Mental health service use and cost by Australian women in metropolitan and rural areas

IntroductionThe use and costs of mental health services by rural and remote Australian women are poorly understood.ObjectiveTo examine the use of the Better Access Scheme (BAS) mental health services across geographical areas.DesignObservational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973-1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services.Findings31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively).DiscussionWomen in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas.ConclusionRegardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.