Better Access to Mental Health Care Initiative

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Better Access to Mental Health Care Initiative
November 2006 MBS changes to Mental Health Care.
The Better Access to Mental Health Care
Initiative (Better Access) aims to increase
community access to GPs, psychiatrists, clinical
psychologists other allied mental health
professionals for mental health care.
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What does Better Access include?

• 1. MBS Item Numbers
• GP Mental Health Care Plan (2710)
• GP Mental Health Care Plan Review (2712)
• GP Mental Health Care Consultation (2713)
• 2. Access to Psychiatrists
• 3. Access to Psychological Therapies
• 4. Access to Focussed Psychological Strategies

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What does Better Access include?
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GP Mental Health Care Plan (2710)
Provides a structured approach for the management
of patients with mental disorders Eligible
Patients - are those with a mental disorder who
would benefit from a structured approach to the
management of their care needs. Referral Patients
are eligible for access to Medicare rebates for
counselling services either privately or
through the divisions Access to Allied Health
Professionals (ATAHP) services. Restrictions 1
per patient per calendar year
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GP Mental Health Care Plan (2710) cont.

• The steps in assessment of a patient must
• include
• Recording the patients agreement for the GP
  Mental
• Health Care Plan services
• Taking relevant history (biological,
  psychological,
• social) including the presenting complaint
• Conducting a mental state examination
• Assessing associated risk co-morbidity
• Making a diagnosis /or formulation
• Administering an outcome measurement tool, except
  
• where it is considered clinically inappropriate.

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GP Mental Health Care Plan (2710) cont.

• In addition to assessment of the patient, the
  steps for
• preparation of a GP Mental Health Care Plan must
  include
• Discussing the assessment with the patient,
  including the
• mental health formulation diagnosis
• Identifying discussing referral treatment
  options with
• the patient, including appropriate support
  services
• Agreeing goals with the patient what should be
  achieved by the treatment any actions the
  patient will take
• Provision of psycho-education
• A plan for crisis intervention /or for relapse
  prevention, if
• appropriate at this stage
• Making arrangements for required referrals,
  treatment,
• appropriate support services, review
  follow-up
• documenting this (results of assessment, patient
  needs,
• goals actions, referrals required
  treatment/services,
• review date) in the patients GP Mental Health
  Care Plan.

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GP Mental Health Care Review (2712)
Enables the review of the patients progress
against the goals outlined in the GP Mental
Health Care Plan. Initial review between 4
weeks 6 months after completion of the GP MH
Care Plan. Further review 3 months after first
review if required.
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GP Mental Health Care Review (2712) cont.

• The review must include
• Recording the patients agreement for this
  service
• A review of the patients 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 expanding education
• A plan for crisis intervention /or for relapse
  prevention, if appropriate if not previously
  provided
• Re-administration of the outcome measurement tool
  used in the assessment stage, except where
  considered clinically inappropriate.

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GP Mental Health Consultation (2713)
An extended consultation with a patient where the
primary treating problem is related to a mental
disorder. Should be at least 20 minutes
duration May be used for on going management of
a patient with a mental disorder, including for
patients being managed under a GP Mental Health
Care Plan.
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GP Mental Health Consultation (2713) cont.

• The consultation must include
• Taking relevant history identifying the
  patients
• presenting problem(s) if not previously
  documented
• Providing treatment, advice /or referral for
  other
• services or treatment documenting the
  outcomes of the consultation in the patients
  medical records other relevant mental health
  plan (where applicable).

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Benefits to Patients

• Structured Mental Health Care through their GP
• Under Better Access clients can have access to up
  to
• 12 individual psychological services in a
  calendar year from their date of referral.
• (These can be provided by eligible psychologists,
  social workers and
• occupational therapists. Services received under
  Fremantle GP Networks
• Referred Counselling Project are also included in
  the 12-service limit.)
• In addition to these 12 individual psychological
  services,
• clients can also receive up to
• 12 group psychology services.

