Expert psychology care now a luxury for the wealthy

This new year marks the halving of psychology sessions covered by the Medicare Better Access program to 10 and a severe stripping back of mental health services for Australians. Ten sessions will not treat many mental health issues. In fact, extensive international research tells us around one in 10 patients simply can’t improve with just 10 psychology sessions.

When people don’t get a system of care that puts patients first, when we don’t offer enough sessions, we find there are greater health, social and judicial costs in the long run.

Psychologists and our patients have been left reeling from these cuts to care and there are sobering realities waiting for some of our most unwell patients who will battle for the help they need in 2023.

Credit:Jozsef Benke

It is difficult to understand how a Labor government could engineer a policy that will ensure that only wealthy Australians can access a sufficient dose of evidence-based psychological therapy.

The cuts, from 20 Medicare rebated psychology sessions to 10, were delivered by Federal Health Minister Mark Butler, who ignored overall findings and recommendations in the Better Access Evaluation report produced by the University of Melbourne.

The report clearly recommends that “the additional 10 sessions should continue to be made available and should be targeted towards those with complex mental health needs”. It also states any alternative model needs to be delivered alongside the existing service.

Instead of continuing to offer Medicare-funded care to Australians with the greatest mental health needs, or announcing a stepped funding model, the new Labor government has slashed care for all. This move cannot be justified through a healthcare lens and the federal government seems comfortable reserving the highest-quality expert mental health care exclusively for the wealthy few who may be able to privately fund it.

The Better Access Evaluation report is based on eight separate studies. However, the minister has consistently focused on one study and ignored the trends in the other seven. This has seen the government try to sell the idea that those who received extra sessions did not have more severe symptoms and were somehow privileged. This is not reflected across the studies in the report. And it is certainly not the reality we see each day in our clinics.

To be clear, overall, the review found that people with more severe symptoms accessed more services. Furthermore, people with more severe symptoms showed the greatest symptom improvement. There is also data showing that people accessing Medicare for their psychological services were often experiencing financial hardship and consumers told the review panel they in fact, wanted more services.

Halving access to quality psychological care when we don’t have alternative care is shortsighted and puts the wellbeing of many Australians at risk.

These cuts won’t just mean reduced access to vital care; in some cases psychologists may have to turn away vulnerable patients with more complex mental health conditions because we know delivering only half the required treatment will not provide beneficial outcomes. This is an enormous ethical dilemma for mental health professionals.

The Australian Clinical Psychology Association took several workforce proposals to the Albanese government in its early days that intended to address waiting lists for psychology services and improve access to care for Australians. We proposed bolstering incentives to move clinicians to rural and regional Australia; providing stepped care models so people with the most complex need received the greatest care; adequately funding university postgraduate positions; and ensuring training opportunities for the next generation of psychologists.

The government’s move to apply a blanket cut to care is at odds with advice from all expert organisations within our profession and comes without acknowledgement of the many workforce and patient-access proposals put forward by experts in the field.

At the same time, some people are stepping forward advocating for more multi-disciplinary care. While team-based care is ideal for disorders such as eating disorders and early onset psychosis, it is not appropriate for the broader mental health spectrum. Previous Productivity Commission reports have shown it is not the optimal model for efficient psychological treatment. In terms of cost, Better Access is the most cost-effective model for providing psychological care.

The truth is that the current evaluation report indicates that Better Access works and works well for people with severe symptoms, that psychologists’ wait times are returning to pre-pandemic levels, and that, appropriately, people with more complex mental health issues were having the greatest number of sessions.

We know that Australians are coming out of a gruelling few years and are headed into another year where multiple life stressors are going to build on common but complex conditions like severe depression, anxiety and traumatic stress-related conditions.

The last time the minister cut sessions, in 2011, population data published in the Australian and New Zealand Journal of Psychiatry suggested the community suffered, and it is our fear more Australians will suffer again through 2023.

Removing a proven treatment option that is working for so many people is, quite simply, unacceptable, and early 2023 is the time for Prime Minister Anthony Albanese to intervene, restore the 20 sessions and ensure vital mental healthcare is available for all Australians.

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