Chapter 1 Introduction
There is ample evidence of the benefits of work for people
with mental illness and that most people with a mental illness want to work.[1]
Work is the best therapy for me...it is vital to that road to
recovery.[2]
Working means the world to me...it gives me something to do
[and] look forward to.[3]
The issue – increasing numbers of people with a mental health condition on
income support
Statistics
1.1
In the 2007 Australian Bureau of Statistics National Survey of Mental
Health and Wellbeing 45 per cent of Australians aged 16-85 years reported
experiencing at least one, or a combination of, mental illnesses at some point
in their lifetime. And 20 per cent of Australians reported experiencing one or
a combination of mental disorders in the previous 12 months.[4]
1.2
Mental illness is the single largest cause of disability in Australia.[5]
According to the Australian Institute of Health and Wellbeing:
Mental disorders account for 13.1 per cent of Australia’s
total burden of disease and injury and are estimated to cost the Australian
economy $20 billion annually in lost productivity and labour participation.[6]
1.3
The 2007 Organisation for Economic Cooperation Development’s (OECD) report
titled Sickness, Disability and Work (Vol. 2): Australia, Luxembourg, Spain
and the United Kingdom (the OECD report) notes a large increase in the last
15 years in the number of working-age people receiving disability benefits in
Australia.[7]
1.4
A joint submission from the Commonwealth departments of Education,
Employment and Workplace Relations (DEEWR), Health and Ageing (DoHA) and
Families, Housing, Community Services and Indigenous Affairs (FaHCSIA)
(hereafter referred to as the joint department submission) states that income
support payments through the Disability Support Pension (DSP) are the single
largest outlay of welfare benefits for Australians experiencing mental illness.[8]
1.5
The Centrelink website sets out the eligibility criteria for receiving
DSP. Claimants must be:
n 16 years of age or
over at the time of claiming and under age-pension age;
n Assessed as having a
physical, intellectual or psychiatric impairment of at least 20 points [against
Impairment tables] and are either:
Þ Participating
in the Supported Wage System, or
Þ Unable to
work or be retrained for work of at least 15 hours or more per week at or above
the relevant minimum wage within the next two years because of their
impairment, and assessed as having either a severe impairment or as having
actively participated in a program of support.[9]
1.6
The advantage of a DSP benefit, over other types of benefits such as
Newstart or Youth Allowance, is the higher benefit payment. For instance, a
single person aged over 21 years on the DSP without children may receive a
maximum fortnightly payment of $695.30 as compared with $489.70 a fortnight on
Newstart and $402.70 a fortnight on Youth Allowance.[10]
1.7
Data presented by FaHCSIA showed that in the last decade the numbers of
DSP recipients with a psychiatric or psychological condition recorded as their
primary condition has grown by some 76.1 per cent. Of the approximately 793,000
DSP recipients at June 2010, nearly a third, 28.7 per cent (approximately 227,000),
had a mental illness as their primary condition. DSP expenditure for people
experiencing a mental illness in 2009-2010 was estimated at $3 billion. These
numbers do not include people on other types of benefits, such as Newstart
allowance or Parenting Payment, who may also have a mental illness as a barrier
to participation.[11]
1.8
The updated FaHCSIA document Characteristics of Disability Support
Pension Recipients (June 2011) reports a small increase of DSP recipients
in the psychological/psychiatric category (29.5 per cent) and notes:
The proportion of DSP recipients with a Psychological/Psychiatric
primary medical condition surpassed Muscluo-skeletal and connective
tissue for the first time in 2011.[12]
1.9
The 2007 OECD report found that employment rates of Australians with a
disability stands at around 40 per cent, which is lower than five years ago and
only half the rate of those without a disability.[13]
1.10
While Australia has enjoyed high rates of economic growth for more than
a decade and the unemployment rate has fallen as low as 4.3 per cent, the
living conditions of those with a disability has not improved.[14]
The incomes of Australians with disabilities are about 15 per cent lower than
the national OECD average.[15]
1.11
Despite average health status improvements in OECD countries, there is a
growing trend of people reporting mental health conditions and their low market
participation rates. This issue is a key policy challenge for all OECD governments,
including the Australian Government.[16]
1.12
While mental health and disability, social welfare and workforce
participation are topics that have all received considerable policy attention
in recent years, there has been something of a gap in focusing specifically on
the employment prospects of persons with a mental illness.
1.13
Given the statistics on the sheer numbers of people affected by a mental
illness receiving the DSP it is timely to look more closely at the issue. This
is the first Australian parliamentary committee inquiry to look specifically
into the nexus between mental health and workforce participation.
Filling workforce shortages
1.14
At the same time as the numbers of people with a mental health condition
on the DSP are increasing, it is well-documented that Australia must redress an
ageing workforce[17] with workforce shortages
in parts of rural and regional Australia in various sectors that include health
professionals, teachers and the trades.[18]
1.15
The resources industry is perhaps the most obvious example of a sector
that will need more workers to cope with anticipated demand into the future.
The National Resources Sector Employment Taskforce Report titled Resourcing
the Future (July 2010), chaired by then Parliamentary Secretary for Western
and Northern Australia, the Hon. Gary Gray AO, MP, referred to 75 major
resources projects expected to commence in Australia over the next five years
and the need for tens of thousands more workers in both their construction and
operational phases. Existing and anticipated shortages span a diverse range of
professions, trades and other skills, including mining engineers,
geoscientists, drillers, electrical trades, mechanical technicians, machinery
operators and drivers.[19]
1.16
The Australian Bureau of Statistics reported that the mining hubs of
Western Australia and Queensland posted a rise in job vacancies in the year to
November 2011.[20]
1.17
The mining company BHP Billiton estimates that the resources industry
will need more than 150,000 extra workers in the next five years.[21]
Upskilling: a mainstream issue
1.18
The Commonwealth Government encourages upskilling the Australian population
as a whole. Complementing the Government’s ‘Building Australia’s Future
Workforce’ initiative, a National Workforce Development Fund will provide $558
million over four years to industry to support training and workforce
development in areas of current and future workforce need.[22]
1.19
One of the Fund’s current three priority areas is to support the
resources sector, with attention focused on where workforce shortages are the
most acute.[23]
1.20
The new Skills Connect website is a service designed to:
link eligible Australian enterprises with a range of skills
and workforce development programs and funding....[24]
Policy framework and strategies
1.21
The 2007 OECD report made policy recommendations in the following three
areas:
n strengthening
employer involvement in the early phase of a health condition;
n ensuring everybody
who could benefit from employment services can get them; and
n reform of benefits to
improve work incentives and increased incomes.[25]
1.22
A later report by Rachel Perkins, Paul Farmer and Paul Litchfield titled
Realising Ambitions: Better employment support for people with a mental
health condition, which was prepared for the Department of Work and Pensions
in the United Kingdom in 2009, made a number of recommendations in three broad
categories to the UK Government:
n increasing capacity
and dispelling myths within existing structures so that they are better able to
meet the needs of people with a mental illness;
n “model of more
support”: implementing Individual Placement and Support; and
n establishing
effective systems for monitoring outcomes and driving change.[26]
1.23
A more recent OECD report titled, Sick on the Job? Myths and
Realities about Mental Health and Work[27] notes new evidence that:
... questions some of the myths and taboos around mental
ill-health and work. People with a severe mental disorder are too often too
far away from the labour market, and need help to find sustainable employment.
