Are you confused about the range of mental health services available? Do you know the difference between a psychotherapist and a psychiatrist? Are you put off from seeking this type of help because it’s too expensive? If so, you’re not alone, however, we’ll aim to break it all down for you to help you work out the type of help that will best suit your needs.
Adding to the confusion are the different qualifications required for each type of mental health professional, different regulations governing the services they offer, and different levels of Medicare rebates available to patients. It’s important to note that although Medicare benefits do not currently apply for some services, that does not mean those services are not evidenced based or beneficial.
Let’s look at the main types of mental health professionals first and weigh up their similarities and differences.
Different types of mental health professionals
That’s right, your GP can also provide mental health services. They can diagnose many mental health conditions as they would have covered this as part of their general training. It may be beneficial to ask if they have additional training in mental health and related fields such as trauma informed care.
Your GP is usually the best person to turn to first when you are struggling with mental health concerns as they can offer general support and advice as well as prescribe medications for both mental and physical health issues if appropriate.
If you are assessed as having mental health difficulties and you both feel that further help would be beneficial, your GP can prepare a Mental Health Treatment Plan (MHTP) for you – which is a Medicare-subsidised service in Australia. A MHTP allows you to access up to 10 individual and 10 group sessions per calendar year with one of the following types of practitioners:
- General practitioners
- Psychologists (clinical and registered)
- Occupational therapists
- Eligible social workers
Psychiatrists are fully-qualified medical doctors who then undertake additional mental health qualifications, meaning that they generally study for around 12 years. Psychiatrists can prescribe medications, order pathology tests, and admit people to hospital. They can treat a wide range of mental illnesses – from simple through to severe or complex cases such as those with drug addictions or psychosis. The therapies they offer can also vary greatly (depending on their additional training) and may include counselling and psychotherapy.
Psychiatrists usually work in hospital settings, although some also have their own private practices. In public hospitals, their services are free, in private hospitals, their services may be partly covered by private health insurance, and in private practice, Medicare rebates are available.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) does not recommend or set a schedule of fees. They are decided by individual psychiatrists. According to 2014–2015 Department of Health data, the average psychiatrist fee for a 45–75-minute consultation was $267. Medicare will rebate $156.15 of this amount. However, there is a great deal of variation on this and fees can be a lot higher. Always ask what the costs will be when you schedule your appointment. There is no limit on the number of sessions a client can attend privately.
Private psychiatrist sessions can also be included in the MHTP as outlined above.
Psychologists can also diagnose and treat mental health conditions, but their qualification pathway is quite different to that of psychiatrists. Psychologists study for at least 6 years at university, focusing on the mind, behaviour, and how the two influence our response to day-to-day events.
Psychologists’ areas of speciality can include (but are not limited to):
- Clinical psychology
- Educational and developmental psychology
- Forensic psychology
- Health psychology
- Organisational psychology
- Sport and exercise psychology.
Both psychiatrists and psychologists can diagnose and treat conditions and issues like post-traumatic stress disorder (PTSD), depression, anxiety, and relationship problems using a range of therapies tailored to the individual. Psychiatry and psychology treatments tend to follow structured processes.
Apart from their qualifications, one key difference between the two professions is that psychologists cannot prescribe medications, order medical tests, or admit clients to hospital.
Sessions with a psychologist can be included in a MHTP or Medicare rebates can apply to individual ongoing sessions. The Australian Psychological Society (APS) schedule of fees for a psychologist for a 60 minutes session is $246 with a rebate of around $80. Again, there can be some variation to this and you should always ask what the costs will be when you schedule your appointment.
While psychology and psychiatry are more structured approaches to treatment, psychotherapy is a form of ‘talking therapy’ that allows a strong and trusting relationship to develop between the practitioner and the client. It uses communication and other methods to help the client through a process of self-discovery and change while addressing deep behavioural, emotional or personality attributes. The client tends to be more of a partner in this treatment process than in psychiatric or psychological processes.
Psychotherapy works exceptionally well for issues such as depression, anxiety, addictions, compulsive disorders, complex trauma, and personality disorders such as borderline personality disorder. It is considered a mid to long-term form of treatment (usually with weekly sessions) focused on building self-awareness and a more balanced perspective. As with psychiatry and psychology, psychotherapists are free to choose the treatment approach for their client, such as The Conversational Model, Somatic Psychotherapy, Eye Movement Desensitising Reprocessing (EMDR), Schema Therapy, Dialectical Behavioural Therapy (DBT) just to name a few. Some psychotherapists use an integrative approach using a variety of techniques that are responsive to client needs throughout the course of treatment.
