Supplementary Submission F1 Mental Health (Primarly):
Preamble: Note: this submission is based on an excerpt of information from a Motion I made to the Branch of the Political Party Which I am a member of. I am aware this talks about Mental Health Reform generally. However, I argue that it maintains its relevance to Terms of Reference code F1 Mental Health due to how the potential expansion of the MBS Better Access Scheme would not only act as an Inclusive Safety Net for Autistic People but also reduce the Economic Cost. This also comes upon the Insightful observation by other sources and submissions that the NDIS generally does a bad job in providing Mental Health Support to Autistic people and that Autistic people are often ‘ping ponged’ between Mental Health and Disability Services.
Reason: The reason for this is based on a submission by the Australian Psychology society (APS), a peak body representing psychologists in Australia. The submission recommended the introduction of a stepped care approach with Level 1 being 10 session for cases such as mild depression and anxiety, 20 for Level 2 for moderate such Persistent Depressive Disorder and 40 for Level 3 which is stated as Chronic/Severe/Unremitting disorders such as ASD (Autism Spectrum Disorder), ADHD (Attention Deficit Hyperactivity Disorder) and Conduct Disorders etc. (Littlefield, L. and Kozlina, M in APS, 2018). In addition, the Australian Association of Social Workers (AASW) the peak body representing Social Workers in Australia also recommends Better Access to be extended to 40 sessions (AASW, 2019). However, the level 3 label can be stigmatising by branching such conditions alongside the ‘severe’ category as many with ASD and ADHD identity as ‘Neurodivergent’. For many getting to terms with ones Identity based on a diagnosis is a sensitive manner, therefore its best to increase the cap to 40 for everyone to promote equality of treatment as well as avoiding the need to label neurodivergent people as chronic/severe etc. In addition, this would act as a safeguard for those not eligible for the NDIS for whatever reason serving as a ‘safety net’ of emotional and mental support especially as many ‘fighting’ the NDIS may need it due to potential emotional distress perpetuated by the process as well as to being needed anyway to provide evidence when applying. In addition, since the phasing out of many adult community mental health services due to the NDIS, increasing the amount of sessions would fill a chasm especially for those with Psychosocial disability who struggle to access the NDIS, in fact only 1,000 participants of the NDIS have a Psychosocial disability (Productivity commission 2019). In addition, this would create a broad spectrum of support for the diverse and unique range of Individuals who currently fall through the cracks of the mental health system. For example, adults who are too old for headspace, Neurodivergent people, people with disabilities unable to get NDIS or even neurotypical/able bodied adults that simply need more than 10 sessions. In
addition, the productivity commission has reported that many people with more moderate-complex cases returned to treatment the following year after there Mental Health Plan was exhausted highlighting the inadequacy of treatment covered by the plan (Productivity Commission, 2019). Motion/Issue 2: Review and increase the Rebate covered by Medicare for all covered practitioners to address disparities. Reason: The rebate is currently quite low leaving gaps in coverage. Even within the already inadequate amount of session’s covered by Better Access, there remains a considerable gap between the scheduled fee’s by practitioners. For example, according to the Medicare Benefit Schedule (MBS) Medicare covers $124.50 per 50 minutes for a Clinical Psychologist and $84.80 per 50 mins for a Registered Psychologist (APS, 2018). However, this is well below the recommended fee schedule set by the APS and some practices charge minimum $200 (McGorry in SBS, 2019). For Social Workers the MBS Schedule fee is $63.25 with a rebate of $53.80 per 50 minutes however many social workers charge more than this as the AASW sets a recommended fee of $240.08 per 50 minutes. In addition, this reflects the large disparity in the Medicare rebate for mental health professionals favouring Clinical Psychologists over other mental health professionals. This is unfair as it fails to acknowledge that everyone’s needs are different for example for one person a psychologist is more appropriate or for other a social worker, everyone’s needs are different, and no professional is better than another. In summary the rebate for ALL professionals is inadequate and should be interpedently reviewed and amended accordingly. Motion/Issue 3: Allow Flexible modes of delivery regardless of location. Reason: Currently only remote clients can access Medicare funded session via telehealth modes such as phone or video conference. This should change in order to better accommodate those who may live in urban areas but have difficulty attending face-to-face for example shift workers, students who work, people who don’t have access to reliable transportation etc. However, the first few sessions should be at least face-to-face to allow a therapeutic alliance to be established with the subsequent session carried out in a mode that suits the client. An example model of flexibility could include the first 5 session being face-to-face (compulsory) then the client has the flexibility to choose which mode of delivery to use of any combination as the client would see fit, e.g 15 phone/video conference and 25 face to face. There is strong evidence that e-therapy and other digital solutions can be as effective as face-to-face therapy with little detriment (Productivity Commission, 2019). In addition, further research and development of e-mental health solutions may be of Interest to this sector. In summary this motion would allow greater freedom and flexibility on how to access therapy session covered by Medicare fostering choice and control as well as a sense of empowerment for consumers, a very important step for effective mental health treatment.
References:
Australian Association of Social Workers. (2019). Medicare Benefits Schedule (MBS)
Review - AASW - Australian Association of Social Workers. [online] Available at: https://www.aasw.asn.au/social-policy-advocacy/campaigns-consultation/mbsreview [Accessed 5 Jan. 2020]. Littlefield, L. and Kozlina, M. (2018). APS Submission to the MBS Review: Better Access to Psychiatrists, Psychologists and General Practitioners. [online] Melbourne: Australian Psychology Society. Available at: http://file:///C:/Users/ASUS/Downloads/2018-APS-submission-Better-Access following-presentation-aug.pdf [Accessed 5 Jan. 2020].
Productivity Commission (2019). Productivity Commission Draft Report: Mental
Health - Overview & Recommendations. [online] Available at: https://www.pc.gov.au/inquiries/current/mental-health/draft/mental-health-draft overview.pdf [Accessed 5 Jan. 2020].