The chair of the royal commission, Penny Armytage, said when handing down the final report:

Good mental health and wellbeing have been a low priority of governments for decades, despite the high prevalence of mental illness and poor mental health in our community.

She said the system had ‘catastrophically failed’. How is it and why is it that a public system should get to such a low point before it becomes a priority?

We are seeing similarities now with our child protection system and in our broader health system. We cannot let these systems continue to teeter on the verge of collapse and then expect the public to be grateful for the rebuild.

The bill before Parliament is considered to be delivering on the royal commission’s recommendations for a new mental health and wellbeing act. With more than 600 pages to absorb, I must say that in many respects we have to take the government’s word for it because to critically compare the bill to the existing act has been a fairly difficult exercise when so much of it is enabling legislation and questions we have raised point to yet-to-be drafted regulations and implementation, hence my motion this week.

I have no doubt that an enormous amount of work has been put into drafting this bill and that it is extremely complex work. I thank the people who are involved in redesigning the system and recognise that they have on their shoulders the weight of millions of Victorians who are relying on a better system being available in the future. I acknowledge the longstanding important role of mental health workers, paramedics, police and the alcohol and other drugs and social services sectors, who work in this space every day. They have battled within a broken system for too long, so have the families and carers of people affected by mental illness. The system has to be better for all of them.

I would like to express my thanks to the people who engaged with us on this bill, including those with lived experience, sector workers, the great team at the Health and Community Services Union, the AMA, the Royal Australian and New Zealand College of Psychiatrists, paramedics’ unions, community paramedics, police and health services. Given the size of this bill and the time available I will limit my focus to a few parts of the bill that hold particular interest for me as a member for Northern Victoria and as a member of Derryn Hinch’s Justice Party and that have been brought to us as concerns by stakeholders.

Stakeholders have expressed some frustration with what they consider was a rushed consultation process. The royal commission recommended a new act be delivered in 2022, and we respect that the government wants to meet this deadline, but it has put pressure on the consultation process and prevented stakeholders from properly engaging with their frontline workers and giving robust and detailed feedback.

The royal commission acknowledged the struggle that people in regional areas face every day in accessing services close to home. This is even more pronounced for those needing youth mental health services. The royal commission report noted that changes to the framework must consider the challenges of delivering services in rural and regional areas. Regional areas must not be left behind or be given lower priority or be put at the bottom of the funding list. I hope the new regional mental health and wellbeing boards and multi-agency panels will be strong advocates for regional areas and that their work and advice will be transparent to support public confidence.

There is also a sense of scepticism in how new models of care will be delivered in regional areas. Establishing health-led responses rather than relying on police is a positive aspiration: it is better for patient care and to focus police resources back on their core business. But we asked a few questions about how this would work in implementation in regional areas, and the reality is that it will fall back on police if a health-led response is not available. In regional areas a lot of police time is spent supporting the ambulance service to transport mental health patients to a hospital, which could be an hour away. Police then might sit with a patient for hours in the ED until they are seen, only to return them home and be called to do it all again in a few days time. This takes police away from other important work.

Our ambulance service is already stretched, and this takes our paramedics away from other code 1 call-outs. Regional areas are also particularly vulnerable to natural disaster, with substantial flow-on effects for the mental health of these communities. The royal commission said the system needs to reflect and provide for these vulnerabilities. This backs up research that was conducted after the Black Saturday fires, which identified a need for policymakers to strategically target regions with a high risk of persistent mental health distress and to ensure services are available to those communities.

The royal commission said the new system will be designed to attract, develop and retain a sustainable workforce. Professor Ian Hickie has noted that 80 per cent of people exiting a treatment centre will need ongoing care, but there is neither the workforce or capacity at the state level to look after them. These shortages are keenly felt in many settings in regional Victoria: mental health, family services, child protection, alcohol and other drug services, aged care, nursing, GPs—the list is long. Where professionals are recruited there is now great pressure to house them, and I know that while the family services and AOD sectors are supportive of the mental health reforms, there is some sense of dread that their workforces are going to be depleted as a result, particularly in those regional areas. This will make their work even more challenging. Already stretched services in these sectors will be harder to access, the wait times will be longer, and this will have a roll-on impact on the future demand for mental health services.

The definition of ‘paramedics’ is limited in this bill to those who are employed by Ambulance Victoria. While I understand the arguments for this, I am told that there are around 3500 paramedics in Victoria who do not work for Ambulance Victoria and are a resource that we could tap into. I have been advocating for them to be utilised more broadly in regional Victoria to help take pressure off our hospitals and our ambulance service. Community paramedics want to be part of the solution and be part of the system where it is safe and appropriate to do so, but they say that this bill does not facilitate that potential.

This bill includes an aspiration to eliminate the use of restrictive interventions within 10 years, an ideal which is suggested by those working on the front line to be dangerously flawed. This was reflected in the department’s report on its engagement process in 2021, where 58 per cent of respondents said the seclusion and restraint proposals do not meet the royal commission’s recommendations. While I recognise this is an aspirational statement, we listened intently to a range of stakeholders—in particular frontline workers—about restrictive interventions and the important role they can play as a last resort to keep a patient, workers and the public safe. While we support endeavours to reduce removing restrictive interventions as much as possible, serious consideration of eliminating the use of restrictive interventions requires substantial consideration and consultation.

The royal commission report noted that it is likely that demand for inpatient services, including more people presenting in crisis and pressure on the model of care, is contributing to the use of restrictive practices. So it is incumbent on the system to provide a safe environment and resourcing to reduce restrictive interventions rather than simply taking it all out of the toolkit.

Moving on to forensic mental health, as the Forensicare submission to the royal commission notes:

Although the vast majority of people with mental illnesses do not offend or become violent, people with serious mental illnesses are three times more likely to engage in offending and four times as likely to commit violent offences compared to other Victorians.

The tragedy is felt from all angles when someone commits a violent offence, most notably the victims and their families. Our party works with a number of those families who are severely impacted, and their pain is raw and enduring. People living with severe mental illness are also 11 times more likely to be a victim of violent crime compared with the general population.

The royal commission heard that 56 per cent of offenders on a community correctional order had a mental health treatment rehabilitation condition. But the imposition of a mental health treatment condition does not mean that treatment is received. Lack of services means that offenders often complete a CCO without receiving treatment. As Ms Stitt said in her second-reading speech, it took many years of underinvestment to get the system to breaking point and it will take a decade of unwavering commitment to workforce, legislation and sustainable investment to rebuild.

I greatly respect the work of the royal commission. I have great confidence in the capable, dedicated people that are working to reshape our mental health system, and I hope for success. There are certainly many people who are counting on it so they can get the help they so deeply need. As chair of the royal commission, Penny Armytage, said when delivering the final report:

I hope that with the full implementation of the reforms …an inquiry of this nature will never need to be repeated.

I commend this bill to the house.