When Sarah Bryan quit her job after her mental health spiralled, she withdrew $20,000 from her superannuation account to pay for her mental healthcare costs and living expenses.

Key points: Ms Bryan was not eligible for disability payments but says she felt too unwell to job seek

Ms Bryan was not eligible for disability payments but says she felt too unwell to job seek Advocates say those who need mental healthcare the most are often unable to pay for it

Advocates say those who need mental healthcare the most are often unable to pay for it Research has found mental ill-health costs the economy billions of dollars each year

"Prior to that, I was using my credit card to survive. I had about $4,000 of credit card debt," Ms Bryan said.

"Worrying about money is not something you want to deal with when dealing with your mental health."

In November, the Royal Commission into Victoria's Mental Health System interim report found a disproportionate number of people with mental health issues have a low income.

The commission's findings revealed that this, combined with the high cost of mental health services, was a major barrier to people accessing the care they needed.

Ms Bryan, now 30, estimates her PTSD and a binge-eating disorder have cost her $85,500, including $58,500 in lost income.

The Melbourne resident accessed 10 Medicare-subsidised psychological sessions through the Commonwealth's Better Access program but said the out-of-pocket costs were still difficult to afford.

The Productivity Commission found about 1.3 million people accessed the scheme last year — but estimated one in three only attended one or two sessions due to the out-of-pocket costs or difficulty finding the right psychologist.

People who are deemed too unwell to work could be eligible for the Disability Support Pension, but Ms Bryan did not make the cut.

She was eligible for the Newstart Allowance, but felt too unwell to actively hunt for jobs and go to job-seeking appointments, so those payments stopped too.

"The reason I left my job was because I was too unwell to leave my bed, so Newstart just added to the pressure," she said.

Ms Bryan now dedicates some of her time to sharing her story as an ambassador with mental health not-for-profit group SANE.

She said she now felt "quite stable" so was able to prioritise her living expenses, but said the high cost of care meant she often waited until "things got really bad" before seeking help.

System built on cost over outcomes

The royal commission estimates $4.8 billion in wages is foregone in Victoria every year due to mental ill-health.

Australian National University (ANU) mental health policy researcher Sebastian Rosenberg said people who were unable to work could find themselves in a vicious cycle, where a loss of income made the care they needed to recover unaffordable.

"The people who need mental healthcare most, may be able to least afford it," he said.

Not long after he turned 29, Tim Hillier spent two years out of work while he dealt with obsessive compulsive disorder (OCD) and depression.

His parents let him stay in an apartment they owned and financially supported him.

He has been in and out of work in the decade since then.

"People save to go on holiday but I don't do that much. I save money so I can maintain my treatment and living arrangements when I am too unwell to work," he said.

Tim Hillier estimates caring for his mental health has cost him and his family about $222,000. ( ABC News: Jordyn Beazley )

His psychiatrist recommends he admits himself to The Melbourne Clinic's OCD program, but this cannot be accessed without private health insurance — something he worries he cannot afford.

The high cost of private health insurance means this option is not available for many people living with mental illness, the royal commission's interim report found.

"Our system currently is set up around the issue of who pays, not what works," Dr Rosenberg said.

Mr Hillier currently sees a psychiatrist every few months.

He would like to go every three weeks, but cannot afford the $149 out-of-pocket cost.

"I never get to spend time on more exposure-type therapy to deal with obsessive thoughts and come up with proper game plans or strategies," he said.

"So, a lot of the behavioural therapies have dropped away to just medical check-ups."

Overall, Mr Hillier estimates his mental health has cost him and his family $222,000, including care and medication, lost wages, and the $40,000 his parents lost in rent over two years.

The royal commission's interim report recommends recovery be at the centre of mental health services, but recognises that is dependent on access to treatment.

In late February, the Victorian Government met with the Federal Government to propose a rise in the Medicare levy or a new federal tax to fund the response to the mental health crisis.

With the Productivity Commission inquiry finding mental health concerns cost the Australian economy up to $180 billion a year, CEO of Mental Health Victoria Angus Clelland said a levy could be "be a stimulus to the economy".

"This will dwarf any tax reform in terms of its impact," he said.

With financial support, recovery is possible

Lawyer Elly Danks, 30, said one of the reasons she was able to manage her lengthy mental health journey was a financial safety net.

"Because of how severe and elongated my mental health journey has been, if you meet me as a lawyer and you hear this, they say 'well how the hell did you become a lawyer'," she said.

Her parents paid for appointments with mental health professionals as a teenager, and supported her through a five-week stay at a private psychiatric ward when she was 21.

It was then doctors suggested Ms Danks might have epilepsy, which was causing her anxiety and depression.

She was diagnosed 18 months later after being referred to a specialist.

Elly Danks said with regular psychological sessions, she was able to develop coping mechanisms. ( Supplied: SANE Australia )

Now, despite being diagnosed with PTSD in 2017, she said she rarely had to see her psychologist.

"But that is because I saw a psychologist for so many years that I already know what she will say and what strategies work for me, so I don't need that support as much as I did before. I almost feel like I could be a psychologist myself now," she said.

Ms Danks said she was constantly reminded how she was privileged within Victoria's mental health system.

"What shocks me is the amount of clients or people I meet in the justice system that have a really similar story to mine, but have just couldn't afford access or steady access to help," Ms Danks said.

"It makes me wonder where I'd be if I didn't have the financial support to get the help I needed."