Mental health decline creating ‘moral distress for GPs’

More than 20% of Australians delayed or did not see any mental health professional due to cost last year – almost double the rate just four years ago.
 
That is according to an alarming new report from the National Mental Health Commission, which aims to ‘take the pulse of Australia’s mental health system’ by measuring its successes and shortfalls.
 
Released on Thursday, the 2024 National Report Card reveals that mental health treatment rates are falling well below current targets, exacerbated by a spiralling cost-of-living crisis.
 
‘Financially stressed people are cutting corners everywhere to survive so it’s no surprise that they avoid or reduce GP visits,’ said Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine.
 
‘Government freezes and inadequate Medicare Benefits Schedule rebates have severely limited GP capacity to bulk bill vulnerable patients, and this creates moral distress for GPs at times.
 
‘And when we over-function to compensate for a fragmented and broken system, we risk burnout and the associated loss of efficacy, exhaustion and stress.’
 
The report card reveals GPs continue to be the predominant providers of mental health care in Australia, with patient rates highest for GPs by a significant margin when compared to other healthcare professions.
 
It found almost 40% of Australians aged 16–24 now has a mental health disorder, and 45.1% of people with a 12-month mental disorder see a health professional for their mental health.
 
Signs of financial stress have also spiked significantly – up from 17.1% in 2020 to 34.6% in 2024, with women consistently reporting more financial stress compared to men.
 
In 2023–24, 10% of people in Australia received Medicare-subsidised mental health-specific services – an increase of 14.8% since 2014–15 and equivalent to 467 services per 1000 population.
 
The analysis found that last year, the majority (84%) of all mental health-related prescriptions dispensed were issued by GPs, with antidepressants the most dispensed medication.
 
Dr Andronis told newsGP this ‘vicious cycle’ presents as a common undercurrent in mental health conditions GPs see in their practice. 
 
‘It is not only the spiralling costs of goods and services, but the sense that people are feeling out of control and losing the autonomy to make important decisions about how they want or need to live,’ she said.
 
‘Because so much of modern life is based on a capacity to pay, people’s choices have become limited, and this causes people to feel hopeless and helpless, key features of mental distress.
 
‘Social isolation results because people are too busy – their capacity to reach out and give and receive support and comfort from others can seem overwhelming when exhausted.’
 
However, the report said there are knowledge gaps when it comes to measuring continuity of care, with the data currently available focused on those receiving care from public hospitals.
 
‘We know people access mental health care in a range of settings outside of public hospitals, including GPs and private practices,’ the report said.
 
‘As such, overall, we know relatively little about the extent to which the system as a whole provides uninterrupted care across programs and providers.’
 
Commission CEO David McGrath said it is vital that funding for mental health support and treatment meets the needs of the community.
 
He said greater integration among health services and other services, such as housing and financial supports, is now needed.
 
‘Ultimately, everyone deserves fair access to the right mental health care, no matter where they live or how complex the system may be,’ Mr McGrath said.

‘The Commission has an important monitoring and reporting role. The report card calls out issues for governments to pay attention to, and that’s the value of this report.’
 
For GPs, Dr Andronis said doctors need to discuss the social determinants of mental health as standard practice during consultations as a ‘destigmatising strategy’.
 
‘Patients frequently blame themselves for problems out of their control and we need to counter these false assumptions,’ she said.
 
‘Often the truth can set people free.’
 
Moving forward, the Commission said it will continue to build on the report card with key stakeholders and the sector.
 
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