This chapter investigated a range of issues associated with the impact of Better Access on the future mental health workforce. Consultations with key stakeholder organisations were undertaken to assess current workforce capacity and the ability to provide adequate training and supervision. An additional component of the consultations reviewed the effect of Better Access on the relationship between psychologists and GPs.

Better Access was seen to have had the most impact on the psychology workforce. Both clinical and registered psychology workforces were said to be working to capacity, although waiting lists for registered psychologists were said to be shorter than that for clinical psychologists. Of most concern to stakeholders in the psychology workforce was how the increased demand for clinical placements due to increased enrolments in university courses and the retraining of registered psychologists (who wanted to be eligible for the higher rebates associated with clinical accreditation) was going to be managed. Some of this increased demand was said to be due to Better Access. The concern was that the demand for clinical placements was occurring at a time when Better Access was making it more attractive for psychologists to work in the private sector. The withdrawal of senior clinical psychologists from the public sector meant that either supervision was not available or it was more likely to be provided by junior psychologists who had yet to develop the clinical experience or skills required for supervision. To provide some perspective on the extent of this problem, data from an APS survey indicated that approximately 5% of the public sector psychology workforce was considering moving into the private sector, while another 17% were considering increasing the number of hours consulting in the private sector.

Better Access was said to have increased the numbers of social workers seeking mental health accreditation, with mental health becoming an increasingly popular area of specialisation. The social work workforce was the only one where current spare capacity for increasing the levels of mental health workload was identified, with comments suggesting that the social work mental health workforce was underutilised by GPs.

For the occupational therapy workforce, Better Access was viewed as having only a marginal impact, with some increased interest being expressed in mental health specialisation. There is currently no accredited pathway for occupational therapists to work in mental health, although this will be changing in the near future. Some concern was expressed about the withdrawal of occupational therapists from the public mental health sector, and the impact this might have on training.

For GPs, the impact of Better Access was less clearly defined. It was not viewed as impacting on the availability of training places for medical graduates; and there was some capacity within the GP workforce to increase their provision of Better Access services. However, on one hand it was suggested that Better Access had increased the level of skills and interest in mental health training; on the other hand, it was suggested that because Better Access did not require GP training (at the time of the consultations), it had decreased GP engagement in mental health. Contrasting views were also evident in consultations about the impact of Better Access on Regional Training Programs for GPs with one suggesting that it had no impact, and another suggesting that there had been such an increase in interest that they were unable to keep up with training. Web-based training was now available for rural continuing professional development.
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Better Access was seen to have created some capacity for psychiatrists to see new patients, but that it was still insufficient to meet demand. Better Access was not viewed as impacting on the workforce shortage of psychiatrists, or their training, more generally.

Overall, Better Access has increased the demand for mental health training and continuing professional development for the allied mental health and GP workforces. Professional bodies were attempting to meet this demand through increasing the size of the training workforce and using online modes of delivery. Another, related, area that was identified as experiencing increased demand was in multi-disciplinary training to increase inter-professional understanding and the effectiveness of referrals. With respect to clinical training for the allied health workforce, Better Access was viewed as having an indirect impact by making it more attractive for senior clinicians to work in the private sector and therefore reducing the availability and perhaps standard of clinical supervision. In addressing this issue, some capacity for expanding clinical supervision in the private hospital system was identified, but this would require supporting infrastructure; and the use of simulation centres, especially in rural centres, was being explored.

The second aim of this chapter was to review the impact of Better Access on the relationship between psychologists and GPs. Better Access was seen as having successfully expanded access to mental health interventions for clients with high prevalence, non psychotic disorders, but did little for clients with more serious psychological disorders or who could not afford to access private services. In expanding access to mental health interventions, the Better Access initiative promotes collaboration between GPs and psychologists and the quality of this relationship is likely to impact on the efficacy of care provided.

Several factors were identified that were impacting on the quality of interactions between psychologists and GPs. This includes unfamiliarity with each others' professional protocols around client management; the lack of clarity about their respective roles, which was viewed as having overlap especially in diagnosis; and the confusion caused by the incorrect use of referral pathways where psychologists refer patients to GPs for a care plan so that the client can then access the Better Access rebates. Despite these difficulties, both GP and psychology organisations indicated that a shared literacy is developing and that issues are being attended to as they arise (for example, the development of a set of feedback standards to help manage the quality of communication). Many of the issues raised in the consultations reinforce the findings in Chapters 4 and 5 about the relationship between the medical and allied mental health workforces.

Finally, this chapter investigated GPs' use of care plans. The consultations indicated that the quality of care plans differs between individual GPs. Some GPs were seeking training on how to use them more effectively; others found them difficult to use because of the differences in approaches to mental health. There were some indications that clients were not requesting long enough appointments in which to fully develop the care plans, and that this may be a matter of providing more information about how the system works. Concerns were raised about the forms used, including the inability to adequately cater for co-morbidities or nuances in care; the complexity of the form; and the lack of an evidence base for the impact of care plans. Despite these issues, the major driver to use a Level D consultation in lieu of Better Access is concern about labelling clients, privacy and the implications for patients having a mental health diagnosis (including the over-diagnosis of conditions such as depression in order to meet referral requirements).