Address, Orygen Parkville, VIC
25 March 2022
PRIME MINISTER: Well, thank you very much Pat. It's wonderful to be back here at Orygen today. Can I, like you, commence by acknowledging the Wurundjeri people of the Kulin nation and pay my respects to their elders past, present and emerging. Can I also acknowledge any service men and women and veterans who are with us today as I always do, and acknowledge the struggle of many veterans with mental health issues, which I know Pat and Lucy, are very familiar with, and Christine, who carry that burden as a result of their service. And say thank you for the amazing service you've given to our country.
And we recognise the addictions, the depressions, the nightmares, the PTSD and the many pains that are the result of the service of our veterans. We are pledging once again to stand with you today and always. To Australia's mental health and suicide prevention workers, can I say thank you for your work, particularly over the course of these past two years where your skills, your patience, your physical endurance and mental health endurance also has been pushed to the absolute edge. But I know that you have saved countless lives and we know that through your work, through your purposeful work. I know it is gratifying in the work you do, and I know you love what you do, and you are so passionate about what you do, but it does take a toll. And so to the countless Australians living also with mental illness, I just want to say I see you and I acknowledge our shared humanity and the shared vulnerability that we all have on these issues.
Because mental illness doesn't have an accent, it doesn't have a nationality, it doesn't have a skin colour, it doesn't have a gender, it has none of these things. It doesn't discriminate. It goes where it will, and it touches those who it touches. And so the fact that there has been judgement, and indeed shame, in the past about these things, I think is one of the achievements of this generation, particularly our young generation coming through that are seeking to put an end to that. We face these challenges together and with respect for each other. And with that comes an understanding of the vulnerability and frailty of every single human being. And that is something we all share in common regardless of our past, regardless of our genetics, regardless of our own stories.
It's particularly wonderful to have with me here today, my Assistant Minister for Mental Health and Suicide Prevention, David Coleman, who's been a friend of mine for a very long time. And David has a capacity to deal with hard problems, but balance that out with a true empathy. And I asked David to do this job just over a year ago now, and he's done tremendous work, and I'm so pleased he can be with me here today. And so thank you, David.
Can I also pay tribute to Greg who is not here, he's had to see the pharmacist this afternoon up in Queensland, but we've been together over the course of this morning and I was really pleased that he was able to join me for the discussion that we just had, and I'll come back to that in a moment. Greg's advocacy and persistent determination about our commitments to mental health across the country, I think, well, it’s one of his greatest legacies as a health minister. Personally, I think Greg Hunt is the best Health Minister the country has ever seen. Because he combined, a lot like David, that incredible intellect with the problem solving capability, with a heart as big as the sun, which is what you need.
Christine Morgan's here. Now, my brains trust is here today. My mental health brains trust is here today between Christine and Pat and Lucy together with my ministers. They are definitely my brains trust on these issues. And to you, Christine, CEO of the National Mental Health Commission and the National Suicide Prevention Adviser, you've taught me so much over these years that you've been in that work, and we both came into these roles not long, about the same time. And we've been on a journey on this, and I'm so pleased to have had your counsel and your support.
And to Pat of course, I can't think of anyone who's done more to elevate awareness of mental health in this country than Pat McGorry. I can't think of anyone who has been more effective in communicating the needs and challenges of mental health to prime ministers, to ministers, to premiers, to chief ministers, those in the bureaucracy. But to do so in a way that is as a partner, it's a very constructive way in which Pat goes about this job, because he's always just interested in getting the outcomes. He couldn't care less about politics. I don't think we've ever had a discussion about politics Pat, ever. But I’ll tell you what, we've talked a lot about the needs of people with mental health and he's always totally focused, his eyes are always on the ball when it comes to these things, and I want to thank you, Pat. Particularly during the course and as you I've acknowledge this many times, together with Christine and Pat and of course, Lucy and those on the Mental Health Commission, we have turned to you time and time again through this pandemic and you've kept us on task the entire time. So to you, and the entire team here at Orygen, thank you for having me back again.
