Lessons from Australia, England in addressing access to mental-health care

Two-thirds of Canadians have access to an employer-sponsored health plan, compared to one-in-five Australians and one-in-10 Britons, according to one speaker at Benefits Canada’s 2018 Mental Health Summit Toronto on Nov. 12.

Research also found, when looking at publicly funded therapy programs in Australia and England, the goal was to increase access and bridge the gap in care, said Claire Duboc, managing director at CBT Associates and Beacon. “In Canada, we too have an access problem, which isn’t going to be solved soon. Worldwide, it’s recognized that mental health represented up to 23 per cent of the disease burden, but it receives a much smaller portion of health funding.”

Read: Assessing the impact of online therapy as digital health tools proliferate

Also speaking during the session, Peter Farvolden, clinical lead at CBT Associates and Beacon, said Canada is similar to Australia in its challenges in delivering mental-health services due to geography and population distribution. He noted Australia launched its Better Access Initiative in 2006 to bulk bill medicare for psychotherapy, covering up to 10 traditional face-to-face therapy sessions or video visits. It received great uptake, with the program accessed by more than one million Australians each year.

“What they also learned is you can only get so far by expanding access to traditional face-to-face psychotherapy services,” said Farvolden. “They didn’t overcome many barriers to access. For example, most of the people who were accessing the program lived in urban centres. And the initiative, at least initially, suffered from a general lack of rigour. Patients received, on average, five to six sessions or services of treatment when we know that effective treatment for anxiety and depression is likely eight to 10 sessions.”

Australia also funded a new clinic to provide online assessment and treatment, which found internet-based cognitive behavioural therapy is effective and outcomes are comparable to controlled trials, he noted.

Read: An in-depth look at digital cognitive behavioural therapy

In England, the publicly funded access program is focused on disorder-specific treatment for mood and anxiety disorders, primarily using CBT. It also appears to be headed towards the online CBT route, even though it was initially aimed at increasing capacity for face-to-face treatment, said Farvolden. The reason for this, he added, is the program was only reaching 16 per cent of those with depression and anxiety, and expanding the program presented financial challenges.

The consensus for best outcomes around mental health includes shorter wait times, the ability to self-refer for treatment, rigorous assessment at the front-end, triaging to specific care, problem-specific care and the right step of care, said Farvolden.

“Because assigning people to the wrong care or the wrong step of care can lead to problems, you can do harm. Give people meaningful choices when you can. For example, a choice between medication and psychotherapy. Ensure that therapists are well-trained in delivering protocol-driven treatment. Measure recovery continuously to allow for the adjustment of treatment. Ensure fidelity of treatment and ensure quality control. You cannot overcome the barriers to reach and access by simply expanding access to traditional services.”

Read more coverage from the 2018 Mental Health Summit.