Key messages

  • Between 2012 and 2021, growth in the use of mental health related services and mental health prescriptions was highest for females and those under 25 years of age.
  • Mental health consumers living in Least disadvantaged areas or in Major cities had higher use of both mental health and non-mental health services and prescriptions than consumers in more disadvantaged or remote areas. 
  • Most mental health consumers accessed at least one of their mental health services (83%) or prescriptions (91%) through a General Practitioner. 
  • Antidepressants were the most frequently dispensed mental health prescription, while prescriptions of Psychostimulants, agents used for ADHD and nootropics, had the largest increase.

Introduction

This article presents an overview of the demographics and use patterns of mental health consumers who accessed clinical services (both mental health and non-mental health) and prescription medications provided through the Medicare Benefits Schedule (MBS) and Pharmaceuticals Benefits Scheme (PBS) over the period 2012 to 2021 (see Box MH.1). 

  • MBS mental health related services are provided by psychiatrists, other medical practitioners (for example, paediatricians), General Practitioners (GPs), psychologists, and other allied health professionals (for example, accredited mental health social workers). They are delivered across different settings, including in hospital, consulting rooms and at home. 
  • The PBS provides a variety of mental health related medicines prescribed by GPs, psychiatrists, other medical practitioners and nurse practitioners. 

People with mental illness can also access a range of non-mental health related services provided through MBS and/or PBS to meet their health care needs. 

It should be noted that mental health consumers may also access a range of health services which are not within the scope of the MBS or PBS. These include specialised admitted hospital psychiatric care, specialised community mental health services, and mental health services funded by Primary Health Networks. 

The rationale for considering non-mental health services and medications is based on the fact that people with mental illness, in particular long-term serious illness, are more likely to have comorbid physical conditions (AIHW 2023d). Of the 22% of Australians aged 16–85 that reported a mental disorder in the last 12 months, around 40% also reported a long-term physical health condition (ABS 2023).

Specification of the analysis can be found in the Technical notes.

This article has 4 sections. They are on mental health consumers’ use of:

  1. MBS mental health related services
  2. MBS non-mental health services
  3. PBS mental health related medicines
  4. PBS non-mental medicines.

In summary, the analysis found that the number and type of MBS and PBS services accessed by mental health consumers were influenced by a variety of factors, such as age, sex, socioeconomic status, and remoteness.

This article uses the terms mental health consumer and population rate. These are defined below:

mental health consumer: a person who accessed at least one MBS or PBS mental health services within the reporting period (2012–2021 or 2017–2021 for this article).

population rate: a rate calculated as the number of consumers who accessed MBS or PBS services divided by the Estimated Resident Population for the relevant year. It is presented as a percentage (%) in this article, equivalent to the number of consumers per 100 population.

 

Box MH.1: About Medicare services and pharmaceuticals

Australia’s health system is a complex mix of funders, service providers and health professionals across the Australian Government, state and territory governments and the non-government sector (AIHW 2022c). Medicare is Australia’s universal health insurance scheme which subsidises the cost of medical and health services, providing patients with services and medicines at a reduced cost via a government rebate or subsidy. The MBS lists many medical and allied health services; the PBS and the Repatriation Pharmaceutical Benefits Scheme (RPBS) list a range of prescription medicines (AIHW 2023c).

People experiencing mental illness can access a variety of Medicare-subsidised mental health specific services and/or prescription medicines. Included as a subset of all mental health related services is the initiative Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access), which provides Medicare rebates to eligible people to access needed mental health services. During the emergency phase of the COVID-19 pandemic in 2020, the Australian Government made a range of changes to the MBS items. For example, the number of Better Access Medicare-subsidised psychological therapy sessions were doubled from 10 to 20 per year (Department of Health and Aged Care 2022a) and the availability of telehealth sessions were expanded (Department of Health and Aged Care 2022b). 

This article focuses only on Medicare-subsidised services and PBS pharmaceuticals to provide a snapshot of the findings and does not represent or reflect Australia’s entire health system. For example, Medicare-subsidised services have greater use in high socioeconomic areas and Major cities due to the location of health practitioners (AIHW 2023a, 2023b). However, for some settings and sectors mental health services have a higher population rate of services accessed in more remote areas compared with Major cities, such as state and territory specialised community mental health care, emergency departments and admitted patient care in hospital (AIHW 2022a, 2022b, 2023d).

