Geographic variation in access to Medicare-subsidised psychotherapy

Within Australia, evidence is limited regarding how access to mental health care varies across geographical regions, and which areas experience the lowest levels of service use. This study aimed to provide new population-level evidence on the geographic variation in the use of Medicare-subsidised psychotherapy over the past decade and identify regions with the lowest service use.

We used administrative data from the Medicare Benefits Schedule to identify 2.7 million adults aged 25-54 years across mainland Australian states with a new mental health treatment plan from a general practitioner between 2014 and 2023. State-level trends were examined by calculating the proportion of individuals who accessed Medicare-subsidised psychotherapy within 3 months of receiving their mental health treatment plan in each state per year. We then examined variation in the use of psychotherapy across regions in 2023 (Statistical Area Level 4), and assessed how this psychotherapy use was associated with area-level socioeconomic disadvantage.

Between 2014 and 2023, psychotherapy use among adults with a mental health treatment plan declined substantially across all states, from approximately 60% of adults in 2014 to <50% in 2023. Psychotherapy use also varied markedly across sub-state regions (Statistical Area Level 4s) in 2023, with uptake ranging from 36% in Sydney's Outer South West to 60% in Perth's inner suburbs. Access was generally lower in non-metropolitan regions and in areas with higher socioeconomic disadvantage.

The results highlight the need for system supports that make psychological services more accessible, particularly in socioeconomically disadvantaged areas. Addressing access gaps will require coordinated efforts across general practice, service delivery and policy settings. Prioritising support and policies towards regions with the poorest access can assist with designing a more equitable mental health system.