Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia

Bartram, Mary; Stewart, James

doi:10.1016/j.healthpol.2018.10.011

Cited by 39 publications

(22 citation statements)

References 15 publications

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“…An increasing number of persons with mental health problems seek treatment. However, structural barriers prevent many of those affected from getting the best help possible (1,2). Depending on the health care system, a major structural barrier results from financial reasons (treatment costs or lack of insurance coverage), lack of time for undergoing treatment, or lack of clarity about where to get an appointment.…”

Section: Methodsmentioning

confidence: 99%

Maintaining Outcomes of Internet-Delivered Cognitive-Behavioral Therapy for Depression: A Network Analysis of Follow-Up Effects

et al. 2021

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Background: Depression is a highly prevalent mental disorder, but only a fraction of those affected receive evidence-based treatments. Recently, Internet-based interventions were introduced as an efficacious and cost-effective approach. However, even though depression is a heterogenous construct, effects of treatments have mostly been determined using aggregated symptom scores. This carries the risk of concealing important effects and working mechanisms of those treatments.Methods: In this study, we analyze outcome and long-term follow-up data from the EVIDENT study, a large (N = 1,013) randomized-controlled trial comparing an Internet intervention for depression (Deprexis) with care as usual. We use Network Intervention Analysis to examine the symptom-specific effects of the intervention. Using data from intermediary and long-term assessments that have been conducted over 36 months, we intend to reveal how the treatment effects unfold sequentially and are maintained.Results: Item-level analysis showed that scale-level effects can be explained by small item-level effects on most depressive symptoms at all points of assessment. Higher scores on these items at baseline predicted overall symptom reduction throughout the whole assessment period. Network intervention analysis offered insights into potential working mechanisms: while deprexis directly affected certain symptoms of depression (e.g., worthlessness and fatigue) and certain aspects of the quality of life (e.g., overall impairment through emotional problems), other domains were affected indirectly (e.g., depressed mood and concentration as well as activity level). The configuration of direct and indirect effects replicates previous findings from another study examining the same intervention.Conclusions: Internet interventions for depression are not only effective in the short term, but also exert long-term effects. Their effects are likely to affect only a small subset of problems. Patients reporting these problems are likely to benefit more from the intervention. Future studies on online interventions should examine symptom-specific effects as they potentially reveal the potential of treatment tailoring.Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT02178631.

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Section: Methodsmentioning

confidence: 99%

Maintaining Outcomes of Internet-Delivered Cognitive-Behavioral Therapy for Depression: A Network Analysis of Follow-Up Effects

et al. 2021

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“…For example, co-payments associated with receiving mental health services can be a financial barrier to accessing care. 13,14 COVID-19 response has sought to increase access through telehealth but since the medicare benefits schedule (MBS) items allow co-payment they may not improve equity. 15 The LGA-specific estimators of relative need and demand from this model could guide assessment of equity for these innovations.…”

Section: Advancing the Research Agendamentioning

confidence: 99%

Socio-economic disadvantage and resource distribution for mental health care: a model proposal and example application for Victoria, Australia

Meadows

Shawyer

Dawadi

et al. 2020

Australas Psychiatry

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Objective: A spreadsheet-based model for supporting equitable mental health resource distribution in Australia was developed, based on the Australian Health Survey (AHS) psychological distress findings associated with area socio-economic disadvantage (SED). An illustrative application is presented. Method: Stratum-specific psychological-distress rates for area SED quintiles are applied to local government areas, catchment areas and local health networks (LHNs). A case study applies the model to Victoria, including examining recommendations in the Royal Commission into Victoria’s Mental Health Services (RCVMHS) 2019 interim report for increases to bed stock in two LHNs. Results: Need-adjusted demand estimates considered as a ratio of raw population proportions for catchments range between 0.6 to 1.4 in Victoria. Applying the formula to the Royal Commission recommendations suggests the proposed distribution of beds is a reasonable correction for these two LHNs and indicates next expansion priorities for more equitable distribution to other LHNs. Conclusions: The spreadsheet, adaptable for other states and territories, could complement National Mental Health Services Planning Framework outputs and assist in evaluation, for instance, determining potential supply shortages in the tele-mental-health response to COVID-19. We outline research directions including consideration of the moral bases of value judgements and identification of other variables including their use in parameterisation and calibration.

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“…Not in current model. Private-sector varies with SD (although this is better measured with another index (13) This bears on an interface with activity-based funding considerations and possible adjustments for travel time and other challenges of service delivery to more dispersed populations. Column B: Data were calculated by dividing each catchment's population by the total state population Column C: We estimated the number of people with very high K10 per catchment by applying IRSD quintile-specific very high K10 rates (Enticott et al, 2016) to the local government areas (LGAs) in the catchment, including proportional distribution of LGAs where these span multiple catchments.…”

Section: Private Sector Activity Correctionmentioning

confidence: 99%

Socio-economic disadvantage and resource distribution for mental health care; a model proposal and example application for Victoria, Australia

Meadows¹,

Shawyer²,

Dawadi³

et al. 2020

Preprint

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The attached pre-print (working paper) paper describes an application of available epidemiological evidence in guiding the adjustment of mental health resources to areas. Described with an illustrative application in Victoria, Australia. We have also provided our research data as a supplementary spreadsheet to showcase our analytic approach (the spreadsheet cam also easily be adapted to calculate mental health resource adjustments in other states and territories, or nationally).

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Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia

Cited by 39 publications

References 15 publications

Maintaining Outcomes of Internet-Delivered Cognitive-Behavioral Therapy for Depression: A Network Analysis of Follow-Up Effects

Maintaining Outcomes of Internet-Delivered Cognitive-Behavioral Therapy for Depression: A Network Analysis of Follow-Up Effects

Socio-economic disadvantage and resource distribution for mental health care: a model proposal and example application for Victoria, Australia

Socio-economic disadvantage and resource distribution for mental health care; a model proposal and example application for Victoria, Australia

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