The start of 2023 has been an interesting one in the mental health world. My feed has been full of personal and professional opinions on the changes to the government's Better Access to mental health changes. One of the most common questions I get asked is if I accept mental health care plans and whilst they have a place and a purpose, I am not a red hot fan for several reasons.
As a professional who work largely with neurodivergent women, couples and within the confounds of domestic violence and coercive control, I hear far too often from my clients they have frequented a number of professionals at a premium price tag and did not feel heard and understood and when I ask how they came to engage those services it was usually misguided information by other professionals who believe the mental health care plan is the one stop fix to all mental health related challenges. The purpose of this blog is to take that apart and provide professionals and consumers with some clarity around the topic.
What is a mental health care plan or mental health treatment plan?
"A Mental Health Treatment Plan (previously known as a ‘mental health care plan’) is a plan for people with a mental health disorder. If you have mental health issues, your doctor can write a plan for you." A mental health care plan (MHCP) is a treatment plan issued with the intent to ensure that consumers/clients/patients have access to the correct kind of service for the condition or challenges they present to their GP. Medicare offers a rebate to the professional which offsets the payment you make. The rebates vary between professional applications. As at 1 January 2023 the rebate for seeing a psychologist is $89.65 (calculated at 85% of $105). The APS schedule of fees recommends a 40 - 60 minute session with a general psychologist to be charged at $280. Most psychologists in my local area charge between $220 - $280 rendering the client $131 - $191 out of pocket at the GAP fee. This recommendation can be found here
Who qualifies for a mental health care plan?
"A Mental Health Treatment Plan is available to you if you have a mental health disorder diagnosed by a doctor." You get a mental health care plan by visiting your GP who in turn is meant to screen for diagnosable mental health disorders prior to completing the paperwork for a referral to a psychologist, psychiatrist or other suitable professionals. For instance: Jane presents to her gp after weeks of feeling low. Everything feels like too much effort. She has trouble getting out of bed in the morning, doesn't want to go to work and nothing brings her much joy anymore. Lately she has thought that is not much point to being around, and has contemplated ending her life. Jane's physician administers a screen and identifies that she is possibly struggling with depression. She is referred to a psychologist for further assessment and treatment and given a mental health care plan (MHCP). Her psychologist offers her an appointment at $250/50 minute session. Jane attends the appointment pays $250 before or following the session and receives an $89.65 rebate to her nominated bank account leaving her $160 out of pocket.
What does a mental health care plan cover?
The mental health care plan covers a set number of sessions with your psychologist, psychiatrist or *other mental health professional. Prior to COVID-19, these plans covered a total of 10 sessions of which 6 were immediately approved and then reviewed with your referring practitioner prior to releasing the other 4. During COVID-19 mental health systems took a strain and this was increased to 20 sessions per year/per plan. As of 1 January 2023 the allocation was readjusted to 10 sessions per year/per plan.
The problem with mental health care plans (MHCPs)
Whilst the idea behind the Better Access scheme is a noble one, it is fundamentally flawed. I will own my opinion and support it by summarising the issues I have identified since its inception.
Mental health care plans are and have been issued for years as 'free/cost effective therapy' - there has been little done by way of educating GP's (again my professional observation) or the wider community about the actual cost and impact of these plans.
When a mental health care plan is issued it comes with a suspected or provisional diagnosis. A DSM diagnosis should be reserved for people who are experiencing an impact in several areas of their lives. This diagnosis whether found to be valid or not comes with implications that can vary between states but also likely has a wider more general reach. A diagnosis of depression for instance is likely to affect or lead to exclusions on Life Insurance. It could also potentially impact on career prospects - especially government/defence force-based prospects. This comes straight from the recruitment page of the Queensland Police Force. Consider this - your grade 12 student is struggling with their workload, and you take your child to the GP who issues a mental health care plan for anxiety/depression for "free/cheaper" therapy. Your child was also hoping to join the police force when finished with school.. This is now on hold.
