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The Battle for Better Access to funding for Mental Health Treatment in Australia. Get Informed & Be Heard.

1/1/2012

1 Comment

 
The Battle for Better Access to funding for Mental Health Treatment in Australia. 
Get Informed & Be Heard.

As some will know from November 2011 funding for mental health changed radically in Australia. Unfortunately, this change was for the worse in my opinion. The is certainly so for the eating disorders sector.

Before November 1st, 2011, patients were eligible for 12 sessions of therapy which would be subsidised under Medicare.  For patients with “special circumstances” another 6 sessions could be accessed.  Patients with eating disorders were usually granted the “special circumstances” sessions and so, in effect received 18 sessions subsidised by the government.  Sessions were not fully covered and patients still paid around $80 - $100 per session out of pocket.  After 18 sessions all fees for treatment became out of pocket as psychological therapy is poorly covered by private health funds (although massages and running shoes are).

Public disquiet with this decision led to a Senate enquiry.  The chair of that committee, Senator Penny Wright of the Greens, prepared a majority report calling for the changes to be held off until a suitable replacement for funding can be found.  However, this report was not tabled until after November 2011 and the changes have already taken place.  I understand that Senator Wright has tabled a private members bill to reverse the changes and that this will be debated in February 2012.

In my role with the Australia and New Zealand Academy for Eating Disorders, I had the opportunity to meet with the Minister for Mental Health Mark Butler on two occasions. On both occasions it was at the invitation of The Butterfly Foundation, Australia’s leading eating disorder patient advocate group.  I do believe that Minister Butler was unaware of the “unintended consequences” of the decision on patients with eating disorders.

In meeting with the Minister it is clear to me that a combined consumer/practitioner voice is the most important way to effect political change.  The role of consumers (which is not a great term but it is the one politicians have become accustomed to) is of utmost importance.  

Here are some things you could do:

  1. Get informed.

A sad reflection of the media and my own professional bodies is that the majority of information available comes through activist groups on social media outlets.  Such sources are biased in a direction of reverse the cuts, but I’m not pretending to be balanced in this argument.  Twitter and Facebook has led to a few regime changes recently so social media is not a bad thing.  The best fb page i have come across is
 http://www.facebook.com/groups/GetBOMHC/

The also have a website at http://www.betteraccess.net/

The Australian Psychological Society also has some information of use in their “news” section at:  http://www.psychology.org.au/

2. Be Heard

You can join social media campaigns by joining  http://www.facebook.com/groups/GetBOMHC/

You can raise the issue on Twitter if you have an account. Some members are engaging in a 30 tweets to Minister Butler in 30 days campaign.

You can sign an online petition at http://www.gopetition.com/petitions/better-access-to-psychologists.html

You can vote on http://suggest.getup.org.au/forums/60819-campaign-ideas/suggestions/1833821-better-access-to-psychologists to raise the profile of this issue.

Most importantly you can write to the politicians.  You should write two letters. The first should be to your local member, asking them to raise the issue with Minister Butler. The second is to Minister Butler himself.

http://www.betteraccess.net/index.php/take-action/stop gives you lists of your local members and Minister Butlers address.

http://www.psyber.net.au/index.php/media/57-articles/1623-tell-the-minister has some sample letters that you might want to copy points from.  

The letters don’t need to be long.  They DO need to be hand written.  My information from the Department of Health and Aging tells me that handwritten letters are far more effective in getting a politicians ear that computer generated ones.

I’m posting this because of the importance of this issue. The government has unintentionally raised an unacceptable barrier to effective treatment. I’ll write more on the issue in later blogs with information specific to eating disorders.  We have until February to take some effective action so we need to move now.

Please post any feedback or comments either on the Facebook page or on the website.




1 Comment

First Post!

