Are you serious Jeff? The people accessing these services have in the majority of cases serious mental health disorders - the stats show this to be the case over 80% of the time. This can't be appropriately addressed through church services. And what are people meant to do if they are secular?

You claim that we can't afford to address these issues, but in fact, we can't afford as a society to abandon people with serious mental health issues. It costs us all, in so many ways, to leave people who are suffering with these conditions without any help. And there are benefits to society when we do look after people, insofar as helping support families and keeping people functional and able to contribute to our society.

And you say there is no point half-cooking a pie, but how would this change if you are simply recommending that we choose another team of bakers who have a track record of spending their time (our money) on things other than baking? How about we just let our existing team of bakers get on with doing their job and doing it at a reasonable price?

Wow - what an over-reaction Jeff!

The article you are talking about ('Medicare - 12 sessions is not enough') looks at the evidence from controlled research, showing that for common problems like depression and anxiety a person need closer to 15-20 sessions of psychological support. This is a consistent finding across many studies for many decades. This evidence was actually the reason why the Better Access system adopted a 12 session model with an additional 6 sessions available if needed (maximum of 18 sessions per year). Having up to 18 sessions available still doesn't quite reach 20 session figure, but it does come pretty close. The reason we look to scientific evidence like this Jeff, is that it tells us how we can make policy that gives people a reasonable chance of getting better. The government's latest proposal, to offer just 10 sessions with no exceptions, directly contradicts all of those years of peer-reviewed controlled research about the subject.

How is it that you arrive at the conclusion that offering any psychological services is "a pure waste of tax-payer's money"? If the money was sent to NGOs instead, then they too would need more than 12 consultations with a client to make a lasting difference. This is as much to do with how long it takes ANY practitioner to work as it is about how long it takes the average person to improve their situation and turn their life around.

The main difference with sending all of the funds to NGOs instead is that a lot of the tax-payer's money would get swallowed up with the cost of admin and meetings and other areas unrelated to service delivery. And where is the evidence that people who go to see a GP and get diagnosed with a mental health disorder would want to go to an NGO in the first place? In short, you seem to be arguing for a system that will (a) consume more of our limited funds on non-services; and (b) you are arguing against the choice of a person to decide which practitioner they want to see and under what circumstances they see them.

That doesn't sound very sensible to me Jeff.

The other thing that needs to be pointed out here too Jeff is that all of the arguments made about competition and so on apply equally to practitioners who work in the 'Better Access' system, except that there is even GREATER flexibility and competition when there are more individuals involved in that process. Data from practitioner surveys and other evaluations show high rates of bulk billing, so the claim that this is more expensive doesn't really stand up. The reality is that the Better Access program has opened up access to a lot more people in society than has previously been the case when the norm was -only- to fund NGOs.

Hello Jeff: I think your information is incorrect there mate.

The funding that is being taken directly from psychological services in 'Better Access' is being redirected to the ATAPS scheme. Also, you seem to be basing your stance on this issue on a number of rather idealistic claims there, which don't have data to back them. The fee-for-service model used in the 'Better Access' program has been shown to be extremely cost effective. The evaluation of the scheme that was completed earlier this year, demonstrated very clearly that the 'Better Access' program outperformed cost-effectiveness expectations by a long margin. That is, it turned out to be quite a lot cheaper than expected for each person treated.

There are a lot of problems with forking out tax-payer funds for NGO's, including quality control issues, problems with accurately monitoring projects, and funds being siphoned out covertly into administration, meetings and other expenses that have little to do with service provision. I am not saying that NGO's should not be funded. On the contrary, what I am saying is that investment in those programs should not come at the cost of our existing services that have been shown to work efficiently and effectively.

These cuts to psychological services are unwarranted and will actually increase the overall burden of mental health issues on society.

Hi Jeff: There are a couple of problems with ATAPS being used as a replacement for the services needed by people with anxiety and depression.

First, the overwhelming majority of people with these conditions who reach out for help are seeking psychological services - that is, talking through their problems with a mental health professional. This is the reason why the 'Better Access' system took the format it did back in 2006. That is, the predecessor to the program, the 'Better Outcomes in Mental Health Care' initiative, trialled a whole range of different models of service delivery, looking at what worked best in practice. The model that we have, where a client sees a GP and gets a referral to a psychologist or other mental health practitioner, ended up being quite effective for the overwhelming majority of people with these highly prevalent conditions people face in Australian society. In short, the system worked and that is why the model for 'Better Access' was made the way it was.

