Dear Mental Health Client, please don’t be too unwell

Dear Mental Health Client,

Mental Health ClientYou came quietly into my counselling room,  looking a bit unsure, eyes cast downwards.  Hesitant to speak.

It had been tough to pluck up the courage and ask your GP for a referral to a psychologist. You hardly ever see your GP and felt uncomfortable when they asked about your mental health and living situation. You gave the GP brief answers, just wanting the appointment over and done with. This stuff so hard to talk about.

Starting your treatment

Mental health clientYou left the GP with a Mental Health Care Plan for 6 sessions, a bit surprised to learn that they’re not free because most psychologists can’t afford to bulk bill. Ouch, this is more expensive than you anticipated. You also learned that you can only have 10 Medicare subsidised sessions each year.  Still, you think, 10 sessions must be enough for the psychologist to “fix” you. Why else would they only give you this many? It seemed like quite a lot of sessions at the time.

It was so hard for you to come to the first appointment. Initially you tell me you are “just a little bit depressed and anxious”. By our fourth session, you’ve trusted me enough to share the horrendous abuse you have suffered at the hands of others, the debilitating shame that washes over you and the nightmares that haunt your sleep.  You used up boxes of tissues as you told me your story. Oh… and you also revealed that alcohol is a problem and that you’re struggling to maintain your part-time employment.

We were really just getting started with treatment when I sent you back to the GP to get a referral for the last 4 sessions for this year.  We decided to space the last sessions out, once a month… its only April… and your sessions will be used up by August.  I promised I’d reduce my fees after that… but I can’t afford to do that for everyone. I have a lot of clients in similar circumstances. You still won’t be able to afford to continue therapy if you lose your job. We both know monthly sessions is not enough.

10 sessions is nothing after the trauma you have experienced.

You lamented that you must be a bad client because you can’t be fixed with 10 sessions. I explained that 10 session was an economic Medicare rationale, not a therapeutic decision.  You and I are both caught up in a system of unrealistic expectations.  I’m so sorry that the system fails you, and that I am part of that system.

Please don’t be too unwell

You are exactly who I expect to meet in my therapy room, but you are “too unwell” for the system. Yet we both think you’re making great progress.

The system may get worse

Now I have to tell you the system is at risk of getting worse! The Medicare Benefits Schedule Taskforce Review into Mental Health is currently underway. It’s complicated, but the Australian Psychological Society (APS), which is meant to represent psychologists, and advocate for our clients, has put forward a devastating proposal. They propose that I will no longer be able to see you as you’re “too unwell“! You will be categorised as “severe” and they want to restrict me from treating you under Medicare, but I would be able to continue if you were a private client.  I know, it sounds ridiculous to me too.

Under the new proposal, as soon as you told me about your symptoms of Post Traumatic Stress Disorder and your substance abuse, I would have to refer you to another psychologist. I don’t know how to explain this to you because the other psychologist doesn’t need to have more experience than me. They don’t need to have any more trauma training than I have. In fact, they could be newly registered, in comparison to my 20 years of experience.  They have come to psychology through a different pathway, and they have a clinical or perhaps a counselling psychology endorsement, which I don’t have. We are all registered as psychologists with the Australian Health Practitioner Regulation Agency.

You’ll need a new psychologist

Stressed psychologistIf the proposal comes to pass, I will help you find a new psychologist, and I’ll make sure she’s a good fit for you.  I know you’ll hate to tell your story again. I’ve already suggested some alternatives to you and you’ve refused. You’ve told me that you would not want to restart the therapy process but it’s so important that you keep going.

There may be a long waiting time though before you get to see your new endorsed psychologist, perhaps months, because most psychologists in Australia are not endorsed, or don’t have the right endorsement. My colleague’s diary will be full and she will be seeing the most severe clients. I know you don’t think of yourself like that but the system does. She will probably have less appointments each day in her diary so she can manage the complexity and weight of her caseload. Also, under this proposal, you will be able to have more Medicare subsidised sessions with her and that’s fantastic…. if you can get in! She will be seeing fewer clients more frequently.

Another good thing is that your rebate from Medicare will be higher when you see her than when you see me, however, she probably charges more so your out of pocket expense will remain about the same. I hope they find some way of helping you to meet the cost of more sessions. Your new psychologist is likely to be a woman, there are very few men working as psychologists.

I don’t think I will be able to continue seeing you while you’re on her waiting list.

