At Adelaide Night and Day Family Therapy, with Williams deKort Consulting, we are reviewing the new document “Australian Government Response to Contributing Lives, Thriving Communities – Review of #Mental Health Programmes and Services.”
This blog will begin by just listing the specific paragraphs that address ‘Better Access” program.
- exploring options for the modification of the COAG #Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative (#Better Access) to better target the needs of people with moderate to severe mental illness;
5.3 Refocusing primary mental health care programmes and services to support a stepped care model (P13-14 )
In addition to embedding a stepped care approach in the mental health system, the Review also noted opportunities to improve primary mental health care services and programmes within a stepped care model, and to better support health professionals to work within a stepped and integrated approach.
The Government invests significantly in a range of programmes which offer primary mental health care, including #Better Access, but also ATAPS, MHSRRA, headspace and the Mental Health Nurse Incentive Programme. However these programmes are not designed in a way which offers easy access to a continuum of services, or which offers the flexibility to make optimal use of the available workforce. Alternatives to face-to-face service delivery such as digital mental health and self-help have not been well promoted. The result has been, as the Review points out, the ‘over medicalisation’ of some consumers, and the under servicing of others.
The Government is committed to ensuring that the current blunt and ‘one size fits all’ approach to providing psychological services to people in the community is transformed in line with the stepped care model to match consumers to the intensity of service they need.
There is an opportunity to bundle together the grant programme funding available for primary mental health care services into a single flexible pool available to PHNs to commission and target regional needs, as previously outlined in this response.
The development of a stepped care model also offers opportunity to better target Medicare based services. Modification options for #Better Access will be explored which would encourage more judicious referral to Medicare based services targeting people whose needs cannot be met through other first-line responses, such as digital mental health, and which would consider alternative options for people with severe and complex mental illness.
14 Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services The Review recognised that Medicare-based services through #Better Access has provided an efficient means of providing access to primary mental health service delivery for many people. Of the 1.9 million Australians who received mental health care through the MBS in 2013–14, 92% or 1.77 million received their care through #Better Access. Nearly one million of this group received their mental health services from allied health professionals. #Better Access has been the single biggest driver of advances in treatment rates since its inception as part of the Howard Government’s COAG Mental Health package in 2006, lifting treatment rates from one in three to more than 50% of those with mental illness.
However, the #Better Access initiative in particular is a ‘one size fits all’ programme which the Review suggested may not be the most efficient service pathway for either people with mild mental illness or with severe and complex mental health needs. Data has indicated that between 2 to 5 percent of #Better Access users seek support from the initiative year in and year out, suggesting they have an enduring and severe form of mental illness, which could potentially be better addressed through an alternative service delivery model.
At the other end of the needs spectrum, evidence points to use of #Better Access and other MBS mental health items by many people who might equally be assisted by alternative, less costly models of evidence-based service delivery. Ease of access to a new digital mental health gateway and low intensity services would offer an alternative for GPs to referral to psychological services that enables better matching of consumer need to the intervention delivered. Upon establishment of the digital gateway, GPs will be actively encouraged and supported to target referral to face to face psychological services under #Better Access to those for whom a self-help or low intensity service is not clinically appropriate.
Progressive and phased implementation of the new arrangements through PHNs will assist the government in refining a model of stepped primary mental health care which will combine the above elements and help to inform modification options for #Better Access. PHNs will also be encouraged and supported to work towards better utilisation of low intensity ‘coaching’ services for people with lesser needs, building on evaluations of programmes such as the NewAccess model of care, and the Improving Access to Psychological Therapies model of stepped care implemented in the United Kingdom. In line with the principle of redirecting funding within the mental health system, savings achieved from redesign of #Better Access which may ensue will be reinvested in expanding primary mental health care services provided through PHNs.
5.8 Improving services and coordination of care for people with severe and complex mental illness (P17-18)
The Review reiterated that fragmentation of care is particularly problematic for people with severe and persistent mental illness who often have to navigate a complex system across multiple providers. …………..
A key focus of the Commonwealth’s efforts will be on the development of new innovative funding and delivery models through primary care to better support coordinated wrap around services for people with complex needs, including physical comorbidities. This will initially include proportionally accessing funding from Medicare-based #Better Access services for people with severe mental illness and streaming this funding to packages of care to support the role of the GP in managing needs, along with exploration of alternative funding options for this population group.
The arrangements will also be supported through an enhancement of the Mental Health Nurse Incentive Programme, including arrangements to address the geographic inequities of the scheme. Sustainable innovative funding models and arrangements will need to be developed in partnership with state and territory governments, non-government organisations and the private sector, and be informed by work underway through the Primary Health Care Advisory Group.
The role of the GP in assessing the need of individuals for complex care packages will be supported through new assessment arrangements for people with severe illness to be supported through PHNs, which will have links to referral pathways to non-clinical services including the NDIS but also state government and broader educational, vocational and social supports.
Please feel free to respond to this blog and get the conversation going