Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative?

[Sly Saint]

Abstract
Objective
We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative.
Conclusion
A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20–40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.
To reduce the burden of common mental health conditions in the community, the Australian federal government has invested in psychotherapies through the Medicare Better Access initiative.1 By 2021, one in every 10 Australians received at least one Better Access service, and one in 20 had one or more sessions of psychotherapy, at a cost to the Australian government of AUD 1.2 billion.2 Despite this large investment, the prevalence of psychological distress and suicide were not reduced by the introduction of Better Access in 2006.3 This raises questions about why increased access to psychotherapies has not improved population mental health.4

https://journals.sagepub.com/doi/10.1177/10398562231172417

eta: the Australian equivalent of the UKs IAPT recently renamed NHS Talking Therapies.

 

[DokaGirl]

Abstract
Objective
We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative.
Conclusion
A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20–40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.
To reduce the burden of common mental health conditions in the community, the Australian federal government has invested in psychotherapies through the Medicare Better Access initiative.1 By 2021, one in every 10 Australians received at least one Better Access service, and one in 20 had one or more sessions of psychotherapy, at a cost to the Australian government of AUD 1.2 billion.2 Despite this large investment, the prevalence of psychological distress and suicide were not reduced by the introduction of Better Access in 2006.3 This raises questions about why increased access to psychotherapies has not improved population mental health.4

https://journals.sagepub.com/doi/10.1177/10398562231172417

eta: the Australian equivalent of the UKs IAPT recently renamed NHS Talking Therapies.

Good to see some monitoring of this program. Not just assuming it will be effective.

Why has psychological distress and suicide not been reduced?

Could it be because more practical help is needed?

Problems in living such as poverty, disease, violence and abuse, low education, lack of life skills etc., are either not readily solved, or not solved at all, with talk therapies.

A band-aid not solution, instead of grappling with the root of these problems.

 

[Hoopoe]

This raises questions about why increased access to psychotherapies has not improved population mental health.4

Maybe because poor population mental health is not caused by a lack of access to psychotherapies?

 

[rvallee]

Mental health care is currently a free-for-all wild west that is at best similar to the era of snake oil merchants, and so much worse in some ways because the pseudoscience is now official and has the full weight of law and government.

Of course it performs poorly. Here they only account for worsened outcomes, but in most cases the outcome is unchanged, at great expense, but there is a widespread belief that, somehow, it should work 100% of the time, even when applying generic solutions to different problems than people actually have.

Hell if we compare to the claims from PACE about ME, they boast, actually boast, about a 1/7 response rate that can't be measured in any way. And from that they claim 100% success rate. The entire industry is founded on hype and marketing. They don't deliver because they never had to, they can simply claim that they do and somehow keep getting money dumped on their head. It's like their unwavering belief that they just have to find the perfect words to snap us out of... whatever. At the system level, it's the infinite belief that there is a very large sum of money that will somehow make it all work as hyped.

Recent decades have seen massive investments in mental health. And yet what keeps being found is that things are actually getting worse. True or not, because massively inflating this problem is necessary to match the giant sums they keep getting despite delivering nothing. Because none of this is ready, pseudoscience is not effective no matter how much money you put into it.

Now there is a small % of people who have issues that can be helped with the current state of knowledge. That % is very small, most of the other problems have no psychological factors but the entire house of medicine was bet on the idea that it's the single most important concept in all health care, so they keep pumping money at a failing system, where the solution always seems to involve putting evermore money.

This is what happens when reality is dismissed, when real problems are substituted for cheap generic solutions. It has nothing to do with psychology, psychotherapy or mental health either. If you apply the wrong solution to a problem you're part of the problem. Their solution may as well be a giant party where everyone is invited for all that it matters. You're just paying huge sums to get the answer 42 in an infinite loop.

 

[Sean]

Problems in living such as poverty, disease, violence and abuse, low education, lack of life skills etc., are either not readily solved, or not solved at all, with talk therapies.

A band-aid not solution, instead of grappling with the root of these problems.

Maybe because poor population mental health is not caused by a lack of access to psychotherapies?

Exactly.

As I have said before, I will take psych's hand-wringing about mental health seriously when they make reliable unconditional access to both an adequate minimum standard of material resources, and basic civil and politic rights, their core policy positions.

Will it solve mental health issues completely? No. Like physiopathology, psychopathology will be with us forever.

But those two policies alone could deliver more improvement in general mental health than all other policies combined, IMHO.

 

[Sly Saint]

report covered by cbtwatch, to compare with situation in UK;
NHS Talking Therapies – A Black Hole For Psychological Wellbeing Practitioners?

On January 23rd 2023 NHS mental health director, Claire Murdoch, announced that:

‘Despite the disruption caused by the pandemic the NHS is on track to deliver its Long Term Plan commitment to boost mental health spending by £2.3 billion a year, enabling around 4.5 million adults and over 700,000 young people to access mental health services’.

All this without independent evidence of effectiveness. The best evidence available Scott (2018) suggests that for adults only the tip of the iceberg recover.

Australia [Allison et al (2023)] has just completed an inspection of its similar service and concluded:

http://www.cbtwatch.com/nhs-talking...le-for-psychological-wellbeing-practitioners/