Redress funds for abuse survivors should be used to expand Medicare, a royal commission has been told.
Louise Roufeil, executive manager of the Australian Psychological Society (APS), said an overhauled Medicare system was essential to properly help thousands of people traumatised by childhood experiences in care.
Dr Roufeil said the doorway to services was very narrow and entry "very difficult and when you can get in, the capacity to fully provide treatment is limited".
Her evidence on Thursday to the Royal Commission into Institutional Responses to Child Sexual Abuse came a day after the federal government knocked back a commission suggestion that Medicare be expanded.
The commission had factored counselling costs into a $4.3 billion redress model to be funded by governments and non-government institutions.
APS, the peak professional body for psychologists, said Medicare expansion had merit but adjustments would be needed.
Eligibility for redress should be a way in, the 10 visits a year limit should not apply and providers should not be able to claim gap fees.
At present, people need GP referrals to get psychological help, and gap fees can come to more than $100 a visit.
Thursday was the second day of a hearing into redress.
Heavy criticism of the government's refusal to back a national scheme continued.
Francis Sullivan, CEO of the Catholic Church's Truth Justice and Healing Council, said he was surprising the government had "so quickly discounted itself" from the issue of redress.
The Catholic Church backs a national independent scheme run by the government to which it and other non-government institutions would contribute.
Caroline Carroll, chairwoman of the Alliance for Forgotten Australians, said the "dismissive" response from Canberra was deeply hurtful to those who spent their childhoods in Australian institutions.
"People suffer today from medical issues that happened because they were forced into labour - child labour - before their bones were cemented," she said.
Earlier on Thursday, child protection law expert Patrick Parkinson said psychological treatment was the most important aspect of the royal commission's redress proposal.
Professor Parkinson said his preferred solution would be that organisations, through a trust fund, provided reasonable gap funding beyond what Medicare provided.
"That does entail some modifications to the Medicare system for funding psychological counselling," he said.
Cathy Kezelman, president of Adults Surviving Child Abuse (ASCA), also called for reform of health services.
ASCA, with Pegasus Economics, recently released a report showing unresolved childhood trauma, including abuse, was costing Australia $9.1 billion every year.
Dr Kezelman said diverse and comprehensive counselling and psychological services should be available.
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