Medicare-subsidised mental health services from the beginning of Better Access in 2006–2007 to 2019–2020: Descriptive analysis by state, profession and consultation profile

Abstract

Objective Since 2006, the Australian Federal Government has aimed at expanding mental healthcare through the ‘Better Access’ programme of Medicare-subsidised services by private practitioners. We comment on population access to subsidised mental health treatment via health professionals in Australia. Methods We descriptively analysed Australian Institute of Health and Welfare (AIHW) data. Results Increasing percentages of the Australian population of people received Medicare-subsidised services from 2008–09 to 2019–20. Population access to mental health treatment increased from 5.7% to 10.7%. In 2019–20, psychiatrists provided services for 1.7% of the population, while GPs provided for 8.8%, clinical psychologists 2.2%, registered psychologists 2.9%, and other allied health providers 0.4%. Over the period, numbers of Australian psychiatrists providing services increased, but the numbers of patients seen per year, and other indicators, have either been flat or declined. GP, Psychologist, Clinical Psychologist and other allied health consultations increased overall, but again the numbers of sessions have decreased. Conclusions Medicare-subsidised private practice has greatly increased population access to mental health treatment. However, there appear to be a relatively limited number of consultations per patient for most provider groups. Further research is required on the effectiveness of treatment through collecting data on casemix and outcomes.

Patients languishing in emergency departments: A descriptive analysis of mental health-related emergency department presentations in Australia between 2016-17 and 2020-21

“…Better resourcing, infrastructure and staffing of both acute hospital and community MH care 19 could reduce the need for emergency MH presentations. This should be matched by better access to private sector outpatient 20 and inpatient 21 Medicare-subsidised MH services, especially primary care underpinned by GPs. Epidemiologically based health needs assessments and mapping of services are needed to ascertain the mental healthcare terrain.…”

“…A coordinated national approach to the management of substance use disorders may improve outcomes and reduce MH-related ED presentations. We also need to understand why there have been significant increases in ED mental health–related presentations despite increased investment in Medicare-subsidised MH services, 20 increased use of psychotropics (antidepressants) and whether this may also relate to underlying secular changes within society. Finally, we acknowledge that the other elements of the quality and LOS public sector inpatient care 22 and hospital exit block 23 are also factors that warrant separate future research.…”

Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative?

“…4 In 2021, the average number of psychotherapy sessions per patient in Better Access (5.4) was lower than most research trials of CBT. 1,2…”

“…4 In 2021, the average number of psychotherapy sessions per patient in Better Access (5.4) was lower than most research trials of CBT. 1,2 About a half of psychotherapy patients fail to improve or their mental health deteriorates in real world studies. 5 Deterioration rates would be even higher in untreated populations, especially for severe conditions.…”

“…T o reduce the burden of common mental health conditions in the community, the Australian federal government has invested in psychotherapies through the Medicare Better Access initiative. 1 By 2021, one in every 10 Australians received at least one Better Access service, and one in 20 had one or more sessions of psychotherapy, at a cost to the Australian government of AUD 1.2 billion. 2 Despite this large investment, the prevalence of psychological distress and suicide were not reduced by the introduction of Better Access in 2006.…”