How often have you heard someone say the following phrase (or even said so yourself):
“Once I’ve sorted everything else out, then I’ll focus on my mental health”?
Take this first scenario: You are a university student who is responding in the most natural way to the stressful conditions around you and your mental health takes a dip in the not-so-sunny side. Your options? You can see a psychologist with obscenely expensive fees and an inane waiting list, attempt to find help online (“You’re not alone!” Which means we’re all suffering!”), or wait until the situation gets incredibly dire and you find yourself in an inpatient hospital setting. It is easier to just ignore this whole issue altogether, you say to yourself — there are more pressing concerns to deal with.
Now here is our second scenario: You wake up with a UTI, but your regular GP is all booked out for the day. Your next best options are to call around and try to find another GP who can see you ASAP, or you’re doomed to face the emergency department for the rest of the day when you know that all you need is that script for an antibiotic.
Of course, the Australian government is well aware of the gaps in treatment between these extremes in both scenarios. What was their response in the 2024-2025 financial budget? For your physical health concerns, they have invested $227 million to add 29 more bulk-billed urgent care clinics (free of cost if you have a Medicare card), with a rapid open date of July 15th in Belmore and Green Square so far.
For your mental health concerns, the new budget shows promise. Over the next four years, plans are being made for an early intervention service to connect all individuals with support before their distress escalates, free walk-in mental health centres, and funding for Primary Health Networks allocated between allied health supports and general practices for improved team care coordination.
These are some significant steps forward — in particular, issues regarding accessibility and the importance of early intervention are being recognised and tackled — but the problems that Australians are facing are far larger than a simple walk-in can address. Anybody who has dabbled even the tiniest bit in Australia’s mental healthcare system knows that these initiatives are nowhere near the investment required to achieve long-term reform. The system is so overstretched in that it is mostly only able to deal with crises through the public sector, essentially requiring patients to be actively suicidal in order to access care. Even at this point, care is hastily herded back to GPs and private psychologists. The most effective treatments exist in this private sphere, but the biggest barrier to such is undeniably the cost of those services.
The Australian Psychological Society currently suggests a 45-60 minute consultation to be priced around $311. This unsustainable cost leaves the next best option for most people is to visit their GP for a Mental Health Care Plan, and under the Better Access initiative you are able to receive 10 rebated sessions with a psychologist. However, the plan itself is costly with the Medicare rebate only covering $99.70, and the out-of-pocket fee running you around $100. The same goes for the session with the psychologist itself: the rebate covers roughly $93, and with 10 sessions the gap fee is sure to accumulate, at least, to a thousand dollars.
At the most basic level, there is simply not enough funding to allow the average Australian to see a psychologist regularly. Combined with increasing rent prices and the ever-present cost of living crisis, mental health is essentially what you could call a ‘rich man’s problem’. Not to mention, it is precisely those with lower income levels who need mental health services more, whereas it is the more well off that tend to access them easier. Such stems from the inequalities of low-income communities’ social, economic, and physical environments and their associated issues (e.g. limited resources, lack of housing, hunger etc.) that all contribute to compounded stressors that are less prevalent in higher socioeconomic groups.
Accessibility aside, there are further issues regarding availability – 10 sessions is nowhere near enough to treat any serious issues with the necessary depth, trapping those who are not in a financially secure enough position to continue to shell out on full private fees. While this may suggest that the short-term mental health care plans are better suited to those with more mild issues, an evaluation of the Better Access initiative revealed that brief psychotherapies may be ineffective for individuals with less severe mental health issues, and in many cases, even cause deterioration. A large part of such is that mental health services are often fragmented, with inadequate integration and coordination. The Victorian mental health royal commission identified in 2021 that the current options are mostly focused on crisis management, and as reported by the National Association of Practising Psychiatrists, this still hasn’t improved in 2024 – there is a profound lack of targets on long-term support, preventative care, and a necessary focus on social determinants of mental health that require larger systemic reform.
According to the Australian Institute of Health and Welfare, most Australians consult a GP for mental health, rather than mental health professionals. This then begs the question — how beneficial is the Better Access scheme which itself hinges upon having a referral to a psychologist?
The new budget falls short in its attempts to bridge the gap in mental healthcare by alleviating some pressure off GPs — there is no point modernising the healthcare system if there are not enough mental health trained professionals to work in these new locations. The Australian Psychological Society reported that 25% of psychologists are 55 or older, the largest workforce shortfall of any mental health profession. However, there is no shortage in demand for a profession in psychology at all. Psychology is incredibly popular as an undergraduate course, but is subject to a high bottleneck across all Australian universities due to the extreme competitiveness of postgraduate degrees, a necessary qualification to become a practising psychologist.
Postgraduate psychology training is incredibly costly to run — firstly on account of the requirement for high clinical supervision and secondly, due to placement costs, thereby limiting the number of spots available. As outlined by the Psychology Training and Public Health Workforce Alliance, universities have also resorted to reducing Commonwealth-supported places in favour of full-fee spots, running a student $35,000 a year. This affordability barrier itself greatly impacts student diversity, and does not measure up to expectations to continually develop a culturally representative sector that is able to respond and engage with the intricate and multifaceted needs of Australian society.
As for the individuals who do become qualified as psychologists, there is a massive (and understandable) preference to immediately go into higher-paying private practice. The alternatives of bulk-billing leave a meagre $15-20 of pay per hour, and public health roles are typically also bypassed for similar reasons. Such a lack of funding once again diminishes the general public’s access to community mental health services, which theoretically, should exist as the backbone of care.
The additions to Australia’s current mental health care system that will be delivered across the next four years are a positive step forward in reducing the gap in mental healthcare, but it is clear that more extensive foundations are required to ensure longevity and more meaningful change to the everyday Australian. Additional funding and evaluation of current systems in all aspects is prudent from the reachability of the Better Access scheme, to the increased training of psychology students. Besides, what use is there to have extra shiny rooms without the trained professionals to staff them?
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