Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

“医疗保障福利计划”下的“心理医师、心理学家、普通工作者好通道”，是澳大利亚联邦政府为改善心理卫生服务获得渠道而做出的举措。十多年来，得到认证的心理健康社会工作者参与了“好通道”的服务发放。在这期间，精神健康服务领域发生了很大变化，导致“好通道”规模的扩大和成本的增加。“好通道”每年需要十亿美元的公共支出，但对其影响却无持续的记录。本文梳理了政策的前后变化以及项目的评估，根据现有资料质疑了好通道对于服务体系以及精神卫生社会工作性质所产生的影响。作者强调了对精神卫生社会工作的范围做清晰表达的重要性，并指出，要对基于“新公共管理”的原则而结构的个人化融资及服务发放政策环境下的政策影响做持续的监控。

KEYWORDS:

• Mental Health
• Social Work
• Better Access
• Medicare
• Australian Association of Social Workers
• Mental Health Policy

Disclosure Statement

No potential conflict of interest was reported by the authors.

ORCID

Angelika Papadopoulos http://orcid.org/0000-0003-2123-0406

Chris Maylea http://orcid.org/0000-0003-3688-0487