Responding to criticisms of the federal budget's failure to reinstate 20 Medicare rebates sessions for psychological therapy, Health Minister Mark Butler dubbed the extra subsidised sessions as "lazy policy" and his "decision to allow the number of subsidised sessions for psychological therapy to halve from 20 to 10 was made after a review last year deemed it ineffective".
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This is an appalling misrepresentation of the review, which actually found improved psychological health in a program that is cost effective relative to other available options. Yes, some improvements can be made, but what is inexplicable is that Mr Butler has removed a program that is working and cost effective when there is nothing to replace it.
His ill-considered decision to slash Medicare rebated sessions has resulted in less access to effective psychological therapy for disadvantaged and rural members in our community.
It also flies in the face of what we know from scientific evidence: 18-20 sessions are needed to treat most mental health conditions.
In just four months since the rebated sessions were halved, the real-world impact of Mr Butler's decision is starting to bite. People across our country are finding they cannot complete treatment because they cannot afford out of pocket expenses once the Medicare rebate ceases.
This impacts more on people with lower incomes, mortgages and children to support. Yet, these groups have a proportionally higher need for psychological support.
When treatment is not completed, relapse is more likely, and can worsen the original condition.
I have countless examples from my own psychological practice and others in my network.
Like a single mother in an abusive relationship with her methamphetamine-addicted boyfriend, who developed anxiety and depression. She was making steady progress until she reached the 10-session limit of her rebated psychology sessions. She is on a single mother's pension, and cannot afford to pay for more sessions, even on a reduced fee. This mother is not acute enough to qualify for psychological support in the over-burdened public health system.
Or the 11-year-old whose sensitivity developed into an anxiety disorder during the pandemic, whilst shut off from the world. He silently worried about his mother's death as she left each day to nurse patients in the COVID ward. A clinical psychologist taught him to manage his anxiety and he recommenced school, on more days than not. But now that 10 sessions are up, the family budget cannot cover more sessions, even on a reduced fee. His mum says his anxiety has increased and she describes emerging signs of depression.
And a woman with complex trauma after a childhood filled with violence and abuse. She made remarkable progress in psychological therapy through 2021 and 2022, as 20 rebated sessions were available. She commenced study, found a part-time job, and started to build supportive friendships.
Yet, she still wakes screaming in terror at night, has panic attacks and periods of depression, and cannot discern friend from foe. The slow and careful psychological work required to repair the shattered pieces of her life is compromised by an inadequate health system.
These are just some glimpses of Australians in a group called "the missing middle": their psychological needs are too complex to be treated in 10 Medicare sessions per year, yet they are not sufficiently unwell to qualify for NDIS or the public health system.
A government commissioned evaluation showed that Australians with more severe illness got more treatment, had more Medicare sessions, paid less out-of-pocket, and improved the most.
Health Minister Mark Butler consistently misrepresents these findings.
Why dismantle a system that rates amongst the world's best practice in mental health outcomes and cost effectiveness? Why dismantle this system when there is nothing to replace it?
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Cutting these services does not even make sense economically: the Productivity Commission estimates the economic cost to our nation from mental ill-health as $40 to $70 billion per year.
What we pay in the extra Medicare rebated psychology sessions is more than compensated for by the increase in well-being and productivity of our nation.
By slashing Medicare rebated sessions in half, the federal government is saving a penny to spend a pound on mental health. Yet, we have a surplus in the budget, delivering psychological services in the private sector is more cost effective than the public sector, and we work in multi-disciplinary teams, alongside GPs, Psychiatrists and allied health.
My colleagues and I urge the federal government to follow the recommendations from its own large-scale evaluation, and re-examine the decision to halve Medicare rebated psychology sessions.
The human cost of January's decision is too great a burden for Australia, and Australians with mental health conditions to bear.
- Dr Marjorie Collins is president of the Institute of Clinical Psychologists.
