Mental health is a growing area of concern in public health, with over 2.2 million Australians reporting being diagnosed with a mental illness in 2022. With limited access to mental health services, out of pockets costs, and long waiting lists for specialists, it can be challenging for doctors to manage patients experiencing mental health issues. We speak to Medical Council Adviser Dr. Juliet Freeborn and Deputy President of the Psychology Council, Prof. Chris Willcox to help identify what resources are available to doctors to help care for patients, how to assist patients who have received a mental health diagnosis, and knowing when to refer.
Why is it important to act promptly in identifying mental health concerns at the level of primary care?
General practitioners’ involvement in mental health is growing, with the BEACH survey showing GP engagement for mental health concerns has been increasing since 2007 and now accounts for over 12% of all GP appointments. GPs are ideally placed as a trusted professional who is often the first person a patient will speak with about their concerns. It is important that patients are listened to and responded to appropriately. If a mental health condition is treated at an early stage, it may be more amenable to treatment and not escalate to a higher risk condition.
Often the patient will initially require longer appointments with the GP to manage their concerns with appropriate time and attention.
At what point should a patient be referred to a psychologist or other specialist? What steps to be taken before reaching this point?
Referral to a Psychologist depends on the GP’s level of comfort and experience as well as appointment capacity, in managing mental health symptoms and diagnoses in primary care. Some GPs have further qualifications in Mental Health Skills Training.
GPs may refer some patients under the Better Access initiative, however this referral requires a diagnosis and Mental Health Treatment Plan. These subsidized appointments under MBS can help a patient access another medical practitioner with specific mental health training, as well as psychologists, social workers and Occupational Therapists for 10 sessions in a calendar year. During the Covid pandemic, 20 sessions were subsidized under the Better Access Initiative, however this has reverted to the pre-Covid number of 10 sessions since 1 Jan 2023. The Medical Council has seen complaints which stem from a misunderstanding in the public about the time required for a GP to complete a Mental Health Treatment Plan and the eligibility requirements. It is recommended that there is appropriate signage and patient education so that patients understand that mental health concerns often require longer appointment times and GPs can consider how they can facilitate their patient booking system to allow patients to choose a longer appointment.
Professor Willcox highlights the importance of including in the referral all the relevant pieces of information relating to the patient’s presenting condition, as well as discussing the referral with the patient before their initial appointment with the mental health practitioner, so they understand the information which will be shared.
Referrals to other mental health care professional appointments, such as to a psychiatrist, may be required for patients with complex or higher risk mental health conditions, as well as patients not responding to primary care treatment.
How can doctors assist at-risk patients who are unable to access additional mental health treatments?
There is a growing awareness about the importance of access to mental health resources for patients, particularly for complex and acute issues. For acute issues, a GP can contact the local Acute Care Team or Mental health line. Patients may also be eligible for additional publicly funded programs, including the Aboriginal Community Controlled Health Service or for a young person aged 12-25 by referral to headspace.
Health pathways for GPs https://www.ciap.health.nsw.gov.au/specialty-guides/nsw-healthpathways.html
Health pathways SE Sydney https://sesydney.communityhealthpathways.org/15718.htm
Finding a Psychologist, Psychiatrist or other counsellor
RACGP Guidelines for eMental health resources https://www.racgp.org.au/getattachment/a5a2daae-77ca-4d0a-8dfd-81b04105409e/e-Mental-health-A-guide-for-GPs.aspx
Youth aged 12-25 – headspace https://headspace.org.au/
RANZCP website for resources (for patients) https://www.yourhealthinmind.org/mental-illnesses-disorders
RANZCP website for resources (for health professionals) https://www.ranzcp.org/practice-education/guidelines-and-resources-for-practice/gps-and-psychiatrists
Mental Health MBS https://www.health.gov.au/our-work/better-access-initiative