Mental health in Melbourne
People...I’ve been nuts for as long as I can remember. From suicide attempts before I was 5 and depressive break downs over Care Bears at kindergarten, through to hospitalisations and experimental trials in adulthood - I’ve experienced a lot of mental health issues and lots of treatment options. But one of the things that really drives me crazy, is how fucking difficult it can be for people who are unwell to get the help that they need.
A few years ago, I wrote an article about my experiences in the public psych ward. At least once a week I get an email or message from someone who read that article asking for advice on how to find good quality mental health care. So I thought I’d put together something more comprehensive to try and support people having tough times with their noggin.
Finding the right doctor
Not all doctors are created equal. We tend to have this idea of doctors as infallible, almost godlike figures who hold the keys to our mortality. The truth is, they’re people just like you and I. They have their own prejudices, their own quirks and their own shortcomings.
If you’re experiencing any kind of mental health issues, it’s really important to find a GP who is going to be, not only compassionate, but also helpful.
In Doctor Land there’s a thing called “CPD points”. It stands for ‘continuing professional development’, and it’s a system that exists to make sure your doctor isn’t still trying to cure you with cocaine and leeches. Each year, doctors have to earn ‘50 points’ from attending workshops, lectures, and other skill building events. They can choose what area they focus on to collect these points. So, for example, some doctors might attend a whole heap of development sessions on heart health, or working with elderly patients, or even on communication skills. This way, they get to specialise in areas that interest them.
Find a doctor with mental health experience
Why am I telling you about the intricate details of doctoring? Well, what a doctor chooses to upskill in determines the kind of care they’re going to give you. A doctor who hasn’t looked into mental healthcare since they were a resident, might have certain stigmas and outdated attitudes towards mental health.
Studies have shown that a single bad experience with a healthcare professional is enough to put people off seeking care a second time. For those of us with mental health issues, this is doubly true. It takes us so much energy and willpower, just to make that first appointment to ask for help, that if they turn around and say “Maybe you should try exercising more,” we’re likely to give up, spiral into self hatred and not try to get help again for at least another 6 - 12 months.
So it’s super important to try and find a GP that’s going to have the right attitude the first time around.
These days, most medical clinics will have websites with short bios on each of their GPs. These bios will usually mention the doctor’s areas of interest. But if the clinic doesn’t have a website, or doesn’t have doctor bios, the admin and reception staff will usually be able to make a recommendation when you call to make an appointment. It’s okay to ask if they have a doctor who specialises in mental health. And if they don’t, most clinics will let you know and give you the name of somewhere that does.
And if you’re stuck for where to start, this website will let you search via suburb and health concern and will even tell you if the clinic bulk bills or not.
Find a doctor that comes recommended
If you’re in a position where you can talk openly about your mental health issues, reach out and ask friends for recommendations on a good GP.
Given that around 45% of Australians will experience a mental health condition at some point in their life, it’s more than likely that within your circle of friends there’s someone who has already been through the GP journey. Don’t be afraid to ask for details of doctors they had good experiences with.
And if you’re really struggling to function (because let’s be honest, we’ve all been there), it’s okay to ask a friend to help you make an appointment.
The mental health care plan
The mental health care plan is basically Australia’s strategy for dealing with mental illness. It’s only for people with a ‘mental disorder that has been diagnosed by a doctor’. It entitles you to 10 medicare rebates for individual or group appointments within a year.*
To be honest, it’s a fucking stupid system, and I hate it.
But it’s the only help available to a lot of us, so let’s look at how you get it.
Be honest with your doctor
Once you’ve found your GP, you’ll need to tell them what’s wrong.
You and I both know how fucking hard that can be if you’re used to downplaying your mental health issues. Fronting up to a stranger’s office and casually saying “Yeah some days I wake up and I just want to die” isn’t as easy as it sounds. But again, this is why it’s so important to find the right GP first. Because it’s much easier to be vulnerable with a medical professional you trust. And a GP with mental health experience will be able to read between the lines a lot more if you’re someone who struggles to open up. They’ll know which questions to ask and how to ask them in a way that won’t make you feel like shit.
If you’re experiencing depression or anxiety symptoms, the doctor might give you a survey to fill out (or will ask you the questions off their screen). They’ll be things like “In the last 2 weeks, how often were you so depressed that nothing could cheer you up” or “How often were you so anxious nothing could calm you down.”
