We are the highest value mental health care in the country, using less than 3% of the total mental health budget to see the majority of patients who need community care. The current lack of funding added to the rhetoric that marginalizes and misrepresents general practitioners appears to be a counterproductive strategy when trying to provide better mental health outcomes for all Australians.
In recent years, we GPs have witnessed an exponential increase in mental distress, and the cracks in the system where the most vulnerable fail are familiar to all of us. We are fully aware of and agree with the enormous unmet need for mental health care at this time. rosenberg and hickeywho wrote Insight+ These days, primary mental health care reform is long overdue.
Where we disagree with Rosenberg and Hickey is our understanding of the problem, particularly the role of general practitioners in contributing to the current mental health crisis and its various solutions. Although they have the right to question the effectiveness and efficiency of their players, Rosenberg and Hickie feel they have misunderstood the GP data.
As a diverse group of GPs who share significant expertise in mental health care, we would like to take this opportunity to correct these misconceptions. Without an accurate understanding of the data used to inform policy, the solution may not be effective.
Myth: General practitioners provide poor quality care because they do not see patients
Rosenberg and Hickie found that “GPs produced more than 1.2 million mental health plans for Australians in 2020-21, but just over a third (36.8%) of them were reviewed. Patient progress was largely unmonitored by general practitioners.” This argument has been used previously by Rosenberg and Hickie (here and here). I was wrong then and I am wrong now.
Counting mental health items has always been a poor proxy for quantifying mental health care provided by general practitioners. Or if you need access to an occupational therapist, you should use a mental health plan item number such as MBS item numbers 2700, 2701, 2715 or 2717. However, the other mental health item numbers (2712 Mental Health Review, 2713 Mental Health Consultation, and Focused Psychological Strategy numbers) are optional.
The number of review items has a lower return rate than the number of consultation items. Mental health review numbers offer a rebate of $75.80 and comparable duration consultation item numbers are $76.95. Why would you choose to use them?
Patients are understandably concerned that evidence of mental illness in their medical records could affect their access to insurance. Especially when mental health concerns are self-limiting and short-term. privacy concerns. This is especially problematic for children, as any mental health treatment plan must include a diagnosis. Reasonable concerns about stigma and the pathogenesis of common childhood stressors may make parents reluctant to “label” their children with “mental health disorders.”
GPs are actively discouraged from using mental health-specific item numbers by the Department of Health. A recent nudge letter from the Australian Government’s Behavioral Economics Team (BETA) threatened “compliance action” when mental health item numbers were “improperly” billed alongside consultation item numbers. We aggressively targeted general practitioners who were statistically outliers, even without evidence of poor practices. The fear of “nudges” and the importance of professional services reviews may have changed the way all GPs are billed. Many GPs consider it safer not to use these numbers at all.
GPs see 82% of the Australian community each year and more than 65% of GP consultations involve psychological problems. Only her 8.8% of patients receive a mental health item number. According to the MBS mental health item count, only 36% of mental health consultations are billed. That is, for every mental health-related consultation billed using a mental health item number, another 1.8 of her 1.8 consultations addressing mental health concerns billed using a different item number I have a consultation. Using mental health item numbers as a proxy for clinical activity is highly misleading.
Myth: General Practitioners Act as Solo Clinicians and Use Multidisciplinary Teams for Better Outcomes
General practice would not be possible without the diverse skills of a medical professional colleague. But a multidisciplinary team dedicated to mental health is not the answer for many patients. There is also evidence that it may not be as effective as expected with GP settings. In the UK, the introduction of multidisciplinary teams into primary care has increased costs, reduced patient satisfaction and reduced quality of care.
Complex systems can harm patients with complex needs. Our patients do not always experience the collaborative, patient-centered care these teams advocate. Indeed, there are some suggestions that patient-centered care may increase inequities. Dr. Tim Sr. writes:
“When patients claim to be integral members of the team, their role feels akin to that of the ball on a football team being kicked back and forth between team members in search of an elusive goal. there is. “
We also know that long-term therapeutic partnerships improve treatment outcomes. This is especially important for vulnerable patients with a history of trauma. We also know that long-term therapeutic relationships reduce health care costs. Outsourcing and modularizing this relationship can have unintended consequences, so careful consideration should be given to ensure that the benefits of such an approach outweigh the potential harm.
