The 'legislative mistake' resulting in a regional mental health crisis

At the moment, only patients of clinical psychologists can receive a Medicare rebate of $125 under a mental health care plan.

Patients of all other psychologists can receive a rebate of $88 - 40 percent less than the clinical tier.

Only 25 per cent of psychologists Australia-wide are clinical, and the Australian Association of Psychologists (AAPi) say the two-tiered rebate system means regional areas are missing out.

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"We know regional areas are really struggling with mental health," AAPi director Tegan Carrison said.

"They've experienced loss of industry and employment, we've had floods, drought and now the pandemic.

"And the biggest challenges that we are facing in mental health care in regional areas really relate to access."

Ms Carrison said in regional areas, clinical psychologists are hard to come by.

"So a lot of the psychologists that are in regional and rural areas, tend to be those with general registration," she said.

"So they're only able to offer their clients that low rebate.

"So it really means to clients that sometimes it's just not affordable to see a psychologist that they might desperately need to see."

The AAPi have been advocating for several years to have the two-tiered system changed and argue there is no discernible difference between clinical and non clinical psychologists.

"The two tiered system has absolutely nothing to do with a better psychologist, or a psychologist with more education and experience," Ms Carrison said.

"It's essentially a legislative mistake that needs to urgently be corrected.

"All psychologists have undertaken at least six years of education and training before they registered and undertake minimum annual professional development."

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Clinical endorsement is achieved by completing a masters or doctorate in clinical psychology.

Other qualifications such as community psychology, educational and development psychology and health psychology do not result in clinical endorsement.

Geelong based general psychologist Laura Lee echoed Ms Carrison's sentiments, arguing research on patient outcomes saw no difference.

"There's been numerous studies that have shown that the outcomes for clients are no different, whether or not the psychologist had clinical psychology endorsement or not clinical endorsement - it doesn't lead to greater client outcomes," she said.

Ms Lee runs a private practice and said the two tiered system was significantly impacting her patients, and putting some off receiving urgent mental health support.

"We know there's huge demand for regional psychological services," she said.

"If the Medicare rebate was increased, we would see more psychologists able to bulk bill and greater access to private psychology services for Australians, which in regional areas in particular is so dire - the services are stretched so far."

The demand is so great, since opening her practice at the end of February, Ms Lee has had to close her books to new patients.

Despite being fully booked out within two months of opening, Ms Lee said some patients that urgently needed care were being forced to spread out or cancel appointments due to the cost.

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"We have got people spreading out their appointments or prematurely ceasing treatment," she said.

"People start to kind of anticipate the costs, they think 'oh I can't afford this at this frequency' so they spread it out or stop all together."

While the cost is one disincentive to treatment, the AAPi argue long regional wait times could also be decreased by mirroring the financial incentives for regional GP's to psychologists.

"GPS can receive access to financial incentives when they work in regional areas," the AAPi director said.

"They also have schemes where they wipe HECS debts for doctors who are working in regional areas - we need that expanded to psychologists."

After months of panic attacks, Bendigo's Mitch Blackman tried to access mental health services in 2021, however was so disheartened by the regional wait times and the cost of services he never went back.

"About a year ago I was at my nana and pops and all of a sudden my heart started beating really fast," he said, "I didn't know what on earth was happening - it was just out of the blue."

The next day Mr Blackman booked in to see his GP, where he was referred to a mental health provider.

"They then hooked me up with a psychologist, but I couldn't get in for three months," he said.

Mr Blackman ended up being referred to a psychologist in Brisbane.

"So I was talking to someone about panic attacks and debilitating mental health in Queensland, over a screen," he said.

"The only help I could get in town was just a GP prescribing me drugs."

For the 26-year-old, the tele-health system didn't work for his needs.

"He wanted to see me every week," he said, "but it was $200 of which some got rebated, but it was for something that I couldn't justify.

"Paying $50 to $100 just to see someone on screen once a week that wasn't getting anywhere."

Mr Blackman said the lack of available in-person care in Bendigo meant he never got an anxiety diagnosis, resulting in significant confusion about his symptoms.

"I had almost 25 doctor's appointments with all these different physical symptoms," he said.

"And I didn't know what it was because it was never diagnosed.

"So I was just bouncing around the healthcare system trying to find an answer."

Mr Blackman presented to Bendigo Health's emergency department multiple times thinking he was having a heart attack, only to be turned away without answers.

"I went and had ECG's and all those things, and was just sent home saying it was fine," he said.

"If it turns out that I am physically fine, then I shouldn't just be sent home.

"There should be a referral system in place with an on site psychologist to talk you through what's happening and what the next steps are.

"But there's just not enough psychologists around - the wait times are huge - and they're too expensive."

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The Bendigo man was so demoralised by the system, he sought help from the internet.

"Google was my best friend and my worst enemy for the best part of a year," he said.

"I should have been able to have someone to talk me through some coping mechanisms instead of the trial and error of googling and trying things out myself."

Mr Blackman's experience is not isolated, a new survey from Lived Experience Australia found that 60 percent of respondents said cost was a barrier to seeing a psychologist and 57 percent blamed psychologist availability.

The AAPi are now calling on the federal government to address the regional mental health crisis by abolishing the two-tiered rebate system and provide financial incentives for psychologists to work in regional areas.

"There's nothing concrete yet," the association said, "but we're going to keep working on it."

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