It was really hard for Sharon* to reach out for help.

Not everything is solved in ten sessions

For a while now her sleep had been terrible, and each morning she woke up feeling tired and thinking that her life was pointless. She felt alone, scared and full of self-doubt. Sharon had very little motivation and her head was filled with thoughts of failure. Her GP thought it would be a good idea to see a psychologist, so she called the number and made an appointment.

There was no quick fix. Sharon hadn’t told her GP, but as a child she had been subjected to repeated sexual abuse. It wasn’t something she could share at first because she didn’t feel safe trusting anyone with this. For the first few months she just told the psychologist what they wanted to hear.

By the time she built up the courage to face her fears Medicare support was cut off. Being unable to afford therapy on her own hit Sharon hard. From her point of view, she had opened up and was promptly turned away.

Next year Medicare support for psychological treatment is being scaled back to 10 appointments, with no exceptions. In a case like Sharon’s there are no other realistic treatment options - it was difficult enough for her to trust anybody to begin with.

We know from research that people often need around 20 appointments for common mental health conditions, like depression, anxiety, and post-traumatic stress disorder. In a lot of cases when we offer 10 sessions, and no more, it barely scratches the surface. The danger is that the system can leave a person feeling exposed and without any options to work through the problems they are facing.

The current mental health system has patchy delivery. Services vary from one Medicare Locals region to the next and they change all the time. Mental health professionals struggle to keep up with whether a patient can get into a program and the fragmented entry criteria leave people who reach out feeling confused about whether anyone can help them.

That’s the reason why thousands of people are calling on the Government to expand Medicare support for psychological treatment, rather than scaling it back. 

Our first National Mental Health Report Card released last month showed that Australia needs to greatly expand support and treatment options right across society. It is very difficult to see how a reduction in Medicare access to psychological services is going to help.

The problem we face as a whole society is similar to the challenge that Sharon faces. Our shadows won’t vanish by turning a blind eye. We need our politicians to make the time to listen. Like many others, my hope is that those who make policy may come to understand that people need time to work through their difficulties.  A lot of people don’t know these cuts to psychological treatment are coming, but if they did, I get the sense that we may well be able to turn this decision around.

If you can spare a moment, let others know and tell the Minister for Mental Health that 10 sessions is not enough (ministerbutler@health.gov.au).

* Sharon is a hypothetical case example, with a presentation that is frequently encountered in referrals through the Better Access initiative and other similar treatment and support programs

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24 comments

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    • Philosopher says:

      08:05am | 06/12/12

      Actually there is a quick fix for ‘Sharon’: tie her father (or whoever abused her) up, drop his pants and hand her a pair of shears. Her therapy would be over in about ten seconds, slightly longer if the blades are blunt. Primal and effective, the antithesis of modern society’s mores.

    • Megan says:

      10:08am | 06/12/12

      This is a terrible ‘solution’ - perhaps it was meant as a joke? To suggest that attacking another person will help a person feel better ignores a big component of mental health problems - the enemy can often be just as much yourself and other people. These are usually thought patterns and behaviours that have, often subtly, developed over years of experiences and treatment from yourself and others. The continuing idea that people with mental health problems need a ‘quick fix’ is in effect telling them that they, and their problems, aren’t as worthy of attention as other illnesses. Would we treat people with cancer the same way?

    • Haxton Waag says:

      02:18pm | 06/12/12

      There are places in the world where your idea would be taken seriously. (Probably not in favour of women, though.) Think about that and it might seem a little less amusing.

    • Sally-Anne McCormack says:

      09:32am | 06/12/12

      There are many similar stories across Australia.  There are also those people who have a change in circumstance while going through therapy (such as dealing with a job loss after using many of their sessions dealing with depression and anxiety.  There will no longer be “exceptional circumstances” as of January 2013.  An adult does not have access to Headspace, and waiting months for a public service and then having to start again with developing a trusting relationship with a new therapist is often too difficult for the person in distress.  Sadly for some, suicide becomes a viable option…
      We need to INCREASE accessibility to mental health practitioners, not halve it from last year’s 18 sessions…

    • Ken Davis says:

      09:43am | 06/12/12

      An eye for an eye and the whole world ends up blind. Having worked in the health field for 30 years now, “closure”, “revenge” and “justice” are rarely a magic bullet. But then if Philosopher really loved knowledge, he/she would know that. The evidence is plain - trauma is a world-wide problem that is not going away. We have a choice, humane effective treatment that takes time, compassion and money…or business as usual.