Psychotherapists have usually completed an approved tertiary degree before beginning the process of psychotherapy accreditation which often takes 3-4 more years more and may include going through their own psychotherapeutic process. To practice in Australia, they must be registered with the Psychotherapy and Counselling Federation of Australia (PACFA), or Australian and New Zealand Association of Psychotherapists (ANZAP).
Psychotherapy tends to cost around $150-$200 for a 50-minute session. Again, always check the costs at the time of making your appointment. Unless the psychotherapist is already a psychologist or psychiatrist, psychotherapists do not get access to the Medicare rebate at this time.
As many mental health professionals offer counselling as part of their services, it is often seen as an umbrella term that covers all forms of talking therapy. However, qualifications vary greatly, ranging from Diplomas to Masters’ degrees. Ask the counsellor what their qualifications are, how long they studied, how much experience they have, and which governing body they come under. There are 2 well recognised governing bodies in Australia, PACFA and Australian Counselling Association (ACA). These bodies have united under The Australian Register of Counsellors and Psychotherapist (ARCAP) in order to more easily regulate the industry and lobby the government for inclusion in the Medicare system.
Counselling is usually a short-term form of treatment designed to help the client deal with immediate and specific issues such as divorce, job loss or conflicts. Session fees are around $80 – $150.
Limitations of the current funding system
Under the current Medicare regime, psychotherapy and counselling services are not covered in the MHTS. A possible reason for this funding bias against ‘talking therapies’ is that they are sometimes berated as being ‘unscientific’. However, there is a growing mountain of evidence to show that this is not the case. In fact, these therapies are often equally beneficial and can have a much better long-term outcome than more traditional treatment approaches.
The 10-session limit for services that are covered by the MHTP is still a problem for many people, especially those with chronic health issues, as it only covers a limited range of short term therapies (such as Cognitive Behavioural Therapy) which may not be appropriate for some people. In addition, they usually need far more than 10 sessions per year. After that, recommended fees for psychologists jump to around $246 per hour, which is unaffordable for many. By comparison, the average fees for counsellors and psychotherapists are generally around $150, making them much more cost effective in the long run for those with chronic, complex or long-term conditions.
Many individuals and peak bodies, both within the industry and further afield, are pushing for major reform in Australia’s health care system, and for funding changes in particular. The new Health Care Homes scheme that is currently being rolled out in parts of Australia may address these concerns to some degree, although it is not without its shortcomings either.
Other ways to reduce your out-of-pocket expenses
In the meantime, there are some other things you can do to help ease the strain on your budget.
Private health insurance
Some private health insurance policies pay limited benefits for mental health care services. These are usually for services given in a hospital and the cost of the policy may not justify the benefits in these cases. You’ll need to shop around different insurers and check their fine print. Currently, clinically registered counsellors with PACFA have access to rebates from Medibank Private and from the 1st of July 2018, Bupa will also offer rebates to suitably qualified counsellors and psychotherapists.
Medicare Safety Net
If you or your family have to see a doctor often, your costs can add up very quickly. However, if you register with Medicare for the Safety Net scheme, once your expenses reach a fixed threshold in a calendar year, you will receive increased benefits at each of your appointments for the remainder of the year. This scheme is not limited to those on Centrelink benefits, so all eligible Medicare Cardholders can apply.
Public hospital services
Australia’s public hospitals offer a vast range of mental health services for free to eligible Medicare Cardholders who have been assessed as having a clinical need for them. The service models are currently in a state of change across the country, with many of the Primary Health Networks (which encompass all the primary health services in defined geographical areas) rolling out new service models that utilise the strength of existing private mental health care providers in the local community.
Some current public mental health services will slowly transition and become part of the new National Disability Insurance Scheme. Individual psychologists, counsellors and psychotherapists can apply to be a provider with the NDIS. Your doctor should be able to advise you of the relevant public services available in your area.
Where can I get more information?
Australian Government Department of Health: Better access to mental health care: fact sheet for patients
Psychotherapy and Counselling Federation of Australia (PACFA): http://www.pacfa.org.au/
Australia and New Zealand Association of Psychotherapy (ANZAP): http://www.anzap.com.au/
The Australian Counselling Association (ACA): https://www.theaca.net.au/
Australian Register of Counsellors & Psychotherapists (ARCAP): http://www.arcapregister.com.au/
The Royal Australian and New Zealand College of Psychiatrists (RANZCP): https://www.ranzcp.org/Home
Australian Psychological Society (APS): https://www.psychology.org.au/
The Royal Australian College of General Practitioners Ltd (RACGP): https://www.racgp.org.au/home
Jonathan Shedler: ‘Where is the evidence for evidence-based therapy’ article from The Journal of Psychological Therapies in Primary Care’ http://jonathanshedler.com/wp-content/uploads/2015/07/Shedler-2015-Where-is-the-evidence-for-evidence-based-therapy-R.pdf
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