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When I was 25, a friend of mine told me a lawyer she knew had asked her to explain the term “bulk-billed”. She’d never not paid to see a doctor, and with her law firm income had never noticed the expense. That same year, I paid an out-of-pocket medical cost for the first time. Before moving from the outer suburbs to Melbourne’s inner north, I hadn’t even realised there were doctors who didn’t bulk-bill. And I’m frustrated to say it was the best medical experience I have had. The doctor I had to pay for was the doctor who literally changed my life.
Here’s the thing though—I haven’t been back since she prescribed me Lexapro, an SSRI used for anxiety and depression, because I cancelled my credit card and cannot afford to see her without it. Each appointment with this doctor cost me $80, with $35 instantly rebated. There were times I put appointments off because I didn’t have the cash. When I sat through helpful tests that helped prove I needed medication for my brain and not for my body, they cost me more than half a week’s pay.
When my doctor prescribed me my meds, which at $10 a month I still take every day, she explained they should work in conjunction with regular therapy. I have tried to see three different therapists. Each cost at least $80 per hour after the Mental Health Care Plan rebate. All told me they’d like to see me at least once a fortnight. I did not and still don’t have $80 a fortnight. I, like many twenty-somethings in this country, don’t have a high-paying job or wealthy parents. The stigma around medication is still very real, and I still feel great shame that I “rely on pills” instead of seeing a psych.
While I’ve personally been lucky to find medication that works for me as well as receive boundless support from family and friends, it’s a little-acknowledged fact that mental health isn’t well-covered by Australia’s much-bragged-about universal healthcare system. It’s expensive to get diagnosed in the first place, and once you are told what you need to do in order to recover, the costs only escalate. It can seem like an insurmountable financial burden to get better.
It’s not just me
Researching this piece, I did a Twitter call out for people to share their stories of financial distress as a result of mental health issues. The response was overwhelming, and most people stressed a disconnect between what psychologists prescribed, and what they as patients could afford.
Sarah*, a young woman living in Melbourne, said her psychologist was a specialist in her field. But because most of her adolescent patients had their bills bankrolled by relatives, Sarah’s doctor failed to understand why she couldn’t schedule weekly appointments.
“When I realised I could never afford the schedule she had for me I withdrew from treatment for a really long time until I got really sick and had to go back,” she says. “Now, even though a maintenance appointment would be nice, I can’t justify the money and taking the day off work to go. So I just don’t go.”
Sarah told me her therapist cost $180 a session. Mine cost only $80, and that was enough of a struggle.
John* is in his 50s and lives in Western Australia. He’s had a long mental health journey, beginning with this story that might sound pretty familiar to those of us who have sought help:
“[After a suicide attempt] I found myself sitting in a psychiatrist room. He was not helpful—a typical bougie. The session ended with him declaring I had manic depression and would need to see him weekly. At $200 per hour, I said it wouldn't be possible unless I was on some kind of payment plan. He informed me he wasn’t a charity…that I’d have to go on a [six month] waiting list if I wanted to go through the public system.”
Despite experiencing these issues, John still considers himself lucky. He has a job that pays a decent wage, has an HR department and a mental healthcare package. Not all of us can say the same.
Claire* has a history of anxiety and depression that has been compounded by terrible experiences with mental health professionals, including one who claimed her suicide attempt was caused by a vegetarian diet which meant she “wasn’t getting enough vitamins”. After the birth of her first child last year, Claire was diagnosed with postnatal depression.
“So I asked my GP to recommend a new free psychologist. Being on parental leave left me with very little money for anything other than essentials,” she recalled.
“The person my GP sent me to was a complete waste of space. They couldn't remember anything about me or my situation, didn't understand me at all or take any notes. Just told me very basic ways of dealing with depression or anxiety without listening to a thing I said. They literally just read to me from a textbook. I saw them four times and gave up.”
For Claire, the difference between free and paid psychological services are like night and day.
“I'm currently in a position where I feel completely helpless because I can't afford to pay to see someone and the free services are a complete waste of my time.”
What are we going to do?
You need only look at the university entry requirements for medicine and psychology degrees, as well as the incomes of psychologists and psychiatrists, to understand that the rich and educated get more rich and educated while most of us struggle. That our healthcare system is saturated with out-of-touch people is not a surprise.
But while conversations about privilege are ubiquitous now, and groups like Beyond Blue, Black Dog and Headspace are making strides in creating awareness of mental health issues, we’re not doing enough to make mental health care accommodating once you make it past the initial often-insurmountable hurdle of diagnosis. Sure, Medicare provides some mental health cover—but what does it matter when the gulf between free and paid psych services is so vast? Australia likes to pride itself on its free healthcare, but when will we stop seeing mental illness as separate from that?
As with mental health as a basic concept, money is something we struggle to discuss publicly. But it’s something we have to do. No one wants to talk about money, no one wants to talk about the ways they’re crazy. It feels gross to tell people about my pills, but the more I do it, the easier it gets. The more we are open and honest about the way we’re struggling financially, the more we can work together to make policy changes that support the whole community—not just those that have the financial means to explore all the options.
*Names have been changed
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