Health system fails to fix mental health skills gaps

SKILLS gaps exist in the primary care treatment of patients with difficult-to-treat depression (DTTD) despite widespread government initiatives to improve mental health in Australia, experts say.

And GPs themselves, interviewed in focus groups, report sometimes feeling “stuck” when choosing management strategies or with patients suiciding despite their best efforts, including consulting with psychiatrists.

A qualitative study published in a special MJA Open supplement this week shows gaps in GP appraisal of taxonomy, available literature and specific resources.

The fact that the term ‘difficult to treat depression’ is often used interchangeably with others such as ‘treatment-refractory depression’ and ‘major depressive disorder’ raised a clinical need for accurate diagnosis as “meaningful subtypes of depression might have different treatment outcomes”, the authors said.

“To improve management and treatment of DTTD in both primary and specialised care, resources need to be more available and accessible, including guidelines that are current and relevant to general practice in Australia,” they wrote.

“Overcoming barriers to accessing specialist and non-medical care should be seen as a priority in assisting GPs to treat patients with DTTD.”

Professor Leon Piterman, professor of general practice at Monash University and a co-author, said there were two key areas of skills gaps for GPs: psychotherapy and the use of psychotropic drugs.

“I don’t believe GPs necessarily need skills in psychotherapy to take this on routinely. Some will be interested in it but will need to learn the skills thoroughly,” Professor Piterman told MO.

“GPs do need further education and training in the use of psychotropic drugs, but not just by attending lectures. It should be based on actual interventions and discussing the problems with psychiatrists. Appropriately trained GPs could manage 70–80% of patients with depression or anxiety,” he said.

Professor Piterman said access to psychiatrists remained limited, in part due to an approximate $100 gap between Medicare rebates and charges for treatments of lengthy duration.

The supplement, Difficult-to-treat Depression: A Guide to Management in Primary Care, funded by AstraZeneca, also includes an article written by Shadow Finance Minister Andrew Robb about his 43-year journey to confront his depressive condition, which turned out to be fuelled by an abnormally delayed release of serotonin.

“It took six months of experimentation with different types of medication but I finally found a treatment that worked,” he wrote.

An RACGP spokesperson was not available for comment.

MJA Open 2012; 1 Suppl 4, 1 Oct