The landmark Better Access mental health reform has provided demonstrably effective, cost-efficient and accessible psychological services for millions of Australians with common mental health disorders since it was introduced in 2006. The availability of psychological treatment through Australia’s Medicare scheme has significantly increased the treatment rates of people with mental health disorders and reached large numbers of people who did not access mental health care in the past, and has facilitated significant destigmatisation of help-seeking for mental health problems. This has been a huge advance for the mental health of the Australian community.
These significant and hard-won achievements as the result of Government mental health policy need to be protected and built on. Recent funding cuts are eroding the effectiveness of this highly successful program. It is imperative that the Government provides the appropriate level of funding to ensure that many thousands of Australians with serious yet all too common mental health disorders can continue to access effective and cost-efficient psychological treatment.
Read important details of the APS Better Access campaign on this regularly updated page.
The APS has used the results of a new study on mental health service usage under Medicare (published in the Medical Journal of Australia) to call for the Better Access initiative to be expanded so that all Australians can access mental health treatment offered by psychologists. The study showed that Better Access is working, as evidenced by increased rates of psychological treatment across the study period, but there was a relatively lower usage of Better Access services in areas of socioeconomic and geographic disadvantage. The APS has identified incentives to increase psychological service provision to these areas, such as those used to increase medical services in rural areas. The APS has also called on the Government to release the National Mental Health Commission’s report of the review of mental health services to start an informed and consultative debate on improving access to psychological services for all Australians.
The APS has contributed to the Federal Government’s 2014-15 Budget planning following the call for pre-Budget submissions. The APS submission was prepared with recognition of the difficult fiscal environment in which the Government is operating, and was underpinned by principles of effectiveness, efficiency and equity.
One of the key recommendations of the APS submission was that funding be allocated to improving access to services for people with complex mental health issues and challenging life situations and/or comorbidities through restoring the number of Better Access sessions per annum to 18. The number of Medicare-rebated sessions of psychological treatment was cut from 18 to a limit of 10 sessions per calendar year following funding cuts in 2013. Partially as a result of these cuts, there are major gaps in the mental health system for mental health consumers with complex needs who do not meet the criteria for public mental health services. Studies by the APS and others have demonstrated that access to additional psychological treatment sessions is effective and necessary for these people. The APS pre-Budget submission stressed that the restoration of the number of allowable sessions of treatment to 18 for a specific group of mental health consumers would provide an effective and cost-efficient means of providing sufficient evidence-based treatment to this cohort to achieve vastly improved clinical outcomes.
The APS has also continued to emphasise the need for the reinstatement of the 18-session per annum limit in proactive advocacy in relation to the Government’s National Mental Health Services Review which was undertaken by the National Mental Health Commission last year. The report from the Review was handed to the Government in December last year and the Government has indicated that it will provide a response to the review in early 2015. The APS has called for the report of the National Mental Health Commission’s Review to be released publicly as soon as possible.
The cover feature for the October 2014 edition of InPsych highlights psychological treatments for high prevalence mental health disorders, in order to present a final showcase of psychology’s expert contribution in the lead-up to the completion of the National Mental Health Services Review. The special feature showcases a summary compendium of evidence-based psychological treatment guidance from a panel of expert Australian psychologists for eight of the commonly occurring mental health disorders – depressive disorders, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, adjustment disorder, substance use disorders, childhood behaviour disorders and childhood anxiety disorders. The special feature also presents a discussion of the evidence for the cost-effectiveness of psychological interventions for high prevalence mental health disorders as well as some service delivery responses to facilitate access to psychological treatment for harder-to-reach consumer groups.
The InPsych special feature directly supports APS advocacy for the Better Access initiative as a Government program providing access to funded psychological interventions for high prevalence mental health disorders. The special feature has been disseminated widely to the National Mental Health Commission, politicians and their advisors and senior bureaucrats. In the context of the Government’s Review which is “aimed at delivering mental health services and programmes more efficiently and effectively”, the APS is emphasising that access to funded psychological interventions through the Better Access initiative is certainly one of the most effective and cost-efficient ways of delivering treatment for high prevalence mental health disorders.
