How Medicare & Private cover mental health
Be supported financially for a range of mental health treatments.
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Mental health issues might not be as easy to pin down as physical health problems, but this area is finally getting the recognition it deserves from both the public and private segments of Australia's healthcare system.
Between Medicare and private health insurance, it's possible to access a large portion of the services available, from counselling to psychiatric care, without breaking the bank.
Contents of this guide
What do we mean when we talk about mental health?
Mental health refers to how you feel emotionally and psychologically and how you're able to weather the ups and downs of life. It covers all of the following:
- Your mood
- Your ability to make good decisions
- How you behave
- How you handle stress
- How you relate to others
What is a mental illness?
You can think of mental illness as a health problem that significantly affects any of the abilities mentioned above. According to the Black Dog Institute, a leading non-profit Australian mental health organisation, one in five Australians is living with a mental illness at any given time.
What are the types of mental illness and how are they treated?
Mental health issues can range from a short bout of work-related stress, to debilitating schizophrenia. In addition, there is a lot of overlap between the types of illnesses. For example, it is common for someone with bipolar disorder to also suffer from depression.
It's no surprise that it's been tricky navigating the world of mental health care. Following are some common conditions that are treated within the mental health system.
Anxiety and depression
These two very common conditions can range from mild to severe. Your first stop if you need some help would be your GP. If your GP thinks your condition is manageable, they may prescribe one of a range of widely used medications and perhaps refer you to a psychologist for some therapy.
For more severe cases, you may be referred to a psychiatrist, who will have more experience than a GP in diagnosing mental illness and prescribing more specialised medication.
Except in the most severe cases, which often involve an underlying disorder besides the anxiety and/or depression, most of this will be outpatient treatment. It can generally be covered through the public healthcare system and a private health insurance extras policy.
People with these disorders lose touch with reality and need specialised treatment even in less severe cases. Examples that come under this heading include schizophrenia and bipolar disorder. People with these symptoms are usually referred to a psychiatrist who is well versed in managing such conditions. Medication and psychological counselling are generally included in the treatment plan.
Sometimes these conditions can be treated in an outpatient capacity, and are covered by a mix of Medicare and a private extras policy. However, some cases can be quite severe and require in-hospital care. In these instances, Medicare and private hospital cover can help with the cost of inpatient treatment.
Stress and daily management
Sometimes people just get stressed out and need psychological treatment even though there is no underlying "illness" to speak of. Conditions in this category include those such as work-related stress and relationship problems.
In most cases, all that is needed to help with symptoms is a few sessions of therapy with a psychologist. You don't even need a GP for that. If you have a private extras policy, you can book straight into see a psychologist and a few sessions will be covered.
Substance abuse, eating and other behavioural disorders
Substance abuse and other behavioural disorders can be the result of low self-esteem, an underlying mental illness such as depression or merely physical dependence. In cases where a person's health is at risk, hospitalisation is the first step that would be taken. From there, medical professionals generally work with the patient to help them stop the unwanted behaviour. They then try to work out if there is an underlying mental illness, such as post-traumatic stress disorder (PTSD), bipolar disorder or depression.
Treatments can include in-hospital care, rehabilitation, support groups and therapy. A mix of Medicare, private hospital cover and/or private extras cover would be required to help cover these costs.
These disorders can occur when a past traumatic experience affects someone's mental health. Examples include post-traumatic stress disorder and postnatal depression. These conditions can include depression, anxiety and/or behavioural disorders, which can often be severe.
A GP might treat someone who presents with one of these complaints by prescribing anxiety/depression medication. They would then most likely refer the patient to a psychiatrist, who can then develop a course of treatment. Therapy and medication may be enough in many cases, but in more severe cases, hospitalisation may be necessary.
What healthcare support is there in Australia?
Mental health treatment sometimes requires a cocktail of treatments and medications. Luckily, there is a variety of professionals who are trained to treat various aspects of mental illness. These include:
- General practitioners. This should be the first port of call for anyone needing help with a mental health condition. GPs can coordinate the treatment of mild mental issues by prescribing medication and/or referring the patient to a psychologist for therapy. For more serious cases, they may be referred to a psychiatrist for further diagnosis.
- Psychologists. You would visit a psychologist for therapy or counselling. Psychologists can help with almost all mental issues, from the mildest conditions to the most severe. You can see them without a referral and without needing to be on medication.
- Psychiatrists. These are medical specialists who have trained to diagnose and treat mental disorders. They take on more severe cases that a GP is not qualified to diagnose. Psychiatrists can prescribe specialised medication and lay out a treatment plan that may also include therapy.
