Better Access – Changes to the number of allied mental health services from 1 January 2013

Issue

Changes to the number of allied mental health services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative from 1 January 2013.

Response

The 2011-12 Budget changes to the Better Access initiative, which took effect from 1 November 2011, included reducing the number of rebates available for allied health services from 12 (up to 18 in ‘exceptional circumstances’) to 10 for individuals each calendar year.

In recognition that reducing the number of allied mental health services for which people could receive a Medicare rebate was a cause of concern, the Minister for Mental Health and Ageing, the Hon Mark Butler MP, announced on 1 February 2012 that the Australian Government would reinstate the additional six allied mental health services available under exceptional circumstances from 1 March 2012, for a limited period up to 31 December 2012. These arrangements were reflected in the Health Insurance (Allied Health Services) Determination 2011, with the necessary provisions coming into effect on 1 March 2012.

From 1 January 2013, the standard number of allied mental health services for which an individual can receive a Medicare rebate is 10 services per calendar year.

Although Better Access was neither designed nor intended to provide intensive, ongoing therapy for people with severe and persistent mental illness, the Government acknowledged that there are some people with more complex needs who have been using the services provided under the Better Access initiative for care and support.

The Government also recognised that some of the new mental health services announced as part of the Delivering National Mental Health Reform 2011-12 Budget package needed time to build further capacity before they are able to provide care and support to people with more complex needs or people with severe and persistent mental illness.

The reintroduction of exceptional circumstances up to 31 December 2012 has provided time for allied mental health professionals and consumers to adapt to the new arrangements and time for the new mental health services to be able to build capacity to effectively respond to people with more complex needs.

Individuals are also able to receive Medicare rebates for 10 group therapy services per calendar year, on top of their individual allied mental health services. GPs can also continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services, where 50 sessions can be provided per year, or state/territory specialised mental health services.

On 1 July 2011, the Government introduced Medicare rebates and financial incentives for specialist video consultations, including psychiatry consultations, for patients living in eligible areas of Australia. These telehealth consultations provide patients with access to a psychiatrist sooner than would otherwise be the case and without the time and expense involved in travelling to major cities.

The Government has provided, through the largest mental health investment in the nation’s history, a $2.2 billion investment over five years from 2011-12 to drive fundamental reform in Australia’s mental health system. Implementation of this investment is being informed by extensive engagement with experts, service providers and consumers and carers.

The changes to Better Access enable the Government to deliver a package of mental health services that better targets and supports some of the most disadvantaged people in our community and rebalances investments across new and innovative services that address mental illness at all stages of life. So far the Government’s achievements include:

headspace - developing 15 new locations as announced in October 2011, and announcing another 15 in August 2012, bringing the total number of centres announced to 70. The average funding each existing headspace site receives has also been almost doubled;
Partners in Recovery (PIR) program - releasing the Invitation to Apply for engagement of PIR organisations in October 2012;
Access to Allied Psychological Services - providing increased funding of $205.9 million over five years, from 1 July 2011, to target hard to reach groups;
Establishing an expert group in child mental health in September 2011 to inform the implementation of the expanded Medicare Healthy Kids Check, the implementation of which will commence in early 2013;
KidsMatter Primary initiative - achieved 1,044 participating schools by December 2012;
Expansion of Early Psychosis Youth Centres - service development planning currently underway for two centres in Western Australia and one in the Northern Territory, and negotiations continuing for sites in Victoria and as many as four sites in New South Wales; and expressions of interest for funding under round two closed on 12 December 2012. This process is currently being finalised;
Support for Day to Day Living - organisations provided with additional funding of $19.3 million over five years for structured activity programs;
New National Mental Health Commission - established on 1 January 2012, the Commission has now released the 2012 national report card on mental health and suicide prevention. The report card takes a new approach to information and reporting in mental health in response to calls by people with lived experience of mental health issues, their families and other support people, along with the broader community;
National Partnership Agreement Supporting National Mental Health Reform - agreed by the Council of Australian Governments (COAG) on 13 April 2012, under which the Commonwealth is providing $200 million over five years for 17 projects to benefit people with severe and persistent mental illness;
Mental Health Consumer Organisation - the Government has appointed a Consumer Reference Group that is working together with its auspice body, the Mental Health Council of Australia, to establish the organisation;
New Mental Health Research - providing funding of $7.4 million over five years through the National Health and Medical Research Council (NHMRC) to three mental health Centres of Research Excellence focussing on suicide prevention, substance abuse and better mental health planning and $7.5 million over five years for a fellowship to support mental health research; $68.2 million research funding boost for mental health focussing on anxiety, eating disorders, depression and other mental health conditions; announced by the NHMRC on 19 October 2012;
Tackling suicide through measures including providing free calls from mobiles to Lifeline, under the Taking Action to Tackle Suicide Package, which commenced 1 July 2011;
e-mental health portal, mindhealthconnect - went live on 29 June 2012;
COAG released The Roadmap for National Mental Health Reform 2012-2022 at its meeting on 7 December 2012. The Roadmap recommits the Australian Government and states and territories to a whole-of-government and whole-of-lifespan approach to mental health reform, and to maintaining mental health as an ongoing national priority. The Roadmap outlines the direction governments will take over the next ten years, building on current efforts and working together to improve the lives of people with mental illness, their carers and families;
A new COAG Working Group on Mental Health Reform (the COAG Working Group) will be established early in 2013 to oversee detailed work on mental health reform, and ensure that all levels of government are supporting reform. The COAG Working Group will be co-chaired by the Commonwealth Minister for Mental Health and a Minister to be nominated by states and territories, and will be assisted by an Expert Reference Group to be chaired by the National Mental Health Commission; and
An ambitious 18-month work program is proposed by COAG for the COAG Working Group, including improving access to mental health data; developing indicators that track the progress of national reform; setting targets for as many indicators as possible, where supported by evidence; and the development of a successor to the Fourth National Mental Health Plan.