Parliament: Parliamentary Initiatives

Co-Morbidity

Adjourned debate on motion of Hon. K.L. Vincent:

That the Social Development Committee inquire into and report on the issue of co-morbidity, which here refers to a dual diagnosis of both intellectual disability and mental illness, viz:

1. Facilities in South Australia currently treating people with a dual diagnosis with particular reference to the Margaret Tobin Centre and James Nash House;

2. The possibility of establishing a new forensic facility similar to James Nash House in South Australia to deal specifically with offenders with intellectual disability;

3. The level of training offered to general practitioners, psychologists, psychiatrists and other relevant professional in the area of dual diagnosis and possible measures to enhance that training;

4. Information given to individuals and carers on how to manage a dual diagnosis;

5. Supports to aid individuals and carers in managing and living with a dual diagnosis; and

6. Any other related matter.

(Continued from 14 September 2011.)

The Hon. S.G. WADE : I rise to speak briefly on the motion moved by the Hon. Kelly Vincent about co-morbidity. As members are well aware, I could speak all night about the issue of co-morbidity. One of the great abuses of citizenship is to treat people who are different the same; to not recognise distinctly different challenges people face. Within the disability services sector there has been too much of a focus on a diagnosis and far too many people have fallen between the cracks of services too focused on particular diagnoses. That is particularly the case where the services for diagnoses are provided by different portfolios within government, such as mental health and intellectual disability.

It is my view that, through bitter experience, the Labor Party is infected by its roots of paternalistic socialism. It has a recurring bias towards a bureaucratic, centralist, one-size-fits-all approach to services. This approach was strongly evident in the Labor Party’s determination to centralise disability services in the so-called reforms of 2006. Minister Weatherill, soon to be Premier Weatherill, driven by his Labor Party’s government knows best credo, nationalised and amalgamated a range of services. His successor, minister Rankine, is still being dragged to implement individualised funding, having resisted it for so long.

The one-size-fits-all approach is devastating for people with a dual diagnosis or, for that matter, a multiple diagnosis. As the original motion identified, people with mental health issues find that mental health services often do not allow for their intellectual disability; conversely, their intellectual disability does not allow sufficiently for the mental health issues they face. Often, access to one service is used to as a basis to deny access to another or, worse still, the buck-passing means that the person receives no services at all.

The Liberal opposition supports the motion and looks forward to improving services for people not only with mental illness and intellectual disability but with other pairs of co-morbidity.

The Hon. T.A. FRANKS: The Greens support this motion. I am very pleased to see the issue of co-morbidity placed on the agenda of this council, and I have every confidence that the Social Development Committee will admirably do the work of inquiring into and reporting on this issue. I am also supportive of the amendment to this motion that has been moved in the name of the Hon. Ian Hunter. I think that the amendment adds much to the definitions within the motion in the areas we are talking about.

Co-morbidity is a word that many people in the community may possibly never have heard; certainly, those who have heard it often have only scant understanding of what it implies and the effect it has. Co-morbidity is also referred to here as ‘dual diagnosis’ but, as the Hon. Stephen Wade noted, ‘dual’ might only be skimming the surface of what can happen when someone has not just a simple illness, not just a straightforward tick-the-box illness, ‘This is what I’ve got, this is how you treat it.’ The fact is that in real life co-morbidity is more realistic in terms of the treatment of real human beings than trying to fit them into a category of a particular single diagnosis.

People have complex needs, and the Greens and I would certainly agree that we need to move from a diagnosis basis to a needs basis. I know from my experience, having worked for the Mental Health Coalition of South Australia, that co-morbidity was not only the buzz word but also the area we focused on quite extensively, particularly when you discover, for example, that if someone with a mental health issue seeks treatment for that issue, but they are in fact self-medicating and have a substance abuse issue, they are quite often made to make a choice between having treatment or remedies, or roads and pathways to recovery for that mental illness.

