When I learned that Medicare funding for psychologist sessions had been reduced from 20 to 10 sessions, I was disappointed and angry, but not surprised.
Mental health has long been seen as somewhat non-essential and something to be hidden from polite society. It has been drastically underfunded compared to other health branches and psychology sessions remain one of the few health services capped on the number of appointments per year, instead of being based on the clinical needs of a client’s care team.
Although the pandemic has changed how we want to talk about mental health, it remains political football, with no one willing to take responsibility for skills training deficits and the lack of funding for therapy services.
When the Better Access program started, it allowed people to access 18 (12 + six in exceptional circumstances) sessions per year. This matched research which found that most psychological disorders required between 13 and 18 sessions for treatment to be effective. These sessions were capped at 10 in 2011 and remained at that number until Covid hit.
The 10 additional sessions were introduced by the former government in the midst of the pandemic in 2020. These sessions were widely attended. Many of my clients have found that they no longer have to ration their funded sessions, allowing them to progress better. One session every six to eight weeks is only enough to keep someone in a waiting pattern, and will not lead to significant progress.
A cap of 10 sessions is completely insufficient for the most serious mental health conditions, including trauma, substance use difficulties, neurodevelopmental disorders, psychosis, bipolar disorders or personality disorders . For families where more than one person needs care, the cost of privately funded sessions will be enormous. For those who cannot access care and whose condition deteriorates, the long-term social, psychological and economic costs will be enormous. The clients most in need of support are also typically those struggling to work or study due to mental health and are therefore the most unable to fund sessions without the discount.
Although we have a public mental health system, it is currently resourced primarily to treat the most serious disorders and provide acute care.
If we treated heart problems the same way we treat mental health, we would turn someone away with high cholesterol and other risk factors and ask them to come back once they had a cardiac arrest. We would offer them funding to see a specialist to manage their cholesterol, but we would cap that regardless of any complications or co-morbidities. Once they had a cardiac arrest, we offered to bandage them, but then we would unload them.
There simply aren’t enough clinicians to go around and the lack of Commonwealth funding for postgraduate places in psychiatry and psychology means this bottleneck in supply will persist. While politicians continue to talk about the importance of mental health funding, there seems to be little recognition of the urgency of increasing training places for professionals.
Now that those sessions have been cut, I worry about my clients. Psychologists across the country discussed ways to help clients manage this, including letting people know upfront if they need more than 10 sessions, spreading out sessions, working in increments, and considering referrals to community services. We are very aware of the cost of psychological services and we are concerned for those who do not have access to the care they need. We will no doubt absorb some costs and offer sliding scale pricing to some, but if we did this for every client, our longevity in the profession would be in jeopardy.
The decision to reduce these sessions is not in line with health policy. This decision is also not based on sound long-term economic policy, as untreated mental health issues significantly affect productivity. Although it was justified by stating that this decision was made to enable more people to access services, in reality, instead of underserving some (largely due to decades of poorly worded), it appears to have been deemed best to under-serve the most, and focus on short-term cost savings, at the expense of the longer-term health and well-being of Australians.
I’ve been on both sides of the couch. When I was a young psychology undergraduate in my early twenties, I held a part-time minimum wage administrative position and also participated in weekly trauma therapy for several years. When I exhausted my 10 Medicare sessions for the year, I paid about 40% of my after-tax salary for the therapy. Although I didn’t blame my excellent psychologist for a penny of the money I paid her, I was only able to afford it because I had no dependents. I am aware that many of my clients hold different positions and will not be able to pay my fees. We will have some difficult decisions to make in the months to come.
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