Growing numbers of mental health consumers are speaking out against the Federal Government's proposal to redirect mental health consumers to the the ATAPS program instead of the Better Access program. We asked the members of our Facebook Group what they thought about the idea that delaying the cuts to the Better Access program would resolve the problem, as has been proposed by the Greens. The members of our group (mostly mental health consumers and the general public), described a host of problems with the ATAPS program that would not be resolved by simply delaying these service cuts to a later point in time. I have summarised the areas of concern that we identified below.
There Are Many Patients Who CANT Access ATAPS Services
The ATAPS program is only accessible to three 'tiers' of the Australian population. Tier 1 funding includes funding for services that target difficult to reach groups, such as young people, culturally and linguistically diverse groups, and the indigenous population. Tier 2 includes special funding for highly specific purposes, such as people affected by droughts, bushfires, floods, or other groups with special needs like the homeless or people who have attempted suicide or self-harm. Tier 3 funding aims to reach people with 'severe mental illnesses', which generally speaking, means that services are restricted to people with conditions like bipolar disorder and schizophrenia. It is obvious that these groups often need psychological care, but what about those who do not meet these types of criteria?
There are vast numbers of people who cannot afford psychological treatment but who are blocked from receiving ATAPS services because they do not meet the above criteria. Their mental health needs may be just as serious, but without access to timely and appropriate psychological services, their condition is likely to deteriorate. In addition to this, the ATAPS program is simply unavailable in some places right now, partially due to the fact that Medicare Locals have not yet been established to oversee these services. But what these concerns essentially show is that even when the ATAPS program comes up to speed, there are going to be many individuals with serious and complex mental health disorders who are going to slip through the cracks. The price they pay is not simply personal, it is a cost that all of us in Australian society ultimately have to deal with.
When we compare the two programs on their reach, the Better Access program targets ALL people with a recognised mental health disorder, so it reaches all sectors of our society. The ATAPS program has entry criteria that differ from region to region. Consequently, this means that the ATAPS program can only provide patchy treatment of mental health problems for highly targeted groups, resulting in many people being turned away from psychological care because they do not meet the criteria for that region.
The ATAPS Program Results in Scattered Service Delivery
In many regions, the contract for an individual ATAPS provider covers just a few days of services per week. Beyond the obvious cost cutting going on here, the main reason this occurs is that the service provider needs to be given a space in order to provide their consultations. In a busy medical centre, this can mean that the mental health professional is required to share their consulting room with other health practitioners who use the same room on different days. The practical issue for a patient is that when a practitioner is only available several days per week, it can be quite difficult to find an available time to get an appointment with that mental health provider. We have heard news from some large geographical regions of Queensland where one full-time position is split between 3 separate practitioners, who each provide services for just 2 days, working across 4 different treatment centres which are hundreds of kilometres apart. With such a poor level of coverage for psychological services, very few people are going to be able to access psychological treatment for their condition. This problem is avoided in the Better Access program, where the mental health practitioner is required to organise their own consulting room and is therefore able to deliver services that better reflects the actual needs of local people.
Continuity of Care is Broken with ATAPS
When mental health consumers are referred from the Better Access program to the ATAPS program, the result is a break in the continuity of their mental health care. People in that situation are left with no alternative but to tell their story over from the very beginning to a new therapist, which means that they will need to re-establish trust. A patient can also find that they begin treatment unemployed, only to find that as soon as they begin to recover they are no longer eligible to continue seeing the same mental health professional.
Nobody wants to see a 'revolving door effect' for mental health care in Australia
ATAPS Blocks The Patient's Choice of Therapist
Under the ATAPS program, the patient has a very limited choice in the therapist they see (in some cases, no choice). Under this system, their GP directs them to a specific practitioner who is funded to provide treatment for that region. We would argue that in the sensitive area of mental health care, the wishes of a distressed person to see their trusted therapist of choice does actually matter. To use but one example, a patient may be aware that there is a local therapist with specialised skills in treating their condition. Sometimes a person finds out about this through word of mouth, or sometimes they know this is the case because they have seen that therapist some time in the past. Under the ATAPS system, people will not be able to see the therapist they want to unless that mental health practitioner happens to be the one that is contracted by their Medicare Locals region to do the work.
