National Mental Health Reform 2011-12
The Commonwealth Government’s major responsibility in the mental health sector is primary mental health care, which is largely targeted to the needs of approximately three million people with common mental disorders such as anxiety and depression. By providing the right mix of well-connected services in their local community, people with less persistent symptoms and less complex needs have a better chance of leading productive lives, participating in the community and staying well.
The Better Access initiative (Better Access) has been instrumental in improving the proportion of people with mental illness who use mental health services, by encouraging General Practitioners to work collaboratively with allied mental health providers. In 2007, only 35 per cent of people with a mental health disorder in the previous 12 months were estimated to have accessed treatment. In 2010, this had grown to an estimated 46 per cent, predominantly as a result of the Better Access initiative. Over two million people have benefited from services since its commencement in 2006.
A comprehensive program evaluation of the initiative has now been conducted showing that the program is increasing the community's access to mental health care. But while the evaluation shows that access for hard to reach populations has improved to some extent, those groups traditionally less well served by Medicare (such as Indigenous Australians, those in regional Australia and people on low incomes) continue to miss out on the mental health services they need. The cost of the Better Access initiative is large and growing quickly.
The Access to Allied Psychological Services (ATAPS) program has proven itself effective at reaching people in these groups, but funding constraints have limited the program’s ability to fill more of these gaps.
Primary mental health care services will be reshaped to increase treatment rates and offer a broader range of service pathways, building on the Government’s clear commitment at COAG to fast-track initiatives to strengthen primary health care and to develop Medicare Locals with an integral coordinating role.
The Australian Government will continue to support people to see a psychiatrist, psychologist, mental health social worker or occupational therapist when they need one through Better Access, with some changes to improve the cost-effectiveness of the initiative. The Government will continue to drive improved access to primary mental health care through a major expansion of ATAPS, and improving awareness and use of evidence-based online psychological therapies which provide self help and lowintensity treatment. In addition, we will continue to provide support to access
psychiatrists through general Medicare rebates.
Budget Measure: Expansion of ATAPS - more services for children and families, Indigenous people and other hard to reach populations - $205.9 million over the next five yearsThe Government is allocating an additional $144.0 million over the Forward Estimates period to ATAPS so that children and their families, Indigenous people and other hard to reach populations will be better able to access psychological services. Funding will grow to $205.9 million over five years. This represents a doubling of current investment for this program.
This measure builds on the Government’s National Health Reform priority to strengthen primary care and keep people well in the community. Medicare Locals will coordinate and be fund holders for ATAPS services.
ATAPS has proven it can reach groups who have difficulty in accessing mental health services and demand for ATAPS is increasing. Many people being referred for services are being put on waiting lists due to funding constraints. This growth in demand is expected to continue in the long term as some people directly affected by disasters such as cyclones, floods and bushfires experience significant distress which, if prolonged, may lead to mental illness.
Through this measure, over 180,000 people will receive services through ATAPS, including children with mental illness and their families, Aboriginal and Torres Strait Islander people, and additional people from other hard to reach locations or groups.
Budget Measure: Establishment of a single mental health online portal - $14.4 million over the next five yearsOnline therapy - e-therapy - is a clinically proven and cost-effective way of treating mild to moderately severe depression and anxiety disorders – the bulk of mental illness affecting about 3.1 million Australians each year. For some people, e-therapy is enough to put them back on track and learn coping strategies, without needing any or many face-to-face services.
However, the uptake of e-mental health programs is low. Current treatment websites are poorly signposted and not well connected with the broader health system. To fix this, the Government will spend $14.4 million over five years to establish an online national mental health portal.
This single portal will bring together and consolidate the often scattered websites and telephone services currently available and provide an additional avenue to traditional face-to-face services. It will guide people to programs most suited to their needs, from self directed programs and clinician assisted support through a ‘virtual clinic’. As a result, about 45,000 additional people will have access to web-based therapies over five years.
Training and resources for the delivery of e-treatment within general practice will also be established together with electronic mental health training and support for Aboriginal Health Workers and other clinicians in remote areas.
To build a more equitable and effective system of primary mental health care, the Government will act to increase the cost-effectiveness of the Better Access initiative, which will allow some funding to be redirected into the ATAPS program (which is more effective at meeting the needs of hard-to-reach groups) and other measures in this package that will benefit more Australians with mental illness.
These changes are being guided by the evidence of actual General Practitioner activity and the evaluation of the initiative.
Budget Measure: Adjustment to the Better Access Initiative - Two tiered rebate for treatment plan sessions – saving $405.9 million over the next five yearsIn this Budget, the Government is recalibrating rebates for General Practitioners (GPs) who provide Mental Health Treatment Plans under the Better Access initiative. The change is based on data showing the actual time taken for GPs to complete the plans. Analysis of Bettering the Evaluation and Care of Health program data indicated that over 80 per cent of GP Mental Health Treatment Plans under Better Access were being completed in less than 40 minutes, with the median consultation length being 28 minutes.
The Government will create two tiers of rebate for GP Mental Health Treatment Plans, of less than 40 minutes and 40 minutes or more, and bring the rebate closer to that applying for standard consultations of the same length.
The Government will maintain its incentive for GPs who have completed mental health skills training in order to continue to encourage quality and GPs to engage with patients who require mental health treatment.
Budget Measure: Cap Allied Health sessions to 10 from 12 – saving $174.6 million over the next five yearsData shows that almost three-quarters of patients who accessed allied health services under the Better Access initiative needed only between one and six services a year – not the twelve that are currently on offer. The average number of allied mental health services received after a GP Mental Health Treatment Plan is five.
This measure will cap allied mental health services available under the Better Access initiative at 10 sessions per patient per calendar year. Savings will be reinvested in other mental health services that target particularly hard to reach and vulnerable groups, who continue to miss out on mental health services, such as the homeless, Indigenous Australians, regional and rural Australia and those Australians with severely disabling mental illness and complex care needs.
87 per cent of current Better Access users receive between one and 10 services and will be unaffected by this change.
This adjustment also recognises that individuals requiring more than 10 allied mental health services sessions may be experiencing more severe symptoms and may not necessarily be ideally suited to treatment through a universal Medicare scheme like Better Access, but rather could benefit more through referral to more appropriate mental health services such as Medicare-subsidised psychiatrist consultations or state services for people with severe and debilitating mental illness.
The Government will, through these measures, continue to improve access to mental health services, including by harnessing technology, particularly for at-risk and disadvantaged groups who are currently missing out. Through better targeted and more efficient mental health services individuals will be supported to maintain full and healthy lives across the lifespan and in remote, regional and urban areas.