For Chantelle Gardiner, her rescue dog Ollie is more than just a pooch — he's a lifeline.
"Living alone, he's sometimes just enough company," she said.
"He likes to lick your tears when you cry. He's funny, he's a clown, too, and he makes you laugh."
The duo live in a tiny, rented granny flat out the back of a share house in Sydney's inner west.
Ms Gardiner also lives with a multitude of health conditions, including anxiety and depressive disorder, hypothyroidism, insulin-resistant polycystic ovary syndrome and fibromyalgia.
The retail worker cannot afford all the treatments and medication required to manage those illnesses so she has been forced to make sacrifices.
One of the first was her mental health.
"I stopped seeing my psychologist just before the last Sydney lockdown [in 2021]," she said.
"The out-of-pocket cost after the Medicare rebate was well over $100. When the cost is that much to begin with, it's completely prohibitive.
"I know so many people who genuinely just can't access mental health care [and] can't go to a psychologist because they just can't afford the up-front cost."
The cost of mental health care was briefly thrust into the spotlight late last year when the federal government abandoned a lockdown-era policy that doubled the number of annual Medicare-subsidised mental health sessions available to patients from 10 to 20.
The government defended paring the Better Access program, arguing its expansion had aggravated wait lists, making it harder to access care for new patients, especially those in low socio-economic areas.
The cuts provoked outrage and outcry from mental health advocates, patients and politicians who argued the expanded program was still benefiting many.
For Ms Gardiner, the cuts made no difference — she couldn't afford 10 sessions, let alone 20.
Instead, she's been forced to use medication to help manage her mental health.
"I've been put on antidepressants and just decided to up the dosage of those," she said.
"But while I was seeing a psychologist, I didn't have any need for antidepressants."
Links between disadvantage and higher rates of mental health issues are well-established.
Disadvantaged households reported having anxiety disorders and affective disorders (such as depression and bipolar) at a much high rate than wealthier households, government data from 2020 and 2021 shows.
A review of the Better Access program last year found lower-income earners were more likely to be prescribed medication, rather than be referred to a psychologist.
Ms Gardiner said mental health care was increasingly becoming something only affluent people could afford and that needed to change.
"It's just not accessible," she said.
Inequality increasing
Tegan Carrison, executive director of the Australian Association of Psychologists, said the gap between who could and could not afford to access mental health care was widening.
She said disadvantaged Australians faced "barrier after barrier after barrier" when trying to access mental health care.
"The first barrier … is that [patients] need to see a GP," she said.
"Often there is quite a long waiting list [and] often there'll be an out-of-pocket expense just to get that referral. Then we have barriers with regards to wait times to see a psychologist.
"When patients do have that psychologist appointment, then they have this huge barrier of what the Medicare rebate is."
Ms Carrison said the rebate of around $89 for most psychology sessions still left people "out-of-pocket well over $100 in most instances".
"That means accessing a psychologist is out of reach for people on the lowest incomes."
Recent data also points to difficulties lower-income Australians are having accessing treatment.
Last month, a productivity commission report showed the number of Australians who delayed or avoided seeking health care because of cost had grown by 50 per cent last year.
Almost a quarter of people delayed seeing a mental health professional because of cost — and 22 per cent of people postponed appointments with a mental health professional other than a GP.
Research by The University of Sydney's Brain and Mind Centre found out-of-pocket payments rose year-on-year between 2013 and 2021.
In fact, out-of-pocket costs for patients increased by 164 per cent over that time period.
Sebastian Rosenberg, a senior lecturer at the Brain and Mind Centre, said out-of-pocket fees had been increasing "very swiftly" and it had entrenched disadvantage.
"In an overall context where mental health care is underdeveloped, underfunded and poorly organised, along with workforce maldistribution, that all accentuates the disadvantage people from poorer circumstances face in finding and paying for care," he said.
Dr Rosenberg said the current system was creating "repeat customers", where patients get "stuck in a cycle" of receiving a few sessions of care "but not actually get any better".
"We need to fundamentally alter the way we design our service system," he said.
"We also need to design a better way of taking into account the impact of the care we provide to see whether what we've done has actually helped [the patient]."
'We are in dire straits'
Ms Carrison said there were a number of levers the government could pull to start reducing inequality within the system.
"We need to increase Medicare rebates to psychologists and allied health professionals, as well as to GPs," she said.
"We need to offer incentives for mental health care providers to provide services in regional, rural and remote regions … and expand who can provide services. We would love for the government to allow provisional psychologists in the last phase of supervised practice to be able to provide services on Medicare.
"And we need to look at improving career pathways and increasing Commonwealth support in places so that we can have more psychologists on the ground".
Ms Carrison said Australia also had "about 30 per cent fewer psychologists than we need" to service the population.
"It's essential that we fix things. We are in dire straits at the moment," she said.
In a statement, Health Minister Mark Butler acknowledged there were inequities in the mental health system and the government was consulting with the sector and people with lived experience on making improvements.
"The Australian government is committed to expanding the range and supply of psychological services for everyone, but this ultimately will involve building the mental health workforce and developing new digital and direct models of service," he said.
"The government recognises the complexity and fragmentation of the mental health and suicide prevention system and is committed to implementing ongoing system reforms to make a real difference to Australians' mental health."
Ms Gardiner said she wanted to see action now.
"We know who needs care the most and we're ignoring the fact that the people who need the care the most just can't afford it."
