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.