This section reports on the outcome of consultation with consumers and carers.

4.9.1 Summary of findings from consumers and carers
4.9.2 Satisfaction with services
4.9.3 Affordability of services
4.9.4 Access to services
4.9.5 Recommendations of consumers

4.9.1 Summary of findings from consumers and carers

Consumers, carers, and consumer and carer advocacy groups were unanimous in their support for the Better Access initiative. The initiative is highly valued by consumers and carers and perceived as providing improved mental health outcomes. Many consumers and carers reported the benefits that they have realised through services provided through the Better Access initiative as life changing. They feel better, and feel able to take more control over their life; it has improved their life and that of their families. For many consumers with a long history of anxiety or depression, access to psychological therapies through the Better Access initiative has allowed them to gain improvements previously unavailable through their GP, psychiatrist or episodic admissions to a psychiatric hospital. These consumers reported that they are able to return to, or remain in the workforce, and the instances of self harming behaviours have reduced, as have the number of times they have been admitted to hospital because of their mental health problems.

For consumers with higher prevalence disorders who are not able to receive services through the public mental health system, the Better Access initiative provides a rebate for services provided by allied health professionals. Consumers and carers reported that, without this rebate, many consumers would be simply unable to afford and unable to access mental health services, or at least at such an intensive level. Many simply went without services or were reliant solely on their GP for assistance with their mental health problems.

4.9.2 Satisfaction with services

Consumer respondents to the online survey also reported high levels of satisfaction with the services that they received: 70 per cent were satisfied, 18 per cent were dissatisfied and 13 per cent unsure (see Table 14).

A better indicator of the valuing of the Better Access initiative by consumers is that 86 per cent of respondents to the online survey would recommend the services to a family member or friend, with only five per cent indicating that they would not recommend referral (see Table 15).

Table 14: Consumer perception on degree services met needs

Overall, did the services meet your needs? (number of respondents)
RegionVery satisfiedSatisfiedNeither satisfied or dissatisfiedDissatisfiedVery dissatisfiedDid not respondTotal
Major City
31
27
12
5
5
6
86
Inner Regional
3
11
2
2
2
20
Outer Regional
2
5
2
3
12
Remote
1
1
Very Remote
1
1
(blank)
1
1
3
5
Total
36
44
15
11
10
9
125
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Table 15: Consumer rated likelihood of referring family or friend

If a family member or friend were experiencing a mental health problem, would you recommend to them that they seek a referral to a therapist from their GP through Medicare?(number of respondents)
RegionYes, certainlyPossiblyNot sureUnlikelyNoDid not respondTotal
Major City
58
15
6
1
6
86
Inner Regional
15
3
1
1
20
Outer Regional
5
1
3
2
1
12
Remote
1
1
Very Remote
1
1
(blank)
2
3
5
Total
78
22
10
4
2
9
125

4.9.3 Affordability of services

For those consumers and their families who were previously obtaining services from private providers, the Better Access initiative has made services more affordable. For people on a low income, struggling to pay $80 to $150 per week to see a private psychologist or social worker,76 it meant that they and their family had to go without other things. A couple of consumers reported missing meals because of the cost of therapy, while others reported the financial drain on their families. Consumers who experienced financial hardship as the result of the cost of therapy, either paying the full cost or after the MBS rebate, reported that they did so as the benefit of the therapy outweighed its cost.

Consumers seeing social workers and psychologists through the Better Access initiative were most likely to talk about the unfairness of the lower rebate paid for seeing these professionals, compared to that for seeing a clinical psychologist, particularly when they valued the services of the psychologist or social worker and/or were seeing them because of their professional background and expertise in a particular area of treatment or therapy. Three consumers expressed concern that they did not receive a rebate for the counsellor that they were seeing but did not want to change providers because of the perceived value of the therapy being provided.

Overall, the consumers interviewed reported improved affordability. Approximately half of those interviewed thought services were affordable, while many of the consumers interviewed were receiving low gap or no gap services. Of the consumers responding to the online survey, 56 per cent agreed with the statement that, as a result of the Better Access initiative, mental health services were now more affordable (see Table 16).

While the MBS rebate has increased affordability, many AHPs still charge a gap payment and affordability remains a barrier in access to service for many people from low socio economic backgrounds. Thirty six per cent of consumers responding to the question on affordability strongly disagreed (14 per cent) or disagreed (22 per cent) with the statement that services were affordable.

Table 16: Consumer perception on affordability of services

Overall, to what extent do you agree that the services were affordable? (number of respondents)
RegionStrongly agreeAgreeUnsureDisagreeStrongly disagreeDid not respondTotal
Major City
14
31
6
20
11
4
86
Inner Regional
3
8
3
3
3
20
Outer Regional
1
7
1
1
2
12
Remote
1
1
Very Remote
1
1
(blank)
1
1
3
5
Total
18
48
10
25
17
7
125
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4.9.4 Access to services

Consumers in some regional areas reported that the real increase in the number of AHPs meant that services were now available in areas where previously there were no mental health services. The consultation process included very few consumers from rural and remote areas. Those that did participate in the teleconferences from more remote areas indicated that service availability was the major impediment to access and that this had not improved through the Better Access initiative. One consumer from a remote area reported service availability reducing as a result of the Better Access initiative and AHPs being less willing to provide 'fly in fly out' services.

