The National Association of Practising Psychiatrists (NAPP) welcomes the Government’s announcement of restoring the 50% fee loading to bulk billed Medicare Benefits Schedule (MBS) psychiatry services delivered by video telehealth to rural and regional Australians.
But NAPP highlights that this package fails to address the needs of more than 2.5 million vulnerable Australians with internet access and affordability issues who face ongoing discriminatory exclusion from vital mental health services and are being placed at risk.
In an August 2022 submission to the Health Ministers, NAPP – a member-led association comprised of practising RANZCP psychiatrists and psychiatric trainees – communicated its deep concerns regarding the removal of Medicare item 91840, which facilitated medically-necessary and at times life-saving psychiatric care and psychotherapy treatments by telephone, generally not available from the public mental health system.
NAPP queried the clinical evidence underlying the Health Minister’s decision to cease / not to extend MBS item 91840 at the end of June 2022. NAPP summarised that “For some patients, accessing psychiatric treatment by telephone is necessary due to geographical and/or digital inequity factors; for others, access to psychiatric treatment by telephone is best practice, facilitating genuine individualised mental health care and preventing traumatic or iatrogenic risks and harms that can result from in-person or video-telehealth access / attendance.”
By not including rebates for MBS 91840 in the recently released Telehealth package, the government ignores the evidence provided by practising psychiatrists, supported by testimonies from Lived Experience Australia, detailing the unmet need, risks and harms that emerge from the maintenance of an inequitable psychiatric rebate system that prioritises video telehealth consultations without equivalent rebates for audio-only consultations and as such, cannot facilitate genuinely individualised and trauma-informed care.
NAPP quoted the American Psychiatric Association’s Position Statement on Telemedicine in Psychiatry, 2021, that during the covid-19 pandemic “Telemedicine, including the use of video conferencing and audio-only care, became an essential strategy to improve health equity and increase access to high-quality psychiatric care” and that “Telemedicine in psychiatry should: 1. Allow persons with mental health and/or substance use disorders to be seen via audio and/or video … at the discretion of the treating psychiatrist; 2. Permit the use of audio-only communications for evaluation and management of patients with mental health and substance use disorders when it is in the patient’s best interest and is clinically appropriate at the discretion of the psychiatrist”. NAPP wrote to the Health Minister that “There is ample evidence from clinical practice that video-consultation (telehealth) may not be appropriate or clinically indicated for some patients (and) presentations (and) may, if applied when not appropriate or clinically indicated, contribute to harms and risks for patients”. These risks include disruption to psychiatric treatment, destabilised mental illness, self-harm, suicidality and potential risk to family members, dependents, carers and the broader community.
NAPP has not yet received a response to its submission from the offices of Health Minister Mark Butler MP or Assistant Minister for Mental Health and Suicide Prevention Emma McBride MP. We are grateful to the many Senators and Ministers who have written to the Health Minister supporting the resumption of MBS 91840.
NAPP calls on the Government to urgently resume MBS item 91840 to ensure that the most vulnerable patients are genuinely able to access appropriate vital psychiatric care.
Dr Philip Morris AM Dr Vivienne Elton Dr Pia Brous Dr Melinda Hill
President NAPP Vice President, NAPP Treasurer, NAPP Secretary, NAPP