Welfare reform

08 September 2017

Ms McBRIDE (Dobell) (12:17): I rise today to speak on the Social Services Legislation Amendment (Welfare Reform) Bill 2017 and in support of the amendment moved by the member for Jagajaga. Many people on this side of the House have spoken about the harsh schedules in this bill. I'm going to speak from my firsthand experience over the last 20 years of working with people with substance dependency.

Dependency doesn't discriminate between those who are working and those who are looking for work. The government's attempt to conflate drug misuse with unemployment is not just wrong; it's harmful. While I was training as a pharmacist, I worked in a community pharmacyone of the first in New South Wales to provide an opioid treatment program. This program, underpinned by the principles of harm minimisation, has led to many people being able to rebuild their lives and relationships and gain employment. It has been provided by community pharmacies since the late 1970s. I met teachers, chefs and executives who were all turning their lives around with the support of GPs, pharmacists and addiction specialists.

More recently, I worked as a mental health pharmacist, providing clinical support to an OTP clinic and a withdrawal management unit in Wyong Hospital. This in-patient unit provides withdrawal management from an evidence based, clinically-proven harm minimisation approach. It works. The problem is there are just 15 beds at Wyong Hospital for the entire Central Coast. This unit is also part of the statewide referral process, receiving clients from all across New South Wales, particularly from regional areas such as western New South Wales and the Tamworth region, where there are no local services.

If the government is genuine in its claimed intention to help those burdened by dependence, a good first step would be properly funding units like this and not attacking welfare recipients. The current services are overstretched and there are long waiting lists. Clients wait anxiously by their phone for a text message, hoping that they can enter as soon as there is an available bed. If there is to be any likelihood of success, the government must work with the states to ensure there are sufficient places for people entering treatment, and the necessary mental health and social services available.

This legislation implements a range of complex measures, many lacking detail and many lacking an evidence base. As previous speakers on this side of the House have indicated, there are measures that Labor could potentially support if they are separated from other measures in this bill. However, there are several measures that Labor will not support, including establishing a drug-testing trial for certain social security recipients, removing exemptions for drug or alcohol dependence, changes to reasonable excuses, axing the bereavement benefit, postponing the start date for some participation payments and removing the intent-to-claim provisions so that payments are delayed until claimants are able to complete the documentation requirements.

The most disturbing aspects of this legislation are the proposed drug-testing trial for social security recipients and compliance changes relating to drug and alcohol dependence. As I mentioned, I've worked as a pharmacist in a withdrawal management unit for alcohol and all other drugs as part of a dedicated team working from an evidence based harm-minimisation approach. Consistent with my experience is the widespread opposition to these measures among health and welfare groups. Concerns have been raised by, amongst others, the Royal Australasian College of Physicians, the Australasian Chapter of Addiction Medicine, the Australian Council of Social Service and UnitingCare. These measures fail to meet even the most basic standards for evidence based policy. To quote from the submission to the Senate inquiry by the National Drug and Alcohol Research Centre:

There is no evidence that any of these measures will directly achieve outcomes associated with reductions in alcohol or other drug use or harms, and indeed have the potential to create greater levels of harm, including increased stigma, marginalisation and poverty.

Drug testing of income support recipients has been tried in several countries and there is no evidence that it is effective. For example, the New Zealand government instituted a drug-testing program among welfare recipients, In 2015, only 22 of 8,000 participants tested returned a positive test result for illicit drug use. This measure was introduced without any consultation with those with expertise in the area of drug rehabilitation and treatment. Kevin from Tumbi Umbi in my electorate put it very plainly:

I am amazed that the government is considering withholding welfare payments from drug and alcohol dependent people without consulting with addiction medicine specialists over the policies. They have not been given the chance to share their concerns and expertise.

Further, a wealth of scientific evidence in clinical experience has proven that people suffering from severe alcohol and drug problems cannot be punished into recovery. Pushing people into poverty will only undermine their chance of recovery.

Addiction medicine specialists are concerned about the technical aspects of the trial also. While details of the costs of this measure have not been made available, the cost of conducting reliable tests is significant. According to the Royal Australasian College of Physicians, 'gold standard' urine tests cost between $550 and $950 to administer. Lower cost tests present a risk of false positives. The government has provided no details to suggest that additional resources will be made available to rehabilitation services to deal with any increased demand as a result of this trial.

Comments from the treatment sector are consistent with my experience locally on the Central Coast. There are long waiting lists for treatment locally and around the country, particularly in regional and remote areas. These trials will put increased pressure on the system and, where treatment is unavailable, jobseekers who are identified as having a dependency will have difficulty accessing the treatment prescribed. A constituent of mine, Amber, made a telling comment about where public funding could be better directed, and that is to treatment services, not punitive drug testing. This is what Amber wrote to me:

If this government genuinely wants to help people struggling with drug and alcohol problems, Parliament should redirect public funding away from harmful, extensive drug testing trials and expand referral pathways to treatment services.

Another constituent, Gerry, wrote: 'People unfortunate enough to be in the grip of addiction will not be helped by further reinforcement of their problem. Rather than insinuate that they are not to be trusted by requiring them to be tested, the better approach would be to encourage them to engage in alternative activities or programs which have the potential to entice them into more hopeful life-changing behaviour.' Gerry lives opposite the Salvation Army's rehabilitation centre, and its success in transforming lives damaged by drugs and alcohol reflects a more understanding approach than that proposed by the government.

