But without improving cost or capacity, halving the number of subsided psychologist appointments won't help either.
The government’s latest move in the mental healthcare space may improve access, but it’s unlikely to shift the biggest barrier to care: cost.
Following the release of an independent evaluation of the Better Access scheme yesterday, Health Minister Mark Butler announced that the additional 10 subsidised mental health sessions which were introduced in 2020 as a temporary covid measure would be discontinued.
The review found that the Better Access initiative has indeed provided better access – but mainly for people already on the highest incomes.
People on the lowest incomes were the least likely to access care under Better Access, but were roughly twice as likely to be experiencing high or very high mental distress as people on the highest incomes.
The lower socio-economic cohort were also more likely to be prescribed medication, instead of being referred to a psychology service.
When the number of available sessions was doubled in 2020, the bulk of the additional appointments went to existing patients, and the number of new patients in the system declined by 7%.
Australians on the lowest incomes received fewer services than they had pre-pandemic.
Gap payments have also been on the rise both in terms of size and frequency.
While the median co-payment had been stable at around $74 per session for a number of years, it increased to $90 in the first half of 2022.
Where only 53% of appointments under the Better Access scheme attracted a co-payment in 2018, last year it rose to 65% of appointments.
Across the various studies which informed the independent evaluation, cost was continually raised as a barrier to care.
Clinical Associate Professor Louise Stone, a Canberra GP with special interest in mental health, told The Medical Republic that cutting the number of subsidised appointments was unlikely to affect the cost factor.
“It improves access, it just doesn’t approve affordability,” she said.
“When we increased [available appointments] by 10 sessions, but didn’t increase the workforce, it just meant that less people got more services.
“Whatever you think about that, the government’s made a call saying, ‘we want more people to have services, rather than [fewer people have more services]’.”
Because there’s still a workforce shortage, psychologist books are going to be full either way. There’s simply no incentive to lower the gap fees.
Even in this scenario, Professor Stone said, the people who are most in need are unlikely to benefit from any increase in service availability.
“In order to access a complex system, you need the literacy, the health literacy, and the health service literacy to find your way through it,” she said.
“If there’s a service funded by the government … then you have to know that it exists, you have to be able to look it up, you have to [meet certain] criteria and you usually need a referral.
“All of that requires money to get places and literacy to find these things.”
The very fact that some Primary Health Networks employ a mental health service navigator is a sign that something has gone very wrong, according to Professor Stone.
Fixing accessibility and affordability means resourcing general practice.
“We may not like, as a community, the idea that everyone gets a one stop shop, which is … generalist primary care,” she said. “But at least then the only thing you need to know is: no matter what you’ve got, you go to the GP.”
Minister Butler has also flagged ongoing modifications to the initiative: there will be provisions for family involvement and case conferencing between GPs and psychologists, as well as discussions on how to respond to the evaluation.
