The $820 million program aimed at helping people with mild to moderate mental health issues to access help through Medicare has fundamental failures in the way it operates, according to research by Australian National University that was published in the Medical Journal of Australia.
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Dr Sebastian Rosenberg from the Centre of Mental Health Research at the ANU analysed Medicare data and how it was applied to the Better Access Program.
- More repeat clients using the program
- Only half of all mental health plans reviewed
- Program failing men and people in the bush
- Program doesn't account for complex needs
Under the Better Access Program, patients can access up to 10 Medicare-subsidised sessions with a single mental health care professional. In many cases, these sessions require out-of-pocket costs so Medicare doesn't necessarily cover their full cost.
Dr Rosenberg found that there's been massive cost blow-outs since the program began in 2006, and that there's little accountability over how it's working.
'There was a lack of appreciation of what the demand would be for this program. We talking about 46,000 Australians accessing these services every week, which is mind-boggling,' he told Hack.
He said the program costs $28 million a week, when you factor in patients' out-of-pocket costs.
Cutter mp3 for mac download. 'I have no doubt that many of that 46,000.. feel a lot better from seeing their GP and seeing a psychologist. So I'm not suggesting that this program is a waste of time or that the initial idea of making public access to psychology services easier was a mistake. I think it remains a good idea,' Dr Rosenberg said.
'With this many Australians engaged in this program I just think that it merits some scrutiny.'
Failing young men and people in the bush
Even though the purpose of the Better Access program was to get new clients into mental health care, Dr Rosenberg said services were still failing to reach the people who needed them most.
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'Particularly services to do with clinical psychology, you can find it very difficult to see and get access to that kind of health professional if you don't live in an urban area. So what that means, paradoxically, is that there are more services available in areas where psychological distress is lower, but people's ability to pay is higher,' he said.
'You will find more services in the leafy eastern suburbs of our main cities than you will out in the sticks, and that's a really critical matter.'
He said future funding needs to look at the viability of telehealth services - like doing counselling sessions over Skype, for example - instead of the traditional face-to-face model.
Dr Rosenberg pointed to a national survey conducted in 2007 that found only 13 per cent of young men who needed mental health services actually accessed them. He said that figure has barely changed in more than a decade.
'If you replaced the word mental health with say, cancer or diabetes, and such a large proportion of an important demographic were missing out on care, I would have thought there'd be demonstrations in the street,' he said.
'Australia has failed to build a model of healthcare that deals with these psycho-social elements.'
Failing people with complex needs
The research found that the number of repeat clients using the program has significantly increased.
'In 2009 two thirds of clients into Better Access were new but by 2016 only a third were new,' Dr Rosenberg said.
If more people are coming through the program for a second or third time, this indicates they didn't get the care they needed the first time.
Dr Rosenberg said that while the program was designed to assist people with mild or moderate conditions, he had 'no doubt' that people with more complex needs were accessing it.
That could be a problem, as the program only covers sessions with one type of healthcare professional.
'If you take a person with more complex needs like an eating disorder, it's really likely that that person is going to need to see a GP, a psychologist and potentially a psychiatrist, a social worker, a counsellor, a dietician and nutritionist, potentially a peer-worker as in someone who's been through this before,' he said.
'The Better Access Program does not pay for this kind of multi-disciplinary team-based care.'
The research found that only half of all mental health plans written out by GPs were ever reviewed.
'At the moment there is no incentive for GPs to complete the review. And there's not necessarily an incentive for the patient to go back to the GP because they have to pay another out-of-pocket fee,' Dr Rosenberg said.
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