In response to Professor Ian Hickie’s piece in The Guardian 9/01/2023, we at the Australian Association of Psychologists Incorporated take issue with many of the points he has raised.
The Medicare rebate system for psychologists and our transdisciplinary peers in general practice has not increased in line with inflation for over a decade. This, plus a workforce shortage of mental health workers and community rates of mental ill health trending upward for over a decade, are contributing factors to the current state of the Australian mental health system problems.
The Better Access program was found in the recent government-commissioned report to be helpful to people accessing the service and rightly pointed to affordability issues that do, in fact, limit the support for Australians living in rural and low socio-economic areas. Hickie, and the government, gloss over this critical point, and the government has instead chosen to cut access to service for all Australians, instead of utilising well-evidenced ideas such as the deployment of mental health workers and provisional psychologists to support these communities. Just as a reliable car still needs fuel to make it to its final destination, the Better Access program (and any system, for that matter), cannot deliver its full potential without adequate funding.
Additionally, by ignoring the ever-widening disparity between low-income and high-income Australians, a fundamental component of this issue is simply being ignored, which will do nothing but continue to perpetuate harm to those who are suffering. While we shouldn’t ignore that the Better Access report highlighted that certain demographics had greater difficulty accessing psychological support during the pandemic and that there is room for improvement, this could be rectified with interventions that provide targeted support. Low-income cards are an existing mechanism that enables additional support to those with greater needs.
The additional Covid 10 psychology sessions are not the reason that it is harder to get an appointment with a psychologist. There was already an increase in wait times to access psychology services pre-pandemic, and the pandemic exacerbated this, increasing the need for services under Better Access due to its impact on mental health (for both existing and new patients) and the additional 10 sessions were not introduced as a solution to waiting times but instead as a measure to ensure people with worsening mental health received adequate treatment over this period.
Minister Butler was correct to note that consumers likely “appreciated” access to these additional sessions – most individuals would appreciate access to affordable care when they require it. However, continually referring to the COVID sessions as “additional” implies that the original 10 sessions is sufficient for most individuals requiring psychological assistance. The evidence indicates otherwise, and we advocate for the 10 COVID sessions to not only be reinstated but made standard (i.e., 20 sessions/year) for those who need it.
Finally, ‘more cash’ as Prof. Hickie stated, is sorely required to support a sustainable mental health system where individuals have agency in choosing whom they receive support for in their lives. “More cash”, when used effectively, can have hugely positive impacts. We need only look to Labours “stimulus packages” during the GFC, or “JobKeeper” during the pandemic to see how “more cash” helps ordinary Australians. “More cash”, is exactly what an underfunded, but effective, system such as the Better Access program requires. Psychologists have needed to move to a blended fee-for-service system due to the grossly inadequate price point for bulk billing, and this policy decision directly impacts who can access support for a psychologist and where.
We are calling on Prof. Hickie to make public the modelling he has accessed so Australians can better understand this push to decrease Medicare funding.
AAPi continues to call for a $150 rebate for psychology clients across the board, making it much more affordable for the general population and utilising the 7,900-strong provisional psychology workforce through Medicare rebates to reduce the long waiting lists we see around the country.