“Yyes, I do,” I honestly answer when a new client asks me if I like my job. I really, really want to. I am a psychologist and have worked and volunteered in the Australian mental health field for over 10 years. What I don’t share with my new client is that I’m becoming increasingly concerned about the proportion of people I see less often than their treatment plan calls for. I felt exhausted, but that’s something I’m keeping under control.
The psychologist’s role is to support people through situations, relationships and connect them or refer them to different health and social services if and when necessary. But we are only one component of a person’s recovery. There are many components of the therapeutic relationship and outcomes that we cannot control.
Material well-being, on the one hand, is a key element that determines basic access to services, such as mental health, for many. It also includes the cost of basic necessities such as food, bills and rent, household income, wages and benefits from employment, financial security, standard of living and housing. In short, good – or good enough – living conditions are essential for mental health and well-being.
This year in particular, I have noticed that an increasing number of clients find it difficult to meet their basic needs. They drastically reduce their living conditions, which affects the effectiveness of the work that my colleagues and I try to support them with.
The Reserve Bank raised interest rates this month for the seventh consecutive month and warned it was prepared to go further to fight inflation, which is forecast to reach 8% this year. This increase affects people with mortgages and is passed on to tenants. Feeling the increasing stress of paying mortgages and rent, many clients cancel treatments saying they cannot afford to continue treatment.
These clients sometimes left therapy for months, returning in a worse psychological state than before. They know they should seek treatment, and yet there’s no room in their dwindling budgets. Housing affordability has declined greatly since the early 1980s, and many clients are unable to pay for housing or health care.
Australia is experiencing a significant increase in the working poor population, where full-time employees are evicted from rental properties or forced to sleep in temporary accommodation. The Australian Institute of Health and Welfare reports that the waiting list for those seeking social housing has grown by more than 8,000 households in 2021, from 155,141 to 163,508, while the latest available census data from 2016 has more than 116,000 Australians left without home.
With these financial pressures affecting people, how are psychologists supposed to do their job effectively? Good therapy happens when people have enough money to meet their basic needs. It is incredibly difficult to help someone improve their mental health when their stress, anxiety and depression are coming from external factors.
What mental health professionals experience is a type of moral injury. Moral injury is the social, psychological and spiritual impact of an event on people who have strong values. We know that financial stress is a risk factor, not only for anxiety and depression, but also for suicide. We know that living conditions affect health and well-being. We know that people will choose to feed themselves and their families, secure their shelter for another week, instead of accessing vital health services. But none of these things are under our control.
Psychologists will often have to turn people away because mental health services are not adequately funded. We often choose to see the share of bulk billing clients and then see more clients than recommended. This puts us at risk for burnout and other mental and physical health challenges. But this could be solved by smart government policy.
I love my job. I really want to. But it’s heartbreaking to know that there are limits to what I can do to help people.
Carly Dober is a psychologist living and working in Naarm/Melbourne @enrichinglivespsychology