News
Scrapping GP mental health plans a path to fragmented care, GPs say
Dr Cathy Andronis says psychological presentations need a holistic approach and that properly funding mental health care consultations would be much more effective than widescale reform.
Increasing numbers of people are seeking mental health care support, but GPs say referrals remain an essential part of the system.
As we enter a third year of the COVID-19 pandemic amid natural disasters and troubling global events, an increasing number of Australians are finding themselves in need of mental health support.
Now two peak bodies for psychologists – the Australian Association of Psychologists Inc (AAPi) and Australian Psychological Society (APS) – are calling for the Federal Department of Health to review the Better Access Scheme to allow people to self-refer themselves to a psychologist, and still access a Medicare rebate, without obtaining a mental health plan from their GP.
But Dr Cathy Andronis, Chair of RACGP Psychological Medicine, is concerned the move would significantly fragment care and, in some cases, even lead to further barriers.
‘This [would be] a major paradigm shift in how we operate in the Australian healthcare system,’ Dr Andronis told newsGP.
‘We’ve created a pretty sacrosanct system that’s reliable, predictable, secure and that people understand – and at the cornerstone of it is the GP.
‘As the primary contact, GPs can take a holistic biopsychosocial approach to coordinate care, help the patient navigate the system and advocate for the patient. So it would be unwise to go back to this very fragmented system, which is also a lot more expensive and completely unsupported.’
Under the current Federal Government scheme, people can receive up to 20 Medicare-rebated sessions with a psychologist per year. However, the patient is required to create a mental health plan with their GP prior to their initial appointment.
APS President Professor Tamara Cavenett told Nine Newspapers that the requirement is leading new patients who are offered last-minute appointments to delay care.
‘There’s a lot of people who additional red tape is potentially stopping from getting treatment or stopping them from getting treatment as early as they would otherwise,’ she said.
However, Dr Andronis says GPs are often very accessible for patients, and are better equipped as a first point of contact to manage mental health presentations in a ‘very timely and affordable way’.
The Melbourne GP says the prospect of separating psychological care from standard healthcare also carries the possibility of there being a bias.
‘Sometimes there are biological determinants for the distress, like poor diet or lack of exercise, or there are social issues,’ Dr Andronis said.
‘But when you fragment a system, you narrow the focus of the lens through which you view that problem, and so the answer will come out with what you often want it to be, rather than what it really is.
‘Medicine is about viewing things from every angle – biological, social, and psychological – and being able to assess the best way to help somebody really to help themselves. And that’s what GPs excel at; having a wide-angle lens and the capacity to take their time and to review things holistically.
‘So there’s a huge place for the generalist. In fact, it’s essential.’
RACGP President Dr Karen Price agrees. She told Nine Newspapers that many patients who present with mental health issues, also have chronic health conditions that require a holistic approach.
‘We do whole-of-person care,’ Dr Price said.
‘[And] patients can already access psychologists without a referral [and claim it] on their private health insurance.’
In addition to scrapping GP referrals, the AAPi is advocating for the number of Medicare-funded sessions to be doubled from 20 to 40 per year, alongside an increase in the rebate to $150 per visit.
Further to that, both the AAPi and APS are calling for the requirement that patients have their mental health plan renewed after the sixth session be removed.
Dr Andronis, however, says the review process is ‘essential’.
‘When the GP reviews in the case of a mental health issue, it’s about working out if the person is on track – is this the right [therapist]? Is this the right treatment modality?’ she said.
‘The assumption that it is, is not always correct.
‘I see it quite frequently in psychological medicine where people have seen the psychologist and it’s not until the review that it becomes obvious that either they haven’t actually engaged very well or they’ve stopped seeing them.
‘Or they go out of a sense of duty or wanting to please the psychologist, but aren’t actually improving.’
In response to the pressing need for access to mental health care, the RACGP is instead calling for the current system to be better funded, with
higher Medicare rebates for longer GP consultations to ensure doctors can respond to their patients’ needs.
Dr Andronis believes the core problem goes back to the ‘gradual and severe underfunding’ of mental health, and the deskilling of GPs. But says recent Government initiatives over the past two years to educate GPs are a step in the right direction.
‘GPs are affordable and accessible, and more likely to bulk bill than most psychologists, certainly in urban areas or areas when there’s high demand,’ Dr Andronis said.
‘And most of the problems we see in general practice have a mental health basis and we actually manage them.
‘So GPs need to start recognising that they can do this work, they are doing this work, and most of the time they’re doing it well enough, and they can learn to do it even better, rather than letting our system fragment and our sense of ourselves as GPs be dictated by other people’s assessments of how we do our work.’
Rather than being focused on person-centred care, Dr Andronis believes the peak bodies are instead ‘taking advantage’ of stress in the community in the lead up the Federal Election.
‘It seems to me that people are taking opportunities really to protect their small territory and to become very narrow focused in their work,’ she said.
‘It’s a reality of the political system; we’re closer to an election and, unfortunately, we live in a very competitive system, and it makes people fearful, and the more fearful people will become the more competitive and protective of their turf.
‘But really, why are we fragmenting a system we know works?’
Log in below to join the conversation.
fragmented care holistic care mental health care psychology
newsGP weekly poll
What is your chief concern with role substitution?