    • Philosopher says:

      10:41am | 06/12/12

      therapy and knowledge alone won’t snap the muscle memory like action does. We over-think everything until we doubt if Caesar crossed the Rubicon, or if the river even existed.

    • More support needed says:

      10:26am | 06/12/12

      My treatments are coming to an end and there is no way I am remotely close to having completed treatment for PTSD, anxiety, depression and insomnia.
      Treatment is expensive and hardly something that people can fit into an already tight budget. The idea that you can solve such illnesses in 10 sessions when often it takes at least half of that to truly discuss all of your issues let alone talk about treatment is absurd.

    • Bob from the bush says:

      10:59am | 06/12/12

      In rural areas help is either expensive/private or non existent! !  !

    • Claire says:

      11:00am | 06/12/12

      @ Philosopher, I’m not sure that this would be quite the fix “Sharon” needs… and it might be a bit more complex than that… I could imagine that this intself would bring a lot of trauma and guilt…

      Thank you Dr Ben Mullings for this article. Indeed, it takes a lot more sessions than 10 to open up about trauma… it can be trauma of any kind really, things that people have not talked about or kept secret because it is so painful to just look at… and somehow if it doesn’t get talked about or worked through, it can take various forms of mental illnesses later on…

      I lost my brother to suicide when I was 12, he hung himself, in our house, in the bedroom, in the room next to mine…  this was the most traumatic experience…. which I could not deal with at that age. I lost my brother to suicide, but also my parents to grief, and my other brother to rage…. and we all lived with this in silence. I had to pack up that story and live with it’s horror in secret, pretend that all was well in my world… it caught up with me, even though I thought I had dealt with it and slowly rebuilt a sense of my world being secure… another suicide in my world rocked this frail sense of security , and threw me into what has been the most difficult period in my life to date… threw me into a place of hopelessness , an existential crisis… maybe it’s complicated grief, or maybe it was some kind of depression, but either way, it’s a place I can’t describe. As I thought I was strong I pushed on… but then realised I couldn’t deal with this by myself…

      I have needed all the sessions I could get to simply gently reopen the infested wound inside and to clean it out, clean it out with tears and tears that were held in there for too long… and with words that sometimes could not yet be uttered… 10 sessions is definitely not enough, it would have meant just put a band aid back on and push it all back in, half cleaned out half with some cleaning product into it, not a good mix I’m sure…

      strange metaphor really…. but it works for me…

      18 sessions, is a minimum for some… some people need more, some people need less… I think though that we need to hear what the research says… 15 to 20 sessions as a minimum to do work that can last, that can help someone recover meaningfullly… cutting down sessions to 10 for those who need it is absolutely ludicrous…

      When you are dealing with loss, the mere idea of losing your therapist after 10 sessions is terrifying, and can easily put someone into further despair… especially after only beginning to open up (which doesn’t happen in the first session… trust needs to be build, you need to make sure this is a safe place, that it’s safe to let it all out, and the therapist has to ensure that with trauma, you don’t get retraumatised, so the descent into the trauma story has to be done slowly….)

      well this was a longer comment that I meant to give… I hope the government will listen to the voice of consumers who have a say in who they should choose as their therapist…

    • Anjuli says:

      11:02am | 06/12/12

      Government of Australia burying it’s head in the sand again, people with anxiety and depression need all the help they can get and then some more, not less.

    • Does my voice matter? says:

      11:14am | 06/12/12

      Scaling back to 10 sessions is barely enough to establish rapport, the foundation of creating a working relationship to heal the pain of the past. Halving the sessions is silencing my voice to recover from the pain I had no choice in having. Alliance for Better Access are doing their best to speak for people of the past, present and future but Mark Bulter is not stepping forward to speak with them. People are suffering from these cuts which is only going to put strain on hospital and increase suicide rate. There will be no one to turn to where healing is possible.

