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Removing mental health from GPs sets the stage for fragmented care, say GPs

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Dr. Cathy Andronis says psychological presentations require a holistic approach and that adequately funding mental health care consultations would be far more effective than large-scale reform.

Growing numbers of people are seeking mental health care support, but GPs say referrals remain a vital part of the system.


As we enter a third year of the COVID-19 pandemic amid natural disasters and troubling global events, growing numbers of Australians are in need of mental health support.


Now two leading bodies for psychologists – the Australian Association of Psychologists Inc (AAPi) and the Australian Psychological Society (APS) – are asking the Federal Department of Health to review the program to improve access to allow people to self-refer to a psychologist, while still having access to Medicare reimbursement, without getting a mental health plan from their GP.


But Dr. Cathy Andronis, chair of psychological medicine at the RACGP, fears the move could dramatically fragment care and, in some cases, even lead to new hurdles.


‘This [would be] a major paradigm shift in the way we operate in the Australian healthcare system,” said Dr Andronis newsGP.


“We’ve created a pretty sacrosanct system that’s reliable, predictable, secure and people understand – and at the cornerstone of that is GP.


“As the primary contact, GPs can take a holistic biopsychosocial approach to coordinating care, helping the patient navigate the system, and patient advocacy. It would therefore be unwise to go back to this very fragmented system, which is also much more expensive and completely unsupported.


Under the current federal government program, people can receive up to 20 sessions with a psychologist per year with reimbursement from Medicare. However, the patient is required to create a mental health plan with their GP before their first appointment.


APS President Professor Tamara Cavenett told Nine Newspapers the requirement causes new patients who are offered last-minute appointments to delay care.


“There are a lot of people for whom additional paperwork potentially prevents them from getting treatment or prevents them from getting treatment as soon as they otherwise would,” she said.


However, Dr Andronis says GPs are often very accessible to patients and are better equipped as a first point of contact to handle mental health presentations in a “very quick and affordable way”.


The Melbourne GP says the prospect of separating psychological care from standard healthcare also carries the possibility that there is a bias.


“Sometimes there are biological determinants of distress, like poor diet or lack of exercise, or there are social issues,” Dr. Andronis said.


“But when you fragment a system, you reduce the lens through which you see this 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 looking at things from all angles – biological, social and psychological – and being able to assess the best way to help someone really help themselves. And that’s what GPs are good at; having a wide angle lens and the ability to take your time and review things holistically.


“There is therefore a huge place for the generalist. In fact, it is 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 take care of the whole person,” Dr. Price said.


‘[And] patients can already access psychologists without referral [and claim it] on their private health insurance.

 

In addition to removing references to general practitioners, the AAPi advocates that the number of Medicare-funded sessions be doubled from 20 to 40 per year, alongside an increase in the rebate to $150 per visit.

Additionally, the AAPi and APS are asking that the requirement for patients to renew their mental health plan after the sixth session be removed.

Dr Andronis, however, says the review process is “essential”.

“When the GP looks at a case of a mental health issue, it’s all about whether the person is on the right track – is it the right one? [therapist]? Is this the right treatment modality? ” she says.

‘The assumption that this is the case is not always correct.

“I see it quite frequently in psychological medicine where people have seen the psychologist and it’s only after the exam that it becomes apparent that they haven’t really engaged or they’ve stopped looking at them. to see.

“Or they go out of a sense of duty or want to please the psychologist, but don’t really improve.”

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 visits to ensure doctors can meet the needs of their patients.

Dr Andronis believes the central problem goes back to the “progressive 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 bill en masse than most psychologists, certainly in urban areas or areas of high demand,” Dr Andronis said.

“And most of the issues that we see in GP have a mental health basis and we actually manage them.

“So GPs need to start recognizing that they can do this job, they do this job, and most of the time they do it well enough, and they can learn to do it even better, rather than letting our system become fragmented and our perception of ourselves as general practitioners is dictated by other people’s assessments of how well we do our job.

Rather than focusing on person-centered care, Dr. Andronis believes peak bodies are instead “taking advantage” of stress in the community in the run-up to the federal election.

“It seems to me that people are really taking the opportunity to protect their little territory and to focus very narrowly on their work,” she said.

“It’s a reality of the political system; we are closer to an election and unfortunately we live in a very competitive system, and that makes people fearful, and the more fearful people are, the more competitive and protective of their territory they will be.

“But really, why are we fragmenting a system that we know works?”

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