Most GP patients discuss psychological issues, so why can’t they see mental health professionals in GP clinics?
With 71% of the health problems discussed with GPs relating to psychological issues, a recent scoping review by Monash Rural Health researchers raises the question of why mental health professionals are not co-located at GP clinics.
A scoping review commissioned by the North Western Melbourne Primary Health Network, aimed to identify models where mental health services were effectively integrated within primary care settings. The review also explored factors that facilitated their implementation into routine practice.
Lead researcher Dr Anton Isaacs said that “The purpose of the review was to identify what mental health integrated models would work in the Australian primary care setting and what needed to be in place to make it work.”
The review identified 1387 studies and analysed 12 key studies, highlighted the clear benefits of having co-located mental health and substance abuse services, with positive benefits such as symptom reduction, improved coping and relationships, enhanced community participation, clinical effectiveness, and delivering of more patient centred care.
Dr Isaacs reflected on the benefits of co-located mental health and substance abuse services.
“While the models worked slightly differently in different settings, In Australia and the UK, there have been trials of mental health nurses providing primary mental health care from general practices. Evaluation of these trials showed improved patient outcomes as well as positive nurse experiences such as more autonomy and flexibility in their role and more time for health promotion to support early intervention in mental health issues.”
However, despite the obvious benefits of co-located mental health and substance abuse services, there are challenges to setting up these services in the Australian primary care setting. According to Dr Isaacs:
“The main difficulty is the difference in funding between primary care and mental health services. While primary care is mostly paid for by the Australian government through medicare, mainstream mental health is block funded by state governments. In order to work together in Australia, a rethink of funding models may be required to implement co-located mental health and substance abuse services on a larger scale.”
Whilst bureaucratic funding barriers exist, the concept of co-located services removes a lot of other barriers for clients, such as lack of awareness, social support, privacy concerns, lack of availability and fear of treatment and stigma related to going to designated separate mental health and substance abuse services.
Dr Isaacs reflected that with 23% of the Australian population (5.9 million people) at risk of developing a mental health problem annually, the development of co-located mental health and substance abuse services at primary care centres should be seen as a priority.
“Having co-located services at primary care centres has a huge potential to support early intervention in mental health and substance abuse issues, potentially saving billions of dollars in treatment of patients down the track who have not received early intervention and treatment support.”
This view supports the recommendation of the 2021 Royal Commission into the Victorian mental health system that the system needed to be adaptive so that it ‘can identify and test new ideas, gather evidence about what works, and translate this into effective treatment, care and support’
With the growing problem of mental health and substance abuse in our communities, looking at innovative approaches such as co-locating mental health and substance abuse services at primary care centres has the potential to save healthcare spending, provide patient-centred care, and ultimately, save lives.
Dr Isaacs sees that integrating mental health care into primary care would be a key part of the solution.
“We know that our mental health system is dated. We know what we need is a paradigm shift similar to what occurred during deinstitutionalisation. Integrating mental health care into primary care is one of the key requirements of a reformed mental health system. Political will and collaboration between all stakeholders can materialise this shift.”
Read the full scoping review: Mental health integrated care models in primary care settings and factors contributing to their effectiveness – a scoping review