Achievement of key objectivesThe Better Access initiative seeks to improve outcomes for people with mental health disorders through the following objectives:
- Encouraging more GPs to participate in early intervention, assessment and management of patients with mental disorders; and to streamline access to appropriate psychological interventions in primary care;
- Encouraging private psychiatrists to see more new patients;
- Providing referral pathways for appropriate treatment of patients with mental disorders, including psychiatrists, GPs, clinical psychologists and other appropriately trained allied mental health professionals; and
- Supporting GPs and primary care service providers through education and training to better diagnose and treat mental illness.
Encouraging more GPs to participate in early intervention, assessment and management of patients with mental disordersThe predominant message from GPs were that they were doing more mental health work than ever before. The new MBS items for GPs were welcomed as recognising the effort in assessing individuals with mental health problems and developing care plans and treatment options. Most GPs noted that the capacity to refer patients to an allied health professional (AHP) provided the referral options to encourage and allow them to manage more patients with mental health problems.
Psychiatrists noted that with the new and expanded items for psychiatrists to undertake patient assessments and care plans, GPs were more willing and capable of managing more patients and more complex patients than before the Better Access initiative.
Nearly all AHPs noted that the number of GPs referring patients was expanding, AHP stakeholders were uncertain whether this was a feature of increased GP activity or the increased development of referral pathways.
Many public mental health providers noted an increased capacity to refer patients to their GP for common mental health problems, and the capacity for GPs to develop and coordinate treatment options.
Nearly all representatives of consumer groups and NGO mental health providers also noted the increased awareness and increased role of GPs in managing mental health problems.
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Encouraging private psychiatrists to see more patientsAll psychiatrists consulted indicated that the new MBS item for consultation with a patient referred by a GP and expanded rebates for existing items related to patient assessment and preparation or review of treatment plans to be carried out by a GP was effective in encouraging psychiatrists to see more patients. It was noted by most psychiatrists that they and many of their colleagues were now able to allocate scheduled timeslots to see new patients. They reported a greater preparedness to see new patients knowing that the GP would provide the patient's ongoing management and that alternative specialist mental health treatment options were available through AHPs.
Many GPs also reported that is was now somewhat easier to have a patient seen by a psychiatrist than prior to the Better Access initiative, although it was highlighted by both GPs and consumers that it remained difficult to gain access to a private psychiatrist, particularly a psychiatrist with low fees or who bulk billed. The GPs and consumers that discussed this difficulty in accessing psychiatrists predominately perceived it to be a result of there being too few psychiatrists.
A very small number of psychiatrists expressed hesitations about the Better Access initiative. This related to concerns of patients being 'held onto' by a GP and not being referred to a psychiatrist and/or inappropriately referred to an AHP for focussed psychological interventions when assessment and treatment by a psychiatrist would be more appropriate and achieve a better outcome for the patient. Most perceived this is an issue for increased education and training rather than an inherent problem with the initiative.
Providing referral pathways for appropriate treatment of patients with mental disordersIt was reported by all stakeholder groups that the Better Access initiative had both developed treatment options and developed and improved upon existing referral pathways between GPs, psychiatrists and AHPs. Service providers and consumers demonstrated an effective understanding of how these pathways worked and reported that referrals were initiated by all service provider groups (with AHPs and psychiatrists encouraging non referred individuals seeking treatment to see their GP) and consumers initiating referrals by raising mental health issues with their GP and seeking a referral to an AHP.
Supporting GPs and primary care service providers through education and training to better diagnose and treat mental illness.At the time of the consultations very little of the training planned to be provided through the Better Access initiative had commenced. As such, the majority of GPs and AHPs were unable to comment on the impact of the planned education and training on the diagnosis and treatment of mental illness.
The sole stakeholder who had participated in the rollout of the education and training that was just commencing in their local area identified the approach as positive in respect to both content and the opportunity to develop referral networks across GPs, psychiatrists and AHPs.
Constraints and opportunitiesWhile reporting the success of the Better Access initiative, stakeholders noted that the improvements in access to services and referral pathways did not equally benefit all communities and population groups. All consumer groups and public mental health providers, nearly all GP and psychiatrists and most AHPs noted that some communities and populations benefited more than others and that many communities and population groups experienced barriers in access to service that included affordability of gap payments, service availability and appropriateness of the service model to their particular needs. The small number of stakeholders from very remote communities suggested that the Better Access initiative made it more difficult to access services because of reduced availability of AHPs to provide 'fly in, fly out' services through ATAPS or industry supported health care programs.
A more detailed discussion of the outcomes of the Better Access initiative, identified constraints and opportunities for improvement identified in the consultations follows.