Fears for mental health patients after MBS cuts

Removing phone items leaves the vulnerable and unsafe worse off, and favours drug-focused therapy, psychiatrists say.

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With the bulk of GP and psychiatry phone telehealth items wiped, people struggling with mental health could be among the first to feel the pinch. 

Last week, the Department of Health gave the final remaining temporary telehealth items the boot, even as covid numbers begin to tick up once again.  

Most video items were made permanent at the end of last year, and some phone items will remain available for patients in MMM6 and 7 regions. 

Items numbers which hit the cutting room floor include 92746, which covered Level C GP phone consults, as well as 91840 and 91841, which covered phone consults with psychiatrists lasting longer than 45 minutes.  

The Royal Australian and New Zealand College of Psychiatrists said it was “disappointed” with the cuts, as did RACGP vice president Dr Bruce Willett.  

Other organisations have gone further in their criticism.  

The National Association of Practising Psychiatrists argued that taking away phone consults was a “movement away from genuine trauma-informed, individualised psychiatric treatment” and would disadvantage patients who may not be able to access video consults for any number of reasons.  

“By maintaining the video consultation equivalent of 91840 but not the telephone equivalent, the Department of Health discriminates against the most vulnerable of patients, who are generally not able to access the required continuity of care and/or specialist psychotherapy via the public mental health system,” NAPP says. 

“Maintaining Medicare rebates for only shorter psychiatric telephone consultations prioritises medication-focused psychiatric treatment and restricts patient access to trauma-informed psychotherapy treatments, which for many are first line treatments and not accessible via the public mental health system.” 

Taking away longer phone consults won’t just hurt the extremely vulnerable people seeking these more complex private treatments, but also people on the larger end of the wedge, according to Lived Experience Australia, a consumer organisation representing people with mental health conditions and their carers. 

“Not everyone can see a private psychiatrist or psychiatrist in a public system,” LEA chair Professor Sharon Lawn said.  

“Only a very small number of people in crisis or severe mental illness even see the publicly funded clinical mental health services in the community.  

“The vast majority of people are seen by general practitioners [for mental health needs].” 

Professor Lawn told The Medical Republic that there were a multitude of reasons why people may need phone telehealth over video, ranging from internet access to concerns for safety to plain inconvenience.  

Phone conversations can also be much more discreet. 

“A really good example is where the person may live in an unsafe environment, and be fearful or worry about their privacy and the confidentiality of the conversation, particularly if it’s a family violence situation,” Professor Lawn said. 

So much of what good Healthcare is remains invisible to others who are fortunate to have good health and good access to healthcare. There are many of our most vulnerable and housebound patients who need long Telehealth consults.

Yeah NOT video because that’s privilege. https://t.co/jpDm7TEs9W

— Dr. Karen Price RACGP President ? (@brookmanknight) July 2, 2022

The importance of supporting ease of access also cannot be understated, particularly for people experiencing a mental health crisis.  

“Sometimes, the person doesn’t always understand that they need help,” Professor Lawn said.  

“Having the convenience of it being in the house, where [the carer] won’t have to try and encourage them to get in the car to go to see someone is a much, much easier scenario.” 

When comparing phone and video telehealth, phone tends to have the lowest barrier.  

Professor Lawn described one situation in which a woman was on the phone, trying to get help for her husband. 

“The person on the phone said, ‘oh, you know, he just needs to come to the phone’, and she said that he can’t, he’s on the floor in a fetal position, he cannot come to the phone,” said Professor Lawn.  

“In that scenario, they couldn’t actually do a video conference, but at least there was some contact via phone.”