GPs critical to mental health reform

THE federal government’s planned 3-year transformation of the mental health system will provide many opportunities for GPs interested in holistic care. But it won’t be without its challenges. While system-level changes are needed and welcome, it’s the people who provide care, and those in primary care in particular, who will make change happen.

The starting point for the reforms is to enable a holistic view where all of an individual’s needs – mental, physical, cultural and social – are considered. Unfortunately, physical health and mental health are often viewed and managed as separate issues.

GPs already know this is the best route to effective care, and now they won’t have to look to Canberra for mental health funding and services.

From 1 July, much of this responsibility will be transferred to Primary Health Networks (PHNs), giving GPs the chance to influence which services are funded and how multidisciplinary teams are put together. This will give GPs an opportunity to strengthen their profile with their local PHN and get in at the ground level.

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We know not all mental illness requires medication, and we know people often present with more than one condition. To date, a system funded almost exclusively on episodic care has got in the way of a person-centred approach that takes both these factors into account.

Some of these obstacles will be removed by the government’s planned reforms but it will be what happens on the ground, at the community level, that will make the difference.

At the National Mental Health Commission, we want everyone to lead a contributing life and to participate and engage in their community in a productive way. For people living with a mental illness, that means getting services appropriate to their need.

We all know there is a huge spectrum of mental illness in Australia, ranging from mild to severe conditions. Rather than one-size-fits-all, a stepped care approach is both more effective and more efficient – delivering services based on local level needs that span the life course and illness severity.

For many people living with common mental illness such as stress or depression, digital services can be a good first-line option. These can also be helpful for prevention and early intervention.

Many people like self-help when provided under the primary care umbrella. Mental health led the way in telehealth, and this will continue with the development of a single gateway for digital mental health. 

For those living with severe and persistent mental illness, funding for wrap-around services will be provided by a new flexible funding pool that PHNs will use to commission mental health programs. This enhanced flexibility means access will be better matched to different levels of need at a local level. The philosophy behind the funding pool arrangement is similar to that which underpins the National Disability Insurance Scheme.

These new changes recognise the important role of GPs and other members of the care team working with those living with mental illness, their families and support people to determine the best way to spend available funds and best support a contributing life.

We hope this new approach to mental health service delivery will prove to be the vanguard of substantial change across the broader health system, one where a person-centred approach will gradually come to dominate. 

We can’t promise the changes will give you more hours in the day. However, we think those who make the most of the new arrangements will gain more room to manoeuvre, and the flexibility to improve outcomes for people living with mental illness.

Professor Allan Fels, AO, is Chair of the National Mental Health Commission, and Chairman of the Haven Foundation, which seeks to provide accommodation and support for the long-term mentally ill.