Four years after a teenager's death prompted a government pledge to fix the system, the state’s auditor-general finds just one of 32 reforms has been delivered.
A 13-year-old girl took her own life in 2020, moments after leaving an appointment with a child and adolescent mental health service clinic in Perth’s southern suburbs.
Her death triggered a chief psychiatrist’s review, a ministerial taskforce, and a government promise to deliver all 32 of the taskforce’s recommendations for reforming the system.
Four years on, and a damning West Australian auditor-general’s report has found just one of those 32 government commitments has been delivered.
Tabled in parliament on Wednesday, the report assessed whether the Mental Health Commission, Child and Adolescent Health Services and WA Country Health Service were effectively implementing the mental health reforms package the review promised.
To drive these reforms, the MHC established the Infant, Child and Adolescent Mental Health System Transformation Program in January 2023. It was on a nine-year timeline, extended from the original five years recommended by the taskforce.
However, this week’s AG’s report has found that even with this extended timeframe, very little has been accomplished and planning was incomplete from the beginning.
“The January 2023 implementation plan did not fully address all of the taskforce’s 32 recommendations, with 12 recommendations not addressed at all. It also did not address the scale of funding, staffing, and infrastructure required to deliver the promised reform,” the report said.
Furthermore, the dedicated governance structure that was established to drive the reforms was abandoned early on, “further contributing to a loss of focus on the taskforce’s recommendations”, the report said.
The AG’s assessment found that MHC has been overstating its progress in internal reporting and when responding to Parliamentary questions.
In the MHC’s most recent (May) report, it found that four recommendations out of the 32 were complete. However, the auditor’s assessment was that only one was actually finished. Another 26 were in progress and five hadn’t started.
Progress has been concentrated in acute and intensive services, the report found, with relatively little movement on prevention and early intervention. MHC also couldn’t demonstrate what it was progressing towards, lacking the data or measures needed to assess outcomes.
Auditor-general Caroline Spencer said on its current trajectory, MHC has no credible plan or pathway to deliver the Infant, Child and Adolescent Mental Health System Transformation program.
“If persistent organisational leadership capability and accountability gaps are not addressed, these important reforms to mental health service delivery will never be delivered as intended for Western Australian children and families, let alone by the targeted timeframe of 2031,” she said.
“While some positive initiatives have been delivered in conjunction with WA Health service providers, particularly in acute and crisis care in some locations, these have not yet translated to broader system transformation.
“Overall progress has been slow and the transformation program is not on track to deliver the full scope of reform,” Ms Spencer said.
Shadow health minister Libby Mettam said the findings were damning and raised serious questions about ministerial oversight.
“The Mental Health Commission has cycled through multiple governance structures, abandoned implementation plans and failed to adequately track progress, yet neither the current nor previous Minister appears to have held the Commission to account,” she said.
The Royal Australian and New Zealand College of Psychiatrists said it showed children, young people and families across Western Australia have been let down.
“It is deeply disappointing that consumers continue to face the same barriers to care that existed when the taskforce report was first released,” RANZCP WA Branch spokesperson Dr Eileen Tay said.
“Real progress requires adequate investment, seamless service integration and focused governance. System-wide change is urgently needed to restore community trust and ensure young people receive the safe, timely and effective support they need,” she continued.
AMA (WA) President Dr Kyle Hoath said there need to be immediate changes, particularly increased staffing.
“We absolutely can’t deliver any kind of meaningful change without the people to deliver that care, our nurses, our psychologists, our social workers, our doctors, everybody involved. We need a plan for that, because otherwise we’re going to continue to fall behind as we already are, and we can’t wait for that,” he said.
Romina Raschilla, WA state secretary of the Australian Nursing Midwifery Federation, agreed.
“We need more clinicians, we need more nurses, mental health trained to be able to fulfil the gaps. Our nurses are crying out. They are overworked, they’re underpaid, they are working so hard, and they feel so pressured and stressed, and they need more support, they need to be listened to, because they are the ones on the ground with the other clinicians,” she said.
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Beyond staffing, Dr Hoath said families are left to navigate a system with no clear entry point.
“If you’re a parent with a child who needs some mental health support, it’s incredibly difficult to navigate the system, to know where to start. To fall into a gap, to wait for years to see somebody, that’s not okay,” Dr Hoath said.
In a statement to ABC, health minister Meredith Hammat accepted that the implementation of the recommendations had been slow.
“We’re disappointed in the findings in this report, of course we are, these are important reforms that our government started and we want to see them implemented,” she said.
MHC, CAHS and WACHS have all accepted the report’s two recommendations, which focus on re-establishing governance and implementing the monitoring and evaluation framework.
“The MHC remains strongly committed to system transformation, supported through coordinated efforts, ongoing budget processes and continuous stakeholder engagement,” the MHC responded.