The National Survey of Mental Health and Wellbeing conducted in 2007 by the Australian Bureau of Statistics estimates that 3.2 million Australians, or 20% of the adult population, experienced symptoms of a mental health disorder in the preceding 12 months.

“Mental health is the embodiment of social, emotional and spiritual wellbeing. It provides individuals with the vitality necessary for active living, to achieve goals, and to interact with one another in ways that are respectful and just” (Victoria Health). Mental health is one of the top three causes of burden of disease and injury and accounts for 13% of the total disease burden in Australia; cancer accounts for 19%, cardiovascular disease 18%. If neurological and sense disorders were included with mental health, the disease burden is 25%. Anxiety, depression, alcohol abuse and personality disorders dominate the mental health disorders. In addition, anxiety and depression also carries a risk of ischaemic heart disease and suicide. In females, the leading cause of burden of disease was anxiety and depression (10%). In the case of psychotropic medications: 27% percent of adult Australians reported using anti-depressants, 23% used sleeping tablets, 10% used medications for anxiety or nerves. In 2005, there were 2,101 deaths from suicide and nearly 80% were males (Burden of disease and injury in Australia 2003).

To improve access to effective primary mental health care, the Australian government introduced the Better Outcomes in Mental Health Care in 2001 which was followed by the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) program in 2006.

GPs can refer patients with mental health disorders to psychologists and allied health professionals through both these programs for government subsidised focused psychologists strategies.

The Better Outcomes in Mental Health Care Program
This program was introduced in 2001 and offers high quality mental health care via two components: referrals to allied health professionals and access to patient management advice from psychiatrists (GP Psych Support).

Access to Allied Psychological Services (ATAPS) supports GPs and allied health professionals (AHPs) such as psychologists, clinical psychologists, social workers, mental health nurses, Aboriginal and Torres Strait Islander health workers and occupational therapists to provide mental health care. This program enables GP to refer patients with mild to moderate high prevalence disorders such as depression, anxiety and stress to AHPs for up to 12 sessions (or 18 sessions in exceptional circumstances) for individual or group sessions of government subsidised focused psychological strategies per financial year. This approach to mental health care is occurring through all the divisions or networks of general practices using range of service delivery models.

The Better Access Program
This program was introduced in 2006 as part of a reform package and was designed to improve access to psychiatrists, psychologists, GPs and other AHPs via a series of new mental health Medicare Benefits Schedule item numbers that offered a rebate. These Medicare Benefits schedule items numbers are 2710 or 2710 for GPs, 80010-80170 for AHPs.

This program is similar to ATAPS where a GP can refer a patient to a AHP after carrying out a Mental Health Treatment Plan (Item Number 2710 or 2702). Under the Better Access program a GP can refer a patient for up to 12 sessions (or 18 in exceptional circumstances) of individual or group sessions per calendar year for various psychological strategies.

Better Outcomes versus Better Access
The Better Outcomes program, started in 2001, is being administered by all divisions of general practice with capped funding from the Department of Health and Ageing. This means that only a finite number of patients can be referred to an AHP through this program. As some of you will be aware, in the current financial year, all the money was committed to the clients by early January and the program has only just started accepting new referrals again.

Fortunately, under the Better Access program, there are no limits the number of patients who could be referred to AHPs. So when the funding for ATAPS was all committed by early January, the GPs were able to use the Better Ac- cess program to refer their patients to AHPs.