Education guide - Mental health services - supporting Indigenous health

An overview of Medicare services for managing and treating patients with mental health care needs. Includes an Indigenous patient case study.

Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.

A GP mental health treatment plan (GPMHTP) helps people with a mental health disorder access mental health services. It also helps practitioners to better manage a patient's treatment by referring them to Medicare-subsidised allied mental health services. Practitioners can use a GPMHTP under the Better Access initiative.

We use ‘practitioner’ as a generic reference to medical practitioners eligible to provide these referrals, including:

  • general practitioners (GPs), and
  • non-vocationally recognised medical practitioners (non-VR MPs)

This page covers:

  • preparing a GPMHTP
  • referring patients to mental health professional
  • claiming treatment items
  • an Indigenous patient case study

Preparing a GPMHTP

Before preparing a GPMHTP, practitioners have to assess whether their patient is eligible. They must then follow all steps to complete a GPMHTP.

Patient eligibility

To be considered eligible, a patient’s treating practitioner has to assess that the patient has a mental disorder. A mental disorder is a clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional or social abilities. A patient doesn’t have to have a chronic medical condition to have a mental disorder.

Eligible practitioners treating in-patients must claim a GPMHTP item as an in-hospital service.

Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders under this initiative.

Steps in the GPMHTP process

To get a Medicare benefit, the practitioner must complete all actions of the GPMHTP process. There are 2 main steps in the process:

1. preparing a GPMHTP

  • assessment of a patient - assess and plan
  • preparation of the plan - provide or refer the patient for appropriate treatment and services, if required

2. reviewing a GPMHTP

The table below details steps and requirements of the GPMHTP process.

Component Description Actions by the eligible practitioner
Step 1 - Part A Assessment of a patient

The practitioner must:

  • attend to the patient and complete all parts of the consultation
  • explain all steps involved in the service to the patient
  • explain steps to the patient’s carers if needed and if they have the patient’s permission
  • get and record the patient's agreement for the GPMHTP service
  • take relevant history, including biological, psychological and social history as well as details of the presenting complaint
  • conduct a mental state examination
  • assess associated risks and related illnesses
  • make a diagnosis and/or formulation
  • administer an outcome measured tool, except where not clinically needed
Step 1 - Part B Preparation of a GPMHTP

The practitioner must:

  • discuss the assessment, including diagnosis and/or plan formulation, with the patient
  • identify and discuss referral and treatment options with the patient
  • agree on goals with the patient
  • provide psycho-education
  • create a plan for crisis intervention and/or relapse intervention, if needed
  • arrange for required referrals, treatment, support services, review and follow-up consultations
  • document all information in the patient's GPMHTP and keep it in the patient's file
  • offer a copy of the treatment plan to the patient
  • offer a copy of the treatment plan to the patient’s carers if needed and if they have the patient’s permission
Step 2 Reviewing a GPMHTP

The practitioner must:

  • attend to the patient and complete all parts of the consultation personally
  • explain all steps to the patient
  • if needed and with patient’s permission, explain steps to the patient’s carers
  • get and record the patient's agreement to proceed
  • review the patient's progress against the goals outlined in the GPMHTP
  • modify the documented GPMHTP, if required
  • check, reinforce and expand on education
  • create a plan for crisis intervention and/or relapse prevention, if needed and not previously provided
  • re-administer the outcome measurement tool used in the assessment step, unless not needed clinically
  • document all information in the patient's GPMHTP and keep it in the patient's file
  • offer a copy of the reviewed treatment plan to the patient
  • offer a copy of the reviewed treatment plan to the patient’s carers if needed and if they have the patient’s permission

Practitioners can complete Step 1 for more than 1 consultation, but can only claim 1 GP mental health treatment item.

See below for claiming details for GP mental health treatment items.

Referring for follow-up allied mental health services

Under a GPMHTP, practitioners can refer eligible patients to allied mental health professionals for these services:

  • clinical psychologists for psychological therapy services - items 80000-80020
  • registered psychologists for focussed psychological strategies (FPS) services - items 80100-80120
  • occupational therapists for FPS services - items 80125-80145
  • social workers for FPS services - items 80150-80170
  • non-VR MP and GPs for FPS services - items 283-287 and 2721-2727

All mental health professionals must register with us and meet the eligibility requirements as set out on MBS Online.

Patient entitlements for follow-up services

Under a GPMHTP, patients can get:

  • a maximum of 10 individual allied mental health services per calendar year, and
  • a maximum of 10 group therapy services per calendar year

Practitioners can refer a patient for a course of treatment, which can:

  • include a maximum of 6 services in any 1 referral
  • be for individual services and/or group services
  • be a combination of services, such as FPS services and psychological therapy services

Practitioners can refer a patient for multiple courses of treatment within the patient's maximum entitlement in the calendar year. It is up to the referring practitioner to determine whether this is necessary.

