Mental Health Care Has A Privilege Problem

It's time to make it more accessible.

I’ve struggled with anxiety all my life. I was first diagnosed at 20 with Generalised Anxiety Disorder and Panic Disorder, but can recall plenty of moments in my childhood and teen years where fear gripped me like a vice. When I was 14 and convinced the world would end at any minute of the day, for example. I’d sleep with the light on (if I slept at all) and every moment of fun was snuffed out as I walked around under that dark cloud of anxiety, trapped in a cycle of traumatic thoughts.

I’ve been seeing psychologists on and off since that diagnosis. When I say on and off, I mean that I’ll see someone until I’m relatively okay (as in, not crippled with anxiety so bad I can’t work) then I’ll stop for months, sometimes years. Why? Because I can’t afford it.

Yes, I am a privileged woman in Australia. It’s important to remember this. I make a decent amount of money, definitely enough to live on in Sydney, which means comparatively I am fairly well-off. I could, for example, afford mental health care on a regular basis if I cut out a lot of the things I do for enjoyment – in the same way many Australians live hyper-frugally to make owning property a reality, I could likely see a psychologist fortnightly if I limited my lifestyle. 

But there is a huge difference between buying a house and staying mentally healthy. One is a choice, the other should really be a human right. The attitude that we should be budgeting regular mental health care into our finances like it’s a luxury, not a necessity, feels wrong to me.

Yes, we live in a country with universal health care, and one that does, at least, have a mental healthcare support system in place. This system grants six Medicare rebated sessions when you complete a mental health care plan with your local GP, and you can go back to apply for another four. This totals to ten per year. There are, currently, an extra ten sessions available to Australians as part of the COVID response. But these ten extra sessions won’t exist after July 2022.

The rebate amount is $124.50 per session to see a Clinical Psychologist in a 50 minute session. It sounds like a lot back in your pocket, but in my personal experience it’s resulted in me being at least $70 out of pocket, each session. Plus, there’s the fact that you need that money upfront to pay in the first place. 

Manageable for me? Yes. Affordable when it comes to the long-term? No, and here’s why.

In 2017, I had my worst year ever. Following a horrible breakup and a year of disordered eating, I was at rock bottom in terms of self esteem. I was broken, depleted, and having panic attacks weekly. 

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I started seeing a psychologist weekly. Well, first I had to find the right psychologist, which took up at least three of my sessions after two failed attempts to land the right fit. This is, after all, someone you’re meant to sit in front of, at peak vulnerability, discussing your trauma with. They need to be someone you feel you can trust.

The next three sessions were almost entirely dedicated to getting my new psychologist across my backstory – my family history, childhood, and current issues. Then, I applied for the four extra sessions as we finally started to work on what was happening in my life right now. 

When those four were used up, I panicked. I felt nowhere near “fixed” or prepared for the daily waves of panic I was experiencing. I was still a mess, crying daily, barely able to function at work.

So I started to pay in full. That was $220 a session, every week. No rebate. It was, at the time, around a third of my pay. 

This lasted for months –  I relied on that weekly session to keep me going for most of the year, to be honest. Without them, I don’t know what would have happened to me – I was genuinely in the darkest hole of my life.

As I recovered thanks to my amazing psychologist and her slow, but methodical rebuilding of my self-esteem and belief patterns, I wound back to fortnightly sessions – still paying in full. Eventually, that became monthly. I would have easily spent $2,000 over the second half of the year on non-rebate psychology bills.

I’m so thankful I made it through 2017, and I’m so thankful that I was financially able to get the help I needed, when I needed it. But still, I often find myself saying “ugh, guess I won’t see the psychologist this month” because I can’t afford it. All it takes is a bad parking ticket. The gas bill. Car repairs. The stuff that throws out your monthly budget and means you have to cut costs somewhere else. I’ll drop the psychologist visit because it’s expensive, and I’ll say “I’m doing okay” – when really, there is so much benefit from seeing your psych during periods where you can dig in and do the work without the weight of anxiety attacks.

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There will be Australians who just need mental health care for a few months. For these people, the current system probably works. But there are plenty of us who will battle disorders for the rest of our lives. Depression, anxiety, bipolar – these aren’t issues that go away, we just learn – often via the help of a psychologist – to manage them better. But those ten sessions go FAST. Suddenly, caring for your mental health year on year cuts a decent chunk from your monthly living expenses – especially if you go through a particularly bad period and use them up in a matter of months.

And what about those Australians who don’t have comfortable incomes? Who support children or family on a small wage? Who have illnesses and situations that prevent them from working for periods of time? How do they afford mental health care even WITH the rebate? These people who, often, need it more than most?

There is a privilege problem here. A $70 gap is nothing to some, something to many and all the money in the world to many more. The privilege of finding $220 a week to pay for mental health care you desperately need? That’s unheard of for most of Australia, but it would be the reality for many if you used up your 10 sessions – and let’s remember that you need that money in your bank account in the first place, followed by waiting to get your rebate. 

Really, the only people who can afford to fully care for their mental health are those in the top 1%. 

“But what about bulk-billing psychologists?”, you ask. They do exist, and they can be fantastic, for sure. But they’re not always the right option. What happens if the best psychologist for you is the one that costs $200+? What if there is no bulk-bill psychologist in your area? Why should most Australians be limited to a handful of psychologists that may work for them, because they’re financially unable to have choice. 

It’s been wonderful seeing workplaces embrace concepts like mental health days, and the government’s response to COVID’s psychological impact is something, at least. But it’s not enough. We need to stop treating mental health care as if it’s some optional alternative therapy like acupuncture or a remedial massage. When will we make it easy for Australians to access affordable mental healthcare, regularly.

No one goes to the psychologist just for a fun time. We’re not all out here abusing the system, making up problems so we can sit in a chair and talk uncomfortably about our trauma and fears for an hour. Yet we’re treated like psychological help is something to be rationed, not embraced. Like working on your mental health can – and should –  be done in six, easy sessions – maybe ten, if you’re really messed up.

There has never been a better time for changing our response to mental health. The uncertainty of COVID and stress of lockdowns has only further revealed how desperately we as a nation need health support for our brains, not just our bodies. 

Enough with the complicated processes, extreme limitations and unmanageable out-of-pocket expenses. Let’s make mental health accessible.

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