Uptake of a federal government mental health program has been so slow many of the people needing it will be dead before they get their entitlements, the aged care royal commission has been told.
Just two per cent of depressed aged care residents have accessed the multi-million dollar scheme during the past 18 months.
Half of the 280,000 people living in nursing homes suffer from depression, the inquiry was told.
Residents do not have access to a standard mental health plan under the Medicare Benefits Scheme, instead covered under a separate Primary Health Network program overseen by the Department of Health.
But just 3605 people have received treatment since January 2019.
Commissioner Lynelle Briggs said she hoped the department would urgently address the slow rate of access to assistance.
"Given that the average time in residential aged care is under a couple of years, many of these people will be dead before they get access to these entitlements."
Counsel assisting Richard Knowles SC told the inquiry the program is already halfway through its four-year life and has consumed one quarter of its $82.5 million budget.
Access was also dependant on where a person lived, with residents of facilities in north and south Brisbane receiving a thousand times more services than elderly residents in Adelaide, Mr Knowles said.
Between "one and four" services were provided in Adelaide over an 18-month period, compared to more than 5000 in Brisbane.
Yet the South Australian capital still received more than $1 million in funding for its primary health network in 2019/20, Mr Knowles said.
Tania Rishniw, of the Department of Health, said funding discrepancies were due to the way the program was being rolled out "incrementally".
"It will depend on the relationships that the PHNs have built with the residential aged care facilities and the mental health workforce in their area," Ms Rishniw told the inquiry.
She also agreed the scheme needed to grow faster.
"But I would also make the point that residents have a choice to participate here as well."
She blamed the outbreak of COVID-19 for some interruptions.
However Mr Knowles said in the six months prior to the pandemic only 2400 people had been reached.
"So, if anything, the rate has probably increased during the time of COVID."
The witnesses were asked why the Commonwealth was keen to have PNH funding be equal to what was offered on the MBS when people in aged care had much greater health needs.
Mr Knowles pointed to the government's November four-fold increase in free sessions for people diagnosed with an eating disorder as proof the MBS could be tailored when needed.
The Royal Commission into Aged Care Quality and Safety has been examining funding models for mental, oral and allied health this week.
It will return to hold public hearings in Sydney on August 10.