How Mental Health Care Plans can get you discounted psychologist sessions and help you better manage your care
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A mental health care plan is a strategy for people with mental health disorders, which outlines the support, goals, and actions that the individual and their healthcare provider have agreed upon. This plan is tailored to the person's needs and developed in collaboration with a general practitioner (GP) or psychiatrist. It can be seen as a roadmap guiding the management and treatment of an individual's specific mental health needs
A Mental Health Care Plan from your GP gives you access to a Medicare rebate for each session you have with a mental health professional.
Currently the Medicare rebate is $79.05 for a Mental Health Social Worker, $89.65 if you see a psychologist, and $131.65 if you see a Clinical Psychologist.
This means that for a 50 minute session with a Clinical Psychologist you would be paying $118.35 after rebate based on Help Link data (1).
Mental health is an integral part of overall wellness, and in Australia, there's a structured approach in place to address it. This blog post will guide you through the specifics of mental health treatment plans in Australia with some key points to keep in mind.
Having a MHCP offers numerous benefits, all designed to support your mental health journey. First and foremost, it provides a structured and personalized approach to treatment. Instead of a one-size-fits-all method, the MHCP is tailored to your specific needs, circumstances, and mental health goals.
Additionally, a MHCP can help streamline communication among various healthcare providers. Whether you're seeing a psychologist, psychiatrist, or other mental health professional, everyone can work together more effectively when there's a coherent plan in place.
The financial aspect is another significant benefit. In Australia, a MHCP can provide Medicare rebates for up to ten individual and ten group therapy sessions per calendar year with a registered psychologist, occupational therapist, or social worker.
Under the Better Access initiative, Mental Health Care Plans in Australia are designed to provide up to 10 individual and 10 group therapy sessions per calendar year for people with mental disorders. Each calendar year, starting January 1st, this allowance resets, with no opportunity for unused sessions to roll over to the next year. (2)
As part of the Mental Health Care Plan, the patient is required to visit a general practitioner (GP) at specific intervals - this is known as the 6-4-6-4 rule. Initially, the patient must visit their GP before the first session. The next visit is due after the 6th session, then after the subsequent 4th, and finally after the next 6th. (3)
When considering treatment plans for children, the rules allow for 2 out of the 10 sessions to be utilized by parents. However, it's essential to note that the child must attend the remaining 8 sessions. (4)
The above infographic illustrates a set of 10 sessions, each represented as dots. Green dots highlight the 6th and 10th sessions, marking the points where you visit your GP after the sessions. These 10 sessions can span across calendar years.
In a scenario where all 10 sessions are used early within the year, there would be a gap for the second half of the year. The patient would then have to wait for the next year to start to get more rebated sessions.
Alternatively, if you spread your sessions evenly throughout the year, then as long as you have your MHCP renewed your can visit your psychologist at a constant pace and still have the sessions rebated. However, the 6-4-6-4 rule must still be adhered to, requiring GP visits after the 6th and 10th sessions.
In this case, the 6-4-6-4 rule's counting spans years as well. Thus, if a set extends over years, you might have to visit your GP as early as your 3rd session of a year, considering the count of sessions from the previous year.
There’s often confusion between the terms Mental Health Care Plan (MHCP) and Mental Health Treatment Plan (MHTP). In reality, these terms are used interchangeably and refer to the same thing—a structured plan developed by your General Practitioner (GP) to manage your mental health condition. This plan outlines your mental health goals, the treatments and services to be provided, and the steps you can take to achieve these goals. MHTP is simply newer terminology which is being used by the government, however an MHTP and MHCP is essentially the same thing.
The process of obtaining a MHCP involves a longer consultation with your GP, typically around 20-40 minutes. During this appointment, your GP will assess your mental health and discuss potential treatment options with you. It's important to note that not all GPs have the same level of experience or comfort in discussing mental health, so if you have a choice, it may be beneficial to choose a GP with a special interest in mental health.
It's possible to get the MHCP on the day of your consultation, but some GPs may require a follow-up appointment to finalize it. This varies depending on the complexity of your situation and the GP's assessment.
The eligibility for a Mental Health Care Plan (MHCP) is fairly broad as long as you have what your GP views as a 'mental health disorder'. While that might sound like a high bar, it's always best to discuss what you're going through with your GP and let them make an assessment. Sometimes the word 'disorder' can make it sound worse than it is in your head.
Conditions can range from common mental health conditions such as depression and anxiety to more severe and complex mental health disorders. A key point is that your mental health condition must be significantly impacting your ability to manage your everyday activities.
However, it's important to note that the final decision on eligibility rests with your GP or medical practitioner, who will assess your mental health status, discuss your symptoms, and decide if a MHCP is appropriate for your situation.
If you think you may benefit from a MHCP, it's always best to discuss your concerns and symptoms with your doctor, who can guide you through the process and assess your eligibility.
Telehealth services have revolutionized healthcare delivery, and this includes the process of obtaining a MHCP. You can get a MHCP online through a video consultation with a GP. However, the GP might suggest a face-to-face consultation if they feel it's necessary, especially for more complex mental health conditions.
It's important to note that not all medical practices may offer this service, so it's worth checking in advance. Remember, the quality of care remains the same, whether you have your consultation online or face-to-face.