If a service or medicine is not covered by Medicare or the PBS, the data is not included in this article. For the purpose of the analysis and ease of presentation, both PBS and RPBS data are aggregated and reported as PBS findings. 

MBS mental health related services

Box MH.2: MBS Mental health related services data analysis

For the purposes of this article, mental health MBS consumers are categorised into 4 groups according to the number of services, or level of service usage, over the year:

  • Low: one mental health related service per year
  • Low–Medium: 2–5 mental health related services per year
  • Medium–High: 6–15 mental health related services per year
  • High: 16 or more mental health related services per year.

These groupings have been selected for presentation purposes and are not based on the types of services accessed nor on demographic or clinical factors related to consumers. 

Details of the mental health services included in this section are outlined in the Technical notes. The Better Access MBS items include treatments, mental health plans, reviews, and other activities. 

In 2021, there were about 14 million MBS mental health related services (an average of 5.0 services per consumer) compared with about 8 million (an average of 5.1 services per consumer) in 2012. In 2021, about 11% (2.8 million) of the estimated Australian population accessed MBS mental health related services, an increase from about 7% (1.6 million) in 2012.

Between 2019 and 2021, there was a steady increase of MBS mental health consumers in the High service use group and minor changes in the other groups (Table MH.1). In the High service use group, there were 73,000 consumers in 2019, increasing to 158,000 in 2021. This increase may have been driven by the range of changes made to the MBS in response to the COVID-19 pandemic, including the increase in the number of Better Access sessions provided – from a maximum of 10 to 20 treatment sessions per year (Department of Health and Aged Care 2022a) (see Better Access Evaluation Final Report for more details on Better Access services).

Table MH.1: Rate of MBS mental health consumers per 100 population in each service usage group, 2019 to 2021

Service usage group

2019

2020

2021

Low

34.1

34.3

35.3

Low–Medium

37.9

36.8

35.9

Medium–High

25.2

24.5

23.2

High

2.7

4.4

5.6

Note: Percentages may not total 100% due to rounding.

Source: MBS data (sourced from the Department of Health and Aged Care).

Females are more likely to use MBS mental health services

Female MBS mental health consumers had a higher rate of service use than males across all service usage groups and years. In 2021, females made up around 60% of consumers in the Low and Low–Medium service use groups, 65% in the Medium–High group and 71% in the High group.

The proportion of females who accessed MBS mental health services grew from 8.7% in 2012 to 14% in 2021. For males the proportion increased from 5.5% in 2012 to 8.4% in 2021. The rate for males remained relatively stable from 2019 to 2021 (Figure MH.1).

Figure MH.1: Females had a higher population rate than males and more consistent growth from 2012 to 2021

This butterfly graph shows that females had a higher population rate than males; however, the population rate for both sexes increased between 2012 and 2021. The highest population rate was for females in 2021 (13.6%).

MBS mental health consumer population rate (%) by sex, 2012 to 2021/figcaption>

Largest growth for MBS mental health service use has been for young people

The use of mental health services has shifted over time for younger people. In 2021, consumers aged 15–24 had the highest population rate for service use (17%), increased from 8.3% in 2012 (Figure MH.2). They also had the largest percentage increase (111%) in the number of MBS mental health consumers from 2012 to 2021.

Figure MH.2: The highest population rate was for people aged 15–24 in 2021

MBS mental health consumer population rate (%) by age group, 2012 and 2021

This vertical column graph shows, for all age groups, the growth in the percentage of the population using MBS mental health services between 2012 and 2021. The 15–24 age group had the strongest percentage growth across the period, increasing from 8.3% in 2012 to 17.4% in 2021.


Source: MBS data (sourced from the Department of Health and Aged Care).

Between 2012 and 2019, the population rates (% of the population) for service use steadily increased across all age groups; however, there were differences across age groups between 2019 to 2021. The population rate dropped from:

  • 5.3% to 5.1% for the 0–14 age group
  • 11.3% to 11.1% for the 45–64 age group
  • 6.2% to 5.8% for the 65 and over age group.

