Equity in mental health services

Socio-economic disadvantage and resource distribution for mental health care

Equitable mental health resource distribution is a major gap in the Australian National Mental Health Services Planning Framework (NHMSPF). In a paper published online in Australasian Psychiatry October 2020, we proposed a resource distribution formula to complement NMHSPF outputs in order to help address this gap. The preprint is available here, and this also with an accompanying conversation piece.

More mental health care money is not changing prevalence - why?

In a viewpoint paper published in the ANZJP in late 2019 with a wide international collaborative group we set out a proposition about why we are not seeing positive changes in mental health problem prevalence despite increased expenditure and we are now pursuing the research questions set out there.

Mental health services utilisation - A national equity investigation

Australia provides national health insurance funding for psychological treatment services, and this funding has increased substantially since 2006. Concerns have been raised as to whether these funded services are distributed equitably. We assessed whether adult utilisation of mental health services subsidised by Australian federal national health insurance (Medicare) varies by measures of socio-economic and geographic disadvantage between July 1st 2007 and June 30th 2011. The results, published in 2015 in the Medical Journal of Australia as per details below, clearly show significant disparities in non-GP mental health Medicare funded services, whereby people residing in lower socio-economic areas are utilisation services at much lower rates compared to advantaged areas.

For further information view Health Services Research MBS Study

Mental health services utilisation by postpartum mothers - an equity investigation (confirmed 2021 Honours project)

It has already been observed that access to the Medicare-subsidised mental health services by Australians shows significant disparities such that those living in the least disadvantaged one-fifth of areas in Australia access 2-3 times more services than those living in the most disadvantaged one-fifth. Currently we don’t know if these significant area disparities in the utilisation of MBS mental health services also affects mothers in the postpartum period. This study aims to address this gap in knowledge by examining a large longitudinal dataset of women in the ALWHS with linked MBS and PBS data. Increasing understanding of the determinants of mental health is necessary to strengthen the support system for postpartum mothers. We will investigate the potential disparities in access to resources, stratifying access by the mother’s income, location, race and ethnicity to underpin structural and area-related barriers to care.

Equity publications

Journal articles

Meadows, G., Shawyer, F., Dawadi, S., Inder, B. & Enticott, J. (2020). Socio-economic disadvantage and resource distribution for mental health care: a model proposal and example application for Victoria, Australia. Australasian Psychiatry, online 8 October 2020.

Meadows, G. N., Prodan, A., Patten, S., Shawyer, F., Francis, S., Enticott, J., Rosenberg, S., Atkinson, J.-A., Fossey, E., & Kakuma, R. (2019). Resolving the paradox of increased mental health expenditure and stable prevalence. Australian & New Zealand Journal of Psychiatry, 53(9), 844-850.

Isaacs, A. N., Enticott, J., Meadows, G., & Inder, B. (2018). Lower Income Levels in Australia Are Strongly Associated With Elevated Psychological Distress: Implications for Healthcare and Other Policy Areas. Frontiers in Psychiatry, 9(9), 536.

Enticott, J. C., Lin, E., Shawyer, F., Russell, G., Inder, B., Patten, S. & Meadows, G. (2018). Prevalence of psychological distress: How do Australia and Canada compare? Australian & New Zealand Journal of Psychiatry, 52(3), 227-238.
This paper was awarded the Editor's best pick.

Enticott, J. C., Meadows, G. N., Shawyer, F., Inder, B. & Patten, S. B. (2016). Mental disorders and distress: Associations with demographics, remoteness and socioeconomic deprivation of area of residence across Australia. Australian & New Zealand Journal of Psychiatry, 50(12), 1169-1179.

Meadows G, Enticott J, Inder B, Russell G, Gurr R. (2015). Better access to mental health care and the failure of the Medicare principle of universality. Medical Journal of Australia, 202(4),190-5.

Meadows, G., Enticott, J., Russell, G., Inder, B., & Gurr, R. (2015). Private Psychiatry as funded through medicare considered in terms of social equity. Australian and New Zealand Journal of Psychiatry, 49(S1), 69.

Pieces in The Conversation

Meadows, G., Inder, B., Shawyer, F., Enticott, J. (2020). Greater needs, but poorer access to services: why COVID mental health measures must target disadvantaged areas. Retrieved from: https://theconversation.com/greater-needs-but-poorer-access-to-services-why-covid-mental-health-measures-must-target-disadvantaged-areas-146306

Meadows, G., Cichello, A., Isaacs, A. N., & Shawyer, F. (2019). When it’s easier to get meds than therapy: how poverty makes it hard to escape mental illness [Press release]. Retrieved from: http://theconversation.com/when-its-easier-to-get-meds-than-therapy-how-poverty-makes-it-hard-to-escape-mental-illness-114505

Meadows G, Enticott J, Rosenberg S (2018). Three charts on: why rates of mental illness aren’t going down despite higher spending.  Retrieved from:  https://theconversation.com/three-charts-on-why-rates-of-mental-illness-arent-going-down-despite-higher-spending-97534. This piece had extensive media attention including being discussed in the New York Times.