Above video: Mental health across time and place
The scheme providing Medicare rebates for psychology services needs an overhaul and could be wasting taxpayer money, according to new research.
The publicly-funded Better Access Program - which provides up to 10 subsidised therapy sessions a year - costs taxpayers more than 15 million dollars a week.
The government is currently considering expanding the program but Dr Sebastian Rosenberg from Australian National University Centre for Mental Health Research said the scheme may be failing people with complex mental health needs.
“Our system only supports people with mild or extreme mental health conditions - there’s not much in between," he said.
"For someone who is in need of help and needs a team of healthcare professionals, but perhaps not suicidal, doesn’t have anywhere to go.”
The Better Access Program was introduced in 2006 to help Australians with common health problems like mild depression or anxiety.
The ANU study found more than seven billion dollars in the last nine years has been spent on the program but with no reporting that services actually had an impact.
Dr Rosenberg said one reason is that only half of patients report back to their GPs after their ten sessions.
This research isn’t about discouraging the government from investing money in mental health, but ensuring patients get the right care in the right way.
A Productivity Commission review into the effectiveness of the nine billion dollars spent annually on mental health is taking submissions.
But a proposal to expand the scheme has been put forward in the Federal Government’s Medicare Benefits Schedule Review.
Dr Rosenberg says such a move would represent a massive taxpayer-funded gamble given how little is known about the program’s outcomes.
“In 2009 two thirds of clients into Better Access were new but by 2016 only a third were new to the program,” he said.
“Repeat clients seems to indicate people did not get the care they needed when they needed it."
Better Access doesn't solve affordability
As part of the Better Access Scheme, patients are provided mental health care plans by their GP for up to ten rebated sessions a year.
A clinical psychologist attracts a rebate of $124.50, while for generalist registered psychologists the rebate is $84.80.
With psychology sessions costing upwards of $200 in some clinics - mental health treatment is still inaccessible for many people, says the founder of headspace and executive director of Orygen Professor Pat McGorry.
“The co-payment gap is a barrier, especially for young people,” he said.
“That’s why headspace insists on bulk billing.”
Cheaper services have blown out the waiting times for services at headspace centres across the country, says Mr McGorry.
Certainly we’ve seen people die on these waiting lists from suicide.
Professor McGorry said headspace often has trouble recruiting experienced psychologists.
“There is a huge financial incentive for practitioners go to elsewhere because of the demand for their services,” he said.
Tech solutions
Clinical psychologist Dr Alicia Franklin who works in a private practice in Sydney explains that cost reflects the training and experience of a psychologist.
“Other contributing costs include - running a practice, registration, insurance, rent and advertising,” she said.
Price can depend on location.
“If a psychologist is in a lower socioeconomic area they might lower the cost to reduce their fees.”
She believes the Better Access Scheme is a valuable initiative but doesn’t solve affordability issues.
“It improves accessibility and affordability,” she said,
“But it certainly does not solve all the issues regarding mental health accessibility.”
Dr Franklin supports initiatives like online therapy and counselling to make psychology services more accessible.
“The research shows that there isn’t too much difference in clinical outcomes in getting treatment online,” she said.
“But the mental healthcare plan hasn’t caught up with that.”
Dr Franklin believes tech-psychology with grow in the next decade.
“I think there needs to be more done in that space.”
