Thursday, 18 August 2022

Bills

Mental Health and Wellbeing Bill 2022

Second reading

Debate resumed.

Dr RATNAM (Northern Metropolitan) (14:04): The Greens welcome the Mental Health and Wellbeing Bill 2022. For a long time Victorians facing a mental health challenge stood a very real chance of getting inadequate support or no support at all. Our mental health sector has been desperately underfunded, with very real consequences for our friends, neighbours and family and sometimes ourselves. The royal commission and big increases in funding have seen things start to change, and this bill is the next step in that journey. The bill implements some of the key recommendations of the Royal Commission into Victoria’s Mental Health System. This landmark investigation was the culmination of decades of hard work by the mental health workforce and people experiencing mental health issues, who have known for years that the system was falling apart. As someone who previously worked in the sector, I experienced this firsthand.

The bill creates a new mental health act as recommended by the royal commission. This recommendation was made to redress the previously narrow focus on medication and compulsory treatment. This emphasis on medication and compulsory treatment combined with an underfunded, under-resourced sector led to many people having very negative and often traumatic experiences of mental health treatment. This new framework now emphasises having people with lived experience of mental health issues as part of the system to help address this. The bill seeks to address these concerns through a new set of principles which we support and are welcome.

We do note, however, that these principles can only be realised with proper funding and the cultural shift that is needed for governments to move away from only focusing on tertiary treatment to actually funding proper preventative and early intervention work, so we cannot rest here. These principles are a good start, but they must be met with the necessary funding support as well as the shift to proper preventative and early intervention care.

The bill also legislates a number of new entities that are welcome. The bill legislates a 10-year target for an end to seclusion and restraint, which the royal commission recommended, and I note the careful work that is needed to further consider the decisions concerning compulsory seclusion and restraint.

We also note that those on the ground in the sector have raised a series of concerns, and I will speak to these briefly. At the moment, if you have a psychotic episode in the middle of a shopping centre, it is the police who are to be called. The royal commission recommended that this shift to healthcare workers taking the lead instead. This is a sentiment that is widely supported, including by the Greens, but the practicalities of it are more complicated. Both the Health and Community Services Union and the Victorian Ambulance Union are concerned that health workers are already overstretched and need assurance that these shifts will be properly resourced with staff and other support. Others have questioned if the wording in the bill really reflects the royal commission’s intent, given the commission called for responses to be led by health professionals, not for health professionals to be exercising these powers on their own.

The Victorian Aboriginal Legal Service is concerned that despite the shift away from police, this bill expands the power of PSOs to respond to mental health crises. They question if they have the training to be the right people to deal with someone in distress. The Aboriginal legal service has also raised other concerns, including about the statement of recognition and the cultural safety principle. They would also like to see rules on locking people in a room on their own not exceeding maximum solitary confinement periods in prisons. We hope that some of these concerns are taken on board in the debate in this chamber, in the writing of regulation and in the implementation of the bill.

While it is important to get the rules right around how our mental health system deals with people in distress, it is worth remembering that funding is also key. The last few budgets have included significant increases in mental health funding, which the Greens welcome; however, they are yet to make a real difference on the ground.

I recently had the pleasure of meeting with some of the mental health workers represented by the Health and Community Services Union, who described working in what is still a very challenging environment. Thank you to Liam, Lisa, Rachel, Kate, Jason, Clare, Lee, Phil, David, Marissa and Noah for taking the time to help me understand your experiences and for the work that you do. These workers told me that they are understaffed and working very long hours and struggling to find the time to take leave, and that is just in the city, with worse understaffing problems outside of Melbourne. People move out of the sector because they feel undervalued, and allied health staff do not get the pay they deserve.

The sector is gradually employing more people with lived experience of mental health issues but is still struggling to provide them with proper supervision. Without enough staff, mental health workers often find themselves unable to give the quality of care that helps avert a crisis, instead having to rely on physical restraint when things go badly to stop people getting injured. The mental health workers I met with also told me about people being discharged too soon from mental health wards into the under-resourced community mental health sector, which often sees them back in a ward before too long, and they told me about people being discharged into appalling rooming houses because there just is not enough affordable and public housing to look after people in crisis. They are putting forward suggestions to address some of these issues that we encourage the government to consider, including establishing a chief mental health and wellbeing nurse with delegated responsibilities relating to nursing that reports to the chief psychiatrist and also ensuring funded professional development for all staff so the reforms in the bill can be applied in practice with confidence.

It is also disappointing that some of the allied health professionals so important to providing care in our mental health system have been caught up in lengthy negotiations over pay and conditions. Fair pay and conditions for mental health workers will be crucial in making the mental health system work, yet some allied health workers working alongside nurses in the community—doing the same job—are paid significantly less. In fact, as I understand, there are some allied health workers who even manage nurses but get paid less. It is time allied health workers were no longer treated as the poor cousins in the system. Addressing these workforce issues to maintain and grow the allied mental health workforce will be necessary to the effective implementation of the reforms to improve the mental health system so people can get the care that they need. It is a challenging situation, but these are hardworking people who are doing what they can to look after the people they care for. I would like to thank them both for the work that they do and for taking the time to make sure people in this Parliament understand some of the realities of the sector.

While there are some issues with this bill, the Greens sincerely hope that the changes it makes as well as the extra funding which is working its way through the mental health sector will soon be making a really big difference, not just to workers but also to people seeking mental health support, whether they be our friends, neighbours, families or ourselves.

It cannot be overstated: our mental health support system is more important than it has ever been. After years of chronic neglect of the system by governments, coupled with structural forces such as rising inequality, precarious work and weakening universal health and community services that we know lead to poorer mental health, more and more people will require the support of our mental health system at some point in their lifetime.

The decision the government has before it now is whether to choose to rise to the opportunity that we have to help create a properly funded, well-staffed mental health care system that centres prevention, early intervention and lived experience and that cares for people when they need it the most.

Ms TAYLOR (Southern Metropolitan) (14:12): What is certainly unequivocal, amongst many things, with this bill and our approach as a government to the issue of mental health is a bold and aspirational commitment to the Victorian community to deliver on every single one of the recommendations of the Royal Commission into Victoria’s Mental Health System. At its core we are looking at legislative transformation, significant workforce expansion and sustainable, ongoing investment, which are really critical elements if we are going to seriously tackle this issue, as we are, from the ground up. Noting that the system has well and truly been broken, we are not shying away in any way, shape or form. In fact reforms were being implemented even before the full recommendations of the royal commission had landed, acknowledging the crucial and critical elements and the demand and need for change in our system out of respect for the broader Victorian community, noting that, I am sure, everyone here in this chamber and beyond would know someone—and there may indeed be people here—who has experienced a mental health episode in their life, so it is certainly important.

Another limb to this, when you are looking at reforming the mental health system, is also seeking to diffuse some of the stigma that probably in times gone by has been associated with mental health conditions. It is about being very frank and candid about the issues that need to be addressed; tackling them head-on, as they deserve to be tackled; and really making sure that people with lived experience are at the heart of these reforms. A critical element of the royal commission was heeding the voices of those most impacted, most vulnerable, and continuing to take on board those voices, which are critical in order to deliver the best possible outcomes for our state.

With regard to the investment, certainly the $3.8 billion in 2021–22 was a record investment. I am not stating that just for the sake of saying it, so to speak, but because I know there were some questions in the chamber about how much investment there was. Well, that certainly sends a very strong signal—and beyond, because it is actually leading to very practical reforms—that this is of the highest priority for our state. Then in the 2022–23 the Victorian state budget is investing a further $1.3 billion for brand new initiatives which will build on last year’s record investment as well, and I only state that really out of respect for those who are working in the system and those who may be suffering from or have various mental health conditions and challenges. This is being taken very seriously, and we are proud to be able to deliver on these reforms, noting how fundamental they are to so many Victorians.

I did want to zone in on what the investment actually looks like, because I take on board some of the commentary around the mental health workforce, which is obviously critical in being able to really take the reforms forward and make sure that the system can function optimally. So I did want to zone in on in particular the $372 million for workforce initiatives which include training an additional 1500 mental health workers, including 400 mental health nurses, 100 psychiatrists and 300 psychologists, because obviously there have been huge demands on the system. I do not pretend that such demands will necessarily go away, and therefore we need an empowered and well-trained workforce and adequate numbers within that workforce to be able to handle the extraordinary workloads as well. I think it is always useful to be able to say, ‘Well, okay, what is the financial investment actually delivering on?’, and we can see that that is really a very pragmatic and very much needed element in order to be able to truly transform our mental health system.

