Calling a spade a fuckwit

Credit: No idea - it did the FaceBook rounds...

Given good quality and regular psychological care is now only within the realms of the rich, I have decided to try screaming obscenities.

Brace yourself.

I have been e-mailing politicians in order to enlighten them of my concerns to the cutting of the Better Access Initiative.  Over the last couple of days, I have received mostly automatic replies, with a few "I've told my assistant to tell you I'll look into it"'s, and a couple of "you do not live in my electorate therefore bite me"'s.  Fair enough - they are (god I hope) busy running the country and thus this was to be expected.

One reply however, pissed me off in a rather spectacular way, and not simply because it was a cut-and-paste disguised as an actual reply (I can Google people).  What pissed me off was the content of the information itself, as well as the fact that it is being used in a formal capacity as the justification to screw the average person with a mental illness over.

I have included the e-mail, and addressed it, below:

Dear Ms Wemyss,

Senator Cameron has asked that I acknowledge your email of 25 October 2011 and thank you for raising your concerns regarding the Better Access initiative.

While I'm sure Senator Cameron did not actually ask that Jessica reply to Linda's e-mail, but rather said something along the lines of "get onto those fucking e-mails too will ya - my inbox is getting full" - it is a nice personal touch.

The 2011-12 Budget provided a record investment of $2.2 billion over five years in new and expanded mental health services.  Included in this investment were some changes to the Better Access initiative.

The government says "changes" - I say we got our fucking arses handed to us.

The Australian Government is concerned that while Better Access is a good program for those it is reaching, it is still not servicing hard to reach groups like young people, men, people living in rural and remote regions, Indigenous Australians and people living in areas of high socio‑economic disadvantage.  In fact the evaluation showed that people on lower incomes received both significantly less services and funding under Better Access than those on higher incomes.

I'm on a low income (DSP).  I live in a rural area.  And to whoever thought to come up with this particular argument for taking away the one support I have - go fuck yourself.

If the system is working, but not reaching the "right" people (and I don't accept the premise that this is the case), then change the system to make it better - don't throw it away.

From 1 November 2011, the cap on Medicare rebates for eligible people with a diagnosed mental disorder will be changed from 12 sessions per year to ten.  Following the initial course of treatment (a maximum of six sessions) consumers will be able to access more sessions of up to ten.  Consumers are also eligible for ten group sessions per calendar year in addition to their individual sessions. 

Bullshit.  It is being cut from 18 to 10 sessions.  My two year old is pretty good with his numbers, if the government would like some tutoring.

In making these changes the Government has listened to mental health experts and examined the available evidence, including the independent evaluation of Better Access.  After more than four years of operation, the Government has a clear sense of how the program is being used by providers and consumers.

Actually - in making these changes, the Government has listened only to those it has deemed "worthy".  Many mental health experts have challenged the cuts.

Providers and consumers, in general, are pissed off at the cuts.  I suggest to the government that given providers and consumers are the ones providing and consuming, we have a pretty good fucking sense of "how the program is being used".   At this point, I really wouldn't assume that the Government has a "clear sense" of where to find it's dick, except that we're all being royally screwed.

The findings of the Better Access evaluation showed that almost three-quarters of people who access services used between one and six sessions a year.  The majority (87 per cent) of current Better Access users received between one and ten sessions and will therefore be unaffected by this change.

Yes.  Fuck the 13%.  The 13% are I'm guessing, more likely to have complex needs and more likely to be suicidal.  A fair whack of cancer patients don't go on to have chemotherapy - should we stop funding that too?  And if the government thinks we're talking about talk-therapy vs. death, then I'd invite the government to go and meet the families and friends of the approx. 65000 Australians who try to kill themselves each year, and tell them that their loved ones aren't worthy of treatment.  I don't suggest the government tell it to people trying to kill themselves.  I think the government has given them enough to deal with for now.

People currently receiving services under Better Access will be able to access up to 12 individual and/or up to 12 group sessions prior to 30 October 2011.  In exceptional circumstances, and where there is a clinical need, they can access an additional six individual services prior to 30 October 2011.

From 1 November 2011, the new arrangements will apply. Individuals who have already accessed ten or more individual and ten or more group services by 1 November 2011 will not be eligible for additional services until 1 January 2012.

