For over a decade now I have tried to convince politicians of the need to address mental health care. For my part, the main focus has been on basic public access to psychological care in the community. I’ve largely been motivated by an optimistic notion of democracy: that if we inform our politicians adequately then their commitment to a better society would translate across into improved public policy. I feel like I have invested a large chunk of my life on that hopeful view, without much of a noticeable impact. So now it’s crunch time.
I reckon that just about every possible avenue has been exhausted in my attempts to clarify why we need better access to therapy in Australia. I find it difficult to imagine any other way to get the message through, and similarly, it’s also pretty hard to know where to begin with any kind of summary of all the things we’ve tried. Bear with me as I rewind the clock to show you what I mean.
Six years ago the former Labor government announced cuts to Medicare. Their newly appointed Minister for Mental Health (Mark Butler MP) said that over $500 million in funding would be redirected away from psychological support, leaving people with access to “ten sessions, with no exceptions”. My colleagues and I were alarmed and wondered whether the wider public understood what those cuts would mean and whether they shared our concerns. So we established a group on Facebook to start that discussion and found we had thousands of supporters. Our first efforts to articulate the problems with these Medicare cuts came from there. People with lived experience of mental health issues bravely opened up about personal stories, expressing their view on what the planned cuts would mean to them. There was very little response from the media and no response at all from our government.
With that in mind, we began raising awareness over radio interviews, newspaper articles, and web-based media. Alongside this publicity, we launched a petition (via Change.org) which in addition to hard-copy signatures gathered over 20,000 supporters. Over 3,500 people left comments on our petition too – some of which are really quite heart-breaking (here’s a link). Despite the petition being designed to fully conform to senate rules, it was difficult to find a politician willing to table it in parliament. Fortunately we were helped by former Senator Sue Boyce who lodged our petition, but even so, nothing ever came of it. No debate and zero interest.
Throughout this time I drew together all of the research. I wanted to show our politicians and the wider public how important it is to make sure people get access to enough care to make a lasting difference. The often cited statistic we kept hearing from politicians is that a growing number of Australians are accessing therapy, but that’s a bit misleading when we learn that they only receive help for a very brief time. My early attempts were to make summaries which were simple to understand, so I began with basic statistics from randomised clinical trials showing that ten sessions of cover is inadequate. I followed up with a summary of the research demonstrating that it will cost us a lot more as a society to scale back on funding for psychological care. Over the last five years I’ve written over a hundred articles on this blog of a similar nature, analysing the data from various angles to show that whatever way we look at this situation there is no benefit to cutting Medicare support. Despite receiving hundreds of comments from supportive members of the public, our politicians have more or less ignored the issue entirely.
Probably the most extraordinary length I’ve gone to is asking Dr Aaron T Beck himself – the man who created cognitive behavior therapy – to send a letter to our former Minister for Health (Peter Dutton MP). It’s amazing that I even got a reply (the man is in his late 90’s), let alone that he actually wrote a letter to the Minister for Health supporting our cause. Beyond all of that, I don’t know what other kind of evidence there is (you can find nearly all of it concisely summarised here).
And yes, I’ve tried reaching out to politicians directly too. So many times over these past few years, I coordinated mass letter-writing campaigns, getting hundreds of Australians to write directly to politicians on all sides of the spectrum and send in submissions to government inquiries on this topic, with practically no effect. A case in point is the review of the National Mental Health Commission which acknowledges in volume 3 that “by far the biggest complaint” was about the inadequate support of Medicare for psychotherapy concluding that the system should not be based on a predesignated number of sessions – and yet the report recommends exactly that! For the entire three years that Mark Butler MP was the Minister for Mental Health he stonewalled our requests for a meeting and ignored nearly every letter from consumers. Put simply, Labor showed no interest in discussion about the cuts. Initially, I held out some hope that The Greens would disallow the cuts (as they promised) but that too was quietly abandoned. The Liberal party were enthusiastic to fix the system when in opposition, however in the years since coming into power it seems pretty obvious that nothing is being done to address the issue.
As far as I’m concerned, the big parties can have one more try to show us they can do the right thing. My eyes will be on the Federal Budget coming up next month and we’ll see if any of them will tackle this issue. Will we see the same re-packaged funding, with rhetoric that no new investment is needed? Will most of the spending go to niche sectors, for point scoring on topical issues and the approval of a few hand-picked mental health experts? Will we see the vast majority of people in need of mental health care abandoned, yet again?
Let’s wait and see. And if it doesn’t work out, you can join me in taking this issue directly to the political arena.
NOTE: Look maybe I’m wrong. As far fetched as I might think it is, maybe our Prime Minister hasn’t yet realised how important this is – so why not email him ahead of budget night? (at https://www.pm.gov.au/contact-your-pm). And perhaps it hasn’t occurred to the Minister for Health either that Medicare support is vital to ensure that people access care – so go ahead and send him an email too. You could also try the Shadow Minister for Ageing and Mental Health to see if she feels strongly enough about Medicare support to call for change. Honestly though, they’ve all had ample opportunity to do something constructive over these last five years based on the best evidence we have, all to no avail. So I’m giving this one more go and taking it from there.
Frank Breuer, Clinical Psychol
Ben Mullings, you are dead right. The neglect of the Australian Government is really unsurpassed, from my point of view, having worked as a Clinical Psychologist in both Germany and Australia for combined nearly 20 years, I clearly see the difference and I hope it is ok to benchmark. It’s not only the ludicrously limited number of sessions but also the cumbersome referral system that is responsible for the revolving door phenomenon and skyrocketing expenses (!). German population has access to sufficient numbers of sessions, no awkward referral system (yes, direct access to ‘Medicare’ psychologists) and expenses are at only about 1% of the total of medical expenses. Everything bulk billed, by the way, no out of pocket expenses. The beauty of the system is cost-efficiency and sufficient provision of care. It’s not paradise though, but psychotherapy is not meant to be paradise, it is a treatment option that requires the client to be pro-active but is rewarding because it aims at increasing self management, self responsibility etc. In my years in Germany the average number of sessions was around 20-25 which clearly indicates that the number of sessions would not skyrocket even if they were unlimited! Also, the average cost of completed (!) treatment is really not that high. I do not get why the Government has been stonewalling for so long.
The merits that led to establishing psychological therapy into German “medicare” have resulted from a hard and long battle that included ongoing serious pressure from voters, professional bodies and high profile academics.
In a changing, increasingly individualised world, psychological services are even more needed, not just a repair workshop, but as an societal value and instance, that stands for equality of psychological and physical health. Without psychological health everything is nothing, likewise to physical health.
Harvey Skaggs
How about working with politicians to fix the issues that cause people so much suffering, instead of bandaging and medicating the symptoms?
And yes, you ARE wrong. Give up. You’re nothing but a shill for Big Pharma.
betteraccess
From where I’m sitting, it seems like you’ve completely misread where I’m coming from Harvey.
Did you know that psychologists don’t prescribe medication? For around ten years now I’ve worked hard on trying to move away from a system of diagnostic labels, so that we don’t end up medicating people as a first-line treatment. The philosophy of my discipline (Counselling Psychology) is focused on building psychological strengths for all people in society and moving beyond simplistic individualism, to more relational, interpersonal, and social ways of understanding distress, coping, and positive functioning.
As for working with politicians, correct me if I’m wrong, but it does seem pretty clear from the above that we have tried quite hard to do that.