    • Such a shame... says:

      11:20am | 06/12/12

      I’m desperately waiting for the new year to tick over so that I can see my psychologist again. It wasn’t until my ten sessions expired this year that I started to really open up to her, and was thankful for the additional six sessions due to my ‘exceptional circumstances’ .

      Unfortunately during those additional six sessions (which came to an end in September), I started to take a turn for the worse. It was quite distressing in my last session with her, when it was clear that I needed her support more than ever, that it would be the last time I’d be able to see her for quite a while. Suddenly I had to go from weekly support, to nothing for 4 long months. 

      I can’t believe that funding is being cut back for a service which is so important within our society. You’d think that with the growing awareness of ‘Movember’ and organisations like ‘Beyond Blue’ and ‘The Butterfly Foundation’, cutting back access to mental health services would be the last thing the government would do. Is the government planning to make public psychological services more accessible as an alternative? I hope so, because at the moment I’m clinging on, waiting for January 2013.

    • Anjuli says:

      12:59pm | 06/12/12

      It is the same with Autism in this state of WA the way I understand it the cut off is age 7 for funding. Yet Autism does not go away it is an ongoing learning and teaching disability.

    • Kassandra says:

      01:03pm | 06/12/12

      Rather than funding more private treatment through Medicare why not spend the money on expanding services in the public sector which are free? Since the advent of Medicare rebates for psychological services there has been a large shift of psychologists into the private sector especially experienced psychologists. Completely understandable and predictable, but a good thing? Probably not if it comes at the expense of free public services that have no session limit. State governments of course are contributing to this with their usual cost-shifting onto the commonwealth by reducing provision of free public outpatient services.

    • Dr Ben Mullings says:

      03:02pm | 06/12/12

      Great questions Kassandra.

      I suppose the best way to look at it is that we do need more investment in both public sector services and standard Medicare support for people to access in the general community. In terms of cost factor, we know that Medicare supported psychological services have high rates of bulk billing, particularly with disadvantaged populations and people in rural and remote locations. The latter group aren’t just going to be reached by the public system or centre-based services.

      The real issue though is in reaching as many people who cannot afford treatment on their own as we possibly can. A couple of days ago we wrote an article about that on the Alliance for Better Access website, which you can find here: http://www.betteraccess.net/index.php/information/latest-news/better-access-reaches-more

      Simply put, we aren’t going to be able to link people up with the help they need through the public system alone. We actually need to expand services, rather than cutting off even more options.

    • kitteh says:

      01:08pm | 06/12/12

      Since medical funding decisions rarely reflect what is morally right and instead focus on finance, here’s something the powers that be might actually pay attention to: this would be money well spent. A person with a condition such as OCD, typical depression, PTSD, social or generalised anxiety who is treated and medicated appropriately has a very good chance of recovery, and of managing any future lapses. That means they will likely remain in/rejoin the workforce and therefore contribute to the economy.

      Adults who suffer (and they really do suffer) with mental health conditions but don’t appear actively ‘crazy’, for want of a better word, get the least sympathy from the public, active discrimination at work, scant financial support and precious little understanding of their conditions. Yet these conditions are incredibly common and in most cases, very treatable with small outlay. It’s ridiculous.

    • andrew says:

      03:38pm | 06/12/12

      And this is what it comes down to - money. Health is a massive proportion of government expenditure each year and growing rapidly. Reducing public hospital waiting lists for surgery and ensuring ambulance wait times at hospitals are minimal seems to be the key health-related concerns currently, probably because they are the most easily measured.

    • Daniel Sullivan says:

      02:11pm | 06/12/12

      This government has failed to protect those in our society living with mental illness. I urge everyone to write to the Minister and to express their concerns.

