The August edition of Medical Journal of Australia has published research on the treatment rates for depression in Australia, comparing the Better Access program with it’s earlier predecessor, the Better Outcomes program. Rates of depression management by GPs were compared across the period when each of these programs were in place, showing significant improvements since 2006 when the Better Access program was launched. Data showed that in the years prior to Better Access, GPs used mental health care items with only one in every 500 appointments they had with people diagnosed with depression, whereas after the Better Access program launched the use of mental health care items improved dramatically, to one in every six appointments with a person experiencing depression.
The report states:
The rate of depression management increased significantly during Better Access for advantaged patients from major cities (16.0% increase) and for disadvantaged patients from non-major city areas (21.5% increase)…During Better Access, the proportion of depression contacts with a record of medication being prescribed decreased significantly among the advantaged major-city patients while the proportion involving GP counselling decreased in both advantaged patient groups. During Better Outcomes and Better Access, a greater proportion of disadvantaged patients from non-major city areas had a record of medication being prescribed at their depression contact than did advantaged patients from major cities. Conversely, in both periods a greater proportion of advantaged patients from major cities received GP counselling at their depression contact than did disadvantaged patients from non-major city areas. (p. 172)
These results provide further evidence that the Better Access program has been successful in providing psychological treatment options for people with the most common mental health conditions. The findings contradict claims from critics that Better Access turned GPs into “glorified referrers”. Instead, the evidence shows that GPs played a major role in helping people battle depression by providing psychological treatment options and assisting them to reduce their dependence on medication along their pathway to recovery. The need to find ways to expand the program to effectively reach even more disadvantaged areas should be obvious.
The findings add further detailed information about the essential role of the Better Access program in reducing dependence on medications, among the host of other recent mental health reforms across the last decade. Recent data from over 48,000 people aged 25 years and over living in Australia has shown that between 2001 and 2008 the prevalence rates for psychological disorders have remained relatively unchanged, despite increasing rates in similar nations across the same period. Parallel to this, the data also shows that we have also seen reported use of antidepressants or anti-anxiety medications progressively decreasing for adult Australians between 2001 and 2008. An article in the Medical Observer suggests that this significant population-level drop in the reliance on such medications was likely to be attributed to the Better Access initiative.
Deakin University professor of psychiatry Michael Berk is quoted as stating:
One of the big changes might have been that with the Better Access system there would have been a shift from antidepressants as a primary treatment strategy to psychological treatments as primary… More widespread access to psychological therapies has to be welcomed. In many ways it really does put Australia at the forefront of mental health reform. There are a couple of studies that have looked at the prevalence of depression in the UK and US, and prevalence rates in those studies seem to be rising, so it’s interesting that in Australia prevalence rates are flat.
The problem is that very few other programs allow people to access enough psychological treatment to make a difference, and many mental health programs don’t provide any psychological treatment at all. For example, an audit of Orygen Youth Health (including EPPIC) conducted in 2007 showed that in over 75% of cases young people were being prescribed antidepressant medications too early, before they had been provided with enough counselling and psychological treatment. Setting aside some of the concerns about over-medication, programs such as EPPIC and Headspace may be useful for some young people, however, for adults the psychological treatment options remain extremely limited. As we have mentioned elsewhere on this website, the alternative ATAPS program being promoted by the Federal Government blocks access to treatment for those who do not meet stringent entry criteria that differ from one suburb to the next and actually delivers LESS appointments to those who are lucky enough to have a match between the problem they are experiencing and the entry criteria for the program available in their region.
Which leaves psychiatrists as the only publicly accessible form of treatment, which is fine according to the Government, because with psychiatrists you can still access up to 50 appointments – provided you can get an appointment that is. The reality is that most people CAN’T get an appointment, or the waiting list is far too long. Now that people can’t access other mental health practitioners for psychological treatment they are forced to see a psychiatrist for treatment, resulting in psychiatrists being overloaded. And with less time to see each patient, there is even more pressure than usual for psychiatrists to give people medication.
As you can see, the system is now broken since the Federal Government cut the Better Access to Mental Health Care program. Some would say that the Better Access program was working too well, in that people with mental health conditions used psychological treatment when it was offered, resulting in an unexpected growth in the rates of treatment. And if people who need treatment for their condition actually use those services, it costs money. So the question is, “is it worth providing affordable mental health treatment to those who need it?” The statistics only show us things like reduced dependence on medications, reduced levels of distress, and stabilised rates of prevalence for mental health disorders across the population. Behind those statistics however, there are real people out there feeling happier, working harder, getting more out of life, and enriching their families and communities. Put another way, these are people who are not giving up on themselves, not turning their backs on others, and not losing hope with life itself. From that point of view, listening to people and helping them work through their problems is worth every penny.