When the recent Budget threatened to cut social workers and occupational therapists provision of services to clients under the Better Outcomes in Mental Health Care (BOiMHC) from July 1, there was a huge outcry from health professionals and clients.  The cuts occurred without any consultation, discussion, or input from the social work body, the Australian Association of Social Workers (AASW).

Thanks to a passionate and concerted campaign, the government has since deferred its decision until April 1 next year and committed to give the AASW an equal role with other health professions in the shaping of federal policy on mental health.  However, the government has not changed its view that social workers and occupational therapists will no longer work under the BOiMHC program.

With the recent focus on social workers and the Medicare rebate, it is timely to promote greater awareness, and understanding of, what social workers (and specifically social workers in private practice — mental health social workers), provide in terms of psychological and emotional assistance.

The BOiMHC scheme was introduced by the Liberal government in 2006.  Under this program, any individual GP could refer a client, diagnosed with a mental disorder under Medicare, to a psychologist, social worker, or occupational therapist, for 12 sessions of mental health treatment.  It was widely recognised that current mental health services were unable to meet the demand, were crisis driven in nature, and therefore unable to provide early intervention.

BOiMHC was designed as an early intervention measure, where people were encouraged to seek help for mental health issues in the early to mid stages of illness. The aim was to reduce the high ongoing and cyclical cost and burden on resources (such as hospitals and GP’s) while increasing the effectiveness of treatment.

It is still unclear why the decision was made to  discontinue the Medicare rebate for social workers.

There have been several criticisms of BOiMHC.  There was a huge blowout of costs: this occurred within the first four months of the scheme’s introduction.  It was thought that BOiMHC was not reaching the most disadvantaged (such as young people and those in remote communities), and the Medicare co-payment excluded the poor.

Social workers account for 4% of the costs of BOiMHC. Excluding social workers from the scheme is not an effective means of reducing costs.  Ironically, a major client group of mental health social workers are disadvantaged, poor, and remote clients.  Therefore there was no logical reason for the cessation of the BOiMHC for mental health social workers.

Mental Health social workers are highly specialised therapists.  Each social worker has their own way of working, dependent upon their area of specialisation, postgraduate training, personal style and work experience.   Social workers may conduct individual, group or family therapy to people experiencing a range of psychological problems, to resolve associated psychosocial issues and improve quality of life.

However, mental health social work is underpinned by social work values of social justice, respect, importance of human relationships, integrity and competency are the key focus of mental health social workers as distinct to other professionals providing therapeutic services.

Mental health social workers completed a four-year undergraduate degree and have at least two years of experience working with clients with mental health issues.  They are all accountable through the profession’s complaints management process, and all complete mandatory professional development each year.

The majority of mental health social workers have undertaken extensive specialised postgraduate training, including counselling, psychotherapy and family therapy; while nearly 75% have more than 10 years’ experience in public mental health services.

  • There are presently more than 1100 social workers offering Medicare rebate for mental health treatments, and in 2008-2009 they provided 121,540 occasions of service
  • More than one-third are based in regional, rural and remote parts of Australia
  • Many work in outer suburban areas
  • More than 60% of them offer bulk-billing to at least some clients
  • More than two-thirds (68%) of clients say they would be unable to access their services without Medicare funding.

The AASW and the government have stated they are working together to “shape and develop the new funding arrangements delivered through the GP networks, to ensure that social workers’ clinical expertise is utilised to deliver services to Australians with mental health issues, especially those from disadvantaged and low income backgrounds, indigenous people, those with multiple needs and those in rural and regional areas”.

To what extent this collaboration will address social work concerns about mental health service delivery is still to be determined.

Peter Fray

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