When we talk about Australia’s mental health crisis, we rarely mention that it’s also a gender equity crisis. The professions systematically excluded from Medicare funding – counselling, psychotherapy, mental health nursing – are overwhelmingly staffed by women.
The feminised professions left behind
Counsellors and psychotherapists make up a workforce of over 25,000 qualified professionals, 78% of whom are women. Like aged care workers, early childhood educators, and community support workers before them, they’ve been systematically undervalued despite meeting substantial community need. The pattern is familiar: when women dominate a profession, that profession is underfunded, under-recognised, and treated as supplementary rather than essential.
This mirrors broader patterns across Australia’s care economy. The Fair Work Commission’s landmark gender undervaluation review acknowledged what women have known for decades – that female-dominated industries are systemically underpaid precisely because they’re associated with women’s work. Awards covering health services, children’s services, and community care have now been adjusted to remedy this “gender-based undervaluation”. Yet counselling and psychotherapy remain locked out of Medicare entirely, their exclusion justified by the same gendered assumptions the Fair Work Commission is working to dismantle.
Jobs and Skills Australia’s recent research confirms that 98% of occupations see men out-earn women, with pay gaps widening in highly gender-segregated roles. The care and support workforce, 72% female, remains “female-dominated, undervalued and insecure,” key drivers of Australia’s gender pay gap. The national gender pay gap stands at 21.1% in total remuneration, meaning women earn 79 cents for every dollar men earn, or $28,356 less per year on average.
The cost of care economy devaluation
This isn’t just unfair to the workforce, it’s failing patients. We know that one in four registered counsellors and psychotherapists want to work more hours, with a third of those in regional and remote areas where mental health access is worst. That represents around 100,000 hours per week of mental health care sitting idle because policy settings won’t fund it.
Meanwhile, psychology waiting lists stretch to three to six months, with teenagers waiting 100 days on average for help. Before the pandemic, only one in 100 psychologists had closed their books to new clients. Today it’s one in three. Mental health has been the single most common reason Australians book GP appointments since 2017.
The 2025 Federal Government endorsement of National Standards for Counsellors and Psychotherapists finally gave this workforce regulatory clarity. Counsellors are now explicitly recognised as appropriate for mild-to-moderate mental health presentations, which represents the bulk of GP referrals. The workforce has always been qualified. What’s changed is the system can no longer pretend it doesn’t exist. But regulatory recognition without funding is hollow progress.
Valuing women’s work means funding it
The Australian Government recognises that “paid care work is dominated by women… and is undervalued and often low paid and insecure”. It acknowledges that achieving equality requires “valuing the substantial contribution unpaid and low paid care makes to families, the community and the Australian economy”.
Including counsellors and psychotherapists in Medicare’s Better Access scheme isn’t just workforce policy, it’s also a matter of gender equity. In a workforce dominated by women, exclusion from Medicare recognition reinforces a broader pattern in which feminised care professions are routinely undervalued, despite delivering critical mental health support. Australia has built this workforce. We’ve trained them, credentialed them, and regulated them. Now we need to fund them.