Complex problems require well thought out solutions
Feature Story by Frank Quinlan, Chief Executive Officer, Mental Health Australia
Welfare is currently the subject of heated debate. Everyone, it seems, has an opinion on who should receive welfare, when, how much and why.
What isn’t in question is whether or not we should have a welfare system. As a country that prides itself as ensuring a fair-go for all, welfare remains an integral part of our social psyche.
ACOSS, unions, business, churches, all sides of politics and commentators like Neil Mitchell have all expressed their support for the safety net that welfare provides. What remains contentious are the rules of that system and who benefits from it.
Mental Health Australia also agrees that welfare is an important part of any country’s support system. We have an obligation as a just society to look after those who are vulnerable and in great need. However, we don’t currently have a system that works well. Our welfare system needs significant reform.
The current system is inadequate. It does not provide enough support to meet the day-to-day needs of many people reliant on it, nor is it geared to move people off the system into more sustainable social and economic participation.
These problems are even more pronounced when it comes to people with a mental illness or a psychosocial disability.
The Federal Government is currently reviewing our welfare system and we have provided a submission , in conjunction with the National Mental Health Consumer and Carer Forum, to this process.
We outline the systemic reform needed to make our system fair, progressive and geared towards helping people with a mental illness or a psychosocial disability obtain paid work, if they can, while providing a level of support that will give them choice and dignity in their day-to-day lives.
A high functioning welfare system which meets the needs of people with mental illness and psychosocial disability would:
- Be easy for people to access and navigate
- Treat people fairly and in good faith at all times – providing similar benefits to individuals with similar needs
- Provide welfare recipients with enough money to participate meaningfully in the community, economy and society – as well as meet the basic additional costs of living and looking for work
- Focus on individual capabilities through strengths-based assessment and support, rather than focussing on the perceived deficits associated with a diagnosis of mental illness
- Ensure that people with mental health issues are appropriately identified within the system and referred to the right services to support recovery
- Wherever possible, avoid exacerbating known mental health conditions
- Ensure that services are delivered in culturally appropriate ways
- Proactively support mental health consumers and carers to undertake education or training, and
- Provide supported and predictable pathways to social participation and employment for all mental health consumers and carers who are able to work now or wish to work in the future.
Our current system does none of these things effectively.
To achieve this new approach a lot needs to change. Our full submission outlines our approach to tackling this important issue, however, some matters deserve highlighting.
The Interim Report released by the McClure Review currently proposes that only people assessed as having a ‘permanent impairment and no capacity to work’ be eligible for the Disability Support Pension. Such an approach would be enormously difficult to implement in practice, as experience to date in the National Disability Insurance Scheme (NDIS) trial sites has shown. More importantly, such a requirement contradicts the well-established recovery paradigm in mental health, which recognises that someone’s capacity to work (and indeed to participate more broadly) depends in large part on the support they receive over time – not just their disability.
Regardless of the structure of payments, the income support system must provide people with disability, including people with mental illness and psychosocial disability, the right support to participate socially and economically, including but not limited to paid work where possible.
We also don’t want a system that locks someone in or out of welfare simply because they happen to be assessed by Centrelink on a day when they happened to be feeling particularly well or particularly unwell. Assessment is complex and can take a lot of time and the episodic nature of many symptoms of mental illness should not distract us from the permanent barriers to participation that many people who experience mental illness face.
It is well-established that people who rely on income support payments are frequently living in poverty, and as a result are unable to participate fully in their communities. For people with mental illness, as with people with other disabilities, high out-of-pocket costs for care and treatment make the financial barriers to participation particularly pressing.
Payments to people with mental health conditions should be based on needs, including medical needs, and not based on short term political needs or misguided social attitudes. Most of our current payments do not come close to meeting this standard.
Carers of people with mental illness do not currently receive the recognition they deserve for their caring role. The value of informal care should be acknowledged through adequate payments, so that carers can continue doing what the government would otherwise need to do at much greater expense.
There is currently a shortage of available jobs for people seeking employment, and frequently a mismatch between the skills of those looking for work and the skills required by employers. This means that people with multiple barriers to employment (including people with mental illness) face additional disadvantage in the current labour market.
Individually tailored mutual obligation requirements would be far preferable to the rigid generic conditions seen in the present system. Current mutual obligation activities can sometimes be difficult for people with mental illness to consistently comply with, and can unintentionally lead to an escalation of symptoms or other negative outcomes, further undermining both recovery and work capacity.
To increase the likelihood of people meeting any mutual obligation commitments without jeopardising their health and wellbeing, welfare recipients should be afforded greater choice and control over the types of mutual obligation activities they are expected to undertake, and these activities should contribute to their recovery.
In addition, we oppose the imposition of arbitrary punitive sanctions for alleged non-compliance, such as suspensions and non-payment penalties, on people with mental illness. In their place, we propose that positive incentives are put in place to encourage and reward participation. Past evidence has shown that punitive measures make people sicker, sometimes even leading to hospitalisation – an outcome which is damaging to individuals and expensive for government.
Approximately 3.2 million Australians experience mental illness at any given time, most commonly anxiety and depression. 264,000 people with psychosocial disability currently receive the Disability Support Pension, which equates to 32% of all recipients. Over 200,000 recipients of the Newstart Allowance have an identified mental illness and 70,000 mental health carers receive the Carer Payment.
Australia already has a low rate of employment participation by people with mental illness compared with other OECD nations. In 2009, only 29.2% of people with a psychosocial disability were participating in the labour force and many were unemployed.
Indeed, the labour force participation rate by people with severe and persistent mental illness has only marginally improved over the past 15 years.
We need to change the way we approach welfare for people with mental illness and psychosocial disability. Our goal is a welfare system that provides a pathway to work for those who can, and realistic and fair support for those who can not.
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