For those who have been following this issue for a while, you’d be familiar with the pledge that The Greens made to disallow the cuts to the Better Access initiative following the senate inquiry on mental health care in 2011. Senator Penny Wright, mental health spokesperson for The Greens, issued a statement on 24 November 2011, pointing out that “the current system is just not ready” for the cuts to go ahead and that the Government would “need to demonstrate that other programs are adequately equipped” to meet the demand for mental health care. This statement received strong public support, so it was a bit of a surprise to everybody when just a few short months later, they withdrew their disallowance motion. The Greens issued another statement putting the Government on notice, which stated that “time is ticking” and that the Government “needs to ensure these programs are ready come January 1 next year”. Well I hate to say it, but time is up. The new year has come and gone, with all indicators showing that the rate of public access to psychological treatment is fading and that the level of care per person is shortening.

All through the month of December, we have shown that the alternative program offering psychological treatment (ATAPS) is simply unable to meet anywhere near the capacity of Medicare, either for disadvantaged groups, or for the treatment of mental health disorders more generally across the Australian population. It covers some of the gaps, but it is a patchy program by design, much better suited to picking up some of the niche areas missed by bigger systems of care, such as Medicare.

Unfortunately, all of the emphasis put on ATAPS by the Minister has resulted in the program being dramatically overstretched, such that the few patients who do qualify for services based on demonstrating more complex needs for treatment are being crammed into the program. This has led to a situation where Medicare Locals managers have applied ‘demand management strategies’ to deal with the influx of patients. This means that appointments are being rationed with voucher systems, 6-session appointment limits, and a maximum GP quota of 3 referrals. An ATAPS report from 2006 stated that “Demand Management is a cop-out” and identified a broad range of problems with the prior implementation of such strategies in the ATAPS program. What this means is that our Government knew that ATAPS wouldn’t be able to cope with the demand and that it was well-known by both policy-makers and practitioners working in the field that rationing treatment wasn’t an effective way to address the issue, but they just went right ahead anyway.

There are a couple of things that bother me about the entire concept of ‘demand management strategies’ being applied to mental health care in Australia. First, you can’t curb the public demand for treatment until the people who want treatment actually recover from their mental health condition… which in most cases requires treatment. Second, the concept of demand management is based on there being inadequate resources to meet the demand. The limitation in this case should, in principle, be the human resources required to meet public demand for mental health care. In the case of the South Brisbane Metro area where the most recent ATAPS memo was leaked, the limit is the allocated funding not a shortage of therapists. But deeper than all of that, these strategies expose the reality that our Government is significantly under-funding mental health treatment in the first place, trying to scale back on costs as far as they are able to. What really bothers me is the suggestion that public demand for psychological treatment can be properly ‘managed’ by simply cutting off treatment. That isn’t management, that’s neglect.

We have shown as clearly as we possibly can that we still need Better Access and it is premature to rely on such an over-stretched, under-funded, and under-staffed program as ATAPS. The situation may change in years to come, but right now we are just nowhere near ready to scale back Medicare – yet that is exactly what our Federal Government has done. Fewer patients will be seen for even shorter periods of time, in a program that the Government claims is meant for people with a need for more intensive psychological treatment. So you might be wondering where do The Greens stand on this, given their prior statements on the issue?

At the beginning of December I asked Senator Penny Wright where she stood on this and whether she would help us lodge our formal petition with around 10,000 signatures. The senator declined to lodge our petition, because (quote) “the reforms to Better Access as advocated by the Alliance for Better Access are not strictly consistent with Greens policy”. It is hard to understand how the reforms we have suggested go against Greens policy, when we are simply calling for patients with a mental health disorder to have fair access to the bare minimum level of psychological care based on the scientific research in the field. We were told that the extra 6 sessions that The Greens compromised on for 2012 were just a temporary measure and that the funding cut from Medicare must now be redirected to other programs.

Make of this what you will, but personally, I think The Greens have something to answer for here. The way I read it, they pledged to oppose the cuts to Better Access and then later retracted, putting the Government on notice that it would have to prove that other programs would come up to speed. The deadline has now arrived and all of the indicators show that the juggling of funding has not produced anywhere near the capacity of Medicare to deliver psychological treatment, even to the most disadvantaged groups. Now they say they aren’t prepared to do anything about the 10 session limit. So what has happened to their warning that “time is ticking” for the Government? Time has run out and the situation has in fact become worse.

I have urged The Greens to reconsider, and likewise, I ask all of you to please join me in urging them to take a stand on this vital issue! You can email The Greens mental health representative Senator Penny Wright about this via [email protected]. Please also make sure that the leader of The Greens, Senator Christine Milne is also CCed in on your email too ([email protected]), because access to affordable mental health care should be that much of a priority to all of us. Join us in speaking out – every voice makes a difference!