Mental Health, Poverty and Life Expectancy – A decades-long Crisis which finally Demands our Attention

 

above: Stigma is a major problem with mental illness ; But arguably there is another neglected crisis - mental health related life expectancy - which results in hundreds of thousands dying decades before their time...

Tristan Ewins

 

Last week was ‘Mental Health Week’ in Australia. Importantly this has drawn attention to related issues such as poverty, stigma and a decades-long crisis in mental-health-related life expectancy.

 

 

 According to a study from The University of Queensland and The University of Western Australia mentally ill Australians are on average dying 16 years earlier than the general population. This would include sufferers of Depression, Bipolar, and Anxiety. The study noted that the vast majority of cases of early death actually related to “physical causes such as cardiovascular disease and cancer, rather than from suicide or accidents.” Medication can certainly play a role in promoting obesity – which as noted can lead to heart disease, but also diabetes.

 

Also despite this, recent research has established that suicide claims approximately 2,500 lives a year. Proportionately the most likely to commit suicide were elderly men.

 

What is more, regarding mental health related life expectancy, “the gap is growing”. And the figure for sufferers of Schizophrenia – which is estimated to be a minimum of 200,000 Australians (some say closer to 300,000) – is 25 years. That is, those with Schizophrenia in Australia die on average 25 years earlier than the general population.

 

Also according to the UQ/UWA study this result was worse than that experienced by smokers, and comparable to that suffered by indigenous Australians. Indeed, research on Indigenous Australian life expectancy revealed a gap of around 10.6 years. The figure for indigenous Australia is of the highest concern and demands a significant commitment of resources. But the comparison begs the question why mental health related life expectancy does not attract the same relative amount of attention given the numbers, and given the dire plight of those involved. Indeed, both indigenous and mental health related life-expectancy warrant a very significantly increased amount of resources.

 

Furthermore the statistics on mental health related life expectancy have not improved in 30 years revealing gross negligence by governments of all stripes.

 

In early 2014 Ryan Bachelor of the Chifley Research Centre condemned apparent moves by the Abbott Government to vilify and scapegoat disability pensioners. This approach was reinforced by a disgraceful campaign by Australia’s Murdoch tabloid press. Bachelor also emphasized that while the figures for the Disability Support Pension (DSP) were high (approximately 800,000 people), more recently these figures were slowly declining. The cost to the Budget was approximately $15 billion in a $1.6 Trillion economy. And the proportion of Disability Pensioners with a psychosocial disorder was 31 per cent.

 

Considering life expectancy statistics, no – sufferers of mental illness are not ‘having us on’ when it comes to the Disability Support Pension. As Frank Quinlan of the Mental Health Council of Australia argued in 2014, many amongst the mentally ill want to work – but cannot do so on account of discrimination. And they are also deterred because of severe means testing of their pensions. As Quinlan explained elsewhere:

 

 

 

“The reality of the experience of severe and persistent mental illness is that it can have a profoundly disabling impact on day-to-day living and social functioning, leaving some Australians requiring ongoing financial assistance despite their eagerness to work independently."

 

 

 

It may not be so popular to draw on Karl Marx in this day and age. ‘Marxism’ as such has been so distorted by those who claimed to act in his name that many would not give his ideas a second thought. But Marx’s maxim: “From each according to ability, to each according to need” should seem an eminently reasonable basis on which to fairly organize an economy and a society. And it is a perfectly reasonable basis on which to organize pensions, and the social wage and welfare system more broadly. This should mean an end to severe means testing, more positive incentives to find flexible work (rather than ‘punitive welfare’), emphasis on fighting mental health related discrimination, and positive incentives for employers to provide suitable flexible employment.

 

Specifically, Disability Pensioners have trouble maintaining any kind of social existence; not only because of illness, but also due to poverty. Poverty means it is often difficult or even impossible to run a car, for instance. This impacts on ability to even search for suitable work. There’s the option of public transport ; but that is not always available. This can also make it difficult to keep friends, or to find friends in the first place. Poverty also makes fitness a more difficult prospect. Again, ill health, obesity etc can contribute significantly to early death, while the mentally Ill need to work so much harder to maintain health and fitness due to the side-effects of medication. Due to poverty Gym memberships are generally out of the question. And health costs can also be prohibitive. Consider Dental and Optical just to start. This affects all pensioners, but the disabled are likely to be dependent long term with no way out.

