New study reveals the gap between rich and poor in access to psychiatric help during COVID-19
Psychiatric consultations, largely driven by the increased availability of telehealth, skyrocketed during the COVID-19 pandemic as people struggled with isolation, unemployment and working and schooling from home.
Now new national data, collected by Monash University researchers, on psychiatric consultations during the COVID-19 pandemic from 2020 to 2022, has revealed that significant socioeconomic barriers existed during the harsh second year of the pandemic, despite government efforts to increase access.
The study, led by Associate Professor Joanne Enticott from Monash Centre for Health Research and Implementation (MCHRI) and published in the International Journal of Social Psychiatry, shows that psychiatric consultations increased by five consultations daily between the 2020/21 and 2021/22 financial years. This then decreased slightly the following year – but it did not decrease equally across all socioeconomic areas – instead, it decreased far more in the most disadvantaged areas.
The research team analysed seven years of Medicare data from 321 regions across Australia defined by their socioeconomic status. The researchers found that in the most disadvantaged areas consultation rates declined by 15.9 per cent between the 2020/21 and 2021/22 financial years, compared to a smaller decrease of 1 per cent to 4 per cent in wealthier areas.
The most alarming result of the study, according to Associate Professor Enticott, was growing inequality as measured by concentration indices that rose from 0.169 in 2020/21 to 0.177 in 2021/22. The result indicated that access to psychiatric care became more disproportionately concentrated among wealthier populations by around 5 per cent more, exacerbating disparities in mental health service utilisation.
“Our study shows that inequality in mental health service provision increased in the second year of the COVID-19 pandemic to the highest level seen in the 7 years of data we analysed (from 2015 to 2022),” she said.
“Individuals within the most disadvantaged regions experienced a significant and disproportionate decline in service rates.”
The researcher used Medicare data to calculate daily rates of psychiatry attendances per 100,000 working-age adults within each socio-economic region.
Associate Professor Enticott, who leads Big Data at MCHRI acknowledges that there has always been a disproportionate burden of psychological distress and mental disorders in socioeconomically disadvantaged and some rural populations.
“However, though these groups have greater treatment needs they report lower uptake of mental health services. This inequity is exacerbated by the high price of gap fees.”
An analysis of Australian Bureau of Statistics (ABS) data from 2017 found that less than 30 per cent of initial psychiatry consultations were bulk billed and psychiatry had the highest yearly co-payments per person of all medical specialties, although bulk billing rates were higher for Australians in lower socioeconomic areas.
There are also fewer psychiatrists working in more disadvantaged rural areas compared to other areas, further compounding the barriers to access, according to Associate Professor Enticott.
In Australia, nationwide pandemic restrictions were first introduced in March 2020 but the burden of COVID-19 cases and lockdowns subsequently diverged sharply on a state-by-state basis, depending on lockdown rules.
During the pandemic, new Medicare Benefits Schedule (MBS) items for video-linked and phone consultations were made available from 13 March 2020.
About Monash University
Monash University is Australia’s largest university with more than 80,000 students. In the 60 years since its foundation, it has developed a reputation for world-leading high-impact research, quality teaching, and inspiring innovation.
With four campuses in Australia and a presence in Malaysia, China, India, Indonesia and Italy, it is one of the most internationalised Australian universities.
As a leading international medical research university with the largest medical faculty in Australia and integration with leading Australian teaching hospitals, we consistently rank in the top 50 universities worldwide for clinical, pre-clinical and health sciences.
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