The APS has proactively taken steps to have significant input into the Government’s National Mental Health Services Review which is being undertaken by the National Mental Health Commission. The APS has met with National Mental Health Commissioners and senior officers including the CEO, the Health Minister and his advisors, and other influential Members of Parliament and senior bureaucrats to highlight the vital role of psychological knowledge and treatment within Australia’s mental health system. A significant focus of ongoing APS advocacy in the context of the Review has been the major achievements of the Better Access initiative as a landmark mental health reform that has provided demonstrably effective, cost-efficient and accessible psychological services for millions of Australians with common mental health disorders.
Although the Federal Budget announced many cuts to services and benefits, mental health was not a focus. There were no measures that directly impacted on community access to psychological services provided under the Better Access initiative. However, it is important to note that there is wide recognition that the National Mental Health Services Review currently being undertaken by the Government and due to be completed at the end of November this year is likely to see significant changes to funded mental health programs. The APS advocacy work for the maintenance of Better Access is therefore certainly not over and will continue over the coming months.
There were no measures in the 2014 Federal Budget that impacted on the structure and funding for psychological service provision under the Better Access initiative, which was very welcome news as the APS advocated strongly for the maintenance of Better Access in the lead-up to this year’s Budget.
The annual indexation of Medicare rebates and schedule fees, which was due to occur on 1 July this year, will now be deferred until 1 July 2016 for all Medicare-funded services (except GP services). This means that the current rebates for Medicare items provided by psychologists under Better Access will remain at the level they are.
The APS has ascertained that the patient contribution of $7 that will apply to GP attendances (and out of hospital pathology and diagnostic imaging services) from 1 July 2015 is not applicable to psychology services provided under Medicare.
In the lead-up to the Federal Budget, the APS has strongly advocated that spending cuts should not impact on community access to psychological services and that there needs to be a strong psychology workforce to deliver such services. Professor Littlefield has met with the Federal Health Minister, Peter Dutton, and was able to stress to him the remarkable success of Better Access and the substantial community impact of any funding cuts to the initiative. Although she was not able to get any firm indication that there would be no changes to Better Access in the Federal Budget, she felt that the Minister listened attentively to the information that was provided. This high level meeting followed a number of other similar meetings Professor Littlefield has held with Alan Fels, the Chair of the National Mental Health Commission, David Butt, the CEO of the National Mental Health Commission, and senior bureaucrats in the Department of Health in relation to Better Access.
The Federal Health Minister, Peter Dutton, is to be congratulated for his recent announcement that 150 mental health programs will continue to receive funding for the 2014-15 financial year, as this provides reassurance for consumers of those programs and the capacity for effective planning of service delivery. The APS is seeking a similar assurance for continued funding of the Better Access initiative, which is not considered to be one of the 150 programs applicable to the Minister’s announcement.
As the Federal Government finalises its plans for the May Federal Budget, the APS has stepped up its advocacy campaign. Professor Littlefield has a scheduled meeting with Health Minister Dutton in April and will stress that the Government must honour its commitment to maintain frontline mental health services, of which Better Access is a shining example. This high level meeting follows other recent engagements with senior members of the Federal Government, their advisors and senior bureaucrats, as well as a number of media interviews, where strong advocacy for the maintenance of Better Access funding has been undertaken.
A new Australian health policy study has found a significant increase in the population treatment rate for mental disorders in Australia from 37% in 2006–07 to 46% in 2009–10. The study authors attribute this increase to the introduction of the Better Access initiative in November 2006, which allowed people with mental disorders to access psychological treatment under the Medicare system for the first time. Writing in the Australian Health Review, Harvey Whiteford and colleagues stated that the increase in the treatment rate is “remarkable by international standards. No other country of which we are aware has demonstrated such an increase within three years.”
