Several key documents have recently been released which propose changes to the way mental health services are delivered to the public. Some proposals are welcomed by experts in the field, while others raise alarm.
The Australian Clinical Psychology Association (ACPA) commends the Australian Psychological Society (APS) on its White Paper: The future of psychology in Australia. Dr Judy Hyde, past President of ACPA states, “ACPA stands for safety and quality in mental health service delivery. We support the new direction of the APS in founding its recommendations for psychology service delivery on the areas of practice endorsement defined by the Psychology Board of Australia. In this, the intent of the White Paper appears to support the quality of services delivered to the public, for the benefit of the public, and this is to be commended”.
In relation to the recent Report from the Mental Health Reference Group review of Medicare Benefits Schedule (MBS) items, Dr Hyde confirms that there is widespread support within the profession for the recommended proposal for a stepped care model of mental health service delivery, with the number of sessions offered, and types of therapy delivered aligned with patient need and appropriate levels of training of those delivering services.
Within both documents, ACPA supports recommendations of increased access to group therapies and to mental health services for those in aged care facilities, the introduction of e-Mental Health as a first-line evidence-based treatment for those with mild conditions, and the creation of a mental health case conference item. The need to amend the way interventions are funded in the treatment of children and young people, to allow parent or carer sessions and evidence-based treatments such as family therapy, is widely recognised as an imperative.
ACPA also supports the inclusion of the clinical neuropsychology items proposed by the APS, which will allow patients with mental health presentations to undergo assessments for the differential diagnosis of neurodevelopmental disorders and dementia. This will enable delivery of the most appropriate treatments for these conditions.
The profession widely agrees that all mental health services provided under Medicare need to be delivered in an environment that mandates evaluation of patient progress and outcomes, including the measurement of treatment harms.
However, Dr Hyde states, “the potential re-definition of Focussed Psychological Therapies through the amendments proposed by the Mental Health Reference Group for the MBS Better Access scheme is clinically and fiscally irresponsible. Dilution of the defined evidence-based treatments associated with these MBS items essentially means that treatments which have proven efficacy and efficiency when provided with fidelity will be less likely to be applied when treating patients. The defined Focussed Psychological Therapies treatments were written into the current MBS items for the very reason that they work for the conditions to which they are targeted, and it is therefore these specific treatments that Government funding should be spent on.”
With a lens on quality and safety, Dr Hyde also notes concerns about practitioner training levels. She explains that the minimum international standard for the independent delivery of mental health services by psychologists is a two-year Master’s degree in professional psychology practice focussed on mental health.
While practitioners who do not hold this level of accredited training are currently allowed to deliver Focused Psychological Therapies under the MBS, any effort to extend the range of allowable treatments available to these practitioners beyond Focussed Psychological Therapies carries potential increased risk to highly vulnerable patients, and would need to be carefully regulated and closely supervised. Dr Hyde believes that efforts would be better placed in ensuring that Focussed Psychological Strategies are, in fact, being delivered by practitioners in the way directed by our current MBS items
“Overall, recent proposals for change have many positive aspects for those seeking mental health services. We just need to ensure that we follow through with improvements, while at the same time, we avoid changes that will downgrade services and potentially waste Government funds.”