There is a further $490 million in acute hospital-based care, which includes 82 new mental health beds, and these are in key growth areas at Northern Hospital and Sunshine Hospital. Again, you can see—and I think it is always good to be able to bring it down to that very human level—a translation of what the investment actually means for Victorians: $9.1 million to establish social inclusion action groups in 10 local government areas, appreciating that there is a huge demand at the community level and therefore bringing this help to the community in a way that is truly accessible makes good sense and certainly is delivering on outcomes of the report; $12 million in mental health and wellbeing support for families whose infants or children and young people are accessing acute care in regional Victoria; and $20 million to provide tailored support for people with eating disorders, including delivery of 15 mental health beds specifically for eating disorders—and this investment will support Eating Disorders Victoria and the Centre of Excellence in Eating Disorders—along with the development of a new Victorian eating disorder strategy.

I know I have reflected on this before, and there are so many different triggers and causes. I am certainly not an expert, and I should not speak with any kind of expertise on this subject, save to say that when I used to do ballet in my younger years there was a lot of pressure on young dancers to be very thin and there was some strange behaviour. Sometimes people were encouraged to actually shadow in some of their bones to make themselves look thinner. It really became quite bizarre. I am just reflecting on a personal tangent where you can see that there really is an acute need for this kind of long-term strategy in this space. I do not mean to zone in only on the world of dance or otherwise. I mean, I think this disorder can permeate so many different facets of life, but this is just to say that it can be quite destructive for a person’s wellbeing and indeed unfortunately there is a significant death rate associated with it as well, which is very sad. It is very good to see that there is specific and targeted investment in this space, because there clearly is a need to have it.

There is $21 million to support suicide prevention initiatives, including after-care services and an 18-month pilot of a Victoria-wide peer call-back service for families, carers and supporters of people experiencing suicidal behaviour. I can only imagine how stressful that must be. Therefore having a service which targets that specific and vulnerable position and situation is absolutely vital.

We have invested $3.5 million in partnership with Aboriginal community controlled health organisations to keep Aboriginal Victorians safe and well and $29.3 million to support the implementation of the new mental health and wellbeing act, which includes training for the mental health sector to deliver new models of care, help for Victorians to understand their rights and an independent review of compulsory treatment orders. This goes hand in hand with some of the newer principles that are evolving in this space, with good reason, via the introduction of modernised rights-based mental health and wellbeing principles. These principles will guide service providers and decision-makers to support—and I particularly like this because I think that at its essence this is what I would imagine contemporary treatment and management of mental health should incorporate—the dignity and autonomy of people living with mental illness or psychological distress. They will ensure people are involved in decisions about their treatment—anyone can understand as a layperson why that would be meaningful and appropriate—and care and support.

The principles recognise the role of families, carers and supporters, because obviously when someone is not feeling their best—and I am massively understating the various conditions and experiences that people can endure—it is generally speaking not necessarily only one person, it is all those people around them that are part of that experience. In fact as part of even helping someone to get to a healthier space and to feel more empowered in their lives, having carers, family and supporters also empowered with knowledge and understanding of the best way to manage those situations has got to be a positive thing. The principles will also ensure the service system responds to the diverse needs and preferences of Victorians. Again, even as a lay person one can see why that makes good common sense and should be an inherent element of the reforms underway.

There are system-wide aspirations for this bill that have been framed to support an overarching objective to pursue the highest attainable standard of mental health and wellbeing for the people of Victoria. I think that that is right and proper, and I think for everyone in this chamber that would be the goal. That is the outcome—not only a goal but actually the end-point outcome—that we are seeking here in the role of not only making an extraordinary and unprecedented investment in mental health but also making sure that there are appropriate legislative controls in place and that those principles are duly and appropriately honoured and acted upon so that every Victorian gets the care and support that they deserve.

When we look at this as a whole—I do not mean to overstate this, but out of respect for those who do work in the mental health space, noting that it is such critical work but also highly specialised, I have the greatest admiration for those who are doing this critical work for the benefit of fellow Victorians—if we look at what has taken place in terms of outcomes and deliverables in jobs created in this space, since the royal commission’s report over 2500 mental health jobs have been created in Victoria. So that is beyond actual aspiration; that is actually seeing deliverables delivering on exactly our mental health workforce strategy, which was identified as necessary for this reform. We know that without caring mental health workers there just cannot be a mental health system. I know I am stating the obvious there, but that is absolutely a fact, and that is why it is a fundamental part of the reforms that we are absolutely backing in—because if our mental health workers are not appropriately supported, how can they then fully undertake their roles in that very critical space? We are completely cognisant of the incredible responsibility that they carry but also the compassion and the devotion that they show in undertaking what is such important work in our state, hence the absolute need for this investment in those jobs.

But I am glad to say that today is a discussion about not only what will be taking place but what has already taken place, because it also can give confidence to those in the community who may have in times gone by wondered where the system would go, when it would actually evolve, when it would get better, and probably despaired. That was only a human response, and hence it led to the impetus for the royal commission. Those who led to that impetus and who have advocated for so many years to bring about these changes should indeed be very proud of their commitment and their resolve. Certainly as members of Parliament being able to be part of a collective that is able to deliver on this and to improve in this vital space is something that underpins why we are here at the end of the day. These are the things that I think validate some of the work we do and our service to community. I cannot speak on behalf of everyone, but I know that certainly at the heart of our party and of our government is truly a genuine commitment, already seeing deliverables, to really bring about a better future in this space for the betterment of all Victorians.

Mr GRIMLEY (Western Victoria) (14:27): I rise to speak on the Mental Health and Wellbeing Bill 2022. It is a bill that was born out of the Royal Commission into Victoria’s Mental Health System and acquits the government of its commitment to introduce the bill before the election, within the recommended time line of the royal commission. Whilst it is slightly flawed in some areas, in the opinion of our party, we will still be supporting this bill. There are many things to be optimistic about with the passage of this bill, including a more therapeutic approach to mental health issues and significantly more investment in the sector. It was an ambitious task to have this bill consulted on and drafted in the short time frame stipulated by the royal commission. There are feelings out in the healthcare community that the government are pushing this bill through now because they are sticking to the somewhat arbitrary time lines provided by the royal commission, but they are doing it at the expense of getting the bill perfectly right. I appreciate the desire to pass these reforms and start implementing their contents, but the reality is that this bill does not actually come into effect until September next year, so there would have been some time to fix up some of these issues.

Regardless, this brings me to the first issue with the bill, which is around consultation—or the lack thereof. This bill had two years of consultation before it was introduced, but there is a difference between receiving feedback and actually putting that feedback into the bill. The government have had to deal with competing interests, naturally, between the healthcare sector and the lived-experience advocates and carers. This is unenviable, but it is clearly still flawed, and the review in five years should not be pointed to as the time to fix current issues. One stakeholder told us they had one weekend to look over a section of the draft bill before feedback was expected to be provided before the bill was introduced. This meant that non-lawyers had a weekend to look over 500 pages of legal jargon. I hope that in the future there is a political will to fix the bill, which will inevitably need to change.

In relation to the bill’s move to the health-led response, as a police officer I had the frequent duty of transporting and sitting with mental health patients—or, as the force would be familiar with, section 351s. This refers to the part of the current act, the Mental Health Act 2014, that allows the apprehension of a mentally ill member of the community. The new health-led response will change the way that mental health episodes are responded to. Police will still have a role in the system—as they always will, in my opinion, as long as there are drugs and alcohol in the community—but this role will be complemented by others such as paramedics, psychiatrists, PSOs and future prescribed persons. This has not resulted in rejoicing from police officers saying, ‘One less job to do’, but police do recognise that they are often not the best people to deal with mental health patients. Many patients have had negative interactions with the force. Many police members, whilst they are trained, do not have the level of training required for some patients where they perhaps pose no physical danger to others and can be treated or transported without apprehension. Further, they are not equipped with knowledge of the sector and the broad available help. Our job has been to try to de-escalate, to apprehend where needed and to transport to hospital. From there it is up to the hospital to deal with the patient. Frequently police have been held up for over 6 hours waiting with a patient for an admission at a hospital. In real terms that is 6 hours that a divisional van is off the road, almost a whole shift consumed guarding a mental health patient and not being able to provide the community with any law and order response, a recipe for disaster. It needs to change sooner rather than later.

