Success of the ATAPS program
Article by Helen Tang, Psychologist

Under ATAPS, eligible consumers have access to 12 sessions per year with a registered psychologist, at no cost to the consumer. Eligible consumers are either low income earners who cannot afford to pay the gap for services under the Better Access Program and / or are from a non-English cultural or language background.

Typical Consumer
While there is a list of mental health conditions that can be treated under ATAPS, there is no typical consumer per se. Each consumer is assessed during the initial session with the information gained used to construct an individualised case formulation. This formulation guides treatment.

I recall treating two consumers during the same 3 month period who, on paper, seemed to have the same condition. Yet the course of treatment was quite different despite the use of the common framework of cognitive behavioural therapy. Sarah* was a woman in her 60s, she was married, and had two adult children who were no longer living with her. Sarah presented for treatment as she had become the carer for her husband who recently had surgery. Julie* was a woman in her 30s, she was married, had three children (two of whom were under the age of 5), and she presented for treatment after her husband was injured in the workplace. Both women felt trapped within their marriage and were suffering from depression.

One of the core steps of the CBT treatment of depression is behavioural activation, in other words getting the consumer to engage in more activities, and a better balance of pleasant (eg. gardening, reading) versus unpleasant (eg. chores) activities. While this was a relatively easy task for Sarah as she had a few neglected hobbies that she could engage in, Julie’s parenting demands left her with sparse time for herself. Thus, part of Julie’s treatment involved improving her parenting skills such that she was less frustrated with her young children, creatively involving her children in her pleasant activities (eg. taking the children to the park), and increasing the rewards gained from everyday activities (eg. cooking meals that she enjoyed).

Another core step of the CBT treatment for depression is examining the cognitions that may be maintaining their depression. Consumers are taught to analyse their maladaptive beliefs, to examine the evidence for and against this belief, and to generate a realistic belief that is based on the available evidence. Sarah believed that her husband did not love her and she was considering leaving him.  By the end of treatment Sarah was able to acknowledge that her husband is not an emotionally expressive man, he watches TV most of the day because he likes sports, and his behaviour demonstrates that he does love her. Further, Sarah had unrealistic expectations of grand romantic gestures from her husband that he had never previously done and she had never told him that she wanted. At the end of treatment, Sarah was much happier in her marriage and had learnt to engage in activities that she wanted to do without the guilt that her husband was sitting at home watching TV.

Julie believed that she had ruined her life by marrying the wrong man, and was now trapped as she had young children and did not have the financial means to leave. By examining the evidence Julie was able to view her husband differently and to identify the positive aspects of her marriage as a starting point to improve the relationship. Thus, much of treatment was helping Julie to strengthen her relationship with her husband.

In addition to consumers such as Sarah and Julie, other consumers who I have treated under ATAPS include adolescents struggling with the stress of the HSC, problems in the relationship between adolescents and their parents, unemployed adults struggling with depression, women who have been victims of domestic violence or rape, and elderly widows grieving over the recent death of their husband of 50 years.

Under-utilised service
Despite the success stories, there remain a large number of potential consumers who are not being linked to available services. Registered psychologists are available to accept referrals from GPs who practice within the Canterbury LGA, with consumers typically booked in for their initial session within 2 weeks of first contact. This service is located within the Community Health Service Centre of Canterbury Hospital.

*Names changed

Helen Tang is a registered psychologist who has been treating consumers under ATAPS in the Canterbury LGA for the past 1.5 years. She holds a Bachelor of Psychology, Master of Psychology (Clinical), and has recently completed a PhD investigating the psychological impact of ostracism.