The majority of people with a common mental disorder, however, are employed but
struggling in their jobs. Neither are they receiving any treatment nor any
supports in the workplace, thus being at high risk of job loss and permanent
labour market exclusion. This implies a need for policy to shift away from
severe to common mental disorders and sub-threshold conditions; away from a
focus on inactive people to more focus on those employed; and away from
reactive to preventive strategies.[28]
1.24
Supporting people who are currently in the workforce and experiencing
mental ill health to retain their employment is as important as enhancing access
to jobs and training for those looking to enter into employment.
1.25
The Committee’s inquiry and report is informed by the principles that
underpin these reports and considers these principles as they apply in the
Australian context.
1.26
As previously indicated, much has been and is happening within the
spaces of mental health and workforce participation respectively.
1.27
It is not within the remit of this report to propose fundamental reform
to either mental health or welfare sectors. The Senate Select Committee on
Mental Health conducted a comprehensive mental health services inquiry in 2006[29]
and this Committee does not seek to repeat that work. Neither will it propose
major overhauls of the social welfare system. These much broader debates have
been and are still taking place in other forums.
1.28
This report is specifically about the barriers to workforce
participation for people with mental ill health and the ways to best overcome
them.
1.29
The report presents the key issues repeatedly raised during the inquiry,
highlights best practice, and suggests ways forward to capitalise on gains and
build momentum to make long-lasting improvements.
Benefits of employing people and keeping them in employment
1.30
The 2007 OECD report asserts that helping people with mental ill health
to work is a win-win scenario:
It helps people avoid exclusion and have higher incomes while
raising the prospect of more effective labour supply and higher economic output
in the long term.[30]
1.31
Throughout the course of the inquiry, the Committee heard many success
stories relating the benefits of employing and retaining employees who had
experienced mental ill health, for both employees and employers.
1.32
Mr Gary Wanstall described the difference that having a job had made to
his life, and alluded to the importance of early intervention and understanding
of the episodic nature of his illness from his long-standing employer in
Western Australia. His case exemplifies how an employer, an employment service
provider and a clinician can work together to tailor employment to the
individual’s situation and benefit everyone involved:
At the end of 2009, I had another episode and ended up in
hospital again. I did not know what to do with my life...Edge Employment, St
John of God Hospital and my psychiatrist got together and they created a [new]
job for me [after having previously held different jobs at the hospital over a
number of years].
I admit patients. I take them up to their rooms and introduce
them to the hospital, St John of God hospital, Murdoch. It is the best job in
the hospital and I love it. I think I do a good job. I love getting up every
morning and going to work. I feel very lucky and very privileged to have Edge
Employment, St John of God Hospital and the support system that I have with me,
which I am very happy with...I feel worthwhile; I feel like I’m doing
something...I feel normal, which is good.[31]
1.33
Mr Wanstall added:
I think if my CEO were here now, he would put me up on a
pedestal and tell you how well I do at work.[32]
1.34
Rio Tinto spoke of its commitment to supporting existing employees and
their families, when an employee suffers from a mental illness, and pointed to
a range of available policies and programs. Further, Rio affirmed its
engagement with finding new ways to help the workforce manage mental health and
resilience by building and sustaining a supportive and healthy working culture.[33]
1.35
Anecdotal evidence suggests that there may be a greater loyalty to
workplaces from employees who support staff in this manner.
1.36
Mr Rhett Foreman, General Foreman at Abigroup Inc. intimated that
Abigroup’s proactive approach to mental health had been a factor in his
acceptance of a position at that company:
That certainly tilted things in Abigroup’s favour, from my
point of view, [despite my having had other job offers].
1.37
The Australian Chamber of Commerce and Industry (ACCI) advised that
while there was no hard research to support that this would be the case:
It would make sense that where an employee has found an
understanding employer and where an employer values that employee I would think
that would be far more likely to be long term [loyalty to the employer] and
that is a benefit.[34]
Mental health reforms
1.38
Significant resources have been devoted to reforms in the mental health
and workforce participation spaces respectively in recent years. It is useful
to background some of these reforms before moving on to consider the
intersection between mental health and workforce participation.
1.39
Professor Patrick McGorry AO, 2010 Australian of the Year and Chief
Executive Officer of Orygen Youth Health – a world renowned mental health
organisation for young people – noted that we are at a tipping point for mental
health reform in Australia:
Not only can we no longer afford to do nothing, but we now
have the opportunity, capacity and momentum to deliver genuinely
transformational change... to live in communities in which people are
increasingly enlightened about mental health issues and where locally based
services respond early, expertly and effectively whenever we begin to struggle
with mental health.[35]
1.40
The Prime Minister, the Hon. Julia Gillard MP, has indicated that mental
health reform is a key priority for the Commonwealth Government. In 2010 the
first Commonwealth Minister for Mental Health, the Hon. Mark Butler MP, was
appointed to affirm this focus. The 2010-2011 and 2011-2012 budgets reflected
this commitment with a $2.2 billion mental health reform package to be
delivered over five years for mental health services.[36]
1.41
The 2011-2012 Budget contained $1.5 billion for new measures and
improving existing ones. The priorities are:
n providing more
intensive support services, and better coordinating those services for people
with severe and persistent mental illness;
n targeting support to
areas and groups that need it most, such as Indigenous communities and
socioeconomically disadvantaged areas that are underserviced by the current
system; and
n helping to detect
potential mental health problems in the early years and supporting young people
who struggle with mental illness.[37]
1.42
The Parliamentary Library Budget review, Mental health – centrepiece
of this year’s health budget, highlights some of the significant measures
in the 2011-2012 Budget:
n $419.7 million over
five years to establish up to 12 new Early Psychosis Prevention and
Intervention Centres (EPICC), and 30 new headspace sites to help young
people with or at risk of mental illness;
n $343.8 million over
five years to provide more coordinated care services to people with severe
mental illnesses;
n $269.3 million over
five years for community mental health services, in particular to expand Family
Mental Health support services and increase the number of personal helpers, mentors,
and respite care services;
n $201.3 million over
five years for a National Partnership Agreement on Mental Health. Funds from
this agreement would be made available to state and territory governments on a
competitive basis for projects designed to address major gaps in mental health
services ;and
n $205.9 million over
five years to expand access to the Access to Allied Psychological services
programs in hard to reach and low socioeconomic areas.[38]
1.43
Other important initiatives include the establishment of a Mental Health
Commission and an online portal that will make it easier for people to find and
access mental health services.[39] The National Mental
Health Commission was launched on 23 January 2012.[40]
1.44
At its meeting on 19 August 2011, the Council of Australian Governments
(COAG) agreed to commence work on the development of a National Partnership
Agreement on Mental Health to address priority service gaps in Australia’s
mental health system, and to develop a Ten Year Roadmap for National Mental
Health Reform that will set out the main steps to achieving this vision. The
draft roadmap was released on 17 January 2012, with comments currently being
sought from interested parties.[41]
1.45
The national partnership and roadmap operate in the context of COAG’s fourth
national mental health plan: an agenda for collaborative government action which
covers the period from 2009 through 2014.[42]
1.46
In Australia states and territories are responsible for the provision of
clinical health services. This means that health services differ between jurisdictions.
As a result, the extent to which services join seamlessly varies and there can
be silo effects with service delivery.
Welfare reforms
1.47
Efforts to improve Australia’s welfare system has been another priority
for the Australian Government.
