Medicare support for psychological care has been problematic for many years. At the National Conference, the Australian Mental Health Party will propose several areas of reform to directly address and resolve these issues.

More appointments for those who need them

In the current Medicare system people can access up to ten visits of psychological care per year. Research consistently shows that this level of care is woefully inadequate for the majority of people seeking help (click here for a summary). There are two possible solutions to this problem: (1) providing a higher upper-limit of appointments, or (2) moving away from a fixed number of sessions and towards a more open-ended or time-based model. A relatively simple change in policy might allow up to six months of uninterrupted therapy with review. Importantly, our party would like to see reforms where GP review allows further care for those who need it.

Revising diagnostic and referral limitations

As it stands currently, people can only access psychological support from Medicare with a GP referral and a diagnostic label for a mental disorder. For many, this limitation prevents help-seeking due to stigma, concerns about implications for work and access to insurance, or simply because people may not wish to label their distress in that way. There’s also the additional problem of the approved list of disorders for Medicare being somewhat out-dated, relying on older diagnostic codes which have either been replaced already or are about to be changed next year. Put simply, Medicare support cannot be provided for those who experience a type of distress which isn’t on the approved list (page 11 of manual). We believe that some of these restrictions may need to be revised as they impose significant barriers to accessing care for vulnerable populations. People shouldn’t need to see a GP for the sake of a piece of paper or be tagged with a label in their medical file, just to get some help. There are better ways to manage the key concerns around this and we intend to explore those possibilities.

Access to a wider range of therapies

When Medicare access to psychological support was first conceived a decade ago, it was based on an older system of brief GP-delivered interventions called ‘focused psychological strategies’ (more info here). This brief set of techniques was typically trained in two-day workshops, which is in stark contrast to the training of psychotherapists across the mental health disciplines in more comprehensive evidence-based therapy approaches. Our Medicare-approved shortlist of therapies desperately needs an update as it does not reflect the range of evidence-based approaches therapists are qualified to deliver (see pages 13 and 14 for the Medicare approved list). In order to work effectively and meet the unique needs of each individual, therapists require greater flexibility. Mental health professionals are in the best position to select up-to-date approaches, matched to the presenting needs and preferences of the client, in the context of a person’s current situation. It is not in the interests of people seeking help to have an administrative system which places external limitations on therapy and compromises best practice.

Fairer recognition of practitioner skills

In the rush to establish a simple system for accreditation back in 2006, the government settled on a model which links provider eligibility for psychological treatment items with the professional title of ‘clinical psychologist’. Of course, clinical psychologists are one important type of therapist, however there are many other kinds of skilled mental health care practitioners.  The current Medicare model has had a detrimental impact on the diversity of training (for psychology in particular), with other kinds of postgraduate training courses closing down all across Australia (for example). Our party will explore the development of a fairer system to better identify skilled mental health care practitioners. We will develop a new model which can independently verify skills and knowledge relevant to each mental health profession without prejudice or favour. We hope this will resolve tensions within the sector and allow greater focus to return to the needs of people who access therapy.

Consistent levels of Medicare support

Further to the above points, the impact of this fragmented system has been that people seeking care get different levels of support from Medicare depending on who they see. For example, a person may be referred to receive cognitive behaviour therapy for a diagnosis of depression, but depending on which therapist they see, the Medicare system will provide a smaller or larger refund. In our view, the Medicare system should not put people at a financial disadvantage over their choice of therapist. Best practice in mental health care needs to empower the treatment preferences of those who seek help. We will call for a Medicare system with fair and nationally consistent support for all people when they reach out for help.

Please support us by joining the party (here). We hope to see you at our National Conference to further develop our policy ideas!

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. Let’s keep the discussion positive and focused on improving the system to benefit people who access care. Thanks in advance.

Ben is a Counselling Psychologist with an interest in psychotherapy and evidence-based policy. He co-founded the party with the aim of bringing positive and preventative mental health care to the top of Australia’s political agenda. Our party strives to have inclusive representation across all mental health professions and members of the public including people with lived experience, family and carers, and all others with an interest in positive mental health and well-being. We believe that good mental health belongs to all of us and that if we hope to change society, then we all need to identify personally with the way forward. If you would like to get involved and help us find better solutions, please contact us (at communications@amhp.org.au). We would love to hear from you!