But can I particularly thank Mikey, and Luca and Mali and Aiesha and Johannah and Oscar and Tash for the time we've just spent before coming in here. If you all want to know what courage looks like, go and talk to them. Go and talk to them, that's what it looks like. You want to know what resilience looks like, go and talk to them. So I want to thank you for sharing your experiences with me. It's only redoubled my interest and concern and efforts, I think, to continue going forward in the way that we have.
I thought it was important to return and report to you, it was about 18 months I was here last year, on the progress we're making, the progress we're making on the shared national project. Lucy knows all about that because she's been part of this journey. There was a time in this country when we thought good mental health, good health, I should say, meant your physical health, your blood pressure, your cholesterol, your fitness, your lifestyle. We're all familiar with that. And there was a time when we collectively thought that the answer to difficult circumstances was to tell people to be strong. I was just sharing then, that when I was a kid, it was 'here's a teaspoon of cement, harden up'. That's how mental health issues were dealt with, and it's easy for us to go back and judge those times. But they were those times. And I think the progress that has been made in changing the stigma and understanding of mental health by this young generation is extraordinary. They're changing it, not just for their generation, but future generations as well, because there was a time when issues like an addiction, depression, anxiety, PTSD and trauma were seen as some sort of reflection amazingly of character, rather than matters of physical health ultimately. That's all changed, and it's all changing still. The silence that was the accepted norm is changing. People carrying burdens on their own, and I heard today again that one of the hardest burdens to carry when you're particularly a young person with mental health, but not restricted to young people is the feeling of isolation and internalising those self-created issues and the issues that you're trying to deal with as a result of the stigma. Feeling alone, feeling like you failed, and this is of course, nonsense. It's absolute nonsense, and it's been called out time and again. And what's great is that young people who are challenged and going through mental health challenges are calling it out themselves. They're calling it as they should. And so we need to continue to work hard to put an end to the stigmatisation that occurs and the social norms that have sadly dominated the times in the past and are still there. But if ignored, if ignored, they will continue and we certainly won't be doing that. And we want to ensure that people feel comfortable talking about mental health and about death by suicide as well. In the past, of course, funding was sporadic, but with the great advocacy of Pat and so many others around the country, we've been able to change that as well. There were gaps between well-meaning but often underfunded services, and I have no doubt there are still gaps and we're going to still keep working to close those gaps. Symptoms were tackled, but the causes overlooked complex problems, well they stayed complex and frequently became worse. And for too many people facing mental health issues and for those who care for them, who we shouldn't gloss over either. Lucy and I were there last Saturday week with the Kookaburra Kids Foundation, which supports young people who live in families where there is mental illness and it recognises the burden that they carry as well, out of the love and care they have for their siblings or indeed their parents. And so for those who care for them too, an inaction in the past has added to that despondency, but most of all stole hope. And it was so pleasing to be with Mikey and Luca and everybody today and to see the hope expressed in what they spoke to me about.
So, all too often, the unspeakable turned into the unimaginable, and for some, the result was funerals. As Mikey was telling me, Headspace saved his life. And with mourners struggling to understand the disconnect between the action of death by suicide and the person that they knew all too often it was a bolt from the blue, with family and friends and colleagues unaware of the burdens and struggles of the people they loved and what they were going through. But that realisation came all too late. I think of the undiagnosed burdens, the quiet toll of those undiagnosed burdens over generations, and I think of my own grandfather who served in the Second World War. A defining experience of his life, he was one of the first to sign up, and I only knew him as an older man. I won't say an old man because he passed away in his 60s, but I knew him through his late 50s and 60s. And away from all he knew when he was a young man, confronting the brutality and deprivation of war, and then expected just to return home, as if the tour was over and not ever say a word, except on Anzac Day, when he'd have a few beers with his mates down in Bronte Beach or up at the local pub at The Charles, and after all, it's not there anymore. But after all the logic had gone and what was right to do and have to complain when he was thinking, well, I survived, so how do I have the right to talk about anything bad that happened to me? And I'd ask Pop, because we used to walk along the cliffs of the eastern beaches where I grew up, when I was a kid, and I'd ask him about what happened. He never talked about it, never talked about it. But after he passed away some time, my grandmother would tell me of their life and how Pop would wake up in the middle of the night with terrible nightmares. And his silence didn't help his PTSD and he suffered with it, and I suspect it probably claimed his life because of the anxiety that was associated with his high blood pressure and hypertension and things like this.
