Impacts on Australian Government-funded mental health service activity

Use of MBS subsidised mental health items

During the course of the COVID-19 pandemic, the Australian Government introduced a wide range of additions to the Medicare Benefits Schedule (MBS) to support provision of care via telehealth, to help reduce the risk of community transmission of COVID-19 and provide protection for both patients and health care providers. These items include mental health services provided by GPs, psychiatrists, psychologists and allied health workers.

MBS subsidised services under the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative are available for patients with a mental disorder to receive up to ten individual and ten group allied mental health services per calendar year (DoH 2020). In August 2020, the Better Access initiative was expanded to provide 10 additional MBS-subsidised individual psychological therapy sessions for patients in areas subject to lockdown restrictions due to the pandemic. As part of the 2020–21 Federal Budget in October 2020, the Australian Government expanded access to these 10 additional sessions to all Australians.

Between 16 March 2020 and 24 January 2021, almost 11.5 million MBS-subsidised mental health-related services were delivered nationally ($1.3 billion paid in benefits); almost 3.7 million (32.1%) of these services were delivered via telehealth (as opposed to face to face) and $428 million was paid in benefits for telehealth services. In the 4 weeks to 24 January 2021, 736,344 services were delivered, slightly exceeding the services provided in the 4 week periods to 26 January 2020 and 27 January 2019 (noting that in 2019 and 2020 these weeks include a national public holiday). Services in the 4 weeks to 31 January were 3.4% and 6.0% higher than services in the 4 weeks to 2 February 2020 and 3 February 2019 respectively.

The number of services delivered via telehealth peaked in the week ending 26 April 2020 when half (49.9%) of MBS-subsidised mental health services were provided remotely. A large downward spike in services occurred during the Christmas period, which is consistent with patterns in previous years (Figure COVID.1).

Figure COVID.1: Line chart showing the number of Medicare Benefits Schedule (MBS) mental health services delivered each week nationally by mode of delivery including telehealth, face-to-face and total, from March 2020 to January 2021. The number of services delivered via telehealth increased from 6,866 in the week beginning 16 March 2020 to a peak of 121,779 in the week beginning 20 April 2020, with a steady decrease to 58,475 in the week beginning 18 January 2021. The number of services delivered face-to-face decreased from a peak of 230,916 in the week beginning 16 March 2020 to a low of 99,859 in the week beginning 13 April 2020. The number of services delivered face-to-face continued to increase steadily to a peak of 219,487 in the week beginning 14 December 2020. This increased to 200,320 in the week beginning 18 January 2021. The total number of MBS mental health services increased from 237,782 in the week beginning 16 March 2020 to 297,198 in the week beginning 7 December 2020 with a low of 62,864 services in the week beginning 28 December before increasing to another peak of 258,795 in the week beginning 18 January 2021.

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Pharmaceutical Benefits Scheme (PBS) prescriptions

In the 4 weeks to 20 December 2020, there was a 3.6% increase in mental health-related prescriptions dispensed under the PBS compared to the 4 weeks to 19 Dec in 2019. Prescriptions for antidepressants increased by 4.6% in this period. A spike in PBS-subsidised and under co-payment prescriptions, including all mental health-related prescriptions, was observed in March 2020. This represented an 18.6% increase in the number of prescriptions dispensed in the 4 weeks to 29 March 2020 compared to the 4 weeks to 28 March 2019 (Figure COVID.2).

Figure COVID.2: Line chart showing the number of Pharmaceutical Benefits Scheme (PBS) mental health-related prescriptions dispensed by week from January 2019 to December 2020. The number of prescriptions dispensed increased from 749,169 in the week beginning 6 January 2020 to a steep peak of 1,013,864 in the week beginning 16 March 2020. There was a low in the number of prescriptions dispensed in April 2020 with 661,362 in the week beginning 6 April 2020, gradually increasing to a peak of 899,533 in the week beginning 14 December 2020. The number of prescriptions dispensed throughout 2020 remained slightly higher than in 2019.

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Use of crisis and support organisations and online mental health information services

There are a range of crisis, support and information services to support Australians experiencing mental health issues, such as Beyond Blue, Lifeline, Kids Helpline, and ReachOut. Head to Health is a website provided by the Australian Government that brings together apps, online programs, online forums, phone services, and digital information resources to help people find the digital mental health services most suited to their needs.

