The consultations identified that the Better Access initiative had assisted in improving access to mental health services for children and young people. Increasing access to mental health services by children was a strong theme from the consultations while noting the opportunities to further improve access and clinical outcomes for children and their families.
Previously, low cost treatment options for children with mental health problems were through the very few child and adolescent psychiatrists in private practice (who bulk billed or had a low or sliding fee scale), outpatient departments of the children's hospitals or the public mental health child and adolescent mental health service (CAMHS). Stakeholders emphasised that CAMHS were generally aimed at the most severely ill, and were usually associated with chronically long waiting lists. Services for children and young people are described as fragmented and highly localised.30
Families requiring mental health services for their children were largely forced to rely on the private system for which there was no rebate available. As such, the Better Access initiative was perceived as providing an additional route for children to access mental health services in a much more timely manner, providing intervention before the young person became acutely unwell, and addressing the psychological problems underlying behavioural and learning problems. The Better Access initiative has allowed a number of providers with expertise in child and adolescent mental health to enter the private system. The inclusion of occupational therapists, psychologists and social workers within the group of approved providers allows GPs to refer to the professional with the most appropriate skills and experience to address the needs of the child.
It was also noted that paediatric referrals are coming via paediatric surgeons through the paediatrician. A number of AHPs suggested that paediatric surgeons also be given delegation to refer to the Better Access initiative providers.
Respondents noted that the key areas for improvement in respect to services for children were to expand the range of MBS items to include the provision of family therapy and sessions with family and carers at which the child was not present.
In respect to services for youth and young adults many stakeholders and interviewees (GPs, AHPs and NGOs) noted that traditional professional providers and the Better Access initiative service models did not provide adequate access by youth for the following reasons:
- higher likelihood of cancellations, 'no shows' and no payment for 'no shows', reducing the financial viability for providers in providing a service on a sessional payment basis;
- limited capacity to pay gap fees required to sustain financial viability;
- longer periods of engagement required to develop a therapeutic relationship;
- high likelihood of co-morbidities such as substance abuse;
- longer engagement and co-morbidities requiring more sessions than available through the Better Access initiative; and
- often the need to engage with other services providing support to the client not funded through the Better Access initiative.
Consultation with Headspace programs indicated a difficulty in becoming self-funding because of the limited capacity of youth to pay gap payments to AHPs and high rates of cancellations and no shows limiting a Medicare based revenue stream.