Wed Sep 21

We can't solve Australia's mental health emergency if we don't train enough psychologists. Here are 5 fixes

Written by: Dana Wong, Associate Professor & Clinical Neuropsychologist, La Trobe University

Almost 50% of Australians experience mental illness in their lifetime, costing our economy up to A$220 billion annually, according to pre-pandemic figures ^[1].

The full impact of the pandemic on our nation’s mental health is still emerging, but early signs ^[2] are bleak, with one in five Australians ^[3] experiencing a mental health disorder between 2020 and 2021.

This includes 3.3 million people with anxiety disorders, 1.5 million with mood disorders, 650,000 with substance use disorders, and more than 3,000 deaths by suicide every year ^[4].

But accessing help can be very difficult ^[5]. Government investment in psychology training programs is part of this problem.

A severe shortage of psychologists

Currently, the federal government is meeting only 35% of its psychology workforce target ^[7].

One in three psychologists report having closed their books to new patients ^[8], due to overwhelming demand. Despite this, psychology workforce issues were not on the agenda at the recent jobs and skills summit ^[9].

Brain and mental health disorders including stroke ^[10], dementia ^[11], ADHD ^[12], depression ^[13] and alcohol/substance misuse ^[14] are major causes of disability, with significant personal and societal impacts ^[15].

Timely diagnosis, assessment and treatments for these complex conditions are crucial. However, these services require psychologists with advanced training. This includes clinical psychologists, clinical neuropsychologists, counselling psychologists, educational and developmental psychologists, forensic psychologists and health psychologists. These psychologists are comprehensively trained in assessment, intervention and treatment of people with mental illness and brain conditions.

Hundreds of hospital-based psychology positions remain unfilled ^[16], with patients (including children) waiting up to two years for care ^[17]. Positions are often advertised for months with no qualified applicants, particularly in regional and remote hospitals ^[18].

Some students are unable to undertake psychology university courses due to affordability, which can impact equity of access and student diversity. Shutterstock ^[19]

Psychology training places are declining despite high demand

Postgraduate psychology courses are costly to run, requiring high staff-to-student ratios and incurring high clinical supervision and placement costs.

Unlike medical degrees, government funding for these programs does not come close to covering the costs of the courses ^[21]. The recently reduced federal government support is half ^[22] that given to veterinary science. This means universities lose money on these programs, making them an unattractive financial prospect for ever-tightening higher education budgets.

This has led to program closures ^[23], despite consistently high demand for training places. Across Australia, the number of clinical neuropsychology training programs has fallen from eight to five in the past ten years. There have been similar reductions in health, counselling and forensic psychology training.

La Trobe University’s neuropsychology program received more than 300 applications annually for up to ten places, yet the program was closed in 2020. Similarly, according to course conveners, clinical psychology programs regularly receive at least 20 applicants for each available place.

Universities are now resorting to reducing government-funded masters places in favour of costly full-fee places (around $35,000 each year), impacting affordability, equity of access and student diversity. This disrupts any endeavour to develop a culturally and socioeconomically representative workforce and fails to meet the needs of our healthcare sector.

Many psychologists choose to enter better-paying private practices straight out of university, bypassing public health roles. This affects the general public’s access to mental health services.

We must do better. Vulnerable people living with mental health problems deserve to be supported and protected.

Vulnerable people might miss out on mental health services due to lack of affordability and limited psychologists available. shutterstock ^[24]

5 solutions to the psychology workforce problem

There are straightforward steps that could go a long way to addressing this issue.

Increase funding for postgraduate psychology training so universities do not lose money by offering these programs.
Ensure a minimum number of Commonwealth Supported Places ^[25] (that is, with no, or reduced, student fees) are protected for students in psychology training programs and make sure these align with workforce demands and job vacancies.
Consider training models that incorporate “return-of-service” obligations. This is when the government subsidises student fees but requires graduates to engage in paid health services work for a minimum period, such as two years.
Invest in joint university/health service psychology staff positions (as occurs in medical training) to provide supervision and placements within the sector.
Increase placement opportunities for postgraduate students via better collaboration between universities, services and government.

All Australians deserve to have their mental health needs supported by trained and qualified psychologists. Investing in the psychology workforce will be good for the economy ^[26], increase total workforce participation, reduce wait times and save lives.

The authors would like to thank Tamara Cavenett (President, Australian Psychological Society) and Lynda Katona (Manager, Psychology Services, Alfred Health) for their contributions to this article.