This chapter concludes with a summary of the key issues identified in the critically reflective analysis, including those that could lead to the improvement of mental health services.

  1. Concordance between data sources relating to mental health services could be improved in the areas of occupational definitions, demographic data, regional categories, estimations of fulltime equivalence and the level of private-public service provision. The new National Health Workforce Dataset provides a unique opportunity to collect the types of data that would be beneficial to the mental health workforce.

  2. Each of the mental health workforce objectives have been met to some degree and the Better Access project is likely to have contributed to these achievements, although causal relationships could not be established. These objectives are:

    1. Encouraging more GPs to participate in early intervention, assessment and management of patients with mental disorders;

    2. Streamlining access to appropriate psychological interventions in primary care;

    3. Encouraging private psychiatrists to see more patients and expand their role as specialists in backing up the primary health care sector;

    4. Providing referral pathways for appropriate treatment of patients with mental disorders;

    5. Supporting GPs and primary care service providers with education and training to better diagnose and treat mental illness.

  3. The provision of Better Access services entails a relatively small amount of time per week for any of the allied mental health workforces, indicating a level of spare capacity to increase the provision of Better Access mental health services.

  4. Better Access allied mental health service providers were older than the mental health workforce more generally. The reason for this could not be determined from the data, but it could have workforce planning implications.

  5. Better Access allied mental health service providers were more likely to work in rural and remote areas than the allied mental health workforce more generally.

  6. At the national level, there have been increases in the numbers of allied mental health professionals (FTE/DFTE) in each of the occupational groups in both the private (Medicare) and public sectors since the implementation of Better Access. State / territory differences in the distribution between the private (Medicare) and public sectors indicate that the specific policy context in each jurisdiction was likely to have influenced the outcome.

  7. Data indicated that the public sector psychology workforce had increased (especially in Queensland, NSW and SA) since the implementation of Better Access, however the rates of growth have slowed and there are state / territory differences. The data could not determine why the public sector psychology workforce in Victoria decreased in 2007-08 and is now smaller than the private (Better Access) workforce.

  8. To expand the social work and occupational therapy Better Access allied mental health workforces, a more inclusive use of referral pathways may be required. This would involve clarifying the roles of social workers and occupational therapists in mental health service provision; promoting their role to GPs, creating opportunities for a shared literacy to develop across mental health paradigms; and the pro-active development of broader GP professional networks.

  9. Concerns about the lack of clinical supervision and training in the public sector psychology workforce may be due to issues that could not be evaluated using data on FTE/DFTE numbers. For example, there may be a decrease in the number (headcount) of psychologists in the public sector; a shift in the demographic structure of the workforce; or an increase in the turnover. To assess the reasons for the shortages, data related to these issues would need to be collected.

  10. Trends toward the provision of remote supervision of GPs and allied mental health professionals may assist with professional development in rural and remote areas and in some outer metropolitan clinical practices. This needs to be associated with quality assurance measures that equal the standards imposed on face-to-face models of supervision.

  11. Areas of additional training required were identified including:

    1. GPs: use of care plans, including benchmarking; multi-disciplinary communication practices; and multi-disciplinary networking.

    2. Occupational therapists: clinical practice; business skills; and peer support.