‘We’ve created a system that is crisis-driven’

Fragmented services.
 
Long wait times.
 
Inadequate training and funding.
 
These are just some of the barriers identified by 143 clinicians – including GPs – that are preventing vulnerable children and adolescents from accessing high-quality mental health care in Australia.
 
The study, led by the Murdoch Children’s Research Institute, also found that a shortage of psychiatrists and psychologists, particularly for children under 12 years, has led to clinician burnout, particularly in regional areas.
 
Study co-author and consultant paediatrician, Professor Harriet Hiscock told newsGP she was not surprised by the findings.
 
‘It confirmed a lot of what we knew about the fact that there is such fragmentation in the healthcare system for children,’ she said
 
‘There are not enough services and the clinicians themselves feel that they’re not trained, or supported to manage the moderate mental health problems in the system.
 
‘GPs really need help in diagnosing children; is it a problem that is part of normal development, or is it something we need to take more seriously that needs help and support now?
 
‘The second thing is certainly trying to navigate the mental health system and services for families, because it’s really confusing as to where to start.’
 
In addition to better training and clearer referral pathways, study participants also called for improved access to child psychiatrists, co-located support services, and Medicare funding changes.
 
Almost one in seven (13.9%) Australian children aged 4–17 years has a mental health problem, and there is concern that number may rise as a consequence of pandemic-related stressors for families.
 
And while half of mental health conditions present before 14 years of age, clinicians reported that service access is often restricted by the condition’s severity and complexity, with age ranges for specific services.
 
Dr Cathy Andronis, Chair of the RACGP Specific Interests Psychological Medicine network and Mental Health Australia board member, says the findings align with her own experiences.
 
She believes the continued lack of funding into general practice, and in turn preventive health, has resulted in a system that is ‘crisis driven’.
 
‘Child and adolescent mental health public services tend to be very booked and oversubscribed, with many of the inpatient units here in Melbourne having a two-three-four month wait,’ Dr Andronis told newsGP.
‘A lot of patients and their families are brought to the point of crisis before they will access the system, because it’s very difficult to start accessing things earlier. But we shouldn't have to, as a community, get to that stage before we can start to offer kids support and help.’
 
Dr Andronis says GPs should be supported to have more time with patients.
 
‘[We need] to talk to parents about how their family is functioning, about how their children are going, and encourage them to bring their children in for consultations, even if it’s for minor consultations and check-ups,’ she said.
 
‘For instance, if they’re coming in for a vaccine, rather than quickly just doing the vaccine, we can ask them “How are you going? How’s the family going?” and have a small conversation where we can start to notice if there is anything underlying that could be picked up early.
 
‘If you haven’t got time to do it then and there, then be brave enough to schedule another time.’
 
In its 2021–22 pre-budget submission, the RACGP has called on the Federal Government to introduce an unrestricted MBS item number to allow patients to spend more than 40 minutes with their GP discussing their mental health, which Dr Andronis strongly supports.
 
‘That would send a strong signal to patients that there is help for mental health issues, and that it can occur in general practice,’ she said.
 
‘But it has to be recognised that it takes time to do this work well, and time spent doing things well early saves a lot of time, cost and effort later.
 
‘It also empowers GPs to think it’s okay if I spend more time with somebody because I can afford to do it and it’s not going to make my practice unviable.’

Professor Hiscock believes the current funding through Medicare is inadequate, and does not provide support for a shared care model.
 
‘We know GPs can do training for adult mental health and bill Medicare more, so we need to think about a similar structure for children’s mental health,’ she said.
 
‘But I also think we need item numbers so that GPs and paediatricians can consult together, as well as GPs and psychiatrists, and GPs and psychologists.
 
‘There was a real willingness [among clinicians in the study] to really work together, recognising that different clinicians have different skill sets, and that together we could learn from each other and support each other in a much better way.’
 
Meanwhile, the RACGP has been working closely with Emerging Minds to develop a series of CPD-accredited resources and webinars around child mental health.
 
‘I propose GPs really get on board with that,’ Dr Andronis said.
 
‘We shouldn’t put our hands up and think this is all too hard. Actually, what we need is to slow down and think “What do we already do well?”
 
‘We’re good at having engaging conversations and we’re good at preventive care. What if we start to apply that to families and to children, and supplement that with extra information, extra knowledge, and extra information?
 
‘GPs are experts in patient-centred and individualised care so we are in a unique position to advocate for patients and to coordinate multidisciplinary care, and GPs need to stay central to the process.’
 
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