National mental health report 2013

Indicator 13: Percentage of population receiving mental health care

Page last updated: 2013

Key messages:

  • The percentage of the population seen by state and territory community mental health services from 2006-07 to 2010-11 remained relatively stable at around 1.5%.
  • The percentage of the population receiving mental health specific Medicare­ funded services rose from 3.1% in 2006-07 to 6.9% in 2010-11. This increase was largely due to the introduction and uptake of services provided through the Better Access initiative.
  • Targets for population coverage by mental health services are yet to be agreed but are expected to be advanced as part of the continuing development of the Roadmap for Mental Health Reform1 agreed by the Council of Australian Governments (COAG) in December 2012.
Widespread concern about access to mental health care was a key factor that underpinned the COAG National Action Plan on Mental Health endorsed by governments in 2006, and was reinforced in the commitments made under the various National Mental Health Plans. The Third and Fourth National Mental Health Plans in particular have emphasised the need to improve access to primary mental health care, especially for people with common mental illnesses. For consumers, having access to the right services at the right time is of paramount importance.

First insights into the gap between need for mental health services and services actually delivered were provided by the National Surveys of Mental Health and Wellbeing undertaken in 1997 and 1998. The surveys revealed that only 38% of adults and one quarter of children and younger people with a mental illness received treatment from a health service. Of those who received services, the majority (77%) consulted their general practitioner, although about half also attended another health service. The implication is that, 15 years ago, about two thirds of the one in five adult Australians who were experiencing a recent mental illness received no treatment for that illness from any part of the health system.

An updated picture on the extent of unmet need for mental health care in the adult population became available from the 2007 National Survey of Mental Health and Wellbeing. Conducted by the Australian Bureau of Statistics (ABS) in 2007, results released in October 2008 suggested that little change had occurred over the preceding decade in the overall rates of treatment for people with mental disorders, with approximately two thirds (65%) continuing to receive no treatment. Similar rates of treatment for mental illness have been reported in all population surveys conducted in other developed countries.

When the 2007 survey findings were scaled to the total population, they suggested that 2.1 million adult Australians experienced the symptoms of a mental illness but received no health care for their conditions. Treatment rates varied according to the severity of the person's condition and type of disorder. Approximately two thirds (64%) of those with disorders classified as severe according to the ABS methodology received some level of health care. About 39% of people with moderately severe disorders and only 17% of people with milder (but still clinically significant) disorders were found to receive mental health care. People with an affective disorder (mainly depression) were more likely to have received services for their mental health condition than those affected by one of the various anxiety disorders (59% and 38% respectively). These rates were similar to those observed in 1997.

Large scale population surveys like the National Surveys of Mental Health and Wellbeing provide snapshots of the level of mental illness in the community but cannot provide routine and regularly available information to monitor this indicator over time. To complement the periodic population surveys, for the purposes of this and related reports, health administrations within each jurisdiction agreed to pool data on the number of people receiving services through government­funded clinical mental health care streams. The Private Mental Health Alliance, covering private hospitals and other providers of mental health care, also agreed to contribute data on people treated in private hospitals.

Results at the national level over the period 2006-07 to 2010-11 are presented in Figure 59. Assuming minimal overlap between state and territory and Medicare-funded person counts, the data suggest that approximately 1.9 million people, or 8.5% of the population, received clinical mental health care in 2010 -11, compared with 970,000 in the 2006-07.

Overall, the percentage of people seen by state and territory mental health services has remained relatively stable, fluctuating between 1.5% and 1.6%. Growth in the number of people seen by Medicare-funded mental health services, rising from 3.1% of the population in 2006-07 to 6.9% in 2010 -11, is the sole driver of overall growth in treatment rates over the five year period. Top of page

These figures highlight that the ABS estimates made in 2007 of access to mental health care are unlikely to reflect the population's current use of services. Analysis was undertaken by the Australian Government Department of Health and Ageing as part of the national evaluation of the Better Access program, and factored in the growth in the number of persons treated by Medicare-funded Better Access services and incorporated estimates from other service utilisation data.31 The analysis suggested that the percentage of the population with a current mental illness who received care in 2009-10 was 46%, substantially higher than the 35% estimate found by the ABS in 2007. The growth occurring in 2010-11 evident in Figure 59 will have further increased treatment rates beyond those found in 2007.