 

 

 

Also many experiencing mental illness are stuck in substandard and insecure accommodation. Further, not all the mentally ill have support from Carers, and many ‘fall through the cracks’ into homelessness. A 2002 report had also noted:

 

 

“many people with mental illness are unable to afford stable housing or make their own housing choices, and frequently have problems accessing appropriate housing and difficulty maintaining tenancies because of disruptions caused by their illness.”

 

 

 

  New Turnbull Government Health Minister Susan Ley says there are “no easy fixes” and that the system must “[catch] people before they fall.” (“The Age”, 5/10/15) This implies some insight as to what people actually go through. Though while early intervention is crucial in preventing such suffering few can really conceive of, healing for the afflicted is just as necessary. Expecting people to just “pull themselves together” demonstrates an appalling lack of empathy, understanding and humanity. So if Minister Ley is serious she must decisively reject the disgraceful stigmatization and vilification of Disability Pensioners conducted by the Murdoch Press, and by some elements in her own party. 

 

 

 

We are yet to see whether or not there will be a decisive change of direction under the new Turnbull leadership. Resolve to achieve the following will comprise the degree to which we can judge the extent to which the Turnbull Government is meaningfully addressing the crisis:

 

 

•  Increase the Disability Support Pension by at least $35/week indexed. To begin, this might make it possible to run a vehicle and to eat better quality food ; Improve support for Carers as well

• Implement anti-discrimination legislation and provide positive incentives for employers to offer flexible work

• Provide much more generous means-testing of Disability Pensioners – especially the mentally ill, slowing the rate at which the Pension is withdrawn ; and make it easy for those affected to immediately re-access the pension even if they had found full-time work – but relapsed into illness       

• Provide comprehensive Medicare Dental and Optical – ideally on a universal basis – but if this is not possible under the current government, then at least offer it to those in poverty, including those on welfare

       

• Provide access to ‘physical health case managers’ – who assist in improving the physical health of the mentally ill – a dimension which is commonly neglected by mental health professionals

• Provide funding so the mentally ill can actually act on such advice: subsidised access to health and fitness facilities, gear and services.

• Condemn any stigmatisation or vilification of the mentally ill in the media, including the Murdoch tabloids       

• Subsidise internet access to help maintain social-connectedness       

• Promote social-connectedness for inpatients as well by enabling access to internet and social media where viable

• Increase social expenditure on mental health to make it reflect its proportion of “the country’s health burden”; ie: raise it from 7 per cent to 14 per cent of the Health Budget ; but achieve this by increasing the investment; and not through cuts elsewhere

• Finally follow through on the demand by ‘Australians for Mental Health’: for “improved access to mental health services, clear pathways for treatment and support, more early intervention and prevention services, and service integration”

 

Again the mentally ill are not ‘having us on’ when some of them can expect to die on average 25 years earlier than the general population. We have to hope that the new Turnbull Government will mark a shift in attitude. But what is actually necessary is an increase in funding for programs assisting the mentally ill. (as considered in the dot points above) We must judge all the political parties and independents on the basis of action and not just words.

 

 

 

Labor needs a policy ‘circuit breaker’ - NOW

In the following article Tristan Ewins argues that overcompensation is key to 'selling' the carbon tax' - and that welfare recipients should not be 'left behind'; But also that Labor needs a 'policy circuit breaker' NOW if it is to have any hope of re-election in 2013. A National Disability Insurance Scheme, and pay parity for community sector workers - could provide 'a way forward'.

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Speaking to Melbourne’s ‘Herald Sun’ on June 18^th Australian Prime Minister Julia Gillard seemed calm in the face of appalling poll results.    In an article titled: “Why I Rolled Kevin Rudd”, the Prime Minister seemed to hold out hope for a Labor victory in 2013.   (nb: we will assume PM Gillard did not anticipate the choice of title used by the Herald-Sun, with the usual loaded language and negative connotations)

Specifically, Phillip Hudson reported how Gillard:

“warned that poll numbers might not lift until after the tax begins in July next year and anxious voters "live it" and see the effect of the whole package and compensation on their daily life.”  http://www.heraldsun.com.au/news/more-news/why-i-rolled-kevin-rudd-prime-minister-julia-gillard/story-fn7x8me2-1226077339474

What is most crucial at this point is for Labor to implement some kind of policy “circuit breaker”, to stop voters from ‘switching off’ before it is too late.  

