A Better Future for Children's Mental Health
Changing Medicare Rules to Support Parent-Directed Therapy
What is this all about?
Medicare's Better Access scheme allows Australian children with mental health challenges 10 rebateable mental health treatment sessions per calendar year when referred by their GP. However, for all but 2 of these sessions, Medicare rules dictate that the child must be present in the room and receive the service directly themselves.
What's the problem with this?
It means parents/caregivers - you are unable to receive the best, evidence based "parent-directed therapy" from therapists which would equip you with the skills and strategies needed to be able to improve your child's mental health.
These rules are in stark contrast to decades of research which show that parent directed therapy is often the most effective way to improve young children's mental health.
In addition, these rules stop you as parent/caregivers from being able to freely communicate 'adult only' content (such as information about violence, abuse or strongly worded concerns about your child) to your child's mental health professional (or worse - forces you to say these things in front of your listening child - which then may cause them further psychological damage).
Finally - this situation is leading to a reduction in the child mental health workforce, and thereby lengthening wait times - as mental health workers choose to work in other fields outside child mental health - where they feel they may be able to provide therapy which is more effective.
We're calling for a change to allow all 10 Medicare-funded sessions under a child's mental health care plan - to be able to be used for parent-directed therapy when appropriate and agreed upon by the family.
This will:
👉 Provide (especially young) children with better, faster, and more effective care - and thereby reduce mental health problems in Australian children.
👉 Reduce harm caused by adults discussing sensitive or damaging topics in front of children during sessions.
👉 Sustain levels of the child mental health workforce leading to more and faster access for families.
AND:
👉 Not require any significant additional funding (as we are not asking for additional sessions just the flexibility to use them differently when required)
Read on to find out exactly what the problems are with the current rules - and why a change is vital for the sake of Australian children's mental health.
Or if you have heard enough and want to see this change happen - click the "Add my support" button below so we can advocate to make this change happen.
Problem 1: Child mental health professionals unable to use effective treatments for children with challenging behaviours
Problems associated with ADHD and (separately) disruptive behaviour disorders (DBDs), like Oppositional Defiant Disorder and Conduct Disorder, are the most common reason for children being referred to child mental health clinics in Australia.
These children - if not treated and supported effectively, are at higher risk of serious long-term problems, such as substance abuse, unemployment, poor school outcomes, and other mental health concerns - and this leads to significantly higher costs to Australian healthcare, education, and justice systems.
The good news is that decades of research show that parent-directed treatments—where parents work with mental health professionals to support their child—are highly effective for improving the well-being of these children - especially when children are aged under 12 years. As a result, parent-directed therapy is widely recommended as the gold standard treatment by trusted organisations like:
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Australia's NHMRC ADHD Guidelines (2022)
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The NICE Guidelines for disruptive behaviour disorders (2017)
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The Australian Psychological Society recommendations for Conduct Disorder (2018)
Australian universities train child mental health professionals in parent-directed therapy approaches and most child mental health professionals are keen to use it with families because they know it works well.
So what's the issue?
As the current Medicare rules only allow 2 out of 10 funded sessions per year to provide treatment to parents, psychologists cannot use the gold standard treatment for these kids - and instead are forced to deliver less effective 'child-focused therapy' (eg like CBT), even though it has been shown to be not the best option for many younger children (who often aren’t developmentally ready to fully engage in therapy on their own) with disruptive behaviour disorders and ADHD.
Most child mental health professionals are well aware of this — and sadly, they are not surprised when many young children don’t improve under their treatment in the current system. They know that a large part of this is because Medicare doesn't allow them to provide the most effective treatment.
It’s no surprise that concerns about challenging behaviours, bullying, and classroom challenges continue to make news headlines in Australia. Without the option to provide the most effective treatment to families, these problems will only continue—and so will the costs to our society
(For peer reviewed references and evidence for all of the above points go to "full brief")
What does this look like in real life?
Sam is a 6-year-old with ADHD and Oppositional Defiant Disorder (ODD), experiencing severe behaviour problems and emotional overwhelm - like daily meltdowns, aggression, and school refusal.
His behaviours have led to child protection concerns and his school restricting his attendance due to safety risks.
Sam’s experienced psychologist knew that given Sam's age - parent-directed therapy (teaching and coaching his parents to use strategies to coach, understand and support Sam) would likely be the most effective treatment for Sam. However, Medicare rules forced her to work directly with Sam, despite his young age and limited ability to engage in therapy.
Over three years and 30 Medicare-funded of 'child directed' sessions later (many minutes of which had to be used in trying to engage the young Sam in therapy), Sam had made little progress. He still had serious episodes of overwhelm and behaviour concerns, educational delays, and ongoing family stress, with his siblings temporarily removed from the home and his mother leaving work due to the pressure.
This is the type of situation research shows could have avoided with parent-focused treatment, which was not permitted under Medicare, leading to prolonged struggle and preventable harm.
Problem 2: Child mental health professionals are prevented from using effective therapy for many children with anxiety disorders and OCD.
