Evaluation of the Better Access initiative component C: analysis of the allied mental health workforce supply and distribution

1.3 The Better Access allied mental health workforce

Page last updated: September 2010

This component of the evaluation focuses on the impact of the implementation of the Better Access initiative on the Better Access allied mental health workforce. Better Access introduced Medicare rebates for services provided by eligible allied mental health professionals. Following referral of a client from a general practitioner, psychiatrist or paediatrician, allied mental health professionals can provide clients with services such as psycho-education, cognitive behaviour therapy, relaxation strategies, skills training and interpersonal therapy. There are two categories of Better Access services:

  • Psychological Therapy Services which can only be provided by eligible Clinical Psychologists. Clients can access up to 12 individual sessions per calendar year (in exceptional circumstances an additional six services may be provided), and up to 12 group sessions per client per calendar year.

  • Focussed Psychological Strategies which can be provided by any of the eligible provider categories in the allied mental health workforce. Clients can access up to 12 individual sessions per calendar year (in exceptional circumstances an additional six services may be provided), and up to 12 group sessions per client per calendar year.
The Focussed Psychological Strategies are differentiated on the basis of provider category. In general, psychologists attend to issues pertaining to the behavioural aspects of mental disorders, social workers to the psychosocial factors relating to mental disorders, and occupational therapists to the functional implications of mental disorders. These differences are elaborated further in the following sections.

1.3.1 Psychologists
1.3.2 Mental health social workers
1.3.3 Mental health occupational therapists

1.3.1 Psychologists

Psychologists work with individuals (and groups) with the aim of helping people to manage their thoughts, feelings and behaviours. They have particular expertise in

human behaviour, mental processes, and the way in which these can impact on a person's physical state, mental state, and their external environment (Australian Psychological Society 2007).Top of page
Psychology is an evidence-based profession, and as part of their training, psychologists study psychopathology and therapeutic interventions for mental health disorders. Psychology skills are implemented in a range of settings including private practice, education, workplaces, sport, community services and health services (Australian Psychological Society 2007).

Many psychologists specialise in an area of psychology and are members of specialist Colleges within the Australian Psychology Society. Clinical psychologists have specialised training in the assessment and treatment of mental disorders. Their training enables them to treat clients with severe and complex mental disorders, including those with co-morbidities of mental health problems and substance abuse.

Better Access differentiates between registered and clinical psychologists:
  • Psychologists within the allied mental health professional category can claim for MBS Items associated with Focussed Psychological Strategies (80100, 80105, 80110, 80115 and 80120). To be eligible to register with Medicare Australia to provide these services, a psychologist must be registered with a Psychologists Registration Board in the State or Territory in which they are practising (Dept of Health and Ageing 2009b). Within this report, psychologists in this category are called 'registered psychologists'.4

  • Clinical psychologists can claim for MBS Items associated with the provision of Psychological Therapy Services (80000, 80005, 80010, 80015, and 80020). To be eligible to claim for these services, clinical psychologists must be meet the requirements of membership of the Australian Psychological Society's College of Clinical Psychologists.

1.3.2 Mental health social workers

Mental health social workers work collaboratively with clients, carers and other health professionals to resolve psychosocial problems associated with mental health disorders. They have particular expertise in helping clients whose 'mental health difficulties co-exist with other problems such as family distress, drug and alcohol abuse, unemployment, disability, poverty and trauma' (Australian Psychological Society 2007). The focus is therefore on:

... the social context and social consequences of mental illness. The purpose of practice is to promote recovery, restore individual family and community wellbeing, to enhance development of each individual's power and control over their lives, and to advance the principles of social justice. (AASW 2010, emphasis in original)
Within Better Access, accredited mental health social workers can provide services associated with Focussed Psychological Strategies and have access to five MBS Items (80150, 80155, 80160, 80165, and 80170). In order to practise as a Mental Health Social Worker, the Australian Association of Social Workers (AASW) accreditation requirements must be met. These are:
  • Current membership of AASW;

  • Evidence that the Practice Standards for Mental Health Social Workers (AASW 2008) have been met;

  • Evidence of at least two years of supervised social work practice (post qualifying) in mental health or demonstrably related field;

  • Evidence of pre-qualifying, qualifying or post-qualifying education and or recognised professional development of training relevant to working in mental health; and

  • Provision of a testimonial from an employer or supervisor (AASW 2010).
The Practice Standards for Mental Health Social Workers (AASW 2008) set out the knowledge, skills and values considered to be specific to social work in mental health. These include an emphasis on personhood; valuing the lived experience of individual consumers and family members and carers; affirming the importance of partnership and mutuality; addressing powerlessness, marginality, stigma and disadvantage; and conveying empathy, compassion and hope.
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1.3.3 Mental health occupational therapists

Mental health occupational therapists (OTs) work with clients, their families, carers, schools and workplaces to address the functional implications of mental health problems. They:

... work collaboratively with people, who experience distress, illness, disability, and developmental delay, their occupational consequences, and occupational deprivation, as well as with people who desire to further develop their existing skills, and options for occupational development (OT Australia 1999).
Mental Health OTs have a view of mental health that is broader than clinical diagnosis, and takes account of personal functioning, opportunities, resources and suffering (OT Australia 1999). As stated in the APS Better Access Orientation Manual (2007: 38), OTs 'are evidence based specialists, whose academic training includes broad based education in physical and psychological components of mental health and wellbeing.' Mental health OTs work both independently and in multi-disciplinary teams.

Within Better Access registered mental health OTs can provide services associated with Focussed Psychological Strategies and have access to five MBS Items (80125, 80130, 80135, 80140 and 80145). To provide services under the Better Access Initiative, occupational therapists apply through their professional association, Occupational Therapy Australia for registration. To be eligible, OTs must:
  • Be a current member of OT Australia;

  • Provide evidence that the Australian Competency Standards for Occupational Therapists in Mental Health (OT Australia 1999) have been met; and

  • Provide evidence of at least two years of supervised social work practice (post qualifying) in mental health or demonstrably related field (OT Australia 2009).

Footnotes

4 Note that registered psychologists may also include clinical psychologists. The categories are not mutually exclusive but based on the types of Better Access services provided.