A significant volume of mild-to-moderate presentations can be effectively managed by counsellors, freeing up psychological and psychiatric capacity for those who need it most.
When a patient presents with mental health concerns, GPs face a familiar dilemma: how to refer the patient for timely mental health support without the client joining an interminable waitlist.
Now there is another option backed by the Australian government.
Federal health minister Mark Butler’s recent endorsement of the National Standards for Counsellors and Psychotherapists (National Standards) should make a difference in how GPs manage mental health referrals going forward.
These standards create, for the first time, a national baseline for education, supervision, ethics and competency across the counselling and psychotherapy sector.
For GPs, this means more confident, effective referral pathways and, most critically, faster access to care for patients.
The access crisis GPs know too well
Since 2017, mental health has been the single most common reason patients book GP appointments, yet the system’s capacity hasn’t been adequate.
Recent research shows Australian teenagers are waiting an average of 100 days after GP referral to see a psychologist, with current wait times for psychologists now exceeding three to six months.
The National Mental Health Service Planning Framework estimates a shortfall of approximately 7800 full-time equivalent psychologists, and the federal government is currently meeting only 35% of its psychology workforce target.
Before the pandemic, only one in 100 psychologists had closed their books to new clients. Today, that figure has surged to one in three psychologists unable to take new patients.
For GPs making referrals, these statistics are crucial as they represent patients whose anxiety or depression worsens while waiting as the window for effective early intervention closes.
Why counsellors have been overlooked
For most GPs, the default to psychologist referrals hasn’t been about clinical appropriateness. It’s been about certainty.
Without national standards, GPs haven’t had a reliable framework to assess whether a counsellor or psychotherapist held appropriate qualifications, adhered to ethical guidelines, engaged in ongoing supervision and maintained professional development. The sector’s self-regulation, while well-intentioned, created a real patchwork of varying standards which made confident referrals difficult.
This is precisely why the Psychotherapy and Counselling Federation of Australia stepped up to support the national standards recommendation when it was first proposed by the Select Committee into Mental Health and Suicide Prevention in 2021.
We were the only peak body to do so at the time. We understood that professional credibility requires regulatory clarity and that this benefits the entire mental healthcare system.
What the National Standards actually mean for GPs
The National Standards establish six core domains: education and training, supervision, ethical practice, competency and scope of practice, professional development and complaints management.
These standards articulate clear scopes of practice, making it explicit when a counsellor or psychotherapist is appropriate for mild-to-moderate presentations such as anxiety, depression, grief, adjustment issues, relationship difficulties and stress.
Crucially, the standards recognise three career stages for counsellors and psychotherapists (from diploma through to masters level) who meet specific training and registration requirements.
With more than 25,000 registered counsellors and psychotherapists across Australia, this is not a small, experimental workforce.
At the third and highest career stage under the new National Standards are registered clinical counsellors, trained professionals with higher education qualifications and at least 830 hours of supervised clinical practice at least two years’ post-graduation.
This group of counsellors has been providing effective mental health support for decades, but without the regulatory framework that would allow GPs to refer with confidence. And now they can.
Related
The clinical case for counsellor referrals
The evidence base for clinical counselling and psychotherapy is sound.
For the bulk of GP mental health presentations (including as generalised depression, anxiety, adjustment disorders, trauma and PTSD, grief, couples and family counselling, addiction and compulsive behaviour, stress management, and eating disorders), outcomes from appropriately qualified counsellors are equivalent to those from psychologists, with evidence suggesting that patients prefer speaking to counsellors.
This makes for happier patients all round!
Accessibility is a key consideration and a patient referred to a counsellor can often be seen within days or weeks, not months. For those in regional and remote areas, many counsellors offer telehealth appointments, dramatically expanding access for patients who would otherwise have limited or no local options.
Counsellors are also more affordable than other mental health options. While sessions don’t attract a Medicare rebate, they are often covered by private health insurance and generally cost about the same or considerably less out-of-pocket as seeing a psychologist with Medicare support.
What happens next
Now that the National Standards have been endorsed, implementation is the next critical phase. Consultation on how to put these standards into action will begin in the coming weeks and months, and final full implementation will undoubtably take years.
For GPs, the immediate implication is awareness of the National Standards and what they mean regarding the regulatory landscape and how to find practitioners who will meet their patient needs.
PACFA-registered counsellors and psychotherapists already meet (and in many cases exceed) Career Stages 2 and 3 of these standards through our existing registration structure, which has always required tertiary qualifications, clinical supervision, adherence to a code of ethics and ongoing professional development.
GPs can verify PACFA registration level through our online register, providing immediate assurance of their credentials and, if relevant, enabling them to find appropriate professionals local, or accessible, to their patients.
A practical path forward
For GPs managing the continually growing demand for mental health support, the National Standards offer a genuine opportunity to expand referral options without compromising quality of care.
For example, when a patient presents with anxiety about a work transition, grief following a bereavement or relationship distress, a referral to a qualified counsellor can provide effective support without the months-long wait that has become standard for psychologist appointments.
This isn’t about replacing psychologist referrals. Complex presentations, severe mental illness, forensic work and specialised psychological assessments could still require psychologist or psychiatric intervention.
But a significant volume of mild-to-moderate presentations can be effectively managed by counsellors, freeing up psychological and psychiatric capacity for those who need it most.
For GPs, being able to refer confidently to counsellors and psychotherapists means offering patients timely access to effective, appropriate, affordable and well-regulated mental health support.
Johanna de Wever is CEO of the Psychotherapy and Counselling Federation of Australia.
