FAQ

How do I make an appointment?

To see a Psychiatrist at our Centre, please see your GP and obtain a referral. The GP referral letter needs to be sent to us by fax (07 3319 6862) or e-mail ([email protected]). Please make sure that your contact details on the referral letter are up to date. Once we receive your referral, we will contact you to make an appointment. The same process needs to be followed for Telepsychiatry i.e. video-consultations.

Fee

Norman Park Specialist Centre does not provide “bulk billed” services. Fees for various doctors vary, so please contact us to enquire about fees. 

No Show/Cancellation Policy
If you are unable to attend an appointment, please call us or email us and re-book at least 48hrs before your appointment. All late bookings and missed appointments will incur an out-of-pocket fee.
What is Medicare Safety Net?

As in 2021, after an individual or family has spent $2184.00 in out-of-pocket fees ($647.00 if you are a concession card holder or family receiving family tax benefit (A)) in a calendar year, the Government Medicare Safety Net will pay 80% of your out-of-pocket costs for out-patient medical services (including appointments with psychiatrists). Once you reach the threshold for out-of-pocket fee, this will significantly reduce the costs of seeing a psychiatrist. Though you will still pay for appointments, Medicare will refund 80% of your costs. The threshold amounts are set each year from 1 January.

To receive this benefit, you must be registered for the safety net (either as an individual or family). You might have already registered for the Medicare safety net. For more information regarding the Medicare safety net or to register for the Medicare safety net, visit https://www.humanservices.gov.au/individuals/services/medicare/medicare-safety-net

What about emergency/ out-of-hours?
Norman Park Specialist Centre offers routine consultations only. For emergencies, please visit your local Emergency Department or dial 000.
How long do consultations with Psychiatrists last?
New consultations with psychiatrists last about 45 minutes, depending on complexity of the case. In this consultation, initial diagnosis and management plan are discussed. Subsequent visits are scheduled as per individual requirement.
Do you see people for on-going treatment?

Yes. The Centre is recovery-oriented and dedicated to providing continuous treatment for all stages of the journey towards full recovery.

What is Psychiatry? What is the difference between a Psychiatrist and a Psychologist?
Psychiatry is a branch of medical science about the study of the mind and its function. It aims to treat and minimise psychological suffering and develop a meaningful and rewarding life. Psychiatrists are medical doctors who specialise in the diagnosis and treatment of mental health issues with medications and therapy. Psychologists are professionals who are specialised in range of therapy techniques for mental health issues. Often Psychiatrists and Psychologists work in collaboration to help patients.
What about medications, blood tests, scans etc.?
As medical doctors, Psychiatrists at our Centre can order and review diagnostic tests, prescribe psychiatric medication taking into consideration individual’s physical health and limitations and provide continuing care in acute, stabilisation and rehabilitation phases of care delivery. If in discussion with the treating psychiatrist it is felt that additional input is required from other professionals i.e. therapists, neurologist etc, appropriate referrals can be made.
What is the role of Medications in Psychiatry?

The aim of using medication in psychiatry is to achieve an overall reduction in distress. Better understanding of brain function has resulted in more effective, better tolerated and targeted treatment, though the scope to improve effectiveness and minimise undesirable effects remains. Medications in their effectiveness are aided immensely by suitable therapy.

Do I need to take medications to help with my difficulties?
Not all disorders or difficulties in life need medications or respond to medications. There might be better ways to treat certain disorders i.e by therapy, relaxation techniques, problem solving strategies, exercise, dietary changes etc. Psychiatrists are trained to first evaluate the need for medication and advice any other strategies that might be more beneficial.

What are the ethical aspects of prescribing?
As in any other form of treatment the individual is required to give “informed consent”. This means agreeing to accept the medication after a proper discussion. The basis of ethical prescribing is the psychiatrist’s comprehensive knowledge of risk and benefits of psychiatric medications which is based on adequate training and experience in evidence-based practice. Any fears or doubts about prescribed medication should be discussed with the psychiatrist unreservedly. A collaborative doctor-patient relationship is essential for necessary exchange of information and joint decision making. The therapeutic partnership between the individual and the psychiatrist gives the best framework for medication management.

