Beating around the Bush-The Australian Government pays lip service to regional mental health service needs &fails to support small business providers.

I am a clinical psychologist, accredited supervisor, adjunct university lecturer, and Director of Adaptive Strategies North Queensland. ASNQ is the largest private practice psychological service provider in the Whitsundays Regional Area. My multi-clinician practice has been operating full-time since late 2019. My team has provided face-to-face & group therapy services to thousands of clients from the Whitsundays area (Bowen, Collinsville, Proserpine, Cannonvale, Airlie Beach) & beyond. Our primary clinic is located in Bowen. Bowen has been classified as a Modified Monash Model category 4 (MMM4)[1] location & according to ABS SEIFA disadvantage index rankings is in the most disadvantaged 15% of all geographic locations within Australia [2]. We provide a specific outreach service to Collinsville which is categorised as an MMM6[1] location & rated as being in the most disadvantaged 10% of all geographic locations in Australia [2]. Moreover, Australian Institute of Health and Welfare data indicates that the Whitsundays region sits well above the State and National averages in deaths by suicide & intentional self-harm hospitalisations.[3]

While I have successfully brought 17 individuals to the Whitsundays from as far as Adelaide, domestically, & Finland, internationally, I have largely only been able to secure provisional psychologist staff seeking registration via the 4+2 psychologist registration pathway. This pathway is now closed. Unfortunately, all my provisional psychologists are 'out of towners' & will be returning to their cities of origin when they attain full registration in early 2024. I cannot compete with the incentives & pay offered by like businesses in metropolitan areas, especially those businesses that scale greater than ASNQ. There is no extra pay, tiered system, or other advantage on offer which might tip the balance in terms of my provisional psychologist staff deciding to remain in this regional location.

Although I have affiliated myself with the two closest universities to my current location, I have been unable to secure any 5+1 pathway trainees, much less someone who has general registration as a psychologist. Although the federal Government has promised more funding for 5+1 places, there will still be insufficient funded 5+1 spots to replace those who would otherwise have undertaken 4+2. Furthermore, provisional psychologists are not eligible to provide psychological services via Better Access

I am familiar with several federal Government incentive programs that exist relevant to attracting & maintaining health staff to/in regional, rural, & remote areas of Australia (e.g., National Mental Health Pathways to Practice (PILOT) Program[4], the Rural Health Multidisciplinary Training (RHMT) Program[5], & the Workforce Incentives Program [6]). Unfortunately, a private psychology practice business like mine is not eligible for any staff attraction help or advantages under any of these programs. As mentioned above, there is also no extra remuneration for any psychologist working regionally in private practice. The only exception to this is when psychologists are treating clients in accordance with their NDIS plan. Remuneration for NDIS services is calculated based on MMM treatment provision location.

I do not wish for my multi-clinician regional psychology clinic to cease operating in the Whitsundays. If I am unsuccessful in recruiting further staff, however, I will likely be forced to return to operations as a sole practitioner. This would not be a ruinous thing for me personally, since I would be free of the stress of managing a multi-clinician practice, & financially, it would probably be even prove more lucrative for me. In those circumstances, I might even consider that returning to Brisbane may be the best option for my family as compared with staying in the Whitsundays. My extended family is located in Brisbane, where I grew up. Either way, I am lucky enough that it would work out fine for me & mine.

Sadly, one or both outcomes would be disastrous for the Whitsundays community, & leave thousands of Whitsundays residents either unable to access psychological therapy or subject to even more unconscionable psychological service wait times than presently exist. In addition, Bowen (& the wider Whitsundays) would lose the substantial infrastructure & social capital I have painstakingly built to operate a multi-clinician private psychology practice in this disadvantaged area. Moreover, either outcome would place even greater strain on the already overburdened public mental health system.

I was previously a Queensland Police Detective, finishing up as an Officer in Charge of a Child Protection & Investigation Unit in regional Queensland. I have also worked in a variety of Queensland’s most disadvantaged locations. I have too often seen, first-hand, how the impact a lack of access to evidence-based psychological services contributes to individuals heading down problematic & disastrous life trajectories. I have spent significant periods of time educating myself to get in the best position I could to deliver psychological services to as many of those who need it as I can. I also have a particular affection towards maximizing the mental wellbeing of of those living in regional, rural, & remote areas especially those locals who identify as First Nations people.

