Exclude

• Thyroid Disease

• Menopause / Andropause

• Chronic pain

• Sleep disorders

• Low iron, B12, folate

• Cancer

• Diet related

• Medication / Supplements

Family History

• Genetic similarities, consider same medication across generations e.g. mother / daughter

Case Formulation

• What is happening to this person in this situations at this time?

• Predisposing

• Precipitating

• Perpetuating

• Protective

Logistics

• 8 to 15 pages

• 45 minutes to 60 minutes

• Often over multiple consults

Risk Assessment

• Have you thought about killing yourself?

• How would you kill yourself?

• Have you taken any steps to enact this method?

Risk Management

• Low Risk - Manage in community

• Medium Risk - Manage in community with ongoing risk assessments

• High Risk - Intervention / Admission

Mental Health Team

• GP with special skills

• Practice Nurse

• Mental Health Care Nurse

• Psychologist

• Psychiatrist

• Social Worker

• Counsellor

• Pharmacist

• Drug and alcohol Counsellor

• Aboriginal Health Worker

Timeline

• MHCP needs SMART Goals

• Needs goals to be achieved in a timely manner and then close plan

MHCP

For GPs to undertake early intervention, assessment and management of mental health disorders

• Assess and Plan

• Procide and/or refer for appropriate treatment services

• Review and ongoing management as required

Eligibility

• Access to medicare

• Ptients with a mental health condition that would benefit from structured approach to treatment

• Eligibility criteria Chapter V of ICD-10 from 1996 - Primary care version

• https://apps.who.int/iris/bitstream/handle/10665/41852/0889371482_eng.pdf?sequence=1&isAllowed=y

• Excluding delirium, dementia, tobacco use disorders and mental retardation

Assessment

• Record agreement

• History (biological, psychological, social) including presenting complaint

• MSE

• Assessing risk + co-morbidity

• Diagnosis and/or formulation

• Outcome tool

Plan

• Record agreement, including formulation/ diagnosis / provisional diagnosis

• Identify and discuss referral + treatment options

• Agreeing on goals with patient

• Provide psychoeducation

• Crisis plan if appropriate

• Make arrangements - referrals, treatment, support, review, follow up

• Document

Goals

• SMARTER

• Make your bed everyday

• 20 minutes walking each weekday from 7am for the next week = Increase Serotonin

Shortcuts

• SSRI

• SNRI

• TCA

Diagnosis

• Caution with terms used and making diagnosis unless beneficial

MBS

• 2715/2717 can be billed 12 monthly

• A new plan should not be prepared unless clinically required and generally not within 12 months

• Live document - should be updated each MH consult 2712

• The first 2712 can occur at 1 month

• Medicare does not expect more than 2 reviews in 12 months

• Initial maximum of 6 sessions with a psychologist, need to specify the number of sessions

• Can then do 4 more for a total of 10 / calendar year

Tips

• Read the MBS description

• Should usually be done over multiple consults, particularly if a newer patient

• Need to rule out organic contributing factors, substance use

• Can use a provisional diagnosis or formulation

• Don’t diagnose something unless fulfils ICD-10 criteria

• Anxiety / Depression isn’t a diagnosis, Document ICD-10 code if able

• Careful diagnosing conditions such as major depression for a transient life stressor e.g. grief, bullying, exam stress, relationship breakdown

• Diagnosis has tremendous implications for applying for defence force, life insurance especially if suicide, and for a patient’s overall well-being e.g. incorrect labelling of BPD in 18yo

Accumulation

• Consult 1 - Fatigue (10min = 23 PB) + Start MHCP for anxiety (10min - nothing billed)

• Consult 2 - Review blood tests (10min = 23 PB) + Continue MHCP (10 min - nothing billed)

• Consult 3 - MHCP only for 25 min (+ 10 mins + 10min) = 2717