Gaps and inequalities in access to primary mental health care for young people during COVID-19: stud

Gaps and inequalities in access to primary mental health care for young people during COVID-19: study

19 December 2022

A new Orygen study has found gaps and inequity in service use by young people who sought primary mental health support during the first year of the COVID-19 pandemic.

The study analysed trends of Medicare Benefits Schedule (MBS) subsidised mental health services in 332 geographical areas (typically home to 30,000 -130,000 residents) across Australia.

The data captured more than 22.4 million service records for all young people ages 12 – 25 years for 10 years.

Overall, the study identified only a small increase of 6.2 per cent in the use of MBS-subsidised primary mental health services among young people in the first year of the pandemic.

Dr Caroline Gao, senior biostatistician at Orygen, said the overall increase is lower than expected, based on information from other sources such as population surveys and studies focusing on mental health impacts of the pandemic in Australia and elsewhere.

In response to the pandemic, the Australian Government invested in an expansion of the (MBS) through the Better Access initiative with the maximum number of subsidised mental health sessions increasing from 10 to 20. However, the study findings suggest that this may have only partially addressed the mental health needs of young people.

Professor Sue Cotton, senior author of the study and head of health services and outcome research, said the capacity of mental health services was restricted by staff availability and multiple lockdowns during the pandemic, which impacted the overall functionality of mental health services.

“As a result, our system has and continues to underserve young Australians.”

Notably, the study identified two equity issues of significant concern: the reduction or limited expansion of service use among young males and for those living in lower socioeconomic areas.

“Our study showed a decrease of 3.5 per cent in young males accessing mental health services during this time,” Dr Gao said. “This indicates that the ongoing concern relating to service access among young males remains problematic – at the same time, the rise in mental ill-health noted in young people over recent years has been more dramatic in young women.”

The inequality of mental health service use was also observed in young people living in low socioeconomic areas.

‘High infection rates, increased social isolation and greater reduction in incomes were felt strongly amongst low-income families, possibly limiting the capacity of adults to assist their young people to access appropriate help, in particular relating to the challenges of paying out-of-pocket fees,” Dr Gao said.

The pandemic is an exacerbating factor of existing socioeconomic-related inequalities in mental health service provision as highlighted by the recent Evaluation of the Better Access initiative.

Dr Gao said the most vulnerable groups in our community are unlikely to access 10 Better Access sessions under current mental health funding models with extensive co-payment, let alone 20 sessions.

“The increase in MBS session numbers or the introduction of telehealth did little to improve access to care for these groups.”

On 12 December 2022, the Federal government announced that the Better Access scheme will revert back to the limit of 10 sessions from 1 January 2023 due to concerns of social socioeconomic-related inequalities.

Professor Patrick McGorry, executive director of Orygen said addressing these equity issues will require policy makers to consider alternative mental health funding models for people with more complex needs beyond the current primary care model.

“Funding more salaried roles within multidisciplinary community mental health/health services to provide mental health care for young people with more serious and complex mental health conditions can be one of the key solutions.

“There are other critical reforms that are needed, for example, addressing the workforce shortage, providing incentives to work in communities experiencing socioeconomic disadvantage, and developing new service models for more assertive outreach to groups, such as young men, who are less likely to engage with services.” Professor McGorry said.