Cuts to therapy on Medicare will hurt our poorest
STEPHANIE LOUISEThe Albanese government has halved the number of Medicare-rebated sessions Australians can access for psychology services. Picture: AAP
- 12:00AM DECEMBER 29, 2022
In October 2020, as Covid-19 played havoc with Australians’ mental health, the Morrison government introduced 10 additional Medicare-subsidised individual psychological sessions a calendar year. This meant Australians could access up to 20 rebated sessions with a psychologist.
This decision was welcomed by GPs, mental health professionals, academics and consumers, who had been advocating for an increase in the number of rebated sessions since they were slashed from 18 to 10 sessions a year in 2011.
Last week, the Albanese government decided to end the Morrison government initiative. It has halved the number of Medicare-rebated sessions Australians can access for psychology services, slashing the additional 10 sessions. In doing so, Health Minister Mark Butler took just a weekend to disregard the scientific evidence and clear recommendations of a review by the University of Melbourne. He decided eight hours and 20 minutes (10 50-minute sessions) were all the psychological treatment that Australians needed a year.
Think about it. Are eight hours and 20 minutes enough support for a woman who has had a stillbirth and is struggling to get out of bed, let alone care for her existing child because of severe depression? Or a young person who cuts their thighs to try to take their mind off the voices they hear that tell them to kill themself? Are eight hours and 20 minutes really enough consultation time for them?
What about someone who was verbally and physically abused as a child, who now finds themselves in a debilitating state of fear of their own and others’ emotions? Or an adult who was sexually abused by their relative as a child, who uses drugs and alcohol to numb the secret feelings of shame that they carry daily? Eight hours and 20 minutes. Surely improving their mental health takes more time than that?
The evidence tells us it does. Research suggests that most people will need between 13 and 18 sessions of psychological treatment to see reliable improvement, with more sessions required when an individual’s mental health experiences are more complex.
During my time working as a research fellow and now adjunct at a university, we continually reinforce to postgraduate students the importance of evidence-based practice. But what happens when the system we are working in is no longer evidence-based? Scientific evidence tells us eight hours and 20 minutes of psychological treatment are not the magic number and not a sufficient dose for most people seeking help.
You may think the case studies I’ve described are “complex clients” (as the government put it) that the reformed scheme, the Better Access initiative, was “not designed for”. In fact, these are clients with whom psychologists (including me) work through the Better Access initiative every day. These case studies involve everyday Australians: your sister, brother, mother, father, daughter, son, friend or colleague.
Suicide is the leading cause of death in Australians aged 15 to 49, with more than eight people a day dying of suicide last year alone. One in eight Australians has seriously considered suicide at some stage in their life and there are more than 65,000 suicide attempts a year. These are real people, and the ripple effects of these attempts and deaths on family, friends, colleagues, classmates and communities are dire.
In making his reforms to the Better Access initiative, Butler has focused on issues of increased waiting times for services and inequity for poor Australians and those accessing services in regional areas. There is some truth to these concerns. Waiting times did increase during the first two years of the pandemic. However, as outlined in the review Butler chose to ignore, waiting times have not only returned to pre-pandemic levels but are lower than they have been in the past five years. Lower-income earners also have been found to receive the least psychology service.
However, cutting these additional 10 sessions for the 200,000 or so Australians who need them does not rectify this inequity. From my experience running a psychology clinic I know, if service is required after session 10, some high-income earners continue to access services as a private client. This is not possible for low to middle-income earners, so these clients will continue to be underdosed, with only high-income earners affording access to a full treatment course. Can you imagine a healthcare system where oncologists were not able to provide a full course of treatment? Why does such a bias continue to exist when it comes to mental health when the prognosis for both can be death?
So speak up. Say no. Let the government know that as a country we value mental health and eight hours and 20 minutes are not enough. This change can and should be reversed. A cap of 10 sessions a year leaves mental health professionals and GPs powerless. Twenty rebated psychology sessions a year, with a review at 10 and an additional 10 accessible for those with complex needs, as proposed by this recent evaluation, allows for Australians to access adequate mental health care they deserve.
Stephanie Louise is a clinical psychologist, director at Connected Minds Psychology and an adjunct research fellow at Swinburne University of Technology.******************************************************************The root cause of this is Australia's mass immigration programme.
Australia's mass immigration programme is the cause of many ills and this is but one of them. Our health system like our roads and hospitals etc cannot keep pace with the torrential rate of immigration through which we see the arrival in our country of huge numbers of people who have never contributed to Medicare or any other taxpayer- funded services and many who similarly never will.
In terms of Medicare and all other government services and infrastructure and so much else besides,. The situation is unsustainable.
