Opinion: Australians Turning into Chemical Mental Health Depositories

By Philip Armstrong

New figures released last week by the Australian Institute of Health and Welfare paint a dire picture for Australians who are becoming reliant on chemical interventions for their mental health.

  • 42.7 million mental health-related medications (subsidised and under co-payment) were dispensed in 2020–21.
  • 4.5 million patients (17.7% of the Australian population) filled a prescription for a mental health-related medication in 2020–21, with an average of 9.4 prescriptions per patient.
  • 62.3% of mental health-related prescriptions filled were subsidised by the Pharmaceutical Benefits Scheme (PBS)/ Repatriation Pharmaceutical Benefits Scheme (RPBS) in 2020–21.
  • 84.7% of mental health-related prescriptions filled were prescribed by GPs; 7.5% prescribed by psychiatrists, 4.9% were prescribed by non-psychiatrist specialists in 2020–21.
  • 73.1% of mental health-related prescriptions filled were for Antidepressant medications in 2020–21.

Australians Turning into Chemical Mental Health Depositories

The most disturbing figure is that 84.7% of prescriptions were prescribed by GPs who have minimal formal training in mental health, usually a 20-hour course[1], and have no mandatory requirements to undergo annual ongoing professional development (PD) or clinical supervision. To be fair to GPs, when would they have the time?

The cost to Australians in 2019-20 for government-subsidised mental health-related prescriptions under PBS/RPBS was $566 million[2]. This doesn’t take into account that Australians pay a gap fee up to $42.50 for most PBS medicines or $6.80 if they have a concession card.

Take into consideration a study published in World Psychiatry “The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons (2013)” concluded that pharmacotherapy and psychotherapy have comparable effects in several depressive and anxiety disorders[3]. With 73.1% of prescriptions being for depression brings into question why the government isn’t making counselling available to the public through the Medicare Benefits Schedule (MBS). Surely giving Australians access to a non-chemical alternative is in everyone’s interest, bar the pharma’s.

Australians Turning into Chemical Mental Health Depositories

What would the annual cost to MBS for 3,000 Registered Counsellors and Psychotherapists to be able to offer ten 1-hour sessions to Australians suffering from depression? Answer: less than $250 million a year. Compared to $556 million for prescriptions alone, which doesn’t consider the added cost of people taking prescriptions who are also seeing a psychologist under MBS rebates.

It’s time Registered Counsellors and Psychotherapists became a part of the Medicare system to give Australians a choice between chemical interventions or equally effective counselling services delivered by humans.

[1] General Practice Mental Health Standards Collaboration (2022). https://mentalhealth.racgp.org.au/guidelines/index/616b4fb1-9755-464b-9b04-30228eb78572.

[2] AIHW (2022). https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services.

[3] World Psychiatry (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683266/.

Australia’s Mental Health Crisis: Unlocking a qualified and ready workforce

By Philip Armstrong

I recently read an article from The Conversation (click here to read) about Australia’s mental health crisis, titled: We can’t solve Australia’s mental health emergency if we don’t train enough psychologists.

While I certainly agree there is a severe shortage of mental health practitioners in Australia, I must disagree that training more psychologists is the only solution to this crisis.

None of the measures put forward in The Conversation article address the most urgent issue facing the mental health sector today: how can we provide access to mental health services for Australians who need immediate support?

Currently the challenge for mental health providers is how to cope with this surge in demand and ensure that support is provided when and where it is most urgently needed.

So what does this mean in real terms for everyday Australians? And what options are available to help alleviate the pressure?

Unlocking an overlooked workforce

One potential and swift solution to our mental health crisis involves making better use of the thousands of Registered Counsellors and Psychotherapists employed right across Australia today.

Registered Counsellors and Psychotherapists are a qualified, highly trained sector of the mental health workforce, but are currently under-utilised. As counselling specialists, Registered Counsellors and Psychotherapists could significantly reduce the burden on the system, freeing up psychologists to focus on more advanced cases and lowering wait times across the board.

As expert communicators and relational practitioners, Registered Counsellors and Psychotherapists are strong compliments to multidisciplinary teams and should be utilised broadly throughout the workforce.

What’s more, this is a workforce that can be accessed immediately: right now, the Australian Counselling Association has a membership of over 11,500 Registered Counsellors and Psychotherapists that can make a difference.

Safeguarding Australian’s mental health

While there are multiple external factors contributing to Australia’s current mental health crisis, many of which are outside of our control, right now there is an opportunity to alleviate and potentially even reverse the declining mental health of our nation.

It is the strong recommendation of the Australian Counselling Association that Registered Counsellors and Psychotherapists are added to the list of allied health professions in the Health Insurance (Allied Health Services) Determination 2014, which provide Focussed Psychological Strategies under the Medicare Benefits Schedule (MBS) Better Access Initiative (BAI).

There are at least 4,000 Registered Counsellors and Psychotherapists who meet the current criteria for the Medicare Benefits Schedule (MBS), while a further 1,000 could be eligible to register within six months.

Including Registered Counsellors and Psychotherapists into the MBS will significantly increase access to bulk billing services, especially for our nation’s most vulnerable. In the absence of a viable solution from the Government, it presents an appropriate, cost-effective and immediate solution that would ultimately help save lives.