH-Kids, an area-hosted unit of the Mental Health and Drug and Alcohol Office. It is leading policy development and service planning to improve the mental health of children and adolescents in New South Wales. MH-Kids now guides a number of prevention and early intervention initiatives delivered by area health services targeting children and adolescents and their families.
      Child and adolescent mental health services are provided both on-site at Hornsby hospital and in the neighbouring community. Those services are part of a broader network of child and adolescent health services provided across Northern Sydney Central Coast Area Health Service. Increasingly young people are being treated in developmentally appropriate specialist mental health settings. These specialist CAMHS settings are the ideal and the practical goal to which we are working. Assessments of the provision of further specialist child and adolescent mental health settings across the State are being made on a continual basis and this is certainly the case in relation to the Hornsby Ku-ring-ai area. The Government is continuing with the provision of services to enhance the quality and continuity of care for consumers of child and adolescent health services. I commend the amendment to the House.

      Mr GREG APLIN (Albury) [12.25 p.m.]: Across New South Wales the number of children and adolescents with mental health problems is rising. It is a problem not confined to Australia, of course, and many psychologists believe it is caused mainly by environmental rather than biological factors, by social fragmentation and the breakdown of the family unit. However, whatever the fundamental causes may be, the rise in numbers is alarming and its effects are being felt in our schools and health services. Getting the attention of Government for funding, research and improved treatments is increasingly difficult. With childhood usually being associated with happiness and carefree fun, there is a greater need to prevent the early years of life from being hindered with the weight of sadness, depression, pain and inner torment.

      Many childhood or adolescent disorders can be treated with medication or behavioural management therapy—in other words, intervention. The need to identify and effectively treat these conditions at an early age is vitally important to allow our young Australians to lead a mostly normal life if identified and managed early. With the Mental Health Association of New South Wales indicating that one in 10 children between the ages of six and 12 experience persistent feelings of sadness, providing care and assistance for that vulnerable age group is imperative to facilitate the need for a sense of normality in their developing years.

      Unfortunately, the list of disorders affecting children and adolescents is increasing. Today that portion of society faces conditions including anxiety, a whole host of phobias, separation anxiety disorder, obsessive compulsive disorder, attention deficit hyperactivity disorder, depression and bipolar, to name just a few. Between 1996 and 2006 cases of self-harm in adolescent girls increased by 51 per cent, according to the Australian Institute of Health and Welfare. In a report published only yesterday by the institute, it indicates that that is more than double the rate of self-harm for adolescent males in the same time frame. The report continues to state that young people account for almost one-third of intentional self-harm admissions to hospital in 2005-06, and that young people accounted for 14 per cent of suicide deaths in 2005.

      A significant number of adolescents, particularly girls, suffer from serious eating disorders. Those conditions place a great deal of pressure on community health resources as the treatment—namely, counselling—needs to be ongoing and can take many months. In my electorate, to take one example, the Albury-Wodonga Acorn Support Group provides assistance and care services for people with eating disorders and their families to meet once a week. However, as beneficial as that is to my community, many other communities have no facilities at all and families are forced to travel to major centres. For example, I refer to Oak House in Melbourne, a specialist outpatient facility providing recovery programs for sufferers of all forms of eating disorders, including anorexia nervosa, bulimia, binge eating disorder and eating disorders not otherwise specified, which includes obesity. We are significantly under-resourced in New South Wales, particularly in the country. The Minister could look at this issue in relation to the Hornsby electorate.

      With the onset of adolescence, depression becomes a real problem, particularly for boys in Australia. Studies indicate that there is a close correlation between depression and self-harm incidents and, of course, the high rate of suicide in Australia among adolescent boys. Treatment of depression is essential and, through the use of psychotherapy and sometimes medication, children and adolescents can learn to express their feelings and develop coping strengths and strategies to deal with their illnesses. Hence, they improve their self-esteem and prospects for the future. Organisations such as Lifeline and Kids Help Line are often the first point of contact for those young people. Again, there is an ever-increasing need for trained people to handle this very serious problem. Again, as my colleague the member for Hornsby has amply identified, a child and adolescent mental health facility providing those services in the electorate of Hornsby is needed.

      However, the Government seems to be wavering in its efforts to provide real, long-term assistance to this important sector of our society. Tuesday's budget revealed that New South Wales Labor has not only underspent on the Shellharbour Hospital child and adolescent unit but the day unit portion has been delayed another 12 months. How can the Government claim to make mental health a priority when there is major underspending on vital projects and delays in completion? That is not an isolated case. The Sydney Children's Hospital proposed child and adolescent inpatient unit has also been delayed by 12 months, and underspent to the tune of $1.7 million. Children and adolescents across New South Wales are being hurt by a Government that is unable to effectively plan or manage a mental health system that is crying out for assistance and support.

