What is a Mental Health Care Plan and why should I get one?

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What is a Mental Health Care Plan?

A Mental Health Care Plan (MHCP) is a support plan for people going through mental health issues, which outlines treatment goals and actions that an individual and their healthcare provider have agreed upon. The plan is tailored to the person's needs and is developed in collaboration with a general practitioner (GP) or psychiatrist. It can be seen as a roadmap that guides treatment of an individual's specific mental health needs.

A MHCP from your GP gives you access to a Medicare rebate for each session you have with a mental health professional. Currently, Medicare provides a rebate for up to 10 individual therapy sessions per calendar year, as well as an additional 10 group therapy sessions.

The Medicare rebate for a standard 50-minute session is currently $79.05 for a Mental Health Social Worker, $89.65 for a registered psychologist, and $131.65 for a Clinical Psychologist.

On average, Clinical Psychologists in Sydney charge $250 per session (1). This means that for a 50 minute session, you would pay $118.35 after the Medicare rebate.

Mental health is an integral part of overall wellness. This blog post will guide you through the specifics of mental health treatment plans in Australia with some key points to keep in mind.

Why should I get a Mental Health Care Plan?

A mental health care plan offers numerous benefits, all designed to support your mental health journey. First and foremost, it provides a structured and personalized approach to treatment. Instead of a one-size-fits-all method, the MHCP is tailored to your specific needs, circumstances, and mental health goals. Additionally, an MHCP can help streamline communication among various healthcare providers. Whether you're seeing a psychologist, psychiatrist, or other mental health professional, everyone can work together more effectively when there's a coherent plan in place.

What Does a Mental Health Care Plan Include?

A mental health care plan (or mental health treatment plan, MH plan, GP MHTP) is a document that your GP writes with you to address a mental health condition. It identifies what type of healthcare you will require and details what you and your doctor have agreed you are aiming to achieve.

Benefits and Coverage

A GP mental health treatment plan allows you to claim up to 10 sessions each calendar year with a Medicare-registered mental health professional. This means your GP may refer you to see a psychologist, psychiatrist, social worker, or occupational therapist for an initial 6 sessions, with the possibility of 4 further sessions after a review.

For example, your GP may refer you for 6 sessions to see a psychologist for your anxiety. After the Medicare rebate, your out-of-pocket cost per session will be significantly reduced compared to the full price.

Financial Aspects

After the first six sessions, you can revisit your GP for a mental health review. They will assess your progress and, if required, refer you for 4 further sessions, which are also Medicare-subsidized psychological consultations.

Conditions Covered

Mental health covers a broad range of conditions, and the Better Access initiative under the scheme provides professional help for various issues, including:

• Anxiety
• Depression
• Grief and loss
• Panic disorders
• Phobia
• Post-Traumatic Stress Disorder (PTSD)
• Eating Disorders (such as anorexia, bulimia, and binge eating)
• Sleeping problems
• Alcoholism
• Drug addiction
• Obsessive-Compulsive Disorder (OCD)
• Attention Deficit Disorder (ADD)
• Sexual disorders
• Conduct disorder
• Psychotic disorders
• Schizophrenia
• Bipolar disorder
• Adjustment disorder
• Co-occurring anxiety and depression

Practical Application

For example, if you're struggling with anxiety, your GP may refer you for an initial set of six sessions with a psychologist. After completing these sessions, you can have a review appointment with your GP to discuss your progress and potentially receive a referral for additional sessions if needed.

By providing a structured, personalized, and financially accessible approach to mental health care, a mental health care plan ensures continuous and adaptive support tailored to your specific needs.

How many psychologist sessions does Medicare rebate per year?

Under the Better Access initiative, Mental Health Care Plans in Australia are designed to provide up to 10 individual and 10 group therapy sessions per calendar year for people with mental health disorders. Each calendar year, starting on the 1st January, this allowance resets. Any unused sessions from the previous year will not roll over to the next year. (2)

How to Check Your Remaining Sessions

To find out how many sessions you have left, follow these simple steps:

1. Log In to your MyGov account.
2. Access Medicare: Open your linked Medicare account from the dashboard.
3. Navigate to History: Go to the "History and statements" section.
4. View Claims: Click on "Medicare claims history." This will display a detailed list of your past claims, including the remaining sessions.

By following these steps, you can easily keep track of your available sessions.

