The National Association of Practising Psychiatrists (NAPP) is deeply concerned by the decision of Health Minister Mark Butler MP and the Department of Health not to extend Medicare Benefits Schedule item number 91840, which ceases tomorrow.

Item number 91840 currently facilitates vulnerable patients to access psychiatric continuity of care and trauma-informed medical psychotherapy treatments by telephone.

Patients who access these treatments by telephone either do not have access to video-enabled consultations due to poverty, inability to access reliable internet services, are not able to ensure the privacy required for video-consultations, have mental illness complexity and / or trauma histories that prevent or limit their capacity to use video-consultations, physical issues that either prevent video-access and / or in person-attendance during the current pandemic.

By maintaining the video consultation equivalent of 91840 but not the telephone equivalent, the Department of Health discriminates against the most vulnerable of patients, who are generally not able to access the required continuity of care and / or specialist psychotherapy via the public mental health system.

Maintaining Medicare rebates for only shorter psychiatric telephone consultations prioritises medication-focused psychiatric treatment and restricts patient access to trauma-informed psychotherapy treatments, which for many are first line treatments and not accessible via the public mental health system. This is not in keeping with contemporary best practice care.

With this decision, patients will be placed at risk of losing or having disrupted psychiatric treatment, of being destabilised and (re)traumatisation; patients and their families will be placed at risk. Some patients will be required to return to the public mental health system via emergency departments and inpatient admissions, which will offset the savings of ceasing 91840. Some patients may be placed at risk of self-harm or suicide in the context of loss of access to effective treatment in which they are currently engaged.

This decision is a movement away from genuine trauma-informed, individualised psychiatric treatment that meets legitimate need and is recovery-focused.

The National Association of Practising Psychiatrists calls on Health Minister Mark Butler MP and Mental Health Minister Emma McBride MP to review this decision and urgently resume MBS item 91840.

Dr Philip Morris AM           Dr Vivienne Elton                  Dr Pia Brous                  Dr Melinda Hill
President NAPP                Vice President, NAPP            Treasurer, NAPP           Secretary, NAPP

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