Equity, accessibility and appropriate delivery of mental health care

In July 2023 the NSW Legislative Council set up an inquiry into the equity, accessibility and appropriate delivery of outpatient and community mental health care in NSW. Put simply: can everyone in NSW get the mental health care they need outside hospital, whoever they are and whatever they can afford? Portfolio Committee No. 2 (Health) ran the inquiry and invited submissions.

We made a submission because we believe everyone should be able to get comprehensive, competent and empathetic mental health care. In our view, the system in NSW was not delivering timely, affordable and consistent care, and our submission set out three changes we thought would help.

See also our submission to the Senate inquiry into ADHD services and our letter on proposed changes to Better Access.

We made three recommendations.

• Better Medicare rebates for therapy. The rebate for psychological treatment doesn’t reflect the true cost of providing care, so many people are left with out-of-pocket costs that can put them off starting or continuing treatment. Ten rebated sessions a year isn’t enough for many people with moderate to severe conditions, and provisional psychologists, who train under supervision, aren’t covered at all. We asked for a review and increase of the rebate, a rethink of the session limit, and rebates for provisional psychologists.
• Medicare rebates for psychological assessments. Assessments help a psychologist understand a person’s presentation and plan the right treatment. Many aren’t covered by Medicare, and some need at least 10 to 14 hours of clinical work, so many people can’t afford one. We asked for psychological assessments to be included in the Medicare rebate system.
• Psychologists and GPs working together on medication. Only psychiatrists and GPs can prescribe medication for mental health concerns, while psychologists often see a person regularly and in depth. We proposed a pilot in which selected psychologists, after specialised training, work closely with GPs on medication management, with the results evaluated to guide any wider change.

The committee published its report, Report 64, on 4 June 2024. It referred to our submission when discussing the cost of care. Paragraph 2.28 quotes our point that the Medicare rebate for psychological services is “not reflective of the true cost of providing high-quality mental health care”, and notes our concern that out-of-pocket costs can deter people from seeking and continuing treatment. Our submission is also cited at paragraphs 2.27 and 2.29.

You can read Report 64 in full. The report and the NSW Government’s response to it are on the inquiry page.