Doorstop Transcript - AMA Response to COAG Health Announcements

What we see is a significant commitment, a commitment from the Australian Government and the State Governments, to work collaboratively together. We've seen a significant injection of cash, over $1 billion over four years, over and above the normal money that's out there through the health care agreements. We see half of that going towards preventative health, and that's very important, it's something the AMA's been very keen on for some time, and we think that's very important to make that part of health care delivery, not an add-on bit.

This could be the start of a beautiful relationship between the State and Federal Governments, and that would be only a very good thing for health. We have an excellent health care system currently, and the better relations between the two layers of government will make that an awful lot better.

We've seen commitment for older people, to make sure that they are in a more - in an environment that's better for them, rather than being in an acute hospital bed, to have more transitional kind of services, and certainly to increase the number of nursing home beds that are available out there.

Young people in nursing homes, they need care that's more appropriate for their age group - they certainly get their care needs met in aged care facilities - but, really, that's not the right sort of environment for younger people. We need more facilities for them, whether it's adapting nursing homes, or having specific stand-alone facilities for them.

There are disappointments in this package of course. We've very disappointed that mental health, although widely talked about, actually is getting no additional funding, although there is a commitment towards that for the next round of COAG.

We do need that collaborative movement, we need to make sure mental health is looked after, and looked after quickly.

Public hospitals, of course, continue to suffer. There is a lack of capacity within the hospital sector, but that's something that we would hope would also be addressed between now and the next COAG meeting.

What we see, however, is a significant move together, of collaborative working between governments, and a collaborative working across the spectrum of health care delivery, and that, as I say, can only be good.

QUESTION: Do you think there is the political will there to do more for mental health, and do you agree that there is a causal link between marijuana and amphetamines use and psychiatric illnesses?

HAIKERWAL: Certainly mental health has become an issue at every meeting that I go to with government ministers, both in the State and at the Federal level. So there is a significant understanding. Obviously the political figures who've had problems with mental health highlighted has made that situation more clear, and organisations like beyondblue have made it much more acceptable for people in the community to say, "I have a mental illness, and I need it treated". So it's much - there's much more awareness, there's much better treatment, and there is much more understanding that something needs to be done. We need action, though, and we need to see it soon.

QUESTION: Do you think drugs do cause mental illness?

HAIKERWAL: There is some evidence that mental illness is made more likely if people take drugs, but the causal link is still difficult to find, and we're doing some specific research on this in our public health committee, and we'll certainly use a lot of the other research that's out there before we come to a final conclusion on this. But certainly, the use of amphetamines, and the use of cannabis and other drugs, is a significant problem today, and something that we need to deal with, because yes, it can cause problems with mental health, we're not sure exactly what those problems are.

QUESTION: How do you feel about the increase in university full-fee paying places?

HAIKERWAL: The so-called increase in university places is, I'm afraid, a bit of a smoke and mirrors trick. It is very important that we do have sufficient training places, but what we see here is an increase in private, full-fee paying places for Australian students, and that really is an increase of around 250 places, but there's not an additional cent of government money going into that process. This will be out of the hip pockets of people that are seeking that education - and the already stretched resources used to train people in hospitals, in general practice and beyond, will also be stretched further.

So if we're going to see more university places, they need to be funded by government, and if we're going to see more university places, we've got to make sure that there are the people there, the academics out there, properly paid to do that work, and that the facilities are there to allow that training to happen.

QUESTION: How about the increase of fee help, to actually help these people take these places?

HAIKERWAL: Well, I think that what's important is that the fees need to be paid by government in much the usual way, through the HECS system. And if we're going to have a commitment to medical school places, they need to be HECS funded medical school places. Otherwise, in reality, there are going to be a very few places for the very few people that can afford them.

QUESTION: So that's 250 new places every year?

HAIKERWAL: That'll be 250 new places every year, and the question is, will they be taken up? And certainly it's not in the way of equal access to education that we would expect to see.

QUESTION: Would that lower the tertiary entrance scores for medical students in any way?

HAIKERWAL: I don't believe the tertiary scores have been lowered for medical students at all, and indeed the new intake into the ANU, who we met yesterday, were talking about a significant nine month assessment process through exams, to actually get into that post-graduate course, so the grades have not dropped, but it looks like the financial requirements are increasing.

QUESTION: What would these 250 expect to pay?

HAIKERWAL: The rates vary from university to university, but we believe that it can be up to a quarter of a million dollars in a place like Bond, and that's quite a significant amount of money.

QUESTION: What's the problem with having people who can afford to pay, to boost the medical school placing?

HAIKERWAL: There's no particular problem about people paying to have medical school places, obviously if they made the grade, they should be allowed access, and if they want to pay for it, that's fine. But the commitment of the community, the commitment of government towards medical school training, and towards any training, needs to be through the HECS system. If we have an egalitarian society where people do well, and need a place, they should get a place based on merit, and based on their marks, and should not be based simply on their ability to pay.

QUESTION: Just on mental health, is there a risk, or how great a risk is there that these governments are raising enormous expectations that Australia will finally tackle mental illness, and there may not be the money to actually match that rhetoric?

HAIKERWAL: If money does not flow to match the rhetoric that's come out so far, then there'll be significant consequences for the governments that are not allowing mental health to be properly dealt with. We've seen a significant swing in the State system, of people out of long-term mental health institutions to the community, but no community care to follow. The care of people is really tragic in the community, they have to go to emergency departments, because there's no emergency teams, they do get care immediately, but then the ongoing care is not there, and that's when they fall into a hole, that's when suicidality increases, and that's when mental health becomes a significant problem.

So we need to make sure they have access to mental health services at a State level, from the States and services, and we need to give them access to general practice services, and specialist psychiatrist services, through the Medicare Benefits Schedule. The two layers of government say they will work together, well, let's make sure they do, and they say they're going to put money into the system, well they must.

QUESTION: Should the cap on fee help be lifted all together then, so people can take up these places, if a degree is $250,000, can they then borrow $250,000 under fee help, as the AVCC argues?

HAIKERWAL: Well, I suppose that is a possibility, but if you are going into a four year, five year, six year program, with that hanging over your head, it's really a significant burden, and really you're not going to enjoy your university experience particularly.

QUESTION: If there is a link between substance abuse and mental health, mental illness, what's the solution to that - are tougher laws part of the answer to that?

HAIKERWAL: Look, I think that there are many and varied views of the community as to how to deal with significant mental health problems, and certainly substance abuse problems. One of the core problems is that they're always dealt with separately, and many people have both - a dual diagnosis. So the way to tackle mental health, and the way to tackle substance abuse, and both those problems combined, is to have a combined approach, so you don't have to have a certain set of criteria to get onto one program or the other.

Getting tough on drugs has been used for some time - it's questionable how useful it is - but it's certainly an approach. There's also the approach of whether you should actually have harm minimisation, and that's the debate we're having within our own organisation, and we're going to come to some conclusions around that over the course of the next few months. But we need to be active, and we need to be very clear that all drugs cause harm, and that harm may well include mental illness, and we have to make sure that people get that message.

Thanks very much.