Still raving about Better Access

From: //blog.artdoxa.com

This blog post is actually a very long comment on the blog by Jacinta Patterson titled "Argument by anecdote in mental health". The anecdote that Better Access money was being wasted on the over-concerned rich and not on the disadvantaged and genuinely mentally ill, seemed to be the main reason put forward in the press, explaining the cuts to Australia's mental health budget for 2011- 2013.

Aha- this post (referred to above) is still getting responses! I dropped in when it was first posted, but my comment doesn't seem to have got through! As a Better Access client and a former mental health researcher trained in public health, I can find many ways of examining the whole scheme!

It's difficult, firstly, to examine Better Access without the stats from the rest of the outpatient mental health sector. As someone said above, many people, mainly with schizophrenia or manic depressive disorder [these names make it clearer as far as I'm concerned; I know the controversy], are covered by Headspace and  community mental health clinics [which are hospital outreach disguised]. The NEW cases of psychoses, or those at high risk [pro-dromal; the people who were to receive medications if they seemed on the edge of real psychosis], hopefully benefited from Better Access, but I can't see how I can tease them out of the figures from the govt. I would assume that plenty of these people would not recognise they needed help, just as always happened in the past- the only way I imagine they got into Better Access would be if their GP was alert enough when seeing them for another complaint. How alert are GPs usually? Don't know- no figures. There's no epidemiological data from the past on this and I don't know anyone collecting it, so we can't judge.

Anguish at work- needs help

The figures suggest many new clients for mental health care under Better Access and the sudden proliferation of various therapist groups in the community suggests the same- there are community nurse mental health counsellors, psychology-trained, social-work-trained, [I don't know any] occupational therapy-trained plus more, putting up shingles. Most have few empty slots in their calendars, so someone is filling them. My guess is that new clients who couldn't afford private care before are cashing in on the Medicare scheme to get help they've needed for a long time. I know hardly anyone besides myself who has seen a psychiatrist for more than one session under Better Access and I think that is because psychiatrists won't take merely the Medicare rebate as full payment. Mine agreed to it beforehand, because I asked specifically and because I knew her before she qualified. However, her receptionist didn't know this and when I had received 2 sessions and handed her the rebate cheque for the first one she asked: "How would you like to pay the rest; cheque or credit card?". I told her I had no income, no insurance and no benefits, so she was going to have to accept Medicare or take me to court! My shrink cleared it up with her!

USA, ER visits for mental illness increased

I would suggest that psychiatrists have kept on seeing the same sort of clients they always saw- those referred through hospitals and other professionals, mainly privately insured [the uninsured wait to see their psychiatrist in hospital outpatient clinics every week and get the same doctors as they had privately], a slight leaning towards upper income, definitely more city/suburban people and hardly a trace of indigenous Aussies. However, at outpatient clinics there have continued to be stacks of lower-income clients, young people avoiding parental scrutiny and indigenous and other-cultural-group clients. Because there are virtually no psychiatric emergency "drop-in" centres, the poor old Emergency departments of public hospitals have copped the majority of psychotic, alcoholic and suicidal people, usually in terrible emotional states and which the emergency doctors, nurses, police and ambulance personnel are least trained to handle. Better Access could do with setting up a few Psych Emergency Facilities at least on the outskirts of  major towns. I don't think the community is going to suddenly get better at detecting mentally ill relatives and friends before they reach crisis point- they've never seen psychosis etc before, it's scary and they hope it will go away if they ignore it. Maybe the NEW Headspace places can change the culture of stigma and disdain of help-seeking by young men, but I'd like to see it happen before I'd have much hope.

In bed crying? Get help via Better Access

I'm a bit confused about why the change from 10 to 18 sessions in Better Access had to be made and announced because the clients from last year are going to have to see SOMEONE sooner or later. If clients who are still in need of care go back to their previous therapist, which most of us would prefer to do [and that would be therapeutically beneficial], are they suddenly going to say "Bugger off or pay me twice as much?" I can't see it happening except where psychiatrists have hard-hearted receptionists! I'd like to hear from some people about their experiences, since there's NEVER going to be a statistic on this!

As for GPs getting less money for the first consultation under Better Access- I can't work out how the huge amount extra was justified in the first place. The GP gives you a batch of questionnaires to fill in while he/she sees another person, then asks a few brief questions face-to-face, adds up the simplest depression/anxiety scores, gives feedback and may write a standard referral on the computer if you seem to need care elsewhere. Otherwise, if the GP is doing the counseling themselves, people just make regular appointments as they would for anything. I can't imagine that many GPs deduce much themselves from this 1st appointment, even those with special mental health training- mine didn't, that's for sure. Apart from questionnaires, the GP does have some documents to complete proposing a treatment plan, etc, but it's not clear how an ordinary GP could predict what is going to happen with a mental health case anyway- psychiatrists find it hard enough. In my book, the cut in Medicare rebate is justified- doctors just got used to it. Couldn't they feel good about contributing to Public Health with these sessions, rather than through some dubious primary care "health promotion" program? The cuts for ongoing counseling I'm not sure about- halving the rebate seems harsh.

