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Medicare review of psychologists derailed by professional stoush

Health lawyer Michael Gorton has been appointed as independent chair of the committee convened by the APS to consult with its 24,000 members.

The stoush comes as the government grapples with a mental health crisis that saw the suicide rate increase by 9 per cent in 12 months, according to ABS data released last year. 

A Productivity Commission review into the effectiveness of the $9 billion spent annually on mental health is taking submissions, while the separate Medicare Benefits Schedule review is examining more than 5700 item numbers across the health system, including in psychological services.

The APS submission to the MBS review had proposed a new three-tiered system which bulk-billing generalist psychologists feared would lock many clients out, by restricting rebates for the treatment of moderate to severe and chronic mental health conditions to clinical or “endorsed” psychologists.

The proposal – written by previous APS executive director Lyn Littlefield – had suggested that Medicare rebates for sessions with registered psychologists who are not clinical psychologists be restricted to “mild to moderate” cases.

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Clinical psychologists must have a master’s or doctoral degree to be registered with the Psychology Board of Australia, on top of a four-year undergraduate honours degree. They make up about 36 per cent of the profession.

The pathway to become a generalist registered psychologist allows practitioners to undertake supervised work experience in place of postgraduate study.

Psychologists endorsed in specialist areas such as educational and developmental, counselling, forensic and community psychology, who spend the same length of time at university as clinical psychologists, complain of being wrongly treated as less qualified.

A breakaway group called the Australian Association of Psychologists is pushing for a single rebate for psychology services, regardless of how many years the practitioner spent at university.

Currently, a session with a clinical psychologist attracts a rebate of $124.50, while for registered psychologists the rebate is just $84.80.

AAPi executive director Michael Pointer said there was “no evidence” that clinical psychologists were more competent than their peers.

“If you look at the interim report of the MBS taskforce, that they issued last year, they made the statement in respect of medical services that the rebate should be paid for the services provided and not for the qualifications of the service provider – which is absolutely logical,” he said.

Mr Pointer warned that the difficulty of accessing psychological support outside major cities, where most clinical psychologists worked, would be exacerbated if the three-tiered model was pursued.

Former Australian of the Year Patrick McGorry says warring psychologists should put patients first.

Former Australian of the Year Patrick McGorry says warring psychologists should put patients first.Credit:Dan Peled

“When you consider that we have a situation in this country where nearly nine Australians a day are committing suicide, we have a major problem that needs to be dealt with.”

Psychiatrist and youth mental health advocate Patrick McGorry said that while quality control “can be an issue” within the psychology profession, both sides of the debate had merit.

“I think we’ve got a lot of work to do in mental health across all disciplines to improve the level of expertise,” he said.

Professor McGorry said there was no doubt that clinical psychologists overall went through more rigorous training than generalist psychologists, although Australia lacked a nationally standardised training system for the profession.

He warned against self-interested lobbying by professional groups, saying mental health practitioners “should focus on the people they are trying to help” and put patients first.

He called on the Medicare review taskforce to support an increase in the number of fully-rebated psychologist visits, currently limited to ten sessions per year.

Ms Mirabelli said the APS review would consider a wide range of views.

A spokeswoman for Mr Hunt said the minister was “aware of the differences in opinion between various sub-groups within the profession”, and the failure of the MBS review taskforce’s mental health reference group to reach a consensus.

“This has been a long-standing internal debate within the psychology profession,” she said.

For help contact Lifeline 131 114 or beyondblue 1300 224 636.

Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.

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