Access to Psychologists Is Becoming More Unequal, Map Shows

When you're struggling with your mental health, visiting your GP for a mental health treatment plan can be an important first step.

These plans indicate a diagnosed mental health condition (such as depression or anxiety) and allow you to access up to ten subsidised psychotherapy (or "talk therapy") sessions through Medicare's Better Access Initiative .

But what happens next?

Our recently published research suggests whether you actually see a psychologist may depend on where you live.

We found those living in low-income neighourhoods were much less likely to receive psychological care soon after receiving a plan, compared to those in wealthier neighbourhoods.

And in the decade between 2014-23, this gap widened substantially - particularly for children.

Even with subsidies, mental health care can be expensive

While private psychologists can choose their own rate, the suggested fee for a 45-60 minute consultation is A$330. But the Medicare rebate is set at $149.05 for a clinical psychologist - and even less for general psychologists - meaning the gap you pay can be substantial.

High out-of-pocket costs , long waits and limited local services can prevent people from getting the care they need.

In the Australian Bureau of Statistics' 2024-25 Patient Experience Survey , about one in four people who needed to see a psychologist reported delaying or going without care because of the cost.

Financial barriers to mental health care were more common in disadvantaged areas .

What we did and what we found

We wanted to understand how large the income-related gaps in psychological care are across Australia.

We used de-identified tax and Medicare data to study 5.4 million Australians who received a GP mental health treatment plan between 2014 and 2023, to look at whether they went on to receive Medicare-subsidised psychotherapy (talk therapy) within three months.

This included services delivered by eligible psychologists, social workers and occupational therapists.

In one study of adults, we found substantial regional differences in access: in 2023, psychotherapy use within three months of receiving a GP mental health treatment plan ranged from approximately 28% in parts of regional New South Wales and South Australia to 60% in inner Perth.

But we also wanted to look at whether income-related gaps had changed over time, and whether children are affected differently from adults.

In another, related study , we looked separately at children under 18 and adults aged 25-54, and compared neighbourhoods with different average incomes.

In 2023, only 32% of children in the lowest-income neighbourhoods received psychotherapy within three months of receiving their plan, compared with 55% in the highest-income neighbourhoods. For adults, the figures were 40% versus 55%.

The gap has widened

A decade earlier, rates of psychotherapy use were higher across the country and the income-related gaps were smaller.

In 2014, 56% of children and 53% of adults in the lowest-income neighbourhoods received psychotherapy within three months of getting a plan. This compared to 70% of children and 61% of adults in the highest-income neighbourhoods.

Over the following decade, uptake fell across all groups - but more steeply in low-income neighbourhoods.

As a result, the income gap widened, especially for children. The divide grew particularly sharply during the COVID pandemic.

Among children in the lowest-income neighbourhoods, the proportion receiving timely psychotherapy fell from more than half (56%) in 2014 to around one-third (32%) in 2023.

We also find a growing "reverse" pattern for medication. Lower-income people are increasingly likely to receive antidepressants without psychotherapy, suggesting a shift toward lower-cost treatment pathways.

This is concerning, especially for children, for whom psychiatric medication without psychotherapy is not typically recommended .

What's behind this widening gap?

We checked whether the widening income gap could be explained by an increase in diagnoses of complex conditions, such as ADHD and autism , or by the rapid expansion of telehealth in 2020.

But when we analysed these factors separately, the income gap remained - whether or not people had also seen a psychiatrist or paediatrician for a complex condition, and whether they'd received psychotherapy via telehealth or face-to-face.

Rising costs are a more plausible explanation. Between 2014 and 2023, the average out-of-pocket cost of a first therapy session rose from about $44 to $90 for children, and from $35 to $80 for adults. These amounts are adjusted for inflation and expressed in 2023 dollars.

The price increases are consistent with demand for mental health care growing faster than providers' capacity to offer appointments , particularly during the COVID pandemic.

When demand outpaces supply, waiting times can lengthen and fees can rise. People on lower incomes have less capacity to absorb these higher costs.

Expanding capacity takes time. Training new psychologists takes years, while shifting psychologists from other sectors may create shortages elsewhere.

The regional differences we observed also point to uneven access: where psychologists work matters, as well as how many there are.

So, what would actually help?

Reducing out-of-pocket costs should be a priority. This could include increasing Medicare rebates, introducing targeted subsidies for low-income families, or expanding low-fee and no-gap service models.

Bulk billing may also have a role. Recent reforms have strengthened incentives for GPs to bulk bill , particularly in regional and rural areas. A similar approach could be considered for psychological services, though we need to first carefully evaluate whether these GP reforms have worked.

Improving access will also require building a bigger workforce . Expanding training places, addressing bottlenecks in supervised placements, and supporting early-career psychologists could help increase capacity while maintaining high standards of training and clinical care.

In rural and regional areas, this could mean targeted programs to attract and retain psychologists where shortages are greatest. These could include extra funding for providers in those areas, relocation payments , or waiving higher education loans.

For people with milder symptoms, lower-intensity options such as guided digital therapy or suitable group programs may help reduce pressure on individual therapy services.

Ultimately, Medicare-subsidised psychotherapy was designed to make mental health care more accessible. Our findings show access has declined and become less equal.

Reforms should prioritise reversing this decline for people in low-income neighbourhoods, especially children.

Danusha Jayawardana receives funding from the Australian Research Council.

David Johnston receives funding from the Australian Research Council.

Nicole Black receives funding from the Australian Research Council.

Anh Trinh receives funding from the Australian Research Council.