But a new generation has a different experience. And while time might heal some wounds, it won't heal them all, unless you confront them. And over these past few years, that's what we've been doing. And as a nation, I think it's what we've all been doing, ushering in a generational change about how we see and address mental health issues. So again, I pay tribute to the team here at Orygen for the world leading research and work they put in place in clinical practice. Part of this generational change has been recognising that mental illness is a normal part of life, just like physical illness is a normal part of life - and sometimes, as I was hearing this morning, it's enduring and you've still got to be wary and stay on top of it and have the strategies to manage it. For some, it might be for an episode or a period of time in their life, but equally, these must be addressed managing stress and emotions, anxiety and difficult circumstances. It's just a normal part of life and what it means to be a human being. And our mental health is best managed when we do it in partnership with others and those we love and those who we can get proper care from. Because in a typical year, and we haven't many of those lately, I can't say I've had a typical year in the entire time I've been Prime Minister, it's been very untypical times. But one in five Australians, still, regardless of the times, experience a mental health issue. One in five. Around five million of us in a normal year. And around half of us experience a mental health issue during their lifetime. And the most common experiences are, of course, depression, anxiety and substance use disorders.
And right now, more than one million Australians, as we speak here, are living with an eating disorder. One million Australians. And for many Australians, mental health, mental ill health emerges early in life, 75 percent of adults with mental illness first experience mental ill health before the age of 25. And that underscores the important work of Orygen and of Headspace, and we also know that too many lives are lost to death by suicide. On average, nine Australians are lost to death by suicide every single day. That's nine too many, every single day. Men and boys make up three quarters of those death by suicides. Women and girls have higher rates of suicide ideation, self-harm and attempts. For every life lost, it is conservatively estimated that 135 people are impacted. That's nine - multiply that by 135. Naturally, some more profoundly than others. And for friends, family and colleagues who are bereaved by suicide, they in turn, become two to five times more likely themselves to sadly go down that path. In 2020, there were 223 Aboriginal and Torres Strait Islander Australians who died by suicide. That's more than double the rate for the non-Indigenous population. And suicide is the fifth leading cause of death for Aboriginal and Torres Strait Islander Australians.
And our service men and women and veterans, they're also a great risk. Between 2001 and 2019, there were 1273 deaths by suicide of current and former serving members of the ADF, and they are the known ones. To create some perspective, in Afghanistan, Australia's longest war, 41 Australian service men and women. Men I should say, were killed. The Royal Commission into Defence and Veteran. Suicide is systematically working through these incredibly sensitive and complex issues faced by those who wear our uniform. And on the basis of these confronting realities, we've set ourselves a goal to improve the mental health of Australians and reduce suicide towards zero. Towards zero. Now some say a zero goal that's unrealistic. What other goal could you accept? What other goal could you not aim for? And that's why our zero suicide focus forces us to reject that notion at every level. There is no acceptable level, and that is why our zero goal compels us. It is an ever receding finishing line, as I was saying to the young people, and it is, but we keep going forward to that finishing line every single day, it compels us to listen to those who have attempted suicide, as well as those who've been impacted by its aftermath. It means we must continually reflect on where and why it's happening. We have to reflect, as Christine reminds me, on the lived experience, the stories of individuals, not just the stats and the data and the metrics. It compels us to study though, the different groups to identify the gaps in services and consider where the system is not meeting its goals and be honest about that. It forces us to try things, and if they don't work, to change it and to do more of the things that do work and not to sort of get lost in some debate about whether things failed or whether things succeed, which often goes into political discussion and frankly, is totally unhelpful. We should try everything we possibly can, call out the things that aren't working, not as a failure, but as a pathway to success. It reinforces that one loss, one loss, one life lost, try and say that quickly. But it's a serious matter. One life lost to suicide is always one too many, and given the extent of the challenge, we have taken a system wide approach to address the ways that government's policies, systems and services interact.
