SSWAHS = SWSLHD + SLHD and the Medicare Locals - 69

If ever we needed to see what the agenda of the College of GPs (and some of the existing Board members of the Divisions of General Practice) has been in their submissions for ownership of the Medicare Locals, this Media Release spells it out emphatically - "We intend to maintain control because none other than a medical practitioner can do the job of running the Medicare Local".

Local allied health practitioners and community members with health and/or business acumen should be champing at the bit to ensure that they can rein in the entrepreneurial plans of this Juggernaut.  

The only way to provide the diverse, effective and efficient community based health services to the Southern Highlands is for the community members delivering and receiving those services to have equality in the decision making of their Medicare Local. Only then will the Vision of the Bankstown Health Coalition be able to be replicated in the Southern Highlands.

7 November 2011
 
Medicare Locals – GPs must retain a strong leadership role

To avoid fragmentation of patient healthcare, the Royal Australian College of General Practitioners (RACGP) urges the Government to consult closely with the medical profession as it progresses the establishment of Medicare Locals.

On Friday, the Minister for Health and Ageing released a list of 38 organisations that have been selected to become the next Medicare Locals.

RACGP President Professor Claire Jackson said that Medicare Locals will have a broader focus than their predecessor Divisions of General Practice, and whilst this should provide a greater opportunity for integrated team based care, it is essential that GPs retain strong leadership roles, and that the general practice is seen as the patient's community healthcare home.

“Quality general practice is the foundation of primary care and must be the basis of Medicare Locals. Our focus needs to remain on enhancement of services to the patient and the community taking care to avoid fragmentation,” she said.

The College is pleased that Minister Roxon acknowledged the importance of ‘GPs and general practice being at the centre of a strong, integrated primary healthcare system’ and the need to ‘build on the excellent work already done by the local Divisions of General Practice’.

“The RACGP believes it is important we remain included in the discussions around the development of each of these organisations and we urge members to remain involved so that general practice continues to be the cornerstone of reform.

“It is likely that the governance of a Medicare Local will be through a skills based board rather than representative based board. GPs with such skills are encouraged to apply and have a voice,” Professor Jackson concluded.
– ends

SWSLHD and Bowral's Health - 51

Government "committed" to mental health cuts

• By Gemma Collins on  3 November 2011 6Minutes

Doctors have pledged to continue their fight against cuts to mental health services as the government said today it was still “committed” to its original Budget plans.  

Following the release of the long-awaited Senate report into mental health services (link) President of the RACGP Professor Claire Jackson said it had “opened the door to ongoing constructive discussion” with the government. 

But her assurance came as Minister for Mental Health Mark Butler said the government would be considering the enquiry’s recommendations but was “committed to the measures in our budget”.

“We’ll consider the recommendations of the enquiry, just like we would with any other Senate enquiry,” a spokesperson told 6minutes.  

“However, we're committed to the measures in our budget which together deliver the single largest investment in new mental health measures in Australian history.”

The report released on Tuesday recommended that the cuts to the Better Access scheme, which will see GP mental health services slashed by nearly half, be delayed until there is an “adequately equipped” alternative program for patients.

“Overall, the final Senate report leaves much open for interpretation due to its failure to provide clear recommendations,” Professor Jackson said. 

“It is the opinion of the College that a strong case has been made to justify greater reward and recognition in relation to providing mental healthcare plans – an issue the College will continue to fiercely advocate for”.

She said she would be urging the government to take on the recommendation “to revise its scheduling for the 2011-12 Federal Budget changes to ensure continuity of care”, in order “to allow for a final consensus to be formed, agreeable to the vast majority of health professionals desiring the best mental health outcomes for their patients and communities.”

SWSLHD and Bowral's Health - 44

We’ll fight cuts, GP groups vow

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer


GP LEADERS have vowed to keep fighting the “very dangerous policy” of cutting mental health rebates, after a survey found half of family doctors were dissatisfied with their efforts to stop it.

A survey of 150 GPs nationwide, carried out by Cegedim on behalf of MO, found an overwhelming 95% of respondents did not feel their views and experiences with mental health had been “adequately taken into account by government” in the  push for mental health reform.