So they are left with nothing.  Over Christmas of all fucking times of the year.  Bravo.

The Department of Health and Ageing is working on implementation arrangements and further information will be made available to consumers and providers in the near future.

What near future is that?  I received this e-mail on the 27th October for fuck's sake - the cuts kick in this Tuesday.  I'm guessing Jessica didn't proofread before she sent this e-mail.  There has hardly been a mass advertising campaign - certainly NOTHING to the general public.  Not surprising obviously.

The Better Access initiative was introduced to address low treatment rates for high prevalence mental disorders such as depression and anxiety – particularly presentations of mild to moderate severity where short term evidence based support is most likely to be useful.

Short term evidence based support is MORE than 10 sessions.

While some people with more complex or intensive care needs may benefit from psychological interventions under Better Access, the initiative was not designed to provide intensive, ongoing therapy for people with severe, ongoing illness. 

And yet, it is working for that anyway.  In any other area of medicine, this would be seen by all as a GOOD thing.

It is important that people get the right care for their needs.  People who currently receive more than ten allied mental health services under Better Access are likely to be patients with more complex needs and would be better suited for referral to more appropriate mental health services. GPs can continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services, where 50 sessions can be provided per year, or state/territory specialised mental health services. 

Many people ARE getting the right care for their needs.  Or they were at least.

If people wanted to see a psychiatrist - if they thought that would work for them - they would be doing it already.  And probably are.  Thus, the government is forcing people to see a specialist they do not want, or do not need - or just forcing them to go without altogether if they figure it's not worth their time to see someone they do not want or do not need.  People with "complex needs" are still capable of deciding for themselves what works for them.  For the very very few who are not, I'm sure their GP isn't sitting there going "well, I could refer to a psychiatrist because I think that would be more appropriate, but fuck it, I'll refer to a psychologist instead, just for shits and giggles".

The Government is also investing through this year’s Budget, $549.8 million to provide coordinated and flexible funding for people with severe mental illness and complex multi‑agency needs.  This will provide eligible individuals with a single point of contact, a care facilitator, and will assist about 24,000 people and their families.

Again with the telling people what they need.  That aside - where is this funding?  Where are these services?  Who is this single point of contact that I might call this Tuesday?  Might it not have been a good idea to set this shit up BEFORE taking away current services?

To help make psychiatrist services available in more areas, from 1 July 2011 the Government is providing new Medicare rebates for video psychiatrist consultations for patients living in regional, remote and outer metropolitan areas.  GPs, specialists and other health professionals will be provided with financial incentives to help deliver these online services and funding will also be provided to support training and supervision for health professionals.

ROFL.  Has the government ever tried to access the internet rurally?  It's provided by satellite and coverage depends on the weather, the satellites, and I imagine some higher power's general mood at any given time.  I can just imagine the conversations now... "Hello Dr. Quack, I'm feeling suicid... beep beep beep".  Not to mention added complications such as ensuring privacy ("Yes you can talk to your doctor about how I'm beating the crap out of you, but I'll be standing behind the desk here where he can't see me" - it's every abusers wet dream), whether or not the person is computer literate (or literate in general), or even whether someone has access to a bloody computer at home (because doing therapy in a public library is really what we all wish for *rolleyes*).

Hey, it's a great idea to offer it as an option.  But to take from a program that works in order to do so?  Is the government fucking kidding me?

Also - taking money from psychologists and giving it to psychiatrists is like taking money from therapy and giving it to medication.  Oh wait... that is exactly what it is doing.  If only all mental illnesses could be cured with a few pills...

Credit: Picture - Steve Sneider (2011); Text - Ania Krysztofiak

Every cent generated from the changes to Better Access is being redirected to double the number of services targeted at vulnerable and hard to reach groups through the Access to Allied Psychological Services (ATAPS) program, as well as investing in additional services for early intervention youth services and improving the coordination and accessibility of services for individuals with severe mental illness.

ATAPS in my area gives you a maximum of 8 sessions per year.  No choice of practitioner - not even a guarantee of seeing the same practitioner for each visit. I have done "see whoever is on shift at the time" and it nearly fucking killed me.

If a private psychologist gets a little mouthy, you can tell them to fuck off and find another one before it gets too bad - if a psychologist at ATAPS gets a little mouthy - you've got nothing.  And if the government thinks for a moment that there are "complaint systems" in place - then I'd like to shove their arse into a public psych ward, and a week later tell me how well those work in real life.

