CHAPTER 4
COMMUNITY SECTOR INVESTMENT
4.1
One of the main strengths of the COAG National Action Plan was that significant
funding was finally channelled into community-based mental health services
through NGOs. Such funding recognised that a broad range of supports, along
with clinical care, are needed to assist people with mental illness to live in
the community. However, the committee received evidence about strain within the
NGO sector, due to the pace at which funding had been rolled out and successive
rounds of competitive tendering.
4.2
In this chapter the committee considers the contribution of the COAG
Plan to community-based mental health care in general. It first reviews support
for the COAG Plan and the difference that funding to the community sector is making.
The committee then considers evidence about the competitive tender process used
to distribute funding for community-based programs. In the next chapter the
committee considers in detail the largest of the COAG Plan community programs,
the Personal Helpers and Mentors Program.
Community sector funding
4.3
The COAG National Action Plan put significant money into the community
sector, as outlined by the Mental Health Community Coalition ACT:
The COAG Mental Health package 2006 allocated about $800 million
mainly through FaHCSIA programs and some DoHA programs to community sector
services. That initiative by itself more than met the combined allocation from
the states and territories to specialist mental health community support
provision. We think that that was a strategic development of an extremely high
order in terms of the reform process.[1]
4.4
The Queensland Alliance Mental Illness and Psychiatric Disability Groups
Inc commented on the increased funding:
I think the amount of community based service that is available
has increased radically. The fact that we were at such a small base means that
perhaps to the broader public that is not so noticeable. In Queensland this
year the amount of funding to the non-government sector has quadrupled. So the
federal government in just one year is now investing more in non-government
organisations than our state government. There has been a massive increase.[2]
4.5
Many witnesses considered that the new funding was having a notable
effect and had improved service access for some consumers.
Effect of the new funding
4.6
The Mental Health Coordinating Council summarised that the Commonwealth
funding to NGOs through the COAG Plan has had three substantial outcomes:
- it has increased assistance for people who are unable to get
service from public health services because their illness is not acute and for
those who do not wish to engage with clinical approaches;
- it has allowed the field of NGO mental health providers to
increase, with capacity building in mental health occurring in a number of
mainstream organisations as well as mental health specialist organisations; and
- there has been a rebalancing of the mental health system, with
the role of NGOs being given greater value and recognition.[3]
4.7
In relation to this last point, Ms Bateman Chief Executive Officer of
the Council, noted:
Funding FaHCSIA and DoHA to do community mental health was a
huge step towards creating a more balanced mental health system that
understands that social inclusion, connection to family and friends, occupation
and a decent place to live are as important as medication and clinical care to
recovery from mental illness.[4]
4.8
Witnesses observed that some of the COAG federal initiatives were making
a difference in terms of service availability. Ms Edwardson from the Queensland
Alliance Mental Illness and Psychiatric Disability Groups commented:
With some of this federal money coming down it has been really
good to be able to say, ‘Well, your first port of call is PHaMs [Personal
Helpers and Mentors]. Here are the numbers to ring.’ Whether or not they can
take on all the people is a different story, but at least having an option to
give people instead of sending them away empty-handed has been terrific. I know
there are some people who have successfully got onto that program from
referrals that we have done.[5]
4.9
Ms Carmody from Ruah Community Services in Western Australia commented
on the difference for service providers:
It has been uplifting and encouraging. We have seen some
agencies that have been working on a shoestring resource base for their programs
for many years that have the opportunity now to extend that, such as through
the Health and Ageing Support for Day-to-Day Living in the Community program.