There are a million and one questions about how this bill will play out in practice. Who will be the first port of call to respond to these incidents once 000 is called? The ESTA call taker likely will not know how serious the situation is. How do we know if the person has been affected by drugs or alcohol and could therefore be unpredictable? Who does the risk assessment on the patient? Who transports them, what restraints are able to be used and at what threshold? Who takes on the indemnity in such potentially volatile situations? Are psychiatrists and nurses and others without weapons, such as OC sprays et cetera, happy and willing to take on this role? Are we likely to lose healthcare staff, which we are already struggling to keep, by keeping them as the first port of call for mental health patients? This shows that there are unknowns that we believe should be figured out before this bill passes. There are questions that need to be answered, and I hope the minister representing the Minister for Mental Health will be forthcoming and answer those questions in the committee stage.

One of the more contentious parts of the bill is the rhetoric around restrictive interventions. This includes restraints, both physical and chemical, and the use of seclusion. I have to say that the voice from the healthcare sector has been united behind closed doors. While some of the public statements might be a bit more relaxed, they are collectively unsatisfied with the wording around elimination of seclusion and restraint and how it has been translated into the bill. They also reject claims in the bill that such practices serve no therapeutic benefits. What are the potential outcomes of these laws? Healthcare workers losing morale, walking off jobs potentially and refusing to deliver care? Unlikely. Mass resignations and/or increased healthcare worker injuries or deaths for those who run the gauntlet of providing care for what is being proposed? For instance, the AMA says:

Eliminating these practices entirely will inevitably result in mental health services being unable to meet the health needs of a small but significant proportion of seriously mentally unwell people.

Further:

In legislating on the reduction of restrictive practices, the support to mental health services and workforce needs to be considered and provided for.

This has not happened. The AMA called for the bill to be considered by a Legislative Council committee for further review and consultation. The National Association of Practising Psychiatrists was also very unsatisfied with this part of the bill.

Despite these bodies trying extremely hard to work with the government to make a few tweaks in respect to the above, the government has not introduced these as house amendments. Specifically, the clauses in the bill that they believe should have been reformed include the fact that the health secretary and chief officer for mental health and wellbeing are being tasked in the bill to set targets to reduce and ultimately eliminate the use of restrictive interventions in mental health and wellbeing services, as set out in clauses 254 and 261, and clause 81, which states:

The use of restrictive interventions on a person offers no inherent … benefit to the person.

I would completely disagree on the latter as well. If a person is restrained to stop them from committing suicide, then I think it has a benefit. If a person is chemically restrained to prevent them from harming other patients or staff, that is absolutely of benefit. If a patient is secluded to calm down after a period of psychosis to prevent harm to themselves or others, once again there is a benefit. These restrictive interventions, whilst they should not be used as a first response, should not be condemned as having no therapeutic benefit. By preventing violence and harm and thereby preventing a criminal justice response, we are adding a huge benefit to the care of that patient. Put simply, it is the view of most healthcare bodies that Derryn Hinch’s Justice Party has spoken to that some new clauses and references to restrictive interventions need to be reconsidered.

That brings me to my next point: such practices will be considered by an independent panel from October. But the recommendations of the panel will not be handed down until after the new laws are fully functional. This panel was created by the former minister and there were a lot of issues that had not been resolved from the royal commission and that were not going to be finished in time for the bill. The minister said in his second-reading speech:

… one theme we heard very strongly was a need to delve deeply into the laws around compulsory treatment and restrictive interventions. Key stakeholders … called for more time to work through these complex issues, outside the tight time frames for introduction of this bill. For this reason, we announced in December that an independent review panel would be established to examine best practice in modernising these laws for a future amending bill.

This means restrictive interventions will be considered by the panel, right? Well, I cannot tell you for sure, because the terms of reference for the panel will come in in October, after this bill is passed, which is ridiculous given that the panel was established last December. Shouldn’t the terms of reference have been established some time ago? Perhaps that is a question that can be asked in committee.

The government says that while the intention to conduct the review was announced in December 2021 the panel were only appointed recently, but they were announced in June and it is now August. Either things are moving slowly or there is something strategic, perhaps, about the timing of the release of the terms of reference. The people in charge of creating the terms of reference include three former patients, two carers and one peer-experience worker, likely another former patient. The AMA said there was likely an inherent selection bias in the application and selection process for this committee, as those who have strong opinions on compulsory treatment would have applied. They said this does not represent a true cross-section of professionals involved in treating psychiatric illnesses under the Mental Health Act. The AMA has made sensible recommendations about increasing the diversity of the panel, including representation from the emergency physicians and nurses who have no voice on the committee, and I would say to the government it should absolutely consider this.

On the issue of the definition of ‘paramedic’, my colleague Ms Maxwell will likely ask some questions in committee about the implications for qualified paramedics who do not work for Ambulance Victoria. This bill limits their scope of practice despite them being qualified. Whilst we understand there is future scope to include such community paramedics, we think this should be done expeditiously, because not only are they qualified but in many circumstances they are more qualified than other healthcare professionals who will be required to attend acute mental health incidents. Further, the workforce will require a boost, with numbers already dwindling.

Lastly, my colleague Ms Maxwell raised the issue of Forensicare and the startling statistics that people with serious mental illnesses are three times more likely to engage in offending and four times more likely to commit violent offences compared to other Victorians. We hold concerns over day-release policies for places such as Thomas Embling Hospital and would make the point that victims and their families should always be consulted and informed about such decisions where they may be affected.

I would like to think some of the key stakeholders who we consulted on this bill, including the Health and Community Services Union, the Royal Australian and New Zealand College of Psychiatrists, the Victorian Alcohol and Drug Association, the National Association of Practising Psychiatrists, the Police Association Victoria and the Australian Medical Association’s Victorian division. We also spoke to individuals in the healthcare sector who spoke in their personal capacity, some with over 40 years experience. I would like to thank all those who bravely contributed to the royal commission, including those who have lived experience and those who care for others with mental health conditions. You never know when you will be affected by mental health issues, either through our own experiences or someone we love, so this bill and the focus in Victoria are very much welcomed. I commend the bill to the house.

Ms SHING (Eastern Victoria—Minister for Water, Minister for Regional Development, Minister for Equality) (14:38): This is an enormously significant bill, not least because it creates the technical framework by which the recommendations of the Royal Commission into Victoria’s Mental Health System can be established but also because it gives effect to an idea whose time has well passed here, and this is an issue which many, many Victorians and Australians and indeed people here and around the world live with and grapple with and all too often suffer with, and that is mental illness, whether of a mild or of an acute form, characterising the lives of a large proportion of the population.

The statistics here in Victoria are worth mentioning. One in five Victorians will live with or manage mental illness as a matter of course. One in two Victorians will experience in the course of their lifetime a form of mental illness. This may be reactive depression, it may be anxiety, it may be suicidal ideation or it may relate to self-harm or to an eating disorder. This is difficult terrain to discuss, and I suspect it is an area of public health that, because of its very sensitive nature, has been a challenge for lawmakers to lean into and to contemplate for a really long time.

When Victoria embarked upon the mental health plan, the 10-year plan, the objectives and the rationale were good. They were intended to achieve a wholesale improvement of the system by which consumers, clients, patients and carers could access services within community and within acute settings. These challenges have taught us a lot about the way in which the system needs to improve. This has not been an easy journey, and these are challenges which have been faced by governments of all persuasions for many decades now. We continue to evolve the way in which mental illness and disease are managed within the community. We continue to work alongside peak bodies and organisations to better understand the lived experience of mental illness and the way in which it has far-reaching consequences for quality of life, for participation in workforces and for connection and engagement with activities that make being part of a community so wonderful and so validating.

The mental health royal commission was a process which, as we all know, set an historic narrative in train, and what it did was lean into the reality of a system which had failed too many people, which was stretched to capacity and which in many instances simply did not exist for the people who needed it most. We saw in the work of the royal commission and its 67 recommendations a range of findings informed by round tables, by submissions and by the evidence given by individuals and by groups and that there were significant inconsistencies in the system.

