Successive Australian governments have increased their spending on mental health over the last few decades, which is a good thing. But when the rate of mental illness isn’t going down, we need to step back and ask why.
Our research shows there is unfairness in how Australia’s mental health care is delivered. Improving mental health will depend at least in part on fairer distribution. While this means increasing spending in regional and remote Australia, it also means getting more resources to poorer urban areas.
Higher spending, but no effects
Major funding streams into mental health care come from state and territory governments (60%), the Australian government (35%) and private health insurance funds (5%). Total dollar spending has been increasing. Today it is around $150 more per person than in 1999-2000.
The Kessler 10 (K10) is a questionnaire answered by around 20,000 Australians in national surveys every three years. It asks about depressive and anxiety symptoms in the last 30 days. The percentage of Australians with very high K10 scores has stayed steady at a bit over 4% since 1999-2000.
We might hope the proportion of the population with active mental health problems would be going down with the increase in spending. But this isn’t the case.
Funding isn't getting to the right people
Put simply, increased spending is not getting care to people in the areas that need it most.
Medicare data reveal that once you leave the major urban areas, the rate of sessions with a clinical psychologist just about falls off a cliff.
It’s important to note the rate of very high K10 isn’t appreciably higher outside the big cities. Overall living in regional and remote Australia doesn’t seem to mean you’re more likely to have clinical anxiety or depression. But, you are much less likely to get to consult with a clinical psychologist to help you with the condition if you live in a regional or remote area.
Socioeconomic disadvantage
Paradoxically, as the rate of disorders goes down in better-off areas, the rate of use of these mental health services goes up. Use of these services may be as much as nine times less proportionally to the number of people with mental health problems in the worst-off areas, compared with people in the best-off fifth of the country.
For example, we find double the specialist services in Melbourne’s City of Bayside (a wealthy region) compared to Dandenong (a poor region) or in North Sydney (wealthy) compared with Blacktown (poor).
GP mental health services, it is worth saying, are delivered somewhat more evenly.
Continued funding growth for mental health care is needed and welcome. However, we suggest more be done to ensure care gets to where it is needed most. This will not be simple: delivery models, mental health literacy, gap fees, funding and planning models all need urgent attention or reform.
This will require new levels of leadership and cooperation between governments, professional bodies and communities.
