GPs say patients’ mental health continues to deteriorate. Will cuts to psychologist visits make it worse or improve access?

Nearly 60% of GPs say demand for mental health related care has risen in the past six months, despite politicians claiming the pandemic is easing—new survey data from Healthed suggests.

The results coincide with the government’s announcement that it will cut the number of psychology sessions covered by Medicare down to 10 from January 1. The number of subsidised sessions had been increased to 20 during the pandemic.

The change comes after an independent evaluation from the University of Melbourne concluded that positive outcomes associated with the program were unequally distributed, with people from lower socio-economic backgrounds or outside of major cities, as well as those in aged care, missing out on the benefits.

The research highlighted “a number of equity issues in relation to use of Better Access services and suggest that these may be worsening. The profile of use of Better Access treatment services across income groups is not consistent with the profile of their levels of psychological distress. Those on the lowest incomes are least likely to access services,” according to the report.

“Better Access is certainly serving some groups better than others, and these gaps are widening. Of most concern, increases in utilisation over time disproportionately favour people on relatively higher incomes in major cities,” the report stated

The changes aim to address these gaps. One Canberra-based psychologist told Healthed that she supports the move, as she believes there has been overservicing happening, particularly among the ‘worried well,’ which the report also highlights. She said less consults per person will allow more people to access a psychologist.

However Deakin University senior lecturer and clinical psychologist David John Hallford argued in The Conversation that evidence suggests 50% of people require 13 to 18 sessions, and that there is a dose-response relationship for psychological therapy.

“Ten sessions won’t provide adequate treatment for many suffering from mental ill-health. And waiting until the next calendar year for the next ten sessions could see symptoms spiral in the meantime,” he wrote.

Dr Rachael Sharman, a senior lecturer in psychology at the University of the Sunshine Coast, said the cuts would negatively affect people with more complex/ongoing conditions – who also are less likely to have the means to pay for further necessary sessions.

“This will be an even greater barrier going into 2023 with cost-of-living increases and interest rate rises,” Dr Sharman said. “Failure to complete a course of therapy just means more likelihood of relapse, and in serious cases, presenting to the ED. Similar to a course of antibiotics— if you only take half the packet you risk the infection bouncing back twice as bad.”

Meanwhile, Healthed’s data shows that 59% of surveyed GPs report at least some deterioration in their patients’ mental health over the past six months, while more than half noted a decline in their colleagues’ mental wellbeing (52% of GPs). Interestingly, fewer GPs said their own mental health was deteriorating (38%).

Healthed’s surveys suggest that the observed deterioration in mental wellbeing is accumulating from earlier, pandemic-induced declines. In July, one in ten GPs said that demands for mental health related care had increased as a result of the pandemic, and 95% of GPs said that patient mental wellbeing had deteriorated compared to pre-pandemic.

This week’s survey results suggest that many GPs have seen additional demand and mental wellbeing deterioration over the past six months— on top of what was reported in July.

So why are we still seeing an increase in demand for mental healthcare services? Experts say that lingering effects of the pandemic, worsening economic situation and global events all play a role.

Dr Sharman cited recent research that found increasing cost of living and personal debt are two of the biggest risks to suicide rates. Additionally, she says many people are still suffering COVID-related consequences.

“A number of people are still dying from COVID, it’s just the reporting that has diminished. So there are still elderly people out there in particular who have good reason to worry about their health risk. As we know, this is preventing some from accessing standard health checks which is creating downstream problems for their health,” Dr Sharman said.

“A number of people are still dying from COVID, it’s just the reporting that has diminished. So there are still elderly people out there in particular who have good reason to worry about their health risk. As we know, this is preventing some from accessing standard health checks which is creating downstream problems for their health,” she added.

Clinical Professor Leanne Rowe AM, GP and co-author of Every Doctor: Healthier doctors=healthier patients agrees that multiple factors are contributing to Australia’s mental health crisis.

“The pandemic is not over and GPs are continuing to witness the direct impact of mortality and morbidity from COVID-19 and delay in presentations for serious non COVID-19 conditions,” Professor Rowe said. “The threat of a recession is looming and causing economic stress in Australia. Of course, the other common issues predisposing our patients to burnout and mental illness are ongoing.”

In Healthed’s survey, which was undertaken just prior to the government’s announcement, several GPs said more mental health support was needed.

One GP said they “noticed patients are more anxious, more irritable and have decreased resiliency. There is increase demand for psychological therapy, but long waiting times and unaffordability creates more work load for me as the clinician to fill in the need.”

“Access to bulk-billing psychologists is extremely limited and requires urgent attention,” said another.