Groups like Richmond Fellowship and Ruah, which had a base already, have been
able to apply for things like the Personal Helpers and Mentors program. We see
more counselling opportunities happening for people.[6]
4.10
Mr Dempster, from the Northern Territory Mental Health Coalition
described the energy created by new funding to the community sector:
...there is a sense of, 'Let's go for it.' People are saying,
'Right, we're getting some things that we can do for people,' and consumers are
saying, 'Okay, there's this option and that option.' So there seems to be a
positive view about it. It is not all gloom and doom.[7]
4.11
Similarly, Ms Bateman observed a 'renewed energy, commitment and
confidence' in the community sector stemming from the COAG Plan and relevant
state government initiatives. She noted increases in NGO training, in the
number of organisations implementing consumer outcome monitoring and quality
improvement systems, improvements in professionalism and more involvement in
research and linkages with universities and other academic institutions. Ms Bateman
summarised that 'the COAG initiatives provided the sector with an enormous
boost to morale and the opportunity to meet some of the glaring unmet need not
targeted by state NGO programs'.[8]
4.12
Evidence to the committee suggests that in some areas the COAG Plan
community funding has helped provide new paths to reach people who were not
receiving mental health care and to provide some continuity of care. The Mental
Illness Fellowship of South Australia commended the connections occurring between
some of the COAG initiatives:
...there are people in the community who do not see themselves has
having a mental illness or do not want to connect with services. Things like
the respite program allow us to come in at a different angle and offer some
recreational, fun activities...we are working towards transitioning them into the
PHaMs program...From there, often once they have built their confidence they
enter the Support for Day-to-Day Living in the Community program or the
activity programs options where people build skills or relearn skills in terms
of social, recreational and recovery based programs.[9]
4.13
The committee was encouraged by the positive response within the
community sector to the COAG Plan. At the same time, the committee's evidence
indicates that further investment is required to develop and sustain adequate
community-based services. Some witnesses, such as Ms Colvin from the Council of
Official Visitors in Western Australia noted that even with additional funding
to the community sector, programs are not reaching those in desperate need:
The people in hostels are the sorts of people we would expect to
see getting access to these programs and we are just not seeing it. People in
hostels sit around basically all day long with nothing to do. They have great
difficulty, first of all, finding the programs and, then, getting transport to
the programs. Sometimes they are not able to use the transport system, or the
cost is prohibitive.[10]
4.14
The need for more community-based care is discussed further in chapter 8,
Shortfalls and gaps.
Competitive tendering
4.15
Despite the improved access to some services and positive outlook
generated by the COAG Plan funding, the distribution of this funding has been
somewhat tumultuous. The committee heard evidence that the rollout of large
amounts of new funding through competitive grants has fractured the mental
health community sector. Mr Cheverton of the Queensland Alliance Mental Illness
and Psychiatric Disability Groups observed:
...because all this money was put up incredibly quickly and
through tender processes, the coordination and cooperation that was already
there has diminished. The organisation that you had been working with down the
street was suddenly your competitor on the Day to Day Living tender and then on
the PHaMs tender and then on the Community Living tender. I think there are 18
federal initiatives, but there are 26 Queensland initiatives. So the experience
of community organisations has been for wave after wave of tender applications,
which takes a lot of time and energy away from service delivery and is, in some
cases, a bit of a lucky dip.[11]
4.16
Similarly, Ms McGrath, representing Survivors of Torture and Trauma
Assistance and Rehabilitation Service SA, considered that the tender process
had been 'very destructive'. She explained:
There are always going to be limited resources available for any
type of human services or welfare services. What governments need to be doing
is promoting cooperation not competition. Competitive tendering processes
promote competition, and that means that services that should be working
together actually cannot, or there are limits to how much and how well they can
work together.[12]
4.17
Mr Warner, UnitingCare Wesley Port Adelaide, agreed:
...competitive tendering does create some form of friction. You
keep a lot of your own knowledge to yourself; you will not spread it around.
You are not going to share with another organisation the models that you have
designed and spent months if not years of intelligence developing. Part of my
philosophy in the organisation is that we are not there for ourselves; we are
there for the clients. Really what we should be doing is spreading that
information and intelligence around to all organisations so that we get the
best model and the best practice to provide the best service to the consumer
out there who is marginalised and disadvantaged.[13]
4.18
Some of the key concerns raised by NGOs about the competitive tendering
process included undervaluing of local knowledge and collaboration when
assessing tenders, the onerous amount of information required in the tender
process, a perceived preference for generalist providers and the sustainability
of services.