When do I need to visit my GP? The 6-4-6-4 Rule

As part of the Mental Health Care Plan, a patient is required to visit a GP at specific intervals - this is known as the 6-4-6-4 rule. You must visit your GP before your 1st session, after your 6th session, and then again after 4 more sessions. At this stage, you will have had 10 sessions in the year, and can access another 10 Medicare rebated sessions when they reset, I.e. from the 1st of January. (3) You are able to continue to see your psychologist before this, but the sessions will not be covered by Medicare. If you have private health insurance, they may cover a portion of the sessions.

You need to get a new MHCP if your current one expires, and you wish to continue accessing Medicare rebates for psychological services. As mentioned earlier, a MHCP is generally valid for 12 months. After this period, you'll need to see your GP for a review and a new plan.

Additionally, if your mental health needs significantly change within the validity period of your current MHCP, it may be beneficial to see your GP to revise the plan. This ensures that your treatment remains tailored to your current needs.

Regular Reviews and Professional Input

Your care plan should be regularly reviewed to ensure it meets your mental health needs. While a new plan is generally prepared every 12 months, it is crucial to engage in periodic reviews. These reviews often occur after three to six months and involve your healthcare professionals. This ongoing evaluation helps ensure the effectiveness of your treatment.

When to Consult Your GP

1. Expiration of Current MHCP: If your MHCP is nearing its 12-month validity, schedule a review with your GP.
2. Significant Changes: Should you experience notable changes in your mental health, don't wait for the 12-month mark. Consult your GP to adjust your plan accordingly.

By maintaining regular contact with your healthcare providers and adhering to scheduled reviews, you can ensure that your mental health care plan remains effective and responsive to your needs.

As a parent, can I access some of my child's sessions for parenting help?

When considering treatment plans for children, the rules allow for 2 out of the 10 sessions to be used by parents. The child must attend the remaining 8 sessions in order for a Medicare rebate to be provided. (4)

The above infographic illustrates a set of 10 sessions, each represented as dots. Green dots highlight the 6th and 10th sessions, marking the points where you visit your GP after the sessions. These 10 sessions can span across calendar years.

In a scenario where all 10 sessions are used early in the year, there would be a gap for the second half of the year. The patient would have to wait for the next year to start to get more rebated sessions from Medicare. The patient can continue to see their psychologist, but would need to pay the full fee or use their Private Health Insurance to cover a portion of the fee.

Alternatively, if you spread your sessions evenly throughout the year, then as long as you have your MHCP renewed your can visit your psychologist at a constant pace and still have the sessions rebated by Medicare. The 6-4-6-4 rule must still be adhered to, requiring GP visits after the 6th and 10th sessions.

The 6-4-6-4 rule applies when your set of 10 sessions spans years. This means might have to visit your GP earlier, considering the count of sessions from the previous year.

Understanding Mental Health Care Plan and Mental Health Treatment Plan: What’s the Difference?

There’s often confusion between the terms Mental Health Care Plan (MHCP) and Mental Health Treatment Plan (MHTP). In reality, these terms are used interchangeably and refer to the same thing—a structured support plan developed by your GP or psychiatrist. The plan outlines your mental health goals, the treatments and services to be provided, and the steps you can take to achieve these goals. MHTP is simply newer terminology that is being used by the government, however, a MHTP and MHCP is essentially the same thing.

How Long Does It Take to Get a Mental Health Care Plan?

The process of obtaining a MHCP involves a longer consultation with your GP, typically around 20-40 minutes. During this appointment, your GP will assess your mental health and discuss potential treatment options with you. It's important to note that not all GPs have the same level of experience or comfort in discussing mental health, so if you have a choice, it may be beneficial to choose a GP with a special interest in mental health. Some GPs have extra training in preparing MHCPs and even providing brief counselling to patients.

It is possible to get a MHCP on the day of your consultation. Some GPs like patients to tell the practice that this is what they are coming in for before the appointment. Other GPs might ask you to come back in for a follow-up appointment to finalise the plan. The length of time it takes will vary depending on the complexity of your needs, how well the GP knows you already, and the GP's assessment.

To do this, you will need to:

1. Make an appointment – When making an appointment with your doctor, tell the receptionist that the appointment is for a mental health treatment plan. This will allow your doctor to set enough time for your consultation.
2. See a GP – Any general practitioner can write a mental health treatment plan with you. You can specify with the receptionist if you prefer a male or female GP.
3. Bring your Medicare card.
4. Bring ID – If you are a new patient, you'll need to provide identification so that you can be set up in their system.
5. Speak to your GP – Discuss your symptoms, how you feel, what has been concerning you, and what you feel has affected your life. Your doctor may ask you to come back for a second consultation before deciding whether a mental health treatment plan is the right course of action for you.

