Author: Paul Hayes
The GPMHSC has released a new guide to help improve communication among medical and mental health professionals.
Quality communication – whether between doctor and patient or among healthcare professionals – is vital in a multidisciplinary approach to mental health care and has significant implications for patients and service providers.1,2
‘I think the biggest advantage [of quality communication] is more effective team-based care, and that should improve the clinical outcomes for patients,’ Dr Morton Rawlin, GP and Chair of the General Practice Mental Health Standards Collaboration (GPMHSC), told Good Practice. ‘It helps to make sure that each member of the team is reinforcing what is being done with the patient, making sure we are able to respond to changes in the patient’s clinical state more effectively.
‘For instance, changes in the patient’s demeanour and concerns if another member of the team is starting to unearth significant issues in their past, or in their present, which makes the patient … more anxious or depressed.
‘Those sorts of issues are important for the rest of the team to be aware of so they can respond appropriately back to the psychologist or psychiatrist or GP. That’s more effective for patient care.’
Dr Rebecca Mathews, clinical psychologist and member of the GPMHSC, agrees it is important for all members of the team to be made aware of anything that can potentially benefit, or harm, a patient experiencing mental health issues.
‘It might be things that occur along the way when you’re working with the [patient] which signal that maybe there’s something that needs to be followed up by the referred practitioner; say, the GP,’ she told Good Practice. ‘It might be a review of the medication, it might be that there’s been a relapse that the GP should be aware of, it might be that there’s been a significant event in that person’s life.
‘There might be other triggers that suggest it’s important to communicate with the other professionals working with this person. It’s really about a collaborative approach to care and providing the patient with that experience of a coordinated care plan.’
The GPMHSC was established in 2002 and is designed to support mental health professionals, particularly those who provide services under the Better Access to Psychiatrists, Psychologists and General Practitioners initiative (Better Access). With representatives from general practice, psychiatry and psychology, the GPMHSC works to set standards and accredit general practice training and education in mental health, and develop resources to support GPs in providing mental health services.
One of the committee’s key resources is the GPMHSC practice guide: Communication between medical and mental health professionals (the GPMHSC Guide), which is designed to improve patient outcomes by increasing and enhancing communication and collaboration among providers in the multidisciplinary team.
‘It gives some guidance as to how you may actually improve communication between the team and some of the information that you need to provide across the spectrum, and goes in line with the templates of the gold standard history and records that have been produced by the GPMHSC,’ Dr Rawlin said.
‘Most GPs are doing a great job … and this is just to impress upon them not to forget the important principles and make sure we are doing the best for our patients.’
Dr Mathews, who was responsible for drafting the initial version of the GPMHSC Guide, was keen for the document to appeal to ‘anyone who is qualified to provide mental health services’. This includes mental health nurses, occupational therapists and social workers, in addition to GPs, psychologists and psychiatrists.
‘It is important to have a document like this so there is a shared understanding about the benefits of communication and having a common purpose and intent when you’re seeing the patient,’ Dr Mathews said. ‘It’s not just about the service that [healthcare professionals] are providing when the patient is in front of them, but taking a holistic approach to the patient’s care.’
While Dr Mathews has found the 2006 introduction of the Better Access initiative helped to create greater communication among medical and mental health professionals, she believes the GPMHSC Guide helps to build on those developments.
‘We wanted this document to look beyond that, at what is best practice,’ she said. ‘Not just when you’re required to have that communication or report back to the referring practitioner, but in the interest of the patient.’
According to Dr Rawlin, the GPMHSC Guide can also help different healthcare providers develop a better understanding of how people in other professions approach their patients and the delivery of care. While he describes the relationship between GPs and other mental health professionals as ‘a really positive one’, he believes improvements can always be made.
‘The issue is really that we need to be aware of each other’s skills and needs within what we do, so we are providing the right information to each other and can be effective as part of the team as we look after our patients,’ he said. ‘That’s really where the GPMHSC Guide is trying to help give some clarity and some suggestions as to how we might be able to communicate better together.’
As with so many aspects of healthcare delivery, the pressure on practitioners’ time can be one of the major obstacles to more effective communication among mental health professionals.
‘We are all busy and you can’t always interrupt a conversation to take calls and things like that,’ Dr Rawlin said. ‘It is therefore important to have the right written information going between the professional groups so we can be effective for the patient and not waste each other’s time in terms of trying to communicate.’
