The distribution of the Better Access workforce was examined from the perspective of numbers in the private–public sectors and in urban–rural areas. The extent to which a comprehensive analysis could be undertaken of the distribution of the Better Access workforce was constrained by the limitations of the available data.

5.3.1 Private – public distribution
5.3.2 Urban – rural distribution

5.3.1 Private – public distribution

The allied mental health workforce had increased access to MBS Items following the implementation of Better Access. The impact of this on the distribution of each of the allied mental health occupations between the private and public sectors was evaluated. The evaluation was subject to the following limitations:
  • It was only possible to evaluate the impact on the private (Medicare) or private (Better Access) workforce due to lack of data about the private workforce more generally. This is particularly pertinent to the allied mental health workforce as it had high levels of participation in the private sector (beyond Medicare) prior to the implementation of Better Access;

  • The numbers (headcount) in each Better Access allied mental health occupation were converted to DFTE so that they could be compared to FTE data from the Mental Health Establishments: National Minimum Data Set. The methodology used meant that the FTE /DFTE numbers were not concordant; nevertheless, the methodology used provided the best basis for comparative analysis.
To provide background for the evaluation of the impact of Better Access on the distribution of allied mental health occupations across the private (Medicare) and public sectors, the MHE: NMDS for the years 1995 – 2008 were used. This placed any developments since the implementation of Better Access in the context of pre-existing trends within the public sector allied mental health workforce.

The following sections discuss the private (Medicare or Better Access) – public sector distribution for each of the allied mental health occupations. Overall, there were considerable differences across states/territories indicating that state/ territory policies were likely to have played a role in the distribution of the public-private sector allied mental health workforce. The extent to which state/territory policies had influenced the patterns of distribution could not be ascertained from the available data.
Top of page

Psychologists

Better Access had an immediate impact on increasing the supply of psychologists into the private (Medicare) sector in all states and across each of the geographic regions. However, two-thirds of all psychologists worked in the private sector prior to the implementation of Better Access (ABS Census 2006). The extent to which Better Access resulted in an increase in the numbers of psychologists in the private sector, overall, could not be ascertained without data on the private sector workforce outside of Medicare. By 2008 there were 1,308 DFTE psychologists in the private (Better Access) workforce and 1,741 FTE psychologists in the public sector workforce.

There has been an increase in the public sector psychology workforce since the implementation of Better Access. At 4.5% p.a., the rate of growth since Better Access was lower than the rate of growth over the preceding 11 years at 7.6% p.a. The rates of growth since the implementation of Better Access varied between states / territories with FTE numbers in the public sector psychology workforce increasing in SA, Queensland, WA, NSW and NT; decreasing in Tasmania and the ACT; and remaining virtually unchanged in Victoria. By 2008, Victoria and Tasmania had more psychologists in the private (Better Access) sector than in the public sector workforce.

The consultations provided a contrasting picture of the public sector psychology workforce. While the numbers of FTE psychologists increased following the implementation of Better Access, the consultations indicated that the number of clinicians available for supervision and training was decreasing. Data from an APS survey suggested that around 22% of psychologists in the public sector were considering reducing their hours. Better Access was viewed as exacerbating, rather than causing, this issue. The discrepancy between the statistical data and information from the consultations could be due to:
  • A decrease in the actual number of psychologists (headcount) working in the public sector, creating the situation whereby fewer people are doing more work;

  • An expertise drain created by the movement of senior psychologists into the private sector, leaving less experienced psychologists to work in the public sector;

  • Instability in the public sector workforce due to high turnover, resulting in an increase in short-term employees.
Each of these issues would result in a decrease in the availability of clinicians for supervision and training, while simultaneously maintaining the FTE numbers / rates of growth in the public sector psychology workforce. As these have implications for workforce development, the capacity to treat clients with complex needs and the sustainability of the public sector psychology workforce it would be advantageous if more comprehensive data on the public and private sector psychology workforces could be collected.30 To fully explore the private – public sector distribution of psychologists, there would need to be data about the numbers (headcount) in the public sector workforce; the level of seniority of employees; the proportion of time that clinicians allocate to private and public practice; and the proportion of time spent on clinical supervision and training. To ascertain change over time, this data would need to be longitudinal.