1.48
On 11 August 2010, the Commonwealth Government announced its intention
to:
n spread the dignity
and purpose of work;
n end the corrosive
aimlessness of welfare; and
n bring more
Australians into mainstream economic and social life.[43]
1.49
The Commonwealth Government’s policy consists of ‘carrots’ that connect
people to jobs (including offering relocation assistance to unemployed
Australians prepared to relocate to take up work), and ‘sticks’ that impose tougher
rules on jobseekers and strengthen compliance.[44]
1.50
Proposals for tougher rules for jobseekers, that is, the ability to
suspend social security payments for job seekers if they fail to attend
appointments with job service providers, was the subject of inquiry and an advisory
report on the Social Security Legislation Amendment (Job Seeker Compliance)
Bill 2011 by this Committee, which was tabled in May 2011.[45]
1.51
To further these initiatives, the Commonwealth Government announced a $3
billion package, ‘Building Australia’s Future Workforce’ in the 2011-2012
Budget.[46] The Government intends
the package to:
n reward work through
improved incentives in the tax and transfer system;
n provide new opportunities to
get people into work through training, education, and improved childcare and
employment services;
n introduce new requirements for
the very long-term unemployed, Disability Support Pensioners, teenage parents,
jobless families and young people; and
n take new approaches to address
entrenched disadvantage in targeted locations.[47]
1.52
The Parliamentary Library budget review, Disability support pension
-reforms, highlights the key changes. An important new measure is:
n allowing [DSP]
recipients who are subject to the 15 hours a week requirements to work for up
to 30 hours a week and remain eligible for a part-rate pension.[48]
1.53
Other changes include:
n improving work
capacity assessments for DSP claimants; and
n providing personal
helpers and mentors specifically to help people with mental illness who are
participating in employment services and who are on, or in the process of
claiming income support, including the DSP.[49]
1.54
The Parliamentary Library review outlines some of the initiatives to
support pension recipients into work:
n $558.5 million over
four years for a National Workforce Development Fund to support relevant, industry-based
training in areas of skill shortage;
n $143.1 million over
four years for up to 30,000 additional Language, Literacy and Numeracy Program
training places;
n $133.3 million over
four years for very long-term unemployed job seekers to undertake approved Work
Experience Activities for 11 months of the year (rather than six months under
the current scheme);
n $11.3 million over
three years for wage subsidies to be paid to employers who provide employment
placements to people with disability who have been unemployed for at least 12
months;
n $94.6 million over
four years for wage subsidies for employers of very long-term unemployed job
seekers to provide paid employment experience to help them transition into paid
employment;
n $21.8 million over
three years for an awareness campaign that promotes the benefits of employing
the very long-term unemployed and people with a disability; and
n $35.3 million over
four years for measures that streamline services for job seekers (as part of
the Government’s response to the Independent Review of the Job Seeker
Compliance Framework).[50]
Intersection of mental health and workforce participation reforms
1.55
The preceding section outlines the reforms in the mental health and
welfare/workforce participation spaces in recent years.
1.56
Clearly, there is overlap between the two with regards to encouraging
and supporting job seekers with a mental illness to participate in education,
training and employment.
1.57
As part of its broader Social Inclusion Agenda,[51]
the Government released a National Mental Health and Disability Employment
Strategy (NHMDES) in September 2009.[52]
1.58
The NMHDES aims to address the barriers faced by people with a
disability, including mental illness, that make it harder for them to gain and
keep work.
1.59
The NMHDES recognises the importance of education and training as a
pathway to sustainable employment, and the role of employers in increasing
employment opportunities for people with disability.[53]
1.60
Highlights of the Strategy include:
n new Disability
Employment Services to give job seekers immediate access to personalised
employment services better suited to their needs with stronger links to skills
development and training;
n a DSP Employment
Incentive Pilot that will provide job opportunities for 1,000 Australians who
receive the DSP;
n the Australian Public
Service Commission will develop training and best practice advice for
Australian Public Service (APS) agencies and managers, and establish and
support disability networks for APS Human Resources Managers and practitioners;
n improved assessment
and support for people with a disability. Changes to the Job Capacity
Assessment (JCA) process that ensure that people on DSP who want help to find
work will no longer have to worry about putting their disability pension on the
line;
n workforce
re-engagement through better and fairer assessments for DSP. A number of
measures will support the re-engagement of people with disability within the
workforce as part of the Disability Pension- better and fairer assessments
2009-2010 Budget measure;
n the creation of a new
Employment Assistance Fund that will bring together resources from the
Workplace Modifications Scheme and the Auslan for Employment Program making it
easier for employers, people with a disability and employment providers to
access assistance;
n an Innovation Fund will
help more people with disability into jobs by funding innovative projects that
remove barriers to employment; and
n an enhanced
JobsAccess website to increase awareness among employers of the services
available to support both people with disability and mental illness.[54]
1.61
The NHMDES is supported by – and to some extent now superseded by – the Government’s
more recent National Disability Strategy, which was the result of an extensive
nation-wide consultation process. In February 2011, COAG formally endorsed a 10
year national policy framework to guide government activity and drive future
reforms to improve outcomes for people with a disability, including mental
illness.[55]
1.62
The purpose of the 2010-2020 National Disability Strategy is to:
n establish a high
level policy framework to give coherence to, and guide government activity
across mainstream and disability-specific areas of public policy;
n drive improved
performance of mainstream services in delivering outcomes for people with
disability;
n give visibility to
disability issues and ensure they are included in the development and
implementation of all public policy that impacts on people with disability; and
n provide national
leadership toward greater inclusion of people with disability.[56]
1.63
One of the priority areas for action is:
economic security – jobs, business
opportunities, financial independence, adequate income support for those not
able to work, and housing.[57]
The stigma of mental ill health
1.64
The reforms in mental health and workforce participation policies and
programs occur against a background that is slower to change, that is, the
stigma associated with mental ill health.
1.65
Stigmatisation of mental ill health is based on ill-informed assumptions
such as people with mental ill health have limited capacity or will to
participate or they will be disruptive and dangerous.
1.66
Stigma can come from employers, colleagues, clinicians, family, friends
and the wider community and, perhaps most debilitating of all, can manifest as
self-stigma. One of the main adverse consequences of stigmatising people with
mental ill health is an increased reluctance for them to disclose their mental
health issues and associated needs.
Stigma in the workplace
‘When you have a mental illness, employers think of you as a
liability. Some of them think that you’re likely to be an axe-murderer.’[58]
1.67
Negative and misinformed attitudes toward people with mental ill health
create barriers to work by either preventing entry, or by making a person’s
time in the workplace more difficult than it would otherwise be.
1.68
Employers may be hesitant to engage an employee with mental ill health
because of a sporadic work history or concern at potential management issues.
Witnesses reported that disclosing mental ill health lowered the likelihood of
selection for interview or appointment to the position.[59]
Stigma can also present during interviews. Ms Bernette Redwood, Executive
Officer, Vista Vocational Services, related an incident when she accompanied a
consumer to a job interview:
... while we were there the person who interviewed them
basically took the ruler and the scissors off the desk and put them in a
drawer. I do not know whether he thought we were going to attack him or
something.[60]
1.69
Employers and managers need practical strategies to support employees
through periods of unwellness. Ms Therese Fitzpatrick, National Workplace
Program Manager, Beyond Blue, reported that employers may not understand that
people often want to continue working, and that employers and co-workers often
do not know how to support them to do that.[61]
1.70
Representatives from the New South Wales Consumer Advisory Group
reported comments from consumers who had disclosed mental ill health to their
employer and co-workers:
... ‘they asked me if I was aware of my actions all of the
time.’
... [I was treated as] ‘an out-of-control weirdo’...
