The Minister for the National Disability Insurance Scheme (NDIS), the Hon Bill Shorten MP, has announced the establishment of the NDIS Provider and Worker Registration Taskforce. This task force aims to work collaboratively with people living with disabilities to revamp the current registration system for NDIS providers and workers. The move is in response to the recommendations of the independent NDIS Review, which suggested a risk-proportionate regulatory model and a new provider risk framework to enhance visibility and regulation of NDIS services.

The media release was announced on 12 February 2024:

A new Taskforce will work with people living with disability to ensure provider and worker registrations lead to better outcomes for National Disability Insurance Scheme (NDIS) participants, Minister for the NDIS the Hon Bill Shorten MP announced today.

The NDIS Provider and Worker Registration Taskforce will provide expert advice to Government on the best approach to overhaul the current registration system for those who deliver supports while, crucially, maintaining choice and control for participants – as recommended by the NDIS Review.

The landmark independent NDIS Review recommended a graduated risk-proportionate regulatory model, as well as a new provider risk framework, to improve the visibility and regulation of NDIS providers and workers. The Taskforce will support the co-design and development of the reform for Government’s consideration.

This Taskforce will be led by trusted lawyer and disability advocate Natalie Wade, former chair of the Australian Competition and Consumer Commission Allan Fels, former ACTU Assistant Secretary and training and safety expert Michael Borowick and former Administrator of the Northern Territory Vicki O’Halloran.

“The new regulatory system currently being designed will help ensure no one is invisible or forgotten on the NDIS,” Minister Shorten says.

“Australia can lead the world in a regulation model of disability services, including delivering trail blazing solutions like we want to achieve with the NDIS.

“To do this, we need to overhaul the current shoddy and inconsistent registration by making it more transparent and targeted to deliver quality and consistent outcomes that reach all groups of participants and providers.

“Together with the disability community, this Taskforce will give Government advice to design a new regulatory model to close the gaps that currently exist in regulation of the NDIS market for people with disability.

“We want to reassure participants and their families this is not about removing choice and control, rather delivering quality and safety.

“It is about ensuring participants continue to receive quality supports that recognise their human rights and support their safety and quality of life.

“Australians also reasonably expect the Government to know how funding is being spent, whether it’s the NDIS, Medicare or Centrelink.

“The Taskforce, led by Ms Wade, has deep knowledge and experience about the regulation of supports and services used by people with disability in the NDIS, and contemporary regulatory practice.

“The NDIS is about people with disability, not making millions of dollars for some shonky providers. It’s about genuine small businesses, start-ups, people who want to make a difference on a level playing field and a fair go against the fly-by-nighters and quick-buck merchants.”

The NDIS Review’s recommendation is designed to ensure there is greater oversight of those responsible for delivering services through the NDIS, while continuing to promote choice and control for the participants who receive those supports.

The Taskforce will look at ways to ensure all providers meet a minimum regulatory standard, especially those delivering more intensive supports, while minimising the administrative impacts associated with the enrolment and registration process.

The Taskforce will take a gradual approach and will be informed by the disability community, as well as the NDIS provider market and workers to ensure the best outcomes for everyone.

It will also work directly with the Department of Social Services, where a specialised Review team has been set up to work through the Review’s recommendations.

Based on recommendations in the Review, the Taskforce will consider options to:

• Ensure the new regulatory arrangements support the rights of people with disability so they can continue to exercise choice and control, including a direct employment model
• Enable participants who are self-managing to continue to do so
• Reduce the risk of harm to people with disability.

The Taskforce will provide a report with advice and recommendations in mid 2024.

MEDIA RELEASE 

12 February 2024 

Student lives at risk over school mental health policies  

While schools across Australia have unfilled vacancies for mental health practitioners, thousands of tertiary-qualified counsellors are available but are being shut out of the system.  

The peak body representing Australia’s counsellors and psychotherapists wants to know why. 

CEO of the Australian Counselling Association (ACA) Jodie McKenzie has revealed that all state education departments except one only accept limited professions like social workers and psychologists to fill the role of a school-based mental health practitioner, despite the fact that counsellors are qualified and experienced.  

She said there were simply not enough people in those categories to meet the needs of students, and “as counsellors, we know that sadly, when people cannot get the help they need, the consequences can be tragic.” 

Recently there has been a breakthrough of sorts with Victoria now recognising “counsellors of a prescribed class,” a move hailed by Ms McKenzie. 

“These are counsellors who are registered, experienced and are more than capable to meet student needs,” she explained.  

