Pa­tient re­fer­rals fail­ing guide­lines

The Weekend Australian - Travel - - Health -

From Health cover above this — the Aus­tralian Psy­cho­log­i­cal So­ci­ety rec­om­mends its mem­bers charge $192 — leav­ing pa­tients with an out-of­pocket ‘‘ gap’’ of at least $80.

Hall says a lack of guide­lines and train­ing about how to use the new items is re­spon­si­ble for the high rate of re­fer­rals from GPs of pa­tients who had no men­tal health treat­ment plan pre­pared. In many cases this means psy­chol­o­gists have to spend ex­tra time with the pa­tient to fig­ure out their di­ag­no­sis, re­fer them back to the GP, or chase the GP for more in­for­ma­tion on the pa­tient.

‘‘ The prob­lem is that many GPs are not aware of the vast ar­ray of psy­cho­log­i­cal ser­vices that are cur­rently cov­ered by the re­bate,’’ Hall said.

El­iz­a­beth Moh, a psy­chol­ogy stu­dent work­ing on a place­ment with Hall, said there hadn’t ‘‘ been much guid­ance for psy­chol­o­gists and GPs. We don’t want to be crit­i­cal of GPs — it’s more that the Gov­ern­ment hasn’t pro­vided enough guid­ance,’’ Moh said. ‘‘ The sys­tem isn’t work­ing as well as it should.’’

The con­cerns echo crit­i­cisms of the Gov­ern­ment’s men­tal health re­forms, re­ported in The Aus­tralian last month, by Ian Hickie — pre­vi­ously one of the lead­ing ad­vo­cates for the mea­sures.

In a pa­per pub­lished last week­end in the Med­i­cal Jour­nal of Aus­tralia (2007;187:100-103), pro­fes­sor Hickie and coau­thor Pa­trick McGorry, ex­ec­u­tive di­rec­tor of the Ory­gen Youth Health Re­search Cen­tre at the Univer­sity of Melbourne, stepped up the at­tack on the new sys­tem.

The ar­ti­cle sug­gested while the med­i­cal pro­fes­sion might be happy with the re­shaped pro­gram, be­cause it was less oner­ous and re­stric­tive, pa­tients ‘‘ may be poorly served by a fail­ure to sup­port a gen­uine in­crease in wide­spread ac­cess to af­ford­able and col­lab­o­ra­tive care’’.

Hickie, the ex­ec­u­tive di­rec­tor of the Brain and Mind Re­search In­sti­tute in Syd­ney, says the rev­e­la­tions that up to half of GP re­fer­rals are be­ing made with­out a men­tal health plan ‘‘ cuts to the chase’’ of the con­cerns over the new scheme.

‘‘ The most ideal form of care is col­lab­o­ra­tive care, with GPs, psy­chol­o­gists and psy­chi­a­trists work­ing as a team,’’ he told Week­endHealth .

‘‘ What has hap­pened here, un­for­tu­nately, is that many of the es­sen­tial el­e­ments of col­lab­o­ra­tive care are no longer re­quired, and it’s sim­ply left to the in­di­vid­ual pro­fes­sion­als to pur­sue or not.

‘‘ The dan­ger is peo­ple will say it’s all the GPs’ fault, but I don’t think that’s fair — the sys­tem needs to pro­mote, re­ward and re­quire bet­ter prac­tice.’’

Pic­ture: Michael Pot­ter

Con­cerned: Janet Hall says sig­nif­i­cant pa­tients ar­rive for treat­ment with­out a GP plan

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