Mental health
Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) program
Overview and Introduction to Better Access
Medicare Items
Psychological services available under Better
Access
GP Mental Health Care MBS Items
Locating an eligible mental health
professional
Psychiatrists Item 291 - referred assessment and
management plan
Working with GPs - Information for allied
health professionals
Overview
As part of the Council of Australian Governments (COAG) mental health package, the 'Better Access to Psychiatrists, Psychologists and GPs through the MBS' initiative (Better Access) introduced new Medicare items in 2006 to provide better and more affordable mental health care.
The Better Access MBS items are designed to promote a team approach to mental health care, with GPs better supported to continue working with psychiatrists, clinical psychologists, and other allied mental health professionals to increase the availability of care.
Introduction to Better Access Medicare Items
Under the Better Access initiative, Medicare rebates are available for GPs to provide early intervention, assessment, treatment and management of patients with mental disorders as part of a GP Mental Health Care Plan (Item 2710). Under item 2710 GPs can refer patients for Medicare rebated psychological services to:
- Psychiatrists
- Clinical Psychologists - registered with the Psychologists Registration Board in the State or Territory in which they are practising. (Psychologists whose State/Territory registration includes any limitation, for example, where marked 'provisional registration', are not eligible
- GPs who are Registered Providers of Focussed Psychological Strategies) – GPs who have completed the required training recognised by the General Practice Mental Health Standards Collaboration and are registered with Medicare Australia - GPMHSC page – all about providing FPS
- Social Workers - who are members of the Australian Association of Social Workers (AASW), including certification by the AASW as meeting the standards for mental health set out in the AASW's 'Standards for Mental Health Social Workers 1999'.
- Occupational Therapists - with full or part-time membership of OT Australia, a minimum of two years of experience in mental health and an undertaking to abide by The Australian Competency Standards for Occupational Therapists in Mental Health
For more information on the rebatable psychological services please refer to 'Psychological services available under Better Access'
A GP Mental Health Care consultation item (2713) is available for GPs to provide continuing management of patients with mental disorders. A Review of GP Mental Health Care Plan item is also available (2712).
There are also Medicare items which aim to support psychiatrists to see more new patients. Items 291 and 293 enables a GP to seek assessment and management advice from a psychiatrist. Under this item psychiatrists undertake a patient assessment and prepare or review, a management plan to be carried out by the referring GP.
For more information on the Better Access Medicare items please refer to the section on GP Mental Health Care Items or visit the Department of Health and Ageing website
Psychological services available under Better Access
Better Access has introduced a range of Medicare rebates for services provided by different allied mental health providers, divided into two types of services - psychological therapy and focussed psychological strategies (FPS).
Focussed Psychological Strategies
Psychological therapies
These services attract Medicare rebates for up to 12 sessions in a calendar year where the referring GP has completed a GP Mental Health Care Plan (2710) for the patient, and the rebate for the 2710 service has been claimed.
Key points
- A GP Mental Health Care Plan must be in place (and item 2710 billed) to refer
- Patients with a Referred Assessment and Management Plan from a psychiatrist (item 291) are also eligible
- No specific referral form is required (GPs may wish to consider providing a copy of the plan)
- Each patient eligible for 12 individual + 12 group sessions per calendar year
- 12 session cap is inclusive of division run ATAPS services
- Allied health professional must report back to the GP after each block of 6 sessions
- GP needs to review the patient and confirm the referral in writing after each block of 6 sessions
Focussed Psychological Strategies
Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies, that have been shown to integrate the best external evidence of clinical effectiveness with general practice clinical expertise.
Focussed psychological strategies are:
- Psycho-education (including motivational interviewing)
- Cognitive-behavioural therapy including:
- Behavioural interventions
- Behaviour modification
- Exposure techniques
- Activity scheduling
- Cognitive interventions
- Cognitive therapy
- Relaxation strategies
- Progressive muscle relaxation
- Controlled breathing
- Skills training
- Problem solving skills and training
- Anger management
- Social skills training
- Communication training
- Stress management
- Parent management training
- Interpersonal therapy
For a brief description of each of these FPS, see FPS Description page.
