Dear Psychiatrist Colleagues,

Here is an update of the work that the National Association of Practising Psychiatrists (NAPP) has been involved with this year on our behalf. 

Contents

  1. InToughTimesText.org.  New approach to assisting members of the public help individuals with suicidal thinking
  2. Protecting psychiatrist independent clinical decision-making in the private hospital sector
  3. New MBS Item 319 descriptors
  4. Continuation of MBS Telehealth Item 91840
  5. The NAPP Guide to gender dysphoria
  6. Psychodynamic psychotherapy within the College CPG on Mood Disorders
  7. NAPP hosts sessions for psychiatric trainees
  8. Australian Medical Council re-accreditation of RANZCP
  9. Your Say about future NAPP activities
  10. Join NAPP

1. InToughTimesText.org: (ittt.org.au)  New approach empowering the public to help individuals with suicidal thinking

The blight of suicide remains a major public health, professional, and personal issue for our members, their patients and their families. Suicide is the most commonest cause of death and injury under the age of 45, causing almost 3 times the death rate compared to car accidents. Preventing suicide is an absolute high priority, and effective ways of helping prevent suicide are very important in our role as psychiatrists.

Dr David Horgan (a senior psychiatrist in both clinical and academic practice in Melbourne and a NAPP member) has a model of suicide prevention that engages the general public in being able to better handle and respond to individuals who may be having suicidal thoughts.  David has produced a brief article about his program available at: https://mcusercontent.com/d7804e6d64ae6a0d3871b6028/files/48826aa2-0cd2-658f-2abf-b86f63c6a7eb/MC83_Aug2022.pdf

Visit David’s website at: https://intoughtimestext.org/

2. Protecting psychiatrist independent clinical decision-making in the private hospital sector

In July 2022 NAPP in conjunction with the Australian & New Zealand Rehabilitation Society and the Australian Medical Association was able to come to an agreement with Honeysuckle Health (a joint partnership between NIB private health insurer and the Cigna Managed Healthcare Services group from the United States) to limit Honeysuckle Health’s proposals to constrain independent health decision-making by physicians (including psychiatrists) on behalf of patients in the private hospital sector in Australia. 

In 2021 the Australian Competition Consumer Commission (ACCC) authorized Honeysuckle Health to introduce new purchaser-provider contracts with hospitals and medical specialists.  These new agreements placed restrictions on the independent medical decision-making of doctors for the necessary care of their patients and introduced admission and discharge policies, quotas on inpatient care, and access to only approved forms of outpatient rehabilitation.  These contracts affected the autonomy of doctors to determine care based on the best interests of their patients. 

In late 2021 NAPP asked for a review of the ACCC decision before the Australian Competition Tribunal and proceedings were held before the Tribunal from then until mid-2022.  A settlement (Deed of Agreement) between the parties was reached in July before the Tribunal had heard the full case. 

The settlement was based on terms that preserved doctor clinical autonomy in the care of their patients no matter which contracts the Honeysuckle buying group might introduce in the future.  NAPP has previously outlined the Deed of Agreement and it is available on our website for those who are interested.  NAPP was very proud to have been involved in this action to defend the clinical autonomy of psychiatrists and other doctors as we consider that these new contracts would have adversely affected psychiatric care in private hospitals. 

3. New MBS Item 319 descriptors

NAPP has been involved in reviewing the new description of Item 319 in the Medical Medicare Benefits Schedule (MBS).  This item provides for up to 160 sessions a year of long-term (45 minutes or longer) psychiatric continuity of care and psychotherapeutic treatment of patients. 

The recommendations from the committee working on MBS Item 319 were that specified clinical diagnoses should no longer be required for the item to be used.  Recommendations also included to remove the requirement to rate the patient on the out-dated Global Assessment of Functioning (GAF) impairment rating scale.

These changes mean that patients who are treated using Item 319 would no longer be identified as having certain psychiatric conditions nor having specific a level of psychiatric severity.  These changes will protect patients’ privacy and reduce discrimination against patients who need longer-term psychotherapeutic treatment.

4. Continuation of MBS Telehealth Item 91840

NAPP has been heavily involved in advocating for the continuation of the Telehealth arrangements beyond the acute Covid-19 pandemic period.  The Commonwealth government has allowed continuation of Telehealth items through the MBS for patients seen by video for more than 45 minutes. 

However, the government ceased the Item 91840 for telephone consultations of the same duration.  This significantly disadvantages patients who (i) have poor internet coverage and cannot get video Telehealth services, (ii) do not have laptop and other equipment to enable video consultations, (iii) patients who are not able to pay the price of internet connections and can only use the telephone, and (iv) patients who require a telephone (rather than video). 

We believe that the loss of the telephone consultation discriminates against patients who are not well off and do not have the advantages that other patients have.  Furthermore, some patients require a telephone (rather than video) psychotherapeutic treatment environment. 

