In this section a summary is provided for each of the Better Access mental health occupations in relation to the capacity of the current workforce to increase in numbers or service provision.

4.1.1 Psychologists
4.1.2 Social workers
4.1.3 Occupational therapists
4.1.4 General practitioners
4.1.5 Psychiatrists

4.1.1 Psychologists

The APS reports that, since the Better Access initiative, there has been a one-third increase in applications for membership. According to the psychology organisations which took part in the consultations, clinical psychology is, on the whole, fully occupied in practice and has little to no capacity to increase service provision. As with clinical psychology, representatives of the registered psychology workforce describe it as working at capacity but able to keep up with demand as demonstrated by having few waiting lists (APS).

There have been indications in the literature that one of the implications of the introduction of Better Access has been the movement in the psychology workforce away from the public sector and into the private sector (Gleeson and Brewer 2008; Kelly and Perkins 2008; Stokes 2008). Responses from the consultations also highlighted perceptions of the changing structure of the workforce.

In examining this issue, the APS surveyed its members in 2009 (Forsyth and Matthews 2009). A total of 1,167 members of the Australian Psychological Society completed the online survey (it is not a random survey), which revealed that nearly a quarter of those who responded to the question were actively planning to shift working hours to private practice (see Table 4.1). Without data on intentions to move into private practice prior to Better Access, it is difficult to make a definitive statement about the impact of Better Access on intentions. Nevertheless, it was evident from discussions with the APS that there is an assumption that the results can be explained as an effect of the Better Access initiative.

Registered psychologists were said to be moving to private practice in a step-wise fashion, reducing public sector hours rather than leaving the public sector altogether, while they establish a private practice (ACCP). According to the accounts provided in the consultations, the Better Access initiative is enabling psychology graduates to set up private practice through the financial incentives that it provides; and the movement of more experienced practitioners into private practice has provided younger psychologists with employment opportunities in public hospitals (APS, ACCP, and APHA). The APS highlighted the need for better support and supervision for these recent graduates in order to enable them to practice safely.
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Table 4.1 Intention of APS members to commence or increase private practice

The data in Table 4.1 is presented as a list in this HTML version for accessibility reasons.

Are you currently actively preparing or planning (e.g. organising premises, Medicare registration) in order to depart from your current employment, or decrease your working hours with the intention of commencing or increasing private practice?
  • Yes, actively planning to resign from current role to commence private practice - 51 responses (5%)
  • Yes, actively planning to reduce my hours of work to increase private practice hours - 184 responses (17%)
  • No, I am not currently actively planning or preparing to reduce or cease my current employment to commence private practice work - 842 responses (78%)
  • Total responses - 1077 (100%)

Source: Forsyth and Matthews (2009). Survey of APS members..

4.1.2 Social workers

The AASW indicate that the introduction of Better Access has had a substantial impact upon the number of accredited mental health social workers, indicating that they receive five to ten enquiries per week from social workers wanting to register with the Better Access initiative.

It was also noted that mental health is becoming an increasingly popular area of specialisation for undergraduate students and recent graduates. According to AASW, there is spare capacity within the mental health social work workforce and this workforce is, in fact, 'underemployed' or underutilised. They suggest that this may be a result of a lack of understanding by GPs about the role of social workers in mental health, resulting in fewer referrals than optimum. Some movement of social workers into the private sector was also been noted, although this was not thought to have affected public mental health service provision by social workers. The AASW estimates that approximately one-third of social workers practice in rural Australia.

4.1.3 Occupational therapists

OT Australia reports having 5,600 members, of whom 250 are registered for the Better Access initiative. Occupational therapists currently require registration in five states, but from 2010 they will be part of the National Registration and Accreditation Scheme and registration will be required nationally.

The consultations indicate that all OTs have mental health training as part of their undergraduate degree, with the expectation that they will increase their skill level on the job. OT Australia has identified some movement into specialising in mental health, and from public to private practice as a result of the Better Access initiative. It was reported that there are two to three enquiries per week from OTs wanting to access the Better Access initiative.

4.1.4 General practitioners

Information received from AGPT, suggests that GP registrars are increasingly recognising the importance of gaining mental health skills, as are GPs, and this interest in training is leading to an increase in the mental health skill level of both registrars and GPs.

In contrast, the GPMHSC viewed the mental health skill level of GPs as declining as a result of the lack of requirement (at the time of consultations) to undertake continuing professional development under the Better Access initiative. Given the subsequent budget decision (Department of Health and Ageing 2009a) encourages continuing professional development, it is likely that interest in mental health training will again increase.

4.1.5 Psychiatrists

According to the RANZCP, the introduction of Better Access has resulted in some movement of the workforce from the public to the private sector, which they saw was one of the aims of the initiative; however this movement was not viewed as having reduced psychiatrists' ability to attend to other aspects of their role. Better Access was viewed by the RANZCP as a mechanism through which the new referral pathways could increase the capacity of the workforce. The RANZCP suggested that while there are indications that psychiatrists' use of Better Access services has created some capacity within the workforce, it is not yet enough to cater to community needs.