President backed Two-Tier system

An email sent to RAPS by a concerned member shows that the APS President, Anthony Cichello has strongly supported the two-tier system.

From: “APS Member Groups – Anthony Cichello” <>

Sender: “APS Member Groups – Anthony Cichello” <>

Date: 4 Jul 2011 18:09:27 +1000

To: <clinical member’s name withheld>

ReplyTo: (Anthony Cichello)

Subject: URGENT – Possible loss of clinical rebates – Senate Community Affairs Reference Committee inquiry into Commonwealth Funding and Administration of Mental Health Services

Dear <Clinical member’s name withheld>

  • 1.    Senate Community Affairs Reference Committee inquiry into Commonwealth Funding and Administration of Mental Health Services

“The Senate Community Affairs Committee has concluded that there are no grounds for the two-tiered Medicare rebate system for psychologists and recommends the single lower rate for all psychologists including clinical psychologists…..”

This could very well be one of the outcomes of the upcoming Senate Community Affairs Reference Committee. Close your eyes for a minute and see the impact of having Medicare rebates cut by 50 percent. How would your patients and practice accommodate this? What impact would this have on demand for Clinical Psychology postgraduate enrollments amongst our brightest fourth year graduates?

The good news is that this committee was established in response to the overwhelming numbers of letters sent regarding the Better Access cuts by members and other psychologists to their MPs, the Greens and opposition members. However, a very loud minority of four year graduate psychologists have lobbied to have the difference between clinical psychologists and psychologists not recognised conceptually and industrially/financially. Clearly, loud lobbying works! This is very disappointing behaviour from our colleagues, however, it is now apparent that it is entirely up to EVERY ONE of us to make a difference to the outcome. We have until 28 July to send in submissions to this committee.

Fortunately, clinical psychologists are trained to intervene in the most complex of scenarios, so our task is to utilise our skills to maintain, and even lift, the ‘specialist clinical psychology’ rebate. We are also arguing for a resumption, and even extension, of rebated sessions per annum based on our unique skills set with the most complex and severe of presentations.

Please be advised that this recommendation of a single rebate seems likely to be made UNLESS ALL members, and other clinical psychologists, fight en masse to demonstrate that clinical psychology is the specialisation of psychology in psychiatric disorder. Five thousand submissions WILL make the difference and prove to be a critical PR intervention for the discipline. For those time-poor members, can I suggest that this is an unprecedented critical period for clinical psychology and that perhaps specifically clearing just 50 minutes in your diary per week for four weeks dedicated to formulating a robust submission will enable you to protect our discipline? The college will also submit, however, individual submissions and client submissions are not viewed, and dismissed, as self-serving like college and organisational submissions.

  • 1.1  Resources for your submission *cut and paste or other) –

Thank you to members who have offered resources to the college for distribution to our four and a half thousand membership, as below –

  • 1.1.1      Work Vale Case, Western Australia 2001 –

Work Value is an industrial term referring to the nature and complexity of the work and the minimum industry accepted qualifications required to undertake that work. A Google search will further elaborate if required. It is the basis upon which salaries and conditions are set.

For those of you who are familiar with the successful “Work Value” case for Clinical Psychology in Western Australia in 2001 heard by the Full Bench Hearing of the Industrial Relations Commission, my West Australian colleagues and I, along with other expert witnesses, won an industrial case that reclassified the discipline that was already pegged higher that general psychology. This we accomplished in a similar manner to that which is now required with the Senate committee – by all clinical psychologists contributing to the work that was required to be submitted. We were able to transform our previous experience of pessimism, anxiety and of being stonewalled by the then Health Department to success by demonstrating sound evidence-based reason.

I attach a culled version of the submission written for this W.A. Work Value Case (the bulk email system can only support a maximum of 200MB attachments). In this document, you will find definitions of clinical psychology and the differentiated industrial levels with which clinical psychology and general psychology are pegged. Please note that these figures were taken from salaries in 1997and that a salary range for a Grade 3 clinical psychologist with a minimum of five years’ experience in the field, for instance, is now around 115,000. Therefore, please provide a temporal context for these figures if you decide to include them.

1.1.2 National Health Service Review of psychological services.

In 1989, the Management Advisory Service to the NHS differentiated the health care professions according to skill levels. Skills in this sense referred to knowledge, attitudes and values, as well as discrete activities in performing tasks. The group defined three levels of skills as follows:

Level 1- “Basic” Psychology – activities such as establishing, maintaining and supporting relationships; use of simple techniques (relaxation, counselling, stress management)

Level 2 – undertaking circumscribed psychological activities (e.g. behavioural modification). These activities may be described by protocol

Level 3 – Activities which require specialist psychological intervention, in circumstances where there are deep-rooted underlying influences, or which call for the discretionary capacity to draw on a multiple theoretical base, to devise an individually tailored strategy for a complex presenting problem. Flexibility to adapt and combine approaches is the key to competence at this level which comes from a broad, thorough and sophisticated understanding of the various psychological theories.

The group suggested that almost all health care professionals use level 1 and 2 skills and some have well developed specialist training in level 2 activities. The group went on to argue that clinical psychologists are the only professionals who operated at all three levels and (I quote) “it is the skills required for level 3 activities, entailing flexible and generic knowledge and application of psychology, which distinguishes clinical psychologists…”

This is consistent with other reviews which suggest that what is unique about clinical psychologists is his or her ability to use theories and concepts from the discipline of psychology in a creative way to solve problems in clinical settings.

