Patients need affordable psychiatric care and a system that can provide it

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) recognises that high out-of-pocket costs can put essential mental healthcare beyond the reach of Australians, particularly those requiring ongoing or complex treatment. 

Psychiatrists have a professional and social responsibility to charge reasonably and transparently, taking patients' circumstances into account wherever possible. Genuinely excessive fees should not be defended, but assessments of what constitutes excessive charging must be fair, evidence-based and reflect the care provided. 

Equally, responsibility for affordable psychiatric care cannot rest with individual psychiatrists alone when workforce shortages and gaps in publicly funded services leave patients with few alternatives. 

In a policy brief released this month, the Grattan Institute identified stagnant and patchy investment in specialist training as a major barrier to improving access and affordability, highlighting the lack of government action in expanding specialist training despite projected shortages. Its latest report calls for governments to properly plan and fund the specialist training pipeline. 

The nature of psychiatric care also needs to be understood when comparing specialist fees. Unlike many other specialist consultation items, psychiatric Medicare items are time-defined. Initial psychiatric assessments commonly take an hour or longer, while consultations in some other specialties may appropriately be considerably shorter. 

Psychiatric assessments also involve substantial clinical work before and after appointments, including reviewing clinical information, preparing reports and management plans, and coordinating care with GPs, families and other services. Much of this work is not separately remunerated through Medicare. 

While the Grattan Institute compares fees against specialty-specific Medicare schedule fees, these benchmarks do not necessarily reflect equivalent clinical time, complexity or costs. A more meaningful comparison would consider total clinical work, including differences between consultation-based and procedural specialties. 

Differences in clinical time and complexity do not justify every high fee. Excessive charging occurs across healthcare and should be addressed. Equally, higher fees should not automatically be labelled excessive without understanding the care provided. 

Medicare rebates have historically failed to keep pace with inflation and the rising costs of delivering psychiatric care. The Grattan Institute has previously acknowledged that Medicare schedule fees do not necessarily reflect the actual cost of specialist care and recommended an independent review. The RANZCP supports this recommendation, including consideration of clinical time, non-billable work and practice costs. 

Private psychiatrists provide essential care in a system where public mental health services cannot meet the full spectrum of community need. This is particularly evident among people in the 'missing middle', whose needs exceed what primary care alone can provide but who cannot readily access public specialist services. 

Significant psychiatrist shortages, uneven workforce distribution and insufficient public and community mental health capacity compound these pressures. Access remains deeply unequal, with more advantaged communities receiving substantially more psychiatric care, reinforcing the need for targeted investment based on clinical need rather than income or postcode. 

Comments attributable to RANZCP President Dr Astha Tomar

"We absolutely need to make psychiatric care more affordable. But addressing fees without tackling workforce shortages and gaps in services will not deliver better access for patients. 

"We also need to compare like with like. A psychiatric assessment can take an hour or more, with considerable clinical work before and after the appointment. Other specialists may appropriately see several patients in that time. Comparing consultation fees alone does not tell us whether those fees are reasonable. 

"Psychiatrists see what happens when the deficiencies in our mental health system meet at their front door. They see patients waiting months for care, families desperately seeking help, and people whose needs are too complex for primary care but who have nowhere else to turn. 

"In many communities, private psychiatrists provide essential care because there is no readily accessible public alternative. 

"We have known for years that Australia is not training and retaining enough psychiatrists, that public services lack capacity, and that access depends too much on where people live and what they can afford. 

"These are longstanding failures of funding, workforce planning and service capacity. Governments must address them. Fee transparency and reasonable charging are important, but regulating fees alone will not expand public services or strengthen community-based and inpatient mental healthcare across the public and private sectors. 

"We welcome a more meaningful analysis of specialist fees that considers the actual clinical work involved, alongside an independent review of Medicare funding and sustained investment in the psychiatric workforce and services.” 

ENQUIRIES: For more information, or to arrange an interview call Dishi Gahlowt 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 or the Suicide Callback Service on 1300 659 467 or www.suicidecallbackservice.org.au. 

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