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

1e. Has Better Access reached consumers with moderate to severe disorders, or has it predominantly provided care to those with mild symptoms?

Page last updated: 22 February 2011

As noted above, the Medicare claims data used in Component B only allowed Better Access consumers to be profiled in terms of basic socio-demographic characteristics (see Question 1c).5 They did not contain information about consumers' diagnoses or the severity of their disorders. Two alternative sources of data had the capacity to assess these characteristics among consumers of Better Access services.

The first source was Component A3 which collected information about consumers' diagnoses and levels of psychological distress at the commencement of treatment (that is, at their first session). Table 12 summarises the results. More than 90% of consumers recruited to Component A by clinical psychologists, registered psychologists and GPs had diagnoses of depression and/or anxiety. This compares with 13% of the general population. Around 80% of consumers recruited by each type of provider were experiencing high or very high levels of psychological distress (as assessed by the Kessler 10, or K-10). Again, this is much higher than the 10% observed in the general population.

The second source of relevant information was the study by Harris et al which used data from the 2007 National Survey of Mental Health and Wellbeing to explore the use of Medicaresubsidised allied health services.14 This study found that the vast majority (93.2%) of consumers estimated to have used Better Access allied health services in 2007 had either a 12-month ICD-10 affective, anxiety or substance use disorder (81.7%) or another indicator of treatment need (11.5%)f.

Byles et al reported similar findings in their study of uptake of Better Access item numbers by participants in the Australian Longitudinal Study on Women's Health.29 They observed that women who used Better Access item numbers tended to have poorer mental health, and that this had often declined prior to use of the item numbers.

Harris et al's study also included information from the 2007 National Survey of Mental Health and Wellbeing about the level of severity, disability and psychological distress among consumers of Better Access allied health service consumers.14 The study selected people with a 12-month affective or anxiety disorder, and compared the characteristics of those who received Better Access allied health services with those who used other services for a mental health problem, or used no services. Almost half of the Better Access consumer group had a severe disorder (47.6%, as opposed to a mild or moderate disorder), 45.5% reported a high level of disability as measured by the World Health Organization Disability Assessment Schedule (WHO-DAS), 45.9% reported high or very high levels of distress as measured by the Kessler-10 (K-10), and 28.1% had experienced more than seven days out of role in the past 30 days. These proportions were comparable to those for people who used other mental health services (37.8%, 51.9%, 49.9% and 30.1%, respectively). However they were significantly greater than those for people who had not used services on all measures except the WHO-DAS (13.5%, 35.9%, 23.5% and 12.9%, respectively).

Harris et al's study also included information from the National Survey of Mental Health and Wellbeing about the level of severity, disability and psychological distress among consumers of Better Access allied health services.14 The study selected people with a 12-month affective or anxiety disorder, and compared the characteristics of those who received Better Access allied health services with those who used other services for a mental health problem, or used no services. Around half of the Better Access consumer group had a severe disorder (47.6%, as opposed to a mild or moderate disorder), 45.5% reported a high level of disability as measured by the WHO-DAS, 45.9% reported high or very high levels of distress as measured by the K10, and 28.1% had experienced more than seven days out of role in the past 30 days. These proportions were comparable to those for people who used other mental health services (37.8%, 51.9%, 49.9% and 30.1%, respectively). However they were significantly greater than those for people who had not used services on all measures except the WHO-DAS (13.5%, 35.9%, 23.5% and 12.0%, respectively).
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Harris et al also used a multivariate logistic regression model to compare Better Access psychological service users to other mental health service users and non-mental health service users on a comprehensive set of demographic, socio-economic and clinical variables. Severity was one of only two variables that distinguished between the service use groups. Specifically, having a severe disorder and having an affective disorder (either alone or in combination with another disorder, as opposed to an anxiety disorder alone) increased the likelihood of using a Better Access allied health service. There were no variables that distinguished Better Access allied health service users from other service users. That is, Better Access consumers appeared to have more severe and complex disorders than those who did not seek treatment, and were not less severely ill than those seen elsewhere in the mental health service system (e.g., in specialist mental health sector services).

These findings suggest that, as a rule, Better Access consumers are not typically people with mild symptoms. Most have clinically diagnosable disorders – predominantly depression and/or anxiety, but also substance use and other disorders – or have other indicators of treatment need. Most are experiencing significant levels of psychological distress.

Table 12: Clinical profiles of consumers who participated in component A1

Table 12 is separated into 2 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.

Diagnosis

Consumers recruited by clinical psychologists (n=289)2
Freq
Consumers recruited by clinical psychologists (n=289)2
%
Consumers recruited by registered psychologists (n=317)2
Freq
Consumers recruited by registered psychologists (n=317)2
%
Consumers recruited by GPs (n=277)2,3
Freq
Consumers recruited by GPs (n=277)2,3
%
Depression and anxiety4
99
34%
121
38%
113
41%
Depression without anxiety4
105
36%
117
37%
102
37%
Anxiety without depression4
66
23%
60
19%
38
14%
Other5
19
7
19
6%
24
9%

Pre-treatment K-10 score

Consumers recruited by clinical psychologists (n=289)2
Freq
Consumers recruited by clinical psychologists (n=289)2
%
Consumers recruited by registered psychologists (n=317)2
Freq
Consumers recruited by registered psychologists (n=317)2
%
Consumers recruited by GPs (n=277)2,3
Freq
Consumers recruited by GPs (n=277)2,3
%
10-15 (Low psychological distress)
13
5%
8
3%
8
3%
16-21 (Moderate psychological distress)
37
13%
43
14%
26
10%
22-29 (High psychological distress)
103
36%
93
31%
81
30%
≥30 (Very high psychological distress)
133
47%
159
53%
158
58%

Table 12 footnotes

1. Received care through Better Access between 1 Oct 2009 and 31 Oct 2010.
2. Consumers recruited by GPs may have received treatment from the GP in isolation or may have been referred to an allied
health professional for further care.
3. Cells do not always sum to the total n due to some missing data.
4. With or without alcohol and drug use disorders, psychotic disorders, and/or unexplained somatic disorders.
5. Alcohol and drug use disorders, psychotic disorders, unexplained somatic disorders, and/or unknown or missing diagnoses.

Footnote

f Other indicators of treatment need were a lifetime ICD-10 disorder, 12-month symptoms (but no lifetime diagnosis) for at least one disorder, or lifetime hospitalisation for a mental health problem.