4.2.1 Workforce sizeWhereas there have been increases in the number of Better Access service providers, as evidenced by the quantitative data, the qualitative data suggest that these increases are not necessarily accompanied by changes in the size of the overall mental health workforce or the capacity of practitioners to take on extra work. Indeed, the qualitative data suggest that most of the Better Access mental health occupations are already working at their full capacity (except social work, whose representative suggested that social workers have the capacity to further increase their involvement in mental health).
Strategies for increasing numbers in the mental health workforce were discussed in the interviews. Two suggestions were put forward for addressing this issue in the short-term: the re-entry of nonpracticing mental health professionals, and moving health professionals between sectors (i.e. from the public to private sector).
126.96.36.199 Re-entry of non-practicing mental health professionalsThe re-entry of professionals who were not actively engaged in the workforce has the capacity to increase the overall mental health workforce. The qualitative data indicate that Better Access is unlikely to be the trigger for this due to the proportion of the workload that relates to the Better Access initiative. This is particularly the case for GPs and occupational therapists for whom Better Access is only a small proportion of their overall workload, mostly because their client needs are not primarily related to mental health; or psychiatrists, who mainly use Better Access for new patients, often those with high prevalence, low severity disorders, who make up only a small proportion of their clientele. Re-entry of GPs, occupational therapists and psychiatrists was therefore thought to be unlikely by representatives of these occupations.
The implementation of Better Access was not viewed as having an impact on the numbers of registered psychologists re-entering the workforce, as the financial incentive was considered to be too low to encourage re-engagement, and re-accreditation requires retraining, which is expensive and difficult to access. In contrast, clinical psychologists and, to a lesser extent, social workers were seen to have been encouraged by the Better Access initiative to delay retirement or to continue or extend their (private) clinical hours.Top of page
188.8.131.52 Increase in private practiceBetter Access provides opportunities for professionals in the allied mental health occupations to increase their participation in private practice. This, however, would not necessarily increase the overall workforce. Participants in the consultations reported that the Better Access initiative has broadened the scope of work for the clinical workforce by encouraging more consultative work for psychiatrists (RANZCP) and supported private practice for allied mental health practitioners (ACCP, APS, OT Australia, and AASW). The move from the public to the private sector for both clinical psychologists and registered psychologists was mentioned in several interviews, but there were also indications that the move to the private sector was occurring among social workers and occupational therapists.
In further examining the impact of the Better Access initiative on the distribution of the workforce across the public and private sectors, responses from the 417 allied mental health professionals who completed the KPMG online questionnaire were examined. Although the sample is nonrandom and cannot be generalised, these responses provide some insight into the experience of these workers.
Approximately one third of the clinical psychologists and social workers who responded to the survey work in both public and private practice; while the registered psychologists who answered the survey were more likely to work in private practice only (see Table 4.2).
Table 4.3 shows that, of those respondents to the survey that were in private practice, around 50% had been there for 5 years or less. This loosely corresponds to the period during which allied mental health professionals have had access to MBS Items, initially through Better Outcomes (since July 2004) and then through Better Access (since November 2006). However, allied mental health professionals also work in the private sector by accessing funds from private patients and private health companies and it is unknown whether this result may be related to changes in access to funds from these sources.
It is therefore difficult to say whether the shifts into the private sector discussed in the consultations have been a result of the implementation of Better Access or for other reasons.
Table 4.2 Public and private work among allied health professionals
|Occupation / sector||Frequency|
|Clinical psychologist - private sector|
|Clinical psychologist - both public and private|
|Clinical psychologist - sub-total|
|Registered psychologist - private sector|
|Registered psychologist - both public and private|
|Registered psychologist - sub-total|
|Occupational therapist - private sector|
|Occupational therapist - both public and private|
|Occupational therapist - sub-total|
|Social worker - private sector|
|Social worker - both public and private|
|Social worker - sub-total|
Table 4.3 Length of time in private practice for allied health professionals
|Less than 2 years|
|2 to 5 years|
|6 to 10 years|
|11 to 20 years|
|21 years and over|
4.2.2 Skill levelOverall, the consultations revealed little evidence that the Better Access initiative had a direct impact on the skill level of practitioners. This is unsurprising given that the initiative does not focus on training provision or continuing professional development. However, it was noted that there is an increasing emphasis on the importance of mental health education which will, in turn, have a positive impact on the skill level of practitioners.
It was suggested by the GPMHSC and the AGPT that the focus on common conditions, namely depression and anxiety, created by the Better Access initiative has lead to a marginalisation of awareness and skills development for less common, yet important, conditions seen in general practice. There was also concern from the APS that the skills required to manage low prevalence disorders, such as schizophrenia and psychosis, which are treated in the public sector, are being further eroded by the shift of experienced allied health practitioners to private practice.
Psychology organisations also noted that hospitals have been converting psychology positions into general mental health positions to allow other allied mental health professionals to apply for positions, possibly at lower rates of pay (APS). However, they claim that in doing so the role is generalised to the point where no specialist skills are able to be employed by the person in the role. The concern is that this will reduce the overall skill levels among mental health professionals working in hospitals.
4.2.3 Geographic distributionThe analysis of the MBS data in previous chapters demonstrated that there has been an increase in the number of Better Access service providers in small, rural and remote communities (RRMA 4- 7). In this geographic group, the number of psychiatrists claiming Better Access MBS Items has increased from 57 to 83 from its introduction in 2006 to 2008, the number of GPs has increased from 1620 to 2925, the number of psychologists has increased from 407 to 841, the number of occupational therapists has increased from 23 to 46, and the number of social workers has increased from 21 to 89.
Information from the consultations suggest that these increases do not result from any substantial increases in the numbers of practitioners in rural and remote areas but are instead a reflection of the increase in the viability of existing services in these areas (AGPT and APS). This could be indicative of existing service providers in these areas seeing more clients due to increased client access to claims on Medicare. For some organisations, the Better Access initiative was viewed as making services more affordable and more accessible for clients as the provision of services for high prevalence disorders moved from psychiatrists (who have a very small presence in nonmetropolitan areas) to psychologists (who have a more substantial presence outside of metropolitan Australia).