In 2006, the Australian government launched the Better Access initiative, which gives people improved access to mental health treatments under Medicare.
Under this initiative, anyone with a mental health issue is covered for up to 10 sessions with a qualified psychologist and psychiatrist. All that's required is that you see your GP first to get a mental health treatment plan.
If you require hospitalisation, Medicare will cover you for treatment in a public hospital.
If you are experiencing mental health issues or suicidal feelings contact Lifeline on 13 11 14 or BeyondBlue 1300 224 636. If it is an emergency please call 000.
How does private health insurance cover mental health?
Private health insurance can supplement any rebates you are entitled to from Medicare. It can cover you in two ways:
- Inpatient psychiatric care. Currently, many insurers cover this service fully cover this service in their mid- to top-tier policies, but by April 2020, all policies labelled "Gold" under the government's new rating system will offer it. If you already have health insurance, you can upgrade to a policy covering psychology without having to serve any waiting periods. Treatments include therapy, psychological evaluation, addiction treatment and a host of in-patient mental health services.
- Outpatient mental health cover. Most extras policies will cover you for a handful of therapy or counselling sessions with a psychologist, and you don't need a referral. This is the perfect complement to Medicare's outpatient services because this benefit does not cover psychiatry whereas Medicare does. If you have both, you can maximise the visits to whichever professional services you need.
Compare options for psychology sessions
You can find plenty of options for outpatient services that can help toward treatment such as psychology sessions. The below policies from Finder partners include rebates for psychology sessions.
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What are the most recent mental health reforms?
In April 2018, the Australian government implemented some changes to the way private health insurance covers mental health treatments. They were designed to make it easier for people to get the in-hospital mental health treatment they need, including treatment for anxiety, depression, drug/alcohol addiction and other mental health issues.
Here are the two major improvements:
- Easy upgrades. You can upgrade to a policy will full in-hospital psychiatric cover anytime you want, without having to fulfill a waiting period for that treatment. You can even do so up to 5 days after being admitted and you'll still be covered.
- No treatment limits. You insurer can't place limits on the number of times you can receive a particular treatment per year. This applies mainly to day programs, electroconvulsive therapy and transcranial magnetic stimulation - meaning you'll be covered for as many of these sessions as you need.
By 2020, further reforms will make it easier to identify policies that cover in-patient mental health treatment. Under a new tier system, all top-tier policies (called Gold policies under the new reforms) must include full, non-restricted cover for in-patient psychology. Most top-tier policies already include it, but the Gold designation makes it easier to identify these policies. The new system starts rolling out in April 2019 and all policies must conform by April 2020.
What is the Mental Health Act?
Each state and territory has its own legislation that seeks to improve treatment for mental health patients. The focus of all of the Acts is protecting the rights and dignity of patients, and placing the patient at the centre of decision-making.
- NSW. The Mental Health Act 2007 is New South Wales’ most recent mental health legislation, although an amendment was passed in 2013. The Act aims to promote community-based care that gives patients the right to receive the best possible care, involves them in decisions about their own care, and acknowledges the important role that carers play in treatment.
- VIC. Victoria's most recent legislation is the Mental Health Act 2014. It too places the patient at the centre of decision-making. It also promotes voluntary treatment instead of compulsory treatment and protects the rights and dignity of the patient.
- QLD. Queensland's Mental Health Act 2016 aims to protect people who do not have the mental capacity to consent to treatment, while also trying to keep them out of the criminal justice system.
- ACT. Patients in the Australian Capital Territory are currently protected by the Mental Health Act 2015. Again, it puts the patient at the forefront of their care while honouring their dignity. It also aims to raise mental health awareness and encourage early intervention.
- WA. Western Australia's Mental Health Act 2014 also looks out for the rights and dignity of people with mental health issues and recognises the role that carers play in finding the right treatment for them.
- SA. South Australia's Mental Health Act 2009 focuses on the recovery of people with mental health issues. It also places emphasis on community, including working collaboratively with traditional Aboriginal healers.
- NT. The Northern Territory's Mental Health and Related Services Act was most recently updated in 2018. It protects the rights of people with mental illness while ensuring that they have access to appropriate care.
- TAS. Tasmania's Mental Health Act 2013 enables people to have a say in their own treatment, while also recognising the role of family members and other carers. It also helps provide a safe treatment environment for those who are unable to make their own decisions.
Picture: Dmitry Ratushny - Unsplash, Pixabay
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