Here are a list of common concerns and issues raised by GPs when considering referring to a Psychologist.
Do you Bulk Bill?
Many GPs ask us this question. The answer is NO. We do not recommend Bulk Billing for psychological services.
We have provided bulk billing for a small percentage of patients [10% of referrals] with a GP recommendation in the past but we DO NOT RECOMMEND bulk billing because we have found it undermines the process of treatment and sets up a patient to fail.
We find patients who contribute, even a small amount, to the fee receive a significant increase in benefits from treatment. Patients paying for sessions are more motivated to participate in treatment, more likely to follow treatment plans and as a result they are more likely to improve.
We also find that patients not contributing to the fee are extremely likely to cancel or not attend their appointments. For these reasons we strongly discourage offering bulk billing to patients.
How much would my patient be out of pocket?
Out of Pocket Costs
- Full Fee…………………………………………………………………………………………………$70.00
- Couple Fee^……………………………………………………………………………………………$90.00
Medicare Rebates for Psychological Support under the Better Access to Mental Health Care Initiative are:
- MBS Item No. 80110 – Session 50+ mins – Focussed Psychological Strategies ……………$86.15
- MBS Item No. 80010 – Session 50+ mins – Psychological Therapy*…………………………$126.50
+We can offer a concession rate, subject to suitability and availability, for Pensioners or those aged 65 years and over, those currently seeking employment and young people aged 25 and under who are not currently employed.
^One partner is eligible for claiming the Medicare Rebate for psychological support providing they have a Mental Health Care Plan.
*We are not offering Session Rebates for MBS Item No. 80010 currently.
How do I discuss the need for psychological treatment with my patient?
Psychological conditions and symptoms, particularly in the case of trauma, are very often many years in the making. It is common for patients to keep their symptoms secret for a long time before attempting to find help. Asking for help can be a confronting experience. Many do not want others to see them as being less or broken in some way. This fear can become a serious obstacle to seeking treatment. There is a risk of humiliation, embarrassment, rejection, shame and or being disbelieved when sharing their experience of symptoms with their GP.
For most patients improvement and symptom reduction is not immediate. This can be disappointing and frustrating for patient, GP and Psychologist. The special trust patients have in their GP can be a powerful way to significantly improving outcomes.
GPs are able to;
- provide an initial safe opportunity for patients to discuss the difficult nature of psychological symptoms
- assist patients by clarifying expectations they may have of psychological treatment
- provide needed motivation and focus when the treatment becomes challenging as it inevitably does
What can I do to improve treatment outcomes for my patient?
We find assisting patients to develop an accurate understanding of the process of psychological treatment, change and recovery assists greatly in achieving good outcomes. We have gathered together a small sample of statements and questions GPs have used with good effect when discussing the need for psychological treatment with their patients;
Q. “How long will it take?”
A. “These symptoms have taken time to develop so they will take time to resolve”
Q. “How can Psychologists help me?”
A. “Psychologists work with the way in which people learn. They help people find new ways to deal with old problems.”
Statement: “I have tried Psychologists before, my situation is too hard. Psychologists can’t help me.”
A. “Many people need to try treatment several times before their symptoms start to improve. Psychology can work for you because it has worked for others. People find the more they can put in to treatment, the quicker their symptoms start to improve. I think we should try again.”
How can I determine when my patient is ready to begin treatment?
Deciding when to offer psychological treatment to a patient is a significant factor in achieving positive outcomes. Not all patients experiencing symptoms are ready to commit to treatment. We have found offering psychological treatment before a patient is ready actually prevents them from accessing treatment and therefore resolving symptoms in the future.
We have found the Transtheoretical Model of Behaviour Change (Stages of Change) initially developed by Prochaska and DiClemente (1982, 1986) to be a quick, useful, easy to use method of assessing patient readiness to change. This approach is supported by several decades of research across a wide variety of behaviour change in the health care setting.
The five stages of change
People in this stage are not thinking seriously about changing and tend to defend their current AOD use patterns. May not see their use as a problem. The positives or benefits, of the behaviour outweigh any costs or adverse consequences so they are happy to continue using.
People in this stage are able to consider the possibility of quitting or reducing AOD use but feel ambivalent about taking the next step. On the one hand AOD use is enjoyable, exciting and a pleasurable activity. On the other hand, they are starting to experience some adverse consequences (which may include personal, psychological, physical, legal, social or family problems).
Have usually made a recent attempt to change using behaviour in the last year. Sees the ‘cons’ of continuing as outweighing the ‘pros’ and they are less ambivalent about taking the next step. They are usually taking some small steps towards changing behaviour. They believe that change is necessary and that the time for change is imminent. Equally, some people at this stage decide not to do anything about their behaviour.
Actively involved in taking steps to change their using behaviour and making great steps towards significant change. Ambivalence is still very likely at this stage. May try several different techniques and are also at greatest risk of relapse.
Able to successfully avoid any temptations to return to using behaviour. Have learned to anticipate and handle temptations to use and are able to employ new ways of coping. Can have a temporary slip, but don’t tend to see this as failure.
“CHANGE ~ READY OR NOT?”
What ‘Stage of Change’ is your patient currently experiencing?
NOT READY FOR CHANGE
If your patient is not ready to change, that is, they are in PRECONTEMPLATION or RELAPSE we recommend;
- Validating their current position
- Providing information
- Providing contact details for Telephone Counselling Service contact details such as Life Line 13 11 14
READY FOR CHANGE
If your patient is considering making change, that is, they are in CONTEMPLATION or PREPARATION, we recommend;
- Assisting the patient to identify the negative impact their symptoms are having on their quality of life
- Introducing and offering psychological treatment as a way forward