I am awestruck that a situation can arise where a highly experienced & qualified clinical psychologist like me, who has willingly established a multi-clinician private practice that services highly disadvantaged areas of regional Queensland will likely need to cease operations due to a lack of Government support.

My situation is especially perplexing given findings & recommendations of various inquiries & reviews the federal Government itself commissioned around mental health services in regional, rural, & remote locations of Australia (for examples see below references [4], [8), [12], [13], [14], [15]). These Government-commissioned reviews make clear that local services are key to best attending to the mental health service needs of those living in regional, rural, & remote settings. This proposition is supported by a 2022 study that concluded those in rural & remote Queensland “strongly prefer in-person mental health care to telehealth.”[11] The commissioned reviews also make clear that addressing the extensive mental health workforce shortage in these areas is an essential element to achieving the best outcomes.

The Australian Productivity Commission has acknowledged that Allied health services are “mainly delivered in the private sector.” [8] Unfortunately, as mentioned above, small, allied health businesses located in regional, rural, & remote areas are ineligible to apply for workforce attraction & retention incentives provided by the Government. Again, psychological service provider small businesses in country areas also receive no extra renumeration for providing psychological services in those areas. This situation does not seem to fit with the Federal Treasurer’s recent declaration that “We recognise how important the small business community is to this country & to our national economy ? that’s why we want to create more opportunities for them to grow & prosper.” [9]

In 2022 Minister for Health & Aged Care Mark Butler acknowledged that “Our rural & regional communities have endured drought, bushfires, floods & the impacts of COVID-19 in recent years – a perfect storm of factors that have taken a significant toll on people’s mental health.”[10] In addition, earlier this year he also acknowledged "People in areas with the most significant need — the highest level of mental distress — receive far fewer services than other areas in the community."[11] Bowen & Collinsville are among the highest-need areas within Australia. I wish to add that I have seen no local evidence whatsoever that supports your assertion that "The level of access, particularly the level of equity, was made worse by the additional 10 [Better Access] sessions.”[11] Having said that, with all due respect, his assertion also does not seem to be supported on my read of his own department’s Better Access Evaluation report as a whole [12].

I recognise money is not infinite and hard decisions must be made by the Government regarding where to best spend money in the National interest. In the present circumstances however, it seems inherently indisputable that genuine investment in endeavours aimed at addressing the regional, rural, and remote mental health crisis as well as the mental health workforce inequity in these areas should be amongst the federal Government’s highest priorities. It is my humble request that the Australian Government immediately and urgently provide due assistance to privately owned psychological service businesses (and other allied health practices) operating in socioeconomically disadvantaged regional, rural, and remote areas of Australia. Such Government assistance may include the provision of extra workforce attraction & retention incentives, tax concessions, increased sessions for country clients, HECS debt reductions for staff, rental assistance, tiered & locality need-based service payment/remuneration systems, general incentives for businesses themselves willing to provide evidence-based psychological services in country areas, allowing provisional psychologists to provide services under Better Access. Every one of these endeavors have already been proposed in inquiries & reviews the Government itself has commissioned.

On the 9th of September 2023, I wrote a letter to Minister Butler outlining my situation & the concerns I have expressed above. I requested that he meet with me to discuss these issues. As yet, I have heard nothing back from Mr Butler or his Department. I am aware they have received a copy of the letter.

Please repost this article to show support for my advocacy relating to the need for increased psychological service provision in regional, rural, and remote Australia and the need for the Australian Government to provide genuine assistance and incentives for private business psychology service providers in country areas.