On the other hand, the age groups 15–24 and 25–44 showed sustained growth for service use over this period, from 14.4% to 17.4% and from 14.2% to 15.2%, respectively.

Major cities had the highest use of MBS mental health service use

About three-quarters (74%) of MBS mental health consumers accessing services resided in Major cities and Inner regional areas (similar to the overall distribution of the Australian population). Generally, the percentage of MBS mental health related services among the populations of Major cities and Inner regional areas were similar for each service use group and the total overall; in each category of greater remoteness, however, the population rate decreased for each service use group and the total overall. 

  • For example, in 2021, in Major cities and Inner regional areas, MBS mental health consumers comprised 11% of the population, compared with 8.7% in Outer regional, 5.8% in Remote and 3.3% in Very remote areas. This is due, in part, to MBS mental health services being more readily available in Major cities,based on the distribution of the health workforce. For instance, mental health workforce data for 2021 indicated that there were: 
    • 19 psychiatrists per 100,000 population in Major cities compared with 2 in Very remote areas
    • 142 psychologists per 100,000 population in Major cities compared with 20 in Very remote areas (AIHW 2023f).

The population rate of service users increased for all remoteness areas from 2012 to 2021. Although Remote and Very remote areas had the lowest rates, they had the largest increases relative to 2012; namely from:

  • 3.1% of the Remote population in 2012 to 5.9% in 2021
  • 1.5% of the Very remote population in 2012 to 3.3% in 2021. 

This may be due to increased awareness of mental health issues, assistance in rural and remote communities (Department of Health 2019a) and the introduction of Better Access telehealth services in 2017 (Department of Health 2019b).

MBS mental health consumers in least disadvantaged areas had the highest service use

People residing in areas of lower disadvantage had the highest rate of MBS mental health consumers, with the rate decreasing with increasing disadvantage. In 2021, the population rate (% of the population) in least disadvantaged areas were 14% compared with 9.1% for the most disadvantaged areas. This difference has grown over time, with the population rate for the:

  • least disadvantaged areas increasing by 5 percentage points from 9.1% in 2012
  • most disadvantaged areas increasing by only 3 percentage points from 6.2% in 2012 (Figure MH.3). 

Box MH.3: Socio-Economic Indexes for Areas analysis

The Australian Bureau of Statistics calculates Socio-Economic Index for Areas (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) scores, accounting for social and economic indicators of advantage and disadvantage (such as education, occupation, employment, income, families, and housing). These scores are used to summarise the socioeconomic conditions of a geographical area. 

The SEIFA IRSD indexes are assigned to areas. SEIFA scores are determined by dividing the Australian areas into 5 equally sized groups (called quintiles), ranging from the most disadvantaged to the least disadvantaged.

For more information on SEIFA, see Socio-Economic Indexes for Areas (SEIFA), Australia (ABS 2021).

Between 2012 and 2019, the population rate for MBS mental health consumers grew steadily for all socioeconomic areas. From 2019, people in the 2 least disadvantaged areas had a stronger increase in the population rate than people in the most disadvantaged areas, where it remained steady.

Figure MH.3: The least disadvantaged areas had a higher population rate than the most disadvantaged areas

MBS mental health consumer population rate (%) by SEIFA quintile, 2012 and 2021

This column graph presents MBS mental health consumer rates by the 5 SEIFA quintiles for 2012 and 2021. The highest population rate in both these yeas was for people in the least disadvantaged group – 8.9% in 2012 and 14.4% in 2021. 


Source: MBS data (sourced from the Department of Health and Aged Care).

General practitioner services are used by the largest number of MBS mental health consumers

In 2021, 83% of MBS mental health consumers had one or more services from a GP; with GPs having the largest increase in consumer numbers for mental health services – an 80% growth from 1.3 million in 2012 to 2.3 million in 2021. GPs are often the first point of contact for people seeking mental health care services; they provide consumers with mental health services, prepare mental health treatment plans and/or refer consumers to other health professionals (AIHW 2023f).