Commonly occurring mental disorders such as anxiety, depression and substance use are leading causes of disease and disability in Australia, with major economic costs and personal suffering associated with untreated mental disorders. Previously only one third of people with these disorders accessed treatment. The study authors expect treatment rates to continue to rise with ongoing Medicare-funded access to psychological treatment, and stressed that good outcomes require access to evidence-based treatment. Psychological interventions for common mental disorders such as depression and anxiety have a strong research base indicating their effectiveness.
In 2013 the APS conducted a study of Better Access consumers to assess the impact of the reduction in the number of allowable psychological sessions under Better Access, which took effect from 1 January 2013. Better Access consumers were limited to 10 sessions of psychological treatment per year (down from a maximum of 18 sessions of treatment per year when the initiative was first introduced). The APS undertook a study of 900 consumers who, at the end of the allowable 10 sessions of treatment in 2013, were judged by their treating psychologist to need further treatment. The study aimed to investigate the nature of these clients and the additional treatment arrangements that were put in place by the treating psychologist.
Results indicate that 86 per cent of clients who were deemed to need more treatment than the allowable number of sessions had high prevalence depression and/or anxiety disorders, with 90 per cent having moderate or severe presentations. The study results show that for nearly a quarter of these clients, further treatment was postponed to the new calendar year due to the lack of alternative treatment arrangements, while the need for additional treatment for half of these clients was managed by the psychologists providing treatment either free of charge or at a reduced rate. The outcome of the cuts to the number of allowable sessions under Better Access is clearly very unsatisfactory for affected consumers with serious high prevalence mental health disorders, and it is not sustainable for psychologists to be ‘carrying’ the financial burden for the Government’s cuts.
The seventh anniversary of the introduction of the Better Access initiative is being used in the APS advocacy campaign to highlight the success of this landmark mental health initiative. After seven years of community access to Medicare-funded psychology services, the broader impact of the Better Access initiative and the effect of the cuts to the number of treatment sessions on Better Access consumers has been examined in a new APS report (published in the December 2013 edition of InPsych). The report highlights the success of Better Access and the impact of the funding cuts, and will support the APS advocacy in relation to the new Government’s comprehensive review of Commonwealth mental health programs.
The APS is continuing its campaign for the reinstatement of the Better Access ‘exceptional circumstances’ sessions and has set up a series of meetings with relevant Ministers in the new Federal Government. The Coalition Government has asked the National Mental Health Commission to conduct a comprehensive review of all existing mental health programs to ensure that funding is provided to those proven to be most effective on the frontline at delivering services to people who are most in need. The APS is preparing a submission to this review and will advocate strongly for the maintenance of existing funding for all current mental health programs, including the highly successful Better Access initiative.
Members are urged to provide data for the 2013 APS Better Access study investigating the impact of the 2013 session cuts, which will assist in informing APS advocacy.
On 27th August, the Australian Greens announced their mental health policy for the Federal election, which included the reinstatement of the exceptional circumstances sessions under the Better Access initiative that were lost in recent funding cuts. The Greens’ costed policy to reinstate the additional sessions of psychological treatment under refined criteria is based on a proposal developed by the APS to ensure that people with serious high prevalence mental health disorders can access the extra sessions of effective and cost-efficient psychological treatment they require. The APS policy was presented to politicians from the three major parties in the context of the upcoming Federal election, and it is very pleasing to see that this has been adopted in the Greens mental health platform.
In the context of the September Federal election, the APS has prepared a number of costed initiatives that have been presented to Federal politicians from the major political parties, including a costed proposal to reinstate the Better Access initiative. The initiatives span 10 areas where there are real opportunities to bring significant benefits to the Australian community by increasing access to effective psychological care and knowledge.
The APS has contributed an article on Better Access to a new strategic publication by the Mental Health Council of Australia, Perspectives: Mental Health and Wellbeing in Australia, which was published earlier this month. The APS article, titled ‘Funded Psychological Treatment in Primary Care’, discusses the impact of the Federal Government’s mental health reforms over the last decade including the highly successful Better Access initiative. The article argues that Better Access has been a huge advance for the mental health of the Australian community and that it is imperative that recurrent Government funding is provided to maintain these gains.
