Treatments for elderly ‘to be cut’

Warring psychologists could lead to vulnerable and senior Australians being denied Medicare-rebated mental health services, if the Government accepts a peak body’s proposal.

A submission to the Medicare Benefit Scheme review is at the core of a brewing battle to convince Health Minister Greg Hunt to subsidise more therapies, but to limit the number of mental health practitioners who can deliver them.

Peak body the Australian Psychological Society (APS) is asking the minister to expand scheduled mental health services in the Medicare scheme, so long as the treatments are delivered by “endorsed” members.

However, the call for exclusivity has angered many of APS’s 24,000 members who do not have the endorsement, which can only be achieved through extra post-graduate training and 80 hours of supervision.

Another professional group, The Australian Clinical Psychology Association, told the Medicare review it was concerned about the current lack of access older Australians already have to mental health services, including dementia sufferers still living at home.

According to the APS, this access should be further restricted.

It explained that an “Area of Practice Endorsement indicates that a registered psychologist has qualifications in a particular area of practice and an additional two years or more of supervised experience in that area”. Such a psychologist has at least eight years of training.

The APS submission is also calling for an expansion of the range of treatments psychologists can offer patients beyond cognitive behavioural therapy (CBT). It recommends adding:

  • psychodynamic therapy and Schema therapy for borderline personality disorder
  • online CBT, mindfulness-based cognitive therapy, problem-solving therapy and psychodynamic therapy for depression
  • eye movement desensitisation and reprocessing for post-traumatic stress disorder.

However, writing online for The Australian Independent Media Network, freelance writer Eva Cripps slammed the APS submission as an “astonishing attempt to restrict access to psychology services for the most vulnerable of Australians”.

She argued the APS’s recommendations represented “a kick in the guts to over 60 per cent of Australian psychologists, who may have their ability to provide affordable and accessible services to clients with complex mental health needs significantly reduced”.

The APS explicitly excludes four Area of Practice Endorsements (AoPE) categories from providing MBS-rebated services for severe and chronic/unremitting disorders, recommending, and thus inferring, that only practitioners holding endorsements for clinical, counselling, forensic, health or education and development psychology are competent to treat clients with complex health issues,” Ms Cripps claimed.

“These endorsed psychologists make up less than 34 per cent of all registered psychologists in Australia.”

She argued the proposal was a brazen attempt by the APS to monopolise the market in favour of a select few endorsed psychologists.

“If accepted by Minister for Health, Greg Hunt MP, it may see registered psychologists with decades of experience and expertise in specialist areas lose their livelihoods. Vast swathes of the population, including the most disadvantaged in the community, may lose access to crucial services, particularly as many AoPE practitioners do not bulk-bill.”

The blog attracted more than 60 comments, the bulk of which were purportedly provided by practising psychologists claiming they felt betrayed by their peak body.

Commentator Natasha Kavanagh said that if the APS recommendations are accepted, her career would be damaged.

“I am a Masters qualified psychologist with 15 years of practice experience … working in a low socio-economic area … The impact on my career will be catastrophic if it passes, but the impact on the community is my greatest concern. Basically there will be very few, if any, psychologists in the area. If by some miracle a clinical psychologist does stay in the area they will have months to years-long waiting lists, can charge what they like and are highly unlikely to offer bulk-billing when needed, as myself and my colleagues currently do,” Ms Kavanagh wrote.

Sharon Snowdon wrote: “I am a psychologist with clinical endorsement. The APS has for too long not appreciated and respected the wealth of experience and expertise of all its members. It is a very sad situation that a Society that is meant to advocate for all its members has produced this submission.”

Cherie Dorotich went further, calling for the peak body to be scrapped: “This is a total injustice for the people of Australia that are already experiencing a mental health crisis in terms of access to services. Purely to play elitist politics, the APS’s actions have simply intensified our country’s crisis. To restrict access to 70 per cent of Australia’s available Psychologists with no evidence or valid reason for the action, is purely hostile to the Australian public and to the thousands of passionate Psychologists who want to be there for the public when and as needed. Disband the APS.”

Credited with forcing the APS to make its submission public, Facebook group Reform APS accuses the current regime of having created a two-tier system within the profession in a “disunity” drive dating back to 2006.

Disclaimer: Australian readers seeking support and information about suicide and depression can contact Lifeline on 13 11 14. For more information on treating depression, please visit Beyond Blue.

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Written by Olga Galacho

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