While the introduction of the Better Access to Mental Health Care (Better Access) initiative has undoubtedly had many benefits, there have also been adverse effects for both the profession of psychology and clients.
Better Access was never meant to be the main psychological service for clients with mental health concerns, but an adjunct to the existing state services which provided free access for all clients with mental health issues, from the worried well to the severely unwell. Better Access was meant to cover mild to moderate mental health issues that would respond to short-term interventions. Unfortunately, as early as 2007, state health services began trimming back their mental health programs and focusing on case management rather than treatment.
As a result, psychology has lost many of the long established professional pathways in the public service, where a psychologist could progress from new graduate to competent professional in a standard process that recognised both experience and postgraduate training in its pay grades. Better Access has led to sharp divisions between clinical psychologists and other psychologists as each feel their training, knowledge and skills should be recognised, and this is proving to be a difficult issue to resolve.
Many psychologists working in a contractor arrangement have lost conditions such as sick leave, paid maternity leave, annual leave, long service entitlements and other benefits such as paid CPD, and this is not typically compensated in the take-home pay. Newly registered psychologists may only have the option to work in private practice for their professional life.
The big losers are the clients. Criteria for admission to State Mental Health Services are now quite rigid and primarily limited to the acute phase of a serious mental illness. As a result, many referrals to psychologists in private practice are for people with complex issues, who are expected to be treated in 10 sessions in a calendar year. Further, private practice is not the appropriate service to manage clients who are disorganised, erratic or acting out, yet desperate GPs often refer these clients to us.
In addition, many clients are on low incomes or under financial stress and need to be bulk-billed, and some psychological practices either will not or cannot offer bulk-billing. Where do these clients go?
We need to identify those clients who have lost out in the privatisation of psychological services, and I believe the APS needs to advocate for a return of the state services that should never have been abandoned.
Dr Sandra Pertot MAPS