WA News Letters ATAPS chop devastating
ATAPS chop devastating
Written by Website update
Thursday, 27 April 2017

Dear Editor,

Thank you for your feature article about Mental Health’s direction by Nathan Gibson (Inside WA’s Psychiatry Services, March). I was disappointed not to see any reference to Access To Allied Psychological Services (ATAPS).

As a GP in North Metro, I do a lot of mental health and have established some really supportive teamwork with two excellent local psychologists who have used ATAPS for financially challenged patients and the Lighthouse program (unlimited free sessions for a set time period) for those at risk of suicide.

I also use these psychologists for private referrals via Better Access.

ATAPS has been very useful especially as there were 12 sessions instead of 10, and it could be extended to 18 where necessary.

One of the most important prerequisites of good mental health care is continuity of care. With ATAPS, extremely vulnerable people could start with Lighthouse two or more times a week, then, as things settled, could transition to ATAPS.

If they had a little money and needed ongoing long-term help we could use Better Access for brief periods until they were eligible for ATAPS again. This has worked well and I have seen amazing results in patients who see the same psychologist for ongoing therapy.

Suddenly the psychologists told me that ATAPS was ending, with no new patients being accepted and existing patients only given one more session.

What an extraordinarily cruel way to treat vulnerable people!

Black Swan informed me via a letter about a patient they rejected that he could make an appointment under Better Access with one of their counsellors. I have no idea of the credentials of their ‘counsellors’ and am doubtful that such a service can provide continuity of care.

This also means vulnerable people having to front up the full fee before getting a rebate with a larger out-of-pocket cost. The most vulnerable simply can’t do that.

I am incredulous that I have had no letter from the PHN about this change. I wonder under what justification it is OK to withdraw treatment from people who were already accepted into the system? I wonder whether the same will happen to the Lighthouse program at the end of the financial year, and whether anyone will tell GPs?

Are other people having the same experience in other regions, and is anyone going to recognise the devastating loss of continuity of care that this means?

Dr Jane Ralls, GP, Woodlands

Dear Editor,

Your GP’s letter captures one of the issues inherent in the ATAPS program, which was that for many years, patients have had to move in and out of programs to get the mental health care they need.

In accordance with Commonwealth Government guidelines, we are transitioning to an evidence-based model of stepped care for mental health, which gives patients access to a wider range of care options so they receive the right level of care at the right time.

All patients presently accessing mental health care through ATAPS will be able to complete their cycle of care with current ATAPS providers who are contracted until June 30, 2017.

In the future, GPs will have the option to refer patients to a virtual psychology clinic known as Practitioner Online Referral Treatment Service (PORTS).

PORTS will offer face-to-face, telephone and clinician supported internet based CBT treatments for patients aged 16+ with mild to moderate anxiety, depression or problematic substance use.

PORTS will provide GPs with a single referral point for all patients.

Like the ATAPS program, PORTS is for people who hold a health care card and/or are in genuine financial hardship. Unlike ATAPS, however, PORTS will not have any co-contribution, ensuring cost is not a barrier to care.

Referring doctors will receive initial assessment feedback on their patients and ongoing progress reports allowing them to adjust their care provision as required.

Information packs for GPs and practice managers will be available and will detail the evidence underpinning stepped care models, as well as information about the transition to the new treatment options. WAPHA will provide GPs with the support and resources they need to explain the change to their patients.

The Commonwealth guidance indicates that long-term psychological therapy is not in scope for WAPHA-commissioned services. Nonetheless WAPHA is aware that a small number of individuals with enduring and/or severe mental health problems are managed by GPs who rely on ongoing access to psychological therapy as a component of long-term care.

WAPHA is keen to hear from affected GPs to gauge the extent of this issue. Phone 6278 7913 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Learne Durrington, CEO, WAPHA

27042017-durrington-learne-ms jan16Dr Learne Durrington

Dear Editor,

Primary care access to sustained, quality psychological services is critical. There are issues of access and then there are issues of continuity. They are linked but separate.

As Chief Psychiatrist, my concern is that where psychological services are not accessible, affordable and reliable, restricted options may lead to higher rates of psychotropic prescription as the initial treatment. Psychotropic medications are an essential component of therapy in a range of complex and serious mental disorders. However, in cases of mild-moderate anxiety or depression, the RANZCP Guidelines tell us that non-pharmacological therapies are often the most effective initial treatment. We have to advocate for access to best practice for our patients and families.

Regarding continuity, changes to funding options for subsidised psychological and psychosocial services is destabilising for patients who require longer-term psychosocial interventions.

It is important to note that 10 sessions or less of talk therapy within a year is often sufficient for many patients, but not all mental disorders respond to this type of package. An important example of this might be Borderline Personality Disorder with potentially significant distress and dysfunction impacting the individual, family, workplaces and broader community, but where extended psychological treatment often leads to good outcomes.

We see significant numbers of very disabled individuals in the public sector who cannot afford paid psychological services or even to pay a gap fee. Why should these folk be barred from accessing basic mental health care?

Access to subsidised and sustainable psychological therapy makes ethical, clinical and economic sense.

Dr Nathan Gibson, WA Chief Psychiatrist

27042017-gibson-nathan-dr-dec16 colDr Nathan Gibson