Border counsellors fear many clients needing mental health assistance will have to go without because of what they see as major flaws in the Medicare funding model.
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While people who get a mental health plan from their GP are entitled to discounted psychology sessions, the rebate does not extend to counsellors.
One counsellor said exceptions were sometimes granted, but this was not an easy process to embark on - and achieving it was quite difficult.
'The wait lists are terrible'
Wodonga counsellor Cyan von Gija said the issue was one that had been around for several years and "wasn't getting any better".
Mr von Gija said that given the demands inherent in long waiting lists of people seeking help with their mental health, it wasn't fair that counsellors were not paid a Medicare gap fee despite their experience.
"One of the things that upset me is ... for someone like myself, who has had 10 years of training and over 40 years of experience, we don't get any rebates at all," he said.
Mr von Gija said that when compared with the bigger cities, this region had only half the number of health practitioners "and that's where our problem is".
"The wait lists are terrible," he said.
"It wouldn't be so bad if people only had something mild.
"But some people are in crisis, and it's quite tortuous that they have to wait to see a psychologist or pay full fees to see someone who can get them in quicker."
Mr von Gija said he had many people approach him who couldn't afford the service and so asked for a discounted rate.
"Sometimes we can do it out of the goodness of our heart, but it is unfair," he said.
"I've given up worrying about the Medicare rebate gap now. That's even though I've done so many severe trauma cases through to coronial reports, yet there's people who have hardly any experience and get the Medicare rebate."
Mr von Gija said there were still negative impacts flowing through from the COVID-19 pandemic.
"It's increased the pressure for life in general," he said.
"There's not enough therapists out there to meet the services."
'A week can feel like a long time'
EMJ Counselling Wodonga's Emily Janda said it is disappointing that GPs aren't referring people to counsellors as often as they could be.
"GPs are often focused on psychologists as the only referral option because it fits in with the MHCP model," she said.
"However, with the wait time for psychologists being between 3 and 6 months in this area, people aren't getting the immediate help they need.
"When people are in acute mental health pain, a week can feel like a long time, months can seem like forever."
Ms Janda said there was "lack of awareness" around the distinction between psychologist and counsellor
"There isn't enough exposure for counsellors and this means that people don't always know where to look for counselling other than through a psychologist," she said.
'There are limitations'
Accredited mental health social worker and counsellor Anita Geary, of Wodonga's Insight Therapies, said although she is registered to provide mental health services under Medicare so clients can access a rebate, it was rare and she had to do extensive training and years of practice post-graduation to get to that stage.
"The other therapists that work here cannot offer rebates even though they've been working in the field for the same amount of time because they are counsellors or social workers who have not yet completed the accreditation process," she said.
"Accreditation as a social worker is quite a big task to go through, so if you wish to see them then it's a full out-of-pocket cost, but in reality probably isn't really that much different than a psychologist's out-of-pocket cost.
"We see clients with long-standing trauma work, so six or 10 sessions, generally speaking isn't going to be enough to really move forward successfully long term.
"You can do a lot in 10 sessions under a mental health care plan. But years of trauma leave deep emotional wounds and this often needs need more sessions."
Ms Geary said there were pros and cons when it came to Medicare.
"But there are limitations to that as well," she said.
"Medicare is a medicalised model based on diagnosing, treating, and then discharging, which can clash with a more therapeutic approach that a lot of counsellors or psychotherapists might use.
Ms Geary said she would like counsellors to be recognised, something she felt would happen in the next few years.
"But it will likely be restricted to counsellors that have master's degrees and years of experience to ensure client safety," she said.
