The much-anticipated Productivity Commission Final Report on the Inquiry into Mental Health
was launched by the Prime Minister on 16th November. The final report includes and acknowledges evidence and advocacy positions presented to the Commission throughout the Inquiry process, including evidence presented by PACFA and the ACA at Public Hearings and material from two written submissions from ARCAP (April 2019) and PACFA (Jan 2020) and it is heartening to see that our messages were heard by the Commission.
However, the Final Report has rejected our repeated calls for MBS recognition for Counsellors and Psychotherapists. It is disappointing that the qualifications and scope of practice of registered Counsellors and Psychotherapists, along with those of other Allied Health professsions have not been more fully recognised by the Commission, as noted by Claire Hewatt, CEO of the AHPA who observed that while increased MBS access to access to psychological therapies was welcome, “opportunities to make a real difference by capitalising on the expertise of the broader allied health workforce have been missed.”
However a thorough reading of the full (1,400 page) Final Report indicates there could be opportunities for more meaningful inclusion and recognition of counsellors and psychotherapists in the mental health workforce. The overarching intent of the final report is to shift the Australian Mental Health system away from a medicalised model of care, centred on ther provision of services through the MBS, towards a patient-centred model that includes a broad range of health, allied health, welfare and community services.
While it is easy to criticise the Commission for a failure to recognise and validate the skills of the counselling and psychotherapy workforce alongside those of other professions including Social Workers and Psychologists, outside clinical health settings the report offers several opportunities for expanded access to counsellors and psychotherapists in the community, through services commissioned at the local and regional level though Primary Health Networks or other commissioning bodies, for the provision of what the Commission refers top as “low-intensity non-clinical services”.
In the Final report, the Commission clearly identifies ‘dysfunctional’ approaches to the funding of services and supports, including an over-reliance on MBS-funded services for the commissioning of mental health supports through PHNs.
The Productivity Commission has recommended that the Australian Government should fund the development and ongoing provision of a national digital mental health platform, to be co‑designed with consumers and clinicians. The platform should provide:
a tool for free person‑centred assessment and referral, to be used by GPs and by individuals to access mental health clinician-supported online assessment and referral. This tool should not only replace the Mental Health Treatment Plan as a requirement for accessing MBS‑rebated Psychological Therapy Services and Focused Psychological Strategies, but also provide a gateway to other clinical treatment and non-clinical support services.
The Commission also recommends that the Australian Government Department of Health should reform the way that it allocates funding to PHNs (or other regional commissioning bodies) to support greater regional equity and access to a wide range of service providers, including Counsellors and Psychotherapists.
This recommendation would essentially free up funding currently locked into the MBS-funded system for the provision of supports in the community through service providers not currently funded through the MBS; in other words, shift a quantum of funding for mental health services away from a narrowly defined set of health and medical services, towards more holistic community based care, and facilitated government-funded service provision by Counsellors, Psychotherapists and a range of other community service providers.
The Commission has also recommended that the Australian Government Department of Health should establish a Mental Health Innovation Fund to trial new system organisation and payment models.
The Commission’s Final report also includes a range of other potential opportunities for increased access to Counsellors and Psychotherapists, including a new budget measure to support access to privately-health funded mental health services in the community and more consistent approaches to state and territory-funded mental health workforce initiatives and the provision of services through Employee Assistance Providers.
PACFA, alongside the ACA , will continue top advocate for the inclusion of our workforce in the MBS. The Final Report, while disappointing in some ways, also provides an incredibly useful basis from which to build on our current advocacy agenda and ensure that we are included from the ground-level in crucial system redesign processes.
We are currently engaged in providing further feedback to several key national reform processes and will provide all our members with a detailed summary of the Commission’s Final Report and updated information on the progress of other reform process before the end of the year.