A person in distress must first obtain a different appointment to be allowed to pay for the one they need
Better Access requires a GP Mental Health Treatment Plan before any rebated psychology session, and a return visit for review before the later sessions. Eighty-one days elapse before a first session. The same government runs walk-in centres that require none of it.
Steps this would change
Rationale
On the Better Access process, the elapsed time before a first session is about 81 days: a GP appointment, the preparation of a Mental Health Treatment Plan, and finding a psychologist with capacity. A review appointment with the GP is then required before the later sessions can be claimed.
The plan has a genuine clinical purpose and this proposal should not be read as denying it. It puts a general practitioner in the loop, creates a record, and connects psychological therapy to the rest of a person's care rather than leaving it to run in isolation. Continuity of care is a real value and the GP is a reasonable place to anchor it.
Procedurally, though, what it requires is that a person in distress first obtain, wait for and usually pay for a different appointment with a different clinician in order to be permitted to pay for the one they came for. And then do it again at session six.
The comparison that makes this hard to defend is not with another country. It is with the Medicare Mental Health Centre — same department, same portfolio, same year — where a person walks in with no appointment, no referral, no plan and no fee.
Two Commonwealth programs, built on opposite assumptions about how much a person should have to do before being seen.
The proposal. Allow direct referral to a psychologist without a Mental Health Treatment Plan for an initial course of sessions, with the plan required only where treatment continues beyond that course — and replace the mandatory review appointment with a written report from the psychologist to the GP. The continuity purpose is preserved; the person stops being the courier between two clinicians.
Who acts: the Commonwealth alone, through the Medicare Benefits Schedule.
What is being traded away
Removing the GP from the front of the pathway removes the differential diagnosis. Low mood can be thyroid disease, anaemia, medication side effects, or the early presentation of something else entirely. A GP assessment before psychological therapy is not only administrative gatekeeping; it is the point at which a physical cause is considered. A person who receives twelve weeks of therapy for a condition that was organic has been harmed by an efficiency.
The plan is also a rationing device, and removing it will increase demand against a workforce that is already the binding constraint. The process map shows the longest step is finding a psychologist with capacity, at reported waits of six to sixteen weeks for a bulk-billed appointment. Removing the gate does not create psychologists; it lengthens the queue behind the gate that remains, and the people who lose in a longer queue are those who cannot pay a gap.
GPs would lose visibility and income. Mental health treatment planning is a substantial part of general practice work and revenue. Removing it has a real effect on practice viability at a moment when practice economics are already being reshaped by the bulk billing incentive — and a weaker general practice is bad for everything else in this database's health processes.
And the 42 day estimate is soft. It assumes the GP appointment and review are avoidable time rather than clinically useful time, which is the contested proposition. Better Access has been formally evaluated and this project has not read that evaluation into the database; anyone acting on this entry should start there rather than here.
Precedent
Medicare Mental Health Centres, funded by the same department, provide free assessment and brief intervention with no appointment, no referral and no plan. The Commonwealth already operates a no-gate model in the same portfolio.
Sources
- Better Access: up to 10 individual and 10 group sessions per calendar year, requiring a referral or plan from a GP, psychiatrist or paediatrician
- 2026 Medicare rebates of $141.85 per session for a clinical psychologist and $96.65 for a registered psychologist; reported bulk-billed psychology waits of 6 to 16 weeks
- Department of Health, Disability and Ageing: Medicare Mental Health Centres are free walk-in services with no appointment needed