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GP mental health plan referrals hamper help, say psychologists

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Psychologists are pushing for patients to be able to see them and claim a Medicare rebate without a GP mental health plan or referral, at least for initial sessions, arguing the current system is hampering access to mental health support.

They want a Health Department review of the Better Access scheme to change how patients access rebates of between $84 and $124 a visit and scrap the need for GP mental health plans to be renewed as frequently, if at all.

“If someone’s in crisis, that creates some real barriers of accessing timely care,” Australian Association of Psychologists Inc (AAPi) executive director Tegan Carrison said.

“We would love people to be able to self-refer to a psychologist.”

The Better Access scheme provides up to 20 Medicare-rebated sessions a year with a psychologist. The threshold was lifted from 10 sessions to help people struggling in the coronavirus pandemic, but this is funded only until June 30. To access the scheme, patients require a GP mental health plan, which must be renewed after the sixth and 10th sessions.

Australian Psychological Society (APS) president Tamara Cavenett said new patients offered last-minute appointments after a cancellation were delaying care because they had not yet obtained a GP mental health plan.

“There’s a lot of people for whom the additional red tape is a hindrance from getting treatment as early as they would otherwise,” Ms Cavenett said.

But GPs are opposed to the proposed changes. Royal Australian College of General Practitioners president Karen Price said GPs should be co-ordinating patients’ mental health treatment under Medicare.

“Patients can already access psychologists without a referral [and claim it] on their private health insurance,” Dr Price said. “Many patients with mental health issues will also have chronic health issues. We do whole-of-person care.“

The college is calling for extended consultations with higher Medicare rebates to help GPs look after mentally unwell patients. But APS, which represents clinical psychologists, wants people to be able to see a psychologist for an initial session or sessions before having to get a GP referral signed, and for the maximum 20 sessions to be retained.

AAPi, which represents registered psychologists, wants to scrap the need for GP referrals, lift the Medicare rebate to $150 a visit for all psychologists and double the maximum number of visits to 40 a year.

Both peak bodies say patients should not have to get their GP mental health plan renewed after six visits. Medicare data shows almost half of people who see a psychologist under Medicare use three or fewer sessions, which the Productivity Commission found was “rarely enough to enable recovery, in those for whom psychological therapy is the most appropriate intervention”.

The commission’s mental health inquiry final report, handed to the government in November 2020, recommended that GP mental health treatment plans be replaced with a digital assessment and referral tool.

It said some people faced “significant delays in getting a GP appointment”, which could be expensive and time-consuming, and that “not everyone experiences their GP as a useful, accessible or culturally capable person with whom to discuss their mental health”.

“The way most GPs are subsidised creates a financial incentive for them to limit their discussion time with each person,” the report said. “[Some] rely too readily on medication as a treatment option.”

A Health Department spokeswoman said the review would assess the system’s effectiveness “in improving patient outcomes and increasing access to mental health care”, responding to the Productivity Commission report.

“This will include consideration of the optimum number of sessions required to improve patient outcomes and the appropriateness and effectiveness of current treatment planning mechanisms and referral pathways,” the spokeswoman said.

Original content from The Sydney Morning Herald. Note: Content has been edited for style and length.

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