The Royal Australian College of General Practitioners (RACGP) has urgently called on governments to relieve pressure on psychology waiting lists by restructuring Medicare, instituting new service incentive payments for GPs managing mental health conditions and making longer telephone consultations a permanent fixture of telehealth.
It follows reports of people with mental health concerns facing a 12-month waitlist for a psychologist.
RACGP President Dr Karen Price said the situation was dire.
“This is a national emergency, plain and simple,” she said.
“I’m hearing reports that one in three psychologists are closing their books to new patients. The figure was just one in 100 before the COVID-19 pandemic and a precipitous decline like that should ring alarm bells.
“If you live in a rural or remote area the options are especially scarce and that really worries me. Eight out of 10 psychologists are in major cities.
“GPs see the consequences of people who aren’t accessing the help they need for mental health issues almost every day. Patients can rapidly deteriorate without the right type of interventions and, for many people, consultations with their GP in combination with psychological services, are essential.”
Dr Price said that urgent measures were required.
“One step that would make an enormous difference is providing new Medicare items for longer GP consultations,” she said.
“This will allow us to really take the time to get to the bottom of what is going on. 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.
“Telehealth is also essential in helping people with mental health concerns and, for many people, longer telephone consultations with their GP can significantly improve their health trajectory.
“Medicare rebates for longer telephone consultations have been extended to mid-way through this year but that isn’t good enough – we need to make this permanent. This is particularly important for patients living in rural and remote areas, where access to local GPs can prove challenging. If you need to drive a considerable distance to physically sit face-to-face with your GP, telehealth can make your life that much easier.
“We are also calling for a new service incentive payment to better support general practice services that help patients with mental health issues. This would include early identification and ongoing management of mental health conditions such as depression and anxiety.
“Under this plan, the services could include a General Practice Mental Health Treatment Plan with at least one review and physical health assessment because people with mental health concerns are twice as likely to report having a physical health condition too.
“Another important step is encouraging and supporting GPs to train and deliver more advanced mental health care, such as Focussed Psychological Strategies or FPS, which refers to specific mental healthcare treatments based on evidence-based psychological therapies.
“Uncoupling FPS sessions delivered by the GP from the pool of 20 allied health services patients are eligible to receive following preparation of a GP mental health plan would help meet patient demand for these services.
“Given the immense shortage of psychiatrists, the development of GP psychiatry pathways, like the models used for GP obstetrics and GP anaesthetics, would also make a real difference, particularly in rural and remote Australia.
“The reality is that general practice is the most accessible service for many people who require mental health care. In some areas outside of major cities, GPs are the only option. So, by investing in general practice we can help people who otherwise may fall through the cracks in the system. This includes Aboriginal and Torres Strait Islander patients, people from culturally and linguistically diverse backgrounds and those from a lower socioeconomic background who otherwise would not have contact with the health system outside of general practice.”
Dr Price said that GPs can’t do it on their own.
“Let me be clear, GPs are not psychologists and we can’t solve these problems single-handedly,” she said.
“We need to ensure Australia has the right mental health support structures in place so that people can get the help they need regardless of where they live.
“This isn’t a short-term problem that will go away in a few weeks. Unfortunately, the full scale of what we are facing may only become apparent in the months and years ahead because many patients avoided or delayed consults with their GP during the pandemic. So, addressing the causes behind this profound shortfall in psychologists must be addressed.
“We need more psychologists but also psychiatrists and other skilled mental health professionals such as occupational therapists. Better access to paediatricians is also needed because many younger people are suffering from mental health issues during the pandemic.
“The time for action is now. It is simply unacceptable that so many people are missing out on the support they need. Whilst we couldn’t have predicted a once in a lifetime public health crisis, we should not be this poorly prepared. The Royal Australian College of GPs will continue to speak out – because no patient should be left behind.”
The RACGP President said that the mental health of people across Australia must be a priority.
“No matter your postcode, all people deserve access to mental health support,” she said.
“We must remember that the huge demand for psychologists is being driven by younger people – both adolescents and young children. If they can’t get the help they need now, this could have a significant impact on their development and long-term health and wellbeing.
“I am particularly concerned about my home state of Victoria given that we spent more days in lockdown than any other city in the world. That took an enormous toll on many people who were isolated from loved ones and experienced a lot of stress and uncertainty.
“Improving the mental health of people in communities across Australia must be front of mind for all policy makers in every jurisdiction.”