There will be no additional sessions funded under the Better Access scheme as the federal government fully accepts seven of 16 recommendations from the review.
It’s taken over 18 months but the federal government has finally released its response to the December 2022 independent evaluation of the Better Access scheme, with one expert saying it was time for “serious commitment” and no more “snakes and ladders”.
The Better Access scheme, which began in 2006, allows GPs to refer some patients for 10 MBS-subsidised psychologist appointments each year. Approximately 1.3 million people receive therapy through the program yearly.
In August 2021, the University of Melbourne undertook an independent evaluation of the service, releasing their final report containing 16 recommendations in December 2022.
Over a year and a half later, the federal government has released a response to the evaluation, albeit in a Friday night news dump with no fanfare, welcoming the report and committing to “delivering a more equitable, comprehensive and sustainable mental health system”.
“There are significant gaps in services for people with mild mental health concerns and limited supports available for people with complex needs,” read the government response.
“The mental health system is fragmented and difficult to navigate.
“The system needs to evolve and move away from episodic care to holistic, person-centred and integrated care.”
Out of the 16 recommendations made by the independent evaluation, the government fully supported seven (1, 2, 3, 7, 8, 13 and 15) and supported two others “in principle” (6 and 11), all of which were already underway or complete.
It noted six recommendations (4, 5, 9, 10, 15 and 16) for “further consideration” and rejected one (12) to introduce additional treatment sessions as part of a tiered model under Better Access.
The required “whole-systems approach” to reform will involve “solutions to not only Medicare-subsidised services, but also to services across the system – from early intervention services to multidisciplinary services for people with complex needs”, said the government.
First on the list of supported recommendations was a plug for additional models of care to complement the Better Access scheme for those with complex needs.
Speaking to Health Services Daily, Professor Ian Hickie, co-director of the University of Sydney’s Brain and Mind Centre, said rather than simply “throwing money at new initiatives”, like the new Medicare mental health care centres potentially fragmenting care, the key was coordination.
“One of the biggest issues is, how do we use new technologies to increase access to care, but also the coordination of care,” said Professor Hickie.
“There’s no point in throwing good money at bad.
“I would not be in favour of the government throwing billions of dollars at mental health in the current system, because the waste would be huge.
“We’ve got to have structural reform and then have the new investments track that reform, and that’s got to be about better coordinated care [and] better triaging of care.”
The only evaluation recommendation not supported was to maintain 20 subsidised sessions in the Better Access scheme.
In early 2023, the health minister Mark Butler halved the subsidised sessions.
Professor Hickie reiterated his support for the move, which was “controversial among health professionals”.
“Limiting the amount of care has resulted in more people getting care, and waiting lists, interestingly, as reported by Australian Psychological Society recently, have gone down because more people are getting in.”
Professor Hickie said the Better Access scheme had moved away from the original intent of ensuring access was affordable and equitable.
While the program’s predecessor, Better Outcomes, employed distributional mechanisms to ensure money from the program was funneled regionally, most of the Better Access funding remains where there are higher practice densities of doctors: in metropolitan areas.
Professor Hickie was hopeful, after the meeting of mental health and health ministers of all levels last Friday, that all levels of government would offer “serious commitment” to “operate collectively” to coordinate care.
“[I am hopeful] that health ministers take a much more proactive role, so it does not become a fight just between treasurers, in which case we won’t see progress.”
While the private system “plays an important role” in mental health care, he said, a successful and equitable health system had to involve a coordinated and accessible public system outside of hospitals, particularly regionally.
“People aren’t going to get [equitable care] if it relies entirely on the private MBS system,” Professor Hickie told HSD.
“It’s always going to be difficult, because in Australia, that’s a small business model that preferentially funds professionals in city areas.”
Patients needed “smart assessment” of needs when entering the system and clear pathways for publicly funded care laid out, no matter the area.
“We have enough access points,” said Professor Hickie.
“What we don’t have is coordination and ongoing care.
“If you’ve got a complex problem, it’s a great game of snakes and ladders.”
Professor Hickie added that staffing of publicly-funded, multidisciplinary mental health care would need involve partnerships with the state health systems to bring in trainees – in psychology, psychiatry, mental health nursing – to make the care affordable to provide and improve system coordination.
Professor Hickie also put in a plug for outcome-based funding.
“We had it back in 2001 through to 2005 and the professionals didn’t like it, because they got paid at the end of an episode of care, not for every activity along the way.”
Dr Hickie said the National Health Reform agreement, which is currently under discussion, should incorporate a “much more serious focus on mental health”, and multidisciplinary care, rather than solely hospital funding.