Doctors (and everyone), pay attention! Why should you refer mental health patients to counsellors?

It is unwise to use the term "crisis" indiscriminately, but if reports and testimonies are true, we are facing a major problem with mental health — not least of all characterised by people needing help but not being able to access it, due to cost and availability. Psychiatrists, psychologists, and other allied health professionals have long wait lists or may have even no wait list at all, promising to provide services only to their existing clients. If my conversations with peers are representative, general practitioners and other health professionals seem to default to referring patients only to these other services who do not have capacity, when there are plenty of counsellors (a different professional) with availability, willing and able to provide the type of mental health support many (or perhaps even most) mental health patients need. This neglect for counselling is most likely due to a number of myths. In this article, I will suggest why the medical community should be more willing to refer to counsellors, by debunking these myths about our profession. And before anyone accuses me: no, I am not simply selling my services here! As educated professionals, defaulting to convention without critical thinking is a betrayal of our credo.

Myth 1: "Counselling is more expensive than psychology as there is no Medicare rebate".

The lack of critical thinking evident in this myth is worrying. A mental health care plan from a general practitioner entitles a patient to claim up to a maximum rebate from Medicare for up to 10 appointments with a psychologist (Services Australia, 2025). At the time of writing, the maximum rebate per appointment is $145.25 for a clinical psychologist (Australian Government Department of Health, Disability and Ageing, n.d.a) and $98.95 for a general psychologist (Australian Government Department of Health, Disability and Ageing, n.d.b). Unless the psychologist accepts this rebate as their total fee for the appointment, called "bulk-billing", the client will have to pay a "gap fee" to cover the rest of the cost. It is difficult to find psychologists who bulk-bill, and most charge a total fee of more than $200 per appointment. This means that a client could easily be paying more than $100 in gap fees for each of the first 10 appointments, and more than $200 for each of the rest of their appointments until eligible for a new plan. By comparison, plenty of counsellors charge fees approximately equivalent to the gap fee, and they remain so without eligibility criteria. I charge on a sliding scale and most of my fees are also in this range. Make the calculations yourself. And while there are "free" services available, I earnestly encourage you to speak to as many people as possible who have used them — and that is all I will opine here.

Now, many will scoff at this and state that counsellors are not competent to work with mental illness, which brings us to the next myth.

Myth 2: "Counsellors just empathise with you. They do not conduct therapy that could help a person with 'real' problems or mental illness."

As I explained in an article last year (Cuturilo, 2025):

"A problem, however, is that there is often segregation of (usually newer or less conventional) roles where the essence is similar...[this implies] that approaches applicable to one role are not applicable to another. These are instances of what is called "reification", meaning that the objective realities of the roles are treated as different by referring to them using different invented concepts and language. This is fallacious; in the domains in which these roles function, helping any client requires a basic understanding of psychology with an accompanying common set of skills, and this knowledge is practically always inherent in the different frameworks, albeit referred to with different language. These frameworks often claim to be distinct due to having certain qualities, when those qualities should be present in any framework for the same purpose."

Competent mental health counsellors are trained in the same types of therapeutic methods as psychologists, such as cognitive and behavioural therapies, acceptance and commitment therapy, and schema therapy. We can work with many of the same problems including depression, anxiety, complex trauma, addiction, fears, and relationship problems. We are also trained to manage risk and prevent suicide and self-harm. Of course, this does not address the full spectrum of needs; a psychologist is additionally qualified to diagnose mental illness and treat more severe problems such as schizophrenia, related psychotic disorders, and personality disorders. However, these are not the most common mental health problems, and treating every issue as a serious mental illness is actually harmful because it interrupts the mind's natural exploratory and coping tendencies. Although I am not professing our perfection or guaranteeing the results of any therapy, I and other counsellors whom I have known have helped people prevent self-harm and eliminate destructive behaviours. Some have even been the preferred practitioners over psychologists, by clients with diagnoses such as schizophrenia. You as the referrer make the decision about to whom you refer, but we must admit that prescribed titles are not proxies for real-world competence and wisdom — which brings us to the third myth.

Myth 3: "Counselling does not require a licence and is a largely unregulated profession; therefore, its quality control can not be trusted."

It is true that, in Australia at the time of writing, a person does not require a licence or any specific qualifications to legally call themselves a counsellor, although they will in order to obtain membership with a professional body. Requirements may also become more stringent with the potential introduction of the proposed national standards for counsellors (Australian Counselling Association, 2025). Regardless, any person professing to provide the mental health services that a counsellor does, regardless of what they call themselves, is still legally liable for them. Furthermore, there are plenty of instances in the treatment histories of myself, friends, relatives, clients, and other people I have known, of so-called "licensed professionals" causing harm by incompetence. Both a psychologist and registered counsellor must undertake regular professional development and supervision regardless of seniority. Even if the requirements to maintain a psychologist's licence are more rigorous than those for a counsellor's accreditation, both professionals work alone with clients. The harm that is the subject of those fears of "unregulated" mental health professions is often only addressed when a client who has experienced it makes a report to the relevant authority — it is not as if licensed professionals have a scrutineer regularly observing their appointments with clients. Furthermore, as I have discussed and continue to in my work, much of what is considered sound practice by academic standards is not objectively logical, but dogma maintained by convention and politics, and would not raise any problems were it reported. We need to ask more often about what is in the client's best interests, not what is stated in a textbook.

In conclusion

All of our respective professions have a place. But we must not default to convention and in doing so neglect a problem which we know exists. Regardless of the reason, let us all be aware of the resources available to our clients. I appreciate opportunities to share resources, and encourage every one of us to do the same.

References

Australian Counselling Association (2025). "Your Guide to National Standards for Counsellors & Psychotherapists". https://theaca.net.au/national-standards

Australian Government Department of Health, Disability and Ageing (n.d.a). "Medicare Benefits Schedule - Item 80010". https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80010&qt=item

Australian Government Department of Health, Disability and Ageing (n.d.b). "Medicare Benefits Schedule - Item 80110". https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110&qt=ItemID

Cuturilo, J. (2025). "Is our mental health system disjointed?" https://www.yourlistener.com.au/post/is-our-mental-health-system-disjointed

Services Australia (2025). "Mental health care and Medicare". https://www.servicesaustralia.gov.au/mental-health-care-and-medicare?context=60092

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Thought of the month

One of the simplest and most effective courtesies which I can pay to someone on a daily basis is to ensure that I have spelled their name correctly.