We know, for example, that people in rural and regional Victoria have comparatively greater difficulty in accessing specialist care and services. We know that eating disorder treatment, identification and care and the wraparound whole-of-person support that is needed in often very complex presentations did not have the resourcing, engagement and indeed understanding across medical and healthcare worker communities—not because of a lack of desire to become informed but as much as anything because of resourcing. We know also that with vulnerable cohorts—including LGBTIQ+ people, Aboriginal and Torres Strait Islander people and those in the adolescent youth and family space and in the geriatric space—there are a number of specific challenges that need an informed set of solutions as part of a wholesale rebuilding of the mental health system in Victoria.

We know that mental health challenges do not occur in isolation, which is where lived experience is such an enormously important part of giving effect to the royal commission’s recommendations, and that where we can in fact learn from lived experience—and this can be at the heart of the work that is done to deliver on these reforms—there will be a system created that is durable, that is respectful, that is grounded in autonomy and self-determination, that is based in dignity and that is as much a part of validation as anything else.

This royal commission has specified the need to have this legislative framework in place in 2022. This is something which this bill gives effect to, but it is also worth noting that there are a range of other matters as part of reforms, rebuilding and resourcing of the mental health system here in Victoria that will take place over a considerably longer period of time, and that is exactly how it should be. When we have large-scale systemic change like this, we see that it is necessary to undertake these changes carefully and thoroughly and that it is necessary to continue through engagement, through discussion, through reflection and often through the challenge of understanding where perhaps governments of all persuasions have got it wrong to commit to long-term reform.

This is about workforce development, it is about retention, it is about recruitment, it is about professional and career development opportunities for people in this sector. It is about recognising the hard work that is undertaken, often with no expectation of recognition or reward, to safeguard the rights, the dignity and the identity of people in their care. It is about partnering between specialist and medical and allied health workers, peak bodies and those very organisations who have stood at the forefront of public discussions on this—the chief psychiatrist, Professor McGorry and the work of Mental Health Victoria and the Butterfly Foundation. The list is a very long one.

When I was Parliamentary Secretary for Mental Health, one of the things that was most compelling about the discussions relating to the terms of reference for the royal commission was the need to engage in the breadth and the complexity of mental health challenges from a variety of different perspectives. This is about understanding that the way in which service delivery occurs in the middle of Melbourne will be very, very different from the way in which it occurs in Mildura. It is about understanding the interrelated needs of clients, consumers and patients within the system in a range of ways that recognise comorbidities. This is about understanding that barriers to uptake of services include stigma, something which the royal commission has acknowledged and, indeed, which the Premier and the then Minister for Mental Health, Minister Merlino in the other place, acknowledged when this report was tabled. But stigma is not the only thing—there are cultural and linguistic differences in the way in which mental health and wellbeing are discussed, and there are elements of nuance and of intricacies in communication which often limit or deter people from seeking support or assistance.

We need to understand that this bill is an enabling framework. This bill sets in train the work that will deliver on the 67 recommendations beyond what has already been done. This builds upon the work that this Andrews government committed to doing to implement all of those recommendations before the commission’s report had even been begun. This is about understanding that the system must be improved in the interests of all Victorians, whether they are people who live with mental health issues or disease or illness themselves or their families—their kids, their parents—their colleagues or the people at their footy clubs. All of us know people who live with and struggle with, and try to get by despite, mental illness. We all know of somebody who has buckled because they cannot cope. Many of us are these people.

It is also about understanding that as we do this work it must translate from the statute book on the one hand to real and respectful outcomes and engagement on the other. This is about delivering on that framework. This is about making sure that the way in which we manage challenges to whole-person care is well understood. To that end I would commend the second-reading speech which Minister Merlino in fact read directly into the record when this bill was first tabled in the other place, and in particular the statement of compatibility—the requirement that the impact upon human rights be considered in the making of new law. This is where questions such as the harm minimisation principle and proportionality have been considered very, very carefully, particularly as they relate to chemical and physical restraints, particularly as they relate to the sharing or disclosure of health information by a mental health practitioner and particularly as they relate to the sorts of matters that are intended in good faith to reduce the silos that all too often prevent or deter people from accessing the care and support that they need. This is about understanding that if we do not set the right framework now, we cannot hope in all good conscience to achieve the ends of the royal commission’s report and the objectives to make for a better system that accommodates and respects lived experience.

It is important to note that in replacing the Mental Health Act 2014 this bill, once enacted, will set a basis upon which further improvement can occur. There are a lot of similarities between the Royal Commission into Victoria’s Mental Health System on the one hand and the Royal Commission into Family Violence on the other. One made 227 recommendations; it was about 1900 pages, the family violence royal commission. Again, this is wholesale, long-term, attitudinal, cultural, regulatory and legal change. The mental health royal commission, with its 67 recommendations, contemplates the very same difficulty of a new system to replace the old whilst also acknowledging that some of the very good, very well intentioned and very effective measures that already exist in the system can and indeed deserve to be preserved as part of these new reforms.

We need to make sure also that the work in this bill is given the commitments and the funding and the support that it deserves from any future Parliament. In this regard I note that the first set of findings from the interim report of the mental health royal commission foreshadowed a levy to meet the costs associated with implementing its recommendations and reforms. It would be a tragedy were it to unfold that the recommendations of the mental health royal commission could not be implemented because to do so would be inconvenient to a political narrative. These changes require investment. They require enormous investment in funding, in training, in recruitment and in wholesale change to the way in which community-based and clinical settings operate to provide services to people within the system and adjacent to it. We need to make sure that supported decision-making of individuals within the system is given the respect and the consideration that it deserves.

This bill is an inherently important part of an enormous level of change that will hopefully outlast all of us, that will ensure that those who never know our names will be better off for a system that we are taking the time now to improve. This bill has been developed in careful consultation with specialist and peak bodies. It reflects the will of the royal commission. It reflects the will and the desire of this government to see that we effect and deliver a better mental health system. It contemplates the very best parts of our system and the most tragic parts of our system. It does so in a holistic, whole-person and lived experience way. It is an important bill, and I wish it a speedy passage.

Ms PATTEN (Northern Metropolitan) (14:53): I am pleased to rise briefly to speak on this bill, and I will speak briefly because we have heard so many really terrific contributions to this legislation today. It is incredibly important work for this Parliament. As Ms Shing recently mentioned, it will set a new course in our approach to mental health and wellbeing, and not before time.

As someone who has been chairing the Legal and Social Issues Committee this term, I know the impact of mental ill health and the impact of a lot of our mental health policies are so broad reaching. We see that whether it is when we are doing an inquiry into homelessness and looking at the impact that mental health has on people’s housing or whether it is recognising that two out of five people who enter our prison system have been diagnosed with mental health issues—and if it is women, two out of three women have been diagnosed with mental health issues. Nearly half of the women in our prisons are taking medication for their mental health. So the policies that we have made on mental health impact our justice system, impact our housing and the services that we offer people who are experiencing homelessness and impact a lot of our drug and alcohol policies. I think that the harm minimisation approach that is taken throughout this bill and is taken throughout the intentions of this bill is very good. I hope that that means we will start seeing a strong harm minimisation approach to alcohol and other drugs, not just in the services we provide but in the laws that surround drugs and alcohol in our community, particularly illicit drugs.

But as we know, we have been forever operating ambulances at the bottom of a cliff. We have constantly been in crisis mode. I know that all of us have had those desperate calls from constituents who just cannot get help for their loved one or are really struggling with their own mental health and there is nowhere for them to go. This bill and this approach, this plan, will enable far easier early intervention. It will also assist us in addressing stigma. We know of the stigma around mental health. We also know that people delay seeking help for their mental health because of the shame and stigma that they experience from having mental ill health.

The Royal Commission into Victoria’s Mental Health System found all of this—that we need a complete rebuild. But I have never met more dedicated people than the people in the mental health sector. I was recently at Heidelberg at the Austin’s acute mental health ward, and the dedication and the passion of the allied health workers there, of the nurses there, of the psychiatrists there and of even the receptionists there were quite overwhelming. But they were working with this incredibly dilapidated infrastructure and, to be honest, a fairly dilapidated system. There was a patient there who had an eating disorder, and I saw where she was staying and I could not help but think it was the last place that someone should be to get better. It was not conducive to making someone feel better and improving their health.