Mental health social workers

Better Access provided mental health social workers with access to MBS Items. It therefore had an immediate impact on increasing the supply of social workers into the private (Medicare) sector in all states and across each of the geographic regions. Just over 50% of all social workers worked in the private sector prior to the implementation of Better Access (ABS Census 2006). The extent to which Better Access resulted in an increase in the numbers of social workers in the private sector, overall, could not be ascertained without data on the private sector workforce outside of Medicare. By 2008 there were 61 DFTE social workers in the private (Better Access) workforce and 1,598 FTE social workers in the public sector workforce.

There has been an increase in the public sector mental health social work workforce since the implementation of Better Access. At 3.3% p.a., the rate of growth since Better Access was lower than the rate of growth over the preceding 11 years at 6.3%p.a. FTE numbers in the public sector social work workforce increased in all states / territories except for NSW and ACT, with Tasmania, WA and the NT recording the highest growth rates.

Mental health occupational therapists

Better Access had an immediate, but relatively small, impact on increasing the supply of OTs into the private (Medicare) sector in all states and across each of the geographic regions. Just over 50% of all OTs worked in the private sector prior to the implementation of Better Access (ABS Census 2006). The extent to which Better Access resulted in an increase in the numbers of OTs in the private sector, overall, could not be ascertained without data on the private sector workforce outside of Medicare. By 2008 there were 12.6 DFTE OTs in the private (Better Access) workforce and 859 FTE OTs in the public sector workforce.

There has been an increase in the public sector mental health OT workforce since the implementation of Better Access. The public sector OT workforce was the only Better Access allied mental health workforce to have increased its rate of growth in the public sector following the implementation of Better Access. At 5.6% p.a., the rate of growth since Better Access was higher than the rate of growth over the preceding 11 years at 4.4%p.a. FTE numbers in the public sector OT workforce increased in all states / territories since 2006, however this varied by year with decreases registered in Queensland and Act in 2006-07, and in Victoria and Tasmania in 2007-08.Top of page

5.3.2 Urban – rural distribution

The lack of concordance between RRMA (MBS data), non-standard classification (MHE: NMDS) and Section of State (ABS data) meant that it was difficult to assess whether the Better Access mental health workforce was more or less widely distributed, geographically, than the menta and allied mental health providers were more likely than health professionals in the broader mental health workforce to work outside of major metropolitan areas. We could not ascertain from the data the extent to which this was the result of demand or supply factors.

GPs were the most widely distributed Better Access workforce with 30% of service providers located outside of capital cities and other metropolitan centres. Better Access psychiatry and clinical psychology services were the least likely to be provided in rural or remote areas, with around 11% of these workforces providing services in rural areas and less than 1.0% in remote areas.

Overall, approximately 20% of psychologists provided Focussed Psychological Strategies outside of capital cities and metropolitan areas. Since the implementation of Better Access the numbers of FTE psychologists in the rural/remote public sector workforce have varied between states. Numbers in rural/remote areas decreased in Victoria and WA, increased in Queensland and remained relatively static in NSW and SA. The workforce in Tasmania, ACT and the NT was too small to analyse.

Approximately 25% of social workers and 20% of occupational therapists also provided Focussed Psychological Strategies in rural areas, with around 1% of social workers and 2% of OTs working in remote areas. Since the implementation of Better Access, the number of FTE social workers in the public sector workforce has increased at a higher rate in areas outside of capital cities; while the number of FTE occupational therapists in the public sector has increased at higher rates within capital cities.

The provision of training for the rural and remote mental health workforce was identified as being an issue. Although some web-based training has been developed and delivered, concern was expressed in the consultations about the capacity to provide good quality mentoring to health professionals in rural and remote areas. Given the accreditation process for allied mental health professions requires evidence of supervision in mental health practice; this may be an issue that requires addressing.

Footnotes

30 The NSW Psychologist Registration Board conducted a survey of their members in 2009 which covered at least some of these issues. Findings were not available at the time of submitting this report; however they are due for release early in 2010.