how Australia’s mental health system is failing those who need it most

Australian pride in our universal health system stems in part from our belief that services should be more accessible to those who need them most. Logically, this should apply as much to mental health as to other parts of the health system.

But our new research notes that Australia’s mental health system is not equitable in this way.

While Australians living in the most deprived areas experience the highest levels of mental distress, they appear to have the least access to mental health services.

Mental health disparities

To understand levels of mental distress in the population, we looked at data from the Australian Bureau of Statistics (ABS). The ABS classified levels of mental distress according to Kessler Psychological Distress Scale (K10).

Use of this information and demographic data of the censuswe calculated that 29% of Australian working-age adults in the lowest income households experience high mental distress. This figure compares to around 11% in the highest income households.

About 6% of working-age adults experience “very high” mental distress, indicating severe distress and most likely a mental disorder. Our analysis showed that around 14% of the lowest income households meet this threshold, compared to just 2% of the highest income households.

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This obvious link between mental distress and socio-economic disadvantage exists both in Australia and internationally.

Mapping inequalities

We first looked at federally funded Medicare mental health services, largely provided through the Medicare program. Better Access Initiativeto establish the extent to which these are fairly – or not – distributed. These services are provided by general practitioners, psychiatrists, psychologists and paramedical professionals (social workers and occupational therapists).

Better Access has shown solid initial results in lifting overall access to mental health services in 2006-2010. However, more recent data suggest that this has plateaued.

We calculated the total number of Medicare-subsidized services provided in a year and divided it by the number of people most in need of those services. We defined this group in our study as those with “very high” mental distress according to the K10 scale. This gave us an average number of services available per person. For our calculations, we assumed that all services were accessible to those most in need of care.

In 2019, if all people most in need had equal access to mental health care, each person would benefit from an average of 12 services. The map below highlights regions where the average is higher (darker shades) or lower (lighter shades). This shows significant inequalities and gaps in services.

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Traditionally, comparing the use of mental health services between regions has been difficult due to different levels of need for care. So, as part of our research, we created what’s called an equity indicator.

The equity indicator makes it possible to compare apples with applesfocusing on a key group: those most in need of mental health services. Essentially, we can take one area with wealthy residents and another area with a poorer population and compare them to see how those who need it most access services.

We found that the equity metric was six for Medicare-subsidized mental health care in 2019. This means that among those most in need of care, people living in the poorest areas received six times fewer mental health services subsidized by Medicare than those living in the poorest areas. richest areas.

In 2015, the indicator was five. Inequalities have therefore increased over time.

Community Mental Health Services

We then looked at public community mental health services. These are primarily outpatient services from public hospitals and a few other community services not funded by Medicare. We wanted to understand whether poorer Australians were accessing these services, thereby balancing the apparent inequity of Medicare.

When we included these services in our calculations, the equity indicator dropped from six to three. In other words, people with the greatest need for care living in the poorest areas received three times fewer mental health services (community services and Medicare-subsidized services) than those in the richest areas.

In 2015, the equity indicator was 2.6, demonstrating once again that inequalities are increasing.

How can we bridge the gap?

Rates of mental distress and demand for mental health services vary across socioeconomic areas. But our analysis paints a picture of a two-tier mental health system, in which the “poor” rely more on public community mental health services while everyone else relies on Medicare.

People with the greatest need for mental health care living in poorer areas might have access to fewer Medicare mental health services for several reasons. For example, reimbursable expenses are increasing, which risks creating financial barriers for many. There is also a lack of services in many rural areasmany of which are relatively deprived areas.

Although community mental health services appear to partially alleviate socioeconomic disparities Mental health services subsidized by Medicarethe two types of services cannot be considered equal or comparable.

Medicare services are largely provided to people with less severe mental health care needs. Conversely, public community mental health services typically treat people facing serious or complex mental illness in times of acute distress.

Community mental health services are more and more tense and does not replace Medicare-subsidized mental health care in socioeconomically disadvantaged areas.

Improving access to Medicare mental health services could even help prevent some of these episodes more acute, potentially alleviating some of the pressure on community mental health services.

A big part of the problem is that these two programs were not designed to complement or work together. They operate separatelymainly for different clients, rather than as part of an overall package »staged care” model.

We need to properly configure these larger pieces of our mental health services puzzle into a more contiguous design, which will reduce the risk of people falling into dangerous cracks.

This goal can be achieved through better, more coordinated planning between federal and state mental health services, and funding research to better understand who is really affected. access current services.