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RACGP wary of calls to scrap mental health treatment plans
Acting President Associate Professor Ayman Shenouda has warned a proposal to replace the treatment plans with an online assessment tool is ‘lacking clarity’.
The RACGP has cautiously welcomed the Productivity Commission’s Mental Health Inquiry report, but says any changes must reflect the level of work involved.
The Commission’s three-volume report, released on Monday, has called for a $2.6 billion overhaul of Australia’s mental healthcare system that could see GP mental health treatment plans replaced with a digital mental health platform.
According to the report, the free online tool would help GPs to conduct assessments and patient referrals by offering suggestions about the types of services likely to best meet needs and preferences.
‘The platform would also include some low-cost, accessible and evidence-based low-intensity digital services … and provide an entry point to other clinical treatment and non-clinical support services, delivered digitally or face-to-face,’ the report states.
While the Commission has assured the tool is not designed to override clinical expertise or patient preference, it would provide GPs with feedback on how closely their treatment and referral practices align with the platform’s recommendations.
RACGP Acting President Associate Professor Ayman Shenouda welcomed the report’s aspirations for what is ‘a historically underfunded but critical area for the health of our nation’, but warned the proposal lacks clarity.
‘Mental health treatment plans provide a structured way for GPs to help their patients with mental health concerns, including early intervention, accurately assessing and managing their condition,’ he said.
‘The process also helps guide GPs to engage their patient in conversation, so they can discuss what they are experiencing and their concerns.’
The report notes that at least five million people see their GP for their mental concerns in any given year, and the vast majority are pleased with the care they receive.
However, the Commission claims it found ‘no evidence’ that consumers are benefitting from the mental health treatment plans.
By automating the assessment process, it is suggested GPs would have more time to help patients understand the outcome of the assessment and support them to choose among treatment options, including low-intensity options where suitable.
‘Currently, too many people who go to their GP for help with their mental health are being prescribed medication, or referred to a psychological therapist, without being given the opportunity to consider the full range of treatment and support options for their condition,’ the report states.
If the proposal goes ahead, Associate Professor Shenouda said GP input would be essential, as failure to design and implement any changes properly could risk ‘undermining the vital role of GPs’.
‘While we of course welcome efforts to improve mental healthcare systems, it is absolutely essential this is done in close consultation with GP representative bodies, such as the RACGP, as well as health consumers,’ he said.
‘Any change to GP mental health treatment plans needs to be usable for both GPs and patients.’
Associate Professor Shenouda said any changes would also have to appropriately reflect the level of work involved.
‘Like many mental health care systems and services, [mental health treatment plans have] suffered from lack of funding,’ he said. ‘Any review of the mental health treatment plans process must address the chronic underfunding.’
To address access issues, the report is calling for Medicare Benefits Schedule (MBS) telehealth item numbers, introduced during the COVID-19 pandemic for psychology services – including those delivered by GPs – to be made permanent.
The Commission did take note of the RACGP’s submission request for a psychiatric advice service for GP support. The report recommends immediate consideration for a new MBS item number for GPs and paediatricians to consult a psychiatrist via phone for further guidance.
Calls for GP rebates for use of the service, however, were denied.
Meanwhile, despite 90% of GPs having completed level one mental health skills training, the Commission has recommended improved training on medications and non-pharmacological interventions, and that the Federal Government promote and fund further trials of social prescribing ‘as alternatives to other clinical interventions’.
Where medical treatment is appropriate, it is suggested prescriptions should include a prominent statement indicating the clinician has discussed possible side effects and evidence-based alternatives to medication, where available, prior to prescribing.
The report estimates the total cost of poor mental health and suicide at as much as $70 billion a year.
With the majority of mental health care already delivered in general practice, and GPs preparing to manage the long-term impacts of the pandemic and summer bushfires, the RACGP has called on the Federal Government to better support the sector.
This includes investment in new Medicare subsidies for longer consultations so GPs can spend more time with their patients to discuss what they’re experiencing and help that is available.
‘The answer to this problem is right in front of us,’ Associate Professor Shenouda said.
‘Funding reforms must address the underfunding of mental health care in general practice, which is still poorly remunerated compared to physical care from a GP.
‘The report validates the unique role GPs play in mental healthcare, recognising the need for a whole-of-person approach to care, addressing mental and physical health in a holistic way, which is what a GP does.’
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