Now to look at the unique issues facing different groups; young people, Indigenous communities, non-English speaking communities, as we were learning just today, new parents, LGBTIQ communities, remote and regional communities. It's about responding to the unique lived experiences I said, the individual within every single group because every single person is different and we have to appreciate their unique value as individual human beings. And we also know that the circumstances of our times can compound mental ill health. Drought, fires, COVID lockdowns, floods, have become like stress fractures, stress fractures in our lives and often in our communities. Our approach has been to simultaneously act with immediacy to those current needs, as well as address the longer term, more systemic challenges, and often those systemic issues are across governments, agencies and services. There's no one answer in any one place, and mental ill-health can cut right across issues such as jobs or the lack of a job. One of the first things, that Pat and I worked on, was how getting young people into a job was part of a holistic response to a young person's mental health treatment. Lack of a job, homelessness, managing debts, relationship breakdowns. As one submission to the Productivity Commission wrote, "Those of us with mental illness need much more than weekly therapy to bring us back to health and stability. We need support, companionship, help connecting to community, help with friendships, and support to study and work." The whole person.
As Treasurer, one of my earliest decisions was to ask the Productivity Commission to deliver a report on mental health. And that report, which I spoke about here in late 2020, is the most comprehensive study of Australia's mental health system ever undertaken. It examined the interaction, the effectiveness of outcomes of the policies, the processes and systems across so many jurisdictions. It also assessed the economic and social costs of our collective action. It acknowledged the significant need for those with a lived and living experience and mental health and suicide to fully participate in reform of the system, in designing the system and the support and care it provided. It also recognised that too many Australians living with mental illness experienced systemic cultural, social and interpersonal stigma and discrimination related to their mental illness. As well, I appointed Christine to take on the role as a result of that, as National Suicide Prevention Adviser, and she drew on the voices and experiences of over 3000 people, and they shared their own lived experiences and the experiences of people they knew and love.
In December 2020, we asked the National Mental Health Commission to develop Australia's first National Stigma and Discrimination Strategy under Lucy's leadership. And the strategy will be about creating a future where stigma and discrimination on the basis of mental ill-health are no longer barriers to being able to contribute. And we have adapted to the advice, we've adopted to that advice and the circumstances we have faced as a country. The first budget that I delivered as Treasurer, and we worked on together, included an additional $740 million dollars in investment over seven years to tackle suicide. In last year's Budget, in response to the Productivity Commission Report and Christine Morgan's advice and the great work that David has done as Minister assisting me on these issues, we announced the biggest package we've ever seen from the Federal Government. $2.3 billion, $2.3 billion in a National Mental Health and Suicide Prevention Plan. And the plan represents, as I said, the single largest investment. That's how serious we are about this, and this was happening in the middle of a pandemic. There are many other pressing needs, but this need and this issue did not go away during the pandemic. If anything, the pressures were more intense and the urgency was greater, and the additional $2.3 billion in funding took the total estimated mental health investment of $6.5 billion in the Health portfolio alone in 2021-22, up from $3.3 billion when we first came to government.
As part of this plan, the new initiatives included universal suicide aftercare service for Australians discharged from hospital following a suicide attempt, the most dangerous period. That was very clear, and that's expected to support about 30,000 people a year, when people are at their most vulnerable. We get it, we recognise it, and working together with the states and territories to provide that support in that critical time zone. National suicide postvention services to support those bereaved by suicide. Establishing 32 new Head to Health Adult Mental Health Centres to do for the adult population, which John Howard started doing for the youth population through the establishment of Headspace. Further expansion of the Headspace network to 164 sites, establishing 15 Head to Health Kids centres. Funding for a National Eating Disorder Research Centre. Psychological support for 14,000 people with severe mental illness who did not qualify for the NDIS. And working with the Gayaa Dhuwi and Lifeline to establish a culturally appropriate 24/7 crisis line to be delivered by Aboriginal and Torres Strait Islander people. And as Minister Wyatt has rightly said, "The fact that Aboriginal people are dying by suicide at twice the rate of non-Indigenous Australians is one of the gravest and most heartbreaking challenges we face. We need to address the influence of social and cultural factors if we are to see significant change," Ken said.