      You can read my letter to the minister here:
      http://t.co/lEhSyVSy

      and also follow my campaign for Better Access on twitter:
      @D_Sullivan92

    • Haxton Waag says:

      02:31pm | 06/12/12

      I am well on the way to recovering from my crippling, life-destroying anxiety and the depression that went with it. It took forty-five years. Most of that time I was emotionally incapable of asking for help. On one occasion a GP referred me to a psychologist. I had six sessions with him. That was all that was permitted. No apparent effect. That was about five years ago. I was and am too poor to pay for such things, because of my condition. Now I am truly coming out of it. Buddhist concepts helped, (without the religious baggage). So, there is hope.

    • Stormy Weather says:

      02:44pm | 06/12/12

      Where do they get their qualification from, the back of a cornflakes packet? Government ministers can be so short sighted.
      By reducing access to mental health support they are in turn saying mental health doesn’t matter and that people should be able to “just get over it” after 10 sessions.

      Maybe the Minister should be held accountable should someone kill them-self after their 10 sessions is up.

    • Nadene van der Linden says:

      02:47pm | 06/12/12

      This story is a reflection of many people I have seen as a Clinical Psychologist over the years. 10 sessions may help someone deal with an acute crisis assuming they have an otherwise unremarkable developmental history, but for those with complex trauma experiences, particularly those who need time to trust, 18-20 sessions is a minimum.
      Almost all of the people I see, would not meet criteria for government services and need more specialised help than general counselling services provided by NGOs. They are also low to middle income and cannot afford to privately fund their treatment without the medicar rebate. This means these people will face therapy in 3-6 month brackets - somehow having to function and go on until the next calender year when they are eligible for more rebated sessions. This is likely to put further pressure on public mental health services and emergency departments as these individuals present in distress. How can these cuts happen as a one size fits all approach without looking at the clinical evidence. And if these cuts continue where is the extra funding for public mental health so that real and accessible services can meet our communities need

    • Darren Stones says:

      04:56pm | 06/12/12

      I think we have a government that does not get it.

    • Jane Rowe says:

      05:24pm | 06/12/12

      Many, many mental health problems are complex…..they can involve trauma (trauma used in a broad sense of anyhting that causes distress which cannot be processed to a point where it can be integrated)...they can involve ways of thinking and being that have developed over years…..in many instances 10 sessions will not even be enough for the practitioner to make sense of a client’s whole story. Ethically it is not wise to commence therapy that cannot continue for the length of time it needs…it can leave people overwhelmed, confused, psychologically raw and wounded and potentially more harm than good can be done. (We do not expect someone who has experienced severe physical injuries to have completely recoverd after 10 session with a physio…sometimes rehab takes years and years of regular, perhaps weekly physical therapy, so how does the government think that those who have complex psychological injury/problems are going to benefit from 10 sessions) 18 sessions a year for those who need it is an absolute minimum…if people need less that is excellent, but denying mental health care for those who need it is false economy. If people are struggling with mental health problems, many other areas of their lives are potentially in turmoil too. Better mental health means the likelihood that other areas of life are better managed…work, family, education etc…..the positive flow on effect from adequately addressing mental health problems can be enormous. The Better Access program was working….it gave people better access to psychological care…it does not make sense to reduce a service that works. As a worker in, and a consumer of mental health services I have first hand experience of the benefits of the original BA scheme…6 plus 6 sessions followed by 6 more for exceptional circumstances.

    • Suzanna Copp says:

      08:47am | 07/12/12

      As a psychologist in the private sector, it has been my experience that cutting medicare rebatable sessions means that treatment has insufficient time to reach the root or core of a problem and merely attend to the management of symptoms. This may be in the governments eyes sufficient, but what it is in fact doing is merely applying a band-aid solution to people’s often very complex and entrenched difficulties. Many of those who find the courage to present for treatment in the first place, with a range of difficulties, are exposed to implicit messages of invalidation of those difficulties on some level, with the government’s meagre offering of 10 sessions a year, it merely implies that those longstanding difficulties are in fact or should in fact, be “fixable” in those 10 sessions. It discounts the complex nature of the human psyche not to mention the neurological and physiological changes that occur as a result of trauma, particularly when that trauma occurs in the early years. It is so very unfortunate that the government are attempting to provide another quick fix at an affordable rate to them.

 

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