Award-winning study puts GPs in the mental health spotlight

As a young GP, Professor Jane Gunn became aware that the GPs’ role in mental health care support was somewhat undefined.
 
‘I noticed that for most young people I saw, there was not a clear physical-only problem, or a clear mental health-only problem – there were a lot of mixed symptoms,’ she told newsGP.
 
‘From [a] GP’s perspective we’d say, “We’ve done this forever, this is our bread and butter, we’ve seen so many of these problems, and we’d really love to have better options for supporting our patients and to be able to do that more effectively”.’
 
Around the late 1990s, findings from one of the first national mental health and wellbeing surveys showed that GPs were people’s first port of call. Professor Gunn said this came as a bit of a surprise at the time – to nationally recognise that the GP was so important to mental health care.
 
‘I was looking around for why I was hearing these competing stories,’ Professor Gunn said.
 
‘Why weren’t people understanding what GPs did? Why were GPs feeling that mental health care was a major component of what they did? And what did we know about what actually happens with depression in primary care?’
 
So Professor Gunn, who is now Chair of Primary Care Research and the Department of General Practice at the University of Melbourne, decided to explore this misconception further, which became the driver for her project, the Diamond Cohort Study, collating 10 years of data collected from 789 patients. 
 
In January 2021, her study was named one of the National Health and Medical Research Council’s (NHMRC) ‘10 of the best’ projects currently underway in Australia.
 
Established in 2005 to explore the course and management of depression in the primary care setting, the Diamond Cohort Study identified that most treatment and management of common mental health disorders occurs in general practice.
 
‘That spawned an enormous amount of research, which led us on to developing different ways of doing things, intervention research, and developing processes and tools to help GPs to undertake that very important work more effectively,’ Professor Gunn said.
 
Data from the study was used to develop an intervention tool, Target D, of which trial findings were recently published in the British Journal of General Practice.
 
Target D is an app accessed via a tablet in the general practice waiting room. Embedded in the app is the Diamond Clinical Prediction Tool for depression, developed from the cohort study.
 
‘This app can be used in the general practice setting to quickly triage patients into three groups: those at a high risk of experiencing persistent and disabling depression; those at a moderate risk; and those at a low risk,’ Professor Gunn explained.
 
‘It also includes a way of engaging a person in their care, by assessing their motivation, confidence, and engaging them with treatment options.’
 
As well as offering a patient-centred approach administered within the general practice setting, the tool helps patients to prioritise needs by emailing the findings back to them with simple advice, then linking them back to their GP.
 
Professor Gunn highlighted the importance of identifying the strengths of caring for these patients in general practice, and when to link them with other specialist services.
 
‘I’m keen to develop models of care where [the patient] can actually access the things they need, but not get lost in the system, and have the general practice setting as the coordinating hub for going out and getting access to things,’ she said.
 
‘It’s a very holistic approach and it puts the patient at the centre.
 
‘It recognises the role and expertise that GPs have in mental health care, but it also acknowledges that in order to do that well, we can do that even better if we get support from primary care nurses, the allied health sector, psychologists, etcetera.’
 
Part of that approach is implementing a multidisciplinary model in the mental health care space, which is what was used for the Diamond Cohort Study.
 
‘We have a very large research team and we had a very holistic approach in the study and recognising the important role that everyone plays – it was a very multidisciplinary team with specialist psychiatrists, psychologists, GPs, [and] people with lived experience,’ Professor Gunn said.
 
‘That is a key ingredient for us to get depression care right.’


Most treatment and management of common mental health disorders occurs in general practice. 

One of the biggest challenges, according to Professor Gunn, is identifying early intervention approaches for people at risk of, or already experiencing depression.
 
‘It’s very difficult, because for many patients in general practice, by the time we’re engaging with them they may have years of suffering, it is a complex diagnosis,’ she said.
 
‘And how do we then go and put interventions in place that reduce the likelihood of them becoming depressed – so earlier in their illness trajectory. This is a shift in mindset of how we might approach prevention.’
 
Professor Gunn said that although such interventions might work in the research setting, they don’t necessarily translate financially to healthcare systems. As such, another key focus of her research is how to establish a cost-effective model that allows collaborative care for people who have disabling complex depression.
 
With the rise in mental health issues in Australia following the pandemic, and GPs seeing an increase in such presentations, Professor Gunn believes her research can help.
 
‘We will see more mental health issues … and the approach is to focus on those people who are more likely to have ongoing problems,’ she said. ‘The work we have done could be potentially used in that setting, and hopefully it’s a useful approach.’
 
But Professor Gunn says there is no silver bullet.
 
‘I don’t think we’re going to see massive blockbuster change, we’re likely going to see incremental change in improving the way we manage these problems,’ she said.
 
‘It’s important we keep trying to optimise and improve. Even though they might only be slight improvements, if we keep that process going so that over time, we see big improvements.
 
‘So not to give up, but focus on how we can tweak different ways of doing things and what we can focus on, have support to do our research, so we know that we’re moving in the right direction.’
 
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