By following these steps, you can ensure that you are well-prepared for your appointment and can make the most out of your consultation with your GP.

Is a Mental Health Care Plan hard to get?

Eligibility for a MHCP is fairly broad and depends on your symptoms, as well as their functional impact on your day to day life. Conditions can range from depression, anxiety and worry, sleep problems and disordered eating, to more severe and complex mental health disorders such as post-traumatic stress, bipolar and psychotic symptoms. A key point is that your mental health condition must be significantly impacting your ability to manage your everyday activities, like work, study, relationships, social commitments, or your physical health.

The final decision on eligibility rests with your GP who will assess your mental health status, discuss your symptoms, and decide if a MHCP is appropriate for your situation.

If you think you may benefit from a MHCP, it's always best to discuss your concerns and symptoms with your doctor, who can guide you through the process and assess your eligibility.

What Happens If I Got a MHCP Last Year but Didn’t See a Psychologist?

If you received a Mental Health Care Plan (MHCP) last year but didn't visit a psychologist, here's what you need to know:

Plan Validity:

• No Expiry: Your MHCP itself doesn’t expire. The plan remains valid as long as the number of referred sessions hasn’t been used up.
• Session Reset: At the start of the calendar year, your MHCP renews, allowing you access to 10 new rebatable sessions. This means you can continue your mental health treatment without needing a new plan.

Doctor’s Role:

• Plan Review: During your treatment, your doctor might review and update your plan based on your current situation. This ensures that your treatment remains relevant and effective.
• Updated Referrals: Your doctor can provide an updated referral letter while maintaining the original care plan. This helps in aligning your treatment without starting from scratch.

In summary, even if you didn’t use your MHCP last year, you can still benefit from it, thanks to its ongoing validity and the annual reset of rebatable sessions. Make sure to consult with your doctor to keep your plan up to date and relevant.

Can I Get a Mental Health Care Plan Online or Do I Need to See the GP Face-to-Face?

Telehealth services have revolutionised healthcare delivery, and this includes the process of obtaining a MHCP. You can get a MHCP online through a video consultation with a GP. However, the GP might suggest a face-to-face consultation if they feel it would be beneficial, especially for more complex mental health conditions or if it is the first time they’ve seen you.

Not all medical practices offer this service, so it's worth checking in advance.

Which Conditions Do Mental Health Care Plans Cover? What Is the Eligibility Criteria?

The eligibility for a Mental Health Care Plan (MHCP) is fairly broad as long as you have what your GP views as a 'mental health disorder.' While that might sound like a high bar, it's always best to discuss what you're going through with your GP and let them make an assessment. Sometimes the word 'disorder' can make it sound worse than it is in your head.

Who Is Eligible For A Mental Health Care Plan?

A Mental Health Care Plan is available to those with a mental health disorder diagnosed by health professionals. This includes children, teenagers, and adults alike. Conditions can range from common mental health conditions such as depression and anxiety to more severe and complex mental health disorders.

A key point is that your mental health condition must be significantly impacting your ability to manage your everyday activities. However, it's important to note that the final decision on eligibility rests with your GP or medical practitioner, who will assess your mental health status, discuss your symptoms, and decide if a MHCP is appropriate for your situation.

In summary, if you're experiencing mental health challenges, don't hesitate to reach out to your GP for an evaluation. They are there to help guide you through the process and determine the best path forward for your mental well-being.

What Information Should I Bring to My GP Appointment for a Mental Health Care Plan?

Preparing for your appointment to discuss a Mental Health Care Plan (MHCP) is crucial for a productive session. Here's what you need to bring and consider:

Appointment Details

Personal Identification

Symptom Details and Medical History

Preferences

Questions and Concerns

Follow-Up Readiness

By bringing these items and being prepared, you’ll help your GP provide you with the most effective care possible.

How Do I Get a Mental Health Care Plan from a GP?

Getting a MHCP starts with making a longer appointment with your GP to discuss your mental health concerns. It's essential to be open about your feelings, symptoms, and the impact these are having on your life. Your GP will ask about your mental and physical health, lifestyle, and personal circumstances. Based on this comprehensive discussion, they will assess whether you're eligible for a MHCP. If a MHCP is suitable, the GP will work with you to create the plan, outlining your treatment goals, the strategies to reach these goals, and any necessary referrals to mental health professionals.

The Cost of Getting a Mental Health Care Plan

The cost of getting a MHCP varies. Some GPs bulk bill this service, which means you won't have any out-of-pocket expenses. However, GPs who bulk-bill are less and less common, and more often you will have an out-of-pocket expense. If your GP doesn't bulk bill, you may need to pay for a portion of the consultation. It's a good idea to ask about the cost when you book the appointment so you can prepare accordingly.

