This article originally appeared on News GP and is republished with permission.
Researchers have identified a growing income-related divide in patients’ ability to access timely mental health care, with high out-of-pocket costs preventing many from following through with their mental health treatment plans.
The study used de-identified tax and Medicare data to explore 5.4 million Australians who received a GP mental health treatment plan between 2014–23.
Researchers explored whether these patients went on to receive Medicare-subsidised psychotherapy within three months, including services delivered by eligible psychologists, social workers and occupational therapists.
Income-related inequity was found to be substantial.
‘By 2023, only 32% of low-income children and 40% of low-income adults accessed psychotherapy within three months of receiving a mental health treatment plan, compared with 55% among both high-income children and adults,’ the authors wrote.
They ruled out changes in complexity of mental health disorders and the introduction of telehealth services as key drivers.
Data showed that real out-of-pocket costs for both children and adults more than doubled over the past decade. For children, the average cost per session rose from approximately $44 to around $90 in 2023, while for adults, it increased from $35 to $80.
‘The rise in out-of-pocket costs is due to the increase in fees charged by psychologists (up by 12% over the period of analysis) and only moderate increases in the Medicare subsidy (of 1.3% over the same period),’ authors wrote.
‘Mirroring this trend, the share of zero-fee services declined substantially, from 44% to 17% for children, and from 50% to 23% for adults.
‘These patterns suggest that financial barriers to accessing care have intensified over time, disproportionately affecting lower-income individuals.
‘While subsidies such as those under Australia’s Better Access initiative are intended to make psychotherapy more affordable, our findings show that average out-of-pocket costs have more than doubled over the past decade.’
The Australian Psychological Society suggests fees for 2026–27 has the standard 46 to 60-minute consultation fee at $330. However, the Medicare rebate is $149.05 for a clinical psychologist and $101.55 for a general psychologist.
‘This does not imply that the subsidies are ineffective, but rather reflects that provider fees have risen faster than the Medicare rebate. As a result, the subsidy covers a smaller proportion of the recommended session fee over time, contributing to rising out-of-pocket costs.’
The results back data from the Australian Bureau of Statistics’ 2024–25 Patient Experience Survey, which found around one in four people who needed to see a psychologist reported delaying or going without care because of the cost.
Chair of RACGP Specific Interests Psychological Medicine Dr Karen Spielman said this important study reflects a reality seen by many GPs.
‘It is heartbreaking to see it so clearly presented in this research – certainly I have been fearful of this for many years,’ she told newsGP.
‘It is a really important paper, and the discussion and conclusion raises really valid points and offers thoughtful solutions.’
While the delayed or forfeited mental health care appointments might put pressure back on general practice, Dr Spielman said many GPs are interested, trained and happy to work in this space.
‘But there are many barriers,’ she noted, ‘including time and cost, system fragmentation and of course financial disincentives for GPs and their patients to provide longer appointments’.
When examining use of antidepressants, lower-income individuals were found to be increasingly reliant on medication without psychotherapy, relative to higher-income individuals.
‘This suggests a shift towards lower-cost treatment pathways among disadvantaged groups,’ the authors wrote.
‘Our findings on psychiatric medication use reveal a different pattern: individuals in lower-income neighbourhoods are much more likely to receive medication without accompanying psychotherapy.’
Dr Spielman said there are a few factors that could be contributing to this.
‘Traditionally, prescribing psychotropic meds has been in the realm of paediatricians and child psychiatrists but increasing mental health concerns and complexity has meant it has moved into the bread-and-butter GP space,’ she said.
‘Many GPs are capable of prescribing appropriately and monitoring and providing care for patients and their families. There is access to education training and resources for this but generally in many ways we, GPs, carry the cost for this.
‘Also increased pressure in specialists and tertiary system means we may prescribe earlier as we see conditions and distress earlier – it’s not a simple matter of blaming GPs for this; GPs are using the tools available to them in a pragmatic way, as usual cobbling together care as best they can in a broken system.’
Amongst the solutions is a need to increase workforce capacity, especially therapists and psychiatrists as well as carers and the consumer support workforce, Dr Spielman said.
‘There also needs to be better recognition that GPs are most prevalent providers of mental health care and to support us to do this in order to manage more in community and take pressure off secondary and tertiary services.’
The researchers said this study highlights the need for policies that address the increasing cost barriers to care, especially for lower-income households.
‘Reducing out-of-pocket costs for psychotherapy should be a central focus,’ they wrote.
‘This could involve increasing Medicare rebates, introducing targeted subsidies, or expanding low-fee service models.’
A similar policy to the recently introduced GP bulk-billing incentive could also be applied to psychological services may improve affordability, though the impact of the GP reforms should first be evaluated, they added.
‘Overall, these findings highlight the need for targeted policy responses to improve equitable access to mental healthcare and ensure that support is timely, appropriate, and available to all who need it,’ the authors wrote.