Information and services for Doctors

From 1 November 2017, the Medicare ‘Better Access to Psychiatrists, Psychologists and General Practitioners’ (Better Access) initiative expanded to include telehealth (videoconference) consultations with eligible allied health professionals for Australians who are geographically isolated. The introduction of the telehealth measure aims to improve access to mental health services for people living or working in rural and remote locations.

What are the eligibility requirements for those seeking Telehealth sessions?

In addition to the usual eligibility requirements under Better Access, to be eligible for telehealth the individual must:

• Be located within an eligible area at the time of the service; that is, at the time of the consultation the individual must be in a region classified as MMM 4 to 7 under the Modified Monash Model
• Be located at least 15 kilometres by road from the eligible telehealth provider
• Not be a patient of an emergency department or admitted to hospital at the time of the service

How do the Telehealth Better Access items differ from the standard face-to-face Better Access items?

Are all people suitable to receive telehealth psychological services?

When assessing patient suitability to receive telehealth services, it is important to consider:

• The capacity of the patient to access suitable technology (e.g., access to smart phone, laptop, iPad or computer; ability to incur data usage costs)
• Form, frequency and degree of patient symptomatology
• Extent of patient psychological disturbance/crisis
• Potential barriers to effective use of technology Telehealth measure to improve access to psychological services for rural and remote patients INFORMATION FOR GPs psychology.org.au Australian Psychological Society Limited 2 (e.g., language, physical or visual impairment; computer literacy)
• Quality and accessibility of social supports, particularly in the vicinity of the patient
• Potential for risk of harm to self and/or others and capacity for mental health provider to manage this from a distance.

Note that while important to assess, many of the above factors do not necessarily preclude the use of telehealth. If in doubt about the suitability of a patient to receive services via telehealth, it may be helpful to discuss this with the mental health provider. For example, risk may be able to be successfully managed in partnership with support people and agencies located in the same community as the patient.

How can the GP determine whether the patient is in an eligible geographic region?

For the Better Access telehealth initiative, eligible rural, remote and very remotes regions are those classified MMM 4-7 under the Modified Monash Model of geographical classification system. This interactive website enables GPs to obtain the classification of a geographical area by entering the postcode: http://doctorconnect.gov.au/internet/otd/%20publishing.nsf/Content/MMM_locator

Is a telehealth consultation as effective as a face-to-face consultation for the delivery of psychological services?

There is strong evidence demonstrating that psychological services provided using videoconferencing technology can be as effective as a face-to-face consultation for a variety of mental health problems. For example, the quality of the therapeutic alliance in telehealth is comparable to face-toface consultations, particularly when the provider makes adjustments to the expression of empathy, is clear about the purpose, goals and limitations of treatment, and where they take steps to optimise the visual and audio experience.

Can a patient currently undertaking extensive travel to obtain face-to-face psychological treatment under Better Access transfer to telehealth?

If the patient has a Mental Health Treatment Plan, a valid referral, access to appropriate technology and is in an eligible location, then they can transfer to services via telehealth. However, their treating mental health professional may not be able to provide telehealth services. It is important to note that changing service providers may require a new referral and has implications for the therapeutic relationship. Furthermore, the ten sessions per calendar year cap on the number of claimable sessions must be maintained.

What equipment does the patient need for videoconferencing?

Patients need access to a private, quiet space; a device (i.e., smartphone, iPad, computer) with a camera, microphone and speakers; and a reliable broadband internet connection. If your patient does not have the equipment required, their local medical or community clinic may have these facilities and be able to offer them to community members. Please note that patients are responsible for all costs associated with their personal data usage for the videoconference consultations.