Politics Research Therapies — 19 January 2017

The federal government is under mounting pressure to rescind a “blatantly discriminatory” Medicare rule that bars nursing home residents from accessing key psychological treatments, as the Mental Health Commission of NSW joins calls for its repeal.

old-woman--woman_19-135708Saying it was “not tolerable” that the federal government was treating aged care residents as if they were “second-class citizens” or “going into prison”, commission president John Feneley on Monday added his organisation’s weight to a growing list of peak bodies calling for the regulation’s removal.

Fairfax Media reported last Sunday there was widespread neglect of mental healthcare in the homes, as tens of thousands of residents were being denied needed treatments, and that experts said the Medicare rule was a central cause.

Under the regulation, almost all nursing home residents are barred from GP mental health treatment plans and associated psychological therapies provided to other Australians through the Better Access Medicare program, because the government deems residents not to be patients “in the community”.

Late on Monday, the federal government appeared to respond to the growing pressure, as a Health Department spokeswoman announced that “access to services through the Better Access initiative for [residential aged care facilities] will be considered” in the government’s ongoing Medicare review.

Stakeholders’ views would be considered “in any future review of the [Better Access] initiative”, the spokeswoman said.

Mental illness occurs at extreme rates in nursing homes, where about 82,000 of 176,000 residents are estimated to suffer a mental illness (excluding dementia) or significant mental distress.

Mr Feneley said that to “class a whole group of people out of those services is just not tolerable” and that an “old prejudice” – that it was natural to be depressed in old age – was being played out in “commonwealth funding issues”.

“To me it’s a bit like treating people as they get older like people going into prison, where they cease to be recognised under the [Medicare Benefits Schedule] and [Pharmaceutical Benefits Scheme]”.

Council on the Ageing NSW policy manager Lisa Langley said residents in aged care facilities “should have access to the same level of assistance available to the wider community” and called for the rule’s withdrawal.

The Royal Australian and New Zealand College of Psychiatrists, the Royal Australian College of GPs and the Australian Psychological Society have made the same call.

Fairfax Media’s investigation revealed that audits showed fewer than 2 per cent of depressed residents had been receiving psychological treatments, such as cognitive-behavioural therapy, which were clinically recommended for most depression experienced in the aged-care setting.

Experts said homes were neither legally required nor adequately funded to provide clinical mental health treatments, while researchers found residents were being put at risk of falls and fractures through the over-use of antidepressants.

NSW Institute of Psychiatry director of psychiatry and mental health programs Rod McKay, who called the Medicare regulation a “a blatantly discriminatory … disgrace”, estimated more than 30,000 nursing home residents experiencing mental illness were being denied access to “medically indicated” treatments. 

For assistance, call SANE Australia, 1800 187 263

This piece was first published on ‘The Sydney Morning Herald’ on January 15, 2017.


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