Valuing local knowledge
4.19
Submitters were concerned that tender processes for COAG Plan community programs
have favoured large organisations with the capacity to formulate tenders that
suit the department's preference and criteria, rather than organisations with
good local knowledge, linkages and an understanding of what is actually
achievable.[14]
Ms Bateman, CEO of the Mental Health Coordinating Council assessed:
...the open tender process which occurred under COAG has worked
against recognition of the importance of local connections in a number of
areas, with tender-writing skills, rather than local connections, being
prioritised in the awarding of tenders.[15]
4.20
Mr Quinlan, Executive Director Catholic Social Services Australia
commented:
...local services that have been part of the local community for
many years, often offering a broad range of services, can lose out on a
particular program to agencies that are essentially just coming into town to
deliver that program. The merits of that could be argued both ways, but the
impact on the local community can be enormous.[16]
4.21
Mr Calleja, Western Australian Association for Mental Health (WAAMH),
observed that a large number of agencies without a track record of delivering
services in mental health had won tenders. He raised questions about how long
it takes such agencies to start to deliver services and the initial learning
required, particularly if agencies are to have a recovery focus.[17]
4.22
The Queensland Alliance Mental Illness and Psychiatric Disability Groups
suggested that select, rather than open, tenders would be a better method of
awarding funding. Submitters also advocated that local knowledge and history of
involvement in a community be given greater weighting in the assessment of
tenders. Ms Bateman, CEO of the Mental Health Coordinating Council suggested:
...perhaps there should be consideration of a more select tender
process where, if you are planning on putting services up in the northern area
of New South Wales, organisations operating in that area are prioritised and
there is, perhaps, a weighting for organisations that can actually demonstrate
their local linkages, because to create local linkages takes time and energy.[18]
4.23
Ms Kilroy, from Sisters Inside, suggested that in assessing tender
applications it is important to consider who the organisation is currently
working with, what outcomes they have achieved in other programs and what
evaluations they can provide.[19]
Ms Carmody, from Ruah Community Services also advocated finding additional
ways to assess a tender, not only on the written application.[20]
Ms Bateman suggested that support for the tender from other local
organisations could be taken into account:
I think they should go to the smaller organisations or other
groups and agencies in the local area and ask them to submit support for the
organisation, because I think a lot of organisations can say they have links
but when you actually come down to it they are pretty scant—it might have been
a phone call two days before the tender went through or something like that.[21]
4.24
There was a common view that generic program models will not fit across
the whole of Australia; the tender process needs to be sensitive to local need,
to local knowledge and local linkages. At the same time, it was recognised that
if NGOs do not exist in an area, that area may continue to miss out on services
unless new providers, often large organisations, are encouraged to set up
services.[22]
4.25
Mr Lewis, Group Manager FaHCSIA, stated that while there may be an
impression that there is a preference towards awarding tenders to larger
organisations, in his experience this is not the case:
...over some four or five years, across three or four major
programs of billions of dollars that I have been involved in, it has not always
been the larger ones that have got the contracts. It certainly has not. In many
cases, and certainly in the PHaMs situation, there are many smaller
organisations who have the bona fides in terms of practice and experience, are
genuinely new, are small and have done very well in the tender processes.[23]
4.26
While this may be the case, the committee's hearings gave some insight
into the tension within the NGO sector that is running counter to the positive
momentum derived from the availability of more funds for mental health
programs. An energised, well resourced and inter-connected NGO sector stands to
improve outcomes for people with mental illness; fracturing of the sector will
not. In this context the committee urges efforts to improve the tendering
process, such as increased transparency as to the weighting given to local
knowledge and linkages and looking at improving opportunities for collaborative
tendering.
