It’s a nice idea, but more therapy won’t fix our growing mental health crisis

By this time of year, most people who regularly see a psychologist will have exhausted their allocation of 10 Medicare-funded sessions. This, combined with statistics showing that one in five Australians experience mental illness, has prompted calls from some within the sector for additional funding and an increase in the number of government-subsided sessions available to Australians.

But as a psychologist working in private practice, let me tell you that more psychology sessions is not the answer to our national mental health crisis.

Australians are currently entitled to 10 Medicare-rebated private psychology sessions each year. Some experts say this is not enough. Credit: Istock

I’ve dedicated my professional life to psychology and therapy, and continue to spend a fair bit of my personal life engaged in it, too. Beyond the superficial position of potential financial gain, I know that carte blanche funding for private services is not the best way to allocate mental health funds. This is namely because the people who need services the most are those most likely to find themselves effectively shut out of the current system through unaffordability (most private psychologists charge a gap fee) or ineligibility (Better Access does not include family therapy or couples’ counselling). This is especially true for adolescents and young adults, who are disproportionately represented in mental illness statistics, but are the least likely to engage in private therapy. Low-income and unemployed adults are similarly impacted.

Adding additional sessions for people already in treatment would also impact a psychologist’s capacity to accept new referrals. It would do nothing but potentially drive up the already too-long wait times.

Decades of empirical evidence demonstrate conditions such as anxiety, mild-to-moderate depression, and simple phobias (such as arachnophobia, fear of flying, fear of heights) can be treated in around 10 sessions. For these people, who are generally relatively psychologically healthy but experiencing a specific life crisis, this brief intervention may be sufficient to help them gain insight and develop coping skills.

Longer-term therapy can also be beneficial. This comprises of more than simply providing the same treatment over a longer period, and many psychologists are simply not trained to deliver this kind of care. And so, in a system with limited resources and an ongoing shortage of psychologists, an unenviable choice must be made – provide fewer people with more treatment, or more people with some.

For many, a set number of sessions can be containing and sends a message that their concerns are valid but treatable. Endless sessions without clear goals or outcomes, on the other hand, can erroneously signal their problems to be insurmountable.

Of course, mental illness and its treatment is not one-size-fits-all – any system treating it as such is problematic. But instead of a continued focus on more individual therapy, we need to look towards providing services to those most in need, not just those who can afford it. This “missing middle” of people who are too unwell for private psychology services, but not unwell enough for public mental health services.

Despite the government acknowledging more needs to be done for this population, there has been no uptake of recommendations for a stepped care model, in which sessions are allocated based on patient need and clinician skill, despite this model has demonstrated efficacy.

Perhaps more interesting than the political fray around funding, though, is the impetus for additional psychology sessions.

Psychologists often bemoan the inadequacy of the short intervention model, despite evidence pointing to its efficacy. It is sad to see a seeming increase in self-interest among some psychologists who perpetuate the idea that more sessions is the only antidote to a person’s problems. Perhaps this is motivated by the financial incentive of retaining a full caseload, or is indicative of a “saviour complex” that reflects the need of some psychologists have to be wanted or revered. But in calling for more private sessions, psychologists risk no longer fulfilling their fundamental role of expressing empathy and providing treatment that supports improved wellbeing and instead joining a patient in their despair. Here, empathy and collusion blur. And while the former is essential in promoting a patient’s wellbeing, the latter is decidedly unhelpful.

Of course, current times are difficult. But no time in history has been without its challenges. The role of a private psychologist working under the Better Access scheme is not to remedy all perceived ills, but to help patients regain and maintain sufficient psychological health to enjoy a life of function and purpose.

Sometimes I am asked how I cope in a vocation in which, as one acquaintance framed it, I am exposed daily to “a carousel of human misery”. My answer is always the same: I can cope because I see that most people get better.

Yes, a panacea for our current mental health crisis is a big ask. But at the very least, we should be ensuring the equitable opportunity for treatment for everybody.

Dr Bianca Denny is a practising clinical psychologist based in Melbourne.

The Opinion newsletter is a weekly wrap of views that will challenge, champion and inform your own. Sign up here.