Cultural and Linguistic Characteristics of People Using Mental Health Services and Prescription Medications

The whole Australian population is culturally and linguistically diverse with characteristics varying amongst the population. People may face language and cultural barriers when accessing mental health care [1]. Cultural beliefs about what constitutes mental illness and how to respond to it can affect how people explain symptoms, seek help, and access health services [2].

This publication is the fourth in a series of analyses based on data from the 2011 Mental Health Services-Census Integrated Dataset. It explores cultural and linguistic characteristics of people using Medicare Benefits Schedule (MBS) subsidised mental health-related services and Pharmaceutical Benefits Scheme (PBS) subsidised mental health-related medications in 2011, building upon previous releases from the Integrated Dataset. These are:

• Characteristics of People using Mental Health Services and Prescription Medications, 2011 (cat. no. 4329.0)
• Patterns of Use of Mental Health Services and Prescription Medications, 2011 (cat. no. 4329.0.00.003)
• Housing Circumstances of People Using Mental Health Services and Prescription Medications, 2011 (cat. no. 4329.0.00.002)
   

MBS subsidised mental health-related services are those provided by psychiatrists, general practitioners (GPs), clinical psychologists, other psychologists and other allied health professionals. PBS subsidised mental health-related medications comprise antipsychotics, anxiolytics/hypnotics and sedatives, antidepressants, and psychostimulants, agents used for ADHD and nootropics. See Appendix 1 and Appendix 2 respectively for more detail about mental health-related services and medications listed on the MBS and PBS.

The 2011 Census of Population and Housing asked several questions to provide a picture of Australia’s cultural and linguistic diversity [3]. For the purpose of analyses in this publication, the Australian population has been divided into four groups based on country of birth and language spoken at home:

• Born in Australia, speaks English at home
• Born in Australia, speaks a language other than English at home
• Born overseas, speaks English at home
• Born overseas, speaks a language other than English at home
   

In the Integrated Dataset, the Census of Population and Housing provides insight into a range of socio-demographic characteristics including age, sex, remoteness, socio-economic disadvantage, household income, labour force status, educational attainment and others.

There are a number of factors that should be considered when interpreting information presented in this publication.

While the MBS items included in analysis include a range of subsidised mental health-related services provided in Australia, consultations with some medical practitioners such as paediatricians were not captured in the Mental Health Services-Census Integrated Dataset, even if they were related to mental health. Consultations with GPs that may have involved discussion of mental health issues but were not recorded as mental health-related services were also not captured.

For certain countries, the Australian Government’s Reciprocal Health Care Agreement (RHCA) allows visitors to access MBS and PBS subsidised services and medications. Australia currently has RHCAs with the United Kingdom, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia. Overseas-born people living in Australia who are not eligible for MBS or PBS subsidised services or medications are not in scope of the Mental Health Services-Census Integrated Dataset, but are included in Census counts on which rates of use of MBS or PBS subsidised services or medications are based [4].

A person's use of mental health-related services or medications does not imply a diagnosis of a mental health condition. For information on people who reported having a mental or behavioural condition in Australia in 2014-15 (4.0 million people) see National Health Survey: First Results, 2014-15 (cat. no. 4364.0.55.001).

The cultural and linguistic diversity of Australia's population has been shaped by historical events and policies both in Australia and other parts of the world [1]. In particular, successive waves of migration since World War II have contributed to the make-up of the overseas-born population in Australia in 2011 [2]. Initially most of these migrants were born in countries in North-West Europe such the United Kingdom and Germany, and were then followed by large numbers of migrants born in Southern and Eastern Europe, including Italy, Greece and Yugoslavia. In the 1970s, many migrants arrived in Australia from South-East Asian countries, including Vietnam, the Philippines and Cambodia, and more recently, from North-East and Southern Asian countries such as China and India.

In 2011, around one-quarter (25%) of the Australian population were born overseas, while around one-fifth (18%) spoke a language other than English at home. Of people born overseas, one-fifth (21%) were born in the United Kingdom, 9% were born in New Zealand, 6% in China and India each, and 4% in Italy. Amongst people who spoke a language other than English at home, 9% spoke Mandarin, followed by people who spoke Italian (8%), Arabic or Cantonese (both 7%), or Greek (6%).

When country of birth and language spoken at home are considered together, 64% of the population were born in Australia and spoke English at home, 5% were born in Australia and spoke a language other than English at home, 11% were born overseas and spoke English at home, and 13% were born overseas and spoke a language other than English at home.

Across Australia, the age structures of groups of people from different cultural and linguistic backgrounds differ. For example, in 2011, people born in Australia who spoke a language other than English at home were considerably younger (a median age of 18 years) than people born in Australia who spoke English at home (35 years). People born overseas who spoke a language other than English at home had a median age of 41 years, while people born overseas who spoke English at home had the highest median age, of 49 years.