On 18th June 2011  “popular support for the Federal Government [had] fallen to its lowest level in 39 years, with a…Nielsen poll putting approval for Labor at only 27 per cent.”   http://www.efarming.com.au/News/general/18/06/2011/80081/abbott-blames-policies-for-labor-slide.html

This was a devastating result for Labor.

Gillard cannot afford for everything to hinge upon reception to a carbon tax a whole year into the future. (ie: mid-2012)    Even if compensation (and overcompensation) does emerge as intended, voters may already have firmed in their judgements before then… 

 But a National Disability Insurance Scheme could provide the vital ‘policy circuit breaker’ needed so desperately by Labor.  We will return to this issue later.

The carbon tax is perhaps the most problematic issue for Labor, as fear has been whipped up so effectively by Abbott and by sections of the media.

There are also tensions between the Greens and Labor.

The Channel 7 website has published an article reporting a developing impasse between Labor and the Greens on the form any future carbon tax will take.   

Specifically, Jeremy Thompson reported that:

“It is understood the Greens are unhappy with the Government's preferred deal on industry compensation, including substantial assistance to coal miners.”  http://au.news.yahoo.com/a/-/australian-news/9660562/carbon-tax-rift-emerges-between-labor-greens/

Here assistance to coal miners seems pointless.  Already low and middle income consumers – as well as trade-exposed industries - should be compensated for any increased flow on costs from coal-fired energy.  If coal-fired energy plants are directly compensated, however, then where are the ‘market signals’ driving a shift to renewables?  

The other question, here, is what rate the carbon tax will be set at.  Ross Garnaut has argued that a carbon tax at $26/tonne would raise $11.5 billion in its first year. http://www.smh.com.au/business/carbon-tax-to-raise-115b-in-year-one-garnaut-20110531-1fdvi.html?skin=text-only

This author has argued in the past that there will likely be a rate of $20/tonne: a position that seems to be popular with Labor.  But in the past the Greens have argued for a rate as high as $40/tonne.    

 Also notable (again as I’ve reflected elsewhere) is Garnaut’s argument that pensioners ought not be ‘overcompensated’ because of previous improvements to pensions.  Garnaut had also argued that compensation to be phased out only for incomes “well north” of $80,000/year. http://www.theaustralian.com.au/national-affairs/early-carbon-compensation-plan-under-garnaut-review/story-fn59niix-1226066805423

It’s important to note here that even before carbon tax implementation electricity prices have risen in Australia by about 30% in recent years, and already this has hit pensioners hard.  (see: http://theconversation.edu.au/increasing-electricity-prices-watts-the-culprit-1408 ) 

Melbourne University Researcher, Roger Darville blames this situation on the troika of renewable quotas, the need for new infrastructure, and increased demand.  But privatisation is the real ‘elephant in the room’ with increased finance costs and profit margins for the private sector, and reduced market power for small consumers.  (see: http://leftfocus.blogspot.com/2011/06/right-populist-monopoly-media-attempts.html )  And in any case increased demand should not simply translate into higher charges pocketed by private companies in the form of profit.

Pensioners are already absorbing these and other costs (eg: water), and so should not be ‘left out of the equation’.

From this it’s possible to draw a number of conclusions.

Firstly, a higher carbon tax rate could provide more scope for overcompensation for pensioners, as well as low and middle income working families. 

As this author has argued elsewhere, Newstart recipients  are ‘doing it tough’ – to put it mildly.  Indeed, Newstart is currently only $474.90/fortnight, and has not kept up with a rising basic cost of living. (See: http://www.centrelink.gov.au/internet/internet.nsf/payments/newstart_rates.htm )

In light of existing punitive active labour market policies there are no decent or valid arguments not to reform Newstart.  And real increases to Austudy are also crucial to provide conditions where students can apply themselves fully to study, rather than risk failure or underperformance as a consequence of the pressures of part-time work. 

And here a ‘loans scheme’ is neither equitable nor fair.

 If reform is not implemented here in the context of carbon tax overcompensation, then it needs to be achieved separately; But progressive Labor figures on a cross-factional basis, and the Greens -  need to demand reform one way or another during the current term of Labor government.  Ultimately carbon tax overcompensation may prove the easiest path to reform regardless.

But to achieve robust overcompensation for low and middle income groups difficult decisions need to be made about ‘cut off’ thresholds. 