... [they] ‘initially suggested medical retirement ... I
remain appalled at their reaction and still feel the stigma because of it.’[62]
Stigma amongst clinicians
1.71
Some of those charged with diagnosis and expert care of people with mental
ill health are not immune to unfounded and incorrect assumptions associated
with these conditions. The authority accorded to clinicians who are not fully aware
of the benefits of work to sufferers of mental ill health can reinforce stigma
circulating in the broader community.
1.72
Dr Aaron Groves, Executive Director, Mental Health, Alcohol and Other
Drugs Directorate, Queensland Health, described how people with severe mental
illness, such as schizophrenia, were traditionally not expected to return to
work. Dr Groves indicated this traditional view can mean that clinicians may
also present a significant barrier to participation.[63]
1.73
Ms Laura Collister, General Manager, Rehabilitation Services, Mental
Illness Fellowship Victoria, stated that prior to a partnership with her
organisation, some health services had indicated that work was not a priority
for their clients:
... when we first started doing this model we spoke to
clinical teams and some of the people said ‘We have no idea if our clients work
or not. We are a health service; we are not interested in work.’[64]
1.74
Professor Killacky, Director, Psychosocial Research at Orygen Youth
Health cited one instance of a case-manager’s ‘well-intentioned but misdirected
care’:
A young woman who out employment consultant was working with
wanted to work in retail. Our employment consultant thought she probably was
not quite there, but there was a course she could do through VET-the TAFE side
of that-that gets people ready to work in retail. It is a small course-there
were only around six people in it- and it is very well linked into things, so
there is pretty much a guaranteed job at the end of it. We got the client onside
with that, as well as her boyfriend and family. Everyone was really supportive.
In her case it was said, ‘No, it would be too stressful for you.’ That course
has one opening every six months.[65]
Stigma in families
1.75
The concerns of well-intentioned family members that the return to work of
their loved one will be stressful and exacerbate mental ill health can also contribute
to stigmatisation. Dr Groves of Queensland Health commented that families and
carers can find it difficult to comprehend that someone who has been very
unwell can get back to work. Dr Groves indicated that family members can try to
prevent further work-related stress by creating a:
... protective layer of ‘If we then encourage them or force
them to go to work, we are only going to make them crook again.’[66]
1.76
This protective response was also identified by Ms Christine Bowman,
Transforming Perceptions Project Coordinator, Mental Health Community Coalition
ACT. Ms Bowman related a case of a mother who wanted to protect her daughter.
The daughter had mental ill health and her mother had protected her from stigma
in the community by keeping her out of mainstream society.[67]
1.77
In culturally and linguistically diverse (CALD) communities, the stigma
of mental ill health may be particularly acute and complex. Shame associated
with mental ill health and the treatment methods in countries of origin can
prevent diagnosis and treatment. Ms Brooke McKail, Executive Officer, Mental
Health Community Coalition ACT, explained that CALD communities can consider
mental ill health to be a private issue, not one for the broader community.
This is because mental ill health can be perceived within the context of:
cultural or traditional beliefs around the ideas of madness
and the shame and humiliation that can come from that. Often people blame
themselves for mental illness or see it as a punishment.[68]
1.78
While the Committee heard that some families support was not forthcoming
or perhaps misguided, the Committee does acknowledge the many supportive
parents and carers it met throughout the course of the inquiry, clearly doing
their utmost to help their loved one into employment.
1.79
Professor Killackey made the very important point that:
While work can be stressful, being unemployed is pretty
stressful too-probably more so – so there needs to be some education with
families around those two different stresses.[69]
Self-stigma
1.80
People with mental ill health may internalise the stigma that is
circulating throughout the community and workplace that can be reinforced by
families and clinicians, forming a negative perception of themselves, with
associated low expectations. This is called self-stigma. Mr Keith Mahar,
Ambassador, Disability Employment Australia, reported that self stigma had
brought him close to suicide.[70]
1.81
Ms Lisa Thiele, Sessional Education Worker, Mental Illness Fellowship of
South Australia, stated that she too experienced self-stigma. Ms Thiele said
that she did not feel comfortable talking about her health issues because she
had internalised the social stigma of mental ill health:
I felt I could not share my past with anybody because it was
just far too embarrassing.[71]
1.82
Self-stigmatisation is perhaps the most debilitating manifestation of
stigma associated with mental ill health. When limits are self-imposed it can
be exceptionally difficult to rebuild people’s self-esteem and self-confidence.
1.83
One respondent to the Australian Youth Forum (AYF) consultation on
mental health and workforce participation said:
A lot of times the only obstacle to success is
ourselves...after having a mental illness you need to overcome the fear and
pity and reject the stereotype of your illness yourself to move on and be all
you can be![72]
Disclosure
1.84
‘Disclosure’ refers to the decision of an individual to inform others of
conditions associated with their mental ill health. Disclosure of mental ill
health relies on individuals being diagnosed, identifying that they have mental
ill health, and then being comfortable sharing that information.[73]
1.85
A recent National Centre for Vocational Education Research report, Unfinished
business: student perspectives on disclosure of mental illness and success in
VET (the NCVER report) referred to students’ reasons for not disclosing
their illness:
Students usually do not disclose their illness at the outset
for the following reasons: they want to be self-reliant and to protect their
sense of self as a coping person; they fear stigma, prejudice and rejection;
and they don’t consider an episode of psychosis or depression as a ‘disability’[74]
1.86
Every interaction is considered a high risk event. Therefore, disclosure
is a complex, personal decision, and witnesses insisted the decision to
disclose must be made by the individual.[75] Cases of nondisclosure
remain ‘very high’ due to associated and perceived stigma among associates and
colleagues.[76] Self-stigma is another
factor.
1.87
Many witnesses reported negative experiences of disclosure. A former
client of Orygen Youth Health commented that when she disclosed her mental ill
health in job applications she had received ‘quite significantly less’
interview opportunities than when she did not disclose.[77]
Similarly, Ms Sarah Reece, a participant in the PHaMS West program relayed her
negative experiences of disclosing at university:
... when I screwed up my courage and disclosed to the
counsellor whom I had been seeing there a few times the nature of my mental
illness, she told me I was not to come back to the service and closed the
entire counselling support service to me at the university, which devastated me
and left me without any support on site and I withdrew. In fact, I failed at
each of my attempts to re-engage [with] university.[78]
1.88
Ms Bernette Redwood, Executive Officer, Vista Vocational Services,
reported an instance where disclosure provoked negative perceptions, such as
when she spoke to a human resources manager at the Australian Taxation Office
about her organisation:
He sat there with his arms folded looking extremely
uninterested. At the end of my spiel he said ‘Bernette, the trouble is you can
always tell a person with a mental illness’. I said ‘You know, that is really
interesting because I have one’. And I thought the man was going to run out of
the room. That is the attitude of HR managers in government situations. And I
think, although it might not often be stated, it is often what is felt.[79]
1.89
Whilst disclosing mental ill health can present a significant cost for
individuals, by not doing so they may miss receiving support that could be
available to help them. Nondisclosure can also exacerbate anxiety. Ms Reece
commented that choosing to not disclose is difficult:
... not telling them leaves me really scared that they might
find out, which means that if you are doing something like accessing support at
a place like the Mental Illness Fellowship you are always worried that someone
might see you someone going in that door. It is very difficult. It also leaves
you without any sort of support if things do get a bit rocky.[80]
1.90
Interestingly, the NCVER report showed that while students struggled to
decide whether to disclose or not, most staff members expected students to
disclose if they had an illness, perceiving it to be part of taking responsibility
for their own education.[81]
1.91
Ms Laura Collister, General Manager, Rehabilitation Services, Mental
Illness Fellowship Victoria said that they encourage disclosure because they
think that encourages a very open relationship with employers. She emphasised that
disclosure is ‘not an all or nothing thing’:
How much you disclose is an individual thing. It may be that
somebody says they have a health issue that at times is going to cause this and
this to happen. How are we going to manage it? Versus, ‘I have this diagnosis’.
