Introduction by Croakey: Expanding the mental health workforce and improving access to digital mental health services in underserviced areas of Australia could significantly improve national mental health outcomes, a new study has found.
The paper by researchers at the University of Melbourne and Monash University, published in the Journal of Health Economics, analysed Medicare data to determine government spending on mental healthcare services in different regions.
Areas with lower spending on out-of-hospital mental health services, typically rural areas where accessing care from a psychiatrist or a psychologist is difficult, had higher rates of mental health-related emergency department visits, hospitalisations for self-harm, and suicides.
Suicide rates in rural Western Queensland, at 10.3 suicides per 100,000 population each year, are almost three times the level of urban Sydney.
Boosting out-of-hospital mental health services in these areas at a cost of about $150 million could lead to a 10 percent reduction in both mental health emergency department visits and suicides, and a 20 percent drop in hospitalisations for self-harm, the paper found.
This article was first published at The Conversation under the headline, ‘Just $7 extra per person could prevent 300 suicides a year; here’s exactly where to spend it’.
Karinna Saxby, Dennis Petrie and Sonja de New write:
Medicare spending on mental health services varies considerably depending on where in Australia you live, our new study shows.
We found areas with lower Medicare spending on out-of-hospital mental health services had poorer mental health outcomes, including more suicides.
This variation across the country was mostly related to factors such as a shortage of mental health providers and GPs, rather than people in some regions being in poorer mental health in the first place.
We also looked at how much extra government funding in today’s money would make a difference to people’s mental health across the population, using the latest data.
We worked out increasing government spending on out-of-hospital mental health services by A$153 million a year – about $7.30 per adult per year – could lead to:
- 28,151 fewer mental health emergency department visits (a 10 percent reduction)
- 1,954 fewer hospitalisations due to self-harm (a 20 percent reduction)
- 313 fewer suicides (a 10 percent reduction).
Services vs prescriptions
Here’s where our research suggests it’s best to target this extra funding.
We looked at Medicare-funded out-of-hospital mental health services, such as GP mental health visits, as well as visits to psychologists and psychiatrists. For the purposes of this article, we’ll call these Medicare-funded mental health services.
We also looked at mental health prescriptions (such as for depression or anxiety).
We looked at these services and prescriptions for the entire Australian population from 2011 to 2019.
We followed adults as they moved between regions to see how their use of mental health services and prescriptions changed after the move. This meant we could account for underlying individual factors, such as someone’s mental health needs.
Our study allowed us to assess how differences in the availability of mental health care across regions impacted how much the government spends on mental health services and prescriptions, and how this links to people’s mental health outcomes.
We found that only 28 percent of variation in spending on mental health services across regions was driven by patient-related factors, such as their need for mental healthcare. The rest was due to geographical reasons, such as availability of mental health providers and GPs.
But about 81 percent of the regional variation in spending on mental health scripts was due to patient factors.
In other words, when people experience mental health distress, accessing mental health medications, largely provided by a GP, is much easier than accessing care from a psychiatrist or a psychologist.
Areas with lower spending on out-of-hospital mental health services had higher rates of mental health-related emergency department visits, hospitalisations for self-harm, and suicides.
Mapping access
We also compared funding for people with the same “need” for mental health services across different regions. This was from the best access (the most funding) at 100 percent down to 0 percent (no access).
After controlling for factors such as socioeconomic background and underlying mental healthcare need, the region with the best access was the Gold Coast, with the highest Medicare spending on out-of-hospital mental health services.
The regions with the worst access were western Queensland and the Northern Territory. Here, a person with similar mental health-care needs would receive about 50 percent less in mental health service spending compared to someone on the Gold Coast.
Recommendations
Recent analyses suggest government mental health expenditure has barely changed in 30 years. It now sits at about 7.4 percent of the total health budget.
Our results suggest there is unmet need for mental health services across the board. But some regions are more affected than others.
So we should target extra funding to rural and low-income regions – particularly when considering expanding access to psychologists and psychiatrists.
Recent policy initiatives have tried to improve access to GPs. This includes creating financial incentives for providers to bulk bill and to practise in underserved regions.
However, these policies have had little or modest effects on boosting access to GPs. There has also been much less focus on attracting more specialty mental health providers, such as psychologists or psychiatrists, to underserved areas.
To address the disparities and unmet needs in mental health care, we recommend:
- expanding the mental health workforce: implementing targeted incentives to attract and retain psychologists, psychiatrists, and mental health-trained GPs in underserved areas
- reforming funding models: adjusting funding allocations and incentives to target regions where there is significant unmet need. Our map shows which regions should be targeted first
- improving access to digital mental health services: using technology to provide accessible mental health support, particularly in areas with limited in-person services, while ensuring digital solutions are integrated with traditional care pathways.
Author details
Karinna Saxby is a Research Fellow, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne. Karinna Saxby receives funding from the University of Melbourne McKenzie Fellowship.
Dennis Petrie is Professor of Health Economics, Centre for Health Economics, Monash University. Dennis Petrie receives funding from National Health and Medical Research Council (NHMRC), Medical Research Future Fund (MRFF), Australian Research Council (ARC), Transport Accident Commission (TAC), National Disability Insurance Agency (NDIA), Department of Health, Disability and Aged Care, Department of Social Services (DSS), Breast Cancer Trials and WISE (Employment Service Provider).
Sonja de New is Associate Professor, Centre for Health Economics, Monash University. Sonja de New receives funding from the Australian Research Council (ARC) and the National Health and Medical Research Council (NHMRC).
Support services
Lifeline: 13 11 14 or text 0477 13 11 14 for 24/7 crisis support and suicide prevention services
13YARN: 13 92 76
1800Respect: 1800 737 732
The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP)
Suicide Call Back Service: 1300 659 467
Kids Helpline: 1800 55 1800
MensLine Australia: 1300 78 99 78
Beyond Blue: 1300 22 4636
QLIFE: 1800 184 527
StandBy Support After Suicide: 1300 727 247
headspace: 1800 650 890
See Croakey’s archive of articles on mental health
