About our Program

3-step mental health plan in 2 consultations
Following the Red Tape Taskforce Review of PIP and EPC the 3 Step Mental Health Process has been streamlined. From 1 May 2005 the number of Level C consultations will be reduced from 3 to a minimum of 2. This will allow GPs to complete two steps in one long consultation (i.e. mental health assessment and mental health plan) but still within the three-step framework. The requirement for planning and review to be completed in separate consultations and within 4 weeks – 6 months will be retained.

Mental Health and Chronic Disease Management
Available to all GPs (since May 2005) is the GP-psychiatrist liaison where GPs can refer patients to see a psychiatrist for one or two sessions. The psychiatrist is able to provide assessment, diagnosis and management information to the GP to enable GP management of the patient. The psychiatrist input could be incorporated into either:

• a GP management plan (new MBS item number 721)(GPMP)
• a Team Care Arrangement (new MBS item number 723)(TCA)
• or a 3-step mental health plan for BOiMH registered GPs.

A GP-psychiatrist referral template is available on the division’s website. To find a psychiatrist, GPs can access the psychiatrist database, available at the RACGP website. It provides psychiatrist contact details with a search by suburb or area along with specific treatment, language etc available.

Overview of Mental Health MBS Items 2710 for GPs from November 1, 2006

These new items promote a team approach to mental health, with GPs encouraged to work with psychiatrists, clinical psychologists and other allied mental health professionals (general psychologists, social workers, and occupational therapists with mental health training) to increase the availability of care. Referral to rebate attracting psychological services is available upon completion of GP Mental Health Care Plan.

The new items are:

• 2710 Preparation of a GP Mental Health Care Plan (MHCP) Fee $150
• 2712 Review of a GP Mental Health Care Plan Fee $100
• 2713 Attendance for a mental health consultation (Level C minimum) Fee $ 66

2710 Preparation of a GP Mental Health Care Plan

What is involved – Assess and Plan
Rebate available to GP who has undertaken an assessment and prepared a GP Management plan. An assessment of the patient must include:

• Recording the patient’s agreement for conducting a mental state examination;
• assessing associated risk and any co-morbidity;
• making a diagnosis and/or formulation; and
• administering an outcome measurement tool, except where it is considered clinically inappropriate.

The assessment and plan can be conducted in the same consultation in which the GP MHCP is developed.

PREPARATION OF A GP MENTAL HEALTH CARE PLAN must include:

• discussing the assessment with the patient, including the mental health formulation and/or diagnosis;
• identifying and discussing referral and treatment options with the patient, including appropriate support services;
• agreeing goals with the patient – what should be achieved by the treatment - and any actions the patient will take;
• provision of psycho-education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
• making arrangements for required referrals, treatment, appropriate support services, review and follow-up; and
• documenting this (results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date) in the patient’s GP Mental Health Care Plan.

Once a GP MHCP has been completed and claimed on Medicare, a patient is eligible for access to up to 12 Medicare rebates per calendar year for clinical psychology or focussed psychological strategies. 12 rebated group therapy sessions are available in addition to these services.

2712 – Reviewing a GP Mental Health Care Plan

REVIEW of a GP MHCP must include:

• recording the patient’s agreement for this service;
• a review of the patient’s progress against the goals outlined in the GP Mental Health Care Plan;
• modification of the documented GP Mental Health Care Plan if required;
• checking, reinforcing and expanding education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
• re-administration of the outcome measurement tool used in the assessment stage, except where considered clinically inappropriate.

Note: This review is a formal review point only and it is expected that in most cases there will be other consultations between the patient and the GP as part of ongoing management.
The initial review service should occur between four weeks to six months after completion of GP MHCP .
A further review is permitted 3 months after the initial review.
Limit: 2 reviews in 12 month period (apart from exceptional circumstances)

2713 GP Mental Health Care Consultation

Extended consultation (>20minutes) where the primary treating problem is related to a mental disorder, including management under a GPMHCP. May be used for ongoing management of patient with a mental disorder. (Should NOT be used for development of GP MHCP).
The GP Mental Health Care Consultation must include:

• taking relevant history and identifying the patient’s presenting problem(s) (if not previously documented);
• providing treatment, advice and/or referral for other services or treatment; and
• documenting the outcomes of the consultation in the patient’s medical records and other relevant mental health plan (where applicable).

