Great idea in principle, shame about the reality  

3 minute read

General practice Mental Health

By

Dr Linda Calabresi

The principle behind subsidising visits to privately practising psychologists is admirable, but we have fallen well short of what we were trying to achieve, says Dr Linda Calabresi

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!

Reference:

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

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David King
David King
7 years 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 completely fully booked by providing rooms and receptionist support, in return for no gap counselling services.
I’m sure there are ways that we can rise to the challenges of poor access for low income patients, rather than simply criticising the Medicare item numbers. Maybe we GPs also need to speak up publicly about the enormous gaps in specialist fees. I totally agree with your comment – is any one really worth $800 for an hour or two of work, when some of our patients earn less than $20 per hour or on poverty level benefits?
Maybe this is the real problem, but somewhat of an ‘elephant in the room’.

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sarah Cunningham
sarah Cunningham
7 years 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

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Shastra Morris
Shastra Morris
7 years 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 their fees for patients as required. But the bigger question is why don’t they do anything about specialists and allied health workers and astronomical fees for procedures, ever increasing radiology/ pathology investigations etc., and hospital costs – this is where most of the health budget is being spent, often unnecessarily with lots of investigations, before even the patient is seen, in lieu of a good history and examination – basics! – all in the name of progress! I wonder if we are really progressing – doesn’t look like it to me! This is not to target our specialist and allied health worker colleagues, majority of whom, I’m sure, do good work- it’s the discrepancies in fees, where most of the work is actually done for patients and the way the systems are set up and work. It’s all just snow balling and I can see it all getting worse and worse and becoming more and more inaccessible to the poorer and inequality in Australia increasing and therefore general discontent in the country and going down the path of other countries, where there is much more discontent and then its consequences! Unfortunately! When it is all avoidable , if only people could think more clearly with a better overall perspective, for the good of everyone and not just themselves.
Australia had a world class, low cost medical service system, that was working well. You only had to listen to stories of patients from overseas or Australians traveling and their experiences with the expensive and not so nice medical services they received eg in USA or England (GPS are fleeing from these countries esp England in droves to escape their NHS ) only to return to their GPs in Australia to sort it all out etc.
There is a lot of wastage of money by successive governments also, dismantling and putting in place new systems, names, bureaucracies, every time govt changes, just so they can appear to be doing something different, again apparently in the name of progress. I don’t think we are progressing; I think we are going backwards and wasting a lot of money in the mainstream services in Australia, because of the way political parties are chopping and changing how they want to do things and actually wasting a lot of money.

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