But the survey also found the disquiet went further than government with 54% answering “no” when asked: “Are you satisfied with the efforts of the RACGP and AMA in their attempts to convince the government to cancel the cuts?”

The cuts to the Better Access scheme, designed to save about $400 million to fund other mental health services, look set to begin next week unchecked.

From 1 November, existing MBS rebates of $163.35 for a GP mental health plan will be reduced to $85.92 for a plan drawn up in a consultation of 20–29 minutes and $125.43 for one drawn up in a consultation of more than 40 minutes.

The tabling of a mental health Senate inquiry report,  sparked by the cuts, originally due in September and expected to provide advice on their impact, has been delayed. It is understood the report will be released this Friday – just three days before the cuts take effect.

RACGP president Dr Claire Jackson said GPs should be reassured by the quick and cohesive action of both bodies and the AGPN, under the United General Practice Australia banner,  to block the cuts.

“In my presidency it is the most critical issue the profession has faced, and the college was determined to work closely with the AMA and the AGPN,” Dr Jackson said.

“It was very much a team effort to try and bring all our strength to bear on overturning what we think will be a very dangerous policy initiative for the most vulnerable Australians,” she said.

AMA president Dr Steve Hambleton said dissatisfaction with his organisation’s representation came from its inability to prevent the cuts, but he would continue pushing the government to restore them.

The poll also found 31% of GPs would continue to bulk-bill mental health plans despite the cuts, while 39% said they would charge a gap and 13% said they would seek other options.

Tasmanian GP Dr Graeme Alexander said “general practice has been abandoned” by government at state and federal levels but dismissed the AMA and RACGP as “out of touch”.

“We certainly can’t get a political person of any flavour to show leadership and fix [the health system],” he said.
“We have no representative body.”

Tags: Mental Health; MBS; Better Access; AMA; RACGP; Steve Hambleton; Claire Jackson

Comments:

Ross
26th Oct 2011
5:48pm

As a bulk billing GP who derives a considerable part of my income from treating mental health cases my income is set to drop when the new item numbers take effect. This is in addition to rebates not keeping up with inflation. The government continue with their so called reforms to improve General Practice when in fact they are wrecking it.

 

SMS
26th Oct 2011
8:51pm

i am putting a big sign up in my waiting saying gillard and roxon big axe to mental health- so far i have alot of angry patients toward labour government- soon i will have charge a gap payment of $80 for drawing up a mental plan

27th Oct 2011
4:06pm

I very much respect Prof McGorry as a defender of youth mental health. However, in this interview, he seems to narrow the mental health budget debate to youth mental health only. That GPs work with Headspace centers would not be much help to a 32 year old with depression.
That we introduce yet more Medicare item number to differentiate between treating a 20 year old and a 25 year old is only going to give those of us at the front line of service delivery more unnecessary administration issues.
Youth mental health is important but not more important than child mental health or adult mental health. Whilst mental illnesses tend to first manifest in youth, most of the burden of disease is manifested by adults who present to their local GP practices in distress. Surely the government has to appreciate the fact that as an aging society, prevention should be focus, but so too the distribution of resources need to accommodate the current demands in mental health services.

 

Annabel
27th Oct 2011
5:26pm

Well said...Prof McGorry is terrific at championing his cause. Does it need to be at the expense of other mental health needs. Rob Peter to pay Paul. Was there no way of gaining the extra funding for Headspace and EPPIC without alienating the whole General Practice and psychologist Profession? Prof. McGorry is saying that in no other area of health care would one group be pitting itself against another for funding (I doubt this is true) and he seems to be pointing the finger at primary care providers as being the divisive faction.

 

Liz
28th Oct 2011
9:21pm

Having previously worked in Addiction and Mental Health, the Mental Health package available to GPs enabled continuing treatment of this group of patients within the GP environment. The ability to refer these patients to a psychologist also assisted their care significantly because ongoing care was often not available in the public sector. These changes to Medicare are such a retrograde step. Professor McGorry seems to think that transferring funding from GPs who mostly do a good job in supporting mental health patients of all ages, to just one group just doesn't make any sense.