However she says one state is not enough, and has called on other states to follow Victoria’s lead. 

“New South Wales and Queensland both claim to be placing a mental health practitioner in every school in 2024 but I can’t see how this will be achieved while their current eligibility excludes counsellors.” 

Ms McKenzie said issues in the schoolyard include bullying, relationships, family issues, conflict, anxiety, stress, self-harm and suicide – all issues that counsellors deal with on a daily basis, “and when required we refer the student to more specialist support.”  

Pointing to the current cost of living crisis, she explained, “many parents currently can’t afford to pay for a therapist, so being able to access a mental health practitioner for free counselling at school will mean more students receiving support.” 

She said it’s time to be blunt. “Students who can’t access the right help are at real risk; their lives are at risk. 

“This doesn’t have to be the case because there are qualified counsellors available. 

“Victoria has acted, now other states must act.” 

-End- 

Today Assistant Minister for Mental Health, Hon Emma McBride and a team of other government officials and stakeholders held a one-day forum at the Members Policy Forum for Mental Health Australia to discuss the fallout from the budget. At this meeting it was announced that: “The government will invest $0.3 million over 2 years to develop national standards for counsellors and psychotherapists.”

This meets the recommendation made by the Prime Ministers Select Committee for Suicide and Mental Health that ACA made a presentation to last year.

The purpose of the recommendation is to secure confidence by the government through the development of a National Standard so counsellors and psychotherapists can potentially move into the Primary Health Network and Medicare spaces.

Philip Armstrong the CEO of ACA stated, “This is great news, after decades of advocacy we now have an unequivocal message from the Federal Government that we have been formally recognised. To be mentioned in a budget and be allocated funding for the purpose of laying down of a National Standard reflects the government now recognises counselling and psychotherapy as a profession in our own right, distinct from other mental health disciplines.”

Philip went on further to mention he has been informed he will be contacted by the Department of Health to start discussing ACA’s role in the development of a National Standard in the next few weeks.

By Philip Armstrong, ACA CEO

This week we saw the Minister for Health, Mark Butler and the Assistant Minister for Mental Health, Emma McBride make the courageous, and in my opinion correct decision, not to extend the amount of sessions psychologists can offer clients under Medicare’s Better Access scheme.

In doing so, they sent a clear signal that the mental health system is at a tipping point and that we need to do better, for all Australians.

So why is this the correct decision? Our mental health care system is in crisis and one of the primary reasons is because psychologists are by and large only servicing inner-city, mostly affluent Australians. This was evidenced by the Review into the Better Access Scheme.

Nearly three-quarters of private psychology practices are situated in inner-city suburbs around Melbourne, Sydney and Brisbane, with a splattering in Perth. If you live anywhere else, good luck trying to get an appointment, and budgeting for the massive gap payment that is applied on top of the Medicare rebate.

So yes, Australians who can afford the gap fee and have services available in their suburbs will be the hardest hit.

For the rest of the country, it’s just business as usual. Expanding sessions would have no impact on the lack of current services or high gap fees. That’s if you can find a psychologist in the first place.

In fact, it would have quite the opposite effect. Overstretched services will have fewer sessions available for new clients.

So what’s the solution? I’ve long advocated to expand entry into Medicare for counsellors, addressing the critical issue of access and cost while lowering the burden on GPs and psychologists.

Having counsellors included in Medicare would alleviate the workforce shortage of psychologists and allow counsellors to offer services in low socio-economic and rural and regional areas where psychologists in private practice are rare.

As the head of the Australian Counselling Association, I know counsellors can be found in abundance and where GPs are burning out.

Medicare was created to ensure universal medical and mental health services for all Australians, regardless of income or where they lived. So let’s use Medicare to get better outcomes by including counselling services.

The research is clear, counsellors get equal outcomes for patients, so there is no danger of lowering of standards or outcomes for Australians, just more services at a lower cost.

Let’s get this argument on track; the average Australian is not paying taxes to ensure only inner-city Australians can have access to mental health services at their expense.

By Philip Armstrong

New figures released last week by the Australian Institute of Health and Welfare paint a dire picture for Australians who are becoming reliant on chemical interventions for their mental health.

