Each time that concerns about cuts to the Better Access program have been broadcast across the media, the Federal Minister for Mental Health has been quick to reassure the public that people who need more than ten appointments with a therapist will still be able to access a range of other services, including services provided through the Access to Allied Psychological Services (ATAPS) scheme. But are these claims true? In a word, no.
Shortly after the Minister for Mental Health started making these claims, a statement on the Medicare Australia webpage on national mental health reform was released, which appeared to confirm that people who need more than 10 services would not be left in the lurch (emphasis added):
“Is it a new measure that will affect my family or me? If so, how are we affected?
Yes, this measure will affect people who receive more than 10 allied mental health services, per calendar year, under the Better Access initiative. These patients are likely to have more complex needs and may be better suited for referral to more appropriate mental health services such as the Australian Government’s Access to Allied Psychological Services (ATAPS) Flexible Care Packages.”
About a week ago, the draft of the Medicare Benefits Schedule for 2011 was released, and our information is that the government are in the process of formalising this document by tabling it in parliament. Over the last few days, there have been quite a lot of mental health consumers and Medicare providers who work in the scheme who were shocked to learn that those who need more than ten sessions will not be able to access services through the ATAPS scheme if they run out of appointments with their GP referral to the Better Access program (page 45 and 50, emphasis added):
“Services provided under the Access to Allied Psychological Services (ATAPS) should not be used in addition to the ten psychological therapy services (items 80000 to 80020), focussed psychological services-allied mental health services (items 80100 to 80170 or GP focussed psychological strategies services (items 2721 to 2727) available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year.”
In other words, GPs and psychiatrists referring patients to a psychological service provider will be required to speculate about the patient’s ongoing treatment needs from an initial brief consultation. Given that GPs are also having their time with patients shortened with the new budget cuts, they will be under enormous pressure to make an accurate prediction in advance. If it turns out that a patient actually needed more than ten sessions of psychological treatment, there will be no options for that patient to receive psychological services when the Better Access appointments run out. So much for the reassurances!
It is difficult to comprehend how a GP could predict ahead of time whether a patient might need more than ten sessions of psychological treatment, particularly in cases where the patient may not trust someone they have just met. In a lot of cases, psychological problems are sensitive and personal, so it is quite understandable that people may not open up to their GP and in some cases would prefer to get their referral to a therapist and establish trust from there. How on Earth could any health professional assess the ongoing mental health care needs of a patient in advance from a brief initial consultation? And what are people supposed to do if their situation deteriorates rapidly? The implication that people who are referred to the Better Access program will have their therapy cut short at ten sessions has left many of us wondering if the government is trying to make the Better Access program so difficult to use that people stop using the program altogether.
ATAPS is a capped program which has a budget to provide services to a limited number of people. Even with these modest funding increases flagged in the budget, the capacity for the ATAPS program to deliver services will be constrained by financial concerns rather than the presenting needs of people with mental health disorders in the community. For large numbers of people in regional and remote Australia, receiving treatment at an EPPIC or Headspace centre is just not an option, regardless of whether that person would be willing to front up to a large mental health clinic signposted out in front of the building.
These changes have wrestled mental health care back into a capped and under-resourced system with a psychiatric focus. The reality is that there are insufficient numbers of psychiatrists to service mental health care in the community, which was one of the core reasons why the Better Access program was established in the first place. Frankly, this step is a cynical move aimed at reducing mental health services from the Australian community to save a few dollars. Whoever made this choice doesn’t appreciate the cost of their decision on the lives of people with mental health disorders trying to recover in our society.