Buenos Aires is the centre of the therapy world. According to the World Health Organization, Argentina has 222 psychologists working in mental health settings for every 100,000 residents, and the rate in the capital is reported to be seven times higher. Local priest Jorge Bergoglio had half a year on the couch in the late 1970s on his way to becoming Pope Francis.
Comparing statistics across countries with differing mental health systems is risky, but WHO figures have Australia leading the Anglosphere on this metric. Only Argentina, Costa Rica, Finland and the Netherlands are more generously equipped. Even so, there is a widespread view that we need not just more psychologists, but many more. Finding a psychologist who doesn’t have a lengthy waiting list has been especially difficult since the pandemic hit.
The mental health crisis narrative has been successful in shaping public opinion and governments are taking note. A report on the psychology workforce released in April by the Department of Health, Disability and Ageing recognises the profession plays a key role in the mental health system, providing roughly half of Medicare-billed mental health services. It finds that Australia’s demand for psychologists vastly exceeds the current supply, and that the situation is going to get much worse.
Based on its estimate of unmet demand for services, the report finds that in 2025 the nation’s mental health system needed 58 per cent more psychologists than it had. Despite projected growth in the profession, workforce modelling predicts that by 2038 the shortfall will swell to 97 per cent: we will only have half the psychologists we need.
The report is clearly a call to action: more on that later. But it also makes some puzzling claims. On the demand side, its estimate of the size of the current shortfall is astonishing. The report also predicts that the required quantum of psychologists will rise by 92 per cent between 2025 and 2038. This represents a compounding annual increase of 5.2 per cent, almost five times the expected rate of increase in Australia’s population.
Why this steep projected growth in need for psychological services should occur is opaque. It sits uneasily with epidemiological evidence that rates of common mental disorders have not risen significantly in recent years, except among young people, and that they have stabilised since the pandemic. Why need for treatment should race ahead of population growth is a mystery.
The supply side is equally mysterious. The number of registered psychologists has been growing at steady clip — around 4.8 per cent annually this decade after roughly doubling in the previous one — but the report anticipates that from 2025 to 2038 growth in the number of psychologists in the health workforce will be a sluggish 2 per cent annually. Why the slowdown, when psychology remains stubbornly popular among students and universities continue to roll out new training programs?
It is hard to escape the conclusion that these forecasts inflate the psychologist shortfall by overestimating the rising need for services and underestimating the robust growth of the psychology profession. Moderate the unrealistic demand increases and extrapolate existing growth and the shortfall dwindles.
Whatever the merits of the government forecasting, it is worth asking whether many more psychologists will indeed improve the nation’s mental health. Psychologists can do a lot of good, but it doesn’t follow that proliferating them will turn things around. Studies on the “treatment-prevalence paradox,” some of them carried out by leading Australian researcher Anthony Jorm, suggest it won’t.
Research around the world shows that the large increases over recent decades in the proportion of unwell people who receive treatment have not been accompanied by reductions in rates of mental ill health. Successful treatment would be expected to help people recover from episodes of illness and prevent relapse, thereby reducing rates of diagnosis, but these reductions have not eventuated. Opinions differ on why that might be — some think it reflects the limited efficacy of treatment, especially for chronic cases — but the disconnect between rates of treatment and of ill health is real.
Studies of the efficacy of psychological treatment in Australia are equally sobering. Recent evaluations of the Medicare’s Better Access scheme, which subsidises psychotherapy delivered primarily by psychologists, have found that although 50–60 per cent of clients improve with treatment, 20–30 per cent experience no meaningful change and 10–20 per cent deteriorate. Importantly, people who enter treatment with milder problems obtain substantially less benefit. A 2024 review of the Ten to Men program also found that receiving more Better Access sessions had no effect on depression or anxiety symptoms in men.
These findings suggest that funnelling more psychologists (or other psychotherapists) into Australia’s existing system of care is unlikely to move the dial on our population’s mental health. It also raises awkward questions about whether well-meaning efforts to boost access to treatment by tapping into a supposedly deep reservoir of unmet need may backfire.
These efforts may simply direct people experiencing less severe difficulties into treatments unlikely to help them and may even do harm. They may also increase what is sometimes called “met un-need”: the delivery of services to people who don’t require them. It is surely wiser to focus resources on the more severe end of the mental health spectrum and find more effective and less psychologist-intensive means of dealing with the milder end, scaled up by technological developments or other social initiatives.
This argument implies that tackling the nation’s mental health predicament requires systemic change, not just a larger workforce. Part of the problem is not how well resourced the system is, but how well those resources are distributed. Beyond our major cities psychologists are thin on the ground, as they are outside Buenos Aires. Per capita, psychologists are four times as prevalent in metropolitan areas as in small rural towns. Simply producing more of them will not fill the geographical gaps.
Psychologists are also maldistributed across the private and public sectors. New graduates are flocking to private practice settings and the share of psychologists in the public sector is in decline. Between 2019 and 2023, the increase in full-time equivalent psychologists working in the private sector exceeded the increase in the public sector by a ratio of forty-two to one. Training more psychologists (and other professionals) to dispense private therapy in our cities is the current trend, but it is unlikely to boost mental health meaningfully.
Universities have a large stake in these questions. Australia’s alleged need for a radically increased psychology workforce is the primary rationale for a proposed overhaul of training programs. The plan put forward by the Psychology Board of Australia, responding to a directive from the federal education minister, is to replace the existing model, which requires completion of undergraduate and postgraduate qualifications, with one in which a five-year undergraduate degree is the sole pathway to professional registration.
The many critics of the new model argue that it relegates professional training to a lower level in Australia’s qualifications framework, erodes the commitment to a broad-based and science-led education, and makes the psychology profession less accessible to equity groups, among many other concerns. Most of these critics accept the premise that there is an urgent need to produce more psychologists, disagreeing only on the means to that end.
That premise needs more careful scrutiny. wWe are indeed facing significant mental health challenges, there is unmet demand for services, and psychologists do have a large role to play in dealing with these problems. We could do with more of them, and there is strong momentum within the field to boost their numbers incrementally. But the case for a massive expansion of the psychology workforce is weak, especially via an imposed revolution in professional training. •
