Mental health care in Australia is fundamentally flawed, say researchers

Proudly supported by

  Last updated July 19, 2019 at 1:57 pm

Topics:  

A programme making access to mental health care easier has booming costs but little accountability, argues new paper.


Medicare card Better Access Program mental health


The Better Access Program, a scheme providing Medicare access to psychology services, has fundamental failures, according to new research.


The paper, published in the Medical Journal of Australia today, is led by Dr Sebastian Rosenberg, from the Australian National University and involved detailed analysis of Medicare data, as well as other data presented by the Australian Institute of Health and Welfare and the Productivity Commission.


Dr Rosenberg, part of the ANU Centre for Mental Health Research, said the publically-funded system, which provides up to 10 Medicare-rebated therapy sessions a year, is in need of an overhaul to make it fairer and more effective.


“Better Access costs taxpayers $15.8 million a week and it operates with little or no accountability at the practitioner or national policy level,” said Dr Rosenberg.


“This spending has boosted the number of people in care.  The program has grown every year over the decade. In 2016-17, it delivered 8.6 million services at a cost of $820 million but there is no evidence that people are getting better.


“The only mechanism to tell if the program is working is if the patient goes back to their GP but only half of the plans ever written by GPs are reviewed,” said Dr Rosenberg.


Questions whether people get the care they need


The Better Access Program was introduced in Australia in 2006, focusing on providing short and targeted sessions of therapy, typically Cognitive Behavioural Therapy (CBT), to people with common mental health problems, like mild depression or anxiety.


“The idea is that you have a short burst of CBT and get better, but it is not possible to be sure that this is what is actually happening,” said Dr Rosenberg.


“In fact, in 2009 two thirds of clients into Better Access were new but by 2016 only a third were new to the program,” he said.


“Repeat clients seems to indicate people did not get the care they needed when they needed it.


“Perhaps their mental health problems were too complex for a short burst of CBT working with a single health professional. It could mean the wrong people are receiving the wrong care at the wrong time.”


Expansion would be a taxpayer-funded gamble


A proposal to expand the Better Access Program has been put forward in the Federal Government’s Medicare Benefits Schedule Review.


Dr Rosenberg says such a move would represent a massive taxpayer-funded gamble given how little is known about the program’s outcomes.


Dr Rosenberg also highlighted concerns over the use of registered psychologists as opposed to clinical psychologists, particularly for people with complex mental health problems.


“Clinical psychologists have done extra training in order to work with patients, but they are often not available in regional areas,” said Dr Rosenberg.


“The evidence indicates that for people with complex conditions you need a team. The program is trying to fix mental health problems by prioritising access to psychologists.


“Other allied health professionals, like social workers and occupational therapists, as well as peer support workers, need to be part of the mix.  But fee for service programs like the Better Access Program do not buy teams.”


Programme needs reworking to improve outcomes


The paper calls for a fresh look at the Better Access Program, to ensure consumers get the right care in the right way.


Key failures according to the report:


More than $7bn spent between 2011-12 and 2017-2018 with no regular reporting of impact on service users, no success measures



  • GP role in checking on impact of psychology care not functioning as envisaged

  • Increasing dominance of repeat customers indicating wrong clients, wrong model

  • Program not operating equitably, with some areas able to access services much easier than others (this is common, due to maldistribution of Medicare workforce)

  • Significant out of pocket costs to service users

  • Unintended impacts on workforce making team care less likely


Related


Psychology: Freud has a lot to answer for


Being an early-riser is in your genes and might affect your mental health


Millenial mental health: The stats behind the story




About the Author

ANU Newsroom
The latest and best news from the Australian National University

Published By

Featured Videos

Placeholder
Space technology predicts droughts several months in advance
Placeholder
ANU Science On Location: Booderee National Park
Placeholder
ANU Science On Location: Ningaloo Reef
Placeholder
A mix of science and sourdough
Placeholder
How does the crested pigeon make their mysterious alarm sound?
Placeholder
Why do magpies swoop?
Placeholder
Critically endangered swift parrot needs your help!
Placeholder
ANU Science On Location: Siding Spring Observatory
Placeholder
ANU Science On Location: Mountain Ash forests
Placeholder
ANU Science On Location: Warramunga Station
Placeholder
Secret life may thrive in warm caves under Antarctica’s glaciers
Placeholder
Scientists help solve mystery of what causes exploding stars
Placeholder
Case Closed: Mystery of How First Animals Appeared on Earth Has Been Solved
Placeholder
Palm cockatoos beat drum like Ringo Starr
Placeholder
Butterfly wings inspire new solar technologies
Placeholder
From window to mirror, on demand
Placeholder
The search for exploding stars
Placeholder
Coral bleaching on the Great Barrier Reef
Placeholder
Join The Search For Planet 9