These services have reported substantial increases in demand during the COVID-19 pandemic. The Australian Government funded Beyond Blue to create a dedicated Coronavirus Mental Wellbeing Support Service to provide free 24/7 mental health support, particularly for people not already connected to the mental health system. Other support organisations have incorporated COVID-19 support into their day-to-day services.

In the 4 weeks to 24 January 2021:

  • Over 85,000 calls were made to Lifeline (call data only), which is a 10.0% increase from the 4 weeks to 26 January 2020 and 21.4% from the 4 weeks to 27 January 2019.
  • Kids Helpline received almost 23,000 answerable contacts attempts (call, webchat and email), which is an 8.7% decrease from the 4 weeks to 26 January 2020 and a 1.3% increase from the 4 weeks to 27 January 2019. In the same period, 2.9% of contacts with Kids Helpline were related to COVID-19 (inclusive of outbound contacts). Note that answerable contact attempts exclude phone contact attempts abandoned during the privacy message, which cannot be skipped. This message was increased from 22 to 48 seconds during April 2020.
  • Over 22,000 contacts were made to Beyond Blue (call, webchat and email), which is a 27.2% increase from the 4 weeks to 26 January 2020 and 29.6% from the 4 weeks to 27 January 2019 (Figure COVID.3). Contacts to the Coronavirus Mental Wellbeing Support Service accounted for 11.6% of all contacts to Beyond Blue in the 4 weeks to 24 January 2021.

Direct comparisons between organisations are not appropriate due to differences in populations being serviced, service models, funding envelopes, workforce availability and information systems.

Figure COVID.3: Combined line chart showing the number of contacts made per week from September 2019 to January 2021 and table showing the total number of contacts in the 4 weeks to 24 January 2021 to Lifeline, Kids Helpline and Beyond Blue. The number of calls to Lifeline increased from a low of 17,319 in the week beginning 14 October 2019 to a peak of 21,399 in the week beginning 20 April 2020. The number of calls to Lifeline have fluctuated with a peak of 21,954 in the week beginning 7 September 2020 before dropping to 20,679 in January 2021. Kids Helpline contacts increased from a low of 5,082 in the week beginning 23 December 2019 to a peak of 9,435 in the week beginning 30 March 2020, with a gradual decline then decreased to 5,900 contacts in the week beginning 18 January 2021. Contacts to Beyond Blue (including the Coronavirus Mental Wellbeing Support Service) gradually increased from a low of 3,735 in the week beginning 23 December 2019 to a peak of 7,709 in the week beginning 3 August 2020, with a gradual decrease to 5,435 contacts in the week beginning 18 January 2021. In the 4 weeks to 24 January 2021, there were 85,182 calls to Lifeline, 22,937 contacts to Kids Helpline, and 22,115 contacts to Beyond Blue.

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The ReachOut and Head to Health websites each saw an uptick in activity early in the pandemic, peaking in March 2020, with subsequent fluctuations. ReachOut reported an average of 7,089 website users per day in the 4 weeks to 24 January 2021, an increase of 7.1% compared to the 4 weeks to 26 January 2020 and 6.4% compared to the 4 weeks to 27 January 2019. In the same 4 week period, Head to Health received an average of 4,190 users per day, an increase of 490.3% compared to the 4 weeks to 26 January 2020 and 58.6% compared to the 4 weeks to 27 January 2019 (Figure COVID.4).

Figure COVID.4: Line chart showing the average number of daily website users by week of use for ReachOut and Head to Health from October 2019 to January 2021. The average number of daily ReachOut users per week increased from a low of 4,320 per day in the week beginning 23 December 2019 to a peak of 13,380 in the week beginning 30 March 2020. The average number of daily ReachOut users then declined to 7,560 in the week beginning 18 January 2021. The average number of daily Head to Health users per week increased from a low of 429 in the week beginning 23 December 2019 to a steep peak of 9,309 in the week beginning 23 March 2020. The average number of daily Head to Health users then gradually declined to 4,078 in the week beginning 18 January 2021.

