Patients “at risk” of developing a mental health disorder should be able to access Medicare-rebated psychological therapy in the same way diagnosed patients can, the MBS Mental Health Reference Group (MHRG) has recommended.
And the maximum number of rebated sessions with a psychologist a patient can have per year should be lifted from 10 to 40, they suggest as part of a new tiered system of eligibility and funding.
The “at risk” component of the recommendations is designed to encourage GPs to intervene earlier than a formal diagnosis, an idea which experts believe may have significant economic returns to the health system.
GPs would not have to write a mental health plan to make such a referral, they could simply write a referral including the result of a patient-completed questionnaire. It is unclear what a GP would be paid for this new item.
No estimate has been made of how much such an item might add to the MBS, should it be introduced. The federal government currently spends $9 billion per year on mental health services and prevention.
Commenting on the recommendation, Professor Allan Fels, former chair of the National Mental Health Commission, said “the evidence is strong that there is an economic pay-off for early intervention of this kind”.
He also said that such an initiative would likely encourage access for people wouldn’t otherwise be recognised or come forward, for fear of the stigma associated with diagnosis, or of such a diagnosis somehow infringing their chances of future employment.
But not everyone is convinced.
Mental health advocate and psychiatrist Patrick McGorry has been quoted questioning the need for a new “at risk” item, saying there was no evidence of GPs being in any way reluctant to issue a mental health plan.
“Every second person is disclosing that they’ve got depression,” he told the Fairfax Media, saying that there wasn’t a problem with people seeking help, the issue was the availability of services. Most psychologists already had long waiting lists, and most addED a gap fee. Affordability and access were more the issue, he suggested.
Limitations on the number of rebateable sessions has also issue been an issue particularly for patients with more severe mental health illness. This has been addressed by the second major recommendation of the review committee.
They have recommended that GPs be able to oversee a process that would see patients being able to access up to 40 sessions in a year, and for the most severe cases up to 70 sessions.
The MHRG recommends:
- changing the item descriptors to specify that instead of 10 planned sessions in a calendar year, patients can access up to three tiers of Better Access sessions, with each tier allowing a greater number of sessions with:
- each tier to provide access to a different maximum number of sessions within a 12-month period (for example, Tier 1 -10, Tier 2 – 20, Tier 3 – 40).
- access to, and progress through, the three tiers will depend on the severity of the patient’s condition requiring treatment, defined by a number of factors outlined below.
- a patient’s access to each higher level tier would require GP review.
A GP would need to endorse, by way of a review, a patient’s need to progress from Tier 1 to Tier 2 at the completion of Tier 1, and from Tier 2 to Tier 3 at the completion of Tier 2.
The intent, says the Reference Group is that the GP’s central stewardship role be maintained in the proposed tiered Better Access system.
Professor McGorry said that while the increase is welcome, “there shouldn’t be a cap”.
“You don’t cap the number of chemotherapy sessions based on cost,” he said.
The report noted that agreement still has not been reached on whether to give higher rebates to clinical psychologists and limit work for non-clinical registered psychologists to lower tier cases.
A fierce battle between various parts of the psychology profession began late last year after it became apparent that the MBS recommendations would include a tiered system.
Non-clinical psychologists complained bitterly, maintaining that such a system would create an access issue for many of their clients.