This legislation is really welcomed by our community. We commend the government on this work. It is well considered, and it is building from the base up. I was almost pleasantly surprised by the opposition’s amendments, which I am supportive of for recognising alcohol and other drugs and recognising they are important components of this and having that recognition introduced to the bill. This legislation and the implementation of it, being the implementation of the recommendations of the royal commission, will absolutely save lives. I do not think there is a single one of us who has not been affected by suicide or who has not mourned the loss of someone because of mental ill health and because of the fact that they were not able to get the help that they needed when they needed it. I think this legislation creates a vision for what a compassionate mental health system can look like—something that is responsive, something that is flexible, something that recognises that it is people centric. Having people with lived experience, which is so crucial to the system and to the checks and balances of this legislation, is incredibly important.

I thank everyone who spoke to me, whether that was Professor McGorry, the college of psychiatrists, the Health and Community Services Union or even the individuals in my community who wrote to me. I am very grateful for all of the people who spoke to my office and who I met with as part of our consultation on this. But to that end, there were a number of concerns raised with me by the nurses and midwives union and the Health and Community Services Union, and this led us to drafting a series of amendments. I am wondering if we could circulate those amendments now.

Fiona Patten’s Reason Party amendments circulated by Ms PATTEN pursuant to standing orders.

Ms PATTEN: These amendments establish a legislative basis for the Mental Health Workforce Safety and Wellbeing Committee. This is a committee that already exists, and it is currently established administratively via the secretary, so this is actually just embedding it into the legislation to ensure that this committee does continue to exist and continue to operate. Being a workforce safety and wellbeing committee, it will assist in some of the concerns that the workforce have about the implementation of various parts of the legislation and what impact they will have on the safety of their workplaces, and this ensures that there is transparent oversight of that. It flows from the royal commission’s recommendation 59, and as I say, its purpose will be to look at the prevention of and responses to the occupational health, safety and wellbeing risk to the mental health and wellbeing workforce. I think this is very sensible. It is implementing something that already exists, and I hope that it will be supported here.

As I said, I support the amendments that the opposition has raised and introduced for this bill as well, because alcohol and other drugs should not be seen as either/or in mental health. An alcohol or drug use disorder is part of a mental health spectrum, and so often we have seen and heard of people saying ‘I can’t treat you for your mental health until you’re treated for your drug use disorder’ or ‘I can’t treat you for your drug use disorder until you have been treated for your mental health disorder’. It needs to be seen on the continuum, and we can do both. I think this legislation also enables that to happen. I hope this also means that we will see a lot more funding for alcohol and other drug services. I would like to see a lot more law reform in regard to alcohol and drugs because I think that actually would enable us to make far better early interventions before someone’s drug use or alcohol use becomes a problem, but particularly their drug use.

Just finally, I would like to highlight something that the Health and Community Services Union sent to me. It is not in the legislation, but I think it is something that really should be considered. It is recognising the importance of our allied health workers, whether that is our occupational therapists, our speech pathologists or our art therapists. They have such a crucial role to play in our mental health systems, and that really should be recognised:

HACSU believe that having access to the right intervention, at the right time, is integral to the experience of Consumers and the smooth functioning of the mental health system. We view Mental Health as a holistic service, rather than silos of disciplines. All professions must work hand in hand for the sector to work. Without one of the pieces the system falls apart. That is why we are advocating for staffing profiles across all disciplines …

Staffing profiles historically only apply to nursing staff. HACSU members know that staffing profiles must extended to all those working in the mental health sector.

I concur, and I hope as part of the implementation of this legislation we will see staffing profiles being extended to allied health workers.

Again, I would like to extend my thanks and gratitude to the many people who reached out to me about this legislation. As I have said, it goes directly to harm reduction in our community. It will save lives, and of course in that important context it has my full support.

Mr LIMBRICK (South Eastern Metropolitan) (15:06): My office, like I imagine many MPs’ offices, has had a large number of contacts from constituents who have had serious trouble navigating mental health services, with an enormous increase during the pandemic response—an explosion of mental health issues unlike anything I have ever seen before. We are still learning about the damage done, but make no mistake: much of the current mental health crisis in Victoria was man-made, and it was made right here. Allow me to remind you of some real-world examples of how mental health issues have been treated in the state.

Around mid-2020 my office started to be contacted by people around what most considered to be a trivial thing: masks. There are many people that simply cannot wear masks, such as victims of trauma or some children living with autism spectrum disorder. Mandating masks, along with the severe messaging from the government, made these people outcasts. They suddenly became branded as anti-maskers and people who were not doing the right thing. We heard stories of survivors of sexual assault being scared to leave their houses because of fear of abuse in the street. We later heard stories of mothers with teenage children living with autism being scared to go to the supermarket for fear of people staring at them or saying things to them. I pleaded with the government and the Department of Health to back off and raised this issue many times, but my pleas fell on deaf ears.

In September 2020 a passer-by filmed a man by the side of the road in Epping being arrested by police. This man was returning from a hospital visit, where he had been waiting for 19 hours for treatment for a mental health issue. He had been reportedly knocked to the ground by a police vehicle when a passer-by managed to film what happened next. The man alleged that a policeman stomped on his head. The man suffered severe injuries and was not only under arrest but also placed into an induced coma. IBAC cleared the police officer who appeared to stomp on him but found the officers had failed to inform the man of the reason for his arrest or provide him with care after he was capsicum sprayed. The police officer who hit him with a car was barred from driving a police vehicle. Last year we heard there would been an internal police investigation, but I expect, as I have learned to expect when I ask questions about these things, absolutely nothing. There seems to be no government body or institution in this state capable of stopping it happening again. This was a visible example of what was happening in this state, but as I have said before, mental breakdowns are rarely seen in public.

While police helicopters hovered over their houses, thousands of men, women and children were locked up. Kids were eventually not even allowed to use playgrounds, others felt worthless because they could not cope with online learning and thousands of people were left to battle anxiety and depression in private, unable to even go for a walk and watch the sunset. Even worse, when many of these people decided that they had had enough of their businesses being shut down, being locked in their homes and their kids not going to school and they took to the streets in protest, they were derided by government cheerleaders as ‘cookers’, a term deliberately intended to stigmatise opponents of the government as mentally ill or suffering from drug-induced brain damage.

I am proud to say that at the time when it mattered the most we were talking about mental health. For example, we put forward a motion to allow children to go back to school. I invite members to look at my speech from 16 September 2020 where I told several harrowing stories from mums and dads who were naturally worried sick about their kids. I spoke about an article in the Lancet medical journal highlighting research by neuroscientists from Cambridge University. This showed adolescents who miss out on face-to-face interaction are more likely to have long-term mental health, behavioural and cognitive problems later in life. This built on numerous studies showing how socialisation impacts the developing brains of young people. The response from a government member was ‘for some children adversity can be character-building’. It is still not clear what scientific study about the character-building characteristics of isolating children she was referring to, but this was illuminating. If you want to know what the government thought about mental health, you have it right there. Compared to much of the world, Victorians suffered from extreme lockdowns, and to get extreme lockdowns you need extreme callousness. The Liberal Democrats lost the motion to get kids back to school. And for those of you who are making speeches today but did not support us then, I will say this: you stood by and allowed Victorians to be subjected to this, and now you want to take credit for something to clean up the mess, which you partially created, which has resulted in a massive increase in demand and an overextended workforce unable to meet that the demand.

Our constituents told us in no uncertain terms they were not okay. It was not only children; it was single mothers, people living alone and the elderly. It is questionable that any amount of money or counselling, even if we can find the staff, will undo the damage that may have been done. The Liberal Democrats will not oppose moves to clean up this mess, but we will not forget who was responsible for adding to it in the first place.

Mr TARLAMIS (South Eastern Metropolitan)

Incorporated pursuant to order of Council of 7 September 2021:

I’m pleased to have the opportunity to make a contribution on the Mental Health and Wellbeing Bill 2022.

This bill is not only an important step in our state’s reform journey but one of the most consequential pieces of legislation that has been put before this Parliament.

We know our mental health system is broken. We have all heard the lived experiences of our constituents and how, more often than not, the system failed them.

Today, we have the opportunity to take another important step in rebuilding our state’s mental health system.

In March 2021, the Royal Commission into Victoria’s Mental Health System released its final report.

The final report laid out a blueprint for building a more compassionate and effective mental health and wellbeing system from the ground up.