There are already many interdisciplinary teams in this field. Unfortunately, most of our patients face a series of closed doors when trying to access care. Patients in rural areas who cannot access or are irrelevant to metrocentric services. patients with comorbidities that limit access to siled services; increase. Patients with physical health needs are already informed by many multidisciplinary teams, and they and their caregivers face full-time jobs just managing appointments and related bureaucratic requirements. doing. Patients who are too poor, geographically isolated, unsupported, culturally and linguistically diverse, or simply too tired to face the complexities of navigating care.
Mental health care inequality appears to be growing. However, patients living with systemic disadvantages often access general practice more than other medical services.
GPs treat populations presenting a wide range of clinical presentations. Individual disorders such as depression and anxiety are just a small part of our practice. As such, our curriculum is very broad. Includes remote areas to residents. Given the diversity of care we provide, we expect to work with a variety of individuals, agencies and teams to provide care. These are bespoke teams that include informal support networks, peer workers, individual health professionals, non-governmental organizations, public and private outpatient and inpatient services, and social services.
A good GP integrates context, relationships, meaning, life stories, and an understanding of physical health with what the psychiatric model segregates as “mental health.” This fundamental difference in how people view means that strategies developed for psychiatric and psychology-driven segments cannot be generalized to our context. Using evidence justified in one context to drive policy in another is poor science and poor practice.
Myth: Technology is Fundamentally “good”
Technical solutions are a growing resource, especially when used to analyze the outcomes of patient-centered care, but are currently best suited for modeling single diseases. There are ethical concerns about the use of artificial intelligence in mental health care, especially privacy and transparency that need to be considered. AI algorithms have built-in hidden value that subconsciously reinforces current injustices.
Australia leads the world in technology-enabled mental health care, but only 4% of Australians in need of mental health care are using digital mental health services. This may be an access or literacy issue, but it should be considered before making substantial investments in technology-enabled mental health products.
GPs are as diverse as their patients. We have the training, skills and insight to contribute meaningfully to mental health discourse and service delivery. What we need now is real collaboration from other services with a smaller population than ours. It is frankly disgusting that the worldview of professionals is held as the most reliable solution for the care of patients they will never see.
What frustrates, angers, and even harms us and our patients is excluding our voices and perspectives from medical discourse, policy-making, and treatment planning. Ignorance of our rolelow compensation and negative portrayal of GPs contribute to early retirement and low recruitment among GPs, only exacerbating access to mental health care.
The GP workforce is shrinking, and by 2032 it is expected that there will be a shortage of over 11,000 FTEs. Our hospital is the most valuable mental health care in the country, using less than 3% of his total mental health budget to see the majority of patients who need community care. The current lack of funding added to the rhetoric that marginalizes and misrepresents general practitioners appears to be an unproductive strategy when trying to provide better mental health outcomes for all Australians.
Dr. Louise Stone is a GP with clinical, research, education, and policy expertise in mental health. She is an Associate Professor in the Infrastructure Medicine Group at ANU College of Medicine.
Dr. Karen Spielman is a GP in Sydney, Clinical Lead at Headspace Bondi and Primary Care Advisor at the Inside Out Institute.
Dr CW Michael Tam is a General Practice Staff Specialist in the Primary and Integrated Care Units of the South West Sydney Local Health District. He is a Co-Senior Lecturer in the School of Public Health at the University of New South Wales.
Dr. Johanna Lynch is a General Practitioner, Psychotherapist and Senior Lecturer in the General Practice Clinical Division at the University of Queensland School of Medicine.
Dr May Su is a Sydney GP, Australian General Practice Training Supervisor and RACGP Examiner.
Dr Tim Senior is a General Practitioner and Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health.
Adjunct Professor Karen Price is a GP and President of the Royal Australian College of General Practitioners.
Dr Sarah Chalmers is a local generalist living in Winton, West Queensland. She is a medical educator at Flinders College in her Northern Territory and James Cook University in her Territory.
Dr Gwendolyn Barton is a General Practitioner and Chief Obstetrician at the Brisbane South Primary Health Network and Chair of RACGP’s Antenatal/Postnatal Special Interest Group Victoria.
Statements or opinions expressed in this article reflect the views of the author and do not necessarily represent official AMA policy. MJAMore Also Insight+ unless otherwise stated.
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