NAPP believes that the loss of the >45 minute telephone consultations is discriminatory and introduces digital inequity into the psychiatric section of the MBS.

NAPP has combined with the RANZCP and others, including Lived Experience Australia, to extensively lobby the government to reintroduce the MBS Item 91840 for telephone Telehealth consultations.  We hope we will be successful in this mission but currently we have no final response from the government. 

5. The NAPP Guide to gender dysphoria

NAPP has updated its Guide to the Management of Gender Dysphoria in Young People.  Over the past year, there have been considerable new developments in this field.  Advice to governments by health authorities in Sweden, Finland and the United Kingdom have led to a more cautious reevaluation of the care of young people with gender dysphoria.  The use of medical interventions to transition children and adolescents from their birth sex/gender to a gender that they wish to achieve has been critically reviewed and the advice from these authorities is to be more cautious in the use of puberty-blocking agents, cross-sex hormones, and sex reassignment surgery. 

A review led by eminent pediatrician, Dr Hilary Cass OBE (former President of the Royal College of Pediatrics) has recommended the closure of the original gender clinic for children in England (the Tavistock Clinic) and its replacement by regional-based gender clinics operating with a more holistic approach within a child and adolescent psychiatry clinical framework. 

These overseas developments have been incorporated into the NAPP Guide to keep it a contemporary document providing a compassionate, caring, respectful, and evidenced-based approach to the treatment of gender dysphoria in young people.  The Guide is available on the NAPP website:

6. Psychodynamic psychotherapy within the College CPG on Mood Disorders

NAPP members along with other College fellows from the Faculty of Psychotherapy were responsible for initiating the Members Requisition General Meeting of the RANZCP held earlier this year.  At this general meeting four resolutions were proposed that sought the College to remove its endorsement of the recently published Clinical Practice Guideline on Mood Disorders’ (CPG) content relating to psychodynamic psychotherapy, set up an independent RANZCP working group to review this area of practice and evidence base and, if determined appropriate by the working group, provide recommendations and a revised version of the specific CPG content relating to the psychodynamic psychotherapies in the assessment and treatment of Mood Disorders (including Complex and special presentations), referencing the contemporary evidence base, with a view to obtaining RANZCP endorsement and publication, replacing the current CPG to facilitate multi-stakeholder reference.

Members of NAPP, the RANZCP Faculty of Psychotherapy and the broader College membership were concerned that the Mood Disorders CPG had dismissed, ignored and devalued the role of, and evidence base for, the longer-term psychodynamic psychotherapies in the treatment of depressive and other mood disorders.  The substantial evidence base that supports the role of psychodynamic psychotherapies for mood disorders did not justify the discounting of this form of treatment in the CPG. 

At the Members Requisition General Meeting the four resolutions proposed were passed with overwhelming majorities.  NAPP has been monitoring the response of the College to this expression of will of College members.  So far there has been little tangible evidence that the College leadership hierarchy is responding positively to the resolutions passed at the meeting. 

If a review task force is established, NAPP has offered to contribute to its membership but nothing formal has yet been requested.  NAPP will continue to advocate for a more informed and inclusive approach to psychodynamic understandings and formal psychotherapies in the assessment and treatment of mood disorders, which forms part of trauma-informed psychiatric clinical practice.

7. NAPP hosts sessions for psychiatric trainees

After the RANZCP difficulties in holding online examinations for trainees in 2021, there was a great deal of confusion and distress amongst the trainees.  Dr Gabriel Feiler (NAPP member) initiated a series of three online sessions for any trainees who wished to join with him and two facilitators Dr George Halasz and Dr Nardine Elzahaby, chaired by Dr Viv Elton (NAPP Vice-President). The intention was to create a space for trainees to speak freely about their experiences and think together with the group and facilitators.

8. Australian Medical Council reaccreditation of RANZCP

The RANZCP is currently undergoing its regular reaccreditation as a provider of specialist training for psychiatrists.  As part of this process the Australian Medical Council calls for submissions from interested parties.  NAPP has provided a submission with positive suggestions for increasing registrar representation on the College Board of Directors and enhancing the diversity of training experiences to better equip trainees for the variety of roles they will encounter as specialists.

9. Your Say about future NAPP activities

Finally, we are in discussion with our members about what new areas of interest we could provide in the form of webinars.   If you have any suggestions, please do not hesitate to make contact me.  I very much look forward to your comments and advice.

Join NAPP – you will be very welcome!

I encourage all current members of NAPP to renew their membership annually.  I invite psychiatrists and trainee psychiatrist colleagues to join NAPP.  The joining fee is waived for registrars.  You will be very welcome.  It is easy to join or renew a membership.

I hope this report keeps you informed about the activities of NAPP.

Yours sincerely

Philip Morris

Prof Philip Morris AM
President
NAPP

Interview with Paul Turton on Gender Dysphoria