There is much hoo-ha following the government’s decision to revert to 10 subsidised psychology sessions from the pandemic-fuelled 20 sessions in place for the last couple of years.
The Australian Psychological Society (APS) and its proxies are all clamouring for various things to fix the countries mental health problems – namely, keep the 20 sessions, give rebates to the 7000 + provisional psychologists yet to finish their training and increase the number of training spots for psychologists.
This monochrome and unilateral approach to the complexities of the human mind – probably the most complex organism in the known universe – is naive – and not going to help the growing problem we face.
It is no accident that the universal belief is that the only people who can support someone in some stage of mental-ill-health who is not a psychiatrist is a psychologist and therefore more psychologists are needed to treat increased mental health needs. This is promoted by the powerful lobby group that is the APS and their influence on the debate of the allocation of the mental-health rebate budget.
However, as the data shows, outcomes are not improving regardless of the amount of money and extra sessions being ploughed into psychologists. All that is happening is that waiting lists are growing, co-payments are increasing, and people are going unserved.
Indeed, as a mental health practitioner myself, I know anecdotally that many people are being failed by psychologists who are not suitably trained to deal with specific problems – especially amongst the younger sections of society where behavioural-based therapies are known to be less effective – and are carried out often by psychologists without specific training. That problem will only be exacerbated if the APA get their way and 7,000 wet-behind-the-ears provisional psychologists are fast-tracked into the industry.
As a country we have plenty of psychologists – compared to other countries we are positively swimming in them (1 per 700 head of population in Australia vs 1 per 1500 head of population in the UK). What we need more of is “non-psychologists” practicing counselling and psychotherapy, which aim to be part of the treatment mix, but with a broader more experience based modality that allows people to understand themselves and their minds better which is often a key to alleviating suffering.
There are already roughly 5,000 of these types of mental health practitioners in the country delivering services outside of the Medicare system, with no rebate and an archaic requirement to also charge GST (as it is not considered a health service under the current legislation). Most are highly trained – just not the same way as a psychologist – and part of peak bodies such as PACFA and ACA – highly professional organisations.
So what is the difference? Generally speaking – and this is a simplification by necessity – Psychologists are trained in a medical-model to deliver a suite of Behavioural Therapies that seek to change people’s behaviour using a number of tools and strategies. Psychotherapists and Counsellors – trained in a non-medical model – focus more on the source of the problems and work with the client in trying to help them understand why they feel what they do. No school of thought is a one size fits all – psychology is fantastic for some, and not for others, and vice versa for psychotherapy and counselling.
The primary point is that given the complexities that lie within our brains – and the still unknown parameters of what makes us who we are – and why we suffer mentally – it is madness – literally – to think all that we can do to help is based on one way of treating mental illness, especially as the results suggest it is lacking in overall efficacy. Surely a better way to go is a broader suite of modalities that with skill and knowledge can match a particular person’s problem to the right form of treatment and assistance that can help them engage in the world to their full potential.
However, without government support and recognition for their role in addressing the mental health needs of the population there are many disincentives for going into the profession as a psychotherapist or counsellor that is biased towards the psychology model as the only legitimate treatment choice.
An enlightened mental health policy would seek to take a broader perspective of treatment modalities and encourage the take up of counselling and psychotherapy services alongside the psychology services that currently dominate. This could involve a three point plan whereby:
- Members of existing psychotherapy and counselling associations that meet rigorous training requirements – similar to or in most cases in excess of psychologists clinical training – are granted provider numbers and access to rebates, as well as having the need to charge GST dropped. This would immediately put 5,000 professionals into the market for Medicare-subsidised spots, take away the ante-competitive requirement to charge GST when Psychologists do not have to, and increase provision by 15% overnight.
- Counselling and Psychotherapy trainings should be increased at both University and TAFE level with a specific emphasis and incentives to attract people with more life experience (and lived experience) to re-train and start second careers in what is – unfortunately – a guaranteed growth area of need. In the same way that mature aged adults are encouraged to re-train as teachers in the UK under the NowTeach initiative, the same strategy could be implemented for counsellors and psychotherapists in Australia.
- GP’s and the Public should be made aware of the broad range of mental health services that are available beyond what is offered by Psychologists so that more holistic and accurate referrals can be made to people looking for help – thereby freeing up the over-subscribed psychology system and creating a more sophisticated suite of mental health offerings to match the increasingly complex world we live in.
Guest author Bernard Macleod
Bernard Macleod is a Psychoanalytic Psychotherapist practicing in Sydney. He works in Private Practice with people across the lifespan, with a specific interest in Child & Adolescent psychotherapy. He is an Associate Member of the New South Wales Institute of Psychoanalytic Psychotherapy (NSWIPP) and a Clinical Member of the Psychotherapy and Counselling Association of Australasia (PACFA).