Psychiatric consultations – largely driven through increased availability of telehealth skyrocketed during COVID as people struggled with isolation, unemployment, working and schooling from home etc.
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 harshest second year of the pandemic, despite government efforts to increase access.
The study, led by Associate Professor Joanne Enticott and published in the International Journal of Social Psychiatry, shows that psychiatric consultations increased by an extra 5 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, headed by Associate Professor Joanne Enticott, at the Monash Centre for Health Research and Implementation (MCHRI), analysed 7 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% between the 2020/21 and 2021/22 financial years, compared to a smaller decrease of 1% to 4% 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. Indicating that access to psychiatric care became more disproportionately concentrated among wealthier populations by around 5% more, exacerbating disparities in mental health service utilization.
“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% 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 of lockdowns subsequently diverged sharply on a state-by-state basis, depending on lockdown rules.
During the pandemic, new Medicare Benefit Schedule (MBS) items for video-linked and phone consultations were made available from 13 March 2020.
Contact:
Amanda Hamilton
Monash Centre for Health Research and Implementation (MCHRI)
T: +613 8572 2667, amanda.hamilton@monash.edu
