Australia’s ‘disempowering’ dependence on mental health medication

Michelle Wisbey

10/11/2023 2:43:42 PM

New data has revealed more prescriptions are being filled than ever before, but there are fears many patients are skipping follow-up care.

Person holding two pills in their hand.
Tasmania has the highest proportion of mental health-related prescriptions, followed by the Australian Capital Territory and New South Wales.

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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Dr RMA   11/11/2023 9:01:52 AM

Co-billing a 23 with a 2713 is discouraged
GPs do a lion share of managing MH in the community and are a much cheaper alternative for many patients than formal psychologists
The billing data is not reflective of work in GP clinics as co-billing is on the decline and time only billing is more common
Also stressors from covid and now cost of living are still severe

A.Prof Christopher David Hogan   11/11/2023 10:38:44 AM

Ah, lies, damn lies & statistics.
The Medicare item numbers aren’t used because their billing is too complicated & clumsy; because General Practice is complex & because patients like their privacy.
An extrapolation from dodgy figures is worthless- next patient please.

Dr Suzette Julie Finch   11/11/2023 1:21:58 PM

With respect, this article misses GP-administered mental health care & re-direction to eMH. I have found MOST of my patients prefer to attend appointments for repeat mental health non-medical assistance, including lifestyle modification (with frequent review of a mini SMART style plan), exercise, non-medical > medical management of insomnia, diet advice, relaxation & mindfulness, maladaptive coping strategies (usually AOD & eating problems), interpersonal relationship advise including active socialisation, crisis care & just simple valuing & human connection by engaged listening. NONE of this will be billed as Mental Health billing if over 40 minutes (always) unless I can separate a specific physical condition & charge a 36 & 2713, otherwise the (inappropriately low for effort) billing is the 44 or new 123. Many patients stop seeing their Psychologist as they feel they are making more progress with my nuts & bolts approach over crouch sitting. BUT it can't be measured by Item #s.

Dr Karl Heinrich Van Wyk   12/11/2023 8:03:25 PM

I would love my patients to access psychology. Even when they do the wait time is long. Then faced with the gap payment of around $80-100 when a MHCP in place. It is not over prescribing but under funding surely that prevent access to care.