A new study has found that the out-of-pocket costs for mental health care are skyrocketing, causing Australians to delay seeking help amid a surge in demand for psychologists and psychiatrists.
The study found that out-of-pocket costs were rising much faster than overall expenditure on mental health care. Average co-payments per service have almost doubled between 2013 and 2021.
Experts say the data highlights issues with a fee-for-service mental health care model, arguing the sector needs greater investment to improve multidisciplinary care and better match patients with the right professionals.
More demand and higher costs
The study looked at mental health service costs from 2013 to 2021. While Medicare rebates for mental health services grew by 70% between 2013 and 2021, out-of-pocket costs increased by 164%.
There has been some improvement: in 1980 Australia ranked third highest in the world for co-payments, and by 2018 we had dropped to 10th place.
But mental health care is still expensive. Services cost $35 million a week, around $8 million of which comes from copayments. Around 12 million mental health services were provided each week from 2020 to 2021, an increase from 8 million in 2013 to 2014.
The study also found huge variations in how much people were paying for services based on where they lived. Some communities paid four times as much in out-of-pocket costs, even when compared with statistical local areas of similar socio-economic status.
Lead author of the study and lecturer at Sydney University’s Brain and Mind Centre Dr Sebastian Rosenberg told Crikey people were being deterred from seeking help.
Australians delaying help
The National Study of Mental Health and Wellbeing found that in 2020-2021, 43% of Australians aged 16 to 85 had experienced a mental disorder at some point in their lifetime, and one in five Australians had a 12-month mental disorder. That number increases to two in five people for those aged 16 to 24.
But just 47% of people with a 12-month mental disorder saw a health professional, with women more likely to seek out services than men.
That same year, 15.3% of people delayed or didn’t see a psychologist, psychiatrist or other mental health professional for their mental health due to cost (compared with just 5.8% of people who delayed seeing or didn’t see a GP).
The Better Access initiative was introduced in 2006 to increase access to Medicare rebates for mental health treatment. But the number of new clients in the program has been decreasing over time. In 2008, 68% of those accessing the program were new clients. In 2016-17, that number had dropped to just 32.6%.
Rosenberg said the fee-for-service model wasn’t appropriate for mental health care, arguing multidisciplinary care teams provided better support, especially for those with long-term mental illnesses. Medicare funds 20 sessions with a mental health care professional — an increase from 10 following the COVID-19 pandemic.
But for those who have used up their sessions, or who can’t find a professional, it means they have to wait until they are in an acute crisis to be hospitalised, and are often discharged with no ongoing support. While the National Disability Insurance Scheme funds support worker services, it’s incredibly difficult for those seeking support for psychosocial disabilities.
“What do we do with a person with schizophrenia when they are well?” Rosenberg said.
“We need to be thinking about primary care beyond just anxiety or depression. We need to be saying, ‘How do we provide for the physical health care needs of a person with schizophrenia? How do we manage their medication? How do we also deal with their psychosocial needs of employment and housing, education and other things?’”
Where to from here?
Australians for Mental Health campaign director Chris Raine told Crikey current national funding for mental health services should be doubled.
Mental illness and substance use disorders account for 13% of the burden of disease. While the October budget was lauded as the “well-being budget,” it included just $24.3 million over four years to improve access to mental health services.
The pandemic saw a surge in demand for mental health services, especially in Victoria following protracted lockdowns. Doubling Medicare-funded mental health sessions has also put a strain on the system.
Raine says there needed to be not just a focus on increasing the workforce, but on improving how people are matched with professionals, to ensure they’re getting the care they need.
“We’re advocating for investment in waitlist and access systems so that people know how to find someone, and where else they can go to find someone when they need to,” he said.
“We don’t put a lot of effort or enough effort into improving the evaluation of the service and the navigation to find the right service and to move into a different service if that’s not right for them.”
Mental health disorders affect 99.99999999999999% of the population. That’s everyone except me. Unless it’s just me, and everyone else is OK.
My old dad used oft to say -“All the world be mad but me and thee and thou art s bit strange.” which I assumed was old Aussie (early 20thC).
According to “The Houghton Mifflin Dictionary of Biography,” Welsh social and educational reformer Robert Owen (1771-1858) is reported to have uttered the following words to his partner W. Allen on the dissolution of their business partnership:
“All the world old is queer save thee and me, and even thou art a little queer.” (1)
A Utopian socialist, Robert Owen was born in Newtown, Montgomeryshire (Wales) on May 14, 1771-1858), the sixth of seven children. His father was a saddler and ironmonger who also served as local postmaster; his mother came from one of the prosperous farming families of Newtown.
Robert Owen founded the famous New Lanark Mills in Scotland as an example of the viability of co-operative factory communities…New Lanark is an exceptional example of a purpose-built 18th century mill village, set in a picturesque Scottish landscape near the Falls of Clyde, where in the early years of the 19th century, the Utopian idealist Robert Owen inspired a model industrial community based on textile production.
Unless your intake is hospital, it can be months before you can even see a psychiatrist, that’s you sitting around without meds you might need to be on (I got lucky with mine there was a cancellation so saw them within a few weeks)
And yes, it’s pricey, even with the rebate
Where I live Ms Schultz patyment is not much of an issue. Not because everyone is wealthy, but because there are no bloody mental health services. I live 40km from a town of 40 000. I am a teacher. Waits to see a mental health worker (never mind psychlogist) are 3 months minimum. Psychiatrist….on line maybe. Specialist facility? 250 km one way. 30 km less than Sydney to Canberra.
Mental health costs will always be high under current government thinking which seems to accept that you might be mentally ill if you are in hospital under a doctors care but the minute you are discharged you are a malingerer and therefore have to pay top dollar. Not sure how to fix this but the problem definitely appears to be governments doubts around the validity of mental claims.
As opposed to which government? I’ll vote for one that actually has mental health care available. It sure as hell wasn’t Scummo, it’s not Domicron Perrottet so we’ll give the new guys a go, probably no better, but can’t be worse.
But what about the mental health of people earning >$120,000 if they don’t get their tax cuts?