It is not entirely confidential. Your referring practitioner and the accepting professional will exchange communication about you, your engagement and progress as this is needed to evaluate future/extended sessions. Underwriters can also access the information if there is a reasonable suspicion on insurance claims, as can government departments/employers.
Low - Middle income earners still struggle with presenting the upfront cost before the rebate is even applied. Even more so now than ever before with rising inflation and cost of living. Once the sessions under the plan have been exhausted, many psychologist pause sessions or expect the full fee to be paid which often leads to premature disengagement. Not only does this come with the risk of further challenges being experienced, but it also leaves a negative experience of the usefulness and benefits of therapy.
Sessions are few and far between. Many professionals try to stretch the care plan sessions across the year at 1 a month. Subsequently some clients do not get to move beyond rapport building phase, and it is challenging to gain traction or momentum when applying the skills, they are introduced to in therapy.
Waitlists are long. At the moment I am told (by my local community) waitlists for psychologists are up to 12 months long, psychiatrists anything from 8 to 18 months. When you are in crisis - 12 months is a long time to wait to still be $160 out of pocket.
Everyone is an expert - at least everyone who qualifies for delivering services under the Better Access scheme. This is the part that I am most in disagreement with. A quick scan of google proved to me very quickly that lately 80% of psychologist pages I opened cites "ADHD Coaching" as an area of specialisation. This is not a problem in itself however coaching is a qualification on its own and it takes more than a general understanding of ADHD to be neurodiversity affirming and 'specialist' in practice. Several psychologists in my local area have engaged in couples therapy under a 'mental health care plan' for one individual in the relationship - at risk of the individual being placed in harm’s way because they are not necessarily trained to look for things like coercive control and covert domestic violence. And whilst I unfairly searched for and focussed on psychologists - the issue has a much wider reach when I look at and consider other allied health professionals who are not necessarily as well trained or familiar with certain presentations.
So what are the implication of fewer sessions under Better Access for me?
In short - longer waitlists, longer times between appointments, people taking any and every appointment regardless of the level of training, area of interest or expertise of their medicare eligible professional and potentially increased prices to access medicare eligible professionals.
Okay smarty pants, what's your proposed solution? In the ideal world, we would overhaul the mental health system. Do away with over diagnosing, under identifying and stigmatising mental health and everyone would be able to afford the service that suits their needs. But the world is not ideal - and that is still a long way off. In the meantime, here is what you can do.
Ask questions. Ask your GP about the implications. If they don't know, get them to check. Ask your psychologist about the implications. Ask what happens when your sessions run out. Ask them what the average "duration of treatment" is for similar presentations. Research tells us about 20 sessions (if not more).
Do your homework. Look around, call around. There are many professionals who are trained to provide services for experiences and challenges that do not necessitate a diagnosis. Your experience may be a adequately dealt with by a counsellor as it would have been by a psychologist. Counsellors are well trained to deal with a range of issues from low mood, to grief and loss, to relationships and conflict management. Counsellors as an option come with a range of qualifications and or experience and you may be able to access a counsellor with experience/expertise in the area that you need support with, with a shorter waiting time and at similarly, most likely more affordable rate. Counsellors have long been overlooked as a common myth is that counsellors aren't as well trained as psychologists, however many counsellors have postgraduate qualifications and the area of focus in counsellor training is not a medical assessment/diagnostic focus but a therapeutic alliance focus. Many counsellors also carry professional registration with the Australian Counselling Association (ACA) or PACFA and are expected to uphold professional development AND clinical supervision requirements.
If ever you are unsure.... ASK questions or find another professional and second opinion, because you deserve to be heard! References used: Health Direct Australian Association of Psychologists Medicare Benefits Online - changes to Better Access MBS. References used: Health Direct Australian Association of Psychologists Medicare Benefits Online - changes to Better Access MBS
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