I have severe depression anziety and do not think even 18 sessions are enough to help people suffering and I am on a pension.

Read the research people - the therapies (IPT and CBT) that Medicare psychologists are supposed to be administering in 10 sessions actually take an average of 16 sessions for non-complex conditions (the exclusion criteria of methods sections of published clinical trials always exclude chronic, complex, and co-morbid conditions, as well as PDs, substance use, treatment-resistant depression, psychosis and organic brain problems. Yet, in real-world conditions, these mental health problems co-occur with depressive and anxious diagnoses). The research and treatment manuals alike also indicate the need for follow-up (i.e., 'booster' sessions). Also, in many CBT studies, the therapy is administered twice a week for the first 4-6 weeks, which is also different to real-world conditions where clients come weekly, or even less frequently!

'Sudden gains' (i.e., rapid, robust, between-session symptom reductions) and an 'early response' to psychotherapy (i.e., improvement within 6 sessions), only tends to occur to small numbers of patients, and this research (which has only been done since 1998) has not yet properly identified WHO these people are or whether their response profiles are indeed the direct result of psychotherapy (or whether it is just life events, the therapeutic relationship, or the natural recovery course for certain participants), nor has research assessed the impact of terminating treatment early (eg,. after 6 sessions). But don't worry, Medicare's new system (without ethical Approval from Research Committees, whatsoever) is just about to do this. Let's hope some research is done.

In the meantime, clients (including adolescents, such as those wishing to acess a psychologists through the Government's Youth Mental Health Initiative, "http://www.headspace.org.au/") are all left to pay for the remainder of their treatment, or in the case where they can not afford it, to go without! Yet, Psychiatrists (who do not teach the life skills and emotional coping strategies that psychologists teach) are able to bill over 50 sessions a year (i.e., virtually unrestricted) through Medicare.

SHAME SHAME SHAME!

All the public can do is to complain to their local MPs, the Government's Department of Health and Aging, and the Minister for Health!

Legitimacy of your comments is strained when you report inaccuracies and inconsistencies. Budget rhetoric says the appointment rebates are cut from 12 to 10, the media follow in reporting this yet comments such as yours are deceptive. Compare apples with apples, standard rebates have indeed been cut in half from 12 to 6 and the "exceptional circumstances" annex has been reduced from 6 to 4. Let's try not to pollute the debate with errors of fact.

Further, there is an inconsistency in the argument per number of appointments required. It would appear that the number of appointments used per calendar year by percentage has discrepancy and the APS are currently completing research into this area for last years program use. Further, I would think that the idea of removing funding from those people requiring more appointments would be penalising exactly the more severe presentations the govt purports to want to accommodate.

Could I suggest that people invested in mental health funding of alternative programs understand that trying to discredit and remove funding from one area leaves the critic looking as if they have an agenda different from aggregate mental health outcomes? Perhaps professionals could invest in the advocacy for psychology treatments instead of assisting political division and justify fund diversion. I know, how idealistic when political points are to be scored.

Interesting spin exists within reforms to national mental health policy which the Gillard government seem keen to prevent becoming common knowledge. The person presenting without "exceptional circumstances" will have Medicare rebates for psychologists halved from 12 to 6. This is well below the visits required for evidence based treatment and will leave the program effectively having the impact of putting out half a fire. Two reports commissioned by the government indicate that over 80% of people seen under Medicare have moderate to severe disorders and that the Medicare system covered these people in a cost effective and accessible way. Rhetoric and half disclosures justify the "giving with one hand, taking with the other" piecemeal and unjustified approach to mental health. Consider that we are all only one vital event away from needing to see a psychologist. Protect your direct access to the psychologist of your choice now.

If not for this current scheme I would not be able to afford the medical assistance for my 21 year old son that he requires and is currently receiving with view to the outcome of becoming a functional, contributing, healthy and happy individual within society.

I did not even know that this assistance existed until 12 months ago and it was only in pure desperation at the GP that we finally accessed this assistance.