Forty seven per cent of consumers responding to the question on service availability in the online survey agreed that services were available in their local area and 53 per cent did not think services were available (32 per cent) or did not know whether services were available or not (21 per cent). Neither of the respondent from the remote and very remote areas thought services were available in their local area (see Table 17).

The option of remote access teleconferencing or VOIP based therapy was also discussed. This was perceived by consumers as less satisfactory than face to face counselling but a valuable option for:
  • people living in areas where there were no mental health services;
  • individuals with particular problems requiring more specialised expertise;
  • individuals who do not speak English well and require a therapist who can speak their own language; or
  • individuals who, because of the size of the community and relations within the community, may not want to see the sole psychologists in town.
In these situations, consumers also identified the potential emotional and psychological intensity of therapy and suggested that individuals receiving remote therapy would benefit from access to a local support person (this may be a generalist health worker, local service provider, friend) who could also talk with the therapist to understand how to help the individual receiving therapy.

Waiting times were generally reported as acceptable in the consultations, with long waits being reported where a particular provider was desired. Sixty one per cent of consumer respondents to the online survey rated waiting time for AHPs as acceptable (see Table 18).

Consumers did not generally perceive any changes in the behaviour of their GP as a result of the Better Access initiative, and very few had had formal counselling sessions with them. Consumers interviewed generally had positive opinions in relation to their GP with very few (less than five per cent) reporting strongly negative perceptions. Respondents critical of their GP were those who had no or very limited choice in GPs due to limited availability in their local area.

Fifty nine per cent of consumers responding to the online survey reported that their GP had developed a Mental Health Treatment Plan for them and 38 per cent indicated that they had not.

In the teleconferences with consumers, participants reported that they felt the level of awareness of GPs of the Better Access initiative and the provision of information to consumers on options for referral to an AHP could be improved. Many reported that their GPs were still hesitant of how to best work with people living with a mental illness, and expressed a desire for better education for GPs, both in terms of the Better Access initiative itself, and more broadly in terms of mental health. Approximately a third of consumers reported that they initiated the referral to the AHP rather than the GP. Consumers continued to report instances of themselves or acquaintances going to see their GP and only being offered medication.

Consumers generally thought that up to 18 sessions was sufficient for more simple problems or maintenance support. Most did however feel that more sessions may be required when more intensive problems were being experienced, at times of high external stress or at the commencement of therapy for more complex problems. It was also noted by a number of consumers that, as the number of sessions related to a calendar year, it could be more difficult for individuals commencing therapy at the beginning of the year to receive a rebate for the number of sessions that they needed. Generally, nearly all consumers thought that there should be scope for more sessions where the situation warranted it and that this should be the decision of the treating therapist and individual consumer.

The overall process of referral and rebate (how the system worked) was generally seen as operating well. Consumers receiving services through the Better Access initiative appeared to have a sound understanding of how it operated and once the first payment was made and rebate received, the processes were reported as operating adequately. For some the first up-front payment was difficult financially. A couple of consumers reported that they were bulk billed and the payment and rebate transferred to their account at the psychologist's office. This was perceived as an ideal situation by most consumers.
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Table 17: Consumer rated availability of services

Overall, to what extent do you agree that allied health providers (psychologists, social workers and occupational therapists) were available in your local area? (number of respondents)
RegionStrongly agreeAgreeUnsureDisagreeStrongly disagreeDid not respondTotal
Major City
7
38
17
11
9
4
86
Inner Regional
5
7
4
4
20
Outer Regional
1
3
1
3
4
12
Remote
1
1
Very Remote
1
1
(blank)
1
4
5
Total
8
47
25
19
18
8
125

Table 18: Consumer rated waiting time for services

Q7. Overall, to what extent do you agree that waiting times for the services were acceptable? (number of respondents)
RegionStrongly agreeAgreeUnsureDisagreeStrongly disagreeDid not respondTotal
Major City
13
39
9
11
11
3
86
Inner Regional
1
10
2
2
4
1
20
Outer Regional
1
6
1
1
3
12
Remote
1
1
Very Remote
1
1
(blank)
1
4
5
Grand Total
15
56
12
15
19
8
125

4.9.5 Recommendations of consumers

The key recommendations from consumers on how the Better Access initiative could be improved were:
  • Reduce the gap fee for seeing allied health providers.
  • Introduce a more equal rebate for all approved allied health professionals.
  • Provide capacity for more than 18 sessions where this was assessed as required by the therapist and consumer.
  • Review the purpose and format of the Mental Health Treatment Plan.
  • Provide better education for GPs on how to work with clients living with a mental illness.
  • Provide better education for GPs and consumers on client rights under the Better Access initiative.
  • Enhance the availability of services in rural and remote areas.

Footnotes

76 None of the consumers interviewed reported seeing an occupational therapist