Radio interview with Minister Butler and Patricia Karvelas, ABC RN Breakfast - 15 December 2023

Read the transcript of Minister Butler's interview with Patricia Karvelas on the new digital services being the first step towards a better, fairer mental health system.

The Hon Mark Butler MP
Minister for Health and Aged Care

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PATRICIA KARVELAS, HOST: Australia has been facing a mental health crisis, and it's estimated to cost the country around $220 billion a year, according to the Productivity Commission. Last year, when the Federal Government cut the number of subsidised psychological sessions from 20 to 10, there was an outcry from so many. It said the support wasn't reaching those who needed it in the lower socio economic, regional and disadvantaged areas. That was the reason for making that change. Now, a year on, the government is announcing its first step towards what it believes will be a fairer mental health system by increasing funding to crisis support services like Lifeline and Beyond Blue. Mark Butler is the Minister for Health and he's our guest this morning. Minister, welcome.  
KARVELAS: You cancelled those subsidised extra sessions. Is this announcement funding for digital mental health service a response to that? 
BUTLER: Only in the broadest possible sense. Just to be clear, we didn't particularly cut the sessions. They were put in place by the former government for the COVID era only, and they were scheduled to end at the end of December last year. One of the things I remember saying on your program that I was concerned about is that the addition of those ten sessions had meant that actually far fewer people were getting into the system. So far fewer people were getting any help whatsoever - some tens of thousands fewer people were getting into psychology. And that had been predicted by people like Professor Ian Hickie at the time that having these ten sessions would actually create a bottleneck for people who needed, you know, even one session, let alone 20. I'm really pleased that this year, compared to last year, almost 50,000 additional people have been able to get into the system and get psychological therapy.
The thing that also came out of the evaluation of this program is that those additional 10 sessions were not necessarily going to people with more complex needs. The evaluation actually found that there was no difference in the baseline mental health of those who were getting the additional 10, and those who weren't getting the additional 10. That's no real surprise, really, because that system doesn't have a built-in mechanism to identify people who have particularly complex needs and triage them into additional sessions. There's definitely a gap there for people with more complex needs, but Better Access, which is the scheme that provides Medicare rebates for psychological therapy - the one that we're talking about - that is not designed to pick up those people, and really, we need to find alternative systems of support for them. 
KARVELAS: So, what are those alternative systems of support? 
BUTLER: What we're trying to do through this process, I've been working alongside Emma McBride, the Assistant Minister for Mental Health, with a range of leaders from the sector: carer and consumer representatives, but the leaders of organisations your listeners will be familiar with, like Beyond Blue, Black Dog Institute, the AMA, the Society of Psychologists and so on. I think their broad advice, our broad conclusion we all share, is that Australia needs a more stepped model of mental health care, because there's a very wide variety of levels of need. Some people go through situational distress, through a relationship breakdown or a job loss or a bereavement, and they need relatively short periods of support. They might not have a diagnosable mental illness, but they're certainly distressed, and they need support. And that really is what the digital investment we're looking at today is particularly targeted at.
There are people who go through periods of anxiety and depression, and Better Access, the psychology support is well designed for those, generally people need four to six sessions and that's well designed for that. But there are really serious equity issues with that. That scheme has largely been set up in locations in wealthier suburbs of Australia. It means poorer Australians, who have more than twice the level of distress of richer Australians, for reasons I think your listeners will well understand, are not getting good access to psychological therapy. So, the Committee is working on ways in which we can get better equity. That's challenging because we don't have enough psychologists in Australia. So, we can't just shift a whole lot of psychologists into our outer suburbs and rural Australia, which is why in the Budget we had hundreds and hundreds of additional scholarships and training places for new psychologists. 
KARVELAS: Also, psychologists are only getting more expensive. The Australian Psychological Society recommends clinical psychologists should be charging $300 a session for a 45-to-60-minute consult. Now, I don't want to insult the people who do this work because I know they're highly skilled. But if you're a lower income person, you can't afford that. 
BUTLER: Absolutely. So, affordability - it's not just the location of these practices, this is a relatively new scheme, it's only around 15 years old, so a lot of these practices are new, they are largely set up in the wealthier suburbs or middle-income suburbs of Australia. It's harder to actually see them in some of the outer suburbs or rural Australia. But as you say, the gap fees have climbed dramatically. They're now close to $100 a session on average, but there's many that are higher than that, as you indicate. Affordability is a driver of inequity as well and so, we're looking at ways in which we can create different systems for people who just don't have the capacity to pay those sorts of gap fees. 
KARVELAS: But even in looking for it, I mean, it's taken an entire year for you to announce this announcement today, the $456 million for Lifeline and 13YARN and Beyond Blue. But beyond that -
BUTLER: And Kids Helpline.
KARVELAS: Yeah and Kids Helpline, thank you. But beyond that people are still waiting in these really high need groups, and we're in a cost-of-living crisis, there is more demand than ever? 
BUTLER: What we're also doing in the meantime is what we call private PHN’s or they used to be called “Medicare Locals” have funding from government to deliver psychological therapy in some of those areas where there's really a market failure, they're continuing to do that, and that addresses equity issues to some degree. We're also in the process of rolling out some 61 what we're calling “Head to Health” centres. These are adult mental health centres that again sort of provide a level of support free of charge to people who can't get something from the more private sector part of the system.
And part of our Strengthening Medicare reforms are also targeted at boosting the ability of general practice to deliver high quality mental healthcare. Now, the College of GPs report that they produce every year was only released in the last couple of weeks, and that again reaffirmed that mental health is now the largest part of a general practice's services. It is the biggest thing that they do, and they probably do more of it than any other part of the health system in the country. So, we can't ignore the role of GPs, so we've provided them with support for longer consults. We're also building their support for multidisciplinary care so that they can have mental health nurses working in their practice and such like. But there is still, I think, a recognition that we haven't got a stepped level of care. And so, this Committee is going to continue working with me over the course of early next year to find even more supports for people with complex needs, because that is really the concerning growing area of need in the country, not just here in Australia, in other countries as well, more complex levels of mental health needs. 
KARVELAS: So, is that - what is the timeframe then? Is it the May Budget for announcing a wider mental health overhaul? 
BUTLER: This is really a rolling effort. As I said, we're opening these Head to Health centres now as we speak, and they're providing substantial additional support in communities. There's 61 of those budgeted to roll out. Emma McBride is rolling them out very, very regularly. We're rolling out these additional investments in general practice, but we are willing to continue to talk to the sector about other ways in which we can provide that support.
The last thing I'd say, really, in terms of this stepped level of care, is that the National Cabinet decision in the last couple of weeks around disabilities is incredibly important for mental health. You might remember, Patricia, the PM and the premiers talking about the need for foundational supports for people with disability who aren't getting access to the NDIS. Now, there was a lot of discussion about kids with developmental delay being a key target group for that, and they are. But the other group is people - adults, usually - with lifelong mental health issues, often psychotic disorders who fall outside the NDIS, but need quite significant support. Now, we provided them with support in the Budget, with some hundreds of millions of dollars of support, but that's intended to be temporary while we build this system of foundational supports for the very large number of adults who used to get a range of psychosocial programs that were all rolled into the NDIS and are now left in a bit of a gap, which was a very significant part of the National Cabinet decision over the last week or two.  
KARVELAS: Mark Butler, many thanks for joining us this morning and I hope you have a happy and safe Christmas, speak to you next year.
BUTLER: You too. A well-earned break for you, Patricia.
KARVELAS: Thank you. You too.

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