The accumulating data from the 2013 APS Better Access survey has provided information on over 400 clients seen by APS psychologists in 2013 who, at the end of the allowable 10 sessions of treatment, were judged by the psychologist to need further treatment. Results indicate that 78 per cent of these clients had moderate to severe presentations, with the most prevalent mental health disorders being depression, anxiety and posttraumatic stress. For nearly a quarter of these clients (22%), further treatment was postponed to the new calendar year due to the lack of alternative treatment arrangements, while the need for additional treatment for nearly half of these clients was managed by the psychologists providing treatment either free of charge (17%) or at a reduced rate (32%).
The outcome of the cuts to the number of allowable sessions under Better Access is clearly not satisfactory for these clients with moderate to severe mental health disorders, nor is it sustainable for psychologists to be ‘carrying’ the financial burden for the Government’s cuts. With major problems in access to alternative care, the APS has urged the Government to find a permanent solution under Medicare for those affected by the changes.
Clients who commenced treatment with a psychologist under the Better Access initiative at the beginning of 2013 have started to reach the 10 session limit per calendar year, and the reductions to the session allowance this year will increasingly have an impact. APS advocacy for the reinstatement of the exceptional circumstances sessions under Better Access is continuing, as is the overall advocacy with both the Government and the Opposition for the maintenance of this highly successful and cost-effective mental health initiative.
To inform the APS advocacy, members are invited to participate in the APS Better Access Survey 2013. The aim of the 2013 survey is to collect data on clients seen by APS psychologists under the Better Access initiative in 2013 who, at the end of the allowable 10 sessions of treatment, were judged by the psychologist to need further treatment. The study aims to investigate the nature of these clients and the additional treatment arrangements that were put in place. The survey will remain open for the 2013 calendar year and data can be entered at any time. It is recommended that data for relevant clients is entered close to the time when their 2013 episode of treatment ended.
The APS has tendered its Budget submission ahead of the setting of the 2013-14 Federal Budget, which contained a measure to improve access to psychological services for all Australians by restoring the six sessions for exceptional circumstances under the Better Access initiative for clients meeting specified criteria. The APS Budget submission is being followed up with personal advocacy with key Ministers and their Advisors.
Although the APS will continue its advocacy and negotiations with the Federal Government, members need to be aware that from 1 January 2013 the ‘exceptional circumstances’ sessions are no longer be available. The maximum number of sessions of psychological treatment that a client can receive in the 2013 calendar year is 10 sessions.
A new APS study of Better Access clients has been undertaken to inform the campaign for permanent reinstatement of the exceptional circumstances sessions, given the effectiveness of the 2011 APS study in assisting APS advocacy. The 2012 study results will be presented to the Minister for Mental Health and Ageing, the Hon. Mark Butler, and his advisors in meetings in November. On the basis of the study results, the APS has prepared a funding proposal to present to the Minister to enable those many thousands of Australians with serious high prevalence mental health disorders to continue to access the appropriate length of effective and cost-efficient psychological treatment under the highly successful Better Access initiative.
The APS has prepared a Briefing Paper with background information on the APS advocacy campaign, the results of the APS 2012 study and the funding proposal to the Australian Government for the continuation of the Better Access ‘exceptional circumstances’ sessions. A media release has also been prepared as part of this advocacy.
The steady decline in the use of antidepressants and anti-anxiety medications in Australia has been attributed to increased access to psychological treatments under the Better Access initiative.
A study examining data from the Australian Bureau of Statistics and the Australian National Health Survey — published in the May 2012 edition of the Australian and New Zealand Journal of Psychiatry — found that the rates of psychological distress had remained steady. Survey data related to 48,000 adults aged over 25 for the period 2001 to 2008.
Professor Michael Berk, Chair in Psychiatry at Deakin University, told Medical Observer that he believes the decline in use of antidepressants may be due to the introduction of Better Access, and a “shift from antidepressants as a primary treatment strategy to psychological treatments”.
He said that the more widespread access to psychological therapies put Australia at the forefront of mental health reform.
