A review of Medicare is underway, giving you an opportunity to have your say about access to psychological care in the system. To make this easy I have assembled some basic points you can use to strengthen your message. Thousands of people support the Alliance for Better Access. Some people are fully behind us whereas others only want to see some of the changes we are asking for. I think that’s a great thing and shows what a diverse group we are. With that in mind, we have separated out each area for change. That way we can all join together to make the system fairer without working against one another.
The following sections give you an overview of each area of mental health care we want to change in the Medicare system. It is really important to share your own distinctive view in these Government submissions, because cut-and-paste replies tend to get binned. Under each heading we explain why we recommend these changes and show you which section of the survey is relevant to those issues. I have suggested some ideas on what your response in those sections could include. At the end there’s a link that will take you to the survey.
Remove Excessive GP Visits
Under the current system you need a GP referral to start getting help. That’s fine if the first person you speak to is a GP. But at the same time, if someone books in to see a mental health professional first that shouldn’t put them at a disadvantage. We want to see a system where there is no wrong door to start getting help. The other problem is that Medicare currently requires people to keep going back to their GP every few sessions to review their mental health care plan. There is often not a great deal to report after 6 visits, which is no failing on the part of the therapist or the client. Bouncing backwards and forwards between the GP and therapist is a hassle for clients and a needless drain on Medicare. The Alliance for Better Access has proposed a model for change to streamline the system (please take a look).
Remove Diagnostic Red-Tape
The current system requires your GP to generate a ‘mental health care plan’, diagnosing you with a mental disorder. Some people refuse to seek help because they are afraid of being labelled with a diagnosis of mental illness. You do not need a formal diagnosis to receive Medicare support for other common medical conditions, so why have that barrier in mental health care? If we are going to improve the Medicare system, then access to preventative care should be available in mental health care. We note that the recently published findings of the Royal Commission into Institutional Responses to Child Sexual Abuse (here) calls for the removal of the current Medicare rule which requires ‘an assessed mental disorder’ before psychological help is made available. We believe the same basis for that decision, around shame and the reality of mental health stigma, stop many people from reaching out for help when they need it. Another aspect of this problem is the suggestion that symptom severity alone should determine the number of sessions you can access. We know from decades of research that there are many factors, besides symptom severity, which contribute to the rate of recovery.
Increase Number of Visits Covered
The evidence from research is clear. We need to offer at least 15 to 20 visits of psychological care for the majority of people to improve from common mental health disorders, like depression, anxiety, and PTSD – and some people will need considerably more than 20 appointments too. Whether we look at randomised clinical trials (RCTs), or dose-response studies, or manualised treatment guides for specific mental health disorders, we find essentially the same results over and over again (here’s a quick summary). Ten sessions are not enough for most people to reach a stable point of recovery. By comparison, the Medicare system currently offers 50 sessions of psychiatric care, which is more focused on medical treatment. Our system should be equally supportive of medical and psychological treatment options.
One Medicare refund for psychological care
In the current Medicare system, a patient receives less support if their preferred therapist is not a clinical psychologist. There are many different kinds of highly skilled and experienced mental health professionals available in Australia and patients deserve fair and consistent support when they seek help. I should add that there are in fact a multitude of different post-graduate qualifications (i.e., Masters, PhD, and Doctorates) offering expertise in mental health care, besides clinical psychology. In principle, Medicare support should be equitable for patients who see any suitably qualified therapist who delivers the same service. We need a system which values each individual’s right to seek mental health care from a professional they trust.
We should not automatically assume that having one Medicare item for psychological care will reduce support for clinical psychology. There are in fact three possibilities:
- An MBS refund of around $85 per visit for all patients (decrease refund for clinical psychology items)
- An MBS refund of around $125 per visit for all patients (increase refund for other psychology items)
- An MBS refund of around $100 per visit for all patients (meeting somewhere in the middle)
The Alliance for Better Access is squarely focused on the needs of people seeking care. We want to see a system where the Medicare support you receive for psychological care is fair, consistent, and equal. Your choice of mental health professional should not be skewed by financial concerns. If you agree with us on that point, then please consider joining with us in recommending a single rebate at a level of support you think is reasonable.
When you are ready, click the button below to proceed (link opens new tab at Department of Health website).
MENTAL HEALTH PROFESSIONALS (Please take note): Make sure you carefully read the consultation overview before you proceed. In particular, I draw your attention to the section on the ‘Principles of Medicare’ which state “Medicare is a system for the payment of patient benefits, not a remuneration system for doctors.” Let’s all stay focused on the wider public need. Cheers.
This is at times a highly charged topic and comments on this thread are moderated. If you are speaking as a mental health care professional please identify yourself to maintain ethical standards and professional respect for one another. I would like to keep the discussion positive and focused on improving the system to benefit people accessing care. Thank you in advance.