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 provides Australian children with mental health concerns 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 is required to be present in the room and receive the service directly themselves.
This means parents/caregivers are not allowed to receive evidence based "parent-directed therapy" which could equip them with the skills and strategies needed to actively treat and improve their child's mental health themselves.
These rules go against decades of research which shows that parent directed therapy is often the most effective way to support young children's mental health.
And these rules requiring children to almost always be present in the room with mental health professionals stops their parents from being able to say some of the 'adult only' things they need their child's mental health worker to know (or worse - forces parents to say them in front of the listening child - which then cause psychological damage).
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 children with better, faster, and more effective care - and 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 access for families.
👉 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 Australian children's mental health.
Problem 1: Child mental health professionals are prevented from using 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 children are referred to 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 lead to higher costs to 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. Because of this, 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)
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 are forced to deliver less effective, child-focused therapy (like CBT) instead, even though it is not the best option for younger children who often aren’t developmentally ready to fully engage in therapy on their own.
Studies show that parent-directed treatments actually work better than child-only therapy for managing some of these challenging behaviours associated with disruptive behaviour disorders and ADHD in younger children. Most mental health professionals already know this — and sadly are not surprised when many young children don’t improve under their treatment in the current system simply because they aren’t allowed 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 references and extensive evidence for all of the above 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 (coaching his parents in strategies to coach, understand and support Sam) would 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 child directed sessions later, 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 exactly the type of situation research shows could have improved significantly 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 treatment for child anxiety and OCD is Cognitive Behavioural Therapy (CBT) with 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, where again - parents themselves learn 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 details of all the 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. Referred to a psychologist through Better Access, she refused treatment after learning about the gradual exposure process, and stopped attending sessions.
The psychologist offered parent-directed treatment, coaching Tali's dad, Simon, to support Tali at home using proven strategies. Simon was interested but couldn’t afford it without Medicare rebates.
Instead, they pursued medication through a psychiatrist, which wasn't successful in her case. Two years later, Tali is still housebound, not attending school, and has developed worsening health problems. 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 4. Children in mental health treatment sessions are frequently witness to psychologically damaging material.
Under Better Access, parents often attend their child’s sessions. This is of course vital (*remember, parents being in the room IS supported under Better Access - it's just that parents ONLY in the room is NOT supported).
However, because parents/caregivers can't see mental health professionals almost at all during their child's treatment, parents sometimes unexpectedly 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, psychologists 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 psychologist 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 psychologist 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.
Good news! 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 and therefore will 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?
We need your support! Please click on ADD MY SUPPORT "to see who already supports this change - and add your name to the list of supporters for this change so that we can effectively advocate on this issue to government.
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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 below.