The week before Christmas 2022, Health Minister Mark Butler announced to the shock of many, even those in government, a cut to Medicare's Better Access rebated psychology sessions from 20 to 10 sessions.
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There was an outcry as clinical trials show that more than 10 sessions are needed to properly treat most mental health conditions.
The minister promised that instead, he would improve future delivery of mental health services, and established a Mental Health Advisory Committee to do so.
Yet a year later, he has failed to deliver. The advisory committee review has been extended into 2024. Meantime, the needs of Australians with moderate and serious mental health conditions are not being adequately catered for.
Butler tried to soften the blow last Friday, by announcing funding for a small section of existing digital services. But these are suitable only for people with "low intensity needs" and nothing new has been offered to support the mental health needs of Australians with moderate or more complex needs.
This is beyond disappointing. It is irresponsible. A recent Australian Bureau of Statistics National Health Survey shows that Australians experiencing a mental health condition has increased dramatically in the last five years, with more than 5 million experiencing a chronic mental health condition each year.
While we await the deliberations of the advisory committee, there is no adequate care for those in need. We have solid evidence from a government commissioned in-depth review of Better Access for psychology sessions, which was delivered to Butler in December 2022. This evaluation incontrovertibly demonstrated that those with more severe mental health conditions benefited the most from the extra 10 Medicare rebated psychology sessions.
This is no surprise to psychologists who found they were finally able to deliver proper treatment, and discharge people without fear of relapse, when 20 sessions were rebated. And not all people accessed this many sessions - the number of sessions delivered is based upon need and some only required six sessions.
The minister has advised that the advisory committee (a group of individuals hand-picked by the minister) "has advised that additional Better Access sessions are not the solution for people with complex needs, and that clinicians and patients need a more sophisticated offering than additional mental health sessions".
This, despite a wealth of scientific evidence and every independent review of recent years, supporting that the gold standard treatment for moderate to severe mental health conditions is at least 16-20 sessions of individual psychological therapy delivered by qualified psychologists. At this point in time the public health system is not a viable option to support the mental health needs of Australians as it is overburdened. It is the "missing middle" (ie those with moderate mental health conditions such as moderate depression, post-traumatic stress disorder, anxiety disorders, child conduct problems) whom psychologists are trained to treat.
This group is being left out of adequate psychological treatment unless they can afford to pay for sessions without the assistance of a Medicare rebate. With cost-of-living pressures, mental health needs will often be sacrificed.
Providing enough sessions to cover an entire course of psychological treatment is essential for recovery. There would be an outcry if Medicare rebates did not cover a full course of chemotherapy, or if support lines or self-help tools were offered instead.
There is no limit to the number of rebated psychiatry sessions across a year (and nor should there be). Yet, for evidence-based treatment with psychologists, who are specifically trained to deliver this in the community, just 10 rebated sessions are covered in a year.
The authors of the Better Access Evaluation, based on the evidence, recommended continuation of 20 rebated psychology sessions a year. Yet, Butler chose to ignore them and continues to misdirect attention to some limitations in the system. For example, the extraordinary conditions under COVID-19 increased demand for sessions and there were insufficient psychologists to cater for this need, but this was no different to the shortage of workers across a range of sectors during COVID-19.
It is also acknowledged that the system needs to address the maldistribution of services across urban and rural areas. However, the evidence from the Better Access Evaluation is that allowing up to 20 sessions of Medicare rebated sessions for psychology delivered good outcomes for those most in need, and catered well for a community with increased mental health demands.
Butler has replaced a system that was working, with nothing. A year later he still has not come up with anything viable and effective and sadly, it's those who can least afford it, that will suffer the most this Christmas.
- Dr Marjorie Collins is president of the Institute of Clinical Psychologists, and Professor Caroline Hunt is president, of the Australian Clinical Psychology Association
