Better access to psychological treatments through Medicare: Rejoinder to Carey, Rickwood and Baker

The inclusion of evidence-based psychological interventions within Medicare through Better Access addresses an inequity within the Australian health system against people with mental disorders. The question of "Who is qualified to provide these services" is the overriding focus of many commentaries on Better Access within psychology. Carey et al. (2009) argue for examination of the Medicare data to answer this question. We show that Carey et al. (2009) fail to clarify if and how the Medicare data could be used to answer the questions they put and that the reasons for the current eligibility requirements within the Medicare Benefits Schedule are transparent, justifiable and responsible. The preoccupation with within-profession distinctions is counterproductive because it distracts from a proper examination of the impact of Better Access on mental health care in Australia. Research dollars need to be directed to questions that most directly affect the quality of care, such as how can interventions under Better Access be delivered appropriately according to best practice, improve access and equity for everyone and be most cost efficient? Given the current policy agenda in primary care favouring integrated, multidisciplinary models of care, these questions are the critical ones for the future direction of Better Access.