Medi­care must dif­fer­en­ti­ate be­tween men­tal health op­tions

The Weekend Australian - Travel - - Health - KAREN GOODALL-SMITH

THERE is no ques­tion that spe­cial­ist clin­i­cal psy­chol­ogy ser­vices should con­tinue to be in­cluded as part of Medi­care. The enor­mous ben­e­fit to the over­all health of the Aus­tralian pop­u­la­tion is not un­der ques­tion. How­ever, it is time to fine-tune Medi­care’s new Bet­ter Ac­cess to Men­tal Health sys­tem, as there are far too many peo­ple pro­vid­ing ser­vices — and I sus­pect there will be many more be­fore long.

While Medi­care has recog­nised spe­cial­ist clin­i­cal psy­chol­o­gists in their own right, and pro­vides a sep­a­rate level of re­bates, it has also cre­ated sub­si­dies for what it terms ‘‘ fo­cused psy­chol­ogy strate­gies’’. In my opin­ion, this area needs to be mod­i­fied.

The re­quire­ments for providers of fo­cused psy­chol­ogy strate­gies un­der Medi­care are com­pletely dif­fer­ent to re­quire­ments for spe­cial­ist clin­i­cal psy­chol­ogy ser­vices. Fo­cused psy­chol­ogy strate­gies is a ser­vice that can be pro­vided by GPs and other al­lied health pro­fes­sion­als, in­clud­ing reg­is­tered psy­chol­o­gists (who com­plete four years of univer­sity train­ing), so­cial work­ers and other men­tal health pro­fes­sion­als.

Ac­cord­ing to sta­tis­tics re­ported in The Week­end Aus­tralian (July 21), there were 84,318 fo­cused psy­chol­ogy ser­vices pro­vided un­der the new Medi­care item 80110 in May alone. This is al­most dou­ble the 42,407 pro­vided by spe­cial­ist clin­i­cal psy­chol­o­gists (un­der item 80010) in the same month.

Many prac­ti­tion­ers pro­vid­ing fo­cused psy­chol­ogy strate­gies do not pos­sess the spe­cialised train­ing that is vi­tal in treat­ing spe­cific and di­ag­nos­able psy­cho­log­i­cal disor­ders. How­ever, Medi­care has al­lowed for th­ese prac­ti­tion­ers to pro­vide ser­vices within the same cat­e­gory as spe­cial­ist clin­i­cal psy­chol­o­gists. This in­cludes de­pres­sion, anx­i­ety disor­ders, ob­ses­sive com­pul­sive disor­ders and even acute and chronic psy­choses and schizophre­nia. Be­cause prac­ti­tion­ers are self-as­sessed, there is also no on­go­ing mon­i­tor­ing or spe­cific train­ing or su­per­vi­sion re­quired by ei­ther the Aus­tralian Psy­cho­log­i­cal So­ci­ety (APS), Medi­care or each state’s reg­u­la­tory body for the providers of th­ese ser­vices. Fur­ther­more, ses­sions can be as short as 20 min­utes.

Be­cause Medi­care pro­vides such gen­er­ous re­bates for th­ese ser­vices, and a min­i­mal time com­mit­ment by the prac­ti­tioner, the mar­ket is be­ing flooded by less highly trained pro­fes­sion­als pro­vid­ing th­ese ser­vices. No won­der the costs of men­tal health ser­vices have blown out of con­trol.

Treat­ment by a spe­cial­ist clin­i­cal psy­chol­o­gist en­sures that a men­tal health is­sue will be treated with ex­per­tise and by some­one with seven or more years of train­ing. This in­cludes an ap­pro­pri­ate masters de­gree in ap­plied or clin­i­cal psy­chol­ogy, and a fur­ther su­per­vi­sion pe­riod for be­tween one to two years by a fully reg­is­tered clin­i­cal psy­chol­o­gist. Medi­care has set up rig­or­ous screen­ing of prac­ti­tion­ers, and en­sures through the APS Clin­i­cal Col­lege that stan­dards of clin­i­cal psy­chol­ogy prac­ti­tion­ers are main­tained.

