New figures released by the Australian Institute of Health and Welfare paint a dire picture for Australians who are becoming reliant on chemical interventions for their mental health.

■ 42.7 million mental healthrelated medications (subsidised and under co-payment) were dispensed in 2020-21.

■ 4.5 million patients (17.7% of the Australian population) filled a prescription for a mental healthrelated medication in 2020-21, with an average of 9.4 prescriptions per patient.

■ 62.3% of mental healthrelated prescriptions filled in 2020-21 were subsidised by the Pharmaceutical Benefits Scheme (PBS)/Repatriation Pharmaceutical Benefits Scheme (RPBS).

■ 84.7% of mental health-related prescriptions filled in 2020-21 were prescribed by GPs, 7.5% were prescribed by psychiatrists and 4.9% were prescribed by non-psychiatrist specialists.

■ 73.1% of mental health-related prescriptions filled in 2020-21 were for antidepressant medications 1 .

The most disturbing figure is that 84.7% of prescriptions were prescribed by GPs. GPs have minimal formal training in mental health, usually a 20-hour course 2 , and have no mandatory requirements to undergo annual ongoing professional development or clinical supervision. To be fair to GPs, when would they have the time?

The cost to Australians in 2019-20 for government-subsidised mental health-related prescriptions under the PBS/RPBS was A$566 million 3 . This doesn’t take into account that Australians pay a gap fee of up to A$42.50 for most PBS medicines or A$6.80 if they have a concession card.

Take into consideration a study published in World Psychiatry in 2013, the efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons, which concluded that pharmacotherapy and psychotherapy have comparable effects in several depressive and anxiety disorders 4 . The fact that 73.1% of prescriptions are for depression brings into question why the government isn’t making counselling available to the public through the Medicare Benefits Schedule (MBS). Surely giving Australians access to a non-chemical alternative is in everyone’s interest, bar that of the pharmaceutical companies?

What would the annual cost be to the MBS for 3000 registered counsellors and psychotherapists to offer 10 one-hour sessions to Australians experiencing depression? Answer: less than A$250 million a year. This is compared to A$556 million for prescriptions alone, which doesn’t consider the added cost of people taking prescriptions who are also seeing a psychologist under MBS rebates.

It’s time registered counsellors and psychotherapists became part of the Medicare system, so that Australians have a choice between chemical interventions and equally effective counselling services delivered by humans. ■

References

1 Australian Institute of Health and Welfare. (2022). Mental health: Overview. Australian Government. aihw.gov.au/mental-health/overview

2 General Practice Mental Health Standards Collaboration. (2022). Developing focussed psychological strategies skills training (FPS ST) courses (Level 2). mentalhealth.racgp.org.au/guidelines/index/616b4fb1-9755-464b-9b04-30228eb78572

3 Australian Institute of Health and Welfare. (2022). Mental health: Expenditure. Australian Government. aihw.gov. au/reports/mental-healthservices/mental-healthservices-in-australia/report-contents/expenditure-on-mentalhealth-related-services

4 Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons. World Psychiatry, 12(2), 137–148. ncbi.nlm.nih.gov/pmc/articles/PMC3683266