The National Association of Practising Psychiatrists (NAPP) calls on Health Minister Mark Butler MP, Assistant Minister for Mental Health Emma McBride MP and the Department of Health to urgently resume Medicare Benefits Schedule item number 91840, which ceased on 1st July 2022.

MBS 91840 facilitated vulnerable patients to access essential psychiatric continuity of care and trauma-informed medical psychotherapy treatments by telephone.

Reports from practising psychiatrists highlight a significant number of patients with serious mental illnesses, including schizophrenia, bipolar disorder, treatment-resistant depression, OCD, PTSD and complex trauma histories, current severe self-harm and suicidality, have been significantly adversely impacted by the cessation of MBS 91840 and are being unnecessarily placed at risk.

The vulnerable and voiceless group includes patients not able to afford the required technology for video consults, not able to access reliable internet or not able to effectively use IT for video telehealth. This includes patients who are elderly, medically unwell, lacking IT literacy or unable to engage with the processes due to mental illness. For some patients, being able to pick up the telephone and call their psychiatrist has been the only point of access to essential mental health treatment. For some, this is life-preserving.

NAPP expresses deep concerns that the removal of the 91840 rebate for long psychiatric telephone consultations, equivalent to available video consultations, is discriminatory, introducing digital inequalities, ‘defined as differential access to healthcare depending on digital access, digital literacy, or both’ into the Australian mental health system (Greenhalgh T & Wherton J, 2022, Telepsychiatry: learning from the pandemic, British Journal of Psychiatry; doi: 10.1192/bjp.2021.224).

NAPP has been informed that the removal of 91840 has resulted in some specialist telehealth services to remote rural communities being abruptly ceased, leaving patients who had been on waiting lists of one year now unable to access any psychiatric treatment.

Patients unable to access video telehealth or afford the now increased out of pocket fees for telephone consults are being required to access psychiatric consultations in person. This places patients with medical comorbidities, or who are elderly, at increased risk of covid-19 infection despite being at higher risk of complications, including death, with flow on mental health detrimental effects for patients, families and carers. Patients who are parents of children unable to travel by car for treatment have lost access.

NAPP is aware some patients have had to cease effective psychiatric treatment and highlights risks of disrupted effective psychiatric treatment can include mental state deterioration, self-harm and increased suicidality with threat to life. Costs of patients returning into primary care and the public mental health system will offset any financial savings from the removal of MBS 91840.

NAPP’s previous media release can be found at:

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

Stronger protection for patients and doctors secured in additional conditions on medical buying group arrangements
Government decision to limit telehealth services will cause vulnerable Australians to suffer