Australian children from poorer communities are increasingly missing out on psychological care. Monash University research shows the gap in treatment between wealthy and disadvantaged families has widened over the past decade, with children being the hardest hit.
The study, published in the journal SSM—Mental Health, analyzed data from 5.4 million Australians who received a Mental Health Treatment Plan between 2014 and 2023. It found that income-related inequity in access to psychotherapy had nearly doubled over this period, highlighting substantial inequalities in Australia’s mental health care system.
Widening gap in access to care
By 2023, fewer than one in three children from the lowest-income neighborhoods received Medicare-subsidized psychological treatment within three months of obtaining a plan, compared with more than half of children from the wealthiest neighborhoods. This disparity shows the growing divide in access to essential mental health services for vulnerable populations.
The difference in access between the highest- and lowest-income groups increased from 14 to 23 percentage points for children. Among adults, the gap grew from eight to 15 percentage points, with only 40% of low-income adults accessing psychotherapy within three months of receiving a Mental Health Treatment Plan in 2023, compared with 55% of high-income adults. These figures reveal a deepening inequity that disproportionately affects those in lower-income brackets.
Associate professor Nicole Black from the Centre for Health Economics at Monash Business School expressed deep concern over the findings. She noted that many individuals who have sought help and received a treatment plan are still not getting the care they need, particularly those from poorer communities. “Missing or delaying treatment can have serious consequences, including prolonged mental health problems, reduced quality of life, and higher downstream health care costs,” Black said.
Decline in psychotherapy use
The overall use of Medicare-subsidized psychotherapy has declined since 2014, despite growing mental health needs and recognition of psychotherapy as an effective first-line treatment. Between 2014 and 2023, psychotherapy use within three months of receiving a plan fell from 63% to 45% among children and from 58% to 48% among adults. The decline was considerably greater among children living in lower-income neighborhoods, exacerbating existing disparities.
The cost burden for families has surged, as the average out-of-pocket expense for a first psychotherapy session jumped from $44 to $90 for children and from $35 to $80 for adults when adjusted for inflation. These rising costs disproportionately strain households with limited financial means, further limiting access to necessary care.
Geographic disparities in access
A related study in the Australian Health Review, analyzing data from 2.7 million adults, found that disadvantaged communities, both in cities and regional areas, consistently had lower rates of accessing psychotherapy. This pattern highlights how socioeconomic factors intersect with geographic barriers to mental health services.
In some regional areas of New South Wales and South Australia, only 28% of adults with a treatment plan accessed psychotherapy. In contrast, areas of inner Perth had an average psychotherapy use rate of 60%. These disparities show the need for targeted interventions in underserved regions to improve access to care.
Improving access will require addressing both the affordability and availability of psychological care. Johnston emphasized the need for carefully evaluated policy responses to understand which approaches genuinely improve access, particularly for those facing the greatest barriers. “There is unlikely to be a single solution, and it is important that policy responses are carefully evaluated to understand which approaches genuinely improve access,” he said. The studies by Nicole Black et al. provide critical insights into these challenges, with detailed findings available in SSM – Mental Health (DOI: 10.1016/j.ssmmh.2025.100580) and Australian Health Review (DOI: 10.1071/ah26029).