A timeline of ‘The Troubles’ in psychology

Green Paper feedback

RAPS has received a number of emails from people who are unable to find the survey link. You will find the link in an email sent by the APS on 25th March. The email address used was MBSconsult@psychology.org.au

The survey link is at the bottom of the email. If you have not received this email then please contact MBSconsult@psychology.org.au ASAP as submissions close on Monday 8th.

If you have not yet read the Green Paper then you can access it on the APS website.

A timeline of ‘The Troubles’ in psychology

In 2006 the Medicare 2-tier rebates were introduced after the APS made submissions to the Government that only Clinical Psychologist should be included in Medicare. However, the APS did NOT want members to know this, and it took several years, through freedom of information, to even get access to the submissions.

This created the schism in the profession, which has deepened in the years since:
– Increasing work allocated ONLY to clinical psychologists:
1) assessment reports accepted from clinical psychologists only (eg Centrelink)
2) enterprise agreements restricting senior psychologist classifications to clinical psychologists only
3) national guidelines restricting assessments and treatments by clinical psychologists only (eg ASD assessments)

– Fewer referrals to non-clinical psychologists, often due to the bottom line for clients – they need higher rebates to attend.

– Restriction of psychological treatment by psychologists, based on Focussed Psychological Strategies for non-clinical psychologists, and any modality for clinical psychologists.

– Decreased numbers of Master’s degrees other than clinical.

And while the arguments are that fewer students are wanting to undertake other Masters, the reality is that if future psychologists want a range of career options, including an income to survive on, then they will have to undertake a Clinical Master’s. No wonder other Master’s programmes have been decimated.

In 2011 a Senate Enquiry was undertaken. The APS submission continued to support the 2-tier system. This continued to widen the schism. Importantly, the APS did not acknowledge that there had been unintended consequences of the 2-tier system.

In 2011 – Pirkis et al, undertook their research of outcomes of psychology services under Better Access (publicised widely). It showed no differences in treatment outcomes between clinical and non-clinical psychologists. Yet the schism remained.

The APS continued to support and entrench the 2-tier system. Lyn Littlefield continued to defend it. And the APS presidents since 1996? All clinical psychologists.

The clinical college felt free to state that ‘Australia had the worst trained psychologists in the western world’, and that only clinicals were able to do everything because of their ‘superior training’. The two clinical psychologists who wrote the above were Ros Knight (the current APS president), and Anthony Cichello (the immediate past president).

The clinical cohort argue, just go and do the extra study. Yet the costs are huge, anywhere between $20,000 to $40,000.

More importantly, the APS has not pushed for, organised, or advocated for bridging courses – and so Universities have not bothered to establish them.

Again – as at the start there was no evidence – we still have no evidence. Since the Pirkis et al (2011) study, there has been NO study or research undertaken to prove better outcomes of treatment by clinical psychologists.

And so, we arrive at 2018-2019.

The APS with Lyn Littlefield as executive director, Anthony Cichello as president, and Ros Knight as vice president (remember the 2014 paper above), were in charge of the Board when the APS made their first submission under the MBS review, in 2018. The more recent 2019 version of the APS submission is affectionately coined as the Green Paper. Not content with 2 tiers, the APS now proposes 3 tiers.

The crumbs thrown to appeal to the non-clinical psychologists are the:
– same 10 sessions at level A1 Mild and
– extra +10 sessions at level A2a Moderate.

BUT wait – only with so-called ‘evidence-based interventions’, as opposed to ‘psychological therapy’ at level A2b Moderate and level A3 Severe by psychologists with AoPE or with practice certificates. It’s just like the focussed psychological strategies (non-clinical) versus the psychological therapy (clinical psychologists) all over again – just with different titles. There will be no rebates for the clients of non-endorsed psychologists and/or psychologists without practice certificates beyond level A2a Moderate.

As GPs often consider the financial impact of psychological services on their patients, there will be many cases assigned to the ‘severe’ level [even if they are not], so they can have access to the highest rebate possible as clients of endorsed psychologists.

Thus, non-endorsed psychologists will not be able to provide the services they have been providing for decades. And as government agencies continue to push for clinical psychologists to do more of the work (which many non-clinical psychologists have done for decades) the non-endorsed psychologists will reduce in numbers.

And the APS is promoting this. Criticisms of the green paper were curtly dismissed during the recent Town Hall Meetings. Even at the recent Advisory Council, the facilitator asked the gathering to discuss ‘the positives’ of the green paper – there are obviously no ‘negatives’.

The so-called Expert Committee which created the green paper consisted of at least 4 clinical psychologists, greater than any other single grouping:
– 2 psychologists from the DGPP, for around 11,000 of their members
– 1 counselling college member
– 2 clinical college members, for a grouping of around 6,000, & 2 other clinicals, including Ros Knight, the co-author of the 2014 paper – an over representation of clinical psychologists, for a society that has mostly non-clinical members.

Yet, none of this seems to matter.

The opposition mental health spokesperson sent letters to psychologists stating the APS submission had been withdrawn. Yet the APS states it was never withdrawn. How can anyone trust the APS?

So the current green paper excludes psychologists from levels 2b & 3, unless they have an Area of Practice Endorsement. Only the services of psychologists with an AoPE will attract the highest rebate (level A3).

As such, the majority of DGPP will have their clients unable to claim Medicare rebates for PTSD, OCD, Eating Disorders, BiPolar Disorders, Personality Disorders – which many non-clinical psychologists have successfully been treating for decades. The people who miss out are the Australian public, desperate for psychological treatment undertaken by qualified, registered psychologists.

The green paper is a white wash: to entrench the unproven, non-evidence-based superiority of endorsed psychologists.

Supporting this green paper is putting more nails into the coffin of the psychology profession in Australia – other than for clinical and other endorsed psychologists.

Stand up and be counted! Fight, record your disgust, contact MPs – do whatever you can!

Support the APS green paper at your own peril – as you will get even less work than you have been in the last 13 years.