MEDICUS MARCH 2016

C O V E R S T O R Y

Dr Tim Koh Chair, RACGP WA

F or GPs across Western Australia, I suspect that the first response to the news that the Federal Government was looking to reform the delivery of mental health services was one of scepticism. GPs are responsible for the vast load of mental healthcare for Australians and the last significant change to government policy saw substantial reductions to the MBS rebate for mental healthcare plans. This move was vigorously opposed by both the AMA and the Royal Australian College of General Practitioners (RACGP) but was unilaterally pushed through without consultation with the profession. The most recent reform will see the delivery of services coordinated by the newly formed primary health networks (PHNs) which for WA translates to our sole PHN–WA Primary Health Alliance (WAPHA). The question is, will this result in meaningful delivery of care for patients across WA? At first glance, the PHNs will have a tall order to assess what is working and what needs improving within the existing services for the states. For WA, WAPHA seems to have started in the right direction. WAPHA has commissioned a mental health atlas, which will address the needs and services for communities within the State. It has also commenced consulting with a wide range of key stakeholders involved in supporting patients with mental health issues.

For GPs, the critical question is: how

Aside from the mental health units and Psychiatrists, it has been interesting to sit down with providers such as housing, justice and social services to see the imprint that patients with mental health problems have on our society and support services. For GPs, the critical question is: how will any changes affect mental health services for our patients? Prior to these proposed changes, most GPs found that there were already significant difficulties with mental healthcare delivery and services. In the months before the announcement of the mental health reforms, I had the opportunity to meet with both the WA Mental Health Minister Hon Helen Morton, and the Mental Health Commissioner, Mr Tim Marney, to discuss the concerns of GPs interacting with mental health services. The feedback I provided was that firstly, GPs had difficulty accessing mental health services for patients (in particular children and adolescents) and secondly, there is a need for improved communication and integration of care between GPs and mental health services. This feedback was well received and the result was a plan to trial incorporating community mental health services into general practices to support high needs mental health patients. With the announcement of reform to mental health services through the PHNs, there was further development of the suggested trial with state-based mental health services.

WAPHA has been receptive to advancing this trial as well as exploring solutions to the problems that GPs face with providing high quality care to complex mental health patients under the existing Medicare Benefits Schedule (MBS). Most GPs acknowledge that the MBS is not well devised for supporting the management of mental health patients as we see a sliding remuneration for longer complex consultations. This in combination with the aforementioned degradation of GP mental healthcare plans continues to make delivery of quality mental healthcare a challenge. In summary, I suspect that the announced reforms will not result in an immediate revolution of mental health services. Instead we will likely see an evolution of services and funding so as to preserve what is already working and to augment and realign services that were not delivering. ■ will any changes affect mental health services for our patients? Prior to these proposed changes, most GPs found that there were already significant difficulties with mental healthcare delivery and services

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