Collaborative tendering
4.27
The Australian Mental Health Consumer Network described circumstances
where larger NGOs, without a local presence or experience in providing mental
health services, turn to smaller NGOs after receiving funding, for
advice and assistance in delivering the programs. Ms Gardner, a board member
for WAAMH and Chairperson of the Bay of Isles Community Outreach in Esperance
provided an example of the kinds of requests made of local NGOs:
...other groups that have obtained funding do not have the
capacity or experienced staff to man some of what they want to do and are
looking for us to provide that training. We are such a small group that we
cannot include that in what we are currently able to do, and they are not
prepared to pay to employ other people to replace our staff while we try to do that...[24]
4.28
A more positive arrangement would be collaborative and alliance
tendering, with larger NGOs able to auspice smaller NGOs that have specialist
skills and local knowledge. Ms Richardson, Community Services Manager Carers
South Australia, said 'I think the encouragement of collaborative partnerships
with other organisations when they are working across the regions to be able to
put in joint submissions would be very beneficial'.[25]
4.29
Mr Wright, Director of Mental Health Operations South Australia, saw
opportunities for more collaborative tendering in South Australia:
I have brought some new experience from New Zealand, where we
have a non-government sector that has been up and running for a lot longer. I
think we have learned a lot of things about how to get a new organisation to
partner with a more experienced organisation and to put in a joint tender, with
the view that we are developing the capacity of the new organisation. We still
need to do that in South Australia.[26]
4.30
However, Mr Quinlan Executive Director Catholic Social Services
Australia, saw challenges in collaborative tendering:
...it is a very tricky process to realistically establish
consortiums in the community between agencies that often have very different
values bases, very different histories and very different raisons d’etre.[27]
4.31
Dr Gurr, CASP, raised concerns about grants based funding at a systemic
level. Because of the rigid nature of contracted services, Dr Gurr argued that
providers are not able to adapt in response to changing needs:
You can end up with one organisation...swimming in money because
they do not actually need to provide the level of service but they have been
given the money for it. But their auditors will not let them use the money in
some other way because it is not the purpose of the contract.[28]
4.32
Similarly, the Mental Health Coordinating Council argued that the
long-term effect of current funding models will be 'a loss of responsiveness to
the changing needs of the community served by the NGO'.[29]
4.33
Dr Gurr also noted that the current competitive tendering approach
results in a plethora of providers all contributing elements to a person's
support, care and treatment. He suggested that Australia may need to learn from
other countries and look at more consolidated service provision:
If we think about packages, we have got to get more
sophisticated about how we think about purchasing packages. I think this is the
issue in New Zealand. They have gone through this whole phase—they have
experienced the purchasing and having multiple contractors providing for it—and
they ended up with too much fragmentation. I think they are going back now
towards saying, ‘We need a bit more of a consolidated view about how we do
this.’[30]
4.34
The committee is concerned that, following a history of underspending on
mental health care delivered through the NGO sector, the injection of COAG Plan
funds through competitive tendering has lead to fractures within the sector. The
committee recommends that governments consider alternative forms of tendering
which better promote collaboration and coordination.
Onerous application process
4.35
Some NGOs found the information requirements associated with tendering
for community-based mental health programs quite onerous. The Northern
Territory Mental Health Coalition commented that 'a lot of organisations,
particularly the smaller ones, get scared off because there is so much to do
and so much information to provide'.[31]
Top End Association for Mental Health Inc observed that even though they are
the largest NGO in the Northern Territory, they are still not a very big
organisation and found the competitive tendering process 'extremely onerous'.[32]
4.36
Mr Quinlan suggested that much of the burden involved in applying for
funding could be reduced if government departments coordinated with regard to the
information required:
It seems to me that, once you are deemed a suitable organisation
to deliver Commonwealth programs, you should have jumped that hurdle. With
appropriate regular accreditation you should not have to jump that hurdle every
time you go for a particular funding grant. It should be similar at the state
level. There could be enormous effort taken out of some of those tender
processes if, on the funders’ side, there was better coordination of
information and effort so that agencies are not supplying the same information
over and over again to a range of government departments that never speak to
each other.[33]
4.37
Professor Calder, First Assistant Secretary DoHA, noted that while some
of the details required in tender documents are about financial viability year
to year and would need to be supplied repeatedly, there may be scope to reduce
the demand for basic eligibility information. For example, it may be possible
to establish a register of providers that have been assessed as meeting basic
criteria. As eligibility requirements currently differ across departments, it
would be a substantial undertaking to set up a consolidated register. The
committee notes that it would greatly improve tendering processes if
standardisation could be increased.
4.38
Mr Lewis, Group Manager FaHCSIA, noted that two reviews are underway
which encompass some of the issues raised in the inquiry: a community grants
review looking at how government does business with NGOs, and a red tape review
looking at barriers to funding and issues such as pre-accreditation of
providers for certain purposes. Mr Lewis summarised 'We are cognisant of some
of the issues and trying to do something, and we are looking across all of our
grants processes.'[34]
4.39
The committee looks forward to the outcomes of the reviews currently
underway and considers that they should include mechanisms to reduce the
information burden placed on NGOs that tender for multiple programs and
standardise requirements for information across different government
departments.
