Advanced Mental Health Training Recognition

Position Statement

GPs are an important source of support and referral for those who experience mental health conditions.¹ Often considered as the first point of contact for people concerned about their mental health, GPs are in a unique position to provide mental health care across the illness spectrum and the lifespan. According to the Australian Institute of Health and Welfare (2017), approximately 18 million GP encounters in 2015-16 were mental health related. This is an annual increase of 4.7 percent and comparable to the 9 million services provided by State and Territory mental health services in the same period.² 

The limited availability of specialist services means that patients are more likely to seek help for mental distress from their GPs.³ 

At present, two distinct levels of care are defined within the MBS structure. Level 1 Mental Health Skills Training care enables GPs to provide basic assessment and management of high prevalence disorders, such as depression and anxiety. Level 2 Provider of Focussed Psychological Strategies care enables GPs to provide psychoeducation and cognitive behavioural therapy to patients. Both levels have specific training requirements as defined under the Better Access initiative, and the standards of this training are accredited by the GPMHSC. 

However, the GPMHSC believe there is a need for a third level of care and training to be recognised by the MBS – Level 3 Advanced Mental Health Skills. The purpose of this position statement is to acknowledge the GPs who have undertaken extended and extensive training and education for additional skills in psychiatry and psychology.

This position statement will serve as an advocacy tool when the GPMHSC meet with key Government stakeholders in ongoing work to champion the vital role of the GPs in primary mental health care. 

GPs with Level 3 Advanced Mental Health Skills would be likely to operate at a secondary care level: equivalent to GP anaesthetists or GP obstetricians. This includes acute and emergency care for patients with acute psychosis, acute suicidality and severe mental illness. It is expected this cohort of GPs would work with other mental health agencies, such as acute mental health units, and provide alternative services to psychiatrists and psychologists in areas that are geographically isolated and/or lack appropriate services. These skills would be particularly important in rural and remote communities so GPs and can provide these services to patients who are unable to access other services. 

Advantages of Level 3 Advanced Mental Health Training Recognition includes: 
 

• A way of addressing the predicted shortage of psychiatrists in the Australian workforce now and into the future • The ability of carers, consumers and other health professionals to identify highly skilled GPs in their area to provide care for patients with complex needs
• The capacity of the MBS to incorporate targeted remuneration to this group to enable them to practice advanced mental health without experiencing profound financial disadvantage
• The capacity to target training and upskilling programs to appropriate GPs to enable psychiatry and psychology cover in areas of need. 
• Secondary care, on referral by other GPs or care providers
• Provider and coordinator of care and support to patients with chronic and complex mental and physical health needs, and severe mental illness in the community
• May provide complex mental health care in specialised contexts, e.g. paediatrics, ATSI, palliative, substance abuse, homelessness, CALD, torture and trauma survivors
• Continuing care in the community for patients at high risk of suicide and/or chronic suicidality
• Leadership, professional development, clinical supervision and collegiate support for other GPs caring for patients with mental illness. 

Example of training and education completed by GPs with Advanced Mental Health Skills 
 

Prerequisites

 

• Fellowship in ACRRM or RACGP  
• Registrars training for an AST/ARST in Mental Health
• All should have mental health skills training and accreditation via the GPMHSC – MHST Level 1 and FPS ST Level 2 (Registered with Medicare Australia).

 

Desirable

 

• TESQA accredited qualifications in mental health e.g. a grad cert, grad dip or Masters degree in psychiatry, psychotherapy, mental health or related field.
• Extended clinical experience in a mental health field, e.g. registrar experience in psychiatry
• Advanced specialised training in mental health (ACRRM)
• Advanced rural specialised post in psychiatry (RACGP)
• Previous qualifications in a mental health related discipline, e.g. psychology or social work • Extended peer-learning experience, e.g. Balint groups, clinical supervision
• Leadership roles in a mental health field, e.g. in mental health education, policy or research
• Clinical supervision in mental health eg participates in personal supervision, Balint groups or similar. 

 

References

1. Britt H MG, Henderson J, Bayram C, Harrison C, Valenti L, Wong C, Gordon J, Pollack AJ, Pan Y, Charles J. General practice activity in Australia 2015–16.
2. Australian Institute of Health and Welfare (AIHW). Mental health Services in Australia, 2017.
3. Kelly BJ, Stain HJ, Coleman C, et al. Mental health and well‐being within rural communities: The Australian Rural Mental Health Study. Australian Journal of Rural Health 2010;18(1):16-24.