SWSLHD and Bowral's Health - 42

Pride and prejudice: the mentally ill GP

24th Oct 2011 Pamela Wilson   all articles by this author

Medical Observer

Should doctors with mental health issues continue to practise? Pamela Wilson investigates.

Sydney magistrate Brian Vincent Maloney has fought a very public battle with bipolar II disorder – and because of it he very nearly lost his job.

Earlier this month he survived a motion in the NSW Legislative Council to remove him following a string of complaints about inappropriate behaviour in the years before his illness was diagnosed, including that he repeatedly asked a pregnant woman to stand up to show how pregnant she was and showing a screensaver of half-naked women to a female colleague.

In May, a NSW Judicial Commission had deemed him incapable of performing his role as a magistrate, despite his condition now being treated and well controlled. MPs’ debate centred on whether Mr Maloney remained incapacitated for the job – though for him their decision had more important implications.

“Upon your decision, in this case, depends whether a person suffering from a mental illness will dare to seek medical assistance,” Mr Maloney said in an address to the Upper House in June.

He could have been speaking for the one in five GPs with mental illness, many of whom are continuing in their professional role: should a well controlled mental illness be a barrier to employment for those in positions of responsibility?

“We know that even with severe mental illness, doctors can practise safely once it is controlled,” says Brisbane GP Dr Margaret Kay, who works with the Doctors’ Health Advisory Service Queensland.

The only time a doctor’s health status should be called into question – legally and ethically − is when it severely impacts on their ability to perform their job within the accepted standards and puts the public at risk, she says.

“We are not allowed to have untreated depression that is affecting our practice because we can hurt people. But we also know that it’s very rare for that to happen,” Dr Kay says.

The law governing medical practice states that anyone who places the public at risk should not be working, but as Medical Board of Australia (MBA) chair Dr Joanna Flynn points out, conversely this means that anyone not placing the public at risk is well within their rights to practise medicine.

If a doctor’s behaviour is brought to the attention of the board, the conditions or penalties they face are not draconian.

“It’s an extremely rare thing for someone to have their registration taken away because of a health problem. It’s only in circumstances where someone is severely ill and not taking the medical advice they are given that their registration would be taken away,” Dr Flynn says.

“There is a process of assessment and negotiation with the practitioner about the conditions under which they can work safely and what monitoring needs to be put in place.”

Despite the laws mirroring the medical profession’s long-standing philosophy of what constitutes best practice in these situations, national mandatory reporting legislation introduced last year seems to have blurred the lines of perception and reality for many in the medical fraternity.

Because doctors are now bound by law to report ‘notifiable’ behaviour of their colleagues, many doctors with mental illness are not seeking help for fear of putting their livelihoods at risk.

Legal sanctions can be imposed on doctors who fail to report colleagues who place the public at risk of substantial harm because they have an impairment or severely breach professional standards. Practising while intoxicated and sexual misconduct in connection with work are also considered notifiable conduct.

Western Australia is the only state in which treating doctors are exempt from mandatory reporting laws.

Since the introduction of mandatory reporting, there has been a drop in the number of doctors seeking help. While hard data is not available, anecdotal evidence suggests a direct correlation between the two.

Dr Kay says the advisory service reported a marked drop in doctors calling for advice at the same time that mandatory reporting was introduced in Queensland.

“It was very hard for us to not think this sudden precipitous drop in calls was related in some way, and then we started getting a number of calls from people asking about mandatory reporting,” she says.

“It’s not that much different to what we have always been professionally and ethically required to do... It’s the perception that is different.”

Dr Kay says the service’s consultants also report that callers are now admitting they delayed seeking treatment because of mandatory reporting, and that they are seeing an increase in doctors reporting to be suicidal.

AMA president Dr Steve Hambleton says it’s regrettable that doctors don’t feel they can seek the advice of a treating doctor without fear of being reported.

