Better Access cartoon by Alice Carroll


In the coming months Senators have been asked to pass the ‘Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 2) [F2011L02134]’ through the Senate. Part of this amendment involves reducing the number of sessions through Better Access from 18 down to 10. I urge anyone who is concerned about these cutbacks to contact your local senator NOW to let them know you don’t support this policy before it’s given the seal of approval (contact details for senators can be found here).

The following is some food for thought to encourage you along the way.

As part of this amendment, the Minister for Health and Ageing has provided an explanatory statement outlining the rationale for these reductions. This statement contains a number of inaccuracies and greatly misrepresents the needs of mental health consumers. The following quotes (in bold) have been taken from this explanatory statement, and the points that follow explain why these statements are misleading and/or reveal the need to reverse these cutbacks immediately. Much of this information can be found in the Senate Report from the Inquiry into the Funding and Administration of Mental Health Services. The rest is based on information available on the Alliance for Better Access website and my ongoing participation in its associated Facebook Group. If I haven’t got around to referencing something and you’d like to know where it came from, just ask!

“[Better Access is] not servicing hard to reach groups like young people, men, people living in rural and remote regions, Indigenous Australians and people living in areas of high socio?economic disadvantage.”

  • Better Access has had the highest growth rates of uptake for treatment of people in these hard to reach groups.
  • 25% of people accessing services through Better Access are from rural and remote areas. Over 1 million Australians have used Better Access, meaning more than a quarter of a million people in rural and remote areas are accessing this service. That is hardly an insignificant number.
  • Some rural and remote areas have zero access to other mental health services (see here). Old services have been cut and new services have not yet been introduced. This leaves people in rural and remote areas worse off than they already are.

“…people on lower incomes received both significantly fewer services and less funding under Better Access than those on higher incomes.”

  • Many individuals involved in the campaign to stop these cutbacks are in a low-income bracket and/or on a Disability Support Pension or other Centrelink payment, yet they have still had their treatment cut because people on higher incomes are using the service.
  • Without Better Access I would not have been able to afford psychological treatment. Everyone else I have encountered have also said they would not be able to afford this treatment without Medicare rebates.
  • The cutbacks further interfere with people on low incomes receiving recommended treatment lengths (between 15-20 sessions for common disorders). From now on, only those who can afford it will be able to do so.
  • Even people on middle incomes struggle to cover the full costs of therapy while they are coping with mental illness.
  • All Australians—no matter what their income level—deserve access to evidence-based treatment lengths that lead to recovery in the long term, as is the case with physical illnesses.

“In making these changes the Government has consulted mental health experts and examined the available evidence…”

  • Some of the experts consulted have publicly disagreed with the cutbacks to Better Access. This includes Dr Christine McAuliffe and Professor Lyn Littlefield.
  • As a whole, the expert working group in fact had very good things to say about Better Access
  • The recommendations of those experts who criticise Better Access do not match my experience as a consumer. Nor do they match the experience of many other consumers and services providers. This is clearly evidenced by the range of conflicting viewpoints presented in the report from the Senate Inquiry.
  • A large portion of the mental health sector does not agree with the recommendations of this small group of experts.
  • Available evidence showed 87% of people using Better Access wouldn’t be affected by the cutbacks. This means 13% will. Chances are, that much of that 13% of people are in great need of psychological treatment (Read here to get an idea of how one of the 13% feel about this).
  • The 13% of people that will be affected equates to approximately 87,000 per year.

“While some people with more complex or intensive care needs may benefit from psychological interventions under Better Access, the initiative was not designed to provide intensive, ongoing therapy for people with severe, ongoing illness.”

  • Such people have been using Better Access because there are no other options for ongoing psychological treatment available.
  • The use of Better Access for this purpose is evidence in itself of the great need for this kind of service, but the Government has not provided an alternative before reducing sessions available through Better Access.

“It is important that people get the right care for their needs. People who currently receive more than ten allied mental health services under Better Access are likely to be patients with more complex needs and would be better suited for referral to more appropriate mental health services.”

  • Years of research into evidence-based psychological treatments show that 15-20 sessions are required to treat even uncomplicated conditions. It is therefore not true that all people who use more than 10 sessions have “more complex needs” and are better suited to other “more appropriate” care.
  • For many people one-on-one psychological care (beyond 10 sessions) is the most appropriate service for their needs. For such people there are now little to no options for treatment.
  • Not all mental health problems are the same, nor do they need the same kind of treatment. This kind of blanket statement about the needs of patients who need more than 10 sessions oversimplifies the needs of mental health consumers, and misinforms the Government and the general public about the way treatment works.

“GPs can continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services, or state/territory specialised mental health services.”

  • Care offered by psychiatrists is significantly different to that offered by psychologists. One cannot be said to replace the other.
  • Many ongoing mental illnesses are more appropriately treated by a psychologist than psychiatrist, or are best treated through a collaboration between the two. Examples include Eating Disorders, Personality Disorders, and Post-Traumatic Stress Disorder. These are all life-threatening conditions that require ongoing psychotherapy. In my experience, few psychiatrists offer this and psychologists are better at it.
  • Psychiatric care relies more heavily on the use of medication than talk therapy. Reducing sessions with a psychologist will place people in a position where they are more likely to resort to the use of psychiatric medication in cases where it is not necessary or appropriate.
  • Access to psychiatrists is limited, especially in rural and remote areas.
  • The use of medication should be avoided where ever possible due to the significant side-effects, and the lack of data to prove their safety and efficacy.

“…there were no consultations on the specific details of the Better Access changes announced in the 2011-12 Budget.”

  • The Better Access initiative is one of the most widely used mental health treatment initiatives in Australia. The Government cannot fully understand the impact of these cutbacks without consulting those people most significantly effected by these changes.
  • The sheer volume of submissions to the senate inquiry into this matter (close to 2000 submissions) is evidence enough that this initiative is highly valued by those that use it, and that more extensive consultation is required before putting the changes into place.
  • The report from the senate inquiry reveals that the majority of senators on the committee believe that patients will be put at risk by these cutbacks.
  • A petition started by the Alliance for Better Access has over 6200 signatures (and counting) contesting these cutbacks, showing a great backlash in the community against these changes. Obviously more extensive consultation is needed before these cutbacks are finalised.

Thembi Soddell originally posted this on November 10, 2011 at her Better Access to Psychological Services Campaign blog. I cross-post it here with her permission.