Put your money where your mind is – an exploration into our attitudes to paying for mental health services

Image source: http://savingsuniversity.files.wordpress.com/2013/06/money-mind-dollar1.jpg

Over the past few years, I have worked as a medical receptionist at two clinics that offer mental health services. In that time, I have noticed something about the way the general public conceptualise and treat paying for mental health services. This post is likely to raise more questions than answers – questions like: what value do we put on mental health services? In particular, why do some people treat paying for mental health services differently to other medical and even non-medical services? Unsurprisingly, this leads to even more questions, such as – how well do the general public understand the difference between the qualifications and specialisations of the different types of mental health professionals?

But at least questions are a logical place to start. 

Over the past decade there has been a significant increase in public awareness and normalisation of mental health issues. In fact, I get the sense that it is ‘trendy’ to promote mental health awareness on social media platforms. Social media is a powerful tool for facilitating the ongoing process of reducing the misunderstandings held by the general public toward mental health challenges and the discrimination and stigma faced by those who have them.

Most people can think of more than one example off the top of their heads. ‘Movember’ is a case in point. Australians from many walks of life have been quick to embrace and represent the message of promoting and establishing an ongoing dialog on men’s mental health (to find out more click here). There has also been an increase in the visibility of mental health services such as Beyond Blue and the Black Dog Institute. Although there is still room to improve, more and more people are getting the help they need, especially those who, for whatever reason/s previously wouldn’t or couldn’t. I have met people from all walks of life who have made the step towards improving their mental health. This is very encouraging and I am not shy about the fact that I have been seeing mental health professionals for many years and will continue to do so for many years to come.

Perhaps it is this relative ‘newness’ which has lead to the questions posed at the start of this thought bubble. The fact that people are using mental health services suggests that they find them valuable. Yet this doesn’t seem to match up with the monetary value they place on it. In short, people want to use the service without paying for it.

Don’t get me wrong. I am not taking issue with the cost of mental health services. Mental health services can be expensive. Rather, the issue is our attitude towards paying for this treatmentWe need to change our minds on how we view paying for mental health services.

We need to change our minds on how we view paying for mental health services.

I find myself in the minority of patients who do not question or subversively (or otherwise) try to renegotiate my psychologists’ fee. I am very grateful for the assistance I have received from the government in the form of mental health rebates. In addition, as a low-income earner who requires regular sessions, I am particularly grateful that my current psychologist offered to provide her services at a discounted rate. The difference is that I did not expect or feel entitled to that assistance. My intention here is not to boast from a high horse. Rather, it is to illustrate what I assumed was normal thinking and that most people had this same attitude. As it turns out, I assumed incorrectly and I want to understand why this is the case.

As a medical receptionist who has received intensive mental health therapies, I have the fairly unique opportunity of seeing it from both the practitioner and client’s point of view. The fact is that some people who use the Medicare rebate choose to rather than need to. That being said, it is called Better Access for a reason: “the Better Access initiative is available to patients with an assessed mental disorder who would benefit from a structured approach to the management of their treatment needs.” (Better Access to Mental Health Care: Fact Sheet for Patients). It is not for me to judge (I will leave that up to the professionals). What I take issue with are those clients who can afford to pay the gap between the Medicare rebate and the practitioner’s fee but either refuse to or argue the matter. Under the conditions of the Better Access scheme it clearly states that “charges in excess of the Medicare rebate are the responsibility of the patient.” Some people genuinely can’t afford to pay the gap, however, many can but just don’t want to. I have never had a chiropractic or naturopathic client question paying the gap for their treatment. Not once. So what is the difference? It seems to come down to the notion that there is a dissonance between the value and the perceived value of mental health services.

…there is a dissonance between the value and perceived value of mental health services.

In typical Claire fashion, I turned to research for answers. Despite being conducted in the United States of America and published in 1997, Farberman’s research findings give insight into the current situation in Australia. According to her research findings “…concerns about cost and insurance coverage and a general lack of knowledge of what appropriate mental health services are and can accomplish were the most serious barriers for consumers to seeking out mental health services.” (Farberman 1997, p.135) Furthermore, despite recognising the value of mental health services, participants in the study were not willing to pay more to have that coverage (Farberman 1997, p.134). 

