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Psychologists say many mentally ill Australians are missing out on adequate care or cutting back on treatment six months after the government halved the number of psychology sessions people can access through Medicare.

President of the Australian Clinical Psychology Association Caroline Hunt said psychologists were needing to have “very difficult conversations” with people who were getting to the end of their subsidised 10 sessions for the year and could no longer afford treatment.

There is a gap in mental health services for people who need more than 10 psychology sessions but don’t need hospital admission.Credit: AP

She said people with post-traumatic stress disorder, obsessive compulsive disorder, persistent depression, schizophrenia and bipolar needed more than those 10 hours of treatment for it to make a difference to their lives.

“We have been waiting since the end of 2022 for advice from government on care options for these patients with more complex conditions and we are now nearing a crisis point,” she said.

Health Minister Mark Butler was criticised last December when he cut the number of Medicare-covered psychology sessions from 20 to 10 a year, ending a COVID measure introduced by the former Coalition government.

A review of the system found the additional sessions had clogged up services for new patients and were used more in wealthier parts of the country, but recommended keeping them for people with complex mental health needs – which the government did not do.

Butler said the 20 sessions policy had meant tens of thousands of people were shut out of care, including the most vulnerable. He said government data showed 64,000 additional people were able to access treatment in the first quarter of this year, after the policy ended, compared to 2022.

“Tens of thousands more Australians have been able to get in to see a psychologist compared to the same time last year,” Butler said.

However, Hunt said cutting the sessions hadn’t addressed the equity problem because people who could afford to pay out-of-pocket were able to continue treatment when their subsidies ended. “You do get this bias to people getting care in higher economic areas.”

Melbourne clinical psychologist David Hallford said bulk-billed patients, which represent about 30 per cent of those using Medicare rebates for psychologists, were the most affected. “The patients who are more able and affluent can continue with care, but the people who rely on bulk billing are left with very few options,” he said.

“People are holding off on treatment, or saying they’ll come back to it next year, but we know if people don’t get appropriate treatment their condition will worsen, or if they have residual symptoms – which many will after 10 sessions – they will relapse. It’s the equivalent of giving people half a course of antibiotics.”

Australian Psychological Society president Catriona Davis-McCabe said the result was a “merry-go-round of under-treated patients stuck in the system longer than [if they] had simply received their full treatment dose in one year and returned to health”.

“In a cost-of-living crisis patients shouldn’t have to choose between paying for their treatment and other essentials. It typically takes patients longer than 10 hours of treatment for common issues like major depression or the loss of a loved one, and the government needs to follow the evidence or risk falling further behind international standards.”

Australian Association of Psychologists executive director Tegan Carrison said she was often asked by members what services they could recommend to clients who need additional sessions. “Unfortunately options outside of Medicare are few and far between,” she said.

The “missing middle” – referring to a gap in services for people who need more than 10 psychology sessions, but don’t need hospital admission – was identified by a 2020 Productivity Commission report into reforming Australia’s mental health system.

Butler said the government was determined to strengthen the mental health system, and had laid the groundwork for reform in the May budget with a $93 million workforce investment.

“We are committed to … making sure those most needing support have the access they need and deserve. This work is underway, in consultation with the sector, and we will provide further detail in coming months,” he said.

The government is also establishing 61 Head to Health mental health service hubs across the country, which offer free walk-in support for people with moderate to severe mental health needs.

The Coalition’s policy is to reintroduce the 20 sessions. “There has been an unprecedented rise in Australians reporting mental health problems and the persistent escalation in the cost of living is causing more Australians to struggle with the mental strain of just getting by,” said MP Melissa McIntosh.

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