SSWAHS = SWSLHN and mental health in the Southern Highlands - 6

Better Access debate rages

21st Feb 2011

Catherine Hanrahan all articles by this author

2 comments

CONTROVERSY continues to dog the Better Access mental health program, with two new studies reporting conflicting results about equity of access for disadvantaged people.

University of Newcastle researchers found between 88% and 99% of a sample of 15,000 women reporting a mental health condition had not used MBS mental health items, including those from the Better Access program.

The study, linking data from the Australian Longitudinal Study on Women’s Health (ALSWH) with Medicare records, found those who did not use the MBS items, despite having mental health conditions, were more socioeconomically disadvantaged than those accessing the services.

The findings conflicted with data published in the British Journal of Psychiatry by researchers from the Universities of Queensland, NSW and Melbourne.

They used data from more than 8000 respondents from the 2007 National Survey of Mental Health and Wellbeing.

To assess Better Access use, they determined who had seen a mental health professional, paid partly or fully by Medicare, and whether or not they had a disorder.

Among the 1521 respondents who had a mental health disorder, they found there was no difference in socioeconomic disadvantage between those who used Better Access psychological services, other mental health services or no services.

However, in general agreement with the ALSWH study, the BJP study did show that 92% of respondents with a mental health disorder did not use Better Access mental health services.

Professor Ian Hickie, executive director of Sydney’s Brain and Mind Institute, said the women’s health study data showed the Better Access program had the same issues as specialist mental health systems.

“It’s really driven by those who already have the greatest access getting more access and many of those who need, missing out,” he said.

Dr Caroline Johnson, mental health spokesperson for the RACGP, said neither survey was designed specifically to assess the Better Access program.

“We need to know more about the population who report mental health concerns but are not accessing care,” she said. “[And] what we don’t know is whether being in the scheme makes more of a difference than usual care.”

Meredith Harris, lead author of the BJP study, said it controlled clinical factors in the socioeconomic analysis, whereas the women’s health study did not.

Sebastian Rosenberg, senior lecturer at Sydney’s Brain and Mind Research Institute, said that unlike the women’s health study, the BJP study didn’t use Medicare data.

“When it’s Medicare data and it’s public information, then it’s possible to recreate and confirm,” he said.

BJ Psych 2011; 198:99-08

MJA 2011; 194:175-79

Comments:

Bibiana

22nd Feb 2011
9:59am

Just wonder is there any study which examines the 'stigma' associated with accessing mental health services? Since the 'beyondblue' - the National initiative to combat depression first established in 2000, de-stigmatization of clinical depression in mainstream Australia has been very successful. However, I was recently told by an Australian-born Chinese wanting to see a psychologist through the Better Mental Health Access Program that her GP asked her to think carefully whether she really wanted to do so. The reason being it will be entered in her Medicare record that she is a person needing mental health service.
I then shared my personal experience with her about the benefit of seeing a psychologist. However, I also told her that if she was really concerned, she could self-refer and pay the fees out of her own pocket. As a mental health researcher for nearly 10 years, I am very aware of the stigma of mental illness perceived by people from Culturally and Linguistically Diverse communities. This is another aspect of access issues not picked up by the mainstream radar.

wenz
23rd Feb 2011
5:10pm

It is quite clear to myself that the better educated and probably, financially better off patient is able to access psychology care. For a lot of disadvantaged patients, a 20 to 40 dollar copayment per visit to a psychologist is beyond their means - and there are very few bulk billers available. I understand that a small co payment might weed out the client with less commitment - but it also weeds out the sort of patients that require our assistance.