The 2021 census reveals that about 2.2 million Australians (one in 12 people) report a chronic mental health condition. This is consistent with other evidence. In 2011, the Australian Institute of Health and Welfare calculated mental ill-health as the third highest burden to the Australian community. When an individual's mental health is compromised, this impacts the individual, their family, support networks and the broader community. Mental health is also integral to economic participation and productivity.
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Mental health has been a focus across the COVID-19 pandemic, with increased incidence of anxiety, depression, domestic violence and marital breakup. However, the incidence of anxiety and depression was increasing within our community before the pandemic. In 2016, serious mental ill-health was estimated to cost the Australian economy almost $60 billion and 6 per cent of GDP.
Unsurprisingly then, effective psychological treatment has ripple effects through families and the community. A report commissioned by Beyond Blue in 2014 demonstrated that for every dollar spent on implementing an appropriate mental health treatment, on average there was $2.30 in productivity gains. In 2020 an inquiry into mental health in Australia was undertaken by the Productivity Commission. Two of their recommendations were to address healthcare gaps in community settings and consider increasing the number of Medicare-rebated psychological services.
Indeed, a simple and cost-effective way to address existing gaps in accessible and affordable mental health care is to permanently increase the number of Medicare sessions for psychology services. To date, psychology treatment within community settings has been hampered by the inadequate number of sessions rebated under Medicare: at 10 per year. During the pandemic the federal government increased this to 20 sessions per year which assisted psychologists to more effectively complete treatments. Alarmingly however, these extra sessions are due to cease in December 2022.
An essential question when deciding whether to invest in a permanent increase in the number of Medicare-rebated sessions for psychology treatment is a cost/benefit analysis. Research convincingly demonstrates that psychological therapies provide relief of suffering and benefits the community, in terms of wellbeing and economic productivity. Yet, the therapy must be completed for these benefits to be realised.
Research has found that the number of psychology treatment sessions is directly associated with the degree to which symptoms reduce. In one study, the treatment effect was small for patients with depression who had 12 or fewer sessions, and significantly larger for patients given 18 or more sessions. Other research found that the appropriate treatment dose for psychosis was a minimum of 25 psychological treatment sessions whereas 12-16 sessions was effective for people with panic disorder.
Ten sessions of psychological treatment are inadequate for many mental health conditions. Early termination commonly results in reoccurrence or worsening of the original condition. As a corollary, would anyone expect a good outcome when only half the recommended treatment is provided for a medical condition? Would one remove a cancer patient's treatment part way through? We are advised to complete a course of antibiotics, otherwise our condition can worsen. The same applies to psychological treatment.
For the wellbeing and productivity of our community, based upon research outcomes for psychology treatment, the Institute of Clinical Psychologists recommend a permanent increase in the number of Medicare-rebated sessions available for psychology, with i) 10-12 rebated sessions per annum for mild mental ill-health; ii) up to 20 sessions for moderate mental ill-health; and iii) up to 40 rebated sessions per annum for those with severe mental ill-health which can be delivered by Clinical Psychologists (who have specialist training in assessing and treating more complex mental health conditions).
Providing additional Medicare-rebated psychology sessions will most benefit patients from lower socio-economic and disadvantaged groups who have limited capacity to pay for unrebated sessions once they reach the 10-session limit. These are the most vulnerable members of our community, and government should not turn their back on them.
Certainty and an appropriate therapeutic dose of psychology sessions is essential to properly remediate mental health conditions. Permanently increasing the number of Medicare-rebated psychology sessions is a simple and cost-effective way to long term better health outcomes, increased engagement in families and communities, and increased productivity for our nation, all of which is deliverable through the private sector and does not involve additional costs of health care in the public sector.
- Dr Marjorie Collins is a clinical psychologist and president of the Institute of Clinical Psychologists.
