Exemptions to the telehealth "12-month rule" in areas of natural disasters
Patients in areas affected by natural disasters are now exempt from the existing relationship ("12-month rule") requirement for telehealth. This means patients don’t need to have had a face-to-face consult with a GP in the last 12 months to access MBS subsidised telehealth services.
A person is exempt from the "12-month rule” if, at the time of accessing a telehealth service, they are living in a local government area that is declared by a State or Territory Government to be a natural disaster area.
Update to Continued Dispensing Arrangements – Emergency measures
From 4 February 2025 to 31 March 2025, a temporary Pharmaceutical Benefits Scheme (PBS) Continued Dispensing Emergency Measure has been put in place to support people affected by the flooding disaster in Far North Queensland and Tropical Cyclone Alfred to continue to access their PBS subsidised medicines.
This PBS Continued Dispensing Emergency Measure will support access to a wider range of PBS medicines than under ongoing Continued Dispensing arrangements, covering most medicines on the General Schedule of the PBS. For further information, please see the Pharmaceutical Benefits Scheme Continued Dispensing arrangements webpage.
Who may be affected by disasters?
A variety of people may be directly or indirectly exposed to disasters and their reactions may range from acute distress to denial and disbelief. Such shocking experiences may have an immediate impact on some, leading to acute and ongoing severe distress. Others may experience a temporary shutting off of feelings, revealing little external response. There is no right or wrong way to respond. Making sure people are physically safe, listening and comforting them are basic responses for general practitioners.
Experiences range from those with the most direct exposure to the disaster, to those with contact only through what they have seen on the media; both groups may be affected. Most people recover from such traumatic events but if distress continues people may need professional assessment, and possibly intervention. Those who seek help from a health professional will most often first present to a GP.
What are normal reactions?
Distress, denial and disbelief are common reactions people may show for days and sometimes up to weeks after a disaster. In the initial hours and days, people may be stunned and dazed, particularly in response to a sudden and devastating disaster.
The first consultation
The most important provisions in the first hours to the first weeks after a disaster are safety, comfort and the support of family and/or friends.
GPs should ensure their impacted patients are safe and have the support of family members, friends and the community.
During the first consultation with an impacted patient, GPs are advised to:
1. Listen, comfort and quietly accept information
- Offer help and comfort.
- Be quietly responsive.
- Some people may be helped by talking, for others talking may make it more difficult or, it may not be the right time. Let the individual guide you.
- Identify support systems of family, friends and local community groups.
- Remember the special things in families that may be important, e.g. pets.
2. Ensure survival, safety and security
A stunned mental state can leave people relatively unaware of their own safety and vulnerability.
A brief medical assessment allows:
- Assessment of physical injuries
- A review of changes to pre-existing physical and mental health conditions
- Time for contact and talk
- Gives reassurance and shows interest. Provision of a safe place to stay is important. If very concerned about someone's mental health, talk to a mental health professional.
3. Orient towards goals
Trauma and grief can leave a sense of chaos and fear. Activities that can help patients regain a sense of structure include:
- Basic routines (meals etc)
- An early follow-up appointment at 1 month and again if concerns at 3 months
- Being in the company of others until the acute distress/denial subsides (hours to days)
- Show patients things they can do themselves towards recovery
- Practical tasks and everyday routines are helpful.
The main issues for patients in your initial consultation are fear, grief and loss, and dislocation.
It is common to experience grief and trauma after a disaster.
Feeling dislocated from one’s home and environment, due to the loss of a house or neighbourhood, are factors that can lead to ongoing distress.
Common themes that patients might express are:
- Difficulty falling and remaining asleep
- Anxiety
- Uncertainty about the future and what they can do to feel safe, supported and happy again
- Disruption to normal routines and patterns of life adding to uncertainty
- Irritability, anger and frustration can be common
There are ways to help people reengage with the practical aspects of their lives, including:
- Linking to others such as family, friends and neighbours. This could be done directly, through social media, or any other channels that work best for them.
- Getting the best sources of information, including local radio and newspapers, media and call centres.
- Helping people call upon their own personal strengths that they have used in the past or in difficult situations (everyone has these). This is a very powerful part of getting better.
Who is at greater risk?
It is important to identify those at greater risk of problems in the early weeks, months, or over a longer time. These include groups with the following experiences:
- Belief that they were about to die
- Loss of a loved one
- Pre-existing and chronic health problems
- Lack of support systems or connections
- Very severe or disabling injury
- Exposure to multiple deaths or injuries of others
- Pre-existing vulnerabilities including socioeconomic disadvantage
Vulnerable groups may include Aboriginal and Torres Strait Islander people, refugees, children, the elderly and single parents.
When is referral needed?
Specialist help may be needed after one month if a person:
- Still feels upset, very teary, or fearful most of the time
- Has changed behaviour compared to before the trauma
- Can't function in normal activities
- Has worsening relationship issues.
- Is overusing or abusing substances
- Feels jumpy or disturbed sleep
- Is dwelling on the event
- Is unable to enjoy life; numbness or withdrawal
- Is experiencing overwhelming grief that prevents functioning,
GPs should feel confident to assess and refer on for specialist mental health treatment those patients with persisting symptoms that disrupt daily functioning after the disaster.
Major psychiatric syndromes following disaster or trauma
- Major depression
- Major anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Substance abuse
- Major behavioural change
- Psychosomatic complaints
- Panic disorder
Note that these may co-occur with physical health problems and that both should be assessed and managed.
‘Normal’ responses of children to disaster or trauma
- Withdrawn, quiet
- Whiny, irritable, angry
- Headaches, stomach aches
- Regression to younger behaviours- thumb sucking, bedwetting, baby talk
- Clinginess
- Over reactions to minor hurts, physical and emotional
- Behavioural problems
- Acting out.
If a child is so acutely distressed and unable to function continuing beyond the first week then an assessment by a mental health professional is required.
See this from the Australian Childhood Foundation
Mental health resources
External mental health resources are available to support community and self in the wake of traumatic events: