Evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative: summative evaluation

1b. Has Better Access increased the treatment rates of people with mental disorders?

Page last updated: 22 February 2011

In answering this question, we need to monitor trends in the overall treatment rate for people with mental disorders in Australia since the implementation of Better Access. In order to estimate the proportion of Australians with mental disorders who have received mental health treatment each year, we need to know:

  1. how many Australians had a mental disorder in each year and
  2. the number of these persons who were treated in each year.
The major challenge in obtaining these estimates is the absence of a single data source that can directly address the issue.

The 1997 and 2007 National Surveys of Mental Health and Wellbeing can examine changes in the rates and patterns of mental health treatment over time because each survey collected information about individuals' mental health status and their use of a diverse range of health services. Previously published analyses of data from these surveys (see table 6) suggest that service use rates for common mental disorders (that is, affective, anxiety and substance use disorders) remained relatively stable over the 1997 to 2007 period, a finding that was counter to expectation.12 13 16

Component F used National Survey of Mental Health and Wellbeing data to examine whether the use of different types of providers for mental health problems changed between 1997 and 2007.10 These showed a shift towards greater use of mental health providers. Figure 1 shows that, in 2007, the proportion of people with a 12-month mental disorder who sought treatment from a mental health professional (psychiatrists, psychologists and other mental health professionals) doubled, while the proportion who sought treatment from a GP alone or from another health professional decreased.

These analyses suggest that, between the two surveys, access to specialised mental health care for people with mental disorders had improved. This may reflect the combined early impact of the Better Access program in its first year (introduced November 2006), and its precursor, the Better Outcomes in Mental Health Care program that was more modest in financial investment and population coverage.c

The National Survey of Mental Health and Wellbeing has two major limitations that preclude its use in estimating the impact of Better Access on rates of treatment of mental disorders. The first is that the 2007 survey was conducted between August and December 2007, and therefore does not capture the first full year operation of Better Access for all respondents. Nor can it provide any information on the impact of Better Access in the years following its initial establishment in 2006-07. The second limitation is that the survey data do not provide complete coverage of the Australian population. Specifically, the 2007 survey did not sample Australians who were younger than 16 years of age or older than 85 years of age. In addition, the scope of the survey was restricted to those living in households. It therefore excluded elderly people in hospitals and aged care facilities with mental disorders, and others with mental disorders living in nonhousehold residential establishments.

To overcome the limitations in the epidemiological data, the Department of Health and Ageing conducted a modelling exercise using routinely available data to estimate the change in treatment rates between 2007 and 201017. This model used administrative data on health service utilisation collected by the Commonwealth and states and territories to answer the question: What percentage of Australians with a current mental illness can be estimated to have accessed a health service for assistance with their illness? Top of page

Details of this modelling were provided to the consultants for inclusion in this report. The consultants reviewed the methodology and key assumptions of the modelling and undertook additional analysis to assess the effects of uncertainty in key parameters and assumptions on the estimates. The purpose of the uncertainty modelling was to assess the extent to which apparent increases in the proportion of persons with mental disorders who receive mental health treatment may be due to sampling error or uncertainty in key parameters used in the Department's model. The details of this work are described in appendix 2. c This program delivers similar services to those offered through Better Access, but does so through projects run by Divisions of General Practice

The results of the uncertainty modelling are summarized in table 7 below. There are three key findings. First, the estimated proportion of persons with a current mental illness who received treatment increased steadily each year from 37.4% in 2006-2007 to 46.1% in 2009-2010, an overall increase of 8.7%. Second, the 95% confidence intervals indicate considerable uncertainty around each of these estimates. They generally fell within plus or minus 3.9% of the mean estimate. For example, in 2006-2007, the 95% uncertainty interval around the estimate of 37.4% ranged between 33.9% and 40.8% (a range of 6.9%). Third, the intervals around the best estimate for each year did not overlap for 2007-2008 and 2008-2009 with the best estimate in the year before. This was not the case for 2009-2010. This pattern of results indicates that the increase between 2006-2007 and 2008-2009 in the percentage persons with a mental disorder who received treatment was unlikely to be due to chance variations in the data. We can be less confident about the smaller increase between the last two years of the period, suggesting a possible slowing in the percentage treated in the most recent period. With this exception, overall, there has been a significant increase in the proportion of persons with a mental disorder who receive mental health treatment for that disorder in the past year.

The Better Access program appears to be the sole driver of increased treatment rates for mental illness. Figure 2 shows the contribution of Better Access persons treated to overall treatment rates, as estimated by the Department of Health Ageing model. The percentage of persons with a current mental disorder who were treated using Better Access mental health services (alone or in addition to other health services) rose from 9.0% in 2006-07 to 25.4% in 2009-10. Expressed another way, in 2006-07 Better Access persons treated represented one-quarter (24%) of all persons treated. This increased in successive years to 42% in 2007-08, 49% in 2008-09. In 2009-10 Better Access persons treated represented more than half (53%) of all persons treated.

There are currently no nationally agreed targets for treatment coverage (i.e. the proportion of persons with a mental disorder who ideally should be treated). Expert opinion suggests that an attainable level of coverage with good quality treatment may lie between 60% and 67%.41-43 Judged against these targets, the Department of Health and Ageing modelling suggests that Australia's mental health reforms have made significant progress in closing the gap between current and desirable treatment rates, but that there remains some way to go. In saying this, it is acknowledged however that just seeing a practitioner does not guarantee that good quality treatment has been provided. Although target setting is a separate exercise, information about treatment coverage needs to be supplemented with information about the extent to which treatment provided represents good value for money.
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Table 6: Proportion of people with a 12-month mental disorder who received services for a mental health problem, 1997 and 2007 National Survey of Mental Health and Wellbeing

Disorder class1997 NSMHWB2007 NSMHWB3
12-month ICD-10 affective disorder
60.41
58.6
12-month ICD-10 anxiety disorder
45.21
37.8
12-month ICD-10 substance use disorder
27.91
24.0
Any 12-month ICD-10 disorder
38.02
34.9

1. Parslow and Jorm, 2000
2. Australian Bureau of Statistics, 1998
3. Burgess et al, 2009

Figure 1: Proportion of people with a 12-month disorder who used services for a mental health problem, 1997 and 2007 National Survey of Mental Health and Wellbeing, Component F


Text equivalent below for Figure 1. Proportion of people with a 12-month disorder who used services for a mental health problem, 1997 and 2007 National Survey of Mental Health and Wellbeing, Component F

Text version of Figure 1

19972007
Other health professional +/- GP
9.8
2.1
Mental health professional +/- GP
11.1
21.8
GP only
11.6
9.8
Total
32.5
33.7

Table 7: Percentage of persons with a mental disorder treated, results of uncertainty modelling

Year Mean95% confidence interval
2006-07
37.4
35.0 – 39.6
2007-08
41.5
39.7 – 43.7
2008-09
45.0
42.7 – 47.3
2009-10
46.1
43.8 – 48.4
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Figure 2: Percentage of persons with mental disorders in the total Australian population treated using Better Access mental health services and other health services, 2006-07 to 2009-10


Text equivalent below for Figure 2: Percentage of persons with mental disorders in the total Australian population treated using Better Access mental health services and other health services, 2006-07 to 2009-10

Text version of Figure 2

2006-072007-082008-092009-10
Better Access mental health services (+/- other health services)
9.0%
17.3%
21.8%
24.5%
Other health services only
28.3%
24.2%
23.2%
21.6%
Total
37.3%
41.5%
45%
46.1%

Footnote

c This program delivers similar services to those offered through Better Access, but does so through projects run by Divisions of General Practice