This is an issue so close to my heart that it become ranty and emotional (although I think this is entirely justified).
At the end of 2012 the Australian Federal Government intends to drastically reduce psychological treatment in Medicare from eighteen sessions down to ten with absolutely no exceptions. A massive uproar in 2011 had the cuts moved from 2012 to 2013 – instead of ten sessions for the entire 2012 year they oh-so-kindly (can you detect the sarcasm?) relented and allowed sixteen sessions for 2012.
To be honest I don’t know where to begin with this issue. I’ve discussed it with my GP (brilliant woman), psychologist (also brilliant) and helpline counsellor (another brilliant one!) and aside from kicking up as much fuss as humanly possible… none of us know what to do. To be perfectly blunt – I feel doomed.
I’ll back up a little and explain my situation. I have chronic mental health issues. Certainly not worst case scenario, but certainly not living a life free from mental illness. I’ve collected a fairly lengthy list of diagnoses over the years (I’m twenty-five, have been in therapy since I was seventeen, but unwell for many more years) and have spent many, many hours and an extraordinary amount of money on private psychological services. I can’t even imagine the cost of the public funded care I’ve received from Child and Adolescent Mental Health Services, Community Mental Health Services, public hospitals and the countless times my psychologist has seen me at no cost. There’s also the helplines I’ve used – some staffed by volunteers, but another that has paid staff. I have spent hundreds of hours (over the years) on the phone with counsellors.
For the last two years I’ve been the recipient of a Disability Support Pension (DSP). Although it fills me with guilt to be receiving this, the reality is that I can’t work enough hours to support myself financially. My mental health is highly unpredictable – sometimes I’m incredibly high functioning and appear “normal” (without mental illness) yet, at other times, my level of functioning is so low that work becomes impossible. Being on DSP means that I’m on a very tight budget, yet I manage it reasonably well. I work a small number of hours when I can and my employer is incredibly understanding of my varying ability to work.
Now let me explain the issue that makes accessing psychological services difficult. I have Dissociative Identity Disorder (DID). Long story short – it used to be called Multiple Personality Disorder (MPD) – and it means that I have other personalities/alters/parts that can and do take over. I lose chunks of time, I have frightening flashbacks and body memories, and have a talent for dissociating to the point of appearing catatonic. When I’m not well, I’m really not well. The issue with having DID as a primary diagnosis is that so many health professionals only have a limited knowledge of it, and even then tend to be lost as to how to treat it. This means that I can’t see any psychologist or psychiatrist. To make any progress with the chaos that can be my life I need to work with professionals who actually know what they’re doing. Let me also add that DID is not as rare as some professionals will make out – 1.1% of the population are estimated to have DID and 1.3% are estimated to have Bipolar Disorder.
To add to the diagnosis of Dissociative Identity Disorder there is Post traumatic Stress Disorder, Depression (although possibly Bipolar, but that’s a wait and see diagnosis) and Eating Disorder Not Otherwise Specified. Add all that together and, on a bad day, I cease to function. I can’t work, I can’t study at university, I can’t socialise, can be terrified to leave the house. I’ll go ahead and say I have severe mental illness but will add that I tend to be extremely high functioning (in comparison to others with mental illness).
I am ever so blessed, lucky (however you want to refer to it) to have a psychologist that gets it. I’ve been seeing her for a bit over three years now and most of that time I’ve been seeing her weekly. I am lucky that before I had DSP she would see me for free. Free. I’d pay when I could, if I could. Once I started receiving DSP a comparably tiny fee was negotiated and that’s what I continue to pay each week. I’m (once again) very lucky that she will bulk-bill all of my medicare sessions. This year that means I save over $1200. For someone on a pension, that is a lot of money!
I understand that the Australian Government would rather have me seeing a psychiatrist (fifty sessions available through medicare per calendar year) than a psychologist. I think that’s a lovely idea, but not something that’s possible for me. I run into, again, the issue of finding a professional who has the knowledge and capability to work with my diagnosis. There are certainly psychiatrists that have excellent knowledge, understanding and experience in treating trauma and dissociative disorders…. but their books tend to be closed. Getting an appointment is almost impossible. The other issue with seeing a psychiatrist is the cost. Money, once again.
Let’s go with a scenario that’s very much like mine – someone has a chronic mental illness, is unable to work (or only in a limited capacity), is receiving the Disability Support Pension, is on a very tight budget, living in less than ideal housing…. and it could go on with less than desirable circumstances, but you get my point. How does someone on such a tight budget afford to see a psychiatrist? How do they afford to see a psychiatrist as often as is needed for adequate treatment? How? Who is going to pay for it, because the person on DSP is highly unlikely to be able to afford it.
I’m in a bit of an awkward position at the moment in that my GP refuses to prescribe psychotropic medications to me due to a long history of overdoses. I understand that and respect her decision however, this leaves me with a public mental health team to manage my medications. I’ve been in the public mental health system for nearly four years now, and treatment is less than adequate. Staff are clearly overworked and definitely don’t have the time needed to work with clients in a productive way. There are some staff who take the time to really try and make a difference, but they are few and far between. There’s also what seems to be a general lack of understanding of trauma and dissociative disorders in the public system. So whilst I do have a free psychiatrist to prescribe my medication there is little understanding, very limited support and certainly no therapy.
I just can not understand how reducing medicare sessions with a psychologist is going to help anyone. I know it’s not going to help me. It’s going to add a heck of a lot more stress to my life with the financial burden of therapy. Quit therapy, I hear you say. No. This is not a journey I can make on my own or do in isolation.
I’m already facing my public mental health team discharging me because they don’t believe they can provide any more support for me. They can’t – but prescribing my medication takes away the financial burden of having a private psychiatrist do that. To consider seeing my psychologist only fortnightly or monthly is unthinkable. There’s also the issue of me approaching the age limit for a helpline I use- as soon as I turn twenty-six I’ll be unable to use that service. If it weren’t for an incredibly generous psychologist I know that, next year (if these changes to the Better Access Scheme are made), I would be faced with a drastic decrease in the psychological services available to me. Oh, well, they’d be available but unobtainable due to financial constraints.
How the heck can the government think that they are improving access to mental health services? Seriously – how? Because I really, really don’t understand.
I’d also ask that you sign the petition asking that the Better Access to Mental Health Care initiative be amended to provide a minimum of fifteen sessions per year, with an additional five available to those experiencing chronic or severe levels of distress.
I’ll just add that I can see people are coming to this page. If you’ve made it through my lengthy post please, please please sign the petition (link in previous paragraph). People power is the only way we have of making any change! You do have to submit a name and email address but you don’t get spammed (I haven’t been spammed).