There is a need for fo­cused psy­chol­ogy strate­gies. How­ever, th­ese providers should pro­vide a more gen­eral type of coun­selling ser­vice that is quite sep­a­rate and un­re­lated to ser­vices al­lowed for by spe­cial­ist clin­i­cal psy­chol­o­gists. There needs to be a clear dif­fer­en­ti­a­tion be­tween the types of disor­ders and treat­ment ap­proaches used by spe­cial­ist clin­i­cal psy­chol­o­gists, and the prob­lems and treat­ment ap­proaches that can be dealt with by fo­cused psy­chol­ogy strate­gies.

It is not up to the GP to un­der­stand the dif­fer­ence be­tween a clin­i­cal psy­chol­o­gist and a reg­is­tered psy­chol­o­gist, or any other type of al­lied men­tal health pro­fes­sional. Rather, it is up to Medi­care to de­fine the type of psy­cho­log­i­cal con­di­tions that can be re­ferred to whom, and un­der what cir­cum­stances.

This will take the con­fu­sion out of re­fer­rals for spe­cial­ist clin­i­cal psy­chol­ogy ser­vices. It will also mean that gen­eral coun­selling (fo­cused strate­gies) will be pro­vided to pa­tients who don’t need some­one with spe­cialised train­ing, and that the more com­plex cases will be ap­pro­pri­ately treated by spe­cial­ist clin­i­cal psy­chol­o­gists and/or psy­chi­a­trists if ap­pro­pri­ate.

There needs to be ap­pro­pri­ate reg­u­la­tion and high stan­dards of train­ing for providers of fo­cused psy­chol­ogy strate­gies, on­go­ing as­sess­ment of qual­i­fi­ca­tions as well as re­bates re­flec­tive of the type of treat­ment pro­vided. This is al­ready the case for spe­cial­ist clin­i­cal psy­chol­o­gists. It needs to be the case with any prac­ti­tioner pro­vid­ing a psy­cho­log­i­cal ser­vice.

There is no rea­son why spe­cial­ist clin­i­cal psy­chol­o­gists, con­sul­tant psy­chi­a­trists and those pro­vid­ing more gen­eral coun­selling ser­vices can’t pro­vide com­ple­men­tary ser­vices to the com­mu­nity and work side by side, but be dif­fer­en­ti­ated by the types of in­ter­ven­tion they can pro­vide and the types of psy­cho­log­i­cal prob­lems they can treat.

It is ul­ti­mately hoped that early in­ter­ven­tion and the abil­ity for any Aus­tralian re­gard­less of fi­nan­cial means to ac­cess ap­pro­pri­ate spe­cial­ist clin­i­cal psy­chol­ogy treat­ment will even­tu­ally mean that the over­all phys­i­cal and men­tal health of the pop­u­la­tion will be bet­ter and the over­all func­tion­ing of so­ci­ety will im­prove. This has been a very ex­cit­ing time. Medi­care’s ac­knowl­edge­ment of the need for clin­i­cal psy­chol­ogy treat­ment within the gen­eral pop­u­la­tion has nor­malised the need for treat­ment and has taken away much of the stigma of need­ing ei­ther spe­cial­ist psy­cho­log­i­cal or psy­chi­atric treat­ment. In­stead of be­ing a lux­ury treat­ment ac­cessed by a se­lect few, it recog­nises that any Aus­tralian could need spe­cialised clin­i­cal psy­chol­ogy treat­ment at some time in their lives, and will get fi­nan­cial help to en­sure that they re­ceive it.

It recog­nises the value of both clin­i­cal psy­chol­o­gists and psy­chi­a­trists, and ac­knowl­edges that there is an ex­tremely im­por­tant role in main­tain­ing and im­prov­ing men­tal health. Karen Goodall-Smith is a clin­i­cal psy­chol­o­gist in West­ern Aus­tralia and is vice-pres­i­dent and me­dia, mar­ket­ing and pro­mo­tions di­rec­tor for the In­sti­tute of Clin­i­cal Psy­chol­o­gists

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