Between 2019 and 2021, the number of consumers receiving services from psychiatrists grew 15%, from 419,000 to 480,000 consumers each year, compared with the growth for:

  • GPs – an increase from about 2.26 million to 2.33 million consumers
  • other psychologists – an increase from about 728,000 to 742,000 consumers
  • clinical psychologists – a decrease from 545,000 to 541,000 consumers.

Despite slower or no growth in the number of consumers receiving services from other psychologist and clinical psychologists during this period, these providers had strong growth in the number of services delivered (21% and 25% increase, respectively), compared with a 3% increase for GPs and a 9% increase for psychiatrist services.

More MBS mental health consumers are using telehealth to access services

While videoconference telehealth consultations have been available for some mental health MBS services for many years, the proportions of consumers who used telehealth increased markedly from 2020 to 2021 – from 1.3% in 2020 (34,100 consumers) to 36% in 2021 (1,010,000 consumers). This large increase was due to the broad introduction of teleconference services and videoconference services in response to the COVID-19 pandemic. 

The number of MBS mental health consumers accessing face-to-face services fell from about 2.7 million in 2019 to 2.6 million in 2021.

MBS non-mental health related services

Almost all (98%) MBS mental health consumers accessed one or more MBS non-mental health service during 2017 and 2021. The number of mental health services accessed by mental health consumers increased from:

  • 46 services per 100 population in 2017 to 55 in 2021 for mental health services
  • 240 services per 100 population in 2017 to 302 in 2021 for non-mental health services (Figure MH.4).

In considering the use of non-mental health specific services it should be noted that GPs may choose to treat a patient for a mental health issue using a general consultation MBS service item. As such, it is likely that there are some non-mental health services where mental health may have been one of the conditions managed, or the main condition managed. 

Figure MH.4: Between 2017 and 2021, the rates of MBS mental health and non-mental health services per 100 population increased each year

Rate of MBS mental health and non-mental health services per 100 population, 2017 to 2021

This stacked column graph shows the service rate per 100 population of non-mental health services ranged from 240 services in 2017 to 302 in 2021, while the rate for mental health services ranged from 46 in 2017 to 55 in 2021. 


Source: MBS data (sourced from the Department of Health and Aged Care).

Older mental health consumers had the highest median number of non-mental health services

Between 2017 and 2021, the median (see glossary) number of non-mental health services increased with age, from 8 services per year for consumers aged 0–14 to 40 services for people aged 65 and older. Overall, females had a higher median number of services (21 per year) than males (13). For most age groups, females had a higher median number, except for consumers aged 65 and older where both sexes had a median number of 40 services per year. 

The largest difference between the sexes was in the 25–44 age group, where females had a median number of 21 services compared with 12 for males. One factor that may affect these findings is the use of services related to reproductive health care. 

Major cities had the highest use of MBS non-mental health services

The proportion of MBS mental health consumers who accessed non-mental health services was lower in Remote and Very remote areas than in less remote areas. 

  • For example, in 2021, the broad type of non-mental health service with the highest proportions of patients were unreferred GP attendances and pathology tests which were accessed, respectively, by 98% and 84% of mental health consumers in Major cities compared with 96% and 77% of consumers in Remote and Very remote areas. 

The largest percentage point difference was for specialist attendances, which were accessed by 41% of mental health consumers in Major cities, compared with 27% in Remote and Very remote areas. Practice nurse services was the only broad type of service accessed by a higher proportion of mental health consumers in Remote and Very remote areas (13%, compared with 9% for Major cities). 

MBS mental health consumers in the least disadvantaged areas had the highest use of MBS non-mental health services

In 2021, the non-mental health rate for mental health consumers ranged from 403 services per 100 population for the least disadvantaged areas, to 254 services for the most disadvantaged areas (for information on SEIFA see Box MH.3). 

In 2021, consumers in the most disadvantaged areas had the highest population rate of receiving GP (98%) and diagnostic imaging (52%) services. However, consumers in the most disadvantaged areas had the lowest rate for receiving operations (18%) and optometry (32%) services, compared with other areas. 

