Increasing the Medicare rebate on private psychology sessions won’t fix our national 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.

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.

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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.