It Seems The Road To Mental Health Is Only Open To The Rich.

Question: It seems the road to mental health is only open to the rich. The going rate for therapy seems to be over $100 a session. While I appreciate that practitioners need to get paid, what are the alternatives for someone who does not have the money?

Answer (1) There are therapists who are willing to charge under the $100 an hour rate, which I feel is a bit excessive, especially for long term work. It was once fairly common practice to negotiate a mutually acceptable fee with the client on assessment and enter into an agreement based on that assessment. I never saw that rigidly sticking to a set fee, advantaged anyone. Doing so was usually a lose, lose, situation. Even if the patient acquiesced, the financial hardship produced, only fostered resentment at the nagging feeling of being exploited and bullied, adding unhelpful factors to the treatment, that cannot be resolved through discussion. Alternatives include seeing someone in a community health centre or a Church based charitable service but the qualifications and skill levels of the multidisciplinary workers vary widely and the frequency and duration of the treatment, will depend heavily on the pressure of demand and the type of therapy offered, often of the "quick fix" variety. Before exploring this option, I would suggest you first shop around to find someone who will negotiate a manageable fee with you. If successful, this will augur well for the treatment itself.

Answer provided by David White, Psychotherapist

Answer (2) Yes, it's a lot of money, especially if it becomes a weekly expense. It's a shame Medicare doesn't cover seeing a psychologist to the extent it covers seeing a psychiatrist. The alternative to seeing a private practitioner is to get counselling from a community health centre or a similar government funded organisation. Counselling is usually free (but sometimes attracts a very small fee according to income), but the downside is there is often a waiting period (of several weeks) before you can see someone, and sometimes, there are restrictions on the number of sessions that can be provided. I work at a community health centre part-time, and I know the waiting list for our program is not an issue most of the time, so I'd encourage you to find out which organisations offer counselling in your area. If the phone book or council aren't helpful, you could ring Lifeline and ask them.

Answer provided by Graham Cox, Psychologist

Answer (3) I can sympathise with your comments on personal experience while knowing that at the $90 I charge per hour, I am not going to be rich (not that that would be a personal goal). Fees vary between therapists so a few more phone calls or emails may pay off. Social workers and mental health nurses sometimes charge less and many will take ability to pay into the equation. Depending on what issues are concerning you, there will likely be an agency which will offer free or means-tested fees. These agencies tend to be jointly funded by state or local government together with the resources of the agency itself, perhapas welfare, charity, interest group. In Victoria, your local communtiy health service will provide access to a social worker or psyhologist trained in the area of your concern, or be able to provide an appropriate alterantive referral. Your local council social services department is also worth a call. Finally, Lifeline has an extensive database and a call to this 24 telephone support and referral service should provide you with worthwhile contact numbers to explore. It is true that wealth may make it easier to make a first appointment. But agency professionals are also bound by privacy and confidentiality and as a rule are very competent at what they do. As with all health care, be prepared to be a critical consumer. If you are not happy with the service, tell your therapist why. Good luck.

Answer provided by John Hunter, Counsellor

Answer (4) Apart from the free telephone and internet services that are available in Australia and Canada and an option for rural and remote areas (see my self help page), I reckon the best option if you are not in rural or remote areas, is to join your local Co-counselling or Re-evaluation counselling community. The training workshops are excellent and you exchange sessions with a co-counselling partner/s for as long as you want, face to face or by telelphone and free apart from membership dues. Some of the communities have special interest support groups like gay/lesbian, non-owning class, chronic illness. This is their home page and here is a report on its benefits from an Australian perspective from which I have excerpted this quote about generosity:

'The first workshop I attended was a three-day 'teachers and leaders' meeting, with about 140 participants, mostly from Australia. It was an eye-opener to me. I was presented with a model of how I would like everyday interactions between all people to be in the whole of society. For me it was the frontier of socially developmental acting and thinking. The workshop was held in the Blue Mountains. On the first morning the leader asked for a volunteers to drive to Sydney airport to pick up some participants who were due to arrive that afternoon. When no one responded, she had us turn to our neighbour and 'have three minutes each about what's so hard to volunteer immediately'. After this, she gave an impassioned speech about how in our society there is so much emphases on individual advantage, a value that ultimately hurts us all. She pointed out that we would not have a slim chance to ever create a better society if we could not even respond to such a small challenge. She suggested that at least half the people in the room could have immediately raised their hands. She also pointed out why a number of excuses were not valid: if we had a car, but did not know the way, we could just request someone to come with us as guide. If we had a driver's licence but no car we could have asked to borrow one. Needless to say, she had a large number of volunteers to pick from after this short interlude. Generosity has since become a quality I have actively developed.'

Answer provided by Peter Fox, Clinical Psychologist