With the federal governments intended cuts to Medicare funding for Social Workers and Occupational Therapists under mental health plans I thought I’d interview a Psychiatric Social Worker and get the scoop on what these folks actually do and how is it different to what a Psychologist or Psychiatrist might offer.  I interviewed Roxahn Thomas, MA, BSW, BA, MHSW
Here’s our interview.

DONNA WILLIAMS

Hi Roxahn.  Thanks for agreeing to the interview.  Most people have some idea of what a Social Worker is but many people have never heard of Psychiatric Social Workers until this recent debate about the governments funding cuts under the Better Access program.  For many people there are Social Workers OR there are Psychiatrists/Psychologists and they presume that if you have mental health issues, why would you see a Social Worker.  As you’re a Psychiatric Social Worker could you give people an idea what Psychiatric Social Workers and OT’s do for those with mental health issues?

ROXAHN THOMAS

Social Workers (SW’s) and Occupational Therapists (OT’s) are equipped with diverse skills, training and experience; these strengths are employed the moment a client makes contact. We have a long tradition of working with the full spectrum of mental health conditions. The Better Access program emphasizes early intervention and predominantly targets those in the community with high prevalence conditions such as depression, anxiety, bereavement disorder, post-traumatic stress and adjustment disorder. Under the Better Access scheme, mental health Clinical SW’s and OT’s provide focused psychological strategies for adults, adolescents and children with mental illness and for people with co-morbidities that significantly complicate their mental health conditions (such as head injuries and drug and alcohol issues). This care is integrated and responsive to the needs of each client.

DONNA WILLIAMS

I didn’t realise these funding cuts would also affect the children who has mental health issues as part of their disabilities.  Working with children, teens and adults on the autism spectrum I’m well aware of the mental health complications children with disabilities face and being a Sociologist and teacher I see it from a social-psych perspective.  Sometimes mental health complications are linked to things like financial issues, bullying at school, isolation from wider family support, community discrimination where parents can’t bring themselves to take their children to the shops, to entertainment in the community or environments and approaches that could be adapted better to the disabilities etc.  Then complications start up for both the child and the carers like social phobia, depression, generalised anxiety disorder, school phobia, separation anxiety, learned helplessness, family breakdown etc.  But whilst I’m sure some look further, I commonly find that school psychologists tend to see these things as ‘just part of the autism’.

From your perspective why is A Social Work or OT perspective and service different to that of psychologists or psychiatrists?

ROXAHN THOMAS

SW’s and OT’s therapeutic intervention with clients is holistic and systemic. We see the importance of working with the individual and the systems they exist within.

DONNA WILLIAMS

I can relate to that.  Whilst people can be medicated for their mood, anxiety, compulsive disorders or psychoses, there’s clearly need to have someone on board to work holistically with the social issues, part, present and social trajectories for people’s future.  Hope is the greatest medicine and as someone with both disabilities and co-morbid psych challenges I don’t look at my Seroquel and see ‘hope’.  It’s part of the management of my issues but my issues are more than my own psych pathologies, they are part of wider social issues and how I navigate those as someone with disabilities.

What is the training of a Social Worker or OT within mental health?

ROXAHN THOMAS

To register as a Better Access provider, Clinical SW’s and OT’s are required to have clinical experience of at least two years fulltime postgraduate work in mental health facilities.

DONNA WILLIAMS

So that’s a two year post graduate specialisation then, on top of the 3 years it takes to become a Social Worker or OT.

ROXAHN THOMAS

Mental Health Clinical SW’s receive more training in focused psychological strategies and hold more experience in mental health service provision than newly registered psychologists who are automatically eligible as Better Access providers.

DONNA WILLIAMS

Then it’s ludicrous that newly graduated psychologists with a 3 year graduate degree and no training in social work will continue to get funding and funding for mental health social workers with a 3 years graduate degree and a further two years of post grad specialisation in mental health will be cut.  Also, in my experience, the fees for psychologists tend to be far higher with less rebate for the service user.

ROXAHN THOMAS

Approximately two thirds of our clients are either bulk billed, or pay a small ($5-30) gap for service. We operate in a culturally and community/milieu – sensitive context
. We look at developmental history, family of origin, and environmental factors when making an assessment and treatment plan. Psychology tends to follow the medical or “germ” model, where the illness or pathology is in the individual, whereas we are much more systemic in our approach.

DONNA WILLIAMS

Who are their services most relevant to?

ROXAHN THOMAS

Individuals who experience mental health issues, the financially disadvantage, and those who live in rural and remote Australia. I live and work in Rural Victoria and offer affordable and accessible counseling to individuals, couples, and families. Other local psychology counseling services have month long waiting lists. What will happen to those clients who currently utilise our services and those who will need to in the future?

DONNA WILLIAMS

What is the reasoning behind thinking only psychiatrists or psychologists can best address mental health issues?

ROXAHN THOMAS

To date, there has been no reason why only OT’s and SW’s are to be removed from the initiative.

DONNA WILLIAMS

Tell us about the funding cuts and what rationale do you think they’re based on?

ROXAHN THOMAS

The Government has provided us with no rationale. From 1 April 2011, Australians, including low-income earners, disadvantaged and those in rural and remote areas will no longer receive specialist mental health care from SW’s and OT’s under the Medicare Better Access Initiative. The provision cost of these services is very low, yet removal of the Medicare rebate will be far reaching and devastating, and ultimately costly. This decision was made at least eight months before the evaluation of the Better Access funding was complete.

DONNA WILLIAMS

Who will these cuts hurt most?

ROXAHN THOMAS

Individuals who experience: mental health issues, are financially disadvantaged, clients who don’t or can’t access mainstream counseling services, and clients who have built upon a long-term therapeutic relationship with an OT and/or SW and will no longer be able to be rebated for these sessions after 1st April 2011.

DONNA WILLIAMS

If these cuts hurt social minorities why should the ‘general public’ care?

ROXAHN THOMAS

The general public themselves are possibly clients of SW’s or OT’s! And if not, maybe they have family or friends that are. Mental Health won’t be so accessible or affordable.  It’s also important for individuals to be able to choose what therapeutic intervention suits them – and if their preference is to see a SW or OT they shouldn’t have to pay more than if they wanted to see a psychologist.

DONNA WILLIAMS

Is it to late to turn around the government’s decision to cut Medicare funding for SW’s and OT’s?

ROXAHN THOMAS

Absolutely not. The Labor Government can reverse their decision.

DONNA WILLIAMS

What can people do to show their support for the continued funding of these services?

ROXAHN THOMAS

They can sign the petition, make contact and raise the issue with their local MP’s, write letters to the Government supporting OT’s and SW’s to remain in the initiative, attend mental health vigils in their communities, network and inform others of this issue, and if having been a client of an OT and/or SW – write about this experience to: the media, Government, local MPs, etc

DONNA WILLIAMS

Thanks for your time Roxahn.

Warmly,

Donna Williams, BA Hons, Dip Ed.
Author, artist, singer-songwriter, screenwriter.
Autism consultant and public speaker.

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