The final report into equity, accessibility and appropriate delivery of outpatient and community mental health care in New South Wales has been released this week as part of a parliamentary inquiry. The report highlights several key issues and recommendations to address the gaps and challenges within the mental health care system.
AAPi provided a submission, and AAPi’s Amanda Curran and Sahra O’Doherty were called as expert witnesses in the inquiry hearings. In addition, we sought feedback from members in NSW and met with key stakeholders in the leadup to the inquiry. The majority of AAPi’s priority advocacy items have been included in the inquiry recommendations.
Upon the publication of the report, the NSW Government has announced $118 million to support community mental health. A full government response to the inquiry is due in 3 months.
AAPi will continue to work with the NSW Government and all stakeholders to ensure the recommendation actions in the report are implemented.
AAPi’s key recommendations included:
- AAPi provided recommendations regarding increasing access equity.
- Addressing and preventing practitioner burnout.
- We provided a comprehensive plan for increasing the number of psychologists living and working outside of capital cities and further initiatives to support our existing regional, rural and remote workforce.
- We raised concerns about the Federal Government’s decision to halve the subsidised psychology sessions under the Medicare Better Access scheme and urged reinstating the additional ten sessions. Left at the current maximum of ten sessions per year, the public sector will continue to experience increased pressure, and the community will be largely underserviced.
- We recommended reinstating the 4+2 supervised pathway and increasing Commonwealth-supported places for psychology students.
- We recommended increasing the Medicare rebate for all psychologists and expanding career pathways for psychology students.
- We advocated for developing culturally sensitive mental health services to promote accessibility and cultural safety by collaborating with First Nations leaders, CALD community representatives, LGBTQIA+ organisations, and disability advocates to ensure that services are tailored to the unique needs of these communities.
- AAPi strongly recommended increasing Medicare rebates for psychologist clients to reduce out-of-pocket expenses and make mental health services more accessible.
Key Report findings:
- There are significant barriers to accessing appropriate mental health care in NSW, including cost, waiting times, and geographical or cultural inaccessibility.
- The mental health services in NSW are highly fragmented, leading to difficulties for clients and carers in navigating the system, which often exacerbates mental distress and inefficient use of resources.
- While digital and telehealth services can improve access to mental health care, they should supplement rather than replace in-person treatment.
- Safe workloads and appropriate remuneration are crucial for staff recruitment and retention. Integration issues between primary care and mental health services are significant concerns.
- The presence of police in mental health emergencies can escalate distress and has been harmful in several cases. There is broad support for a health-led approach to these situations.
Key Report Recommendations:
- The NSW Government make representations to the Australian Government to address the gaps in funding and workforce for primary care and mental health services, including improved equitability of the Better Access scheme and incentive schemes equivalent to those for procedural skills to better enable primary care services to support mental health.
- The NSW Government immediately increased pay for NSW public mental health clinicians, including allied health professionals, to at a minimum on par with other states and territories.
- Changes to pay grades for staff working in community mental health services should also take into account the level of expertise, further training, independent practice and risk associated with a role.
- NSW Health increase resourcing for formal clinical supervision for all clinicians providing mental health care in NSW Health.
- The NSW Government should undertake comprehensive reforms addressing social and environmental determinants of health, including housing, cost of living, transport, education, employment, and the impact of natural disasters.
- NSW Health should explore mechanisms to enable the greater application of therapeutic services and discipline-specific expertise to ensure clinicians are working to the top of their scope of practice to provide safe, effective, patient-centred care, including assertive outreach.
- The NSW Government urgently request the Federal Government provide HELP fee relief for mental health priority courses.
- Safe workloads for clinicians working in public mental health services, as well as remuneration that reflects their skills and the challenges of their roles, can assist in the recruitment and retention of staff.
- Immediate and sustained increases in funding for mental health care, particularly for community-based services, are necessary.
- Enhancements in service and referral pathways, information sharing, and the employment of peer navigators to aid in navigating the mental health system are recommended.
- The NSW Government facilitate relocation and housing for mental health care workers in the public system and address social and cultural barriers to relocation.
- That the NSW Government immediately commit to increase and maintain funding across the entire mental health system to support both the workforce and consumers, with a priority investment in community-based mental health services.
- Increased pay and formal clinical supervision for mental health clinicians, and facilitating relocation and housing for mental health care workers in the public system.
- A shift towards health-led responses to mental health emergencies, reducing police involvement unless necessary for safety, and the establishment of additional Safe Haven programs.
- The NSW Government should review Community Treatment Orders to ensure they are used appropriately and reduce their overuse or misuse.
- Improvement in data sharing and collection to enhance coordinated care and workforce allocation.
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AAPi referenced in the report:
“Throughout the inquiry, the committee heard that too many people in NSW are missing out on mental health care because it is too expensive, too far away, or the right type of care for a particular condition is not available.”
“The Australian Association of Psychologists put forward the view that the current demand on the public mental health system is significantly impacted by the lack of affordable and accessible services in the private sector.”
“The current Medicare rebate for psychological services is 'not reflective of the true cost of providing high-quality mental health care and that the resulting out-of-pocket expenses for consumers can deter people seeking and continuing treatment.”
“Some stakeholders were frustrated that the number of GP Mental Health Treatment Plans, which were increased from ten to twenty during Covid, reverted back to ten in 2022.”
“The Australian Association of Psychologists Inc. also recommended supporting the rural and regional workforce' by providing the following:
- financial incentives
- training opportunities and professional development programs
- rural loading
- covering location expenses
- subsidised housing
- reduced education debts for individuals who committee to a period of rural and regional practice.
“On the effect of burnout on staff and service provision, Mrs Amanda Curran, Chief Services Officer, Australian Association of Psychologists Inc said that staff were reducing their work hours to cope, which could lead to both financial instability for individual staff and a general reduction in the available support for consumers.”
“Mrs Amanda Curran, Chief Services Officer, Australian Association of Psychologists Inc said that additional financial resourcing for supervision of the psychological workforce was important, to ensure workers had adequate support.”
“A lack of funding was a common theme in stakeholders' evidence, with many drawing links between a lack of funding and the creation of a crisis-driven system. This was consistent across both staff and consumers. Ms Sahra O'Doherty, Acting President of the Australian Association of Psychologists Inc., said she could not treat, case manage and advocate for her patients without adequate funding, describing the current lack of funding for community managed organisations as creating a system that is 'understaffed and overburdened'. “
“Mrs Amanda Curran, Chief Services Officer Australian Association of Psychologists Inc, argued for additional Medicare funding for psychologist sessions, which she asserted would allow children and families to be seen at lesser cost, decreasing the current strain on acute mental health services.”
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Conclusion:
The report calls for urgent and significant reforms in NSW's mental health care system and at a Federal level to ensure that mental health care is accessible, equitable, and effectively delivered. Immediate action is required to address the chronic underfunding and to provide better outcomes for people, their families, and carers.
Thank you to all our members who contributed to this work. The final report reflects the consistent reiterations from across the sector. Many voices contributed to this inquiry and the final report reflects this.
Further information: