NDIA Accountability Project

Submission 28 — Services for Australian Rural and Remote Allied Health (SARRAH) — Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

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Services for Australian Rural and Remote Alied Health SARRAH

21 September 2020

Dear Commissioners,

Royal Commission to Examine Psychotropic Medication, Behaviour Support And

Behaviours (Fed)

I am writing with regard to the Royal Commission’s forthcoming examination of the use of psychotropic medications, as described below in the Commission’s media release of 4 September: The use of psychotropic medication in response to behaviours of concern in people with disability is to be examined by the Disability Royal Commission at its next public hearing beginning on Tuesday 22 September. Psychotropic medication is an umbrella term used to refer to any drug capable of affecting the mind, emotions or behaviour, including anti-psychotics, anti­ depressants and mood stabilisers. The extent of reliance on such medication and its effects on the health and wellbeing of people with disability is likely to come under scrutiny at the Royal Commission’s sixth public hearing. The Royal Commission will also examine other types of responses to behaviours of concern, including behaviour support. Services for Australian Rural and Remote Allied Health (SARRAH) appreciates the opportunity to contribute to the Royal Commission’s inquiry and values the important work you are conducting on behalf of the Australian community. SARRAH is the peak body representing rural and remote allied health professionals (AHPs) working across the public and private sector, across health, disability, aged care and other settings. SARRAH advocates on behalf of rural and remote communities in order for promote access to allied health services that support equitable and sustainable health and well-being. AHPs are tertiary qualified health professionals who apply their clinical skills to diagnose, assess, treat, manage and prevent illness and injury and support people with disability. Unfortunately, there is a chronic shortage of AHPs and the service supports needed to enable and sustain

ABN 92 088 913 517    I T: (02) 6285 4960    I sarrah@sarrah.org.au     I www.sarrah.org.au

Unit 4, 17 Napier Close, Deakin, ACT, 2600 I PO Box 74, Deakin West, ACT, 2600

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their practice in many rural and remote communities. This has major impacts on peoples’ opportunity and capacity to access allied health services on an equitable or needs basis. The issue was recently investigated in depth by the previous National Rural Health Commissioner (NRHC) who, following an extensive consultation and development process provided a report to the Minister for Regional Health, Regional Communications and Local Government on the Improvement of Access, Quality

and Distribution of Allied Health Services in Regional, Rural and Remote Australia.*

The shortage of AHPs working in rural and remote Australia is more severe than for either the general practice or hospital medical workforces or for nursing. If means many people, especially those without substantial personal means are unable to access allied health services that would enhance their health and well-being. In some cases, the inability to access certain allied health services lead to the development of conditions (and/or the worsening of conditions) that could have been prevented and/or ameliorated if people had access to health services on a more equitable basis. People with disability, who are also more likely to face financial and other access constraints can be especially disadvantaged. The NDIS has improved the situation for many people, however, for large numbers of people living in rural and remote Australia, structural impediments to access remain.

Over the past several years, the Australian Commission on Safety and Quality in Health Care (ACSQHC) has produced a series of reports on the variation of health care provided and related health implications on a location basis: called the Australian Atlas of Healthcare Variation Series?.

The Series shows wide discrepancies in health care treatment and outcomes, across a range of health conditions and treatments. Importantly, the Atlas has highlighted very substantial variations in the use of antipsychotic medicines by location.

The following excerpt from the Atlas? raises issues that may be of direct concern to the Royal Commission.

Magnitude of variation*® In 2016-17, the rate of dispensing of antipsychotic medicine prescriptions in people aged 18-64 years was 14.1 times as high in the area (Statistical Area Level 3 —- SA3) with the highest rate as in the SA3 with the lowest rate. The magnitude of variation decreased from 2013-14, when there was an 18.5-fold difference between the highest and lowest rates (Figure 5.13).

SARRAH would like to have provided a more detailed submission to the Commission, we are a small, national organisation with a broad remit and do not have the capacity to do so.

We hope the Royal Commission will have the opportunity to investigate the factors that contribute to such discrepancies in treatment, and note the possibility that the relative shortage of qualified mental health qualified staff, including psychologists, social workers and occupational therapists (among others) may be linked to a

1 See https://www1.health.gov.au/internet/main/publishing.nsf/Content/National-Rural-Health Commissioner-publications (June 2020)

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greater propensity to use psychotropic medicines in some under-serviced areas as other forms of treatment (e.g. cognitive and behavioural therapy) are not as readily available. SARRAH is not inferring any fault on the part of practitioners providing services per se, but question whether the resources and systems available to support the most appropriate level of care is adequate.

| hope this information is of assistance in your important work.

SARRAH has no objection to our submission being made public.

Yours faithfully,

Catherine Maloney

CEO, SARRAH

Services for Australian Rural and Remote Allied Health (SARRAH) exists so that rural and remote Australian communities have allied health services that support equitable and sustainable health and well-being. SARRAH also supports Allied Health Professionals who live and work in rural and remote areas of Australia to confidently and competently carry out their professional duties in providing a variety of health services to people who reside in the bush.

SARRAH is a national, multidisciplinary member association and has been operating for 25 years. SARRAH is the only peak body to be fully focused on rural and remote allied health working across all disciplines. (More information is available at http://www.sarrah.org.au/).

ABN 92 088 913517 | T: (02) 6285 4960 | sarrah@sarrah.org.au | www.sarrah.org.au

Unit 4, 17 Napier Close, Deakin, ACT, 2600 | PO Box 74, Deakin West, ACT, 2600