Cross Post: Halving Subsidised Psychology Appoints is a Grave Mistake—Young Australians Will Bear a Significant Burden 

Written by Dr Daniel D’Hotman, DPhil student studying mental health and ethics at the Oxford Uehiro Centre

The original version of this article was published in the Sydney Morning Herald

Unprecedented times called for unprecedented measures. COVID-19 was the most significant health crisis many of us had ever faced. While the physical effects were much discussed, the mental health burden was arguably just as devastating. In response, the previous Government doubled subsidised mental health appointments under the Better Access Program, allowing Australians suffering from mental illnesses like anxiety, PTSD and depression to claim an extra 10 appointments per year.

Now we are trying to convince ourselves COVID-19 and its impacts are over. In addition to requiring referrals for some PCR tests, the Australian Government is cutting the number of mental health visits available under Medicare to pre-pandemic levels, arguing this is a necessary step to improve equity. According to a review of the program, extra appointments clogged up waitlists and reduced access for those not engaging with services.

But halving subsidised mental health appointments is misguided. Australians need more mental health services right now, not fewer. Cutting services risks potentially disastrous consequences for those in care, harming mental health, increasing suffering and suicide, and resulting in economic costs through reduced productivity.

Most people can’t afford to pay exorbitant private bills and fork out $200 for a psychology appointment when prices of everything else are going up—from rent and mortgage repayments to food and fuel. Mental health appointments will be the first cost cut in many budgets. Ironically, good mental health is what people need to deal with these difficult times. Mental illness dampens labour market participation, hampering the ability of Australians to accumulate human capital—via education and work experience—to thrive in the economy.

Concerningly, this burden will fall disproportionally on the shoulders of young people, who are already struggling under cost-of-living pressures and sluggish wage growth. Almost 40 percent of young Australians reported a mental health condition last year. Untreated mental illness amongst young people results in undue suffering and sharpens the risk of youth suicide—a devastating tragedy endured by too many communities.

Community mental health services play a critical role in reducing the burden of mental illness. And many Australians suffering from mental illness have significantly benefitted from the extra psychology and allied health services under the temporary program. According to the Australian Psychological Association President Tamara Cavenett, a proponent of the 20 sessions per year, “There is really strong evidence that around 18 to 20 sessions is what’s required for even someone who’s experiencing a mild mental illness.” The Royal Australian College of General Practitioners also supported extending the extra sessions.

This fact was recognised by the very review the Government is now trumpeting. The review noted that the number of people who used at least one extra session “has not been insubstantial”—17 percent in 2021 and 14 percent in the first half of 2022. It recommended maintaining the subsidised appointments at 20 per year, with the extra 10 sessions targeted at those with more complex health needs based on a review by GPs.

What did the Government do? Ignore the expert review and scrap the extra 10 sessions.

It’s true that access to psychologists is a problem—particularly in regional and low-income communities. This wouldn’t be a shock to many Australians. One in three psychologists have closed their books and aren’t accepting new patients. For those who are seeing new patients, there are long waiting lists. But the answer to access concerns for some should not be cutting services for those who desperately need more care.

We need a smarter approach to this crisis that addresses the root causes of poor access. This should start with a campaign to aggressively increase the numbers of psychologists and other mental health professionals, through a mix of incentives, training, and investment. One no-regrets move would be resolving a bottleneck in final-year university placements by providing the same funding for psychology as that received by medicine. Cavenett claims this could double the number of psychologists in a few years.

Of course, training new mental health professionals takes time. In the short term, the Government could target overseas psychologists for streamlined migration streams—the Australian Labor Government likes to say that it is busting the congestion in visa applications, so let’s turn this effort to mental health professionals. It could also do more to fund community mental health and suicide hotlines. These aren’t perfect solutions, but they do valuable work to provide crisis support to those in need.

Finally, if the Government is concerned about equity, then it should get creative to close the access gap in regional and low-income communities. Psychologists could receive incentive payments to move to these areas with their families—as we do for doctors. Perhaps emergency funding could be allocated with higher payments to psychologists willing to work out of hours and weekends in these areas.

The mental health crisis is not going away any time soon. We need to increase our commitment to mental health in this country. The Government is right to focus on access and equity, but it can’t do so at a cost to those who need more treatment now.