This week, I had the opportunity to work with a journalist on an article discussing the impact of the two-tier system. Not only does the two-tier system cost clients of psychologists approximately $150 million a year due to lower rebates, but it has had profound impacts on the diversity of areas of practice and funnelled future psychologists into increasingly narrow course options.
The significantly pressing and systemic issue that must be addressed is the preferencing of psychologists with clinical endorsement above psychologists with either endorsement in one of eight other endorsement areas, and general registration. This is referred to as the two-tier system. The introduction of Better Access brought into effect a two-tiered rebate system whereby the clients of psychologists with clinical endorsement were afforded a 40% higher rebate than clients of all ‘other’ psychologists. This two-tier system has permeated many separate funding schemes and the public sector. It has profoundly and negatively impacted psychology in Australia and is attributed to promoting the false assumption that psychologists without clinical endorsement have lower qualifications, competencies and scope of practice.
Community Psychology, a vital area, has been a casualty of the two-tier system. The last course in Australia is now listed as teach-out only, with only a couple of students still enrolled, and other students who were undertaking a community psychology pathway changing streams. This loss is a stark reminder of the system's detrimental effects on the diversity of psychology practice.
There are 124 APAC-accredited level 3 and 4 post-grad courses currently available (noting that some of these are combined Masters and Doctorate programs). Only 36 of these are non-clinical psychology. There are 9 Areas of Practice Endorsement, of which clinical psychology is only one. Forensic, health, sport and exercise and counselling psychology have only a couple of options for the next generation of psychologists to battle it out for a place.
Clinical psychology is undoubtedly an important area of practice, but so are all areas of practice and interest.
The Government is further exacerbating the reduction in diversity. A recent $55 million grant to incentivise higher education providers to grow the profession excluded Master of Professional Practice and 4 of the 9 AoPE (ed and dev, forensic, org, and sport and exercise).
This is all the more galling when reviewing the Federal Government Select Committee into Mental Health and Suicide Preventions recommendations:
Recommendation 17
The Committee recommends that the Australian Government support the growth and diversity of psychology specialties by:
- funding ongoing Australian research to compare outcomes across the nine areas of practice endorsement in the psychology profession, and using this research to inform future policy and funding decisions
- increasing university master's level programs to improve distribution across the nine areas of endorsement, with at least one educational and developmental psychology program in every state and territory
- dedicating a percentage of Commonwealth-funded scholarships to psychology specialisations outside of the primary clinical psychology pathway
- providing funding or tax incentives to registered psychologists to increase their capacity to offer placements to psychologists in training and ongoing clinical supervision and for continuing professional development.
Recommendation 30
The Committee recommends that the Australian Government’s evaluation of Better Access, and reform of the system, focus specifically on:
- the viability of bulk-billing incentives available to general practitioners (GPs) being similarly made available to mental health practitioners for the treatment of mental illness, where there are patient affordability constraints
- the two-tier system impacts on treatment access, appropriateness and affordability of psychological care
- including psychologists with other areas of endorsement (non-clinical endorsement) on the higher rebate tier, noting that this will increase access to specialists, address non-clinical endorsement disincentives and support the diversity of the psychological workforce
- the value of extending the annual cap on psychologist sessions, to ensure evidence-based delivery of care for complex presentations to increase affordability for people experiencing serious and/or complex mental illness.
Through Senate Estimates last week, AAPi has again asked for a Government response and action plan for the above. We have also asked why the MPP and other endorsement area courses have been excluded from Federal grant funding. Our question is on notice for a Government response.
Earlier in the week, I attended a consultation for the Health Workforce Scope of Practice Review Phase 3. The consultation covered four key areas:
- National Skills and Capability Framework Matrix
- Legislation and regulation
- Workforce design, development and planning
- Funding and payments
The Scope of Practice Review has the potential to fix the two-tier system. With current recommendations to address the fee discrepancy and ensure all psychologists are enabled to work to the top of their scope of practice.
Other key AAPi activities this week included:
- Disability Framework Reference Group meeting.
- Allied Health Professions rural and remote working group.
- The NDIA mental health sector reference group.
- Allied Health Professions Australia Member Forum Meeting.
- Meetings with Occupational Therapy Australia and the Australian Association of Social Workers to further our advocacy work in the NDIS.