Given the relationship between demographic characteristics such as age and the use of MBS and PBS subsidised mental health-related treatments [3], it is important to take these into consideration when interpreting data presented in this publication on the use of mental health-related treatments by specific populations such as people from culturally and linguistically diverse backgrounds.

There were 1.5 million people (7.2% of all Australians) who used at least one MBS subsidised mental health-related service in 2011. Rates of use differed amongst people from culturally and linguistically diverse backgrounds.

In 2011, 8.0% of people born in Australia who spoke English at home accessed an MBS subsidised mental health-related service. Similarly, 7.5% of people born overseas who spoke English at home accessed mental health-related services. Around 6.0% of people born in Australia who spoke a language other than English at home accessed a mental health-related service in 2011, while 5.6% of people born overseas who spoke a language other than English at home did so.

Across age, the pattern of people accessing mental health-related services was broadly similar amongst the four groupings of people from differing culturally and linguistically diverse backgrounds, with rates of use generally highest amongst people aged 25-54 years and lowest amongst children and older people.

People born overseas who spoke a language other than English at home had considerably lower rates of use between the ages of 15 to 54 years. In 2011, 6.0% of 15-54 year old people born overseas who spoke a language other than English at home used at least one MBS subsidised mental health-related service, compared with 10.9% of people born in Australia who spoke English at home, 9.4% of people born in Australia who spoke a language other than English at home, and 9.3% of people born overseas who spoke English at home.

In 2011, 10.9% (2.4 million people) of all Australians had at least one script filled for a PBS subsidised mental health-related medication such as an antidepressant. Rates of use differed amongst people from different culturally and linguistically diverse backgrounds.

Of all people born in Australia who spoke English at home, 11.6% accessed a PBS subsidised mental health-related medication in 2011, while 13.1% of people born overseas who spoke English at home accessed mental health-related medications. Around 9.8% of people born overseas who spoke a language other than English at home accessed mental health-related medications, while 4.6% of people born in Australia who spoke a language other than English at home did so.

It is important to consider the age structures of these groups when interpreting their rates of accessing mental health-related medications. For example, the relatively low rate (4.6%) for people born in Australia who spoke a language other than English at home was largely related to the young age structure of this population (a median age of 18 years). Conversely, the higher rate (13.1%) for people born overseas who spoke English at home was influenced by their older age structure (a median age of 49 years).

Across age, the pattern of people accessing mental health-related medications was broadly similar amongst the four groupings of people from differing culturally and linguistically diverse backgrounds, with rates of use increasing with age.

People born in Australia who spoke English at home had the highest rates of accessing mental health-related medications for all age groups other than 75 years and over. Amongst 15-54 year olds, people born overseas who spoke a language other than English at home had the lowest rates of accessing mental health-related medications.

In 2011, 10.4% of people aged 15-54 years who were born in Australia and spoke English at home accessed at least one mental health-related medication, compared with 5.2% of people of the same age who were born overseas and spoke a language other than English at home. People aged 15-54 years who were born in Australia and spoke English at home or those who were born overseas and spoke English at home had relatively similar rates of accessing mental health-related medications (6.9% and 7.7% respectively).

The Mental Health Services-Census Data Integration project brings together the breadth of 2011 Census of Population and Housing (Census) data with administrative information on people accessing subsidised mental health-related MBS services and PBS prescription medications. The project was initiated on behalf of the National Mental Health Commission (NMHC) with the aim of informing the National Review of Mental Health Programmes and Services.

Integrating a selected subset of data items from the MBS, PBS and 2011 Census has greatly increased the power of the data to support analysis of the circumstances and characteristics of people experiencing mental ill-health as they interact with the health care system. The Mental Health Services-Census Integrated Dataset includes people who responded to the 2011 Census and those who accessed subsidised mental health-related items listed on the MBS or PBS in 2011

This Integrated Dataset contributes significantly to the pool of mental health-related data available in Australia to assist in the development and evaluation of mental health programs and support services now and into the future. Questions can be answered about people accessing subsidised mental health-related services and medications with evidence that up until now has not been available. For example, analysis of the integrated data answers questions about the relationship between mental health-related services, medication use and key socio-economic information such as education, employment and housing.

The confidentiality of these data are protected by the Census and Statistics Act (1905) and the Privacy Act (1988). MBS and PBS information provided by the Department of Health and the Department of Human Services to the ABS is treated in the strictest confidence as is required by the National Health Act (1953) and the Health Insurance Act (1973).

This release previously used catalogue number 4329.0.00.001.