One Tier Medicare will Increase Access for Disavantaged

Dear Minister Hunt

Firstly, RAPS would like to say congratulations to the Liberal Government in the recent Federal Election. The victory was truly remarkable and a testament to the party. It also revealed that the majority voice is often silent whilst the vocal minority creates an inaccurate perception about what the community wants. This is particularly relevant to the current debate in psychology which is being led by a very vocal minority of clinical psychologists (and the APS). This group and its supporters have undergone a very aggressive promotional campaign with the specific aim of discrediting the good standing and credibility of most psychologists who currently treat mental illness. As you know, the impact on the profession has been devastating and significantly limited important services to the general public.

RAPS suggest that there is an opportunity for the newly elected Government to act quickly to resolve the current dissent by implementing a one-tier system for psychologists; and in doing so solve many of the issues currently plaguing the delivery of mental health services in Australia. It is the contention of RAPS that all psychologists should be eligible for the same rebates, in other words a one tier system, with different items attracting different rates. This is in contrast to the current two-tier system in which clinical psychologists attract a higher rate for the provision of the same services despite there being no evidence of superior outcomes. To the contrary, all training pathways undertaken by psychologists throughout Australia follow stringent guidelines developed by either the Psychology Board of Australia or the Australian Psychology Accreditation Council in consultation with the broader professional body of psychologists across the country.

Within this context, all training guidelines across all training pathways to registration and practice are scrutinized closely to ensure the international standing of all psychologists practicing in Australia is upheld. It is critical to note also that the training of clinical psychologists does not facilitate engagement within a wider scope of practice than other registrants and thus is in contravention of the Health Practitioner Regulation National Law Act (2010) explanatory memorandum. The skills and competencies obtained in clinical psychology training do not deviate from the training of other registrants. The perception of a difference is not accurate and has been artificially created by members of the profession with a separate agenda but has resulted in a discrepancy in fees charged to the public and a misrepresentation of the services, skills and competencies of other registrants. It is critical at this point that the Government does not perpetuate a misconception created by a minority faction irrespective of how vocal they might be. To do so will be to deny access to important services, particularly in areas such as Centrelink and the NDIS (systems generally supporting heavily disadvantaged and vulnerable populations) where non-clinical psychologists have been prevented from providing psychological interventions, for no other reason than the inaccurate perception perpetrated by the clinical faction.

The importance of a one-tier system utilizing the expertise of all psychologists equally cannot be over-emphasized as a solution to the current crisis in mental health care. This is particularly relevant given paucity of mental health services available to disadvantaged members of the community who have mental health issues. This has been recently highlighted in the media with several spokespeople discussing perceived gaps between acute in-patient psychiatric care and community based mental health services. Very recently, the significant number of youth and men suffering from mental health issues has also been raised as a serious issue and illustrates the urgent need for system reform. Providing greater access to psychologists in the community alternative pathways to deal with immediate crisis will go a long way towards avoiding the revolving door of acute presentations to hospital emergency departments. However, availability of services cannot happen while the artificial distinction is maintained, and more psychologists are forced out of the profession.

RAPS contends that there is a vast network of psychologists within the community available to fill existing gaps in services. However, this is only possible once the serious discrediting by the clinical minority is stopped and equality within the profession is achieved. In addition, the discrepancy in remuneration between clinical and non-clinical psychologists must be addressed, namely with a one-tier system, so that all psychologists can continue to offer services to all members of the community irrespective of socio-economic status and capacity. Specifically, the availability of a one-tier system that adequately remunerates all psychologists to provide services would enable more psychologists to offer bulk-billing services to vulnerable populations. This would divert those individuals from the public health system freeing up resources for only those requiring acute care. This would also attract more psychologists into lower socio-economic areas which are currently under-serviced.

RAPS urges the Minister not to listen to the vocal minority of members who do not speak for the majority of our profession, most of whom simply want equality and the ability to provide high quality services to all members of the Australian public. This is a unique opportunity to restore equality to an essential community service. A one-tier system is the only system that makes logical sense and provides a sensible solution to much of the issues in mental health care reform.


Jenny Corran on behalf of the RAPS Team