How Do I Get a Referral For DS Under the Mental Health Scheme?

So, DS has some issues....his 3 yo kindy teacher has flagged him and suggested an OT might be helpful. From my research, it looks like it could be a sensory problem. So I've booked him in to see an OT for an assessment. The info from the OT suggested there may be funding available under the Mental Health Scheme and to see a GP for a referral.

So off we trot today to the GP. When I explain what's going on and ask her about whether the Mental Health Scheme might be an option, she looked at me as though I wanted to have my son committed and said something like, 'Im not diagnosing a little boy with a mental condition just so you can save a few bucks'!!! Seriously?! It was obvious she didn't think there was a thing wrong with him. Did I go about it wrongly? Did I ask for the wrong thing? Did I miss a step? What should I have done instead? Or, was she just rude and obnoxious (I can't say the words I'd like to)?

She also dismissed my concerns about DS having been sick and the suggestion from the community health nurse after his 3yo check up last week that he get checked for a uti. She didn't even look at him, despite me saying we were there for a check up. I didn't push it as I was so angry by this time and just wanted to get out of there!

For the record, DS hasn't seen a Dr since we moved to Perth, but he's been with me twice when I've seen this Dr before. We won't be returning.

Does anyone know if this plan is the right one and how to go about getting a GP to give us one? Is there any other funding we might be able to access? Should we have asked for a paed referral?

Sorry can't help but I'm very interested in the answer to this question! My son has been flagged for sensory issues and possible asd so if we can get funding for the pediatrician visit that would be massively helpful, I've heard they are super expensive. Hope someone stops in soon with an answer!

It's never okay for a medical professional to make you feel bad for asking the question! I'm sorry you were made to feel that way.


Medicare can cover the cost of things but the Dr does need to make a diagnosis or at least a tentative diagnosis of "something" so perhaps there is no appropriate diagnoses for your DS that will allow such a referral. It would be totally reasonable to ask the question again perhaps like "I was a bit confused last time, my understanding is that medicare can cover some OT sessions, am I mistaken? And is my DS eligible for that?"


The other option is that local community health centres often provide these services at a lower cost, and maybe you can access something that way for some screening at least. The maternal health nurse may also be able to advise??


I hate it how medicos make you feel stupid for asking questions, nothing should be out of bounds and if it was inappropriate that should have been explained rather than making such a judgement about you. :hug: I'd be going back to a different GP and trying again if u were you. Even if she is right, she s a right royal cow for treating you like that..

You weren't asking for a diagnosis, you were addressing his teacher's concerns. she had no right to make you feel that way.
We got a referral for an OT with an enhanced primary care plan, because ds has poor fine motor skills and his prep teacher was concerned. Try that, but not with that doctor, obviously. You didn't do anything wrong.

A health care plan is what a DR can write to give you 5 subsidised sessions thru what ever allied health etc is needed. My GP wrote one for my DS1 for speech pathology. And I know others who have had them for OT, counsellors, psycologists, dieticians.

Probably issue was you asking for a mental health scheme, but NO way should they have been so rude and horrible.

Hope you get help soon.

Thanks ladies. I did ask if maybe I'd gotten the name wrong, if there was another source of assistance, or if there was additional information she needed, but I think she tuned out after I asked the first time. Still really peeved, and the more I think about it, the more unhappy with her manner I am. DH saw a dr in another practice that he was happy with, so we might go there next time. Feeling really nervous and anxious about how I might be treated now though - I was shaking and felt sick by the time I left yesterday. DH said to tell them I've had a bad experience when I book, and to book in person so I can ask questions and see the place (which I did here. The original Dr I was seeing was great, but has just gone on maternity leave :().

Regardless, DS will still see the OT next week.

That dr was very rude, what you needed to ask for is an EPC (enhanced primary care) plan. As Feeb mentioned, you then get 5 sessions at nominated specialists, this can be at a reduced rate or some are free.

i had one for my DS. 1 session was for audiology (free) and 4 went on speech (reduced rate). I also had one for DD1 and used 5 on OT (reduced rate per session)

Copied from the Department of Health and Ageing...

Enhanced Primary Care (EPC) care planning items were removed from the Medicare Benefits Schedule in 2005 and replaced by the Chronic Disease Management (CDM) items (721 -732). The term 'EPC plan' is now obsolete.

CDM doesn't apply to DS either...

Hey Hun

Are you referring to the 'Better Access' Initiative? Not sure if its the same thing you are talking about or it's different. But if you google that you should get some helpful info.
Yes, a GP does need to make some sort of diagnosis for the referral (out daughter's is Separation Anxiety) so that may be perhaps tricky for your little one just yet. However definitely get all your courage together and grab DH and go and see another GP. It can be very overwhelming speaking about this sort of stuff with a GP and trying to explain everything to them, but hopefully you can find a good understanding doctor (they do exist but can be rare to find!) somewhere.
All the best.