When are medications used?
Psychiatrists consider the long term and short term risks and benefits, as well as alternative treatments and therapies before prescribing or changing medications. A lot of research, trialling and data gathering from practical use have gone into developing evidence based guidelines in prescribing these medications. Psychiatrists make use of these internationally accepted guidelines and personal skill and experience to decide what to prescribe. The choice of a particular medication for a particular person will depend on many factors such as the diagnosis, medication history, previous response and side effects, current life circumstances, physical condition and any other medication taken concurrently.

How are doses decided and optimised?
Based on comprehensive assessment and diagnosis, doses are decided based on clinical guidelines and experience of the Psychiatrist. Careful dose titration is essential to achieve the best balance of benefit with minimum side effects. After stabilisation of acute symptoms, the aim is to maintain the relief from distress and improve functionality and quality of life. Response to medications, side effects and interaction with other medication need to be monitored regularly. A plethora of factors affect response to treatment. In general earlier initiation of treatment by medication &/or therapy predicts better outcome and quality of life

What about side effects?
As in any other form of treatment, psychiatric medications have undesirable effects which need to be minimised. This is done by careful assessment and skilful prescribing. It is important for the individual to talk to his or her Psychiatrist about how they feel on any particular medication and if they are having side effects so this can be looked into. As psychiatric medications work on various groups of receptors in the brain and body, side effects arise due to them affecting many other receptors co-laterally apart from the beneficial ones. It is important that medications produce enough improvement in symptoms and general well being to warrant the unpleasant side effects that may occur. Each person is unique in the distribution and density of neuro-receptors in the brain and body, so the extent of side effects from medications is different for each person. Many individuals experience no side effect or minor tolerable side effects in exchange of immense benefit.

What are the types of medications in psychiatry?
Medications in psychiatry are commonly grouped under antidepressants, mood stabilisers, antipsychotics, anxiolytics, hypnotics, stimulants and cognitive enhancers, though many medications have multiple indications and use. Each class of medication predominantly works on certain set of receptors and have unique action profile and side effects. For effective treatment psychiatric medications need to be taken regularly to achieve therapeutic levels in the body, cross the blood brain barrier and effectively target areas in brain for benefit.

Why am I not benefiting from medications?
A number of factors can contribute to poor response to treatment. First of all the need for and the effectiveness of medication needs to be reviewed! Are you prescribed the right combination of medication at the right dosage for you? Taking medications every day is a chore and requires dedication but taking them regularly is important in maintaining adequate levels in the body. Other issues that need looking at are concurrent stressful social and interpersonal circumstances, alcohol and substance use, personality factors and physical health. Many a times there are issues from the past which still affect people and do not allow them to relax, have rewarding relationships and sometimes even to go about day-to-day life. There are excellent therapies to address these psychological aspects of treatment in psychiatry and can be combined with medications to provide relief from distress and improve one’s quality of life

What is the role of Therapy in Psychiatry?

There has been tremendous research and refinement in psychological therapies in their variety and effectiveness. Overall benefit depends on various intrinsic and extrinsic factors. There are many kinds of talking therapies which therapists use to help individuals deal with their difficulties. Therapists can choose components of various therapies to achieve desired outcomes based on their training and experience, and assessment and need of individuals accessing therapy. Many kinds of therapies are practised in Australia i.e. Cognitive Behavioural Therapy (CBT), Acceptance Commitment Therapy (ACT), Dynamic Therapy etc. We have made a brief description of some therapies in the following paragraphs.

Cognitive Behavioural Therapy (CBT):
CBT is an evidence-based, structured, here and now practical approach to treating a wide range of psychiatric conditions such as anxiety, depression, phobias, PTSD, OCD,  eating disorders, substance use problems, to name a few. CBT has also been shown to be an effective adjunctive treatment to medication in serious mental disorders like bipolar disorder and schizophrenia.

In CBT, both the therapist and the client work together to solve problems, to remedy errors in thinking, change unhelpful thinking styles, emotions and actions to more helpful ways of thinking, reacting, coping and doing things. Thus, it is a ‘here and now’ approach which looks at identifying and working on the impact of our thoughts and feelings on our behaviour.

CBT uses different protocols for different problems and relies on active participation of both client and the therapist in treating the underlying condition. The number of sessions vary between 6 and 18 for one course of CBT. The gap between any two sessions can be anywhere between 1-3 weeks, depending upon the condition being treated. As it is a highly structured talking therapy, it involves the client and therapist agreeing on regular assignments for the client to complete prior to attending the next session. CBT is usually a one-to-one therapy, but it is also suited to be delivered as a group therapy.

