Why is accessing a Psychologist expensive?

The question of why psychologists are expensive in Australia is one that consistently arises within the walls of therapy rooms and across households contemplating psychological support for themselves and their families. People seeking therapy find themselves confronted with the cost of our services but with a growing sense of confusion about why these costs seem to rise year after year.

I must admit I have studied, lived, and worked in Australia and, therefore, cannot comment on other countries. The answer to the above question lies within the complex systemic issues within the psychology field, which spans education, legislation, and registration. It is a multifaceted challenge, with a particular emphasis on a profoundly ingrained two-tier system that influences how psychological services are delivered and perceived.

The Systemic Divide.

At the heart of the issue is what psychologists describe as a "two-tier" system. Clinical psychologists receive higher rebates under the Medicare system than other psychologists. This system creates a significant divide that both reflects and perpetuates the misunderstanding that clinical psychologists are the only true experts in all areas of mental health. Many fail to realise that all psychologists in Australia must complete at least six years of education and training before they can practice. Within this foundation, they choose a specialisation—whether it be clinical, counselling, organisational, educational and developmental, health, community, forensic, or sports psychology—or they may remain generalists.

Let's be clear: A general psychologist is also an equally qualified psychologist!

However, despite all psychologists' comprehensive and rigorous training, the two-tier system elevates clinical psychologists as the perceived authority on all psychological matters, leading to a skewed public perception of their role and expertise.

The Discriminatory Impact of the Two-Tier System

The two-tier system doesn't just influence public perception; it has real-world consequences for psychologists in Australia, especially regarding their earning potential and career advancement. Medicare rebates, which were designed to help make mental health services more accessible, are set at levels that fall far below what would be considered appropriate for professionals with such specialised expertise. For a 50-60 minute session, the Medicare rebate is often inadequate in reflecting the depth of skill, understanding, decision making, and training a psychologist brings to their practice.

The unfortunate outcome is that while clinical psychologists can claim higher rebates, many other types of psychologists are forced to charge clients more to maintain financial sustainability.

In private practice, psychologists can charge fees that reflect their expertise, their time spent with the client, researching, professional development, and their time spent completing letters and reports for the client, along with the costs associated with running a business in a highly regulated profession. For example, under Medicare, psychologists are expected to write letters to referrers after their initial session, sixth session, and last session. There is no fee associated with these, suggesting there is no value for our time. Often psychologists collaborate with schools and doctors via phone calls and email, in many cases this is without a fee.

Career Stagnation in the Public Health Sector

Another dimension to Australia's rising costs of psychology services is the stagnation many psychologists face in the public health sector. While clinical psychologists are given opportunities to advance in their careers within public services—such as hospitals, youth mental health centres, and law courts—other psychologists are often left with limited career pathways. After spending 2-3 years in public service, many psychologists find themselves stuck at grade 2 with an hourly rate approximately around $55. Meanwhile, other allied health professionals like social workers, occupational therapists, speech pathologists, and nurses can continue to climb the career ladder without the same level of formal qualifications in mental health.

Don't get me wrong. I am not against having a multidisciplinary team. There are enormous benefits. But I am against the segregation and disrespect of psychologists in these spaces. This divide leads to many psychologists moving into private practice very early in their careers, often soon after graduation without any experience in the public and community sectors.

The lack of career growth in the public and community sectors forces many psychologists to leave employment and move into private practice, where they can regain control over their careers, build their skills, and have the autonomy to apply their specialised knowledge. The shift to private practice is often seen as the only viable option for many psychologists who feel trapped by the lack of opportunities for professional growth and diversity in roles.

Strength in Diversity:

It is important to note that most non-clinical psychology courses have been shut down over the years, including courses in counselling psychology and community and health psychology. The intake for Clinical psychology courses has been limited to a restricted number of applicants, making it very difficult to enter the workforce. Alternatively, a post- registration course in clinical psychology has taken shape. The expectation is that any psychologist who is qualified and willing to pay more can enter the elite clinical psychology field by doing a post-registration course.

Simplified: you have studied 6 years, completed your required practicums/ trainings, completed the national psychology exam and become a registered psychologist. But you are not yet a good psychologist! So, there is a new course for two years at $33,000 per year to earn the elite title so that you can get a higher rebate!

The Growing Costs of a Divided System

In conclusion, Australia's rising costs of psychological services cannot be attributed to any single factor. As a society, we must begin to recognise and address the inequities in our mental health system. We must acknowledge the diverse skill sets of all psychologists and ensure that we are fairly compensated for the vital work we do. By doing so, we can work towards creating a more sustainable and equitable mental health system, one that truly reflects the diverse needs of those who seek psychological support. It is important to point out that the 2025 budget nor current election campaigns have not addressed the current systemic issues.

*This article reflects my opinions.