Plan to expand mental health sessions overlooks most needy, warns psychiatrist

The Medicare review, launched by the federal government in 2015, is examining more than 5700 Medicare Benefits Schedule item numbers across the health system.

The mental health reference group’s report, which is out for consultation and will inform expected reforms, this week called for up to 10 Medicare-funded therapy sessions a year for people who have not been diagnosed with a mental illness.

Health Minister Greg Hunt and opposition mental health spokeswoman Julie Collins both declined to comment on the proposed new item number, because the report is only at the consultation phase. A decision will not be made before the federal election due in May.

It comes as the Productivity Commission’s review of mental health examines how the $9 billion a year in government spending is allocated and its effects on social and economic participation, and the Victorian government’s royal commission prepares to release its terms of reference.

Professor Hickie said the Productivity Commission review would be crucial to determining what structural changes might be needed to ensure the system was geared towards effective treatment outcomes, and that the health minister of the day must think carefully before making changes.

He said the nation’s mental health sector was set up so that «everyone gets a little bit of everything», while locking out the most needy patients from the more care they need — likening it to a hospital where patients «get their cancer detected, but they don’t get treated».

«The idea that access to mental healthcare will fix the problem [means] the more severe and complex problems will not be fixed,» Professor Hickie said.

«We need to take care of those who actually have complex cases and who actually result in the most healthcare, but also the most lost productivity — because they don’t go to school and they don’t go to work.»

Professor Hickie called for a new bundled care model, under which a larger sum could be allocated to put together a team of specialists — such as a GP, psychologist, mental health nurse and dietician — to provide a tailored «package of care» to the patient.

«People need combined interventions — medical, psychological but also social, occupational and educational — to get an outcome,» he said.

But GPs say the proposed new item number could help patients access support that would prevent them from developing more serious problems later.

Royal Australian College of General Practitioners president Harry Nespolon said that while it was important to avoid «medicalising normality», patients facing challenging life events such as divorce or bereavement often needed help — and that easy access to a psychologist would be beneficial.

«These people are often extremely distressed,» Dr Nespolon said.

«If someone comes to see you and is worried about their mental health, without a diagnosis, they probably do need some treatment,» he said.

«The problem is that you have the ‘worried well’ all the way through to pre-diagnosis of a serious condition … We don’t want to move to the American model, where people have to go to their therapist over spilt milk.»

He said the tendency of people with more significant problems to put off seeking help meant that «the people who really need it are the ones who’ll come up short».

The general practitioners are also pushing for a new item number to allow GPs to spend longer with mental health patients, who make up about half of their visits.

Australian Psychological Society president Ros Knight backed the new item number, saying it would enable people fearful of stigma to access mental healthcare.

She said allowing psychologists to treat patients with «subclinical» mental health problems would help prevent more serious problems from developing — and this would deliver cost savings over time by reducing hospital admissions and boosting productivity.

The Psychological Society also wants the 10-session annual cap on the number of Medicare-rebated therapy sessions to be lifted.

«We want to create a system that approaches mental health the same way as physical health, from cradle to grave and from mild things through to chronic conditions,» Ms Knight said.

Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.




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