A few days ago we heard that BeyondBlue is now calling for their NewAccess program to be rolled out nationally and funded by Medicare. We’ve talked about NewAccess a couple of times previously on our Facebook Group (in July 2013, in August 2013, in March 2016 (twice), and November 2018). A number of the concerns we raised seem to have been overlooked in this new push, so I’m hoping this short blog post refreshes everyone’s memory.
I’d like to start by making it really clear that I’m not against the NewAccess program, or the idea of making a dedicated program where people with relatively mild levels of distress can receive structured psychoeducation about basic CBT principles. The idea has merit, but like anything in this space, it all comes down to the way we implement new policy. And if we are going to do that, then let’s allocate some dedicated funding for it rather than drawing from the funds of other mental health care programs which are already under-resourced.
In short, the NewAccess program provides a brief training model to qualify mental health coaches to provide low-intensity CBT. When this program was first trialed, we raised some concerns about the plan for the program to be funded by other programs. From a quick google search, I can see that the NewAccess program is now funded by Primary Healthcare Networks (PHNs) but the proposal now seems to be that Medicare would foot the bill. It looks like sessions for the Better Access scheme (i.e., Medicare) would be cashed out to NewAccess as part of the stepped care framework.
However, what happens if a person uses up their sessions with NewAccess and needs to step up to higher intensity services? If their annual Medicare rebate has already been cashed out to fund these low-intensity services, then how will people access psychotherapy later on if they need to? Where do those people go if Medicare won’t provide any further support?
There are broader issues here too around defining the scope of this program. For around a decade, political representatives for both major parties have denied that Medicare’s Better Access program targets people with moderate-to-severe and complex mental health issues. It has been repeatedly stated that Medicare was designed for relatively mild problems. It seems like the NewAccess program is being promoted as a solution to address the unmet need of mild mental health issues. If that’s the case, then what role, if any, do psychologists and others have in the provision of psychological care in the Medicare system?
If the plan is to step up the level of care when needed, then will we see Australian politicians finally accept that the Better Access program does target moderate-to-severe and complex mental health issues in our community? It’s hard to imagine that being true in a context where the program has been capped at “ten sessions, with no exceptions”. If we accept the claim that NewAccess meets an unmet need to address mild distress, then it stands to reason that the number of sessions allowable for the Better Access program needs to be doubled or left uncapped so that fully accredited mental health care providers can do their work in the system.
There are some workforce issues in this proposal as well. If there is such an unmet need for low-intensity therapies aimed at optimal well-being, then I can’t help but wonder why the existing workforce of counsellors and psychotherapists aren’t being better utilised? That is, Australia has an existing workforce of counsellors and psychotherapists who do not qualify as health practitioners, but otherwise have extensive postgraduate training. Would it not be more sensible and ethical to provide appropriate training to those practitioners in low-intensity CBT, rather than training a new workforce who potentially have just one year of training in mental health care?
You may be wondering what the training of a mental health coach consists of in the NewAccess program? Here’s a description from the BeyondBlue website:
The training is apparently competency-based, and follows the UK IAPT training model provided by a group called the CBT Institute with a view “to develop Australia’s first stepped care IAPT service”. From what I gather, there’s six weeks of intensive training, then supervised practice with real people in conjunction with some additional unspecified training across a one year period. We’ve heard concerns that trainees have been sought with no background in mental health care, no prior training or qualifications and that supervision of cases was haphazard. If you’re aware of further details or information on what that training consists of, please let us know in the comment thread below.
Aside from these concerns though, what I’d really like to know is why can’t we just call this psychoeducation if that’s all it really is? Why is it that policy-makers feel the need to shoe-horn all supportive mental health care interventions into psychotherapy? In my view, when we try to frame everything as a form of psychotherapy we devalue so many other forms of effective mental health care – including powerful and transformative approaches like creative arts therapies and peer support. It seems to me that framing psychoeducation as psychotherapy in this case is more about sourcing funding from Medicare than about making the case that this program deserves support on it’s own merits.
PLEASE NOTE: 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.