The Australian Psychological Society’s (APS) submission to the Commonwealth Government’s Medicare Benefit Schedule (MBS) review is an astonishing attempt to restrict access to psychology services for the most vulnerable of Australians. The submission, which was only made available to APS members on Friday, 17 August 2018, represents a kick in the guts to over 60% of Australian psychologists, who may have their ability to provide affordable and accessible services to clients with complex mental health needs significantly reduced.
The submission preferences psychologists who have been “endorsed” by the APS above all other psychologists, for treating clients with “Severe and Chronic/Unremitting Disorders” and “Moderate – Severe Disorders and more Complex Disorders”. This includes disorders ranging from bipolar, autism and ADHD, to obsessive compulsive disorders, trauma disorders, eating disorders or anything else a referring practitioner thinks is “moderate/severe”.
The APS explicitly excludes four “Area of Practice Endorsements” (AoPE) categories from providing MBS rebated services for “Severe and Chronic/Unremitting Disorders”, recommending, and thus inferring, that only practitioners holding endorsements for Clinical, Counselling, Forensic, Health or Education and Development Psychology are competent to treat clients with complex health issues. These endorsed psychologists make up less than 34% of all registered psychologists in Australia.
Additionally, the proposal excludes over 66% of registered psychologists from providing MBS rebated services to clients presenting with “Moderate – Severe Disorders and more Complex Disorders”. It states that these clients should be treated only by AoPE practitioners, or “psychologists who can demonstrate equivalent competence”. While on the face of it, the addition of demonstrated equivalent competence implies that other experienced practitioners will be able to access the MBS for clients with moderate/severe disorders, sources have revealed that the APS requires onerous and unrealistic requirements to be met to demonstrate experience and competence (eg, failing to recognise relevant qualifications which were obtained prior to a psychology degree), which will effectively exclude the vast majority of experienced practitioners from treating clients with a broad range of moderate disorders.
All psychologists are registered with the Psychology Board of Australia. They are required to have a minimum of 4 years of university training and two years of supervised experience, and engage in yearly professional development to keep up to date with knowledge, and supplement their skills, experience and training.
Less than 38% of registered psychologists are “endorsed” by the Psychology Board of Australia across nine separate areas of practice. However “endorsement” does not equate to better clinical skills or greater practical experience. It is not a confirmation of demonstrated and practical expertise. It simply means that the practitioner may have attended university for an additional two years. This study does not necessarily provide the AoPE practitioners with further people and practice skills required to form and build relationship with clients. The endorsement purely recognises an academic achievement which over time becomes less relevant compared with decades of actual practical experience in a specialist field.
To fully appreciate the offensiveness of this proposal, its estimated that up to 50% of “endorsed” psychologists do not hold the higher qualifications now required for AoPE. Historically, what preceded the “endorsement” was simply paid membership of an “interest group” or “College”. When the APS changed to a qualification based endorsement system, paid members of Colleges were grandfathered into the AoPE. The “grandfathered” practitioners may only hold undergraduate qualifications, yet are now preferenced by the APS above psychologists who did not pay membership to an interest group, but hold requisite qualifications.
The proposal is a brazen attempt by the APS to monopolise the market in favour of a select few endorsed psychologists. If accepted by Minister for Health, Greg Hunt MP, it may see registered psychologists with decades of experience and expertise in specialist areas lose their livelihoods. Vast swathes of the population, including the most disadvantaged in the community, may lose access to crucial services, particularly as many AoPE practitioners do not bulk-bill.
Under the proposal, a client with autism, ADHD or or schizophrenia would potentially be restricted to seeking services from less than 33.4% of registered practitioners. A client with a trauma disorder would be restricted to accessing less than 40% of registered practitioners. The remaining 60% of practitioners would have their client base severely curtailed, almost certainly resulting in the closure of many rural and regional practices, where dedicated professionals have formed and built relationships to ensure the best possible services are provided.
Psychologists have slammed the proposal, which they claim is unethical and potentially exposes them to claims of professional negligence, with the APS inferring that general practitioners lack the experience, skills and qualifications to treat complex health issues.
The APS strong inference that a practitioner who was formerly a paid member of a special interest College, or a recent university graduate, is capable of providing better service than a general practitioner who has diligently gained experience by working with clients in the community while maintaining professional development requirements, is plainly offensive.
Australians should be able to choose a medical specialist based on their skills and experience and expertise. If the APS proposal is accepted, clients with complex issues will not be able to access Medicare benefits for their preferred practitioner.
Each year in Australia, approximately one in five people will experience a mental illness. However a recent national survey showed that only 35% of people with a mental disorder had accessed a health service within the 12 months before the survey.
Research by Meadows et al (2015) of MBS items claimed under the nationally funded mental health program, Better Access, shows unequal distribution across the Australian population for psychiatry and clinical psychology services, compared with the equal distribution of general practitioner and non-clinical psychology services. This suggests that distribution of practitioners in the community has an impact on the accessibility of services. It is evident that the APS proposal to reduce number of practitioners able to access Medicare benefits for clients with complex mental health needs will significantly impact on levels of care and outcomes.
If accepted by Minister Hunt, the APS proposal will have the effect of funneling vital health funding to psychologists preferenced because of their privilege/access to higher education, rather than to those with proven and demonstrated skills at treating clients with complex mental health issues. It will result in reduced access to health services and consequently lead to poorer outcomes for Australians who require mental health services. It will restrict access to necessary and vital services for the most vulnerable of Australians. It will unfairly impact on Indigenous Australians, the homeless, those disadvantaged through circumstance, trauma or financial status, those in lower socioeconomic groups and rural and regional areas – in fact, the APS proposal will impact unfairly on exactly those people the Better Access program is intended to support.