For many people with mental health issues, the new year will be an especially difficult time.
From January 1, the federal government has ended a program which increased access to treatments subsidised under Medicare from 20 per calendar year, bringing it back to the pre-pandemic limit of 10.
Many mental health experts such as Matt Berriman, chair of Mental Health Australia, have attacked the decision, which they say puts at risk many vulnerable people who will no longer be able to afford care. They say that the pandemic is still weighing on people’s mental health and 10 sessions are not enough to deal with complex mental health problems.
This year could be a difficult time for many people with mental health issues. Credit:iStock
Health Minister Mark Butler has justified the decision, citing an independent review by Melbourne University experts, which found that while the extra therapy had helped some people, the benefits were unequally spread.
The extra sessions mostly benefited people in socially advantaged groups because they were already far more likely to receive mental health treatment.
A study by the Grattan Institute in 2020 found that Medicare spends about 40 per cent more per person on mental health of people who live in wealthy areas compared to people who live in low-income areas.
On the other hand, the move to a 20-session limit attracted very few new patients from disadvantaged groups even though they were probably under more stress during the pandemic.
Ian Hickie, co-director of the University of Sydney’s Brain & Mind Centre said that the extra sessions might even have exacerbated the inequality because there are not enough psychiatrists and psychologists to cope with the extra demand. Mental health professionals were being sucked towards private practice in better-off areas where they could charge co-payments and away from public health programs which are more equitably distributed.
Both sides of this debate make valid points. There is a need for better mental health services, but there is also a need to ensure that they are effective and targeted to those that need them most.
The Productivity Commission, in its report into the sector in 2020, said that the key problem was the “missing middle.” There are not enough services for people who need long-term intensive and complex support in the community but do not need to go to hospital as inpatients.
The commission also raised questions about the effectiveness of Medicare funding for individual mental health sessions. Close to half of people drop out after three or fewer sessions, which is rarely enough to make a difference. It recommended some people would be better served by lower intensity treatments such as self-help, psycho-education and lifestyle advice group therapy, and online guided self-help. By contrast, the current system seems to encourage over-prescribing of mood management drugs. Australians are the third most frequent users of antidepressants among OECD countries.
The commission recommended money be spent on programs to help high-risk groups such as young people, people who have attempted suicide and young parents.
Butler has promised to convene an expert forum to consider the issues and provide advice with a focus on giving all Australians the same access to evidence-based care. The frustration felt by mental health advocates that, in Berriman’s words, “We don’t need more round tables; we need real reform urgently,” is entirely understandable.
But the government has done the right thing by taking time to reassess: it is not clear that a permanent increase in the limit on individual consultations is the best way to improve Australia’s mental health, particularly in light of a shortage of professionals.
A review should not waste time. The need is urgent. But it should look holistically at the costs and benefits of all the options.
Michael Bachelard sends an exclusive newsletter to subscribers each week. Sign up to receive his Note from the Editor.
Most Viewed in National
From our partners
Source: Read Full Article