Hey Hun

Are you referring to the 'Better Access' Initiative? Not sure if its the same thing you are talking about or it's different. But if you google that you should get some helpful info.
Yes, a GP does need to make some sort of diagnosis for the referral (out daughter's is Separation Anxiety) so that may be perhaps tricky for your little one just yet. However definitely get all your courage together and grab DH and go and see another GP. It can be very overwhelming speaking about this sort of stuff with a GP and trying to explain everything to them, but hopefully you can find a good understanding doctor (they do exist but can be rare to find!) somewhere.
All the best.

I have been on the diagnosis rollercoaster for years with ds, so I can sympathise. Some medical professionals just have no idea and can be REALLY insensitive. I would suggest you keep at it and move GPs if necessary. An EPC referral doesn't mean the GP has to sell their soul or make a diagnosis in the truest sense (like ASD for example). They really can say that the patient has "fine motor difficulties" or "possible sensory issues" or something like that. I have used EPCs for the past 3 years for ds and have had different GPs write them (one didn't even request to see him!). All I can say is just keep going - early intervention is absolutely everything! Shades I will PM you - can you clear out your inbox?

We ended up seeing a second GP, who was at least a little more sensitive than the first! He still didn't see anything wrong with DS (be amuse he has such great language skills and prefers adult company, so of course was chatty and happy at the dr's!). He said we just have to 'tough out' the sleep issues, that all kids develop differently and have different strengths and weaknesses and that there int anything we can do about his anxieties (he'll grow out of them). But, he I'd say it all very nicely at least :)

So we went off to the OT in Friday and paid out of our own pocket. What an eye opening experience. Yes, DS does have sensory processing issues, and yes, she can help with strategies so that we can help him cope better (and he can learn to cope better as he gets older). So glad we went, and although it's quite expensive, we feel its well worth it at this stage. We got a little back through PHI too.

*As an aside, DS let DH wash his hair tonight (water only) for the first time in three months! And he went down a slippery slide today with no one holding his hand or needing to talk him through it! These are huge things for DS :) :dance:

I've just come across this thread. Urgh ... some GPs are painful, in the extreme. My GP is bemused by SPD - she reckons nearly all kids have some SPD issues, it's "just a phase" that so many are being diagnosed. Nonetheless, she helped us with a referral. My DS2 has SPD. Short story is since he was approx 18 months his behaviour at home is extremely challenging. Meltdowns and tanties when he gets frustrated, can't make something "work" to his specifications etc. You can't ask him to do one single thing without it escalating into a drama. But he's a bloomin' angel at daycare - they (quote) wish all kids were like him!! And I'm not a pushover parent, so I know I'm not 100pc to blame, lol.

Anyway, the upshot is I went to my GP and explained this to her - I wanted a referral to an OT to get to the bottom of whatever was going on. She worked out a mental health plan for DS2 under the umbrella of sensory processing disorder. It gave us 10 Mediare rebatable sessions with an OT. Subsequent to that, we've since been able to access an EPA ... EPC, sorry I forget the exact title of it. It gives us a further 5 sessions of Medicare-rebatable OT sessions. He had to be assessed by the nurse at my GP's clinic in order to get the additional sessions/plan.

OTs are so expensive - I had no idea until we started going. And we've found that with DS2, it's not just a matter of a few sessions and that's it. It's at least a fortnightly (give or take) appointment, plus follow up at home. DS2 is starting to improve - his issues affect his problem solving ability (hence, meltdowns when he can't fix/do something), plus we're getting help with his rather fast engine speed - how to slow it down so he'll listen to us etc. It's all an eye opener, so hopefully you get lots out of it. But re: the mental health plan, there's no reason in the wide world that a GP shouldn't sign you up to one (in my opinion, anyway).

AndiE - I tend to agree...yes, most kids (and adults) can have SPD tendencies, but then, most people have one or more indicators of ASD, ADD and any number of other issues. Not all kids have trouble functioning in their environment though, and that's why I asked for help!

At the moment, we can afford some OT sessions, but this may change in the future. In which case I'll push for some Medicare funded sessions.

Not sure if it's the same all around, but with the ecp we get $50 back from medicare. Luckily we found a lovely OT who only charges $150 (and she came to the school and talked to ds' teacher about her concerns before evaluating him in the classroom) but the first one I called was asking $350 for the initial consult. So it's worth ringing around.
GL

Our paed was the same about SPD AndiE. That was frustrating, because I was more interested in the SPD diagnosis than the ADHD. I wanted that under control - at least to try get that under control - before we went further with the ADHD diagnosis.
No matter what we did for her SPD though. nothing was working for the lack of concentration & I had to go the other way :(

When I was first referred to the OT with DD, we were under an EPC Plan - 5 sessions. The initial assessment cost about $250. I don't think that was covered by the EPC though :/ After that I paid the amount minus the EPC, then received money back from medicare. In total I was out of pocket about $20 for each session from memory.

Once there is a diagnosis you can get the Mental Health Care Plan. Pretty sure its 12 sessions a year under the MHCP. My GP was able to give me those, but still only after I had paed diagnosis.