Mental Health Services: 10-Month Wait Times and a System at Breaking Point
By Direct Democracy
The Crisis in Plain Numbers
If you or someone you love has tried to access mental health support in Australia recently, the statistics probably won't surprise you - but they should still outrage you.
The average wait time to see a public mental health outpatient service in Australia is currently between 4 and 10 months, depending on the state. In regional and rural areas, that figure is often worse. A 2023 report by the Australian Institute of Health and Welfare found that nearly 1 in 2 Australians who needed mental health care reported an unmet need in the previous 12 months. Suicide remains the leading cause of death for Australians aged 15–44.
And yet, despite years of inquiries, royal commissions, and election promises, the system remains structurally broken. The question worth asking is: why?
What the Policy Actually Looks Like
Mental health funding in Australia is split - awkwardly and deliberately - between the federal and state governments, and this is where much of the dysfunction lives.
The federal government primarily funds mental health through Medicare, including the Better Access initiative, which provides subsidised sessions with psychologists and GPs. After a COVID-era expansion to 20 subsidised sessions per year, the Albanese government controversially cut this back to 10 sessions in 2023, citing a review that suggested more sessions weren't improving outcomes for the majority of patients.
State and territory governments are responsible for acute and community mental health services - the hospital emergency departments, community mental health teams, and public outpatient clinics. These are chronically underfunded. Victoria, which has undergone a high-profile Royal Commission into Mental Health (final report delivered 2021), committed $3.8 billion to reform - but implementation has been slow, and frontline workers report that the promised workforce simply doesn't exist yet to deliver the services.
Nationally, Australia spends approximately $11.7 billion per year on mental health - around 7.4% of total health spending. The OECD average is closer to 12%. We are, by international standards, significantly underinvesting.
Why the Better Access Cut Was So Controversial
The decision to reduce Better Access sessions from 20 back to 10 became one of the most criticised health policy decisions of the Albanese government's first term. Here's why it stung:
- People with complex conditions - chronic depression, trauma histories, eating disorders - had structured their treatment plans around the expanded entitlement
- The review cited to justify the cut was itself contested; many clinicians argued its methodology was flawed and that it measured the wrong outcomes
- The move saved the federal budget an estimated $800 million over four years - making it transparently a budget decision dressed up as a clinical one
- Private psychology sessions cost between $180 and $300 per hour. Without Medicare subsidies, only higher-income Australians can afford ongoing care
The opposition criticised the cut - but it's worth noting that the Coalition government never expanded access to 20 sessions in the first place. This is a bipartisan failure wearing a single-term costume.
Who Bears the Cost?
The people hurt most by these policy failures are predictable and consistent:
| Group | How they're affected |
|---|---|
| Low-income earners | Cannot afford private psychology; rely entirely on public systems with longest waits |
| Regional & rural Australians | Fewer providers, longer distances, telehealth gaps |
| Young people (15–25) | Highest rates of unmet need; school and university services overwhelmed |
| People with complex needs | 10-session cap cuts treatment short; public services not resourced to fill the gap |
| Culturally diverse communities | Language and cultural barriers compound access problems |
Why Does This Policy Persist?
This is the uncomfortable question. We have had royal commissions, Senate inquiries, Productivity Commission reports, and decades of advocacy. The evidence is not in dispute. So why doesn't it change?
The honest answer involves a few uncomfortable truths:
Federal-state blame shifting is politically useful. When the system fails, both levels of government can point at each other. Patients fall through the gap while ministers hold press conferences.
The people most affected have the least political power. People in acute mental health crisis, or cycling in and out of the system, are not a well-organised lobby group. They don't make major political donations. Their suffering is often invisible.
Budget repair is prioritised over preventative spending. Mental health investment has strong economic returns - the Productivity Commission estimated that better mental health support could add $17 billion annually to the Australian economy. But that return is diffuse and long-term. The cost saving from cutting Better Access sessions is immediate and visible on a budget bottom line.
Private providers benefit from scarcity. When public services are overwhelmed, those who can pay go private. There is a profitable industry that does not have a direct financial incentive for the public system to function well.
What Would Voters Actually Choose?
This is where it gets interesting. Poll after poll shows Australians list mental health as a top-three healthcare priority. A 2022 Essential poll found over 70% of respondents supported increased government investment in mental health services, even if it meant higher taxes or redirected spending.
In other words: the public already knows what it wants. The problem is that what the public wants and what governments deliver are two different things - because governments respond to electoral cycles, donor relationships, and bureaucratic inertia, not to the considered preferences of ordinary people.
If Australians could vote directly on whether to restore the 20-session Medicare cap, redirect health funding toward public mental health staffing, or implement the outstanding recommendations of state royal commissions - the outcome would almost certainly look different from what either major party has delivered.
That's not a radical claim. It's just arithmetic.
What Direct Democracy Changes
At Direct Democracy, we believe that policies like this persist precisely because citizens have no real mechanism to override them between elections. You can vote out a government every three years - but you cannot tell them, specifically, to fund mental health services properly while leaving other priorities intact.
A participatory model changes that. Members vote on specific policy positions. Elected representatives are bound to follow those instructions. Mental health funding doesn't get quietly traded away in a budget negotiation you never knew was happening.
The system is broken. The evidence is clear. The public knows what it wants. The missing ingredient is a mechanism to make government actually listen.
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