Mental health

Budget Review 2020–21 Index

Elliott King

In October 2019, the Productivity Commission (PC) released its draft report into Mental Health, estimated the cost of mental ill-health and suicide at $43 to $51 billion per year, plus an addition $130 billion cost ‘associated with diminished health and reduced life expectancy for those living with mental ill-health’ (p. 2).

Around twelve months later and in the context of the pandemic, the Minister for Health highlighted the mental health impact of COVID-19, noting that since 16 March, there has been a ‘15 per cent increase in the number of Medicare-subsidised mental health services delivered’ nationally. In Victoria, between September and October the number of these services accessed rose by 31 per cent, while support services such as Beyond Blue, Lifeline and Kids Helpline have experienced substantial increases in the use of their services.

The Government has highlighted mental health and suicide prevention as one of its ‘highest priorities
(p. 23), with Health portfolio mental health spending expected to reach $5.7 billion in 2020–21. The Treasurer flagged future announcements in the Budget Speech (p. 13):

In coming weeks, we will release the Productivity Commission’s Mental Health final report and the interim report into suicide prevention commissioned by the Prime Minister.

These reports will guide our future actions, working together with states and territories to save lives. [emphasis added]

The most significant budget initiatives in terms of funding or policy change are briefly outlined below. These measures do not appear to require legislation.

Better Access Initiative

The Government has announced a doubling of the number of Medicare-funded psychological services from 10 to 20 through the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access initiative). This change to the Better Access initiative will allow patients with an assessed mental disorder to access up to 20 psychological therapy services per calendar year. Patients referred by a GP under a mental health treatment plan, a psychiatrist assessment and management plan, or a psychiatrist or paediatrician, can claim Medicare rebates for these sessions.

This measure is the largest mental health expenditure item announced in Budget Measures: Budget Paper No. 2: 2020–21 (p. 96), estimated to cost $100.8 million over two years from 2020–21. The measure expands an earlier initiative that increased the session cap for people in areas affected by the second wave of COVID-19, by extending the program to 2022 and removing the impacted area criteria (p.26).

This measure is a response to the PC’s Mental Health draft report recommendation 5.4, which recommends trials of up to 20 sessions of therapy (group or individual) as part of an evaluation of the effectiveness of MBS-rebated psychological therapy.

COVID-19 and extended measures

The COVID-19 Response Package—Additional Mental Health and Crisis Support for Victoria (p. 93) provides $47.3 million over two years for Victorians experiencing mental illness and distress due to the pandemic. Over half of this is allocated to establishing 15 enhanced mental health clinics within six Primary Health Networks ($26.9 million). The enhanced clinics will ‘support GPs by providing access to multidisciplinary teams of mental health workers, including psychologists, mental health nurses, social workers, and alcohol and drug workers’. The centres are intended to provide a local referral point for mental health treatment. The remaining funds are split over:

  • digital and telephone support services for vulnerable groups ($5.0 million) and
  • outreach and crisis support services for young people administered by headspace ($5.0 million), Beyond Blue, Lifeline, and Kids Helpline ($7.0 million).

A further $3.4 million has been allocated for an evaluation of these initiatives and to support the Victorian Mental Health Taskforce.

The Government has also announced its continued support of the 2019–20 Prioritising Mental Health measure (p. 139), allocating an additional $62.1 million over four years from 2020–21 to mental health services (p. 103). The bulk of this funding ($45.7 million) expands the Youth Employment Strategy Individual Placement and Support program by increasing the number of headspace sites that can provide vocational assistance integrated with clinical mental health and non-vocational support services. The package also includes support for:

  • the Prevention Hub’s (Black Dog Institute and Everymind) research targeting mental ill-health and suicide ($2.1 million)
  • mental health and career information for students ($5.0 million)
  • digital mental health services, including Head to Health ($6.9 million) and
  • upgrades for the Mount Barker headspace centre in South Australia ($2.3 million).

Other mental health initiatives

Small business owners

The Government has committed $7.0 million to support small business owners (p. 17) who are under increased financial and emotional pressure during the COVID-19 pandemic. The BusinessBalance program is scheduled to run in 2020–21 and will expand Beyond Blue’s NewAccess coaching program ($4.3 million) and a free mental health literacy program operated through Deakin University ($2.2 million) (Budget Paper No. 2, p. 114). Commencing in early 2021, the NewAccess service will be accessible through the Australian Small Business and Family Enterprise Ombudsman’s My Business Health support portal and provide small business owners with six free telehealth sessions with mental health coaches. This follows on from other mental health support initiatives targeted at small business, such as Ahead for Business.

Veterans’ mental health

The Government has announced $101.7 million for veterans’ mental health support and services, the largest component of which is a ‘one-off increase to the fees paid’ to the Department of Veterans’ Affairs’ approved mental health service providers ($94.3 million) (p. 168). This measure is discussed in the separate Veterans’ Affairs article elsewhere in this Budget Review.


Stakeholder groups have expressed mixed responses to the Budget. The Australian Healthcare and Hospitals Association argued that the Budget was ‘disappointing’ as the Australian Government had not used the opportunity to implement the regional community-based mental health services reforms recommended in the PC’s draft report.

Mental health consumer advocate, Being, welcomed the extension of the Prioritising Mental Health and COVID-19 support measures and the increase in Better Access services, but highlighted issues which may affect program delivery. Others, such as the Australian Association of Social Workers and the Victorian Mental Illness Awareness Council (VMIAC), have welcomed the increase in Better Access services, with VMIAC highlighting the imminent release of the PC’s mental health report and the likelihood of further government action as flagged by the Treasurer. The national Australian Medical Association (AMA) president, Dr Omar Khorsid, included the Better Access initiative measure in his praise of the Government’s health response.

Some commentators have argued that services such as headspace and Beyond Blue are not suited for those with complex needs. According to Professor Ian Hickie of the University of Sydney, the doubling of Medicare-subsidised psychological services through the Better Access initiative ‘does nothing for those who cannot afford the out-of-pocket expenses (often in excess of $50 per session), or those who live in those outer urban, poorer or rural and regional areas that are grossly underserviced’. More fundamentally, Dr Sebastian Rosenberg of the Australian National University and University of Sydney, argues that while ‘many people may be helped by these new sessions’, the program has ‘fundamental design problems’. He further suggests that ‘there is little if any evidence it has fundamentally improved the mental health of Australians’. Similar concerns were raised in the PC’s draft report, with the PC finding that Better Access is ‘poorly targeted’ and disproportionately used by people in large urban centres, and that it suffers from an ‘absence of data’ which limits the ability of government to robustly evaluate the initiative (pp. 20–21; p. 222).


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