4329.0.00.003 - Patterns of Use of Mental Health Services and Prescription Medications, 2011  
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TYPES OF USE AND TRANSITIONS BETWEEN TREATMENTS

The following analysis examines patterns of use of MBS and PBS subsidised mental health-related services and/or medication over the period January 2011 to December 2012 using logistic regression modelling. The results of this analysis assist with better understanding the extent to which particular personal, family and household characteristics impact on a person’s transitions between treatments. Details of the modelling are outlined in the Explanatory Notes.

TYPES OF USE

To investigate whether particular socio-demographic characteristics were associated with an increased likelihood of receiving different combinations of mental health-related treatments, people who received at least one MBS or PBS subsidised mental health-related service or medication between January 2011 and December 2012 were split into five groups:
  • single MBS transaction (or ‘single service only’) – a person had only one MBS transaction and no PBS transactions between January 2011 and December 2012
  • multiple MBS transactions (‘multiple services only’) – the person had two or more MBS transactions and no PBS transactions
  • single PBS transaction (‘single medication only’) – the person had only one PBS transaction and no MBS transactions
  • multiple PBS transactions (‘multiple medications only’) – the person had two or more PBS transactions and no MBS transactions
  • mixed MBS and PBS transactions (‘mixed service(s) and medication(s)’) – the person had one or more MBS transactions and one or more PBS transactions.

The following table shows the distribution of people by type of use. Around one-third (31.0%) of all people who received a mental health-related treatment received multiple services only (i.e. the person had multiple MBS transactions only), while one-quarter (24.7%) used multiple medications only. A further 16.0% received mixed service(s) and medication(s). Almost the same proportion of people received a single service only (14.9%) or had a single use of medication only (13.4%).

PEOPLE WHO ACCESSED AT LEAST ONE MBS OR PBS SUBSIDISED
MENTAL HEALTH-RELATED TREATMENT IN 2011–2012, Type of use

Type of use
Proportion (%)(a)

Single service only
14.9
Multiple services only
31.0
Single medication only
13.4
Multiple medications only
24.7
Mixed service(s) and medication(s)
16.0

(a) Proportion of all people who accessed at least one MBS or PBS subsidised mental health-related treatment in 2011.


A number of socio-demographic characteristics were associated with an increased likelihood of particular types of use of MBS or PBS subsidised mental health-related medications or services.

After controlling for the effects of other variables included in the model, males were more likely than females to use single medications only, multiple medications, and mixed services and medications. Conversely, females were more likely than males to use single and multiple services only.

The likelihood of receiving mental health-related services, either as single or multiple services, decreased with age, while the likelihood of using medications increased. In particular, young people aged 0-19 years were more likely to have received multiple services, and to a lesser extent a single service, than other types of use, while older people (aged 60 years and over) were more likely to have used medications (either multiple or single).

Graph Image for PREDICTED PROBABILITIES of TYPE OF USE, Age and type of use

Source(s): The Mental Health Services-Census Integrated Dataset



Type of use differed by state and territory. People living in New South Wales and Victoria were more likely to use multiple mental health-related services with no medications than any other type of use, while people living in the Australian Capital Territory and Western Australia were more likely to use multiple mental health-related medications than any other type of use.

The more remote an area was, the more likely its residents accessed mental health-related medications and less likely they accessed multiple mental health-related services.

People living in the most disadvantaged areas of Australia were more likely to use mental health-related medications (either single or multiple) with no services, and less likely to use multiple mental health-related services with no medications, relative to people in other areas of Australia.

A number of other socio-demographic characteristics were associated with different types of use:
  • married people were more likely than unmarried people to use single or multiple services with no medications, and less likely to have used multiple medications with no services and mixed services and medications,
  • people born overseas were more likely than people born in Australia to use multiple medications with no services and mixed services and medications, and less likely to use a single service with no medications;
  • people with higher levels of educational attainment were more likely to use multiple services with no medications, compared with people with lower levels of educational attainment, while the use of medications decreased with increasing level of educational attainment;
  • labour force status also influences the likelihood of particular service and medication uses. Unemployed people and people not in the labour force were more likely to use medications and no services compared with employed people.
  • people with lower incomes were more likely to use medications (either single or multiple) and no services, and less likely to use services with no medications, compared with people with higher incomes.
  • people living in special dwellings (such as aged care facilities) were more likely to use multiple medications with no services, and less likely to use single or multiple services with no medications, than people who lived in private dwellings.

