25 September 2017

Great idea in principle, shame about the reality  

General practice Mental Health

Let me say at the outset that I’m definitely a fan of the initiative that allowed subsidised visits to psychology services for patients with mental illness. Or more particularly, I’m a fan of the principle behind better access to psychology services.

It has definitely been a godsend for some of my patients, and I have enormous respect for the skills of the practitioners to whom I refer. 

My issue is that these services remain out of reach for most of my poorer and more vulnerable patients. In the area where I practise, which isn’t especially affluent, I am unable to find a psychologist who will accept to Medicare rebate alone for a consult. And the out-of-pocket costs for the patient are significant – certainly enough to ensure they are inaccessible to anyone struggling financially.

And it’s not only private psychologists. Recently I tried to find a psychiatrist who would accept only the rebate for a single 291 consult (the one-off opinion and report) for a patient who might have adult ADHD. Despite the rebate being worth over $380, the best I could find was a psychiatrist, many kilometres away, who only charged $158 above the rebate!  My patient is unemployed, largely because of mental-health issues, so even the $158 proved prohibitive. The closest psychiatrist with expertise in this area wanted to charge $800! Who is worth $800 for one consult? Isn’t it only orthopods who are supposed to have a God complex?

You have to think what has happened here is that these practitioners have simply increased their fees in accordance with the rebate. 

Have we really improved access to these services for everyone, or just for the wealthier in our community? The people who could afford the services prior to the subsidy. Certainly the psychology industry appears to be booming. Statistics from the AIHW show that psychologist visits have more than doubled in the last 10 years,1 but who is going? Not my single mother struggling with two small children and post-partum depression. Not my 40-year-old postal worker who has developed debilitating panic attacks and has used up all his sick leave. And not my 34-year-old unemployed man who may or may not have adult ADHD.

For these people, I’m faxing off referrals to the faceless bureaucracy that determines access to mental-health services through ATAPS – the latest reincarnation of community services which we had long before these mental health treatment plans and psychologist subsidies. No doubt these services continue to be overwhelmed and under-resourced, as they struggle to provide care for our most needy.

The principle behind subsidising visits to privately practising psychologists is admirable, I just fear we have fallen well short of what we were trying to achieve. Another Red Queen moment perhaps  –  running faster and faster to stay on the same spot!


1. https://mhsa.aihw.gov.au/services/medicare/

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3 Comments on "Great idea in principle, shame about the reality  "

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Shastra Morris
Shastra Morris
27 days 13 hours ago
Great article, Linda. I’m a GP who worked in Eastern suburbs of Melbourne for 30 years and recently moved to Mornington Peninsula. I agree wholeheartedly- my experience is exactly the same, over so many years – very, very difficult for the not so well off patients and the disadvantaged in our communities, who have the most significant mental health issues and really need the extra help, who can’t afford the psychologists and psychiatrists! The successive governments are only after GPs and getting them to bulk bill – would have been better left to GPs discretion, most of who were adjusting… Read more »
sarah Cunningham
sarah Cunningham
28 days 2 hours ago

And now they are messing with the fabulous mental health nurse programme which was a godsend for our poorest and most seriously ill mental health patients

David King
David King
28 days 10 hours ago
Indeed access to health care is a major issue across the board, made worse by the inequality in our society and the high cost of specialist care. It is a shame that the Better Access scheme seems to bear the bulk of criticism for these broader access challenges. Many divisions of General Practices, then Medicare Locals, organised block funding for more disadvantaged groups to subsidize psychology services. My practice provides a room free of charge for a part-time psychologist so they can ‘bulk-bill’ under a GP mental health care plan. Maybe a group of practices could keep a psychologist almost… Read more »