My son is 5 sessions into the program and is only just beginning to vaguely open up, it is a long journey to recovery and wellness in front of him. I pray that the government sees sense and continues this program for the benefit and wellbeing of both my son and future mental health issue sufferers.

It seems that mental health AGAIN is the first to suffer in another government budget. When will this madness end!!

Thanks for the templates. In the 'client letter' 2nd para 6th line the "achieve" should be 'achieved'.

It does not slash the number of sessions available in half. The extra 6 sessions available were rarely used because it is specified they are for exceptional circumstances only. Effectively the slash is only from 12 to 10 sessions. Lets be honest and realistic here.

In their latest newsletter the APS publish the following statistics:
74% of people received 1-6 sessions
21% received 7-12 sessions
5% received 13-18 sessions.

This indicates that the information on which the decision to alter the number of sessions for Psychologists is fair enough. The money saved is going to other ares of mental health in greater need.

I just emailed the Minister. I used only the first and last paragraphs of the sample letter, but my message is delivered none-the-less. I'd like to see the Minister inundated on this subject, and urge others who feel the same to email or write him today.

Thankyou Ben, for your efforts in organising this. We must fight to stop this step backward. This is especially so with the government saying things like "those requiring more than 10 sessions may benefit more from higher-level psychiatric treatment" (The Age, 11 May 2011, "New services to benefit mentally ill"). It appears our Government have been led to believe that psychotropic medication, which only a psychiatrist may prescribe, is superior to the psychological therapies in the treatment of serious mental disorder. Incidentally, the same article reports "The budget redirects $580 million over five years to needier areas from the Medicare 'Better Access' scheme."

Our Government either has binkers on here, or has simply not been shown the evidence base for the psychological therapies, which have been demonstrated to be effective alone in treating major mental disorders (even psychosis with sufficient frequency and duration of treatment). They should be increasing sessions if anything, and means-testing the scheme.

There needs to be a balance of treatment options and a multi-disciplined team approach to mental health. Some do well on meds and are happy to take them, others don't and cannot endure the side effects.

People need options, not herding away, or into a psychiatric regime.

Thanks for organising.
Have just email letter to Minister!
Cheers
Sue

thanks again ben, excellent and very helpful advocacy work.

I have emailed your Sample Letter from a Psychologist, after adding a paragraph about my personal experience as a client. I will pop a hard copy in the post today as well.

Ania

I have posted the following letter:

Dear Minister,

I am writing to object to the proposal to cap the maximum number of sessions available to people who access a psychologist under the Better Access to Mental Health Care at a maximum of 10 sessions. I make this objection for the following reasons:

Government policy development needs to be informed by evidence.

The decision to cap the number of sessions to 10 seems to be based on the opinion of a few vocal individuals who have lobbied against Better Access since its inception, but have failed to provide any evidence for its ineffectiveness. On the contrary, the evaluation of Medicare-funded Better Access to mental health indicates that it is not only clinically efficacious but also cost-effective.

Government policy implementation needs to be efficient and ethically accountable.

The decision to cap the number of sessions to 10 is likely to impact on patient care negatively and, therefore, no longer evidence-based leading Better Access to become ineffective in achieving its identified purpose.

Government policy needs to be implemented in a cost-efficient manner.

Savings in Better Access can achieved without impacting and patient care by rebating at an equally low rate independent of the providers’ title. The recent evaluation of Better Access provides no evidence that psychologists who are members of the APS clinical college provide superior care to those who are not; therefore, the need for higher rebates is unjustified.

I urge you to reconsider these new proposals about the Better Access initiative and not only leave the length of treatment intact at 12-18 sessions, but consider increasing the amount of sessions in line with the evidence-based literature available.

The best possible solution to the current cost overrun on Medicare acces to psychological services would be to apply a means test.

This would ensure that Medicare rebates are directed to those in greatest need who cannot affort private services.

This rather than capping Medicare rebates to only 10 sessions is the way to go.