Peter Shallard, a mental health practitioner, wrote an enlightening blog post on this topic. His clients described his service as “expensive” despite the fact that, at first, he only charged $50(!). According to the Australian Psychological Society, the ‘average’ recommended fee for services lasting between 46-60 minutes is $235. In my experience, psychologists do not even come close to charging this recommended amount. Why? Is it because they think that people can’t afford it or because they know that people won’t pay for it – or is it a bit of both?  Most psychologists charge between $100-180 with an average of approximately $145 for a 50-60 minute session. The Medicare rebate is $124.50 which pays for most of the session. At my current workplace the gap is $18.50 – an amount which most people in my world spend on Saturday morning brunch. 

My best friend is a provisional psychologist. I have witnessed how hard she has had to work to get to this point and every day I see how much time, energy and money is spent on continuing her journey to become a registered psychologist. People don’t become mental health workers to get rich. They do it because they want to help people. It costs ‘that much’ because the costs of being a mental health worker need to be covered. These costs vary according to a mental health worker’s qualifications, job title, specialisation and level of experience. For example, to become a registered psychologist requires six years of tertiary training and supervision, a process which requires at least $50, 000. Then there are ongoing costs such as professional development, registration with the Australian Psychological Society, and, for those in private practice, renting premises to conduct their service.

Back to Peter Shallard’s post. He makes the point that when a client says “that’s too expensive” they are demonstrating an unconscious comparison. In response, he started to ask “expensive compared to what?” and the answers were very telling. They indicated that clients were comparing mental health services to something unrelated and often incomparable. However, there is a difference between mental health and other services. In Peter’s example, a client was comparing his service, which specialises in overcoming addictions, with their child’s piano lessons. In keeping with our previous image, an hour of specialised mental health treatment is not comparable with eggs benedict and a certified organic latte. In Peter’s words, “They’re not the same, and there are no similarities that can be drawn.The unconscious comparisons people make regarding price…rarely hold up to closer scrutiny.”

…clients were comparing mental health services to something unrelated and often incomparable. However, there is a difference between mental health and other services…

In light of the above, what lies behind and how do we go about reconciling the actual value of mental health services with its perceived value? There is a subtle but important difference between paying for a product and a service. A service is much more complex and variable than a product. However, unlike other services, the outcomes or ‘product’ of mental health are particularly variable and difficult to measure. For example, unlike paying a hairdresser for a haircut, a client doesn’t necessarily have anything to ‘show’ five minutes after an appointment with a mental health worker. In this way, mental health services cannot (rightly so) guarantee a particular outcome and don’t provide instant gratification. Clients need to approach mental health services with this in mind. This can be facilitated in a few different ways. Mental health workers and those who use these services can talk about their experiences and suggest some more realistic expectations, in particular how therapy is a process that won’t happen overnight. In addition, a client’s reluctance to pay for mental health services provides an insight into and opportunity for the practitioner to address the client’s belief systems.

So what now?  The general public would benefit from a better understanding of the different types of mental health practitioners and the services they provide. This can be achieved by incorporating these differences into mental health public awareness campaigns and information services. 

Finally, it is more important to find a mental health worker with whom you have an effective practitioner-client relationship than finding someone who is “more affordable” but is not the right fit. Otherwise it is a waste of everyone’s time, money and energy. If you have questions about the financial cost of mental health services don’t hesitate to talk with your practitioner or healthcare professional (after all that is what they are there for). Most of all, try to approach and value mental health services on its own terms.

Have you experienced this? I’d love to engage with you and your thoughts and experiences on this topic. 

I would like to thank Angie Hodgkins for her feedback and insight.

References

Farberman, R.K. (1997), ‘Public attitudes about psychologists and mental health care: Research to guide the American Psychological Association public education campaign’, Professional Psychology: Research and Practice, Vol 28(2), Apr 1997, pp.128-136 <http://dx.doi.org/10.1037/0735-7028.28.2.128> (accessed June 4, 2015)

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