- Supportive work for the National Autism Strategy.
AAPi is dedicated to addressing the two-tier system. Promoting a one-tier profession means ALL psychologists are valued and respected. We are the only psychology association that holds this position. We ask all psychologists to unite through AAPi for a diverse, fairer, stronger psychology profession. We are stronger together!
‘Heartbreaking’: Students plunged into poverty as they miss out on $300 placement payment
AAPi's Executive Director Tegan Carrison is featured in this news.com.au article discussing psychology students facing HECS debt and placement poverty, pointing out that postgraduate psychology degrees were left out of the Federal Government’s recent announcement to provide $319.50 per week of placement for courses.
Ms Carrison said it was disappointing that psychology students had been ignored in the paid placement scheme, given the significant shortage in the psychology workforce and exclusion from this scheme will further entrench this shortage.
She said student placements provide valuable clinical experience but being unpaid puts them at a disadvantage.
“Psychology students can do up to 1000 hours unpaid labour for their placements which pushes them into placement poverty, impacts their mental health and wellbeing, and is a deterrent for many who come from low socioeconomic backgrounds to be able to participate in higher education,” she said.
"Given the mental health workforce needs to grow rapidly to care adequately for the country’s mental health needs - psychologists are only meeting 35 per cent of the Federal Government’s psychology workforce goal - we are calling for the urgent inclusion of psychology students in this scheme.
“As healthcare professionals in training, they should be given equal consideration.”
Read the full article here.
NSW Parliamentary report on mental health
AAPi Executive Director Tegan Carrison spoke on 2SM News in response to the NSW Parliamentary report on mental health, which found the support system to help those who are vulnerable is in crisis.
"Now is a key time for action for all levels of government to address the country's mental health crisis with a unified, realistic and appropriately funded approach," she said.
Ms Carrison said she was encouraged by the report's call for urgent and significant reforms to the mental health care system.
Listen to the news item here.
Concerning social media algorithms, and online scams
AAPi President Sahra O'Doherty provided commentary on two topical issues in articles published across News Corp channels.
The first discusses the rise of alpha male behaviour in boys as young as 11 and social media algorithms proven to be targeting and influencing men.
“What we’re often seeing as psychologists are young men who are feeling quite lost, they don’t feel like they belong or they don’t fit in,” Ms O'Doherty said.
“Or they’ve had negative experiences with friendship groups or with people that they’re wanting to date, often women, and they feel the need to improve themselves.
“The alpha bro marketing that is being shown to these young men is playing into that idea that if you have this particular product, then you will exceed in the gym and excel at dating and have all of these wonderful things that I’m going to show you in this video.
"I see this a lot in high schoolers and there’s a lot of research around this being quite an issue. It’s often coupled with misogynistic attitudes or pushing those traditional stereotypical gender roles,” she said.
“And it can often result in not engaging in healthy conversations or relationships with young women. And it can in the extremes result in these young men withdrawing from conversations from society.”
Read the full article in the Daily Telegraph and Yahoo! News.
The second article covered the rise in online scams, particularly through AI.
Ms O'Doherty said scams targeted people’s emotions to trick them.
“When we’re talking about scam products, or even legitimate products that are sold in quite a scammy marketing way, it’s often because it can feed into our sense of insecurity, or anxiety about ourselves,” she said.
“So when we’re buying something that we probably don’t need, but it’s being sold to us as though we need it. It’s usually playing into our insecurities that we’re not good enough, or that we don’t fit in with a particular image that we wanted to step in. And it’s often being sold as a quick fix.”
Read the full article in the Australian here.
Whitsunday psychologist explains why mental health professionals don’t stay
Long wait lists and lack of staff is an ongoing problem for mental health services in the Whitsundays, according to an article in The Whitsunday Times, which detailed the issues around retention of professionals in this region.
AAPi members Christine Franklin and Corey Lane were both quoted in the article.
Mr Lane said he had tried to alert the federal Minister to the mental health crisis in the Whitsundays last year, in a letter that outlined the need to provide incentives directed at mental health practitioners, as well as re-establish the 20 sessions that Australians were offered during the Covid-19 pandemic.
“In my letter I outlined all of their approaches and said, why this doesn’t work and doesn’t apply to our circumstances,” he said referring to the average salary for psychologists being higher in cities than in rural areas, giving practitioners zero reason to move to the regions.
