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RESEARCH ARTICLE
Contents Vol 47(6)

Deterioration of mild anxiety and depression with Better Access treatment: implications for scaling up psychotherapy worldwide

Stephen Allison A B * , Tarun Bastiampillai A B C , Steve Kisely https://orcid.org/0000-0003-4021-2924 B D E and Jeffrey C. L. Looi https://orcid.org/0000-0003-3351-6911 B F
+ Author Affiliations
- Author Affiliations

A Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia.

B Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.

C Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia.

D School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia.

E Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.

F Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia.

* Correspondence to: stephen.allison@flinders.edu.au

Australian Health Review 47(6) 741-743 https://doi.org/10.1071/AH23163
Submitted: 19 August 2023  Accepted: 3 October 2023  Published: 17 October 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

The Australian Medicare Better Access initiative in mental health reached one in every 10 Australians in 2021 (more than 2.6 million people) with interventions targeted at mild-to-moderate anxiety and depression, provided by general practitioners, allied health professionals, and/or psychiatrists, at a cost of AUD1.2 billion. However, the overall mental health of the Australian population has not improved since the introduction of Better Access. The benefits of population-scale mental health interventions (medications and psychotherapies) might have been overestimated for milder conditions, and the iatrogenic potential underestimated. A recent evaluation of Better Access found that mild anxiety and depressive symptoms were threefold more likely to worsen (32%) rather than improve (10%). Better Access might be targeted more cost-effectively towards severe and complex conditions, for which treatment appears to have superior risk–benefit ratios. These findings have implications for similar initiatives worldwide, such as those proposed by the World Health Organization.

Keywords: anxiety, Better Access initiative, depression, global mental health, health policy.

References

1  World Health Organization. World mental health report: transforming mental health for all. Geneva: World Health Organization; 2022.

2  Ormel J, Hollon SD, Kessler RC, Cuijpers P, Monroe SM. More treatment but no less depression: The treatment-prevalence paradox. Clin Psychol Rev 2022; 91: 102111.
| Crossref | Google Scholar | PubMed |

3  Pirkis J, Currier D, Harris M, et al. Evaluation of Better Access. Melbourne: University of Melbourne; 2022.

4  Jorm AF. Australia’s ‘Better Access’ scheme: Has it had an impact on population mental health? Aust N Z J Psychiatry 2018; 52(11): 1057-1062.
| Crossref | Google Scholar | PubMed |

5  Enticott J, Dawadi S, Shawyer F, Inder B, Fossey E, Teede H, Rosenberg S, Ozols AM I, Meadows G. Mental Health in Australia: Psychological Distress Reported in Six Consecutive Cross-Sectional National Surveys From 2001 to 2018. Front Psychiatry 2022; 13: 815904.
| Crossref | Google Scholar |

6  Organisation for Economic Co-operation and Development. Health Statistics. 2023. Available at https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC# [accessed 17 August 2023].

7  Jorm AF. Lack of impact of past efforts to prevent suicide in Australia: Please explain. Aust N Z J Psychiatry 2019; 53(5): 379-380.
| Crossref | Google Scholar | PubMed |

8  Bastiampillai T, Allison S, Looi JC, Tavella A, Agis U. Why are Australia’s suicide rates returning to the hundred-year average, despite suicide prevention initiatives? Reframing the problem from the perspective of Durkheim. Aust N Z J Psychiatry 2020; 54(1): 12-14.
| Crossref | Google Scholar | PubMed |

9  Duggan M, Harris B, Chislett WK, Calder R. Nowhere else to go: Why Australia’s health system results in people with mental illness getting ‘stuck’ in emergency departments. Mitchell Institute Commissioned report 2020. Victoria University; 2020.

10  Meadows GN, Prodan A, Patten S, Shawyer F, Francis S, Enticott J, Rosenberg S, Atkinson JA, Fossey E, Kakuma R. Resolving the paradox of increased mental health expenditure and stable prevalence. Aust N Z J Psychiatry 2019; 53(9): 844-850.
| Crossref | Google Scholar | PubMed |

11  Berk M, Parker G. The elephant on the couch: side-effects of psychotherapy. Aust N Z J Psychiatry 2009; 43: 787-794.
| Crossref | Google Scholar | PubMed |

12  Sreeharan V, Madden H, Lee JT, Millett C, Majeed A. Improving Access to Psychological Therapies and antidepressant prescribing rates in England: a longitudinal time-series analysis. Br J Gen Pract 2013; 63(614): e649-e653.
| Crossref | Google Scholar | PubMed |

13  Bastiampillai TJ, Allison S, Harford P, Perry SW, Wong ML. Has the UK Improving Access to Psychological Therapies programme and rising antidepressant use had a public health impact? Lancet Psychiatry 2019; 6(3): e8-e9.
| Crossref | Google Scholar | PubMed |