Psychological therapies
Psychological therapies can be provided by a clinical psychologist (as defined by the Australian Psychological Society), and are more broadly defined than are FPS.
The MBS recommends that clinical psychologists using these items provide psycho-education and cognitive behaviour therapy. However, other evidence-based therapies - such as interpersonal therapy - may be used if considered clinically relevant by the psychologist.
GPs may wish to consider referral to a clinical psychologist for psychological therapy for patients with more complex mental health problems and/or significant comorbidities, as clinical psychologists have generally had a high level of supervised training in the provision of evidence-based psychological therapies.
GP Mental Health Care items
Item 2710: Preparation of a GP Mental Health Care
Plan
Item 2712: Review of a GP Mental Health Care Plan
Item 2713: GP Mental Health Consultation
Items 2721-2727: Provision of Focussed Psychological
Strategies by a GP
More information and templates
Item 2710: Preparation of a GP Mental Health Care Plan
This item covers both the assessment and preparation of the GP Mental Health Care Plan.
Preparation of a GP Mental Health Care Plan is required before a GP can refer for Medicare rebated psychological services under the Better Access to Mental Health Care program, except where the patient is being managed under a Referred Assessment and Management Plan from a psychiatrist (Item 291)
Assessment of a patient must include:
- recording the patient's agreement for the GP Mental Health Care Plan service
- taking relevant history (biological, psychological, social) including the presenting complaint
- conducting a mental state examination
- assessing associated risk and any co-morbidity
- making a diagnosis and/or formulation
- administering an outcome measurement tool, except where it is considered clinically inappropriate.
In addition to assessment of the patient, 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
- 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
Offering a copy of the plan to the patient if appropriate (and their carer with the patient's consent) is recommended.
Item 2712: Review of a GP Mental Health Care Plan
A patient's GP Mental Health Care Plan should be reviewed at least once, in addition to ongoing management through the GP Mental Health Care Consultation item and/or standard consultation items.
The review must include:
- recording the patient's agreement for the 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
- re-administration of the outcome measurement tool used in the assessment stage, except where considered clinically inappropriate.
The recommended frequency for the review is an initial review, which should occur between four weeks to six months after the completion of a GP Mental Health Care Plan; and if required, a further review three months after the first review.
Item 2713: GP Mental Health Consultation
The GP Mental Health Care Consultation item is for an extended consultation with a patient where the primary treating problem is related to a mental disorder. A GP Mental Health Plan does not have to be in place to use this item.
A 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;
- documenting the outcomes of the consultation in the patient's medical records and other relevant mental health plan (where applicable).
A GP Mental Health Consultation has a minimum duration of 20 minutes.
Items 2721-2727: Provision of Focussed Psychological Strategies by a GP
These items cover the provision of focussed psychological strategies (FPS) by a GP.
For more information please refer to the 'All about providing focussed psychological strategies' page.
For information on eligibility to provide FPS, and for descriptions of the specific FPS which can be provided under these items, see FPS descriptions page.
Download a copy of the FPS item fact sheet
More information and templates
Department of Health and Ageing
Department of Health and Ageing information about the GP Mental Health Care Medicare items.
Template for GP Mental Health Care Plan
PDF Printable version of the Medicare GP Mental Health Care Items – fact sheet
Other
Information for consumers: GP Mental Health Care Plan Medicare items fact sheet
Locating an eligible mental health professional
Psychologists
The Australian Psychological Society operates an expanding referral service of psychologists: under the link to 'Find a psychologist'.
To locate a psychologist in your area: www.psychology.org.au
Occupational therapists
OT Australia continues to compile a list of eligible occupational therapists (OTs) accessible via their website:
To locate eligible OTs: www.ausot.com.au
Social workers
Social workers are easily located through the Australian Association of Social Workers website, grouped by Division of General Practice, and with professional biographies available online.
To locate eligible social workers: www.aasw.asn.au
Psychiatrists
The Royal Australian and New Zealand College of Psychiatrists has a database that GPs can search for psychiatrists by geographical location or by specialty area. The database is available to members of the RACGP.
