Skip to main content Accessibility help

Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey

  • I. Bobevski (a1) (a2), A. Rosen (a3) (a4) and G. Meadows (a1) (a5)



While epidemiological surveys worldwide have found a considerable proportion of people using mental health services not to have a diagnosis of a mental disorder, with possible implications of service overuse, other work has suggested that most people without a current diagnosis who used services exhibited other indicators of need. The aims of the present study were, using somewhat different categorisations than previous work, to investigate whether: (1) Australians without a diagnosis of a mental disorder who used mental health services had other indicators of need; and (2) how rate and frequency of service use in Australia related to level of need, then to discuss the findings in light of recent developments in Australian Mental Health Policy and other epidemiological and services research findings.


Data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) 2007 was analysed.


Most people using mental health services had evident indicators of need for mental health care (MHC), and most of those with lower evident levels of need did not make heavy use of services. Only a small proportion of individuals without any disorders or need indicators received MHC (4%). Although this latter group comprises a fair proportion of service users when extrapolating to the Australian population (16%), the vast majority of these individuals only sought brief primary-care or counselling treatment rather than consultations with psychiatrists. Access and frequency of MHC consultations were highest for people with diagnosed lifetime disorders, followed by people with no diagnosed disorders but other need indicators, and least for people with no identified need indicators. Limitations include some disorders not assessed in interview and constraints based on survey size to investigate subgroups defined, for instance, by socioeconomic advantage and disadvantage individually or by characteristics of area.


MHC for individuals with no recognised disorders or other reasonable need for such care may be occurring but if so is likely to be an area-specific phenomenon. Rather than revealing a large national pool of treatment resources being expended on the so-called ‘worried well’, the findings suggested a generally appropriate dose–response relationship between need indicators and service use. Definitive ascertainment of area-specific disparities in this national pattern would require a different survey approach. Government proposals for widespread introduction of stepped-care models that may seek to divert patients from existing treatment pathways need to be implemented with care and well informed by local data.


Corresponding author

*Address for correspondence: G. Meadows, Department of Psychiatry, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. (Email:


