Mental health care plans – what are they?

We take a look at what exactly a mental health care plan is and how it could help those suffering from a mental illness.

What is a mental health care plan?

A mental health care plan is generally provided by a GP to a person they view as in need of support for a mental health disorder. It outlines what you and your doctor are aiming to achieve and steps to get there. It may suggest assistance from psychologists, social workers and occupational therapists, including up to ten individual or group sessions that are eligible for a Medicare rebate. 

After six of these sessions, you will generally need to return to your GP to review how the treatment is progressing. After this, if needed, you may be able to access the remaining four sessions. 

There is also a Medicare Benefits Scheme (MBS) Eating Disorders Treatment Pathway that was introduced in November 2019 to support people suffering from an eating disorder to access psychological treatment and dietetic services.

Who is eligible to receive a mental health care plan?

You are eligible to receive a mental health care plan if you are a Medicare card holder and have been diagnosed with a mental health disorder by your GP. There is a limit of one mental health care plan per patient per calendar year. 

How can I get a mental health care plan?

According to Queensland Health, you may visit any GP of your choice who will assess whether you have a mental health disorder and potentially create a mental health care plan for you. It can take longer than a normal consultation, so Queensland Health suggests asking for a longer appointment when making the booking. 

Your GP will likely talk to you about the symptoms you are experiencing and what you would like to achieve from a mental health care plan. They may also ask you questions about how you have been feeling, which can help them make an appropriate diagnosis. Your doctor may then offer a plan outlining their suggested treatments, including a referral to an allied health professional, who may be either recommended by them or someone of your choice.

What does a mental health care plan cover?

If you have a mental health care plan, you are entitled to a Medicare rebate on up to ten individual or group sessions with certain psychologists, social workers or occupational therapists. 

If you need a referral to a psychiatrist this will be subsidised separately by Medicare up to a set amount, called the scheduled fee, but is not included in the mental health care plan. Likewise, any prescription medication you may require may be subsidised separately and according to the pharmaceutical benefits scheme.

How long does a mental health care plan last?

The mental health care plan will cover up to ten sessions in a calendar year. If you need more than the ten allocated sessions in a calendar year, you may be able to claim for the extra sessions using your private health insurance. Your GP can prepare another mental health care plan for you in the next calendar year if they believe it would be useful.

Will I have any out-of-pocket expenses with a mental health care plan?

A mental health care plan allows you to claim Medicare rebates for up to ten sessions with specialists such as psychologists and social workers. These professionals set their own fees, so it can be a good idea to check the cost of the service and the Medicare benefit available before making an appointment, so you know in advance of any gap you may need to pay.

Will having a mental health care plan impact my insurance premiums?

It’s a good idea to check with your insurance providers, including health, life, income protection and travel insurance, regarding any impacts having a mental health care plan may have on your premiums and future claims. According to Beyond Blue, there is evidence to suggest that people with a history of a mental health condition can experience difficulties obtaining insurance, including higher premiums, refusal of insurance or denial of claims.

In a recently released report following an investigation of the travel insurance industry, the Victorian Equal Opportunities and Human Rights Commission found that, over an eight-month period, three major Australian travel insurers sold more than 365,000 policies containing terms that discriminated against people with mental health conditions. However, since this investigation the Insurance Council of Australia has said most of Australia’s largest travel insurers had either removed or would soon remove general exclusions for mental health conditions, with cover also widely available for first-instance episodes of mental health conditions.

If you or someone you know needs support, call Lifeline of 13 11 14 or BeyondBlue on 1300 224 636. If it is an emergency, call 000. 

About Katie Rodwell

Katie Rodwell is a senior communications professional. She has worked both locally and internationally for almost 20 years with a particular interest in the personal finance, banking, professional services, government, not-for-profit and telecoms sectors.

Main image source: GBALLGIGGSPHOTO (Shutterstock)