As a counsellor and therapist specialising in pornography use problems, these are questions I am asked often. Both men and women contact me seeking help, either for themselves or their partners, around use of pornography and dating websites. Sometimes they are concerned or convinced there is a mental health or medical condition involved and want to take advantage of the Australian Medicare rebate for psychology consultations. So I thought I should explain how the Medicare rebate works and under what circumstances this and other forms of health insurance are available.
The Better Access to Mental Health Care initiative was introduced to improve outcomes for people with a clinically-diagnosed mental disorder through evidence-based treatment. As a Mental Health Social Worker, I have been assessed and accredited as having specialist mental health expertise to provide this treatment (selected psychiatrists, GPs, psychologists and occupational therapists work are also working in similar ways under the same programme). Medicare has specific criteria used to determine who is eligible to receive these sessions. You need to first be diagnosed as having a mental health disorder and generally this diagnosis is done by a GP or occasionally a psychiatrist. Your GP will complete a ‘mental health care plan’ for you and you can then access up to 10 sessions of focussed psychological strategies (individual therapy sessions) per calendar year meeting me in-person or with another mental health professional*.
Can I be Diagnosed with Addiction to Pornography or Dating Websites?
According to the World Health Organisation, ‘disorder’ is not an exact term…
…but used to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder…
(source: http://www.who.int/classifications/icd/en/bluebook.pdf)
Despite popular ideas about the existence of ‘porn addiction’, there is no such diagnosis of pornography addiction in the current International Classification of Mental and Behavioural Disorders (within the ICD-10) used by Australian medical practitioners and the British NHS*. This is the manual Australian doctors use to determine their diagnosis under Medicare’s Better Access programme. There is also no diagnosis of ‘pornography addiction’ or ‘sex addiction‘ in the DSM V – the Diagnostic and Statistical Manual of Mental Disorders used by American Psychiatric Association. So technically a GP cannot give you a diagnosis of ‘addiction to pornography’ that will permit you access to Medicare rebates or health insurance for psychological services. (If you want to purchase either of these manuals, click the links to take you to Amazon).
However, my own professional experience is that many people presenting with concerns about what they believe is excessive use of pornography or dating sites will eventually be diagnosed with a particular mental health condition provided they see a GP. Often the diagnosis they receive will be a form of depression or anxiety (or a combination of both), diagnoses related to grief or loss, mood disorders (e.g. bipolar), post-traumatic stress (e.g. PTSD) or adjustment disorders. Very occasionally it could be a form of sexual dysfunction not caused by organic disorder or disease. These kinds of conditions are often present alongside relationship difficulties, work stress, sleep difficulties, domestic violence or a particular physical illness or health condition.
In other words, it’s important to remember that your access to the Medicare rebate may hinge on whether the doctor considers you have an underlying mental health condition rather than how often you are using dating websites or what kinds of pornography you are using and when. Some people look at pornography regularly and do not report any disturbance to their mental well-being. But patterns around the use of sexual images and even sex itself can be a response to psychological difficulties a person is experiencing. Men, particularly, talk to me about their use of the Internet as a way to escape from anger, stress, boredom, shameful feelings or thoughts of inadequacy. People can use sex as a way to avoid sadness or distract from the emotional pain of separation or even a coping strategy when work, a relationship or loneliness is overwhelming them. Some build up a reliance on the Internet or using sexually explicit adult websites which ends up in sleepless nights, arguments with partners, downloading banned material or many wasted hours and time lost at the expense of other priorities. If internet dating or porn websites have started causing you problems, it can be a sign that all is not well with your mental health.