The report contained 65 recommendations that would be required to fix our system.

These recommendations gave us opportunities to change the system—not from within, but to rebuild it entirely.

They gave us an opportunity to rethink the way we distribute mental health knowledge, resources and services around the state so that they are fit-for-purpose and appropriately meet the requirements of those in need, providing quality mental health assistance for everyone when and where they need it.

The bill before us today is a direct response to recommendation 42, which called for the establishment of a new mental health and wellbeing act.

The bill before the house sets out the foundation for the future of mental health and wellbeing services in Victoria—one where lived experience is at the centre of decision-making and mental health professionals are given the support necessary to deliver treatment and care in fully resourced facilities.

This is on top of the work that has already been done by the government which has seen us deliver over 2500 mental health jobs since the royal commission’s report, delivering exactly what our mental health workforce strategy identified as necessary for this reform.

I am also pleased to note that the bill includes a statement of recognition and acknowledgement of the treaty processes that we are currently undertaking here in Victoria.

It is one of the first pieces of health legislation that incorporates a statement of recognition.

This underscores the Andrews Labor government’s commitment to Aboriginal self-determination in achieving positive health outcomes.

It recognises the key role of the Aboriginal health sector in the delivery of Aboriginal mental health and wellbeing services, and it supports healing, acknowledges trauma and provides a foundation for future legislative reform to strengthen Aboriginal self-determination within mental health and wellbeing processes.

It is also important to understand that some aspects of this bill do go beyond the recommendations of the final report.

This includes the establishment of Youth Mental Health and Wellbeing Victoria.

This is a significant inclusion as mental health is often identified by young people and youth organisations as a key challenge faced by our youth.

The bill also includes specific decision-making principles concerning compulsory assessment and treatment and restrictive interventions.

It provides for a reduced maximum duration of community treatment orders, from 12 months to six months, and changes to support a health-led response to a mental health crisis.

These changes are vitally important if we are to ensure that no stone is left unturned in our mental health reforms.

Importantly, the bill establishes key new entities and offices for the governance and oversight of the mental health and wellbeing system.

This includes the new Mental Health and Wellbeing Commission, regional mental health and wellbeing boards, regional and statewide multiagency panels and the chief officer for mental health and wellbeing.

The commission will be an independent statutory body reporting directly to the Parliament and comprising of a chair commissioner and three commissioners to be appointed by the Governor in Council.

The commissioners will include people with lived experience of mental illness and with lived experience as a family member, carer or supporter.

The commission will incorporate the existing complaints function of the mental health complaints commissioner and have a suite of broader powers, including an ‘own initiative’ investigation power.

The commission will be empowered to hold the government to account for the mental health and wellbeing system and its implementations of recommendations made by the royal commission.

This will ensure public trust in the government’s reforms and the new system, which is integral to the process.

However, legislation alone cannot mend a broken mental health system. That is why I am proud to be part of a government that in the first 17 months since the release of the final report has acted on 90 per cent of the royal commission’s recommendations.

This extraordinary outcome was achieved through the 2021–22 state budget where the Andrews Labor government invested $3.8 billion to kickstart the next decade of mental health reform and in this year’s budget where the government invested an additional $1.3 billion to build the momentum necessary to fully deliver on the royal commission.

This achievement is a testament to the strength of the commitment to the delivery of tangible outcomes that will benefit Victorians.

It is worth noting the hard work that has gone into drafting this bill.

Not only has it been informed by the findings of the royal commission, but also an expert advisory group was appointed to support the bill’s development and extensive feedback through engagement in 2021 and this year.

Remarkably, we received 283 written submissions to the discussion paper released last year, along with hundreds of direct engagements with stakeholders and sector leaders throughout the past 12 months.

The level of engagement from the community shows how eager Victorians are to help fix our system.

Those of us on this side of the chamber, along with our government colleagues in the other place, are incredibly proud of this bill.

It is the type of bold, landmark reform that only Labor governments have dared to implement.

It goes to the very heart of our values.

I’m extremely proud to be part of a government that is leading major reform that will make a real difference to Victorians—that listens to experts, consults with the community and puts those with lived experience at the centre of its reforms.

This bill is another step forward for Victoria.

I commend it to the house and I wish it a speedy passage.

Mr LEANE (Eastern Metropolitan—Minister for Commonwealth Games Legacy, Minister for Veterans) (15:11): The Mental Health and Wellbeing Bill 2022 delivers on key recommendations of the Royal Commission into Victoria’s Mental Health System. It is an important milestone in the 10-year mental health reform program required to give full effect to the royal commission’s vision. The bill sets out the foundations for the future of mental health and wellbeing services in Victoria, one where lived experience voices are at the centre and mental health professionals are supported to deliver the best treatment, support and care in facilities that actually help people recover. The bill puts people with lived and living experience of mental illness and distress, and their families, carers and supporters, at the core of the mental health and wellbeing system. It does this through new rights-based objectives and principles and the inclusion of designated lived experience roles at the highest level of government and oversight entities. The bill establishes key new elements of the system architecture, including the chief officer for mental health and wellbeing, statutory regional mental health and wellbeing boards to provide advice on the planning and commissioning of services at a local level, the new Mental Health and Wellbeing Commission and Youth Mental Health and Wellbeing Victoria.

Of course the bill is just part of a broader context of reform that sits alongside record service investment—more than $5 billion in the past two budgets alone and a massive expansion of the workforce, with over 2500 more mental health workers in the next four years. The delivery of this bill acquits in full recommendation 42 of the royal commission’s final report, getting us another step closer to full delivery of every single one of the royal commission’s recommendations. To date work has commenced on over 90 per cent of the recommendations, generating real momentum and hope for a reimagined mental health and wellbeing system.

I understand Ms Patten has proposed an amendment to enshrine the requirement for a workplace safety and wellbeing committee in the bill, with its establishment to be a function of the chief officer. The government will support this amendment. We are committed to supporting those who work in the mental health and wellbeing sector and know that nothing can be achieved without a strong, committed and safe workforce. As the former Minister for Mental Health noted in his second-reading speech for the bill, the clinical, community and support staff that make up the mental health workforce are the true heroes. We have already established a mental health workforce safety and wellbeing committee in line with recommendation 59 of the royal commission. Enshrining this committee into legislation will ensure its important work of monitoring and providing advice about the physical safety and psychological wellbeing of the workforce continues throughout and beyond system reforms.

The opposition have proposed an amendment. I think it was proposed in the other place but of course it is being proposed here for the committee’s consideration. The government will support this amendment. We are committed to ensuring mental health and wellbeing services are closely connected and work in coordination with alcohol and other drug services. This is consistent with our commitment to deliver on recommendation 35 of the royal commission, which called for integrated treatment, care and support for people living with mental illness and substance use or addiction. It also aligns with our commitment to establish a new statewide service for people living with mental illness and substance use and addiction. The proposed amendment is consistent with the existing health needs principle—clause 22—that requires that:

The medical and other health needs of people living with mental illness or psychological distress are to be identified and responded to, including any medical or health needs that are related to the use of alcohol or other drugs.

I want to just quickly run through some responses to issues and concerns raised in the debate so far. I hope that these clarifications can assist members going forward. During the debate earlier today Ms Crozier asked whether the bill would provide a dedicated entity to address the mental health needs of older Victorians. I understand that this was a view emerging out of the creation of Youth Mental Health and Wellbeing Victoria in the bill and that perhaps more was needed to cater to the needs of older people. Whilst I do not agree that the needs of older Victorians should be prioritised with reforms, a separate entity would essentially duplicate the function of the Victorian Collaborative Centre for Mental Health and Wellbeing, the establishment of which is incorporated in this bill. As noted in the second-reading speech, the functions of the VCC include to provide, promote and coordinate the provision of mental health and wellbeing services. This will include providing a comprehensive range of multidisciplinary services to adults and older adults in the local community, and that is actually a statement in the speech. Dedicated consultation mechanisms to capture the lived experience and new mental health issues of older Victorians will be established through the support of the VCC in delivering on the functions without the need for an additional entity.

