Occupational therapists' experiences in Australia's primary mental health funding scheme: Navigating complexity in a constrained system

INTRODUCTION: Occupational therapists in the Australian context provide significant value to mental health, including through Better Access, a Medicare initiative that gives individuals access to up to 10 sessions with a psychologist, social worker, or occupational therapist following a referral from a medical practitioner. However, the experiences of occupational therapists working under the initiative are not widely understood, with no recent occupational therapy-specific research. This study aims to explore the experiences of occupational therapists working under Better Access, their distinct role, and how the system shapes the care clients receive. METHODS: The study used a qualitative, inductive approach. Thirteen occupational therapists who work with people funded by Better Access participated in 30-minute, semi-structured interviews. Data were analysed via thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: The lead researcher for this study has lived experience of mental illness and Better Access, but further consumer and community involvement was not undertaken. FINDINGS: Analysis generated themes highlighting the complexity of occupational therapy practice within a psychology-centric system. Participants described how occupational therapists drew on specialised skills to support clients with complex needs, yet worked within structural constraints such as restrictive practice rules, session caps, and limited remuneration. Themes also reflected the undervaluation of occupational therapy and the need for ongoing advocacy to ensure equitable access to services, appropriate funding, and recognition of the profession's contribution. CONCLUSION: The design of Better Access restricts the ability of occupational therapists to provide meaningful and sustainable occupational therapy services. Findings provide further evidence that longstanding issues identified in early research have persisted and that the burden occupational therapists face of consistently advocating for the profession and their clients is symptomatic of broader structural inequities. Findings highlight the need for systemic reform.