I’m sorry to convey this confusing information to you but as a mental health consumer, you have a right to know what’s going on. If you want to understand more, you can read what I have written as an Enraged Psychologist and in Why reduce access to 100 years of psychological expertise? Reject the APS Submission to the Medicare Review (these were in response to the first APS proposal.  Things have not got better!)

I am at a loss to understand why there is even a chance that I won’t be able to continue seeing you.  I know that this will seem like yet another act of injustice when you have already been so hurt by others.

Easy access to an affordable psychologist of your choice

I don’t know why its all got so complicated.  Really, this all you need.

  • Easy access to the psychologist of your choice.
  • Increased sessions
  • A Medicare rebate to assist with the financial burden of treatment.

Fight to improve the mental health system

As a mental health client, you have the right to be heard. Below are some ideas about how you might fight to improve the mental health system for yourself and for other mental health clients.

Take care

Your Enraged Psychologist

Mental health clients, advocates, and consumers, you can take action

Are you also an Enraged Psychologist? You can take action.

  • Has the APS represented you as a psychologist? Or are your best interests being overlooked? Has the APS provided a workable suggestion for mental health clients? Is it in your benefit to remain a member?
  • Join the Australian Association of Psychologists –
  • Follow
  • Make your views known to:
  • Join the Australian Psychologists Facebook page. This is a closed group of enraged psychologists with a huge passion, great debate, and inspiration. They are an amazing brains trust.  Make sure you answer the questions required to join the group.
  • Share this post on social media.




9 thoughts on “Dear Mental Health Client, please don’t be too unwell

  1. Tracey 12/04/2019 / 1:41 pm

    We have to travel 300km for a psychiatrist…no Medicare rebate and we’re on a pension…things need to change

    • Anne 15/04/2019 / 4:49 pm

      That’s a huge distance to travel. I thought that at least part of psychiatrists fees attracted a rebate from Medicare. Definitely, things need to change.

  2. Anonymous 14/04/2019 / 5:55 pm

    I am struggling with depression when will this ease up

  3. Larry (Lawrence) Desmond 16/04/2019 / 11:20 am

    Hello Anne
    I wrote to you previously re the possibililty of your putting your blogs/thioughts on to the RAPS Blog site and Australian Psychologist facebook group page. I forgot to ask what thoughts you have about the APS’s MBS “green paper” and whether you might be sending those thoughts to RAPS/Australian Psychologiost facebook page? I’d certainly like to hear what you think and I strongly suspect so would many other psychologists. If you have already done the above, my apologies, but I don’t recall seeing you on the sites.


    • Anne 16/04/2019 / 2:17 pm

      Hi Larry, I did make some changes to Enraged Psychologists to encorporate the Green Paper. I definitely shared this blog on Australian Psychololgists, and others did too which is fabulous. Its getting lots of reads so lets keep promoting it. Someone also shared it on RAPS. I’m pretty active on the AP page… but we are all just names which float by. Very hard to keep up. You have inspired me to share it again!
      I have a new blog brewing! Thanks for the encouragement.

  4. Owen 18/04/2019 / 6:25 pm

    Hi Anne. I am a little concerned about some of the inaccuracies you are sharing in this post re the APS green paper and what this will mean for clients. The paper is recommending extending the number of sessions to between 20 and 40, depending on the severity of the client’s issues. Proposal 8 also specifically addresses the issue of who can treat clients classified as severe. According to Proposal 8, as a psychologist with 20 years experience specialising in treating someone with PTSD (I assume this would have included at least 40 hours of CPD in your specialist area), you would be eligible to apply for a professional practice certificate which would allow you to treat clients with severe issues and receive a higher rebate. Similar to someone who is not newly registered as your blog suggests, but someone who has recently been given an AoPE. The MBS review committee had 3 members from the Division of General Psychological Practice, more than any of the colleges, and it appears to me that their concerns have been addressed. That is my understanding of the submission.

    • Anne 02/05/2019 / 3:31 pm

      Hi Owen, thanks for your comments. I see no reason why, as a registered pscyh I would need to apply for a practice certificate. I already have to maintain my CPD points. I wonder how the Division of General Psychological Practice were able to represent non endorsed psychs because they do not have the same access to email lists as colleges do so they are unable to create a meaningful dialogue. I certainly do not feel that my concerns have been addressed in the Green Paper.

Hi, I'd love to hear what you have to say.