(01:17) Dr Singleton and Dr Stoupas consider what insights each of their guests will bring to the discussion and Dr Stoupas is especially intrigued by the notion of ‘psychodynamic psychotherapy’.
The doctors kick off their conversation with Jas Streten.
Introduction of Jas Streten
(01:33) Dr Stoupas asks about Jas’ background.
Mr Streten explains that he actually came to the position of General Manager of the Australian Patients Association following treatment in the system for some mental health issues. Through that process, he started to understand the importance of the patient voice in healthcare and how it’s delivered.
(02:33) Dr Stoupas explores more detail on Jas’ situation and his experience as a patient.
Jas elaborates and describes the struggle he faced to find the strength to get himself to a GP in the first place, not quite knowing what was wrong. Then when he was confronted with the diagnosis of depression, he found it difficult to access an affordable doctor who bulk billed. Subsequent referrals to specialists compounded the financial burden of managing his health issue and he felt that this would be a common problem for many experiencing mental health issues.
(04:45) Dr Singleton raises the issue of stigma around mental health and asks for Jas’ perspective.
Jas explains that while some medical conditions do in fact have stigma attached to them, he managed to create his own stigma to his diagnosis of depression because he was simply not able to accept it. But over a period of time, he managed to come to terms with his situation.
(06:00) Dr Singleton asks Jas to share some of the things that made a difference for him on his journey.
Jas outlines that a strong support network and external supports helped him through and continue to help him. His GP, his partner, as well as a number of tools that he has picked up along the way help him to keep the ‘darkness at bay’.
(06:43) Dr Singleton enquires about the reasonable expectations of someone experiencing mental health issues from their GP on that first consult. What should they expect?
Jas suggests that the expectations shouldn’t be too different from any other patient and GP consultation experience. For instance, that they’ll be guided and supported through the process and the GP will accurately assess their case and make the appropriate recommendations for care or referrals for that patient. They should feel that they’re in safe hands and on a path to recovery. He also adds that every touchpoint of the consultation is important, right back to the receptionist. He notes that if a patient who presents with a mental health issue encounters a negative experience at any point along the way, then regardless of the quality of the doctor’s consult, they may leave with a negative experience.
(09:01) Dr Stoupas asks if Jas has any instances where that has been the case.
Jas relays the story of a patient who could be quite challenging when they visited the clinic. Significant mental health issues, along with other health issues made them a very complex patient. But the GP is someone who is often called a saint and the clinic is incredibly forgiving and understanding of a whole range of patients who could be described as challenging, so the outcome has been favourable for that individual.
(09:50) Dr Singleton adds to Jas’ response by emphasising the importance of kindness and compassion in consultations.
Jas concurs that kindness can be demonstrated by the language that a doctor uses. Acknowledgment of a patient’s literacy or their understanding of what is happening is critical to their treatment. When a doctor takes that into consideration in their communication and even their choice of words, it shows compassion and kindness. It’s a sort of kindness that extends beyond just accepting people for who they are.
(11:13) Dr Stoupas thanks Jas for his contribution to the discussion and sharing his experiences and introduces Dr James Antoniadis.
Introduction of Dr James Antoniadis
(11:25) Dr Stoupas asks Dr Antoniadis to tell us about himself.
Dr Antoniadis describes his study at Melbourne University and that he and a partner ran a general practice in North Coburg for many years, which was the old practice that he used to attend as a child. During that time, he realised that there were many cases of distress presenting in his practice as physical ailments, but that these cases were often masking deeper psychological issues. But he realised the limitations of what he knew in the field of psychology and went on to study further. He trained in psychodynamic psychotherapy and also did a Masters in General Practice Psychiatry. He ultimately went into full-time practice as a psychodynamic therapist in 2003, but has kept contact with the RACGP through organisations like the general practice psychiatry, liaison committee, the General Practice Mental Health Standards Collaboration (GPMHSC) and various other committees.
(13:06) Dr Stoupas asks for some elaboration on the subject of psychodynamics.
Dr Antoniadis describes psychodynamic psychology in relation to the fluidity of our mental processes. He suggests that to think of the mind as a static system operating in the same way regardless of circumstance is simplistic. But if you take into account the environment that the mind is operating in, whether it’s in a general practice clinic as a patient, or behind the wheel of a car, these environments also have an impact on our thinking and behaviour.
For most, and in most situations, it functions well, and people develop what he calls a reasonable set of templates for how to operate in different environments. However, for some a healthy set of templates isn’t functioning and that can create conflict, confusion or even inappropriate behaviour.
(16:30) Dr Singleton asks, ‘If you had an unlimited budget and complete control over policy, what are the key things that you would change to make a difference to how people with mental health issues are identified and managed in Australia?’
Dr Antoniadis answers with an approach that goes back to early childhood development. He would ensure that we support mothers and fathers financially through maternity and paternity care. As in Norway, where parents nearly universally take three months off to look after their newborn babies, he suggests that we should create a program that alleviates the necessity for parents to work during that critical period of an infant’s development. He thinks that it is a false economy to do otherwise because it results in mental health issues that surface later on. Dr Antoniadis goes on to highlight the school system which he believes should be less regimented and more flexible. He supports a system that endeavours to find ways of stimulating students to learn through curiosity and enthusiasm, as opposed to trying to simply get good grades. Finally, he calls out that the current healthcare system needs an overhaul particularly in mental health, which is fragmented, overloaded and confusing, even to doctors.
(18:43) Dr Stoupas asks about the GPMHSC.
Dr Antoniadis explains that GPMHSC stands for General Practice Mental Health Standards Collaboration. It’s a committee with representatives from the College of Psychiatrists, the College of Rural Remote Medicine, the RACGP, the Australian Psychology Society, and representatives of carers and consumers.
They get together via teleconference or face-to-face once a month where they adjudicate on mental health training programs. Over 20,000 GPs have completed many of these courses and Dr Antoniadis figures that almost every GP in Australia has done at least one. It’s geared towards high prevalence, mental health disorders like anxiety and depression. But they also cover Focused Psychological Strategies (FPS) skills training or other FPS like cognitive behavioural therapy, interpersonal therapy or motivational interviewing. He explains that the committee is often lobbied to get other treatments on the FPS, but ultimately that is mandated by the government who have routinely disallowed too much expansion to the FPS. The committee also discusses and creates policy to advise the various government departments and the college which expands the organisations’ footprint from just training. It’s a very long-standing committee and he is grateful to be a part of it.
(21:24) Dr Singleton offers her thanks for the important work Dr Antoniadis has done and echoes his concerns around mental health services access. She asks if he believes that GPs can make a difference in the treatment of mental health.
Dr Antoniadis strongly believes GPs are best positioned to make a difference. From his perspective, given their pre-existing relationships to patients along with the established community trust, with the right education, GPs are perfectly poised to offer very valuable treatment. Whether dealing with an early episode of anxiety, depression or even psychosis, a GP can be an educated first responder and, in many situations, offer care that can actually head off a lot of mental illness. Psychologists and psychiatrists are secondary and tertiary modalities of care, but GPs are on the frontline and that’s why they are called primary caregivers. In Dr Antoniadis' mind, GPs are also very well positioned to recruit family members and other community members to support people who might be undergoing acute stress. He restates his position that these doctors do the most important work.
(24:34) Dr Singleton thanks Dr Antoniadis and wraps up with a couple of key takeaways.
First, the importance of all GPs being comfortable identifying and managing mental health issues in primary care. Together Dr Singleton and Dr Stoupas outline a couple of the available resources on the subject – the RACGP website as well as the GPMHSC website.