Reform APS replies step-by-step to the Executive Director’s claims in an article in InPsych magazine: titled: “Why create disunity within the profession when there are so many threats from outside?”
APS Advocacy for Better Access: Medicare-funded psychological services.
Executive Director: APS was successful in lobbying for the introduction of Medicare and has fought to hold onto it for a decade.
Reform APS: The Better Access program has been a highly successful program with the public and GPs. Although the ED makes a big deal about waging a perpetual battle to retain Better Access, we aren’t convinced. Many GPs rely heavily on psychologists now and given the public demand for mental health services and the media support drummed up by organisations like Big Blue – but not, alas, the APS – the government would be highly unlikely to scrap such a highly popular program. The public backlash would be immense.
Executive Director: We are aware of, and have received complaints about, a number of emails questioning the APS’ role.
Reform APS: It is the APS’ role that needs to be questioned, not that of Reform APS. RAPS has presented clear evidence to support our claims. The ED hasn’t. All she has offered is a press release by the Minister for Health and Ageing to the general public – because that’s all she has. Otherwise, wouldn’t she have dragged out more solid evidence by now?
The documents obtained under Freedom of Information (FOI) provide clear evidence that the APS never advocated for anyone but members of the clinical college.There was not a single submission from the APS from 2005 – 2009 arguing for a second tier. And if there has been one since, can the Executive Director please show us?
Executive Director: On 9 May, 2006, a media release from Tony Abbott announced that psychological services would be funded under Medicare for clinical psychologists only.
A month earlier the Prime Minister, John Howard, had issued a media release, in which he referred to “psychologists” – not just clinical psychologists. The Howard release shows that discussions had been going on since February and there was barely a mention of clinical psychologists.
The fact that a month later, however, Abbott was making a public statement about only clinical psychologists raises some obvious questions: Given that the first APS submission, advocating for only clinical psychology, also came out in May 2006, it’s not difficult to come to the conclusion that Abbott was being strongly influenced by the APS, the peak psychology body at the time. Very few people in government understood mental health at the time, let alone the then Health Minister.
All the APS submissions, letters and formal documentation from APS to DoHA during the years 2005 and 2006 only ever recommended a single tier for clinical psychologists.
The Commonwealth Government’s correspondence only once referred to clinical psychology, when it mentioned a program funding postgraduate training, which was also for other post-graduate training pathways, including Counselling Psychology. (What happened to that?)
The Executive Director’s version of events are nothing more than historical revisionism. She has not been able to present any solid evidence to support her claims.
Executive Director: Given these conditions, the APS then suggested an expansion of the definition of these psychologists by proposing that those with non-clinical postgraduate professional degrees who possessed the specified training and supervised experience, as well as those with four-year undergraduate degrees who met the specified mental health training and supervised experience criteria, should be considered as an eligible ‘clinical’ psychologist.
Reform APS: Again, where’s the evidence to back this up? These are glib, sweeping statements with no solid basis, and if there was any evidence, why not produce it?
In 2006, Howard had mentioned a program funding postgraduate training, which was also supposed to fund other post-graduate training pathways in psychology, including Counselling Psychology. But 10 years later no alternative postgraduate training pathways have appeared, despite many people trying to push the APS to do something about it.
Very few people in the past decade have been able to be “bridged” into the Clinical College – leaving 70% of APS members with precarious futures. Where was the APS board’s responsibility to its members when this happened?
In reality, once the Clinical College got the higher rebate, they actually began to believe they were superior. They developed an entitlement attitude and forgot that the rationale for the higher rebate was to service complex, low functioning in-patients, who couldn’t afford high out-of-pocket fees.
Now ten years later, most clinical psychologists work in lucrative private practices charging high gap fees. They are thriving financially and passing on their most complex clients to struggling non-clinical psychologists.
Executive Director: Once the door was open, the APS then lobbied strongly arguing that all registered psychologists should be included. Finally, the Government agreed, however, in line with the structure of Medicare, decided to implement two tiers to accommodate all registered psychologists, with clinical psychologists being placed in the higher tier. The APS was not responsible for the two-tier structure but was responsible for getting all registered psychologists funded under Medicare.
Reform APS: How can we be expected to believe the APS lobbied strongly that all registered psychologists be included, when there is no evidence to support it? There are no letters, documents, emails etc. on record to show the APS has ever advocated for anyone but clinical psychologists.
Even today the APS board has not declared its public policy on the two-tier system. Their silence indicates tacit support for it … because the clinical college demands it. That college has even demanded a guaranteed general director position on the board when no one else has one.
The so-called independent Governance Review Committee (GRC) was over-represented by clinical psychologists. Let them explain how the proposed changes were going to help the majority of non-clinical members in the society.
And why would the Government decide, in line with the structure of Medicare, that psychologists should be on two tiers when the only existing mental health providers in Medicare, the psychiatrists, were on a single tier? It stands to reason that it was because of the fight the APS put up to privilege clinical psychology.
Executive Director: In 2014, there was a major risk to ‘generalist’ psychologists being removed from Medicare, following the National Mental Health Commission’s Review of Mental Health Programmes and Services. The Review recommended a ‘cashing out’ of Focussed Psychological Strategies which would have removed all non-clinical psychologists from Medicare. The APS strongly lobbied against these recommendations with the result that they did not appear in the Government’s response to the report. Again, the advocacy of the APS protected the ‘generalist’ psychologists.
Reform APS: This is another unsupported sweeping statement that only the executive director could make because she has been the APS advocate to government for the past 10 years. President and Vice Presidents come and go, but only the ED really holds the knowledge because she’s been there for 17 years. Perhaps that’s why she hasn’t resigned yet? The final step to cement the privileged specialist position for clinical psychologists in Medicare will be decided this year at the November Medicare review.
Furthermore, as our advocate, when faced with the government dumping half the society’s members, wasn’t this her job? And why has she been terrifying generalists since 2014 – with “threats” of being cashed out of Medicare – when we now learn they were not mentioned in the government’s response back then?
In addition, it might be more correct to argue that the ‘generalists’ did not appear in the government’s response because there were/are still not enough psychologists to serve the public.
Executive Director:We are delighted with the Minister for Health’s recent announcement of people living in rural and remote areas of Australia being able to claim a Medicare rebate for online videoconferencing consultations with psychologists, as promoted in the APS’s Budget submission.
Reform APS: The videoconferencing consultations are more likely to have been introduced for psychologists, because they been highly successful with psychiatrists, and also because they will address a shortage of psychological services in rural and remote areas and save the government money. This was not a great advocacy win for the executive director.
The executive director asks why create disunity? We say if we do not take this stand now, disunity will be the least of our concerns. What we are faced with is a serious loss of income and practice opportunities for the bulk of APS members, as the clinical camp continues to tighten its grip on the practice of psychology in Australia.