Where were psychologist when thousands of trained counsellors lost their livelihoods, permanently, to the Medicare initiative in late 2006 ? They knew it was unjust, but they took the bribe and turned their backs.

Ever heard of Agenda 21 ?
"Frist they came for the Socialists, and I did not speak out. Because I was not a Socialist. Then they came for the Trade Unionists, and I did not speak out. Because I was not a Trade Unionists. Then they came for the Jews, and I did not speak out. Because I was not a Jew. Then they came for me, and there was no one left to speak for me." Martin Niemoller

I sent below as email

"The Hon Mark Butler MP

Port Adelaide SA 5015


I must say, I am absolutely shocked by the plan to reduce the maximum number of sessions. For many years research has provided crystal clear evidence that professional counselling and psychotherapy is extremely cost effective - in fact counselling is a lot cheaper for the society than doctor hopping, high numbers of sick days etc (e.g. Grawe, Klaus et al, Psychotherapie im Wandel,1994. 885p (approximate translation: The Changing Landscape of Psychotherapy)

It's really hard to understand that an already low number of sessions is further reduced below any known treatment manual. Not only that it takes time to thoroughly analyse the problem at the beginning, building a relationship, identifying and agreeing on goals etc, crisis management already takes up time.
I am wonderering what GP assume, how far we can assist clients and resolve their issues.

Please allow me to take the opportunity to share only some thoughts about Counselling and Psychological Therapy in Australia from my perspective as a German trained Clinical Psychologist.

Just to see a wider context, let me provide you with some details about psychotherapy in Germany.

Clinical Psychologist (German: Psychologischer Psychotherapeut) have a specialist status since late 1999.
Full payment of clinical psychologist's treatment when either Cognitive Behavioural Therapy or Psychodynamic Therapy is used for the following numbers of sessions:

25 sessions for short term therapy or 45 for a standard long term therapy (e.g. to treat a medium complex, medium severe depression
these 45 sessions can be be extended by 15 sessions to a total of 60 sessions
under exceptional circumstances these 60 sessions can be extended by another 20 sessions to a total of 80 sessions (remember CBT treatment)
Accordingly, for psychodynamic therapy the steps are 25 (short term), 60 sessions (standard long term), 80 sessions extended, 100 sessions in exceptional circumstances.
This is in place since 2000.

Is that pure luxury because Germany is so rich and Australia is so poor or are those allowances simply evidence based? To my knowledge the latter is the case.

As said, the 12+6 sessions per calendar year are already a very limited number for many of my clients, say about 40-50% of my clients, due to complex issues.

In fact, these new allowances make it even harder if not impossible that issues coming to the surface can be resolved. In the long run, things will be worse for clients, therapists and society.

In addition to all that, the downsizing mirrors the denial of the fact that 70% of GP visits are a result of chronic illnesses / lifestyle problems with underlying motivational difficulties which require more psychological support not less. All in all it is a slap in the faces of clients. Also, a slap in the faces of well trained psychologists, prepared to provide proper treatment with lasting effects. In addition to that, a backlash for all those who endeavour to integrate psychology into the health system.

In Australia, the requirements to become a Clinical Psychologist (or to stay registered) including PD requirements are almost equally high to those in Germany.
However, what for? Just to be limited to 6-10 sessions? This is a huge waste of resources. It must be possible to have proper treatment available, for those people who cannot afford to pay a full fee over some time.

One last thought that came up. I feel the referral system as such is anachronistic, produces unnecessary costs (by redundant / needless GP consultations) and devalues the specialist status of clinical psychologists (is a GP judgement on the mental state of a client of more value than a Clin Psychs diagnosis?).

I would like to suggest direct access to qualified psychologists, one compulsory medical check at the beginning of treatment, and a minimum of 30 sessions per rolling year.

Yours sincerely,

Frank Breuer | Clinical Psychologist MAPS
Suite 17, Level 1, The Madison building
25-29 Hunter St | Hornsby NSW 2077
www.newpathspsychology.com.au