Medicare cover for referrals to psychologists could save young lives

From the age of nine, my beautiful, brave 20-year-old daughter has struggled with the scourge of a serious depressive illness. Despite the best efforts of three experienced psychiatrists, she responded to neither medications nor psychotherapy. This culminated in her becoming so dangerously suicidal that aged 17, she was admitted to a psychiatric intensive care unit and was unable to complete her HSC. In her own words:

Every night I go to sleep hoping for a better day, and every morning I wake up wondering why I can’t find happiness. This is my life … this is my depression. But how do you search for happiness when you can’t remember how it feels? And how do you solve a problem that exists only in your mind? This is what my psychologist has been trying to help me with; my struggle to stay alive.

The youth suicide rate in Australia (age 15-24), from 1999 World Health Organisation figures, ranks 5th out of 24 developed countries after New Zealand, Finland, Norway & Ireland. Since 1991 the rate has been consistently 4-5 times higher than that of Greece & Italy, the countries with the lowest rates.

The management of major mental illness in Australia is undertaken by both psychiatrists and psychologists, but only consultations with psychiatrists are supported by Medicare. From my personal observation as a medical practitioner, an experienced psychologist has undoubtedly saved my daughter’s life. I believe that optimal management of serious mental illness requires the combined efforts of both psychiatrists and psychologists who have different skills and techniques. All my GP colleagues agree this would provide invaluable assistance in the overall management of their patients with serious mental illness. The UK National Health Service covers the management of mental illness by both psychiatrists and psychologists.

Fees for psychology consultations are generally slightly less than those for psychiatrists at $125-$150 per hour. Some health funds give very limited rebates towards psychology consultations but I suspect the majority of serious mental illness occurs in families that do not have private health insurance and could not afford the cost of psychology consultations. The solution is to include GP-referred consultations for psychologists under the Medicare umbrella for life-threatening mental illness, perhaps a negligible impact on funding as many referrals to psychiatrists would simply be substituted with those to psychologists. As Medicare already covers optometry consultations, surely it should cover life-saving psychology consultations. Although the president of the Australian Medical Association (AMA), Dr Bill Glasson, has indicated his personal support for the idea, he does not believe there would be general support from psychiatrists. Consequently, I contacted two high-profile psychiatrists, Professors Ian Hickie of Beyond Blue and Patrick McGorry of the University of Melbourne Department of Psychiatry, both of whom were in complete accord with the concept.

Dr Glasson referred the matter for discussion by the Economics & Workforce Committee of the AMA. The response was what I consider to be quite shameful: “ the Committee does not consider that it is in our best interests at this time to campaign for non-medical groups to have access to MBS benefits.” My communicating with the AMA was to seek support for an idea in the best interests of Australians, particularly young Australians, not those of the medical profession.

Of the three main political parties, Health Minister Tony Abbott has expressed considerable interest and has instructed the Health Department to further investigate the proposal. Julia Gillard agrees that GPs have indicated their belief that psychology consultations can provide life-saving support and examining the role of psychologists within Medicare is a commitment of the next Labor government. The Democrat’s Lyn Allison is in complete agreement with the idea. With the Medicare package due for a final decision in February, now is the perfect time for at least a government announcement of a feasibility study of Medicare covering GP-referred psychology consultations for life-threatening mental illness.

As concerns my daughter at present, in her own words again:

Although I still face the darkness of depression every day, I continue the struggle. I am now in the middle of a media and cultural studies degree at university, something I would not have been able to do had it not been for the help of my psychologist, friends and family. It is unfair that the unavailability of Medicare denies many families the affordability of life-saving psychology.