When the recent Budget threatened to cut social workers and occupational therapists provision of services to clients under the Better Outcomes in Mental Health Care (BOiMHC) from July 1, there was a huge outcry from health professionals and clients. The cuts occurred without any consultation, discussion, or input from the social work body, the Australian Association of Social Workers (AASW).
Thanks to a passionate and concerted campaign, the government has since deferred its decision until April 1 next year and committed to give the AASW an equal role with other health professions in the shaping of federal policy on mental health. However, the government has not changed its view that social workers and occupational therapists will no longer work under the BOiMHC program.
With the recent focus on social workers and the Medicare rebate, it is timely to promote greater awareness, and understanding of, what social workers (and specifically social workers in private practice — mental health social workers), provide in terms of psychological and emotional assistance.
The BOiMHC scheme was introduced by the Liberal government in 2006. Under this program, any individual GP could refer a client, diagnosed with a mental disorder under Medicare, to a psychologist, social worker, or occupational therapist, for 12 sessions of mental health treatment. It was widely recognised that current mental health services were unable to meet the demand, were crisis driven in nature, and therefore unable to provide early intervention.
BOiMHC was designed as an early intervention measure, where people were encouraged to seek help for mental health issues in the early to mid stages of illness. The aim was to reduce the high ongoing and cyclical cost and burden on resources (such as hospitals and GP’s) while increasing the effectiveness of treatment.
It is still unclear why the decision was made to discontinue the Medicare rebate for social workers.
There have been several criticisms of BOiMHC. There was a huge blowout of costs: this occurred within the first four months of the scheme’s introduction. It was thought that BOiMHC was not reaching the most disadvantaged (such as young people and those in remote communities), and the Medicare co-payment excluded the poor.
Social workers account for 4% of the costs of BOiMHC. Excluding social workers from the scheme is not an effective means of reducing costs. Ironically, a major client group of mental health social workers are disadvantaged, poor, and remote clients. Therefore there was no logical reason for the cessation of the BOiMHC for mental health social workers.
Mental Health social workers are highly specialised therapists. Each social worker has their own way of working, dependent upon their area of specialisation, postgraduate training, personal style and work experience. Social workers may conduct individual, group or family therapy to people experiencing a range of psychological problems, to resolve associated psychosocial issues and improve quality of life.
However, mental health social work is underpinned by social work values of social justice, respect, importance of human relationships, integrity and competency are the key focus of mental health social workers as distinct to other professionals providing therapeutic services.
Mental health social workers completed a four-year undergraduate degree and have at least two years of experience working with clients with mental health issues. They are all accountable through the profession’s complaints management process, and all complete mandatory professional development each year.
The majority of mental health social workers have undertaken extensive specialised postgraduate training, including counselling, psychotherapy and family therapy; while nearly 75% have more than 10 years’ experience in public mental health services.
- There are presently more than 1100 social workers offering Medicare rebate for mental health treatments, and in 2008-2009 they provided 121,540 occasions of service
- More than one-third are based in regional, rural and remote parts of Australia
- Many work in outer suburban areas
- More than 60% of them offer bulk-billing to at least some clients
- More than two-thirds (68%) of clients say they would be unable to access their services without Medicare funding.
The AASW and the government have stated they are working together to “shape and develop the new funding arrangements delivered through the GP networks, to ensure that social workers’ clinical expertise is utilised to deliver services to Australians with mental health issues, especially those from disadvantaged and low income backgrounds, indigenous people, those with multiple needs and those in rural and regional areas”.
To what extent this collaboration will address social work concerns about mental health service delivery is still to be determined.
You are confusing two entirely different programmes.
The current Medicare arrangement is the Better Access to Mental Health Care (est 2006).
Referral to Better Outcomes in Mental Health Care (est 2002) and its current offshoot Access to Allied Psychological Services (ATAPS) is restricted to GPs who had done the appropriate mental health training, and was to registered and accredited psychologists only.
In some areas this was also extended to social workers and OTs.
Patients did not have to pay anything. This programme (which still continues in a limited way) is a far better process than the Better Access programme, because it did reach the patients who couldn’t afford a co-payment, and GPs tended only to refer patients with the higher needs.
However, under lobbying by the Australian Psychological Society, Abbot and Pyne delivered the current dog’s breakfast, with its divisive two-tier payments for psychology and its total lack of targeting.
It would have been far better to extend the funding and the reach of BOiMHC, perhaps with some incentives for GPs to undertake the (quite moderate) training.
As Little Eric says, we are talking here about Better Access (2006), rather than Better Outcomes (2001).
The federal government has decided to exclude the clients of social workers and occupational therapists from claiming Medicare rebates under Better Access. This effects aroung 25,000 clients currently being seen by by social workers.
Why the federal government would do this escapes me.
It won’t save them much money, given that rebates to clients of social workers amount to some seven million per annum, while rebates to other professions are approaching three hundred and fifty million per annum (plus another two hundred million for clients of psychiatrists).
It won’t improve targetting by excluding some professions but leaving others.
Bottom line: it removes the choice of people who want to see a social worker for mental health problems, and removes the choice for GP’s who think a social worker is the best person to help their patient.
According to the ATAPS Review – Discussion Paper, the better outcomes program was established in July 2001.
There is currently no restriction under ATAPS to referr to psychologists (clinical or not). “ATAPS enables GPs to refer consumers with high prevelence mental health disorders to allied health professionals for 6 sessions of evidence based mental health care” – this includes psychologists, social workers and OT’s.
“BOIMHC originally held components to support education and training for GP’s and GP renumeration. These components are superseded by the Better Access MBS items and education/training.”
Under ATAPS, “approximately 10% of sessions delivered involved a patient incurred co-payment ranging from $5 – $30.”
“For the 2007/2008 period, unit costs calculated for individual Divisions of General Practice for ATAPS ranged from $57-to as high as $1155 per session. This represents a high cost to the Government (with an average cost of $219/session and a median cost of $171/session) compared to Better Access which had a lower cost to government of approximately $80/session.”
I think we need both programs! ATAPS to allow for low-income or groups who have difficulty accessing suitable treatment, as well as allowing and providing appropriate treatment through Better Access for those mental health disorders, it provides appropriate treatment for!! Why throw out the baby with the bathwater??!!! One program is not better than the other…they are both different in meeting appropriate treatment for mental health consumers.
Also forgot – ATAPS is CAPPED!
@ RR2280:
ATAPS is 6 + 6 sessions.
Yes, ATAPS was set up in 2001, but many schemes didn’t get funding until 2002.
Under the ACT system (ATAPS is administered by local divisions of General Practice) referrrals are to psychologists who are paid $120 per session (well below APS rates, but this is for people on low income) with no co-payment. I know some divisions felt a small co-payment was useful to ensure that the undeserving poor recognised the value of the service, but in Canberra we didn’t see the need.
Better Access refunds $87 to psychologist’s patients, $117 if they are clinical psychs – I don’t see how this works out to a level of $80 a session.
I have no idea what you mean by “$1155 per session” – even psychiatrists don’t charge that much! Was this a referral to a lawyer?
ATAPS is the better system. Chuck out the expensive baby and make room for the effective one to grow and deliver service to the people who really need it – not the affluent worried well.