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Access to mental health care services under threat

‘Enough is Enough’….All consumers and psychologists in Australia deserve equal access to Medicare!

The following is reproduced with permission from the Australian Psychologists’ communityrun petition which calls for all consumers and psychologists in Australia to have equal access to Medicare.

Please read the below and sign the petition here.

“Access to mental health care for millions of vulnerable and disadvantaged Australians is under threat. The peak representative body for psychologists, the Australian Psychological Society (APS) has put the majority of its members and their clients’ needs second to the interests of just 36% of all registered psychologists. It has submitted a proposal to the Federal Department of Health’s review of the Medicare Benefits Schedule (MBS) which, if accepted, will have devastating consequences for rural and regional Australians, effectively denying them access to mental health services.

Medicare is the main funding program enabling the Australian public to access psychologists. In a nutshell, the APS has recommended that Australians seeking referrals for mental health issues should be restricted to seeing only 36% of psychologists. The APS has done this by proposing that only psychologists who have been “endorsed” in selected areas of practice by the Psychology Board of Australia can claim Medicare benefits for clients presenting with moderate, severe or complex mental health disorders.

The APS’s proposed three-tier model must be rejected. The existing two-tiered model which provides significantly higher rebates to clinical psychologists providing the same psychological service to clients as registered psychologists, must be replaced with a fair and equitable MBS model which recognises the expertise, experience and skills of all registered psychologists.

We need a single rebate for consumers and their psychologists in Australia! Please sign and support one rebate for all!

By the ‘Australian Psychologists’ Facebook team (a group containing over 1800 psychologists with a diversity of qualifications from all areas of psychology)

Why is this important?

The APS submission (https://www.psychology.org.au/About-Us/What-we-do/advocacy/Submissions/Professional-Practice/2018/APS-Submission-to-the-MBS-Review-Better-Access?) recommends that over two thirds of registered psychologists (many of whom hold higher degrees, specialised training and significant experience in their field) but have not applied for “endorsement” would only be able to provide services to the estimate 10% of clients presenting with mild to moderate disorders. The complicated model states that psychologists may be given an opportunity to “demonstrate equivalent competence” to be able to treat what is, for many, their existing client base. Recognition would almost certainly come at a significant cost. The APS has yet to explain just how this recognition would occur, leaving experienced practitioners at a loss as to how they can protect their livelihood and deliver crucial services to clients.

All registered psychologists are currently permitted to practice across all areas of psychology and mental health and can diagnose, assess and treat clients, regardless of whether they are endorsed or not. Ethical guidelines require psychologists to only provide services within their limits of personal competence.

Endorsed psychologists primarily operate in urban areas, while the majority of psychologists operating in rural areas are non-endorsed. Data from the Psychology Board of Australia’s ‘Area of practice endorsement data tables: January 2014’, shows that only 23 endorsed psychologists work in remote communities across Australia; 212 in outer regional; while 7 969 work in metropolitan/capital cities. Our rural areas have some of the highest rates of suicide in Australia. If accepted, the APS recommendations will leave rural and regional Australians without access to vital mental health care services.

The consequences to Australians in desperate need of mental health care will be disastrous. If accepted, the APS model will result in higher session fees, with clients unable to claim any Medicare rebate unless their preferred practitioner is “endorsed”. Market forces would likely push up out-of-pocket fees to see endorsed psychologists and waiting lists would blow out. By losing a major funding stream, many non-endorsed psychologists would be forced to close their practices, leaving vulnerable clients without access to vital and affordable health services. Many endorsed psychologists do not bulk bill, meaning only those in higher socioeconomic groups would be able to afford treatment for the most debilitating of conditions.

There is no evidence to support that better health outcomes are achieved by “endorsed” psychologists. In fact, a significant amount of “endorsed” psychologists achieved this status through historical paid membership to special interest “Colleges”, and not through demonstrated experience or completing a masters/doctorate degree. Some psychologists were granted up to six endorsements via this process. The Australian Clinical Psychology Association stated that ‘More than half of those clinical psychologists currently endorsed by the Psychology Board of Australia do not have qualifications in clinical psychology…’ (source: https://industry.gov.au/Office-of-the-Chief-Economist/SkilledOccupationList/Documents/2015Submissions/ACPA.pdf). Therefore, many endorsed psychologists hold the same level of training and qualifications as non-endorsed psychologists.

The APS position is a crushing blow to over two thirds of registered psychologists, many of whom will be unable to continue treating the majority of their clients if the proposal is accepted by the Government. It is clear the APS is not acting in the best interests of its members (who currently pay $640 for annual membership) or their clients, by advocating that the majority of psychologists lose access to the MBS.