Regards,

Dr Corey Lane

Clinical Psychologist

References

?1.????? 1.????? Australian Government Department of Health and Aged Care. (2023a). Health Workforce Locator. https://www.health.gov.au/sites/default/files/documents/2019/12/modified-monash-model-mmm-suburb-and-locality-classification-home-care-subsidy-modified-monash-model-suburb-and-locality-classification-home-care-subsidy_0.pdf

2.?????? Austrailan Bureau of Statistics. (2021). Socio-Economic Indexes for Areas (SEIFA), Australia. https://www.abs.gov.au/statistics/people/people-and-communities/socio-economic-indexes-areas-seifa-australia/latest-release

3.????? Australian Institute of Health and Welfare. (2023). Suicide & self-harm monitoring. https://www.aihw.gov.au/suicide-self-harm-monitoring

4.????? Australian Government Department of Health and Aged Care. (2022). Prioritising Mental Health and Suicide Prevention – Workforce and Governance (Pillar 5) - Budget 2022-23 fact sheet. 24 - Prioritising Mental Health and Suicide Prevention – Workforce and Governance (Pillar 5) - Budget 2022-23 fact sheet

5.????? KBC Australia. (2020). Independent Evaluation of the Rural Health Multidisciplinary Training Program: Final Report to the Commonwealth Department of Health. In. Orange, NSW: KBC Australia. Independent Evaluation of the Rural Health Multidisciplinary Training Program

6.????? Australian Government Department of Health and Aged Care. (2022). Workforce Incentives Program Practice Stream. Workforce Incentive Program Practice Stream | Australian Government Department of Health and Aged Care

7.????? Amos, A. J., Middleton, J., & Gardiner, F. W. (2022). Remote mental health clients prefer face-to-face consultations to telehealth during and after the COVID-19 pandemic. Australasian Psychiatry, 30(1), 18-22. ?Remote mental health clients prefer face-to-face consultations to telehealth during and after the COVID-19 pandemic - Andrew James Amos, Jocelyn Middleton, Fergus W. Gardiner, 2022 (sagepub.com)

8.????? Australian Government Productivity Commission. (2023). PART E, SECTION 10 Primary and community health. In Report on Government Services 2023. Australian Government Productivity Commission. https://www.pc.gov.au/ongoing/report-on-government-services/2023/health/primary-and-community-health

9.????? Australian Government Treasury Portfolio. (2023). Albanese Government delivers over $1.5 billion in new tax incentives for small and medium businesses. https://ministers.treasury.gov.au/ministers/jim-chalmers-2022/media-releases/albanese-government-delivers-over-15-billion-new-tax#:~:text=Treasurer%20Jim%20Chalmers%20said%20this,them%20to%20grow%20and%20prosper.%E2%80%9D

10.? Australian Government Department of Health and Aged Care. (2022). Improving mental health services in regional Australia. https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/improving-mental-health-services-in-regional-australia-0

11.? Dalzell, S. (2023, 25 Jan 2023). Cuts to subsidised psychology sessions causing clients to 'ration' care, health workers warn. ABC News. https://www.abc.net.au/news/2023-01-25/mental-health-clients-ration-cheaper-psychology-after-cuts/101885652

12.? Pirkis, J., Currier, D., Harris, M., Mihalopoulos, C., Arya, V., Banfield, M., Bassilios, B., Buchanan, B., Butterworth, P., & Brophy, L. (2022). Evaluation of Better Access (Main Report). Australian Government—Department of Health Aged Care. Main Report – Evaluation of the Better Access initiative | Australian Government Department of Health and Aged Care

13.? Australian Government Department of Health and Aged Care. (2023b). National Strategic Framework for Rural and Remote Health. Canberra Retrieved from https://www.health.gov.au/resources/publications/national-strategic-framework-for-rural-and-remote-health?language=en

14.? Cleary, A., Thomas, N., & Boyle, F. (2022). National Mental Health Workforce Strategy-A Literature Review of Existing National and Jurisdictional Workforce Strategies Relevant to the Mental Health Workforce and Recent Findings of Mental Health Reviews and Inquiries. ?National Mental Health Workforce Strategy – A literature review

15.? Australian Government Productivity Commission. (2022). Mental Health and Suicide Prevention Stocktake. https://www.pc.gov.au/research/completed/mental-health-stocktake

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