Mental health services in the bush failing

Apr 14 2008

Figures released by the Australian government show that a Medicare scheme aimed at improving mental health services appears to be failing to meet its original objective.

Medicare's 'Better Access' $141.8 million scheme brought in by John Howard's government has come under heavy criticism for failing to ensure services are delivered where they are most needed.

Figures show that Medicare benefits paid since the program was adopted in November 2006 and the end of last year had already reached $278.1 million.

Federal Health Minister Nicola Roxon released the figures after complaints from mental health experts that the new system lacked transparency and was not working.

Before the figures were released the implication from Ms Roxon was that changes needed to be made to funding and program restrictions which limited access and flexibility.

But despite the cost blow-out it appears that of the almost one million consultations provided by registered psychologists, only 30.4 per cent were were bulk-billed, and of the of the 470,000 consultations provided by clinical psychologists just 25.9 per cent were bulk-billed and 79% of all Medicare claims for mental health services were in urban areas.

Yet a survey conducted in 2007 by the Australian Psychological Society claimed that 66 per cent of clinical psychologists reported they were bulk-billing patients in financial need.

Patients who are not bulk-billed will as a rule need to find $28 per session if they see a clinical psychologist, and $33 if they see a psychologist.

Bulk-billing ensures that Medicare pays the total fee and the patient pay nothing.

Professor Ian Hickie, the executive director of the Brain and Mind Research Institute at Sydney University says the program is failing because the Medicare model, where doctors and other health providers are paid regardless of their geographical location, meant the very professionals needed in the bush had little incentive to relocate from wealthy metropolitan suburbs where most lived and worked, to rural communities.

Professor Hickie says an alternative payment system must be provided to ensure no socio-economic or geographical disadvantage exists.

Hickie says the providers are not about to shift their practice locations or payment systems to help and the health minister will have to buy services for such people.

Ms Roxon has announced a one-year trial telephone program involving people with mild to moderate depression and/or anxiety following the release of the figures which will involve a mixture of face-to-face and telephone consultations.

Ms Roxon says some areas may also receive funding for specialised training in providing clinical care to people who have attempted suicide and self-harm.

According to the Australian Psychological Society 20 per cent of clinical psychologists and 23 per cent of registered psychologists are practising in rural and regional areas.

The Society says a new survey of 2000 psychologists found 73 per cent of clients would have been unable to afford psychology services without the Better Access schemes.