Income divide in access to psychological care widens, with children hardest hit
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Australian children from poorer communities are increasingly missing out on psychological care, with the gap in treatment between wealthy and disadvantaged families widening substantially over the past decade, according to Monash University research.
The study is published in the journal SSM—Mental Health.
By 2023, fewer than one in three children from the lowest-income neighborhoods received Medicare-subsidized psychological treatment within three months of obtaining a Mental Health Treatment Plan, compared with more than half of children from the wealthiest neighborhoods.
Drawing on linked Medicare and tax data from 5.4 million Australian children and adults who received a Mental Health Treatment Plan between 2014 and 2023, the study found that income-related inequity in access to psychotherapy had nearly doubled over the decade.
For children, the difference in access between the highest- and lowest-income groups increased from 14 to 23 percentage points.
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.
Associate professor Nicole Black, from the Centre for Health Economics at Monash Business School, said the findings highlight substantial inequalities in access to needed mental health care in Australia.
"What is particularly concerning is that these are people who have already sought help from a general practitioner and received a Mental Health Treatment Plan. Yet many are still not receiving psychological care, and that proportion is much higher among people living in poorer communities," Black said.
"Missing or delaying treatment can have serious consequences, including prolonged mental health problems, reduced quality of life and higher downstream health care costs."
The overall use of Medicare-subsidized psychotherapy has also declined substantially since 2014, despite rising mental health needs and growing recognition of psychotherapy as an effective first-line treatment.
Between 2014 and 2023, psychotherapy use within three months of receiving a Mental Health Treatment 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.
Over the same period, average out-of-pocket costs for an initial psychotherapy session more than doubled, rising from $44 to $90 for children and from $35 to $80 for adults, in inflation-adjusted dollars.
Black said Medicare subsidies are intended to make psychological care more affordable, but the amount patients are paying has risen substantially.
"While we cannot say that rising costs caused the widening income gap, our findings raise serious concerns about the affordability and equity of psychological care," Black said.
A companion study by the same researchers, published in Australian Health Review, examined Medicare data from 2.7 million adults and found that access to psychotherapy was consistently lower in more socioeconomically disadvantaged communities, across both regional and metropolitan areas.
In some regional areas of New South Wales and South Australia, only 28% of adults with a Mental Health Treatment Plan accessed psychotherapy, while in areas of inner Perth, the average rate of psychotherapy use was 60%.
Professor David Johnston, from the Centre for Health Economics at Monash Business School, said the growing income gap raises serious concerns about the equity of Australia's mental health care system.
"Access to mental health care should be determined by a person's need for treatment, not their ability to pay. Yet our findings show that we're moving further away from that principle rather than closer to it," Johnston said.
"Improving access will require addressing both the affordability and availability of psychological care. 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, particularly for those who currently face the greatest barriers."
More information
Nicole Black et al., The growing divide: Income inequities in access to mental healthcare in Australia, SSM - Mental Health (2026). DOI: 10.1016/j.ssmmh.2025.100580
Nicole Black et al., Geographic variation in access to Medicare-subsidised psychotherapy, Australian Health Review (2026). DOI: 10.1071/ah26029
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PsychiatryPsychology & Mental healthChildren's health Provided by Monash University Who's behind this story?
Swati Mestri
Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →
Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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