This highly regressive measure is linked to the government’s aim to reduce debt and the budget deficit by cutting government spending, including for vital public services. It is also part of the campaign to portray the COVID-19 pandemic as a thing of the past. The number of sessions funded was initially increased from 10 to 20 in 2020, in response to a Mental Health Productivity Commission report released due to concerns about staffing shortages during the pandemic.
The need for subsidized psychological treatment, like the pandemic itself, has not disappeared. COVID-19 infections continue, globally and in Australia, causing debilitating long-term effects and deaths. The deepening social crisis, fueled by rising costs of living and declining living standards, has increased rather than decreased demand for mental health support.
More than 20 percent of the Australian population suffers from some form of mental health disorder. Young people are particularly burdened by the mental health crisis, with around 40 percent of 16-24 year olds struggling with some form of mental health problem. There are many more people who would benefit from an appointment with a psychologist without a formal diagnosis, in addition to those who do not seek a diagnosis. Only 5 percent of the adult population had one or more subsidized psychologist sessions last year.
The halving of subsidized appointments will cause even more suffering. While the affluent upper middle class will remain unaffected and can afford private treatment as needed, the working class will be hit hard.
Labor Secretary Mark Butler tried to cover his tracks by preposterously claiming that the policy of cutting subsidies was to improve health services. He stressed that the 20 sessions available had “exacerbated existing waiting lists and barriers to entry”, with “lowest income Australians” being particularly affected by a shortage of available psychologists.
This situation should lead to a massive expansion of government funding for mental health care. When a system cannot serve some of the people who need it, the solution is to increase the available resources, not to reduce them.
Butler also stressed that a government-commissioned study found that giving people 20 instead of 10 sessions made no difference because “self-reported mental health at baseline was virtually identical for those who received and did not receive the extra sessions” .
Numerous mental health experts have rejected this, denouncing the government’s cuts in subsidized treatment.
Dr. Katrina Norris, director of the Australian Association of Psychologists, wrote in the Daily telegram: “As a psychologist in private practice, whose clients have directly benefited from these additional sessions, I am disappointed, saddened and angry by this decision. […] The extra sessions gave those who had access to services the opportunity to receive more frequent treatment if needed. For those in crisis or with complex mental health needs, the additional sessions enabled them to receive adequate treatment without relying on public health or community health systems. It gave them security, stability and choice in their mental health care.”
She added: “Ultimately, this decision is likely to cost lives and so psychologists and other mental health practitioners are outraged.”
Professor Caroline Hunt, President of the Australian Clinical Psychology Association, and Associate Professor Christopher Lee of the University of Western Australia wrote in the The Sydney Morning Herald“This move cannot be justified through a healthcare lens and the federal government seems comfortable reserving the highest quality expert mental health services exclusively for the wealthy who may be able to privately fund it. […] These cuts not only mean reduced access to vital care; in some cases, psychologists have to reject vulnerable patients with more complex mental illnesses because we know that delivering only half of the required treatment will not produce a favorable outcome. This is a huge ethical dilemma for mental health professionals.”
The Labor government has ignored all these pleas. This is consistent with the previous rejection of recommendations in a report she commissioned reviewing the Better Access initiative (the program under which people access subsidized psychologist appointments).
On December 8, a team of researchers from the University of Melbourne, led by Professor Jane Pirkis, Associate Professor Dianne Currier, Associate Professor Meredith Harris and Professor Cathy Mihalopoulos, provided the government with a 337-page report. It looked at the history and record of the initiative and collected numerous statistics and surveys. It specifically recommended keeping the increase to 20 sessions, explaining: “The additional 10 sessions should remain available and should be aimed at people with complex mental health needs.”
Complex needs refers to the most vulnerable, those who suffer from debilitating mental health problems that prevent them from functioning in society without regular specialist care.
The report included numerous statistics pointing to the class issues within the mental health crisis. The working class and poor people are most affected by mental health problems and have the least access to proper treatment. Of the poorest 20 percent of the Australian population, 22 percent suffer from high or very high levels of mental health problems. This is more than double the level of distress in the wealthiest 20 percent of society.
Wealthy strata are significantly more likely to access psychological treatment. The report explains: “Those with the lowest incomes are least likely to have access to services. The waiting times for treatment for those who did progress from a [mental health] treatment plan was also longer for those in the lowest income quintile; their median wait time was 22 days, while the median wait time for those in the top quintile was 17 days. All of these indicators have deteriorated over time.”
Lower access for workers partly reflects less available psychologists. The report found that 1 in 3 psychologists could not take on new patients in 2022, compared to 1 in 5 in 2021.
Cost is a major barrier to treatment. Nearly two-thirds of subsidized sessions require “co-payment” from the patient, with a median out-of-pocket cost per service now $90. A survey in the report found that of patients who discontinued psychological treatment early, nearly one-third, 31, 7 percent, indicated they did this because “co-payment” was unaffordable.
One person told the researchers, “It’s really just the financial side that’s hard, like taking time off from work and things to get to appointments. That also has a financial impact, but there’s really no escaping that, and I’m casual at the moment, so it’s volatile at first.
The Labor government’s cut in psychological services is a ruthless anti-working class measure that underscores its role as a tool of finance capital and big business.