We also heard concerns from a few members that the translation of a health-led response, a very necessary and welcome policy change, is contingent on the mental health workforce. I would like to clarify that the current arrangements, which require Victoria Police to escort someone to an emergency department and wait for them until an emergency physician is available, are presently the law under the Mental Health Act 2014. It is not a matter of workforce availability, and of course we can all agree the police have many other valuable activities to attend to rather than sitting in a busy emergency department with an unwell person who just needs help. At present police cannot hand over someone who is of risk to the community to someone like a paramedic or a mental health nurse. They absolutely should wait to do that, where it is safe to do so. That is exactly what this bill will deliver—a scaffolding necessary to transition to our health-led response over coming years in partnership with VicPol, Ambulance Victoria, the Royal College of Emergency Medicine and industry partners.

Finally, I just want to respond to some of the claims that the mental health workforce has not been supported by this government and that it has somehow left the workforce behind in these reforms. That is categorically not true. In the past three budgets alone, since the release of the royal commission interim report, we have invested over $600 million into workforce growth and development. As per the recommendations of the royal commission’s final report, we delivered Victoria’s Mental Health and Wellbeing Workforce Strategy 2021–2024 in December last year. That strategy identifies the need for at least 2500 more mental health workers over the next four years. At the recent state budget the government delivered exactly that—a record $372 million package to deliver 1500 more workers on top of the 1000 workers already refunded in the previous year, more than 400 mental health nurses, 300 psychologists and more than 100 more psychiatrists just to start with. We are keeping on delivering the vital work on this workforce, who are the heart and soul of the mental health system. We could not do this reform justice without absolutely doing that.

I might just briefly go to a concern that Mr Grimley raised about the independent review panel. We waited until we had a final draft of the bill to develop the terms of reference as it is a consequential piece of work. There is no strategy behind this timing; it is merely how the work has been managed in the face of a huge deliverable. The panel is chaired by a judge with lived experience of mental illness. Justice Shane Marshall is joined by psychiatrists, a lived experience academic, a consumer with experience of compulsory treatment and a carer. This diverse and expert group will commence work later this year and will report back to the government on any appropriate changes to the bill based on their terms of reference. I will leave it at that and just thank everyone for their contributions in the second-reading debate.

Motion agreed to.

Read second time.

Committed.

Committee

Clauses 1 and 2 agreed to.

Clause 3 (15:22)

Ms CROZIER: Minister, this goes to the definition of ‘registered paramedic’. Mr Grimley raised this in his contribution—I ran out of time in mine—around the community paramedics. When I was seeking feedback from the sector I had some feedback from the community paramedic sector saying essentially that the bill restricts a registered paramedic to working to their full scope of practice, and they are concerned that they will not be able to participate with what I think the intent of the bill is. They are not necessarily employed by Ambulance Victoria, but the bill states that they must be employed by Ambulance Victoria. Their comment to me in the feedback was:

So all registered paramedics can be a mental health and well being professional but can not be an authorised person unless employed by an ambulance service and are excluded from being an authorised mental health practitioner …

For them that does not make sense. Could you explain to the house why they are not included in the definition?

Mr LEANE: Thank you, Ms Crozier. Registered paramedics are one of the many workforces that will be critical in the delivery of the reformed mental health and wellbeing sector. Registered paramedics are included in the newly classed mental health and wellbeing professional. Registered paramedics are also included as one of the professional groups that may inform the exercise of power by police or PSOs responding to mental health crises in the community. Some roles under the bill are limited to registered paramedics who are employed by an ambulance service under the Ambulance Services Act 1986. This includes the roles of authorised persons. This is consistent with the current act, which refers to ambulance paramedics, but it has been updated as paramedics are now a registered profession under the Health Practitioner Regulation National Law to ensure clarity in the drafting of interpretations. Limiting these powers in any way reflects the significant powers exercised by authorised persons, including powers to take people into care and control in the community and to transport them to designated mental health services. Other registered paramedics or other health professionals may be prescribed by regulation to fall within the definition of ‘authorised person’. This is necessary to ensure there can be a health-led response to people experiencing mental health crises in the community. This will only occur after consultation with all affected stakeholders. No? Ask your question again.

Ms CROZIER: Thank you for that answer, Minister. From that answer, I still think they are excluded, but you did make reference to the regulation that they are under:

registered paramedic means a person who is registered under the Health Practitioner Regulation National Law to practise in the paramedicine profession (other than as a student) …

So this definition confirms that a registered paramedic does not have to be employed by an ambulance service to provide the very real issues that the bill sets out in terms of restrictive interventions and sometimes assisting with the transfer of patients. So they are wanting to know—they are registered under the national law but they are not necessarily employed by Ambulance Victoria, and this legislation restricts their ability.

Mr LEANE: To use the powers prescribed in terms of transporting people in the fashion that is prescribed in this bill, they do have to be employees of Ambulance Victoria.

Ms PATTEN: I move:

1. Clause 3, page 18, after line 2 insert—

“Mental Health Workforce Safety and Wellbeing Committee means the Mental Health Workforce Safety and Wellbeing Committee established by the Health Secretary under section 327A;”.

The amendment goes to, as I mentioned in my second-reading speech, establishing a legislative position for the mental health workforce safety and wellbeing committee. This goes to some of the concerns that we heard from the nurses and midwives and some of the concerns that we heard from the Health and Community Services Union, and even from the college of psychiatrists and the AMA. They were concerned about the workplace health and safety that the implementation of some parts of this legislation may put at risk. So the establishment of this committee within the legislation secures that oversight for it. The objectives, as I mentioned in my second-reading speech, would be the prevention of risks to health, safety and wellbeing in the mental health and wellbeing workforce, and monitoring and responding to risks to health, safety and wellbeing in the workforce. The committee may also appoint subcommittees, and the committee will consist of members appointed by the health secretary.

Mr LEANE: The government will be supporting Ms Patten’s amendment, as I outlined in the second-reading summary.

Amendment agreed to; amended clause agreed to; clauses 4 to 11 agreed to.

Clause 12 (15:31)

Ms CROZIER: Minister, clause 12(c)(vi) states the following objective in pursuit of the highest attainable standard of mental health and wellbeing for the people of Victoria:

provide culturally safe and responsive services to Aboriginal and Torres Strait Islander people in order to support and strengthen connection to culture, family, community and Country …

Whilst I understand that they are recognised as a vulnerable group of Victorians and that is why you have specifically put this paragraph into this clause, can I just ask why the CALD communities are not included similarly. They are also a vulnerable group and they can be subjected to stigma and a whole range of things and at times they do not have a good understanding of English and so confusion can occur with interpretation of certain things. I am just wondering why they are not identified as well.

Mr LEANE: Clause 17 contains a cultural safety principle, which does cover not only First Nations people but also those from CALD backgrounds.

Ms CROZIER: I would like now to move my amendment, if I may, because it follows on from that paragraph. I note from the minister’s summing up that the government has indicated support for the amendment that I have proposed. In my second-reading contribution I spoke about this significant part of the sector who feel they need to be included in the reform because it is such a significant reform and they do such an enormous amount of work. I think Ms Patten referenced the sector as well. I do thank the government. I know there was some difficulty with the former minister because the government split the role—it was with Minister Merlino and then it went to Minister Foley—and there were some issues around drugs and the injecting room and all sorts of things. But for the purposes of this, I think, as highlighted by Ms Kealy in her second-reading remarks and others, this sector have done a significant amount of work and they are carrying a huge burden after the last 2½ years where they have seen significant demand. I move:

1. Clause 12, page 36, line 9, after “wellbeing” insert “including alcohol and other drug support services and treatment”.

Mr LEANE: The government will support Ms Crozier’s amendment for the reasons I outlined in the second-reading summary.

Mr HAYES: I just want to speak very briefly to support Ms Crozier’s amendment, and I am very glad the government is going to support it too. I think it is very important that alcohol and other drugs (AOD) are recognised and included, and I note that she talks of the Victorian Alcohol and Drug Association (VAADA). I spoke to them earlier in the year, and they were worried precisely about the matter of this being recognised. As Ms Patten also talked about, alcohol and other drug addiction has to be treated often separately but parallel to other mental issues with mental wellbeing, and sometimes just treating someone for depression and thinking that you are treating the addiction problem as well is not enough. Addicts that are in recovery often need long-term support that is separate to their treatment for mental illness—you know, going to a whole lot of lifestyle issues and personal interrelationship problems with other people—and this takes time and resources.