It is not an all or nothing thing and it changes over time.[82]
Promoting mental health awareness
1.92
Throughout the inquiry process, the Committee met a broad cross-section
of people with mental illness, those battling mild, moderate and severe forms,
young, middle-aged and older Australians, some less skilled and some with very
high levels of skills and professional qualifications. According to the
statistics set out at the beginning of this chapter, anywhere from one in five
people to one in three people are affected. Clearly, we are all affected, if
only by someone we know.
1.93
The Committee hopes that this report will play a part in dispelling some
of the myths about mental illness and people with a mental illness in the
workforce. To this end, it is necessary to relate the stories of people with
mental health conditions who want to work and are already doing so successfully,
across a spectrum of fields. The desire to participate persists, in some cases
despite well-intentioned family members, clinicians or case-managers not
believing that this is possible or beneficial because it is too ‘stressful’.
1.94
To kick-start discussions and set the tone, the inquiry topic was highlighted
in the May 2011 About the House television program. In the segment titled,
‘Helping the mentally ill find work’ Chris Tanti, the Chief Executive Officer
of Headspace, spoke about how critical getting young people with mental health
issues into employment or education is for their wellbeing. The importance of
an understanding boss, effective two-way communication between employee and
employer and other appropriate supports in the workplace were also underlined. Professor
Peter Butterworth, a researcher from the Australian National University
underscored the importance of a positive work environment and high quality job for
mental health and wellbeing as well.
1.95
The August 2011 edition of the About the House magazine also ran
a feature story about the inquiry on the most pervasive barrier for job seekers
–namely stigma. It appears that fear and misunderstanding about mental illness
are the foremost barriers to participation.
1.96
One of the witnesses that appeared at the Committee’s first Canberra
hearing, Vista Vocational Services Executive Officer, Bernette Redwood, was
interviewed together with people helped through the two businesses she runs
that specifically employ people with a mental illness. Vista provides trainees
with practical training in hospitality or horticulture and helps transition
them into mainstream employment.
1.97
The piece shows that great achievements are possible for even the most
disadvantaged individuals. A degree of understanding, support and being ‘given
a go’ can have wonderful results. One trainee related his experience:
I’ve just been sitting on the lounge for about six to eight
years and it’s really got me out of my comfort zone and into work...”I’ve stuck
with it, got fitter and more energy and it’s really helped me a lot.[83]
1.98
It is evident that engaging in purposeful education, training and
employment contributes markedly to recovery.
1.99
This report serves to showcase the diversity, strength and resilience of
people with mental ill health and what the community has to gain by their
inclusion in the workforce.
Promoting mental health in the workplace
1.100
A strong theme in evidence to the inquiry was the critical importance of
actively promoting mental health and wellbeing in workplaces for all employees.
1.101
Recent Medibank[84] research into workplace
health, Economic modelling of the cost of presenteeism[85]
in Australia: 2011 Update found that mental ill-health accounts for 21 per
cent of presenteeism, making it the greatest single driver of the phenomenon.
Medibank stated:
With the total cost of presenteeism estimated at $34.1
billion in 2009-2010, there is a clear incentive for business and government to
work together to address mental health in the workplace.[86]
1.102
A number of submissions to the inquiry, including those from the Black
Dog Institute and Beyond Blue emphasised the importance of early intervention
with employees who may be exhibiting symptoms of mental ill health. And, more
broadly, promoting the mental health and resilience of all employees,
irrespective of whether or not they are known to suffer from a mental illness.[87]
1.103
To this end, sound human resource practices that seek to build mental
health and well-being awareness, amongst managers and employees are integral. These
practices include disseminating information on how to obtain help and support
for individuals when they need it, as well as strategies to promote resilience
in the workforce as a whole.
1.104
The responsibility does not rest solely within human resources
departments either. Leadership and organisational buy-in on the issue is
critical to success. Mainstreaming the issue from the top down (‘normalising
it’) plays an important role in breaking down the associated stigma.
1.105
Having a flexible supportive workplace culture where the channels of
communication are open is one of the most important messages to come out of
this inquiry. This modus operandi does not just apply to accommodating workers with
a mental illness.
National and international stigma reduction campaigns – in schools,
workplaces and the broader community
1.106
One of the strongest calls from witnesses, including state governments,
is for a broad anti-stigma reduction community education campaign, to be
supported by the Commonwealth Government. The views of Canefields Clubhouse
were typical when it asserted:
The introduction of a national reduction of stigma campaign
is long overdue and would provide improved understanding of, and attitudes
towards, mental illness by the community at large, employers and educators.[88]
1.107
Mental Illness Fellowship of Victoria called for an anti-stigma campaign
specifically directed at the workplace:
There is need for a national workplace focussed anti-stigma
and engagement campaign that encourages employers to ‘give people with a mental
illness a go’ in the workplace. [89]
1.108
Neither suggestion is new. The Senate Select Committee on Mental
Health’s report of 2006 recommended that the Commonwealth Government fund and
implement a nationwide mass media mental illness stigma reduction and education
campaign.[90]
1.109
The Queensland Alliance for Mental Health referenced the Australian
Government (DEEWR) 2009 report, Employer Attitudes to Employing People with
a Mental Illness, which stated that research suggests that various
interventions be supported by:
a wider campaign aimed at addressing community prejudice
against people with a mental illness. The majority of participants believed
that without such a campaign the usefulness and effectiveness of resources
targeted towards employers could be compromised.[91]
1.110
Dr Aaron Groves, General Manager, Queensland Department of Employment,
Economic Development and Innovation, explained that in the mid- 1990s an
anti-stigma campaign was run by the Commonwealth Government which started to
increase people’s awareness of mental illness. Since then governments had been
investing in organisations like Beyondblue to educate the Australian community
on depression, although that does not yet extend to more serious illness like
bipolar disorders and schizophrenia. He added, that in 2009, health ministers
agreed to develop a national stigma reduction strategy. However, this has not
progressed very far. He said:
It is still in its early stages. It is fair to say that we
are not having a lot of runs on the board in developing a stigma reduction
strategy that cuts across the whole of mental illness.[92]
1.111
The states are revisiting this issue. The Mental Health Council of
Tasmania (MHCT) indicated that it is working with the Tasmanian Government to
develop a social marketing campaign to redress stigma and discrimination in
Tasmania.[93]
1.112
Dr Groves indicated that the Queensland Government had committed to a
stigma reduction strategy in its 2010 Budget to focus on the more ‘severe end
of the spectrum’ of mental illnesses. He elaborated on the Queensland
Government’s approach, which has a focus on schools and workplaces:
We believe there are a couple of forums that are particularly
good at tackling this. One of them is schools because you tend to have all the
schoolchildren there. It is a nice captive audience to start to talk to them
and demystify some of the issues around mental illness. The other place is the
workplace. Again, most adults do go to work. We find that attitudes towards
people with mental illness are incredibly stigmatising despite the fact that
every worker in Australia is likely to have someone with a mental illness in
their workplace...We think that it is really important to tackle that in the
workplace; one to get a better understanding; and two, so that people can see
that work colleagues with mental illness who are on their recovery are valued
workers.[94]
1.113
Dr Groves described the Queensland Government strategy as being ‘not
just a social marketing campaign’, that is television advertisements explaining
what mental illness is, but rather a more nuanced and interactive experience:
A grassroots activity where community groups and people in
communities can get exposed to people who have a lived experience of mental
illness and talk to them about the sorts of issues they have and how they are
living within their communities.[95]
1.114
Mr Adam Stevenson, General Manager, Queensland Department of Employment,
Economic Development and Innovation reinforced the notion that education
campaigns should go beyond mere ‘awareness raising’; they must engage their
target audience:
These are constant interactions that government needs to have
with employers at various points...it is certainly something that is constant
work.[96]
1.115
The Mental Illness Fellowship of South Australia (MIFSA) echoed how
important it is for governments to play a role in raising awareness. MIFSA
observed that so doing ‘is very much about normalising the idea’ of people
experiencing mental ill health and promoting resilience amongst the workforce
as a whole:
It is that encouragement and awareness from government to say
that one in five are going to have an issue with this...about normalising it:
raising awareness, reducing stigma and building that resilience amongst staff
and providing opportunities for the people who experience mental illness to
have that conversation with their employers.[97]
1.116
Representatives of the South Australian Health Service similarly
espoused the benefits of a strong public education campaign as an effective way
to influence people’s views. Mr John Strachan, Acting Outer South Sector
Manager, Southern Mental Health, Adelaide Health Service, South Australia
Health, said:
[it] starts to really showcase to the public and everyone
involved that there are greater alternatives than what they might have thought.[98]
1.117
The Queensland Government called for a national approach to educate workers
and employers alike, :
To develop a targeted campaign, in
consultation with states and territories, to educate all Australians on mental
illness in the workplace, and to educate employers and workers on how to obtain
support for people experiencing mental illness at work.[99]
1.118
The Mental Health Council of Tasmania referenced other countries’
national campaigns, including New Zealand’s ‘Like Minds-Like Mine’, Scotland’s
‘See Me ‘and the United Kingdom’s ‘Time to Change’ as potential models for an
Australian stigma reduction campaign .[100] Of the three, the
Scottish and UK campaigns are perhaps most instructive in terms of their
engagement with workplaces.
