How to Access Mental Health Treatment in Australia

Mental Health in Australia

In the most recent national survey on mental health and wellbeing, it was found that 45% of Australian adults had experienced a mental disorder in their lifetime, with 20% experiencing a mental disorder in the previous year (ABS quoted by Cook 2019).

In the most recent Burden of Disease Study by Australian Institute of Health and Welfare (2015) found that mental and substance use disorders were among the main disease groups causing non-fatal burden in Australia at 24%, in front of respiratory diseases (10%) and just behind musculoskeletal conditions (25%) (AIHW 2015).

The term ‘mental disorder’ covers a range of clinically diagnosable disorders that negatively impact an individuals’ cognitive, emotional or social abilities.

Currently, the most common mental health conditions in Australia are anxiety, depression and substance abuse disorder (Queensland Government 2018).

At the time of writing, there is a Royal Commission into Victoria’s Mental Health System. We now know that nearly one in six Victorians are living with high or very high psychological distress - but only 1.1% receive clinical mental healthcare, highlighting a serious lack of support for a vulnerable population (Hall 2019).

The aim of this commission is to address and make recommendations for Victoria’s mental health system - a system labelled as ‘broken’ by many, including its Premier. This royal commission was assured prior to the last state election, when it was revealed that Victoria spent less per capita than any other state on mental health (Bennett & Rizmal 2019).

Mental Health Awareness

Mental health is defined by The World Health Organisation (2005) as:

- A state of wellbeing in which the individual realises their own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community.

If a person is not in this state of wellbeing and does not feel that it is achievable, they may be living with a mental illness or mental health disorder. Prominent conditions include depression, anxiety, schizophrenia and bipolar disorder.

Note that while mental health disorders can and do affect all Australians, certain groups have a heightened risk of mental illness. These groups include:

• People living in residential care;
• People who live in remote and regional areas;
• Pregnant or new mothers, and fathers;
• First Nations People are nearly three times more likely to be psychologically distressed than non-First Nations People;
• LGBTQI+ Australians;
• Females are more likely than males to experience depression and anxiety (note, however, that males are considerably less likely to report or seek help for mental health conditions).

(Beyond Blue 2019)

Mental Health Treatment Plan

A Mental Health Treatment Plan (MHTP) is a support plan for someone experiencing mental health issues.

A general practitioner (GP) will assess if a person has signs of mental illness and whether they would benefit from mental health treatment.

General signs that a person may need to address their mental health include:

• They’ve been feeling one or more of the following for two weeks or more:
• Worried;
• Sad;
• Down;
• Angry,
• Depressed,
• Numb; or
• Generally ‘not like themselves’.
• The way they’ve been feeling is affecting their ability to cope at work; school; or in their relationships.

(Queensland Government 2018)

Not only does creating a MHTP allow someone to be referred to appropriate support by a GP, but creating a MHTP gives the patient the opportunity to begin to outline how they’ve been feeling, what their needs are, and what results they would like.

In most cases, a MHTP is required to qualify for government subsidised treatment (Beyond Blue n.d.).

A MHTP will involve the following:

• A referral to a health expert such as a psychologist, psychiatrist, occupational therapist, counsellor, or social worker;
• The type of mental healthcare a person can access;
• Strategies to improve (and maintain) mental health.

(Headspace 2018; Department of Human Services 2019)

Accessing Mental Health Services under Medicare

Step 1 - Make an Appointment With a GP

Before an appointment with a GP or mental health professional, it is recommended that people write down a list of the things they want support with, such as feeling less anxious in certain situations or how to cope in depressive periods. It’s normal to feel nervous going into this appointment.

A list may be a helpful prompt and a useful backup. A patient could even give it to the health professional to read first and ask questions about what has been written down.

Step 2 - Talk to a GP About Mental Health Concerns

A GP will assess the patient’s mental health. They will need to diagnose the patient with a mental health condition to create the treatment plan, to do this a GP will ask a series of personal questions and enquire into what’s been happening and how that person has been feeling recently.

The patient may be asked to fill out a K10 form, which is a checklist intended to measure if and how a person has been affected by anxiety or depression over the past four weeks.

A mental health assessment, conducted by a mental health clinician will likely consist of finding out the following:

• Presenting problems;
• History of presenting problems;
• Current functioning;
• Relevant cultural issues;
• Previous assessments and interventions;
• Psychiatric history;
• Current medications;
• Medical history;
• Family history;
• Developmental history;
• Substance use;
• Forensic and legal history;
• Risk screen;
• Goals for treatment; and
• Mental status examination.

(Queensland Health 2010)

If a person is diagnosed as having a mental disorder, their GP may either prepare a MHTP, or refer them to a psychiatrist who would create a psychiatrist assessment and management plan (Department of Health 2017).