6/5/2011

2 Comments

 
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What just happened. I went to bed before the budget knowing that I could do my best to treat patients with eating disorders in line with the guidelines that we know to be scientifically valid.  Under the original "Better Access" Scheme, patients could typically receive 18 sessions of treatment subsidised by Medicare.  When I woke up after the budget this rebate had been cut to 10 sessions.  Now the government had based this figure in part on data produced by my professional body the Australian Psychological Society.  This data indicated that most patients were receiving about 6 - 8 sessions of therapy before the completion of their treatment. Only about one percent of therapists were using upto 18 sessions with their patients.  I think that 1% may have been me.  The other 99% must have not been seeing patients with eating disorders.

Lets look a little at the treatment of people suffering from eating disorders and why we have a problem.

The eating disorders are amongst the most serious psychiatric disorders.  Eating Disorders effect up to 10% of Australian women.  Anorexia Nervosa is the third most common chronic illness effecting adolescent women.  It has the highest mortality rate of ANY psychiatric illness, with 20% of patients dying from the illness after a prolonged history.  Matched for age, patients with anorexia nervosa have a death rate five times higher than the general population.  Death from suicide is relatively common, being 32 times higher than expected than in the general population (for comparison, patients diagnosed with major depression are 20 times more likely to die from suicide).

The Eating Disorders are often chronic and debilitating illness. On average, patients with Anorexia Nervosa have a similar level of disability to those suffering from Schizophrenia and Borderline Personality Disorder. In a systematic review of the literature eating disorders are shown to have one of the highest impacts on health related quality of life of all psychiatric disorders.  Cost of treatment per year for Anorexia Nervosa is as expensive as that required for schizophrenia.  Data from the private hospital system indicates patients with eating disorders are the most expensive patients to treat in a hospital setting. This is due to the complex psychiatric and physical comorbidity, the protracted length of treatment, and the requirement of specialist care. 

We know that patients who have access to the empirically supported evidence based approaches provided by specialist services have a significantly improved outcome.  This is particularly so for those who are able to access these treatments early in the course of their illness.

There are two well validated outpatient treatments for patients with the eating disorders, Family Based Therapy for Anorexia Nervosa, and Cognitive Behaviour Therapy for Bulimia Nervosa. 

The treatment of the eating disorders is complex and often protracted. The treatment manuals for both FBT and CBT indicate that the number of sessions recommended for treatment 20 treatment session over a 6 - 12 month period.  This is of course the problem.  We had 18 sessions, which almost fitted in with what works.  Now we have 10 session.  This is half the recommended course of treatment. (Actually, I'm not sure 18 was ever really enough but that is an argument for another time {I suspect now in the distant past}. I'm not going to mention the problems of FBT under the current legislation).

The government’s recent reduction of this figure to 10 sessions is woefully inadequate for my patients needs.  The reduction will result in fewer patients accessing appropriate treatment within an adequate time frame.  Outcomes from the eating disorders will deteriorate and the personal, social and economic burden from the eating disorders will increase.  

So, what to do ......
 I am a great advocate of accept what you can't change AND trying to change something that you can do something about.  There was a move to remove Social Workers from the Medicare Scheme which was reversed die to public pressure.  I am hopeful that the same can happen here.

Lift what you want from what I have written above and send an email to the Minister for Health and Ageing Nicola Roxon and Minister for Mental Health Mark Butler

Lets not forget the Greens (whom I've heard are supportive of my position)
bob.brown@aph.gov.au                      
and the independants
senator.xenophon@aph.gov.au            

senator.fielding@aph.gov.au                

Peter.Dutton.MP@aph.gov.au             

Mark.Butler.MP@aph.gov.au             

Tony.Windsor.MP@aph.gov.au

robert.oakeshott.mp@aph.gov.au

Lets get active to support the effective and affordable treatment of eating disorders.  I know I have.


Chris Thornton
Clinical Director 
The Redleaf Practice.

 


 


2 Comments

    Author

    Chris Thornton is a Clinical Psychologist and the Clinical Director of The Redleaf Practice, a specialist outpatient clinic for the treatment of eating disorders.  He is interested in bringing elements of positive psychology, Cognitive Behavioural Therapy and Acceptance and Mindfulness approaches to the treatment of eating disorders.   

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