#241 Little support for GP role in mental health care
18 November 2020
A proposal to scrap GP mental health treatment plans and replace them with an online assessment tool would undermine the holistic approach needed to care for patients with mental health concerns, AMA Federal President Dr Omar Khorshid said.
The proposal is among the recommendations of the Productivity Commission’s long-awaited Mental Health Inquiry Report, which calls for a $2.6 billion overhaul of the system, estimating the total cost of poor mental health and suicide to be as much as $70 billion per year.
Dr Khorshid said the report recognises the crucial role that GPs play in delivering frontline mental health care, but then delivers proposals that result in diminished support for this role.
“The AMA welcomes the report’s aspirations for a person-centred mental health care system, focusing on prevention and early help – both early in life and early in illness,” Dr Khorshid said. “But we cannot accept recommendations that take away support for GPs at a time when the burden of mental illness is growing.”
“The report highlights the fact that GPs are the first port of call for Australians seeking mental health support, with one in five Australians having a mental health consultation with their GP every year, and a satisfaction rate of more than 80 per cent. Yet it offers little in the way of extra support, other than the introduction of a Medicare item for GPs to get advice from a psychiatrist about a patient in their care. While this is sensible policy that recognises the expertise of psychiatrists and encourages collaboration, it falls short of the support GPs need.”
“The report also proposes abolishing Medicare-funded GP mental health treatment plans, which are fundamental to providing well-coordinated care and engaging with a patient about their care needs. Instead, patients would be assessed using an online tool. While the Commission sees this being used by GPs in collaboration with their patients, its recommendations also allow patients using this tool to bypass their GP altogether at a time when holistic care is so important.”
“The report should have placed much more emphasis on the patient-centred medical home as the ideal model for people seeking care for their mental health. Under this model, psychologists, mental health nurses and social workers can all be integrated into the patient’s health care as part of a well-coordinated and holistic model of GP led care.”
“As the report states, comorbid diseases are responsible for much of the average 10-15 year mortality gap between people with severe mental illness and the general population.”
“GPs form lifelong relationships with their patients, and building mental health into general practice will further enhance the role of GPs in early intervention. Promoting general practice as a safe, accessible and effective place to seek support for mental ill-health is critical to improving access to care for patients.”
“The AMA is pleased that the Commission has acknowledged workforce shortages that often make it difficult for patients to access specialist psychiatric care, and identified the need for a national plan to increase the number of psychiatrists in Australia, particularly in rural areas. The AMA acknowledges that low-intensity mental health services are under-utilised, and supports the development of resources to support GPs in promoting these services to patients where clinically appropriate. GPs should receive feedback from these services about their patient’s progress to ensure continuity of care.”
“With the mental health sector receiving less than half the funding of the comparable burden of disease funding, one thing is clear – any Government response to this report will need to be backed by much greater funding, otherwise patients will continue to struggle to access the vital care that they need.”
The report’s recommendations are extensive, and the AMA is reviewing them in detail.
- In 2018-19, at least five million people - or one in five Australians - had a mental health consultation with their GP.
- About one in eight GP consultations relates to a mental health problem, equating to about 20 million consultations per year.
- As well as being a key gateway to other mental health services, GPs are key providers of mental health. More people receive mental health treatment from their GP than from psychologists and psychiatrists combined.
- Four out of five people with mental illness report that the service they receive from their GP is excellent or very good.