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Government Structure, Service System Design, and Equity in Access to Psychotherapy in Australia, the United Kingdom, and Canada

Publication: Canadian Journal of Community Mental Health
30 July 2020

Abstract

This article reports the results from 22 interviews regarding the relationship among government structure, service system design, and equity in access to psychotherapy in Australia, the United Kingdom and Canada. Key themes focused on the strong relationship between government structure and at least one other factor in shaping psychotherapy reforms in each country, as well the persistence of inequities despite the introduction of universal reforms. These findings suggest that improving equity in access will require explicit focus regardless of government structure or service system design.

Résumé

Cet article présente les résultats de 22 entrevues concernant la relation entre la structure gouvernementale, la conception du système de services et l’équité d’accès à la psychothérapie en Australie, au Royaume-Uni et au Canada. Les thèmes clés ont été axés sur les relations étroites existant entre la structure gouvernementale et au moins un autre facteur déterminant dans les réformes de la psychothérapie dans chaque pays, ainsi que sur la persistance des inégalités malgré l’introduction de réformes universelles. Ces résultats suggèrent que l’amélioration de l’équité d’accès nécessitera une attention explicite, quelle que soit la structure gouvernementale ou la conception du système de services.

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REFERENCES

Australia. (2015). Primary Health Networks grant programme guide: Annexure A1 – primary mental health care. Canberra: Author. Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/F4F85B97E22A94CACA257F86007C7D1F/ $File/Annexure%20A1%20-%20Primary%20Mental%20Health%20Care.pdf
Australia. (2018). Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative [website]. Canberra: Author. Retrieved from http://www.health.gov.au/mentalhealth-betteraccess
Australia, Australian Institute of Health and Welfare. (2017). Health expenditure Australia 2015-16. Canberra: Author.
Australia, Australian Institute of Health and Welfare. (2019). Access to Allied Psychological Services. Canberra: Author.
Bambra C. 2005 Worlds of welfare and the health care discrepancy Social Policy and Society 4 1 31 -41
Banting, K. G., & Corbett, S. M. (2002). Health policy and federalism: An introduction. In K. G. Banting & S. M. Corbett (Eds.), Health policy and federalism: A comparative perspective on multi-level governance (pp. 1–38). Kingston, ON: Institute of Intergovernmental Relations, Queen’s University.
Bartram, M. (2017). Government structure and equity in access to psychotherapy: A study of Canada, with comparisons to Australia and the United Kingdom. (Doctoral dissertation, Carleton University, Ottawa, ON). Retrieved from https://curve.carleton.ca/d8cfa02d-f869-4e2b-bcb3-dc87305f0795
Bartram M. 2019a Expanding access to psychotherapy in Canada: Building on achievements in Australia and the United Kingdom Healthcare Management Forum 32 2 63 -67 https://doi.org/10.1177/0840470418818581
Bartram M. 2019b Income-based inequities in access to mental health services in Canada Canadian Journal of Public Health 110 395 -403 https://doi.org/10.17269/s41997-019-00204-5
Bartram M. and Chodos H. April 29 2019 Closing the mental health gap: expanding coverage as next step toward mental health parity Hill Times 28
Bartram M. and Lurie S. 2017 Closing the mental health gap: The long and winding road? Canadian Journal of Community Mental Health 17 1 -14
Bartram M. and Stewart J. 2018 Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia Health Policy 123 1 45 -50 https://doi.org/10.1016/j.healthpol.2018.10.011
Canada, & Health Canada. (2019). A prescription for Canada: Achieving pharmacare for all: Final report of the Advisory Council on the Implementation of National Pharmacare. Retrieved from http://publications.gc.ca/collections/collection_2019/sc-hc/H22-4-18-2019-eng.pdf
