Life Wellbeing Mental health costs: Young people bill $200 million a year to Medicare

Mental health costs: Young people bill $200 million a year to Medicare

mental health young people
The authors suggest school-based screening for mental illness would be a cost-effective strategy. Photo: Getty
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Caring for young people with mild to moderate mental health issues is costing Australian families and the public purse $234 million a year, according to analysis from Deakin University.

This breaks down to $197 million paid by Medicare and $37 million in out-of-pocket costs for families.

In the main, these are the costs of young people accessing mental health assessment and mental health treatment plans from GPs – and for a limited number of Medicare-rebated sessions with a psychologist.

This is distinct from children needing treatment for severe illnesses such as bipolar disorder, schizophrenia and severe treatment-resistant depression.

Children who don’t meet full criteria

Half these costs – about $100 million – are for services used by children who don’t meet the full criteria of a mental disorder, and most were for “general health-related services”.

Director of Deakin Health Economics, Professor Cathy Mihalopoulos, said: “People with mental health symptoms might seek help from general health professionals, such as GPs or paediatricians, rather than
mental health professionals as they might not be eligible for specialised care via Medicare’s Better Access program.”

Research lead Dr Long Le, an Alfred Deakin Postdoctoral Fellow from Deakin Health Economics, said that children and adolescents “with two or more mental disorders had the highest average annual Medicare costs of mental health services followed by those with depression, conduct disorder and anxiety”.

The study analysed data from the Young Minds Matter Survey.

Are kids with ADHD getting proper treatment?

The study didn’t look at outcomes, but it throws up some questions.

The researchers found that Attention deficit hyperactivity disorder (ADHD) was associated with higher spending on medication and general health-related Medicare costs but with not mental health-related Medicare costs.

This means these children “might be mostly seeing GPs or paediatricians and receiving medication for their ADHD rather than receiving psychotherapy from a psychologist or psychiatrist,” Professor Mihalopoulos said.

The researchers aren’t suggesting that these young people aren’t receiving the level of care they need because they are seeing their GP – as many trained GPs provide high-quality care – but rather, that “we just don’t know if they are seeing these well-trained GPs”.

But compared to children with other mental disorders, “those with ADHD tend to receive their care in the general rather than mental health specific system”.

Does this matter?

Medication is the standard treatment for what is essentially a brain condition.

But psychological treatments, “such as behavioural therapy, may help a child develop strategies and skills for learning and controlling their behaviour”, according to the federal government’s health advice website.

Cognitive behavioural therapy is particularly helpful in adolescents with ADHD.

The ADHD Institute recommends “that non-pharmacological interventions are focused on the individual with ADHD as they mature and become ‘agents of implementation’ in their care”.

And there’s some evidence that neurotherapy – a biofeedback technique that enables individuals to normalise their brain’s electrical activity and improve symptoms – can result in patients functioning successfully with medication.

So it remains unclear whether young people with ADHD (which affects one in 20 Australians) are getting the full suite of necessary treatment.

What the researchers recommend

On the face of it, $197 million billed to Medicare is a lot of money, but perhaps not so much given that Australia spends nearly $11 billion a year on mental health services, according to the Australian Institute of Health and Welfare.

Dr Le said the research findings showed the considerable financial burden for families with a child experiencing mental health issues and presented a strong case for spending on prevention strategies.

“Mental disorders in children and adolescents are common, with one in seven diagnosed with a mental disorder and one in three with mental health symptoms,” Dr Le said.

“Our study shows that aside from the substantive impacts these disorders have on children and adolescents and on their families,
there are significant costs to Medicare and high out-of-pocket costs faced by the families.”

Professor Mihalopoulos said there is strong evidence that school-based screening and intervention for conditions such as anxiety and depression “are the most cost-effective interventions for prevention of mental disorders in children and adolescents”.

“What do we need to implement such interventions?” she pondered.

School interventions: Where are they?

School interventions have been the great hope for preventing anxiety and depression for years. So where are they?

The short answer appears to be that they are either a work in progress or they’re not sufficiently, or at least demonstrably, evidence based.

In 2016, the Black Dog Institute published a paper about school interventions.

It noted that mental disorders in adolescence are the leading cause of illness and disability for young people aged 10 to 19, ahead of any physical disease.

“From a practical perspective, there is good reason to develop prevention interventions for adolescents that can be delivered through the school system as part of the mental health educational curriculum,” the authors wrote.

“This is critically important because adolescents with mental disorders have very low rates of help-seeking (35 per cent), and only 30 per cent seek referrals for psychological therapy”.

The question of evidence-based programs

Jennie Hudson is director of research, Professor of Clinical Psychology with the Black Dog Institute. In an email responding to questions, she told TND that “Black Dog interventions for school-age children and teens are still in the research phase”.

Dr Hudson said Black Dog is running “a large-scale randomised controlled trial with up to 10,000 school students around Australia called Future Proofing, which delivers digital evidence-based mental health interventions to young people, and follows them up for five years”.

One of the therapeutic components of this trial is an app called Sleep Ninja, which is based on cognitive-behavioural therapy principles and targets insomnia and depression symptoms in young people.

Dr Hudson said that one of the issues affecting interventions in schools “is the absence of guidelines or regulatory frameworks to guide this process”.

She said the KidsMatter program, which ceased in 2018, went “some way to address this, but for school principals and welfare staff it is really difficult to determine which programs are evidence-based”.

Programs might advertise as being based on evidence, she said, “yet the program or its components have never been evaluated”.

Dr Hudson said “it would be like attending a doctor for a medical condition like diabetes and given a new drug that hasn’t yet been evaluated”.

Teachers have concerns about their own competence

Dr Hudson said teachers were generally open to supporting the mental health of their students, “but they have concerns about their competence to provide mental health assistance”.

The lack of guidelines or a regulatory framework placed “an unnecessary burden on schools and teachers”.

She said the delivery of evidence-based care is an issue across health but is “a particular issue in the mental health interventions space”.

Black Dog is recommending some guidelines for the delivery of services to ensure they are evidence based.

Although about 3000 of the 27,000 psychologists in the Australian workforce are employed in school settings, Dr Hudson said there were “substantial variations in the ratios of psychologists to young people across different states and territories”.

Access to clinical psychologists and evidence-based care also faces equity issues between public and private schools, she said.

Additionally, regional and rural schools may not have locally based psychologists and therefore face the added difficulty of relationship building and continuity of care with a ‘fly-in fly-out’ workforce.

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