It’s important when they ask you these questions to really think about the last 2 weeks and not the last 48 hours. Because most people with mental health issues have a habit of mentally playing down how bad things have been once they’re in a situation where things might be improving (such as sitting with a doctor who could help them). But you’ll only qualify for a mental health care plan if you get a certain score of shittiness on the ‘how fucked is your shit’ scale.
So don’t hold back.
Don’t panic about a ‘diagnosis’
When your GP understands what you’re going through, they’ll be able to make a diagnosis. Don’t panic - this isn’t as big a deal as it sounds. A lot of the time they won’t even tell you what they’ve diagnosed you with.
When it comes to mental health, the field is still very much in its infancy. We don’t know what causes most mental illness and a lot of the time we don’t understand how certain treatments actually work. So when you think of a ‘diagnosis’ think of it as like a short-hand term for people who seem to have some symptoms in common.
I have depression. Maybe you do too? And if I describe my depression to you, there will probably be a lot of stuff that makes you say “Yes! I get that too!” But, there will also be things I describe that won’t be relatable for you at all. The same as anxiety, personality disorders, and every other diagnosis under the sun. Because it’s not an exact science yet.
So if your doctor listens to you and says ‘It sounds like you have depression’ don’t panic and assume that this means anything in particular about you as a person or about your future - you’re still exactly the same person you were before you got the label. It’s just a short-hand term for a collection of symptoms, not all of which you’re going to have.
Making the mental health care plan
Each GP will have a different process for putting together a mental health care plan. Essentially it’s meant to be a strategy for dealing with your particular situation. So if you’ve been diagnosed with, let’s say post-natal depression, your GP will help you find a therapist who can help with that and might also recommend some medications for you to try. Others will be even more proactive and will recommend support services or community organisations that can provide additional care while you’re recovering.
The biggest issue I have with the mental health care plan system is that it’s based on a recovery model. The idea is that medicare subsidises 10 sessions of therapy, your doctor gives you some medication and you both talk about lifestyle changes you can make in order to get you on the road to recovery - seems reasonable, right?
The mental health care plan is great for situations where someone is affected by environmental factors, e.g. grief or workplace stress, etc. But it’s not super helpful for those of us who have more permanent health concerns. It’s like being given 10 sessions for physical rehabilitation - that’s really helpful if you broke your arm, but less helpful if you were born with cerebral palsy.
And that’s if you’re able to afford the gap, because medicare doesn’t cover the entire session.
Also, you don’t get all 10 sessions at once. You get 6 and then need to go back to your GP in order to get reviewed for the additional 4. Because therapy is dangerous in large quantities and the government doesn’t trust you not to overdose on it.
Getting a referral
Once you have a mental health care plan, you’ll then need a therapist who is covered by the plan. Often your GP will recommend someone - which again is why it’s so important to find a GP who specialises in mental health. A GP with experience will have a network of therapists who specialise in different diagnoses, whereas a GP without this experience will just use a directory to look up some random therapist who happens to be in the right postcode.
If this is your first time going through the mental health care system, it’s okay to just go along with whomever your doctor recommends. But remember that if that therapist doesn’t work for you, it’s 100% okay to ask your doctor for a referral to someone different.
Therapists are like GPs. Each of them has their own area of specialisation and interest. Some of them are great. Some of them are kind of shit and can do more damage than good. Trust your gut and if you feel like you’re not going to get along with a therapist, remember that you don’t owe them any loyalty. Your wellbeing comes first.
Finding the right treatment
You don’t have to accept the therapist that your GP recommends, especially if there’s someone else you’d like to see.
You can Google around to find a therapist who specialises in your diagnosis, you can ask friends for recommendations, or you might have a particular kind of therapy in mind that you’d like to try and can search for practitioners who offer that.
Once you have the name of the person you’d like to work with, take that to your GP and ask them for a referral.
Word of advice - call the therapist first to see if they’re taking new patients. There’s nothing more infuriating and devastating than going through all the effort of getting a referral only to find that they’re fully booked up or not taking on new patients.
Psychiatrist or psychologist? Counsellor or social worker?
