RACGP submission outlines framework to assist child mental health care

Morgan Liotta

24/02/2021 4:35:20 PM

The college recommendations make it clear that not involving GPs in children’s wellbeing would be a potential missed opportunity.

GP consultation with a child.
The RACGP is calling for child mental health services and systems to be more closely integrated with general practice.

The framework formed part of a college submission to the National Mental Health Commission (the Commission), signed by RACGP President Dr Karen Price.
It contains six key recommendations on the Commission’s National Children’s Mental Health and Wellbeing Draft Strategy (the Strategy), including insights related to the role of general practice, parenting practices, and integrated cares models.
‘GPs are generally the first point of contact for families, providing care through all stages of life,’ Dr Price wrote.

‘This holistic, patient-centred and relationship-based approach places GPs in an excellent position to connect with children and their families.
‘The GP role is also often central to supporting young people with a safe environment outside of their family.’
The RACGP’s response builds on its previous submission for the need to support mental health care in general practice – with the most recent response specifically calling for child mental health services and systems to be closely integrated with general practice.
‘If the GP is not involved with children’s wellbeing, there is a missed opportunity for early intervention and effective management and care coordination,’ Dr Price wrote.
Observing the Strategy’s acknowledgement that ‘the foundations for lifelong mental health and wellbeing are built during childhood’, the college positions general practice as central to providing holistic care for children and helping to ensure a seamless transition from childhood to adulthood.
Dr James Best, Chair of the RACGP Specific Interests Child and Young People’s Health network, highlighted key strengths of the Strategy.
‘It is really trying to focus on what is out there already, rather than reinventing the wheel,’ he told newsGP.
‘Another strength is the language the Strategy uses around functionality when talking about “healthy coping”, “struggling and unwell”, rather than using medicalisation or a diagnostic approach.’
Development of the Strategy began in 2019 as part of the Government’s Long-Term National Health Plan. It covers the 0–12 age group and contains a range of recommendations and actions for individuals and organisations who engage with this age group.
According to the RACGP submission, the Strategy outlines the requirements for an effective system of care for children, and backs the recommendations for a shared understanding of the roles of families, communities, services, and educators in promoting and supporting child mental health and wellbeing.
However, while the college is largely supportive of the Strategy’s proposed integrated models of child and family care, it has also called for different providers of government-funded child mental health services to be integrated within the broader health system.
‘While co-location of services can improve collaboration, this can be challenging to maintain and monitor. There has to be a minimum standard for the type and number of service providers,’ Dr Price wrote.
‘The integration of this model with other existing services in the locations chosen needs to be carefully considered.’

The submission also contains other actions for new models of care to consider, including that:

  • GPs should be included in coordinated care for children with disability or a chronic health condition who may have additional health needs, as they have the appropriate skills and knowledge to help facilitate care and communication across sectors
  • GPs have discretion over whether a child needs to be in attendance for them to complete a mental health plan, as it can depend on each family’s circumstances and whether the GP has previously seen the child
  • alternate models of care include support to enable and encourage GPs to diagnose common child mental health presentations, such as autism spectrum disorder or attention deficit/hyperactivity disorder, to relieve pressure on specialist diagnostic services and improve access to support.
The submission also advocates for longer GP consults for mental health presentations – a reform the college has long endorsed.
Chair of the RACGP Specific Interests Child and Young People’s Health network, Dr James Best says children’s mental health issues are becoming more central to their general health. 
Dr Price wrote that the mental health workforce needs to be strengthened by embedding specialist mental health professionals in general practice to help primary care develop greater skills and capacity in this area.
‘To support and enable GPs to deliver the best care possible, they need to be afforded more time with patients,’ she wrote in the submission.
‘Medical Benefits Schedule [MBS] reforms, including an appropriately remunerated item number for longer consultation time, is needed.’
The RACGP also backs a recommendation highlighting the importance of tailored parenting programs, and believes they should be offered to all parents and/or carers. The submission states that these programs should be easily accessible with limited barriers such as cost, and be incorporated into antenatal and perinatal programs.
‘Sustainability of these programs is imperative as parenting needs reinforcement and adaptation to the changing needs of the child and the family,’ Dr Price wrote. ‘GP referral pathways need to be clear and supported by relevant education.’
The Strategy’s objectives to improve data collection for children’s mental health for informing decision making through policy and funding and long-term monitoring is also supported by the RACGP.
However, measuring whether or not children enter care, participate in the education system, and/or are prescribed psychotropic medications should be considered additional indicators of progress, according to the college.
As part of a broader recommendation to improve the mental health and wellbeing for all Australian children, social prescribing should be considered, said Dr Price.
‘Social prescribing can provide a valuable addition to the existing range of healthcare options in Australia,’ the submission states.
‘It can address key risk factors for poor health – including social isolation, unstable housing, multimorbidity and mental health problems – which are often associated with low engagement in preventive activities and low levels of self-management for medical conditions.’
The RACGP also supports the provision of further support and training to kinship carers for Aboriginal and Torres Strait Islander communities, and MBS-subsidised telehealth consultations for all areas, particularly for rural and remote communities.
‘While it is important for GPs to have face-to-face consultations with children, telehealth services should also be available to both children and their families who have difficulty accessing face-to-face services, regardless of where they live,’ Dr Price wrote.
The Strategy, which will be published later this year after all feedback has been received and considered, effectively identifies and looks to address key challenges, while helping to de-stigmatise mental illness, according to Dr Price.
‘Importantly,’ she wrote. ‘It seeks to support and build on existing services, particularly in primary care and community settings.’

Dr Best agrees.
‘It’s great to see an increased focus on children’s mental health issues, which are becoming more central to children’s health in general, in particular due to COVID times,’ he said.
‘The Strategy reflects that our intervention really needs to comes down to a community and family level, and general practice is very much involved in that, which the college is pleased to see.’
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