The interim arrangements to reinstate the ‘exceptional circumstances’ sessions under the Better Access initiative commenced on 1 March 2012, enabling eligible clients to access up to a total maximum of 16 sessions of treatment from a psychologist in the 2012 calendar year. The interim arrangements only apply for a transitional period from 1 March to 31 December 2012.
The additional six sessions of Better Access treatment under exceptional circumstances will be reinstated for a transitional period, a decision announced by the Federal Government on 1 February. The increased allowance, available from 1 March until 31 December this year, aims to protect clients with complex needs who have been left without support following the 1 November 2011 changes to the Better Access initiative. The Government’s rationale for the decision is to provide time for capacity to be built into alternative mental health services where people with greater needs can be treated.
This decision is a direct reflection of the strong and persistent APS advocacy efforts, as well as those of individual members, since the cuts were first announced in last year’s Federal Budget. The reinstatement of the sessions is extremely important for vulnerable people with more complex mental health disorders who have been left without access to appropriate treatment as a result of the funding cuts. The APS will continue to press for the reinstatement of sessions to be made permanent.
The APS has proposed adjustments to the Better Access initiative as part of its Pre-Budget Submission to Federal Government. Many vulnerable Australians have been left without appropriate support following the cuts to the program in November. The APS has developed and costed an alternative solution which will protect the most vulnerable, at minimal cost to the Government – a proposal which has won media attention, in outlets such as The Australian, following interviews conducted by Lyn Littlefield (see media report at right).
The APS advocacy and negotiations around the cuts to the Better Access initiative have continued since the cuts were first announced in this year’s Federal Budget. Although the APS has persistently called for the Better Access cuts to be reversed, when it was clear that the cuts were going ahead from 1 November 2011, the APS proposed an alternative measure. This was to retain the additional sessions of psychological treatment under exceptional circumstances for Better Access consumers, with some changes to ensure appropriate usage. The proposal involved a stipulated criterion for access to the additional sessions based on a measure of the severity of the mental health condition, such as a nominated cut-off score on a mental health assessment instrument. This alternative measure is estimated to result in retaining nearly 70 per cent of the stated Budget savings. The proposal has been presented to the Prime Minister and the Minister for Mental Health, and will also be included in the APS 2012 Federal Budget submission.
In the lead-up to the release of the report from the Senate Inquiry in November 2011, the APS put forward this proposal to the Senate Committee and it was very pleasing to see that this alternative position was included as one of the recommendations from the Senate Inquiry. The proposal was subsequently incorporated into recommendations by The Greens for an interim program, as detailed in a media release by Senator Penny Wright on 24 November 2011.
The focus of the APS advocacy now is to demonstrate the impact of the Better Access cuts, with a view to having the exceptional circumstances sessions reinstated under tightened criteria in the 2012 Federal Budget. To this end, the APS will be conducting a survey in February next year to gauge the impact of the cuts on those consumers who were affected from 1 November when the changes were introduced. APS members will be asked to provide data on clients to whom this is applicable, and the aggregated data will be used to strengthen the APS campaign. Members will be invited to participate in this survey early next year.
The APS campaign against the cuts was strengthened in June 2011 through the collection of data on the potential impact of the cuts on nearly 10,000 clients who received treatment from psychologists in 2010. The APS study provided compelling evidence in support of the retention of the annual session allowance of 18 sessions of psychological treatment under the Better Access initiative. The research demonstrated that the removal of eight sessions will have a dramatic impact on many thousands of Australians with severe mental health problems, who will be denied effective treatment. APS media releases and reports were prepared highlighting the results of this research study.
In June 2011 a Senate Inquiry into Commonwealth funding and administration of mental health services was established, which included an investigation of the impact of the cuts to the Better Access initiative. The APS prepared a submission to the Inquiry which can be downloaded below. The Senate Inquiry received over a thousand submissions and also conducted a public hearing program to which the APS was invited to present. The Senate Committee released its report on 1 November 2011 and is to be congratulated on its recommendations.