Canada Health Act. (1985, c. C-6). Retrieved from https://laws-lois.justice.gc.ca/PDF/C-6.pdf
Canadian Alliance on Mental Health and Mental Illness. (2016). Mental health now! Advancing the mental health of Canadians: The federal role. Retrieved from https://www.camimh.ca/wp-content/uploads/2016/09/CAMIMH_MHN_EN_Final_small.pdf
Canadian Institute for Health Information. (2019). Common challenges, shared priorities: Measuring access to home and community care and to mental health and addictions services in Canada. Ottawa, ON: Author. Retrieved from https://www.cihi.ca/sites/default/files/document/shp-companion-report-en.pdf
Canadian Life and Health Insurance Association. (2018). Canadian life and health insurance facts. Retrieved from https://www.clhia.ca/web/clhia_lp4w_lnd_webstation.nsf/resources/Factbook_2/$file/2018+FB+EN.pdf
Clark D. M. 2018 Realizing the mass public benefit of evidence-based psychological therapies: The IAPT program Annual Review of Clinical Psychology 14 1 159 -183 https://doi.org/10.1146/annurev-clinpsy-050817-084833
Clark D. M., Canvin L., Green J., Layard R., Pilling S., and Janecka M. 2018 Transparency about the outcomes of mental health services (IAPT approach): An analysis of public data The Lancet 391 10121 679 -686 https://doi.org/10.1016/S0140-6736(17)32133-5
Community and Mental Health team. (2016). Psychological therapies: Annual report on the use of IAPT services, England 2015-16. Leeds: Health and Social Care Information Centre.
Diminic S. and Bartram M. 2019 Does introducing public funding for allied health psychotherapy lead to reductions in private insurance claims? Lessons for Canada from the Australian experience The Canadian Journal of Psychiatry 64 1 68 -76 https://doi.org/10.1177/0706743718784941
Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Princeton, NJ: Princeton University Press.
Finance Canada. (2017). Building a strong middle class. Ottawa, ON: Author.
Government of Canada. (2019). Shared health priorities [website]. Ottawa, ON: Author. Retrieved from https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/shared-health-priorities.html
Health Quality Ontario. (2016). Major depression: Care for adults and adolescents – quality standards. Retrieved from https://www.hqontario.ca/portals/0/documents/evidence/quality-standards/qs-depression-clinical-guide-1609-en.pdf
Hickie I. B., Rosenberg S., and Davenport T. A. 2012 Not letting the ideal be the enemy of the good: The case of the Better Access evaluation – Reply Australian & New Zealand Journal of Psychiatry 46 6 581 -582 https://doi.org/10.1177/0004867412437975
Korpi W. and Palme J. 1998 The paradox of redistribution and strategies of equality: Welfare state institutions, inequality, and poverty in the Western countries American Sociological Review 63 5 661 -687
Layard R., Clark D., Knapp M., and Mayraz G. 2007 Cost-benefit analysis of psychological therapy National Institute Economic Review 202 1 90 -98
Mahon R. 2008 Varieties of liberalism: Canadian social policy from the Golden Age to the present Social Policy & Administration 42 4 342 -361
Marks D. F. 2018 IAPT under the microscope Journal of Health Psychology 23 9 1131 -1135 https://doi.org/10.1177/1359105318781872
Marzouk, P. K. (2019, January 7). Has IAPT eaten itself? Mental Health Today. Retrieved from https://www.mentalhealthtoday.co.uk/blog/the-inside-story-of-how-iapt-ate-itself
Marmot, M. G. (2010). Fair society, healthy lives: The Marmot review: Strategic review of health inequalities in England post-2010. London, UK: Marmot Review.
McLennan, W., & Australian Bureau of Statistics. (1998). Mental health and wellbeing: Profile of adults, Australia, 1997. Canberra: Australian Bureau of Statistics.
Meadows G. N., Enticott J. C., Inder B., Russell G. M., and Gurr R. 2015 Better Access to mental health care and the failure of the Medicare principle of universality The Medical Journal of Australia 202 4 190 -194
