RACGP wary of calls to scrap mental health treatment plans

Anastasia Tsirtsakis

18/11/2020 5:14:58 PM

Acting President Associate Professor Ayman Shenouda has warned a proposal to replace the treatment plans with an online assessment tool is ‘lacking clarity’.

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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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Dr Marshall Francis Antony Donnelly   19/11/2020 6:37:26 AM

Please Australia ,
Having returned to NZ where no such system exists and we have a significantly higher suicide rate and poorer mental health outcomes The treatment plans were invaluable in assisting patients access good Clinical Paycholigy ,the system isn’t broken it meeely needs to be accessed better !

Dr Andrew Carr   19/11/2020 8:33:23 AM

I don’t think MHCPs are effective. They just present an administrative barrier to therapeutic time I could be spending with the patient. I think we should be looking generally at intermediate care models, so that at least when a patient arrives at a GP who, shall we say, prefers other areas of medicine over mental health, they could be redirected to someone who can help them, rather than reach for the script pad.

Dr Elysia Thornton-Benko   19/11/2020 8:34:52 AM

Where is the evidence that GPs aren’t “socially prescribing”? Where is the evidence that GPs aren’t discussing the full breadth of potential management and possible side effects? Maybe the focus should be more on funding and access (as mentioned in the article), rather than more burden to GPs whose professional skill set is holistic patient/centred care.

Dr Francisco Rodriguez-Letters   19/11/2020 8:39:03 AM

Great article, but please don't call patients 'consumers'. They're not customers, nor clients (a term I can't stand, this being used mostly by sex workers and lawyers), and certainly not consumers...but patients.

Dr Peter JD Spafford   19/11/2020 10:29:50 AM

Mental Health Care Plans, much like other EPC items, are paperwork and no evidence to show any benefit to the patient. It is all about the rebate, not about the service provided. All should be done away with and for us not to rely on Government to fund General Practice through Medicare. Providing high quality care does not rely on these items, nor should it. SIPS through Cycle of Care or some quality driven outcomes for incentive payments may be a way. But do not link it to patient rebate. That is illogical. Patients should expect quality anyway, and a "Plan" of any sort does not ensure or enable that. If a practitioner provides quality that can be measured, and that can be rewarded, then I am all for it. Patient Rebate is not funding for General Practice.

Dr Alan John Hodgson   19/11/2020 10:55:14 AM

While there are a lot of great GP's who do excellent mental health management, there are many more who don't use the better remunerated longer care item numbers appropriately. We should support efforts to help those who use such item numbers as an income source rather than a patient resource. A more clearly set out plan, that better guides a practitioner through the gathering of the necessary information to write a good mental health plan should be welcomed. It is not a criticism of GP's who do excellent plans, but a guide for those who struggle. Why is it that around 50% of suicides have not sought medical help? Could it be that some GP's are not proficient in taking a helpful mental health history? I am probably writing this to the converted. Those who need to write better plans probably don't read this publication.

Dr Shakeel Kacmarsky   19/11/2020 12:17:27 PM

"no evidence that consumers are benefiting" from MHCPs.. pray tell how on earth did they measure that ? This sounds like the usual right wing health economics excuse to cut services and rebates. You guys in Oz dont know how lucky you are to have MHCPs ..they are an essential gateway to psychological services that most couldn't afford otherwise. In the UK , we have nothing like this.. just online nonsense and MH services are utterly appalling. Almost anyone with psych upset needs f2f contact with a caring , helpful therapist-including their GP. Do NOT let this pass. Your RACGP leaders need to take no crap . I worry that with the passing of your last President who was brilliant, you will be saddled with mealy mouthed polite medical careerists who will be steamrollered over whilst ringing their hands with learned helplessness and singing "We Shall Overcome" ..

Dr Toni Christine Law   19/11/2020 7:19:32 PM

I am unsure what their understanding is of what we, as GP's, do.
Today in practice, I discussed with one patient for over 30 minutes her history of domestic violence and its impact. This did not entail an MHP but did very much entail discussion re social prescribing, encouragement to increase exercise and considering meditation or prayer as a tool she could consider to assist her in managing her mental health.
Another patient discussed her anxiety and we discussed options for how to improve her handling of life circumstances and family relationships and encouragement for setting boundaries and reducing her current overcommitments.
Earlier this week, I have completed about 5 Mental health plans for patients which have also included disc re exercise, social prescribing, sleep, diet etc. This is every day in GOOD general practice by many of us. No medication, very often, wholistic approach. Not saving lives? Says who?