Revealed: Mental health divide between rich and poor
Our mental health system is a dangerous mess where the poor and those in the bush can't get help, while the city's richest residents enjoy abundant taxpayer-subsidised care.
It has sparked calls for a complete overhaul of the ironically-named Better Access Scheme.
And experts also warn the scheme's $2 billion slug to taxpayers is dwarfed by the human cost of increased suicide rates in disadvantaged areas.
The scheme was introduced in 2006 to allow Australians living with mental illness to receive as many as 10 government-subsidised sessions with a psychologist each year. Sessions usually have an out-of-pocket cost between $20 and $100 each time.
NSW Health Statistics reveal North Sydney and South Eastern Sydney local health districts have the lowest levels of "high or very high psychological distress" but clocked up almost $67 million in Medicare-subsidised mental health care plan.
One in 20 in both higher socio-economic areas accessed sessions with a psychologist under the scheme.
Meanwhile, NSW's highest rate of psychological distress was recorded in the local health district of Murrumbidgee, which takes in Young, Wagga Wagga, Cowra and Albury and the Far West.
One in five, or 21 per cent suffer high rates of psychological distress but only 2.8 per cent had access to mental health care plans in the Murrumbidgee and less than 1 per cent in the Far West.
Murrumbidgee also has the highest suicide rate in NSW, double the rate of the rest of NSW.
The Productivity Commission Inquiry Into Mental Health's draft report has found that "the current MBS-rebated psychological therapy program (the Better Access program) should be rigorously evaluated".
"Ironically, access can be an issue with Better Access. Use of the program is disproportionately by people in Australia's large urban centres. This reflects the location of most psychologists and psychiatrists," the draft report said.
Dr Sebastian Rosenberg from the Brain and Mind Research Institute at Sydney University said the Better Access Scheme is intrinsically flawed.
"We know which areas are likely to have higher needs than others but the Medicare mental health services are not arranged in that way, they are arranged to meet the needs of the workforce (psychologists) rather than the communities," Dr Rosenberg said.
"The reason why uptake in North Sydney is higher is because that is where the health professionals are. It is also where you find patients who can afford to pay the out-of-pocket costs.
"Health professionals gravitate to where business is better."
Dr Rosenberg echoed the Productivity Commission's call for the Better Access Scheme to be scrutinised and re-evaluated.
"As a mental health care advocate and even as a taxpayer, I feel this is very poor accountability," he said.
"The model is fee for service through Medicare, which promotes services by solo practitioners acting alone. We know nothing about what is wrong, what is done and what the result is of the treatment.
"The real accountability is shown in those statistics and in the rate of suicide.
"It's very sad. What is being done for those in the Murrumbidgee?"
According to the Productivity Committee, the cost of mental ill health and suicide to the community is between $43 and $51 billion a year.
Professor Anthony Jorm from Centre for Mental Health at Melbourne University said the Better Access Scheme was biased toward those with money.
"People are less likely to work in poorer urban areas or out in remote areas. Where the problems are greatest are in poorer areas, so they need more services in those areas," he said.
Professor of youth mental health Pat McGorry said the workforce was not in disadvantaged areas and the gap payment was also a significant issue.
"The bulk billing only covers part of the service so people in more disadvantaged areas have much worse access for that reason as well, and those two issues should be addressed," Prof McGorry said.
The number of people receiving Medicare subsidised mental health-specific services has doubled from 1.2 million in 2008-09 to 2.7 million (more than 10 per cent of the population) in 2017-18.
Out in the Murrumbidgee, farmers have been hit by record drought, followed by fires. Levels of high and very high psychological distress have doubled since 2015 from 10 per cent to 21 per cent.
Men like Stockinbingal farmer John Harper, who suffered serious depression in 2006 and contemplated suicide, said the farming community has had to help itself. He set up Mate Helping Mate to get people to talk.
"I can't get in to see my family GP for a month. I have to wait a week to get into a generic GP and I live 35km from Cootamundra," the 65-year-old said.
"If we want to see a psychiatrist, it can be three months. Even in crisis, it's impossible to see anyone of substance within six weeks, so we do it ourselves."
Ben Egan, a sixth generation farmer from Warren, has had a similar experience.
"No crop for three years, no water for irrigation, and steadily destocking out cattle herd as the drought continued, effectively shutting down production on the farm," he said.
"Having a young family with two kids under two, 15 months apart, and managing a farm in drought, we found it hard to get out and socialise. We started to isolate ourselves.
"Social media was awash with negativity, pitching farmer against farmer, industry against industry, government providing little relief. Things start to stack up and your mental health starts to take a hit.
"I thought if I'm having these effects, surely others are and the last thing I want to see in our community is mates suffering and, heaven forbid, someone take their own life.
He organised the Yanganbil Trail Ride: Men Riding For Mental Health last October.
"I strung together some blokes to come on a 30km horse trail ride to help spark a conversation, get out and away from it all and have a yarn among mates and create awareness around mental health," he said.
"That night we had a camp oven dinner and listened to John Harper share his story and give some insight into ways with dealing with depression and men's health."
Mr Harper said the key was understanding men in the bush.
"People in the bush, especially blokes won't get off their arse to help themselves but will do anything for a mate," he said.
Danny Byrne works for the Department of Primary Industries as a rural resilience officer who helps link people at risk with scarce mental health services.
"In our region, around Hay, you have to wait five to six weeks to talk to a mental health professional," he said.
"It's a battle. We've had fires on top of drought and people are smashed to bits and have no idea where to start."
But even those in Sydney can also fall through the cracks.
Isaiah Te Rangi first attempted suicide at 16 and again last year at age 22.
"I feel like there is no support. I need intensive therapy every day, but you only get 10 mental health care sessions a year and I don't have the money to do that because my mental health is so bad, I can't work," the 23-year-old said.
"Once you turn 18, you are on your own."
Originally from the eastern suburbs, Mr Te Rangi, a graduate of Cranbrook, is now homeless in Batemans Bay. He has been in and out of hospital in the last year.
"When you are in hospital, after an attempt, they put you on a plan, but when I go to the mental health service, I get rejected because I don't meet the criteria," he said.
"They say they don't have the capacity to look after me, so I get rejected. I keep getting rejected and I have nowhere to go and don't have any money to get proper care."
The Productivity Commission's draft report highlighted the plight of people like Mr Te Rangi, often referred to as "the missing middle" - stuck between those with mild and moderate symptoms who can be treated online or by psychologists, and the emergency department.
"Their condition also does not reach the threshold for access to state or territory-funded specialised mental health services, private psychiatrists or private hospitals due, for example, to long waiting lists or very high out-of-pocket costs. Too often, the necessary services exist but are being absorbed by people whose needs would be met just as well by lower intensity services," the draft report said. The completed report is due in May.
Prof Pat McGorry said the "missing middle" numbered over a million people.
"If he was kicked out of hospital to a GP or psychologist he would not be able to pay the gap and his case would be too complex," he said.
"You need a team-based approach but state governments have not resourced them to keep up with demand."