Based on previous modelling for a CPRS (carbon pollution reduction scheme – ie: via emissions trading), it has been argued that a carbon tax at $30/tonne would cost families $863.20/year. http://www.adelaidenow.com.au/ipad/pms-carbon-tax-to-cost-households-1660-a-week-treasury-figures-show/story-fn6bqpju-1226032314762

 It’s difficult to extrapolate a figure for single income earners from this, but it would be reasonable to assume the costs could be easily absorbed by individuals on $80,000/year.  (as well, the rate is unlikely to be $30/tonne) Therefore, in order to maximise the scope for overcompensation for low-middle income groups – including pensioners and the vast majority of workers  (that is – the vast majority of voters as well) compensation could begin to be ‘phased out’ at around $70,000/year (or maybe somewhat higher), dissipating entirely at $80,000/year.  (ie: for those who could reasonably be described as occupying that range from 'upper middle class' to 'wealthy')

Robust overcompensation for low-middle income groups will be crucial if Labor is to retain government in 2013; but must be paid for somehow.  Therefore after reconsidering, the author believes that to provide the scope for such extensive overcompensation, a rate of at least $26/tonne – as preferred by Ross Garnaut – and with the ‘cut-off points’ suggested here - is preferable.  And of course the rate and cut-off thresholds would have to be properly indexed.

Finally, compensation might best be provided in the form of regular cash supplements (also indexed) – as otherwise tax cuts could be ‘taken for granted’ and forgotten.   With regular cash payments there would be a constant reminder of compensation provisions.

A ‘circuit-breaker’ for Labor

Labor has been taking ‘hit after hit’ in the polls and in popular media for a long time now.  There are many publications which will put a ‘negative spin’ on pretty much anything and everything Labor says and does.  The danger is that voters will ‘switch off’, virtually determining the government’s fate more than two years ahead of the next election.  The carbon tax may turn out well ultimately, but a year from now it may be ‘too late’ for the government. 

 The government needs a ‘circuit breaker’ and needs it now.   Labor needs to break the cycle of fearful speculation now - with an agenda of constructive and visionary reform with which to inspire and engage the electorate.  The National Broadband Network (NBN) helped Labor ‘across the line’ last time; but the government needs new initiatives, as well as substantial progress on the NBN.

 A National Disability Insurance Scheme has long been touted as an option by rising Labor parliamentarian Bill Shorten.  

According to the ‘Every Australian Counts’ website, a NDIS would:

• maximise employment opportunities for the disabled, with comprehensive support services and any necessary equipment

• provide similar support to assist in providing education opportunities

• “provide funding for home modifications and specialised equipment and support to ensure people are able to live as independently as possible in their own homes”

• provide support for family and carers

• provide “early intervention and support” for children with disabilities

(see:  http://everyaustraliancounts.com.au/changing_lives/for_families/ )

In addition to this a NDIS needs to provide substantial new funds (ie: several billions every year) via a Medicare Levy-like mechanism rather than just a restructuring of the funding mix.  New funds are necessary to increase Disability Support Pensions and Carers’ Pensions; extend support services and provision of necessary home infrastructure; and to bring more crucial medications under the umbrella of the Pharmaceutical Benefits Scheme.

 Specifically as a consequence of a NDIS, in current terms carers and disability pensioners should also receive a rise in their pensions of at least $25/week; indexed on top of existing pension formulae.

A NDIS could also source additional funds for improvement of mental health services: an issue which is resonating strongly with the electorate.

While a NDIS could disrupt the cycle of fearful speculation about a carbon tax, it would also comprise a landmark reform – a genuine record of achievement for Gillard Labor.

Finally, the government could move onto the front foot regarding the ‘equal pay’ campaign being driven by the Australian Services Union – to provide effective pay parity for workers (mainly women) in the community services sector. 

Because it is mainly women who are employed in the sector, this issue has been raised as one of effective gender discrimination. But not-for-profit organisations providing aged care and other services (as well as in the public sector) will need support from the government in adapting to any improved regime of pay and conditions.  Hence for these – and other vital reforms – the government needs to aim during this term for a sustainable expansion of social expenditure in the vicinity of 1.5% of GDP; backed by progressive tax reform.

Generous superannuation concessions for the wealthy could also be wound back.

But until the carbon tax is implemented – with accompanying compensation and overcompensation – some degree of fearful speculation will continue. Labor needs to finalise its carbon tax package soon – to put fears to rest. 

But speeding up implementation could also be crucial; and Labor could do well to aim for the end of this year, rather than allowing damaging speculation to continue until mid-2012.  Again: by then it could be ‘too late’.

Debate welcome as always!