PBS mental health related use 

Box MH.4: PBS mental health related prescriptions data analysis

Mental health consumers included in PBS analysis

In this article, PBS mental health consumers are defined as people dispensed one or more mental health related prescriptions during the year. Consumers are categorised into 4 prescription groups according to the number of prescriptions dispensed by health professionals over the year. 

Prescriptions are counted for each medication and repeat dispensed to a consumer (see more details in the Technical notes).

  • Low: 1–2 prescriptions per year 
  • Low–Medium: 3–8 prescriptions per year 
  • Medium–High: 9–15 prescriptions per year 
  • High: 16 or more prescriptions per year.

These groupings have been selected for presentation purposes and are not based on the types of prescriptions accessed, nor demographic or clinical factors related to consumers. 

Statistics used to categorise mental health consumers in this article are related to the number of medications dispensed, not the number of prescriptions written for the consumers by a health professional. Medications dispensed during hospital admissions are not included. 

Results from use of one medication are not directly comparable with those from another due to variability in the nature of mental illness, including its acuity and duration. It is not possible to describe what a good outcome is for a particular medication, as the same number of prescriptions could reflect totally different outcomes, depending on the specific medications (for example, the difference between long-term/ongoing medications and one-off prescriptions). 

Medication groups included in PBS analysis

The analysis in this article includes 5 Anatomical Therapeutic Chemical (ATC) classification medication groups:

  • antipsychotics (ATC code N05A): drugs used to treat symptoms of psychosis (a severe mental disorder, characterised by loss of contact with reality, delusions and hallucinations), which are common in conditions such as schizophrenia, mania and delusional disorder
  • anxiolytics (ATC code N05B): drugs prescribed to treat symptoms of anxiety
  • hypnotics and sedatives (ATC code N05C): hypnotic drugs used to induce sleep and treat severe insomnia. Sedative drugs are prescribed to reduce excitability or anxiety
  • antidepressants (ATC code N06A): drugs used to treat the symptoms of clinical depression and other conditions
  • psychostimulants, agents used for ADHD and nootropics (ATC code N06B): drugs used to treat the symptoms of clinical depression and other conditions. Agents used for Attention Deficit Hyperactivity Disorder (ADHD) and to improve impaired cognitive abilities (nootropics) (AIHW 2023c; WHO Collaborating Centre for Drug Statistic Methodology 2023).

Consumers who were dispensed more than one medication type were counted once for each type; therefore, the sum of consumers by medication type may be larger than the total number of PBS mental health consumers. 

In 2021, 18% of the Australian population had at least one mental health related prescription dispensed under the PBS, an increase from 15% in 2012.

Between 2012 and 2021 the:

  • population rate of PBS mental health consumers per 100 population in the Medium–High and High prescription groups increased from 3.9% and 1.9% in 2012, respectively, to 6.1% and 2.6% in 2021 (Table MH.2)
  • population rate in the Low and Low–Medium groups remained relatively stable (Table MH.2)
  • median number of prescriptions dispensed for consumers increased from 6 to 8 per person per year.
Table MH. 2: Rate of PBS mental health consumers per 100 population in each prescription dispensed category, 2012, 2016 and 2021

Prescription dispensed category

2012

2016

2021

Low

4.5

4.8

4.4

Low–Medium

4.8

4.5

4.9

Medium–High

3.9

5.1

6.1

High

1.9

2.2

2.6

Note: Percentages may not total 100% due to rounding.

Source: PBS/RPBS data (sourced from the Department of Health and Aged Care).

Over half of PBS mental health consumers were females

In 2021, females made up 60% of PBS mental health consumers who were dispensed mental health related prescriptions – a similar proportion to that between 2012 to 2020. Between 2012 and 2021, the rate of the male population who were dispensed prescriptions increased from 12% to 15%, while for females it increased from 18% to 21%. Between 2017 and 2021, females were dispensed a median of 8 mental health prescriptions each year compared with 7 for males.

In 2021, 0.9% of females and 1.7% of males were dispensed psychostimulants, agents used for ADHD and nootropics – an increase from 0.2% of females and 0.7% of males in 2012 (Figure MH.5). While still representing relatively small numbers, the increases for both sexes could be related to a range of factors including:

  • increase awareness about ADHD and associated symptoms, which may have resulted in increased demand for treatment (including prescription of psychostimulants).
  • as well, changes in the ADHD diagnosis criteria, and the impact of the COVID-19 pandemic, may have affected prescribing rates over time. 

