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.

SSWAHS = SWSLHN and mental health in the Southern Highlands - 3

It is important to note the comments of Professor Ian Hickie in regards to the inequitable access of people from the low socio-economic levels within the Australian society. Equally, one must consider the capacity of people from culturally and linguistically diverse backgrounds having an even more limited access to the Federal Government's "Better Access" program. Not only may there be a financial disincentive but the numbers of therapists with other language skills is also limited.

Socrates adds another caveat to the "Better Access" program additional to the concerns raised by Professor Hickie. That concern is whether the newly formed "Medicare Locals" will have the capacity to restrict the businesses of those private practitioners who operate within the jurisdiction of the Medicare Local.

It would seem that even the current Divisions of General Practice, through their control over member general practitioners, have the ability to determine who they will promote and who they will not, within their current jurisdictions. It is not unknown that some CEOs of current Divisions will promote their own staff to general practitioners over any other private practitioner so as to, as one CEO put it: "I will promote my staff member to provide the medicare funded services because if they didn't get the work I would not be able to pay them." Perhaps, the staff member should have been expected, like every other private practitioner to promote themselves, in a competitive market. Such competition, obviously, might lead to bulk-billing and therefore improved access for persons with a low socio-economic status.

Mental health access program failing the needy

15th Mar 2011

Andrew Bracey all articles by this author

1 comment

A SENIOR Government adviser and mental health expert has warned that the contentious Better Access to Mental Health Care program has failed to meet its aims despite its ballooning costs.

Professor Ian Hickie, a member of the Government's National Advisory Council on Mental Health and executive director of the University of Sydney's Brain & Mind Research Institute, has called on the Government to urgently overhaul the program.

His comments, made on the ABC's AM program this morning, come as Mental Health Minister Mark Butler was set to release a long-awaited review of the program today.

Professor Hickie told the ABC patients in greatest need were getting the least services through the program, labelling its results a "travesty".

"The probability is that those in higher-income areas who have a capacity to pay are also getting the most money back from the Government for common mental health services," he said of the program, which was initially allocated $500 million over four years.

"It's now cost over $1.5 billion and it costs over $500 million a year and over the next five years it's likely to grow to being almost $1 billion per year. We won't have any money left for other essential mental health programs unless we restructure this particular program."

Professor Hickie also suggested the Medicare fee-for-service-based system had "allowed the professionals to set up lots of small businesses in the well-off suburbs of our major cities and to charge higher rates for their services".

"So that they can get both the co-payment... plus the Medicare rebate. And that's what the Government's essentially encouraged them to do."

"Nicola Roxon said in opposition that she would change this. A different payment system would see those same professionals providing services in other suburbs - in the outer suburban areas and the regional areas where they're desperately needed."

In response, Minister Butler conceded that there were "some limits to this program in terms of its capacity to apply equitably across the population and to reach the harder-to-reach groups".

"There's no question that it demonstrates the need to balance the fee-for-service arrangement that you see in the better access program that we've just evaluated with targeted programs that deliberately go out to reach the harder-to-reach population [such as] younger people, people who live in rural and regional Australia and people living on our urban fringes in lower socio-economic areas," he told the ABC.

Read the Better Access evaluation

Comments:

Cheung

15th Mar 2011
5:30pm

Try finding a public mental health service without long waiting lists even for those clients considered to be in urgent need. Rarely can you find a Psychiatrist who accepts medicare only and many families can not afford gap payments even if they have health insurance. It is just as difficult to access psychology services and then those with vacancies have only a couple of years experience which is fine for run-of-the-mill problems but not for those clients who are seriously in crisis.
On a positive note, the program has raised interest, awareness and acceptance of mental health issues. It is something we do not want to lose however with some refining and tweaking such as means tested access and taking the services to the people this program could truly be sensational.