“Yes, I do,” I answer earnestly when a new client asks me if I like my job. I really, really do. I am a psychologist and I have been working and volunteering in the Australian mental health space for more than 10 years. What I do not share with my new client is that I am growing increasingly worried about the proportion of people whom I am seeing less frequently than their treatment plan requires. It has left me feeling depleted, but that is something that I take to supervision.
A psychologist’s role is to support people through situations, relationships and to connect or refer them to various health and welfare services if and when required. But we are just one component of a person’s recovery. There are many integral elements to the therapeutic relationship and outcome that we cannot control.
Material wellbeing, for one, is a crucial element that determines many people’s basic access to services, such as mental health. It also includes the cost of basic necessities such as food, bills and rent, household income, pay and fringe benefits from one’s employment, financial security, standard of living and housing. In short, good – or good enough – living conditions are fundamental to mental health and wellbeing.
I have noticed this year in particular that a growing number of clients are struggling to meet their basic needs. They are drastically scaling back their living conditions, which is affecting the efficacy of the work that my colleagues and I are trying to support them with.
The Reserve Bank has lifted interest rates this month for the seventh consecutive month and has warned it is prepared to go higher to combat inflation, projected to reach 8% this year. This hike hits people with mortgages and is passed down to tenants. Feeling increasingly stressed about mortgage and rent payments, many clients are cancelling sessions, saying they are unable to afford continuing treatment.
These clients have sometimes left therapy for months at a time, returning in a worse mental state than before. They know they should be seeking treatment, and yet, there is no room in their tightening budgets. Housing affordability has broadly declined since the early 1980s and many clients are unable to pay for both housing and health.
Australia is experiencing a significant growth in the working poor population, where those in full-time employment have been priced out of rental properties or are forced to sleep in temporary accommodation. The Australian Institute of Health and Welfare reports the wait list for those seeking social housing grew by more than 8,000 households in 2021, up from 155,141 to 163,508, while the latest available census figures from 2016 counted more than 116,000 Australians experiencing homelessness.
With these financial pressures hitting people, how are psychologists meant to do their job effectively? Good therapy happens when people have enough money to meet their basic needs. It is incredibly difficult to help someone improve their mental health when their stress, anxiety and depression are coming from external factors.
What mental health professionals are experiencing is a kind of moral injury. Moral injury is the social, psychological and spiritual impact of events on people who hold strong values. We know financial stress is a risk factor, not just for anxiety and depression, but also suicide. We know that living conditions affect health and wellbeing. We know that people will choose to feed themselves and their family, to secure their shelter for one more week, instead of accessing vital health services. But none of these things are within our control.
Psychologists will often have to turn people away due to mental health services not receiving adequate funding. We often elect to see a proportion of bulk-billing clients and then see more clients than recommended. This leaves us at risk of burnout and other mental and physical health challenges ourselves. But it could be addressed with smart government policy.
I love my job. I really do. But it’s heartbreaking to know that there are limits to what I can help people with.
• Carly Dober is a psychologist living and working in Naarm/Melbourne @enrichinglivespsychology
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255
