Trigger warning: Self-harm, suicide
EDIT: This writeup is mostly focused those who have not interacted with the mental health system before, still have the capacity/clarity of mind/desire to seek help, and want a better idea of what it actually happens. It is a bit gloomy and that is a reflection of my own experiences going through it, but I just wanted to add, reaching out for help is the right thing to do. If you feel discouraged, it's not your fault, you're doing the right thing and we as a country/state should be the ones doing better. Good luck <3
Hi All, I've seen a number of posts recently on this topic and so I'm writing this post to help you or someone you know to better navigate the mental health system in Melbourne as someone who's actually been through it. It can be so hard to understand the actual process like referral avenues and costs, so hoping this can help someone.
Crisis Supports
Crisis helplines
Here I'm talking about phone lines like Lifeline and BeyondBlue. So Lifeline and BeyondBlue are not actually not counselling services, they are only there to "support" you tell you what options you have and to refer you to other services. A lot of people call up these services and come away disappointed because they feel that they have received no help. Unfortunately, the people servicing Lifeline are unpaid volunteers and not actually clinically trained to give you counselling, their main focus to make sure you're physically safe and not going to harm yourself in that moment. That's why you see a lot of complaints like "Lifeline just told me to go make a cup of tea or take a bath". Their primary job is to make sure you're safe in the moment, not necessarily to make you feel better.
Suicideline is better in that the people who staff it are actual counsellors who will counsel you, as opposed to just directing you to services.
Mental Health Triage
This is a staffed phone line affliated with a hospital based on your catchment zone who will do an assessment with you over the phone. I strongly recommend contacting them for yourself or for someone else as the first option. If you meet the criteria, you will be case-managed which means you will have a dedicated team of professionals and support works looking after you. This opens up access to a lot of public mental health programs which require you to be case-managed. However, keep in mind that the criteria for this is also quite high and often requires you to be unable to function independently. For those who hold down steady employment but are really really in the dumps, this can be difficult. They can also refer you to the CATT team which has a lower bar.
Police welfare checks
For a multitude of reasons, I strongly advise against calling the police as a first avenue if someone is expressing suicidal ideation. It is better to call up Mental Health Triage who are better equipped to deal with these situations. If you call a welfare check on someone, the police will generally call them first, and then check on them, but unless the person is actively harming themselves in the moment, say they are planning to take action immediately, or in a psychotic state, the police will generally assess them as low risk with no follow-up actions. The bar for an involuntarily hold under the Mental Health Act is quite high. This is kind of tied into the next part.
Emergency room/public psych ward
When you present to the ER voluntarily and say you're going to unalive, you'll get triaged to see the mental health nurse. The wait time is often upwards of 6 hours in quite an uncomfortable environment. If you do get seen, you will do a mental health assessment. Generally, unless you are presenting in the same case as above (psychotic or current and immediate risk of harm), you'll generally be advised to go home and see your GP who will give you options. You can also be given some drugs to calm you down like Diazepam. Unfortunately, bed spaces are severely lacking and it is a very high bar to get admitted - "just" being suicidal usually does not meet this, like "I really am planning to kill myself in the next two days, but I am not doing it right now". However, they can refer you to CATT.
If you are deemed as needing admission, it's quite a chaotic and scary place with a lot of people who aren't in their best states of mind around. Private is very different as it's voluntary and there is a code of conduct.
CATT
The Crisis Assessment and Treatment Team is basically a team of support people tied to a hospital depending on your catchment zone. If you meet the criteria, which is lower than an involuntary hold and case management, they will assign people to come visit you at your residence and do a risk assessment. Then depending on your level of need they will give you a call to check-up on you every day. The goal of CATT is to act as a stop-gap while you're waiting for admission into a hospital or program. They are able to refer to you a private mental health hospital, which I'll go into below.
Actual stabilisation/treatment
Now it's beginning to look like unless you meet the criteria for case management, every avenue of help is a referral to another service to another service. So where is the actual treatment? How do you actually get better?
GP
Your GP is the primary avenue who can refer you to all the other services. Unfortunately, it's rare to find a good GP who cares and bulk-billing has practically disappeared. Your GP can refer to private hospitals (both inpatient and outpatient) as well as private psychologists where you will be able to access actual treatment.
