We have increased access to mental health treatment,but it needs to be effective treatment

Unlike other major disorder groups, such as cancer and cardiovascular disease, a detectable change in the population prevalence or burden (as defined by disability-adjusted life years) of mental disorders has not been demonstrated (Jorm et al., 2017; Whiteford et al., 2013a). This is particularly concerning in high-income countries, such as Australia, where substantial additional resources have been made available over the past 20 years. The latest figures by Australian Institute of Health and Welfare (AIHW) indicate that Australia spent about $9 billion on mental health services in 2015–2016 (60% by state and territory governments, 35% by the Commonwealth government and 5% by the private sector), a growth from $164 per capita in 1992–1993 at the start of the National Mental Health Strategy to $373 per capita in 2015–2016. ¹ However, the proportion of the health budget allocated to mental health only grew from 7.13% to 7.67% over that time.

Jorm (2018) discusses one particular Australian initiative that contributed to the per capita growth in expenditure, the inclusion of subsidized psychological interventions by non-medical providers in the Medicare Benefits Schedule. This ‘Better Access’ initiative was considered largely responsible for increasing the proportion of the Australian population with a mental disorder receiving treatment from 37% in 2006–2007 to 46% in 2009–2010 (Whiteford et al., 2013b), and given its continued growth, presumably the coverage is now well over 50%.

The population burden of mental disorders can only be reduced in four ways: reduced incidence, increased remission (i.e. a reduction in duration), reduced severity and reduced premature mortality. The target of the ‘Better Access’ initiative was for those individuals with a mild to moderately severe disorder using psychological interventions, such as cognitive therapy, with an evidence base to increase remission and decrease clinical symptoms. The initiative was never designed for treatment of persistent or more complex disorders.

While treatment coverage has improved, with the ‘Better Access’ initiative a major contributor, Jorm rightly highlights we lack evidence that minimally adequate treatment is being received by those accessing services under this initiative (Jorm, 2015). Adequate treatment requires the right type of intervention for a sufficient length of time. In 2014–2015, the last year in the analysis by Jorm, 20% of those accessing this initiative received only one session and 60% used four or less services. There is very little information on what psychological treatment is actually received during the sessions. A reduction in prevalence of mental disorders requires both prevention programs and those accessing services to receive evidence-based treatment for long enough, something we have not yet achieved in Australia.