Better Mental Health Starts with Policy

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Last week, the Australian Doctor reported on new figures released by the Department of Health and Ageing which reveal that the Access to Allied Psychological Services (ATAPS) program had failed meet targets for the delivery of psychological care to the public, despite a $31 million funding boost over the 2013 financial year. Funding to the ATAPS program was increased from $55 mil to $86 mil in the last financial year with the aim of reaching an additional 27,900 patients. A report from the Department of Health and Ageing shows that only 13,200 more people received assistance, less than half of the proposed target. These poor figures raise questions about the former Government’s policy agenda to direct referrals to ATAPS rather than improving support and access to our existing Medicare system.

General practitioners have blamed these poor figures on red tape. Comments responding to the article in Australian Doctor express frustrations about overly complicated referral processes for ATAPS. One GP summed it up as follows:

“I couldn’t agree more about the bureacracy that now surrounds the ATAPS program. The paperwork required is crazy – email this, copy that, fax something else; eligibility seems to change on a regular basis; and I am very uncomfortable with the new system in our area where GPs are required to fax a copy of the MH plan and then a medicare local staff member determines the appropriate service provider. In my view this is an unnecessary breach of privacy and discounts the working relationship between the GP and local psychologists.”

Another GP spoke about the hassles involved in finding a psychologist to refer to given that so many pull out of the ATAPS program due to the red-tape involved for psychologists and other mental health care providers:

“I recently had to re-refer a patient 4 times to different ATAPS providers because each time the pt contacted to make the appt, the psychologist said he/she was no longer part of the program due to the admin nightmare. I rang my medicare local for an updated list and was told they do not have one…”

These comments from GPs confirm the sentiments we have heard from psychologists, social workers, and occupational therapists, who are members of our discussion group on Facebook.  Therapists point to the complicated bureaucratic hoops that need to be jumped through via the ATAPS system. They point to confusion arising from misinformation, nightmarish paperwork needing to be filled out, rigid rules blocking services, patients having no choice of therapist, and many going without psychological treatment for months on end because Medicare Locals offices have either rejected their referral or don’t have any funding left to provide services.

Coming back to the report cited in the Australian Doctor, if Medicare Locals used up all the funding that the DoHA report says was “spent” on ATAPS across the last financial year, then we are talking about $31 million being spent to provide psychological care to 13,200 people. We know that the mean number of sessions utilised by each person for the ATAPS program is 5 appointments. That translates to a cost of $469 per ATAPS appointment over the 2013 financial year, which ultimately comes back to the Australian taxpayer. To be clear, we are not saying that ATAPS is a bad program, but rather, we must repeat our earlier points made to Government (here, here, here, and also here) that ATAPS is far more expensive to run. ATAPS is much better suited to targeting niche sectors of the population, who for various reasons are unable to be reached by Medicare. At the same time we must remember that Medicare reaches far more people than ATAPS in real human terms, with figures showing that Medicare mental health services support 5 times the number of disadvantaged people seen by ATAPS every year. To give you a sense of scale, in the first 6 months of 2013 Medicare provided psychological care to more men than ATAPS has reached across the last decade.

Shortly after the DoHA report, a story in The Age emerged about criticism of the recent policy emphasis on funding early intervention services for young people (i.e., Headspace and EPPIC). Perhaps unsurprisingly, the article presented the mental health sector as being engaged in a war “over who should get the biggest slice of a pitifully small pie”. The article portrays the field as being divided, expressing a call for unity around the need for more funding. The fact of the matter is that there is already widespread consensus across the sector that we need to increase the overall funding dedicated to mental health. The question is whether cutting one program to fund another is the right way to go about improving the system. Most people we have heard from tell us that they want to see additional funding to build on the system, not boosting one good program at the expense of another. There’s a concern that Medicare services which are modelled on well-established standards of evidence-based practice are being scaled back to massively expand programs with little evidence behind them. Even more worrying, it seems that data isn’t being collected on how many young people are being medicated or what the long-term outcomes of these programs might be. When we are already under-resourced the smart thing to do is make sure the programs we can fund are demonstrably effective.

There is no doubt in my mind that Headspace does help a lot of young people indeed, but the bigger question is whether later life mental health problems are prevented. Given that Medicare support for adults was reduced to divert funding to programs targeting young people under 25, then one would hope that the goal is to reduce and prevent mental health problems from occurring for people after they turn 25. For those who are now 25 years or older, the only alternative services that provide psychological care are ATAPS and Medicare.  Put simply, the evidence is sparse that our new innovative programs can actually prevent later life problems, so the recent news that no data is being collected on long-term outcomes is a genuine concern. It may be that young people need support to get through their difficult early years, but even so, many of these same individuals will also need psychological treatment across adulthood in order to fully recover. We need to be realistic and put some thought towards the ongoing lives of a person after they have accessed age-restricted programs of this type. To achieve that aim it is essential to support programs like Better Access to Mental Health Care.

A few days ago Ten news reported that the Federal Government will invest $500 million to the Partners in Recovery Program to help co-ordinate care for people with severe and persistent mental health problems. This is a very welcome funding boost and is roughly the same amount of funding that was cut from Medicare supported psychological care. The success of programs like Partners in Recovery depends on whether there are services available to refer people on to. The Partners in Recovery Program doesn’t offer psychological care, which means that those who need treatment services will once again depend on access to Medicare support. To put it another way, if the required services are unavailable, obstructive, or inaccessible, then programs like Partners in Recovery aren’t of much value at all. We agree with the recent calls for unity across the mental health sector, so let’s call on our Government to restore Medicare services as a key component of that goal. We need to improve the Better Access program so that every person who lives with a mental health condition has fair access to psychological care regardless of age.