AAPi Budget Summary

Posted on 15 May 2024

The dedicated mental health components in this year's budget were a tokenistic $361 million over four years - less than $100 million a year.

To put this in perspective, the new announcements for the entire health portfolio totalled $8.5 billion.

In the budget stakeholder briefing documents, the Federal Government has the audacity to tell us that their $361 million over four years puts mental health “at the heart of a stronger Medicare”. This government needs to grow a heart and start taking mental health seriously. 

Mental health currently has a disease burden of around 13% yet only receives approximately 6-8% of funding. In 2020, the Productivity Commission suggested governments allocate an additional $2.4 billion annually to implement nationwide crucial mental health system reforms. We are still waiting. 

In the lead-up to the Budget, Jim Chalmers said: “Help is on the way” for low-income earners. But what about helping them access affordable, qualified, and timely mental health care? Low-income earners are the most affected by the ongoing systemic underfunding of mental health.

Until the psychology Medicare rebate is realistically raised and enough rebated sessions are funded, people will continue to struggle to get the adequate level of mental health care they need.  

Due to chronic underfunding of Medicare and Better Access, out-of-pocket expenses are at an all-time high. Financial barriers to accessing care was the number one barrier identified in the Better Access evaluation yet this Budget does nothing to address this.

So, where is this paltry $361 million going? Rather than investing in a successful, longstanding, flexible Better Access system, the Government is betting on digital early intervention, hubs, PHNs, General Practice and the formation of a peer workforce. This is under the guise of “relieving the pressure on Better Access”.

Let’s dig into each of these areas.

$163 million early intervention service

The government pitch:

"A new national early intervention service will provide access to someone trained in evidence-based therapies, who can provide safe and high-quality care to get people through whatever is troubling them. Others will benefit from a bit of coaching or advice, and to be given the tools and resources they need to work through things, at their own pace and in their own time.

Approximately 150,000 Australians will use the service each year, getting free support early, without waiting for a referral or being worried about a gap fee. Providing free services to people at the earliest point of intervention will make it less likely that their problem will go untreated and worsen into something more serious.

It will also relieve pressure off the Better Access program to be all things to all people, and support psychologists to work to their full scope of practice and spend more time treating people with moderate and high needs. Improving access to Better Access will benefit all Australians, but particularly those who currently face the highest barriers to access: older Australians, low-income households and people in rural and regional Australia.

Moving to a stepped model of care will help refocus our efforts towards prevention. Providing free services to people at the earliest point of intervention, will make it less likely that their problem will go untreated and worsen into something more serious.

It will also take pressure off the Better Access program to be all things to all people, and support psychologists to work to their full scope of practice and spend more time treating people with moderate and high needs."

Red flags and further questions:

We asked Minister Butler about this directly today, and he told AAPi that developing this new model will take time. The design will undergo further consultation. Initially, it will be a phone and online CBT model and will undergo an open tender process for commissioning. AAPi will keep members updated.

Early intervention is crucial, and while we welcome the concept of a national early intervention service, we need to see more detail on how these will operate.

AAPi is concerned that the National Early Intervention Service is simply a duplication of many services already available. Australians want affordable mental health care in their local community from a real person who is highly skilled and focused on providing them with individualised support.  

Who will the service be provided by? The Government has flagged that this will be “someone who is trained in evidence-based therapies”. We already have a workforce trained in evidence-based therapies - they are called psychologists. 

Where the government sees short-term cost savings by using a lower-qualified workforce, we see risk and long-term costs.

AAPi is seeking further clarification from the government about staffing for this service and will recommend that psychology is the appropriate workforce to provide this service.

$71.7 million over four years on PHN funding

The government pitch:

Red flags and further questions:

This is the government's “answer” to slashing Better Access sessions from 20 to 10.

Eighteen months on from slashing the extra 10 psychology sessions, our mental health crisis still has the community in its grip, and yet the Government chooses to ignore the pleas of so many who are hurting. Mental health needs to be put on the same footing as physical health.

The treating health professional, not the government, should decide on the number and type of services. We don’t force people to ration physical health.  

This announcement adds extra layers and more bureaucracy. GPs, on the whole, are not mental health experts.

Free Medicare Mental Health Centres

The government pitch:

Red flags and further questions:

In one breath, the government is pitching these as “free walk-in” clinics while saying they will provide clinical services for moderate-to-severe mental health needs in the next, yet at the same time, criticising Better Access for trying to be all things to all people.

The proposed 61 Medicare Mental Health Centres will only provide finite services to 61 communities. What about the remaining communities and individuals needing help today? A wiser investment would be to appropriately fund Better Access and provide realistic Medicare rebates so that people everywhere can access their local psychologist tomorrow.  

The Federal Government needs to learn from Victoria’s lessons. Only a week ago, the Victorian Government had to shelve 35 similar services due to workforce shortages. Why is the Federal Government gambling on Australians’ mental health and hoping for a different outcome? 

Most of these hub models are based on Medicare Better Access rebates and rely on subcontracts being remunerated by a percentage of bulk-billed rebates. 

Note the reference to psychologists and psychiatrists being “on-call” and the overall low funding allocated to this initiative. We will be watching this very closely.

$7.1 million on the peer workforce

The government pitch:

Red flags and further questions:

There was a marked lack of detail in the framework and model of care for the rollout of the peer workforce plan. When AAPi questioned this today, it was stated that this initiative would be built around the national census of peer workforces and developed to create a standardised approach.  We are concerned about the details of what training this workforce will require and the ongoing risk mitigation strategy. 

