1d. Has Better Access reached new consumers?

Several sources of data shed light on this question. The most direct evidence comes from Component A.³ Consumers who were recruited to the study by clinical psychologists (n=289), registered psychologists (n=317) and GPs (n=277), were asked whether they had previously received mental health care. Table 10 shows that more than half of the consumers recruited by clinical psychologists and registered psychologists (58% and 51%, respectively) had no previous history of mental health care. The same was true for a sizeable proportion of the consumers recruited by GPs (42%). This suggests that around half of all Better Access consumers may be "new", not only to Better Access but to mental health care more generally.

Medicare claims data were used in Component B to address a related question: to what extent has Better Access attracted first-time consumers of these services in each successive year of its operation?⁵ These analyses, summarised in Table 11, revealed that, of the 953,161 consumers who had received at least one Better Access service in 2008, more than two-thirds (68.0% or 648,465 consumers) were first-time Better Access consumers. In 2009, more than half (57.0% or 644,295 consumers) of the 1,130,384 Better Access consumers were first-time consumers. The percentage of first-time consumers varied by provider type. It was greatest among consumers using Better Access psychiatrist items, and lowest among consumers using Better Access GP items. The 2710 Mental Health Treatment Plan item potentially provides the best estimate of new Better Access consumers, as it is the "gateway" to subsequent Better Access services for the vast majority of consumers. In 2008, 87.2% of consumers received a Mental Health Treatment Plan for the first time. In 2009, the figure was 77.1%. It is acknowledged, however, that the approach taken here uses a limited definition of a "new" consumer because it is based on Medicare Benefits Schedule Better Access item data only. It may have included people who, although new to Better Access, are existing consumers of other parts of the mental health system.

Data from the study of uptake of Better Access item numbers by women also suggest that the initiative has reached "new" consumers.²⁹ Specifically, this study found that 93% of women who used Better Access items had not previously seen a counsellor, psychologist or social worker.

Data from the BEACH program provide a contrary view. BEACH data showed that although proportion of encounters at which depression was managed by GPs increased significantly from 3.5/100 in 1998-99 to 4.0/100 in 2007-08, the management rate of "new" cases of depression remained constant (0.7/100 encounters in 1998-99 to 0.6/100 encounters in 2007-08). There was also no change in the management rate of "new" cases of anxiety or substance use disorders.^{27 28}

Two other studies have examined how many consumers of Better Access services provided by allied health professionals have previously used these same provider groups. The Australian Psychological Society's surveys found that, on average, participating psychologists reported that 70% of their Better Access consumers had not previously consulted a psychologist.^{30 31} Harris et al's analyses of population-level data from the 2007 National Survey of Mental Health and Wellbeing estimated that 62% of people who used Better Access allied health services in 2007 had not previously used allied health services for mental health care.¹⁴

Taken together, these findings strongly suggest that Better Access has reached "new" consumers. Although it is possible that some of these people may have had no need for mental health care in the past. It would seem plausible that a substantial proportion had a prior need but were not able to access care. Better Access would appear to be potentially meeting some of the previously unmet need for mental health care experienced by Australians with common mental disorders.

Table 10: Previous history of mental health care among consumers who participated in Component A¹

	No previous history of mental health care N	No previous history of mental health care %	Previous history of mental health care N	Previous history of mental health care %	Unknown N	Unknown %
Consumers recruited by clinical psychologists (n=289)	168	58%	109	38%	11	4%
Consumers recruited by registered psychologists (n=317)	162	52%	127	41%	20	6%
Consumers recruited by GPs (n=277)2	113	42%	149	56%	4	2%

1. Received care through Better Access between 1 Oct 2009 and 31 Oct 2010.
2. Consumers recruited by GPs may have received treatment from the GP in isolation or may have been referred to an allied health professional for further care.

Table 11: Number and percentage of first-time Better Access consumers in 2008 and 2009 derived from Medicare claims data, Component B¹

1. Data had regard to claims processed up to and including 30 April 2010.