They are told that overnight—cold turkey, in fact, to use the John Lennon reference—they have to lose the substance abuse problem. Of course that is not practical, and it does not happen in real life. As the Hon. Stephen Wade said, in the worst case scenario what happens is that because people cannot tick either of the boxes sufficiently to end up in one of those boxes, they miss out and fall through the cracks. I would say that much work needs to be done, particularly in terms of substance abuse and mental illness and the relationships there. As I say, they are quite complex, and I do welcome this council coming up with some better ways forward in terms of better outcomes for South Australians.

Where we can, we should be providing people with seamless paths to recovery. That does not mean easy paths to recovery; that means that they do not fall through the cracks on the way because our system does not accommodate them. I repeat what I said in my previous speech: this is about making sure that our community and our society is, in fact, inclusive of those people who exist within it and that it does not let them be excluded.

With those short words, I commend this motion to the council and indicate that the Greens will support both the motion and also the amendment.

The Hon. I.K. HUNTER: I indicate at the outset that government members will be supporting this referral motion. I move:

Leave out the words ‘which here refers to a dual diagnosis of both intellectual disability and mental illness, viz:—’ and insert the following :

which may refer to a dual diagnosis involving intellectual disability and/or acquired brain injury and/or mental illness and/or chronic substance abuse, viz:—

Leave out paragraph 2.

I hasten to add, that final paragraph was workshopped a little while ago between me, the Hon. Mr Wade and the Hon. Ms Vincent. Ms Vincent and I take no blame whatsoever for the lack of punctuation in that amendment! I now put some brief remarks on the record.

Improving services to South Australians with a disability has been a key priority of this Labor government. Since coming to office we have more than doubled disability funding, but we know there is still more to do. Of course, we know that simply throwing money at a problem is ineffective if not tied to a significant reform agenda.

The review of the Disability Services Act is currently underway, as is the Promoting Independence strategy and the imminent release of the disability blueprint. The government does feel that improving conditions of people with a disability or mental illness within the criminal justice system is one area in need of further investigation. That is why we are happy to support the referral motion. That is why the significant work through a joint project started in May on this matter, which is currently underway, was made a priority by this government. This reviews the needs of people with a diagnosis of non-psychiatric mental impairment who are under custodial supervision orders in correctional and forensic mental health facilities.

The project is jointly auspiced by the Department for Families and Communities, SA Health, the Department for Correctional Services and the Social Inclusion Unit. At the same time, we welcome the chance to further evaluate the matter through the Social Development Committee inquiry process. The intention of both investigations is to provide information on what could be changed to improve the lives of people in such circumstances. It will be interesting to see whether both inquiries line up, which is why the government will support this motion (with some suggested amendments which I have already moved).

Given that the Hon. Ms Vincent’s proposed inquiry is focused on the forensic system, we recommend that the scope of the inquiry is expanded to be inclusive of all people with a cognitive disability, not just an intellectual disability. People with a disability in the criminal justice system often have multiple issues including psychiatric disability, intellectual disability, acquired brain injury and chronic substance abuse. We feel that it is preferable to consider a broader range of co-morbidities and the issues are likely to be very similar for all people with cognitive disabilities. Having said that, I reiterate that we are happy to support the motion.

The Hon. K.L. VINCENT: I would like to thank the speakers today—the Hon. Ms Franks and the Hon. Mr Hunter—for their contributions and their views on this important issue. Again, this is a motion which has been moved in light of recent stories in the media. As members will recall from the speech I made when introducing this motion, it was largely inspired, if you like, by the story of Beverley Eitzen, who was and is mother to Peter Eitzen, a young man with severe and multiple disabilities whose care needs were so high that the physical and emotional strain of caring for Peter caused Beverley to experience a major depressive episode which, tragically, saw her take the life of her own son.

I reiterate that this is not the first case of this kind of tragic circumstance that we have seen. In relation to the taking of the life of a person with a disability by their own carer—particularly family carer—unfortunately, we have seen at least one or two other cases which I can think of over the past two years. It is therefore an issue which is well worth investigating. I am only sorry that this investigation and this discussion comes too late to save those who have already met this almost unspeakable fate. However, I am heartened to see agreement from all sides of politics on the fact that more needs to and can be done. To that end, with those few brief words, I thank speakers for their contributions and commend the motion to the house.

Amendment carried; motion as amended carried.