My second point on this is that policy makers are doing all kinds of odd things with ATAPS that directly go against what we know about the way mental health services are utilized out in the real world.

The most obvious shift is that they have arbitrarily re-defined the patient group who they claim the service is aimed at. Ever since the inception of ATAPS the program has explicitly focused on 'mild to moderate' disorders, but since the Commonwealth budget was released, they are now claiming it services 'moderate to severe' disorders. By comparison, in practice the 'Better Access' program services the full range of severity in mental health, with over 80% of patients showing 'severe' levels of distress at the beginning of treatment. This has not stopped policy-makers from arbitrarily re-defining the client group who uses 'Better Access' as people with 'mild to moderate' conditions. This arbitrary division, which directly contradicts how these services are actually utilized in the general community, will create needless barriers for vulnerable people reaching out for help. So whoever came up with this idea is simply out of touch.

A related problem here is that under the new Medicare Locals system, patients will not be able to access psychological services through ATAPS if the GP that they consult services people in a different catchment region to where they live. There are a lot of people who live on the borders of these Medicare Locals zones that will be affected by this issue, particularly if their trusted GP is a short drive away, which is often the case. When people find a good GP, they stick to them. In effect, this change in policy disregards patient choices about their preferred health practitioner and sets up regional barriers to care.

I see that you cast doubt on the economic sustainability of 'Better Access' by comparison to ATAPS, but what are the actual figures on this? Well thankfully there have been some recent evaluations of both programs that deal exactly with this issue. Both the Department of Health and Ageing (DoHA) and the Australian National Audit Office (ANAO) assessed the ATAPS program, looking specifically at cost effectiveness and equity on the basis of need. Both of these evaluations found that there were major cost blowouts with ATAPS and problems with inequality in delivering services to those who are most in need.

To give you a sense of the magnitude of this problem Jeff, these reviews found that the ATAPS scheme frequently spends up to 25% of the budget on admin costs, rather than service delivery. In terms of real people, this amounts to one person being denied treatment for every four that seek help. Further to this point, the government's own review show that a single consultation with a mental health professional can cost as much as $635 per consultation in the ATAPS scheme! This is in stark contrast to the fee-for-service arrangement in Better Access, where the taxpayer only funds the delivery of legitimate psychological services. By comparison, it costs the tax-payer $979.20 for a patient to receive a full twelve sessions with a psychologist under the Better Access program. Most rational people would take the obvious position that this represents far better value for money to the Australian taxpayer, when it comes to the limited mental health funding we have available.

For those of you who would like to read the DoHA and ANAO reports, you can see them for yourselves right here:

http://www.anao.gov.au/~/media/Uploads/Audit Reports/2010 11/201011 Audit Report No51.pdf

http://www.health.gov.au/internet/main/publishing.nsf/content/8573A6A3FAB3595BCA257700000D8E78/$File/review.pdf

Murfomurf: Thank you for your reflections.

You correctly point out that politicians mean well in making these changes, but unfortunately they are being sold a bogus story about the Better Access initiative being utilised by "the worried well". The statistics from the recent Better Access Evaluation show that this is not the case. People who access psychological services in this program have quite complex and severe levels of distress in the overwhelming majority of cases.

I also think that you are right about the need for the Australian public to be better informed about how to access psychological services. Likewise, the public also need to be given better information about how these proposed changes will impact on those who need psychological services. One of the most concerning problems right now is that the system they are replacing the Better Access initiative with is actually far more confusing, in that the types of services available will differ from one Medicare Locals region to the next. Helping the public understand what psychological services are available under a uniform scheme like the Better Access initiative is hard enough, let alone expecting psychological distressed folk to understand what they are entitled to in a system where that entitlement differs from one locality to the next. This is going to create more uncertainy, doubt and disengagement from the system. And that's a terrible outcome for mental health care in Australia!

What you say is true about gap fees and the pressure on consumers. I can't see how this is going to improve though under ATAPS, when we have a very limited number of psychologists and other mental health providers, yet in the ATAPS program these mental health professionals are expected to work for next to nothing. What this does in the end is discourages the most skilled practitioners from offering Medicare services. In the context of the personal story you disclosed (thank you), this would make it even harder for a person to find a good quality psychotherapist.