The chair of Mental Health Australia has questioned whether the Albanese government has dropped reform of the system as a top priority in a powerful intervention into the debate over the decision to halve the number of Medicare-funded psychology sessions.
The change, which takes effect from January 1 and will see subsidised psychology sessions drop from 20 per year back to the pre-pandemic maximum of 10, has alarmed mental health advocates and experts, who are urging the government to address the lack of supply of psychological and psychiatric services in Australia.
Mental Health Australia chair Matt Berriman has called on the Albanese government to reveal its longer plan for mental health services.Credit:Simon Schluter
They have also warned that the return to pre-COVID funding arrangements should not be taken as a sign that the pandemic’s hidden impacts were over – a plea which aligns with fresh statistics from Lifeline showing unusually high demand for help may be the “new normal”.
Mental Health Australia chair Matt Berriman said the cut to Medicare-subsidised psychology sessions had raised broader concerns about the mental health system. He challenged the government to reveal its longer-term plan for the sector.
“We need added services and action yesterday, not less,” Berriman said.
“The new government should make mental health a key priority, which has seemed to have been lost since taking power. Where’s Labor’s plan for mental health in this country?”
Health Minister Mark Butler will host a forum on January 30 with key experts and advocates on how to make Medicare-backed mental health services more sustainable and equitable.
But Berriman said more roundtables and reports weren’t the answer, and argued workforce shortages were a major issue given demand for treatment had severely outstripped supply.
“Another round table equals more delays … it’s perplexing that the sector are only now being involved post the decision,” Berriman said.
“We don’t need more round tables; we need real reform urgently.
The Albanese government is halving Medicare-funded psychology sessions to just 10 a year.Credit: iStock
“From lived experience, we know complex mental ill health can’t and won’t be solved with just 10 sessions. There’s no cap on GP visits, so why is mental health diminished in its access versus physical health?”
On December 12, Butler announced the government would not extend access to the 10 additional Medicare-backed sessions, introduced by the Morrison government as a temporary measure at the height of the pandemic. They were always due to expire at the end of 2022.
He has defended the decision based on the findings of a Melbourne University evaluation which found the system was “serving some groups better than others”.
The report found that only about 15 per cent of people accessing treatment had taken up at least one additional session, and may be limiting the ability of new patients to access treatment.
But the evaluation ultimately recommended the 10 additional sessions be retained and targeted towards those with complex mental health needs.
Mark Butler has defended the decision to halve the number of subsidised psychology sessions.Credit:Alex Ellinghausen
“The scheme is called Better Access, but the additional sessions made access worse,” Butler said.
He said the evaluation was not conclusive about how the extra sessions could be appropriately targeted, and that was why the government was “promptly convening a forum to assess reform options with the sector”.
He said the government was “committed to expanding the range and supply of psychological services for everyone”, and flagged this would involve “building the mental health workforce and developing new digital and direct models of service.”
However, the decision to scrap the additional sessions has divided medical and mental health experts, with psychologist groups in particular steadfastly opposed to the change.
Professor Caroline Hunt, the president of the Australian Clinical Psychology Association, said the decision was premature given it would probably take years to roll out specialised services to target the “missing middle” cohort of people with moderate to severe disorders.
“The reason they’re called the missing middle is because there’s nowhere for them to go,” she said.
“They’re not severe enough to go to the acute state-based services, and they’re not mild enough to be treated within general practice primary care.”
Hunt agreed that a broader package of reforms was needed, but said an extension of the 10 additional sessions was needed in the meantime.
Jillian Harrington, a clinical psychologist, director of the Blue Knot Foundation and president of the Applied Neuroscience Society of Australasia, wrote in an opinion piece in The Sydney Morning Herald and The Age on Thursday that the subsidy cut defied years of expert advice.
“We don’t limit Australians to half a course of antibiotics. This cap on necessary services would never happen in cancer care,” she said.
Professor Patrick McGorry, a psychiatrist and executive director of Orygen, the centre for youth mental health at the University of Melbourne, said he broadly supported the government’s decision. However, he stressed the focus must shift to funding specialised treatment programs for people with complex mental health needs.
“A lot of the psychologists are getting upset because they feel like something’s been taken away, but even if it was retained, it wouldn’t be the solution to this major problem that we’ve got,” McGorry said.
He said while there was a “small group of people that for which an extra 10 sessions would be helpful”, the extra sessions amounted to a “really weak and inadequate” second-tier solution. Instead, he would continue to lobby for an expansion of multidisciplinary mental health hubs, like the Orygen-backed Early Psychosis Youth Services programs operating in most states and territories, to treat a broader array of mental health concerns.
Other experts, including former Commonwealth Health Department boss Jane Halton and University of Sydney’s Brain & Mind Centre co-director Professor Ian Hickie, have also backed the government’s decision while calling for longer-term mental health reform.
Crisis support service Lifeline has reported a new normal baseline of demand since the pandemic, with average daily call volumes significantly higher than pre-pandemic levels, up from about 2533 calls per day in 2019 to more than 3000 calls per day in 2021 and 2022.
Lifeline’s 50 busiest days on record have all occurred since the pandemic began, with the highest-demand day being New Year’s Day 2022 when the service received 3726 calls.
Crisis support is available from Lifeline on 13 11 14 and Beyond Blue on 1300 22 4636.
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