Now that the Medicare psychologist sessions have been cut, I worry about my clients

When I heard that the Medicare funding for psychologist sessions had been slashed from 20 to 10 sessions, I was disappointed and angered, but not surprised.

Mental health has long been seen as somewhat inessential and a problem to be tucked away out of sight from polite society. It’s been significantly underfunded in comparison with other arms of health and psychology sessions remain one of the few health services capped at number of appointments a year, instead of being based on clinical need by a client’s care team.

While the pandemic has shifted our willingness to talk about mental health, it remains a political football, with no one willing to take responsibility for the deficits in professional training and the dearth of funding for therapy services.

When the Better Access scheme first commenced, it allowed people to access 18 (12 + six in exceptional circumstances) sessions a year. This was aligned with research which found that most psychological disorders required between 13 and 18 sessions for treatment to be effective. These sessions were capped at 10 in 2011 and remained at this number until Covid hit.

The additional 10 sessions were introduced by the former government amid the pandemic in 2020. There was significant uptake of these sessions. Many of my clients found that they no longer had to ration their funded sessions, allowing them to make better progress. A session every six to eight weeks is only sufficient to allow someone to remain in a holding pattern, and will not allow meaningful progress.

A cap of 10 sessions is entirely inadequate for most serious mental health conditions, including trauma, substance use difficulties, neurodevelopmental disorders, psychosis, bipolar disorders or personality disorders. For families where more than one person needs care, the cost of privately funded sessions will be formidable. For those who can’t access care and thus deteriorate, the long-term social, psychological and economic costs will be massive. Clients who need the most support are also usually the ones who are struggling with work or education because of their mental health and are thus the ones most unable to fund sessions without the rebate.

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While we do have a public mental health system, it is currently mostly resourced to treat the most severe disorders and to offer short-term care.

If we treated cardiac issues the same way we do mental health, we would turn away someone with high cholesterol and other risk factors and ask them to return once they’d had a cardiac arrest. We would offer them some funding to see a specialist to manage their cholesterol, but would cap this, regardless of any complications or comorbidities. Once they had a cardiac arrest, we would offer to patch them up, but would then discharge them.

There simply aren’t enough clinicians to go around and the lack of commonwealth funding for psychiatry and psychology postgraduate places means that this bottleneck in supply will remain. While politicians continue to talk about the importance of mental health funding, there appears to be little acknowledgment of the urgency of increasing training places for professionals.

Now that these sessions have been cut, I worry about my clients. Psychologists across the country have been discussing ways to help clients manage this, including advising people at the outset if they need more than 10 sessions, spreading out sessions, doing work in chunks, and considering discharges to community services. We are acutely aware of the cost of psychology services and worry about those who cannot access the care they need. We will undoubtedly absorb some costs and offer sliding scales to some, but if we did this for every client, our longevity in the profession would be at risk.

The decision to slash these sessions isn’t aligned with health policy. Nor is this decision based on good long-term economic policy, as untreated mental health difficulties significantly affect productivity. While it’s been justified by stating that this decision was made to allow more people to access services, in reality, instead of under-servicing some (largely due to decades of poorly formulated health policy), it appears that it was deemed preferable to under-service most, and to focus on short-term cost savings, at the expense of the longer-term health and wellbeing of Australians.

I’ve been on both sides of the couch. When I was a young undergraduate psychology student in my early 20s, I worked a part-time minimum wage administrative job, and was also engaged in weekly trauma therapy for several years. When I exhausted my 10 Medicare sessions for the year, I paid approximately 40% of my after tax wage on therapy. While I didn’t begrudge my excellent psychologist a cent of the money I paid her, I was only able to afford this because I had no dependents. I’m aware that many of my clients are in different positions and won’t be able to afford my fees. We will have some difficult decisions to make in the coming months.

Dr Ahona Guha is a clinical and forensic psychologist from Melbourne. All views are her own