“As it stands, doctors are actually not self-reporting, not going to see their doctor as much as they were because they are concerned their livelihood is going to be put at risk,” he says.

Dr Flynn concedes this perception now exists, but stresses it is an unjustified fear.

“The biggest concern we have is that people misunderstand the situation and don’t seek care when they need it because they’re afraid of being reported,” she says.

Melbourne GP Dr Caroline Johnson, a spokesperson on mental health for the RACGP, believes the issue is a complex one that needs more debate to get it right.

“The goal is that health professionals can seek treatment, advice [and] support without fear of being reported. By the same token, we obviously need to make sure there are standards in place and there are safety measures, and I think the legislation hasn’t really addressed that balance.”

The first annual report into mandatory reporting will be released in coming weeks, but Dr Flynn says there has been no major increase in mandatory reports since the change in legislation.

All doctors who come before the medical board are treated individually and sensitively.

“The people who do that role understand they need to look at their public protection role but also need to weigh against that the legitimate interests of the doctor in continuing to work… and their health needs,” she says.

Starting the conversation
TWO years ago federal politician Andrew Robb announced he was stepping down from his duties for three months to seek treatment for a depressive illness.

Openly admitting to having a mental disorder took some strength. Mr Robb says in his memoir, Black Dog Daze, that he knew it could be seen as a weakness and could count against him politically, but  he “couldn’t be cowered by that”.

However speaking up and seeking support for a mental illness can actually preserve professional integrity, explains Dr Caroline Johnson.

“If you put your head in the sand... [it could] increase your risk of being unable to work,” she says.

Usually when it comes to mental illness, most doctors who come before the MBA achieve a good outcome, says Dr Kay.

“Even with severe mental health problems, when people are involved with the medical board most of them get back to work very safely,” she says.

Speaking up also helps reduce the stigma of mental illness in the community, says SANE Australia executive director Barbara Hocking.

“[Doctors] have an important role to demonstrate to the community that in fact there is no shame in having mental health problems, and the earlier you get the support and treatment you need, the better it’s going to be for everyone.”

Under the Australian Medical Council’s code of conduct, any doctor concerned that their health status may adversely affect their judgement, performance or their patient’s health must seek medical advice and not rely on their own assessment of the risk posed to patients.

In its document, Guidelines for Mandatory Notification, the MBA offers advice and questions to help reporting doctors choose the best course of action.

It stresses that the threshold that must be met to trigger a mandatory notification is high.

“The notifiable conduct of the practitioner must have placed the public at risk of harm as well as being a significant departure from accepted professional standards before a notification is required,” it says.

AVANT’s special counsel in professional conduct, Helen Turnbull, says the first step for reporting doctors is to approach their colleague with their concerns and encourage them to seek advice.

It is also vital they take time to consider the facts and seek advice from colleagues, medical defence organisations and/or support services so the burden of reporting is a shared decision.

“As they talk through it, they realise in many cases that it’s more an element of a colleague simply being unwell, i.e. suffering from depression, but there is no actual impact on patient safety,” Ms Turnbull says of many of the doctors who call them for advice.

Dr Johnson says all doctors should try to become involved with a GP support network so they have a forum where they can seek advice in these situations.

SWSLHD and Bowral's Health - 40

GPs to prepare for mental health cuts

• By Gemma Collins on  21 October 2011 - 6Minutes

Many bulk-billing GP practices will have to start charging patients for Better Access services, the RACGP says.

With the final report into the Senate inquiry on mental health cuts being delayed, the College has said that the changes to the Better Access general practice mental health item numbers announced in the May budget, are likely to come into effect from November 1. 

Ina  series of likely scenarios (link) the College says it will continue to lobby the government but “practices may require revised practice systems and billings in order to continue delivering high quality patient care”.

College members have come up with a list of different practice scenarios to provide GPs with alternatives models of care for mental health services.

It has given the scenarios of a large practice in the northern suburbs of Melbourne and a small busy private practice in the western suburbs of Sydney that will both no longer be able to afford to continue bulk-billing mental health services through the Better Access program.

They will instead charge a patient co-payment for all the mental health services or refer their patient to public state-based services.

