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RESEARCH ARTICLE
Contents Vol 47(6)

Deterioration of mild anxiety and depression with Better Access treatment: implications for scaling up psychotherapy worldwide

Stephen Allison A B * , Tarun Bastiampillai A B C , Steve Kisely https://orcid.org/0000-0003-4021-2924 B D E and Jeffrey C. L. Looi https://orcid.org/0000-0003-3351-6911 B F
+ Author Affiliations
- Author Affiliations

A Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia.

B Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.

C Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia.

D School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia.

E Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.

F Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia.

* Correspondence to: stephen.allison@flinders.edu.au

Australian Health Review 47(6) 741-743 https://doi.org/10.1071/AH23163
Submitted: 19 August 2023  Accepted: 3 October 2023  Published: 17 October 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

The Australian Medicare Better Access initiative in mental health reached one in every 10 Australians in 2021 (more than 2.6 million people) with interventions targeted at mild-to-moderate anxiety and depression, provided by general practitioners, allied health professionals, and/or psychiatrists, at a cost of AUD1.2 billion. However, the overall mental health of the Australian population has not improved since the introduction of Better Access. The benefits of population-scale mental health interventions (medications and psychotherapies) might have been overestimated for milder conditions, and the iatrogenic potential underestimated. A recent evaluation of Better Access found that mild anxiety and depressive symptoms were threefold more likely to worsen (32%) rather than improve (10%). Better Access might be targeted more cost-effectively towards severe and complex conditions, for which treatment appears to have superior risk–benefit ratios. These findings have implications for similar initiatives worldwide, such as those proposed by the World Health Organization.

Keywords: anxiety, Better Access initiative, depression, global mental health, health policy.

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