Just $7 extra per person could prevent 300 suicides a year. Here’s exactly where to spend it

Medicare spending on mental health services varies considerably depending on where in Australia you live, our new study shows.

We found areas with lower Medicare spending on out-of-hospital mental health services had poorer mental health outcomes, including more suicides.

This variation across the country was mostly related to factors such as a shortage of mental health providers and GPs, rather than people in some regions being in poorer mental health in the first place.

We also looked at how much extra government funding in today’s money would make a difference to people’s mental health across the population, using the latest data.

We worked out increasing government spending on out-of-hospital mental health services by A$153 million a year – about $7.30 per adult per year – could lead to:

• 28,151 fewer mental health emergency department visits (a 10% reduction)

• 1,954 fewer hospitalisations due to self-harm (a 20% reduction)

• 313 fewer suicides (a 10% reduction).

Here’s where our research suggests it’s best to target this extra funding.

What we did

We looked at Medicare-funded out-of-hospital mental health services, such as GP mental health visits, as well as visits to psychologists and psychiatrists. For the purposes of this article, we’ll call these Medicare-funded mental health services.

We also looked at mental health prescriptions (such as for depression or anxiety).

We looked at these services and prescriptions for the entire Australian population from 2011 to 2019.

We followed adults as they moved between regions to see how their use of mental health services and prescriptions changed after the move. This meant we could account for underlying individual factors, such as someone’s mental health needs.

Our study allowed us to assess how differences in the availability of mental health care across regions impacted how much the government spends on mental health services and prescriptions, and how this links to people’s mental health outcomes.

What we found

We found that only 28% of variation in spending on mental health services across regions was driven by patient-related factors, such as their need for mental health care. The rest was due to geographical reasons, such as availability of mental health providers and GPs.

But about 81% of the regional variation in spending on mental health scripts was due to patient factors.

In other words, when people experience mental health distress, accessing mental health medications, largely provided by a GP, is much easier than accessing care from a psychiatrist or a psychologist.

Areas with lower spending on out-of-hospital mental health services had higher rates of mental health-related emergency department visits, hospitalisations for self-harm, and suicides.

We mapped access to mental health services

We also compared funding for people with the same “need” for mental health services across different regions. This was from the best access (the most funding) at 100% down to 0% (no access).

After controlling for factors such as socioeconomic background and underlying mental health-care need, the region with the best access was the Gold Coast, with the highest Medicare spending on out-of-hospital mental health services.

The regions with the worst access were western Queensland and the Northern Territory. Here, a person with similar mental health-care needs would receive about 50% less in mental health service spending compared to someone on the Gold Coast.

How can we use our findings?

Recent analyses suggest government mental health expenditure has barely changed in 30 years. It now sits at about 7.4% of the total health budget.

Our results suggest there is unmet need for mental health services across the board. But some regions are more affected than others.

So we should target extra funding to rural and low-income regions – particularly when considering expanding access to psychologists and psychiatrists.

Recent policy initiatives have tried to improve access to GPs. This includes creating financial incentives for providers to bulk bill and to practise in underserved regions.

However, these policies have had little or modest effects on boosting access to GPs. There has also been much less focus on attracting more specialty mental health providers, such as psychologists or psychiatrists, to underserved areas.

To address the disparities and unmet needs in mental health care, we recommend:

• expanding the mental health workforce: implementing targeted incentives to attract and retain psychologists, psychiatrists, and mental health-trained GPs in underserved areas

• reforming funding models: adjusting funding allocations and incentives to target regions where there is significant unmet need. Our map shows which regions should be targeted first

• improving access to digital mental health services: using technology to provide accessible mental health support, particularly in areas with limited in-person services, while ensuring digital solutions are integrated with traditional care pathways.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.