Figure MH.5: The population rate (%) of male and female PBS mental health consumers who were dispensed psychostimulants, agents used for ADHD and nootropics continually increased from 2012 to 2021

PBS mental health consumer population rate (%) of those dispensed psychostimulants, agents used for ADHD and nootropics, by sex, 2012, 2015, 2018 and 2021

This column graph shows that the percentage of the male population who were dispensed psychostimulants, agents used for ADHD and nootropics increased from 0.7% (2012) to 1.7% (2021). For females, the equivalent percentage was 0.2% in 2012 to 0.4% in 2018 and 0.9% in 2021.


Source: PBS/RPBS data (sourced from the Department of Health and Aged Care).

Use of PBS mental health prescriptions grew most for young people

In 2021, the population rate of PBS mental health consumers who were dispensed a medication was 4% of people aged 0–14, more than double the rate in 2012 (2%). Young people aged 15–24 had the next largest rate rise relative to 2012, increasing from 8% in 2012 to 14% in 2021. Older age groups had slower growth or even decreases during the period.

In 2021, 14% of the population were dispensed antidepressants, the highest rate for all mental health related medications. The rates of antidepressant consumers ranged from 1% of the 0–14 age group up to 24% of the 65 and over age group. For the 0–14 age group, the highest rate was for consumers dispensed psychostimulants, agents used for ADHD and nootropics (3%) (Figure MH.6).

Figure MH.6: Antidepressants were the most commonly dispensed prescription, for mental health consumers aged 15 years and over

PBS mental health consumer population rate (%) by medication type and age group, 2021

This clustered column graph shows the population rate of use of medication types by age group in 2021. The percentage of the population dispensed antidepressants was 1.1% for the 0–14 age group, 11.1% for the 15–24 age group, 13.6% for the 25–44 age group, 18.7% for the 45–64 age group and 23.5% for the 65 and over age group.


Source: PBS/RPBS data (sourced from the Department of Health and Aged Care).

Remote and Very remote areas had the lowest rates of PBS mental health consumers

In 2021, the population rate of PBS mental health consumers who were dispensed prescriptions was highest in Inner regional areas (22%), compared with Outer regional areas (20%), Major cities (17%), Remote areas (15%) and Very remote areas (8.7%). This pattern was similar for each year from 2012 to 2021 (Figure MH.7). 

Figure MH.7: Between 2012 and 2021, Inner regional areas had the highest population rate of PBS mental-health related prescription consumers, while Very remote areas had the lowest

PBS mental health consumer population rate (%) by remoteness area, 2012 to 2021

This line graph shows the proportion of the population who were PBS consumers between 2012 and 2021 by remoteness area. The Inner regional area had the highest percentage of the population who were PBS consumers, followed by the Outer regional, Major cities and Remote areas and Very remote areas had the lowest population percentage (ranging from 6.0% in 2012 to 8.7% in 2021).


Source: PBS/RPBS data (sourced from the Department of Health and Aged Care).

Least disadvantaged socioeconomic areas had the highest population rate of PBS mental health consumers 

In 2021, the least disadvantaged areas (quintile 5) had the highest population rate of PBS mental health consumers (20%), followed by most disadvantaged areas (quintile 1) (18%) (Figure MH.8). Between 2012 and 2021, the rate of PBS mental health consumers increased across all socioeconomic areas. Several factors, such as access to services, health-seeking awareness and behaviour, and ability to pay for services, contribute to the differences across the areas.

Figure MH.8: The population rate (%) of prescriptions dispensed to mental health patients increased in all socioeconomic areas each year

PBS mental health consumer population rate (%) by SEIFA quintile, 2012 and 2021

This vertical bar graph depicts the population rate (%) for 2012 and 2021 for all quintiles of prescriptions dispensed to mental health patients. Quintile 5, the least disadvantaged areas, had the largest increase in the population rate of all quintiles rising from 16.6% in 2012 to 20.0% in 2021.


