Australia’s ‘disempowering’ dependence on mental health medication

One in six Australians were prescribed a mental health medication last year, but many are failing to treat the long-term or underlying cause of their condition, new health data suggests.
 
According to the Australian Institute of Health and Welfare’s latest mental health research, in 2021–22, 4.7 million people filled a mental health-related prescription.
 
At the same time, just 2.8 million people received a Medicare-subsidised mental-health service from a GP, psychologist or psychiatrist, indicating that many patients are not accessing counselling after being prescribed their medication.
 
Around 85% of those prescriptions were written by GPs, and three quarters were for antidepressant medications.
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine said while medications are helpful in alleviating symptoms and reducing distress, they do not treat the underlying causes of a patient’s mental illness.  
 
‘This leaves them at risk of maintaining negative perpetuating behaviours and not addressing the predisposing factors that have led to their mental health symptoms,’ she told newsGP.
 
‘For example, a history of poor relationships or addiction needs to be addressed by changing lifestyle, developing positive habits, and building assertiveness.
 
‘Counselling is ideal in helping people to reflect and build their skills thereby empowering them to lead more meaningful and positive lives.’
 
Tasmania had the highest proportion of mental health-related prescriptions, followed by the Australian Capital Territory and New South Wales, at a time when more people are reaching out for mental health support than ever before.
 
Beyond Blue data reveals in 2020–21, 54.7% of females and 37% of males with a 12-month mental disorder saw a health professional for their mental health.
 
This is compared to 40.7% of females and 27.5% of males in 2007.
 
And while it is a positive cultural step forward to see more people seeking help, Dr Andronis described this increased dependence on medication as ‘problematic’ and ‘disempowering’.  
 
‘It can lead to a sense of hopelessness and reduced pleasure and productivity in our personal and work life, and hopelessness breeds despair and disability,’ she said.
 
‘Social determinants are the main causes of mental distress and without a sense of agency and a belief in our capacity to change for the better, we cannot address these underlying issues.
  
‘Many patients I see feel hopeless about their inability to manage symptoms without medication despite wishing that they could manage their distress naturally.’
 
But another interpretation of the data shines a light on another unfortunate trend – the Medicare Benefits Schedule (MBS) not keeping up with the current demands of general practice.
 
While the raw data says 2.8 million people accessed a Medicare-subsidised mental-health service, it likely underestimates the amount of psychological care provided by GPs.
 
Dr Caroline Johnson, a senior lecturer at the University of Melbourne’s Department of General Practice, told newsGP the figures are not surprising, and the complexities of Medicare can make billing mental health appointments hard to navigate.
 
‘I only use the mental health related item numbers when reviewing mental health in a certain percentage of situations,’ she said.
 
‘For example, many, many mental health consults last less than 20 minutes, hence item 2713 isn’t allowed, and even if I do a mix of mental health and physical health, if I spend 30 minutes with the patient, it will probably be billed as a 36.
 
‘If the patient says, “I am here for a mental health review and a blood pressure review and I want advice about X, Y, Z”, which [item] applies? And is it different if the person says “I am here for blood pressure review and X, Y, Z, but while I am here can I have a new referral to my psychologist?”.’
 
But Dr Johnson said this should not stop GPs reviewing a person’s mental health regularly and aim to do so at every presentation for a mental health-related prescription.  
 
‘[GPs] need to regularly be open to exploring non-pharmacological therapies for patients alongside, and sometimes instead of, medication use,’ she said.
 
‘It’s just the MBS item numbers are an incredibly poor proxy measure of what actually happens in the consultation.’
 
Currently, 38% of all GP consultations include a mental health component, the most common issue for practitioners for the sixth year in a row according to the RACGP’s Health of the Nation report.
 
Dr Andronis said the figures proved the need to update the ‘grossly outdated’ MBS.
 
‘The MBS was designed for relatively quick consultations … but we also know that high patient turnover is stressful for GPs,’ she said.
 
‘I’d encourage GPs presented with mental health related medication requests to spend more time, maybe even just five minutes, discussing deprescribing options and the importance of lifestyle changes.
 
‘An ounce of prevention is better than a pound of cure.’
 
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MBS Medicare Medicare Benefits Schedule mental health