In fact, if the APS proposal is accepted, 66% of the psychologist board members who are “endorsed”, may personally benefit with increased client referrals, while 64% of registered psychologists will have very limited access to Medicare referrals. Questions must be asked about the ability of the APS Board to represent all psychologists equally, and whether the board members are at risk of breaching their fiduciary duties to the APS with a proposal which effectively destroys the livelihoods of the majority of registered practitioners, for the benefit of a few, including themselves. For over ten years now, clinical psychologist’s services have attracted a $39 higher rebate than non-clinical psychologists. Despite this higher rebate, fewer clinical psychologists fully bulk-bill their clients.

Based on the current Medicare arrangements, the proposed changes will represent a significant increase to Medicare, as the cost of providing the same services already being provided by registered psychologists would increase by 47%.

A notable research project commissioned by the Australian Government (Pirkis et al, 2011) demonstrated clearly that psychologists treating mental illness across both tiers of Medicare Better Access produced equivalently strong treatment outcomes (as measured by the K-10 and DASS pre-post treatment) for mild, moderate and severe cases of mental illness. This research demonstrates clearly that there is no difference in treatment outcomes when comparing clinical psychologists treating under tier one of Medicare Better Access with the treatment outcomes of all other registered psychologists treating under tier two of Medicare Better Access (Pirkis et al, 2011a).
Reference: Pirkis, Ftanou, Williamson, Machlin, Spittal & Bassilios (2011a). Australia’s Better Access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45:726–739″.

You can find the petition here.

Also consider writing, emailing or calling your Federal Member of Parliament, Senators, and your local state government representatives, to share with them why you personally support fair and equal access to essential mental health care services.


4 comments

  1. SteveFitz

    Hi Eva – I have signed and you have my full support

  2. damien

    Great article Eva. The proposal builds on the effect of the Centrelink policy of only accepting Clinical Psych assessments for making judgements about eligibility for such things as disability pensions, unless the person is in a remote area. Indigenous people and other disadvantaged people in urban areas often don’t have access to clinical psychs and are effectively denied access to these services. If accepted this proposal will increase inequity of access to those geographically isolated and those attending bulkbiiing practices, increasing the need for greater spending on programs like ATAPS where people don’t have to contribute to cost of services provided,

  3. Sharon Hulin

    Thanks Eva!

    We are eagerly awaiting the outcome of the medicare review submission, we understand that the final decision will be voted on by our Federal Ministers in Canberra, when the time comes.

    We have a task force and are personally visiting each Federal and Local State Minister, and sharing with them the likely impact in their electorates and our communities, how destructive this impact will be.

    If the Australian Psychological Society’s (APS) proposed 3 tier system is adopted, this will see between 20,000 – 25,000 Registered Psychologists unable to provide 90% of the services, which they currently provide to our community.

    The clients who we currently bulk bill will be forced to:

    Travel to the major cities of Australia (as majority of ‘endorsed psychs’ work within a 30 mins drive of the C.B.D of major cities);
    Pay for the full service up front (rates charged are between $180- $340/ hr) and then claim the medicare rebate back for $124.80
    Be unable to see the Registered Psychologist- who they have been working with, as its likely that that Psychologist will be forced out of business by these APS recommended new trade restrictions on their roles as Psychologists.

    To add some context to this, the role I have personally been undertaking as an AHPRA Registered Psychologist for the last 20 odd years, will see me unable to perform 90-95% of the duties I currently undertake within my profession.

    Tragically, we know both the faces of the people and the personal stories of these individuals- who will be most impacted by this APS system if it is adopted.
    These people are often highly complex cases, who have not previously accessed psychological support, (prior to the Medicare rebate, there were very few services for them to access).
    Often these people are suffering the effects of sexual abuse, (religious organisations, institutional care, or family), domestic violence, suicidal thinking, or the pressures of job loss, financial stress, and or marriage breakdown.

    We currently fulfill a crucial roles within our communities, attending to, supporting and providing treatment to the most vulnerable clients in our “care”
    I am not involved in politics, and have no prior experience of speaking with and petitioning an MP..
    This situation has forced me to ACT, because I know the faces of the people and also the impact that this will have on them if I have to tell them that I am closing my practice and there is no one that will be able to bulk-bill them locally.
    These are the conversations I am dreading having to have.

    PLEASE SIGN THE PETITION

    YOUR SUPPORT WILL ENABLE US TO DEMAND A VOICE FOR ALL THE VOICELESS CLIENTS,
    WHO WILL BE FORCED OUT OF TREATMENT,
    IF THIS IS EVER PASSED IN PARLIAMENT

    Thank you in advance

    Sharon Hulin
    B.A. (Double Hons)
    M.A. Psychology
    MAPPi
    ANZMH

    We

  4. Dr Brooklyn Storme

    I love it. Great work. Did you want to mention rural and remote at all given the doctors are all about the mental health crisis there? Given traditionally the clinicals gravitate toward CBD areas it will have far reaching implications for those communities etc.

    Also IMO you don’t need to say ‘registered’ as Psychologist is a protected title 😊

    Thanks so much for your hard work. You’re an inspiration!

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