Anxiety disorders and Obsessive Compulsive Disorder (OCD) affect around 6.5% of Australian children. If these conditions are left untreated, they can cause long-term problems like poor physical health, self-harm, school difficulties, unemployment, and financial stress.
The 'gold standard' type of treatment for child anxiety and OCD is a treatment working directly with a child - using Cognitive Behavioural Therapy (CBT) with a focus on exposure (gradually facing fears).
However, 40–50% of younger children don’t fully benefit from this approach. Many lack the understanding, motivation, or cognitive skills to engage properly, and those with severe symptoms may resist treatment altogether.
To help these children, researchers have developed parent-directed treatments for childhood anxiety. These involve parents themselves learning strategies to treat their child at home by reducing avoidance and responding to anxiety symptoms in particular ways. These treatments have been proven highly effective, especially for younger children or those who can’t engage in therapy themselves - and for some families, these treatments have been found to work more quickly and effectively than child directed CBT.
Despite this, Medicare won’t fund parent-directed anxiety and OCD treatments, which prevents mental health professionals from delivering the best care for some children with very high anxiety needs. As a result, many children continue to miss out on the help they need.
(For references and research evidence for all of the above - go to "full brief")
What does this look like in real life?
Tali is an 8-year-old with severe anxiety about cooking smells and vomiting, leading her to avoid leaving home. She was referred to a psychologist through Better Access, but refused treatment after learning about the gradual exposure process in session 1.
The psychologist offered parent-directed treatment - to coach Tali's dad, Simon, to support Tali at home and explained that this approach has been shown in many studies to be just as effective as working with Tali. Simon was interested but couldn’t afford the sessions because they didnt come with Medicare rebates.
Instead, Simon pursued medication through a psychiatrist for Tali, which wasn't successful in her case. Two years later, Simon called the psychologist to tell them that Tali was still housebound, not attending school, and had developed worsening health problems as a result. Simon is now in therapy himself to manage his own distress.
This is another case where effective parent-led treatment could have improved Tali’s anxiety and family wellbeing—but Medicare’s current rules blocked access.
Problem 3. Children in mental health treatment sessions often witness psychologically damaging material.
Under Better Access, parents often attend their child’s sessions (*remember, parents being in the room IS supported under Better Access - it's just that parents ONLY in the room without their child is NOT supported).
Having parents present in these sessions is vital, however, because parents/caregivers can't see mental health professionals on their own, almost at all during their child's treatment, parents feel forced to disclose distressing, traumatic, or emotionally abusive information in front of the child—such as family violence, child abuse, or harsh criticism.
Research shows even brief exposure to this kind of material is potentially highly harmful to children. Unfortunately, child mental health workers cannot always prevent or predict when this will happen, and in cases of safety concerns (like family violence), the information must be addressed immediately, even if it occurs in front of the child.
For further details and evidence - of all of the above - go to "Full Brief"
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What does this look like in real life?
Jack (8) attends therapy for trauma symptoms from past family violence. His mother, Susan, has already used her two permitted parent sessions but needs to speak privately with the child mental health worker about new safety concerns. Unable to afford a private session, she brings Jack along and, in front of him, discloses that her new partner has been violent and that she fears he might hurt Jack. She adds that she thinks Jack should be placed in care, as he’s “too much” for her.
While the worker tries to limit Jack’s exposure and redirect the conversation, urgent safety assessment is required. Meanwhile, Jack shows clear distress, burying his head and eventually banging his head on the floor.
There is a low or nil cost solution to all of the above.
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All of the problems above could be solved if Medicare rules were changed to allow - when agreed upon by caregivers and the child's mental health professional - a child's 10 rebatable annual sessions to be used for parent directed treatment during parent only sessions - instead of only being able to be used for child directed treatment.
This change would not increase the total number of allowable sessions per calendar year per child. It therefore should have minimal or nil impact on current budgets for the Better Access scheme.
Furthermore, if child mental health professionals were able to provide parent directed treatment - it would be likely to result in larger and faster treatment effects - which would ultimately reduce mental health and other societal care costs.
In fact, there has been some UK based economic analysis directly addressing this question. A recent study found there was a 96% probability that a parent directed CBT therapy (without the child present) was more cost effective than a therapy program which included the child (and parent together) (Creswell et al., 2017).
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What now?
There are many national health organisations and reviews in child mental health which have already suggested this change over the past decade, including the The Mental Health Commission’s (2024) National Children’s Mental Health and Wellbeing Strategy, the Productivity Commission report (2020) into Mental health, the MBS Review Mental Health Reference Group (2018), The Australian Psychological Society’s White Paper (APS 2019) - not to mention hundreds of child mental health workers in Australia - and of course parents/caregivers.
There is very little disagreement about the importance of this change - it appears that politicians have just not prioritised this issue.
We need your help to raise awareness of these problems and the easy solution to fix it. Please click on ADD MY SUPPORT "so that we can effectively advocate on this issue to government - and then share this site with as many people as you can.
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PS - if you would like to read the full brief, which includes more than 30 peer reviewed references supporting the claims in the sections above, click the FULL BRIEF button below.