Hide All
Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lepine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martinez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacin, C, Romera, B, Taub, N, Vollebergh, WA (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica 420, 4754.
Andrews, G (2000). Meeting the unmet need with disease management. In Unmet Need in Psychiatry: Problems, Resources, Responses (ed. Andrews, G and Henderson, S), pp. 1137. Cambridge University Press: Cambridge, UK.
Andrews, G, Slade, T (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health 25, 494497.
Aoun, S, Pennebaker, D, Wood, C (2004). Assessing population need for mental health care: a review of approaches and predictors. Mental Health Services Research 6, 3346.
Australian Bureau of Statistics (2009). National Survey of Mental Health and Wellbeing: Users Guide. Australian Bureau of Statistics: Canberra.
Australian Government Department of Health (2015). Australian Government Response to Contributing lives, thriving communities – Review of Mental Health Programmes and Services. Australian Government: Canberra.
Buist-Bouwman, MA, Ormel, J, De Graaf, R, Vilagut, G, Alonso, J, Van Sonderen, E, Vollebergh, WAM, Esemed/Mhedea 2000 Investigators (2008). Psychometric properties of the world health organization disability assessment schedule used in the European study of the epidemiology of mental disorders. International Journal of Methods in Psychiatric Research 17, 185197.
Burgess, P, Pirkis, J, Slade, T, Johnston, A, Meadows, G, Gunn, J (2009). Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 43, 615623.
Cailhol, L, Pelletier, E, Rochette, L, Laporte, L, David, P, Villeneuve, E, Paris, J, Lesage, A (2017). Prevalence, mortality, and health care use among patients with cluster b personality disorders clinically diagnosed in quebec; a provincial cohort study, 2001–2012. Canadian Journal of Psychiatry 62, 336342.
Culyer, AJ, Wagstaff, A (1993). Equity and equality in health and health care. Journal of Health Economics 12, 431457.
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S, Consortium WH O. W. M. H. S. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291, 25812590.
Doessel, DP, Williams, RFG, Whiteford, H (2010). Structural imbalance and resource shortage in the Australian mental health sector. Journal of Mental Health Policy and Economics 13, 312.
Druss, BG, Wang, PS, Sampson, NA, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2007). Understanding mental health treatment in persons without mental diagnoses: results from the national comorbidity survey replication. Archives of General Psychiatry 64, 11961203.
Enticott, JC, Meadows, GN, Shawyer, F, Inder, B, Patten, S (2016). Mental disorders and distress: associations with demographics, remoteness and socioeconomic deprivation of area of residence across Australia. Australian and New Zealand Journal of Psychiatry 50, 11691179.
Geddes, JR, Carney, SM, Davies, C, Furukawa, TA, Kupfer, DJ, Frank, E, Goodwin, GM (2003). Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 361, 653661.
Geddes, JR, Burgess, S, Hawton, K, Jamison, K, Goodwin, GM (2004). Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. American Journal of Psychiatry 161, 217222.
Goldney, RD, Fisher, LJ, Dal Grande, E, Taylor, AW (2004). Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population. Social Psychiatry and Psychiatric Epidemiology 39, 293298.
Harris, MG, Diminic, S, Burgess, PM, Carstensen, G, Stewart, G, Pirkis, J, Whiteford, HA (2014). Understanding service demand for mental health among Australians aged 16 to 64 years according to their possible need for treatment. Australian and New Zealand Journal of Psychiatry 48, 838851.
Harrison, CM, Britt, HC, Charles, J (2012). Better outcomes or better access – which was better for mental health care? Medical Journal of Australia 197, 620.
Jorm, A (2011). The population impact of improvements in mental health services: the case of Australia. British Journal of Psychiatry 199, 443444.
Jorm, AF (2006). National surveys of mental disorders: are they researching scientific facts or constructing useful myths? Australian and New Zealand Journal of Psychiatry 40, 830834.
Katz, SJ, Kessler, RC, Frank, RG, Leaf, P, Lin, E (1997). Mental health care use, morbidity, and socioeconomic status in the United States and Ontario. Inquiry 34, 3849.
Kessler, RC, Üstun, B (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.
Kessler, RC, Andrews, G, Colpe, LJ, Hiripi, E, Mroczek, DK, Normand, SL, Walters, EE, Zaslavsky, AM (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32, 959976.
Kessler, RC, Merikangas, KR, Berglund, P, Eaton, WW, Koretz, DS, Walters, EE (2003). Mild disorders should not be eliminated from the DSM-V. Archives of General Psychiatry 60, 11171122.
Kessler, RC, Demler, O, Frank, RG, Olfson, M, Pincus, HA, Walters, EE, Wang, P, Wells, KB, Zaslavsky, AM (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.
Korten, A, Henderson, S (2000). The Australian National Survey of Mental Health and Wellbeing: common psychological symptoms and disablement. British Journal of Psychiatry 177, 325330.
Meadows, GN, Bobevski, I (2011). Changes in met perceived need for mental healthcare in Australia from 1997 to 2007. British Journal of Psychiatry 199, 479484.
Meadows, GN, Enticott, JC, Inder, B, Russell, GM, Gurr, R (2015). Better access to mental health care and the failure of the Medicare principle of universality. [Erratum appears in Med J Aust. 2015 Apr 6;202(6):297; PMID: 25832148]. Medical Journal of Australia 202, 190194.
Mechanic, D (2003). Is the prevalence of mental disorders a good measure of the need for services? Health Affairs 22, 820.
Narrow, WE, Rae, DS, Robins, LN, Regier, DA (2002). Revised prevalence estimates of mental disorders in the United States. Archives of General Psychiatry 59, 115123.
National Mental Health Commission (2014). The National Review of Mental Health Programmes and Services. National Mental Health Commission: Sydney.
Pilling, S, Anderson, I, Goldberg, D, Meader, N, Taylor, C (2009). Guidelines: depression in adults, including those with a chronic physical health problem: summary of NICE guidance. BMJ: British Medical Journal 339, 10251027.
Rai, D, Skapinakis, N, Wiles, GL, Araya, R (2010). Common mental disorders, subthreshold symptoms and disability: longitudinal study. British Journal of Psychiatry 197, 411414.
Regier, DA (2003). Mental disorder diagnostic theory and practical reality: an evolutionary perspective. Health Affairs (Millwood). 22, 2127.
Regier, DA, Kaelber, CT, Rae, DS, Farmer, ME, Knauper, B, Kessler, RC, Norquist, GS (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders. Archives of General Psychiatry 55, 109115.
Rosen, A (1999). International perspectives on re-forming mental health services: Australia: from colonial rivarlies to a national mental health strategy, Chapter 14. In The Mental Health Matrix: A Manual to Improve Services (ed. Thornicroft, G and Tansella, M). Cambridge University Press: Cambridge, UK.
Slade, TN, Johnston, A, Oakley-Browne, M, Andrews, G, Whiteford, H (2009). 2007 National Survey of Mental Health and Wellbeing: description of methods and summary of key findings. Australian and New Zealand Journal of Psychiatry 43, 594605.
StataCorp, LP (2007). Intercooled Stata for Unix Select Edition (SE). College Station: TX.
Treuer, T, Tohen, M (2010). Predicting the course and outcome of bipolar disorder: a review. European Psychiatry 25, 328333.
Wakefield, JC (2001). Lowered estimates – but of what? Archives of General Psychiatry 59, 129130.


Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey

  • I. Bobevski (a1) (a2), A. Rosen (a3) (a4) and G. Meadows (a1) (a5)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed