'All animals are equal but some are more equal than others': A discussion of guild capture of psychotherapy and the cost

In 2021 the Australian Government announced the largest planned increase in investment in mental health services in the history of the Commonwealth. In the ‘Prevention, Compassion, Care’, National Mental Health and Suicide Prevention Plan (Commonwealth of Australia., 2021), ‘psychotherapy’ is not mentioned, or funded (although ‘treatment’ is mentioned 14 times). Over half of committed expenditure is to extend existing initiatives in which the clinical work will primarily be provided through a small number of guilds at different rates of remuneration for the same work under the Medicare Benefits Schedule (MBS) scheme, Better Access. Meanwhile, the majority of Australians are unable to access a proper subsidised dose of the right therapy at the right time from the most qualified person (often trained in psychotherapy). This paper discusses how professional guilds have appropriated ‘treatment’ as their own and how treatments provided by professional groups have become over-valued and unaffordable to those most in need. The call for action is for those most qualified to provide psychotherapy to clients most in need be enabled to access a subsidy through the MBS.