If you haven’t really explored the world of mental health too deeply, it’s easy to get confused by all the different people out there that can help you.
Once you have a mental health care plan, most GPs will refer you to a psychologist (since this is what the 10 sessions will cover). But if they suspect you would benefit from specialised medication they’ll refer you to a psychiatrist.
The difference is simple, but can be hard to remember because the words are so similar. A psychologist is someone who will help you change your patterns of behaviour through different types of therapy. A psychiatrist is someone who will help you manage the symptoms of your mental illness with medications.
If you can’t afford a psychologist, even with the mental health care plan, your doctor might give you the name and details of a community service that has free counsellors or social workers.
Counselling is less structured than psychology and tends to focus less on formal therapy methods and more on practical solutions that are immediately achievable. For some people this can be more beneficial than psychology, but for others it can feel too much like a short term fix for a long term condition.
Often the same organisations that provide free or subsidised counselling will also offer social workers. Social workers are people who help you understand all the complex systems that stand between you and actual help. For instance, applying for Centrelink is basically like being beaten to death with wet lettuce, and most of us struggle with the process. A social worker might sit with you and help you fill out the form, help you find all the documents you need to provide as evidence, and help you understand the status of your application as it progresses.
Basically social workers are like the cheat code to being an adult in modern society.
What therapy type?
There are a lot of different therapy types out there. The mental health care plan only covers psychologists. A psychologist will usually work with you using whatever the most commonly accepted therapy technique is for your diagnosis. E.g. Cognitive Behaviour Therapy (CBT) for depression, Acceptance Commitment Therapy (ACT) for Obsessive Compulsive Disorder and anxiety, Dialectal Behaviour Therapy (DBT) for Borderline Personality Disorder, etc.
There are a heap of other psychotherapies out there though. And there are other therapy methods that are currently considered to be on the fringe, but that can provide a lot of relief for people. For instance Voice Dialogue Therapy is a unique form of talk therapy that looks at the different ‘selves’ that we tap into and which ones we might be ignoring.
What about drugs?
Medication is like therapy - there’s lot’s of different kinds out there. Your GP or psychiatrist will usually prescribe whatever medication is considered standard for your condition and then adjust it from there. It’s not unusual to have to experiment with different types of meds before you find the right balance for your condition.
Word of advice - If you can afford it, it’s definitely worth taking this genetic test before getting medication. You can do it at home and they will email you and your GP the results. They’ll give you a report that explains what liver enzymes your body has and how those enzymes will break down different drugs. Some people (like yours truly) have enzymes that break down certain drugs, like SSRIs, too quickly for them to be effective. Others have enzymes that break down some drugs too slowly, which would mean you’d only get side effects, but none of the intended effects. Since it can take up to 6 months to see if some antidepressants are effective for you, this test can save you a lot of time. Not to mention, the process of onboarding and offboarding drugs is a unique kind of misery.
Like therapy though, there are a lot of less conventional drugs that can provide people with a lot of relief from mental illness symptoms. There’s a mounting movement to see hallucinogens such as MDMA, magic mushrooms and LSD included in therapeutic practice as a way of helping people who suffer from PTSD. And Ketamine trials have been producing some incredibly promising results.
Don’t give up - try something else
The reason it’s important to know about all the different types of therapies and drugs is because you need to know that you have options. If you find that one therapy doesn’t work for you, or one medication type makes you feel worse not better - there are other options. Don’t give up. Ask your therapist if you can try a different therapy method - if they can’t provide that, don’t be afraid to change therapists.
If you aren’t happy on the medication your GP or psychiatrist prescribes, tell them.
A good healthcare provider will explain the point at which you should have noticed a result (e.g. SSRIs can take 6 months to work) and if you’re not getting that result they should be open to trying something else. Likewise if your drugs are giving you side effects that you can’t live with - tell your healthcare provider. They will tell you the best way to come off the drugs without doing yourself more harm.
Mental health hospitalisation
I’ve talked before about my experience with hospitalisation in a public psych ward. My TripAdvisor review was scathing. Zero out of ten, would not recommend. If you’re curious about the process of being hospitalised in the public system, please have a read.
Since that time I have now had the luxury of visiting a private mental health hospital. Absolutely worlds apart. Your experience will vary based on the hospital that you or your treating psychiatrist choose to hospitalise in, and the reason for your admission.
