Long wait times, $90 gap fees preventing access to psychology services

Almost 70 per cent of people who receive psychology treatments are paying out-of-pocket for government-subsidised services – with the median gap fee at $90 – in a mental health system that is leaving behind people from regional areas and the lowest socio-economic backgrounds.

As dozens of mental health stakeholders prepare to meet Health Minister Mark Butler in Canberra on Monday to grapple with a system plagued by workforce shortages and access issues, the sector has warned against a “talkfest” and called for broad reforms to address gaping holes.

Health Minister Mark Butler.Credit: Alex Ellinghausen

A background paper prepared for the federal government roundtable, seen by this masthead, declared the government’s Better Access program for mental health treatment had been “serving some groups better than others”, with many in need missing out.

More than half of people with a mental health disorder with symptoms that lasted 12 months or more were not getting professional help while wait times for services and patient gap fees blew out, largely due to critical workforce shortages, the document said.

Health funding is a key issue for federal and state governments this week as Prime Minister Anthony Albanese prepares for a national cabinet meeting on Friday while NSW Premier Dominic Perrottet and Victorian Premier Daniel Andrews put a united case for better access to GPs.

The Resolve Political Monitor, conducted exclusively for this masthead by Resolve Strategic, found that 82 per cent of voters either support or strongly support raising the Medicare rebate for visits to GPs and other health professionals.

While bulk-billing rates for GPs decline, the mental health system has also become less accessible, with patients forced to pay a gap fee for 69 per cent of government-subsidised psychology services in 2022, compared to 53 per cent in 2018.

The discussion paper said cost was by far the biggest barrier to accessing treatment: the median out-of-pocket price was $90 in the first half of last year, up from $74 in 2018.

People are also waiting longer to access services: the median wait time between a person receiving a mental health plan and attending their first session increased from 18 days in 2018 to 22 days in 2021.

Butler has flagged the Better Access system, introduced almost 20 years ago to accommodate people with mild mental health needs, was not well-designed to cater to complex conditions.

“We’ll be having a good discussion about how we improve the equity of this program. This is a good program, where it is received,” he said earlier this week.

“But as I’ve said, now for many years, including in response to the last evaluation more than a decade ago, it is not a program that delivers services in an equitable way.”

For those who did access treatment through the Better Access program last year, services were unevenly spread. Sixty per cent of the areas with the greatest uptake were areas of high socio-economic advantage, while two-thirds of areas with the lowest levels of use were composed of Australians from the bottom socio-economic bracket.

People on the Gold Coast, NSW North Coast, eastern Melbourne and eastern and northern Sydney engaged most with the system, with between 591 and 988 services used for every 1000 people.

Meanwhile, the entire Northern Territory, large swathes of regional South Australia, Queensland and Western Australia, and western NSW had the lowest uptake – between 0 and 220 services for every 1000 people.

Butler has cited this inequity to defend his decision to halve the number of government-funded psychology sessions from 20 to 10; a call met with fury by several elements of the mental health sector.

Caroline Hunt, president of the Australian Clinical Psychologists Association, said she would still be advocating for 20 sessions for people with more severe problems. “But we need to have a conversation with government about what that might look like, given it’s clear they won’t go back to 20 sessions for everybody.”

She said the association recognised there were big issues with gap payments and workforce numbers, particularly outside urban centres. It will push for community mental health hubs for people with less complex needs as well as enhanced training pathways for clinical psychologists.

“The missing middle is very real. There’s not just one strategy to cover everything,” she said.

Australian Psychological Society president Catriona Davis-McCabe said workforce shortages – which mean one in three psychologists cannot take on new patients – should be met by increased public funding for university places or relocation incentives.

Beyond Blue also wants more services for people with less acute needs, such as clinically supervised mental health coaches, whose support could be measured with real-time data on progress.

“We know that many people are accessing Better Access that could be better matched to low intensity service,” chief executive Georgie Harman said. “[We need to be] sitting down with both immediate plans and long-term plans – that’s what structural reform is.”

At the more acute end, a survey by SANE, an organisation representing people with complex mental health issues, found 11 per cent of members were not receiving any form of mental health support because they could not afford it, while almost a quarter had been turned away from services.

“The current single lane system is unaffordable and inaccessible for those who need it most,” said chief executive Rachel Green. “We need better options, where access to support meets need ... rather than being skewed towards those with the ability to pay.”

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