Does having a mental illness mean having to accept second-class healthcare?

National Mental Health Report Card exposes unacceptable gaps in access to specialist mental healthcare

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) says Australia’s latest National Mental Health Report Card raises a confronting question: why are levels of unmet healthcare need that would be unacceptable for other serious illnesses still being accepted for Australians living with mental illness?

Around one in five Australian adults, approximately 4.3 million people, experience a mental health disorder each year, while more Australians are presenting to emergency departments with mental health concerns and waiting longer for care.

The proportion of people avoiding mental healthcare because of cost has risen from 12% to 20% in just three years. Financial pressure is a major source of stress for one in three people with a mental health condition, compared with one in five without one, and people with mental health conditions are twice as likely to experience discrimination.

RANZCP President Dr Astha Tomar said the figures should be unacceptable to Australians.

“As a psychiatrist, these numbers deeply concern me. What concerns me even more is that we seem to have become accustomed to them.

“If comparable numbers of Australians with cancer, cardiovascular disease or another serious illness were unable to afford specialist treatment, deteriorating while waiting for care or spending prolonged periods in emergency departments because appropriate services were unavailable, we would call it a health crisis.

“Why are we accepting it for mental illness?”

Dr Tomar said access to a mental health service should not be confused with access to treatment.

“One assessment or appointment may be important, but for someone living with schizophrenia, bipolar disorder, severe depression, an eating disorder or another serious mental illness, that is often only the beginning.

“Mental illnesses are treatable. People may need psychiatric assessment, medication and psychological therapies, physical healthcare, multidisciplinary treatment and ongoing specialist care. We need to measure whether people receive the right treatment, at the right intensity, for as long as they need it and not simply whether they made contact with a service or service provider.”

More than 318,000 mental health-related presentations were made to Australian public hospital emergency departments in 2024–25.

“Emergency departments provide essential emergency care, but they are not therapeutic environments for someone experiencing psychosis, mania, severe depression or suicidal distress.

“Too often, the emergency department is where all the gaps in our mental health system finally meet.”

Dr Tomar said the same fragmentation affected Australians receiving care outside the public system.

“Private psychiatrists and private hospitals care for many Australians with serious and complex mental illnesses, often over many years. But a psychiatrist working in a consulting room does not have an entire health service behind them.

“When someone’s illness deteriorates and they need intensive community support, multidisciplinary care or urgent admission, the public system needs to be able to step up and work alongside their treating psychiatrist.

“A person’s illness does not distinguish between public and private systems. Neither should their care.”

Dr Tomar said recovery also required governments to address the substantial gap in psychosocial supports for people living with severe mental illness and associated disability.

“Treatment is essential, but recovery can also depend on having somewhere safe to live, support with daily life, opportunities for employment and education, and meaningful social connection.

“Changes to the NDIS must not leave people with psychosocial disability without properly funded alternatives. Otherwise we simply shift the consequences to families, emergency departments, hospitals and homelessness services.”

Dr Tomar said governments also needed to demonstrate what substantial additional mental health investment was delivering.

Victoria’s Mental Health and Wellbeing Surcharge raised approximately $1.26 billion in 2024–25, while Queensland’s Mental Health Levy raises hundreds of millions of dollars annually. Australians also contribute through Medicare, private health insurance premiums and out-of-pocket costs for specialist care.

“These dedicated levies were intended to provide additional investment in mental health. Governments and departments should be accountable not simply for whether that money was spent, but for what it changed.

“Has access improved? Are people receiving specialist care earlier? Are community and inpatient services stronger? Can people access evidence-based treatments? Are we seeing better outcomes?

“These investments carry not only taxpayers’ money, but the hopes and expectations of people living with mental illness, their families and the clinicians caring for them.

"For many people seeking psychiatric care, access to treatment depends almost entirely on Medicare because private health insurance generally doesn’t cover outpatient psychiatry consultations. These appointments are often lengthy, spread over multiple sessions and involve ongoing care for complex mental health conditions, but Medicare rebates have not kept pace with the real costs of providing that care, making it harder for patients to find affordable psychiatric support when they need it."

The RANZCP is calling on state and territory governments to strengthen specialist public community and inpatient services and improve integration with private psychiatrists, GPs and private hospitals.

Dr Tomar also called for stronger Commonwealth leadership.

“I am asking Federal Health Minister Mark Butler to lead the next stage of mental health reform. Minister Butler has long prioritised Medicare and mental health, and important investments have been made. But these figures tell us we need to go further,” Dr Tomar said.

“We need affordable access to psychiatrists, a sustainable specialist workforce, stronger public services, properly funded psychosocial supports, access to innovative and evidence-based treatments, and clear accountability for outcomes.

“We have spent decades asking Australians to challenge stigma and discrimination towards people with mental illness. We must also confront inequity when it becomes embedded in the way healthcare is funded and delivered.

“Australians living with mental illness are not asking for special treatment. They are asking for the same expectation of timely, affordable and appropriate healthcare that we would demand for any other serious illness.

“Mental illnesses are treatable. With the right treatment and support, people can recover and return to their families, relationships, education, employment and the lives they want and deserve.

“Having a mental illness should never mean having to accept second-class healthcare.”

ENQUIRIES: For more information, or to arrange an interview call Kathleen Jessop on +61 437 315 911 or email media@ranzcp.org.  

The Royal Australian and New Zealand College of Psychiatrists is a membership organisation that prepares medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments and other groups on mental health care. For information about our work, our members or our history, visit www.ranzcp.org.

In Australia: If you or someone you know needs help, contact Lifeline on 13 11 14 or www.lifeline.org.au, the Suicide Callback Service on 1300 659 467 or www.suicidecallbackservice.org.au or Beyond Blue 1300 22 4636 or via web chat on beyondblue.org.au/get-support 

In New Zealand: If you or someone you know needs help, contact Lifeline NZ on 0800 543 354 or www.lifeline.org.nz or the Suicide Crisis Helpline on 0508 828 865 or www.lifeline.org.nz/suicide-prevention.