For me, it was a preventative visit that was completely facilitated by my psychiatrist and covered entirely by my private hospital insurance.
Private hospital insurance and ‘psychiatric’ coverage
If you have the dollary-doos to spare, the best piece of advice I could give you is to look into private hospital insurance and ‘psychiatric’ coverage. It is definitely expensive. It is also definitely worth the money if you’ve ever found yourself in mental health crisis.
Counter-intuitively, before you even start looking into health funds you’ll actually want to decide on the private hospital you want to go with. Getting health insurance to cover mental health expenses is a uniquely frustrating experience, and a lot of them will cover X but not Y. So your best bet is to pick a hospital and then call and ask them which fund they would recommend. They’ll be able to tell you which insurance fund has the highest coverage for the services that they provide.
Once you’ve decided on the hospital you want to go with, you’ll need to talk to them about what the process is for becoming a patient. Usually it will involve getting a referral to one of the psychiatrists they have on staff. Your private hospital cover will not cover the cost of seeing this psychiatrist, no insurance will.
The ‘psychiatric cover’ you need for private mental health care will usually only be provided as part of the top tier of hospital insurance. This means it is really expensive. And then you will still have your excess payment each year, which can vary but is usually around $500.
But what does it actually cover?
Each hospital or private provider is going to be different, so it’s worth checking before you sign up as to whether it’s going to provide enough support and care for your needs. My own experience has been with The Melbourne Clinic, and they offer a comprehensive suite of mental health services.
My private insurance completely covers my hospitalisation in their facility, it gives me access to their ‘day programs’ which are group therapy courses that run from 3 months or up to 12 months, and also covers their ‘outreach’ service which provides a counsellor or social worker who comes to my home or workplace once a week for an hour to help me with any issues I’m struggling with.
The combination of these services means that I have my short term support through outreach, my long term support to build skills through any of the relevant day programs, and then my crisis support if everything goes to shit.
We shouldn’t need private cover
We’ve moved past the idea that people with mental illness are just lazy or crazy or have some kind of moral failing. We’re starting to recognise that you can’t just motivate yourself better if your brain isn’t wired the right way. And as we recognise that mental illness is real illness, we need to start recognising that it needs real treatment not just band-aid coverage. Because expecting people who are legitimately ill to just ‘deal with it’ while also expecting them to function like a normal member of society - that’s insane.
I recognise how fortunate I am to be able to access private coverage. I know that not everyone can (I would argue that very few people can). And to be honest, this is the level of support that should be provided by the state. This is the level of care that all people with chronic mental illness need. The public system does not provide enough support for people who desperately need it.
If we properly addressed mental illness, we would see huge reductions in a myriad of different social issues, from homelessness to domestic violence, crime rates and more. And properly addressing it means providing the support that people need in a way that is completely accessible to everyone, not just the few who are high functioning enough to hold down a job so they can pay to access it.
A final bit of advice
This is a lot of information. And if you’re feeling overwhelmed or exahusted or depressed - that’s normal. Asking someone whose symptoms could include not being able to properly care for themselves, lack of energy, lack of motivation and a sense of hopelessness to navigate the intricacies of a national healthcare system is a uniquely cruel exercise. One that only politicans and beaurocrats could have dreamed up. Here’s what I want you to focus on instead - this information will always be here. You don’t have to digest it all today. You don’t have to take action today. When you’re ready, you can come back here at any time and remind yourself what steps you’re ready to take.
If you’re already in the process of getting mental health care, the thing I wish I could tattoo on your heart forever is this - please don’t give up on yourself. I understand how exhausting the process can be. I understand how each time a therapist turns out not to be ‘the one’ you just want to scream at the sky until the world collapses in around itself. I know that when you need to change medication because the one you’re on is either absolutely awful or utterly useless, it makes you want to just stay off them altogether because what’s the point? I know that every time you try something new and it doesn’t help, you feel absolutely exhausted by the thought of trying again.
But each time you feel like that, I hope so passionately that you don’t give up.
Because it does get better. It takes time, but it definitely gets better.
We gather strength as we go.
That is all.
You may go now.
*Depending on when you read this, there has been an announcement of an additional 10 sessions to the mental health plan.