I don't think ATAPS is working as well as the government thinks it is and/or they simply don't give a fuck.

The Government does not take the decision to make changes to Medicare services lightly, but given the tight fiscal environment it has a responsibility to ensure that its investments are appropriately targeted to ensure maximum value.

Maximum value?  My psychologist is not a fucking commodity.  Last night, she was the person who took me from "I've just lined up all the medication I have and was about to down it with a bottle of Jack Daniels except my husband came home earlier than expected" to "Fuck it, let's die another day".  Next week, my only option is hospital.  Let me tell the government about hospital.

A few years ago, the police picked me up at a park and took me to hospital.  I was suicidal.  There were no beds, so despite the fact that I just been made homeless earlier that evening, they let me go at 2am in the morning.  The next day, my best friend, who had travelled three hours to come and get me, called the hospital to tell them I was still suicidal and should he bring me in?  He was told "Call back when she's done something".  When I've done something.  I have to actually cut my wrists or swallow a bunch of pills before they'll even consider a pre-admission meeting.  Now granted, experience has revealed that I'm bad at most things, and I can add trying to kill myself to that list, given I've tried and failed twice (three times if you count the first one, which was pretty doomed from the start).  Next time, I'm not going to fail.  Mainly because some emergency department doctors have given me such great advice on how to succeed next time.  Seriously.  "Next time go up, not across" was said to me as my wrists were being stitched.  I took note for future reference.

THAT is my other option.  And if the government thinks that is acceptable for me - let alone a child, teenager or young adult - then they are cunt of the fucking millennium.  McGorry and Hickie, stand aside...

The Government is also investing in a range of expanded mental health services, including:

·     doubling funding to the ATAPS program delivered through Divisions of General Practice and Medicare Locals into the future;

·         30 more youth friendly headspace services;

·         16 new Early Psychosis Prevention Intervention Centres; and

·         a doubling in the number of Family Mental Health Services.

Wank, fucking wank.

More information about these and a range of other initiatives can be found at www.health.gov.au/mentalhealth

I trust that this information is of assistance.

Well, it did give me something to do today...

Yours sincerely

Jessica Xxx (because the poor woman is just doing her job)

On Behalf of

Senator Doug Cameron

Senator for New South Wales

And not one of these arguments addresses the fact that I've been seeing my psychologist for three years, AND I FUCKING WELL LIKE HER.  After fifteen years or thereabouts, of seeing every quack under the sun, I found someone who knows what she is talking about, and is prepared to do more than just listen to me bitch about my previous fortnight.  I trust her.  And sometimes I may blush and do some deep breathing first, but I can tell her anything.  I don't want or need a "team".  I don't want or need a psychiatrist.  I sure as shit don't want to do therapy online any more than I want to do pap smears online.  ATAPS is simply Better Access without choice or continuity of care, so I don't want or need that either.

I would have had a hell of a lot more respect for the government if they had just stood up and said, "OK, we're in bed with McGorry and Hickie and have decided to fund their pet projects and have decided the rest of you can go and get fucked in order to fund it".  It would have been clean.  It would have been honest.  Instead, on top of having therapy cut, we're continually trying to determine whether the government is truly deluded, or just plain evil.

At this point, I think I'll assume both, and henceforth refer to them as a collective bunch of fuckwits.

Further Blogs to read:

Pretty sure none of them swear ;-)

If I haven't listed your blog on Better Access, and you think that negligent of me, feel free to e-mail me at lindamadhatter@gmail.com and I'll add it for you.

Talking Fairleigh: The Personal Face of Cuts to Better Access

Talking Fairleigh: Impact on Rural Australia

Clem Bastow: The Problem with Health Advocates is When They Don't

Thembi: Better Access Blog

John Alchin: Ian Hickie Rejects Better Access in Mental Health Reform Debate

John Alchin: Prescient Remarks About Mental Health Funding

Mike Stuchbery: Cutting Better Access Hurts Us All

Precocious Lotus: Cuts to Medicare Psychology Sessions: Please Mr Butler Are You Serious?

Left Flank: The McGorry/Hickie Reform Controversy: Why Has Mental Health Become So Political?

