WA News News & Reports Mental Health in Primary Care
Mental Health in Primary Care
Written by Jan Hallam
Wednesday, 07 June 2017

 

Last issue Woodlands GP Dr Jane Ralls wrote to us about her dismay at the axing of ATAPS, which has been subject to review as part of the Federal Government’s revamping of mental health programs to a stepped care model.

We asked the CEO of WAPHA Learne Durrington to comment then and in her reply, which was published in the May edition, she outlined some of the programs that will be replacing ATAPS. We asked some specific questions of Learne and WAPHA to gain a better picture of the changes.

Q: How much has the Federal Government given WAPHA to deliver mental health programs this financial year?

How much of that money has WAPHA distributed to service providers in the past six months?

Has ATAPS money been specifically redistributed to WAPHA for PORTS. How much was that? How much will PORTS cost to set up and deliver?

(WAPHA has combined these questions in its response)

A: There has been a significant change in the way mental health programs are funded. The Commonwealth Government formerly would fund individual programs, such as ATAPS, through a combination of base funding and special purpose funding.

In very general terms, the base funding was designed to enable GPs to access psychological services for hard-to-reach groups to complement Medicare-subsidised mental health services, while special funding provided additional support for those groups whose needs were not being adequately met through ATAPS.

As of 1 July, 2016, funding for a range of former programs, as well as additional mental health funding, was redirected to a Primary Mental Health Care flexible funding pool, which must be used by PHNs to support commissioning of mental health and suicide prevention services in six key service delivery areas:

•  Low-intensity psychological interventions for people with, or at risk of, mild mental illness;

•  Psychological therapies delivered by mental health professionals to under-serviced groups;

•  Early intervention services for children and young people with, or at risk of, mental illness;

•  Services for people with severe and complex mental illness who are being managed in a primary care setting;

•  Enhanced Aboriginal and Torres Strait Islander mental health services; and

•  A regional approach to suicide prevention activities with a focus on improved follow-up for people who have attempted suicide or are at high-risk of suicide.

ATAPS in WA received $10,478,265 during 2015-16, the final Commonweath funding period. The equivalent funding was allocated to providers in 2015/16 to deliver low intensity mental health services.

However, $41m has been allocated to WAPHA for 2016-17 to commission mental health services across WA. Of this, WAPHA allocated $13 million for low intensity services which include face-to-face, telephone-based, group therapy and online services. The remainder has been made available for headspace services, early psychosis, mental health nursing and mainstream and ATSI suicide prevention services.

The 2017-18 funding for mental health is projected to slightly increase.

Q: How many West Australians accessed ATAPS the past 12 months?

A total of 10,596 patients in the 2015-16 financial year, with 9893 attending at least one session. (Depending on the location, 3-8% of those referred did not go on to have an ATAPS session.)

Our understanding is that about 70% received five or fewer ATAPS sessions and 95% received 11 or fewer.

Patients on ATAPS were required to pay a co-payment to an ATAPS provider, with about  $150,000 in co-payments recorded in 2015-16.

Under the new system, all services commissioned by WAPHA will be at no cost to people with a Health Care Card. GPs can refer people in rural and remote communities who would otherwise have little or no access to mental health services, including in areas where access to Medicare-subsidised mental health services is low.

By Jan Hallam

 

 

 

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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