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Emerging research

Since April 2020, surveys have been conducted by the Australian Bureau of Statistics (ABS) and several Australian universities to investigate the impacts of the COVID-19 pandemic on the mental health of Australians. See AIHW's Suicide & self-harm monitoring page for more detailed information on these surveys.

The Household Impacts of COVID-19 Survey, conducted monthly by the ABS, collects information on the impact of COVID-19 across a range of key areas, including psychological distress. The survey found that from early April to early May, women reported higher levels of concern due to COVID-19 than men, and people aged 18–64 years reported higher levels of concern due to COVID-19 than people aged 65 years and over. Women were nearly twice as likely to have experienced loneliness than men (28% vs 15%) (ABS 2020a). In July 2020, 19% of women surveyed had used a mental health support service since March 2020 compared to 10% of men (ABS 2020b). In November 2020, fewer Australians reported feelings that had an adverse impact on emotional and mental wellbeing than in August 2020, however around one in five (21%) Australians still experienced high or very high levels of psychological distress (ABS 2020c). In November 2020, the survey showed that women were more likely than men to have experienced high or very high levels of psychological distress (25% vs 16%).

The Australian National University’s COVID-19 Impact Monitoring Survey Program asked Australians about their experience of multiple mental ill health indicators such as anxiety, psychological distress and loneliness between January 2020 and January 2021 (Biddle et al 2020a, 2020b; Biddle & Edwards 2021). The study found that levels of psychological distress in January 2021 have decreased since November, and are now similar to pre-pandemic levels after rising during 2020, as measured by the K6 measure of psychological distress. Psychological distress has decreased for all age groups since the peak observed during the first wave of COVID-19 infections in Australia in April 2020, however the average level of psychological distress among people aged 18–44 is still higher than it was in Feb 2017. In January 2021 respondents in the following demographics reported relatively higher levels of anxiety and worry: females, those aged 18–24 years, Indigenous Australians, and those who speak a language other than English.

The University of Melbourne’s Melbourne Institute conducted a weekly Taking the Pulse of the Nation survey from April 2020 to December 2020. In the initial survey, 20% of Australians reported feeling depressed and anxious most or all of the time. Employed parents whose youngest child was aged 5 to 11 years reported higher levels of mental distress than parents of younger or older children, nearly quadrupling from 7% in April to 27% in June (Broadway et al. 2020). In December, Melbourne Institute released the report Coping with COVID-19: rethinking Australia, which highlighted key findings from the Taking the Pulse of the Nation surveys throughout 2020. The report found that rates of mental distress had a similar pattern to financial stress over the course of the pandemic. The rate of mental distress in November (24%) was higher than in April (22%), and around 2.5 times the rate of mental distress in the Australian community prior to the pandemic (10%) (Melbourne Institute 2020).

References

ABS (Australian Bureau of Statistics) 2020a. Household Impacts of COVID-19 Survey, 29 Apr - 4 May. May 2020. Cat. No. 4940.0. Canberra: ABS.

ABS 2020b. Household Impacts of COVID-19 Survey, 6 - 10 July. July 2020. Cat. No. 4940.0. Canberra: ABS.

ABS 2020c. Household Impacts of COVID-19 Survey, 13 – 23 November 2020. November 2020. Cat. No. 4940.0. Canberra: ABS

Biddle, N, and Edwards, B 2021. Tracking outcomes during the COVID-19 pandemic (January 2021) – Cautious optimism. Viewed 11 March 2021

Biddle N, Edwards B, Gray M & Sollis K 2020a. Tracking outcomes during the COVID-19 pandemic (August 2020) — Divergence within Australia. Viewed 14 October 2020.

Biddle, N, Edwards, B, Gray M & Sollis K 2020b. Tracking outcomes during the COVID-19 pandemic (November 2020) - Counting the costs of the COVID-recession.Viewed 8 February 2021

Broadway, B, Mendez, S & Moschion, J 2020. Behind closed doors: the surge in mental distress of parents. Viewed 28 October 2020

DoH (Department of Health)2020. Better access to mental health care: fact sheet for professionals. Viewed 5 February 2021

Melbourne Institute. 2020. Coping with COVID-19: rethinking Australia. Viewed 8 February 2021