Now, of course, the COVID storm hit us all. I received over 100,000 letters and emails from Australians about their pandemic experience. It's one of the great privileges of Prime Minister, is Australians share their stories with me. I had a great team at PM&C who helped ensure everyone received a reply, on some cases that involve deliberately intervening to get action and support and services to individuals, who these letters were direct cries for help. And the stories where unique, a single person feeling isolated and alone in their own one-bedroom apartment. During lockdown, the common story, the father who had lost his job through border closures, was separated from his wife and child overseas. The parent who left their job to provide online learning at home, not knowing how to make ends meet. The mother pregnant and in hospital and separated from her other children who could not visit her. The thousands of families with parents in aged care, many of whom were suffering from dementia and couldn't understand why they were alone. Well, we worked to contain the virus in parallel. We worked hard from the start to provide Australians with the resources they might need, informed by experts, as well as the lived experience of Australians, we developed the National Mental Health and Wellbeing Response Plan, one of the few countries to do that during the pandemic. It focused on the urgent provision of telehealth and expanding the capability and responsiveness of existing services, and it was backed by a $1 billion investment.
We increased the number of Medicare-subsidised psychological therapy sessions from 10 to 20, and we expanded the eligibility to residents of aged care facilities to such sessions, something that had previously been limited by previous governments and through, though life has been returning to normal, thank goodness, with the vaccinations doing their job. We are at 95 per cent double dose today, we will continue to face the emotional debris and damage and the mental health impacts of these times for many years, as both Christine and Pat have reminded me on many occasions.
This impact of this pandemic, for mental health, will go well beyond once the physical pandemic passes. The Black Dog Institute highlights the mental health impacts of adversity and trauma and how they accumulate, and the need was clearly there. Calls to Lifeline, who do a tremendous job, increased by 22 per cent. Calls to the Butterfly National Hotline, the hotline that deals with eating disorders, rose by up to 22 per cent. Never before have we seen such a surge in the demand for these services, and that surge in demand for service was matched every time those services were called and said, ‘we need more support’. The checks were written immediately, within, within the day, and we just kept piling the support and resources into the same, the Kids Helpline is another one, so many, Beyond Blue.
And it's to the credit of Australians and all our mental health support services that despite this national trauma, and I still find this, this outcome hard to believe, given what Australia was going through. The number of suicides. The suicide rate during the pandemic actually fell. They're probably saying, 'that can't be true". Now, that's at a national rate, and of course, at different states and territories and different communities, you're going to see different patterns emerge. But I can tell you what we thought it was going to do as we looked into that pandemic and the abyss of that crisis. I can tell you what we feared would happen. That the idea that it would actually stay steady and actually decline at a national rate was a hope that we dared to express. That is one that this country has achieved. And the lesson is that acting pre-emptively works. Backing services that work works, and focusing on prevention works best.
And that's also the approach we've been taking to the compounding natural disasters that Australians continue to face. It's why we've already committed $35.9 million in health services and mental health support to communities affected by the East Coast floods. Importantly, as we know from our experience responding to other disasters, the impacts of trauma, also and hardship, can be long felt and as such, we will continue to need to listen to people and provide the support that is necessary. If we need to do more, and I have no doubt we will, we will. And we've got the track record, I think, to demonstrate that. Our support for communities and individuals rebuilding their lives continues long after the virus, the disaster, the flames, the floods, even the mouse plagues and the mice are gone. Long after that's gone, the mental health challenges remain, and we will continue to stand with individuals and communities as they seek to rebuild, however long that takes.
So finally, looking to the future and I appreciate your patience, but you can see this is an area of great interest and passion of mine. And I know you share it. The Productivity Commission identified the challenge before us, and that was to build a system centred on the experience of those with mental health and that of their carers, to put them in the middle of our gaze and how the system works. A system that seeks not to have gaps, one that is easy to navigate. These are big goals, they're hard goals to achieve. They're ambitious, and our government has made mental health a top priority and suicide prevention a national priority, because it can't be anything less. We're committed to genuine reform and have been demonstrating that. That all Australians can get access to the support that they need, when and where they need it.
