1,000 signatures reached
To: Dear Ministers, Health and Political Representatives
'Enough is Enough'….All consumers and psychologists in Australia deserve equal access to Medicare!
Access to mental health care for millions of vulnerable and disadvantaged Australians is under threat. The peak representative body for psychologists, the Australian Psychological Society (APS) has put the majority of its members and their clients’ needs second to the interests of just 36% of all registered psychologists. It has submitted a proposal to the Federal Department of Health’s review of the Medicare Benefits Scheme (MBS) which, if accepted, will have devastating consequences for rural and regional Australians, effectively denying them access to mental health services.
Medicare is the main funding program enabling the Australian public to access psychologists. In a nutshell, the APS has recommended that Australians seeking referrals for mental health issues should be restricted to seeing only 36% of psychologists. The APS has done this by proposing that only psychologists who have been “endorsed” in selected areas of practice by the Psychology Board of Australia can claim Medicare benefits for clients presenting with moderate, severe or complex mental health disorders.
The APS's proposed three-tier model must be rejected. The existing two-tiered model which provides significantly higher rebates to clinical psychologists providing the same psychological service to clients as registered psychologists, must be replaced with a fair and equitable MBS model which recognises the expertise, experience and skills of all registered psychologists.
We need a single rebate for consumers and their psychologists in Australia! Please sign and support one rebate for all!
By the ‘Australian Psychologists’ Facebook team (a group containing over 1800 psychologists with a diversity of qualifications from all areas of psychology)
Why is this important?
The APS submission (https://www.psychology.org.au/About-Us/What-we-do/advocacy/Submissions/Professional-Practice/2018/APS-Submission-to-the-MBS-Review-Better-Access?) recommends that over two thirds of registered psychologists (many of whom hold higher degrees, specialised training and significant experience in their field) but have not applied for “endorsement” would only be able to provide services to the estimate 10% of clients presenting with mild to moderate disorders. The complicated model states that psychologists may be given an opportunity to “demonstrate equivalent competence” to be able to treat what is, for many, their existing client base. Recognition would almost certainly come at a significant cost. The APS has yet to explain just how this recognition would occur, leaving experienced practitioners at a loss as to how they can protect their livelihood and deliver crucial services to clients.
All registered psychologists are currently permitted to practice across all areas of psychology and mental health and can diagnose, assess and treat clients, regardless of whether they are endorsed or not. Ethical guidelines require psychologists to only provide services within their limits of personal competence.
Endorsed psychologists primarily operate in urban areas, while the majority of psychologists operating in rural areas are non-endorsed. Data from the Psychology Board of Australia’s ‘Area of practice endorsement data tables: January 2014’, shows that only 23 endorsed psychologists work in remote communities across Australia; 212 in outer regional; while 7 969 work in metropolitan/capital cities. Our rural areas have some of the highest rates of suicide in Australia. If accepted, the APS recommendations will leave rural and regional Australians without access to vital mental health care services.
The consequences to Australians in desperate need of mental health care will be disastrous. If accepted, the APS model will result in higher session fees, with clients unable to claim any Medicare rebate unless their preferred practitioner is “endorsed”. Market forces would likely push up out-of-pocket fees to see endorsed psychologists and waiting lists would blow out. By losing a major funding stream, many non-endorsed psychologists would be forced to close their practices, leaving vulnerable clients without access to vital and affordable health services. Many endorsed psychologists do not bulk bill, meaning only those in higher socioeconomic groups would be able to afford treatment for the most debilitating of conditions.
There is no evidence to support that better health outcomes are achieved by “endorsed” psychologists. In fact, a significant amount of “endorsed” psychologists achieved this status through historical paid membership to special interest “Colleges”, and not through demonstrated experience or completing a masters/doctorate degree. Some psychologists were granted up to six endorsements via this process. The Australian Clinical Psychology Association stated that ‘More than half of those clinical psychologists currently endorsed by the Psychology Board of Australia do not have qualifications in clinical psychology...’ (source: https://industry.gov.au/Office-of-the-Chief-Economist/SkilledOccupationList/Documents/2015Submissions/ACPA.pdf). Therefore, many endorsed psychologists hold the same level of training and qualifications as non-endorsed psychologists.
The APS position is a crushing blow to over two thirds of registered psychologists, many of whom will be unable to continue treating the majority of their clients if the proposal is accepted by the Government. It is clear the APS is not acting in the best interests of its members (who currently pay $640 for annual membership) or their clients, by advocating that the majority of psychologists lose access to the MBS.
In fact, if the APS proposal is accepted, 66% of the psychologist board members who are “endorsed”, may personally benefit with increased client referrals, while 64% of registered psychologists will have very limited access to Medicare referrals. Questions must be asked about the ability of the APS Board to represent all psychologists equally, and whether the board members are at risk of breaching their fiduciary duties to the APS with a proposal which effectively destroys the livelihoods of the majority of registered practitioners, for the benefit of a few, including themselves. For over ten years now, clinical psychologist’s services have attracted a $39 higher rebate than non-clinical psychologists. Despite this higher rebate, fewer clinical psychologists fully bulk-bill their clients.
Based on the current Medicare arrangements, the proposed changes will represent a significant increase to Medicare, as the cost of providing the same services already being provided by registered psychologists would increase by 47%.
A notable research project commissioned by the Australian Government (Pirkis et al, 2011) demonstrated clearly that psychologists treating mental illness across both tiers of Medicare Better Access produced equivalently strong treatment outcomes (as measured by the K-10 and DASS pre-post treatment) for mild, moderate and severe cases of mental illness. This research demonstrates clearly that there is no difference in treatment outcomes when comparing clinical psychologists treating under tier one of Medicare Better Access with the treatment outcomes of all other registered psychologists treating under tier two of Medicare Better Access (Pirkis et al, 2011a).
Reference: Pirkis, Ftanou, Williamson, Machlin, Spittal & Bassilios (2011a). Australia's Better Access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45:726–739