Shaking the black dog - the importance of learning how to manage mental health in general practice

Dr Jan Orman from Black Dog Institute discusses the importance of mental health upskilling, putting the onus back on the practitioner, and provides some fantastic insights into the range of resources available to help learn more about mental health.

I’m a GP - do I really need to know about mental health?

 There’s a huge range of interest and skill in mental health care amongst GPs. Some GPs admit they know very little about mental health and want to know only enough to get them through the day, making referrals and prescribing and largely ignoring any mental health problems that don’t present overtly.

 Most GPs, however, are keen to be involved in the holistic care of patients including trying to meet their mental health needs, but many feel under skilled when it comes to mental health. They also feel significantly under endowed with time and resources to manage some of the easy things, let alone the complex mental health problems that so often land on their doorsteps.

The answer is “Yes’’ – we do need to know.

RACGP’s Health of the Nation Report (2017) told us that 61% of GP consultations involved a psychological problem. That alone should be enough to convince us that as GPs we need to know more about mental health.

We remain the first port of call for many patients in distress and that gives us the opportunity and responsibility to intervene early.

 There is pressure to provide psychological therapy in many conditions. Prescribing for anxiety disorders has been considered second or third line, after psychological interventions, for several decades. The 2018 RANZCP Guideline for treatment of depression emphasises the need for “low intensity interventions”, including internet delivered cognitive behavioural therapy, as first line therapy for mild to moderate depression. And there is plenty of evidence that people do better if psychological interventions are combined with pharmacological interventions in a range of conditions.

 One problem for GPs is that, although Medicare gives us the capacity to refer to psychologists if we don’t have the skills to manage problems ourselves, the appropriate practitioners are not always accessible - or affordable if the patient needs more than the 10 sessions a year they can access under Medicare. It’s better than it used to be but its still not enough to take the mental health responsibility away from general practice.

 Another issue is that many patients want to talk to their GP and not to anyone else. We remain the first port of call for many patients in distress and that gives us the opportunity and responsibility to intervene early and sometimes the possibility to help prevent problems from developing. We need to know what to do!

So, where to start with improving our mental health skills?

 I’d like to make mental health upskilling a compulsory part of CPD every triennium, just like CPR, but I suspect I’m not going to get very far with that campaign! As a community we are probably going to have to rely on GPs to see the need for training themselves and to seek it out.

 There are lots of things we can do – from Masters level training like that offered by the Health Education and Training (HETI) organisation in NSW for example, to short face-to-face courses like those offered by Black Dog Institute’s professional education team or the Australian Society for Psychological Medicine . There are also lots of short online courses offered by organisations, like ThinkGP, waiting for us to take advantage of. Another increasingly popular option is to register yourself as a user on one of the Australian evidence based online CBT programs and learn some CBT skills by applying them to yourself. You can find out more about these programs here.

 You are here so you must like blogs! Black Dog Institute has a blog called “Being Well” which is designed to appeal to health professionals with an interest in mental health, but we are finding it has much broader appeal. Here’s a taster.

 Being Well is part of an educational program that started out in 2013 as a campaign by the Federal Government to educate GPs and other mental health professionals about the valuable but underutilised online resources in mental health care, the e-Mental Health in Practice Project (eMHPrac). As the project has progressed we have learnt a lot about the support and education that GPs need when it comes to delivering good mental health care, and the program is now growing into a much more comprehensive set of programs and resources to support health professionals working with patients with mental health problems.

 Common mental health problems, depression anxiety and stress, are not going away. GPs are left to help patients mange them and need some skills to at the very least, help patients help themselves. If you want to know more about what services are out there for you to direct your patients to check out the new Federal Government portal to mental health care Head to Health. It’s a great starting point, designed for community members to find the care that they need but a good learning tool for health professionals as well.

Jow KosterichDr Jan Orman
Dr Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and the GP educator for Black Dog Institute..