Speaking on radio earlier this month about mental health and the Better Access scheme, the federal Health Minister Mark Butler stated that people in rural and regional areas were not being supported by psychologists, which was one of their driving factors for the government cutting the Medicare psychology sessions from 20 to 10 in 2023.
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We know the pandemic, and now the cost-of-living crisis has significantly impacted the mental health of many Australians, and those who were already doing it tough are not faring any better, including those living in the regions.
Data from October 2023 showed that 21.5 per cent of Australians had a 12-month mental disorder, with anxiety being the most common; and that 42.9 per cent of people aged 16-85 years had experienced a mental disorder at some time in their life.
The cuts did not magically create more psychologists for people to be able to access. Psychologists in the regions who already had waitlists, still have waitlists.
The decision to halve the number of subsidised sessions immediately reduced access and affordability to those who needed these services the most.
The minister stated he did not believe the Better Access program was the right program to assess and treat those with complex mental health needs.
Many clients of psychologists seek help for what appears on the surface to be something of lower need, however by taking their history, building a relationship and properly assessing their needs - we come to understand there are often deeper issues, like family violence, sexual assault, mood disorders or chronic stress, to name a few common presentations.
It is these people who now have rationed services, and 19 months on from the federal government's Better Access review, no new supports have been created or announced.
This review found that: "overwhelmingly, participants experienced good outcomes from their Better Access care. The self-rated mental health of 91 per cent of all participants improved. A majority attributed this improvement - at least in part - to the treatment they received from the mental health professional," it said.
In other words, what is needed is more sessions and better affordability.
In this same interview, Mark Butler cast doubt that raising the Medicare rebate for psychologists was going to do anything for the population, or if it would "line the pockets of psychologists". The Medicare rebate is for the client, not the psychologist.
More psychologists would like to offer bulk billing, but bulk billing rates do not cover the cost of providing expert mental health care. This is why there is a gap fee.
The government tripled the bulk billing incentive for GPs in acknowledgement of the chronic underfunding of Medicare, yet lifesaving psychological care is still out of reach for the most vulnerable.
Let's spell it out. The bulk billing rate for the majority of clients accessing a psychologist is only $93.35. Out of this $93.35, psychologists need to provide a welcoming clinic space, amenities, office supplies, utilities, administration staff, software, insurance, registration costs, tax, professional resources, mandated annual training, development and supervision.
This is before even considering a wage to put food on our own tables. Few people understand the preparation and unpaid time that goes into each hour of client treatment time.
The cost of psychology sessions has risen, as has the cost of all businesses, services and living costs and yet Medicare rebates have not risen in line with CPI/inflation. The minister has stated previously that his number one priority is to increase GP bulk billing.
Why is the work of mental health professionals valued less than that of GPs? Mental health should be of equal importance as physical health.
Increasing the bulk billing rebate to $150 for all psychologists would mean that clients would not have to pay a significant gap fee, and psychologists would be able to provide expert mental health care to help people live full and productive lives.
People in need are missing out on vital mental health care. We don't force people to ration the care they receive for their physical health. In 2024, why is there such a devaluing of people's mental health and wellbeing?
- Carly Dober is a director of the Australian Association of Psychologists.