Inequity in mental health care is widening, with treatment ‘out of reach’ for many Australians

For Chantelle Gardiner, her rescue dog Ollie is more than just a pooch — he’s a lifeline. 

“Living alone, he’s sometimes just enough company,” she said.

“He likes to lick your tears when you cry. He’s funny, he’s a clown, too, and he makes you laugh.”

The duo live in a tiny, rented granny flat out the back of a share house in Sydney’s inner west.

Ms Gardiner also lives with a multitude of health conditions, including anxiety and depressive disorder, hypothyroidism, insulin-resistant polycystic ovary syndrome and fibromyalgia.

The retail worker cannot afford all the treatments and medication required to manage those illnesses so she has been forced to make sacrifices. 

One of the first was her mental health.

“I stopped seeing my psychologist just before the last Sydney lockdown [in 2021],” she said. 

“The out-of-pocket cost after the Medicare rebate was well over $100. When the cost is that much to begin with, it’s completely prohibitive.

The cost of mental health care was briefly thrust into the spotlight late last year when the federal government abandoned a lockdown-era policy that doubled the number of annual Medicare-subsidised mental health sessions available to patients from 10 to 20.

The government defended paring the Better Access program, arguing its expansion had aggravated wait lists, making it harder to access care for new patients, especially those in low socio-economic areas.

The cuts provoked outrage and outcry from mental health advocates, patients and politicians who argued the expanded program was still benefiting many.

For Ms Gardiner, the cuts made no difference — she couldn’t afford 10 sessions, let alone 20.

Instead, she’s been forced to use medication to help manage her mental health.

“I’ve been put on antidepressants and just decided to up the dosage of those,” she said. 

“But while I was seeing a psychologist, I didn’t have any need for antidepressants.”

Links between disadvantage and higher rates of mental health issues are well-established.

Disadvantaged households reported having anxiety disorders and affective disorders (such as depression and bipolar) at a much high rate than wealthier households, government data from 2020 and 2021 shows.

A review of the Better Access program last year found lower-income earners were more likely to be prescribed medication, rather than be referred to a psychologist.

Ms Gardiner said mental health care was increasingly becoming something only affluent people could afford and that needed to change. 

Inequality increasing

Tegan Carrison, executive director of the Australian Association of Psychologists, said the gap between who could and could not afford to access mental health care was widening.

She said disadvantaged Australians faced “barrier after barrier after barrier” when trying to access mental health care.

“The first barrier … is that [patients] need to see a GP,” she said.

“Often there is quite a long waiting list [and] often there’ll be an out-of-pocket expense just to get that referral. Then we have barriers with regards to wait times to see a psychologist. 

“When patients do have that psychologist appointment, then they have this huge barrier of what the Medicare rebate is.”

Ms Carrison said the rebate of around $89 for most psychology sessions still left people “out-of-pocket well over $100 in most instances”.

Recent data also points to difficulties lower-income Australians are having accessing treatment.

Last month, a productivity commission report showed the number of Australians who delayed or avoided seeking health care because of cost had grown by 50 per cent last year.

Almost a quarter of people delayed seeing a mental health professional because of cost — and 22 per cent of people postponed appointments with a mental health professional other than a GP.

Research by The University of Sydney’s Brain and Mind Centre found out-of-pocket payments rose year-on-year between 2013 and 2021.

In fact, out-of-pocket costs for patients increased by 164 per cent over that time period.