9 comments

  1. Judy

    Reply

    I thought that a GP had the discretion to provide a referral for more sessions if they are required.

    • Ben

      Reply

      No, unfortunately the initial GP referral covers six appointments, with a review allowing a further four – coming to a total of ten Medicare sessions. After that, people are on their own and for those who cannot afford it, that means no more access to psychological care. Therapy abruptly ends.

      • Andy

        Reply

        Is it not 10 Medicare sessions in a calendar year and then your GP can issue another referral that can be used for Medicare claims in the next year?

        • Ben

          Reply

          The system operates on a per calendar year system running from 1 Jan to 31 Dec each year. People who get a GP referral around October are really the only ones who have any hope of continuity of care under such a system. For example, if you attended weekly appointments for ten visits, then your support from Medicare simply runs out within three months. By contrast, those who depend on Medicare support to access care will need to either ration out their appointments across the year or go without therapy for months on end – sometimes going without for the majority of the year. It is very difficult to assist a person to make meaningful and lasting changes in their life, when appointments are so far apart. The best research we have on the optimal frequency of psychological care actually shows that we need to be providing more regular appointments – with evidence showing that twice weekly visits in the first few weeks is associated with faster rates of recovery, particularly with higher initial levels of distress.

  2. Reply

    What is your position on the question of parity for Medicare rebates for Accredited Mental Health Social Workers and Registered Psychologists? Currently, 1 hour individual focussed psychological strategies sessions with the former profession attract a Medicare rebate of $74.80 and those with the latter attract a rebate of $84.80 despite the same service being delivered. This difference risks undermining the professional standing of Mental Health Social Workers and also makes bulk-billing clients less affordable. Don’t we also have to consider the well-being and professional sustainability of those who are working to provide psychological care?

    • Ben

      Reply

      Thanks for your question Ash.

      You might notice that throughout the above article we talk about ‘psychological care’ rather than the discipline of the mental health professional. The final section on ‘consistent levels of Medicare support’ attempts to clarify exactly this issue you are asking about. We must all remember that the Medicare refund is to support people in getting help. Medicare is not a reward for training of the therapist. People reaching out for help shouldn’t be disadvantaged if their preferred therapist is a mental health social worker, or any other category of professional. The services we provide are functionally (and technically) equivalent and the outgoings of running a practice where we deliver psychological care are the same across the various mental health professions. In my view, the Medicare rebate must be corrected to provide a fair and nationally consistent amount of support for all people, to empower a meaningful choice of an appropriate therapist for their needs. The question is how to assess mental health competencies relevant to the MBS item for psychological care. I think we can work together, across the mental health professions, to arrive at an agreeable set of standards to protect the public. What do you think?

  3. Reply

    Referrals need to reflect needs of the consumer not some arbitrary set of numbers. Visits may need to be Two or three visits or multiple visits of weekly or fortnightly over original contact. The potential for psychology and social work singularly or co-operatively may be desirable,Stephen Brown, Social worker and educator.

  4. Jason

    Reply

    What is the party’s view on Medicare provider number accessibility for university qualified counsellors?

    • Ben

      Reply

      Hello Jason and thanks for your question. At this early stage we are at the beginning of formulating our position across the five areas shown in the article above. Your question speaks to one of those factors, namely looking for a system where there is a ‘fairer recognition of practitioner skills’. What we are hoping to arrive at is a model that can identify skilled mental health care practitioners across all of the training pathways. There are a wide range of mental health care disciplines, so what we are interested in looking at are the skills and attributes required to work effectively in this space. Some training pathways put emphasis on testing and mental health assessment/diagnosis, whereas others focus more on psychotherapy practice, or linking people to community resources. Our view at present is that all of these factors are important for people referred under the Medicare scheme. The question is how to identify a professionally neutral benchmark and find the gaps for various practitioner groups so that the right kind of training can be done to meet those basic minimal standards of care.

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