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THE start of some consultations sinks the heart of the busy GP. The latest addition to that list goes something like this: “I have come to get one of those mental health care plans.”
In one sentence, we have bypassed history, examination, investigations, diagnosis and treatment options and gone straight to the end outcome. Ah … if only medicine were that simple …
From the patient’s viewpoint it is very simple — like getting a prescription renewal, or asking for a throat lozenge at the chemist.
Patients know it is simple because either a counsellor or psychologist has told them that all they need to do to access “free” services is to “see your GP”. Even school counsellors are getting in on the act.
The next part is less simple. “Why exactly do you need this plan?” is the logical GP response. Most of the time it is because the person is stressed … it might be a relationship breakdown, financial worries or problems at work.
In the patient’s mind this qualifies them for the “plan” that the federal government so generously funds. “You know Doc, I am really stressed and the counsellor said all I need is a referral from you and Medicare covers it.”
Now comes the hard part. The Medicare Benefits Schedule (MBS) allows for the preparation of a mental health treatment plan “for patients with a mental disorder who would benefit from a structured approach to the management of their treatment needs. Mental disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities”.
Last time I checked, stress was not included in this definition. This is not to say that people do not have symptoms or distress. Neither is it to say that these people would not benefit from the counselling they seek.
The whole issue is about who pays!
There is a complete disconnect between the parties involved here. The politicians have promised more “mental health funding”, while the bureaucrats have devised a complex system to keep out exactly the type of people who would benefit the most from a mental health care treatment plan.
A senior member of the Professional Services Review told me privately it was nearly impossible to do a plan correctly (apparently less than 5% met MBS specifications). The counsellors want — with the best of intentions — business, and the patient wants help for what is a problem, albeit not an illness.
And stuck in the middle is the GP whose role it is to deliver the politicians’ promise to the consumer of counselling help, while keeping the bureaucrats off their own back — all of this being reverse engineered from the opening statement of “I just need a mental health plan”.
Sometimes, the stress of life can be reverse engineered sufficiently to qualify as mild depression or anxiety, although most of these cases are likely to fall in the 95% of plans that would fail an audit.
The other problem is that those with real mental health illness tend to miss out on services as they get pushed down the queue by the worried well. Meanwhile, every stressful event in life becomes a “mental health illness”.
Are there solutions? One would be to make the psychologists responsible for the plan and its consequences. If they get it wrong, let Medicare chase them not the GP.
Another would be an education campaign about the differences between bad days and mental illness — for counsellors and the public. Don’t hold your breath.
And for the stressed GP, maybe the solution is to get one of those mental health plans.
Dr Joe Kosterich is a speaker, author, media presenter, health industry consultant and a GP. He gives motivational and practical health talks for the public and corporations to help people look and feel better, and is a newspaper and magazine columnist and regular on radio and TV.
Posted 9 May 2011
Mental Health Treatment Plans (no longer Mental Health Care Plans) are for the psychological treatment of a mental disorder, diagnosed by a medical practitioner (GP, psychiatrist or paediatrician), when this is considered a needed component of treatment. People who are otherwise distressed and unhappy may well benefit from counselling, but this has never been covered by these Plans.
The last I heard Medicare is a universal health insurance scheme. It is not the role of doctors to be gatekeepers to the insurance company. Doctors have a responsibilty to their patients to provide them with the best possible service. I am aware that economically this is not possible but why should politicians pretend to offer universal cover when in truth they are unable to deliver. Let the public know the truth. They are not covered. The coverage is political rhetoric.
I must be living in a differing reality. I use either a K10 or a DASS 21 to give some sort of psychometric guide for suggestions to clients. If the client scores high on the test, I refer them on for a MHCP – usually with a covering letter to support the referral. The problems I run into are more along the lines of keeping some clients in therapy past the point where they feel better and long enough to internallise more appropriate cognitive and behavioral skills.