Meeting the needs of specific
groups
4.40
Some organisations were concerned that COAG Plan initiatives have been
limited because they are generic and not targeted to specific population
groups. Representatives from the Mental Health Coalition of South Australia were
concerned that the tender specifications for community programs 'tend to
encourage generalist applications and tend to exclude organisations that might
have a specific expertise'. Examples included organisations that provide
specialist services for people from culturally and linguistically diverse
backgrounds, or for older people, which would find it hard to apply for current
Commonwealth funding.[35]
In Brisbane the committee heard from Sisters Inside, an organisation that works
with women in prison and the justice system many of whom have mental illness
and many of whom are not connected or engaged with mainstream health services. Ms
Kilroy, from Sisters Inside commented:
Because we are not specifically a fundamental mental health
service we are actually not seen by the federal health department as an
organisation that can provide those services. The money goes to the mental
health services but those are services that the women actually move away from,
do not engage with, and instead come to us.[36]
4.41
The committee suggests that in reviewing the COAG Plan community-based
initiatives, the government give consideration to whether quarantining some
funding for services targeted at specific population groups would achieve
better mental health outcomes for the community than the current generic
population approach. In chapter 9 the committee notes that the needs of a
number of specific population groups are not adequately met by existing mental
health initiatives.
Sustainability of services
4.42
An issue raised by several service providers was the uncertainty that
accompanies grants based funding. This included frustration when requests for
tenders were delayed, such occurred with the third round of PHaMs funding, and
concerns as to whether programs would be renewed beyond their initial timeframe.
In South Australia, for example, the committee heard about organisations that
were awaiting funding decisions for both COAG Plan comorbidity projects and
projects under the National Drug Strategy. Although tenders for some programs
closed in December, by early May funding announcements had not been made. Ms
Edwards, Executive Officer South Australian Network of Drug and Alcohol Services
(SANDAS), commented that organisations were losing staff as programs were not
funded beyond the end of June and therefore positions could not be guaranteed.[37]
This stop-start funding approach is not helpful to achieving a connected and consistent
system of care.
4.43
Ms Cassaniti, Centre Coordinator Transcultural Mental Health Centre NSW,
observed that short-term funding can actually have negative effects in a
community:
With anything, trickles of money can at times do more damage
than good, because they set up issues that are not sustainable without ongoing
money and they set up false hopes. I think the longer pilot periods—if there is
no money to do the recurrent—are for a five-year period, so we can at least
build some evidence around what works and what does not work.[38]
4.44
Anglicare Tasmania noted that there had been some improvements in
sustainability, but saw room for further improvement, particularly when
re-tendering for programs:
In the last two years we have moved from what used to be pretty
much one-year contracts to three-year contracts. There has been some progress
in that regard. Some retendering processes look a bit odd, particularly in a
small state where there are not that many players after all and you wonder
whether it is worth the disruption, and each time there is a change from one
provider to another there is a tearing down of infrastructure and relationships
and a restarting. There needs to be an assessment of threshold need before you
retender, given that something is established on the ground.[39]
Concluding comments
4.45
Evidence to the committee's inquiry shows how pleased mental health NGOs
are about the much needed new funding coming into the sector through the COAG
Plan and the improvement in service access occurring in some areas as a result.
However, the rollout of this funding has clearly had adverse consequences for the
cohesiveness of the NGO sector. As with other parts of mental health care,
continuity and coordination are critical to assisting people with mental
illness in recovery. The sector needs to be supported in such a way as to
promote this coordination.
Recommendation 7
4.46
The committee recommends that in purchasing non-government organisation
services for future mental health initiatives, Australian, state and territory
government departments do not rely exclusively on open tenders but also develop
other procurement models such as collaborative and select tenders.
Recommendation 8
4.47
The committee recommends that the following issues be considered in
future funding rounds:
- the weighting given to local knowledge and linkages when
assessing tenders;
- opportunities to increase collaboration;
-
reducing the information burden associated with tendering for
multiple programs; and
- addressing sustainability of services.
4.48
Beneath these specific concerns is the broader issue of the remaining
gaps in community support services for people with mental illness. This is
discussed in chapter 8.
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