Improving rural mental health services

13 May 2011

People in rural and remote areas will be pleased that this week’s Budget announcements will lead to more and better-targeted mental health services locally for those in the Bush. In particular they welcome the greater emphasis to be given to the Access to Allied Psychological Services program (ATAPS) as part of a stronger whole-of-government approach to mental health.
The Budget’s targeting of so called ‘hard to reach groups’ is an important step, with additional mental health resources to be provided for young people and those living in rural and remote areas.
When he released the review of the Medicare Better Access program in March, Mark Butler, Minister for Mental Health and Ageing, said that more needed to be done for groups missing out on mental health care. The Better Access program, while delivering over 4.6 million services in 2009 at a cost to Medicare of $478 million, is unfortunately skewed towards major cities. People living in remote areas received 60 per cent fewer services, and those in rural areas received 12 per cent fewer than those in major cities.
The much more modest ATAPS - currently $24 million a year - delivers about 45 per cent of its services in rural areas, and complements the Better Access program to some extent in areas where GPs and other mental health workers are in short supply.
This fairer distribution to rural and remote areas under ATAPS has been achieved through targeted funding for mental health workers, while ensuring that GPs are still involved in the coordination of services. Until now ATAPS has been managed and delivered through divisions of General Practice; Medicare Locals and other local service providers will also be involved in the expanded program.
The large deficit in mental health services for people in the Bush must be recognised and overcome. The 2007 National Survey showed that around 20 per cent of the population were affected by mental illness in both major cities and rural areas, but those in rural areas receive fewer mental health services.
The Alliance has drawn on the 2010 AIHW report on mental health services to estimate the total number of mental health services by geographical location. Including mental health care in hospital, outpatient mental health services, community mental health services, and services funded by the MBS through GPs, 1000 people in the major cities accessed, on average, 12012
services a year. In Inner Regional areas it was 1194 per one thousand people, and 916, 495 and 643 in Outer regional, Remote and Very Remote respectively. So people in Remote areas received less than half the total number of services for mental health received by those in the Major Cities. (Web-based services are not included in these estimates.)
The composition of the services received also varies considerably. For example, people with a mental health condition in Inner Regional areas are less likely to have accessed a psychologist or psychiatrist, but more likely to have seen a GP or visited a State-run community mental health service.
Better Access and ATAPS are only part of the overall response to mental health. It is to be hoped that, despite poorer health infrastructure and much less access to specialised mental health staff , the extra coordinated care and flexible funding for people with severe and persistent mental illness and the Headspace services boosted by this week’s Budget will be available in fair proportion to people who need them in rural and remote areas.
Given the challenges and deficits to be overcome, it will also be essential to maintain the local capacity that has been developed through modest programs designed specifically for people in the Bush, such as the Mental Health Services in Rural and Remote Areas plan. People in rural and remote areas will also be affected from time to time by natural disasters and should continue to benefit from ad hoc mental health services such as those announced by Minister Butler in January.