The Senate inquiry into mental health funding and administration released their report on 1 November 2011, the same day that the Government went ahead with cutting psychological services in the Better Access to Mental Health Care program. This lengthy report drew together thousands of submissions from the general public and mental health professionals, who almost universally advised the government not to cut mental health services in the Better Access program. Although the senate committee did not come to consensus on the final recommendations, there was agreement from both the Greens and the Coalition that cuts to the Better Access program should not go ahead until the Government can demonstrate that alternative mental health services are in place for people who need them. Disregarding the strong opposition to the proposed changes, our Government has simply proceeded with the plan to cut access to psychological services at the 10 session mark.

On the cuts to the Better Access program, both the report from the Chair and the Coalition report were in agreement that cuts to psychological services need to be stopped immediately. The shared view by both the Greens senators and the Coalition senators was that until services were established to adequately replace those offered in the Better Access program, patients should not be excluded from accessing psychological treatment. As the Coalition senators put it (pages 101 to 109):

1.73
Until the government provides an alternative, effective means to address the needs of people with a severe mental illness, it cannot justify excluding these people from accessing services under Better Access.
…
1.99
Whilst the Coalition appreciates the flexibility of ATAPS, there are concerns that this could result in patchy or inconsistent service delivery across the country. We are concerned that the shift from Better Access to the ATAPS structure is not adequate to meet the challenges of the added requirements placed on the ATAPS program. As a consequence, we share the concerns of those submitters in relation to adequate service delivery.
…
1.116
The Coalition is also concerned about the transitional issues in that the Government is cutting funding for Better Access now, with the expansion of funding of other programs only coming later. Accordingly, the Coalition believes that any changes to Better Access need to be considered in the context of new headspace centres and EPPICs coming online.

The report from the Chair of the senate committee dealt with this issue in the opening recommendations, not only calling on the Government to delay the cuts to services until alternative systems are put in place, but also requesting that an interim program be introduced to the Medicare Benefits Schedule that would allow those with more severe needs to receive additional psychological treatment services (page 80):

Recommendation 1
1.6
The Chair of the committee recommends that the rationalisation of the number of rebatable allied health sessions under Better Access be delayed until it can be demonstrated that other programs (such as ATAPS) are adequately equipped to provide services to people with a severe or persistent mental illness.
Recommendation 2
1.7
The Chair of the committee recommends that the Government consider putting in place an interim program through the MBS that would allow access to six additional sessions under Better Access for consumers who meet tightened criteria based on the severity of their condition.

A related problem which received a lot of feedback from psychologists in the senate inquiry is the two-tiered system in the Better Access program. In this system, clients are given a larger Medicare refund when they see a clinical psychologists – one of the areas that work in mental health care. However, the senate committee also heard from other area of the psychology profession that work in mental health care, whose clients get a substantially smaller refund, despite receiving the same services for the same disorders. This was a divisive issue in the senate committee, because some clinical psychologists feared that their clients would lose access to the larger rebate, and that people with less training would be treated as being equivalent in mental health care delivery. On the other side of this issue, were many other highly experienced and highly trained practitioners, with advanced-level skills in mental health care, who felt that their clients were being treated poorly by the system. Indeed there are many other skilled mental health care practitioners who are not clinical psychologists and it seems fair that consumers should be able to access their services in the Medicare system on a level playing field.

Interestingly though, both the Greens Chair and the Coalition argued in favour of the status quo for the time being. The main reason stated for this is that the evidence they received about this issue was mostly anecdotal, for both those in support and against the two-tiered system.  Greens senators emphasised the need to maintain diversity amongst the various mental health practitioners, in the interests of giving consumers a range of choices of mental health care practitioners. The Coalition argued that the national registration authority (AHPRA) should undertake to resolve the matter of which groups mental health care practitioners are appropriately trained to provide high quality mental health services (page 113):

1.144
The Coalition suggests that consideration be given to referring the issue of the two-tiered system to the Australian Health Practitioner Regulation Agency (AHPRA) for further consideration as to whether current arrangements should be altered, including consideration of all the evidence provided to the inquiry.

And what did the ALP senator have to say about the Government’s decision to cut the Better Access program? (page 86)

Every dollar redirected from Better Access, as part of these measures, will be re-invested into other and new mental health services targeting some of the most disadvantaged people in our community.

Those words will be of little help to the thousands of Australians with a mental health disorder who found out just a few days ago that they can’t receive any more treatment until next year. Some of those people will be strong enough to hold out until new years day, resuming their psychotherapy in 2012, but what then? If they need psychological treatment, the Better Access program has been cut back so severely that now they will only be able to access ten appointments. Even if they only saw their therapist once a fortnight next year, by May 2012 they would be faced with the prospect of having to wait 7 months until they can get another appointment through Medicare. These cuts to psychological services have only just begun to hurt distressed people in our communities, and sadly, we are holding our breath in hope that our decision makers will wake up and reverse this decision before it costs lives.