Mental Health Care Plan vs. GP Referral: Is There a Difference?

Yes, a referral from a GP to see a mental health professional is different from a MHCP. A referral letter is a communication from your GP to the specialist (in this case, the mental health professional), introducing you as a patient and outlining your medical history and reasons for referral.

A MHCP, on the other hand, is a comprehensive plan that not only includes a referral but also outlines your mental health goals and the proposed treatment strategies. It's a broader and more detailed document, and it's this plan that allows you to access Medicare rebates for psychology services.

Choice of Psychologist with a MHCP

A MHCP doesn't tie you to a specific psychologist chosen by your GP. The choice of psychologist ultimately remains with you. Your GP may suggest or recommend certain psychologists based on their knowledge and experience, but you're not obliged to choose these professionals. Some of the most common ways people find psychologists include:

• Word of mouth
• School recommendations (for children and teenagers)
• Google search
• Using a referral network with their GP such as Help Link

Referral networks, such as Help Link, are used in conjunction with your GP. These sites allows you and the GP to view profiles and find practitioners who specialise in your particular area of need, and provides contact details so you can get in touch.

Medicare Coverage for Psychologist Sessions

While the Medicare rebate provided under a MHCP significantly reduces the cost of seeing a psychologist, it doesn't usually cover the full cost. The rebate is fixed, but psychologists are free to set their own fees. This means there's often a 'gap' or out-of-pocket expense for a client. The size of the gap varies depending on the psychologist's fees.

Understanding the 'Gap'

The 'gap' refers to the difference between the psychologist's fee and the Medicare rebate. For instance, if a psychologist charges $180 per session and the Medicare rebate is $88.25, the 'gap' would be $91.75. This gap amount is what you'll have to pay out of pocket.

It's a good idea to ask about fees and the expected gap payment when you first contact a psychologist. Some psychologists may offer a reduced fee or bulk billing (no gap) for individuals in financial hardship, so don't hesitate to discuss your circumstances if cost is a barrier.

What are out of pocket costs for Mental Health Care Plans in Sydney?

With some assumptions we can break down the out of pocket or 'gap' cost for Mental Health Care Plans in various Sydney areas. The below cost estimates are based on the following assumptions:

• You saw your psychologist 10 times in a calendar year
• Each session was rebated by Medicare
• Your therapist was a Clinical Psychologist
• They charged the average rate for Clinical Psychologists in the area that they are practcing in, based on our how much does it cost to see a psychologist data

As you can see, the cost in different Sydney areas varies towards 20% from the most expensive to the least expensive, with a good rule of thumb being that it would cost about $1,100 a year to attend a 10 session Mental Health Care Plan in Sydney.

Please note these figures may differ slightly from the cost page linked above, as that page is based on live data.

When Should You Review Your Mental Health Care Plan?

Significant changes in your mental health may indicate that you need a new treatment plan. Regular reviews are crucial to ensure your care plan meets your evolving needs for mental health services.

• Preparation and Review Cycles: Mental health care treatment plans may be prepared every 12 months. Additionally, healthcare professionals often review these plans after three or six months to make necessary adjustments.
• Professional Guidance: The frequency of these reviews can also depend on the healthcare professionals involved in your care, providing a personalized approach to managing your mental health.

By combining cost considerations with a thorough understanding of when to review your Mental Health Care Plan, you can better navigate your mental health journey in Sydney.

How Mental Hearth Care Plans and Private Health Insurance Work Together

If you have private health insurance, you may be able to claim a portion of the psychologist's fee depending on your level of cover. However, you cannot use your private health insurance ancillary cover to 'top up' the Medicare rebates.

In other words, for a single session, you can either use the Medicare rebate (if you have a MHCP) or claim on your private health insurance—not both. It's worth comparing the benefits under both schemes and choosing the one that gives you the most financial advantage.

If you exhaust your 10 subsidized sessions under a MHCP within a calendar year, you can then start claiming from your private health insurance if your policy covers psychology services.

Conclusion

Understanding mental health treatment plans in Australia is crucial for anyone seeking support. Remember, it's not just about accessing the sessions; it's also about managing them strategically to ensure continuous care throughout the year. If you or someone you know could benefit from this information, please share this post.

Footnotes

1. The average Clinical Psychologist on the Help Link network charges $220 per hour.
2. Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS ↩
3. Mental Health Care Plan: Process & Review ↩
4. How a Mental Health Care Plan Works ↩