Meanwhile a medium sized private rural general practice in Queensland that employs a practice nurse with mental health skills is planning to use General Practice Management Plans (GPMP) and Team Care Arrangements (TCAs) which will involve the GP and the practice nurse who will coordinate mental health screening and assessment. 

Meanwhile a fourth scenario for a bulk-billing practice that is unable to charge a patient co-payment due to its service charter, is to use the new MBS item 2715 in combination with other appropriate MBS items.

GPs are being told to contact the RACGP Policy & Practice Support Unit for advice (advocacy@racgp.org.au)

Comments

We drew up our new fees at the beginning of October and published them at the practice for patient’s information. Mostly our Gap is $30, but the gap for <40minutes plan is higher. I only realised this week when I received a mailing from Psychologist Association the if a patient has already used 10 sessions this year, they are ineligible for any more session after November 1st.

Milton Doctor | 22 October 2011 at 20:56

SWSLHD and Bowral's Health - 35

Four fixes needed for PCEHR

• By Michael Woodhead on  20 October 2011 - 6Minutes

The success of the PCEHR is threatened by the lack of GP input into the program and lack of a Medicare rebate to recognise the extra workload it will create for GPs, the RACGP says.

In a statement released this week,  the College says  the lack of clinical input into the design and implementation of an electronic record system was one of the key reasons for the demise of the UK’s e-health program.

It says the Department of Health and Ageing, NEHTA and the RACGP need to reach agreement on critical issues “such as data quality and ownership within the PCEHR, the PCEHR’s links with clinical software, and possible impact on clinical and practice workflows which will be a disincentive to widespread adoption. “

RACGP president Professor Claire Jackson says the College is also concerned about the lack of any incentives  for general practice for additional tasks such as creating PCEHR documents and obtaining informed consent.

The College has also highlighted two other critical areas of the PCEHR that need attention, citing the need to get patient s from high risk groups to “opt in” and the clinical and medicolegal risks of allowing  patients to alter their clinical record.

A program is needed to encourage PCEHR uptake by the groups that will most likely to benefit, namely patients with chronic and complex conditions, older Australians, Aboriginal people and mothers with new-born children, it says.

SWSLHD and Bowral's Health - 24

Action planned on national PSA testing guideline

4th Oct 2011 Catherine Hanrahan   all articles by this author

THE heated debate about PSA testing is set to intensify, with plans underway to develop a consensus document offering Australia’s first national advice on early detection of prostate cancer.

Cancer Australia CEO Dr Helen Zorbas said experts and key stakeholders would be consulted to develop evidence-based advice and “the NHMRC would be involved in the process”.

“Cancer Australia... undertakes regular surveillance and monitoring of the cancer research evidence to develop advice and inform practice and policy,” Dr Zorbas told MO.
 “Consistent with this activity, we will review and analyse the evidence about early detection of prostate cancer.”

Confirmation of plans for a national guideline coincided with a call last week from Professor Bruce Armstrong from the University of Sydney’s School of Public Health for an “organised approach to prostate cancer screening”.

While key stakeholders – the Urological Society of Australia and New Zealand (USANZ), the Royal College of Pathologists of Australia and the Prostate Cancer Foundation of Australia (PCFA) – rejected the idea of a national screening program, they agreed there was a need for uniform protocols governing PSA testing.

RACGP spokesperson Professor Chris Del Mar – a public health specialist from Queensland’s Bond University – backed a move for national consensus.

“I personally think it’s time for the NHMRC to take a leadership role in this,” Professor Del Mar said.

He said the RACGP Red Book advice on PSA testing would change if different recommendations were reached by a consensus committee, but he added, “it should be evidence based”.

Speaking at the Public Health Association of Australia conference in Brisbane last week, Professor Armstrong called for the current ad hoc testing to be replaced by an organised approach.

Australia already had a “de facto” prostate cancer screening program, given that the rate of PSA testing was similar to mammogram and Pap smear screen rates, he said.