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GP Access
The new MBS items referral of patients to
psychological services is available to all GPs.
There are no mandatory training requirements
for GPs claiming these new MBS items or to refer
patients to psychological services through the
new Better Access initiative.   However, it is
strongly recommended that GPs providing mental
health care using the new GP Mental Health Care
items have completed appropriate mental health
training, such as training recognised through the
General Practice Mental Health Standards
Collaboration. Level 1 and/or Level 2 training
continues to be required for Service Incentive
Payments (SIP) for 3 Step Mental Health Process
services, providing Focussed Psychological
Strategies (FPS).
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GP Access cont.
3 Step Mental Health Process - Service Incentive
Payment The new GP Mental Health Care
items incorporate the existing 3 Step Mental
Health Process items associated Service
Incentive Payment (SIP).  The existing 3 Step
Mental Health process SIP item numbers will be
available until 30 April 2007 to enable GPs to
complete and claim for work commenced but not
finished by 1 November 2006.  From 1 November
2006 GPs should use the new GP Mental Health Care
items to prepare new mental health care plans for
patients who require them.
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Patient Pathways
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Referral Options

• Access to Psychiatrist
• Psychological Therapies
• Clinical Psychologist
• Focussed Psychological Strategies
• Appropriately Trained GPs
• Psychologists
• Social Workers
• Occupational Therapists
• Division of General Practices Access to Allied
  Health Professional Services.

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Access to Psychiatrist
GPs can refer patients to private psychiatrists
if clinical relevant for an assessment the
development of a management plan. Psychiatrists
have access to three MBS Item Numbers for this
process 291 Assessment and development of
the Mental Health Management Plan 293 Review
of the Management Plan 296 Initial
Consultation
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Access to Psychiatrist

• GP Psych Support This component of the
  initiative enables GPs to access patient
  management advice and support from the GP Psych
  Support psychiatrists.
• GPs have access to psychiatrists participating in
  the program via telephone, fax or email.
• The service can be used for assistance with
  management of a patient and offers a response
  within 24 hours.
• It is not an emergency service.

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Psychological Therapies

• Psycho-Education
• 2. Cognitive Behavioural Therapy
• 3. Other evidence based therapies as considered
  clinically
• relevant
• Can be provided by
• - Clinical Psychologists

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Focussed Psychological Strategies

• Derived from Psychological Therapies
• - Psycho-Education
• - Cognitive Behavioural Therapy
• - Relaxation Strategies
• - Skills Training
• - Interpersonal Therapy
• Can be provided by
• - Appropriately Trained GPs
• - Psychologists
• - Social Workers
• - Occupational Therapists
• - Division of General Practices Access to
  Allied Health Professional Services.

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Focussed Psychological Strategies cont.
Appropriately trained (Level 2) GPs are
encouraged to provide evidence based Focussed
Psychological Strategies (FPS) through the
provision of Medicare Benefits Schedule (MBS)
items. Training For GPs to be able to access
these item numbers for the provision of these
services they must be Level 2 Registered with the
General Practice Mental Health Standards
Collaboration. This means they must have
completed both Level 1 Level 2 Training.
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Access to Allied Health Professional Services

• GPs can refer patients for access to
  Psychological Therapies or Focussed Psychological
  Strategies through
• Private Allied Health Professional Practitioners
• Through Divisions of General Practice
• Referred Counselling Project
• Fremantle GP Network co-ordinates an Access to
  Allied Health Professionals Service Referred
  Counselling Project.
• GPs referring to Fremantle GP Networks Referred
  Counselling Project can still do so using the
  Better Access Initiative MBS item numbers.
• Please contact Daniele on 9319 0555 for more
• information on the Referred Counselling Project.

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Referred Counselling Project
Began in November 2002 involves GP AHPs
working together to improve the access equity
of mental health care for consumers, leading to
better health outcomes. Target Group Consumers
aged 16 yrs over who present to the GP with a
mental health problem, would benefit from
short-term individual counselling, but are unable
to access private psychological
services. Counselling Appointments 50 hour-long
appointments are available weekly (3 appts are
specifically devoted to youth clients aged 16
25). Fremantle GP Network contracts a number of
AHPs to deliver these services in local practices
Current Host Practices include Bicton-Palmyra
MC Melville Family Doctors
Quarry Health Centre Canning Medical Centre
Leeuwin Medical Centre Queens Rd
Surgery Fremantle Family Doctors Leeming
Medical Centre Palin Street Medical Centre
East Fremantle Medical Centre Referral
Process Previously GPs MUST be registered with
the BOiMHC initiative, and have a GP Referral
Kit. Patient phones Fremantle GP Network to make
first appointment Patient attends first
appointment follow-up appointments are arranged
with the counsellor.