TMS or Transcranial Magnetic Stimulation has been found to be an effective treatment for depression and has been used to treat thousands of patients worldwide that don't respond to conventional interventions.

I am very excited that the government has announced that Medicare will be adding TMS to the Medicare Benefits Schedule. From 1st of November, rTMS will be added allowing eligible patients access to subsidised Medicare rebates for rTMS treatments.

The Department of Health has stated the following guidelines-

rTMS Medicare rebates will be available for eligible adults with medication resistant major depressive disorder who have tried at least two different classes of antidepressant medicines but remain unwell. Eligible patients will receive an initial course of up to 35 rTMS treatment sessions.. In addition if a patient has responded positively to the initial treatment course but has subsequently relapsed, a retreatment course of up to 15 sessions will be available on the MBS,

The Medicare rebate will be available to patients who have not previously undertaken a course of rTMS treatment services. Medicare rebates will be available for one course of treatment and one course of retreatment services over a patients lifetime. 

The purpose of this petition is to draw as many peoples attention to the limitations surrounding the proposed addition of rTMS to the MBS and to fight for a review before it is too late. As the changes are due to come into effect in November this is an urgent issue.

My name is Olivia Bugiera and I firstly want to acknowledge the hard work Hon Greg Hunt MP has put in to fight for funding towards mental health. What he has done for our nation is genuinely amazing.  

I am  a mother, wife and individual with huge concerns surrounding the limitations of the proposed addition of rTMS to the MBS. I have seen the statement from the Department of Health and whilst I appreciate that the government is dedicating a great deal of money to rTMS, mental health and treatment resistant depression. I feel confident this money will be repaid in returning individuals (and to an extent their families and carers) back to contributing members of society and ease the burden on Medicare.

I feel drawing as many peoples attention to my story and the anecdotal evidence I have witnessed leading to change is pivotal for the funding to work in the way intended. Below I outline my story and why I think it is important for depression sufferers that meet a revised criteria access to more sessions of rTMS-particularly for maintenance.

Last year alone I cost medicare over $12k and I believe a year of rTMS partially funded by MBS will cost the government far less, cost me more but make it affordable and convenient so I can stay with my family, return to some sense of normality and free up a bed for someone more acute than me. Unfortunately, the funding for rTMS will not help our family nor many other people who need it that I know at this stage.

I was diagnosed with Bipolar eight years ago after the birth of my first biological child (becoming manic) and the more years that passed the more complex, treatment resistant and debilitating my illness has become. I am married and we have five children (three that were a bonus when I met my husband 13 years ago) ages 23, 20, 15, 8 and 3. We sure have been tested in our wedding vows in sickness and in health. We have the support of NDIS which has been beyond helpful.

The last three years have been my most challenging since the birth of my three-year-old son triggering a difficult to manage manic episode followed by ongoing, treatment resistant, depressive episodes complicated with difficult to treat mania. Since then, I have trialled every combination of medications under the sun, had 26 rounds of ECT that has left me cognitively impaired and impacted on my short-term, working and long-term memory and had countless hospital stays, often for months at a time. Losing my Dad to Early Onset Alzheimer’s and my experience with ECT have been the biggest traumas of my life. These pale in comparison to the friends I have made over the years. I have spent so much time away from my family unit including during covid19 lockdown when I was not allowed to see the children or even walk the hospital grounds for fresh air for 2.5 months. This cycle of mania to depression with the absence of normal mood has continued for me without relief. The impact on our family unit has been and continues to be absolutely devastating.

I have gone from an insightful, creative, intelligent, caring, hard-working, passionate midwife, mother and wife with two university degrees to a person who is a drain on my family, friends and society.      

rTMS has changed my life. I received my first round of 30 sessions over 30 days at the start of this year at a hospital 1.5 hours away from my home. The first five weeks after discharge in addition to some of my stay in hospital I felt well. This was such a relief, and I could not have been happier to find a treatment that works for me. I began to participate in my household, see friends and access the community. Words cannot describe just how enjoyable a normal mood felt.

Unfortunately, the treatment didn’t hold, and I returned to hospital in a desperately depressed state. I then received a further 20 sessions over 20 days with the recommended ongoing treatment plan from my psychiatrist being weekly sessions for an indefinite period. The problem for us lies in the expense (at $180 per session as an outpatient) and needs to be weighed up against hospital admissions taking me from my family but are covered by our health insurance. This is further complicated because there are no inpatient facilities where we live We are a single income family and my husband’s income is above the threshold for me to qualify for DSP yet we are barely staying afloat as is. I have already missed three years of my children’s childhood and lost my profession as a midwife. I feel like if I could receive the MBS funded sessions at the frequency assessed for my individual complex mood disorder the flow on effect to me and my family would be so great, and I may be able to return to some form of paid employment. As it stands, I won’t be eligible for any and I know the clinical director of psychiatry at the hospital I go to has recommended weekly sessions indefinitely.

I am pleading with you to use my story to explain the ongoing need for rTMS for some people and to reconsider the proposed funding model, as there are people who need indefinite support in order to fully participate in society. It does not mean it has not worked-it just means they need an on-going treatment regime individualised to the person to remain well. I am pleading with you to reassess the access restrictions surrounding the item numbers and allow the individuals own psychiatrist the ability to assess and develop a treatment plan based on the clinical picture and the individual’s response. I ask you why should an individual be denied ongoing treatment that improves their quality of life? A diabetic isn’t denied ongoing treatment or insulin because they aren’t able to stabilise their blood sugars. I may require more treatments and not hold my mood for what has been deemed the acceptable time frame (which after the initial maintenance period is forever) but for the time I do gives me the strength to continue fighting this chronic and debilitating disease.

Over the years in hospital, I have met hundreds of inspirational and very unwell people with similar stories to tell. I know when rTMS works for an individual the length of time it works for varies so much but I have met so many people that either need regular maintenance on an individualised treatment plan or are well for a long time but eventually relapse and need the full treatment course to become well again. Hopefully there are people in the community that recover but I believe that whilst remission or stability is possible, a cure is not.      

I will be forever grateful to Professor Paul Fitzgerald and Dr Ted Cassidy for their leading research and advocacy and wonder what his recommendations were to the Department of Health. I am also thankful to all the doctors that have stood by me to try and treat my difficult illness.

I want to make it clear that the proposed item numbers is of a huge concern to this nation and I strongly believe the proposed item numbers whilst a start will cost the government far more than if a revision could be attended to. The factors I have considered with a revision are not just personal and the cost to Medicare, but savings then passed on to NDIS, DSP and Carer’s payments. Furthermore, the positive impact on individual's lifelong wellbeing and health, the flow on effects of this and  the benefits to society as a whole would be astronomical.

I feel passionately about this and I start this petition not just for me but for my children’s future and others that have already lost so much through mental illness.  

If you have read to the end-thankyou. If you could forward it to as many people as possible, I would appreciate it. If you could ask the people that choose to forward it to do so asking others to forward it that would be amazing. Let's make change! I am only one voice with very little power, but I think my voice deserves to be heard.

Stay safe or as I like to say stay soapy and warmest regards,

Olivia Bugiera.