Source: PBS/RPBS data (sourced from the Department of Health and Aged Care).

Antidepressants are the highest used medication by PBS mental health consumers

PBS mental health consumers who were dispensed antidepressant prescriptions were the largest medication group (77% of the total PBS mental health consumers in 2021). The annual number of antidepressant consumers increased by more than one million people from 2.4 million in 2012 to 3.6 million in 2021.

Consumers dispensed psychostimulants, agents used for ADHD and nootropics were the smallest group of PBS mental health consumers (327,000 in 2021), but had the highest relative growth in consumer numbers, more than tripling from 107,000 in 2012. 

In 2021, the most frequent combination of dispensed medications were: 

  • antidepressants with anxiolytics (339,000 consumers)
  • antidepressants with antipsychotics (189,000)
  • antidepressants with hypnotics and sedatives (176,000).

The majority of PBS mental health consumers received prescriptions from general practitioners

In 2021, 4.2 million consumers (91% of the total PBS mental health consumers) were dispensed prescriptions from GPs (note that consumers may receive prescriptions from multiple provider types during a reporting period). In 2021, 9% of consumers were dispensed prescriptions by psychiatrists, 4% by paediatricians, 6% by other specialists, and 4% by other provider types.

In 2021, around three-quarters of PBS mental health consumers who received prescriptions from GPs, psychiatrists and paediatricians were dispensed multiple prescriptions per year, compared with only around a third from other medical specialists and a fifth from other providers. 

The strongest growth in consumers was among those dispensed prescriptions by paediatricians – an increase of 157%, from 72,234 in 2012 to 185,786 in 2021. This relates to the strong growth for young consumers aged 0–14 and 15–24 who were dispensed prescriptions for antidepressants and psychostimulants, agents used for ADHD and nootropics (see the section 'Use of PBS mental health prescriptions grew most for young people’).

PBS non-mental health related use

Between 2017 and 2021, PBS mental health consumers who were in the higher mental health prescription groups had a higher median number of non-mental health prescriptions dispensed. There was a median of 7 non-mental health prescriptions dispensed within the Low group to 27 in the High group. This is likely associated with some consumers having more complex health care needs, requiring both mental health and non-mental health medications (AIHW 2023e). 

Male PBS mental health consumers aged 65 and over had the highest median number of non-mental health prescriptions

Between 2017 and 2021 there was a trend for higher median numbers of non-mental health prescriptions with increasing age. In the younger age groups, males had the same or lower median numbers of non-mental health prescriptions as females. Comparatively, males in the 65 and over age group had a higher median number of non-mental health PBS prescriptions (43) than females (40). 

PBS mental health consumers living in Inner regional and Outer regional areas accessed the most non-mental health prescriptions

Consumers in Inner regional and Outer regional areas had higher median numbers of non-mental health prescriptions (13) than in Major cities (11) and Remote and very remote areas (10). 

PBS mental health consumers living in the most disadvantaged areas dispensed highest number of non-mental health prescriptions 

There was a trend for higher median numbers of non-mental health prescriptions dispensed with increasing disadvantage of each socioeconomic group. 

For example, people living in the most disadvantaged areas were dispensed a median of 15 PBS non-mental health prescriptions compared with 9 for the least disadvantaged areas. This pattern likely reflects the ‘social gradient of health’, characterised by associations between socioeconomic disadvantage and greater likelihood of chronic health conditions (AIHW 2022c). 

Conclusion

This analysis shows that over the reporting period from 2012 to 2021 there is variability in mental health consumer characteristics and patterns of service use among those who accessed both mental health and non-mental health services subsidised through the MBS and PBS. 

A range of factors can influence who, what, where and how these services are provided and accessed, as well as the impact of and response to the COVID-19 pandemic. The type and volume of the health services can vary for consumers, depending on their care needs, which can also alter due to changes in acuity and duration of conditions over time. Patterns of service use differ with the needs of consumers and the availability and ability to access services due to financial and/or geographical factors. 

It is important to continue to understand the consumer profiles, growth trends and use patterns in this area to deliver better services and meet further needs.

Further reading

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