1.119
The more community focused ‘Like Mind-Like Mine’ campaign from New
Zealand received praised from several witnesses. The Royal Australia and New
Zealand College of Psychiatrists said:
The successful New Zealand ‘Like Minds, Like Mine’ campaign
has used a combination of well-known personalities and everyday people to
remove the social taboo associated with mental illness. Individuals talk on
camera about their illness, discussing the support they receive from their
employer, friends and family, [and they in turn] discuss how their
understanding of mental illness has grown.[101]
1.120
The Welfare Rights Centre described ‘Like Minds Like Mine’ as a ground
breaking program.[102] Mr Bailey of Macquarie
University noted New Zealand’s very good media programs:
with well-known figures, usually rugby players, talking about
mental illness...de-stigmatising it and normalising it.[103]
1.121
Operating since 1997, and the longest-running of the three overseas
programs, ‘Like Minds Like Mine’ is funded by the New Zealand Ministry of
Health and run by a number of national contractors (including Lifeline and the
Mental Health Foundation) and regional providers, with national coverage. The
national contractors are responsible for providing national services like
television advertising campaigns, a free information telephone service and
website. To complement these activities, regional providers undertake
anti-discrimination activities with local community groups and organisations,
maraes, business and media.[104]
1.122
Launched in 2002, ‘See Me Scotland’ describes itself as the sister
campaign to that of ‘Like Mind Like Mine’ and is an alliance of five mental health
organisations funded by the Scottish government to end the stigma and
discrimination of mental ill-health there. A variety of resources are available
on a website, such as case studies of organisations that have successfully
worked with ‘See Me’, and encourages signing a pledge and accompanying action
plan to make a public commitment because:
Such a commitment will be seen by employees, by customers or
users of services and the wider public.[105]
1.123
The Steps to Success section offers practical suggestions for raising
awareness in the workplace of mental illness and appropriate supports to
employees, for example:
n Raising awareness –
through putting up leaflets and posters and getting involved in Scottish
Healthy Working Lives (whose principle focus is to work with employers to
enable them to understand, protect and improve the health of their employees
and contribute to the Scottish Government’s national outcomes);
n Support –
encourage your organisation to use internal or external support for employees
for example Employee Counselling Service;
n Education - the
Mentally Healthy Workplaces Training provides necessary information for
employers while Mental Health First Aid is suitable for all staff;
n Check it out –
Work Positive is a stress risk management resource, developed to support
employers to identify and reduce the potential causes of stress in the
workplace.[106]
1.124
Describing itself as England’s biggest ever attempt to end the stigma
and discrimination experienced by people with mental health problems, the UK’s
Time to Change -let’s end mental health discrimination campaign was established
in 2007. Funded by the UK Department of Health and the charitable organisation
Comic Relief, it is run by the mental health charities Mind and Rethink Mental
Illness, and described as ‘a campaign to change attitudes, and behaviour.’ Not
dissimilar to ‘See Me’, the campaign aims to:
Start a conversation... we want to empower people to feel
confident talking about the issue without facing discrimination...and the three
quarters of the population who know someone with a mental health problem to
talk about it too.[107]
1.125
The United Kingdom campaign is multifaceted and comprises:
n a national high
profile marketing and media campaign aimed at adults;
n community activity
and events that bring people with and without mental health problems together;
n work with children
and young people;
n supporting a network
of people with lived experience of mental health problems to take leadership
roles in challenging discrimination, within their own communities;
n getting workplaces
involved in Time to Change;
n media engagement to
improve media reporting and representations of mental health issues; and
n focused work with
minority and ethnic communities.[108]
1.126
The website offers a comprehensive and impressive array of resources,
including short video clips of well-known public figures (ranging from a boxer
to political aide and television personalities) interspersed with ‘ordinary
people’ relaying their various experiences of a lived experience of mental
illness. There are sections titled ‘support for workplaces’ (aimed at employees
and co-workers) and ‘support for employers’ respectively. Like the ‘See Me’
campaign there are successful case-studies on the website and organisations are
encouraged to make an organisational pledge.[109]
1.127
‘Time to Change’ reports that it is now working with hundreds of
organisations across the United Kingdom.[110]
1.128
Ms Sue Baker, Director of ‘Time to Change’ cites an evaluative study
from the Institute of Psychiatry at King’s College, London that concluded that
there has been a nine per cent drop in discrimination experienced by those
looking for a job since the campaign commenced. [111]
1.129
Chapter three refers to Beyondblue, Sane and other workplace education
campaigns and tools like mental health first aid, which receive some support
from the Commonwealth Government. Beyond blue is supported by the Commonwealth
Government and all state and territory governments.[112]
The NSW Government funds the Black Dog Institute in NSW.[113]A
number of witnesses attest to these programs making a difference in workplaces
and the wider community.
1.130
Black Dog Institute referred to the successes of large awareness
campaigns like Beyondblue’s demystifying depression campaigns.[114]
Professor Helen Christenson, President of the International Society for
Research on Internet Interventions applauded the efforts of Beyondblue and
others for their online presence and success in awareness raising and improving
mental health literacy.[115] The Royal Australian
and New Zealand College of Psychiatrists noted that specific campaigns raise
awareness and expectation of treatment.[116]
1.131
The Committee recognises that there are already a number of stand-alone
government-funded programs that operate in or around this space.