Referral validity

Patients need to get a new referral from their practitioner if they:

  • use all their referred services but are still eligible, and
  • have not reached their maximum entitlements for that calendar year

If patients have unused referrals at the end of the calendar year, they can use them the next year without a new referral. These services count towards their maximum of 10 services for the new calendar year.

Referral forms

Referring practitioners must provide a referral before an allied mental health professional has their first consultation with the patient. The referring practitioner should include similar information to medical practitioner referral requirements in their referral. Practitioners should include a copy of the patient's GPMHTP and the patient's agreement. There are no specific referral forms.

We recommend that the allied mental health professional keep the referral for 24 months after providing the service.

Allied mental health professional reporting

The allied mental health professional must provide a written report to the referring practitioner about the treatment they provided. They should complete this once the patient has completed their course of treatment.

Other referral pathways for allied mental health services

Eligible patients who don't yet have a GPMHTP can access MBS allied mental health services via referrals from:

  • psychiatrists - under an assessment and management plan item 291
  • specialist psychiatrists or paediatricians - under items 104-109
  • consultant psychiatrists - under items 293-370
  • consultant physician paediatricians - under items 110-133

For more information visit the MBS Online website.

Claiming details for GP mental health treatment items

The table below gives details about GP mental health treatment items and claiming them. GPs and non-VR MPs can use these MBS items in general practice. Specialists or consultant physicians can’t use them.

Description MBS items Claiming notes
Preparation of a GPMHTP 272, 2700
276, 2701
281, 2715
282, 2717
  • Practitioners must meet individual item number requirements
  • Practitioners can claim these items once in a 12 month period for each patient
  • Practitioners can’t claim these items within 3 months of a claim for a review item
  • Practitioners can’t claim these items with a service to which items 235-240 and 735-758, or items 279 and 2713 apply (unless there is a significant change in the patient’s clinical condition or care circumstances)
  • Items 272, 276, 2700 and 2701 apply to eligible practitioners who haven’t undertaken mental health skills training
  • Items 281, 282, 2715 and 2717 apply to eligible practitioners who have completed mental health skills training recognised by the General Practice Mental Health Standards Collaboration
Review of GPMHTP or a Psychiatrist Assessment and Management Plan 277, 2712
  • Practitioners must meet individual item number requirements
  • Practitioners can claim these items 4 weeks after a claim for a preparation item
  • Practitioners can’t claim these items within 3 months of a previous review claim
  • Practitioners don’t need to claim these items before providing subsequent referrals to an allied mental health professional
Professional attendance for management of a patient's mental health condition 279, 2713
  • Practitioners must meet individual item number requirements
  • Practitioners can claim these items for ongoing management of a patient treated under a GPMHTP
  • Practitioners can’t claim these with a preparation or review item

There are minimum periods for claiming the items above except when the patient's clinical condition changes significantly.

The practitioner must determine whether the service is clinically relevant when providing these services. A clinically relevant service is one that a relevant professional accepts as necessary for appropriately treating the patient.

Case study

You are a medical practitioner with mental health skills training, practising at a remote community health service. You have an 18-year-old Indigenous patient who:

  • has a history of good physical health
  • has only required minimum medical attention in the past
  • recently underwent a health assessment

Assessment

The patient comes to visit you about a persistent sleep issue, including experiencing frequent occasions of insomnia. During your discussion, your patient becomes very teary and shows signs of mood swings. You assess that they’re not experiencing any other physical health issues requiring treatment for their sleep condition. You are concerned about their mental wellbeing.

To address your patient’s mental health issues, you determine they would benefit from a GPMHTP, items 2715 or 2717. You discuss this plan and they agree. You record their acceptance to proceed.

You collect information about your patient’s past and current conditions and perform a mental health examination. During your discussion, your patient reveals that for the last 6 months they have been:

  • experiencing feelings of isolation and low self esteem
  • avoiding social contact from friends and family
  • having periods of sadness

You assess that your patient is displaying signs and symptoms of depression and may require psychiatric evaluation.

Preparation of the GPMHTP

As part of your strategy to improve your patient’s mental wellbeing, you determine that you should refer them for individual allied mental health services with a psychologist using item 80100.

You discuss your assessment and strategy for managing their mental wellbeing, including the subsidies provided under Medicare. They agree with your plan.

You complete the necessary referral and arrange an appointment for your patient with the psychologist. Finally, you document all required information in their GPMHTP and provide them with a copy.

Review and ongoing support

As part of your strategy to improve your patient’s mental health you:

  • schedule an appointment for a GPMHTP review consultation, items 277 or 2712, in 4 weeks’ time
  • assign follow-up services, item 10987, with the Aboriginal Health Practitioner to monitor risk of self-harm. The Aboriginal Health Practitioner will review the patient during weekly outreach visits to your patient’s community
  • consider the need to refer your patient for a psychiatric assessment
  • continue to provide ongoing care and management of their mental health disorder

More information

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Page last updated: 22 August 2018