Eating disorder treatment just got a boost from Medicare. So why are some experts worried?

New Medicare rebates will help people with eating disorders to access the care they need, including up to 40 psychological treatment sessions each year. So why are some experts sounding the alarm?

Medicare healthcare cards

The federal government spends $32 billion on Medicare each year. Source: AAP

Australians living with eating disorders can now access up to 40 Medicare-rebated psychological treatment sessions each year.

That's four times the number of treatments people with eating disorders could previously access under Medicare, and experts say it will allow them to access the holistic care they need.

"It's a really good thing, momentous really," said Butterfly Foundation CEO Kevin Barrow.
For a really complex mental illness like this, ten sessions is just inadequate. What they'll get now will be so much better, to get longer term care.
However, controversy about the new rebates is already spreading, after an quoted experts concerned that the new plan will "allow insufficiently qualified clinicians to treat complex and life-threatening conditions like anorexia, potentially putting patients in 'great danger'".

The Feed spoke to a number of experts in the field who disputed these claims, but also some experts who said there is cause for concern.
Given that anorexia nervosa has the highest death rate of all mental illnesses, the stakes are high, and it's important to understand where these concerns are coming from.

So, how do the new Medicare rebates for eating disorder treatments work? Do they allow insufficiently qualified clinicians to treat people with eating disorders?

Prior to November 1 2019, a person with an eating disorder could access up to 10 Medicare-rebated psychological treatment sessions annually by visiting their GP and requesting a Mental Health Treatment Plan.

From November 1, people with eating disorders who meet certain criteria will be able to request that their GP prepare an Eating Disorder Treatment and Management Plan instead, which entitles them to up to 40 psychological treatment sessions and 20 sessions with a dietitian over a 12 month period.

The that the November 1 changes mean that "social workers, occupational therapists and all psychologists will qualify for Medicare rebates" for sessions treating patients with eating disorders.

However, Butterfly Foundation CEO Kevin Barrow explained that this is the same group of professionals who already qualified for Medicare rebates for treating patients with eating disorders.

"The concern that's been raised is that people will not be adequately qualified to treat an eating disorder. But as of November 1, nothing will have changed from the 31st of October as to who treats an eating disorder," Barrow told The Feed.

The Department of Health confirmed that the Medicare changes do not change which health professionals are able to provide Medicare-rebated treatment for patients with eating disorders.

"The Department strongly refutes the assertion that unqualified practitioners may be able to claim rebates," a spokesperson told The Feed.

"Currently, providers of services are required to be appropriately trained and qualified to provide medical treatments, including psychological treatment and support through Medicare for Australians experiencing mental illness."

The outlining exactly how the changes work, and who is eligible.

However, there is a small change hidden in the legislation, which does - on paper, at least - expand the group of practitioners who can start offering certain Medicare-rebated treatments for eating disorders.

Associate Professor Vida Bliokas, current president of the Australian Clinical Psychology Association (ACPA), told The Feed she is concerned about a change in wording in the new Medicare Benefits Schedule items.

Where previously a range of health professionals including occupational therapists and social workers could offer Medicare-rebated treatment for specific "focused psychological strategies", the changes introduced last Friday appear to allow those same practitioners to offer a much broader list of rebated psychological treatments.

Bliokas said the ACPA is concerned that the changes allow many different kinds of health professionals to offer advanced treatments that were previously only provided by clinical psychologists, who typically undergo eight years of training.

And because the new Medicare items don't require practitioners to have any specific credentials indicating their experience treating eating disorders, Bliokas is concerned that it's about to become very difficult for eating disorder sufferers to work out whether they're getting the most effective care.
Unfortunately, damage in therapy is not a neutral thing.
"In psychotherapy, you can be incompetent as the therapist and think that's a neutral event where people just don't get better. In reality, it's actually a negative event -- it takes people backwards."

For anyone who is concerned about the qualifications of the practitioners they're referred to, Professor Tracey Wade has some suggestions.

Professor Tracey Wade has worked as a clinician in the area of eating disorders for three decades, and is a member of the steering committee of the National Eating Disorders Collaboration.

She agreed with Barrow that the latest changes to Medicare rebates do not diminish the quality of eating disorder treatments, and should be seen as a largely positive change.
I think this is an opportunity for people -- it offers them for the first time enough sessions under Medicare to get the treatment they need.
"Current evidence-based treatments for anorexia nervosa in particular do require 30-40 sessions. Clinicians have been able to offer those sessions, but they haven't been able to complete them in a calendar year."

Wade agreed that medical professionals need specific expertise and experience to best treat eating disorders, and said that the National Eating Disorder Collaboration and the Australian and New Zealand Academy for Eating Disorders are currently working on developing a credentialing system for practitioners.

In the meantime, Wade pointed out that GPs are well placed to refer patients to qualified specialists.
GPs don't send people who need brain surgery to gastroenterologists.
The Butterfly Foundation also maintains a database of mental health professionals with an understanding of eating disorders, and can suggest local experts qualified to treat an individual's health condition.

Wade said that support organisations and advocacy groups could assist by providing a checklist of questions people can ask their mental health professionals to ensure they have found a provider with expertise.

"I've been advising this for years, but consumers should feel free to ask the person they're referred to what expertise they have, whether they're offering evidence-based treatments, and what their outcomes are like."

Barrow added that mental health professionals from many disciplines are capable of providing excellent treatment for eating disorders.

"Just because you're a clinical psychologist doesn't mean you're fantastic at treating an eating disorder, but if you have an interest you'll build skills."

"Sometimes the discipline is less important than the knowledge. There are outstanding, highly qualified social workers who are great at treating eating disorders."

"What we care about is an improvement in accessible, affordable, quality care. That is really taking a major step forward from November 1, and for that we give the current government a lot of credit."

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6 min read
Published 4 November 2019 4:12pm
Updated 22 February 2022 5:25pm
By Sam Langford

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