Report finds substantial inequalities in access to mental healthcare

AUSTRALIAN children from poorer communities are increasingly missing out on psychological care, with the gap in treatment between wealthy and disadvantaged families widening substantially over the past decade, according to Monash University research.

By 2023, fewer than one in three children from the lowest-income neighbourhoods received Medicare-subsidised psychological treatment within three months of obtaining a Mental Health Treatment Plan, compared with more than half of children from the wealthiest neighbourhoods.

Drawing on linked Medicare and tax data from 5.4 million Australian children and adults who received a Mental Health Treatment Plan between 2014 and 2023, the study found that income-related inequity in access to psychotherapy had nearly doubled over the decade.

Associate Professor Nicole Black, from the Centre for Health Economics at Monash Business School, said the findings highlight substantial inequalities in access to needed mental healthcare in Australia.

“What is particularly concerning is that these are people who have already sought help from a GP and received a Mental Health Treatment Plan. Yet many are still not receiving psychological care, and that proportion is much higher among people living in poorer communities,” Associate Professor Black said.

“Missing or delaying treatment can have serious consequences, including prolonged mental health problems, reduced quality of life and higher downstream healthcare costs.”

The overall use of Medicare-subsidised psychotherapy has also declined substantially since 2014, despite rising mental health needs and growing recognition of psychotherapy as an effective first-line treatment.

Between 2014 and 2023, psychotherapy use within three months of receiving a Mental Health Treatment Plan fell from 63 per cent to 45 per cent among children, and from 58 per cent to 48 per cent among adults. The decline was considerably greater among children living in lower-income neighbourhoods.

Over the same period, average out-of-pocket costs for an initial psychotherapy session more than doubled, rising from $44 to $90 for children and from $35 to $80 for adults, in inflation-adjusted dollars.

Associate Professor Black said Medicare subsidies are intended to make psychological care more affordable, but the amount patients are paying has risen substantially.

While we cannot say that rising costs caused the widening income gap, our findings raise serious concerns about the affordability and equity of psychological care,” Associate Professor Black said.

Professor David Johnston, from the Centre for Health Economics at Monash Business School, said the growing income gap raises serious concerns about the equity of Australia’s mental healthcare system.

“Access to mental healthcare should be determined by a person’s need for treatment, not their ability to pay. Yet our findings show that we’re moving further away from that principle rather than closer to it,” Professor Johnston said.

“Improving access will require addressing both the affordability and availability of psychological care. There is unlikely to be a single solution, and it is important that policy responses are carefully evaluated to understand which approaches genuinely improve access, particularly for those who currently face the greatest barriers.”