      Taking into consideration the dramatic increases and instances of mental illness among children and adolescents, and the appalling cases of self-harm and abuse by that age bracket, the Government must provide more services to combat this alarming and rising crisis. Hornsby has a need for a child and adolescent mental health facility, but unlike its mental health intensive care unit it needs to be staffed for operation. Twelve months on with the establishment of the unit only four of those 12 beds are operating. That is not the way to run the mental health system.

      Ms GLADYS BEREJIKLIAN (Willoughby) [12.31 p.m.]: I support the motion moved by the member for Hornsby. For a short period I had the privilege of being the shadow Minister for mental health. In that period I noticed that the overwhelming lack of services in our community related to the lack of the provision for mental health services for children and adolescents. I commend the efforts of the member for Albury, the shadow Minister for mental health. He more than anyone understands cross-border issues: he understands the difference between the services provided to children and adolescents in Victoria, the Australian Capital Territory and Queensland services and those provided in New South Wales.

      I am concerned most that every time the State Government talks about mental health it fails to back it up with action. I was shocked to learn of the number of gaps in mental health services, especially in acute services but more particularly in community-based services. New South Wales has almost zero psychosocial services available to people who are not sick enough to be in hospital but are not well enough to be on their own. That is where the huge hole is in our community services. The motion moved by the member for Hornsby specifically addresses that issue.

      There is nowhere for people to go when they are not sick enough to be in a hospital but are not well enough to be at home. Very few services are available throughout New South Wales, and those that are available are, in the main, provided by non-government organisations such as Lifeline. In my electorate a woman operates an eating disorders organisation from her home in Artarmon, very close to where I live. The woman has managed to respond to 20,000 calls to her home by families with children, especially teenage girls, but also boys, who have eating disorders. She gets minimum funding from the State Government but operates the service because nothing else is available.

      There is a huge void in mental health services. Although this issue should never be politicised, it is beyond politics. It is a huge shame but, regrettably, the State Government talks about this issue but does not back it up with action. The member for Albury has a keen and active interest in this issue. When I was the shadow Minister for Mental Health I visited his community and was absolutely appalled that people there had to either rent a place in Victoria or claim that they lived in Victoria to access the children's psychosocial services just across the border. The services there are so much better than those in New South Wales.

      The member for Hornsby also has a passion for mental health. As co-convener she has been instrumental in putting together the Parliamentary Friends of Mental Health group and has done a lot of work alongside the Schizophrenia Fellowship and others making Parliament more aware of those issues. I am concerned that the State Government has said a lot about mental health, but regrettably the same announcements are repeated, the same amount of funding is repeated. We hear a lot about the psychiatric emergency centres [PECs]. Yes, they are important but there are not enough of them. What happens to a person who leaves a centre? Nothing. That is the problem. People are released too early because there is a demand on the number of available acute services.

      After a person leaves hospital and returns to the community no support services are available, except for those provided by the non-government sector. Much has been said about the Housing and Accommodation Support Initiative [HASI], but how many positions does it offer? In the last year that I was shadow Minister for mental health the HASI program offered an additional 12 places a year. What did that achieve? Not very much. These are all good programs, but it is not good enough to just announce a program; it has to be backed up with services on the ground. No mental health services are provided between the hospital ward and the home. That is why homelessness is at such an acute level. That is why so many young people get into trouble.
      We do not have the services that the member for Hornsby is advocating for her community. I commend her efforts to meet a need that all communities face. The member for Hornsby is exceptional in her efforts: she is constantly advocating for her community. The least the Government can do is to respect her motion, not amend it; accept the need and do something about it. That is what we should all expect and do as members of this place. I commend the original motion to the House and urge the Government to support it, and to support people who have serious mental health issues. That support can be achieved only by providing the community-based services which have been fought for so strongly this morning.

      Mrs JUDY HOPWOOD (Hornsby) [12.36 p.m.], in reply: It is with pleasure that I commend the member for Albury and the member for Willoughby for their wonderful support of my motion. I acknowledge that the Minister Assisting the Minister for Health (Mental Health) has attended the Chamber and saw fit to spend time on what I consider—and what every member of the House should consider—to be a very important issue. However, I am extremely disappointed that the Minister moved an amendment to my motion to remove the Government's responsibility to establish a child and adolescent mental health facility at Hornsby Hospital.