PARC
Prevention and Recovery Centre provides short-term residential support (stabalisation) for those with mental health conditions and is a public service and is what is called a Step Up Step Down Service (step up from community care, step down from hospitalisation). You can be referred to this service by CATT or your GP (only in certain areas). There is also a YPARC which is for youth.
Private psych ward (inpatient)
These are private hospitals like Epworth, Delmont, Melbourne Clinic, etc. You can be referred by either the CATT team mentioned above or your GP. I highly recommend this service called Bedbrokers. Basically you can ask CATT or your GP to send a generic referral to them, and they will do the hard work of contacting all the hospitals to see which ones have bed spaces. For someone in a crisis, this admin help really makes a big difference, especially if you don't have an advocate in your personal life.
A big factor for many people is cost. You will have no out-of-pocket costs if you have the Gold level of hospital cover, which fully covers all inpatient psychiatric treatment. If you have a lower level of cover, the government has this once-in-a-lifetime mental health waiver that lets you upgrade to the Gold cover and access these services immediately without serving the 2-month waiting period.
At the hospital, a psychiatrist will review you and do an assessment, you'll have your belongings searched and given a room. There is generally not much to do, but you're in a safe environment which might help you get through a crisis. The treatment is generally medication and participation in group programs, such as DBT, that teach you skills to go about your life. After assessment, you usually get two hours of leave a day which can you upgraded to four.
Private day programs (outpatient)
A number of hospitals also offer outpatient group day programs that teach you these skills. They are not individual counselling/therapy, more like mini classes. You need to be referred to this by your GP. This is also covered under your insurance if you have Gold cover, however there is an initial consultation fee with a psychiatrist who has to admit you to the day program. So the GP refers you to the hospital, the hospital's psychiatrist then admits you to the day program which goes weekly for around 12 weeks per module.
Private psychologist
This is the main way to access individual counselling. It is incredibly rare to find a bulk-billed psychologist nowadays who is taking on new patients. If you found this option, great! Otherwise, the Medicare assistance that is available is 10 subsidised sessions a year. To get this, you need to be referred by your GP who will create a mental health care plan. This generally reduces the out of pocket cost, depending on the psychologist and how much they charge, to about $100 for a clinical psychologist and a bit more for non-clinical as the rebate is lower. If you don't have a psychologist in mind, ask for a generic referral which is valid for all.
However, a lot of psychologists will not work with people who are actively suicidal and refer them to the public system. Then, a lot of these same people are told by the public system that they are not sick enough. So you're too sick for private, but not sick enough for public.
Private psychiatrist
Psychiatrists are another option but more expensive than psychologists. There is this "loophole" you can use to make the cost of ongoing psychiatry treatments more affordable. Once you hit $2,699.10, the Medicare Safety Net means you will have 80% of your out-of-pocket costs subsidised. Unfortunately psychologists aren't covered by this. So if you find a psychiatrist who specialises in talk therapy, this might work out to be cheaper if you see them very regularly.
Problems with the system
If you've read this far, you might be starting to see a theme. It is incredibly difficult to actually get meaningful treatment - every visible service is a risk assessment and then a referral to another service. The eligibiltiy criteria for different services leave gaps for those in the middle. It's convoluted and actual treatment is incredibly expensive.
- There is a massive gap in the system for people who are at high risk of suicide but present voluntarily and as high-functioning. These people are asking for help, like they've been told to, they've been told to reach out, they're doing the right thing, only to be shown that the promised help isn't there or they're not "sick enough".
- Almost all of the voluntary treatment programs are private and need you to have insurance. This creates signficant barriers for those who don't meet the requirement for case managment but desperately need help.
- 10 psychology sessions a year is not enough for those with chronic conditions. Best practice for a lot of conditions is weekly, while some are fortnightly. These sessions may work well for those dealing with general stress and anxiety, but are burned through very quickly for those with higher needs. What do you do if you desperately need this treatment but can't afford to continue it? It's heartbreaking to say well you're just out of luck.
I have always been proud of Australia's medical system and what that says about our values as a country. Unfortunately, this is an area where we fall terribly short. It is election season and I implore you, if you are affected by mental health or love someone who is, please bring this up as something you care about and want to see change in.