When it comes to this tricky issue, mental health professionals face a very difficult decision. Would it be better if they withdrew from the ATAPS system, working privately, so that anybody can access their services? Or should they work within the ATAPS system, only to exclude those who don't meet the local entry criteria? With the scaling back of the Better Access program to just 10 appointments, those who are most in need of treatment and least able to afford ongoing care, will find themselves unable to access their services. In rural, regional and remote Australia, this problem is made worse by the scarce distribution of mental health professionals. Compounding this problem is the fact that there is no clear or consistent information available to mental health professionals about how they can become an ATAPS provider - it differs from region to region. With a restricted range of service providers, you might know which therapist would work best with you, but find that you cant access them.
Some ATAPS Funding is Directed to NGOs
In some locations, the ATAPS program contracts out to non-Government organisations (NGOs), including bodies that receive the bulk of their funding from religious associations. For some people this doesn't matter at all, but for others, who wish to have nothing to do with a religious group, this poses quite a big problem. They may be secular or atheistic in their beliefs, or in the worst of cases, they may have had traumatic experiences (such as abuse or discrimination) when dealing with that religious group in the past. Those who have experienced abuse and trauma from religious authority figures may feel quite put off by the prospect of being referred to seek psychological services from such an organisation. In some regions where services in the ATAPS program are contracted out to NGOs, patients may be left with no other option, and that is likely to be an insurmountable barrier to overcome in their efforts to seek mental health care. In our opinion, distressed mental health consumers should not be forced into that scenario. They need the option of truly independent services, and the Better Access program is exactly the kind of system that provides those options.
The ATAPS Program Costs More To Run
There have been multiple reviews of the ATAPS program, indicating that this service model is significantly more costly to run. The Australian National Audit Office revealed that the ATAPS program frequently spends up to 25% of funding on administrative costs, rather than genuine service delivery. By way of comparison, the fee-for-service model in the Better Access program means that taxpayers only pay for treatment services that mental health consumers utilise. That is, psychologists are not paid for writing reports, attending meetings, sick and holiday pay, nor any of the other running costs associated with their work. A large scale review of the Better Access program concluded that the program was a cost effective way to deliver positive psychological outcomes.
There are also practical issues to be considered here. GPs have frequently reported that they prefer referring patients to the Better Access program. The reason is that the ATAPS program is needlessly prohibitive. It typically involves onerous administrative requirements and extra hassles for clients. More importantly however, due to the capped funding model of the ATAPS program, it is frequently the case that funding for mental health services runs out, which then means that GPs can't refer any patients to get help. When this occurs, there is simply no capacity to provide any psychological services to the people who need them. This outcome is unacceptable. People who need proper psychological care should be able to access timely and evidence based treatment for their condition, and unfortunately, the ATAPS program does not deliver on that promise.
The ATAPS Program is Attractive to Less Experienced Therapists
GPs are not the only ones who have expressed concerns about the ATAPS program. When it comes to mental health professionals, those who are more highly trained and experienced in the field tend not to be attracted to the poor working conditions on offer. Capped funding creates a problem where costs are cut, with an emphasis on providing more quantity of psychological services rather than seeking high quality service providers. Those who have higher levels of training and experience in mental health care tend to find work elsewhere. Given that the Federal Government plans to direct more complex and severe cases to the ATAPS program, this factor is a recipe for disaster in mental health care. In effect, this means that the toughest cases will in the majority of cases be referred to a pool of practitioners who generally possess lower levels of training, skills, and experience.
The Federal Government has proposed that the ATAPS program can substitute the Better Access program, but the information shown above shows this plan is flawed. It appears to us that the Federal Government decision to the cut the Better Access program reflects a preference to restrict treatment rather than allowing people with a diagnosed mental health disorders from accessing the psychological care they need. We have also heard from The Greens that cuts to the Better Access program would be acceptable if the ATAPS program was more fully developed, but again, that does not address many (or any) of the issues discussed above. For the mental health system to deliver psychological services fairly across Australian society, we need broader coverage of the sort that the Better Access program used to deliver. Dont get us wrong - we actually do like the ATAPS program. It does an amazing job at providing some appropriate psychological services to hard-to-reach areas. But relying completely on the ATAPS program is quite clearly NOT the solution. So we support the movement from The Greens to disallow the cuts to the Better Access program, but we stress that this should not simply be a matter of waiting until the ATAPS program develops. We hope that the Liberal party also opposes the cuts to the Better Access program, but fundamentally, the Federal Government needs to think hard about how much of a priority it is to make psychological services available to all Australians who need mental health care, while this program remains their responsibility.
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