“They just sent back this cookie cutter type email, not addressing any of my issues.
“It was really disappointing.”
Ms Franklin said she had a wait list of six weeks.
“This is tough on people who have made a decision to seek psychological help because, very often by that stage, a person will be at their lowest point,” she said.
Ms Franklin said people with acute mental health conditions would often be given the treatment they need by hospital staff, but that the difficulty was to provide to the majority of people “at risk” of mental health problems.
“We know that early intervention in mental health is effective and that the best outcomes for individuals are gained by preventing them getting really unwell in the first place,” she said.
Read the article.
AAPi recently provided feedback on the National Autism Strategy. Our recommendations focused on enhancing inclusivity, accessibility, and quality of life for Autistic individuals through targeted modifications to the strategy's vision and goals, ensuring the representation of lived experience, and advocating for comprehensive and accessible mental health services. We emphasised the importance of early identification and intervention, the integration of culturally sensitive practices, and the necessity of legislative changes to improve service delivery.
AAPi remains committed to supporting the implementation of these recommendations to create a more inclusive and supportive society for Autistic people and their families.
Summary of AAPi's recommendations:
- End the two-tier system diagnosis and assessment.
- Emphasise individual choice and the removal of participation barriers.
- Ensure lived experience voices are adequately represented and the strategy is Autistic-led.
- Adopt universal design principles for accessibility.
- Integrate culturally sensitive approaches.
- Address implicit bias and support economic inclusion through research-backed strategies.
- Standardise training and resources for professionals involved in the autism diagnostic process.
- Enhance access to mental health services through legislative changes and increased Medicare support.
- Expand the scope and remove age restrictions on existing Medicare items for autism assessments and treatment.
- Improve the distribution of services and reduce reliance on specialists for initial autism assessments.
- Integrate mental health assessments and autism screening in early childhood health checks.
- Subsidise training and development for health practitioners in rural and remote areas.
- Introduce Medicare eligibility for provisional psychologists.
- Support the diversification of the psychology workforce to include those with lived experience.
- Develop comprehensive training materials for those providing services to Autistic individuals.
- Create tools to help Autistic individuals make informed life decisions.
- Clarify the roles and responsibilities of different government levels regarding the NDIS and related supports.
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Our HR/IR partner WorkPlacePLUS has issued an important workplace relations update for AAPi members outlining:
- Current legislative changes under the Closing Loopholes Act 2024 impacting sole traders, independent contractors, and practice owners with less than 15 employees.
- End of financial year wage increases and considerations to ensure you are paying your staff correctly.
We’re also very pleased to announce the following upcoming webinars delivered by WorkPlacePLUS exclusively for AAPi members:
The Listening More resources are designed to help supervisors provide culturally safe and responsive supervision for psychologists, especially when working with Aboriginal and Torres Strait Islander peoples. Developed by the Australian Indigenous Psychology Education Project (AIPEP) and the Australian Indigenous Psychologists Association (AIPA), the resources include:
- A Guide for Psychology Supervisors
- A Reflective Journal for Psychology Supervisors
- A Manual of Resources for Psychology Supervisors
These resources are free to download. Learn more here.
The law has changed to allow eligible people to access voluntary assisted dying in the ACT from 3 November 2025.
The Voluntary Assisted Dying Taskforce will now spend approximately 18 months preparing the health system and health workforce to deliver voluntary assisted dying as one of the end-of-life choices available, alongside other high quality palliative care services and end-of-life care in the ACT.
Visit the ACT Government website for more information. You can also subscribe for updates from this page. The website will be updated regularly as work progresses on the voluntary assisted dying model in the ACT.
If the topic of voluntary assisted dying raises issues for you or your family, you can contact Lifeline on 13 11 14 or Griefline on 1300 845 745.
AHPA’s NDIS Registration support website has been streamlined with a new format which makes it easier to decide whether to register, via which pathway and where to find the resources you need.
Key updates to assist with compliance have been made in response to:
- Legislative changes related to emergency and disaster management
- Current worker screening, identity and code of conduct compliance requirements.
All changes to the website are listed under the 'updates' tab, including a new webinar detailing and demonstrating the updates.
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