Supported Wage System exploits workers with disabilities

Helen Said, an Australian socialist activist has written to us asking us to help an important "cause [become] better known around the Left."   Specifically she is concerned with "the issue of the 'Supported Wage System' which is embedded into most industrial awards."  As she explains: "The System involves paying a worker with a disability a percentage of the award, depending on how they measure up in a productivity assessment. The worker is then asked to enter into an "agreement" to work for a lesser rate of pay and regularly reassessed. Their pay can be cut at any time through such reassessment."  Helen believes this system is unjust; and the following article explains why... 

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submitted by Helen Said

The Supported Wage System allows employers to legally underpay workers with disabilities, depending on how they measure up in a DEEWR productivity assessment.

The federal government’s Job Access program portrays this ruling as part of a progressive package of egalitarian policies, like funding workplace accessibility improvements. The Job Access website describes The Supported Wage System as “a process that allows employers to pay less than the award wage by matching a person's productivity with a fair wage.”
http://www.jobaccess.gov.au/Services/A-Z_list/pages/Supported_Wage_System.aspx

The Centrelink Website further elaborates: “This system incorporates a process of productivity-based wage assessment. For example, if a person involved in Supported Wage System (SWS) is assessed as having a productivity level of 70 per cent compared to co-workers performing the same duties, the worker and the employer can agree to ongoing employment at a pay rate of 70 per cent of the normal rate.”

The Job Access website hails case studies of two workers with disabilities, who earn 70% and 80% of their respective award’s wages, as SWS “successes”. One of these workers was described by her employer as being “able to perform her duties with limited supervision, is reliable and is considered one of our best back area staff, able to cope with busy workloads and she demonstrates that she enjoys her job.”

Job Access further assures employers that “people with disability can have fewer accidents at work—the workers compensation costs for people with disability can be as low as four per cent of the workers compensation costs of other employees …. people with disability can have lower absenteeism and often take less sick leave than other employees …. employing people with disability can build staff morale, raise management awareness of workplace practices and conditions, and increase customer and staff loyalty.”

Yet these are not the attributes that employers and governments consider in deciding how much to pay employees with disabilities. As described in numerous federal government worksites, including this Fair Work Australia report, the sole criteria in deciding how much a worker with a disability gets paid is productivity as measured by a DEEWR-contracted assessor.
http://www.fwa.gov.au/sites/wagereview2010/research/5_2010_diability_report.htm

According to this report “an employee assessed at 10 per cent capacity would have a minimum wage of 10 per cent of the relevant classification wage specified in the award.” This legalised work-for-pocket-money industrial legislation goes against the grain of the equality and deinstitutionalisation policies which operate in every other sphere of society. People with disabilities are being brought up to participate in all aspects of life as equals. Many marry and have families to support. Our industrial legislation on wage levels hasn't caught up. If anything it is going backwards.

Since its inception in 2005 approximately 5000 DEEWR productivity assessments have been carried out on workers with disabilities annually. The majority of SWS participants are male and aged between 15 and 25, mainly living in Queensland, NSW and Victoria. They typically have “intellectual learning disability,” and work an average of 20 hours per week, mostly as trades assistants or factory hands. Assessments of capacity between 40 per cent and 70 per cent are most common, and the average assessed capacity is 53.3 per cent.

Before undertaking an initial SWS assessment to determine the percentage of the award a worker will earn, the worker may be employed on a trial basis of up to 12 weeks for as little as $71 per week, with a possible extension of a further four weeks. This provision effectively grants employers the right to employ workers with disabilities on a casual basis at third world rates of pay, with no chance of ongoing employment, if these workers are deemed to have failed their “trial”.

Employees with disabilities are regularly reassessed by DEEWR “to ensure the employee’s level of productivity is accurately reflected in their remuneration.” But this has nothing to do with granting workers with disabilities incremental pay increases. In fact some workers with disabilities are having their wages further slashed after reassessment for failing to keep up with their employer’s productivity race. Even underpaid workers at sheltered workshops have had their wages slashed when they were brought under the SWS.

The union movement has largely accepted the SWS in the mistaken belief that it gives job seekers with disabilities a fair go. But the SWS sets up workers with disabilities for life long poverty and stigma, ignores the quality of their work, ignores their attendance and reliability as employees and fails to acknowledge the equal or greater economic burdens faced by workers with disabilities. Workers with disabilities need full protection under equal opportunities provisions, including provisions surrounding rates of pay. Any incentives needed to assist with their employment should not be granted at the expense of their wage levels.