Dr Mathews also feels the time constraints inherent to healthcare often have a real impact on improving communication.
‘One of the things that we acknowledge and talk about in the GPMHSC Guide is that there are plenty of barriers that make it difficult to communicate, and some of those are just the different styles of working,’ she said.
‘GPs, for example, tend to have shorter, back-to-back sessions with patients. Psychologists will typically see patients for an hour and then see another person. So it’s often really hard to find that time to make that phone call, to have that discussion.’
Dr Monica Moore, a former GP who now works as psychotherapist and teaches GPs about the use of motivational interviewing, believes the differing approach to treatment taken by GPs, psychiatrists and psychologists can present an issue in inter-profession interaction.
According to Dr Moore, while GPs’ instinct is often to try and ‘fix’ a problem with which a patient presents, assuming a level of responsibility for the issue and directing a patient along a certain path, that approach is not necessarily the most effective in the context of mental health.
‘[Healthcare professionals] work within different paradigms,’ she told Good Practice. ‘One of the things I think is really different is that, within the psychological framework, someone goes to see you for a problem and they are the one who is responsible.
‘So, the patient decides whether to come to counselling and if they don’t want to do it anymore they stop. It’s a very autonomous process; they’re the one with the problems and they’re the one who makes the decisions and comes up with the solution themselves.
‘Our role is to facilitate that process, and GPs and psychiatrists can find that difficult.’
As part of efforts to help increase understanding between professions, Dr Moore is part of the Mental Health Practitioners Network (MHPN), an initiative designed to improve interdisciplinary mental health practice and collaborative care within Australia.
Given the often-limited understanding of other professional structures and approaches, interested mental health professionals coming together in groups such as the MHPN can be beneficial in broadening knowledge and creating better lines of communication.
‘MHPN meetings are attended by people who are interested in the topic [of mental health care], so they get to meet other people and talk about their own services or find out what sort of work people do and refer to them,’ Dr Moore said.
‘It has created a network of referrals.’
While being aware of the potential issues of communication among mental health professionals is a positive step towards improving outcomes, and publications like the GPMHSC Guide are helpful in better understanding the issue, it is also important to take some more immediate steps to improve the situation.
‘Someone once said to me, “It’s okay to have these guidelines to do things, but how do we actually get them to be taken up in a practice?”’ Dr Mathews said.
Dr Rawlin suggests a very simple step in order to start making helpful changes.
‘Number one, don’t be afraid to talk with other members of the team or write notes or let people know of any job concerns, just as you would with a specialist or a surgeon,’ he said.
One of the most straightforward actions Dr Mathews recommends within a general practice is to create a strong ‘documented policy’ for communicating with other mental health professionals.
‘GPs then know that there’s a strategy for communication and an expectation that there is communication,’ she said. ‘It’s not just about back-to-back patients, it’s also about doing the follow-ups and allocating that time.’
Dr Mathews used an example of a patient experiencing mental health issues going from one health professional to another with limited understanding of what has been happening at other locations, a situation that can leave the patient feeling as though they are unimportant to their doctors.
‘For example, a GP may have referred a patient to a psychologist and the person might have gone once and not gone again for whatever reason,’ she said ‘When they return to the GP, the GP may then be seeing that patient with the assumption that they have had a full course of treatment when, in fact, they haven’t.
‘[The GP won’t be aware] unless they know that from the psychologist.
‘I think it’s absolutely critical for patients to have an understanding that there is collaboration between the different professionals. There’s nothing worse than going from one professional back to the other, and the other having no idea about what’s happened.’
Dr Mathews feels the GPMHSC Guide helps to provide GPs and other mental health professionals with a framework to address these types of issues.
‘The important thing about the GPMHSC Guide is that there’s a position around communication and setting a standard of the expectation that you do communicate outside of government-required reports,’ she said
Regardless of how it is implemented, improving interactions to help facilitate better patient outcomes is the most important aspect of improved communication among mental health professionals.
‘Mental health is as important as physical health for many patients,’ Dr Rawlin said. ‘The communication between the treating team is just as important, if not more important, in mental health as it is in treating physical illness.’
- Grimshaw JM, Winkens RA, Shirran L, et al. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev 2005;(3):CD005471.
- Fredheim T, Danbolt L, Haavet O, Kjønsberg K, Lien L. Collaboration between general practitioners and mental health care professionals: A qualitative study. Int J Men Health Syst 2011;5(1):13.