Overall, GPs, AHPs and public mental health providers perceived the Better Access initiative as providing services complementary to those provided by public mental health services. The Better Access initiative clients tended to have lower chronicity, less complexity, fewer co-morbidities, and were more able to manage their own care than clients of the public mental health system.
However, AHPs also noted an increasing complexity in the profile of clients referred to AHPs as the Better Access initiative has evolved. In part, this was attributable to the revelation of more complex issues underlying what appeared to be more simple presenting problems. More importantly, the increasing complexity of referrals was seen as a product of the maturing of the Better Access initiative. As relationships, trust and referral pathways developed between GPs, psychiatrists, AHPs and local support services, the complexity of those referred increased.
AHPs with well-established practices and relationships with local GPs, psychiatrists and community support services reported managing very complex cases with extensive mental health histories. These AHPs were also more likely to report positive working relationships with local public health providers, based not on formal structures but on relationships with individual public mental health providers. In some instances, these clients were receiving case management from NGO organisations, the public mental health system and/or intensive informal support from families and friends. These providers also reported a capacity to work with the local GP in accessing both the Better Access initiative and ATAPS to provide the intensity and continuity of care required. It was noted in the consultations that the number of sessions being required was increasing and up to 18 sessions was not unusual. 37
The local consultations suggested that the complexity of the caseload referred was also in part a reflection of the capacity of the local public mental health system. Where public mental health services were not available or were overstretched, complex clients were more likely to be referred to an AHP through the Better Access initiative.
Concerns raised by a number of consumer organisations representing more complex patient groups and relayed by a number of public mental health providers were that:
- The Better Access initiative is not available to all clients with more complex needs who may also benefit from the services offered through the Better Access initiative;
- the model of care and number of sessions available was often not adequate for this client group who may require more intensive and longer term interventions; and
- given a perceived under resourcing for this client group, the allocation of an uncapped budget to a client group with lower acuity problems was perceived as a poor prioritisation and inequitable allocation of resources.
37 Changes in the number of sessions per individual as Better Access has developed can be identified in Component B of the evaluation: Analysis of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) Administrative Data.