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Diagnostics, Testing, Doctors and Specialists

The right diagnosis can be incredibly liberating and empowering. The wrong diagnosis can be debilitating and hope destroying. Although counsellors are non-diagnostic, I work with psychologists, psychiatrists and other health specialists to assist with a diagnosis and management where I see it might help.

I have concerns about mental health approaches that involve little diagnosis/short diagnosis timeframes without medical history and short relationship with the client combined with lots of drugs.

I’m not anti-drugs but do feel they are often over-prescribed or wrongly prescribed due to a mental health care system that is under pressure. Or sometimes the side effects of drugs can be better managed through nutritional support and other allied health assistance. I see many clients who heal within counselling from having experienced a rough time in the medical system and feel hopeless.

I also believe that there is often a tailored psycho-nutritional pathway that can complement or in some cases replace a drug approach. This may include dietary changes and/or supplements where there may be a deficiency from poor diet or a genetic or absorption issue.

Let’s face it, very few people eat every day 2x cups of different coloured vegetables (some organic, especially those gas ripened or sprayed with chemicals); 2 x fruits, free-range and grass-fed meats and whole-grain complex carbohydrates. And even that isn’t completely right for some people e.g someone with ADHD who eats fruits high in salicylates may still react OR a thyroid patient eating too many soy products and goitrogen vegetables can feel anxious because these foods may affect the absorption of their thyroid meds.

As a general rule, a lot of vitamins and supplements are ‘expensive pee’, but tailored formulas or protocols, based on diagnostics (that may not be mainstream and Medicare-funded) and interpreted by trained integrative, orthomolecular doctors or nutritionists, dietitians and Naturopaths, is not the same as reading ‘Dr Google’ and going to the local chemist and buying a handful of vitamins!

With many nutritional supplements, individual results vary greatly due to genetics, quality of supplements, how it is taken and what other supplements or medicines it is combined with. Some medics dispute the validity of nutritional supplements and many research studies can’t take into account this level of individual variance, but that doesn’t mean there isn’t a role for tailored supplementation and dietary modification.

Read this case study in my articles for an example: “It may not be all in your mind”

As part of your mental health treatment, I look at psycho-nutrition and may be able to provide advice of further testing with your GP or recommend GPs who I know understand mental health issues well. Sometimes I can make some initial nutritional and supplement suggestions but if complex will suggest referral to other allied health professionals.

What I like to see in a GP or allied health specialist is a holistic approach (or sometimes an open mind and the willingness to work with other specialists is enough) taking into account lifestyle factors. The more highly trained to understand the gut-microbiome combined with some understanding of how epi-genetics is playing a role in diagnosis and tailored natural medicine, the higher on my preferred referral list.

If you are an integrative /orthomolecular/environmental medicine or specialist mental health GP, please feel free to contact me so I can gain an understanding of how you work with a view to referral of clients. If you are a client of someone who works in this way and have had good results, please also let me know.

Health Fund advice

If you decide to use a psycho-nutrition approach (instead of OR in conjunction with medical prescriptions such as SSRI antidepressants), many services are not rebated, but some health funds might cover some things.

You’ll have to decide if you will go with a medical GP with a specialty (a Medicare rebate will apply, but there is usually a gap) OR a naturopath/nutritionist/dietician and then check with your health fund what they cover. Recent changes to private health now excludes naturopathy (albeit short-sighted!), however, some funds still cover nutritionists and dietitians, so this may be a rebate avenue. If you don’t have private health, call them and ask for an indication of what you need to budget for treatment.

Health fund claims – check if the nutritionist/dietitian/specialist is registered with your health fund and what category e.g Dietitian. If they are an integrative GP, a small portion of their fee will be covered by Medicare but not usually covered by private health.

Sometimes funds require specific wording on a receipt/invoice such as “Individual Nutrition/Diet Consultation” but won’t pay up on words like “Health Assessment” or “Health Diagnostic/Test. As far as I know, few funds will cover tests that are not covered by Medicare, which unfortunately are diagnostics often used by integrative specialists.

This is where you might have out-of pocket expenses. Call your fund and find out exactly what they do and don’t pay up on and advise your practitioner in advance to see if they are happy to specifically word your invoice.

If you have private script rebates, compounded scripts are often covered but ask for the script to be named something like Bioceutical or Methylation Formula and NOT Vitamin Capsules! If you can avoid the printing of the ingredients on the official pharmacy receipt, ask if they will not include the list of vitamin ingredients.

You may also like to ring your health fund to check that the compounding pharmacy you intend to use is registered with them. There are many loopholes and hoops to jump through that health funds use to when assessing claims that are not ‘straight forward’. Interrogate them (most calls are recorded) and you may need to be prepared to challenge a claim not paid and request a reissued invoice from your practitioner worded in a specific way.

Mental Health Care Plan, Private Health Or Un-rebated Counselling

At present, Counsellors, even Clinical Level which I am, are not eligible to be providers under the Federal Government’s Better Access Scheme which provides a medicare number allowing clients to receive a rebate under a Mental Health Care Plan (if you disagree I suggest you lobby to your local member to have clinical counsellors added to the Better Access Scheme!). However, I am registered with a number of Private Health Funds and it usually doesn’t cost more to see me than a Psychologist and you don’t need a Mental Health Care Plan.

As a clinical level counsellor, I am registered with the Private Health Funds my Registration body has negotiated arrangements with. Depending on your Extras cover, I am registered with BUPA, Medibank Private, AHM, AHRG (encompasses Police, Emergency Services, CUA, Phoenix Health, St Lukes’s Health). Ring them to find out what you are covered for under your policy.

Due to increasing mental health concerns such as the Queensland mental health crisis, psychologists and psychiatrists are often heavily booked with long waiting lists and most charge over the scheduled fee, so you will still have an out-of-pocket expense of $100 or more, so it does not often cost more to see me.

Here are some things to consider if you and your GP are deciding if you need a Medicare rebateable Mental Health Care Plan:

If you are seeking a formal mental health diagnosis (Yes a plan is ideal)
If you are seeking medication or review of medication (Yes a plan is ideal)
The complexity and seriousness of the issue and threat to life and/or major impaired function to daily life (Yes a plan is ideal and a medical model diagnostic and assessment-based approach)
You have concerns about a Mental Health Care Plan appearing on your medical record (You may benefit talking to a counsellor not under a Mental Health Care Plan which appears on your medicare record)
The presenting issue is to manage stress, anxiety, relationships, communication, trauma recovery, grief and loss, vocational considerations, life and stress management, parenting, life transitions, gain insight into self, access other interventions other than those just specified by medicare (NO – you don’t need a mental health care plan)
You have a diagnosis and are seeking management and coping skills or perhaps you’ve had a bad experience with the medical model/Psych approach to therapy or have not connected with previous therapeutic approaches (No you don’t need a Mental Health Care Plan and it might be worth trying counselling which is non-diagnostic/non-assessment based).