General practitioners should have access to training to provide patients with more advanced mental health care in response to the critical shortage of psychiatrists, the peak body for GPs has recommended.
The Royal Australian College of General Practitioners (RACGP) has called for a comprehensive government restructure of Medicare to address the mental health “national emergency”.
RACGP president, Dr Karen Price, said given some patients were unable to get an appointment with a psychiatrist, with one in three psychologists closing their books to new patients, GPs needed to be given the time to develop the skills, as well as the Medicare subsidies, required to treat them.
In order to address shortages of obstetricians, particularly in rural and remote areas, general practitioners can undertake extra training to provide some of the less-specialised aspects of obstetric care. Price said a similar model was needed for psychiatry so that GPs could do extra training and provide more advanced mental health care.
“The reality is that general practice is the most accessible service for many people who require mental health care,” Price said.
“In some areas outside of major cities, GPs are the only option.”
According to the National Rural Health Alliance, there are 2.2 times as many psychiatrists per 100,000 people employed in major cities as there are in remote areas, and 5.3 times more than in very remote areas. There are 4.1 times as many psychologists and 2.6 times more mental health nurses employed in major cities than in very remote areas.
“This is a national emergency, plain and simple,” Price said.
Price said the federal government needed to make longer telephone consultations with GPs a permanent fixture of Telehealth. As part of the pandemic response, the federal health minister, Greg Hunt, announced in January that rebates for longer telephone consultations for GPs would be extended until 30 June.
“That isn’t good enough – we need to make this permanent,” Price said.
“The way Medicare is structured must change. The current model discourages GPs from treating more than one condition in the same consultation and from conducting longer consultations. Many patients will need time to talk through their mental health issues, it’s not as simple as stitching up a split lip.”
The RACGP is also calling for a new “service incentive payment” for GPs who provide early identification and ongoing management of mental health conditions such as depression and anxiety.
Service incentive payments are payments made by the government directly to individual GPs if they provide specific services such as after-hours care or care in aged care facilities. For example, eligible GPs can get four payments totalling $10,000 for the financial year, in addition to their consultation fee, for providing a certain number of Medicare-subsidised services in registered aged care facilities.
Price said GPs should get similar payments for providing mental health treatment plans, which would include at least one review and a physical health assessment.
“General practice does huge amounts of mental health including psychosis identification, early interventions, as well as maintaining mental health for people with schizophrenia and with bipolar disorder,” she said. “A lot of these patients don’t spend a lot of time in hospital, but do spend a lot of time with their GP. We know many people with very severe mental health issues also have chronic health conditions which need to be addressed and GPs also help manage that as well.”
The government is undertaking an evaluation of the mental health plan referral system, known as the ‘Better Access’ program, as recommended by the Productivity Commission inquiry into mental health. This is due for completion later in 2022.
A spokeswoman for health minister Greg Hunt said a record $2.3bn was allocated in the 2021-22 budget for the national mental health and suicide prevention plan to reform the mental health system.
“The mental health workforce, including GPs, are a key component of Australia’s mental health system and we are committed to expanding, strengthening and upskilling the mental health workforce to deliver accessible and effective services to those who need them,” she said. “We are also developing a national mental health workforce strategy which will provide insights on how to attract, train and retain the workforce required to meet the current and future demands of the mental health system.
“Our government has also doubled services provided under the Better Access program from 10 to 20, which gives Medicare rebates to help people access mental health professionals and care.”
President of the Royal Australian and New Zealand College of Psychiatrists Association, Prof Vinay Lakra, said in the last budget the federal government had provided funding for a diploma for doctors wanting to upskill in psychiatry. This program was in the early stages of development, he said.
Lakra said he supports the proposals put forward by the RACGP.
“Lots of GPs are keen to provide this mental health care, and the reality is many patients can’t afford a psychiatrist.”
But Australian Psychological Society (APS) president Dr Zena Burgess said the APS wanted to see the GP referral red tape removed for patients “first and foremost” before any other reforms.
“Allowing a patient to see a psychologist for up to three sessions under a mental health care plan, without referral from a GP, would get patients to psychologists sooner and ease pressure on our GPs,” she said.
“We’d like to see the regional relocation incentives given to GPs replicated for psychologists, to help us attract more psychologists to rural, regional and remote Australia where we know patients are crying out for help.”
She added that a federal investment of just $5m would create more than 3,500 supervisors and 6,000 additional placement psychologists within two years.
“The federal government is only meeting 35% of its psychology workforce target… the largest shortfall of all mental health professions. We need more support to bolster this workforce, too.”
