Q&A with… Stephen Dawson, who took on the Mental Health portfolio in the last State Cabinet reshuffle.
MF: You previously held the Disability Services portfolio, which had some overlap into health services. Does the Mental Health portfolio feel a good fit for you?
SD: Yes, absolutely. I have a passion for mental health and kept in touch with the portfolio since being the shadow minister from 2013 to 2017. There are many similarities between the two with a strong community sector intersecting the two. Ultimately both sectors are about empowering people and supporting them to live productive, fulfilling and healthy lives. The importance of listening to those with lived experience, and delivering services that are right for the individual, are important in both portfolios.
In terms of the National Disability Insurance Scheme, only 9% (3,310) of total NDIS participants in WA have a primary psychosocial disability; this is lower than the expected 14%. I am keen to see this figure trend upwards. Without support, many people with psychosocial disability will not engage with the NDIS or may not be aware of the existence of the scheme.
It is important the state continues to monitor the progress of the NDIS roll-out for people with psychosocial disability in Western Australia and to implement strategies to ensure they have equitable access to the NDIS and the supports they require.
MF: What are some of the key challenges in the provision of mental health services in WA?
SD: One of the biggest challenges is finding the space and capacity to invest in community-based support and treatment, and prevention activities, while also ensuring we have enough acute services in the face of increasing demand.
Other challenges include managing the impact of the COVID-19 pandemic on mental health, alcohol and other drug problems, particularly ensuring that our young people are provided the support they need to avoid major problems down the track.
Staffing continues to be a challenge in the mental health sector in both clinical and community-based treatment settings. An early focus is on working with my ministerial colleagues to boost the trained workforce so we can deliver the services where they are most needed across the State.
MF: Mental health advocacy groups and the AMA remain critical of the lack of capacity in the health system to manage the number of people with mental health issues. Do you accept more needs to be done?
SD: We know that there is significant work to be done to manage the rise in demand we’ve seen in the mental health system. To address this, we have increased funding for mental health and alcohol and other drug services to a record $1.013 billion this year, an increase of 7.5% compared to the previous year.
However, it is clear that more needs to be done and the Mental Health Commission is currently working on plans to expand services in key areas including expansions of youth community treatment services, eating disorder services and adult community bed-based services.
Last year we released the WA Priorities for Mental Health and Alcohol and other Drugs 2020-2025, which outline the immediate priority areas for action.
MF: Hospital emergency departments, in particular, are struggling to cope with the influx of mental health patients, even though doctors agree these busy and noisy environments are bad for these patients. How do we better help them?
SD: Providing alternatives to emergency departments for people with mental health, alcohol and other drug issues is identified as one of the immediate priorities and we are doing a lot of work in this space. Earlier this year we opened the first Safe Haven(s) in WA, located near, but separate from, Royal Perth Hospital and Kununurra emergency departments, working alongside EDs after-hours and offering peer-based support for those who may otherwise attend EDs, but do not need intensive clinical and medical support.
There are currently mental health emergency centres (also called mental health observation areas) at RPH, SCGH and Joondalup hospitals, with funds committed for Rockingham and Bunbury hospitals to establish similar facilities. These areas provide a low-stimulus, short-stay environment for people experiencing mental health issues.
MF: Where are some of the most pressing gaps that need addressing – are they more at the acute level or at the step-down/low-acuity level?
SD: The Productivity Commission recently referred to the ‘missing middle’ – the area of service provision between higher end acute care (such as hospitals) and lower end primary care (provided by GPs, psychologists etc).
One of the more pressing gaps is the need for community bed-based services to provide people with an alternative to hospital care. These services support people with both high needs (community care units) as well as moderate or shorter-term needs (such as step up/step down services) in the community and support their recovery.
Another key area is providing sufficient and well-coordinated community mental health (outpatient) services. This is where our focus is now turning with active recovery teams being established this year, plans for expanded youth community treatment services and a roadmap to outline the models of care and pathways we will need in the future.
MF: Overall, we are seeing a lot more people presenting with mental health issues. Why do you think this is occurring – is it a real increase or mostly reflective of more people seeking help?
SD: There is definitely a greater awareness of mental health issues and reduced stigma has also gone a long way to encourage people to seek help. A recent report found that 10% of people using state-managed mental health services accessed 90% of the hospital care provided. The Auditor General investigated this in more detail in her report.
This suggests that we need additional services to better support people with high-needs, which is why we are putting in place more high needs services in the community, such as community care units, youth community treatment services and developing plans for more of these services.
MF: What impact is COVID-19 likely to be having on the mental health of West Australians, even if we have not had the big number of cases seen overseas?
SD: In terms of mental distress presentations to EDs, there was a drop in the number of people at the height of the pandemic last year, however, this has since rebounded to pre-COVID levels. We saw a slight increase in levels of distress reported during the initial months of the pandemic last year, and while published reports have shown only minor changes in key indicators of mental health during the period, we will continue to monitor and support the community’s mental health.
The measures we have implemented across the government to support the economy, families and children, the homeless and vulnerable, are also key to supporting mental health and wellbeing.
MF: There are concerns that the recent coverage of the sexual violence/harassment experienced by women is impacting on the mental health of many women in the community? Are they being supported enough?
SD: Widespread media coverage of the issue can certainly expose survivors to content that causes distress. There are sexual assault services available that provide counselling and support and I would encourage women or men to seek the support they need.
- Services include: The Sexual Assault Resource Centre (SARC) who provides free advice, support and counselling for people who have experienced sexual assault.
- 1800 Respect provides confidential sexual assault and family and domestic violence counselling via phone and webchat. (24/7 on 1800 737 732)
- Mensline Australia (1300 789 978) supports men and boys who are dealing with family and relationship difficulties.
MF: What is the role of the family GP in providing mental health support?
SD: A GP is often the first person someone talks to when they are experiencing issues with their mental health. It’s a good place to start – a GP can refer people to appropriate supports, and can help develop a mental health plan.
MF: How early do we need to address good mental health strategies in our children – is it ever too early?
SD: Over 75% of mental health problems occur before the age of 25, and about half of mental health issues start by 14 years of age. These figures highlight the opportunity we have to intervene early. We know that supporting parents from the start results in better outcomes for children later in life.
Parents play a crucial role in shaping their child’s health and wellbeing by modelling behaviours that promote and encourage good mental health such as resilience.
To make sure our children get the best possible start in life, we’ve opened 22 Child and Parent Centres across WA. These innovative, family-friendly centres are for parents with children up to eight years old in convenient locations at or near local primary schools. They provide a range of easily accessible programs and services for families, including early learning programs, maternal and child health services, and child support activities. Families can visit the child health nurse at the centre and there may be speech pathologists, physiotherapists and other health professionals on hand.
Late last year, the Mental Health Commission released an evidence-informed public education campaign to support parents, under the Think Mental Health banner. The Families Under Pressure campaign was adapted from a UK program, and was designed to help parents and carers support their child’s mental health and notice any signs and symptoms. It recognises for example that young people are more likely to seek help if they are able to express their feelings, and if they have some knowledge about mental health issues. In addition to the advice for parents and carers, the program also provides tools to help young people build resilience and equips them to look after their mental wellbeing.