Senator MOORE (Queensland) (21:52): I was just thinking that I did not understand one-fifth of what you just spoke about, Senator Fierravanti-Wells, but I will study up. I promise!
Issues around appropriate access to counselling and psychological care for people who have been impacted by life trauma have been raised in a number of Senate Standing Committee on Community Affairs inquiries over the years. You may have been part of some of those, Mr Acting Deputy President Brockman. It seems to me that we need to be very careful when promising that there will be access to appropriate care when we aren't really sure of where the services are or how they operate.
I can remember-and, in this contribution, I'm going to use examples from three separate inquiries-the two community affairs committee inquiries into people who were victims of institutional care-not the royal commission into sexual abuse that we've just gone through but the original Senate community affairs committees, where we listened to evidence from a range of people who, in their childhood, had been directly impacted by horrific conditions, by treatment that did not generate love, by feelings of insecurity, by a loss of family identity and by just plain fear. These people came to tell us about these experiences. We as a committee, then as a parliament and then as a government came together to offer an official apology to these people.
One of the components of that apology was that there would be an acknowledgement of their suffering and trauma by them having access to appropriate care through counselling for the extent of their lifetime. This was followed up later by the Senate inquiry that looked into the issue of forced adoption in our nation, where women had their children taken from them at birth and then had that ongoing life trauma and that sense of loss, guilt and shame that this had occurred to them. Again, through the parliamentary inquiry, we listened as they talked to us about the impact this had on them and also on the children who were taken. They also said that they had experienced issues of loss of identity and fear and insecurity, all stemming from this significant separation that occurred through our system, through government interference, through strategic processes that we now know, whilst maybe done for reasons that people can tell themselves were appropriate, were in fact illegal. We acknowledged that, we apologised and we told those people that we would be able to provide appropriate psychological counselling for them into the future.
What has occurred has been a great variation of access. There has been an acknowledgement that this care should be provided-and not just any care. One of the things that came out of those inquiries was that there needed to be specialist training and specialist understanding for the professionals dealing with the people with the trauma. Consistently we're told that when people did seek out care they were even further damaged by the fact that people just did not understand the issues around the institutional care or the forced adoption, so people had to retell their stories and had the sense that the professionals with whom they were dealing didn't understand their issues and were trying to treat them within models that were not appropriate. We understood that, and the parliament indicated that there had to be special guidelines introduced and circulated that gave information to medical professionals about these issues, which had been largely unknown until the Senate inquiries brought them to public notice.
But consistently we've heard back from the people who turned to us and told us their stories, and we then said that we would provide support to, who say that access to the care has been varied at best. In regional and remote areas there is absolutely no availability of the care that's required as it is within the cities. There's variation in knowledge and access, and also over the years there have been increasing out-of-pocket costs for people wanting to receive the care. By the model of medical practice and psychological medical access to the MBS, people have had excess out-of-pocket expenditure to access the treatment that we promised we would provide for them.
I am very fearful that the same kinds of issues are going to be evident in what we're doing now with the redress scheme. One of the core components of the royal commission's recommendations around people who had suffered sexual assault in institutions was that they would have lifelong counselling. This lifelong counselling was going to be determined individually by people who had been harmed-about the form of counselling they would need and the access they would require. Subsequently, in the government legislation that's come forward to look at how we would implement the redress program, this has not translated into lifelong counselling. On a scale determined by the seriousness of the sexual assault that has occurred, people have access to hours of care or a lump sum so that they can seek their own care to the extent that the money holds together.
Each state is looking at providing care in different ways. Some states have identified as providers, so that the form of provision of care will be linked to the current providers across the state, and people will be able to access this. Other states have chosen to go different ways, and people will be given lump sums and will be able to seek out providers themselves to provide the care they so obviously need, which has been identified by their trauma and by the circumstances and the evidence that they've provided to the royal commission and to the previous Senate inquiry.
I'm deeply concerned about the access to care, about the quality of the care that's provided and about the flexibility of care, because every person is different; you cannot just state that every person will have the same response and the same need. We need flexible, personal case-based arrangements in this space, and too often this is just not available in our current system. When we raised these issues with the departments, we were told that, if the provisions of care run out, what can happen is that people can access the basic provisions under the current mental health process to access psychological services. That means, after you've been to a GP, you can access up to 10 visits in one year of care. That is not a flexible arrangement. There's also no guarantee that the providers will have the specialist knowledge that is needed for people who have the particular trauma caused by either sexual abuse, which came out during the royal commission process, or being separated from their family and being in institutions.
I think, as a parliament, when we make promises that care will be available to people who've come to us with their circumstances, we should ensure that appropriate resourcing is provided and that that care is effective. I am troubled by the way the care arrangements have been defined in the redress program. In fact, the level of care is determined by how serious the alleged sexual assault was. That's a deep flaw in the process. It's something we'll have to consider because this will not go away. People will continue to need care into the future. We have said to them that we've heard and understood their pain. We have said to them that there should be care available to them. I think we have a responsibility to make sure the people we have apologised to have the care that they so desperately need.