The mental health system in Victoria is a complex and complicated business. The world we live in is modern, up to date and comfortable; the world of mental health is antiquated, out of touch, uncomfortable at best, cruel at worst.
It is experiencing a time of rapid change in attempts to bring it into line with our societal expectations, but unless we are affected first hand our society still doesn’t expect too much.
For too long mental illness has been talked of in hushed tones now, thanks to the good work of many caring people who work in the world of mental health, this is changing.
The Health system in Australia is divided into Primary and Tertiary (secondary is not commonly used).
The Primary sector includes General Practitioners and Community Health Centres. It is usually a first point of contact.
The Tertiary sector is usually accessed with a reference from a primary care doctor (eg a GP). Hospitals are tertiary care. It is possible for a social worker or psychologist to refer to a mental health unit in the tertiary sector (a hospital).
In this category of Tertiary Care can also be found organisations considered as support services such as MIND, NEAMI, EACH and ASCO. These organisations provide a variety of services including: peer support programs, counselling and supplementary programs. See (link) for an explanation of other services. It is possible to make contact directly with these organisations through a 1300 number.
This sector becomes complicated when we take into account the public sector and the private sector, for example private hospitals and public hospitals; or private psychologists, counsellors and psychiatrists.
The situation is further complicated when we consider funding arrangements.
The Commonwealth Health System is divided into Primary Health Networks and Local Hospital Networks. The Commonwealth Govt can directly fund programs such as support services and other health services. The Commonwealth Govt provides funds to the State Govt for Health Services and Hospitals and the State Govt supplements this funding. The State government has its own geographic boundaries. Generally it is these State Govt boundaries that affect us. Click on the link to view the boundaries.
Medicare payments contribute to mental health professional consultations.
If you visit a mental health professional in the public system, the professional claims the subsidy directly to Medicare.
If you wish to visit a private mental health care professional you first need to complete a Mental Health Care Plan with your GP. In the past you could receive 8 subsidised visits to a psychologist, now you can choose to consult a person or a program and it will be subsidised. This is not an increase in funding but an improvement in how the consumer can spend that subsidy. The change was announced late Nov 2015.
The National Disability Insurance Scheme (NDIS) is slowly being introduced across the country. Some people with BPD may meet the criteria for the NDIS, some have been approved already, many have not. It is possible for people to recover from BPD however, and to go onto the NDIS, it is required you have a permanent disability this is one of the challenges faced with being eligible for the NDIS. The scheme was developed with physical disabilities in mind. BPD fits into the category of psycho-social disorder in NDIS jargon.
If you are applying for the NDIS, it pays to research as much as possible before, during and after the process. Tandem, the organisation for mental health carers here in Victoria, has a specialist NDIS who can support families and friends with their role in this process. They can be contacted on 1800 314 325.
A visit to your GP or Community Health Centre and a request for a referral under code 291 is a possible first step. This is a referral for a diagnosis.
There are three places you could be referred:
1) Spectrum is a Victorian service for people with BPD.
2) Alternatively your GP may refer you to a local Area Mental Health Service.
3) If you wish you can consult a private psychiatrist or clinical psychologist to receive a diagnosis.
To get that referral, the doctor will need to be assured that you could have BPD and will ask questions of you so they can make the referral.
For an assessment at Spectrum, it may take a couple of months for an appointment time. This is a process that takes about three hours and involves interviews and lots of questions and discussion with you. Treatment at Spectrum focuses on those who are at risk from serious self-harm or suicide and who have particularly complex needs and may require a few months further wait. Your local Area Mental Health Service may also have a waiting period before an assessment and treatment. Treatment at the local Area Mental Health Service may also be difficult to access. A private psychiatrist or other therapist may not have a long waiting time.
You may do all you can to get a diagnosis and treatment and find it not possible to access treatment. This could be because of the challenges that mental health professionals face with limited resources or it could be because of the stigma and discrimination that is prevalent in the clinical field. The important thing is to stay in touch with your doctor, make contact with your local BPD support network (join our email list), continue to learn about BPD (join our email list) and continue to try and find the right treatment for you. This is not a journey to be done easily without support.
For many, a trip to the emergency dept at a local hospital or a visit from the CAT team is a first point of contact. This will usually occur at a suicide attempt or when the threat of suicide becomes too real. For many people, the emergency dept is a blessing because it can provide a safe haven, however they are not always good places to be. The staff are often dealing with emergencies, the stigma and discrimination against people with BPD that is so prevalent may be experienced here when the person is so vulnerable. Often however it is through these services that a referral can be gained to the public health sector and possible treatment there.
If you have the money, you have many choices. The difficulty lies in knowing what is available and what is the best choice; it is not the place of the site to recommend anyone or any mental health service.
Some points to consider:
Google is your friend. Learn how to use it creatively.
A pre interview of the clinician. Questions to ask could include:
Do you believe recovery is possible?
What is your definition of recovery?
What are the indicators for successful treatment of BPD?
What type of treatment do you offer?
Do you follow the National Clinical Guidelines?
Are you willing to include family members in the treatment process?
Good Clinical Practice or General Psychiatric Management
A word on the research may be helpful. The most researched therapy is DBT. The most successful research confirms the effectiveness of DBT. This does not mean that other therapies are not effective at all. All the above therapies are believed to be effective.
A word on DBT may be helpful. Marsha Lineham developed DBT. She had BPD herself and developed the treatment based upon Cognitive Behaviour Therapy and informed by Eastern Philosophical traditions. She trains therapists who undergo a registration process with her organisation. There are mental health professionals who offer DBT who have not been trained and registered with Lineham’s organisation. This just means that it is helpful to know the difference between therapies.
This depends on the mental health service concerned. For some it is 16, for others 18 and for some it could be 25.
This information may be important. If you have a good relationship with the treating therapist, this is important for the success of the treatment. It would be unhelpful to change that therapist because of an age barrier. If it is suggested that a treatment program be interrupted because of an age limit, it is worth pursuing your case at a higher level.
There are Mental Health Community Support Services. There are three main mental health organisations funded by both state and federal govt. They may offer, for example, an Outreach Program. This could involve having a trained person visit in the home and provide perhaps support in finding employment or budgeting etc. These organisations are: ACSO for rural Victoria; EACH for eastern metropolitan Melbourne; and NEAMI for the north, west and southern metropolitan Melbourne. These organisations can be accessed via a 1300 phone number. The potential ‘consumer’ will need to be assessed and then rated and ranked to access the relevant service.
A program such as Personal Helpers and Mentors Support (PHAMS) can be accessed through MIND, another mental health organisation in Victoria. MIND also offers support in conjunction with hospitals through their Peer Recovery Centre and the Prevention and Recovery Centre which provide accommodation and other support. The MIND College is an excellent resource for all affected by mental health problems.
Community Health Centres such as Star Health in the inner south, Link in the mid south, and ERMHA in the Dandenong area are a good support. Throughout Victoria there are community health centres with a wide variety of programs.