The Age
When Treasurer Jim Chalmers delivers his second budget on May 9 many will no doubt be closely monitoring the federal government’s level of commitment to mental health.
It is evident that, post-pandemic, demand for the services of psychologists, psychiatrists and mental health nurses remains greater than the system can comfortably support and that many Australians are likely missing out on the care we have come to expect as their right. Health Minister Mark Butler has said he wants to make the system more equitable, but we are yet to hear much detail on the path forward: a situation the budget may address adequately — or not.
As we have noted previously, with concern, an increasing number of Australians are finding the cost of accessing mental health help to be a barrier, and that support of any kind — especially psychiatric — can be hard to find in the first place, particularly for those living in remote communities, or even major regional centres, with months-long waiting lists for consultations for non-critical conditions.
On-call services from organisations such as Beyond Blue and Lifeline provide an invaluable safety net to those in crisis but managing mental health long term can often require years-long intervention from medical professionals.
At particular risk, as federal health reporter Natassia Chrysanthos writes this week, are those Australians whose condition is not acute enough to warrant admission to hospital but requires many more sessions with a psychologist than the 10 currently part-funded by the government, delivered after consultation with a GP under a mental health plan. In its report on the sector in 2020, the Productivity Commission described this cohort as the “missing middle”.
The number of Medicare-funded sessions was doubled to 20 during the pandemic by the Morrison government amid a spike in lockdown-triggered anxiety disorders but was controversially reverted back to the previous allowance in January despite ferocious lobbying from peak bodies.
Mental health experts such as Matt Berriman, chair of Mental Health Australia, said the decision would affect many vulnerable people who would no longer be able to afford care, arguing that the pandemic was still lingering as a mental health burden. To justify the decision, Butler cited an independent review of the program by Melbourne University experts who found the scheme had unfairly favoured wealthy Australians and had not significantly improved overall access to mental health services. There is something in this. A 2020 study by the Grattan Institute found that Medicare spends about 40 per cent more per person on the mental health of people who live in wealthy areas compared to people who live in low-income areas.
In mid-2022, meantime, the Australian Psychological Society found that a third of psychologists were unable to take new patients “due to overwhelming demand”; compared to 1 in 100 prior to the pandemic. It subsequently noted in its recent pre-budget submission there was a “a critical shortage” of psychologists, with the current workforce meeting only 35 per cent of the national demand for mental health services.
This is not a particularly new state of affairs. A parliamentary inquiry back in 2006 found that even then access to psychiatrists in particular was “very limited”, with private psychiatrists “largely inaccessible” as few bulk-billed. Most public psychiatrists, meantime, had no time “to deal with the high-prevalence disorders such as anxiety, depression, personality disorders and drug abuse, in the main treating the individually very demanding schizo-affective range of disorders”.
A psychiatrist representing the AMA told the Senate Select Committee on Mental Health at the time, “It is common talk at any psychiatry meeting you go to where you talk to colleagues — everyone is booked out. How can you keep seeing patients? You cannot… You just cannot keep adding on patients and working into the night.″
So while The Age continues to call on the government to re-think its decision to end access to the additional sessions — for reasons that are obvious given the ongoing burden, both psychological and economic, of the pandemic — it is also apparent that the Morrison initiative was a stop-gap measure delivered in a time of crisis that did not necessarily improve the overall delivery of mental health care. The evidence suggests stronger demand led to increased wait times and some practitioners closing their books to new clients; in other words it revealed underlying structural issues that must now be addressed.
What else could be done? Suggestions worth considering include granting a Medicare rebate to those visiting provisional - not-yet-qualified - psychologists and raising the overall rebate to make sessions cheaper out of pocket. The fundamental issue, though, still remains too few qualified practitioners for too many would-be patients, which requires a better training pipeline, as many are urging.
This is the challenge that faces the Albanese government, and it is not one that is easily addressed — government gross debt just hit a record $911.8 billion. But come the May budget we should all expect to see they have made a start down the road. Given the strides we have taken as a nation in recent years to highlight the importance of mental health, to reduce the stigma around seeking care and to encourage discussion of everyday conditions such as anxiety and depression, it would be a terrible failure if we were then unable to continue to follow through with the necessary support.
Patrick Elligett sends an exclusive newsletter to subscribers each week.