Dave Taylor and Sam Biondo from VAADA came to speak to me. I also want to recognise the work that Windana does in our electorate, which Ms Crozier mentioned. This is really important work, and we need to see more targeted treatment facilities for alcohol and other drug addiction, not less. While we have seen an increase in the budget for mental health overall, we have seen a sliding back in separate funding towards alcohol and other drug issues. We need to see more treatment facilities, both private and public, and I would like to see more public intervention in this area. Support for community groups and public funding for facilities where these groups can meet would also help. We do have quite a problem with alcohol and drug addiction, and that has really come to the surface post pandemic. All the evidence suggests that the system seems to be under quite a bit of strain with huge needs in this area. So I support the amendment and I would like the government to look at increased funding in this area.

Ms MAXWELL: I would just like to make a couple of comments in relation to Ms Crozier’s amendment. We know that the AOD sector plays a significant role in the recovery of people with mental illness. As Mr Hayes said, the emphasis and the resources are often not there, so whilst the mental illness itself may be being treated—whether it be through counselling or medication—often the cause and the comorbidity of AOD is not considered or not dealt with because we do not have the rehabilitation supports and resources that we need. So I think that this is an important amendment, and it is a little disappointing to see that there has not been more reference to the AOD sector in this bill.

Amendment agreed to; amended clause agreed to; clauses 13 to 17 agreed to.

Clause 18 (15:39)

Mr LIMBRICK: This clause relates to the principles under this bill, the least restrictive principle. Now, this is something that I have spoken about many times in the operation of the Public Health and Wellbeing Act 2008—the idea that any particular action is meant to be the least restrictive of rights—and I have been quite disappointed with the operation of this principle in the Public Health and Wellbeing Act. Under this bill how will the government ensure that the decision-makers—the public servants making the decisions—are aware of these new principles and how to apply these principles in their decision-making? I give the example: an action that is the least restrictive of rights implies that there are multiple options that a decision-maker could choose from and they would choose the option that is the least restrictive, so how will they ensure that they actually apply these decisions to their decision-making processes?

Mr LEANE: The decision-makers and others that Mr Limbrick has mentioned will have to apply all the principles prescribed in the bill, and guidance on those principles can be helped to be determined by the commissioner as well.

Mr LIMBRICK: I thank the minister for his answer. What measures will be employed to ensure that this test is appropriately applied on a case-by-case basis? What we have seen under the Public Health and Wellbeing Act is that the only real challenges to it came from legal challenges. I would hope that there are some mechanisms in place to ensure in an ongoing manner that all of these principles, including the least restrictive principle, are being applied consistently and methodically in each case.

Mr LEANE: As I stated, guidance on all the principles, including this one, can be assisted by the commissioner.

Ms MAXWELL: Minister, on clause 18, the least restrictive principle, what if any impact will that clause have on people who are either incarcerated or in Thomas Embling Hospital?

Mr LEANE: Thank you, Ms Maxwell. The principles will apply to Thomas Embling and also to mental health facilities within prison.

Ms MAXWELL: Thank you for that answer. In relation to that, Minister, will that impact things such as day release for those who are in Thomas Embling Hospital? Will that have any impact? Will it actually allow for earlier day release or more day release?

Mr LEANE: Thanks, Ms Maxwell. The status quo still applies. Decisions on leave will still be under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997.

Clause agreed to; clauses 19 to 327 agreed to.

New heading and new clauses (15:46)

Ms PATTEN: My amendments insert the heading ‘Mental Health Workforce Safety and Wellbeing Committee’, and the new clauses lay out the formation of the mental health workforce safety and wellbeing committee—how it will be established—and then go on to lay out the objectives of it. I move:

2. Page 264, after line 24 insert the following heading—

“Part 6.5A—Mental Health Workforce Safety and Wellbeing Committee”.

3. Insert the following New Clauses to follow clause 327 and the heading proposed by amendment number 2—

“327A Mental Health Workforce Safety and Wellbeing Committee

(1) The Health Secretary must establish a Mental Health Workforce Safety and Wellbeing Committee in accordance with the regulations.

(2) The Mental Health Workforce Safety and Wellbeing Committee consists of members appointed by the Health Secretary.

(3) The Health Secretary may appoint 2 of the members of the Mental Health Workforce Safety and Wellbeing Committee to jointly chair the Committee.

(4) Members of the Mental Health Workforce Safety and Wellbeing Committee must have experience, skills or knowledge that is relevant to the objectives of the Mental Health Workforce Safety and Wellbeing Committee.

(5) The regulations may make provision for or with respect to—

(a) the appointment of the Mental Health Workforce Safety and Wellbeing Committee, including the number of members; and

(b) the powers and procedures of the Mental Health Workforce Safety and Wellbeing Committee.

327B Objectives of the Mental Health Workforce Safety and Wellbeing Committee

(1) The objectives of the Mental Health Workforce Safety and Wellbeing Committee are to provide advice to the Health Secretary and the Chief Officer in relation to—

(a) the prevention of risks to health, safety and wellbeing in the mental health and wellbeing workforce; and

(b) approaches to monitoring and responding to risks to health, safety and wellbeing in the mental health and wellbeing workforce.

(2) The Mental Health Workforce Safety and Wellbeing Committee may appoint a sub-committee to assist the Mental Health Workforce Safety and Wellbeing Committee to achieve its objectives under subsection (1).”.

Mr LEANE: The government supports the amendments.

New heading and new clauses agreed to; clauses 328 to 410 agreed to.

Clause 411 (15:47)

Ms MAXWELL: An objective of the Mental Health and Wellbeing Commission is to ensure the government is accountable for the performance, quality and safety of the mental health and wellbeing system, including the implementation of recommendations made by the royal commission. Integrated treatment is a recommendation of the royal commission. That will in part be delivered by the AOD sector. Will the AOD sector therefore be measured for performance, quality and safety as part of this objective?

Mr LEANE: Ms Maxwell, the answer is no because we do not regulate AOD services under this bill.

Clause agreed to; clauses 412 to 631 agreed to.

Clause 632 (15:49)

Mr LIMBRICK: I have a couple of questions on this one. Apparently the Scrutiny of Acts and Regulations Committee (SARC) found that in clauses 632 and 702 the Secretary of the Department of Health may issue directions, and the clauses provide that the directions do not constitute discrimination on the basis of political or religious belief. Can the minister please clarify whether or not clause 632—and clause 702, but we are on clause 632—permits the health secretary to discriminate on the basis of political or religious belief or activity, therefore limiting the charter of human rights?

Mr LEANE: Mr Limbrick, the answer is no.

Mr LIMBRICK: I thank the minister for clarifying that. It is my understanding that SARC wrote to the minister seeking clarity on this but the minister has not yet responded. Is that the case, and if so, is the response of ‘no’ the answer effectively?

Mr LEANE: I am unsure of what has happened between SARC and the minister, but I can confirm that the answer is no.

Clause agreed to; clauses 633 to 639 agreed to.

Clause 640 (15:51)

Ms MAXWELL: Minister, the collaborative centre has a responsibility to ‘provide or arrange the provision of specialist support services and care for persons who have experienced trauma’ via the statewide trauma service. It is widely accepted that experiences of psychological trauma are a common vulnerability amongst those with AOD and mental health needs. Does this then suggest that the collaborative centre will offer support and oversight to that AOD sector on issues relating to trauma?

Mr LEANE: Thank you, Ms Maxwell. The VCC does not regulate the AOD sector or any of its services. It is there for research, and it is also there for guidance.

Clause agreed to; clauses 641 to 742 agreed to.

Clause 743—no question put pursuant to standing order 14.15(2).

Clauses 744 to 885 agreed to; preamble agreed to.

Reported to house with amendments.

Mr LEANE (Eastern Metropolitan—Minister for Commonwealth Games Legacy, Minister for Veterans) (15:54): I move:

That the report be now adopted.

Motion agreed to.

Reported adopted.

Third reading

Mr LEANE (Eastern Metropolitan—Minister for Commonwealth Games Legacy, Minister for Veterans) (15:54): I move:

That the bill be now read a third time.

I thank you, Deputy President, and Ms Crozier, Ms Patten, Mr Hayes, Ms Maxwell and Mr Limbrick for their contributions in the committee stage.

Motion agreed to.

Read third time.

The DEPUTY PRESIDENT: Pursuant to standing order 14.27, the bill will be returned to the Assembly with a message informing them that the Council have agreed to the bill with amendments.