Pay for therapy or rent? The heartbreaking mental health choice faced by Emily’s clients
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Some weeks, psychologist-in-training Emily Radford has to choose between paying for rent or therapy. It’s a decision many of Radford’s clients face as well.
While some are on the NDIS, meaning the government subsidises their sessions for ADHD, autism and other complex conditions, the rest of Radford’s clients are paying $156 out-of-pocket for each visit.
“I have some clients who space out their sessions by weeks or months, just because of the cost,” Emily Radford says.Credit: Kate Geraghty
“It’s the same service, whether my clients are NDIS or private-paying,” Radford said.
“I have some clients who space out their sessions by weeks or months, just because of the cost.
“People are having to choose between therapy and paying rent. Even I have to.”
But as a provisional psychologist, Radford can’t offer services under Medicare.
Two psychologist associations are urging the government to remove that quirk in the system in the May budget and allow provisional psychologists to offer a government rebate. They say that would instantly add 8000 workers to Medicare, making mental health treatment more affordable amid soaring cost of living pressures.
Others argue the measure would inflate a Medicare system that already poorly targets people in most need, and the federal government needs to instead urgently invest in higher education pathways and regional incentives to address structural problems with workforce shortages.
But all are calling for the budget on May 9 to invest more in a system that at the moment is widely unaffordable and inaccessible as Australians report rising levels of distress.
Health Minister Mark Butler has said he wants to make the system more equitable, after cutting the number of subsidised psychology treatments from 20 to 10 last year. However, he is yet to present the path forward.
While provisional psychologists have completed four years of university and can see clients, they can operate only under supervision, including regular observation by their supervisor.
Tegan Carrison, executive director of the Australian Association of Psychologists, which represents psychologists without a clinical qualification, is advocating for rebates for provisional psychologists such as Radford.
“The drivers of mental ill-health are increasing, as is the demand for mental health care services … Unless something is done to lower the cost of services and increase the professional mental health care workforce, the crisis will deepen,” she said in the organisation’s budget submission.
The Australian Psychological Society has asked for Medicare funding to be extended to provisional psychologists since 2019. President Dr Catriona Davis-McCabe said too many Australians were living in mental health deserts, where no psychologists were available.
“Millions of people suffer untreated mental illness each year and this must change … existing services are not accessible or affordable enough either, with more and more patients forced to use their credit card and not their Medicare card,” she said.
“We also want to see the GP relocation incentives replicated for psychology, to attract more psychologists to work in regional, rural and remote communities and with vulnerable groups.
“Right now, the government is meeting only 35 per cent of its own psychology workforce target. We must prioritise a rapid expansion of the psychology workforce.”
But Caroline Hunt, president of the Australian Clinical Psychology Association, the peak body for psychologists with a clinical qualification, said her top priority was funding postgraduate places for clinical psychology.
“We’d also say the amount of funding needs to increase per place, to reflect how expensive these programs are to run. The Commonwealth part is currently funded at the level of an English literature course.”
She agreed the government should offer incentives for psychologists working in rural and regional areas, but she didn’t think adding provisional psychologists to Medicare should be a priority.
“The government would be better off putting more money into the training system to enhance that workforce,” she said.
Psychiatrist Ian Hickie, co-director of health and policy at the Brain and Mind Centre, also cautioned against adding more psychologists at a lower level of training.
“The worst thing to do is expand the bottom of the pyramid without the right number of specialists in place. It’s not just a numbers game, it’s a work role issue,” he said. “What we need is more clinical psychologists … we need to make sure those who really need clinical care, get clinical care.”
His centre’s budget submission calls for at least 200 additional Commonwealth-supported university places for clinical psychology each year over the next four years.
Those places could be tied to servicing areas of need such as rural and regional centres, youth and Indigenous mental health, and services for multicultural communities, he said.
“There are contested views about where most emphasis should be at … but where there is agreement is that workforce investments are required. That’s the number one issue, and the number one issue by which the government will be judged as having taken substantive action or not,” he said.
“The danger is once again mental health slips down the priority pole.”
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