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Medicare not suiting mental health needs

By Natalie Graham - posted Monday, 2 December 2013

The mental health status of Australian's young and old is of alarming concern. Among young Australians, depression, addiction and suicide rates are sky high yet only one in four youngsters is receiving assistance. For the 75% who are missing out on services, poor mental health is robbing them of opportunities to build relationships, engage in meaningful employment and establish an independent and satisfying life.

In older Australians, depression and anxiety impacts up to 34% of the population, and with an ageing demographic, these numbers are only going to increase. Older people also face social and practical barriers in seeking treatment for psychological problems and are further disadvantaged by the absence of a coherent system delivering mental health services to this section of the community.

The mental health problems facing our country are also exacerbated by a shortage of practitioners who are able to intervene effectively. In the field of psychology, there are up to 200 students with a four year degree in psychology applying for a postgraduate course that can only take 10 students because the cost of training these individuals is so high that institutions will lose money if they raise their intake numbers.


Among registered psychologists, comparatively fewer work in regional and remote areas than in metropolitan areas, which leave large segments of the population lacking the opportunity to access treatment they need. Furthermore, recent changes to the Medicare system have left gaping holes in community mental health services and the education sector as more psychologists shift into private practice seeking greater financial rewards for their work.

The Australian government have failed to notice that there is a well-trained and resourced group of mental health professionals available to immediately alleviate the shortage of counselling and psychological services in the community. The initial extra funding this would require would be well offset by the resulting improvement in workplace productivity and greater contributions to society that poor mental health typically detracts from.

The group of professionals who are ready to work are counsellors and psychotherapists. Individuals with a background in psychology, social work, psychiatric nursing and occupational therapy often promote themselves as counsellors or psychotherapists, yet they are not required to hold membership with one of the two main professional bodies (the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA)) involved in overseeing the industry.

Eligibility for membership with either association includes completion of an undergraduate degree in counselling or psychotherapy, or completion of a postgraduate degree in the same field following undergraduate studies in a related area. Furthermore, individuals are required to have completed at least 200 hours of client contact and 50 hours of supervision to be able to acquire a basic membership level. For PACFA, a clinical member must have completed at least another 750 hours of counselling work and additional supervision hours.

This is on par with the contact hours required of students completing a master's degree in psychology, who upon graduation are able to provide their clients with Medicare and private health rebates immediately.

Despite ACA and PACFA members having undergone rigorous training combining theoretical and practical experience, they currently have no access to Medicare rebates, are subject to GST, and have limited cover by private health funds. Part of this relates to the timing of the GST introduction; in 1998, the profession lacked the cohesive identity it now proudly embodies. Furthermore, counselling and psychotherapy have not been traditionally associated with the medical model that predominates in the Australian health care system, and therefore the valuable contribution such individuals can make have long been overlooked and undervalued.


Extensive lobbying over the past five years has generated a promising outlook, but the cumbersome and bureaucratic process ignores the fact that the Australian community deserve a government who is willing to take swift and decisive action and extend Medicare and private health rebates to clinical PACFA members effective immediately. At our clinic we have raised concerns about this issue and impact, including calling for support to this petition organised by PACFA.

More broadly, changes to the Medicare rebates for mental health services are also required. When the government introduced the Better Access to Mental Health initiative in 2006, psychologists who belonged to the College of Clinical Psychologists through the Australian Psychological Society were able to offer their clients higher rebates than psychologists who belonged to other professional colleges, such as the College of Counselling Psychology. This two tiered system is part of the driving force behind the mass exodus of clinical psychologists from the public sector and a major source of contention within the Australian Psychological Society.

Non-clinical psychologists, mental health social workers, psychiatric nurses and occupational therapists are therefore painted as less competent providers of counselling and psychology services and in fact many would be staggeringly more qualified to work effectively with unwell individuals than a clinical psychologist with only a few years of experience. While clinical psychologists certainly hold specialised skills in assisting individuals suffering from severe mental health problems including schizophrenia, psychosis and personality disorders, the massive social and financial disadvantage associated with these devastating illnesses means such individuals can rarely afford private services and instead rely heavily upon public and community health resources.

The majority of individuals seeking assistance through the Better Access to Mental Health program were experiencing depression and/or anxiety, which all mental health practitioners, including PACFA and ACA members, are qualified to treat.

It therefore appears logical and paramount that an outdated and cost-ineffective two tiered system is replaced by a framework involving a standard rebate fee that is consistent amongst mental health practitioners and includes clinical PACFA members. This will create a system that reduces consumer confusion, fills gaps in existing services and broadens the scope of treatment and care available to the most vulnerable members of our society.

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About the Author

Natalie Graham has completed a four year degree in psychology and works as a counsellor in private practice at Bayside Psychotherapy in Melbourne. She has recently completed a major research project exploring the impact of attachment styles and parental emotional invalidation on the development of eating disorders in adult females, which is introduced here.

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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