1.132
Besides Beyondblue and Blackdog, there is also KidsMatter, the education
and awareness raising tool for children in schools on mental health mentioned
in chapter two, and Comcare’s anti-bullying campaign targeting workplaces,
‘Work Safety Campaign – Don’t be a silent witness’[117],
designed to be a tool for improving the psychological health of employees in
workplaces.
1.133
Governments in Australia have themselves recognised the need for a
national stigma reduction strategy, through the COAG process and development of
the Fourth National Mental Health Plan. Priority area 1: Social Inclusion and
Recovery has as its first outcome, and corresponding actions:
That the community has a better understanding of the
importance and role of mental health and recognises the impact of mental
illness.
To improve community and service understanding and attitudes
through a sustained and comprehensive national stigma reduction strategy.
To work with schools, workplaces and communities to deliver
programs to improve mental health literacy and enhance resilience.[118]
1.134
Moreover, the National Mental Health Plan recognises that while to-date
the focus has been on the more common mental illnesses, namely depression and
anxiety, national education and awareness campaigns need to also:
Include those illnesses that are more complex and difficult
to understand such as psychosis.[119]
1.135
Further, the campaign should:
Work in conjunction with actions addressed to particular
groups such as those from culturally and linguistically diverse backgrounds,
rural and remote communities and particular age groups.[120]
1.136
The Committee is of the view that the time has come for a much more
significant nationally coordinated stigma reduction campaign throughout
Australia, not dissimilar to the international models presented to it, that
targets workplaces, schools, and also the community at large.
1.137
It is fair to say that there is an increased understanding in the
community about common mental illnesses – depression and anxiety (the most
common forms of mental illness are depression – suffered by approximately 15
per cent of adults, and anxiety disorders – experienced by approximately 26 per
cent of adults)[121], and this is due not
least to the advocacy efforts of organisations such as Black Dog and Beyond
Blue.
1.138
However, perhaps less well-understood by the community are the more
severely disabling ‘low prevalence’ mental illnesses like bipolar disorder,
schizophrenia and other forms of psychosis, which affect about three per cent
of the adult population.[122]
1.139
Any national education campaign should redress this education gap.
Rather than simply replicating the Beyond Blue and Black Dog models, the
national education campaign should complement the work of these organisations, and
include a focus on demystifying the more complex and less well-understood forms
of mental illness.
Recommendation 1 |
| |
The Committee recommends that the
Commonwealth Government coordinate a comprehensive and multi-faceted national
education campaign to target stigma and reduce discrimination against people
with a mental illness in Australian schools, workplaces and communities. The
campaign should:
n include
involvement from the public, private and community sectors, educational
institutions, employers and a range of other stakeholders, including
individuals with mental illnesses, families and carers; and
n complement
existing government-funded education and awareness campaigns on depression
and mood disorders, with an inclusion of psychotic illnesses. |
Scope of inquiry and parameters
What is mental ill health?
Definitions
1.140
There is a fundamental distinction to be made between a mental illness
and intellectual disability or brain damage. When mental illness is considered
a disability, as it tends to be in policy terms (where it is usually subsumed
into the disability category), there is a risk of lumping those with a mental
or intellectual impairment together with those with a mental illness. Someone
may have mental illness such as depression or anxiety as a result or side
effect of brain damage but the terms are not interchangeable.
1.141
Because mental illness is episodic in nature, it is quite different from
a permanent physical or mental disability. Someone with a mental illness may,
in fact, be well most of the time.
1.142
Someone with mental ill health might therefore ‘slip through the cracks’
of services provision if, for example, they are registered with Job Services
Australia rather than disability employment services, or they are in the
disability management service rather than employment support service stream of
a disability employment services provider which offers more ongoing support.
1.143
The statistics indicate that although mental illness and mental health
problems are experienced by many Australians, it is still not a subject that
most people appear especially comfortable with or knowledgeable about.
1.144
Some basic definitions and facts are provided in this introductory
chapter, for the sake of clarity and to frame the discussions in the remaining
chapters.
1.145
DoHA offers the following definitions:
A mental
illness is a health problem that significantly affects how a
person feels, thinks, behaves, and interacts with other people. It is diagnosed
according to standardised criteria. The term mental disorder is also used to refer
to these health problems.
A mental health
problem also interferes with how a person thinks, feels, and
behaves, but to a lesser extent than a mental illness.
Mental health problems are more common and include the mental ill health that
can be experienced temporarily as a reaction to the stresses of life.
Mental health problems are less severe than mental illnesses, but may develop
into a mental illness if they are not effectively dealt with.[123]
1.146
The Victorian Government Health website categorises mental illness into
two groups:
Depression and anxiety disorders – for example,
persistent feelings of depression, sadness, tension or fear that are so
disturbing they affect the person’s ability to cope with day-to-day activities.
Conditions that can cause these feelings include: anxiety disorders (for
example, phobias and obsessive compulsive disorder), eating disorders and
depression.
Psychotic illness – for example, schizophrenia and
bipolar disorder (previously called manic depressive illness). Psychosis
affects the brain and causes changes in a person’s thinking, emotions and
behaviour. People who experience an acute psychotic episode lose contact with
reality and may develop delusions or hallucinations.[124]
1.147
As mentioned in the previous section, the more common forms of mental illness
fall into the first category, namely depression and anxiety disorders. The less
common ones fall into the psychotic illness category.
1.148
Sane Australia, the national charity working for a better life for
people affected by a mental illness, has produced a website that contains a
range of materials that people can access and download that explain the
symptoms, causes and treatments available for a spectrum of mental illnesses
–including the less common and less well-understood ones- in easy to understand
formats. This takes the form of factsheets, downloadable podcasts and other
multimedia materials.[125]
1.149
For example, the website sets out plain English descriptions of
schizophrenia - a medical condition that interferes with a person’s ability to
think, act and feel, and counters the commonly held misperception that ‘those
affected have a “split personality”’.[126]
1.150
Finally, while definitions are helpful for improved awareness and
understanding within the community, people with a mental illness do not wish to
be defined by their condition:
It is not beneficial to label people with a mental illness
(e.g. schizophrenic) as this then becomes their identity.[127]
1.151
Even using the phrase mental illness can have negative connotations and:
Reinforce misleading assumptions about the unsuitability of
people with mental health conditions as employees.[128]
1.152
Dr Geoffrey Waghorn RM, Head, Social Inclusion and Translational
Research, Queensland Centre for Mental Health Research spoke about the
importance of language and the various ways to construct a more positive
narrative about an employee with a mental illness:
From research we know that the word schizophrenia triggers
unfair discrimination but the phrase ‘late starter’ does not...we have to
translate those mental health diagnostic terms into behaviours in the workplace
that employers understand...we know how to do it...what [employment services]
have to do is to develop a plan with their clients to manage their personal
information so they identify the adverse information they do not want to talk
about and give the client a choice about what terms they would prefer to use to
describe their situation..in order to emphasise their strengths...you have to
develop a very balanced, accurate story that does not use medical terminology
typically...Once the employer gets to know the person, research quite clearly
shows that diagnostic terminology is less likely to cause unfair
discrimination, because the employer will say, ‘my worker has schizophrenia but
they do not have multiple personalities. ..They will see past the stigma that
that conjures up.[129]
1.153
Not dissimilarly, Professor Eoin Killackey, Director, Psychosocial
Research, Orygen Youth Health, talked about how many young people, and others
too, with mental health issues do not necessarily self-identify or perceive
themselves as having a disability, therefore may not even register that
disability employment services assistance is targeted at them. He went on to
say that is a good thing:
That lack of perception of a disability, particularly for young
people, is a good thing and we can leverage that to actually help people.[130]
1.154
The report uses the terms persons with a mental illness, mental
ill-health and mental health condition interchangeably for no reason other than
they all appear to be used by and cover the range of mental health problems
from mild symptoms through to more severe mental disorders.
