Psychiatrists back GPs’ role in mental health care

Jolyon Attwooll

19/08/2022 5:03:53 PM

The President of RANZCP has expressed his appreciation of general practice’s work across ‘the entire spectrum’ of mental health care.

GP treating patient
The RANZCP President says psychiatrists rely on GPs 'significantly' both for patients with mild-to-moderate disorders, and for more serious mental health conditions.

‘We rely on GPs.’
So says Associate Professor Vinay Lakra, the President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), who this week spoke to his counterpart at the RACGP, Adjunct Professor Karen Price to offer his support to general practice.
It follows significant social media debate over the role of GPs in mental health care in recent weeks, in part prompted by a highly contested article in the MJA Insight+ journal which cited mental health plan review rates as indicated by MBS data.
Associate Professor Lakra told newsGP he believes it is more important than ever for different specialities to work together.
‘It’s become more and more prominent that we provide care in a multidisciplinary environment where multiple people are involved … because people don’t come with isolated problems,’ he said.
‘A lot of people with psychiatric problems have physical health issues. A lot of people with physical health issues have co-morbid psychiatric problems.
‘And we rely on GPs significantly to provide care and treatment not only for people with mild-to-moderate disorders, but also for people with serious disorders when they are transferred back to the GP or when the GP is involved with shared care.
‘Basically, for the entire spectrum.’
For Professor Price, the backing expressed by Associate Professor Lakra and the RANZCP, as well as other psychiatrists, is very welcome.
‘It was really good to get that affirmation,’ she told newsGP. ‘I’m very pleased.
‘We appreciate that we work together professionally [and] we understand a health system where we’re here on behalf of patients.’
The comments from the RANZCP and its president were not isolated, with other psychiatrists also offering words of public support.
One stated that the ‘silent majority’ of psychiatrists deeply appreciated GPs, calling them ‘both the backbone and best-value in care’, while another described the work of GPs as ‘priceless’.
Associate Professor Mat Coleman, the Chair of Rural and Remote Mental Health Practice at University of Western Australia, also joined the public backing of GPs, saying that psychiatrists had ‘woefully let down’ communities in the bush.
‘In rural and remote Australia there wouldn’t be mental health care without GPs,’ he said.
‘I can only speak for myself ... GPs, we need you more than ever for the mental health of our communities.’
RACGP Board member, NSW GP and practice owner Associate Professor Charlotte Hespe says she has received many messages of support and believes the role of the GP is as central as ever – particularly given the acute strains on access to specialist psychiatric help in many areas.
‘Our local mental health care team had no idea how much we helped them keep their heads above water because we manage so many complex patients who they didn’t need to see very much,’ Associate Professor Hespe told newsGP.
She also cites evidence used by the Lumos program in NSW, which is designed to shed light on how patients move through the health system in the state and ‘identify opportunities for improving … outcomes and experiences’.
One of the statistics their research highlights suggests that if a patient’s chronic mental health diagnosis goes unrecorded by a GP, that individual is 25% more likely to pay a visit to the emergency department within the following two years.
‘I remember learning very early on that with somebody who was quite traumatised and had significant and complex mental health stuff going on, if you made a regular appointment time you stopped them coming to us with an unplanned booking and an unplanned need,’ Associate Professor Hespe said.
‘And you kept them out of acute mental health care services because they knew they had somewhere to go, they had a defined amount of time to be able to talk about it in and they felt very safe.’
As advocated by the college, Associate Professor Hespe wants more emphasis placed on longer consultations to allow for better mental health care.
‘The complexity that gets missed is by the doctors who are churning through on five-minute medicine,’ she said.
‘What we need to do is placing a lot more value on 30-minute consultation than a five-minute consultation.’
While Associate Professor Hespe says new technology has a role to play in mental health care – citing MoodGYM as a ‘fantastic’ example – she believes it is always best when reinforced with regular GP input.
‘We can often do something in 10 minutes that is incredibly powerful and reinforcing and validating for that particular patient,’ she said.
According to Professor Price, the work of the good GP is often unseen.
‘Psychiatrists are likely to see the very pointy end of the iceberg, and we see the rest of the ice shelf,’ she said.
‘We work together, along with a lot of other community organisations, but GPs are still the diagnostic engine of the health system, and we are the care-coordinators extraordinaire.
‘Patients, even if they have a regular psychiatrist, will still be seeing their GP. If they have a regular psychologist, they’ll still be seeing their GP – and we work together in those partnerships.
‘There are also a lot of patients we see who never see anyone else.’
Associate Professor Lakra also reiterates the importance of collaboration and points to a diploma currently in development at the RANZCP that he hopes will help medical professionals, including GPs, upskill in delivering mental health care.
He also believes more discussion is needed around measuring the impact of treatments and care.
‘I don’t think it is about individuals, it’s about system-related issues,’ he said.
‘There was some commentary about measuring and monitoring outcomes. Unfortunately, many of our systems are not set up in a way where we can monitor outcomes for people.
‘The system needs to be set up in a way that we can measure and monitor outcomes and then that can help us understand what is happening.’
He remains sceptical, however, whether social media discourse is likely to help provide the solution.
‘Twitter is not necessarily a great platform to address a complicated issue,’ he said.

Clarification: This article was updated at 2.45 pm on Monday 22 August to remove a reference to Associate Professer Hespe being Chair of RACGP NSW&ACT. Associate Professor Hespe has stepped away from this position for the duration of the RACGP Presidential Election campaign.
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Dr Terence John Rose   20/08/2022 8:12:30 AM

Where does this idea of 5 minute and 10 minute consultations originate? It’s quite foreign to me. In 1975, when appointment time slots were every 10 minutes, I introduced 12.5 minute time slots and still couldn’t keep on time. These days, my average on a good day is lots of 17 minute item B’s. I undercharge item C’s just in case any social aspect of the consult could be interpreted as non-clinical. That’s more like 3+ patients per hour. Admittedly, I manage many baby boomers and a lot of those with the tears and fears, but when I look around the Practice at my fellow GP’s and the many many Trainees I’ve supervised over almost 5 decades, I don’t recall them doing much different to what I have done. I think most of us would say we’re just “average GP’s”. Or are we “modal GP’s” who are just too busy being clinicians to challenge the Panopticon tower when it claims to know what a GP is and does. Ten minute consults? - almost unattainable. Five minutes? - Nonsense.

Dr Henry Arthur Berenson   20/08/2022 11:39:47 AM

If psychiatrists really backed the role of GPs in mental health care they would either make themselves easily available to initiate ADHD meds to newly identified ADHD patients or transfer that power to GPs. ADHD is 6% of the community but a much higher incidence inside general practice.