On Sunday, Health Minister Greg Hunt announced an expansion of telehealth services for mental health. The new telehealth services must be bulk bill only, and the bulk bill amount will be charged at the same rate as its face-to-face equivalent. All Australians who are eligible to receive Medicare can access these items via telehealth.

We commend the Federal Department of Health for introducing telehealth items for most medical and allied health consultations during the current COVID-19 crisis. However, the changes mean that psychologists are now being forced to bulk-bill all telehealth consultations regardless of client income or socio-economic status.

The Australian Association of Psychologists Inc (AAPi), the leading not-for-profit membership association for psychologists in the country, is urging the Minister of Health to:

1. Allow all psychologists to provide bulk-billed sessions under the one, higher Medicare tier. The system currently discriminates by type of psychologist. Australians need all the help possible.
2. Grant an additional 10 sessions in the mental health plan, due to the increase in stress/isolation of the Australian public (similar to the Bushfire Recovery Program).
3. Allow Australians to self-refer to their mental health professional of choice to access rebated counselling (as was authorised for the Bushfire Recovery Program).

The issue with bulk billing

Sticking to the existing two-tier bulk billing system for telehealth services becomes a problem when you consider that psychologists are currently rebated at two significantly different rates depending on whether they are classified as a ‘registered’ or ‘clinical’ psychologist.

Registered psychologists are rebated $86.15 for a 50-minute session, while clinical psychologists are rebated at $126.50 – over $40 more for the same session.

Research [1] demonstrates clearly that there is no difference in treatment outcomes between clinical psychologists and registered psychologists. At the same time, there is no evidence to support that clinical psychologists are better skilled at providing telehealth services than other psychologists.

It’s disheartening for clients and their psychologists when the government releases another set of rebates following the same two-tier structure, without ever satisfactorily justifying the arbitrary distinction.

All psychologists working in private practice have sizeable operating expenses which continue during the COVID-19 shutdowns, whether working remotely from home or not. With an average of five bulk-billed sessions per day at the lower rebate, psychologists - 80 percent of whom are women - are regularly taking home less than $45,000 per year. Bulk-billing of all clients at the lower level is simply not viable or sustainable.

We need psychologists to continue to operate – Australians need them now more than ever. And their businesses are at stake if they cannot cover their costs by charging in the usual way with Medicare rebates available to their clients.

What we’re fighting for

As a result, AAPi is advocating for all psychologists to be eligible to provide bulk-billed sessions under the one, higher Medicare rebate.

Furthermore, due to the increase in stress/isolation of the Australian public, we argue that each Australian should be entitled to an additional 10 sessions of therapy during this crisis (similar to the Bushfire Recovery Program).

Clients are also reporting difficulty in accessing GPs to create mental health care plans during this time of crisis. This administrative requirement also means that clients are expected to visit their GP clinic and potentially be exposed to COVID-19 infected patients. Therefore, we request that Australians should be able to self-refer to their mental health professional of choice to access rebated counselling (as was authorised for the Bushfire Recovery Program). The requirement for all Australians with mental health care plans to be reviewed by their GP after every six sessions should also be lifted to free up more GP time to meet the increasing needs of COVID-19 patients. 

The government needs to consider the mental health needs of the Australian public during the current crisis but also into the future. Forcing two thirds of psychologists to operate on the lower rebate will put them out of business and leave a huge gap in services for the most vulnerable Australians in this time of great need.

[1] Pirkis, Ftanou, Williamson, Machlin, Spittal & Bassilios (2011). Australia's Better Access initiative: An evaluation. Australian and New Zealand Journal of Psychiatry, 45:726–739