MHCPs cover a wide range of mental health conditions, including but not limited to depression, anxiety, post-traumatic stress disorder (PTSD), panic disorder, sleep problems, and eating disorders. The plan also covers certain conditions related to childbirth, such as postnatal depression.
The eligibility criteria for a MHCP is not defined by specific conditions but rather by the need for structured support in managing a mental health problem. If your mental health is impacting your wellbeing and functioning, and your GP believes a structured approach would be beneficial, you could be eligible for a MHCP.
Getting a MHTP starts with making a longer appointment with your GP to discuss your mental health concerns. It's essential to be open about your feelings, symptoms, and the impact these are having on your life. Your GP will ask about your mental and physical health history, lifestyle, and personal circumstances. Based on this comprehensive discussion, they will assess whether you're eligible for a MHCP. If a MHCP is suitable, the GP will work with you to create the plan, outlining your treatment goals, the strategies to reach these goals, and any necessary referrals to mental health professionals.
The cost of getting a MHCP can vary. Some GPs bulk bill this service, which means you won't have any out-of-pocket expenses. However, if your GP doesn't bulk bill, you may need to pay for the consultation and then claim the Medicare rebate. The Medicare rebate for a MHCP consultation is higher than a standard GP visit due to the additional time and complexity involved. It's a good idea to ask about the cost when you book the appointment so you can prepare accordingly.
Yes, a referral from a GP to see a mental health professional is different from a MHCP. A referral letter is a communication from your GP to the specialist (in this case, the mental health professional), introducing you as a patient and outlining your medical history and reasons for referral.
A MHCP, on the other hand, is a comprehensive plan that not only includes a referral but also outlines your mental health goals and the proposed treatment strategies. It's a broader and more detailed document, and it's this plan that allows you to access Medicare rebates for psychology services.
A MHCP doesn't tie you to a specific psychologist chosen by your GP. The choice of psychologist ultimately remains with you. Your GP may suggest or recommend certain psychologists based on their knowledge and experience, but you're not obliged to choose these professionals.
You can research psychologists yourself, considering factors such as their areas of expertise, treatment approach, location, and availability. Once you've made your choice, you can inform your GP, who will then make the referral.
MHCPs are typically valid for 12 months from the date of issue. However, the Medicare rebate is only available for up to ten individual and ten group therapy sessions per calendar year. If you use all these sessions and need further psychological support within the same year, you may need to discuss other funding options with your psychologist.
If you haven't used all your sessions within the year, you'll need a review appointment with your GP to access the remaining sessions. This review is an opportunity to assess your progress and make any necessary changes to your MHCP.
You need to get a new MHCP if your current one expires, and you wish to continue accessing Medicare rebates for psychological services. As mentioned earlier, a MHCP is generally valid for 12 months. After this period, you'll need to see your GP for a review and a new plan.
Additionally, if your mental health needs significantly change within the validity period of your current MHCP, it may be beneficial to see your GP to revise the plan. This ensures that your treatment remains tailored to your current needs.
While the Medicare rebate provided under a MHCP significantly reduces the cost of seeing a psychologist, it doesn't usually cover the full cost. The amount of the rebate is fixed, but psychologists are free to set their own fees. This means there's often a 'gap' or out-of-pocket expense for the client. The size of the gap can vary depending on the psychologist's fees.
The 'gap' refers to the difference between the psychologist's fee and the Medicare rebate. For instance, if a psychologist charges $180 per session and the Medicare rebate is $88.25, the 'gap' would be $91.75. This gap amount is what you'll have to pay out of pocket.
It's essential to ask about fees and the expected gap payment when you first contact a psychologist. Some psychologists may offer a reduced fee or bulk billing (no gap) for individuals in financial hardship, so don't hesitate to discuss your circumstances if cost is a barrier.
With some assumptions we can break down the out of pocket or 'gap' cost for Mental Health Care Plans in various Sydney areas. The below cost estimates are based on the following assumptions:
|Sydney Region||Total Gap|
|Lower North Shore||$1,143.50|
|Upper North Shore||$1,153.50|
As you can see, the cost in different Sydney areas varies towards 20% from the most expensive to the least expensive, with a good rule of thumb being that it would cost about $1,100 a year to attend a 10 session Mental Health Care Plan in Sydney.
Please note these figures may differ slightly from the cost page linked above, as that page is based on live data.
If you have private health insurance, you may be able to claim a portion of the psychologist's fee depending on your level of cover. However, you cannot use your private health insurance ancillary cover to 'top up' the Medicare rebates.
In other words, for a single session, you can either use the Medicare rebate (if you have a MHCP) or claim on your private health insurance—not both. It's worth comparing the benefits under both schemes and choosing the one that gives you the most financial advantage.
If you exhaust your ten subsidized sessions under a MHCP within a calendar year, you can then start claiming from your private health insurance if your policy covers psychology services.
Understanding mental health treatment plans in Australia is crucial for anyone seeking support. Remember, it's not just about accessing the sessions; it's also about managing them strategically to ensure continuous care throughout the year. If you or someone you know could benefit from this information, please share this post.
Lizzie is a Clinical Psychologist based in Sydney's Inner West who has been seeing children, adolescents and families for the past 10 years.