Getting Help for Depression, Anxiety or Other Problems Associated with Using Dating Sites or Porn Addiction
If you are in Sydney, or can travel from other parts of Australia, you can meet with me in person to discuss your concerns. The first step is to contact me, and sending an email is best although you are welcome to call and leave a message. If you think you might have depression or anxiety, an adjustment disorder or another mental health condition, you can either meet with your own GP or I can refer you to competent local medical practitioners in inner Sydney. If you are an Australian resident and meeting with your regular GP, ask for referral to me under the ‘Better Access’ programme. The doctor will generally ask you some questions to ensure your symptoms are appropriate for the referral and then complete what is called a ‘mental health care plan’ for you. What I require at the first appointment is a letter of referral from your GP. This can either be addressed to me or ‘The Mental Health Professional’. Some GPs have existing relationships with other mental health social workers or psychologists, but it is your choice who you see. Unfortunately I cannot meet with you without a referral letter so it is best to ask for it to be addressed to me personally or the generic ‘Mental Health Professional’. Ask the doctor to give you the letter (don’t mail it to me, give it to me in person at the first session). My address for the referral letter is:
Ash Rehn (private and confidential)
PO Box 199
Erskineville NSW 2043
Provided you meet the criteria for the Better Access programme, have been referred and not used all your 10 sessions for the calendar year, Medicare will provide you a rebate that will cover part of the cost of the consultation. To find out more about my fees, please contact me and let me know you are interested in an in-person appointment in Sydney.
If you don’t live in Sydney, cannot travel or simply prefer to meet online over webcam, telephone or through email counselling, we can meet online. Unfortunately, at this stage Medicare does not offer rebates for online counselling or therapy appointments. But many people prefer the privacy and convenience of meeting online. And of course for some people it can feel a lot easier to discuss these kinds of sexual problems online. Take a look at my online counselling and therapy options for more information about the services I offer.
Health Insurance Rebates for Pornography ‘Addiction’ or ‘Sex Addiction’
Once again, as neither Pornography Addiction nor Sex Addiction are officially acknowledged as mental health disorders, health insurers will generally not pay for treatment specifically for these concerns. However they may be satisfied if the appointment was ‘psychology services’. Whether or not your health insurer will pay towards the sessions depends on the insurer. I generally do not mind who pays for the sessions but require payment at the time of the appointment. You will need to discuss payment with your health insurer in advance if you want to be sure. I can provide you a receipt to show you have paid for the sessions but cannot guarantee that your insurer will pay. Some of my clients – both online and in-person consultation – prefer to keep their sessions ‘off the record’. The advantages of not requiring a rebate for private therapy and counselling include:
- It’s much easier to get an appointment. You don’t need a doctor’s referral or to meet the eligibility criteria;
- I will work collaboratively with you and can be flexible to your circumstances. If you go through the healthcare system, the system determines how many sessions you receive and when your treatment is over;
- Funding through both Medicare and health insurers is limited to certain psychological approaches and strategies. You may not find these meet your needs or take your preferences into account. For example, Medicare does not fund relationship counselling, yet many of my clients seek assistance for their relationships and this may require a course of sessions in itself.
How Can a Medicare Provider Help Someone who is Using Porn or Sex as a Response to Mental Health Problems?
Once again, it’s important to stress that using pornography or sexual activity is not necessarily a mental health issue in itself. But if you are having severe mood problems, suicidal thoughts or destructive thoughts, chronic depression or disabling anxiety, and your porn-watching or sexual behaviour is making these worse, it is time to get help.
The focussed psychological strategies that Medicare Providers use include,
- Psycho-education, including Motivational Interviewing
- Cognitive behaviour therapy (CBT) including: behavioural intervention, behaviour modification, exposure techniques, activity scheduling
- Cognitive interventions and cognitive therapy
- Relaxation Strategies (such as progressive muscle relaxation and controlled breathing)
- Skills training and
- Narrative Therapy
Taking the first step is often the hardest and it gets easier after that. The people who consult with me tell me they are glad they made the decision to get help and the first session was much easier than they imagined. So if you have been thinking about doing something positive for your mental health, stop delaying and make contact now. It is the first step towards feeling better.
For more information get in touch with me either by email or phone.
*This information is correct at the time of posting this article.