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how Australia’s mental health system is failing those most in need
Dec
Australian pride in our universal healthcare system partly comes from our belief that services should be as accessible as possible to those who need them most. Logically, this should apply equally to mental health as it does to other parts of the healthcare system.
But our new research states that the Australian mental health care system is not equitable in this way.
Although Australians living in disadvantaged areas experience the highest levels of mental distress, they appear to have the least access to mental health services.
Mental health disparities
To understand the level of mental distress in the population, we looked at data from: Australian Bureau of Statistics (ABS). The ABS classifies levels of mental disorders according to: Kessler Psychological Stress Scale (K10).
Exploit of this information and demographic information from the Censuswe calculated that 29% of working-age Australian adults in the lowest income households experience increased mental stress. For comparison, in households with the highest incomes this figure is approximately 11%.
About 6% of working-age adults experience “very severe” psychological distress, which indicates earnest distress and most likely a mental disorder. Our analysis found that about 14% of the lowest income households meet this threshold compared to just 2% of the highest income households.
There’s a clear connection between psychological distress and socio-economic disadvantage exists both in Australia and around the world.
Mapping inequality
First, we examined federally funded Medicare mental health services largely provided under Better Access Initiativeto determine how fairly – or not – they are distributed. These services are provided by general practitioners, psychiatrists, psychologists and allied health professionals (social workers and occupational therapists).
Better Access has shown good initial results in improving overall access to mental health services in 2006–2010. However, newer data suggest that the situation has stabilized.
We calculated the total number of Medicare-subsidized services provided in a year and divided it by the number of people who most need those services. In our study, we defined this group as people with “very high” psychological distress on the K10 scale. This gave us the average number of services available per person. For our calculations, we assumed that all services were used by those most in need of care.
If in 2019 all people most in need had equal access to mental health care, each person would receive an average of 12 services. The map below highlights regions where the average is higher (darker shades) or lower (lighter shades). It shows significant inequalities and gaps in services.
Traditionally, comparing the utilize of mental health services across different areas has been challenging due to: varying levels of need for care. So as part of our research, we created something called the equity ratio.
The equity index allows us to compare apples to apples by focusing on a key group – those most in need of mental health care. Essentially, we can take an area with a wealthy population and another area with a poorer population and compare them to see how those most in need access services.
We found that in 2019, the equity index for Medicare-subsidized mental health care was six. This means that among those most in need of care, those living in the poorest areas received six times fewer Medicare-subsidized mental health services than those living in the wealthiest areas.
Looking back to 2015, the rate was five. So inequality increased over time.
Community mental health services
We then looked at public mental health services. These are primarily public hospital outpatient services and some other community services not funded by Medicare. We wanted to understand whether poorer Australians had access to these services, redressing the apparent inequality in Medicare.
When we included these services in our calculations, the equity ratio actually dropped from six to three. In other words, those most in need of care living in the poorest areas received three times fewer mental health services (social services and Medicare-subsidized services) compared to those in the wealthiest areas.
In 2015, the equity ratio was 2.6, again indicating increasing inequality.
How can we fill the gap?
Rates of mental disorders and the need for mental health services vary across socioeconomic areas. However, our analysis paints a picture of a two-tiered mental health care system in which the “indigent” are more dependent on public community mental health services while everyone else relies on Medicare.
People most in need of mental health care and living in the poorest areas may have access to fewer Medicare mental health services for many reasons. For example, out-of-pocket costs are increasing, which will likely create financial barriers for many people. Many cities also lack services rural areasmany of which are relatively disadvantaged areas.
Although community mental health services appear to partially alleviate socioeconomic disparities in Mental health services subsidized by Medicarethese two types of services cannot be viewed as equal or comparable.
Medicare services are largely provided to people with less severe mental health care needs. Conversely, public mental health services typically treat people struggling with severe or sophisticated mental illness during periods of acute distress.
Community mental health services are more and more stretched and does not replace Medicare-subsidized mental health care in socioeconomically disadvantaged areas.
It may even improve access to Medicare mental health services help prevent some of these more acute episodes, potentially alleviating some of the pressure on community mental health services.
Ground photo/Shutterstock
A huge part of the problem is that these two shows were they were not designed to complement or work together. They act separatelyprimarily for different clients rather than as part of an overallgraduated caremodel.
We need to properly configure these larger pieces of our mental health services puzzle into a more cohesive design that will reduce the likelihood of people falling through hazardous cracks.
This can be achieved through better and more coordinated planning between federal and state mental health services and funding research to better understand who really accesses current services.
