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Psychiatrists press for sweeping expansion of telehealth as part of pandemic responses

The COVID-19 pandemic is affecting our mental health and wellbeing in so many ways; no doubt entire textbooks will be devoted to this subject in years to come.

Anxiety and distress around the pandemic and associated concerns, such as surviving financially, housing and food security, and worrying about the wellbeing of family, friends and self, are likely to contribute to increased demand for services, just a time when they may become more difficult to access.

How can we ensure people, especially those with the highest needs, can access services at such a critical time?

Hundreds of NSW psychiatrists have written to Federal Health Minister Greg Hunt, calling for all existing psychiatrist MBS item numbers to be deliverable by telehealth, arguing this would help reduce the numbers of people presenting to emergency departments during the pandemic with acute mental health issues, and help to ensure the sustainability of their practices.

The letter was signed by 380 psychiatrists as of 2pm on 21 March, and follows concerns that the Government’s telehealth initiatives announced to date have been too narrowly focused and restrictive.

Meanwhile, on 19 March, the president of the Royal Australian and New Zealand College of Psychiatrists, Associate Professor John Allan, also wrote to the Minister, urging telehealth and telephone access for all psychiatry consultations, including for MBS funded outpatients, privately insured inpatients and Department of Veterans’ Affairs funded consultations.

He said:

As well as providing safer care for patients and their families, these proposed measures would contribute towards protecting staff of private hospitals and private practices, other mental health professionals and support workers, as well as psychiatrists themselves.”

Extract from open letter

The psychiatrists who wrote as part of the grassroots initiative said:

“The most crucial strategy at this point, with Australia at the beginning of the COVID-19 outbreak, is to minimise unnecessary face-to-face contact in order to prevent and slow person-to-person viral transmission.  

As psychiatrists, we are charged with a dual responsibility to our patients and also to the wider Australian population. We can contribute, immediately, to minimising transmission by caring for all our patients using video-conferencing or phone – not just a select few, and continuing to practice high-quality care that our usual psychiatrist MBS item numbers facilitate.

Unfortunately, the new COVID telehealth item numbers do not allow us to transition our practices adequately to Telehealth as they are restricted to certain patients and their limitations will not enable us to provide all modalities of psychiatric treatment, which will interrupt the care of many thousands of the most vulnerable patients.

We recommend that a special allowance be urgently made so that all psychiatrist item MBS numbers (291-328) apply to Telehealth consultations during this high-risk period, and all these item numbers attract both bulk billing and standard subsidies currently in place that minimise gap payments for our patients. History shows that restricting items only to bulk billing will result in increased presentations to emergency departments.

Psychiatrists in private practice make up the bulk of the psychiatric workforce and are tasked with the care of severe mental illness in the community. It is essential that our practices remain sustainable so that we can continue to care for our patients and that we retain the full range of treatment modalities that may be required to provide quality care to prevent relapse and to minimise the risk of people with serious mental illness from posing harm to themselves or others.

The strict patient criteria for COVID telehealth items will exclude the majority of patients and the restriction to bulkbilling will make the continuing operation of private practice psychiatry unsustainable. If private practices close that will inject large numbers of patients into the already overburdened public system. This should be avoided at all costs at this time, in particular when emergency departments need to have capacity to respond to the COVID-19 pandemic. A reduction in the availability of private psychiatric services will potentially also lead to increased rates of stress-related deterioration in mental health including depression and suicidality, and increased rates of substance abuse and domestic violence.

We urge the Federal Government to take the same emergency measures that the Centers for Medicare and Medicaid have taken in the USA and instigate urgently a special, temporary measure enabling us to practice using video-conferencing and phone consultations using the usual MBS psychiatrist item numbers. This measure will also protect psychiatrists who are themselves in a risk category for complications should they be infected with the virus and assist to prevent risk to psychiatrists who provide regular psychotherapy with consults lasting more than 45 minutes.

It would be consistent with the Federal Government’s advice to workplaces that any people who can work from home should be encouraged to do so. Psychiatry is the only medical specialty that does not routinely require physical contact with patients.

This proposed emergency measure will be cost-neutral because the Medicare rebates that patients receive would be identical to what they would receive if they were seeing their psychiatrist face-to-face. Psychiatrists are very aware of the financial challenges patients and their families face at times of crisis and are very used to being flexible in responding to the changing circumstances of their patients. Flexibility is needed now, more than ever, in this current public health crisis, to deliver the best public health outcomes.

Should the recommended change not be urgently implemented, we very much fear that the mental health of existing and new patients will be compromised, lives will be lost, and hospitals and community services will be rapidly overwhelmed.”

PostScript

From Croakey’s perspective, it will also be important to hear the views of other professions involved in providing services to people with mental health needs at this time and in the months ahead.

It would be good to see the various professions working together with community groups and relevant agencies to ensure a holistic response to the wide-ranging mental health concerns arising from the pandemic, including public health and prevention efforts.

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