• 42.7 million mental health-related medications (subsidised and under co-payment) were dispensed in 2020–21.
• 4.5 million patients (17.7% of the Australian population) filled a prescription for a mental health-related medication in 2020–21, with an average of 9.4 prescriptions per patient.
• 62.3% of mental health-related prescriptions filled were subsidised by the Pharmaceutical Benefits Scheme (PBS)/ Repatriation Pharmaceutical Benefits Scheme (RPBS) in 2020–21.
• 84.7% of mental health-related prescriptions filled were prescribed by GPs; 7.5% prescribed by psychiatrists, 4.9% were prescribed by non-psychiatrist specialists in 2020–21.
• 73.1% of mental health-related prescriptions filled were for Antidepressant medications in 2020–21.

The most disturbing figure is that 84.7% of prescriptions were prescribed by GPs who have minimal formal training in mental health, usually a 20-hour course[1], and have no mandatory requirements to undergo annual ongoing professional development (PD) or clinical supervision. To be fair to GPs, when would they have the time?

The cost to Australians in 2019-20 for government-subsidised mental health-related prescriptions under PBS/RPBS was $566 million[2]. This doesn’t take into account that Australians pay a gap fee up to $42.50 for most PBS medicines or $6.80 if they have a concession card.

Take into consideration a study published in World Psychiatry “The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons (2013)” concluded that pharmacotherapy and psychotherapy have comparable effects in several depressive and anxiety disorders[3]. With 73.1% of prescriptions being for depression brings into question why the government isn’t making counselling available to the public through the Medicare Benefits Schedule (MBS). Surely giving Australians access to a non-chemical alternative is in everyone’s interest, bar the pharma’s.

What would the annual cost to MBS for 3,000 Registered Counsellors and Psychotherapists to be able to offer ten 1-hour sessions to Australians suffering from depression? Answer: less than $250 million a year. Compared to $556 million for prescriptions alone, which doesn’t consider the added cost of people taking prescriptions who are also seeing a psychologist under MBS rebates.

It’s time Registered Counsellors and Psychotherapists became a part of the Medicare system to give Australians a choice between chemical interventions or equally effective counselling services delivered by humans.

[1] General Practice Mental Health Standards Collaboration (2022). https://mentalhealth.racgp.org.au/guidelines/index/616b4fb1-9755-464b-9b04-30228eb78572.

[2] AIHW (2022). https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services.

[3] World Psychiatry (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683266/.

By Philip Armstrong

I recently read an article from The Conversation (click here to read) about Australia’s mental health crisis, titled: We can’t solve Australia’s mental health emergency if we don’t train enough psychologists.

While I certainly agree there is a severe shortage of mental health practitioners in Australia, I must disagree that training more psychologists is the only solution to this crisis.

None of the measures put forward in The Conversation article address the most urgent issue facing the mental health sector today: how can we provide access to mental health services for Australians who need immediate support?

Currently the challenge for mental health providers is how to cope with this surge in demand and ensure that support is provided when and where it is most urgently needed.

So what does this mean in real terms for everyday Australians? And what options are available to help alleviate the pressure?

Unlocking an overlooked workforce

One potential and swift solution to our mental health crisis involves making better use of the thousands of Registered Counsellors and Psychotherapists employed right across Australia today.

Registered Counsellors and Psychotherapists are a qualified, highly trained sector of the mental health workforce, but are currently under-utilised. As counselling specialists, Registered Counsellors and Psychotherapists could significantly reduce the burden on the system, freeing up psychologists to focus on more advanced cases and lowering wait times across the board.

As expert communicators and relational practitioners, Registered Counsellors and Psychotherapists are strong compliments to multidisciplinary teams and should be utilised broadly throughout the workforce.

What’s more, this is a workforce that can be accessed immediately: right now, the Australian Counselling Association has a membership of over 11,500 Registered Counsellors and Psychotherapists that can make a difference.

Safeguarding Australian’s mental health

While there are multiple external factors contributing to Australia’s current mental health crisis, many of which are outside of our control, right now there is an opportunity to alleviate and potentially even reverse the declining mental health of our nation.

It is the strong recommendation of the Australian Counselling Association that Registered Counsellors and Psychotherapists are added to the list of allied health professions in the Health Insurance (Allied Health Services) Determination 2014, which provide Focussed Psychological Strategies under the Medicare Benefits Schedule (MBS) Better Access Initiative (BAI).

There are at least 4,000 Registered Counsellors and Psychotherapists who meet the current criteria for the Medicare Benefits Schedule (MBS), while a further 1,000 could be eligible to register within six months.

Including Registered Counsellors and Psychotherapists into the MBS will significantly increase access to bulk billing services, especially for our nation’s most vulnerable. In the absence of a viable solution from the Government, it presents an appropriate, cost-effective and immediate solution that would ultimately help save lives.