This chapter presents findings relating to Evaluation Question 4: To what extent has the Better Access initiative provided evidence–based mental health care to people with mental disorders?

The question of the extent to which the Better Access initiative has provided evidence–based mental health care to people with mental disorders is difficult to answer for two almost contradictory reasons. The first is that the Better Access MBS item numbers are prescriptive about the type of care that is to be delivered, and designed that all such care should be evidence based. The second is that MBS data do not provide a detailed description of what happened at a given session, so it is difficult to assess the extent to which evidence–based care has actually been delivered. Having said this, there will be certain patterns of service delivery that might give some indications of the extent to which evidence–based care has been delivered. For this reason, this section has been re–named 'Protocol–based care'.

Two aspects of the Better Access service delivery protocol were examined. The first relates to the patterns of care delivered following a GP Mental Health Treatment Plan service (MBS item 2710). As already noted, the Better Access MBS item numbers are prescriptive about the care that is to be delivered. In some cases, notably the allied health items, the protocol also specifies the quantity of these services permitted and the period over which they can be provided. For example, the allied health item numbers provide for up to 12 sessions of care on the basis of a review by the referring GP after the first six. The number of sessions that the patient is referred is determined by the GP. After the initial course of treatment (a maximum of 6 services but it may be less depending on the referral) the GP can then refer to patient for up to a further 6 sessions. It is intended that the GP Mental Health Treatment Review item (2712) is used for this purpose. Although there will be considerable variability in the actual number of sessions required for individuals, if a high proportion of individuals were receiving only one or two sessions, this would presumably indicate problems with the protocol.

The second relates to the number of allied health services that can be delivered following a GP Mental Health Treatment Plan service (MBS item 2710) in a calendar year. Under Better Access, a patient cannot have more than 18 individual services (and 12 group services) per calendar year. For example, if the GP Mental Health Treatment Plan is written in November 2008 and the patient has 2 individual sessions with a general psychologist in 2008, then in 2009 they can carry on using the GP Mental Health Treatment Plan and access 10 individual sessions and then 6 more in exceptional circumstances. Even if they then have a new GP Mental Health Treatment Plan written in 2009, they have already accessed 16 individual sessions for 2009 and can only access 2 more in 2009.

A series of research questions was developed, focusing on these two aspects of the Better Access protocol:

  1. Patterns of care following GP Mental Health Treatment Plan

    1. To what extent are GP Mental Health Treatment Plans followed by a GP Mental Health Treatment Review?

    2. What level of allied health services are being received by persons who have a GP Mental Health Treatment Plan followed by a Review?

    3. What level of allied health services are being received by persons who have a GP Mental Health Treatment Plan not followed by a Review?

    4. Does the number of allied services received vary according to number of GP Mental Health Treatment Plans received?

    5. What are the socio–demographic characteristics of people not receiving allied health services following a GP Mental Health Treatment Plan?

  2. Volume of psychological services delivered by allied health professionals

    1. How many Better Access psychological services are delivered by allied health professionals to each consumer within a calendar year?