Meadows, G. N., Prodan, A., Patten, S., Shawyer, F., Francis, S., Enticott, J., … Kakuma, R. (2019). Resolving the paradox of increased mental health expenditure and stable prevalence. Australian & New Zealand Journal of Psychiatry. https://doi.org/10.1177/0004867419857821
Mental Health Commission of Canada. (2018). Expanding access to psychotherapy: Mapping lessons learned from Australia and the United Kingdom to the Canadian context. Ottawa, ON: Author. Retrieved from https://www.mentalhealthcommission.ca/sites/default/files/2018-08/Expanding_Access_to_Psychotherapy_2018.pdf
Myles J. 1998 How to design a “liberal” welfare state: A comparison of Canada and the United States Social Policy and Administration 32 4 341 -364
NHS England. (n.d.). Adult Improving Access to Psychological Therapies programme [website]. London: Author. Retrieved from https://www.england.nhs.uk/mental-health/adults/IAPT/
NHS Scotland. (2014). Proportionate universalism and health inequalities [briefing]. Edinburgh: Author. Retrieved from http://www.healthscotland.com/uploads/documents/24296-ProportionateUniversalismBriefing.pdf
Ouimet H. R. 2014 Quebec and Canadian fiscal federalism: From Tremblay to Séguin and beyond Canadian Journal of Political Science 47 47 -69
Parliamentary Budget Officer. (2018). Fiscal sustainability report 2018. Ottawa: Author. Retrieved from https://www.pbodpb.gc.ca/web/default/files/Documents/Reports/2018/FSR%20Sept%202018/ FSR_2018_25SEP2018_EN_2.pdf
Phillips, K. (2016). Federal health care funding in the current economic context. Ottawa: Library of Parliament.
Pierson P. 1995 Fragmented welfare states: Federal institutions and the development of social policy Governance 8 4 449 -478
Pirkis J., Harris M., Ftanou M., and Williamson M. 2011 Not letting the ideal be the enemy of the good: The case of the Better Access evaluation Australian & New Zealand Journal of Psychiatry 45 11 911 -914 https://doi.org/10.3109/00048674.2011.617724
Pirkis, J., Harris, M., Hall, W., & Ftanou, M. (2011). Evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative: Summative evaluation. Melbourne: Centre for Health Policy, Programs and Economics, University of Melbourne.
Productivity Commission. (2019). Mental Health, Draft Report. Canberra: Author. Retrieved from https://www.pc.gov.au/inquiries/current/mental-health/draft/mental-health-draft-overview.pdf
Rosenberg S. P. and Hickie I. B. 2019 The runaway giant: Ten years of the Better Access program Medical Journal of Australia 210 7 299 https://doi.org/10.5694/mja2.50068
Speer, S. (2019). A dose of reality: The need for a targeted approach to pharmacare. MacDonald Laurier Institute. Retrieved from http://macdonaldlaurier.ca/files/pdf/20190528_MLI_COMMENTARY_Pharmacare_Speer_Finalweb.pdf
Vasiliadis H.-M., Tempier R., Lesage A., and Kates N. 2009 General practice and mental health care: Determinants of outpatient service use Canadian Journal of Psychiatry 54 7 468 -76
Weaver, R. K., & Rockman, B. A. (1993). Assessing the effects of institutions. In Do institutions matter? Government capabilities in the United States and abroad (pp. 1–41). Washington, DC: The Brookings Institution.
Wendt C., Frisina L., and Rothgang H. 2009 Healthcare system types: A conceptual framework for comparison Social Policy & Administration 43 1 70 -90
Whiteford H. A., Buckingham W. J., Harris M. G., Burgess P. M., Pirkis J. E., Barendregt J. J., and Hall W. D. 2014 Estimating treatment rates for mental disorders in Australia Australian Health Review 38 1 80 https://doi.org/10.1071/AH13142

Information & Authors

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Published In

cover image Canadian Journal of Community Mental Health
Canadian Journal of Community Mental Health
Volume 39Number 2July 2020
Pages: 11 - 23

History

Version of record online: 30 July 2020

Key Words

  1. governance
  2. equity
  3. psychotherapy
  4. Australia
  5. United Kingdom
  6. Canada

Mots-clés

  1. gouvernance
  2. équité
  3. psychothérapie
  4. Australie
  5. Royaume-Uni
  6. Canada

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