If this article, or my general being, has distressed you, please feel free to call Lifeline on 13 11 14.

Guest Blog

Someone has asked me to post this for them - they wish to remain anonymous.

As of November 1st, those of us with a "severe and persistent mental illness" (I'm using official political lingo here) who rely on Better Access to keep our heads above water will be forced to take a minimum of 2 month therapy break. We're calling ourselves the 13%ers. That's because we're the 13% of people using Better Access who use more than 10 Medicare funded sessions per year. Apparently, being in this minority percentage means that we're not important enough to consider when readjusting mental health spending. We're only about 87,000 people, so they're just going to chop our services for an extended Christmas break. This would be nice if I could take holiday leave from my illness, but unfortunately the "boss" doesn't approve. So instead, for Christmas it's just going to be me and my illness, with no safety net, no tapering down period, nothing. Just a November 1st cutoff with no appropriate options for support until the following year.

The last time I was exited from a supportive mental health program without a safety net in place, I attempted suicide.

Obviously, I failed miserably (but I did learn a few things about how I might do it right next time). I ended up in hospital for a few weeks and got drugged out of my brain until I started hallucinating. I then had to go through god awful withdrawals, and many of those months after my discharge are still a drugged out blur. They drugged me this much because they seemed to think I wasn't taking the severity of my illness seriously enough. This was because I didn't want drugs, I wanted therapy. I might add, I was the one that checked myself into hospital in the first place (my suicide attempt failed so miserably that I didn't even need medical attention, but after seeing the distress it caused my friends I did figure I probably needed to get some help so once I was lucid again I made a few calls). Had I not told them about the severity of my situation, they wouldn't have known. It was a great lesson in realising it's best not to ask for help unless it's from someone I trust. And boy do I no longer trust the mental health system, particularly psychiatrists.

I trust my psychologist though.

My psychologist is incredibly skilled at preventing me from getting to that point where I'm willing to swallow all the pills I've collected over the years from psychiatrists who are more than happy to dole them out to me to fix my "chemical imbalance" (even though none of them can actually agree on which kind of chemical imbalance I have, or which kind of pills I should be swallowing, or whether they should just zap my brain instead). For me, early intervention has come to mean getting to my psychologist before the shit hits the fan. But too bad if things start to slide after November 1st. My psychologist may start to regret having put his mobile number on his business card (although my anxiety about making phone calls will probably keep him safe from that).

It makes me think of the year I had chronic tonsilitis. Imagine if at an arbitrary date the pharmacist had announced, "Sorry, but you've had your maximum allowance of antibiotics for the year. Come back in two months and let's just hope that infection hasn't spread" Imagine the outrage! Denied access to the most basic and essential care, which could potentially lead to death (yes, that happened from infections before penicillin was discovered, and can happen to someone who is chronically suicidal if their support network is taken away). And as far as I'm concerned, that is all seeing my psychologist is: the most basic and essential care I can receive for my chronic mental illness to stop it from turning into anything worse. And trust me, a chronic mental illness is a lot more painful than chronic tonsilitis.

So, I wonder, what's going to happen to us 13%ers over our extended Christmas break? Will our "infections" spread? Here's hoping not, because if the others are anything like me, they won't want to be banging on any hospital and/or psychiatrists' doors. And not because we lack "insight" into our condition, but because we have a great deal of insight into the sheer incompetence rampant in the profession. It makes me wonder though, is this what the Government wants? To get us out of the system so we stop costing them money, while they can parade around declaring what a wonderful job they have done on mental health reform? The joke's on them though, because I can guarantee I'll still be collecting my disability payment, and with only 10 sessions with a psychologist a year from now on, it's quite likely I'll be collecting this payment for many more years than would've been necessary were the new changes not put into place. Better Access is the best program I know of to facilitate recovery, and therefore reducing sessions is effectively reducing recovery rates. I think it's about time the Government stopped skimping on essential services and started realising us 13%ers are not the people to be taking services away from. Talk about targeting the weakest of the bunch! Here's hoping we can show them we're not the weak target they were hoping for.

But at this point, all I can say is good luck in the following months my fellow 13%ers. I've got a feeling we're going to need it!

