The need to upskill rural general practitioners in mental health care

Statements made last year by the President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) questioned the appropriateness of general practitioners managing mental health problems in people over the age of 45 years without input from psychiatrists.1 This was against the background of a study that had found GPs were poorer than a standardised psychiatric testing tool in identifying, without assistance, patients who had depression.2 The RANZCP used this finding to argue that referral rates to psychiatrists should be higher.

We offer an alternative interpretation. We need to upskill and better support GPs so that they can manage patients presenting with mental illness in primary care. This is particularly vital in rural locations, where there is a shortage of psychiatrists and psychologists.

The prevalence of mental illness is broadly similar in rural and metropolitan regions of Australia. Despite this, only 12% of all psychiatrists work outside the major cities.3

GPs currently manage the majority of mental health patients, often with the assistance of psychologists and other allied health professionals. Despite the excellent work undertaken in primary care settings, there is clearly a requirement for specialist input in the small percentage of patients who present with complex mental illness.

Rates of referral from GPs to psychiatrists vary, depending on the confidence of the GP in managing mental illness, the complexity of the patient, and the acuteness of the situation.

Rural GPs are less confident managing mental health problems than physical illnesses. The perceptions of self-efficacy also differ between locally and overseas-trained doctors. This suggests that certain groups could be targeted by efforts to improve their self-efficacy.4

Long waiting times and limited access to psychiatrists will continue to impair the care of patients with mental illness, as it is predicted that psychiatry workforce shortages will continue into the future.5 Innovative approaches, including enhanced mental health training for GPs and the greater utilisation of telepsychiatry, are needed to ensure Australians in rural areas receive timely diagnosis and excellent care. Adequate recognition and remuneration for GPs who have acquired supplementary mental health training are important incentives.

There is widespread agreement that critical reform of Australia’s mental health system is needed, with several audits finding similar gaps, including inadequate services in rural and remote regions. GPs and psychiatrists must work together, rather than engaging in “turf wars”, to provide the best mental health outcomes for rural Australians