Why is there a 'gap' fee for 'Better Access' to Mental Health Services?

Artwork by Dr Lauren Squires @almostanatomical, who sells her work here. Reproduced with permission. I love this flowery image of the two hemispheres of the brain. It suggests to me that if we look after our brain it will blossom and flourish. This is easier said than done however, and this blog post addresses the issue  of access to mental health services in Australia. 

I have just heard the Radio National program Life Matters, which featured an interesting segment on the Better Access Mental Health Plan (via GP referral) which is due to be reviewed soon, and which raises some very important issues. This is an edited version of my response on their Facebook page. I love doing this work, and feel privileged to be able to do so, but it may be of interest to have an insight into some of the hidden costs of providing this service. 

As a mental health social worker, I do try to offer reduced fees for people with financial stress, which has helped more people access this service. However, as a contractor, or even as someone renting a room, I can't afford to bulk bill (although I have done so in a school, as I didn't pay rent, but even so, that was not sustainable for me).

Clients get a smaller Medicare rebate as I am a social worker (about $10 less than a psychologist) and I don't believe I offer an inferior service, as I am a very experienced art therapist, who has worked in a range of mental health services, and who trained in social work just to be able to work through Better Access.

Its important to remember the additional essential tasks and costs of providing this service. If I work in an agency which manages my appointments, I have to pay them a percentage of the actual fee, (between $35-over 50% of the fee in my experience). If I choose to work for myself, I have to do all the admin tasks: I also have no paid holidays, no sick leave, if people cancel at the last minute I don't get paid, and I write up to 3 letters to GP's per client per 10 sessions, to keep them informed about their progress (all unpaid). Many of us are still paying HECS costs, there is ongoing professional development or training, and supervision. 

In addition, whilst 10 sessions are often sufficient for those with fairly straightforward issues like anxiety, those experiencing depression and trauma are another matter. These are often very debilitating, and clients may need regular (and more than 10) sessions with the same therapist to develop trust and safety, a point not acknowledged by the Radio National speakers. Sure, CBT is an accepted and proven therapy, however the evidence suggests, it is only effective when combined with a good therapeutic relationship.

Trauma informed approaches are also important with clients with a history of abuse, and this can be intergenerational, so for example, trauma may be impacting on current clients whose parents historically never had access to therapy, and so their ability to care for their kids was affected. Also, just because someone has completed one series of treatment does not make them invincible in the face of further destabilising life events, such as grief, relationship breakdown, illness, or other major life changes. There is more to managing life than having tools and strategies: some people do not have family support, and there is an epidemic of loneliness.

Finally, it is worth bearing in mind that the people who keep coming back to the same therapist are lucky, many mental health professionals move on due to the above difficulties.