Sebastian Rosenberg

Sebastian Rosenberg, a senior lecturer at the Brain and Mind Institute (for those playing at home, the same Institute that Ian Hickie heads), has written a piece for the Canberra Times.  It would be sweet to see friends sticking together as such, if it weren't reministant of playground bullies gathering together in order to take our lunches away.  For our own good of course *insert sarcasm*.

As part of his piece, Rosenberg writes "Mark Butler has travelled widely and has proven himself a willing listener. There is never a shortage of complaints in mental health so this is no small thing. Butler is now, as I understand it, formally the Minister Assisting the Prime Minister for Mental Health. This moves him and his portfolio responsibilities clearly out of the realm of health and gives him licence, indeed obligation, to work with Jenny Macklin's Department of Family and Community Services, Tanya Plibersek and Mark Arbib in Housing, and Chris Evans and Kate Ellis in Employment and Education in relation to mental health."

So let me clear this up for people who may not have had the pleasure of attending the two online "forums" I have; and that Mark Butler has "attended" in order to provide a QandA session...  The term ButlerBot has come about for very good reason.  Mark Butler has answered very few questions, and only those that could be answered with what has been an obviously predetermined response that puts forth the usual government spin.  Both times there were photo's of him sitting at his computer - while I didn't bother wasting my download limit, I suspect they were probably very similar.  Indeed the description both times of him being in his PJ's seemed to put forth the idea that the photo's were just for show.  Who knows?

I have talked to many people after both events, and am yet to hear anything positive about their experiences.  Not surprising really, given how obvious it was to all that Mark Butler couldn't have given a rats arse about anyone there, or anything that was discussed.  He had an agenda of selling the latest budget and he stuck to it like glue.

Not impressed.  Tell us what we don't want to hear - but don't just ignore us while pretending to give a shit.

While I'm sure that Mark Butler has been making good use of some frequent flier miles (or at least acquiring them), I doubt very much that he's listening to anyone who isn't singing his praises.

As for how well he'll do with his new title of Minister Assisting the Prime Minister for Mental Health - I'm hardly sitting by waiting on the wings of anticipation.

"Butler has stated that the Government's support for a commission is based heavily on community support for such an entity. In my view, such support reflects fatigue with the same old debates and the same old voices and interests."
Based heavily on community support hey?  Well, you know what?  I think that one of the few things the government and McGorry Crew have done well is unite the country around the issue of mental health.  They've done this so well, that few are asking the pertinent question of "Show Me The Money".  All the community knows is that there is some, and they're happy as.  And who can blame them?  Mental health has had a bad rap for - well, ever.

We may have new voices and interests - and yes - wait - we have new interests.  The new voices are not the welcome change we've all been hoping for - indeed instead of the apathy of old, what we're finding is greed and conflicts of interest.  Lack of full disclosure.  And lies that on the one hand are working really well, and on the other hand, to anyone who is actually looking for the money trail, makes my two year old look like a professional.

We may have new voices, but we have the same shit behind them - money and power.

"Consumers and carers are used to being ignored as government departments and many service providers make arrangements to suit themselves rather than their clients."
This. Is. Fucking. Rich.

Consumer and carers are STILL being ignored.  And a couple of service providers have done well to screw over a majority of mental health consumers this year, suiting themselves nicely, not to mention suiting their bottom line, their current projects, and their end-game.

"Poor services retain their funding while effective services miraculously lose their funding. New service options struggle to emerge and when they do, ugly and ill-founded public controversy often arises. Witness the public vitriol associated with the emergence of a national roll-out of the Orygen model of early intervention for youth psychosis. Commentators like Janet Albrechtsen criticise McGorry for his role in ''politicising'' mental health. From its base in a series of demountable dongas in Carlton, Melbourne, Pat McGorry's service has led the world in demonstrating the benefit of early intervention in psychosis in young people. Supporting this new service does not mean we ignore the mental health of children, adults or the elderly. It simply means that piece by piece, Australian governments are being poked, prodded and persuaded into developing a range of mental health services designed to cover all ages. If this is political then so be it."
We're still talking about mental health right?  What effective services?  Oh, do you mean Better Access, which just had it's arse handed to it?  That one?

McGorry has led the world in jack shit.  The Orygen model of early intervention is a joke. It's that much of a joke, that prominent psychiatrists overseas are scratching their heads.

