Tuesday, March 16, 2010

Subsidies and rebates. Oh My! Oh My!

For too long accessible mental health care has been the under resourced, little brother of the medical world. Depressing clincs hidden in spaces, deemed no longer suitable for other purposes. That 'look' you get from the taxi driver when you give them the address, that you are "one of those people". Walking through a building that is on the verge of giving up, just as many of the souls who enter as patients (I hate the term clients) are.

The care afforded through the Public System, is by necessity, crisis driven. Case workers are overworked, wards are understaffed, bed shortages run amuck. Early intervention into the beginning signs of mental illness is left to poorly equipped GPs. Crisis Care is like a conveyor belt of tick the boxes and process the "crazy" through and out ot the system as quickly as humanly possible. The post crisis interventions as a whole can smack of the "bandaid" approach.
Overloaded caseworkers are unable to give due attention to the long-term needs of their clients. Shortages mean that mental health practitioners refuse to carry out early intervention until the person is ‘acutely’ unwell, leading to forceful intervention. Thus, patients are not kept well, risks are not minimised and disorders are not averted when they ostensibly could be...
Even in times of crisis, anecdotal evidence suggests that patients are not admitted or are discharged early due to an inability to access an available inpatient bed. Reduced access to care has been linked to higher rates of post-discharge suicide

Of course this is not just mental health. Public Healthcare all over Australia is suffering economic and staffing shortages. But Mental Health is an area where it is really easy to cut corners, because the ones who access it are less likely to be able to advocate for themselves.

A few years ago, the Government finally caught onto the idea that the average citizen is as entitled to subsidised mental health care visits, as they have been to visits to GPs, Optometrists ect. Well, kinda... I will use myself as an example: If I was to develop a chest infection and need antibiotics, I would book into my GP. Pay their fee (AUD$65 for short consult) and then claim my Medicare rebate (about AUD$38). So, I pay the $17 gap for the visit.  Now I can do this as often as I need. With me, it is at least once a month to get my scripts filled and blood levels on my epilepsy meds checked. Under the new mental health scheme, I could go to my GP with a mental health issue (in my case PTSD) and she would write up a mental health plan and refer me to a Psychologist for Medicare subsidised treatments. (Pay AUD$130, Rebate AUD$115) The catch is, it can only be for 12 sessions (18 in extremis), which averages at about one a month. now in a soild block, that might be helpful for say a CBT approach, or even short term psychodynamic therapy. but for people like me? Not so much.  Annoyingly, If I was seeing a psychiatrist, who would just want to shove pills down my throat, that would be covered for infinite amounts of sessions under Medicare.

So, the system is kind of better for me then it was, but still not ultra helpful. My private health insurance  would assure you that they take mental health very seriously in their plan. They cover a whole.....6 sessions. Grrrrrrrrrrreat! So, thats 24 sessions covered in all, not even one a fortnight. And when you take someone like me, who has to go 2-3 times per week, well that's a heall of a shortfall I have to cover. Luckily, I have a therapist who works on a sliding scale. But let me tell you, it's still bleeding me dry.

I don't expect that EVERYTHING should be covered, and people should have no responsability for their own healthcare costs. But there has to be a balance. And  something as important as mental health, should be judged just as importantly as cardiac care. IT KILLS TOO.

Which is why it makes me really mad to read about them considering whether the Medicare Subsidy for Psychology should stay. The fact that it is costing more than projected should be telling the powers that be, that there is a serious shortfall in 'other' mental health services. It should be, in my opinion, expanded, not scrapped. Of course, there has to be limits. That's why the GP's have to do a thorough psych evaluation and you have to meet certain criteria to qualify.


*Ahem* Stepping off my soap box for the day

1 comment:

  1. Health insurance generally sucks. Here in the US, we're the only country where most health insurance is provided by employers. Makes things complicated if you have a pre-existing condition and want to change careers.