Distributing mental health care resources: strategic implications from the National Survey of Mental Health and Wellbeing.

Abstract

This paper considers mental health services resource distribution under the Australian second national mental health plan, with its direction to mental health services to be more inclusive of people with higher prevalence psychiatric disorders. We consider inequalities in mental health in Australia,and describe the performance of the composite census variable employed in the Victorian mental health funding distribution formula, the index of relative socioeconomic disadvantage (IRSED), in predicting disorder rates and perceived needs for care. We review data sets generated through the National Survey of Mental Health and Wellbeing (NSMHWB) for their utility in development of resource distribution formulae. We present analyses from the 10 641 cases examined in the household survey to explore the role of the IRSED in predicting prevalence rates of anxiety, affective, substance misuse and other disorders,as well as perceived need for care. Recent epidemiological studies provide some additional sources of data to guide resource distribution,although the available data sets are found not to be optimized for examination of this issue. Greater levels of socioeconomic disadvantage of areas are associated with increased rates of morbidity in metropolitan areas, with different patterns for different disorder groups. The influence of the IRSED is more complex outside the major cities. The descriptive epidemiological data now available, despite significant investment, are relatively crude instruments for this current purpose. The findings support the case for using the IRSED as a proxy indicator for morbidity for the high prevalence disorders, but only within metropolitan areas. This examination confirms the existence of significant inequalities in mental health between Australian urban areas with different socioeconomic characteristics.