Patient Eligibility
Eligible patients are those with a mental disorder who would benefit from a structured approach to the management of their care needs. Most conditions are included.
Notable exclusions: dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder for the purposes of the Mental Health Care items– please refer to Mental Health Disorders and Better Access treatments on the resources page of this website

Referral
The psychological therapy and focussed psychological strategy items provided by allied mental health services apply to patients with an assessed mental disorder and where the patient is referred for treatment by a medical practitioner who is managing the patient under a GP MHCP; and/or a psychiatrist assessment and management plan (or from an eligible psychiatrist or paediatrician).
Allied mental health treatments approved for use are listed in Mental Health Disorders and Better Access treatments on the resources page of this website

Resources to explain the new items produced by ADGP are available below.

• Patient Pathways
• Better Access Flowchart (using the new item numbers)
• GP fees and patient rebates

Local resources have also been produced. To date the following items are available

• Practice tips for making referrals using the new items.
• Checklist for completing the assessment and plan, the review, the mental health care consultation.
• Better Access Referral Cover Sheet

Additional resources are currently under development and will be posted when available.
The MBS item descriptors and explanatory notes are provided in the following documents

• Mental health items
• Explanatory notes

Please also refer to the Department’s Fact Sheets

There is a useful Question and Answer section explaining the new items (including their alignment with CDM and ATAPS.
3 step mental health process items ( ie Mental Health SIP) are available until end of April 2007 to enable services commenced prior to November 1, 2006 to be completed and claimed.
Mental health plans commenced from 1 November should utilise the Mental Health Care Plan item number 2710.

Summary of the Better Outcomes in Mental Health Care Initiative

The aim of the BOMHC Initiative is to support general practitioners in improving the quality of care provided through general practice to Australians with mental health illness by providing mental health education and training for general practitioners and more support for them from allied health professionals and psychiatrists.

The initiative has five major components:

1. Incentive payments for GPs to reward and encourage effective management of mental health problems

2. Education and training for GPs - to familiarize them with the initiative and to increase the number of GPs skilled in counseling.

3. To provide MBS rebates for focused psychological strategies and evidence based treatments provided by appropriately trained GPs.

4. To enable GPs to access psychological and other health services to support their patients.

5. To provide MBS rebates where psychiatrists participate in case conferencing on a patients behalf and to provide consultancy assistance to GPs in emergency situations.

Recognition of prior learning applications can be made if a GP has completed a university qualification in mental health, completed a formal training program or participated in a previously approved 3pph mental health learning event.

The Monash Division has also been successful in attracting Commonwealth funding to support the objectives of the Better Outcomes in Mental Health Care Initiative. The Access to Allied Health Services Project will be accessible to Division members who practice within Division boundaries and have fulfilled the eligibility criteria for the Better Outcomes in Mental Health Care Initiative (ie Familiarisation Training and either Skills Based Training or Recognition of Prior Learning), and are registered for the BOMHCI incentive payment. Those GPs will be able to refer patients with a mental disorder to allied health services for a specific time limited treatment, as part of the 3 Step Mental Health Process. The Division will establish Service Agreements with local allied health service providers to provide short term psychological interventions. GPs will be issued vouchers which entitle patients to a maximum of 6 sessions with the selected service provider. On completion of treatment, the service provider will provide written feedback to the GP and lodge a claim for reimbursement to the Division.
In addition to these services and in partnership with the Primary Mental Health Tem, the project will explore the possibility of incorporating a practice visit by a member of the PMHT to assist GPs with the development of the mental health plan for their patient.

Resources

To view a complete list of all resources located within this site please visit the resources section.

Links

Mental Health and Special Programs Branch of the Department of Health Ageing
Clinical Research Unit for Anxiety and Depression (CRUfAD) - for access to K10 and SF-12 tools