Australia’s ‘Better Access’ scheme: Has it had an impact on population mental health?

Abstract

Background: Australia introduced the Better Access scheme in late 2006, which resulted in a large increase in the provision of mental health services by general practitioners (GPs), clinical psychologists, other psychologists and allied health professionals. It is unknown whether this increase in services has had an effect on the mental health of the population. Methods: The following data were examined: per capita use of mental health services provided by GPs, clinical psychologists, other psychologists, allied health professionals and psychiatrists from 2006 to 2015 according to the Australian Government Department of Human Services; prevalence of psychological distress in adults (as measured by the K10)

Challenges facing Australian counselling psychologists: A qualitative analysis

“…In the present study, it was noted that the Medicare top‐tier allows clinical psychologists to provide “psychological therapy,” while the second‐tier only allows counselling psychologists to offer “focussed psychological strategies.” This split was viewed as an insult, given that the core competencies and definition of a counselling psychologist include “tailored psychotherapies” for “complex and severe mental health disorders” (APAC, , p. 20). Evidently, the far‐reaching implications of the two‐tier system for consumers' freedom of choice and treatment outcomes, as well as the diversity of the psychology profession, are of considerable concern, particularly given the lack of an evidence base or rationale for the two‐tier system as highlighted by respondents in this study and previously noted elsewhere (Jorm, , ; King, ; Meteyard & O'Hara, ; Pirkis, Harris, Hall, & Ftanou, ).…”

“…It has narrowed clients' freedom of choice, such that a therapy pathway may be chosen based on least financial disadvantage, rather than appropriateness of fit. The structure of the two‐tier model suggests to the consumer that clinical psychologists are somehow better trained or equipped to deal with complex mental health disorders when there is, in fact, no evidence that a clinical psychologist achieves any better client outcomes when compared to any other psychologist (Grant, Mullings, & Denham, ; Pirkis, Harris, Hall, & Ftanou, ; Jorm, ; Jorm, ). Consequently, respondents reported that the model itself is harming both the consumer and the profession, through funnelling an uninformed public into higher rebated clinical psychology services when a counselling psychologist is equally trained to treat the presenting issue.…”

“…Third, it is recommended that Australia review and build on international models of psychology and mental health which have been successful in establishing a unique presence and identity for each branch of psychology, while still respecting the overlap inherent between them. This recommendation relates to the current Medicare model, which is arguably not working for the consumer given Australian mental health and suicide rates are continuing to worsen since the introduction of Better Access (Jorm, ).The Medicare model is also damaging the profession and the public image of psychology as it has created significant tensions and caused a rift between psychologists.…”

“…This assumption is not consistent with research evidence, with results of a large scale evaluation of the first 5 years of the Better Access scheme finding no differences in client presentations and outcome between clinical and other psychologists (Jorm, ). A second large scale evaluation was conducted by Jorm (), finding similar results where there has been an increase in the use of mental health services after the introduction of Better Access, but that this has had no detectable effect on the mental health of the Australian population. Jorm examined the per capita use of mental health services provided by mental health professionals between 2006 and 2015, the prevalence of psychological distress in adults from National Health surveys in 2001, 2004–2005, 2007–2008, 2011–2012, and 2014–2015; and annual suicide rates from 2001 to 2015 according to the Australian Bureau of Statistics.…”

“…Jorm examined the per capita use of mental health services provided by mental health professionals between 2006 and 2015, the prevalence of psychological distress in adults from National Health surveys in 2001, 2004–2005, 2007–2008, 2011–2012, and 2014–2015; and annual suicide rates from 2001 to 2015 according to the Australian Bureau of Statistics. Jorm () acknowledged that from the beginning of the Better Access initiative there was considerable controversy regarding cost, inequities in the distribution of services, the model of care and the quality of treatment.…”