      I invite the Minister to visit Hornsby Hospital and attend a Hornsby Ku-ring-gai Association Inc. Action for Mental Health meeting and talk to the parents and significant others of the young people. I am sure that if he did so he would be repent moving the amendment to remove the call for the Government to establish that child and adolescent facility. Members on this side will oppose the amendment. I refer to Budget Paper No. 4, page 3-4, which states:

          Planning Funds—$26.5 million ETC ($22.3 million in 2008-09) for planning future new works including Mental Health Stage 4 (including a new unit at Hornsby Hospital)
      That is what I referred to when I mentioned the lack of detail. The Minister's speech did not enlighten us about what that new unit is. Obviously, I will write to the Minister asking him to explain it. It seems to be a serious oversight in his speech. That unit is not a mental health unit for children and adolescents. It is an extreme oversight and I implore him to respond to my questions and I ask him to agree that a child and adolescent mental health facility is important.

      The Early Psychosis Intervention Service [EPIS], which I mentioned earlier, is a busy, well-frequented unit. It addresses the needs of young people from 18 to 26 years who have a primary diagnosis of psychosis, with onset in the past 12 months. Because the first intervention relating to mental illness is so well frequented we need a child and adolescent mental health facility in the Hornsby campus that will meet the needs of young people. Many of them will go on to have a history of mental illness, and they need adequate and appropriate support.

      The Minister's response is not good enough. We will not support his amendment and I call on other members not to support it. There is an extreme need for an adolescent unit to be established to deal with mental health issues. As the member for Willoughby pointed out, the Hornsby area has a big problem with homelessness and the age group of that population is becoming younger and younger. Many younger homeless people have a mental illness. I had a round table discussion in my office last Monday to talk about the escalating problem of homelessness and it was a big shock to find that the Department of Housing did not have any demographics on the number of homeless people in the Hornsby electorate. There are hundreds of them. I was absolutely flabbergasted by that. It goes to show that planners have not given adequate consideration to funding to meet the needs of young people in the Hornsby electorate who have mental health issues. I commend the member for Albury for his extensive knowledge of the subject, and the member for Willoughby in her role as the shadow Minister. Even though I acknowledged the Minister for coming to the Chamber, that is often not the case.

      Mr Daryl Maguire: It never happens.

      Mrs JUDY HOPWOOD: No. He may feel that the issue is important but he cannot see his way clear to establishing a child and adolescent mental health facility. The issue is imminent; it is very important for these young people as they go forward in education and look for employment opportunities. A stitch in time saves nine, to borrow a phrase. These young people need early intervention to ensure they can lead the sorts of lives they desire and not have continual problems with mental illness that should have been addressed earlier.

      Question—That the amendment be agreed to—put.

      The House divided.

      Ayes, 47
      Mr Amery
      Ms Andrews
      Mr Aquilina
      Ms Beamer
      Mr Brown
      Ms Burney
      Mr Campbell
      Mr Collier
      Mr Coombs
      Mr Corrigan
      Mr Costa
      Mr Daley
      Ms D'Amore
      Ms Firth
      Ms Gadiel
      Mr Greene
      Mr Harris
      Ms Hay
      Mr Hickey
      Ms Hornery
      Ms Judge
      Ms Keneally
      Mr Khoshaba
      Mr Koperberg
      Mr Lynch
      Mr McBride
      Dr McDonald
      Ms McKay
      Mr McLeay
      Ms McMahon
      Ms Meagher
      Ms Megarrity
      Mrs Paluzzano
      Mr Pearce
      Mrs Perry
      Mr Rees
      Mr Sartor
      Mr Shearan
      Mr Stewart
      Ms Tebbutt
      Mr Terenzini
      Mr Tripodi
      Mr Watkins
      Mr West
      Mr Whan
      Tellers,
      Mr Ashton
      Mr Martin

      Noes, 37
      Mr Aplin
      Mr Baird
      Mr Baumann
      Ms Berejiklian
      Mr Cansdell
      Mr Constance
      Mr Debnam
      Mr Draper
      Mrs Fardell
      Mr Fraser
      Ms Goward
      Mrs Hancock
      Mr Hartcher
      Mr Hazzard
      Ms Hodgkinson
      Mrs Hopwood
      Mr Humphries
      Mr Merton
      Ms Moore
      Mr Oakeshott
      Mr O'Dea
      Mr O'Farrell
      Mr Page
      Mr Piccoli
      Mr Piper
      Mr Provest
      Mr Richardson
      Mr Roberts
      Mrs Skinner
      Mr Smith
      Mr Souris
      Mr Stoner
      Mr J. H. Turner
      Mr J. D. Williams
      Mr R. C. Williams

      Tellers,
      Mr Maguire
      Mr R. W. Turner

      Pairs

      Ms BurtonMr Kerr
      Mr GibsonMr Stokes
      Question resolved in the affirmative.

      Amendment agreed to.

      Motion as amended agreed to.