The recent deaths by suicide of Kate Spade and Anthony Bourdain have caused an outpouring of shock and grief on social media, and naturally raise questions as to how we can better support people with a mental illness at risk of self-harm. While sharing advice like “reach out to your friends and family” and “seek medical help” is undoubtedly positive, actually “getting help” in the Australian healthcare system can be both difficult to achieve, and very expensive.
If you have a Medicare card, visit a GP and present with signs of a mental health condition and/or disorder, your GP can set you up with a mental healthcare plan which consists of 10 subsidised psychology sessions per year. For some people, 10 sessions a year is enough to talk through personal issues and work on developing effective coping strategies. For others with more complex or severe conditions or histories of trauma, 10 sessions barely scratch the surface. As a survivor of family violence (which we know is at epidemic proportions in this country), I have done years of work with various psychologists, and a great proportion has been paid for out of my pocket. The gap for psychology sessions tends to be anywhere from $ 40 to $ 100, depending on the charges of the psychologist or practice.
Psychiatrists, unlike psychologists, are able to prescribe psychiatric medications. An initial consultation with a psychiatrist is around $ 360, with a Medicare rebate of $ 220, which leaves a gap of around $ 140. It generally takes a psychiatrist three 45-60 minute sessions to diagnose a patient and set up a treatment plan. This means the patient will be a minimum of $ 400 out of pocket before they are able to even start medication or treatment. The gap for psychiatry varies, but is around $ 67 for a half hour appointment and $ 114 for an hour.
Once you have spent $ 460 on the gap as an individual or as a family, you reach the Medicare safety net and receive back 100% of the scheduled Medicare fee for that particular service. However, this fee doesn’t necessarily match what the medical specialist charges, and Medicare fees notoriously haven’t kept up with inflation, which has left patients increasingly out of pocket. It also has to be noted, that a patient needs to pay for the session before they get the Medicare rebate. What this means is that if you don’t have $ 360, for example, to pay the psychiatrist upfront, you can’t go to the appointment.
Steps towards making our society more equal would help to improve the mental health of those most vulnerable
If you can’t afford to access assistance in the private sector, you will have to go through the public system, which is overloaded and can barely handle those who are at crisis level, let alone provide preventative care. The tragic story of Naomi Watson-Ley exemplifies this – she took her own life only days after being discharged from the psychiatric ward of a hospital.
Seeking treatment takes time. If you need to take time off to go to the psychologist or psychiatrist (or both), that’s time that you won’t be able to work and make money. It’s not hard to see why people just try and “push through” only to end up more exhausted and sick than ever. How many employers are happy for someone to take several hours off every week or fortnight to go to medical appointments? How many employees are comfortable sharing this kind of information with employers?
Seeking treatment can also be risky, because to open up and be vulnerable in front of a stranger (even if they are a medical professional) takes an enormous amount of courage and isn’t always a safe option. Many marginalised people (such as people of colour, Aboriginal and Torres Strait Islander people, LGBTIQA+ people and sex workers) won’t know if a specialist is bigoted or holds prejudicial ideas about the group they belong to, until they have opened up to them in the session. Bad experiences beget a distrust of the system in general, and discourage individuals from seeking further assistance in the future.
It comes as no surprise that those who are the most marginalised in our society, who are the least able to afford or access expensive psychiatric treatment, are also disproportionately affected by social issues that are likely to exacerbate stress and worsen mental health. Housing instability, unemployment (or underemployment) and financial pressure all cause stress that contributes towards making people feel worse about themselves and their future. Steps towards making our society more equal would help to improve the mental health of those most vulnerable.
Telling individuals with mental health conditions and/or disorders to “get help” is easy. Changing the system to better serve the diverse Australian population is much harder.
None of the answers to these questions are easily solved, but what begs understanding is that “seeking help” is only possible when the services are available and accessible for everyone. We need to care more about mentally ill people when they are alive, and not only after they have taken their lives.
• Adele Perovic is an actor and journalist based in Brisbane
In Australia, the crisis support service Lifeline is 13 11 14. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org
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