1.155
The Committee appreciates that categorising someone with a mental
illness as having a disability can be problematic however the report will
continue to do so given that the Government frames services for them in this
way.
People with mental ill health can and do recover – the facts
1.156
Just as the types of specific mental illnesses are not universally
understood, it is not necessarily common knowledge that, with the appropriate
treatment and support, the majority of people with mental illness can be
treated, manage their illness and recover.
1.157
To reiterate, a mental illness is differentiated from a permanent
physical or mental disability as it is characterised by episodic presentation
which means it occurs irregularly, occasionally or sporadically.
1.158
The DoHA website explains:
Episodes of mental illness can come and go during different periods in people’s
lives. Some people experience only one episode of illness and fully recover.
For others, it recurs throughout their lives.
Most mental illnesses can be effectively treated. Recognising
the early signs and symptoms of mental illness and accessing effective
treatment early is important. The earlier treatment starts, the better the
outcome.
Effective treatments can include medication, cognitive and
behavioural psychological therapies, psycho-social support, psychiatric
disability rehabilitation, avoidance of risk factors such as harmful alcohol
and other drug use, and learning self-management skills.
It is rarely possible for someone with a mental illness to make the symptoms go
away just by strength of will. To suggest this is not helpful in any way.
People with a mental illness need the same understanding and support given to
people with a physical illness. A mental illness is no different – it is not an illness for which anyone should be
blamed.[131]
1.159
The Victorian Government website offers some statistics on the rates of successful
recovery for different mental illnesses:
n Anxiety disorders
– the majority of people will improve over time.
n Bipolar disorder
– about 80 per cent of people will improve.
n Schizophrenia
– about 60 per cent of people with schizophrenia will improve and can live
independently with support. About 20 per cent of those diagnosed with
schizophrenia will have an episode or two, and then never experience symptoms
again. For another 20 per cent, symptoms are more persistent, treatments are
less effective and greater support services are needed.[132]
Conduct of inquiry
Referral of inquiry
1.160
The Minister for Tertiary Education, Skills, Jobs and Workplace
Relations, Senator the Hon. Christopher Evans referred the inquiry to the
Committee on 28 February 2011.
1.161
The terms of reference for the inquiry are set out in the front pages of
the report.
The inquiry process
1.162
The Committee announced the inquiry at a press conference held at
Parliament House on 3 March 2011 and called for submissions from interested
individuals and organisations.
1.163
The inquiry was advertised in The Australian newspaper on an
on-going basis and also on the Committee website.
1.164
The Committee also invited submissions directly from a wide range of
stakeholders. These included federal, state and territory ministers, peak and
advocacy bodies, employers, disability employment services providers, research
institutions, and community organisations.
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A total of 76 submissions were received from a broad cross-section of
individuals and organisations with an interest in the subject matter, from people
with a lived experience of mental ill health, either themselves or as a carer, support
groups and social services providers, health professionals, policy makers,
academics, and educational institutions. The submissions are listed in Appendix
A.
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Appendix B details the 42 exhibits accepted as evidence.
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The Committee conducted 16 public hearings as well as 16 site inspections
in all state and territory capitals, and a sample of outer metropolitan and
regional areas in Victoria, South Australia and New South Wales. A private
briefing from Orygen Youth Health was subsequently authorised as public
evidence to the inquiry. Details of hearings and witnesses are included at Appendix
C. Appendix D outlines site visits that the Committee undertook.
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Media releases about the inquiry, submissions received, details of
public hearings and transcripts from the hearings are available from the
Committee’s website.[133]
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In September 2011, the Committee Chair and Deputy Chair met with the
Chair and Deputy Chair of the Victorian Parliament’s Family and Community
Affairs Committee in Canberra and had the opportunity to discuss their
respective inquiries into mental health and workforce participation. The
Victorian parliamentary inquiry has very similar terms of reference, but with a
state focus. The chairs and deputies discussed federal and state perspectives
and agreed to complement, rather than repeat, each other’s work. The Victorian Committee
is due to report in September 2012 and the Committee hopes that this report may
contribute to the deliberations of state colleagues.[134]
Commonwealth departments
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Several Commonwealth agencies participated in the inquiry through
written submission and attendance at public hearings. The primary written
contribution was through a joint submission from DEEWR, DoHA and FaHCSIA. Other
agencies to make submissions to the inquiry included, the Department of Human
Services (DHS) and Comcare. Representatives from each of these agencies as well
as the Commonwealth Ombudsman’s Office and the Department of Defence
participated in a public hearing.
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The joint submission provided information regarding the range of
programs and initiatives that the Commonwealth supports and administers to help
people with mental ill health into education, training and employment.
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The Committee acknowledges that a joint submission is subject to clearances
through the procedures of multiple agencies. However, the submission was not
received until 21 September 2011, five months after submissions closed and over
half way through the Committee’s evidence gathering program.
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The lateness of the receipt of the submission hampered the Committee’s
inquiry because members had only a limited opportunity to explore the
effectiveness of Commonwealth support with stakeholders in light of the
Commonwealth’s responses to the terms of reference.
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Staff from DEEWR, which took the lead role in co-ordinating the joint
submission kept the secretariat appraised of its progress. This does not
appear to be a case of departments not co-operating with a parliamentary
committee but rather the prevention of timely delivery through unwieldy sign
off processes.
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Not dissimilarly, answers to questions taken on notice at the hearing
held on 14 October 2011 by DEEWR were received three months later by the
Committee on 13 January 2012.
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Additionally, at a hearing on 14 October 2011, the Committee requested that
the Commonwealth Ombudsman provide updates on responses from Centrelink and
DEEWR to its Falling through the cracks report.[135]
The Ombudsman provided the Centrelink response to this request on 20 December
2011.[136]
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In that correspondence (Submission 74), the Ombudsman indicated that
DEEWR had requested that the Ombudsman ‘not provide the Committee with a copy
of its July 2011 update to the Ombudsman regarding the recommendations made in
the Falling through the cracks report’.[137]
DEEWR proposed instead that a response would later be made available to the
Committee containing more recent data that was under preparation to a question
on notice from Senator Wright. Following a letter to DEEWR requesting that this
information be made available to it without further delay, the Committee
received a summary of DEEWR’s progress towards implementing the recommendations
of the Falling through the Cracks report on 1 March 2012.
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The Committee endorses a recommendation of the House Standing Committee
on Education and Training in the 42nd Parliament to the effect that
information requested from Commonwealth departments by parliamentary committees
should be provided in a timely fashion.[138]
Structure of the report
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Following this introductory chapter, the report is structured as
follows.
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Chapter two explores some of the barriers to participation in education
and training and a range of ways to overcome these, with a focus on high
schools, universities and vocational education providers.
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Chapter Three focuses on what employers and workplaces are doing and
might do better in this space.
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Chapter Four examines how governments and other service providers endeavour
to overcome the different barriers faced by those with mental ill health
seeking to enter into or remain in education and training and employment.
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The Committee offers some concluding remarks in Chapter Five.
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It is worth stating at the outset that while the Committee received evidence
about the many barriers that present – and these are certainly referred to
throughout the report – it does not intend to summarise or reference them all
in exhaustive detail. The focus of chapters two, three and four is more
solution oriented. All the evidence on barriers is, of course, on the inquiry
record.