‘Missing middle’ slip through mental healthcare gaps

People with complex chronic mental health conditions are ‘slipping through the gaps’ ­between primary care and in-­hospital treatment.

People with complex chronic mental health conditions are “slipping through the gaps” ­between primary care and in-­hospital treatment, unable to ­access services in the community and facing cost barriers to private psychiatric treatment.

The Productivity Commission’s mental health draft report has labelled this gap the “missing middle” between primary care provided by GPs and acute ser­vices delivered within hospitals.

“The missing middle particularly affects people whose illnesses are too complex or enduring to be treated in primary care but are not considered severe enough to meet the high threshold to access constrained specialist mental health services,” the report said.

“For people in the missing middle, the gap in care options — especially gaps in the availability of specialist community mental health services — can cause their condition to worsen, and lead to personal suffering, avoidable ­visits to emergency departments and hospitals, and a reduction in their capacity to participate ­socially and economically.”

Acute patients who are admitted to public hospital mental health wards are treated by psychiatrists at no cost to the consumer, but for those dealing with non-acute conditions that are too complex to be managed by a GP, the report found there are significant out-of-pocket costs for ­psychiatry consultations.

Consumers pay an average of $155 out-of-pocket for an initial consultation with a private psychiatrist, on top of the average Medicare rebate of $233, the commission found.

Up to 10 sessions a year are funded by Medicare for psychology consultations, but the mental health report said that for the 1.3 million Australians who are ­accessing these services, some were not receiving enough sessions while others could be better treated with lower-intensity services such as online treatment and telephone support services.

“Currently consumers do not have easy access to low-intensity mental health services,” the report said.

“Many are being referred for individual psychological therapy when they would have their needs better met through more accessible, lower cost and lower intensity services.”

There was also an urgent need for better access to community mental health treatment, including by specialised nurses.

The Productivity Commission also said better co-ordination was needed between GPs and ­psychiatrists.

It recommended the introduction of a new Medicare Benefits Schedule item for psychiatrists to provide advice to a GP over the phone on diagnosis and patient management.

For those with private health insurance, the Productivity Commission said there was significant scope for expanded mental health care outside of hospitals, but health insurers are currently barred from funding the ­treatment.