Step 3 - Be Referred to an Allied Health Service

A person can be referred to Medicare rebateable allied mental health services once they have the following:

• A Mental Health Treatment Plan in place (note that a MHTP does not expire);
• Are being managed by a health practitioner under a referred psychiatrist assessment and management plan; or
• Are referred by a psychiatrist or paediatrician.

(Department of Health 2017)

Step 4 - Attending Sessions

Initially, a GP, psychiatrist or paediatrician can refer a patient to treatment of up to six individual and six group allied mental health services. Treatment plans will vary upon the individual, it might involve psychological assessment and therapy by a clinical psychologist, or it could consist of psychological strategies conducted by an allied mental health professional (Department of Health 2017).

It is at the discretion of the referring practitioner as to the number of allied mental health services a patient is referred to (it is a maximum of six in any one referral) (Department of Health 2017).

Step 5 - After the Six Sessions

Following the first round of treatment (six sessions or less), depending on a person’s healthcare needs they may want to return to their GP, psychiatrist or paediatrician and obtain a new referral to obtain an additional four sessions. Per calendar year, the maximum is ten individual and ten group services. (Department of Health 2017).

If a person feels that they require more than ten services in a calendar year, they can see their GP and/or treating practitioner to discuss other available options, such as services available through Primary Health Networks (Department of Health 2017).

How Much of the Cost is Covered by Medicare?

On a MHTP, Medicare will rebate $124.50 for 50+ minute sessions (or $84.80 for 30-50 minutes) with a clinical psychologist. If the cost for a session exceeds this, a person is required to pay the difference.

Obtaining a MHTP is a huge step towards becoming happier, healthier and more connected.

The difference mental health treatment can make to a person’s wellbeing cannot be overstated.

Additional Resources

• A Guide to Performing a Mental Health Examination Lecture, https://www.ausmed.com.au/cpd/lecture/guide-to-mental-health-examination
• Fact Sheet for Patients, Australian Government Department of Health, https://www1.health.gov.au
• Find a Health Service, Healthdirect, https://www.healthdirect.gov.au/australian-health-services
• Find a Psychologist, Australian Psychological Society, https://www.psychology.org.au/Find-a-Psychologist
• Who Can Assist? Beyond Blue, https://www.beyondblue.org.au/get-support/who-can-assist

If you’re in crisis and need support, call Lifeline on 13 11 14. Lifeline is open 24 hours a day, 7 days a week.

References

• Australian Bureau of Statistics (ABS) 2007, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, ABS, viewed 11 December 2019, https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4326.0Main+Features32007?OpenDocument
• Australian Bureau of Statistics (ABS) 2018, National Health Survey: First Results, 2017-18, ABS, viewed 11 December 2019, https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Mental%20and%20behavioural%20conditions~70
• Australian Government Department of Human Services 2019, Mental Health Care and Medicare, Australian Government Department of Human Services, viewed 10 December 2019, https://www.humanservices.gov.au/individuals/subjects/whats-covered-medicare/mental-health-care-and-medicare
• Australian Institute of Health and Welfare (AIHW) 2015, ‘Australian Bureau of Disease Study: Impact and Causes of Illness and Death in Australia’, AIHW, viewed 12 December 2019, https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true
• Bennett, J and Rizmal, Z 2019, ‘What to Expect as Victoria's Mental Health Royal Commission Wraps Up’, ABC News, viewed 11 December 2019, https://www.abc.net.au/news/2019-07-28/victorian-mental-health-royal-commission-wraps-up/11351220
• Beyond Blue Ltd 2019, Statistics, Beyond Blue, viewed 22 August 2019, https://www.beyondblue.org.au/media/statistics
• Cook, L 2019, 'Mental Health in Australia: A Quick Guide', Parliament of Australia, viewed 11 December 2019, https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1819/Quick_Guides/MentalHealth
• Department of Health 2017, Better Access to Mental Health Care: Fact Sheet for Patients, Department of Health, viewed 12 December 2019, https://www1.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat
• Hall, B 2019, '“High Distress”: Soaring Demand for Mental Health Treatment Revealed in Victorian Snapshot’, The Age, viewed 12 December 2019, https://www.theage.com.au/national/victoria/high-distress-soaring-demand-for-mental-health-treatment-revealed-in-victorian-snapshot-20191126-p53eb3.html
• Headspace 2018, How to Get a Mental Health Care Plan, Headspace, viewed 10 December 2019, https://headspace.org.au/blog/how-to-get-a-mental-health-care-plan/
• Queensland Health 2018, What is a Mental Health Care Plan and How Do I Get One? Queensland Health, viewed 10 December 2019, https://www.health.qld.gov.au/news-events/news/what-is-mental-health-care-plan-how-to-access-Queensland-Australia