ER will always get self-harm clients

As for the $1.4 billion: Why won't this much be NEEDED for mental health in the future and blow out lesser budgets? You can't hope to "cure" many people, and for the ones fixed up enough to go it alone, another new one will walk in the door & use the Medicare dollars.

Have a look at what happened in California after their mental health budget was slashed. DO we want that in Australia? :
http://disabilityrightsgalaxy.com/2011/10/01/the-system-is-broken/

The USA has even more problems with mentally ill people reporting to ER than we do in Australia:
http://www.msnbc.msn.com/id/25520178/ns/health-mental_health/t/some-psych-patients-wait-days-hospital-ers/
http://vtdigger.org/2011/11/09/frustration-over-upheaval-in-states-mental-health-system-mounts/

Wrong place for mental health care- too tense & anxious

Why self-harm now?: http://thelinc.co.uk/2010/03/self-harm-the-cause-the-facts-the-support/

Moving ahead: http://www.bipolarlifestyles.com/tag/hospitalization/

Little old loudmouth!

This content also appears at: http://www.reportingonhealth.org/blogs/little-old-loudmouth

This morning I decided I needed to let off some steam because I had far too many possible comments circling my brain to get them out in one session! Luckily, I was reading Virginia Hughes talking about a review of treatments for autism. After trying hard to get a very lonnng comment accepted and being told my email address was a crock, I decided I needed to join a forum where I could comment at leisure as a registered contributor. So, here I am.

As I've delved into the health field while doing an MPH, I've found I am quite passionate about a whole range of issues. I'm sure half of it is mere ego- but who cares in blogs? Aren't they a great spot to let the ego run free? My irrepressible impulse to write several pages of response to Virginia Hughes' blog entry is built on 35 years worth of thought about the origins of autism and quite a bit of empirical research, but many years ago. Meanwhile, I have kept up my reading on the topic of my abandoned PhD and I still feel that no one has exactly pipped me at the post and I want to let it all out!

I think I can explain why most autism treatments don't seem to work very well, as well as why traditional drug trials will never show the worth of various anti depressants for major depression. I'd really like to put forward my ideas on possible neurodevelopmental problems behind visual perceptual difficulties that autistic people suffer, especially in relation to social cues. For instance, the review of the work on mental rotation by researchers such as Soulieres et al, 2011, was quite logical and reasonable- but I think there is a totally different way to explain it which links to a lot more research on characteristics of ASD people. Hopefully, over the next few days, I'll be able to log in on the relevant websites and make some comments with my alternative explanations for the findings reviewed.

Then there's the topic of public vs. private payment/hospitals/clinics in health care. Australia has had a fairly good universal health coverage system for many years in Medicare, although lately the gap between the scheduled fee and what an individual doctor names as his/her fee has grown so much that ordinary people find it difficult to get appointments and/or pay at all. The government covers everyone for the scheduled fee, which varies with the length and complexity of the consultation. When the fee gets higher, I certainly visit the doctor less and I know many others are similar. The trouble is, if I give in and visit after some illness has become quite nasty (eg. I get a chest infection and my asthma flares up suddenly), firstly the doctor chastises me, then I have to have a swathe of tests, then I get medication and the illness lasts up to 4 times longer than it would if it hadn't worsened within the first few days. So this episode ends up costing so much that I go into debt with my partner and/or friends in order to pay for the treatment. So the system doesn't really work for certain classes/groups of Australians.

In the UK and USA, recent financial and political changes have meant the health funding in those countries is being cut across some areas. There is obviously huge debate about whether cuts should go ahead in health (could cuts be made in other budget areas?), and then which areas to cut first, should everything be cut equally, will private practitioners cut costs by shedding poor patients? etc The health systems in most Western countries do not set priorities across the board for treatment of certain conditions, ages or use of procedures (such as stenting the heart). Therefore, even with cuts, some specialties are going to go over budget by doing what they did last year, or overspend on questionably necessary procedures and underspend on vital ones. Of course, there is good old health economics weighing in with making assessments of years of quality life gained from treatments and arguments about what a quality life consists of and how can you value a life in dollars! I can have heaps to say on articles about these topics, but I keep using time that should be spent on other things!

Having been a researcher in eating disorders for many years (where most of my publications came from) I also find I have plenty to say about articles and media reports on young children hating their bodies from very young ages and on how "the media" and "advertising" are making kids sick!

I'd better button it up at this point as my partner is crying for stewed quinces and yoghurt, but I could rave on, naming endless topics I want to blether on about!

Lucky Spotrick got hungry, eh?!