The Federal Government has announced that the number of mental health sessions made available to Australians under the Better Access initiative will be halved in 2023.
The Minister for Health and Aged Care, Mr Mark Butler, made the announcement in Adelaide on 12 December 2022, at the launch of an independent evaluation by the University of Melbourne – which revealed that while the scheme had broadened access to mental health services since its introduction in 2006, it had not delivered equally for all Australians.
“Broadly speaking, the evaluation finds that this program is very widely used, and outcomes from the program are largely positive, however, the report also shows that Better Access is failing some Australians,” Minister Butler said.
“Gap fees and wait times make it inaccessible and unaffordable for too many and the most disadvantaged Australians – those among us with the greatest need – have the least access to mental health services.”
The evaluation also considered the Morrison government’s temporary COVID measure to subsidise a further 10 sessions under Better Access, in addition to the existing 10 funded by the MBS.
“And under the former government’s arrangements, those additional 10 sessions were funded to the end of 2022,” Minister Butler said.
“In light of [the evaluation’s] findings, the Australian Government will not be extending the temporary additional 10 sessions beyond the expiration date of 31 December 2022.”
The report revealed that in 2021, Australians used only five sessions on average, with 83% of people using 10 or less, and while it saw benefit in those with more complex mental health needs continuing to access the extra treatment, the evaluation found that the initiative was not being appropriately targeted to reach these people.
In fact, all growth in services went to Australians with the highest levels of income, with the lowest income Australians receiving fewer mental health services over this period than they had before the introduction of the initiative.
Other key findings included:
- COVID has disproportionately impacted disadvantaged Australians
- The additional 10 sessions of treatment for people experiencing difficulties due to COVID accounted for 15% of all individual treatment sessions used in 2021
- The lowest income Australians have more than twice the levels of high or very high mental distress (22%) as those earning the most (9%)
- Those on lowest incomes were least likely to access services under this program and all indicators have worsened over time
- In 2022, less than half of those of low socioeconomic status were able to access treatment that included the additional 10 sessions
- Poor access for lower income Australians means that they are more likely to be prescribed medication, instead of being referred to a psychology service
- The location of provider services contributes to poor access by Australians living and living in rural areas, and lower socioeconomic areas in our major cities
- All additional services went to existing patients
- The number of new patients who were able to get into the system and access a psychology service declined by 7% over the course of the evaluation period
- The additional 10 sessions aggravated existing waitlists and other barriers to access
- With gap fees at an all-time high, people who could not afford them were often choosing to forgo their sessions
- Half to three quarters of participants paid at least some out-of-pocket costs, with those who did so typically paying between $80 and $100 per session
Finally, the evaluation also found that the additional sessions had not had an appreciable clinical impact: the baseline mental health reported in the evaluation was almost identical between those who have received the additional services and those who had not.
“The stark findings of the Better Access evaluation have provided us with an opportunity to address a variety of concerns so all Australians — no matter where they live or what their circumstances —can get the mental health care and support they need,” Minister Butler said.
“The evaluation reinforces the importance, going forward, of making sure that there is more equitable access to this important program for those groups who have been largely missing out.”
As such, Minister Butler also announced that the Government plans to convene a forum of key experts and people with lived experience of mental illness to assess the recommendations of the independent evaluation and provide reform advice on how to improve Better Access.
“I have not fixed a date yet, but I will make this commitment: that very early in the new year, I will be bringing together those groups to have a very frank discussion about what we can do going forward to continue to preserve the benefits of this program – because they are significant,” he said.
“But [we must] ensure that those benefits more equitably flow through the community.”
The forum will consider how to support access to higher levels of treatment for those who need it, while supporting equitable access for vulnerable and marginalised Australians.
Similarly, the Government will strengthen the Medicare Benefits Schedule (MBS) in the first half of 2023 to facilitate family and carer involvement in Better Access treatment and fund mental health case conferencing, based on compelling evidence in support of these changes provided by the evaluation.
Minister Butler also clarified that patients who have a mental health treatment plan and current referral for sessions (whether for the initial or additional 10) will still be able to use that referral to access up to 10 sessions in 2023, without having to go back to their GP.