To locate psychiatrists: www.racgp.org.au/psychiatristdatabase - Psychiatrist referral directory manual
GP providers of FPS
Currently, no centralised list of GP providers of FPS exists. Divisions of general practice often have this information, or the Beyondblue ‘Directory of Medical and Allied Health Practitioners in Mental Health' allows health professionals and the public to search for medical practitioners with an interest in mental health.
This directory can be accessed from the Beyondblue website: www.beyondblue.org.au
Psychiatrists Item 291 - referred assessment and management plan
What is Item 291?
What information needs to be included as part of the
referral from the GP?
What will the GP receive under 291?
More information
What is Item 291?
Item 291 enables a GP to seek assessment and management advice from a psychiatrist.
Please note:
- Item 291 can only be claimed by a psychiatrist once per patient per 12 months.
- Item 291 is for a one-off assessment and management consultation.
- Item 291 is not intended for emergency or urgent assessments.
- Under Item 291 the referring GP maintains ongoing management of the patient i.e. there is no transfer of treatment or patient management.
- Item 293 provides for a subsequent, non-mandatory review of the management plan (developed under 291) by the same psychiatrist within 12 months. It is assumed that the referring GP maintains ongoing monitoring and review as part of ongoing management.
What information needs to be included as part of the referral from the GP?
The referring GP should ensure that they provide the following to the Psychiatrist in their referral:
- Main presenting problem.
- Brief bio-psycho-social history.
- Past and current management including psychological and pharmacological interventions.
- Clearly indicate the reasons for referral i.e. assessment and management plan, and any specific questions.
What the GP will receive under 291:
GPs will receive a comprehensive written assessment and management plan which will:
- Comprehensively evaluate the bio-psycho-social issues;
- Address diagnostic psychiatric issues;
- Make management recommendations addressing the above two.
- The written report will be provided to the GP within 2 weeks of completing the assessment.
- The diagnosis and management plan is explained and provided to the patient unless clinically inappropriate.
More information on Item 291
Frequently asked questions about Item 291
Working with GPs - Information for Allied Health Professionals
The introduction of Medicare items for psychologists, social workers and occupational therapists, on referral from a GP, provides welcome additional support to GPs in managing the health of our patients. Our members have indicated that they value highly the role of allied mental health in patient care.
Consumers with a mental health disorder reap significant benefit from having a regular doctor who is familiar with their medical and psychological history, and can manage that consumer's care from a 'whole person' perspective.
The College has received a number of anecdotal reports of allied health professionals sending their clients to a GP (not in all cases their regular doctor) specifically to obtain a referral and subsequently, Medicare rebated psychological services.
There are a number of problems which may arise where this occurs, but in particular, the RACGP is concerned that this represents a missed opportunity to enhance continuity and quality of care, and in the longer term, mental health outcomes.
Where a psychologist or allied health professional believes that a consumer they are seeing privately may benefit from a GP Mental Health Care Plan, the RACGP believes that a more effective approach, both in terms of clinical management and developing relationships between the professions involved in that person's care, is for the psychologist to:
- discuss with the consumer the importance and value of having a regular GP, and of involving that GP in their mental health care
- obtain the consumer's consent to write to their GP about them; and
- write to the GP to outline the consumer's psychological history, diagnosis and current treatments, and explain the rationale for proposing the development a GP Mental Health Care Plan.
Where an allied health professional does not already have a
relationship with a consumer's GP, the RACGP suggests that providing a
brief introductory letter to the GP outlining your qualifications, areas
of particular interest and the services you provide can be a good way to
begin establishing a professional relationship.
Some patients may not have a regular GP, but do attend a particular
practice - in this case, the RACGP believes they should be encouraged to
make a long appointment with a GP in that practice, and to take the
psychologist's letter with them.
In those cases where consumers don't have a regular GP or practice, it may be appropriate for a psychologist to provide several GPs' or practices' contact details for the consumer to choose from.
The RACGP believes that adopting this approach will assist GPs and allied health professionals to continue developing productive working relationships, to the benefit of their patients.
