Public Health Association of Australia
The following article is based on a paper published recently in the Australian and New Zealand Journal of Public Health by researchers Katherine Petrie, Peter Baldwin, Joanna Crawford and Samuel B. Harvey
Background
Mental health disorders represent a significant burden of disease globally with substantial health, social and economic consequences.
General practitioners (GPs) are the most frequent providers of Medicare-subsidised mental health-specific services in Australia (31.1%). However, it has been estimated that only one in three Australian adults with a mental disorder in the past 12 months accessed any mental health service, and among those that do seek help, the majority do not receive an optimal level of mental health care.
Suboptimal treatment coverage and quality of mental health services have been identified as one of the main reasons for the persistent mental health burden in Australia. Attention to this issue has amplified during the COVID-19 pandemic, which has had a serious acute impact on the mental health of the Australian population. This has resulted in changes to policy and funding priorities to provide increased access to mental health services in Australia. While this survey was conducted prior to the pandemic, it is likely the arrival of COVID has exacerbated existing gaps in the national mental health system.
The survey
The key objective of the survey was to examine the perceptions of health professionals regarding the gaps in mental health service provision in Australia, and their need for assistance in managing patients with mental illness. The survey, which provided both qualitative and quantitative data, was conducted by the Black Dog Institute in Sydney.
A total of 570 health professionals participated in an anonymous online survey in January 2018. Participants came from all Australian states and territories, with 44.2% located in regional, rural or remote locations. Professionals recruited included GPs, psychologists, clinical psychologists and other allied health professionals, including nurses, occupational therapists and counsellors.
The results
Overall, 71.2% of health professionals reported needing assistance in at least one stage of care, for at least one or more mental health disorder(s).
Within practitioner groups, 77.3% of GPs, 74.2% of psychologists/clinical psychologists and 64.6% of other health professionals reported requiring assistance with at least one stage of care for one or more mental health disorders.
A total of 452 health professionals provided free text responses to the open-ended question: What do you believe are the main gaps in mental health service provision in Australia?
Key themes and issues
The issue most frequently identified by respondents was a lack of sufficient funding – for programs, services, rebates, and system resources at all levels – particularly in the public system and for community mental health. The NDIS was often cited as an example of insufficient funding.
Accessibility, which was also noted as partly dictated by funding, covered two main issues: access and timely availability, and location. The gaps in access included long waiting lists, limited public beds, and services at capacity.
Affordability to patients was an issue that directly affected health professionals’ ability to refer their patients on to appropriate care. There was a lack of low-cost care that offered multidisciplinary support, and groups such as homeless, low-income or unemployed patients were often unable to afford the level or duration of care they needed.
Health professionals reported a need for suicide support for youth, adolescent inpatient services (public and private), child diagnostic services, family-based interventions and school-based programs on resilience and early identification of behavioural issues at schools. They also recommended greater provision of free, community-based services for youth that offered mental health support and alternative therapies, and provided a safe environment outside of the family home.
Conclusion
The results of this study provide a unique insight into the needs and gaps in mental health service provision in Australia as reported by a range of health professionals who provide mental health care. These findings, gathered from important stakeholders in the system – the ‘frontline’ of health care in Australia – paint a disturbing image of mental health care.
The themes and insights identified in this study add weight to ongoing calls for reform and greater investment in the Australian mental health care system and can be used to inform future policy and funding decisions to practically improve the mental health system in Australia.
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