The glimmer of hope:

From the Budget papers: This Budget will diversify the psychology workforce, and explore the role that psychology assistants might play in the mental health workforce.

AAPi is working through exactly what this means for our members and the psychology profession.

Other non-headline mental health funding:

• $35.9 million over four years to extend mental health and suicide prevention services (mostly extend existing contracts).
• $29.7 million over three years from 2024-25 to improve child and youth mental health services through uplifting workforce capability and co-designing new models of care.
•  $12.8 million over four years from 2024-25 to extend the Indigenous Youth Connection to Culture program which supports First Nations youth in 12 communities through place-based activities to reduce suicide rates and improve mental health outcomes.
•  $10.0 million in 2024-25 to maintain funding to deliver targeted and culturally appropriate mental health supports for First Nations Australians.
• The budget papers also indicated that “Government will transfer the functions and funding of the National Mental Health Commission to the Department of Health and Aged Care while considering the most appropriate longer-term arrangements.” 
• $90 million to address health workforce shortages by making it simpler and quicker for international health practitioners to work in Australia. Psychology is one of the most expensive, confusing and time-consuming pathways for internationally trained health psychologists. AAPi is disappointed that building the domestic workforce has not been prioritised in this budget through measures such as reinstating the 4+2 pathway, more government-funded university places and paid placements.

Other notable budget announcements: 

• People struggling with or at risk from harmful alcohol and illicit drug use will benefit from extended funding for 20 treatment and prevention services ($41.6m). AAPi has requested further information on this and will provide updates as they become available.
• Rural and remote - A pool of funding to support PHNs and Rural Workforce Agencies to step in where health services are at risk of closing. We'll be seeking further details to understand how this might support psychology businesses in rural and remote communities. 
• Cutting around $3bn in student debts through the changes to the HECS and HELP loan programs providing a $1,200 saving for the average person with student debt.
• $1.2 million over two years from 2024-25 to support training for health practitioners to better treat, care and manage women's health during menopause through training by Jean Hailes for Women's Health.
• $7m over four years to support women and families who have suffered miscarriage. This includes health professional education and increased awareness about miscarriage along with bereavement services.
• Commonwealth Government-Funded Paid Parental Leave enhancement. Funding includes superannuation payments on Commonwealth government-funded PPL for births and adoptions on or after 1 July 2025. 
• $756.4 million over five years from 2023-24 to establish the Leaving Violence Program from 1 July 2025 to provide financial support of up to $5,000 and support services, including risk assessments, safety planning and short-term referral services for up to 12 weeks.
• Outreach health care in women’s crisis accommodation and services will be trialled to support women and children fleeing family, domestic and sexual violence ($6m).
• The Male Health Initiative will continue to provide health information, awareness and support to men and boys.
• Research at the Australian Prevention Partnership Centre will help deliver a solid evidence base for policy-makers in preventative health ($1.1m).
• More First Nations people will get the support they need in times of distress when their mental health is at risk. To address increased rates of psychological distress being experienced by First Nations people, the National Aboriginal Community Controlled Health Organisation will continue to deliver targeted and culturally appropriate mental health support.

Small businesses

• In addition to the household energy bill relief, around one million small businesses will receive a $325 rebate on electricity costs.
• The instant asset write-off scheme has also been extended. Businesses with an aggregated annual turnover of less than $10m will continue to be able to immediately deduct the full cost of eligible assets under $20,000, provided they’re first used or installed and ready by the end of June 2025. 

Disability

• The government's headline surplus has been achieved in part through “significant savings” on the National Disability Insurance Scheme. Spending on the program is predicted to be $14bn less over four years than projected in the mid-year outlook.
• Most of the budget funding announced are for the NDIS reforms, including $214 million over two years to fight fraud and to codesign NDIS reforms with people with disability, announced earlier this year. 
• Will the Government pay for initial assessments as has been previously mooted, including by the Senate Joint Standing Committee on the NDIS? There is nothing on this in the Budget. 
• There was no dedicated funding for the foundation supports program.
• Disability Employment Services Reform-The Government will provide $253.6 million over five years from 2023-24 to reform employment services and support for people with disability.

AAPi will continue to advocate for our key recommendations below. Now is a crucial time for psychologists to stand united.

• A rebate of $150 for every session for every psychologist, along with the end of the two-tier rebate system.  
• End the two-tier system in the public sector and restore the unity and diversity of the psychology profession.
• We must invest in strong and diverse psychology profession across the public, school and private sectors.
• Reversal of the cuts to the Medicare-subsidised psychology sessions to support Australians living with mental ill-health and struggling to access the services they need. The number of sessions someone needs with a psychologist should not be determined by a politician. Limiting Medicare-rebated mental health care to a maximum of 10 sessions a year is not evidence-based and does not adequately help people with complex needs. We don’t force people to ‘ration’ their physical health care. We need up to 40 sessions for those with complex needs.
• Add psychology to the paid placement scheme.
• Allowing provisional psychologists to provide services under Medicare.
• Incentives for rural and regional psychologists to improve access and increase financial sustainability.
• Provision of more university places and greater funding subsidies for the next generation of psychologists to improve the psychology pipeline.

This year's Federal Budget does not instil a sense of hope in alleviating the mental health crisis or appropriately recognising psychologists, with initiatives that are scant in detail and do not address the current needs and realities. AAPi will be working very hard to address these concerns and represent the AAPi community.

We are stronger together. 

Further information can be found here: https://budget.gov.au.