TRANSITIONS BETWEEN TREATMENTS

Further logistic modelling was used to investigate whether certain socio-demographic characteristics were associated with a likelihood to transition from receiving an MBS subsidised mental health-related service to a PBS subsidised mental-health related medication, or vice versa. Modelling took into account the number of services and medications an individual had prior to their most recent transaction (that is, service or medication), as well as the sequence of transactions the individual had.

In general, the probability of changing from using a service to using a medication or vice versa is highest after one service or medication in a sequence, and decreases as the length of the sequence increases. Additionally, the probability of changing from a service to a medication is always higher than the probability of changing from a medication to a service, for the same length sequence.

Age and sex

After controlling for the effects of other variables included in the models, males were slightly more likely than females to change from using a mental health-related service to a medication. However, there was almost no difference between males and females in the likelihood of changing from a mental health-related medication to a service.

Graph Image for TRANSITION PROBABILITIES, Sex and number of services in sequence before current transition - from service to medication

Source(s): The Mental Health Services-Census Integrated Dataset



Graph Image for TRANSITION PROBABILITIES, Sex and number of medications in sequence before current transition - medication to service

Source(s): The Mental Health Services-Census Integrated Dataset



Age showed a significant influence on the likelihood of transition, with the probability of changing from a mental health-related service to a medication increasing sharply with increasing age and the probability of changing from a medication to a service decreasing slowly.

Children aged 0-9 years were least likely to change from using a mental health-related service to a medication, while older people, particularly those aged 70 years or over, had the highest probability of changing from using a mental health-related service to a medication and the lowest probability of changing from a medication to service, especially in short sequences (after 1-3 services or medications). Even after using a mental health-related service a number of times, the probability of people aged 70 years or over changing from a service to a medication was still relatively high in comparison to other ages.

Graph Image for TRANSITION PROBABILITIES, Age and no. of services in sequence before current transition - service to medication

Source(s): The Mental Health Services-Census Integrated Dataset



Graph Image for TRANSITION PROBABILITIES, Age and no. of medications in sequence before current transition - medication to service

Source(s): The Mental Health Services-Census Integrated Dataset



Remoteness

Remoteness showed a strong effect on the likelihood of transitioning between using mental health-related services and medications. People living in Remote/Very Remote areas of Australia were more likely to change from using a service to a medication than other areas, and less likely to change from medications to services. Conversely, people living in Major Cities of Australia were less likely to change from services to medications and more likely to change from medications to services.

Graph Image for TRANSITION PROBABILITIES, Remoteness and no. of services in sequence before current transition - service to medication

Source(s): The Mental Health Services-Census Integrated Dataset



Graph Image for TRANSITION PROBABILITIES, Remoteness and no. of medications in sequence before current transition - medication to service

Source(s): The Mental Health Services-Census Integrated Dataset



Level of disadvantage

Level of disadvantage had an influence on the likelihood of transitioning between using mental health-related services and medications, but no effect on the likelihood of changing from mental health-related medications to services. People living in the most disadvantaged areas of Australia (Quintile 1) were slightly more likely to change from using services to medications than people who lived in other areas of Australia. Similar patterns were found for people with relatively lower household incomes – they were more likely to change from using services to medications than people on higher incomes.

Graph Image for TRANSITION PROBABILITIES, Disadvantage by no. of services in sequence before current transition - service to medication

Source(s): The Mental Health Services-Census Integrated Dataset



Graph Image for TRANSITION PROBABILITIES, Disadvantage and no. medications in sequence before current transition - medication to service

Source(s): The Mental Health Services-Census Integrated Dataset



Other socio-demographic characteristics

Other socio-demographic characteristics associated with the likelihood to transition to a different treatment type were:
  • marital status: unmarried people were more likely to change status than married people, particularly from using a mental health-related service to a medication; and
  • people with lower levels of educational attainment were more likely to change from using services to medications compared with people with higher levels of educational attainment, and conversely, people with higher levels of educational attainment were slightly more likely to change from medications to services.

No differences were found between people born in Australia or overseas in the likelihood to transition between services and medications or vice versa. This was also the case for people who lived in special dwellings (such as nursing homes) compared with those living in private dwellings.