Data on relative access figures across each of states and territories are provided in Part 4 of this report. Several caveats need to be considered when interpreting the data. First, assessing progress against this indicator is not as simple as adding together the percentages in Figure 59 for any given year due to the possibility that a sub-group of service users access both state and territory mental health services and Medicare-funded mental health services. Without a unique identifier that permits individuals to be 'tracked' across service sectors, all that can be said is that a minimum of 3.1% of the population received mental health care in 2006-07 and a minimum of 6.9% did so in 2010-11. The figures are likely to be higher than this, but the true percentages cannot be accurately ascertained. However, the trend is certainly in the right direction.E

Secondly, comparisons of relative coverage between state and territory mental health services and Medicare-funded services need to take account of differences in the type and intensity of services provided across these sectors, with states and territories having their main focus on treating people with severe mental disorders. Thirdly, the growth in Medicare­funded services is, in part, a function of the fact that the Better Access initiative commenced in the first year of the period examined in Figure 59. Fourthly, comparisons between state and territory services need to be made cautiously because jurisdictions differ in the way in which they count the number of people under care. Victoria in particular undercounts patients seen by clinical services when compared to other jurisdictions because it only reports people who are seen and accepted for case management. Top of page

A final cautionary note is needed to guide interpretation of data on use of mental health services. Most people who meet diagnostic criteria for mental illness do not experience a need for professional assistance of any kind. The 2007 National Survey of Mental Health and Wellbeing reported that nine out of ten of those experiencing mental illness symptoms in the previous 12 months who were not receiving mental health care reported having no need for any of a range of services, including counselling, medication and information (see Table 11)9,14 The implication is that the lack of health service use by people with mental illness may be more related to their perception of personal needs than to the actual availability of services. Further work is needed to tease out the extent to which this finding is a function of factors such as lack of recognition by the person that they have an illness, lack of awareness that effective treatments are available, negative experiences of previous service use, and continuing stigma associated with mental illness.

Deciding on an appropriate target for population coverage by mental health services remains a challenge for all governments. The recent Roadmap for Mental Health Reform agreed by COAG in December 2012 foreshadowed the developments of targets in this area. As a broad indication of the scope of a possible target, lifting treatment rates for people with mental illness from the 35% found in the 2007 survey to 66% would require 12% of the population receiving mental health care each year. Top of page

Figure 59: Number of people and percentage of population seen by each of the major mental health service streams, 2006-07 to 2010-11

Refer to the following tables for a text equivalent of Figure 59: Number of people and percentage of population seen by each of the major mental health service streams, 2006-07 to 2010-11

Text version of figure 59

Number of people seen

2006-072007-082008-092009-20102010-11
MBS-funded health services
648,987
1,007,117
1,225,056
1,366,285
1,522,830
State and territory mental health services
324,160
323,189
330,594
339,698
351,690
Private hospitals
22,520
23,155
24,528
25,536
25,710

Percentage of population seen

2006-072007-082008-092009-20102010-11
MBS-funded health services
3.1
4.8
5.7
6.2
6.9
State and territory mental health services
1.6
1.5
1.5
1.5
1.6
Private hospitals
0.1
0.1
0.1
0.1
0.1
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Table 11: Percentage of people with a current mental illness who received no health services reporting no need for services, 2007

Type of service:
  • Information - 94%
  • Medication - 97%
  • Talking therapy - 89%
  • Social intervention - 94%
  • Skills training - 96%
  • Any of the above - 86%

Footnotes

E Work is underway by the Australian Institute of Health and Welfare to use data linkage to more accurately estimate the extent of duplication in consumer counts between state and territory services and MBS-subsidised mental health care. This work is progressing with the assistance of jurisdictions and in compliance with ethical requirements.