Authors: Nicole Black1, David W Johnston1, Martin Knapp2, Michael A Shields1, Gloria H Y Wong3
Affiliations:
1 Centre for Health Economics, Monash University, Melbourne, Victoria, Australia.
2 Health Policy Department, London School of Economics and Political Science, London, UK.
3 School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
The following is a summary of a research paper by the authors. For more information, please see the published full-text journal article: https://onlinelibrary.wiley.com/doi/10.1002/hec.4910
Access to mental healthcare remains a critical policy concern, with many Australians facing long wait times, high out-of-pocket costs, and difficulties navigating the system. This study examines whether individuals with similar mental health needs receive equal access to care and whether access varies with socioeconomic characteristics. Our findings suggest that factors which are strongly associated with educational attainment, such as mental health literacy, familiarity with the healthcare system, and less stigmatising attitudes toward help-seeking, are likely to be important determinants of access.
Using three waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we focus on individuals with new-onset mild or moderate psychological distress. By comparing people with similar mental health status, measured through validated scales, and controlling for a range of physical and contextual health factors, we aim to identify horizontal inequity: unequal access to care among those with equivalent need.
After adjusting for need and local service availability, we find that higher educational attainment is strongly and consistently associated with greater use of mental health services. University graduates are about 50 percent more likely to see a mental health professional than those who left school early. This pattern holds across genders, age groups, and urban and regional settings.
In contrast, we find no association between income or financial hardship and service use. However, it is important to note that our analysis draws on data from 2009 to 2017. Since then, out-of-pocket costs for psychological services have increased significantly. As a result, financial barriers may now play a larger role in shaping access, and income-related horizontal inequity may have become more pronounced.
Improving service capacity and affordability remains essential. However, reducing inequities in access will also require targeted efforts to strengthen mental health literacy and shift attitudes toward help-seeking. Community-based education initiatives and GP-delivered interventions may be effective in reaching those less likely to engage with mental health services.
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