And when you cut programs like Better Access (cuts which affect a hell of a lot of kids with psychosis too, given the very few EPPIC centres around) - you ARE "ignoring the mental health of children, adults and the elderly".  Whether it is political or not is up for debate.  What isn't up for debate is the fact that it very fucking sad to watch.

"It follows that a key role for the new National Mental Health Commission must be as an independent arbiter of what works, what should be funded and, importantly, what should be de-funded."

True that.  What a shame it's never going to happen, when the likes of McGorry and Hickie have their claws in everything and our Hon Mark Butler lacks the balls to tell them both to piss off.

"Mental health needs not only more funding but also to make sure it is spent in accordance with the evidence."
Then why aren't you?  Better Access was working well and some bastards convinced the government to cut it in favour of something that may or may not work (and if it doesn't - could do a hell of a lot of long-term harm).  And even if EPPIC and headspace DO work - they reach such a small number of people it's ridiculous.  One senate inquiry submission put the number of clients seen at a headspace centre to be 17 in a month (Number 483, p. 17).  Not one particular month, but as an average.  Put that money into Better Access and how many could have been helped?

(Edited 5th October 2011 - I had mistakenly put 17 clients at an EPPIC centre, whereas I should have written "headspace centre".  My apologies to all, and thanks to the person who pointed out my error :) ).

"The Government has already committed itself to the task of developing a 10-year road map for mental health, though it is yet to make clear what if any role the new commission will play in this. A simple re-hash of the fourth National Mental Health Plan will leave an expectant mental health sector feeling very let down. This plan has no goals, no targets and commits no one to anything."
Quite frankly, I'd prefer a plan that has no backbone, to the severe fucking over mental health consumers are seeing at the moment.  At least it leaves things open for discussion and debate.  Something I'm sure is a new concept to some of our current players.

"The Government has appointed Robyn Kruk as chief executive to the commission. An experienced and able health administrator, she will have her work cut out to bring these various threads together but in this, she will have the strong backing of a mental health sector keen to ensure that the next 20 years of plans deliver more than the past 20 years. "

I don't know much about Robyn Kruk - however a quick Google search finds that she's been doing a fair bit for the environment lately - not health. 

"The capacity of the commission to build strong partnerships with key organisations in the sector will also be critical. The recent resignation of Dawn O'Neil as chief executive of Beyond Blue is a significant blow in this regard. The ex-chief executive of Lifeline and Deputy Chair of the Mental Health Council of Australia, Dawn had demonstrated commitment to reform and innovation in mental health over many years. In an environment characterised by a lack of resources, Beyond Blue is the largest non-government organisation operating in the area of mental health promotion and awareness.
Under Dawn's leadership, it had begun to show a willingness to support a range of new services and research and from such a huge and influential organisation, this was both very significant and welcome."

Jeff Kennett shows his bigotry against the LBGTI community, there's some scuffling behind closed doors and Dawn O'Neil quits.  My first question was - did she try to out him (and for good bloody reason) and he and  his buddies kicked her out?

"In an environment characterised by a lack of resources..."  WTF?  Beyond Blue is making a profit - quite substantial profits - each year.  2009 - $7 278 315, and 2010 - $1 258 758 (2009/2010 Annual Report, p. 76).

Not that we can be that surprised by anything Beyond Blue does.  In the above report, they state:

"During the 2009-10 financial year, more than 4.2 million Better Access Medicare-subsidised mental health services were accessed by Australians living with mental illness... The number of people who have received primary mental health services clearly demonstrates the need for such subsidies" (p. 57).

Yet, in their submission to the Senate Inquiry, they state:

"The rationalisation of GP and allied health services through the Better Access program is justified. It enables the redirection of funds to other mental health programs and services, which focus on prevention, early intervention, and increasing access to services...The majority of people with depression and anxiety seeking treatment through the Better Access program will not be impacted by the reduction to the number of allied health services" (p. 4).
Clearly their opinion is driven by the given mood of whoever is in charge on the day.  Either that or they just put forth whatever bullshit they've decided to swallow in order to... well, what exactly I don't know.  Not sure about their end-game yet.  I'll find out eventually.  I suspect it's nothing more than an easy pay cheque.

Sebastian - I hope for damn sure you're getting paid well for your soul.

A few Bupa shares perhaps?