1.2 Terms of Reference

Senator Fierravanti-Wells, also on behalf of Senator Siewert, amended business of the Senate notice of motion no. 1 by leave and, pursuant to notice of motion not objected to as a formal motion, moved-That the following matter be referred to the
Community Affairs References Committee for inquiry and report by 16 August 2011:

The Government’s funding and administration of mental health services in Australia,
with particular reference to:

(a) the Government’s 2011-12 Budget changes relating to mental health;
(b) changes to the Better Access Initiative, including:
(i) the rationalisation of general practitioner (GP) mental health services,
(ii) the rationalisation of allied health treatment sessions,
(iii) the impact of changes to the Medicare rebates and the two-tiered rebate structure for clinical assessment and preparation of a care plan by GPs, and
(iv) the impact of changes to the number of allied mental health treatment services for patients with mild or moderate mental illness under the Medicare Benefits Schedule;
(c) the impact and adequacy of services provided to people with mental illness through the Access to Allied Psychological Services program;
(d) services available for people with severe mental illness and the coordination of those services;
(e) mental health workforce issues, including:
(i) the two-tiered Medicare rebate system for psychologists,

(ii) workforce qualifications and training of psychologists, and
(iii) workforce shortages;
(f) the adequacy of mental health funding and services for disadvantaged groups, including:
(i) culturally and linguistically diverse communities,
(ii) Indigenous communities, and
(iii) people with disabilities;
(g) the delivery of a national mental health commission; and
(h) the impact of online services for people with a mental illness, with particular regard to those living in rural and remote locations and other hard to reach groups; and
(j) any other related matter.

Their web page at

provides additional information including

For further information, contact:

Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600

Phone:+61 2 6277 3515 Fax:+61 2 6277 5829


Notes to help you prepare your submission are available from the website at . Alternatively, the Committee Secretariat will be able to help you with your inquiries and can be contacted on telephone +61 2 6277 3515 or facsimile +61 2 6277 5829 or by email to .


In summary, we have less than four weeks to protect our discipline and it is now up to us to mount our best arguments. You will make all the difference if you have the will (which you must!) and each of you submit, but it appears certain we are destined to lose our specialist rebate without your fight now!!


1.3 Mental Health Council of Australia inviting clients to submit re Better Access changes –

The following email was sent to members of a consumer group which clients may wish to contribute to (by 8th July so not long to go). Please consider if you can pass on to your clients so that their stories can also be heard.  Some members have advised that their  clients have emailed their stories already.

Dear NMHCCF members

The Australian Psychological Society (APS) is concerned that people with serious mental health disorders will potentially be left without appropriate mental health care under recent Budget cuts to the Better Access to Mental Health Care program. Please see the attached APS media release and info.
They have highlighted that:

the number of sessions of psychological treatment a person with a mental health disorder can receive each year will be cut from a maximum of 18 down to 10 (not from 12 to 10 as was widely reported).

the Government has stated that people with serious mental health disorders who need more than 10 sessions of treatment should receive services through the specialised public mental health system, private psychiatrists or the expanded Access to Allied Psychological Services (ATAPS) program.

there are concerns that people with severe depression and anxiety related disorders will not be able to get into public mental health services, be able to get timely or affordable access to a psychiatrist or into ATAPS which we understand cannot accommodate all these people.

They are seeking personal experiences of any people affected by these changes, to monitor its impact and inform the Australian government to ensure that people with severe mental illness are not left without appropriate treatment options. The APS are also in the process of developing a consumer and carer survey to provide further data to inform future discussions with government.

Can you please forward any (de-identified) stories about the impact the cuts to the Better Access program are having to me by 12.00pm Friday 8 July to

Please feel free to circulate this to your networks.

Kim Harris
Acting Executive Officer
National Mental Health Consumer and Carer Forum
Mental Health Council of Australia


1.4 Can you identify with this? Reflections from a member re ATAPS –

If you can identify with this de-identified feedback regarding his experience with the local ATAPS program, you may wish to include this into your submission to the Senate Committee, which includes ATAPS in its brief.

I have contacted one GP division in X (Y division) and was told that because my practice location falls just outside (my a km or so) of their boundaries they would not accept my application to become a provider under their program.  I have since contacted the division my practice falls within (Z division) and they have not responded to my application at all.  I was told by both divisions that I would have to agree to see clients at the bulk bill rate of $119.80 (so less than the scheduled fee).  I could not continue to run my practice if this was the fee I was paid for all clients. However,  I decided to see if I could register as I have a number of clients with chronic mental health conditions such as OCD and severe social phobia who will not be able to afford to pay for additional sessions after the 10 sessions end and would be happy to see them under this program.  These clients have been refused services by government mental health services (adult and child).   It is my opinion that these clients would experience significant set backs if they had to change therapists as trust is a big issue for them.

I am also concerned that despite the fact that I have 11 years experience, in government mental health services and in the private sector, and I specialise in areas of child and adolescent mental health and OCD in all ages (which many psychs and clinical psychs struggle to work with) that ATAPS would not consider contracting me to provide services.  The other issue is that despite falling outside the boundary for the X division the majority of my clients and most of the GP’s I have established good working relationships with fall within this boundary.  I have asked them to explain the criteria for selection but they have not responded.  So I am assuming that the only clinical psychologists they will contract to are those that fall within their boundary.  This may mean that if they do not have skilled and experienced psychologists in their boundary they will still only contract work to people within their boundary.  So people in the outer suburbs and rural areas maybe disadvantaged by receiving mental health care that might not be of the highest standard because of work force issues.  I also wonder if my lack of success is because I am a clinical psychologist rather than a psychologist and would cost the division more money to provide services.

  • 2.    Lead Clinicians Group –

A reminder that applications are due by 5.00pm AEST 09 July 2011. (please re-join the broken link if that is preventing access to the website…)



Best wishes and see you at Coolum next week!



Anthony M Cichello

Specialist Clinical Psychologist


National College of Clinical Psychologists



Sent by APS – College of Clinical Psychologists – National