Many missing in the rush for affordable psychological care  

September 26, 2009  

Australians are coming out. Andrew Robb, the senior Liberal politician, has performed a valuable public service in admitting to his depression. A NSW District Court judge, also a depression sufferer, spoke publicly about the illness at a recent international conference of judges, though fear of triggering challenges to his decisions prompted a request for anonymity in the press. 

Judges, politicians, people you know, or maybe you, the reader, have experienced depression or an anxiety disorder or some form of mental illness. One in five Australians suffers a mental health problem each year, the Bureau of Statistics reports. 

In the land of ''she'll be right'', mental suffering is ubiquitous. It is not just high-profile sufferers who have come out. Ordinary people are seeking help in unprecedented numbers. The use of psychological services in Australia has increased at an astounding rate since the Howard government extended Medicare in November 2006 to cover six to 12 visits to a psychologist and some other health workers. It also paid GPs $150 for writing a mental health care plan, which a patient needs as a referral to a psychologist. 

Like the rush to end bad marriages after no-fault divorce began in 1975, the pent-up demand for highly subsidised psychological care has gone off the scale and shows no sign of easing. No one predicted the demand, except some mental health advocates tuned in to the dark side of the nation's soul. 

The demand for psychologists raises questions about modern life. It also raises questions about the effectiveness and sustainability of the well-meaning scheme, called the Better Access program, with its uncapped costs. If the worried well are garnering the greatest benefit, there is a case for refinement to ensure it reaches those who need it most. 

When the scheme was announced, the Medicare mental health items were expected to cost taxpayers $538 million over five years but already the cost to July had risen to at least $787 million, with two years to go. More than 1 million Australians now have a mental health care plan - a conservative estimate, considering GPs have been reimbursed $224 million for writing 1.5 million plans; some people may have two plans. 

Almost 5 million consultations with psychologists have taken place under the scheme, and GPs have presided over a further 1.5 million mental health consultations. The trend line for the new Medicare services is unremittingly upwards. 

Australians are probably no more depressed, anxious, or psychotic than other comparable nationalities. The stresses of modern life take a toll on the vulnerable and the genetically susceptible everywhere. Quite possibly, mental health problems are no more prevalent than in the past. It is just the human condition. 

The nation tests its mental health only once a decade through a survey by the Bureau of Statistics, and in 2007 the rate of mental illness was similar to that in 1997. A study by the University of Melbourne published last year challenged the idea that depression was on the rise, finding no significant increase in people with the diagnosis over the five years to 2004. There are no benchmarks before the 1990s - either life was happier and simpler or mad housewives lived lives of quiet desperation - you pick. 

Whether up or down, mental health problems have been seriously under-treated. It is progress to have the Better Access program. But the Rudd Government is right to have begun an evaluation before it becomes so entrenched, amelioration of unfairness or improvement in accountability is politically impossible. 

Some experts say the main users are middle-aged women; that is because GPs are the gateway to the service, and men and young people are much less likely to see a GP. Considering mental health problems overwhelmingly manifest themselves before the age of 25, according to the Mental Health Council of Australia, it seems a high priority to get more young people into subsidised psychological treatment. It is also important to reach men who are more likely to self-medicate with alcohol. 

Whether clients are getting better as a result of the program is the big unknown. It needs to be tested. Some psychologists have hung up their shingles only since the scheme began. Some are miracle workers; others inexperienced. 

Professor Bob Montgomery, the president of the Australian Psychological Society, says there are several evidence-based treatments with good success rates. Patients' progress in being able to return to work or study, and generally in getting back into the swing of life, is eminently measurable by evaluators. 

The bonanza for GPs is ending now that they have to do some training before getting reimbursed for writing a mental health plan. 

Australia, once notable for its anti-therapy culture, waited too long to take mental health seriously. Thanks to brave souls, Jeff Kennett and the former rugby league star Andrew Johns among them, the stigma of mental illness is slowly receding. The Howard government took a bold step. But it is important now to review the scheme, prune the excesses, find ways to embrace the hard-to-reach, and lighten the dark soul of the nation a shade or two. 

Source: The Sydney Morning Herald