“The way things are happening at the moment out there – with a high degree of variability, no guidelines – means it is pretty unlikely that under present circumstances the benefits [of PSA testing] are exceeding the harms,” Professor Armstrong said.

USANZ president Dr Stephen Ruthven said they were not advocating government-funded screening for all, but believed men should be educated about the pros and cons of the test.

Dr Anthony Lowe, CEO of the PCFA, said there was currently insufficient evidence for a national prostate cancer screening program but more research about this was needed.

Tags: PSA guidelines, Cancer Australia, Helen Zorbas, RACGP, Urological Society of Australia

Comments:

 

Len Moaven
4th Oct 2011
3:36pm

The MBS stats speak for themselves. Look at item numbers 66655, 66656, 66659 and 66660. For calender year 2010 there were 1.65m claims for these item numbers. Then take into account the grand cone and the temporal restrictions on claiming an MBS rebate then I would add at least another 200 000 'unpaid' tests ie there were close to 2 million PSA tests performed in 2010. Even then taking into account that a proportion of these are related to cancer monitoring etc then we already have de facto screening. Furthermore it would appear that there at least 100 000 tests performed in men under 45y of age.

 

Babyteeth
4th Oct 2011
3:42pm

Doesn't the Profession look like a bunch of dumb heads. PSA testing works, like any good test, as long as you are scientific and thoughtful about it. The RACGP anti-PSA testing lobby should be ashamed for their emotive, non-scientific approach. Your spurious pseudo-scientific arguments about statistically significant findings are just intentionally mishandling of the data. You have to make an effort to find what the data can show you and not just making a sabotaging, passive-aggressive interpretation. The data show you people with cancer have abnormal PSAs, and that is the only result you need to comprehend........... The question is early diagnosis of Cancer. The argument about impotency or incontinence after excessive surgery or operating on a benign Prostate is not relevant to the argument. The latter is just poor decision making, or bad luck and nothing to do with PSA testing. The only question you have to deal with is the Patient has an abnormal PSA ...so what do I do?

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 47

Calls for mental health rebate cuts to be reversed

24th May 2011

Byron Kaye and Andrew Bracey   all articles by this author

FEDERAL Parliament has been urged to seek savings in programs such as the GP super clinics and Medicare Locals in order to save rebates for GP mental health plans which were slashed significantly in the recent Budget.

In a letter to all Federal MPs and senators, the AMA has today requested the rebate cuts be axed, arguing that the decision was made with no prior consultation with the profession and would undermine the Government’s own push to bolster mental health services.

The letter came as Mental Health Minister Mark Butler today repeated his claims that GPs were overpaid for drawing up mental health plans. He was answering questions following a speech at the National Press Club.

Last week Mr Butler pointed to data that showed the average Better Access consultation lasted just 28 minutes and attracted a $163 rebate, while a 40-minute GP consultation attracted a rebate of just $99.
But Associate Professor Helena Britt, head of the Bettering the Evaluation and Care of Health (BEACH) program, said the 28-minute average GP consult for mental health – provided by her and quoted by Mr Butler – was only part of the time practitioners spent on mental health plans.

She said the data included only the face-to-face time between GPs and patients and did not include the time doctors spent outside sessions on related paperwork and liaising with other healthcare workers.
“I don’t know what they’re thinking, but it’s possible that they have not considered these other time issues,” she told MO.
“The 28-minute average… is correct [but] I’ve questioned the interpretation.”

The AMA has similarly questioned the Government’s interpretation of the data in its letter.
“It has always been acknowledged that the justification for the higher rebate was based on additional face-to-face time before or after the service attracting the item, additional non face-to-face time, onerous compliance requirements and the non face-to-face time involved in consulting with other health service providers involved,” reads the letter.

The RACGP last week also seized on the 28-minute figure touted by Mr Butler, with college president Professor Claire Jackson calling for the cuts to be reversed as soon as possible to prevent GPs abandoning the scheme altogether.

The AMA’s letter concludes with a request for Parliamentarians to reconsider the cuts and retain existing rebate levels “to avoid an inevitable campaign of opposition from patients and doctors alike”.
“In our view, patient rebates should be maintained at their current level with the realistic expectation, indeed hope, that the program will become more, not less, available and that Australians will continue to benefit from the GP services involved.”

