Psychologists who predominantly bulk bill are making as little as $12 an hour, which is why it “just isn’t an option for the majority of them”, the executive director of the Australian Association of Psychologists, Tegan Carrison, has said.
Almost half of all Australian adults will face mental ill-health at some point in their lives, but for the most vulnerable of them, accessing affordable mental healthcare has become more difficult as general practitioners and psychologists move away from bulk billing.
A GP-approved mental healthcare plan is needed to receive government-subsidised psychological sessions. But psychologists told Guardian Australia they too are cutting back on bulk billing, and one was even forced to close their practice altogether.
“The current Medicare rebate for registered psychologists is $89, and the rebate has not kept up at all with the rate of inflation,” Carrison said.
“Only 6% of private practice psychologists are able to bulk bill, yet 78% say they would bulk bill if the client rebate was raised to $150 per session.
“If psychologists, many of whom own their own small businesses, are to keep their doors open, they need to pass on the difference between the actual cost of service and the rebate amount to the consumer.”
But not all consumers can afford to pay. An entirely bulk-billing clinical psychologist practising in Adelaide told Guardian Australia she “desperately” wants to keep bulk billing and she often won’t charge her clients even if they don’t have a referral from their GP, because wait times to see a GP are long and her clients are desperate for help.
“It is pretty much impossible to run a clinic as a bulk-billing psychologist,” she said.
“But the vast majority of people who need mental health help where I practice are unemployed, or they have just been discharged from hospital, or just released from prison, which usually means that they can’t work and they can’t afford to pay. I’m known for bulk billing, so there is so much pressure on me. People beg me to take them in and if I don’t, they may end up back in hospital or experience other bad outcomes because they can’t get the help they need.”
She said she thought about charging a private fee to only those who do not require concession cards. “But only about five of our clients aren’t concession card holders, so it just wouldn’t be worth it.”
Psychologists spend much longer with clients than GPs, which means they book fewer appointments in a day and receive fewer rebates from the government. Like GPs, they need to pay for rent, education, administration, Covid-related expenses, registration, telehealth software and insurance.
For every 50-minute session with a client, there is additional time invested to research conditions or medications, liaise with the referrer, check referrals and care plans, write up notes and provide reports.
An Australian Association of Psychologists survey of its members found the hourly rate for a bulk-billing psychologist would be on average about $12 to $20 after accounting for additional time and expenses.
The association wants provisional psychologists – in their last stages of supervised practice before achieving full registration – to be able to provide services under Medicare. The association would also like to see incentive payments offered to psychologists working in low-income, regional and rural areas.
A psychologist working in rural Australia told Guardian Australia that despite having a fully booked, bulk-billing practice with a waiting list, he had to close his practice last year because “I could no longer make a living from it” and the clients would not be able to afford private fees.
Meanwhile, a psychologist working at Coffs Harbour on the north coast of New South Wales said for a period of time, she bulk billed all of her clients but was forced to introduce private fees because “I was earning about the same as a full-time cleaner at the hospital”. Bulk billing meant she had little in savings and superannuation, and often, she said, “my own children went without”.
“It’s not possible to primarily bulk bill and remain in private practice,” she said.
A 52-year-old woman living in Tasmania with anxiety, depression and bipolar disorder said she hasn’t seen a psychiatrist, psychologist or GP in over three years because she can’t afford it. Her weekly income of $50 per week is too high to be eligible for a low-income healthcare card and there are no GPs in her local area who bulk bill.
“So I stay at home, spend as little money as possible, and now self-manage my health issues,” she said. “It’s not ideal and certainly not where I thought I would find myself in my early 50s.”
A 59-year-old man living in South Australia said he has been unemployed for three years due to a serious back injury and mental health issues he has had since childhood. The GP in his town does not bulk bill, forcing him to travel.
“I have started to see a psychologist but have to pay a gap fee,” he said. “All this means is that I now have to go without food and medication at times due to living on jobseeker.
“So much for living in a decent country … I have not felt part of this society for many years now.”