Medicare must differentiate between mental health options
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