Acceptance and Commitment Therapy:
Officially pronounced as the word “act” and not as the initials A-C-T is a type of contextual cognitive behavioural therapy with a significant existential component to the model. It is also popular as the “third wave CBT” ( after behaviour therapy and cognitive therapy). The aim of ACT is for an individual to be able to live, rich, full and meaningful life, with the willingness to make room for the pain that inevitably goes with it, a process called increasing ones ‘Psychological Flexibility’. Thus, the goal of ACT is not to get rid of your symptoms, but to change the relationship with your symptoms for ever so that they don’t hold you back.

Research evidence suggests that ACT is effective for a wide range of conditions including depression, anxiety, stress, chronic pain, borderline personality disorder, PTSD, substance use, schizophrenia,  weight management, smoking cessation, and diabetes.

ACT therapists help their clients learn powerful techniques and skills to deal with painful and difficult emotions, thoughts, memories and urges. Some of the techniques are Mindfulness, Cognitive Defusion, Acceptance, use of metaphors, values-guided path, and taking committed action. It refutes the notion that clients are broken and need to be fixed, but believes in the principle of people being just stuck but not broken. A core component of ACT is Mindfulness. Clients are made familiar with different levels of mindfulness skills. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Eastern philosophy though the version taught in ACT does not involve any religious or metaphysical ideas.

A single ACT session typically lasts 50 minutes to 1 hour, but it can be shorter or longer depending upon the target problem. The number of sessions are not fixed as ACT can be delivered both as a brief therapy as well as time-limited short therapy similar to traditional CBT.

Dielectical Behavioural Therapy (DBT):
DBT is an empirically-supported (meaning well researched in clinical trials) psychological therapy for people with borderline or emotionally unstable personality, especially those with self-harming behaviour or recurrent suicidal thoughts, urges or attempts.  People with borderline personality often have difficulties controlling their emotions or experience intense negative emotions. Sometimes, due to the effect of genes, some brains are simply “hard wired” to experience such emotions, but certain type of childhood trauma such as emotional or physical abuse may also lead to changes in the brain making it vulnerable to experience strong emotions, where in, the individual could be feeling happy one moment and angry and sad the next. Apart from this ’emotional dysregulation’, one other thing which DBT believes is related to the development of problems seen in people with borderline personality is ‘invalidating environment’, that is, experiencing an emotionally unstable childhood environment, e.g., caregivers dismissing your emotions as incorrect or trivialising them , childhood trauma, severe invalidation as in physical or sexual abuse, etc.

Clients enrolled in DBT typically receive three modes of treatment-individual therapy, skills group and telephone coaching. Each individual therapy session is once a week one hour session, but sometimes longer. The clients are required to attend the two-hour weekly skills group for one year. The group sessions involve work on four modules-Emotional regulation, Distress tolerance, Mindfulness, and Interpersonal effectiveness. DBT has been evaluated to be one of the best treatments for borderline personality disorder.

Dynamic Therapy:
Dynamic therapy is one of the many types of therapies derived from the work of Sigmund Freud in the late nineteenth century. Since then it has evolved greatly with many types of dynamic oriented therapies e.g. interpersonal therapy, brief focussed dynamic therapy etc. The core commonality of all dynamic therapies is the importance on internal world, the unconscious (aspects of ourselves out of our conscious awareness), psychological defence mechanisms, and interpretation of these. Dynamic therapy is based on the assumption that symptoms individuals present with, such as depression, anxiety etc, are expressions of internal unconscious conflicts. Such painful hidden conflicts are thought to originate in early life experiences. Psychological defence mechanisms (ways of thinking, interpreting or behaving in certain set of circumstances) which individuals develop to deal with inner conflict and pain serve to contain the distress initially, but become limiting and counter-productive when circumstances change. Dynamic therapists help individuals to understand and gain insight into their difficulties by interpreting the link between their behaviour and their unconscious feelings. Some ways to do this are to look at developmental origins of a person’s difficulties, exploring underlying conflicts and mal-adaptive defence mechanisms and identifying recurring patterns in relationships. Such strategies help individuals gain insight into their difficulties and develop ability to minimise emotional pain for a better life.