Furthermore, health professionals warn that treatment is not successful unless someone is ready to seek treatment. Forcing people to turn up will not address their dependency and will only put pressure on already overstretched services. I would like to share another comment I received from a constituent, a social worker with over three decades of experience. She wrote to me: 'As a social worker with 37 years of practice experience17 years in the government income support and employment services fieldI am horrified to hear about the progress of this punitive and dangerous policy.' This is from a social worker. 'This policy, if it goes ahead, will create extreme poverty for a group of people who are struggling with significant physical and mental health concerns. Based on my practice experience, I know that most of these people have been confronted with traumatic life experiences, creating a complex range of social and emotional responses that place them in a dangerous situation if they are unable to access income support. This is also likely to make people in this situation more likely to become isolated and even to attempt suicide. There is also a risk that people in this situation and who are denied income support will respond in drastic ways which may impact on the safety of family members and members of the public.' This is consistent with my experience working with alcohol and other drug dependency for over 20 years. I first started as a trainee pharmacist in the mid-nineties and have continued as a mental health pharmacist at Wyong Hospital for the last 10 years. As a clinician, a mental health worker and a local member of parliament, I am deeply concerned by these punitive and risky measures.

I will now move on to the removal of exemptions for drug and alcohol abuse. Currently, income support recipients with participation requirements can be granted temporary exemptions from these requirements where they are incapacitated due to sickness or injury or where there are special circumstances such as a personal crisis. Schedule 13 would prevent temporary exemptions being granted where the reason is wholly or predominantly attributable to drug or alcohol dependency or misuse. This includes any sickness or injury or special circumstance such as eviction associated with drug or alcohol misuse. Health and welfare groups have also raised concerns about this change, including ACOSS, St Vincent's Health and UnitingCare. Experts say that the changes fail to recognise the complex nature of substance misuse, substance dependency as a health condition and doctors' medical opinions in advising that a jobseeker cannot meet their requirements for a temporary period. This would relate to not just acute episodes of substance misuse but also secondary health problems associated with drug and alcohol use, of which there are many.

UnitingCare's submission to the Senate inquiry states:

It is our view that the welfare system should provide a basic safety net for people most in need and that presence of chronic and significant health conditions should not lead to punitive responses. We subsequently oppose the measure on the basis of its propensity to undermine the effectiveness of treatment strategies that an individual may be seeking or undertaking

Currently job seekers can be penalised for a range of very common participation failures, including not turning up for an appointment with Centrelink. These penalties are not applied where the person has a reasonable excuse. Schedule 14 provides that a jobseeker who cites drug or alcohol dependence as an excuse for a participation failure will be offered treatment. If they take up treatment, it will count towards their participation requirements. If they refuse treatment and their substance-use disorder causes them to not comply with jobseeker requirements a second time, their payments will be suspended. As a pharmacist, a mental health worker and local MP, I join with other health professionals who have raised concerns that the changes in schedules 13 and 14 fail to recognise that substance-use disorder is a health condition.

In its submission to the Senate inquiry, the Royal Australasian College of Physicians commented:

The proposed removal of exemptions is fundamentally stigmatising and vilifying of individuals suffering addiction; which in itself is a known barrier to seeking treatment and overcoming addiction.

Furthermore, the RACP is seriously concerned that Schedule 14 provides for the application of financial penalties in cases where income support recipients do not participate in treatment. Again, this approach places vulnerable people at increased risk of poverty, homelessness and significant social and financial disadvantage.

I worked in mental health at Wyong Hospital for the 10 years before I was elected. I saw people burdened by dependence. Those same people didn't have access locally to the resources they needed to be able to seek treatment, to gain support and to be able to turn their lives around. These changes will only put these really vulnerable people more at risk. We discharged people to couches, to cars and to caves. We have to wrap around the mental health and social services support if we are to have any likelihood of success.

In summary, these changes will not help people to overcome addiction. This is not how dependency works. Instead they will be pushed into crisis, poverty, homelessness and potentially crime. It will place further burdens on the families of those experiencing drug dependency and on already overstretched welfare services. I would like to conclude my remarks on these measures by quoting from Margaret and Ron in my electorate. Margaret said:

My husband and I know, from past experience, just how demoralising it is when you can't find a job and you have to ask for help. To add extra to the burden with drug testing is cruel and humiliating. We are thankful we are no longer in this position and feel for those that are

Finally, Ron said:

This is the most obscene suggestion I have heard in 80 years.

These measures are cruel, as are measures in other schedules. The abolition of the bereavement allowance, hurting Australians at their most vulnerable, would only result in savings of $1 million over the forward estimates. The death of a partner is one of the most difficult times in anyone's life. Grief compounded by financial stress is cruel. Cutting the support for bereaved persons at this time is a harsh and mean-spirited measure and must be opposed.

To sum up, there are measures in this bill that Labor could potentially support if they were separated from other measures; however, there are several measures that Labor will not support and that I cannot support as a pharmacist, as a mental health worker and as a local MP. We are open to working with the government on these complex social problems if they are committed to genuine attempts to help people burdened by addiction, but we will not support blatant attacks on the most vulnerable in our community with no basis of evidence.