This chapter examined the impact of Better Access on the distribution of the allied mental health workforce (psychologists, social workers and occupational therapists). Three aspects of the distribution of this workforce were examined: across the public – private sectors; across states / territories; and the distribution between capital cities and outside of capital city areas.

The analysis of the distribution of the allied mental health workforce was limited by the available data in two ways. Firstly, comprehensive data for the private allied mental health sector was not available for analysis. In the absence of this data, we were only able to comment on the distribution of allied mental health professionals in the private (Medicare) and private (Better Access) sectors. It is recognized that there are allied mental health professionals that work outside of the Medicare sector. Secondly, the analysis did not allow for causal relationships to be established. That is, we cannot say that changes in the distribution of the allied mental health workforce in the public sector or geographically were caused by the implementation of Better Access. Consequently, while changes since the implementation of Better Access are reported, no causal relationship is inferred.

Overall, since the implementation of Better Access there have been increases in the numbers of allied mental health professionals (headcount and FTE/DFTE) in each of the occupational groups in both the private (Medicare) and public sectors. In summarising the distribution in each of the allied mental health occupations, we have placed changes since the implementation of Better Access in the context of longer term trends.

Psychologists
Social workers
Occupational therapists

Psychologists

Psychologists formed the largest component of the public allied mental health workforce, and accounted for the highest rate of growth in this workforce over the 13 year period to 2007-08. During this period, the public sector psychology workforce more than doubled from 777 to 1741 FTE persons, which was 45.5% of total growth in the public sector allied mental health workforce. Most of the growth in the public sector psychology workforce was in NSW, Victoria and Queensland, with there being minimal or no change in the remaining states/territories. The average rate of growth in the public sector psychology workforce prior to Better Access was 7.6% p.a., which fell to 4.5% p.a. after the implementation.

Approximately 65% of all psychologists worked in the private sector in 2006, just prior to the implementation of Better Access (ABS Census 2006). Psychologists have had access to Medicare since July 2004, and there were already 1,429 psychologists registered in the private (Medicare) workforce before the implementation of Better Access. The growth rate in the numbers of psychologists registering for Medicare increased from a monthly average of 2.4% prior to Better Access to 3.4% thereafter. There were differences between the two psychology provider categories. While there were more registered psychologists, the proportion of psychology services they provided fell from 82.5% in November 2006 to 70.2% by November 2008. Clinical psychologists in the private (Medicare) workforce grew at a rate of 6.2% per month over this period, compared to 3.1% for registered psychologists. By June 2008, 27.8% of the psychology workforce (based on registration board data) was in the private (Medicare) workforce.
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Since the implementation of Better Access the number (headcount) of psychologists providing Better Access services increased from 3688 (December 2006) to 8088 (December 2008). This equated to an increase from 214 to 1,308 DFTE psychologists. There was an increase in the private (Better Access) psychology workforce in every state and territory, with the highest rates of growth being in SA, ACT and WA.

There has also been an increase in the public sector psychology workforce since the implementation of Better Access. However there were differences across states/territories with Victoria remaining virtually unchanged and decreases recorded in Tasmania and the ACT. The highest rates of growth in this workforce were in SA, Queensland and WA. Notably, by December 2008 Victoria and Tasmania had more DFTE psychologists in the private (Better Access) workforce than in the public sector workforce.

Changes in the geographic distribution of the public and private (Better Access) psychology workforce working in capital cities and non-capital city areas varied across states. Since the implementation of Better Access, the public sector psychology workforce decreased outside of capital city areas in Victoria and WA; and increased outside of capital city areas in Queensland. Changes in NSW and SA were relatively evenly distributed across geographical categories, while the workforce in Tasmania, ACT and NT was too small to comment.

Social workers

Over the 13 year period to 2007-08, the public sector social work workforce doubled, increasing from 798 to 1592 FTE persons. This accounted for 37.5% of the total net growth in the public sector allied mental health workforce, 1995-96 to 2007-08. The increase in the public sector social work workforce occurred in all mainland states, with Tasmania, ACT and NT remaining relatively static. The average rate of growth prior to the implementation of Better Access was 6.3% p.a., which fell to 3.3% p.a. after the implementation.

Approximately 53% of the social work workforce was in the private sector prior in 2006, just before the implementation of Better Access (ABS Census 2006). In contrast to psychologists and OTs, social workers could not register with Medicare until the Better Access initiative. The private (Medicare) workforce is therefore the same as the private (Better Access) workforce. The proportion of social workers (based on professional association data) registered with Medicare rose from 2.1% in December 2006 to 9.5% in December 2008.

Since the implementation of Better Access the number of social workers in the private (Better Access) workforce has increased from 126 (Dec 2006) to 646 (Dec 2008). This equated to an increase from 5 to 61 DFTE social workers. Increases were recorded in every state and territory, with the highest rates of growth being in Victoria, SA and Tasmania.

The overall trend in the public sector social work workforce has also been one of growth since the implementation of Better Access. There were, however, state differences. Tasmania, WA and NT recorded the highest growth rates, while NSW and ACT experienced an overall decline in the number of FTE social workers in the public sector.

Changes in the geographic distribution of the public and private (Better Access) social work workforce indicated that it increased at a higher rate in non-capital city areas than it did in capital cities.

Occupational therapists

Over the 13 year period to 2007-08, the public sector OT workforce has gradually increased from 498 to 859 FTE persons. Growth in this workforce was strongest in Queensland, NSW and Victoria. The average rate of growth prior to the implementation of Better Access was 4.4% p.a., which rose to 5.6% p.a. thereafter. The OT workforce was the only allied mental health occupation in the public sector to increase its rate of growth following the implementation of Better Access.

Approximately 54% of the OT workforce was in the private sector in 2006, just prior to the implementation of Better Access. Occupational therapists have had access to Medicare since July 2004, with there being 209 persons registered in the month prior to the implementation of Better Access, growing to 457 persons by December 2008. During this time NSW and Victoria increased their proportion of OTs in the private (Medicare) workforce. In contrast to the psychology workforce, the OT workforce registered with Medicare fluctuated markedly from month to month, with the fluctuations reflected across the states. By 2008 the proportion of OTs (based on available registration board data) registered with Medicare ranged from 2.7% in SA to 3.9% in Queensland.

Since the implementation of Better Access the number of OTs in the private (Better Access) workforce increased from 23 in December 2006, to 172 in December 2008. This equated to an increase from 0.4 to 12.6 DFTE occupational therapists. The increase was recorded across all states and territories.

The overall trend in the public sector OT workforce has been one of growth since the implementation of Better Access. The increase in FTE persons did, however, fluctuate over the two years with Queensland and ACT having negative growth in the first year and Victoria and Tasmania having negative growth in the second year.

Changes in the geographic distribution of the public and private (Better Access) OT workforce indicated that it grew at a faster rate in capital cities compared to non-capital city areas over the two year period.