Under the plans, the current rebate of $163.35 for a mental health plan for GPs will be replaced by a rebate based on timed consultations from 1 November.

Rebates will now be $85.92 for a plan written during a consultation of 20–39 minutes and $126.43 for a 40-minute consult for GPs trained in Level 1 mental health skills.

Those without the training will receive $67.65 and $99.50, respectively.

SSWAHS = SWSLHN and mental health in the Southern Highlands - 6

Better Access debate rages

21st Feb 2011

Catherine Hanrahan all articles by this author

2 comments

CONTROVERSY continues to dog the Better Access mental health program, with two new studies reporting conflicting results about equity of access for disadvantaged people.

University of Newcastle researchers found between 88% and 99% of a sample of 15,000 women reporting a mental health condition had not used MBS mental health items, including those from the Better Access program.

The study, linking data from the Australian Longitudinal Study on Women’s Health (ALSWH) with Medicare records, found those who did not use the MBS items, despite having mental health conditions, were more socioeconomically disadvantaged than those accessing the services.

The findings conflicted with data published in the British Journal of Psychiatry by researchers from the Universities of Queensland, NSW and Melbourne.

They used data from more than 8000 respondents from the 2007 National Survey of Mental Health and Wellbeing.

To assess Better Access use, they determined who had seen a mental health professional, paid partly or fully by Medicare, and whether or not they had a disorder.

Among the 1521 respondents who had a mental health disorder, they found there was no difference in socioeconomic disadvantage between those who used Better Access psychological services, other mental health services or no services.

However, in general agreement with the ALSWH study, the BJP study did show that 92% of respondents with a mental health disorder did not use Better Access mental health services.

Professor Ian Hickie, executive director of Sydney’s Brain and Mind Institute, said the women’s health study data showed the Better Access program had the same issues as specialist mental health systems.

“It’s really driven by those who already have the greatest access getting more access and many of those who need, missing out,” he said.

Dr Caroline Johnson, mental health spokesperson for the RACGP, said neither survey was designed specifically to assess the Better Access program.

“We need to know more about the population who report mental health concerns but are not accessing care,” she said. “[And] what we don’t know is whether being in the scheme makes more of a difference than usual care.”

Meredith Harris, lead author of the BJP study, said it controlled clinical factors in the socioeconomic analysis, whereas the women’s health study did not.

Sebastian Rosenberg, senior lecturer at Sydney’s Brain and Mind Research Institute, said that unlike the women’s health study, the BJP study didn’t use Medicare data.

“When it’s Medicare data and it’s public information, then it’s possible to recreate and confirm,” he said.

BJ Psych 2011; 198:99-08

MJA 2011; 194:175-79

Comments:

Bibiana

22nd Feb 2011
9:59am

Just wonder is there any study which examines the 'stigma' associated with accessing mental health services? Since the 'beyondblue' - the National initiative to combat depression first established in 2000, de-stigmatization of clinical depression in mainstream Australia has been very successful. However, I was recently told by an Australian-born Chinese wanting to see a psychologist through the Better Mental Health Access Program that her GP asked her to think carefully whether she really wanted to do so. The reason being it will be entered in her Medicare record that she is a person needing mental health service.
I then shared my personal experience with her about the benefit of seeing a psychologist. However, I also told her that if she was really concerned, she could self-refer and pay the fees out of her own pocket. As a mental health researcher for nearly 10 years, I am very aware of the stigma of mental illness perceived by people from Culturally and Linguistically Diverse communities. This is another aspect of access issues not picked up by the mainstream radar.

wenz
23rd Feb 2011
5:10pm

It is quite clear to myself that the better educated and probably, financially better off patient is able to access psychology care. For a lot of disadvantaged patients, a 20 to 40 dollar copayment per visit to a psychologist is beyond their means - and there are very few bulk billers available. I understand that a small co payment might weed out the client with less commitment - but it also weeds out the sort of patients that require our assistance.