Our plan for future communities continues our vital investment across just five pillars. To invest in prevention and early intervention. Suicide prevention, secondly. Thirdly, new and expanded treatments in communities where people live and work. Fourthly, supporting vulnerable communities which are at greater risk and fifthly growing, upskilling and supporting the mental health workforce, including our peer workers.
I mentioned earlier that we're striving for better coordination to ensure the maximum effectiveness of the investments that we make and just last month the National Mental Health and Suicide Prevention Agreement came into effect. That agreement is about governments identifying, agreeing on roles and responsibilities and planning for the implementation of actions. It's also about collaborating on monitoring and evaluation, working together to address gaps in the system, building the workforce we have and improving suicide prevention for all Australians. This provides a stronger framework for engagement, cooperation and communication between governments and understands that we all have responsibilities here, which in turn will bridge the gaps that so often exist between governments at state and federal level, and will make a meaningful contribution to that, towards your own goal.
Now we've signed bilateral funding agreements now with New South Wales, with South Australia, with Northern Territory, very close to signing with a number of other states and in particular, the ACT was able to sign off on that one this morning. And we look forward to completing with all of them, and I'd encourage the remaining Premiers to get their pens out, let's get on with it. The New South Wales agreement provides more than $383 million in New South Wales over five years. The South Australian agreement provides $127.8 million, with $66 million of the total provided by the Commonwealth. The Northern Territory Agreement provides more than $43 million, with $30.6 million invested by the Commonwealth. And I want to particularly think David again for the great work he's done in working collaboratively in the states, putting politics to one side and just getting this done.
I know there's lots going on here in Victoria at the moment. The Premier and I have only been texting each other this week about how we can progress the agreement here in Victoria. I know the Victorian Government is already investing a great deal in the response to the Royal Commission here. And we, we will recognise that investment in that agreement that we bring together, and I hope we'll be able to conclude arrangements there soon.
An essential part of these agreements is providing vital support for what has been termed the missing middle. Those who are too unwell for general primary care but not unwell enough to require in-patient hospital services and intensive state-based community care.
The Early Psychosis Youth Service. It is clear that we must provide even more support to young people through this, through this channel facing severe and complex mental trauma. Their needs are unique. That's why today I'm announcing here $206 million investment to continue and expand the Early Psychosis Youth Service and the Youth Enhanced Services to support young people experiencing severe and complex mental illness. I love investing in things that I know works and changes lives, and EPYS does exactly that. It will provide continued funding for existing EPYS Hubs over the coming years and for Orygen to continue the National Centre of Excellence in Youth and Mental Health. It will also expand the EPYS network into every single state and territory with new hubs. Really excited about this to be established in Tasmania and the ACT. The new funding for the EPYS program is expected to benefit more than 4,000 young people, just like those I've met here today. Young people aged between 12 and 25 years. There are young people with ultra-high risk of currently experiencing their first episode of psychosis, and I look forward to further strengthening our partnership with Orygen and delivering the expansion of this critical service. And again, if more needs to be done, Pat knows we'll do it. He's probably had more yeses out of me as a Social Services Minister, a Treasurer and the Prime Minister of the day. Your strike rate is to be envied, I'm sure, by every other health advocacy group in the country. But that's a credit to the way he goes about the business and keeping it focused on what works and keeping us focused on the partnership.
So the goal towards zero suicides means we have the services in place to tackle mental illness whenever, wherever it is presented. It means prevention, not letting things escalate. Giving voice to every community in this country. And early in the pandemic, I received an email that I haven't forgotten. First line said, "Prime Minister, I have good days and bad days. Today is a bad day." That's what they wrote to me. Our job is to help people have more good days. We know there will be bad days. Anyone living with mental illness knows that is a reality. But we're going to have more good days ahead. And that's what this funding and that's what our commitment as a Government is to you, that you will have more good days. It's that simple. But it's as hard as well as we know. The work we're doing, it's generational transformation. That's the work you're doing for the thousands of young lives, creating countless and better days ahead.
So thank you for your very patient attention. There is so much to do as an impact. There is just so much to do. We have done so much already, but our plan for the future, I think, is exciting. So thank you very much for everything you do.
