Opinion
by Dr Katrina Norris, AAPi Director
Earlier this week, the health minister Mark Butler announced that the number of sessions available under the Better Access mental health scheme would return to 10 per calendar year as of 31 Dec. This was after an additional 10 per calendar year was introduced in 2020 as a part of pandemic measures to address potential increases in mental health concerns as a result of the COVID pandemic. These became known as the additional COVID 10.
As a Psychologist working in Private Practice and whose clients have directly benefited from these additional sessions, I have been disappointed, saddened, and angered by this decision. I am not alone, as this decision hurts our clients. Our anger is not about any direct impact the loss of these sessions has on our businesses, but instead, it is anger for the clients, the individuals, who are being denied adequate mental healthcare. This is a loss for our clients, this is a loss for those needing critical psychological treatment, and it is an invalidation of the needs of those seeking help for their mental health. Ultimately, this decision is likely to cost lives, and this is why we (Psychologists and other Mental Health Practitioners) are outraged.
So I wanted to share some facts in response to the rationale used to cut session numbers under Better Access:
No, the additional COVID 10 Psychology sessions are not the reason it’s harder to get an appointment with a Psychologist!
In announcing the government's decision, Mr Butler, quoted early modelling and advice by Professor Ian Hickie that increasing session number would only exacerbate the bottleneck for accessing Psychology services and would blow out waitlists. Mr Butler exclaimed that data shows Professor Hickie's modelling was correct as waitlists had blown out over the course of the pandemic and that the number of new patients being seen under Better Access had reduced by 6%. The assumption being that the additional 10 were being used on existing clients and directly resulting in psychologists not having the availability to see new patients. However, this is an oversimplification of the reasons behind longer waitlists and reduced uptake of services by new patients.
Firstly, let’s be specific, yes, there was a decline in new user uptake of treatment services under Better Access across the period from 2018 to 2021, with a steeper decline from 2020 to 2021. The overall reduction was from 56% new user uptake to 50% new user uptake. This has coincided with an increase in continuing users and in the number of sessions accessed by continuing users. The problem with the way Mr Butler presented this data, is that it ignored the facts:
- That there was already an increase in wait times to access psychology services pre-pandemic and that the pandemic exacerbated this;
- That the pandemic increased the need for services under Better Access due to its impact on mental health (of existing patients and new patients); and
- That the additional 10 sessions were not introduced as a solution to waiting times but instead as a measure to ensure people with worsening mental health received adequate treatment over this period.
The number of professionals able to provide services under Better Access simply could not keep up with the demand. This is a long-term issue and can only be resolved through the reform of training pathways and early career incentives to get more practitioners into the workforce sooner.
What about those in most need? Did the additional 10 sessions reach them?
Mr Butler also made the point that for most people who see a psychologist, only use 4 to 6 sessions, and this is because Better Access is intended for the treatment of those with mild to moderate mental health. Therefore the extra 10 sessions were not being received by those with the most need. There are multiple issues with this statement:
- If the uptake of the extra 10 sessions was responsible for the decline in new users accessing sessions with a Psychologist, then this contradicts the data that most people only use 4 to 6 sessions. It is great that most people only need 4 to 6 sessions as this means the treatment they are receiving is effective for the concerns they have at that time and is yielding the outcomes relevant to individual clients. It also means appointments are still becoming available, despite the extra 10 being available.
- The data also indicated that the additional 10 sessions were most utilised by continuing patients. If this is the case, then weren’t those in need, those who were in crisis, having an exacerbation or recurrence of symptoms, and those with complex needs, the ones in receipt of these extra services?
- Who determines who is of greater need when it comes to mental healthcare? Yes, those who are at the highest risk have an urgency to receive treatment, and increased demand for services puts these patients at risk if they have not already engaged with a psychologist. However, ceasing the extra 10 equally places them at risk as they now cannot get the consistency or frequency of care moving forward. 10 sessions per year are simply not enough for people with complex concerns and who are at risk.
In addition, Mr Butler mentioned that access to psychological treatment for those in rural/remote areas and those on low incomes was not improved by the additional 10 sessions. Those in vulnerable psychosocial situations (rural/remote, low SES, Domestic Violence etc.), have difficulty accessing psychological services for reasons separate from the number of subsidised sessions available. Primarily the issues that need to be addressed for those in these situations are affordability (ways to increase or encourage bulk billing of services) and accessibility (ways to link people into services remotely (telehealth) and incentives to encourage practitioners to move to regional areas). Again, the additional 10 sessions were not implemented to solve these problems.
What did the Additional 10 do?
The additional sessions gave those who were able to access services, the opportunity to have more frequent treatment as needed. For those in crisis or with complex mental health needs, the additional sessions allowed them to receive adequate treatment without reliance on the public health or community health systems. It allowed them security, stability, and choice in their mental healthcare.
What happens now, is that these clients have to find alternative ways to support their mental health between sessions with their psychologist. This is going to place demand back onto mental health helplines and mental health care teams within the hospital sector, which are already under strain due to increased demand. At some stage, someone is going to slip through the cracks, and this is what we (Mental health Practitioners) are most fearful of. We don’t want to lose a client because they can no longer receive adequate healthcare!