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The Mental Health Reforms: What They May Mean for Your Health Care

Jonathan April 28th, 2016 0 comments

Back in November, the government outlined proposed changes for mental health services and this has led many people to wonder what the reforms might mean for their access to mental health support.

Around 4 million Australians are affected by mental health issues in the average year and this is only surpassed by cancer and cardiovascular disease in terms of chronic conditions.

The Current Situation

The “one size fits all” approach that is currently being run from Canberra allows patients to access up to 10 sessions with a psychologist per calendar year. These are subsidised by Medicare.

If you need more sessions than this, you’ll need to pay or have ancillary/Extras health insurance with Psychology services to avoid being out of pocket. If you want to see a psychiatrist, you’ll need a referral from your GP.

The Turnbull government has now recognised that this approach doesn’t offer adequate support for many Australians. The new plans are designed to put the individual needs of patients first and reflect the fact that not everyone will have the same requirements as far as mental health is concerned.

What is Likely to Change?

The current approach to mental health is set to be shaken up, with patients receiving different levels of support depending on their needs.

“Coordinated care packages” will be made available for people with complex and severe mental health needs, and “flexible support” for people with more moderate needs.

The “coordinated care packages” will be similar to those being proposed for the National Disability Insurance Scheme (NDIS). They will involve integrated health services including assessments and care coordination, psychological services, mental health nursing, drug and alcohol services, vocational assistance and peer support. These will be tailored to the needs of individual patients.

According to Health Minister, Sussan Ley, the “stepped care” approach will be more efficient in ensuring that patients get the level of mental health care that they actually need, rather than the current “one size fits all” approach.

No new money will be made available for these changes. Instead, $350 million will be reallocated from Canberra to Primary Health Networks (PHNs), who will be responsible for commissioning mental health services in their local area and can adapt them for the needs of their community.

$85 million will be available over 3 years to improve access to mental health for Aboriginal and Torres Strait communities.

There will also be a bigger commitment to using digital mental health services. This will include a telephone hotline, which could work well in areas where there aren’t a lot of mental health services and in situations where patients aren’t able to access support in person e.g where agoraphobia is concerned.

What Could This Mean for You?

If you see your GP with severe or complex mental health needs and they decide that you need a referral, you could be passed onto coordinated/packaged care and this will be organised through your local Primary Health Network. In theory, this should mean that you are able to receive more intensive support than was previously the case.

In reality, the picture isn’t so clear. With no additional funding on the table, many people are unsure of how the reforms will achieve their aims.

The “stepped care” model has a lot of similarities with the NDIS plans and this has prompted fears that it will not offer adequate support, particularly for the most vulnerable.

If psychologist sessions are not going to be available through Medicare once the reforms are bedded in, you can still choose to see a psychologist in a private setting. Obviously this will mean some out of pocket costs unless you have private health insurance.  You don’t need a referral from your GP to see a private psychologist.

Can Health Insurance Help?

If you already have private health insurance, this is a good time to look at your cover and see what mental health benefits it entitles you to. If you’re not getting much from your current health fund, there are two options: upgrade your current policy, or shop around to see if you can get better annual limits elsewhere and then switch insurers if you can.

If you don’t have health insurance at all or your current policy doesn’t offer anything much in the way of mental health support, Psychiatric Hospital services and Psychology Extras services will be the most relevant options.

Not all Hospital policies will cover you for Psychiatric services. You may need to have mid to top level Hospital and Extras cover to get both of these as the more basic policies tend not to include them. You can get combined Hospital and Extras cover but you may choose to have separate policies, and these don’t need to be with the same health fund. Shop around and compare your options to see which is the most cost effective for you, and pay attention to annual limits on Psychology services as these can vary a lot between health funds and will significantly affect the amount of support that you’re able to get from a psychologist.

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