Increasing access to mental health services for those in rural, remote and very remote Australia

Robyn Vines, Psychology Council Member, Clinical Psychologist

New Medicare Telehealth Items under the Better Access to Mental Health Care Initiative

Incidence of mental (and other) health issues and inequities in service access in rural communities

As is well known, mental health is a significant health issue in Australia with almost one in five people suffering from a mental disorder in any twelve month period. However, accurate data on the distribution and determinants of mental health and wellbeing in our rural, remote and Indigenous populations still remains largely unclear and/or speculative. Research findings do indicate that there is a significant “rural-urban” health status divide and that a number of key health issues in rural, and particularly remote areas, require special attention and intervention. For example, considerably higher levels of attempted and completed suicide in rural and remote areas, and comorbid mental health and alcohol and other drug disorders – including, most recently, higher levels of opioid addiction – are seen as key problems in regional, rural and remote Australia.

The recent Report of the Royal Flying Doctors Service (RFDS, 2017): “Mental health in remote and rural communities” confirmed these trends, indicating that:

... farmers, young men, older people and Indigenous Australians in remote areas are at greatest risk of completing suicide, with residents in very remote locations almost twice as likely as those in major cities to die from suicide.

Somewhat anomalously the report maintains that – apart from these suicide statistics – there is no evidence of “higher levels of mental disorders amongst remote and rural Australians”. Recent data does suggest, however, that the rate of access to mental health care services remains at only 20% (i.e. one fifth) of those who access services in metropolitan areas.

New telehealth items for mental health care

In an attempt to redress this inequity in service access, the Commonwealth Government has recently introduced an expansion of Medicare items under the Better Access to Mental Health Care initiative to include telehealth items for rural and remote patients. These new item numbers were introduced on 1 November 2017, enabling those in rural, remote and very remote areas to access mental health services via video-conferencing and skype. Details of this expansion of services are as follows:

  • Patients are able to access the services if they reside in the (new) Modified Monash Model geographic classifications 4-7 (see www.doctorconnect.gov.au  to assess patient eligibility).
  • The service provider must be at least 15 kilometres distance from the client.
  • The patient must have a current GP Mental Health Care Plan (i.e. a formal referral under Medicare via the Better Access Initiative).
  • Seven out of ten of the Better Access services can be delivered remotely (i.e. by video-conferencing) with three sessions, including one of the first four sessions, required to be face-to-face interventions.
  • The service must include both audio and video, meaning that telephone service delivery is not eligible for rebate. The technology must be capable of delivering high quality clinical services and be sufficiently secure to conform with security and privacy laws.

Reflections

Whilst these requirements may appear onerous and seem to provide a number of disincentives to access, the items do provide a considerable advance on what was previously available for those outside metropolitan areas. They have been designed to ensure familiarity by the service provider with the setting in which patients reside, and also to prevent “big corporates” from establishing call centres in the city, thereby profiting from these new service delivery options in a way that may not benefit the patient or the referring GP.

Psychologists need to think creatively about how to make these items work for clients who may not otherwise be able to access help, for themselves as busy practitioners, and also for rural GPs who are often isolated and under-supported. It is recommended, for example, that practitioners who are interested in providing these more remote services, may be able to establish contact with specific GPs and arrange to visit when a number of assessments under Better Access have been organised on the same day. This would then make a visit to rural and remote locations worthwhile and enable patients to access ongoing telehealth treatment after initial assessment. It is also recommended that the peak professional bodies (e.g. RACGPs, the APS, the Rural Doctors Network, ACCRM, etc.) work together to map and facilitate delivery of these services in a way that enables mental health service delivery for the patients who need them.

Feedback from those already using these items would be welcome and can be sent to the Council through newsletter@psychologycouncil.nsw.gov.au