Though AHPs noted a broad range of clients using services, generally clients tended to have a diagnosis of moderate to severe anxiety or depression, largely reflective of the prevalence of these conditions in the general population. Most services were provided in metropolitan areas, reflective of the geographic dispersion of the population and location of AHPs. Services were mainly provided to adults, with some children, fewer older people and few, if any, individuals in nursing homes receiving services. Access by Aboriginal and Torres Strait Islander people and individuals from culturally and linguistically diverse communities was described as low. Importantly, it was noted by AHPs that they rarely 'turned away' referrals and that the characteristics of individuals receiving services was determined by the referring GPs.
It was generally reported that the Better Access initiative was well established and that psychiatrists, GPs, AHPs and other mental health services in the community were well aware of services available and how the referral process operated. It was noted by GPs and AHPs that referral processes and pathways are continuing to improve as the Better Access initiative matures. There was also a perception reported by GPs, AHPs, consumers and carers that general awareness in the community as to availability of services through the Better Access initiative was increasing.
Despite the generally positive consumer outcomes reported by AHPs and GPs, the Better Access initiative was perceived by psychiatrists, GPs and AHPs as having minimal, if any, impact on the level of medications prescribed for mental disorders. Generally, it would appear from the consultations that the Better Access initiative operated as a complementary treatment option to pharmacological interventions:
- A small number of GPs noted that referral to an AHP sometimes allowed trialling non medical interventions or a treatment option for patients reluctant to accept medication;
- AHPs noted that some individuals initiating referrals to an AHP did so as they wanted an alternative to medication; and
- A small number of GPs and AHPs also noted that, on occasions, AHPs would refer back to the GP for a medication review to maximise the impact of the psychological therapies.
A contentious issue between clinical psychologists, psychologists and social workers was the differential Medicare rebate paid for services provided by clinical psychologists. It was argued by a number of psychologists and social workers that the difference in 'gap' allowed clinical psychologists who received a rebate of $37 to $46 per session more than a psychologist or social worker, to charge a lower gap. It was then argued that the lower 'out of pocket' cost to patients in turn encouraged GPs to refer patients to, and patients to seek referrals to, clinical psychologists resulting in the provision of services that were at a higher cost to Medicare. Though outside the scope of Component D of the evaluation, the issue of whether clinical psychologists offered a materially different service and achieved better outcomes for patients than did psychologists, social workers or occupational therapists was also questioned by many psychologists and social workers.
Prior to the Better Access initiative, there were a range of counsellors, psychotherapists and therapists providing fee-for-service counselling and therapy services in the community. Representatives of counsellors, psychotherapists and therapists not eligible to be approved providers under the Better Access initiative perceived the MBS rebate available through the initiative as providing an unfair competitive advantage to approved providers and having a detrimental effect on the financial viability of their members. These representative bodies also expressed concern that the Better Access initiative does not provide scope for psychoanalysis and long-term psychotherapy for more severe psychological disorders4 and that an expansion of eligibility to include their members would expand the availability of services and improve access to services.
Insurers consulted supported the Better Access initiative as it was seen as providing better outcomes for their members in the long term and prevented unnecessary hospitalisation. Subsequent to the introduction of the Better Access initiative, where members may have previously accessed psychologists and occupational therapists through their ancillary insurance cover, they can now do so only after they have accessed all services available through Medicare. As per MBS guidelines, ancillary cover is not available to pay the gap between the fee charged and MBS rebate paid.
4 Nor was it the intent of the Better Access initiative to do soTop of page