Why reduce access to 100 years of psychological expertise? Reject the APS Submission to the Medicare Review.

Sep 2

Author: Anne Moorhouse, Psychologist

Australians requiring psychological treatment will have less access to psychologists if the Australian Psychological Society’s (APS) submission to the Medicare Benefits Schedule Review is accepted.

Our Practice

I am a generalist psychologist in a busy inner-city practice. Our professional team consists of five generalist psychologists, a mental health occupational therapist, a music therapist and a therapy dog.

Our admin team consists of two psychology students and a mental health nurse.

Together we have about 100 years of psychological expertise, hard earned in a range of settings including domestic violence services, sexual assault services, child-focused treatment centres, mental health institutions, relationship services, unemployment services and crisis lines.

Collectively we have completed about 40 years of academic studies which include a Masters of Music Therapy, a Masters of Sexual Health and two Masters of Applied Psychology (Counselling).

As registered psychologists with the Australian Health Practitioners Registered Agency (APHRA) we must maintain our skills and expertise through supervision and professional development. Our team has completed mountainous hours of professional development and supervision over many years. We have a library of books that we delve into. We refer each other to online resources and we share our knowledge. Zumi, our therapy dog also maintains his training.

We provide evidence-based treatment in a compassionate, nurturing and creative environment.

Who is the APS?

The APS purports to be the leading association for psychologists in Australia with their role being to “advocate for the profession of psychology, support high standards, promote community wellbeing, and are dedicated to providing benefits to support members.” That’s why it’s shocking that they would propose restricting access to psychological services and denigrating the workforce they are meant to represent.

What’s wrong with the APS Proposal?

The APS proposes a three-tier model of care and has decreed who can work within each tier:

1. Severe and Chronic/Unremitting Disorders – 40 Sessions
2. Moderate-Severe Disorders and more Complex Disorders – 20 Sessions
3. Mild to Moderate Disorders – 10 Sessions

Under the APS proposal, generalist psychologists regardless of their years of experience working with severe or chronic disorders will only receive referrals from general practitioners, psychiatrists and paediatricians to work with level 3 clients, i.e., Mild to Moderate Disorders. However, a clinical psychologist or an endorsed psychologist, who could be newly registered, will be referred the most complex clients.

Clients currently receiving treatment from our experienced team, who may have severe and chronic disorders, would not be able to receive a Medicare rebate under the proposed scheme. Clients would have to choose whether to pay the fee themselves or be referred elsewhere so they could access the rebate.

Why won’t the APS proposal work?

Clients who initially present with a mild to moderate disorder, then disclose a greater range of symptoms once they have developed a trusting relationship with their psychologist will need to stop treatment if they want to receive a Medicare rebate. To afford ongoing treatment they may need to access a clinical or endorsed psychologist.
Some clients currently receiving long-term treatment with a generalist psychologist will need to stop treatment if they want to receive a Medicare rebate, and access a clinical or endorsed psychologist.
Clients with Moderate, Severe and Chronic disorders will find themselves on a waiting list. An estimated 60% of psychologists in Australia are currently generalists without endorsements, who will no longer be able to provide treatment. The increased number of sessions for treatment, currently 10 for any presentation is beneficial for clients, however, this will also add to the waiting list.
Rural communities often have no clinical or endorsed psychologists and clients in these areas will be disadvantaged.
As generalist psychologists close their private practices, due to the lack of clients, greater stress will be placed on GP’s and community health services.

What’s the difference between psychologists? Aren’t they all the same?

It’s confusing! We are all Registered Psychologists with APHRA.

Generalist psychologists have a minimum four years of academic psychological studies plus two years of supervised practice. They often have much more than this as is reflected in our team. A generalist psychologist completing studies now have a minimum of five years academic studies in psychology.

Endorsed psychologists have a minimum six years study in psychology and complete an accredited qualification in an area of practice, such as clinical, counselling, health or education and developmental psychology. This is then followed by a period of supervision in the area of practice.

Clinical psychologists are a subsection of endorsed psychologists. They generally have completed a Masters of Clinical Psychology and two years of supervised practice. Except… that some haven’t because for a period of time they were able to “grandfather” across to the endorsement of clinical psychologist. When I have worked in teams with clinical psychologists and generalist psychologists we have all treated the same client groups.

Under the current two-tier Medicare rebate system, a client who is referred to a clinical psychologist receives a greater Medicare rebate, regardless of the severity of their condition. If a client sees a generalist psychologist they receive a rebate of $84.80 if they see a clinical psychologist they receive a rebate of $124.50

I am in favour of well-educated psychologists, however, there is strong evidence that clinical psychologists do not achieve better outcomes than generalist psychologists within the Medicare system.

Is there anything good about the APS Proposal?

Yes! More sessions for more complex disorders are vital. The APS also proposes parent sessions without the child in attendance, a greater range of psychological treatment options and more flexibility to run groups. I’m just not sure who will be doing all that work.

What would work?

A one-tier Medicare system where clients can choose an accessible psychologist with the expertise required. An increased number of Medicare-funded sessions for those clients with the greatest need. Clients requiring psychological treatment to receive the same Medicare rebate regardless of who they see. Clients able to access a diverse range of educated and experienced psychologists.